American Overdose: The Opioid Tragedy in Three Acts

by Chris McGreal

Overview

A comprehensive portrait of a uniquely American epidemic — devastating in its findings and damning in its conclusions

The opioid epidemic has been described as "one of the greatest mistakes of modern medicine." But calling it a mistake is a generous rewriting of the history of greed, corruption, and indifference that pushed the US into consuming more than 80 percent of the world's opioid painkillers.

Journeying through lives and communities wrecked by the epidemic, Chris McGreal reveals not only how Big Pharma hooked Americans on powerfully addictive drugs, but the corrupting of medicine and public institutions that let the opioid makers get away with it.

The starting point for McGreal's deeply reported investigation is the miners promised that opioid painkillers would restore their wrecked bodies, but who became targets of "drug dealers in white coats."

A few heroic physicians warned of impending disaster. But American Overdose exposes the powerful forces they were up against, including the pharmaceutical industry's coopting of the Food and Drug Administration and Congress in the drive to push painkillers — resulting in the resurgence of heroin cartels in the American heartland. McGreal tells the story, in terms both broad and intimate, of people hit by a catastrophe they never saw coming. Years in the making, its ruinous consequences will stretch years into the future.

Product Details

ISBN-13:	9781610398619
Publisher:	PublicAffairs
Publication date:	11/13/2018
Pages:	336
Sales rank:	787,331
Product dimensions:	6.40(w) x 9.50(h) x 1.50(d)

About the Author

Chris McGreal is a reporter for the Guardian and former journalist at the BBC. He was the Guardian's correspondent in Johannesburg, Jerusalem and Washington DC, and now writes from across the United States.

He has won several awards including for his reporting of the genocide in Rwanda, coverage of Israel/Palestine, and for writing on the impact of economic recession in modern America. He received the James Cameron prize for "work as a journalist that has combined moral vision and professional integrity". He was awarded the Martha Gellhorn Prize for Journalism for reporting that "penetrated the established version of events and told an unpalatable truth".

He is a former merchant seaman.

Table of Contents

Acknowledgments ix

Introduction: An Epidemic Foretold xi

Act I Dealing

Chapter 1 The Undertaker 3

Chapter 2 Junk Science 14

Chapter 3 Pilliamson 29

Chapter 4 The Sales Pitch 39

Chapter 5 What They Knew 49

Chapter 6 Investigation 65

Chapter 7 Vital Sign 79

Act II Hooked

Chapter 8 A Loaded Gun in the Suicide Ward 99

Chapter 9 Paying to Play 114

Chapter 10 Pursuit 132

Chapter 11 The Silence 145

Chapter 12 Pushback 162

Chapter 13 Sounding the Alarm 175

Chapter 14 Kermit 187

Chapter 15 A Free Pass 204

Chapter 16 The End of Days 217

Act III Withdrawal

Chapter 17 The Public Health 231

Chapter 18 Russian Roulette 247

Chapter 19 Dodging Torpedoes 262

Chapter 20 The National Nightmare 269

Chapter 21 Guilt 286

Timeline 293

Notes 299

Index 305

Editorial Reviews

★ 09/24/2018
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. (Nov.)

Publishers Weekly

"American Overdoseconfirms Chris McGreal's stature as one of the truly essential reporters of our times. It is - in its investigative depth and documentary breadth - a riveting and urgent reckoning of colossal corruption that has taken such a staggering toll on twenty-first century American life."
—Philip Gourevitch, author of We Wish To Inform You That Tomorrow We Will Be Killed With Our Families


"In this gripping account, McGreal exposes the avarice and corruption that caused one of the most shocking crises in American history. A searing expose full of extraordinary characters - heroes, villains and victims."—Katty Kay, contributor MSNBC Morning Joe, presenter BBC World News America


"McGreal shows how the overdose crisis was driven by the pursuit of profits, not just drugs-both of which combine our instinctive craving for pleasure with our evolving capacity for denial and deceit. Fascinating, disturbing, impressively researched and elegantly written."—Marc Lewis, author of The Biology of Desire: Why Addiction is Not a Disease


"With great reporting and compelling storytelling, American Overdose lays bare the tragedy of the opioid epidemic tearing at the soul of the United States. Those who want to understand the issue of narcotics and addiction have to read it."—Ioan Grillo, author of El Narco


"A deftly researched account of America's opioid epidemic. McGreal's book is authoritative in tone and vernacular in style....[A] powerful narrative."—Kirkus Reviews, Starred Review


"This urgent,
readable chronicle, which names names and pulls no punches, clearly and compassionately illuminates the evolution of America's mass addiction problem."—Publishers Weekly, Starred Review


"McGreal, an award-winning journalist, presents this grim cautionary tale of opioids, greed, and addiction in three acts: 'Dealing,' 'Hooked,' and Withdrawal'.... McGreal goes on to successfully address the question of how the greatest drug epidemic in history grew largely unchecked for nearly two decades....What can be done to reverse this? McGreal's powerfully stated indictment is a start."—Booklist, Starred Review


"Thorough, gripping and excellent."——The Straight Dope, Medium.com


"[A] powerful encapsulation of that epidemic....a timely examination of hard-won lessons."—Nature


"Staggering... Zola-esque in its dark twists and turns."—Ed Vulliamy, LiteraryReview


"[A]
searing book... Appalachian accents and anger steam off the page."—TheSunday Times


"Compelling.... reads like a white-collar The Wire, with a cast of characters determined to exact as much money as possible regardless of the human cost."—The Observer


"An engaging, cogently argued book."—Evening Standard


"Astonishing... McGreal's book is forensic in its detailing and turns up some eye-popping examples."—Esquire UK

"McGreal provides a scorching exposé....Most important, American Overdose tells the story of institutional failure and corruption: among local officials, in federal agencies, the United States Congress, and the White House."—Psychology Todayonline


"Vivid reporting...
[McGreal] explains in horrifying detail how this vision of a pain-free America
- pharmacologically unrealistic to begin with - was subverted by a greedy combination of pharmaceutical companies, drug distributors, doctors and pharmacists, aided and abetted by complacent regulators and politicians."—Financial Times

"In American Overdose Chris McGreal of the Guardian looks unsparingly at the causes of the opioid crisis that kills tens of thousands of Americans a year."—The Economist


"A fast, accessible read for those trying to come to terms with a national nightmare."—Law & Crime


"An exposé that will have readers riveted from cover to cover."—GreenBay Press Gazette

"[A] powerful account ... American Overdose is a tale of bad decision making, greed and malfeasance that is still unfolding, and not one about which we can afford to be complacent."—Nick Hopkinson, British Medical Journal


"A detailed view of the corruption that enabled the spread of opiates to go unchecked by the healthcare industry, government or law enforcement."—London Review ofBooks

From the Publisher

★ 2018-09-25

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.

Kirkus Reviews

Winter 2018

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

Library Journal

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