PDF Summary:Dopesick, by Beth Macy
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Dopesick by Beth Macy dives into the history and far-reaching impacts of the opioid crisis in America. The narrative traces the evolution from early opiate use to the aggressive marketing of OxyContin by Purdue Pharma, followed by a devastating surge in heroin abuse and overdoses.
Macy shares stories from rural Appalachian communities impacted first and hardest by the opioid epidemic, illustrating how the crisis spread to suburbia. The book explores efforts by citizens, volunteers, and organizations to combat the crisis through policy, treatment, and harm reduction – while examining the complex web of social and economic factors that enabled such widespread addiction.
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Beth Macy highlights the escalation of the opioid crisis, which initially affected rural regions before permeating suburban neighborhoods, particularly noting an increase in heroin use among affluent circles in Roanoke, Virginia, around the same time a reformulated OxyContin aimed at reducing abuse was released in 2010. Macy delves into the tragic story of Scott Roth, a young man of eighteen from the affluent subdivision of Hidden Valley in Roanoke County, whose life was cut short by a heroin overdose in 2010. The rise of heroin initially went unnoticed, catching families, educational institutions, and police forces by surprise within their own neighborhoods.
Affluent young individuals transitioned to heroin after initially using prescription medications.
The authors detail the progression from prescription pills to heroin among the privileged teens of Hidden Valley and nearby Cave Spring, pointing out that initially most of them didn’t consider themselves addicts because they were able to avoid the “grittier” aspects of heroin addiction often seen in the city – thievery and prostitution. While addiction in Lee County frequently led to people selling their possessions or resorting to theft for money, in suburban areas, individuals generally had more financial resources at their disposal, and it was common for teenagers to trade in electronic devices to support their addiction.
Spencer Mumpower was implicated in the tragic death of his peer, Scott Roth.
Spencer Mumpower's circumstances, a peer of Roth at Hidden Valley, underscore how social status can mask the severity of the problem, thereby hindering timely intervention efforts. Mumpower began his slide into opioid addiction by stealing and selling prescription stimulants from people he knew, a path that eventually resulted in his imprisonment due to his role in Roth's death. The authors document Mumpower's journey from his initial experimentation with pills to his eventual involvement in heroin distribution, a change driven by his dependency and the allure of quick profits linked to the heroin trade after OxyContin was reformulated.
The issue remained concealed due to the support networks available to individuals living in wealthier regions.
Macy suggests that the assumed protective nature of affluence actually erected obstacles that contributed to addictive behaviors, with parents frequently either oblivious to or deliberately overlooking their offspring's actions, and when they did try to intervene, it was often done discreetly and accompanied by a sense of shame. Numerous parents, such as Spencer Mumpower's, were under the impression that their children's addiction issues could be managed through structured recovery initiatives, while they neglected the more affordable and effective approaches rooted in communal health and public efforts.
Community members and local organizations are actively working to address the crisis and the challenges that arise in this effort.
This segment of the narrative delves into the ways in which local individuals confront the widespread drug crisis, chronicling their successes and the various political, ideological, and economic hurdles they encounter in their efforts to advocate for an approach centered on rehabilitation instead of punishment.
Citizen activism
A group called Relatives Opposing Purdue Pharma (ROPP) came together.
Family members of those who succumbed to opioid overdoses were at the forefront of urging legal entities to ensure Purdue Pharma faced consequences. In 2003, Ed Bisch and Lee Nuss, hailing from Philadelphia's Fishtown and mourning the passing of their sons due to overdoses of OxyContin, founded an organization to challenge the pharmaceutical company that produced OxyContin.
Ed Bisch established the website Oxykills.com to commemorate those who perished as a result of opioid intoxication.
Bisch, grieving as a parent, established an online memorial to commemorate individuals who succumbed to OxyContin overdoses, which led to the formation of RAPP and evolved into an extensive collection of information and media coverage on the growing crisis.
RAPP advocates for the establishment of mechanisms to oversee the dispensation of prescriptions.
Activists from RAPP played a crucial role in the fight against opioid abuse, pushing for the creation of community-based prescription monitoring systems to prevent drug abuse and the phenomenon of patients seeking numerous prescriptions from various physicians. The RAPP activists focused their protests and public displays of opposition at the main offices of Purdue Pharma, expressing their objections in public discussions during sessions convened by the FDA.
Volunteers, often hailed as "angels," dedicate their time and energy.
The program referred to as Roanoke's guiding light for progress.
