The book, Dopesick, fully describes the American opioid epidemic with comprehensive interviews of many victom families.
In 1995, FDA approved the OxyContin as schedule I class substance, and the drug was regarded as a safe pain killer with 1% odds of additions. The privately-ownder pharmceducial company, Purdue Pharma adopted very aggressive marketing and sales strategy to boost subscription, such as inviting doctors for vacation resorts. The drug took off in the rural areas of Appalachian Mountains due to the massive demand of retirees from the mining industry. Coincidentally, the medical industry proposed the concept of “pain as the fivth vital signal” in 1996; and the pursue of “zero pain” open the flood gate for pain killer abuses.
People soon used these pills for recreational high: chewing the pill to extract the essense, then snore or inject. The drug is NOT safe as the Big Pharm claimed; the addicted suffered from the opiate withdrawal symptoms, aka dope sick. They would try every means such as armed robbery, prostitution, etc to get the drugs. They would also seek substancesk with stronger potency for economical reason, such as heroine or morphinan, and eventually fentanyl if they survived the overdose.
The death toll of overdose keeps growing, espeically among young demographics. Some liberal cities, such as San Francisco and Seattle forges the safe injection site, — despite illegal in the federal level, just as recreational marijuana.
The author is also a strong proponent of Medicine-Assisted-Treatment, MAT. The addicted should take Vivitrol with close medical supervision to fight the relapse. Unfortunately, the MAT treatment takes 7 - 8 years to detox, not everyone can access or afford such treatments.
There are many heart-broken stories in the book, but my appetites to understand how the perfect storm is weathered are not safisfied. The book also discussed little about the next step to address the problem:
- If we agree that the overprescription of opioid-diverted pain killer opened the pandora box, what we can do to prevent this happening again?
- Does the Medicaid program effectively finance the opiate epidemic, considering the drugs were subsidized by the tax payers’ dollar?
- The overdoes incidents are leathal and expensive. The Middletown, OH municipal considered the controvisal three-strike rules when struggling to deal with the heroin overdose problem. How can we narrow the gap between the demand and limited public health fund?
- The safe inject site should reduce the overdoes dealth and HIV infection. But how can we guarantee that they will NOT become the hotspot for drug dealers, to convince the NIMBYism?
- Can we adopt the Portuguese policy of decriminizing drug use in United State? Why or why not?
The sustance abuse is a complicated matter. In my opinion, it interwines with the relaxation of pain killer use, tremendous financial incentives, and poverty. However, I could not get a better insight after reading the book.