Sales rep bonuses, which had been $1 million in 1996, rose to $40 million in 2000.īy 2005 Purdue faced legal troubles. Instead, it hired armies of salesmen to hand out freebies to doctors, did data-mining to locate high-prescribing doctors, and gave out large bonuses to top-performing representatives. Purdue did not let natural circumstances increase its sales. It could be prescribed for moderate back injuries, tooth surgery, bronchitis, or just treating pain liberally. Its doctors assured the public and the government that its addiction rate was less than 1 percent, well within the range of acceptable medicines. The company had developed Oxycontin, a powerful but time-released pain relieving breakthrough. Macy sketches how this abomination occurred with the willing participation of Purdue Pharmaceutical, a family-owned business. These rates would continue until 2013, the whole time with a 0.5 percent annual mortality rate attributed to overdoses and a shocking increase in Neonatal Abstinence Syndrome, a common malady of babies whose mothers were addicted when they gave birth. Macy describes in excruciating detail how Oxycontin crept into poorer communities in Appalachia as early as 1999, when mortality rates began to spike, with overdoses ranging 65% higher than the rest of the country. Because it was felt in rural areas and small towns first, the crisis did not receive the initial publicity it might have if it had started as an urban or suburban problem. But the opioid epidemic started in rural areas like Appalachia and spread from there. What is different about this epidemic is that new drugs normally start in the cities, as with cocaine and crack. It represents more than guns, cars and HIV at its peak. The first section of Macy’s book is a detailed history of the opioid crisis in America, which is now the leading cause of death of Americans under 50 years of age. Luckily we have Beth Macy’s Dopesick: Dealers, Doctors and the Drug Company That Addicted America to tell us the in-depth story of the opioid crisis in modern America. And yes, the 'Drug Company' referred to in the book's title is the self-same Purdue Pharmaceutical. The company's self-congratulatory description could become the standard account of the company's role in the crisis if more accurate narratives do not emerge. One ad was from Wells Fargo, which we all know was involved in an outrageous scheme regarding illegal sales practices that ultimately led to the firing of many top executives and a fine of $2.09 billion. The other three full-page ads were from Purdue Pharmaceutical's recitation of its activities helping with the opioid crisis. In the past few weeks the New York Times has published full-page ads by companies boasting of their benevolent deeds in the larger community. Dopesick Dealers, Doctors and the Drug Company That Addicted America by Beth Macy (Little Brown, 311 pages)

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