Beth Macy's book 'Dopesick: Dealers, Doctors, and the Drug Company that Addicted America' is a warning to everyone in America who thinks that the opiate epidemic won't arrive at their doorstep.

One recent summer morning, I awoke to discover that the house across from ours had been surrounded by a SWAT team in the middle of the night. That’s unusual stuff here in my sleepy southern neighborhood of two-car garages and young couples pushing baby strollers.

The guy who lived there had escaped our notice—by design, I’m sure. Right under our noses, hidden in plain sight, he managed to operate a thriving mail order business selling fentanyl and Xanax. The police hauled him, and the $700,000 in cash he kept on hand, away at 4 a.m.

The opioid epidemic is carefully reaching its tentacles into the very places we search out to protect our children—middle- and upper-class suburbs with good schools. America is losing almost as many young adults each year to opioid overdoses as the total number of deaths from the entire Vietnam War. One doctor wryly noted that if this were a communicable disease with red blotches we’d be flying in helicopters.

One reason this scourge has flown under the radar so long is that for the past 20 years its victims were mostly rural white guys hit hard by the loss of coal-mining and manufacturing jobs. They hail from places that never make the news—places like St. Charles, Virginia and Bristol, Tennessee. In years to come, as the epidemic makes its way into suburbs like my own, these backwoods hamlets may be regarded as the first signs of a crisis in the making, much like San Francisco and New York were the sentinels of an emerging HIV outbreak.

Crying for Help

In her new groundbreaking book, Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, Beth Macy chronicles the in-depth story of lives lost and communities impacted in a pills-to-needles progression that begins with a pain-killer called OxyContin. The evidence is damning. What used to be a rural problem few people recognized has become a crisis that is unfolding in well-heeled suburban locations previously considered more immune. Perhaps now the cry for help will be heard.

It’s not like opioid addiction is an entirely new phenomenon in the annals of human history, though, as the author explains. After the Civil War, more than 100,000 impoverished, defeated veterans took “to eating and drinking opium to drown their sorrows.” From eating opium we progressed to taking morphine, far more potent, and then to heroin, which was twice as powerful as morphine.

The train really took off in 1996 when the Food and Drug Administration approved the brainchild of the three brothers from Stamford, Connecticut who created Purdue Pharma. The Sackler brothers, a trio of research psychiatrists, saw the opportunity to market the latest and most powerful form of pain-killing heroin beyond hospice and end-of-life care. Their new pill was called OxyContin. All of a sudden, a prescription for a 14- to 30-day supply of these green or yellow pain-killers could be had, easily, for maladies as common as bronchitis or back pain.

Through data-mining research, Purdue Pharma sent out an army of salesmen into rural communities hardest hit by the downturn in the economy, rewarding those salesmen with huge bonuses and luxury vacations. In rural Virginia, they managed to transform average family doctors into the area’s largest group of OxyContin prescribers.

Even the American Academy of Pain Medicine and the American Pain Society climbed on board, pushing for the expanded use of opioids for chronic pain while they pocketed millions from the companies who made the pills. Small wonder that Americans, though 4 percent of the world’s population, now consume 30 percent of its opioids.

Slippery Slopes

The myth fueling the increase in pain-killer prescriptions was best summarized by Purdue Pharma’s David Haddox as he touted OxyContin for all kinds of chronic pain, claiming “it was safe and reliable, with addiction rates of less than 1 percent.” (Subsequent, unbiased studies put the addiction rate as high as 57 percent). Pain became the “fifth vital sign,” and treating it the compassionate, moral thing to do.

The dominating idea was if you took pain-killers like OxyContin for actual pain, you were immune to addiction worries. Too late, we discovered how naïve we were. As Dr. John Burton, the head of the largest medical provider in western Virginia, said, “I can remember telling my residents, ‘A patient can’t get hooked on a 14-day supply of opioid pills.’ And I was absolutely wrong.” Fully three-quarters of those who end up dead from opioids began this way: with that first pill of OxyContin.

The trek from rural America’s opioid use to teenagers in tony suburbs like John’s Creek, Atlanta or McLean, Virginia is a short one. Those in the know claim that suburbs are where you find the best heroin now. These are the kids with money to spend. If a person is willing to drive to Baltimore or Newark he can get a stash of 50 grams of heroin for $4,000 and earn $60,000 selling to desperate users back home. Heroin is so wildly lucrative that the sheer profitability makes the epidemic much harder to contain.

Most young suburban opioid users are introduced to pills that are traded and passed around like hors d’oeuvres at “pharma parties.” Halfway into Macy’s book, she pleads with the reader to get up, this moment, go to the medicine cabinet, and throw away any old prescription pills left over from surgery. Old stashes of left-over opioids are a common introductory source for teenagers.

The pathway from OxyContin pill use to injecting powdered heroin or crushed up pills is slicker than you can imagine. It’s not so much the search for a new high that keeps users returning for more. Rather, it’s the fear of “dopesickness.” Think of your worst flu days of fever, chills, and diarrhea and add a bucket of anxiety, multiply by two, and you have a picture of being “dopesick.” Most addicts claim fear of this misery is what set their addiction on fire. Sooner than anyone would think, the kid who was just popping a few pills a few months ago finds himself injecting heroin directly into a vein.

Recovery for users, suburban and otherwise, is a long battle, fraught with multiple relapses. Many addiction specialists claim it takes roughly five years of ongoing treatment, and many former users remain on medication-replacement-therapy (MAT) much longer.

The Verdict

The Sackler brothers who began this debacle did meet their day in court. They figured that backwoods lawyers in southwest Virginia would be no match for the big-city firm they chose, headed by good-guy Rudy Giuliani. They figured wrong.

Those hillbilly lawyers brought in 2,000 cardboard boxes of documents and depositions to a Roanoke, Virginia courthouse. In 2007, Purdue Pharma coughed up the eleventh-largest fine paid by a pharmaceutical firm in the Justice Department’s history. Company executives were required to come to Abingdon, Virginia and sit through story after story told by parents who lost their child to a drug overdose.

Yet not until 2016 did the Centers for Disease Control announce voluntary prescribing guidelines, strongly suggesting doctors severely limit the use of opioids for chronic pain. That took ten years of pleading. The demand for Oxycontin continues. Today the Sackler brothers remain in the top 20 of America’s richest families—having slid a bit, though, from 16th to 19th place.

Perhaps the best advice comes from one public health professor on the edge of the coalfields of Virginia, a place where folks say things straight. He says, quite simply, “Don’t mess with this sh-t, not even a little bit.”