Somewhat gradually over the course of maybe the last year or so, the opioid epidemic in the US has come across my radar – I don’t know why it’s taken that long for it to come to my attention, perhaps ignorance or a lack of in-depth reading; I do remember it being covered in books like Janesville and Evicted, but not as a central plank of their narrative. Occasionally, a celebrity (say Matthew Perry or Prince) will raise the issue up the agenda, only for it to fall rapidly away again as interest wanes. More recently, the turning away of Sackler money by museums and galleries has made more people aware (more of them in a second).
Reading Dopesick by Beth Macy, I think it’s astonishing that it’s only now fully breaking through to public consciousness (acknowledging it will have done so earlier in the US). She paints a quite horrifying picture of an America being devastated by an opioid epidemic, fuelled by the greed of pharmaceutical corporations and of individual doctors, by the inability of professionals to agree or collaborate (soon enough), and by the sheer addictiveness of the chemicals involved.
Macy’s research is exemplary, and she openly builds on the work of others in tightly weaving a narrative round individual campaigners and individual lives. Each seems worthy of a book in their own right – from the maverick doctor who spots what is happening in deepest Appalachia to the mother who advocates for change to a government unwilling to listen (who ultimately enact what she asked for a decade and more later); from the father who first hears the word ‘Oxy’ (for OxyContin) from the paramedic who has just failed to save his son’s life on their front lawn to the women setting up free needle exchanges to cut down on the virulent spread of hepatitis C. Or, the one that inevitably stayed this reader, the top of the class student who spiralled from painkillers for an ACL sprain into true tragedy.
Some of the villains are obvious – the Sackler family and the pharmaceutical companies (of which theirs made and marketed OxyContin – or OxyCoffin as one place came to call it, for obvious reasons), the highlighting of which is still going on today – check out this recent piece on Mallinckrodt (based in Ireland, by the way) or this one on the Sackler family’s role being exposed by lawsuits. Alongside them are the fairly useless FDA (the drug authority in the US) and a whole cavalcade of doctors getting rich from prescribing (Purdue Pharma, the Sackler’s company, used to even pay for some of their children’s birthday parties…). A more nuanced debate is the one about treatment, with Macy coming out strongly in favour of longer-term methadone-assisted-treatment (or medically-assisted-treatment) which combines gradually being weaned off opioids with a range of support. Simpler, short-term 12-step abstinence solutions are given fairly short shrift by the science and the evidence.
It is a shocking and eye-opening read, and one that will make you angry, depressed and deeply sad by turns. In that sense, Macy has done a fantastic job – the chronology of the book and the story works well, the characters develop, age and grow with the narrative, and the jab to the face of fact after fact doesn’t stop having an impact. More Americans have died from opioids in the last two years than in the Vietnam War; more than of AIDS at the height of the HIV epidemic. And while the NHS provides some better barriers to the same happening here, we should be under no illusion that the problems are coming over the Atlantic. Macy’s book should be required reading for all those involved.