Dopesick

I often spend too much time on the title of an article. Today I thought I would be straightforward. This entire article is an incomplete review of and commentary on the central topic of Beth Macy’s book Dopesick. If you haven’t read it I strongly recommend you do. It is the seminal work on the opioid crisis. With disclosures and introductions out of the way, let’s explore.  

We have a totally unnecessary opioid crisis in America. It became a political topic during the 2016 campaign, primarily in the New Hampshire Primary. With the possible exception of Chris Christie nobody took it seriously. Despite some lip service to the contrary President Trump hasn’t done anything impactful about it during his two plus years in office.

The genesis of the crisis is greed. I guess that’s part of why Chaucer’s The Canterbury Tales is a classic; greed is one of his seven cardinal sins and so much bad in the world can be traced back to it. The Sackler family via their network of pharmaceutical firms anchored by Perdue Pharma marketed the drug OxyContin in devious and deceptive ways. They took the tobacco industry’s marketing model and put it on steroids. Along the way their field reps found willing and/or gullible physicians who overprescribed the drug often turning hard working Americans into junkies. The original “sin” of the victims was having faith in their physician.

The book’s title is derived from the pain of withdrawal from the drug. The user who is trying to withdraw cold turkey gets physically ill. Simultaneous pain, vomiting and diarrhea are common. The only rapid relief is returning to the drug. For those of us fortunate enough to not be victims of this crisis that explanation was necessary so that we can understand this crisis as a social/medical not legal problem. Much more than any pursuit of pleasure it is the avoidance of pain that makes the drug addictive.

While the social costs of addiction are much too substantial to adequately outline in this article here is a brief overview: For a time at least many victims end up on disability. This is typical privatize the profits while socializing the losses. America’s right wing has no problem with socialism when it protects their profit margin. In 2017 the federal government spent $192 billion on disability payments. That is more than food stamps, welfare, housing subsidies and unemployment combined.

Countless times I have written that the three pillars holding up the contemporary Republican Party are greed, racism/bigotry and the promotion of ignorance. While Democrats are not blameless – a lot of them have received big bucks from Big Pharma and remained silent – a significant Republican connection enabling this crisis is undeniable. Two examples of GOP complicity are then-George W. Bush Attorney General Alberto Gonzalez provided favorable rulings to Perdue Pharma and Rudy Giuliani was one of their lawyers. Greed permeates this entire debacle. While whites were prominent among the initial victims almost all were poor, working class whites who the Republicans just use and really never have or will care about. This crisis was dependent on deceiving physicians and thereby keeping victims ignorant of the risks they were taking by using a very short term drug for long term pain. Don’t disregard the fact that it was often cheaper for an employer to bring an unhealthy worker back to work while paying for their drugs via the health care plan until they could terminate them for other reasons.

One of the most frustrating parts of this crisis is that there is no apparent easy fix. In fact all we have conclusively discovered to this point is that a one-size-fits-all plan is not effective. Similar to the pray away the gay scam, therapy only treatment is highly ineffective. The problem with most medications is that they can also be abused if altered or not taken as prescribed. Vivitrol has proven to be the most effective medical treatment. One dose lasts for about 30 days but it costs about $1,500. Is it reasonable to expect a victim of opioid abuse to be able to afford that? How many doses can a non-profit pay for before it runs out of funds?

As a bit of personal advise that I myself follow, beware of the rate your pain question when dealing with medical professionals. Big Pharma was successful in getting pain recognized as an undertreated disease in America. If you rate your pain too high (normally 3 or above on a 1 to 10 scale) your medical professional may be forced to treat it and you could find yourself prescribed an unnecessary and potentially harmful drug.

Like most scandals we have been here before. Bayer initially claimed that heroin was a cure for alcoholism. One of the scariest things to me was the reaction of people who should be helping the victims. Many still believed in Nancy Reagan’s “Just say No” solution. While unlike “Be best” it is at least grammatically correct it is equally naïve if not absurd.

If I find somewhat of a silver lining in this cloud over my country it is that the Sackler family’s money of late is considered dirty and unwelcome. Family scion Arthur Sackler, much like Trump, has always wanted to be accepted as an A-lister in New York society and never has. He and his family have tried to buy their way in with huge philanthropic donations. At least three charities have rejected them in the last month or so.

I read somewhere in the neighborhood of 30 to 40 books a year. Dopesick became the 63rd to make the Recommended Reading List earlier this month. (The list began in 2011.) Only topically pertinent, non-fiction books are eligible. If you read only one book this year make it Dopesick. I seldom write an article about any individual book; placement on the Recommended Reading List is sufficient in almost all cases. Dopesick is an exception!

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