The worst drug crisis in American history

In 2000, a doctor in the tiny town of St. Charles, Va., began writing alarmed letters to Purdue Pharma, the manufacturer of OxyContin. The drug had come to market four years earlier and Art Van Zee had watched it ravage the state’s poorest county, where he’d practiced medicine for nearly a quarter-century. Older patients were showing up at his office with abscesses from injecting crushed-up pills. Nearly a quarter of the juniors at a local high school had reported trying the drug. Late one night, Van Zee was summoned to the hospital where a teenage girl he knew – he could still remember immunizing her as an infant – had arrived in the throes of an overdose.

Van Zee begged Purdue to investigate what was happening in Lee County and elsewhere. People were starting to die. “My fear is that these are sentinel areas, just as San Francisco and New York were in the early years of H.I.V.,” he wrote.

Since then, the worst drug crisis in America’s history – sparked by OxyContin and later broadening into heroin and fentanyl – has claimed hundreds of thousands of lives, with no signs of abating. Just this spring, public health officials announced a record: The opioid epidemic had killed 45,000 people in the 12-month span that ended in September, making it almost as lethal as the AIDS crisis at its peak.

Van Zee’s prophecy and other early warnings haunt the pages of “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” a harrowing, deeply compassionate dispatch from the heart of a national emergency. The third book by Beth Macy – the author, previously, of “Factory Man” and “Truevine” – is a masterwork of narrative journalism, interlacing stories of communities in crisis with dark histories of corporate greed and regulatory indifference.

Macy began investigating the drug epidemic in 2012, as it seeped into the suburbs around her adopted hometown, Roanoke, Va., where she worked for 20 years as a reporter at The Roanoke Times. From there, she set out to map the local onto the national. “If I could retrace the epidemic as it shape-shifted across the spine of the Appalachians, roughly paralleling I-81 as it fanned out from the coalfields and crept north up the Shenandoah Valley, I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame,” she writes.

The word “allowed” is a quiet curse. The further Macy wades into the wreckage of addiction, the more damning her indictment becomes. The opioid epidemic didn’t have to happen. It was a human-made disaster, predictable and tremendously lucrative. At every stage, powerful figures permitted its progress, waving off warnings from people like Van Zee, participating in what would become, in essence, a for-profit slaughter. Or as Macy puts it: “From a distance of almost two decades, it was easier now to see that we had invited into our country our own demise.”

Particularly grotesque is the enthusiasm with which Purdue peddled its pills. In the first five years OxyContin was on the market, total bonuses for the company’s sales staff grew from $1 million to $40 million. Zealous reps could earn quarterly bonuses as high as $100,000, one former salesperson told Macy, adding, “It behoved them to have the pill mills writing high doses.” Doctors were plied with all-expense-paid resort trips, free tanks of gas and deliveries of Christmas trees and Thanksgiving turkeys. There were even “starter coupons” offering new patients a free 30-day supply. As sales rocketed into the billions, noxious side effects began to emerge. Chief among them was the creation of a legion of addicts who, desperate to stave off withdrawal, made the leap to cheap heroin and, later, fentanyl. (“Four out of five heroin addicts come to the drugs … through prescribed opioids,” Macy notes pointedly.)

Many of the casualties have been young adults. In a poignant early scene, Macy joins a mother at the grave of her 19-year-old son. Kristi Fernandez wants to know “how Jesse went from being a high school football hunk and burly construction worker to a heroin-overdose statistic, slumped on someone else’s bathroom floor.” That question – and its larger implications – becomes an engine for the entire investigation, driving it forward with plain-spoken moral force.

In the sprawling cast of “Dopesick,” parents like Fernandez stand out. They have been galvanized by loss. Ed Bisch, an I.T. worker in Philadelphia, hadn’t even heard of OxyContin when it killed his 18-year-old son in 2001. He went on to build a message board, OxyKills.com, that became a parental support network and information clearinghouse. It attracted the attention of Lee Nuss, a grieving mother in Palm Coast, Fla., and together they started a grass-roots protest group: Relatives Against Purdue Pharma. One of the most memorable images of their work together formed during a civil trial against Purdue in Tampa, where Nuss came to a courtroom bearing the urn with her son’s ashes. Lawyers complained. The judge ordered it removed. “My son is not here in body, but he is definitely here in spirit,” Nuss told her friends. “He might have left the building, but he will be back!”

Macy introduces so many remarkable people that, midway through “Dopesick,” readers may find it challenging to keep track of them. (Imagine the writer as the literary equivalent of a triage doctor, with more patients to stabilize than she can linger on.) Taken as a whole, however, this gripping book is a feat of reporting, research and synthesis. Among myriad sources, Macy cites the influence of two earlier works on the crisis: Sam Quinones’s “Dreamland,” which followed the heroin trail back to the Mexican county of Xalisco, and Barry Meier’s “Pain Killer,” published in 2003, which first brought Van Zee’s heroic work to light.

The final third of “Dopesick” is dedicated to recovery – the steep uphill climb facing former addicts and, more broadly, the nation. Here, Macy follows the struggle of Tess Henry, a former honor-roll student, athlete and poet, who tries to stay sober while raising a young son. Macy spends months driving Tess to Narcotics Anonymous meetings, charts her relationship with her mother and hopes for the best when Tess disappears, falling out of communication and into sex work.

This is the place where a traditional storytelling arc tells us to seek redemption. Macy advocates for medical-assisted therapies to help victims of the crisis and notes some pockets of progress. But the epidemic continues to grow, aided by a legal system that criminalizes victims and a health care framework that treats patients as consumers.

While Macy offers some glimmers of hope – chief among them the will of parents and advocates to keep fighting – what echoes long after one closes this book are the unsettling words of Tess Henry’s mother about her daughter: “There is no love you can throw on them, no hug big enough that will change the power of that drug.”

Jessica Bruder teaches narrative writing at the Columbia School of Journalism and is the author of “Nomadland: Surviving America in the Twenty-First Century.”

Source:www.nytimes.com