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Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop
Three out of four people addicted to heroin probably started on a prescription opioid, according to the director of the Centers for Disease Control and Prevention. In the United States alone, 16,000 people die each year as a result of prescription opioid overdose. But perhaps the most frightening aspect of the prescription drug epidemic is that it’s built on well-meaning doctors treating patients with real problems.In Drug Dealer, MD, Dr. Anna Lembke uncovers the unseen forces driving opioid addiction nationwide. Combining case studies from her own practice with vital statistics drawn from public policy, cultural anthropology, and neuroscience, she explores the complex relationship between doctors and patients, the science of addiction, and the barriers to successfully addressing drug dependence and addiction. Even when addiction is recognized by doctors and their patients, she argues, many doctors don’t know how to treat it, connections to treatment are lacking, and insurance companies won’t pay for rehab. Full of extensive interviews—with health care providers, pharmacists, social workers, hospital administrators, insurance company executives, journalists, economists, advocates, and patients and their families— Drug Dealer, MD, is for anyone whose life has been touched in some way by addiction to prescription drugs. Dr. Lembke gives voice to the millions of Americans struggling with prescription drugs while singling out the real culprits behind the rise in opioid cultural narratives that promote pills as quick fixes, pharmaceutical corporations in cahoots with organized medicine, and a new medical bureaucracy focused on the bottom line that favors pills, procedures, and patient satisfaction over wellness. Dr. Lembke concludes that the prescription drug epidemic is a symptom of a faltering health care system, the solution for which lies in rethinking how health care is delivered.
192 pages, Kindle Edition
Published November 6, 2016
143 people are currently reading
3804 people want to read
About the author
Anna Lembke
13 books637 followersAnna Lembke is an American psychiatrist who is Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. She is a specialist in the opioid epidemic in the United States, and the author of Drug Dealer, MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.
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October 14, 2022Almost every review of this book excuses doctors for their ultimate responsibility for the opioid crises. I don't buy it at all. If medicine wasn't such big business in the US, and the profit motive always acceptable in every business, but especially in medicine, the blame for the opioid crisis would correctly be laid at their door and not the manufacturers. If they didn't know what they were doing when they first prescribed them, it became obvious when people were turned into addicts. But still they went on...
Icecream is bad for you, it's just fat and sugar, the prime causes of obesity. Do you blame Ben & Jerry's for making it? No. What about the retailers? Of course not, but if the supermarkets and icecream parlours stopped selling it, Ben & Jerry's would go bust. When people don't buy a product, the manufacturers either make something else or go bust. Same with drugs.
So the Sackler family who produce the synthetic opioids get blamed, the FDA for its licensing practices gets blamed, the PR and advertising companies working for Sackler get blamed for misleading information, (when have PR and Advertising companies ever been known for telling the unvarnished truth?), but the distributors and the doctors do not get blamed.
Ultimately the drug couldn't be sold if the doctors weren't writing prescriptions for it. The pharmacies knowing that some, a lot, of doctors and 'pain clinics' were way over-prescribing alerted no one, all because they were all making money and that's sacred in the US, 'the great meritocracy' as embodied in business and the churches. (There are 8 or 9 books with the title 'God wants you to be rich' or similar).
The Sacklers did not force doctors to prescribe the opioids. They bribed them, and the doctors were happy to take the money and turn their patients into junkies. If they hadn't prescribed the drugs it would have remained a niche drug, mostly available in hospitals. At least until the Chinese got hold of it, now they manufacture Fentanyl and flood the US market with it.
If the opioids did seem at first to be the answer to pain, it became obvious very quickly with repeat prescriptions, people going downhill, admissions to hospital and rehab and the deaths, that there was a problem. Did that stop the doctors from prescribing them? No, the financial inducements were too great. Did that get the pharmacies to alert the FDA or any other healthcare body? No, they were making money.
But here we are told that these highly trained doctors who look at patients' symptoms, perform physical and verbal examinations, do tests in order to find out exactly what the patient is suffering from and prescribe the best treatment to treat them and help them regain full health, being 'duped'.
Opioids are not just manufactured synthetics of course. There is also the scourge of heroin which always enters the country illegally. It used to be considered very cheap and didn't cause many deaths Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic, but fentanyl which unscrupulous dealers (probably most of them) cut heroin with as it is 50 times more potent, but also 50 times more dangerous. My ex-bf's son, a Princeton graduate who played baseball for the school and had the proverbial glittering future in front of him, ws found dead in his room by his youngest brother, a needle in his arm -heroin laced with fentanyl. In the comment thread following the review of Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic 7 people said that their families or friends had been affected by opioids. And still the prescriptions go on.
My ex-bf has been on a road trip on his bike from NY to California. He stayed with friends in several places. One of them has a son of 20 who is addicted to opioids and goes once a week to get his prescription. Still. Another of them also lost a son to drugs. Consider this, all these people and probably a majority of those who commented on the Killing Season are white. Thus it is a big issue! Black Americans and Hispanic Americans accounted for about 13% and 9% of opioid overdoses. Do you think if it was reversed that 75% of PoC were addicted and white people weren't it would be such a big deal?
It's not a crisis for all whites though. The same as heroin it can be considered, "For those who are financially well-off, substance use disorder is often treated as a chronic but survivable illness. That means long-term health care and life-saving medications." And more prescriptions. "By contrast, people of color and poor Americans who experience addiction regularly face arrest and incarceration, while rarely gaining access to high-quality healthcare."
Although it is Blacks who are more demonised and looked down upon for drug use, the reality is that as a community they do less drugs and are more likely to seek treatment. See American Addiction Centers. But should they seek help, sadly "Black patients with opioid use disorder were 35 times less likely than whites to be prescribed Buprenorphine, another medication considered highly effective in preventing relapses and fatal overdoses," from a JAMA 2019 report. I say 'they' but although I am White my sons and my in-laws, my nieces and nephews, are all Black, and a lot are in the US, I feel it as 'We' as well.
It's different on the island, it's all marijuana here for people who like it, black and white. Cocaine too, but almost entirely white lawyers and accountants. Crack - there are three addicts here, they wander the streets, they beg, they look terrible and thin and beaten down and the kids look at Susie and the others and don't want to be like them. There is no opioid crisis here because there are no opioids outside of a hospital setting. No pharmacies except the hospital one sell them. A doctor could prescribe them, but the hospital would query that and so there is no opioid crisis here.
August 2021. I went blind with Endophthalmitis after cataract surgery and had emergency surgery which restored my sight. I was on 7 different eye drops. I had several repeat prescriptions for 5 of them (2 were compounded specially for me in the hospital pharmacy). My medical insurance is just for the island and I co-pay 20%. The total for the 5 is about $11 at a commercial pharmacy. In the US these would cost for one prescription $554.26. That is $543.26 more than I paid and I had 3 repeats, $33 to me. That is $1,629.78 in the US. Anyone who needs medication, might find it cheaper to come to the Caribbean and pay a doctor $100 for the prescription, stay a week and enjoy the island rather than pay those prices. This isn't a throw-away joke, I'm absolutely serious.
