Dopesick

I found myself confused with the messaging in Dopesick. The first part of the book argued that Purdue pharma had forced the opioid epidemic on an unwitting middle-america. It argued that they kept on coming up with "better" opioids that were not as addictive as the previously addictive opioids. Unfortunately, they were over prescribed and ended up being just as addictive. The later part of the book argues that we need better support for treatment options and these treatments should include drugs to help successfully wean people off the drugs. But wait, isn't a "better drug" how we got into this mess in the first place? I do understand that research now shows that the treatment drugs are not addictive. But what if we show later problems?

Aside from this messaging, the book has a scary portrayal of rural America. It gives the impression that these are areas to be avoided. They are just filled with people that are addicted to drugs. They regularly steel and commit other crimes in order to fulfill their drug habit. People from these small towns work their way up from pain relief subscription to drug addict to drug dealer. Once a dealer is knocked out, another one comes into place to fulfill the need. Rural America sounds a crime zone that must be avoided. To add to the misery, there are few job opportunities available and companies are unwilling to move in due to the poor state of the working population. (These regions also often have large number of "non-working" people on disability.)

Big pharma is portrayed as the evil player that thrust this on the people. The drug company reps encouraged doctors to prescribe these medicines to reduce pain. The reps lavished various premiums on the doctors to continue prescribing more. However, the problem is even deeper. "Pain relief" was seen as something similar to a right. The American medical system continues to be based on a system of instantaneous relief without effort. Drugs that can provide this solution are the ideal solution. They are cheaper than therapy or other efforts that require more effort on the part of the patient. The desire for a quick, cheap drug solution helped lead to the big problem. 

Current attempts to address the problem miss the mark. Reducing the drug company monetary  incentives for doctors to prescribe certain drugs is a step in the right direction. However, this is just a small part of the problem. There also needs to be overall reform of the current medical system. There needs to be an incentive for the system to maintain overall health, rather than just look for the quick fix. We also need to make sure people do not slip through the cracks without getting access to treatment they need. The book is a strong advocate for long-term treatment (mentioning the 5 year treatment plans for people such as pilots.) This will be helpful for those already addicted. Though without reforms in the front end, it will be an endless battle with more addictions (and the associated crime, homelessness, despair, and other issues.)