Themes
Key
LitCharts assigns a color and icon to each theme in Dopesick, which you can use to track the themes throughout the work.
Poverty as an Obstacle to Recovery
Cycles of History
Race, Healthcare, and Criminal Justice
Fighting the Medical Establishment
The Value of Science
Summary
Analysis
When Ronnie Jones is arrested in June 2013, the moment is almost anticlimactic. One of his main subdealers is caught and confesses everything in detail. By that time, Jones already knows that the police are on to him. Lutz and other officers had already come to one of Jones’s apartments in Woodstock, only to find that he had moved on to somewhere else. After the attempted raid, Jones keeps a lower profile, changing his cell number and limiting his deals to trusted clients.
Macy begins this chapter with a scene that sharply contrasts the end of the previous chapter—the anticlimactic arrest of Ronnie Jones is the complete opposite of what would happen on an exciting police TV show. Though Jones is difficult to track down, Macy portrays how he wasn’t a criminal mastermind—he was just a regular person doing what he could to put off his arrest for as long as possible. Her goal is partly to dispel stereotypes about how big-time drug dealers are all master criminals (a stereotype largely derived from TV and other fictional depictions).
Themes
At the raid of Jones’s apartment, although Jones has fled, Lutz and the other officers arrest Marie, a user-dealer associated with Jones who is there with her young daughter. Jones knows that Marie will confess everything, and so when he’s arrested six weeks later, he doesn’t seem at all surprised. His run as a bulk heroin dealer lasted about six months—almost exactly as long as Jones predicted when he first started. Metcalf is eager to arrest other dealers in Jones’s ring, but there’s paperwork to do first. Eventually, they arrest other user-dealers in their homes.
The fact that Jones is undone by someone close to him emphasizes just how precarious his position was. Jones doesn’t seem surprised at being caught. This suggests that he was aware of the consequences of his actions and perhaps even expecting them. In some ways, Jones’s motivations are unknown, but Macy hints that desperation may have played a role—one reason why he would take such big risks is if he had few other options in life.
Themes
When Metcalf and Jones first meet, while Jones is in county jail, Metcalf thinks Jones is “very smug, very arrogant.” Jones meanwhile recalls that Metcalf was “very aggressive; he harassed people.” Jones is angry that Metcalf has been interviewing his family, who previously had no idea about his heroin racket.
It's unsurprising that Metcalf and Jones dislike each other, given their history. Still, Macy shows their reactions in parallel to highlight the similarities. She offers the facts to her audience in order for them to reach their own conclusions: did Metcalf go too far by going after Jones’s family, or were his actions justified in the pursuit of a greater good?
Themes
Despite their mutual hatred, Metcalf and Jones have some things in common. Metcalf’s own father was a heroin trafficker who was arrested at the dinner table when Metcalf was seven years old. He grew up in Chapmanville, West Virginia, a poor area that would eventually become a breeding ground for the opioid epidemic. At the time, there were few options for a young man in the area, so Metcalf got out by joining the Air Force. Metcalf sees his pursuit of Jones as a way of atoning for what his own father did. Metcalf’s wife, on the other hand, sees the case as an unhealthy obsession.
Macy presents the stories of Metcalf and Jones side by side to show how the two men actually had a lot in common. One of the things they don’t have in common is race (Metcalf is white and Jones is Black). Because race and criminal justice is such a controversial topic, Macy is careful not to make broad statements. Here, the role of race is mostly unstated, and it is up to the audience to infer what role it may have played in each of the men’s lives. Macy shows how, although Metcalf may seem to be fighting against addiction, in many ways, he is struggling with his own form of addiction (his relationship with his job).
Themes
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Mack, the New York bulk heroin supplier for Jones, is still out there. Shaw’s side of Jones’s heroin ring is also still operating, and so dozens more user-dealers are arrested in the summer of 2013. Metcalf begins plotting to get Mack. He is eager to arrest more people, but Wolthuis, the prosecutor, reminds Metcalf that courts need evidence.
The role of Mack and Shaw shows that heroin distribution in Woodstock was bigger than just Jones. While law enforcement officials often seem to focus on apprehending major targets, Macy introduces the many people in the heroin trade in part to question how much any individual bears responsibility for the supply of drugs (and therefore to question whether imprisoning a dealer actually does much to affect the supply).
