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.
Part 1, Prologue-Chapter 1Chapter Summaries & Analyses
Prologue Summary
Macy articulates the central question of Dopesick: How did an epidemic of heroin dealing and addiction sweep through rural towns in Appalachia and the suburbs? She introduces key informants in her quest to answer that question: grieving mothers, those affected by drug overdoses, and Jones, an incarcerated heroin dealer credited with opening up the heroin market in rural Virginia after a prison-release program brought him to town. Macy’s thesis is that this epidemic began when people became addicted to legal prescriptions and moved on to heroin to avoid becoming “dopesick” (3), a term that describes the physical pain, vomiting, sweating, and disorientation that result from withdrawal from synthetic and natural opium-derived drugs.
Chapter 1 Summary: “The United States of Amnesia”
Addiction to opioids is nothing new in the United States. Macy provides historical context to prove her point. Despite some early opposition to a liberal prescription policy, doctors treated wounded and disabled Civil War veterans with the opioid morphine, allowing soldiers to self-administer their drugs with needle kits the doctors left with them. Doctors and society at large normalized the resulting addiction as “iatrogenic” (23), a supposedly benign form of addiction to legally prescribed drugs. In the 1870s, the Bayer Company created an even more potent opioid called “heroin,” the use of which became so normalized that it was available in pharmacies and was an ingredient in popular products like infant cough syrup.
As opioid use shifted from soldiers and the affluent to poor people in cities, there was a sea change in how doctors and law enforcement saw opioid use. People began to associate heroin use with communities of color, inner-city residents, immigrants, and impoverished people—groups that generally lacked political and economic power. The passage of the Harrison Narcotics Tax Act of 1914 codified negative assumptions about these groups and drug use. Opioid use was strictly controlled by doctors, who mostly prescribed opioids for severe pain associated with cancer and end-of-life care. The legal and medical establishment criminalized use outside of these contexts, and new stigma was associated with opioid use and addiction.
Decades later, several factors drove what became an opioid epidemic. Purdue Pharma, a pharmaceutical company owned by the Sackler family, introduced MS Contin, a sustained-release pain reliever for severe pain, and helped normalize use of potent opioids for mild and moderate pain during the 1990s when it introduced OxyContin. OxyContin was the answer to a so-called epidemic of pain, which Purdue Pharma convinced doctors and patients to see as “the fifth vital sign” (27) that deserved as much attention as body temperature, blood pressure, pulse rate, and respiration rate. Purdue salespeople, relying on information from the company’s medical staff, marketed the drug as effective pain relief with a low probability of addiction.
The Affordable Care Act of 2010 (commonly referred to as “Obamacare”) introduced patient satisfaction surveys that were one of the factors in how much financial reimbursement hospitals got for good patient care. Liberal prescription of pain medications likely contributed to higher survey scores. Small-town law enforcement and pharmacists were the first to notice the potential for addiction and the crime that followed.
Macy introduces Art Van Zee, a doctor in rural Virginia, and Sister Beth Davies, a community activist and healthcare provider, to show that people on the ground in rural communities noticed impending trouble in the 1990s when people with prescription opioid addictions began showing up at their clinics.
Part 1, Prologue-Chapter 1 Analysis
Macy introduces the themes of Race, Place, and the War on Drugs in the Prologue and first chapter. The War on Drugs began in the 1970s when the government mobilized to end drug use and dealing. The government focused its efforts on urban communities where the inhabitants were mostly people of color, leading to a wave of mass incarceration. One of Macy’s central arguments is that the response to the opioid epidemic has been shaped by pre-existing ideas about race and cultural stereotypes around rural versus urban identities.
Macy opens the book with a dramatic account of how she finally got access to Jones, the drug dealer credited with bringing heroin to small-town Virginia. Macy borrows the word “predator” (3) from prosecutors’ description of Jones, a Black man from the Northeast. “Predator” is part of the lexicon used to describe Black men who are apprehended and incarcerated for crimes in the inner cities of places like Baltimore as a part of the War on Drugs.
The vision of Jones as an inmate surrounded by “razor wire” (3) and with “flags framing the concrete structure” (3) at first seems to represent the triumph of law and order over criminals. However, Macy undercuts this stereotypical portrait of a Black, drug-dealing criminal with the inclusion of some important details. Jones is in a prison in West Virginia, not a highly populated metropolis like New York City. She notes that the prison has a recreation area in which “all but one of the prisoners is black and brown,” which signals prejudiced outcomes in the carceral system at large (11). Finally, Macy specifies that a batch of heroin mixed with another potent opioid is leading to overdoses throughout rural areas in West Virginia. Using these details, Macy complicates what readers think they know about drugs, the people who sell and consume them, and where they are consumed.
Macy shows that this epidemic is one running through predominantly white, rural communities due to the hollowing out of rural white America. These communities are “unimportant places, hollows and towns and fishing villages where the treatment options are likely to hours from home” (8). It isn’t just that the counties are rural. They are demonstrably more impoverished because the industries and jobs that supported the economy have collapsed. Rather than blaming racial minorities and city-dwellers like Jones for the epidemic, Macy points the finger at powerful (and largely white) institutions like pharmaceutical corporations, the medical establishment, and government agencies.
While general readers may be accustomed to talking about how lack of economic opportunity in inner cities fuels drug epidemics, Macy identifies the same factor playing out in rural communities. The War on Drugs was the mobilization of law enforcement against people like Jones, but Macy complicates the script by showing that these resources need to be deployed more agilely to address the realities of this epidemic.
