American Overdose

Starred review from September 24, 2018
The U.S.’s opioid epidemic stems from slippery medical and corporate ethics, shoddy research, and lax government oversight, journalist McGreal reveals in his incisive debut. Opening with the story of a shady undertaker-turned-pill-purveyor, McGreal takes the reader into clinics that churned out prescriptions for painkillers like assembly-line widgets, rarely requiring follow-up appointments or other checks on patient progress when issuing refills. He tells tales of individuals whose quest for pain relief turned them into addicts and often took their lives, leaving heartbroken family and friends behind and sending thousands of children into foster care. He writes that classism played a role in the reluctance of the FDA to address the crisis; many victims came from low-income areas such as rural West Virginia, and OxyContin became known as “hillbilly heroin.” Finally, the book describes in detail how lobbyists for both the pharmaceutical industry and in some cases the medical establishment, who were profiting greatly from the dangerous drugs, thwarted early efforts, in the first years of the 21st century, by doctors and others to sound the alarm to Purdue (OxyContin’s manufacturer), the FDA, and the medical establishment. This urgent, readable chronicle, which names names and pulls no punches, clearly and compassionately illuminates the evolution of America’s mass addiction problem. Agent: Zoe Pagnamenta, the Zoe Pagnamenta Agency.

Award-winning Guardian journalist McGreal traces the trajectory of the American opioid epidemic, and with dire conclusions. Avarice, corporate corruption, government malfeasance, and a sustained campaign of misinformation on the part of major pharmaceutical companies have all played roles in exacerbating a crisis that has claimed the lives of hundreds of thousands of people. The author interviews those who have both propagated the crisis and been victimized by it, centering his reporting on West Virginia, which, owing to an impoverished populace and a lack of well-trained physicians, is considered ground zero for the opioid epidemic. After doctors were given carte blanche in the 1990s to prescribe opioids such as Oxycontin for pain, "pill mills" began to proliferate. Patients became addicted and eventually turned to fentanyl and heroin. Efforts by some members of Congress and victims' families to lobby on behalf of more drug regulation and stricter FDA control were ignored. Ultimately, and at every level, greed has fueled the fires of this ongoing tragedy. VERDICT Although McGreal treads the same ground as Beth Macy in Dopesick: Dealers, Doctors, and the Drug Company That Addicted America (a 2018 LJ Best Book), she offers here a brisk, persuasive, and sobering account of an epidemic that is unlikely to abate any time soon.--Barrie Olmstead, Lewiston P.L., ID

Starred review from October 15, 2018
A deftly researched account of America's opioid epidemic.Guardian reporter McGreal's book is authoritative in tone and vernacular in style. He introduces us to the voices of the epidemic--users, suppliers, family members, and others--but also to its antecedents in both medicine and drug policy. "At the time," he writes, describing the 1970s, "American doctors regarded morphine with suspicion to the point of hostility. Whatever its qualities as a painkiller, it was regarded as so addictive and life destroying that the medical profession refused to countenance its use even for the dying." The author's powerful narrative has deep roots in history. In 1908, Theodore Roosevelt appointed the United States' first opium commissioner, "who described Americans as 'the greatest drugs fiends in the world.' " Then, in the 1980s, doctors began to look at the benefits of opioids in palliative care. Many of those physicians were "cavalier" in their research; some of the most disturbing testimony here comes from them, especially juxtaposed against the families that have been destroyed. The real villains, though, are the pharmaceutical companies--especially OxyContin manufacturer Purdue--and the doctors and politicians who abet them. At one point, McGreal cites a West Virginia legislator who, in the early 2000s, told the state attorney general that "one of the federal prisons was having to send a bus to pick up guards out of state because it couldn't find enough people locally who could pass a drug test." Even so, drug lobbyists did their best to shut down regulations. By 2009, "prescription opioid deaths...[were] three times the number of a decade earlier." The numbers are staggering, and the author doesn't offer a lot of hope for change. "What's going on now is a maturing of the epidemic," a former Food and Drug Administration official reports. "People are addicted, and that means they're going to keep needing it. It's going to be years that they stay on it until they finally get over it. If they don't get killed."A well-rendered, harrowing book about dire circumstances.

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Starred review from November 1, 2018
McGreal, an award-winning journalist, presents this grim cautionary tale of opioids, greed, and addiction in three acts: Dealing, Hooked, and Withdrawal. He begins with a real person, Karen Jennings, a former McDonald's manager, who took painkillers to ease her through her recovery from a broken back, and who wound up addicted and on a breadline. McGreal goes on to successfully address the question of how the greatest drug epidemic in history grew largely unchecked for nearly two decades, becoming the leading killer of Americans under age 50. Among other things, McGreal blames misguided doctors and pain specialists, the industry's false claims about the safety and effectiveness of OxyContin, and the failure to heed warnings by alarmed health officials. By 2018, overdoses were claiming more lives in a single year than the number of U.S. soldiers killed in the entire Vietnam War. Victims are everywhere, but especially in West Virginia, where pill mills dispensed opioids and got insurers to pay for them. McGreal paints an unflattering picture of the billionaire Sacklers, the family behind Purdue Pharma, the maker of OxyContin. Their heavily marketed prescription drug so severely hooked users, many continued to feed their habits with illicit drugs, including heroin. What can be done to reverse this? McGreal's powerfully stated indictment is a start.(Reprinted with permission of Booklist, copyright 2018, American Library Association.)