51 pages • 1 hour read
Beth MacyDopesick: Dealers, Doctors, and the Drug Company that Addicted America
Nonfiction | Book | Adult | Published in 2018A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
The Cost of Corporate Greed
Macy’s primary motivation for writing Dopesick is to explain why Purdue Pharma marketed OxyContin despite knowledge that the drug was addictive and destructive. She identifies greed as the company’s primary motivation. At the time of her research and publication of the book, Purdue Pharma was a business in which the Sackler family had a controlling interest, but the family’s use of limited-liability corporations allowed them to avoid personal legal responsibility for the many lives ruined by opioid addiction. Macy examines the company’s involvement in the epidemic to prove that pro-business, pro-corporate attitudes among government agencies combined with corporate greed to create the conditions for the opioid epidemic. In other words, the Sacklers, are part of a larger capitalistic system in which corporate profits trump responsibility to ordinary people who provide the labor and consumer markets within that system.
Macy makes her case, in part, by exploring the many economic dimensions of the epidemic. The economic context that created the epidemic came about because of decisions by government and companies. Politicians who signed global trade agreements in the 1990s promised that new markets would allow American businesses to do this:
[E]xport products to China’s growing consumer class an argument Wall Street championed when stock prices climbed with every new plant-closing announcement. Corporate shareholders and CEOs ate up Clinton’s prediction, a cheery best-case version of Adam Smith’s eighteenth-century “invisible hand” (123).
Macy’s description of globalization reveals a perverse dynamic in which what is good for American corporations is bad for American workers and devastating to rural communities in Appalachia. Companies like Purdue Pharma also engaged in rent-seeking. i.e., manipulating of laws designed to protect workers and regulate industries in order to make more profits.
Macy believes that Purdue Pharma’s rent-seeking made it foreseeable that “the moment OxyContin and other opioid pills became too expensive or too cumbersome to get, illegal drug peddlers would step in to fulfill the market demand” (60) because many with substance use disorders would do anything to avoid dopesickness. Macy portrays heart-rending scenes of parents testifying about loss of their family members to show the costs of this “business model” (60). She uses the clinical language of economics in quotes like these to show that the epidemic is the rational outcome of business decisions. There is a larger story here about the role of corporations in the United States. Because corporations are primarily driven by profit, they feel little responsibility to their consumers. In other words, “the corporation feels no pain” (96).
Economic and Cultural Shifts
Macy believes that globalization led to “the hollowing out of the predominantly white working class,” causing economic changes that became “the kindling in the heroin epidemic” (254) in rural America. A major part of her argument is that these changes weren’t merely economic; they were also cultural. Macy makes this case by contrasting Appalachia’s past and present.
She represents Appalachia in the 1960s as so poverty-stricken that when “President Lyndon Johnson squatted on the porch of a ramshackle house just a few counties west, having a chat with an unemployed sawmiller,” he felt moved to “launch his War on Poverty, which resulted in bedrock social programs like food stamps, Medicaid, Medicare, and Head Start” (18). While Appalachia received much needed help from the federal government, self-reliance was an important part of its culture. The Nickel and Dime Clinic where Art Van Zee practiced “was literally built by coal miners and community activists, people who chipped in every penny of their spare change” (43) in 1967. Poverty notwithstanding, communal effort and work formed the nucleus of Appalachian identity.
By the 1990s at the beginning of the opioid epidemic, the remaining jobs in Appalachia disappeared, making its communities “politically unimportant places” (8) and “the ultimate flyover region […] the precise point in America where politicians were least likely to hold campaign rallies or pretend to give a shit” (17). When people did come, it was to market drugs like OxyContin, which became the “new coal” (18) for Purdue Pharma, without the benefit of providing work for people. Outsiders saw Appalachia as negligible, and people within communities began to internalize the notion that they were negligible as well. Macy describes another perverse dynamic. By the early 2000s, the “federal disability program was becoming a de facto safety net for the formerly employed, a well-intentioned but ultimately disastrous way of incentivizing poor people to stay sick, with mental illness and chronic pain” (124). In this context, work ceased to be part of the core of Appalachian identity.
Macy complicates her own picture of a despair-ridden Appalachia by including examples of promising responses to the epidemic. These responses are rooted in some traditional Appalachian values but also in revised notions of Appalachian identity. For example, Overmountain, a local recovery program in Virginia, is a community-based effort that exhibits both the community’s desire to rely on itself to take care of its own but to do so using resources that come in part from federal grants. Macy shows that individuals and communities had to mobilize at the grass-roots level to hold big corporations and the government accountable for providing the help needed. Doing that required admitting that individuals and small communities alone were not enough to meet the challenge, which represented a big shift for such communities.
Race, Place, and the War on Drugs
Macy makes the case that the ineffective response to addiction in rural and suburban America is the result of preconceived notions of who uses drugs and where they use them. The War on Drugs, a decades-long effort to stem the illegal drug trade in the United States since the 1970s, focuses on treating people with drug addictions as criminals. This means that the primary interaction between people with addictions and government occurs through the criminal justice system. The United States built a system that disproportionately incarcerated people of color in urban communities for drug crimes. During the 1980s, this focus accelerated mass incarceration of people of color and enshrined policies and laws designed to punish rather than help people with drug addiction. In popular culture and political discourse of the time, the stereotype of the typical drug-addicted person or dealer was that this person was Black, lived in the city, and was likely a man.
Macy contends that assumptions about who uses drugs and where they use them meant that individuals, communities, and officials overlooked several trends that led to the opioid epidemic. Because of these biases, “[n]o one was paying attention to heroin arrests when they only concerned the children of inner-city black families” (108-109). When awareness did arise that opioid use was spreading in rural white communities, Macy notes that she was among suburbanites who were “safe in [their] ignorance, […] content to stereotype drug addiction as the affliction of jobless hillbillies, a small group of inner-city blacks, and a few misguided suburban kids” (126). When opioids did finally arrive to the suburbs, people became addicted by diverting or misusing legal prescriptions for medications like OxyContin. Such diversion occurs within households and neighborhoods, but preexisting racial and class stereotypes created stigma that made those with drug addictions and their families unwilling to talk about the scope of the problem or openly seek help. This created a cascade effect when people moved from prescription drugs to heroin, fentanyl, and methamphetamines.
While people like Art Van Zee and mothers sounded the alarm, government on all levels was slow to recognize the problem. Law enforcement and other agencies continued to devote resources to cities like Baltimore instead of the towns to which illegal drugs were increasingly finding their way. Macy notes that teens stole credit cards from their parents to fund their drug addiction, and families were frequently reluctant to prosecute, meaning illegal activity did not initially come up on the radar of law enforcement. In addition, effective treatment for drug addiction is expensive and may require multiple stints in rehabilitation facilities before a person with a drug addiction enters recovery. People with families with the means to cover these costs sometimes managed to stay outside of the control of law enforcement, and stigma of drug abuse made such families avoid grassroots, peer help to organize to fight the epidemic. Ultimately, Macy believes that the opioid epidemic is a challenge that all communities—regardless of where they are located and who lives in them—can meet by seeing the bigger picture: that everyone is vulnerable.
