Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

Purdue Pharma is the parent company of Purdue Frederick, the entity ultimately held legally liable for mislabeling OxyContin. The Sackler family, including Arthur and Mortimer Sackler, acquired the company in the 1950s. The company raked in high profits following the introduction of MS Contin, a drug they touted for its ability to release morphine over time to provide sustained pain relief and reduce drug dependence. Macy signals her text’s characterization of Purdue Pharma in the book’s subtitle (the “Drug Company That Addicted America”) and the title for Part 1 (“The People v. Purdue”) (13). She portrays the corporation as a business built for profit rather than one committed to exercising its duty of care towards the people who took the drugs the company manufactured.

To Macy, Purdue Pharma is the antagonist who stands against people with addictions, their families, country doctors, and overwhelmed social workers and volunteers. Macy quotes Assistant United States Attorney Andrew Bassford, who argues that “the corporation feels no pain” (96), to explain why he saw the $635.4 million settlement against Purdue as too little. In an atmosphere in which regulators refused to rein in corporations, Purdue Pharma was too big and too rich for ordinary people to truly hold the company accountable.

Behind the company is the Sackler family who were enriched by sales of a harmful drug. While the Sackler name appears in the book, there are few direct representations of the family members because the family’s corporation and profits from it give them a shield of privacy. Macy notes the irony that while dealers like Jones and grieving mothers put flowers on the graves of their deceased children, “[T]he Sacklers’ rank among ‘America’s Families’ slid from sixteenth to nineteenth on the Forbes list” (268). The Sacklers, like the Appalachian coal industry and US companies that offshored jobs after NAFTA, represent the capitalistic system that has put profits over the well-being of ordinary people like those Macy portrays in the book.

The Food and Drug Administration is the federal agency tasked with protecting public health through the regulation of food and medicine. It oversees the process whereby drugs like OxyContin are approved for sale. While people assume that FDA approval is evidence that a drug is safe for use, Macy describes the FDA’s lapses and a slow response as partly to blame for the approval of opioids and the resulting epidemic. While the FDA eventually forced Purdue Pharma to label the drug correctly and set up systems to prevent drug diversion, it was too little, too late; their attempted solutions had unintended consequences that pushed people to illicit drugs like heroin.

The Drug Enforcement Agency is a part of the Department of Justice. It is responsible for enforcing restrictive laws controlling the distribution and trafficking of drugs. Their investigations are central to the War on Drugs, the decades-long effort to stop the use and sale of illicit drugs and diversion of prescription drugs in the United States by criminalizing those with drug addictions and dealers alike. Macy portrays the FDA and DEA as being at cross purposes, resulting in policies that criminalize drug use but do little to end addiction. Macy’s frequent criticisms of both agencies are part of a larger critique of the federal government’s inattention to underserved communities in Appalachia.

Jones is a Black American man credited with introducing convenient heroin sales to rural Woodstock, Virginia. In the text, he is serving time in a federal prison in West Virginia for drug distribution. Macy describes Jones as “a gentlemanly and polite” (212) person who spends his days in prison reading literature and books on mass incarceration. Macy paints an arc whereby the young Jones’s combination of bad luck and poor decision-making lands him in prison after a “troubled” childhood in Washington. At 35, Jones participated in a prison-work release program in Woodstock. The job, like others available to a person with a record of incarceration, was poorly paid. Eager to gain funds he needed to start his own business, Jones set up a heroin ring in Woodstock. Macy connects Jones’s focus on profit to the same by Purdue Pharma. Macy takes care to use multiple forms of characterization to show the reader that stereotypes about people in the drug trade are misleading. Jones’s arc and the similarity between his actions and that of Purdue Pharma support Macy’s argument that greed drove the epidemic.

Jesse Bolstridge is a representative figure whose life and death show how destructive addiction to opioids is. Jesse was a young man who used legally prescribed drugs to treat his ADHD and pain from injuries sustained while playing sports. He was a popular football player in high school when he began trading his pills with classmates, then moved on to injecting heroin. Kristi Fernandez, his mother (a respected businesswoman), never realized the danger he was in. After many stints in rehabilitation, Jesse appeared to be in recovery. He was holding down a steady job when he relapsed. He died mere days before insurance approval for further rehabilitation came through. Macy uses the story of Bolstridge and Fernandez to show that parents’ lack of awareness about the course of addiction hobbles efforts to stop the opioid epidemic.

Macy describes Sister Beth Davies as “the pluckiest of the three nuns who had answered the War on Poverty call” (53) in rural Lee County, Virginia. Davies is a colleague of Art Van Zee, and she was among the first frontline workers to see the toll of opioid addiction in the community clinic where she worked. Macy describes her as a tenacious, ferocious opponent to Purdue Pharma who threatened to quit if the grassroots organization organized to combat sale of OxyContin took grant money from Purdue Pharma. Davies is an example of the power of community-based organization and integrity in the face of enticements from corporate America.

Tess Henry is another representative character whose life and death show the impact of a broken healthcare and rehabilitation system on the lives of people with addictions. Tess came from a financially comfortable family from the Hidden Valley in Roanoke, Virginia. Before her addiction, she was “a straight-A student and basketball star” (10). Like other young people in her community, Tess started with prescription pills and moved on to heroin after a legal prescription for opioids to treat bronchitis ran out. By the time Macy encountered her in 2015, Tess was a person whose pregnancy made it virtually impossible for her to get the addiction recovery she needed. Volunteers at the Hope Initiative were not able to get her placed in a local rehabilitation program during the moment when she was receptive to treatment, leading to a series of events that ended with her death, which Macy recounts hearing about shortly before the book was published. Tess represents the middle-class, suburban face of the opioid epidemic.

Lutz and Metcalf are Shenandoah County, Virginia, law enforcement agents who investigated and arrested Jones and several of his dealers. Macy uses these two figures to show the great efforts law enforcement officers make to stem the influx of drugs and how futile those efforts prove to be because of the widespread nature of the drug trade and drug abuse. Macy deepens the characterization of Lutz by including biographical details about his absence from his family as he investigated Jones, while Metcalf is a man motivated by growing up in a household with a father who both used and dealt heroin. By including more personal details about these officers, Macy shows that the cost of the opioid epidemic is personal even for professionals tasked with addressing it. 

Mumpower is a young man who grew up in Hidden Valley and went from using prescription drugs to selling and using heroin, including the heroin that killed Jesse Bolstridge. Macy uses interviews with Mumpower to gain insight into the minds of young people with addictions from the suburbs. Macy’s interview reveals that the desire for novelty and his parents’ inability to maintain firm discipline motivated Mumpower’s behavior. She includes details about Mumpower’s efforts to make amends and live an upstanding life after prison his sentence for contributing to Jesse’s death. Macy describes Mumpower as likable and humble, a characterization that allows her to paint dealers and those with drug addictions alike as people readers are likely to encounter in their own neighborhoods. While Mumpower played a role in Jesse’s death, Macy situates him in a larger cultural and economic context that explains why there is an opioid epidemic in the suburbs at all.