by Beth Macy, Apollo, 384pp, £20
In 1895, heroin was readily available at any American drug store or by mail order. Babies were frequently prescribed medicine containing morphine, codeine, opium, cannabis indica and heroin, a mixture advertised as “containing nothing injurious to the youngest babe”.
Most physicians were perfectly happy with this, but after a while a few prominent doctors began to criticise their over-subscribing peers. Only by 1906 did the American Medical Association step in and suggest this might present a problem.
This situation, Beth Macy argues in her new book on America’s opioid epidemic, subtitled Dealers, Doctors and the Drug Company that Addicted America, is similar to the one we have today.
Although 2.6 million Americans are currently addicted to opioids, Macy suggests that most people only become aware of the scale of this problem when it either affects them or their families personally or a big celebrity case hits the headlines.
The two she mentions are the pop star Prince, who had an exceedingly high level of the opioid fentanyl in his body when he died, and the actor Philip Seymour Hoffmann, who died of acute mixed drug intoxication, including heroin, cocaine, benzodiazepines and amphetamine. These deaths might not seem to have an obvious connection, but Macy sees the problem with drug addiction in America as usually starting with prescription painkillers and then moving on to heroin or other illegal drugs, before coming back to a mixture of the two. Although it happened after she completed her book, the rock star Tom Petty’s death was also connected to fentanyl.
Macy traces the beginning of a new wave of opioid addiction to the late 1990s. This time, she suggests, the heroes are care-workers and physicians of various kinds who have sounded the alarm. Foremost among these in her book are a thoroughly disgruntled 83-year-old Catholic nun-turned-drug counsellor, Sister Beth Davies, and a groundbreaking 70-year-old physician, Art Van Zee, who loves the Grateful Dead so much he wears a Jerry Garcia tie to important meetings.
This is a complicated issue and it is not always clear in Macy’s book where the blame lies. She believes that members of the Obama administration were “slow to address the problem and tepid when they did”. Trump has, she believed, dodged the question, initially saying that the best way to stop people from getting addicted or overdosing is telling young people opioids are “no good, really bad for you in every way”, then claiming that he would make this an official emergency, before failing to follow through.
But if Obama and Trump were unable to stop the problem, how did it get started, and is it fair to see this as drug addiction in the strictest sense?
Macy presents a timeline which begins with drug companies heavily pushing new drugs like OxyContin to doctors, swaying them with free dinners, turkeys, beef tenderloin and Christmas trees. The doctors then hand out pills like sweets. In some cases, the patients themselves trick the doctors, pricking their fingers and putting drops of blood in their urine so the doctors think that the patients have more serious problems than they do and give them extra medication.
Drug dealers step in and exploit the newly addicted, either by selling them stronger pills or persuading patients to move on from opioid-based medicines to snorting or injecting heroin. Many of these patients end up dead, and Macy details many harrowing stories, including one woman who resorts to prostitution and ends up murdered and left in a dumpster.
The bigger question, and it’s one that Macy explores but never really resolves, is how we should treat pain. As these painkillers now exist, is it up to the patient to be responsible with the drugs they are given, or should the doctors exercise more caution?
Alongside the cases of addiction and misuse, Macy also explores incidences where people with serious pain problems do not get access to these sort of drugs.
The majority of opioid addiction cases, she writes, are white people because racist doctors automatically made the assumption that black people were more likely to get addicted to painkillers than others.
The solution Macy suggests is a new “New Deal” – a modern equivalent to the series of programmes, public work projects and financial reforms the government introduced between 1933 and 1936 to combat the Great Depression. For her, the opioid epidemic is, at least in part, driven by the sense of futility many Americans feel when they lose their jobs.
Strangely, even though a nun is the hero of this story, she does not suggest that religion could play a part in helping and healing, even if only in the limited way AA offers when it suggests addicts give up to a higher power. After all, if you take away someone’s drugs, you need to find a new way of healing them.