Read April 2019
Recommended for people who feel completely unfamiliar with oxycodone
A problematic read for me. Yes, I know; awards and all that. But I honestly think the awards go to the fact that Macy made Oxycontin and heroin part of a national conversation, not because this book was exemplary journalism or writing.
Issue 1: Macy does not feel like a competent research or investigative journalist. Apparently, before the book-writing gig, her newspaper job was ‘human interest’ stories. I can so see that. And I am not the human interest kind of reader. Dopesick primarily focuses on those on the front lines… but not the dopesick. Though it begins by talking with a major drug dealer, it quickly moves to one of the physicians who watched the crisis unfold, a very brief history of Oxycontin, the manufacturer Purdue Pharmaceuticals, and the family that owns the company.
But mostly, there are stories from the mothers. Details are heart-tugging and, honestly, facile. She writes about how one son who died of an OD used to help his mom grow sunflowers, so now the mom plants her whole front yard full of them. Another carries around the urn of her son’s ashes and caused a minor disturbance in a courtroom. Does this help us understand drug abuse? No. Does it help stir anger against Purdue Pharmaceuticals? I’d argue, ‘no,’ because it gives the reader a sad, tragic death, only partially from system failure. Macy is trying desperately to relate the individual stories to the larger issues of economics and escape, but never gels. Unlike Evicted: Poverty and Profit in the American City, which dispassionately used the micro-stories of people to show the complexity of the issues around housing, Macy seems desperate to engage the reader through emotion.
Surprisingly, for a book about ‘dopesick,’ Macy largely avoids the elephant of addiction. It feels like she’s quick to blame the system (Ann had a twisted ankle and got twenty-five oxycodone) before looking at individual behaviors that contribute. It is clear, indirectly, that many of the mothers were in denial about the level of their teens’ use. So it kind of ignores the web of deceptions and strategies that occur before the pill takers turn into addicts. She makes it sound like people are prescribed oxycodone, get addicted, start finding someone with extra, start dealing to cover costs, then turn into heroin addicts. There’s a loose attempt to connect that chain with economic depression, but it doesn’t work. Mostly, she makes it sound like the ‘good’ kids did it for fun and then, boom, their lives end. Literally. For me, it’s the most annoying kind of journalism, because it uses stereotypical images and catch-phrases to capture ‘tragedy.’ It’s Hallmark Channel journalism.
Issue 2: Macy is not a great writer. She uses adjectives for things she can’t possibly know, but play into preconceptions (see above re: Hallmark Channel, and below quote about “stone-faced”). She also quotes some people saying really intriguing but largely unsupported things, and then doesn’t address them later. When I checked her ‘footnotes’ in the back (they aren’t actually footnoted in the body of the book–you have to skim through the notes and see if a section you are curious about is highlighted), she has lame-ass citations. By ‘lame-ass,’ I mean one quote she uses from a guy who asserts “Adderall might make the brain more susceptible to addiction,” then she cites a book called “Drug Dealer,” published in 2016. This claim in the middle of writing about 2005-2007, so I’m not sure how prescribers were supposed to know this? Like I said, terrible journalism (But further research has led me to think thatbook has potential).
Issue 3: Purdue Pharmaceuticals is an evil, evil corporation. As a general rule, I’m pretty sure most pharmaceutical companies are greedy, soul-sucking entities, but Purdue seems actively evil, which Macy illustrates. The topic gets a chapter or two, but is severely hamstrung by the fact that it is a privately owned corporation, by the very private Sackler family, and that one of her co-workers already investigated and wrote a book about how Kermit, a town of 400, had enough pills to supply the U.S. The Sackler family has doubled-down by counter-suing the states instead of admitting any kind of culpability. The only ones that have won here are their lawyers, who have made buckets defending them since 2005 or so, when the internet exploded and people really started to get that Oxycontin was addictive. I would have liked an expose of how Purdue built their empire; I want more of the details from the whistle-blowers. Some of those are included, but not in detail. There’s a woman who was terminated and filed a “wrongful termination” lawsuit, asserting she was fired because she refused to sell/push drugs to two of her highest-prescribing doctors. (Her district was Florida, naturally). I wanted to know more about that–they must be saying that they actually tracked prescribers and numbers, and actively promoted to them. Which, by implication, is basically admitting that they were being legal drug dealers. Now that is unbelievably unethical, and if you have problems with kids pushing dope in schools, is because this corporation and the family that owned it ENCOURAGED IT. This family has billions, made from an addictive substance they repeated promoted as not addictive. Anyway, Macy only briefly covers that case, and largely in relation to the fact that she ended up losing.
Issue 4: You want compassion? Talk to someone who isn’t the child of police officers and a cancer nurse. Macy didn’t help me develop that, or make me appreciate the insidious way addiction rewires the brain, one dopamine burst at a time. The last time I took care of an addict at my last hospital, we had to call a “Behavioral Emergency” because we had finally gotten all the (unknown) drug out of his system and he was pissed we messed up his high. His mother was exhausted, tired of coming to the hospital and trying to talk sense into him. He ripped out his IV, leaking blood everywhere (Hepatitis positive, naturally) and left. It was super not fun. Macy’s stories barely even help me with compassion for the parents, seeped as they are in denial and white privilege: “Kristi remembers the first time someone in town suggested her son had a pill problem.… Kristi defended her son, even suggesting that it had been the woman’s son, not Jesse, who swiped the pills.” She continued to make me feel compassion and empathy for the people that love addicts, but didn’t do anything for me about addicts.
Which leads me to issue #5: Macy doesn’t handle The Race Issue well. When someone is black, she usually makes a point of saying it, and “urban” is often code for “low-class-person-of-color.” She will reference ‘sides’ of the town. What has become clear by 2016 is that now that loads of well-to-do white kids are dying, it’s a national issue. The one person I remember in the book as a person of color is black, is in prison, and Macy blames as being the person that brought ‘dope’ to their middle-class burbs. The white twenty-some-old that was in jail is portrayed as ‘reformed,’ living healthy and educating others before he goes to do his time in prison for providing drugs in an OD death.
Issue #6: The Science: this is science-light. I really, really wanted more of this: “Bickel went onto scientifically quantify the indifference of the typical opioid user, comparing the average non-addictive person’s perception of the future – calculated to be 4.7 years – against an addicted users idea of the future, which is just nine days.” I once met an addiction researcher that educated me on brain ‘wiring’ and how it changes with addiction, and it was really the first time I really started to appreciate how terrible trying to combat addiction is. I was hoping Macy would talk more about the changes in addicts and how they can actually be helped, but it felt like this section was science-light and hope-heavy. She likes to blame various aspects of the system–usually lack of affordable rehab beds when an addict finally says, “I’m ready to quit”– but doesn’t really address the most obvious problem, that she herself notes: only 50% of addicts who get into a program and on maintenance drugs stay sober for a year. That’s a really shitty success rate–would you go to a surgeon who was only successful 50% of the time? (“Oh, we got most of your appendix, but not all of it”). Take thyroid medication or insulin if there was only a 50% chance it would work? Yeah, probably not. These people are desperate, so they’re taking what they can get, but the most honest response to the addiction issue? ‘We don’t know the best way to do it yet.’
TL; DR: If you know nothing about what oxycodone is or why it’s part of the national conversation, start here. But if you want investigative journalism, info on Purdue, or discussion on treating addiction, go elsewhere.
One and a half stars, only because I never threw it across the room.
Actual semi-comprehensive overview in under 20 minutes by John Oliver: