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4.11 AVERAGE
4.11 AVERAGE
Should probably move onto the required reading lists for all medical schools and pharmacy programs in the United States.
Definitive work on the opioid crisis which will and should horrify you. And it’s a well-structured read as well. For as much story and fact and tragedy that there is, i was awed and noticed how he melded it all with an engaging voice. Quinones is a fine journalist and a great writer.
This was such an important read. I graduated from Portsmouth High School and continue to be saddened by the dark turn that place has taken. I think all residents of Appalachia need to read it - and all healthcare providers. It's great insight into addiction, the ethics of pain management, and the downfall of the area.
2018 Read Harder Challenge: A book of true crime. I read this earlier this year and didn't note any thoughts here at the time, but I had a lot of them. Most boil down to how I had NO IDEA the depth and detail of this epidemic, even though I had some sense of it from living in Ohio and working with the public. Sam Quinones provides a detailed report of all that went into forming the problem at its current scale.
Especially interesting to me as a librarian is how much of the problem originated from a lack of access to information, lack of critical thinking about that information, and lack of consistent language to track patterns:
"Porter and Jick [authors of the claim that less than 1 percent of patients treated with narcotics developed addictions to them] appeared in that bible of scholarly and journalistic rectitude, the New England Journal of Medicine. Medical professionals assumed everyone else had read it. But only in 2010 did the NEJM put all its archives online; before that, the archives only went back to 1993. To actually look up Porter and Jick, to discover that it was a one-paragraph letter to the editor, and NOT a scientific study, required going to a medical school library and digging up the actual issue, which took time most doctors didn't have."
"Each autopsy physician had different ways of describing a heroin overdose...The numbers had been growing steadily, hidden in the weeds of inconsistent language."
I also didn't know about the massive OxyContin sales campaign mounted by Purdue Pharma (here is where the true crime really starts to come in), and the uniqueness of the morphine molecule in both euphoria and addictiveness.
Other quotes:
"I no longer judge drug addicts," Carol said. "I no longer judge prostitutes."
"The way you're reimbursed in a day, if you actually take the time to treat somebody's pain, you'd be out of business," one longtime family doc told me. "By the model you're stuck in, you can't do it. The hospital will get rid of you. If you're by yourself, you can't pay for your secretary."
"The industry's model was based on creating a pill -- for cholesterol, depression, pain, or impotence -- and then promoting it with growing numbers of salespeople."
"He had no tutelage in pain management. No one did in medical school. 'Just because it's a problem every doctor faces every day,' he said, 'doesn't mean that it's something you would run into in medical school.'"
"To the suburban kids hooked first on pills, heroin fulfilled the dream of the adventures they'd never had in their quiet towns. Part of heroin's new appeal was that it kept them at the edge of a hazardous yet alluring dreamland. Finding dope every day could take them on a wild ride through worlds they hadn't known existed, which, however scuzzy or harrowing, left them with fantastical stories that awed their peers. 'You're as much addicted to going and buying it as to going and using it,' one addict said. 'You feel like James Bond. It's a crazy fantasy.'"
"'It's taken sixteen years to convince the legislature that it is cheaper to put them [in drug treatment] than to put them in prison,' he said. The cost savings weren't what did the trick, though. Treatment has always been more effective and cheaper than prison for true drug addicts. What's changed, Norman said, is that no longer are most of the accused African American inner-city crack users and dealers. Most of the new Tennessee junkies come from the white middle and upper-middle classes, and from the state's white rural heartland -- people who vote for, donate to, live near, do business with, or are related to the majority of Tennessee legislators."
"Many of their constituents were no longer so enamored with that 'tough on crime' talk now that it was their kids who were involved."
"I couldn't remember any drug scourge so ably abetted by silence."
"There are people born without pain receptors. [Living without pain] is a horrible thing. They die young because pain is the greatest signaling mechanism we have."
"Johnson took office in 2011. He and fellow representative Dave Burke, a pharmacist, wrote House Bill 93. This was a rare event. Term limits in Ohio mean that legislators come and go and acquire little knowledge of the issues on which they pass laws by the time they've termed out. Legislation is often written by lobbyists who are the power that accumulates in Columbus as lawmakers rotate through."
"Addicts would relapse. Indeed, relapse is assumed to be part of recovery. Some folks I spoke with, in fact, were redefining recovery as a series of periods of sobriety, growing in duration, but interrupted by relapse. 'It's kind of a cliche, that we can't arrest our way out of this problem,' one prosecutor told me."
"We have build isolation into our suburbs and called it prosperity...I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often."