Somewhat rewritten Oct 13 2022
Icecream is bad for you, it's just fat and sugar, the prime causes of obesity. Do you blame Ben & Jerry's for making it? No. What about the retailers? Of course not, but if the supermarkets and icecream parlours stopped selling it, Ben & Jerry's would go bust. When people don't buy a product, the manufacturers either make something else or go bust. Same with drugs.
So the Sackler family who produce the synthetic opioids get blamed, the FDA for its licensing practices gets blamed, the PR and advertising companies working for Sackler get blamed for misleading information, (when have PR and Advertising companies ever been known for telling the unvarnished truth?), but the distributors and the doctors do not get blamed.
Ultimately the drug couldn't be sold if the doctors weren't writing prescriptions for it. The pharmacies knowing that some, a lot, of doctors and 'pain clinics' were way over-prescribing alerted no one, all because they were all making money and that's sacred in the US, 'the great meritocracy' as embodied in business and the churches. (There are 8 or 9 books with the title 'God wants you to be rich' or similar).
The Sacklers did not force doctors to prescribe the opioids. They bribed them, and the doctors were happy to take the money and turn their patients into junkies. If they hadn't prescribed the drugs it would have remained a niche drug, mostly available in hospitals. At least until the Chinese got hold of it, now they manufacture Fentanyl and flood the US market with it.
If the opioids did seem at first to be the answer to pain, it became obvious very quickly with repeat prescriptions, people going downhill, admissions to hospital and rehab and the deaths, that there was a problem. Did that stop the doctors from prescribing them? No, the financial inducements were too great. Did that get the pharmacies to alert the FDA or any other healthcare body? No, they were making money.
But here we are told that these highly trained doctors who look at patients' symptoms, perform physical and verbal examinations, do tests in order to find out exactly what the patient is suffering from and prescribe the best treatment to treat them and help them regain full health, being 'duped'.
Opioids gained popularity among doctors in the 1990s for treating patients who had undergone surgery or cancer treatment, but in the last fifteen years physicians increasingly prescribed them for chronic conditions, such as back or joint pain, despite concerns about their safety and effectiveness.So for 16 years (the article in the CFC was written last year) doctors have known and been warned about prescribing these medications, as if they didn't know already because everyone else, the public, knew. Yet still they are excused, 'duped' didn't know because, because what?
Opioids are not just manufactured synthetics of course. There is also the scourge of heroin which always enters the country illegally. It used to be considered very cheap and didn't cause many deaths Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic, but fentanyl which unscrupulous dealers (probably most of them) cut heroin with as it is 50 times more potent, but also 50 times more dangerous. My ex-bf's son, a Princeton graduate who played baseball for the school and had the proverbial glittering future in front of him, ws found dead in his room by his youngest brother, a needle in his arm -heroin laced with fentanyl. In the comment thread following the review of Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic 7 people said that their families or friends had been affected by opioids. And still the prescriptions go on.
My ex-bf has been on a road trip on his bike from NY to California. He stayed with friends in several places. One of them has a son of 20 who is addicted to opioids and goes once a week to get his prescription. Still. Another of them also lost a son to drugs. Consider this, all these people and probably a majority of those who commented on the Killing Season are white. Thus it is a big issue! Black Americans and Hispanic Americans accounted for about 13% and 9% of opioid overdoses. Do you think if it was reversed that 75% of PoC were addicted and white people weren't it would be such a big deal?
It's not a crisis for all whites though. The same as heroin it can be considered, "For those who are financially well-off, substance use disorder is often treated as a chronic but survivable illness. That means long-term health care and life-saving medications." And more prescriptions. "By contrast, people of color and poor Americans who experience addiction regularly face arrest and incarceration, while rarely gaining access to high-quality healthcare."
Although it is Blacks who are more demonised and looked down upon for drug use, the reality is that as a community they do less drugs and are more likely to seek treatment. See American Addiction Centers. But should they seek help, sadly "Black patients with opioid use disorder were 35 times less likely than whites to be prescribed Buprenorphine, another medication considered highly effective in preventing relapses and fatal overdoses," from a JAMA 2019 report. I say 'they' but although I am White my sons and my in-laws, my nieces and nephews, are all Black, and a lot are in the US, I feel it as 'We' as well.
It's different on the island, it's all marijuana here for people who like it, black and white. Cocaine too, but almost entirely white lawyers and accountants. Crack - there are three addicts here, they wander the streets, they beg, they look terrible and thin and beaten down and the kids look at Susie and the others and don't want to be like them. There is no opioid crisis here because there are no opioids outside of a hospital setting. No pharmacies except the hospital one sell them. A doctor could prescribe them, but the hospital would query that and so there is no opioid crisis here.
August 2021. I went blind with Endophthalmitis after cataract surgery and had emergency surgery which restored my sight. I was on 7 different eye drops. I had several repeat prescriptions for 5 of them (2 were compounded specially for me in the hospital pharmacy). My medical insurance is just for the island and I co-pay 20%. The total for the 5 is about $11 at a commercial pharmacy. In the US these would cost for one prescription $554.26. That is $543.26 more than I paid and I had 3 repeats, $33 to me. That is $1,629.78 in the US. Anyone who needs medication, might find it cheaper to come to the Caribbean and pay a doctor $100 for the prescription, stay a week and enjoy the island rather than pay those prices. This isn't a throw-away joke, I'm absolutely serious.
Somewhat rewritten Oct 13 2022
July 14, 2021
Dr. Lembke isn't the first health care practitioner to feel like a drug dealer (I'd love a dollar for every time I've said it), but she is one of the only ones to write a comprehensive overview of the relationship between prescribers, patients and pain pills. Drug addiction has been a hot topic in America for the last hundred years or so, but it's ramped up in the past twenty as opioid addiction has hit more people close to home. I'm not particularly fascinated by the topic, but it is unavoidable in hospital medicine. After reading Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, a Lifetime Movie of the Week masquerading as journalism, this book was recommended. I can see why, because it's everything Dopesick isn't: organized, largely factual, and comprehensive. If you want to understand the mechanisms behind the Modern Pain Factory, this will certainly help.
There are ten chapters: What is Addiction, Prescription Drugs as the New Gateway, Pain Is Dangerous, Big Pharma Joins Big Medicine, The Drug-Seeking Patient, The Professional Patient, The Compassionate Doctor, the Narcissistic Injury, Pill Mills, Addiction-the Disease Insurance Companies...Won't Treat, and Stopping the Cycle (abridged titles). Despite the broad overview, it's only about 150 pages, not counting references, so it doesn't feel as overwhelming as it could. In fact, according to my ScienceBrain, for the most part it is written extremely well, with each sentence providing information or an interpretive punch. I literally had highlights on over half the pages I read.
