and rural towns of Appalachia for drug promotion for two reasons. The first reason was that these towns, home to shut-down coal mining industries and factories, were filled with people on disability, many of whom were suffering from chronic pain. The other was that these towns were under the radar. Purdue sales representatives strategically tracked doctors who were prone to frequently prescribing heavy painkillers like Percocet and then wooed them with expensive dinners, golf outings, and other freebies in exchange for promoting OxyContin. Purdue touted OxyContin to doctors as a miraculous panacea for pain, providing chronic pain sufferers such as cancer patients with a blessed twelve hours of relief. Yet the drug abuse potential of OxyContin was never discussed or revealed to the public.

When doctors like Van Zee, social activists like Sister Beth, and journalists like Barry Meir began to blow the whistle on Purdue’s practices, the company ignored them—and in the case of Meir, bullied him by trying to engineer his firing at TheNew York Times. As Van Zee explored Purdue further, he discovered that the FDA had expressed reservations about the drug as early as 1995, highlighting its potential for abuse, but had approved it anyway. Thus, Big Pharma and federal agencies were complicit in unleashing the OxyContin epidemic. Worse, when Purdue was finally brought to trial, a decade after Van Zee’s activism and the efforts of parents who had lost their children to OxyContin abuse, only the executives of shell corporation Purdue Frederick were tried. The Sackler family, who privately controlled most of Purdue’s shares, remained untouched. Thus, Macy exposes the complex dynamic that enabled a drug like OxyContin to be released and sustained in the market.

As drug users, police officers, parents, and doctors throughout Dopesick note, addiction is a hydra: cut off one head and another grows back. To fight such a devious force at any level—personal, community, and political—requires a nimble, fresh, and open approach to drug addiction. However, Macy notes, such an approach is still not a widespread reality in the United States. Until very recently, addiction treatment revolved around rehab-based counseling and abstinence. Yet statistics show that counseling and abstinence very frequently lead to relapse, especially in the case of hard drug users. It is difficult enough to convince public health officials and even doctors of this fact, let alone a culture in which twelve-step programs like AA, which promote accountability and abstinence, are prominent. In the case of drug abuse, though, which fundamentally changes a user’s brain chemistry, such accountability-based approaches are often futile. Further, such approaches ignore the basic reason why addicts remain addicted: not to seek a high, but to stave off the crushing feeling of drug withdrawal called “dopesickness.”

Macy finds through her research that medication-assisted treatment, or MAT, is a better alternative for addicts. Using drugs like methadone and buprenorphine to wean patients off heroin and OxyContin is a strategy that actually yields results. On MAT for five years, even hardened users have only a fifteen percent chance of relapse. However, since MAT uses drugs to address addiction, it doesn’t fit with abstinence-only narratives. Further, Macy speculates that federal government-funded MAT programs would do away with the expensive business of rehabs, often run by doctors themselves. Naturally, doctors and business interests continue to oppose MAT. Lastly, law enforcement agents, who are still hardwired to see addiction as a character flaw, instead of a chronic disease, view drug-assisted therapies as an indulgence. Yet the example of cities such as Vancouver, Canada—which has had great success in drug addiction management by viewing addiction as a chronic disorder that needs maintenance rather than “solution” therapy—shows the importance of a nimble, MAT-focused addiction treatment protocol. Macy notes that by the time Dopesick was released in 2017, the shift toward MAT had begun in the United States, hopefully heralding a brighter future for addicts and their families.