51 pages • 1 hour read
Beth MacyDopesick: Dealers, Doctors, and the Drug Company that Addicted America
Nonfiction | Book | Adult | Published in 2018A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Part 3, Chapter 12-EpilogueChapter Summaries & Analyses
Chapter 12: “‘Brother, Wrong or Right’”
Macy reports on what she discovered during her interview with Jones. Jones’s early life was one characterized by instability in his family and his impatience to achieve success quickly. Once he entered the criminal justice system, it seemed impossible for him to get the resources he needed to succeed. He tried to start businesses but was stymied by his record; at the time of his arrest, he was even working on an organic skincare line using drug sale profits.
During his interview with Macy, Jones references scholarly books about racial bias in the criminal justice system to argue that his imprisonment was a part of a system structured such that Black people, particularly men, made up a disproportionate part of those incarcerated for drug possession and distribution. Jones contends that the deck is stacked against him. Macy notes that 75% of the incarcerated will be back in jail after their initial sentence. Macy includes quotes from Thomas, Jones’s law-abiding, successful brother, to show that even he is subject to racial profiling that made it more likely for him to be swept up into the criminal justice system.
Macy argues that race and class shape the approach to addressing addiction. While many argue that arresting people with addictions isn’t a solution, Macy sees that “this sentiment seemed to apply only to the mostly white group of opioid users who were dealing or committing property crimes to stave off dopesickness” (253). There is also a racial disparity in who becomes addicted to opioids. Ironically, because of unconscious or conscious bias, doctors are less likely to prescribe pain medication to Black people.
When Jones began dealing in Roanoke, he saw himself as a wholesaler who could make huge profits. He confirmed that putting dealers and distributers out of business was a perpetual challenge because there was always someone to take their place.
Macy is disheartened after the interview. She observes the irony that both Jones and people like Purdue medical advisors, Purdue Pharma, and the Sacklers are engaged in distributing drugs that harm people; Jones is being held accountable with a 23-year sentence, but none of the others are.
Chapter 13: “Outcasts and Inroads”
Macy surveys where the United States is in addressing the opioid epidemic now. Overdose deaths in rural America are high in comparison to those in urban areas. An overstretched healthcare system is failing to get resources to people who need help; it would take single-payer healthcare (in which the federal government pays for or manages the care for everyone) to get the needed resources to communities. Current solutions like drug courts, designed to divert the addicted to treatment, are flawed because they reject MAT, and there is limited treatment available in prisons.
The medical establishment’s progress is uneven. In 2016, the FDA created voluntary guidelines to encourage doctors to use opioids only for chronic pain, and the American Medical Association finally rejected the idea of pain as the fifth vital sign. Most doctors are still prescribing individual patients doses of opioids that are too high, while patients with chronic pain are frequently unable to get the medication they need. There are some successes. Regional public health doctors are mustering support for clean needle exchange programs and testing for diseases that circulate due to intravenous drug use.
Macy sees the ongoing response as a political problem and believes we need “a new New Deal for the Drug Addicted” (281). Instead, from 2008 to 2015, the Obama administration moved too slowly to address the opioid epidemic because they feared it would fuel Republican accusations that the nation’s first Black president was soft on crime. They refused to use the term “harm reduction”—programs that are designed to reduce the harms of addiction, not cure it—for the same reason. President Trump appealed to people in rural communities ravaged by opioids in his race for president, but his administration refused to fund programs to counter the epidemic.
The problems preventing an effective response to the epidemic are both cultural and structural. There is continued stigmatization around treatment and harm reduction strategies. Capitalism is also part of the problem. Macy paraphrases a public health dean who believes that economy doesn’t work to address the problem due to the “elevation of rent-seeking behavior: the outsized greed of pharmaceutical companies and factory-closing CEOs” (285) who are content to create people who can’t work and then make profit by selling them drugs that cause addiction.
Fortunately, there are some bright spots. Virginia’s public health system is expanding MAT rather than 12-step programs in rural communities. And Macy closes by highlighting community-based rehabilitation programs like Overmountain, a grass-roots program that is nonprofit and supported with funds from grants and regional universities. Overmountain is in a community that straddles both suburbia and a rural community in Tennessee, and the director of the program persuaded people to support it, despite conservative opposition to social welfare programs, by appealing to ideas of Christian charity in addition to the science of fighting addiction. Macy closes by noting that “if the federal government wouldn’t step in to save Appalachia” then “Appalachia would have to save itself” (296).
Epilogue Summary: “Soldier’s Disease”
Macy wraps up the stories of several of the people she encountered during her research. Spencer Mumpower is out of prison and plans to move away from the place where he was addicted to work in a mixed martial arts studio. The volunteers at the Hope Initiative are still toiling away but running up against a broken system. Local newspapers in places like Roanoke aren’t reporting on the epidemic because many are going out of business. More cities and towns are launching treatment programs using grant funds. Tess’s story has a somber ending. She claimed to be getting clean in Las Vegas but was murdered, perhaps by dealers to whom she owed money.
Part 3, Chapter 12-Epilogue Analysis
Macy comes full circle by including a detailed chapter on the Jones interview she mentions in the Prologue of the book and making her final appeal to the country to do something about the opioid epidemic.
Macy dives deeply into biographical detail to show Jones as a boy and a young man who saw drug trafficking as a means of achieving success quickly. Through the interview, Jones emerges as a complicated figure who belies agents’ simplistic description of him as a “predator” (3, 170). Race and class have shaped the response to drug addiction and trafficking; while Macy references this issue obliquely throughout the book, here, she includes detailed cultural and historical context to show that Jones understands why he is the target of law enforcement and other guilty parties are not.
Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness (2012) and Bryan Stevenson’s Just Mercy: A Story of Justice and Redemption (2014) appear in this chapter as topics in the interview she has with Jones. Both books are about racial and class disparities in the criminal justice system, and she and Jones agree that the books are credible and convincing. Macy uses her discussion with Jones on these issues to advance her assessment of the war on drugs as a failure because of its overemphasis on criminalization of people without many resources, ignoring the larger economic entities that drive addiction and crime, e.g., Purdue Pharma.
Macy attempts to close the main text on a hopeful note in Chapter 13. She does this with a call to action crafted to appeal to multiple audiences. Her call to Appalachia to “save itself” (296) is designed to appeal to members of that community who may still believe that self-reliance is at the heart of Appalachian culture. She even pulls out an allusion to Christian ethics by reproducing the speech Overmountain’s founder gave to sway his conservative audience that supporting the center was in keeping with the Bible. The examples of self-help groups like Overmountain help conservative readers imagine what those efforts might look like. By calling for “a new New Deal” (281), Macy is also appealing to liberal readers who believe the federal government is a force for good and who may disagree with the conservative worldview of many people in Appalachia. Alluding to FDR’s New Deal reminds such people that at one point Appalachia was a major focus of liberal attention.
The Epilogue on the death of Tess Henry is sobering, but it also reminds the reader of the urgency of finding good treatment options; Macy addresses this issue in more detail in Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis (2022), the follow-up to Dopesick.