As a nurse who practiced in inpatient oncology from 2003 to 2020, I have to tell you that I witnessed almost everything she is describing, from the influence of drug companies on doctors ("Eat this steak dinner while we give you a presentation on our drug, XZD"), to patient care surveys ("Did the staff do everything they could to treat your pain?"), to teaching seminars on "Pain as the Fifth Vital Sign" (I proudly held the title of "Pain Resource Nurse" after one of them).
The writing is crystal-clear, and no one is spared: "The prescription drug epidemic is first and foremost an epidemic of overprescribing... today the extent to which doctors rely on prescription drugs, especially scheduled drugs, to treat their patients for even routine, non-life-threatening medical conditions is unprecedented." She notes that in the 1980s, prescribing patterns began to liberalize, speculating that it was because of an aging population, more people living after complicated illnesses and procedures, and the growth of the hospice movement. But I laud her for this summary: "But to ascribe all the blame to Big Pharma is to oversimplify. The pharmaceutical industry was able to influence doctor-prescribing only by joining together with academic physicians, professional medical societies, regulatory agencies (the Federation of State Medical Boards and The Joint Commission), and the FDA."
It's hard for the non-medical person to understand, but Lembke does a nice job of laying out how all of those entities moved doctors to a point where they felt scheduled drugs were 'just another tool in the toolbox' (a very common descriptive term in pain management education). What I was hoping for is how some people are also their own drivers for pain. She talks a little bit about addiction, and how both nature--the genetics of addiction--and nurture--children raised in families with substance use, with trauma, conflict and availability all increasing risk--can increase likelihood of addiction. But chronic pain and addiction are more closely linked than we've been willing to admit, and that's the part that is challenging to tangle out. After seeing a number of cancer patients in intense pain despite massive doses of narcotics--and I'm talking both habituated dosing and needing doses to the point of insensibility--I've been leaning into the idea of emotional/spiritual and even social pain, and I don't think we can legitimately solve the addiction issue until we understand the complex phenomenon of chronic pain.
Personal blah blah:
Since this book was published in 2016 (!), there's been a huge pulling back in prescribers writing scheduled drugs, much to the dismay of many patients. She notes in one section how at the heyday in 2012, 650 million oxycodone were prescribed, enough oxycodone to give every resident 34 pills. After crackdown on the "Pill Mills," it dropped to 313 million in 2013. I fact checked this one for an update, and wow, it's amazing. The CDC reports in 2012, 255 million opioid prescriptions were written in the U.S. Despite population growth, in 2019, it's down to 153 million. (Hint: if you want prescription drugs, go to Alabama). The big unanswered question is what did we accomplish? Decreasing addiction or reducing medicine's role in the phenomena? As I think we've discovered, the overdose rates are just going up as people turn to street drugs instead. Lembke talks a little bit about this path of prescription to illegal drugs, as pill mills dry up while addicts need their fix. However, if you look at prescriptions as the 'gateway' to opening up an addictive path--and Lembke surely does--we have hopefully reduced the addiction risk for the next generation.
As a psychologist, she also touches on the 'types' of patients she sees seeking scheduled drugs, and some of their techniques. I was most wary of this section, which is more broad categories of behavior more than DSM type criteria. She does note the busy crossroads of mental health conditions and addiction as well. I found her examination of the 'professional patient' phenomena intriguing, the idea of an illness diagnosis as both a profession and a way of thinking. I have to say that I've seen what she's talking about. I did appreciate that she touched on disability payments and such as part of the issue--not to say that patients are faking anything, but that the system we have in place dis-incentives people for improving their health and increasing self- management. It was one of those 'ah-ha' moments that made me think of the Universal Basic Income movement and the potential impact it could have.
My other enlightening moment was in her discussion of insurance and addiction. I had read before that only 50% of addicts who go through intensive treatment are successful at staying off drugs for a year, and considered that a dismal success rate for treatment. But if we re-conceptualize addiction as a 'chronic illness,' and treated it with the same resources we treat other chronic illnesses, we could make a dramatic change in many lives. For instance, we invest in years of three-times-weekly dialysis treatments despite no hope of reversing the condition. Likewise, if we stopped blaming addicts and started treating them anyway, noting that we treat other biologically-inclined but self-influenced medical conditions like Type II diabetics. She lays out several possible paths at the end for reform, mostly dealing in the medical reimbursement model, parity, and more education of medical staff. There may have been more details, but they didn't stick, because they are largely not going to happen.
This is a comprehensive overview done relatively quickly, with examples through a couple of detailed case studies to bring the human element. I finished, but felt like a few sections were lacking, particularly in the psychology of the patient, and in the neurological aspects of addiction. But when I flipped back through pages, I realized she did cover those topics in the same broader strokes as others--it's just that I was hoping for something even more detailed. My analysis is that if you want a really in-depth look at a particular aspect of prescriptions and addiction, you will be slightly disappointed and should head towards a text with a narrower focus. But if you want to understand how we got to the prescription drug crisis, this is the book.
Post-script:
It rarely makes the news anymore, but the government is continuing to investigate and prosecute those who were involved in the prescription drug crisis, although they are more than a few years behind. Just as I was wrapping up this book, details were breaking on the Sackler family and Perdue Pharma, and their lawsuit losses against multiple states. Then my medical newsletter provided me with yet another update: five doctors charged, four sentenced, for their role in accepting bribes and kickbacks for prescribing Subsys, spray Fentanyl, in 2012, and the manufacturer of it, Insys, sentenced for his role in the 2012 epidemic.
As always, you'll have better luck with links at my blog. https://clsiewert.wordpress.com/2021/...
There are ten chapters: What is Addiction, Prescription Drugs as the New Gateway, Pain Is Dangerous, Big Pharma Joins Big Medicine, The Drug-Seeking Patient, The Professional Patient, The Compassionate Doctor, the Narcissistic Injury, Pill Mills, Addiction-the Disease Insurance Companies...Won't Treat, and Stopping the Cycle (abridged titles). Despite the broad overview, it's only about 150 pages, not counting references, so it doesn't feel as overwhelming as it could. In fact, according to my ScienceBrain, for the most part it is written extremely well, with each sentence providing information or an interpretive punch. I literally had highlights on over half the pages I read.
As a nurse who practiced in inpatient oncology from 2003 to 2020, I have to tell you that I witnessed almost everything she is describing, from the influence of drug companies on doctors ("Eat this steak dinner while we give you a presentation on our drug, XZD"), to patient care surveys ("Did the staff do everything they could to treat your pain?"), to teaching seminars on "Pain as the Fifth Vital Sign" (I proudly held the title of "Pain Resource Nurse" after one of them).
