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 August 6, 2020, by eNotes Editorial. Word Count: 1267

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.

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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...

(The entire section contains 1267 words.)

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