by Beth Macy

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Dopesick Themes

The main themes in Dopesick are painkillers as gateway drugs, Big Pharma and the opioid epidemic, and effective addiction treatment.

  • Painkillers as gateway drugs: Dopesick shows how prescription pain relievers like OxyContin have the power to quickly addict patients, forcing them to turn to hard drugs like heroin.
  • Big Pharma and the opioid epidemic: The roots of the opioid crisis can be traced to Purdue Pharma’s strategic marketing of OxyContin, which the company encouraged doctors to overprescribe.

  • Effective addiction treatment: Macy’s research concludes that medication-assisted treatment (MAT), rather than abstinence- or counseling-based models, is the best approach to treating drug addiction.


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Last Updated on June 8, 2022, by eNotes Editorial. Word Count: 1270

Painkillers as Gateway Drugs

Iatrogenic, or doctor-caused, drug abuse plays a major part in Dopesick. Macy, who has covered drug crime and addiction extensively in Roanoke, Virginia, investigates the roots of the opioid crisis in the United States and learns startling facts. Beginning with morphine and heroin, opiates first entered the market as prescription drugs. While in the nineteenth century—when morphine was given to end-of-life patients, wounded soldiers, and victims of tuberculosis—the medical use of opiates was still somewhat justified in the absence of other palliative care, the use of strong opiates in the twentieth century and beyond is inexplicable. Macy notes that in the early decades of the twentieth century, even children were being prescribed heroin in cough syrups. Heroin was also seen as an antidote to morphine addiction. It was only in 1930, when the severity of heroin addiction had fully unfurled, that the US government banned heroin. But the drug was already on the streets and in people’s consciousness, never to fade away completely.

The lessons of history apparently forgotten, the current opioid crisis was allowed to develop in the US despite the warnings of conscientious doctors like Dr. Art Van Zee. The trajectory of the opioid crisis was uncannily similar to that of the heroin epidemic of the early 1900s. Macy shows how OxyContin, an extremely powerful painkiller meant for end-of-life patients suffering from chronic pain, was overprescribed in rural and small-town America after routine procedures like gall bladder surgeries. OxyContin abuse was easy: all users had to do was dissolve the tablet’s rubber coating in their mouth and they would get to the “pure” oxycodone at its heart, the synthetic opioid that produces euphoria. Within months of the launch of OxyContin, it was being sold on the black market as a recreational drug. Many doctors, incentivized by Purdue Pharma, or sometimes simply busy or negligent, continued to prescribe OxyContin to overeager patients, creating new drug users.

Macy stresses that strong painkillers like OxyContin, Dilaudid, Percocet, and others act as gateway drugs that push people into addiction. Once their access to these drugs is stopped—either when their prescription runs out or, as in the case of OxyContin, the drugs are limited by federal agencies—users already addicted to opiates turn to heroin, which is cheaper and stronger. Thus the painkiller epidemic lowers inhibitions and barriers to drug addiction. Other drugs that are similarly abused are those like Adderall, commonly prescribed to children for ADHD. To really solve the nation’s drug problem, Macy positions that the cultural attitude toward disease recovery and pain management itself needs to change. The idea of healing has to revolve around rehabilitation and root-cause resolution, rather than suppressing symptoms through pills. Similarly, pain management has to focus on bringing pain to manageable rather than absent levels.

Big Pharma and the Opioid Epidemic

A question which recurs throughout Dopesick is how a strong drug like OxyContin was allowed to enter the market in the first place. The question is particularly pertinent for parents who lost their young adult and teenage children, many of them first-time users, to OxyContin abuse. In trying to answer this question, Macy exposes how the nexus between profit-driven pharma industries, federal agencies, and pliant doctors triggered an unprecedented health crisis. As long as drug use was confined to inner-city or Black neighborhoods, and later to poor white communities, pharmaceutical companies’ practices went largely unquestioned. It was only when the crisis percolated to middle-class and wealthy white neighborhoods in suburban America that companies like Purdue Pharmaceuticals came under the scanner.

Purdue, the sellers of OxyContin—a powerful painkiller that contained opium derivative...

(This entire section contains 1270 words.)

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oxycodone—systematically targeted the smaller 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.

Effective Addiction Treatment

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.


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