As a journalist, Beth Macy is interested in the stories of individuals, but in Dopesick she also frequently cites broader scientific studies, including statistics about relapse, recovery, and the most effective addiction treatments. The opioid epidemic is widespread, and while the experiences of individuals can be illuminating, statistics are an essential way to look at the epidemic on a macro level. At the same time, however, companies like Purdue Pharma often abuse the trust people place in science by making “scientific” claims that fail to hold up under scrutiny. Macy argues that public health policy should always be informed by science, but she is careful to distinguish between legitimate studies and pseudoscientific marketing jargon. While Macy urges caution toward bold scientific claims—especially when they come from drug companies—she shows in Dopesick how healthcare workers and administrators can improve public health by looking at the data with an open mind and by implementing policies that may seem counterintuitive, but that have a strong scientific grounding.
One of the most effective forms of treatment for recovering opioid addicts—medication-assisted treatment (MAT)—is incredibly controversial, which makes it difficult to separate scientific truth from overblown moral rhetoric. MAT is controversial because it’s essentially helping drug users wean themselves off of one drug by giving them another drug, which is counterintuitive to many people. In addition, abstinence-only treatment programs, which have long dominated the medical landscape, are strongly against this practice. Because of this, many people have strong moral or logistical objections to MAT. But by looking at actual scientific studies, Beth Macy convincingly argues that MAT is more effective than abstinence-based treatment. She finds studies showing that only about 25 percent of heroin addicts who undergo abstinence-only counseling are still clean after two years. By contrast, the success rate for people who receive MAT alongside counseling is 40 to 60 percent, showing a clear advantage. This shows how following the science—despite potentially having a strong gut reaction against its recommendations—has the potential to save lives.
Despite the book’s embrace of some scientific studies, it’s also a cautionary tale about uncritically embracing other scientific claims—particularly when they come from the marketing arms of drug companies. When the Sackler family’s pharmaceutical company, Purdue Pharma, was promoting its new drug OxyContin, its marketing team cited scientific evidence to tout the drug’s effectiveness and safety. The team presented statistics purportedly showing that less than 0.5 percent of people who are prescribed OxyContin will become addicted to it. This likely reassured many doctors who were hesitant about prescribing OxyContin. But when skeptics began digging into the source of this statistic, they found that it came from one short letter to the editor in a medical journal from the 1980s. This not at all comparable to a real clinical study, and yet the marketing team at Purdue Pharma continued to cite the statistic as if it really were part of a proven scientific consensus. In fact, despite Purdue’s confident public claims about their new drug’s low probability for addiction, their application to the FDA showed that many people in the company were actually aware of the drug’s potential for abuse. It’s clear, then, that the “scientific” evidence cited by Purdue to promote OxyContin was not real science, but simply a deceptive marketing ploy to disguise the actual science behind the drug.
In this way, Dopesick shows that evaluating scientific claims is always a careful balance. Clinical trials are essential for determining the best way to treat patients, but pharmaceutical companies can easily abuse the public’s trust by trying to give the false appearance of scientific credibility to their claims. The book implies that doctors, patients, journalists, and concerned citizens must trust data but remain skeptical, always digging deeper into any claim that seems too good to be true.
Related Themes from Other Texts
The Value of Science ThemeTracker
The Value of Science Quotes in Dopesick
In the United States of Amnesia, as Gore Vidal once called it, there were people in history who might have expressed skepticism over Haddox’s claim, had anyone bothered reading up on them. Ever since the Neolithic humans figured out that the juice nestled inside the head of a poppy could be dried, dehydrated, and smoked for the purposes of getting high or getting well, depending on your point of view, opium had inspired all manner of commerce and conflict.
By the 1870s, injecting morphine was so popular among the upper classes in Europe and the United States that doctors used it for a variety of ailments, from menstrual pain to inflammation of the eyes. The almost total lack of regulatory oversight created a kind of Wild West for patent medicines, with morphine and opium pills available at the nearest drugstore counter, no prescription necessary. As long as a doctor initially OK’d the practice, even injected morphine was utterly accepted. Daily users were not socially stigmatized, because reliance on the drug was iatrogenic.
But what exactly was adequate pain relief? That point was unaddressed. Nor could anyone define it. No one questioned whether the notion of pain, invisible to the human eye, could actually be measured simply by asking the patient for his or her subjective opinion. Quantifying pain made it easy to standardize procedures, but experts would later concede that it was objective only in appearance—transition labor and a stubbed toe could both measure as a ten, depending on a person’s tolerance. And not only did reliance on pain scales not correlate with improved patient outcomes, it also had the effect of increasing opioid prescribing and opioid abuse.
NIDA, the Institute of Medicine, the World Health Organization, and the White House drug czar’s office would all agree that indefinite (and maybe even lifelong) maintenance treatment is superior to abstinence-based rehab for opioid-use disorder. And even Hazelden, the Betty Ford-affiliated center that originated the concept of the twenty-eight-day rehab, changed its stance on medication-assisted treatment, or MAT, offering Suboxone to some patients in 2012.
But the rehab Jesse went to was aimed at abstinence, as most were, then and now.
Tess was nearly seven months pregnant when she left jail in June 2015. For a month, she lived with her mom and tried to make a go of it with her boyfriend, the baby’s father—“disastrous,” Patricia and Tess agreed—before they found a private treatment center two hours away that would take Tess during her final month of pregnancy. Private insurance covered most of the $20,000 bill while her dad paid the $6,500 deductible, using the remainder of Tess’s college-savings fund. The Life Center of Galax was one of the few Virginia facilities that accepted patients on medication-assisted treatment (methadone or buprenorphine). Tess was now taking Subutex, a form of buprenorphine then recommended for some pregnant mothers. (Suboxone is typically the preferred MAT for opioid users because it also contains naloxone, an opiate blocker; Subutex, which is buprenorphine with no added blocker, was then considered safer for the baby but more likely to be abused by the mom.)
Harm reduction remained slow to catch on in most of the Bible Belt, including Roanoke. When I told Janine about an idea hatched at an opioid brainstorming session in Boston—to segregate users on a boat in international waters, where they could legally inject under medical supervision, ideally then transitioning to counseling and MAT—she was repulsed. “That’s crazy! We’ve created this problem, and now we decide we’re just going to continue to let it happen, and that’s the answer?”
And yet she was miles ahead of most leaders in her conservative community. She’d told her son’s story recently to the local school board and county officials, hoping to raise money for the county’s risk prevention council, which was currently running on fumes and a few small federal grants. She’d explained how she’d pulled strings to get her kids into the Hidden Valley school zone because she considered it a superior place to raise children. But the affluence she believed would protect her family had instead allowed the festering of shame and inaction. Almost daily the Hope Initiative took a call about a heroin user from Hidden Valley or nearby Cave Spring, and police data showed that the problem was worse by far in those two communities than in other, less affluent areas of the county.
The birthplace of the modern opioid epidemic—central Appalachia—deserves the final word in this story. It is, after all, the place where I witnessed the holiest jumble of unmet needs, where I shadowed yet more angels, in the form of worn-out EMTs and preachers, probation officers and nurse-practitioners. Whether they were attending fiery public hearings to advocate for more public spending, serving suppers to the addicted in church basements, or driving creaky RVs-turned-mobile-clinics around hairpin curves, they were acting in accordance with the scripture that nurse-practitioner Teresa Gardner Tyson had embroidered on the back of her white coat:
Verily I say unto you, inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me. (Matthew 25:40)
If the federal government wouldn’t step in to save Appalachia, if it steadfastly refused to elevate methods of treatment, research, and harm reduction over punishment and jail, Appalachia would have to save itself.
