A tough but necessary read ( )

"No one really knows how many have died from a drug overdose either caused by opioids or in combination with other drugs: the official count is 350,000 between 1999 and 2016."

350,000! 350,000! 350,000!

From the first page this book is a riveting account of the rise of the use and abuse of opioids from the pharmaceutical companies who mined the poorer segments of our country like West Virginia to the dubious fraudsters who built businesses shoveling prescriptions by the thousands. It is the story of the people who lost loved ones to overdoses and then the eventual comeback of heroin and fentanyl. This is a story of greed, corruption, intended and unintended consequences. Our families and communities have been laid waste. ( )

If Americans had better health benefits such as paid sick leave, maybe they wouldn't need as many painkillers and opioids. Which might also be why the opioids epidemic is unique to the US.
McGreal's book is a perfect case study in the importance of C. Wright Mills's sociological imagination. Look for the intersection of social structure, history, power, and social location. This is what the book does. Because the epidemic is not a question of people with failing morals, defective hillbilly culture and other such nonsense. The book demonstrates that the structure of development, regulation, approval, distribution, prescription, and delivery of opioids is truly what was at the root of this, along with the powerful entities backing the spread of opioids for everything, pain as the 5th vital sign, and the data-less idea of an epidemic of pain. There is the power of Big Pharma, its sales reps and lobbyists, and their influence in Congress and government agencies, along with that of the medical profession. All of this goes beyond the unsavory characters the book also describes. And the selection of depressed areas such as poor counties in West Virginia, as the "target" for mass dumping of Oxycontin.
As I often tell my students, nothing ever happens by chance in society. An epidemic of addiction to opioids does not just happen. The book shows how it was constructed back in the 1990s, and has morphed over several decades with no clear end in sight. ( )

Wow. The story behind the prescription opioid epidemic. McGreal traces its origins to greedy drug companies, one in particular, and to drug distributors, who are required to report pharmacies that order unusual numbers of opioids.

It primarily began with OxyContin, which is a variation of Oxycodone. OxyContin ("contin" - "continuous") is a controlled release version of the popular oxycodone, meaning it contains megadoses, supposedly so that it lasts twelve hours. The formulation means it is in the system longer and can become addictive more quickly. Yet, on the strength of a letter and a weak study, the drug maker Purdue sold OxyContin as more effective and less addictive than other opioids. Evidence was weak but a few doctors, concerned that many people with chronic pain were not getting adequate pain relief, took to the talk circuits to support opioids in general. They believed they had gotten a bad name from a few abusers but had a legitimate purpose.

The story is actually astounding. Clinics with lines out the door. Pharmacies so busy they are tossing pill bottles to the counter. Obvious drug sales within feet of clinics and pharmacies. A major lack of medical oversight, and a lack of interest by the FDA. It is actually a small voice, followed much later by a big voice, in the CDC, that finally draws attention to the issue.

I admit that, as a person on the sidelines, I was upset when controls were put in place, preventing a friend with chronic pain from getting the amount of OxyContin that she was accustomed to getting. Her husband told me he was worried about her and glad controls were put in place, and I started to think more about it. It turns out that opioids are actually far from the ideal choice for chronic pain.

Much is not what we think. The drug industries' marketing campaigns are so good that they become part of our background beliefs. Sometimes we have to stop and question.

Excellent book, easy to read, with many examples of real people. ( )

Summary: In this heartbreaking work, McGreal covers a detailed history of illegal distribution of opioids by doctors, immoral advertising and drug pushing by big pharma, and the failures of the DEA and FDA in regulating prescriptions. He described how the careless over-prescription of opioids led to addiction, and too frequently to a switch to heroin and/or to overdose.

My thoughts: This book was utterly tragic. I am horrified at the failures of these powerful people who are responsible for keeping us safe. I already knew about the opioid epidemic and how people were switching from prescribed medications to heroin, but I had no clue how careless the FDA and DEA had been. I had no idea about the magnitude of immoral advertising by drug companies and of the illegal prescribing by doctors. I realize, of course, that most doctors prescribe as they see best, and that this book spent a lot of time focusing on a few doctors and pharmacies who did their best to make fortunes off of illegal prescriptions – so I’m not trying to say that all doctors are to blame. That was not McGreal’s point, either, though he did point out that even doctors who are prescribing as they see best may be working under misinformation about how well opioids work on chronic pain and about the addictiveness of these medicines.

This is by far the most powerful bit of nonfiction I’ve read in quite a while. I would highly recommend this book to everybody – it’s a book that should be read. Especially for people who blame the “addicts” rather than recognizing the failures in the system that led to their addictions. ( )