I read Dopesick by Beth Macy on Feb 24th, 2019

The book, Dopesick, fully describes the American opioid epidemic with comprehensive interviews of many victim 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-owned pharmaceutical 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 fifth 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 essence, 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 substances with stronger potency for economical reason, such as heroine or morphines, and eventually fentanyl if they survived the overdose.

The death toll of overdose keeps growing, especially 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 satisfied. 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 lethal and expensive. The Middletown, OH municipal considered the controversial 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 death and HIV infection. But how can we guarantee that they will NOT become the hot spot for drug dealers, to convince the NIMBYism?
• Can we adopt the Portuguese policy of decriminalizing drug use in United State? Why or why not?

The substance abuse is a complicated matter. In my opinion, it intertwines with the relaxation of pain killer use, tremendous financial incentives, and poverty. However, I could not get a better insight after reading the book.