Book Review: American Overdose: The Opioid Tragedy in Three Acts (2019). Chris McGreal.

This is a deeply-researched account of how the American opioid crisis began in the early 2000s. There was so much about how the opioid crisis came about that I did not know, but that I learned from this book.

It began in West Virginia, where coal miners wracked with pain from their hard work in the coal mines were offered a “cure” for their pain by local doctors, consisting of the heavily marketed new artificial opioids such as oxycontin and oxycodone. At the same time, medical practice and thought had been veering from the prohibitionist approach of the mid-twentieth century toward a more “liberal” view that it was the doctor’s job to treat pain wherever possible, using whatever pain-killing drugs were available.

Into this mix of social conditions, changing medical treatment philosophies and opportunities for profit came several Big Pharma companies, with some brand-new drugs to push and a lot of money to be made.

Soon, prescription “mills” were springing up in little towns in the coal fields, aided by a few unscrupulous physicians, and then almost overnight, billions of pills were being sold by a few rural drug stores. From there, the scourge moved outward, as Congress failed to respond to the small number of physicians and whistleblowers who raised the alarm about the addiction crisis in the making. 

McGreal does an excellent job tracing the social and political history of the opioid crisis, and describing in devastating detail the way it spread through American society and families. Recommended.