book review: Dopesick by Beth Macy


Little Brown, 2018


Compelling, informative, compassionate, and harrowing. Dopesick is a comprehensive account of America’s opioid crisis that has plagued disparate rural areas throughout the country, though Beth Macy mainly narrows down her research to her local Appalachia. She pieces together interviews with doctors, advocates, addicts, and individuals who have lost family members to the drug, to weave some kind of narrative out of the onslaught of factors which have contributed to the epidemic.

While the reality of the opioid crisis was not lost on me before this (a friend of mine from high school died of an overdose about a year ago, which spurred my interest in this subject in the first place), Dopesick fills in the disturbing details. How Purdue Pharma saturated the market with Oxycontin in the 90s and continuously shifted blame from the addictive nature of the drug to the addicts themselves; how doctors have been made to prescribe these highly addictive painkillers at the drop of a hat (mainly to white patients, due to racial stereotyping that they are less likely to get addicted, which is why the opioid epidemic has hit white communities the hardest); how the government has essentially turned a blind eye and continues to deny adequate funding to address this issue; how MAT (medication-assisted treatment) has been stigmatized to the extent that many rehab programs require patients to be clean before checking in; and how feeling ‘dopesick’ is so miserable that addicts will do anything to quell the incredibly painful withdrawal symptoms.

Beth Macy fuses thorough research with unfailingly compassionate anecdotes shared with her by mothers who have lost children to the drug. Their individual stories litter Macy’s larger narrative, most of them following the exact same trajectory: being prescribed oxycodone for a minor injury, developing a dependency, being cut off from their supply, turning to illegal means of obtaining the drug, trying to get clean, failing to get clean, overdosing. There’s one statistic that Macy repeats a few times throughout this book that stayed with me – on average it takes an addicted person eight years of recovery before they’ve gone a full year without relapsing. That is how impossible it is to quit this drug.

Since this crisis isn’t going anywhere any time soon, between a lack of funding, the refusal to acknowledge MAT as a legitimate rehabilitation technique, and incarceration of drug users and dealers as the primary tool being used by the government as a band-aid solution, Dopesick is well worth reading as a starting point, for anyone wondering how this crisis has reached such a critical state with so little government intervention.

22 thoughts on “book review: Dopesick by Beth Macy

    • It’s absolutely not; it’s one of those issues that I only know about because Vermont was hit hard by the epidemic, but even then it’s just a word of mouth thing, you hardly ever see this on the news. Anyway I’d highly recommend this, it’s fascinating!!

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  1. This is such a messy, maddening issue. And I’m so sorry that you’ve lost someone to this. Thanks for such a thoughtful and detailed review, I’d been wondering about this one. I read another book by this author and liked her writing, it sounds like she did good work with this topic. Great to hear your thoughts on it and that it seems very worthwhile.

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    • I was hoping you were planning on reading this! I’d love to discuss it further if you do. Messy and maddening, yes, exactly. It’s one of those books that makes you want to scream because you just wish it were fictional.
      How has a drug epidemic that’s affected more people than the AIDS crisis at its height essentially been passed over by the government for underfunded volunteer organizations to deal with?! Ugh, this country.

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      • I’ve been debating reading it! I’m really glad to see your review, actually, because it sounds like it’s a bit different than what I was expecting. I hadn’t read it right away because I read Dreamland last year, which was more about the delivery-style heroin that moved in from Mexico after the opioid epidemic started taking hold, and I recently read American Overdose, which is coming out soon. It focused a bit more on the doctors at pill mills and some of the ways Congress has dropped the ball on controlling this, but of course a bigger narrative of the opioid epidemic and drug companies is in both, and I felt depleted after reading them. I wasn’t sure I was ready for another. But I liked her writing elsewhere, she has a very sensitive way of storytelling and it sounds like this takes a slightly different angle. And it’s an important story, like you said – how has this not been sufficiently addressed when it’s causing such devastation?! I think we have a long way to go still in considering addiction as something beyond personal control, fundamental as that sounds – I saw that in the other stories, even parents struggled against preconceived notions of their kids being able to help themselves to beat a problem, as if it’s something as simple as choosing to diet or exercise!!! This war on drugs-era attitude that addiction is something for poor, weak people, etc. and most of the stories I’ve read already are exactly what you describe – it begins with something to treat a relatively small injury, or to manage back pain enough to keep doing physical labor, etc. and suddenly it’s full blown addiction. I think I’ll have to pick this one up and see what it adds to the whole picture – would love to discuss with you and loved hearing your take on it!!

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      • I’ve got a library hold on the American Overdose audiobook but I wasn’t sure if reading two books on the same subject back to back might be a bit overkill… but it does really interest me so I’m actually glad to hear that American Overdose approaches it from a slightly different angle. Dopesick definitely talks about the pharmaceutical companies responsible and Beth Macy does interview doctors, but I think the backbone of this book were the interviews with family members who have lost someone to addiction. And Macy especially highlights the cases where the parents have educated themselves on addiction since losing their child and have been involved in charity work and activism since then. So it’s definitely not an easy read on an emotional level but it is one of the most compassionate looks at addiction that I’ve ever read. I really hope a book like this can be a small but significant step in destigmatizing addiction, because I agree with you 100% that that’s really what’s at the heart of this crisis, all the horrifying logistics of pharmaceutical companies aside. That’s something I’ve noticed on a microcosmic level – a boy I went to high school with killed himself under the influence of heroin during my senior year, and since then his mom has been active on facebook advocating for suicide prevention, and I mentioned my friend who overdosed – her family has been raising money for mental health charities; no mention of drug addiction from either one. And I’m not criticizing the families at all because when something that horrific happens you deal with it in any way you can, but that’s just the reality in living in a society that places such a stigma on drug addiction; you feel like you can’t even talk openly about it after you’ve lost a family member to it. It’s treated like this dark and shameful secret when it’s really an incredibly devastating disease that deserves so much more awareness and compassion than it’s gotten. The whole thing is just heartbreaking and infuriating. But I really hope books like this and the two you mentioned are contributing to some kind of progress on this discourse. There is so much work to be done and no one even wants to talk about this to begin with.


  2. This book sounds absolutely fascinating! I have wondered about the opoid crisis recently and was thinking about maybe reading a book on the topic. If I decide to do that I will definitely read this one.
    Wonderful review!

    Liked by 1 person

  3. […] 9. Dopesick by Beth Macy.  This book is a masterclass in how to fuse the personal and the professional in nonfiction.  Macy treats the subject of the opioid crisis and its innumerable victims with the compassion they deserve, but also remains factual and informative.  I learned so, so much from this book, and it was written in such a starkly compelling way that I didn’t want it to end.  I’d recommend this to absolutely everyone.  Full review here. […]


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