Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

by Beth Macy
Little Brown

book review by Christopher Klim

“In a region where few businesses dare to set up shop because it’s hard to find workers who can pass a drug test, young parents can die of a heroin overdose one day, leaving their untended baby to succumb to dehydration and starvation three days later.”

Lately, it appears that it’s women doing real journalism in America. Whether it’s Sharyl Attkisson fighting for truth in reporting or Sarah Carter exposing corruption in the US Justice Department, they dig for facts to reveal the salient story. Now it’s Beth Macy’s turn. Hardly her first dive into a story, Macy plumbs the depths of the country’s very sad and particularly dangerous opioid epidemic. It’s a compelling and necessary read. And, by the way, all three women deserve a Pulitzer Prize nomination at the very least.

Macy’s Dopesick begins within the offices of a powerful corporation—Purdue Pharma—which suppressed the addiction rates of their super new painkiller OxyContin and hyper-marketed it throughout the medical community. Their plan was shrewd; their aspirations ruthless and profits large. Addiction came easy. Suddenly cutting off a patient’s prescription was no longer a solution. Logic isn’t a part of an addict’s brain; it’s been reconfigured by the drug. Sooner than later, people spilled onto the streets for a fix, and chaos ensued.

At the turn of the century, in places like the rural and economically collapsed communities of Appalachia, where Macy devotes most of her story, illegal opioid use blossomed, out of view from the rest of the country. However, sophisticated drug dealers in the cities had witnessed spikes in demand before, and the country folk wandering into town for large supplies of heroin was a rainmaker clue. Aided by the interstate highway system, profiteers organized networks of user-dealers to supply the burgeoning black market. The problem quickly transformed into a hydra. Police couldn’t keep up with the addicts committing crimes to feed their need. Families lost loved ones, barely recognizing the problem until it was too late. Hospitals were ill-prepared for this new wave of disease. The courts were outdated in their approach, as well. People from all walks of life suddenly began dropping dead.

Many factors go into the making of a widespread addiction: poverty, desperation, ignorance, greed, and plain bad luck. This modern opium war knows no boundaries. Your next door neighbor, for example, gets an injury, takes painkillers at the advice of a physician, and within weeks—sometimes days—he’s addicted. This is not your casual drug user who gets in over his head story, although there are plenty of those people in this group, too.

Where will this end? Right now, almost 60% of the population knows someone touched by this epidemic, and it’s the leading causes of death among people under the age of fifty. Do we want this to get any worse? And who will stop it? Can we stop it? You may think you’re safe, but wait until next year or even next month. This reviewer lives in an upper middle class east coast community, and he’s heard the stories of opioid addiction from his children and the people he knows. The next historical heroin addiction event is no longer knocking at the door. That was a decade ago, as Macy aptly documents. It’s potentially inside our homes now.

Heavily footnoted and deeply researched, Macy plots the course of disaster for the United States, and we haven’t seen the worst of it yet. On one side, pain management is a legitimate medical course of action, but that’s only part of the issue. Heroin addicts become dope fiends who will do just about anything to feed their habit and avoid the overwhelming “dopesick” feeling of withdrawal. They are good people sucked into a tornado, some by accident, some through ignorance. Spending every dollar, losing every accomplishment, and destroying every relationship appears just a matter of course, and then things get worse. The only hard stop to their fall seems for many to be death. Otherwise, the recovery process is long and fraught with pitfalls and relapses, and the best cures involve alternate prescription opioid intervention.

Spending every dollar, losing every accomplishment, and destroying every relationship appears just a matter of course, and then things get worse. The only hard stop to their fall seems for many to be death. Otherwise, the recovery process is long and fraught with pitfalls and relapses, and the best cures involve alternate prescription opioid intervention.

Considering the fine research and execution within this book—it took Macy five years to write it—one can only conclude that journalism isn’t so much tarnished by fake news, as it is by reporters who refuse to do real work. And there are so many lazy, deceptive reporters afoot. Beth Macy of course is not among their ranks. Her work is vital to the future of an addicted country. She takes you inside with authenticity and compassion—the two very best skills of a modern journalist. She doesn’t have to embellish or thrust her opinions upon us. The facts are bad enough.

RECOMMENDED by the US Review

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The Book Killers: Weak Point of View

The Book Killers: Weak Point of View

In this ongoing series, Christopher Klim, author and senior editor of the US Review of Books, takes a look at common errors that undermine books.

Much regarding point of view (POV) is the artist’s decision. A good choice can add salient new insight to a familiar subject, as seen for example in Picasso’s cubism or Patti Smith’s Instagram account. In both, they don’t necessarily discuss themselves, but over the course of time, we learn about the artist and more importantly their subject matter. In literature, the POV is the person or thing guiding the narrative, and the subject is the consequence of their focus.

POV comes in a variety of shades and colors. Simply put, the story narrative will appear in either first person (I, we), second person (you), or third person (he, she, they). Everything else is a hybrid of these three basic modes. POV might vary within a given work, but each POV requires the reader to suspend disbelief differently in order to engage with the narrative. First person asks the reader to get inside the skin of the narrator, second person asks the reader to be the narrator, and third person provides distance from the narrator.

