Macy follows her consequential book Dopesick with another account of big pharma's role in killing Americans and of the frontline workers who are trying to save them. "They say we're going to lose a generation if we don't do something. I say we've already lost that generation." So noted a West Virginian while recounting that nearly everyone in her town has been affected by the opioid crisis. Macy hits the small towns of Appalachia and the archives to deliver another damning indictment of the Sackler family, who "willfully created the opioid crisis…a murderous rampage that has victimized hundreds of thousands of people in this country." Via their company Purdue Pharma, the Sacklers unleashed a flood of OxyContin on the market, bribed doctors to overprescribe it, and then relied on the stigma and shame attached to addiction to ward off lawsuits. When the lawsuits finally arrived, the Sacklers were prepared. "For a quarter century," writes Macy, "the Sacklers masterminded and micromanaged a relentless marketing campaign for their killer drug, then surgically drained the company of $10 billion when they saw trouble on the horizon." The Sacklers have since been shamed and stigmatized, their name removed from museum halls and university buildings, but they have been able to keep their money--so far, anyway. Meanwhile, in what Macy calls the "Uneven States of America," the drug crisis continues to grow, with future substance-dependent people beginning their drug journeys, not ending them, with heroin and fentanyl. Against this epidemic stand health workers, legal reformers, and pioneering judges who have established drug courts to dispense not punishment but treatment. Then there are the conservative politicians from, ironically, the red states most likely to be awash in a flood of drugs, who remain busy "amplifying NIMBYism" to oppose needle exchanges, free clinics, homeless shelters, and other social welfare vehicles for helping the afflicted. A profoundly disconcerting book that, with luck, will inspire reform to aid the dopesick and punish their suppliers. Copyright (c) Kirkus Reviews, used with permission.

This sequel of sorts to journalist Macy's Dopesick (2018), a Carnegie Medal for Nonfiction Finalist, is a passionate account that splits its attention between the legal cases brought against the Sackler family and Purdue Pharma as a result of their aggressive marketing of OxyContin, and the attempts of individuals in communities afflicted by problems with opioid addiction to help their neighbors. While the courtroom coverage can be overheated and muddled, Macy excels at vivid, detailed depictions of the day-to-day struggles of dealing with addiction in several small towns in West Virginia, Indiana, and North Carolina during a period when those communities were also confronting the pandemic. She argues persuasively that substance abuse should be treated as a medical condition rather than a crime, and focuses on treatments with the potential to help, emphasizing the efforts of people who are necessarily skirting the law in order to provide aid to those who need it most. Thoroughly engaged in the lives of her subjects, never dispassionate, Macy immerses readers in horrific reality while illuminating faint hints of hope.

Journalist Macy, bestselling author of Dopesick (CH, Mar'19, 56-2816), chronicles in painstaking detail the tangled elements that contribute to the opioid epidemic, along with the diverse approaches taken in attempts to find a solution. The legal trials involving Purdue Pharma and the Sackler family point out the role that profiteering greed has played in triggering the addiction predicament and the political favors that delay remediation within a system that continues to deny responsibility. Interviews with some of the addicted casualties and many health care workers illustrate diverse attempts to assist drug dependent populations. Macy emphasizes that substance abuse should not be regarded as a criminal offense, but rather as a medical problem. The current routine of drug user incarceration only exacerbates the situation and punishes poor and jobless victims, especially those with more highly pigmented skin color. The case studies Macy reports highlight the lack of financial support to supply the basic needs of those afflicted (including needles), develop alternative remedies, and provide counseling, and illustrate the critical need for basic courtesy. The addict must be reconceptualized from criminal to medically needy patient. Macy presents an arresting portrayal of the obstacles preventing solutions to this drug crisis and stresses the need to raise these victims from their degrading dependency. Summing Up: Highly recommended. All readers. --Rita A. Hoots, emeritus, Sacramento City College

Award-winning journalist Macy (Dopesick) imbues empathy and compassion into her follow-up book about the opioid crisis. Narrating her own work, Macy heartbreakingly delivers exemplary stories of activists and ordinary people fighting to help those experiencing opioid-use disorder, pleading their cases in courts, and educating others to help remove the stigma of substance-use disorder. She objectively details several types of programs that have experienced successes and have been shut down by local governments, such as needle-exchange programs to slow the spread of HIV, hepatitis C, and deaths from dirty needles; treatment modalities for those with mental illness and addiction; and use of buprenorphine as a tool to help treat opioid addiction. Blame for the opioid crisis is placed squarely on Richard Sackler, the billionaire U.S. businessman and physician who was chairman and president of Purdue Pharma. Sackler covered up OxyContin's high addictiveness and instructed pharmaceutical representatives to promote higher doses to increase company profits. Macy puts a face on this ongoing crisis with stories of hope and success, options to explore, and comfort to grieving families. VERDICT An eye-opening exposé that encourages action and support for those experiencing substance-use disorder.--Stephanie Bange