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Dopesick: Dealers, Doctors, and the Drug Company That Addicted America (2018) examines how OxyContin use exploded in Appalachia in the 1990s and 2000s. When medical providers began restricting access to prescription opioids in the late 2000s and 2010s, many people turned to heroin. The book follows several drug abusers through periods of addiction, recovery, and relapse. In many cases where people are unable to overcome their hunger for heroin or OxyContin, they die from overdose.
In the late 1990s, OxyContin abuse was not yet a major problem. The first police officers to encounter it were surprised by its effects and didn’t recognize the drug’s name. Later on, people found out that they could get high from snorting or injecting it because of its coating, which was supposed to release medicine over time but instead released all of the medication at once. Users quickly developed a dependence on this drug and suffered withdrawal symptoms when they stopped using it. They also would go through terrible dopesickness if they couldn’t have opioids in their system for too long.
OxyContin was a prescription drug that could be used for many types of illnesses. It contained time-release formula, which meant the effects lasted longer than other drugs. Purdue Pharma convinced doctors to prescribe OxyContin by arguing that pain should be considered as important as any other vital sign (blood pressure, heart rate, respiratory rate, body temperature). Doctors were also swayed by gifts and vacations provided by representatives from Purdue Pharma.
By the early 2000s, OxyContin overdoses were responsible for more deaths than other illicit substances such as cocaine or meth. The spread of opioid addiction became notable on a national scale when middle class teenagers began stealing their parents’ and grandparents’ medications to get high. Doctors urged Purdue Pharma to admit that its creation was more addictive than it initially claimed, and withdraw the drug until it could be reformulated so that it would not be as addictive. Purdue Pharma found itself facing multiple lawsuits, most of which were dismissed or settled in favor of the company. Company representatives argued that abuse of the drug was to blame for all those fatal overdoses—not the actual drug itself. Finally, US Attorney John Brownlee put together a case against Purdue’s top executives for felony charges because they disseminated misleading information about OxyContin’s addictiveness and convinced doctors to prescribe more aggressively; this led to an epidemic of prescription painkiller abuse across America that killed thousands every year. Eventually, however, Purdue Pharma agreed to plead guilty only on misdemeanor counts of misbranding (because they had lied about how addictive OxyContin really is), pay $600 million in fines (but did not accept fault), and enter into a five-year program with federal regulators where they will be monitored closely but are allowed continued sales and distribution rights despite their previous lies about how dangerous their product was/is.
When OxyContin was reformulated to be less addictive, it made the problem worse. People who were addicted to the drug suddenly had trouble getting prescriptions from doctors, so they turned to heroin dealers for their fix. Their addiction drove them across the country in search of a new supplier and more drugs.
In the late 2010s, opioids are still killing people. Heroin is widely available and dealers are replaced quickly by police. There’s a stigma about drug abuse that prevents addicts from getting help, and organizations that try to offer help often fail to work together effectively on solutions. If addiction is going to be stopped, communities need programs that treat substance abuse as well as helping users get jobs, homes and hope for a better future.