Last year more than 72,000 people in the United States died from an opioid overdose.

I knew four of them. 

They sat beside me in high school, or they played alongside me on the soccer team, or I saw their faces from across the pews at church. The way I learned of each of their deaths followed a familiar script, one with which I’m sure many of you yourselves are familiar: I’ll open up Facebook on my phone and notice their name being mentioned over and over on my timeline, usually something along the lines of “Damn, bro…this hurts…can’t believe you’re gone” or “My heart is broken…heaven just got another angel today” and then—to eliminate all doubt as to what caused such an untimely death—someone will usually be blunt and say the words that we are all thinking, the same words that are also repeated over and over in Beth Macy’s new book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.

Those words are: “F*** Opioids!!!!!!”

Allow me to admit, I have already broken one of my cardinal rules for writing book reviews, which is to never use the first person. Admittedly, a book review is by design a subjective matter, the thoughts and opinions of myself the critic—of me—but I always felt that this was well-understood by the reader, and therefore to further inject my own personality into the piece would just be another form of egotism.  I’d rather not be the Michael Moore of book reviews, thank you very much.

And yet I make an exception for this book, because it reads so much like a scrapbook of my own family history in Ohio, and later of my experience working as a reporter in Appalachia, where the reports of opioid overdoses that came buzzing through the police scanner in our newsroom were so common as to be nothing more than background noise. Us reporters would quite literally lean our ears toward the scanner’s scratchy speakers at the report of “body found” and then, when the words, “possible overdose” sounded, we would all relax and go back to our work.  It was not even worth reporting on. 

Once a reporter joked to me that the local television news should add a new segment entitled “Opioid Deaths Daily” to be aired, say, right after the weather forecast. It would practically write itself: “alllllllllright folks, now today we’re seeing a slight increase in fentanyl overdoses, with just a light drizzle of intravenous heroin deaths…steer clear of downtown where it’s just a bit overcast thank to a late-afternoon shower of Oxycontin overdoses.”

That we made jokes about it was by no means an indictment on our own sense of humanity. On the contrary: we had to do something to alleviate the chilly depression. The headlines in the papers were so damn depressing, and we, as lowly beat reporters, were the ones tasked with writing them—the ones tasked with knocking on the doors of parents who had just lost children; the ones tasked with visiting the shelters where children cried for mommys and daddys who were never coming home; the ones tasked with visiting grandparents who shook their heads and stared blank-faced over the kitchen table, wondering how they were going to raise the children left orphaned to them. 

A simple search through my own paper’s back catalogue paints a picture of my time as a reporter in Southeast Ohio:

Overdose deaths up by 500 percent”—“19 overdoses in five days”—“Drugged driving rises as menace”—“Man killed, set on fire in dispute over $20”—“Why don’t drug deaths upset us more?”—“Son dies, mom hospitalized in heroin overdose”—“Bad batch of heroin leads to five deaths”—“Heroin overdose deaths hits record high”—“Overdoses claim 17 lives in the city in three months”—“Parents share last moments with their son”—“Children of an epidemic”—“How to talk about prescription drug abuse with your kids”—“Lifesaving heroin overdose drug too pricey for city”—

I could easily go on…and on…and on….and these are only just some of the headlines that showed up on the pages of the Zanesville Times Recorder, the local newspaper for which I used to be a reporter.

In my own family, too, the subject of opioid abuse is all too familiar. My mother has, in some form or another, been addicted to opioids since I was a child, and to this day the names of all the drugs prescribed to her by careless doctors roll off my tongue like an incantation: buprenorphine, OxyContin, Vicodin, Opana, Fentanyl, Exalgo, Dilaudid, Demerol, Palladone, Percocet, Percodan.

My older sister got hooked on opioids sometime around her sophomore year of high school, and a few years later, my mother found her lying in her bedroom closet, dead after having snorted time-release Opana, which she had stolen from my mother’s own medicine cabinet. 

This is why, during my time as a beat reporter, whenever I found myself seated across from a shaking, sobbing mother whose child had just died from an overdose (“He was the star quarterback…he was so funny, so charming…everyone loved him”), I would simply reach out and take her hand and say, in a quiet voice, “I know…I understand…I’m so sorry.”

Dopesick carries us back to how it all began, back to 1996, when Purdue Pharma unveiled its new “revolutionary” pain-treatment drug OxyContin, which was advertised as being far less addictive than any other pain-management drug ever created. A massive public relations campaign touted the absurd and, in hindsight, arguably criminal claim that “fewer than one-half of one percent of users become addicted.” This notion, perpetuated by the drug makers and then repeated by doctors, would spur more than a decade of widespread diffusion-of-responsibility across the entire healthcare industry, as doctors wooed by attractive blonde pharma sales reps reaped the rewards of bonuses, trips to the Bahamas and literal free lunches, suckling on the appeasing claim that “the real epidemic in America is actually widespread untreated pain, not painkiller addiction”—while users themselves, often over-prescribed and prone to take doctors at their word, sunk rapidly into the depths of addiction. 

Entire communities, as a result, collapsed. In many parts of Appalachia now, as Macy reports, “taking pills is just part of the culture.”

The most frustrating part, according to Macy, is that our nation—“The United States of Amnesia,” as she dubs it, borrowing a line from that enfant terrible Gore Vidal—has been here before. History has shown us that drug makers are quick to tout the safety of their newly created pain-treatment products only to be proven disastrously wrong, such as when the doctor who invented the hypodermic needle back in the 1800s claimed it was a far safer and more precise method for taking opiates (aptly, his wife became the first person to die from an intravenous opiate overdose), or later, at the turn of the century, when the name-brand drug “heroin” first hit the shelves of your local drug store, and doctors praised it as a non-addictive cure for everything—the common cold, cramps, housewife depression, or even a crying baby.  (Just imagine the conversation: “Oh darling, it appears baby Theodore is a bit nippy today, perhaps we should give him another spoonful of heroin.”)

Macy follows the story of two unlikely small-town heroes, one a local doctor with a deep love for his patients, the other a fiercely determined nun, who strive to hold Purdue accountable. I assure you I am not spoiling anything when I reveal that they were, for the most part, beaten at every turn. It is a heartbreaking story, which even includes a particularly grotesque cameo by Rudy Giuliani, who was brought in by Purdue to leverage his post-9/11 popularity on the company’s behalf. Giuliani had just been named Time Magazine’s Person of the Year, and Purdue boasted, “It is clear to us, and we hope it is clear to the government, that Giuliani would not take an assignment with a company that he felt was acting in an improper way”—boy, how the times have changed.

The story of such small-time fighters, most of whom were bereaved parents thrust into the battle after losing their children to OxyContin overdoses, can best be summed up by a single moment, which took place in the courtroom during a trial against Purdue. One mother had brought a small urn of her dead son’s ashes into the courtroom with her.  She had only wanted him to be with her in spirit, to give her strength. But when the lawyers for Purdue found out about it, they had the judge forcibly remove the urn from the court, being that such an image could unfairly sway the jury. Never mind that the entire case only began because of these dead children, these dead sons, dead daughters, dead mothers and fathers and grandparents—no, argued the lawyers for Purdue, it must be removed, and the judge, relenting, agreed. 

When the mother and her dead son’s ashes were taken out of the court, she did not scream. She did not even cry. 

Instead, she broke out laughing. 

The whole thing was, after all, nothing more than a farce.