Themes
Wolthuis keeps an old case file open on his desk. The case is for the September 2013 death of high school football star Jesse Bolstridge; Wolthuis suspects this death was related to the FUBI heroin ring. Wolthuis, at age 61, has built his reputation on “death cases” by prosecuting drug suppliers when someone has died from their drug. Though the Jesse Bolstridge case is a big one, it is difficult to prosecute because the timeline of when Bolstridge bought his fatal heroin is fuzzy.
By mentioning Jesse Bolstridge, Macy shows how the story of law enforcement and dealers is intimately connected to the story of people struggling with addiction and their families. As with many aspects of the opioid epidemic, “proving” something anecdotally is much easier than proving something in a court room.
Themes
Kristi Fernandez (Jesse’s mother) is worried in May 2013, when Jesse asks to come home from an Asheville sober house for a visit, saying he’s homesick. This goes against the advice of the counselors, and when he comes back to the sober house, he tests positive for marijuana and is booted out. Kristi takes him back in, even though she is still struggling to pay off his previous stints in rehab.
Jesse is clearly a flawed human who struggles to follow the rules of the sober house, but Macy also questions whether those rules are actually in Jesse’s best interest. As a critic of abstinence-only treatment, Macy seems to suggest that it is counter-productive to kick Jesse out because of a positive marijuana test—since that’s when he needs help the most.
Themes
Jesse is weaned off his medical detox—a common practice at the time that becomes more controversial as more and more evidence shows how long-term medical treatment is more effective than abstinence. By 2016, some government agencies are recommending that medical-assisted treatment for opioids should be indefinite, perhaps even lifelong. One researcher estimates that after the start of treatment, it takes an average of about eight years to get one year of sobriety, including four or five different episodes of treatment for sobriety to last. Many, like Jesse, don’t have that much time.
Although weaning patients off medical detox may sound good on paper, Macy goes beyond common sense assumptions and looks at the evidence. She determines that many of the most reputable sources are recommending indefinite or even lifelong medical treatment to deal with addiction. Macy uses this fact to begin making a comprehensive argument: that addiction is a problem that needs to be managed over the course of a lifetime, not through a short rehab program.
Themes
After returning home from the sober house, Jesse takes a construction job with his father in the D.C. suburbs—a 90-mile commute one-way from Kristi’s house. Despite being a good worker, he is soon overwhelmed with expenses, and he finally admits to his mother that he’s using and can’t stop. Kristi mistakenly believes that her son is only on pills, not heroin, because Jesse’s strong physical appearance helps hide his drug problem.
Physical location often plays an important role in the course of addiction for many people struggling with opioid dependency. In this case, Jesse’s condition gets worse when he’s physically separated from his mother (who is a major part of his support system).
Themes
In late September 2013, Jesse is scheduled to fly to Jacksonville for another attempt at treatment. His friend Dennis, however, is vomiting from dopesickness and buys heroin to ease it. Jesse is reluctant at first, but since he’s also feeling dopesick, he agrees to go on one last hurrah with Dennis.
For many people addicted to opioids, it is the fear of dopesickness that motivates them to keep using more than the pleasure of an opioid high. Macy returns again and again to the physical unpleasantness of dopesickness in order to help readers understand the decisions that opioid users make (which, without the context of dopesickness, may seem irrational).
Themes
The next morning, Dennis and some other friends reportedly leave Jesse alone for two hours, then come back to find him unconscious in the bathroom with a needle in his arm. Dennis calls 911, but by the time Lutz arrives (two to six hours later), Jesse is dead. Kristi suspects that Dennis is lying and that he may have waited to call 911 for a reason that he wants to hide.
As with Fayne McCauley (whose death is mentioned in a previous chapter), there is a lot of uncertainty around the death of Jesse, even though some broad details (i.e., that opioids were involved) are clear. Kristi’s suspicions about Dennis are not necessarily just paranoia—Dennis would have motivation to conceal information if it paints him in a bad (and possibly criminal) light. It’s perhaps worth noting that later, Dennis tries to honor Jesse’s memory and even names his son after him.
Themes
Metcalf interrogates Jones, trying to find out who Mack is. Jones remains defiant and is even caught trying to coordinate new sales from in jail. Like many others who are high up in the heroin ring, Jones prides himself on not being a snitch.
Although Jones refuses to cooperate with the law, Macy seems to see something noble in how he sticks to his principles, even if she doesn’t necessarily endorse them.