In 2015, Roanoke, Virginia's Police Chief Chris Perkins launched the Hope Initiative, a trailblazing program inspired by the Angel program from Gloucester, Massachusetts, which was established two years earlier, to tackle the rising heroin problem in the city. Perkins, with the aim of improving the availability of rehabilitation services for those struggling with opioid addiction, assembled a team that included law enforcement, addiction experts, dedicated volunteers, and family members of addicts. Among them were Jamie Waldrop, who had personal experience with opioid addiction in her family, and Janine Underwood, who started the Hope Initiative after the tragic death of her son.
Obtaining financial support and facing hurdles in accessing treatment.
The staff at Hope struggled in a difficult setting to tackle substance addiction, characterized by a scarce allocation of places for managing opioid dependence, diverse opinions on the best methods for addiction treatment, and a substantial shortfall in funding, in part due to Virginia lawmakers repeatedly rejecting chances to augment Medicaid finances with federal aid.
Assisting those who are grappling with opioid addiction poses a variety of difficulties.
Overcoming the significant challenge of aligning the harshness of the criminal justice system with the numerous barriers to accessing health care was a key issue at Hope. Volunteers like Waldrop and Underwood discovered that securing rehabilitation services for non-incarcerated individuals grappling with addiction frequently required several weeks, and this endeavor typically needed to be undertaken repeatedly, often yielding minimal results.
Approaches focused on minimizing harm
Programs designed to swap out needles
Programs for exchanging needles provide those who inject drugs with clean supplies, thereby reducing the spread of additional blood-borne diseases, including HIV and hepatitis C. Macy highlights the success of these initiatives in reducing HIV rates, especially when examining the situation in Vancouver, Canada.
Naloxone serves as a preventive measure against fatalities resulting from overdoses.
Narcan, also known as Naloxone, is a medication that emergency personnel often administer due to its swift capability to counteract the symptoms of excessive drug consumption. Numerous state-based community activists have advocated for wider availability of Narcan and supported measures like standing orders that allow people to obtain the medication without a doctor's prescription.
The negative reactions and perceptions toward these measures are especially strong in smaller communities.
In many conservative regions, initiatives like supplying sterile needles and making naloxone accessible face substantial opposition from certain members of the community and the police, who hold the baseless conviction that these strategies encourage drug use, even though there is no scientific proof to back this claim.
The opioid crisis is exacerbated by a range of social factors and the challenges faced by efforts to control and regulate it.
This part of the text examines the deep-rooted and pervasive problems fueling the opioid epidemic, underscoring the lack of firm political intervention and the fragmented operation of America's medical and legal systems, which have permitted powerful entities to profit amid the chaos while the most affected communities suffer and the wealth of the Sackler family grows.
Economic desperation's influence
The decline of coal mining led to a substantial decrease in manufacturing jobs throughout Appalachia.
Macy highlights how individuals in manufacturing and mining-focused towns are particularly susceptible to becoming addicted to opioids, especially during times when disability claims rise and job prospects decrease.
People have resorted to filing more disability claims as a means to secure their financial future.
Beth Macy's work chronicles the surge in disability claims across the country, linking this trend to the economic slump that began in 2008 and as a tactic used by those facing challenges in finding work. The authors argue that the structure of federal disability programs unintentionally promotes a situation where individuals who were once employed are now disincentivized from re-entering the workforce, and these programs do not provide adequate retraining for those without jobs or establish a strong social support network to motivate them to seek employment again.
The link between joblessness, physical disabilities, and the reliance on opioids is clear.
Numerous people throughout the nation struggle to find work in more rural regions as job prospects decline, and this issue continues to affect those with past criminal records, no matter how old their infractions are. To cope, some people in remote regions began exchanging prescription drugs or heroin, both to earn money and to stave off the discomfort of withdrawal. Macy follows the proliferation of the drug crisis from its origins in mining areas through its spread to suburban regions, and further into the smaller communities of Virginia, primarily following the route of Interstate 81. This path facilitated the transfer from regions abundant with cheap narcotics to areas with lower populations, where people who initially used OxyContin shifted to other opioids, thereby drawing a wider demographic into an ever-expanding narcotics market.
The shortcomings of current legal and regulatory frameworks
Holding drug companies accountable in a court of law presents a significant challenge.