Second person is the trickiest, requiring the reader to relate to the narrator at least in a general sense. In contrast, most readers could wear the skin of a serial killer in first person, since the reader understands that he/she is secretly slipping inside the abhorrent mind of the narrator, but a second person narrative asks the reader to be the serial killer, which is hopefully a no-go area for most readers. Finally, third person can be described—and perhaps over-described by literature and writing teachers—as providing a variety of distances from the subject, ranging from a nearby viewer, who reveals what he/she sees, hears, or induces, to an omnipresent seer, who can relate everything from the minds of the players to that which has happened off-screen and any point on the timeline.

In all POVs, the narrator is further moderated by reliability. As with real people, the narrator is effected by his/her own past and thought patterns, and therefore interprets events through this lens. The narrator might also be self-deluded for a variety of reasons (i.e. fear, conceit, mental illness, etc.). When intervieweing people at a crime scene, investigators will hear vastly different accounts of the same event. A narrator who runs askew of the facts is referred to as an “unreliable narrator.” Everything from the events, and especially the reasons for them, cannot be trusted from an unreliable narrator, and the reader may only learn this over time. Lolita‘s self-deluded child predator, Humbert Humbert, is a prime example of the unreliable narrator. Nabokov, helped by the fact that Lolita is no angel, manages dark irony through Humbolt’s ultimately pathetic voice.

Regardless of your choice of POV, two factors emerge to support the work: authenticity and saliency.

Authenticity is not necessarily reliability. Authentic narrators involve accuracy in the character’s portrayal. An obsessed narrator, as Lolita‘s Humbert, or a mentally ill narrator, as in Everything Burns’s pyromaniac Oscar Van Hise, form gripping reads. Neither of these narrators are reliable, but they are true to their deluded selves and draw razor sharp accuracy of events. Both characters form the archetype of a villain, which can be useful narration for the story. Therefore, their characters are authentic, holding the reader in place and heightening the drama. Deriving authenticity in the narrator is not only essential, but it requires deep understanding of the character. An unreliable narrator can be a wonderful way to commute the story, but an inauthentic character portrayal will ground the story to a halt.

On the other hand, saliency in the POV character involves that which stands head and shoulders above all else. This speaks directly to the choice of POV character. The modern world presents a great deal of navel gazing characters, and therefore the popular voice in literature today is predominantly a deep first person narrative, whether it be reliable or not. Here we follow the slipstream of consciousness—that ebb and flow of self-awareness—but is first person the best choice for the story? Sometimes it’s more effective to take a step away within a third person narration, allowing a wider view of events while avoiding unnecessary and uninteresting intimate details. In first person, the author tends to have to account for every moment in time, often moving forward by only breaking from the scene. Meanwhile, third person allows for the easy passage of time, skipping around the timeline, events, and details as needed.

Which choice of POV character is the best? This selection is not always clear. Changing the POV provides a different level of experience, maturity, and perspective. What is the story trying to accomplish? What is the story’s theme, tone, or genre? How much does the narrator need to know or get involved? Each of these questions must be answered before the narrator takes control. A story crashes when a POV character suddenly narrates out of character. She may know things she couldn’t. He may appear at a moment where he shouldn’t. He or she may do or feel as they would not. Forced POV is as obvious as an awkward metaphor.

There are many ways to select a weak POV. Most recently, there’s been a preponderance of a child’s POV dominating adult novels. While this might work for the short form, often a better choice exists with an adult POV character. Even if events surrounding a child are dramatic, a child’s ability to interpret events is limited. Remember, readers must not only be compelled to engage the narrative, but the reader needs to be convinced to stay with it.

Study those who have gone before. The choice of Lolita as the predominant character in Lolita would have stifled the narrative and eliminated the irony. The story would have been different, pathetic even. Never revealing Oscar Van Hise’s motivations for arson would have reduced both the depth and urgency of Everything Burn‘s drama. Van Hise’s reclusive, secretive nature would have been impossible to capture, and he’d be a two-dimensional antagonist, found so popularly in television crime dramas. In each, the POV character was vital to what the author was trying to accomplish beyond the events of the story alone. The reader is left feeling and thinking in a particular way. The POV characters took them to those heights, or lows, in an authentic and natural way.

In the end, art is a dialogue between the artist and viewer. Otherwise the work derives little lasting meaning. In all art dialogues, the secrets of the artist are laid bare, but we are not typically focused on them. To paraphrase seminal playwright Arthur Miller: Our best work occurs where we are most naked. As the viewer of the work, we delve into the core of the narrative as dictated by the POV and subconsciously digest the author’s insights and bits of the author as well. In the best of art, wrought through a transporting POV, we leave with new insights of our own.

Next in The Book Killers series: Dead Dialogue

Previously in The Book Killers series: Unfocused Openings