The writing is crystal-clear, and no one is spared: "The prescription drug epidemic is first and foremost an epidemic of overprescribing... today the extent to which doctors rely on prescription drugs, especially scheduled drugs, to treat their patients for even routine, non-life-threatening medical conditions is unprecedented." She notes that in the 1980s, prescribing patterns began to liberalize, speculating that it was because of an aging population, more people living after complicated illnesses and procedures, and the growth of the hospice movement. But I laud her for this summary: "But to ascribe all the blame to Big Pharma is to oversimplify. The pharmaceutical industry was able to influence doctor-prescribing only by joining together with academic physicians, professional medical societies, regulatory agencies (the Federation of State Medical Boards and The Joint Commission), and the FDA."
It's hard for the non-medical person to understand, but Lembke does a nice job of laying out how all of those entities moved doctors to a point where they felt scheduled drugs were 'just another tool in the toolbox' (a very common descriptive term in pain management education). What I was hoping for is how some people are also their own drivers for pain. She talks a little bit about addiction, and how both nature--the genetics of addiction--and nurture--children raised in families with substance use, with trauma, conflict and availability all increasing risk--can increase likelihood of addiction. But chronic pain and addiction are more closely linked than we've been willing to admit, and that's the part that is challenging to tangle out. After seeing a number of cancer patients in intense pain despite massive doses of narcotics--and I'm talking both habituated dosing and needing doses to the point of insensibility--I've been leaning into the idea of emotional/spiritual and even social pain, and I don't think we can legitimately solve the addiction issue until we understand the complex phenomenon of chronic pain.
Personal blah blah:
Since this book was published in 2016 (!), there's been a huge pulling back in prescribers writing scheduled drugs, much to the dismay of many patients. She notes in one section how at the heyday in 2012, 650 million oxycodone were prescribed, enough oxycodone to give every resident 34 pills. After crackdown on the "Pill Mills," it dropped to 313 million in 2013. I fact checked this one for an update, and wow, it's amazing. The CDC reports in 2012, 255 million opioid prescriptions were written in the U.S. Despite population growth, in 2019, it's down to 153 million. (Hint: if you want prescription drugs, go to Alabama). The big unanswered question is what did we accomplish? Decreasing addiction or reducing medicine's role in the phenomena? As I think we've discovered, the overdose rates are just going up as people turn to street drugs instead. Lembke talks a little bit about this path of prescription to illegal drugs, as pill mills dry up while addicts need their fix. However, if you look at prescriptions as the 'gateway' to opening up an addictive path--and Lembke surely does--we have hopefully reduced the addiction risk for the next generation.
As a psychologist, she also touches on the 'types' of patients she sees seeking scheduled drugs, and some of their techniques. I was most wary of this section, which is more broad categories of behavior more than DSM type criteria. She does note the busy crossroads of mental health conditions and addiction as well. I found her examination of the 'professional patient' phenomena intriguing, the idea of an illness diagnosis as both a profession and a way of thinking. I have to say that I've seen what she's talking about. I did appreciate that she touched on disability payments and such as part of the issue--not to say that patients are faking anything, but that the system we have in place dis-incentives people for improving their health and increasing self- management. It was one of those 'ah-ha' moments that made me think of the Universal Basic Income movement and the potential impact it could have.
My other enlightening moment was in her discussion of insurance and addiction. I had read before that only 50% of addicts who go through intensive treatment are successful at staying off drugs for a year, and considered that a dismal success rate for treatment. But if we re-conceptualize addiction as a 'chronic illness,' and treated it with the same resources we treat other chronic illnesses, we could make a dramatic change in many lives. For instance, we invest in years of three-times-weekly dialysis treatments despite no hope of reversing the condition. Likewise, if we stopped blaming addicts and started treating them anyway, noting that we treat other biologically-inclined but self-influenced medical conditions like Type II diabetics. She lays out several possible paths at the end for reform, mostly dealing in the medical reimbursement model, parity, and more education of medical staff. There may have been more details, but they didn't stick, because they are largely not going to happen.
This is a comprehensive overview done relatively quickly, with examples through a couple of detailed case studies to bring the human element. I finished, but felt like a few sections were lacking, particularly in the psychology of the patient, and in the neurological aspects of addiction. But when I flipped back through pages, I realized she did cover those topics in the same broader strokes as others--it's just that I was hoping for something even more detailed. My analysis is that if you want a really in-depth look at a particular aspect of prescriptions and addiction, you will be slightly disappointed and should head towards a text with a narrower focus. But if you want to understand how we got to the prescription drug crisis, this is the book.
Post-script:
It rarely makes the news anymore, but the government is continuing to investigate and prosecute those who were involved in the prescription drug crisis, although they are more than a few years behind. Just as I was wrapping up this book, details were breaking on the Sackler family and Perdue Pharma, and their lawsuit losses against multiple states. Then my medical newsletter provided me with yet another update: five doctors charged, four sentenced, for their role in accepting bribes and kickbacks for prescribing Subsys, spray Fentanyl, in 2012, and the manufacturer of it, Insys, sentenced for his role in the 2012 epidemic.
As always, you'll have better luck with links at my blog. https://clsiewert.wordpress.com/2021/...
September 10, 2017
I am going to start this review by offering some personal information. I am a recovering opiate addict with between six and seven years of sobriety. My own addiction started with a prescription for methadone from a doctor who said, "Don't worry, it's not addictive." About a year later I found out I was pregnant and stopped taking them. My legs crawled, I had tremors, threw up everything that went in my stomach... I felt like I was dying. I went to the E.R. and the doctor told me it was food poisoning. After the hospital I went to fill a prescription for stomach medication. On the table was a pamphlet for addiction. On the cover was a picture of the same methadone I had been prescribed. That's how I figured out I was addicted to opiate pain killers.
In this book the author explains how both doctors and patients have both contributed to the opiate addiction epidemic. This doesn't point fingers to cast blame, it conveys the circumstances that lead to what is now happening. There are also section that tell the stories of people who have lived as an addict. I found the information in this to be accurate to what I was already aware of, and also learned some new things. It is impressive when I learn something new about addiction, I have read and absorbed a lot of information concerning the topic. I am impressed with the way the author made sure to be respectful in the way she worded the content.
This is a good read for anyone. I see people all the time making uneducated comments and forming opinions based on either bad information or stereotyping. I don't blame my addiction on anyone, but had certain contributing factors been removed, I am fairly positive that my life would have been different. It is nice to see things that I have thought and voiced in the past be supported and backed up.
Review copy provided in exchange for an honest review.