Especially interesting to me as a librarian is how much of the problem originated from a lack of access to information, lack of critical thinking about that information, and lack of consistent language to track patterns:
"Porter and Jick [authors of the claim that less than 1 percent of patients treated with narcotics developed addictions to them] appeared in that bible of scholarly and journalistic rectitude, the New England Journal of Medicine. Medical professionals assumed everyone else had read it. But only in 2010 did the NEJM put all its archives online; before that, the archives only went back to 1993. To actually look up Porter and Jick, to discover that it was a one-paragraph letter to the editor, and NOT a scientific study, required going to a medical school library and digging up the actual issue, which took time most doctors didn't have."
"Each autopsy physician had different ways of describing a heroin overdose...The numbers had been growing steadily, hidden in the weeds of inconsistent language."
I also didn't know about the massive OxyContin sales campaign mounted by Purdue Pharma (here is where the true crime really starts to come in), and the uniqueness of the morphine molecule in both euphoria and addictiveness.
Other quotes:
"I no longer judge drug addicts," Carol said. "I no longer judge prostitutes."
"The way you're reimbursed in a day, if you actually take the time to treat somebody's pain, you'd be out of business," one longtime family doc told me. "By the model you're stuck in, you can't do it. The hospital will get rid of you. If you're by yourself, you can't pay for your secretary."
"The industry's model was based on creating a pill -- for cholesterol, depression, pain, or impotence -- and then promoting it with growing numbers of salespeople."
"He had no tutelage in pain management. No one did in medical school. 'Just because it's a problem every doctor faces every day,' he said, 'doesn't mean that it's something you would run into in medical school.'"
"To the suburban kids hooked first on pills, heroin fulfilled the dream of the adventures they'd never had in their quiet towns. Part of heroin's new appeal was that it kept them at the edge of a hazardous yet alluring dreamland. Finding dope every day could take them on a wild ride through worlds they hadn't known existed, which, however scuzzy or harrowing, left them with fantastical stories that awed their peers. 'You're as much addicted to going and buying it as to going and using it,' one addict said. 'You feel like James Bond. It's a crazy fantasy.'"
"'It's taken sixteen years to convince the legislature that it is cheaper to put them [in drug treatment] than to put them in prison,' he said. The cost savings weren't what did the trick, though. Treatment has always been more effective and cheaper than prison for true drug addicts. What's changed, Norman said, is that no longer are most of the accused African American inner-city crack users and dealers. Most of the new Tennessee junkies come from the white middle and upper-middle classes, and from the state's white rural heartland -- people who vote for, donate to, live near, do business with, or are related to the majority of Tennessee legislators."
"Many of their constituents were no longer so enamored with that 'tough on crime' talk now that it was their kids who were involved."
"I couldn't remember any drug scourge so ably abetted by silence."
"There are people born without pain receptors. [Living without pain] is a horrible thing. They die young because pain is the greatest signaling mechanism we have."
"Johnson took office in 2011. He and fellow representative Dave Burke, a pharmacist, wrote House Bill 93. This was a rare event. Term limits in Ohio mean that legislators come and go and acquire little knowledge of the issues on which they pass laws by the time they've termed out. Legislation is often written by lobbyists who are the power that accumulates in Columbus as lawmakers rotate through."
"Addicts would relapse. Indeed, relapse is assumed to be part of recovery. Some folks I spoke with, in fact, were redefining recovery as a series of periods of sobriety, growing in duration, but interrupted by relapse. 'It's kind of a cliche, that we can't arrest our way out of this problem,' one prosecutor told me."
"We have build isolation into our suburbs and called it prosperity...I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often."
This was such a tough read. The topic is hard hitting, but the book is well researched. It also shows how a one-paragraph editorial in a medical journal can have such an impact on health care (Porter and Jick, NEJM 1980).
The writing was shacky in parts, often repeating details unnecessarily among chapters. (In essence the book could have been much shorter or else been able to cover other territory in those 300 pages.)
The writing was shacky in parts, often repeating details unnecessarily among chapters. (In essence the book could have been much shorter or else been able to cover other territory in those 300 pages.)
4 stars for research and content, 2 stars for editing.
This is my second time completing this book - once in hard copy and once on Audible. Both reads offered amazing insight into the circumstances contributing to the opioid and heroin epidemics in the US and for that reason I couldn’t give it anything less than 4 stars. At times, the writing is emotional and engaging but the needless repetition, at times almost word-for-word, takes away from the overall impact of this book. It’s still a book I will continue to recommend for its content.
What an impressively researched and well written book comparing the rise of a different sales model for both black tar heroine and oxycontin. Highly recommended.