Whether you are suffering from Opioid Use Disorder (OUD) or have a family member or friend who is suffering from OUD, learning about the history and impact of opioids can help you better understand yourself or your loved one. This month our blog focuses on a suggested read – Dope Sick by Beth Macy. Published in 2018 after an intensive six year study of the opioid epidemic in the United States, the book not only remains relevant but in fact may be more relevant in 2023 as fentanyl and opioid command headlines across the country.
Inspired by Reporting on the Heroin Epidemic
Ms. Macy began reporting on the heroin epidemic in the suburbs of Roanoke, Virginia and through her initial work was inspired to conduct the research that culminated in the publication of Dope Sick. The book is organized into three parts that focus on 1) the history of opioids in the US and the role of large pharmaceutical companies (primarily Purdue Pharmacy.), 2) the spread of the epidemic and an in-depth look at the tragic impact OUD has taken on individuals, families, and communities and 3) the state of the current criminal justice system and rehabilitation options including the significant relevance and positive impact of Medication Assisted Treatment (MAT).
History of the Opioid Crisis
In Part 1 of the book, the author explores the impact that the opioid crisis had on the communities of Appalachia while also outlining the role of pharmaceutical company Purdue Frederick. OxyContin was released by Purdue in 1995 with assurance to physicians and others that risk for addiction to the newly released drug was very low. As we know today that was not the case.
Also of significant interest in the first part of the book is a more detailed history of opium in the United States dating back to the early 1800’s. The author follows the use of opium in form of morphine and heroin over the decades. Following the history of various forms of opium across more than two centuries was particularly educational and set the stage for the tragedy that opioids has brought to the country. In addition to outlining the history of opioids, Macy also begins the process of telling the very personal stories of individuals and families who have experienced the heartbreak and tragedy of opioid addiction.
The Faces of OUD and Explosion Into All Communities
In the book's second part, Macy follows the continued growth of opioid addiction from the Appalachian communities and into the suburbs and communities of all economic levels.
Throughout the book the personal stories are particularly compelling and engaging as she follows opioid users as they descend into overdose and in many cases prison. Macy recognizes the intensity of OUD and the challenge that addicts face trying to stop using these drugs. Additionally, the perspective of law enforcement and the legal system is presented including following law enforcement officers trying to stop the influx of drugs.
She also highlights the challenge law enforcement faces due to the complex dealer arrangements that allowed the drug to travel along the east coast as well as throughout the country. The book recognizes the challenge of the legal system in efforts to stop the dealing and use of drugs with prison terms and punishment while also weighing the impact of potential rehabilitation paths in lieu of prison terms.
Many heartbroken parents shared their stories with Ms. Macy, detailing how they watched their children descend into the hold of opioid addiction. The parents recount how their children became desperate to obtain the drug in order to stave off the horrific experience of being “dope sick.”
Macy also introduces a number of individuals responsible for the movement and sales of illegal opioid drugs. Her research and investigation details how the network of dealers and people working for such dealers is extensive and makes it hard to track down the top dealer and the original source of drug traffic. She shares the tragic stories of people who become addicted and ultimately become “mules” for larger dealers helping to transport drugs from state to state or city to city in exchange for a cut of the drugs.
A Broken System
In the final section of the book, the author continues to follow many of the same families who were introduced in earlier chapters of the book, and she delves deeper into the continued efforts by multiple state and federal agencies to quell the epidemic. She outlines the continued disagreement between those who recognize Medication Assisted Treatment (MAT) as essential to help those suffering from OUD versus a view of complete and total abstinence as the only path to recovery.
Macy shares the story of people who have worked tirelessly trying to help opioid addicts get into the treatment program they need to recover. She also details how lack of medical insurance and access to healthcare prevents some users from being able to access or stay with the MAT that can help them. This final section of the book introduces the influx of Fentanyl that has now become prevalent across the US. Fentanyl is used to increase the “high” of many street opioids. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Fentanyl is increasingly the cause of many deaths.
For those suffering from OUD this book can offer insight into how opioids impact the brain and bodies of users and acknowledges the extreme challenge in working to stop using. Families will find the background and facts shared in this book helpful to understand how a child or partner became a victim of OUD. They will also gain insights into the ongoing debate and disagreement on how to help those suffering from OUD. Amidst the tragedy, there are stories of hope as Macy follows some individuals who do find recovery with the help of MAT.
Note: If you are a fan of audio books, the author narrates the audio version, and it is an excellent listen. The book has also been made into a series on Hulu. Most viewers describe the series as staying mostly true to the book itself.