By Jody DiPerna
Pittsburgh Current Lit Writer
On the first day of 2017, seven people in Allegheny County died of accidental overdoses. By the end of the year, there would be 730 more deaths. Toxicology revealed some combination of heroin, fentanyl, and synthetic opioids contributed to most of the deaths. Mt. Oliver, McKees Rocks, the Northside and Carrick were hit particularly hard.
But you can’t make the citizenry care about 737 senseless deaths by dumping data and statistics on them.
Veteran journalist Beth Macy wanted to tell the story of the opioid epidemic which has taken more than 200,000 lives since 1996, the year that oxycontin was introduced. The former Roanoke Times reporter and author of Factory Man (2014) and Truevine (2016), set out to bring the story to life.
The result is Dopesick: Dealers, Doctors and the Drug Company that Addicted America (Little Brown, 2018), her heart-rending, sprawling chronicle of the crisis. She describes how easy it is to become physically dependent, how it can happen in just 10 days, and how the shame of addiction helped fuel the epidemic. She takes the reader into boardrooms and courtrooms where greed is laid bare, into kitchens and bedrooms where families are ripped apart, and into clinics, hospitals and jails to bear witness to communities reeling from the flood of drugs.
The makers of oxycontin, Purdue Pharma’s game plan was to blitz on every down to playbook to deluge distressed, vulnerable regions with oxycontin. “They bought the data that targeted people who were already prescribing opioids,” Macy told the Current via telephone, pointing out that in the poorest counties throughout Appalachia, those where doctors were already prescribing pain medicines. Where there were lots of workplace injuries and also job loss were easy marks.
More opioids were dumped in West Virginia than any state. The coalfields in the southwestern part of Macy’s Virginia were flooded, as were western Pennsylvania, Kentucky and parts of Ohio. In some ways, it feels like the next inevitable step after the rapacious exploitation of the region by the robber barons and their political lackeys.
“[T]hey would know in which counties they would have the best chance of making sales. They incentivized the reps with these incredible bonuses — six figure bonuses in a quarter. If they could talk the doctor into prescribing a higher dosage, which is more addictive, the rep got an even bigger incentive, a bigger bonus. That’s just incredible,” Macy said, still clearly shaken by the brazen indifference.
One of the ways that Macy gets inside this agonizing story is to take a page from Mr. Rogers’ book and look for the helpers. She talked to lawyers advocating for devastated families. She talked to medical researchers. She talked to first responders and DEA agents. She talked to activists, like Doctor Art Van Zee and Sister Beth Davies, who treat addicts with compassion and save lives to this very day. Macy says that Dr. Van Zee and Sr. Beth are saints walking around on earth.
She talked to families — too many families touched by the crisis. Macy brings real humanity as she reports what it is like to have your life wrecked by addiction and deal with the pain of being in acute withdrawal, the titular dopesick. Her accounts from parents who have buried their children are some of the hardest passages to read.
For years Purdue fraudulently marketed their drugs as being less prone to abuse, and as having fewer narcotic side effects than competing drugs. As a result, three of the company’s top executives were sentenced for misbranding in 2007. None of the suits did jail time. And the pills kept coming.
“[They] flipped the narrative that ‘opioids are safe’ when we knew for 100 years that they weren’t,” Macy said. “But once all these people were hooked, these other companies entered the market, manufacturing, dispensing and distributing the pills.”
Once Purdue lit the tinder, other distributors and manufacturers like Mallinckrodt and McKesson poured gasoline on the flame. Between 2006 and 2012, they pumped a staggering 76 billion hydrocodone pills into the country.
“Why, in less than two decades, had the epidemic been allowed to fester and to gain such force?” Macy writes.
Pharma reps wooed doctors in all kinds of ways, dumping swag bags along with opioids. Macy laid her hands on a particularly revealing freebie: a mug with the oxycontin logo on one side and, on the other, the phrase, ‘the one to start with, the one to stay with.’
“That says everything. They wanted you on that pill and it’s a really good business model if you’re on that pill forever,” she said.
The first overdoses were from prescription drugs themselves, but as prescription meds became hard to come by, illicit drugs like heroin and fentanyl entered the picture. Overdoses climbed even further. In the simplest terms, people got hooked on prescribed opioids, could no longer obtain prescriptions, and turned to other drugs with disastrous results. Fentanyl is particularly dangerous and was found in the toxicology for 75% of those 737 ODs in Allegheny County in 2017.
Macy does not ignore the fact that heroin has been prevalent in inner-cities for decades before this crisis and was rarely, if at all, talked about by politicians and the national media. But her concern is for the addicted, from the cities to the coalfields to the suburbs. Even now, doctors are ill-equipped to help people get off drugs safely. There are few safety nets in place and no coordinated systems to help the afflicted. It’s compounded by a hard pendulum swing from prescribe and then prescribe some more, to stigmatizing those who seek medication for both addiction and pain. The only beneficiaries of those attitudes, according to Macy, are the pharmaceutical companies and the drug dealers.
Death and hopelessness ripple out. The opioid epidemic has decimated entire blocks and entire neighborhoods. In western Pennsylvania and the places where Macy was reporting from, these are your neighbors, friends and family members. When it happens in your town, it is not something you read about, but something you live and die with.
“It wears families out to the extent that they can’t do it anymore, which is why we need to have systems in place, or just be transparent about the fact that you’re simply going to let people die. Are we just going to let them die?” Macy wants to know.
Beth Macy is traveling to speak to advocacy groups and those affected by the opioid crisis. Dopesick is being released in paperback today.