Themes
Shaw, however, is more willing to talk when he is arrested four months after Jesse’s death. He tells Metcalf about a documentary on YouTube where Mack’s face is clearly featured. Even Shaw doesn’t know Mack’s real name, however.
The appearance of YouTube in the story highlights how media has changed over the course of time. Instead of local newspapers driving coverage of the opioid crisis, it is now new online media driving the discussion. The fact that Mack showed his face in a documentary shows how many didn’t understand the power of this new media when it first began to take hold.
Themes
Metcalf knows Mack has been recently released from prison. Mack is big time, with lawyers on retainer and several assistants. He treats his operation like a business. Still, despite his caution, Mack occasionally slips up, and by tracking some financial records, Metcalf learns that Mack is in fact a Black 37-year-old Brooklynite with a beard, named Matthew Santiago. He also confirms Mack’s address. Though Metcalf is pleased by the success, he realizes that in many ways he’s just like his father—he just has a different addiction.
The fact that Mack runs his drug empire like a business is perhaps noted so that the readers can draw parallels between his illegal drug empire and the mostly legal drug empire of a company like Purdue Pharma. At the end of the day, heroin is not so different from OxyContin—the two are chemically quite similar. Macy again hints at the issue of race without directly stating anything too controversial; it is up to the audience to decide whether race plays a role in why his “business” is illegal while the Sacklers profit off a very similar business or whether other factors are more important.
Themes
Metcalf finds Santiago (A.K.A. Mack) outside his apartment in Brooklyn walking a dog and arrests him. Wolthuis and Santiago’s lawyer work out a plea deal that the judge approves. While Jones received a 23-year prison sentence and Shaw received an 18-year sentence for cooperating, Santiago gets a lesser sentence of 10 years because he is only a “flipper,” not someone who was on the ground and part of the ring. While being transported to the courthouse on the day of sentencing, Santiago tries to taunt Metcalf, saying nothing he does will change anything. Metcalf replies he’s just doing his job.
The fates of the members of the FUBI heroin ring mirror the fates of the Purdue Pharma stakeholders when they were put on trial. Jones, who fulfills a role like the Purdue executives, gets the harshest sentence, just like they did. By contrast, Mack is at the top of the organization and gets the lightest sentence, just like the Sacklers did. While the FUBI heroin ring gets significantly heavier sentences than Purdue Pharma, the case raises similar questions about the priorities of the American legal system. Macy asks if it’s fair that people at the highest leadership positions, like Mack and the Sacklers, often get lighter sentences than people in their organizations who did more hands-on work.
Themes
The end of the Jones/Shaw heroin ring doesn’t change things for users like Dennis. Despite several attempts to get clean, he finds that even after the bust of Jones, it’s easy to go to Baltimore to pick up heroin. Dennis names his son after Jesse and makes plans to move to a bigger city where there might be better jobs and more of a sober culture, the so-called “geographic cure.”
While Macy has spent most of the chapter laying out all sides of the arguments for and against strict drug enforcement, here she begins to more forcefully suggest that the current system doesn’t work. If arresting men like Jones and Shaw is intended to improve the lives of people struggling with addiction, here Macy shows that, for Dennis, it doesn’t really matter whether Jones is in jail or not.
Themes
Jesse’s 2013 heroin death is one of 8,257 in the U.S. that year, a 39 percent increase from 2012. Most of the dead are young men. The FDA is slow to act: they continue to approve new opioids and don’t recall an opioid due to its abuse potential until 2017.
Macy shows how the federal government seems to be at odds with itself. On the one hand, it is arresting men like Jones to try to keep opioids off the street, but on the other hand, the FDA continues to approve new drugs that offer the same potential for abuse.
Themes
Two weeks before Jesse’s 2013 death, the FDA notifies Barbara Van Rooyan that part of her petition to recall approval for the original OxyContin formulation has been approved. This doesn’t matter, however, because Purdue has already voluntarily withdrawn the old drug and reformulated it (not necessarily due to the potential for abuse—it may have been reformulated because of an expiring patent).
The fact that the new FDA action didn’t prevent deaths like Jesse’s is a visceral sign of how ineffective it is. The FDA’s proclamation is largely symbolic (since Purdue has already reformulated its drug) only further highlighted how the response by the federal government has lagged.
Themes