In this book the author explains how both doctors and patients have both contributed to the opiate addiction epidemic. This doesn't point fingers to cast blame, it conveys the circumstances that lead to what is now happening. There are also section that tell the stories of people who have lived as an addict. I found the information in this to be accurate to what I was already aware of, and also learned some new things. It is impressive when I learn something new about addiction, I have read and absorbed a lot of information concerning the topic. I am impressed with the way the author made sure to be respectful in the way she worded the content.
This is a good read for anyone. I see people all the time making uneducated comments and forming opinions based on either bad information or stereotyping. I don't blame my addiction on anyone, but had certain contributing factors been removed, I am fairly positive that my life would have been different. It is nice to see things that I have thought and voiced in the past be supported and backed up.
Review copy provided in exchange for an honest review.
July 24, 2016
Well, this was a frightening look at the systemic breakdown and dysfunction of our health care system. Anna Lembke describes how contrasting concerns and demands placed on doctors have created a culture where medical practitioners have to consider the needs and demands of multiple entities beyond the living breathing patient in the room. She creates a powerful image when she describes patients being accompanied to appointments by the Centers of Medicare and Medicaid Services, State Medical Boards, hospital Legal Counsel, the patient's Lawyer, Patient Relations, Billing, Disability Claims, the Joint Commission, Private Insurance and Big Pharma. All of whom appear as proper nouns, as if they too are living breathing human beings who have a right to their own expectations at every interaction the practitioner has with her patient.
The greed and deception perpetrated by the pharmaceutical companies and doctors who work for them propagandizing the minimal risks of prescribing opioid pain relievers is criminal. Granted they couldn't have been as successful in their endeavor to ratchet up their drug sales without the broken system they operate within. And while the this narrative is quick to point out that Big Pharma isn't alone in the creation of the current drug crisis we are seeing in America today the parallel between them and Big Tobacco is hard to dispel from my mind.
This book is full of frightening information, at the top of the lists is the way the system is set up so that someone with a medical problem can in a relatively short period of time become someone with a prescription drug addiction but that same someone will not have resources to turn their life back around again because of the way our medical system works.
Approximately 40 million Americans are affected by addiction, in comparison heart disease affects 27 million, diabetes affects 26 million and cancer affects 19 million people. Based on these numbers you would think a fair amount of funding would be allocated to treating addiction, right? Wrong. Guess what percentage of the total health care budget in the US went to toward treating addiction...15%? 10%? No...5%? nope. One percent, yes 1%. In addition to that sobering statistic add to it the fact that doctors are not educated in the treatment of addiction and do not feel prepared to screen or treat substance abuse; less than 1% identify themselves as addiction specialists. And while laws require it, insurance companies still do not reimburse for addiction treatment on par with other medical illnesses and they find loopholes in order to deny care to patients.
This is a compelling narrative, depressing and frightening but one that I think is well worth reading if you are curious about the current crisis of drug addiction in America today. The information is well organized and the writing is clear and concise. My only criticism is that it could have been longer and included more anecdotal stories. Short as it is it's still full of frightening enlightenment, at least for this reader.
The greed and deception perpetrated by the pharmaceutical companies and doctors who work for them propagandizing the minimal risks of prescribing opioid pain relievers is criminal. Granted they couldn't have been as successful in their endeavor to ratchet up their drug sales without the broken system they operate within. And while the this narrative is quick to point out that Big Pharma isn't alone in the creation of the current drug crisis we are seeing in America today the parallel between them and Big Tobacco is hard to dispel from my mind.
This book is full of frightening information, at the top of the lists is the way the system is set up so that someone with a medical problem can in a relatively short period of time become someone with a prescription drug addiction but that same someone will not have resources to turn their life back around again because of the way our medical system works.
Approximately 40 million Americans are affected by addiction, in comparison heart disease affects 27 million, diabetes affects 26 million and cancer affects 19 million people. Based on these numbers you would think a fair amount of funding would be allocated to treating addiction, right? Wrong. Guess what percentage of the total health care budget in the US went to toward treating addiction...15%? 10%? No...5%? nope. One percent, yes 1%. In addition to that sobering statistic add to it the fact that doctors are not educated in the treatment of addiction and do not feel prepared to screen or treat substance abuse; less than 1% identify themselves as addiction specialists. And while laws require it, insurance companies still do not reimburse for addiction treatment on par with other medical illnesses and they find loopholes in order to deny care to patients.
This is a compelling narrative, depressing and frightening but one that I think is well worth reading if you are curious about the current crisis of drug addiction in America today. The information is well organized and the writing is clear and concise. My only criticism is that it could have been longer and included more anecdotal stories. Short as it is it's still full of frightening enlightenment, at least for this reader.
May 30, 2019
I’ve read a good number of books on the opioid crisis and am actively fighting its stranglehold in my community. This book was not one I would recommend for the subject. There are many generalizations, excuses, rationalizations, and overall unempathetic language thrown around. The author really lost me when she flippantly said that fibromyalgia is a fictional affliction that drug-seekers made up to get opioids from doctors.
If you want a good read on this subject, I recommend Dopesick by Beth Macy and American Overdose by Chris McGreal. Opioids are definitely dangerous and patients have absolutely misused them in cases and become addicted. But when it comes to the crisis, doctors and big pharma are more to blame than anyone who had surgery and then became addicted to oxy. Let’s place blame where it truly lies.
If you want a good read on this subject, I recommend Dopesick by Beth Macy and American Overdose by Chris McGreal. Opioids are definitely dangerous and patients have absolutely misused them in cases and become addicted. But when it comes to the crisis, doctors and big pharma are more to blame than anyone who had surgery and then became addicted to oxy. Let’s place blame where it truly lies.
December 12, 2017
Edward Fisher
Mr. Ribay-B.9
Literature Hon.
Dec. 10, 2017
Drug Dealer, MD Goodreads Review:
The author of Drug Dealer, MD, is Anna Lembke, a very accomplished woman. She is a Doctor of Medicine, (MD), and to this day, ever since her residency in psychiatry, a licensed psychiatrist. She is also the chief of Addiction Medicine and an assistant professor at Stanford University’s School of Medicine.
In Drug Dealer, MD, Anna Lembke discusses many things about opioids, including their history, the way we use and misuse them today, and among other things, many staggering statistics that describe the results of the opioids on us humans. Lembke does this some of this through describing many things about the substances used and abused, including their compounds, and also lots of other things that she learned in medical school, and for the most part, by describing her story, which has mainly been written through patient interaction. She discusses the true stories of six different patients that she had; Jim, Justin, Karen, Sally, Macy, and Diana, whose names have been changed in order to protect their identities. All of these stories are quite sad, but encompass truly how horrible addiction is. A good example of just how bad our situation really is a quote from Lembke’s prologue; “ ‘I know I’m addicted, doc, but if you don’t give me the pills I want, I’ll sue you for leaving me in pain” (Lembke, 3). This is an example of how, particularly opioids, anything from mild Endorphins all the way to Heroin, and everything in between, and how just one dose—that can be given at the dentist’s office, can lead to a lifetime of addiction. (I suppose that’s the lesson to be learned: that the “just this once” statement, really means “just this lifetime.”)
