This is a well-researched nonfiction book about how the Sackler family of the privately-held company Purdue Pharma, their sales reps, unethical and misinformed doctors, our pitiful healthcare system that only helps some people, and our misguided law enforcement and incarceration laws created an opioid crisis that became a heroin crisis that led to overdosing becoming the leading cause of death for young Americans.
Our country needs to ensure that everyone has access to healthcare, including mental health and substance abuse care. We also need to change our drug laws so tax payers aren’t funding prisons for people who are low-level drug users. It costs a minimum of thirty-thousand dollars a year to incarcerate someone. In states like New York and California, the cost is seventy- to more than one-hundred grand. What if we used that money on healthcare and education and substance abuse treatment?
According to Macy’s book, “Rehab is . . . a multibillion-dollar lie.” It’s unevenly regulated and largely abstinence-focused, meaning people who are trying to get weaned off opioids aren’t supposed to take drugs like Suboxone, even though it’s proven to help dramatically in keeping people off drugs. Most rehab centers, which are unaffordable to many, are abstinence, faith-based 12-step programs (5 of the 12 steps refer to a Higher Power) even though for opioid abuse, there is significant evidences that medication-assisted treated for the long term is a more reliable solution for sobriety.
“When you spend that much money, you think it’s going to work. But it’s killing people for that myth to be out there—that the only true cure is abstinence.”
Not to mention, even for people who might be able to afford (barely) incare treatment, there aren’t nearly enough beds in residential treatment centers to meet the demand.
“The most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: to avoid dopesickness at any cost. To feed their addictions, many users recruit new customers. Who eventually recruit new customers. And the exponential growth continues until the cycle too often ends in jail or prison . . . a grave.”
In terms of the opioid crisis, by now we know it’s a national problem that begin in small towns, places like Appalachia that were one-industry towns. When coal-mining stopped being lucrative because of alternate sources of energy like fracking and wind turbines, there were no more jobs. People often had on-the-job injuries and were overprescribed opioids. A drug that should only be used for end-of-life care or cancer, people were getting hooked after just two weeks and then ultimately turned to the cheaper heroin. Four of five people heroin addicts now come to the drug by originally being prescribed opioids.
What’s the difference between our schwag and other sales reps? Asked a representative for Purdue Pharma, the company that hooked our citizens on Oxycontin. The Sacklers that own Purdue are one of the richest families in America. The difference is that “People aren’t stealing from their families or breaking into their neighbors’ homes over blood-pressure pills,” said small-town Dr. Van Zee, a major voice to change how this drug is prescribed, which took years. “Doctors started prostituting themselves for a few free trips to Florida,” said lawyer Emmitt Yeary, who represented the families of people who committed Oxy-related crimes (stealing copper from buildings to get another fix, for example).
“We know from other countries that when people stick with treatment, outcomes can bet better than fifty percent. But people in the United States don’t have access to good opioid-addiction treatment.”
The state of Virginia, where many of the stories from both sides of the law that Macy reports on, is one of the states that refused to accept Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds for insurance coverage. “In states where Medicaid expansions were passed, the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling, and addiction medications and filling other long-standing gaps in care. It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance.” “ If only (politicians) understood that Medicaid would actually save money and lives!”
“It takes about eight years on average, after people start treatment, to get one year of sobriety . . . and four or five different episodes of treatment for that sobriety to stick.”
Because I’m passionate about healthcare reform, justice reform, and an end to people’s lives getting ruined because they had some injury and became addicted to strong opioids almost overnight, I really enjoyed this book and highlighted many, many pages. We need to treat people with addictions with respect because addiction is not a moral failing of not having enough willpower, it’s about how addicted brains work differently than nonaddicted brains.
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Popular Highlights in this book
Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.Highlighted by 1,465 Kindle readers- Diacetylmorphine—aka heroin—was more than twice as powerful as morphine, which was already ten times stronger than opium.Highlighted by 1,280 Kindle readers
- The Harrison Narcotics Act of 1914 severely restricted the sale and possession of heroin and other narcotic drugs, and by 1924 the manufacture of heroin was outlawed, twenty-six years after Bayer’s pill came to market.Highlighted by 1,242 Kindle readers
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A Public Health Nurse Review
I have been a public health nurse for 16 years and every year, multiple times a year, I see the statistics, I get the training, I hear the stories, I carry the naloxone. And, yet, even being in the periphery of the battle, this book enlightened me to parts of the story I had never heard. I am an avid reader and I have never read a book so devastating, and yet hopeful, in my entire life. I would venture to say that, at this point, every American has been touched by this epidemic in some way. We all know of someone this affects on a daily basis and Beth Macy captures that. She makes this thing personal and real and raw, while managing to maintain her integrity as a reporter and non-fiction author. She explains opioid addiction as the disease that it is and makes the reader confront their biases and prejudices. If you have any interest in this epidemic - or if you personally know someone affected, I would highly recommend this book.
Top reviews from other countries
Anna Leigh Leighton
A Gripping and Essential Read on America's Opioid Crisis
Reviewed in Canada on January 22, 2024
Lucie L
Dommage couverture cassée quand je l’ai reçu.
Reviewed in France on February 5, 2023Cecilia Beecher
Excellent research presented appealingly despite the horror of the tale
Reviewed in Spain on July 27, 2022