Image: The cover of the book is a black and white image of a hilly town surrounded by mountains and trees which mostly obscure the small white houses and the streets that they line. The top half of the book is made up of the sky and says "dopesick" in large white capitalized letters. Below it says "dealers, doctors, and the drug company that addicted america" in small, red, capitalized letters. One the lower half of the book near the top is the author's name in larger white capitalized letters. There are a few white lettered lines of text that are unreadable.
Dopesick by Beth Macy was a mixed bag of a read for me. I understand all of the hype and stellar reviews after reading it and I appreciate that Macy brought a kind and human face of addiction to a wide audience. However, many of the ways that she chose to go about it may do more harm than good. This review is long because there were so many things to explain and dissect.
I will start with the things that Macy did right. I believe she portrayed addicts as struggling human beings to the reader, rather than immoral and heartless. She covered what it's like to be dopesick pretty well and created empathy for how inescapable the cycle of trying to get well is. She grasps how heroin grips you and doesn't let go. She did a good job highlighting the despair caused by all of the barriers to recovery and re-entering society, especially for those imprisoned by the war on drugs. She did well highlighting how Purdue Pharma deliberately ruined lives and lied in order to make money with devastating consequences. Though, I do wish more time would have been spent discussing drug costs and insurance companies. For instance, you can get opioids cheap so insurance will pay for them, but things like lidocaine patches which are risk free and effective are rarely covered.
Macy also taught me a lot about medication assisted therapy (MAT) such a suboxone. I was previously unaware that studies showed it worked far better than abstinence only programs. My experience with 12 step programs (which I have been learning to combat by becoming educated in harm reduction) led me to believe that all MAT was the same as using or was using-lite. She highlighted well how 12 step programs, rehabs, halfway houses, and other institutions malign and exclude recovering addicts on MAT. She taught me about how MAT is exploited by some doctors and professionals requiring hundreds of dollars out of pocket per month and how insurance companies often will not pay for it despite it being proven more successful than abstinence only programs. I now understand and support it as a life-saving, while imperfect, treatment that more places need to embrace.
It seems necessary that I admit while writing that I am a former heroin (and other drugs) addict, who used heavily from age 14-22, who has over 14 years "clean" under my belt. I am also now disabled with multiple chronic health conditions from cancer to severe never-ending costochondritis that have required pain management involving opioids. In the past few years, I have had 4 major surgeries, one severely necrotic tooth requiring an ER visit and opioids, and 3 other procedures under anesthesia that included fentanyl. Due to my experiences in 12 step programs, I was terrified when I had to start dealing with these now commonplace things in my life because I thought as soon as an opioid touched my system, I would lose all control and relapse. I delayed procedures and was bedridden with pain and fatigue due to my fear of trying something that would manage my pain enough to help me take care of myself when other methods failed, made things even worse, or were marginally effective. The reality is that with everything I told you, not once have I become addicted again. I have not finished a bottle of pain killers after a procedure yet, but I take them as long as I need to. I have laid in bed crying and unable to function when my pain after surgery was unmanaged and recovered more quickly from surgeries where it was managed well. I am sure my years of experience with sobriety and ability to be honest with myself and what I need is a huge reason why I've been able to navigate this. But, there are other people who have been or were never addicts who also manage it just fine. I tell this perhaps tl;dr story because it leads into two of my biggest gripes about Macy's approach to this subject.
Macy talks about opioids as if most people who use them become addicted and pretends that exposure to the drug itself alone magically turns you into an addict. This was lazy at best. There are a great many factors that lead to addiction including genetics, isolation, mental illness, untreated illness and chronic pain, insurance companies' refusal to pay for non-narcotic drugs and interventions, employment, afterschool activities, the lies of drug companies, socioeconomic status, and many other things including those science has not discovered yet. It is incredibly dangerous- especially for disabled people with chronic pain- to scare-monger like this. Macy did a really good job covering the problems with 12 step and other abstinence only treatment options, but then ends up parroting what many people in meetings say about drugs.
The second issue causing me to reference my personal story was her lack of handling of how opioid restrictions negatively affect chronic pain patients. She offers one story about a colleague explaining to her that responsible use of opioids allows her to work and remain part of society and how restrictions could remove necessary treatments she needs to be a part of the world. Outside this very small section, she dismisses the lack of pain management as a valid problem- especially for women and people of color who are notoriously disbelieved by doctors which has even lead to their deaths. She chalks it up to a lie and a "big pharma" talking point. While predatory pharma salespeople definitely latched onto the technique as something they could use to sell drugs, that does not mean it was not a serious problem. To offer another anecdote, a friend of mine had to have a hip replaced multiple times due to likely malpractice. The pain of course increased each surgery and on DAY ONE a nurse yelled at her for asking for her pain meds, "YOU'RE GOING TO GET ADDICTED TO THESE!" Her bone had been sawed in half and replaced with metal for the third time and all this nurse could do was label her drug seeking for trying to manage her pain. Pain management is also critical for surgery and anesthesia recovery as unmanaged pain causes excess stress on the system and prevents patients doing important things like getting up and moving around as soon as possible after many surgeries. Do some doctors over-prescribe? Absolutely, and that needs to be better handled. Yet, the fear mongering that pain on the whole is over-managed is a blatant falsehood. This leads to my next point. Inclusion of more science would have helped her greatly with these points.
Macy's handling of race in this book is not very good. She does mention multiple times how white suburban people becoming addicts is what people give attention to, unlike the crack epidemics that were treated with criminalization alone. Then she refers to white, suburban people as "unlikely" addicts, creating a racist and classist dichotomy that is also false as addiction has always been present in all communities for the most part. All of her human interest stories are white people and the only Black person heavily focused on is a dealer. She, again, tries to highlight the injustices in our system that force people back into dealing in order to survive, but then later falls short when she seems to suggest that dealers are solely responsible for addiction in the suburbs. The most egregious mishandling of race in the book, though, is when she discusses the doctors being less likely to believe and to treat Black people's pain. As I mentioned in the previous paragraph, it is well documented that Black people, women, and especially Black women are disbelieved in medical situations. Black people especially are often seen to have a higher pain tolerance even though studies show it is actually lower on average likely due to stress and going untreated. This is residual from slavery times when surgeons experimented on enslaved Black women with no anesthesia claiming they feel no pain. She had the audacity to suggest that this had protected Black people from opioid addiction, turning it into a one-dimensional issue with a great outcome, rather than something that literally kills Black people in hospitals. The aforementioned scare mongering that opioids automatically turn everyone into an addict mixed with other kinds of oppression is a injurious and sometimes deadly combination.
As a result of these issues, I have mixed feelings about this book being so popular. I am not sure if I want people to read this book so they will care about addicts and take things more seriously, or if I want them to avoid it due to it's lack of nuance on several issues and misinformation on others. I hope people who do read it will see Macy as one voice of many on the issue who don't all agree.
This review was also posted to my goodreads.
No comments:
Post a Comment