There are nearly an infinite number of strengths in Drug Dealer, MD, and the of the main one is that Lembke has managed to write this book well enough to make it an extremely fun read, and this is the number one priority for any book. Another thing that Lembke has done that is absolutely wonderful, is include a gigantic number of different statistics, facts, and ideas throughout the book, which makes the reader more knowledgeable as they read—a great feeling for the reader, and also a great phenomenon for a book to possess. One excerpt which displays this idea that there are lots and lots of statistics laced throughout this book is that “In the United States, approximately 4,000 deaths were documented in 1999, and that number increased to 16,235 by 2013…[Doctors] wrote enough opioid painkiller prescriptions by 2012 to medicate every American adult around the clock for a full month” (Lembke, 4). These are just a couple of many facts that this book possesses. Drug Dealer, MD is quite an intriguing book, with facts and true stories interspersed all throughout it.
Anna Lembke’s Drug Dealer, MD, has just one real weakness, and it is quite a big one. This weakness is the whole idea behind what Drug Dealer, MD is: The sadness of the reality that is our opioid epidemic, in which we currently live. Although it seems horrible and really sad at first, the book flows quite well, and keeps one eager for the oncoming information. Essentially, if you are disgusted by doctor-‘y’ things, such as the idea of needles, the effects of natural and synthetic chemicals on the body, and just how scary those effects can be, including the sadness of ruined lives because of these drugs, this book may not be for you.
Personally, this has been the ‘best’ book I have ever read, and I do read quite a lot, both fiction and nonfiction. The combination of facts and ideas in Drug Dealer, MD is just truly amazing, and I think that Lembke has done an excellent job in portraying the reality of the American opioid epidemic to the general public. (Or, more realistically, that part of the general public that is willing to or has already read this book). I would recommend this book to anyone with fairly basic knowledge in chemistry, biology, psychology, and possibly addiction. My opinion may be somewhat biased, though, as I am a fifteen year old, whose dream is to become a gastroenterologist one day. If you have reached the end of this—thank you so much for taking the time to read my review!
Mr. Ribay-B.9
Literature Hon.
Dec. 10, 2017
Drug Dealer, MD Goodreads Review:
The author of Drug Dealer, MD, is Anna Lembke, a very accomplished woman. She is a Doctor of Medicine, (MD), and to this day, ever since her residency in psychiatry, a licensed psychiatrist. She is also the chief of Addiction Medicine and an assistant professor at Stanford University’s School of Medicine.
In Drug Dealer, MD, Anna Lembke discusses many things about opioids, including their history, the way we use and misuse them today, and among other things, many staggering statistics that describe the results of the opioids on us humans. Lembke does this some of this through describing many things about the substances used and abused, including their compounds, and also lots of other things that she learned in medical school, and for the most part, by describing her story, which has mainly been written through patient interaction. She discusses the true stories of six different patients that she had; Jim, Justin, Karen, Sally, Macy, and Diana, whose names have been changed in order to protect their identities. All of these stories are quite sad, but encompass truly how horrible addiction is. A good example of just how bad our situation really is a quote from Lembke’s prologue; “ ‘I know I’m addicted, doc, but if you don’t give me the pills I want, I’ll sue you for leaving me in pain” (Lembke, 3). This is an example of how, particularly opioids, anything from mild Endorphins all the way to Heroin, and everything in between, and how just one dose—that can be given at the dentist’s office, can lead to a lifetime of addiction. (I suppose that’s the lesson to be learned: that the “just this once” statement, really means “just this lifetime.”)
There are nearly an infinite number of strengths in Drug Dealer, MD, and the of the main one is that Lembke has managed to write this book well enough to make it an extremely fun read, and this is the number one priority for any book. Another thing that Lembke has done that is absolutely wonderful, is include a gigantic number of different statistics, facts, and ideas throughout the book, which makes the reader more knowledgeable as they read—a great feeling for the reader, and also a great phenomenon for a book to possess. One excerpt which displays this idea that there are lots and lots of statistics laced throughout this book is that “In the United States, approximately 4,000 deaths were documented in 1999, and that number increased to 16,235 by 2013…[Doctors] wrote enough opioid painkiller prescriptions by 2012 to medicate every American adult around the clock for a full month” (Lembke, 4). These are just a couple of many facts that this book possesses. Drug Dealer, MD is quite an intriguing book, with facts and true stories interspersed all throughout it.
Anna Lembke’s Drug Dealer, MD, has just one real weakness, and it is quite a big one. This weakness is the whole idea behind what Drug Dealer, MD is: The sadness of the reality that is our opioid epidemic, in which we currently live. Although it seems horrible and really sad at first, the book flows quite well, and keeps one eager for the oncoming information. Essentially, if you are disgusted by doctor-‘y’ things, such as the idea of needles, the effects of natural and synthetic chemicals on the body, and just how scary those effects can be, including the sadness of ruined lives because of these drugs, this book may not be for you.
Personally, this has been the ‘best’ book I have ever read, and I do read quite a lot, both fiction and nonfiction. The combination of facts and ideas in Drug Dealer, MD is just truly amazing, and I think that Lembke has done an excellent job in portraying the reality of the American opioid epidemic to the general public. (Or, more realistically, that part of the general public that is willing to or has already read this book). I would recommend this book to anyone with fairly basic knowledge in chemistry, biology, psychology, and possibly addiction. My opinion may be somewhat biased, though, as I am a fifteen year old, whose dream is to become a gastroenterologist one day. If you have reached the end of this—thank you so much for taking the time to read my review!
June 20, 2017
I am a psychiatric nurse practitioner and already knew much of what was in this book but still found it to be a very good read. It is an excellent synopsis of the daily challenges of providing healthcare and the contributing factors to the prescription drug abuse, particularly opiates. It would be a great read for anyone in the general public who is interested in learning more about addiction.
February 1, 2024
Short but good. Great place to jump off if you’re just starting to learn about addiction. This is such a great overview of exactly what the problem is right now. 4.6 stars
June 6, 2024
VÍCIO COM AMPARO MÉDICO
De Anna Lembke já tinha lido Nação dopamina, que suponho ser seu primeiro livro. Acabo de descobrir que quiseram aproveitar seu estouro de vendas pra lhe esticar um rabo chamado The official Dopamine Nation workbook — dessas coisas dos cobiçosos do mercado, inclusive o livreiro. Enfim, este Nação tarja preta é mais linear, sem os altos e baixos do livro anterior — um dos baixos foi a autora ter contado que comeu os chocolates de seus filhos e mentiu pra eles por dias dizendo que não havia comido os chocolates (!); outro foi seu revelado vício em romances eróticos com vampiros. Assemelha-se a uma longa reportagem que se lê em tempo razoável (sem as notas o livro tem 185 páginas, e o espaçamento entrelinhas é confortável).
