51 pages • 1 hour read
Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
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Part 1, Chapters 2-4Chapter Summaries & Analyses
Chapter 2 Summary: “Swag’n’Dash”
Opioid addiction accelerated in the late 1990s and early 2000s due to Purdue Pharma’s ramping up of marketing to doctors. The company used aggressive and unethical sales tactics like giving out free dinners to doctors to listen to salespeople’s pitches. Salespeople vied for “$20,000 cash prizes and luxury vacations” (33) for being top sellers. In addition, changes in FDA rules allowed Purdue Pharma to market drugs directly to consumers.
There was high demand for the drug in towns where factories and industries that were the traditional sources of employment left due to globalization. Macy uses anecdotes to show how average, productive people became addicted to the drug. Once addicted, people actively sought out the drug by visiting emergency rooms, prescription-shopping doctors known to be liberal with prescriptions, and engaging in Medicaid fraud, i.e., using the safety-net medical program to get prescriptions, then selling a portion to others in order to fund their habits. Macy includes the story of a homemaker who went from a pain prescription for surgery to stealing drugs and rehabilitation. Even high-school students showed up in local emergency rooms after overdosing.
Reporting on the problem was already emerging in urban places like Boston, but there was little reporting on the same problems in rural communities like Van Zee’s. In addition, the legal, rehabilitation, and social services needed to address the growing problem were less available in rural counties in Virginia, Pennsylvania, and Maine. Van Zee wrote repeatedly to Purdue Pharma asking the company to end aggressive marketing and to reformulate the drug to make it less addictive.
Instead, the company and its medical director Bill Haddox claimed people were suffering from “‘pseudo-addiction’” (47), i.e., addiction symptoms caused by inadequate pain relief. The company pushed this claim with a marketing video called “I Got My Life Back: Patients in Pain Tell Their Story” in which patients described how pain medication allowed them to live good lives again. The video also included the claim that less than 1% of patients become addicted, but that number came from a letter pain specialist Dr. Alan Spanos wrote to the editor of a respected medical journal. In other words, there was no rigorous scientific study backing this claim.
Dr. Van Zee, Sister Beth, and others in the community started the Lee County Coalition for Health to force the company to act; the Drug Enforcement Agency, tasked with addressing drug problems like illicit drug sales, took the unprecedented step of monitoring both the drug and its maker Purdue Pharma. The company responded with some fixes, including grants to start prescription monitoring programs designed to catch people going from doctor to doctor to get prescriptions. The company also created a supposedly tamper-resistant pill (companies make drugs tamper-resistant, or more difficult to abuse, through different methods, e.g., by creating controlled-release versions, or by adding ingredients that counteract the high or create unpleasant side effects). The FDA finally put a warning label on the drug to warn consumers about the potential harms of the drug. When Purdue offered the Lee County Coalition for Health a grant, Sister Beth and Van Zee rejected it; they knew it was essentially a bribe to stop their effort to get OxyContin off the market.
Chapter 3 Summary: “Message Board Memorial”
By 2001, OxyContin abuse and the crime and addiction that came with it spread throughout Appalachia and beyond. Ed Bisch, whose son died of an OxyContin overdose, created an online message board for grieving people to memorialize family members who died of addiction to the drug. Bisch and others like him lived in suburban towns; their children didn’t fit the stereotype of addicted people as inner-city dwellers. Bisch and other parents formed Relatives Against Purdue Pharma (RAPP) to organize against Purdue. They staged protests at Purdue events. Parents and others learned more about the drug by reading Pain Killer, a 2003 book on opioid addiction by reporter Barry Meier. It was revealed that Purdue Pharma was already aware in 1995 that its drug was addictive, well before the tamper-resistant fixes it instituted in 2001.
Still, the medical, government, and legal establishment seemed incapable of effective action. The drug was the subject of an FDA advisory panel meeting where Art Van Zee pleaded with the company to act. Purdue Pharma’s medical staff rejected this plea despite Van Zee’s documentation of the waves of abuse of the drug. People dismissed Van Zee—a quiet country doctor—as a “kook” (65).