To convince a jury to impose substantial fines, prosecutors are obligated to present irrefutable evidence demonstrating the deceptive or illegal nature of Purdue Pharma's promotional strategies. Purdue Pharma's aggressive marketing of OxyContin, coupled with their downplaying of the risks of addiction, resulted in complications during legal cases because their statements about the medication often appeared to be more opinion-based than grounded in definitive facts.
The disintegration of the movement to prohibit drugs.
Macy emphasizes the ineffectiveness of the War on Drugs in tackling the opioid dependency crisis. The justice system's focus on penalization rather than recognizing addiction as a medical concern has been ineffective in diminishing the desire for drugs or preventing deaths from overdoses.
Support for recovery programs and harm reduction measures was insufficient.
The majority of government funds intended to address opioid addiction in the United States are primarily allocated to efforts aimed at halting the smuggling of illegal drugs over international borders, a strategy that has been largely ineffective, and to apprehend and bring legal action against those involved in drug-related crimes. Inadequate support for addiction management, prevention efforts, and mitigating the harmful impacts of drug consumption, coupled with often unethical and inferior practices, results in a substantial number of individuals falling back into the cycle of drug dependency and an increase in deaths resulting from excessive drug intake.
The authorities' delayed response to the crisis.
Macy argues that the actions of state and federal government bodies regarding the opioid crisis have been inadequate and tardy, often coinciding with the schedules of political agendas. Government bureaucracies frequently impose penalties on low-level participants in the drug trade, but rarely implement measures that significantly change the behavior of pharmaceutical companies and regulatory bodies involved in the crisis.
Challenges in delivering moral care to those struggling with substance addiction.
Conversations about the implementation of strategies involving medication-assisted treatment (MAT).
Despite the fact that using medication to aid in treatment is the most scientifically validated approach to diminish the likelihood of recurring substance use and lethal overdose incidents among those battling opioid addiction, Macy highlights the ongoing debate over this method, especially within circles of law enforcement and the judiciary that handle drug-related crimes, where a common contention is that using drugs to treat drug addiction seems paradoxical, leading to more criminalization and stigma for those receiving these treatments.
The inclination to prioritize treatment methods that concentrate exclusively on refraining from substance use and the adverse views linked to the use of medication as part of addiction therapy.
The writers argue that the widespread conviction that abstinence is the most effective path to recovery, combined with the negative perception of Medication-Assisted Treatment, has impeded the development of efficient treatment methods and resulted in many individuals resorting to illicit substances.
Access to Medication-Assisted Treatment is limited, and the costs for these treatments are significant.
In numerous regions across the United States, individuals persist in encountering obstacles when seeking medications for addiction treatment, which is further exacerbated by the expensive nature of such treatments and the societal prejudices associated with Medication-Assisted Treatment (MAT). Even when patients commit to treatment programs that include Medication-Assisted Treatment, they encounter extensive delays, cumbersome or unfeasible administrative processes, and a societal stigma that frequently dissuades the employment of pharmacological aids intended to control addiction.
Medicaid's role in expanding the accessibility of diverse approaches to treatment.
Despite the expansion of Medicaid under the Affordable Care Act, which has improved access to Medication-Assisted Treatment, political and cultural disagreements continue, even though this approach has proven effective at decreasing the number of deaths due to overdosing. Macy posits that Medicaid is the crucial mechanism for delivering essential financial and social support to individuals and their relatives grappling with addiction.
Additional Materials
Counterarguments
- While Purdue Pharma's aggressive marketing practices have been widely criticized, some argue that the responsibility for the opioid crisis is multifaceted, involving not just pharmaceutical companies but also prescribing doctors, regulatory agencies, and individuals who misuse drugs.
- The FDA's approval of [restricted term], despite concerns, could be defended by pointing out that the agency has to balance the potential benefits of a drug against its risks, and at the time, the benefits for pain management may have seemed to outweigh the known risks.
- The transition from prescription opioids to heroin use is complex and may not be solely attributed to stricter controls on medications like [restricted term]; socioeconomic factors, mental health issues, and individual choices also play significant roles.
- Needle exchange programs and the availability of naloxone are sometimes criticized for enabling drug use, although research...
Actionables
- You can educate yourself on the history of opioid use to better understand current issues by creating a timeline that maps the key events mentioned, such as the introduction of laudanum, the Civil War's impact on [restricted term] addiction, and the rise of heroin and [restricted term]. This visual aid can help you grasp the complexity of the crisis and foster a deeper conversation with peers or family members about its roots and evolution.
- Start a book club focused on social issues, using the opioid crisis as a...
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