No prefácio à edição brasileira, Lembke chama atenção pro alto consumo de medicamentos pra perda de peso no país, muitos deles com anfetamina. (É fascinante: se você quiser tomar anfetamina apenas pra aproveitar longamente uma rave, será tachado de drogado e marcado por esse estigma entre familiares e colegas de trabalho, mas se você usar anfetamina dentro duma pílula pra emagrecer — isso é não apenas socialmente aceitável, como é até incentivado.) Ela também alerta pro aumento no consumo de antidepressivos:
Essa abordagem está em consonância com Nação dopamina, na qual Lembke critica a cultura de não aceitar a dor e o sofrimento como parte da vida, havendo desespero pra curar o que é da natureza das coisas. Ouve-se falar tanto em resiliência, mas parece que mesmo pessoas comuns estão mais frágeis e tendentes a buscar em remédios uma solução — sinal de imaturidade emocional. Imagino que as redes sociais tenham um efeito depressor nesse contexto, pois aumentam as expectativas e as vontades, algo que budistas sempre disseram ser fonte de sofrimento (“o constante querer”). Ou, numa máxima de Boileau pra se ler assim e vice-versa: “Quem vive contente com nada possui todas as coisas”.
Nação tarja preta aproveita histórias de pacientes de Anna Lembke pra denunciar a sanha lucrativa da indústria farmacêutica e especialmente a facilidade com a qual médicos prescrevem medicamentos viciantes pros seus pacientes. O livro aborda pouco o vício em drogas “ilegais” e se atém ao vício em drogas legalmente prescritas. Uma vez viciado, o paciente se torna adepto duma série de truques pra conseguir manter seu vício a partir de novas receitas e da dramatização da sua doença inicial.
Meu capítulo preferido, aliás, é o sexto, de força sociológica, intitulado “O paciente profissional: a doença como identidade e o direito de ser compensado”. Um trecho:
Adiante:
É bom frisar que Lembke escreve pra realidade dos Estados Unidos, onde um auxílio-doença pode ser um benefício mais vantajoso do que um seguro-desemprego.
Acrescento que essa vitimização forçada pra “apoiar um direito” atrai a “simpatia do público” também proutras identidades, como mostram os adeptos da militância identitária. A quantidade absurda de pardos que “se descobriram negros” na idade adulta só pra alcançar o status de vítima racial é uma fraude individual e pública. Mulheres fingindo que O Patriarcado (¡buh!) as oprime no Ocidente de hoje participam do mesmo delírio coletivo. Vítimas são inventadas quando há benefícios pra isso, sejam eles financeiros ou de estima social. Talvez estejamos na era mais vitimista da História, uma treva com culpados, malandros e cúmplices.
Ainda no capítulo sexto, o valor da identidade de doente pra que o indivíduo se sinta importante e membro duma comunidade:
Como se vê, a cultura da vítima dá sentido à vida de tanta gente, move a economia e ainda atende à primitiva necessidade de pertencimento do homem. É necessário não esquecer: a civilização ascendeu e vem se fazendo a partir de animais — sociais, complexos, inteligentes, construtores de pontes e de poemas, mas animais.
Os dois últimos parágrafos do capítulo que decidi destacar:
Num momento crítico de 0,8 ou 800, não custa explicar numa resenha rápida visando leitores gerais: Lembke é uma psiquiatra e seu combate não pretende destruir o ramo da tarja preta. A crítica que ela faz é à prescrição indiscriminada desse tipo de remédio, o que é um problema multifatorial: da indústria farmacêutica, dos médicos (às vezes vilões; às vezes vítimas na realidade estadunidense onde pacientes podem difamá-los ou processá-los por não aliviarem suas dores), dos indivíduos — fracos, desesperados, farsantes — e da sociedade. Há pacientes que precisam dessa medicação pra ter alguma qualidade de vida, mas há pessoas comuns que estão buscando fuga, felicidade, fissura e superpoderes nelas.
Pela objetividade, pela descrição dum problema atual e pelas sintonias com o Brasil, vale a pena a leitura pra quase qualquer tipo de leitor. Nação tarja preta é acessível e, como mencionei, tem jeito de reportagem.
De Anna Lembke já tinha lido Nação dopamina, que suponho ser seu primeiro livro. Acabo de descobrir que quiseram aproveitar seu estouro de vendas pra lhe esticar um rabo chamado The official Dopamine Nation workbook — dessas coisas dos cobiçosos do mercado, inclusive o livreiro. Enfim, este Nação tarja preta é mais linear, sem os altos e baixos do livro anterior — um dos baixos foi a autora ter contado que comeu os chocolates de seus filhos e mentiu pra eles por dias dizendo que não havia comido os chocolates (!); outro foi seu revelado vício em romances eróticos com vampiros. Assemelha-se a uma longa reportagem que se lê em tempo razoável (sem as notas o livro tem 185 páginas, e o espaçamento entrelinhas é confortável).
No prefácio à edição brasileira, Lembke chama atenção pro alto consumo de medicamentos pra perda de peso no país, muitos deles com anfetamina. (É fascinante: se você quiser tomar anfetamina apenas pra aproveitar longamente uma rave, será tachado de drogado e marcado por esse estigma entre familiares e colegas de trabalho, mas se você usar anfetamina dentro duma pílula pra emagrecer — isso é não apenas socialmente aceitável, como é até incentivado.) Ela também alerta pro aumento no consumo de antidepressivos:
A questão é que os Estados Unidos, o Brasil e vários países do mundo estão cada vez mais confiando em um comprimido para lidar com o sofrimento humano, sem avaliar os custos a longo prazo ou cogitar que os comprimidos que aliviam a dor a curto prazo têm a possibilidade de torná-la pior com o tempo.
Essa abordagem está em consonância com Nação dopamina, na qual Lembke critica a cultura de não aceitar a dor e o sofrimento como parte da vida, havendo desespero pra curar o que é da natureza das coisas. Ouve-se falar tanto em resiliência, mas parece que mesmo pessoas comuns estão mais frágeis e tendentes a buscar em remédios uma solução — sinal de imaturidade emocional. Imagino que as redes sociais tenham um efeito depressor nesse contexto, pois aumentam as expectativas e as vontades, algo que budistas sempre disseram ser fonte de sofrimento (“o constante querer”). Ou, numa máxima de Boileau pra se ler assim e vice-versa: “Quem vive contente com nada possui todas as coisas”.