When it did conduct research on the drug, Purdue Pharma stacked the deck. They juiced the studies needed to gain FDA approval by screening out people who were likely to have problems with the drug. They secretly funded medical societies focused on pain treatment, creating conflicts of interest. Meanwhile, the company was making huge profits. In court, the company won all 65 civil cases against it. Purdue Pharma had teams of lawyers and was staffed with widely known people like Rudy Giuliani, then a respected lawyer after his stint as the mayor of New York City during the terrorist attacks on September 11, 2001.
The legal fight picked up steam when the Abingdon, Virginia United States Attorney John L. Brownlee and his staff, including researcher Gregg Wood, decided to take on Purdue for fraud and mislabeling OxyContin. They relied on footnotes from Pain Killer, information from the memorial message board, paperwork from other civil cases, and notes from calls Purdue used to train its sales representatives. Local law enforcement gave them information on bad doctors. These “hillbilly lawyers” (186) had such a strong case that Purdue Pharma settled in 2007 by paying a $600 million fine. Three executives—none of them Sacklers—paid multimillion-dollar fines and were sentenced with community service. The hearing on the settlement also forced the executives to listen to family members testify how the drug affected them and loved ones.
Chapter 4 Summary: “‘The Corporation Feels No Pain’”
Although parents and the attorneys were pleased that the legal system had finally called Purdue to account, the win was unsatisfying. No one served time in jail. The company paid the fines for the convicted executives, but these executives were far removed from the doctors who misprescribed the drugs and the sales representatives who sold the doctors on the drugs. It was a holding company—Purdue Frederick—that the government banned from participating in federal Medicaid programs (a massive market for prescriptions) while Purdue Pharma continued doing business with the government. Finally, the judge presiding over the case was unable to impose any penalties on the Sacklers, the owners of Purdue Pharma.
The only accountability came that day when grieving parents explained what it was like to lose their children to addiction to the drug. Macy includes a detailed account of one parent’s emotional call to the judge to reject the plea deal and hold the company fully accountable; one parent brought her son’s ashes, contained in a small urn, to court. Parents used printouts from Ed Bisch’s message board to read the names of those who died by overdose. The company’s legal status as a corporation allowed it to evade parents’ call for accountability, however.
Part 1, Chapters 2-4 Analysis
In these chapters, Macy focuses on the opioid epidemic as a struggle between individuals and the corporation Purdue Pharma to develop the theme of The Cost of Corporate Greed. Macy describes Purdue Pharma as a typical powerful corporation, where a legal structure separates individual actors from the consequences of their actions. When she represents Purdue Pharma in the text, she frequently relies on statistics to construct a portrait of corporate avarice. For example, she notes that drug companies spent “$4.04 billion in direct marketing to doctors in 2000, up 64 percent from 1996” (32). According to a New York Times story Macy paraphrases, the payoff was “that the drug’s sales in 2001 hit $1 billion, outselling even Viagra” (61). These eye-popping numbers help readers quantify just how much the company profited from the drug in that one-year advertisement and profit cycle.
Macy then relies on sympathetic portrayals of individual human subjects to show the human costs of corporate greed. These two chapters include many anecdotes of ordinary, upstanding people whose lives are overturned by their addiction to OxyContin. Macy describes “a happily married twenty-seven-year-old mother from Lebanon” (40) who “went on to steal painkillers from her husband’s elderly grandmother” (42) once she became addicted. The sharp contrast between this woman before and after OxyContin drives home the transformative and debilitating power of the drug. The juxtaposition of the description of the tactics of Purdue Pharma (such as the absurd sales contests) and the portraits of those affected are designed to ignite anger in the reader.
Macy also dramatizes United States v. Purdue Pharma (2007), the first moment when Purdue Pharma was finally required to pay the cost of its greed, by zeroing in on specific people who participated in the case. The attorneys who litigated the case are “hillbilly lawyers” (186). “Hillbilly” is a pejorative term for people from Appalachia; Macy’s diction encourages the reader to overlook that these are highly educated government lawyers, to instead see them as scrappy native sons who finally used the power of the government to defend ordinary people in the communities they represented.
Macy also includes the stories of truly ordinary people to show how they, too, finally forced the company to pay for their greed with reputational damage. Chapter 4: “The Corporation Feels No Pain” is a somber one that shows how incommensurate the pain of survivors is with the monetary cost to Purdue Pharma. The implication of these chapters is that people-driven efforts like message board memorial boards, Art Van Zee’s courageous testimony, and the statements of grieving family members alone are insufficient to hold corporations like Purdue Pharma to account.
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