Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy.

4/5 rating. 308 pages.

Book #20 of 2023. Read June 17, 2023.

This book follows the pipeline from OxyContin to heroin caused by Purdue Pharma.

It highlights the evils – and I mean EVIL – of the Sacklers who own Purdue Pharma, the makers of OxyContin! If you’re looking for a family to put on the top of the list of public enemy number one in the U.S., no need to go further than the family who did so much to illegally mis-brand and sell OxyContin to a large mass of people who were unaware of its massive addiction potential. These bastards should be locked away to rot for all of the deaths and pain they’ve caused.

I bought this after watching the Hulu original series by the same name based off this book – an incredible series that was disgusting and infuriating, yet so good to watch. The book is interestingly much more about the path that OxyContin takes to heroin use and the lives impacted by this epidemic than Oxy and Purdue itself which are the larger focus of the Hulu series.

Here are some impactful quotes from the book:

• “[T]he American Pain Society and the American Academy of Pain Medicine pushed for expanded use of opioids for long-term chronic pain while taking in millions from the companies that made them.”
• “More recent studies – not letters to the editor penned in 1980 [that said it was less than 1%] – put the [opioid addiction] figure as high as 56 percent.”
• “But had the FDA been doing its job properly with regards to opioids, we never would have had this epidemic.”
• “Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.”
• “[F]our out of five heroin addicts come to the drugs: through prescribed opioids.”
• “Doctors didn’t trust people of color not to abuse opioids, so they prescribed them painkillers at far lower rates than they did whites.”
• “If three-fourths of all opioids prescriptions still go unused, becoming targets for medicine-chest thievery, why do surgeons still prescribe so many of the things?”

Quotes:

“Drug overdose had already taken the lives of 300,000 Americans over the past fifteen years, and experts now predicted that 300,000 more would die in only the next five. It is now the leading cause of death for Americans under the age of fifty, killing more people than guns or car accidents, at a rate higher than the HIV epidemic at its peak.”

“Nationwide, the difference in life expectancy between the poorest fifth of Americans by income and the richest fifth widened from 1980 to 2010 by thirteen years.”

“Little did Davis or the other ER docs understand that the routine practice of sending patients home with a two-week supply of oxycodone or hydrocodone would culminate by the year 2017 in a financial toll of $1 trillion as measured in lost productivity and increased health care, social services, education, and law enforcement costs.”

“Industrywide, pharmaceutical companies spent $4.04 billion in direct marketing to doctors in 2000, up 64 percent from 1996.”

“Within two years of the drug’s release, 24 percent of Lee High School juniors reported trying OxyContin, and so had 9 percent of the county’s seventh-graders.”

“In a county of just 44,000 people, there had been ten armed robberies of drugstores in the past eighteen months.”

“The doctor-narrator heralded the new term ‘pseudo addiction,’ wherein opioid-seeking patients ‘look like a drug addict because they’re pursuing pain relief…[when in reality] it’s relief-seeking behavior mistaken as drug addiction.’”

“A year after starring in the Purdue Pharma video, that same doctor, South Carolina pain specialist Dr. Alan Spanos, gave a lecture insisting that patients with chronic noncancer pain should be trusted to decide for themselves how many painkillers they could take without overdosing…”

“It was possible for a [Purdue] rep who called on indiscriminate prescribers to earn as much as $100,000 a quarter in bonus pay alone, the rep told me.”

“The product shouldn’t be blamed for deaths, because in many cases the victims were also drinking alcohol and taking other drugs. Van Zee scoffed, telling a Roanoke Times reporter: ‘To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”

“Remember the biggest form of drug abuse today is under treatment, and this is a crime that we can all eradicate.” – There were almost 6,500 prescription opioid deaths in 2002 (according to the NIH), with over 100,000 over the next 10 years.

“The [secret] meetings [between Big Pharma execs and the FDA] led to the development of ‘enriched enrollment,’ an aptly named practice that allowed drug companies to weed out people from their studies who didn’t respond well to their drugs, therefore tipping the balance toward FDA approval of new drugs – and away from science.”

Marek, Zakrzewski, an assistant research director filed a lawsuit as he had “described raising safety concerns with seventeen different higher-ups about the ‘serious negative implications’ of the drug, according to his complaint. His bosses banned him from undertaking additional research into the problems and even from informing the company’s regulatory department about his concerns, his suit claimed.”

“When Stallard subpoenaed the physician’s records, he saw Norton had prescribed thousands of OxyContin pills in just thirty days.”

“Prosecutors initially wanted to impose the $1 billion corporate fine as well as multiple felony charges against both the company and the executives. ‘But we got what we could get,’ said a prosecutor involved in the case.”

“These charts represented 1 of forty-six assertions in a ‘statement of facts’ drawn up by Brownlee’s team and agreed to by Purdue, underscoring that the company had knowingly falsified several claims about the drug.”

