Starred review from June 11, 2018
Journalist Macy (Truevine) takes a hard and heartbreaking look at the cradle of the opioid addiction crisis, the Appalachian region of Virginia and nearby states. She places the responsibility for the epidemic squarely on Purdue Frederick, makers of OxyContin, and its sales division, Purdue Pharma, which engaged in near-predatory marketing practices to sell a drug that has wreaked havoc on the lives of 2.6 million Americans who are currently addicted, with more than 100 dying per day from opioid overdoses. In the first of three sections, she addresses “big pharma” in telling detail, outlining how the overprescribing of pain medication in doctors’ offices and emergency rooms created a market demand that was then met by illegal drug peddlers on the streets. Section two follows the spiral of addiction as users of prescription pills no longer able to afford their habit turn to heroin, a cheaper and more lethal solution to feed their fix. In the last section, the author changes the focus to what has become an addiction treatment industry. Macy potently mixes statistics and hard data with tragic stories of individual sufferers, as well as those who love and attempt to treat them. One addict, Tess Henry, was just 26 when she was first interviewed by Macy and, despite multiple attempts at rehab so that she could raise her infant son, she was dead within three years. Macy’s forceful and comprehensive overview makes clear the scale and complexity of America’s opioid crisis.

November 1, 2018

Here is a comprehensive look at the opiate crisis from the formulation of heroin in 1898 to the impact of heroin and fentanyl addiction in Appalachia. Focusing on the crisis in three states--Virginia, West Virginia, and Maryland--allows the author to explore the personal and family impacts of addiction in those areas, although the crisis is paralleled across the United States. The resulting tale includes the aggressive marketing of Oxycodone by Perdue Pharma; the overprescription of pain meds by greedy physicians; the dealing and distribution of heroin laced with fentanyl to those injured on the job, athletes, and students; and overdose deaths, which are occurring at a record pace. This is a big story well told, clearly narrated by the author. The many characters and episodes are interwoven and blur somewhat in the audio format. Those serious about learning about the crisis will need a print copy with its copious source notes. VERDICT Recommended for adult nonfiction collections. ["Macy's use of current research by various experts makes clear how complex the opioid problem is, but the strength of this narrative comes from the people in the day-to-day battle": LJ 4/15/18 review of the Little, Brown hc.]--Cliff Glaviano, formerly with Bowling Green State Univ. Libs., OH

Copyright 2018 Library Journal, LLC Used with permission.

Starred review from June 1, 2018
Harrowing travels through the land of the hypermedicated, courtesy of hopelessness, poverty, and large pharmaceutical companies.A huge number of Americans, many of them poor rural whites, have died in the last couple of decades of what one Princeton researcher has called "diseases of despair," including alcoholism, suicide, and drug overdoses caused by the hopeless sense that there's a lack of anything better to do. Roanoke-based investigative journalist Macy (Truevine: Two Brothers, a Kidnapping, and a Mother's Quest: A True Story of the Jim Crow South, 2016, etc.) locates one key killer--the opioid epidemic--in the heart of Appalachia and other out-of-the-way places dependent on outmoded industries, bypassed economically and culturally, and without any political power to speak of, "hollows and towns and fishing villages where the nearest rehab facility was likely to be hours from home." Prisons are much closer. Macy's purview centers on the I-81 corridor that runs along the Appalachians from eastern Tennessee north, where opioid abuse first rose to epidemic levels. She establishes a bleak pattern of high school football stars and good students who are caught in a spiral: They suffer some pain, receive prescriptions for powerful medications thanks to a pharmaceutical industry with powerful lobbying and sales arms ("If a doctor was already prescribing lots of Percocet and Vicodin, a rep was sent out to deliver a pitch about OxyContin's potency and longer-lasting action"), and often wind up dead or in jail, broke and broken by a system that is easy to game. Interestingly, Macy adds, "almost to a person, the addicted twentysomethings I met had taken attention-deficit medication as children." Following her survey of the devastation wrought in the coal and Rust belts, the author concludes with a call to arms for a "New Deal for the Drug Addicted," a constituency that it's all too easy to write off even as their number climbs. An urgent, eye-opening look at a problem that promises to grow much worse in the face of inaction and indifference.

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Starred review from June 1, 2018
Award-winning Virginia-based journalist Macy, author of best-sellers Factory Man (2014) and Truevine (2016), carefully constructs the through line from the midnineties introduction of the prescription painkiller OxyContin to the current U.S. opioid crisis: 300,000 deaths over the last 15 years, with that number predicted to double in the next 5. Its addictiveness initially far underreported, Oxy was outrageously marketed to doctors and overprescribed to patients, who quickly couldn't do without it. The much-later introduction of an abuse-resistant formula made heroin cheap and easily accessible, a natural next step. Macy's years of following the issue have earned her remarkable access to those suffering from opioid-addiction disorder as well as the people who tirelessly love and care for them and, in many cases, honor their memories. Again and again, she hears of the devotion the addicted claim to the drug, over every other aspect of their lives, and the motivating fear of dopesickness, gutting withdrawal symptoms. And despite its proven long-term success, medication-assisted treatment remains stigmatized and often too difficult to access. Although the realities are devastating, the doctors, the bereaved, and the advocates Macy introduces do offer hope. Hers is a crucial and many-faceted look at a still-unfolding national crisis, making this a timely and necessary read.(Reprinted with permission of Booklist, copyright 2018, American Library Association.)

April 15, 2018

"Americans, representing 5 percent of the world's population, consume 80 percent of its opioids." Macy (Factory Man; Truevine) brings that statistic down to the personal level as she relates individual stories of OxyContin use in the United States, while also tracing its regulatory history and legal, medical, and social ramifications. The intertwined factors that have led to today's opioid epidemic play out in stories of health-care providers, patients, pharmaceutical companies, politicians, drug dealers, users, and family members. Starting with her own community of Roanoke, VA, Macy effectively shows how opioid abuse plays no favorites as it works its way into all socioeconomic levels, races, and ethnicities. The accounts of addicts and their families leave no doubt about the power the chemicals hold over the brains they alter. Addicts soon begin using to avoid the symptoms of withdrawal (dopesick) rather than gaining any pleasurable high. Controversies abound over what treatments work. Abstinence versus medication-assisted therapy is an ongoing debate, while profit motives and insurance problems are also factors. VERDICT Macy's use of current research by various experts makes clear how complex the opioid problem is, but the strength of this narrative comes from the people in the day-to-day battle.--Richard Maxwell, Porter Adventist Hosp. Lib., Denver

Copyright 2018 Library Journal, LLC Used with permission.