‘Dopesick’: The opioid epidemic laid bare

When I was in medical school, a professor instructed me to think of pain as the patient’s fifth vital sign. It was a radical new idea, one that was quickly disseminating across the country, and it was supposed to alleviate suffering, improve outcomes and transform lives.

But as we discover in Beth Macy’s timely new book, “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America” (Little, Brown, 376 pp., ★★★g), that approach was wildly misguided. It led to thousands of unnecessary deaths and created an underclass of marginalized and debilitated drug addicts. How could we have gotten this so wrong?

You’ve probably heard pieces of this story before, but in “Dopesick” we get something original: a page-turning explanation.

We begin in Appalachia, the epicenter of the opioid epidemic, where “few businesses dare to set up shop because it’s hard to find workers who can pass a drug test.” It’s a place that feels forgotten, where Americans are dying in the prime of their lives and those who hang on are known as “pillbillies.”

Here we learn about Dr. Art Van Zee, a soft-spoken minister’s son from Nevada who tries to get OxyContin off the market until it can be reformulated, as well as his patients who game the system to score more pills. “I’d pierce my finger,” one woman says, “then put a drop of blood into my urine sample.” It was enough to convince doctors that she needed Percocet.

Macy introduces us to the cheerleader snorting Oxy in the library, the man who traded his family’s mule for a quick high, and countless grieving families.

From there, the narrative moves to Stamford, Connecticut, and Purdue Frederick, a family-owned pharmaceutical company. In 1952, Purdue was purchased by brothers Raymond, Mortimer and Arthur Sackler. They transformed the small operation into a massive conglomerate called Purdue Pharma, cornering the pain-relief market with MS Contin and OxyContin.

Using information it purchased from a data-mining network, Purdue tracked down the physicians who were most susceptible to its marketing and sent sales reps to their offices.

Macy is certainly not the first to write about the opioid crisis, but in “Dopesick” she brings a new level of nuance and humanity to a story that has been splashed across headlines for years. (I won’t spoil the jaw-dropping ending.)

She also gives us a sense of where things are headed. Medical students are no longer taught that pain is a vital sign – the field is moving toward brain scans to measure discomfort – and a new generation of doctors is learning to focus on mobility and quality of life over complete eradication of pain.

These are tangible signs of improvement, but we still have tremendous work to do. Earlier this month, a woman in the hospital told me she was encouraged to take a potentially dangerous dose of a powerful opiate before a physical therapy session to enhance her workout. My next patient said the same thing. So did the one after that.

Matt McCarthy is an internist and author of “The Real Doctor Will See You Shortly.”