“They refused to take responsibility for the death and destruction caused by the drug – to the point of reiterating, again in court, that ‘the enormous benefits of OxyContin far outweigh the risks, even taking into account the grief from those we’ve heard about today.’”

“[E]nough opioid painkillers had been prescribed in 2010 to medicate every American adult around the clock for a month. ‘And it’s worse now,’ he told me in 2016.”

“What in fact was the addiction rate among those prescribed opioids for chronic, nonmalignant pain? More recent studies – not letters to the editor penned in 1980 – put the figure as high as 56 percent.”

“By 2016, for every unemployed American man between the ages of twenty-two and fifty-five, an additional three were neither working nor looking for work. Having dropped out of the workforce entirely, they had numerically vanished from the kind of monthly jobs report touted by politicians and reporters.”

“We may feel more connected by our cellphones and computers, but in reality we are more divided than ever before.”

“Between 1998 and 2005, the abuse of prescription drugs increased a staggering 76 percent.”

“‘What happens is, we’ve changed our culture, from one where kids don’t take pills at all to one where you’ve got a third or more of kids who are on pills to stay well because of what are believed to be chronic health conditions,’ Burton said. ‘They get so used to talking pills that eventually they end up using them for a recreational high.’”

“‘I distinctly remember teachers skipping entire chapters in textbooks because “you will not need this when you are working in the mines”‘ he told me in late 2016.”

“‘What happens is, it takes about eight years on average, after people start treatment, to get one year of sobriety…and four to five different episodes of treatment’ for that sobriety to stick.”

“Roughly three-quarters of the dead had started down the same painkiller path that led Jesse to his death, the same path as Spencer Mumpower, Scott Roth, and Colton Banks – with a single prescription pill.”

“The FDA concluded that ‘the benefits of this product outweigh the risks.’”

“Tess knew only that her daily compulsion for opioids began in 2012, the same way four out of five heroin addicts come to the drugs: through prescribed opioids.”

“Perkins pointed out that most addicted users return to the streets from jail with more drug contacts than they had when they arrived.”

“Of his 1993 Lee County (Va.) High graduate class of two hundred students, A.J. McQueen said more than half were either in prison or battling addiction.” 

“Among public health officials, buprenorphine is considered the gold standard for opioid disorder because it reduces the risk of overdose death by half compared with behavioral therapy alone.”

“Suboxone doctors prescribed [rural addiction treatment patients] twice as much of the drug as they needed, fully knowing they would sell some on the black market so they could afford to return for the next visit.”

“[Drug court program g]raduates are roughly half to a third less likely to return to crime or drugs than regular probationers. Drug courts remain, then, an almost singular place where probationers, defense attorneys, judges, and mental health advocates gather around a table to coordinate care and punishment, and discuss the daily challenges of the addicted.”

“‘I never saw it coming,’ she told the crowd. ‘And I don’t know what the answer is, but I know it’s important we take heroin out from under a dirty rug. We should be talking about it the same way we talk about cancer.’”

“The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years – and four to five treatment attempts – to achieve remission for just a single year. And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes.”

“‘It’s like, dear God, please please do not pop this balloon,’ she said. ‘Because there is no love you can throw on them, no hug big enough that will change the power of that drug; it is just beyond imagination how controlling and destructive it is.’”

“Why had blacks failed to become ensnared in opioid addiction? That question was addressed in 2014 data issued by the Centers for Disease Control and Prevention: Doctors didn’t trust people of color not to abuse opioids, so they prescribed them painkillers at far lower rates than they did whites. ‘It’s a case where racial stereotyping actually seems to be having a protective effect,’ marveled researcher Dr. Andrew Kolodny of Brandeis University.”

“‘To feed yourself, you’re either going to rob somebody, or you’re going to go back to dealing or prostitution,’ Schroeder said. ‘I’ve been there and done it myself. The whole [“criminal justice” system] is designed for you to come back.’”

“If we reduced our prison population by twenty-five percent, that’s twenty billion dollars we could save. And if we invested half of that in treatment, we could really increase people’s likelihood of success.”

“‘I had put off going to [Remote Area Medical] for years because I figured they’d make you feel like shit about yourself, like ninety percent of the social services people do,’ he said. ‘But everyone was just…so…kind.’”

“I won New Hampshire because New Hampshire is a drug-infested den” – Trump to the Mexican president

“‘The numbers themselves are disturbing, but more disturbing is the pattern – a continuous, exponential, upward-sloping graph,’ Burke told me in 2017. A year before, more than a hundred Americans a day were dying from opioid overdose. Some epidemiologists were predicting the toll would spike to 250 a day as synthetic opioids became more pervasive.”

#dopesick #booksthatmatter #bookrecommendations #opioids #fuckthesacklers

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