Recommendation: A very long time ago, I commented that Dopesick and American Overdose were probably interchangeable. I withdraw that comment – American Overdose covers a different field

Where to read: A cafe, now that’s possible again

Read with: Deep depression

In brief: One of the main critiques of the recent TV series based on the book is that the constant jumping between time periods is confusing and detracts from the narrative. Unfortunately, it appears they got the idea from the source text. Despite these structural flaws, Dopesick is an effective rebuttal against a puritan view which casts addicts as morally defective and calls for punishment rather than treatment.

Dopesick is basically a remake of Sam Quinones’ Dreamland, but focusing on a slightly different set of communities and with even less examination of the corporate and regulatory history of Oxycontin. The main problem in the text is the often jumpy timeline and locations – broadly speaking, the account follows the spread of oxycontin (and then heroin) from coal country to wealthy suburbs and the cities but there is enough jumping back and forward that this historical narrative gets somewhat obscured.

Macy does, however, have the advantage of a background in local journalism and her examination of the crisis in her home town of Roanoke, South Virginia is both fascinating and touching. In particular, she traces how opioid addiction took hold in (white) teenagers and young people living in the richer, suburban areas, and flourished in a culture of middle-class, “respectable” silence. In part, the argument is that a drug friendly culture emerged in local high schools, escalating from trading ADHD medication to party drugs and then to prescription drugs and later heroin.

The other particularly valuable part of the narrative is Macy’s discussion of the difficulties in accessing treatment and rehab facilities and the often shocking lack of scientific support for some popular treatment methods such as the 12 steps program used by Alcoholics and Narcotics Anonymous. While abstinence-only approaches work for some, evidence suggests that a combination of MAT (medication-assisted treatment) and therapy over the very long term are most likely to be effective. If nothing else, the difference in recovery statistics for those who have to navigate the general rehab ecosystem as against the statistics for professionals like doctors who often go through catered 5 year recovery and monitoring programs is suggestive.

Ultimately, the key message here is that addiction is not a moral failing but a disease and addicts require treatment rather than “law and order”. This may seems passé to some but, as Macy shows, is not at all well accepted in places like Virginia, cutting against the “War on Drugs” narrative that has been so dominant in the US for the last 50 or so years. She also makes a bold (for the US) argument in favour of needle exchanges, which remains an urgent concern given the increasing numbers of drug users infected with blood borne diseases like HIV and Hep C.

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