In February 2001, Ed Bisch, a middle-aged American IT worker, received a frantic call from his daughter. She had just found her 18-year-old brother, Eddie, unconscious and turning blue in the bathroom of their house in suburban Philadelphia. By the time Bisch made it home, paramedics had given up the fight to save his son’s life. When a bewildered Bisch asked what had happened, one of them replied, “Oxy” – shorthand for OxyContin, the opioid-based painkiller that Eddie had overdosed on. “The first time Ed Bisch heard the word ‘OxyContin’,” writes Beth Macy, “his son was dead from it.”
Dopesick is threaded through with similar stories of loss and bewilderment: sad stories told by grieving parents and siblings, angry stories told by activists, and stoical stories told by police officers and local representatives who have witnessed entire communities laid waste by addiction. More often than not, these tangled narratives also speak of shame, stigma, denial and harrowing suffering – both for the addicted and their immediate circle. They attest to the unprecedented scale and devastating effect of America’s ongoing opioid epidemic on middle-class as well as poor rural communities, many of which are still grappling with the idea that addiction has taken hold of their all-American small towns.
Dopesick is also an in-depth exposure of corporate greed and regulatory failure. At its heart is one organisation: Purdue Pharma, principally owned by members of the Sackler family, which lauded OxyContin as a miracle drug in 1996, year zero in terms of the crisis.
Of late, the Sackler name has made the news due to the activism of the photographer Nan Goldin, who was initially prescribed OxyContin for tendonitis in her wrist in 2014. She soon became addicted and resorted to the black market when her doctor refused to prescribe her any more. Post-rehab, she has led public protests against art galleries who have taken Sackler money, including the Met in New York. In London, eight out of 10 museums have benefited from Sackler donations, including the Tate, the National Gallery and the Serpentine. In the past 20 years, an estimated 200,000 people have died in America’s opioid epidemic. “I don’t know how they live with themselves,” Goldin told the Guardian earlier this year.
Back in 1996, Purdue Pharma claimed that OxyContin, though much more powerful than other painkillers, was less addictive due to its slow-release chemical formula. Soon, it was regularly being prescribed in 40 and 80mg forms compared to the 10mg Percocet pills that wayward American teenagers were using recreationally to get wasted at weekends. As Macy attests, seasoned users of prescribed medication and junkies alike realised that the coating could be erased, leaving a small ball of pure oxycodone, which could be crushed and snorted or injected. Countless others, though, less aware of the dangers of a drug that their doctors were suddenly prescribing for post-operative pain relief or back problems, found themselves addicted.
Many doctors bought into the OxyContin myth, encouraged by lavish perks provided by pharmaceutical companies which spent an unbelievable $4.04bn in direct marketing in 2000. “Purdue reps were heavily incentivised,” writes Macy, “buoyed by $20,000 cash prizes and luxury vacations for top performers… Internal documents referred to reps as royal crusaders and knights, and supervisors went by nicknames such as the Wizard of OxyContin, the Supreme Sovereign of Pain Management and the Empress of Analgesia.”
The victims of such corporate largesse and self-aggrandisement were the patients. Macy recounts how one woman became addicted after she was prescribed OxyContin and Percocet together to relieve the pain that followed gallbladder surgery. She writes of a septuagenarian farmer who sold all his land, worth $500,000, to feed his addiction. “It’s over,” he told his doctor. “The kids are gone. The wife’s gone. The farm’s gone.”
Shifting effortlessly between the sociopolitical and the personal, Macy weaves a complex tale that unfolds with all the pace of a thriller, her deep journalism – interviews with dealers, police officers, activists, local politicians as well as users and their families – matched by a sense of barely suppressed anger at what is happening to communities like Roanoke, Virginia, where she has lived since 1989. In 2006, Roanoke received its first wake-up call when the news broke that two beloved local TV weathermen had been discovered to be heroin users after emergency services responded to an overdose call and found one of them unconscious in the bathroom of his stylish apartment. Before that, as Macy notes, heroin was seen as “an inner city (read black) drug”. She also contrasts the often sympathetic media portrayal of mainly white opioid addicts with the demonising of mainly black crack addicts.
The link between prescribed opioid addiction and heroin use is implicit throughout the book, one following on from the other in communities where hard drug use had until recently been relatively rare. “Nothing’s more powerful than the morphine molecule, and once it has its hooks on you nothing matters more,” writes Macy. “Not love. Not family. Not sex. Not shelter. The only relationship that matters is between you and the drug.”
Inevitably Dopesick is a book punctuated by tales of the dead and the damaged, many of them recounted by parents who have become anti-big pharma activists. Their small legal victories against Purdue are beacons of light in a story that exposes the legislative and political dysfunction that helps protect global corporations and often tries to hold the victims of addiction accountable for their own choices. As with the all-powerful gun lobbyists, big pharma can seem untouchable – and more so in the Trump era.
This often heartbreaking book advocates ground-level activism in the face of corporate power and celebrates those who tirelessly campaign for reform, often fired by the loss of a loved one. It may make you weep; it will almost certainly make you angry.
Dopesick by Beth Macy is published by Head of Zeus (£20). To order a copy for £17 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99
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