Nação tarja preta aproveita histórias de pacientes de Anna Lembke pra denunciar a sanha lucrativa da indústria farmacêutica e especialmente a facilidade com a qual médicos prescrevem medicamentos viciantes pros seus pacientes. O livro aborda pouco o vício em drogas “ilegais” e se atém ao vício em drogas legalmente prescritas. Uma vez viciado, o paciente se torna adepto duma série de truques pra conseguir manter seu vício a partir de novas receitas e da dramatização da sua doença inicial.
Os prescritores [nos Estados Unidos] assinaram em 2012 receitas de analgésicos opioides suficientes para medicar todos os norte-americanos adultos o dia inteiro por um mês. […] O número total de mortes por overdose de opioides prescritos entre 1999 e 2013 foi superior a 175 mil. Foi um flagelo indiscriminado, que perpassou todos os limites geográficos e raciais, com os maiores aumentos entre brancos de classe média moradores de áreas não urbanas.
Meu capítulo preferido, aliás, é o sexto, de força sociológica, intitulado “O paciente profissional: a doença como identidade e o direito de ser compensado”. Um trecho:
Minha única utilidade para Sally foi renovar suas receitas e assinar seus formulários de pedido de auxílio-doença para que pudesse continuar recebendo 800 dólares por mês da Previdência Social.
Sally representa um tipo de paciente que vejo cada vez com maior frequência: aqueles que visitam o consultório de um médico não para recuperar-se de doenças, mas para serem validados em sua identidade de pessoa com uma doença. São afligidos por problemas cuja autenticidade é indeterminada, tomam várias medicações, com frequência de dez a vinte comprimidos por dia, e sofrem consequências adversas das próprias intervenções médicas que em tese deveriam ajudá-las, incluindo a adicção a drogas prescritas. […] Dado importante é que a maior parte desses pacientes é pobre, com pouca instrução, e depende das pensões por invalidez que recebem do governo como fonte básicas de rendimentos. Em outras palavras, são doentes profissionais.
Pacientes profissionais não estão apenas fingindo ter doenças; estão adotando papéis sociais. Os papéis sociais não são criados por indivíduos. Eles emergem de maneira orgânica em determinado tempo e lugar, dentro de uma dada sociedade, e são um amálgama de figuras de linguagem culturais, de normas sociais e de incentivos econômicos.
Adiante:
Médicos e instituições de saúde são cúmplices na medicalização da pobreza que incentiva a criação de pacientes profissionais. Em algumas situações, a interação médico-paciente reduziu-se a pouco mais que um arranjo de negócios, no qual a meta principal é ajudar o paciente a garantir uma renda — como se fosse uma proposta financeiramente compensadora para hospitais e médicos.
É bom frisar que Lembke escreve pra realidade dos Estados Unidos, onde um auxílio-doença pode ser um benefício mais vantajoso do que um seguro-desemprego.
Ao adotarem o papel de “doentes profissionais”, os pacientes ficam vulneráveis a desenvolver uma identidade de doença e uma narrativa de vítima, o que aumenta sua dependência de médicos e de drogas prescritas e diminui a probabilidade de obterem tratamento para adicção.
[…]
Joseph Davis articula essa situação na revista Social Problems do seguinte modo: “Conquistar simpatia do público e ajuda para os supostamente lesionados requer estabelecer que eles estejam corretos do ponto de vista moral, como pessoas inocentes de qualquer responsabilidade ou falta pelo dano que estão sofrendo”. Fassin e Rechtman escreveram em seu livro The empire of trauma: an inquiry into the condition of victimhood que “o trauma não é apenas a causa do sofrimento que está sendo tratado, é também um recurso que pode ser usado para apoiar um direito”.
Acrescento que essa vitimização forçada pra “apoiar um direito” atrai a “simpatia do público” também proutras identidades, como mostram os adeptos da militância identitária. A quantidade absurda de pardos que “se descobriram negros” na idade adulta só pra alcançar o status de vítima racial é uma fraude individual e pública. Mulheres fingindo que O Patriarcado (¡buh!) as oprime no Ocidente de hoje participam do mesmo delírio coletivo. Vítimas são inventadas quando há benefícios pra isso, sejam eles financeiros ou de estima social. Talvez estejamos na era mais vitimista da História, uma treva com culpados, malandros e cúmplices.
Ainda no capítulo sexto, o valor da identidade de doente pra que o indivíduo se sinta importante e membro duma comunidade:
A adoção de identidades de doença também é motivada pela ruptura dos papéis tradicionais. A patologia possibilita uma maneira de se definir perante um mundo em rápida mudança e cada vez mais fragmentado. Além disso, indivíduos doentes são hoje vistos como heróis, porque travam uma luta contra forças avassaladoras. Em um mundo em que a luta pela sobrevivência básica (comida, vestuário, abrigo) se tornou em grande medida irrelevante para a maioria dos norte-americanos, a pessoa doente está entre os últimos grandes guerreiros.
Identidades associadas a doenças oferecem também uma oportunidade para a comunidade. Grupos de defesa de pacientes instituem dias nacionais associados às doenças, dão palestras educativas, aparecem na mídia, publicam livros e patrocinam sites na internet, o que encoraja as pessoas a verem a si mesmas como distintas e separadas em razão de sua doença. Além disso, grupos de defesa de pacientes costumam ser bancados pela indústria farmacêutica. Por exemplo, a Crianças e Adultos com Transtorno de Déficit de Atenção e Hiperatividade é uma organização de defesa de pacientes sem fins lucrativos que recebe 14% de sua receita total (345 mil dólares) de contribuições do setor farmacêutico, incluindo os fabricantes de metilfenidato e sais de anfetaminas (estimulantes).
Como se vê, a cultura da vítima dá sentido à vida de tanta gente, move a economia e ainda atende à primitiva necessidade de pertencimento do homem. É necessário não esquecer: a civilização ascendeu e vem se fazendo a partir de animais — sociais, complexos, inteligentes, construtores de pontes e de poemas, mas animais.
Os dois últimos parágrafos do capítulo que decidi destacar:
Frueh e seus colegas escreveram no American Journal of Public Health que “as políticas de deficiência exigem uma reforma fundamental para que se crie uma rede de segurança eficaz, ágil e flexível […]. Precisamos garantir que […] recursos finitos não sejam mal alocados e que não estimulem o invalidismo”. […]
Enquanto isso, a triste situação dos pacientes profissionais atuais pode ser comparada à trágica realidade dos pedintes de rua ao redor do mundo, particularmente aqueles que estropiam a si mesmos ou mutilam seus filhos para obter auxílio, fenômeno pouco visto nos dias de hoje, mas muito comum nas ruas de cidades norte-americanas do século XIX. Como os pedintes, os pacientes profissionais também maltratam seu corpo para ganhar a vida; a diferença crucial é que os médicos têm um papel nesses maus-tratos, e o meio utilizado são as drogas aditivas prescritas.
Num momento crítico de 0,8 ou 800, não custa explicar numa resenha rápida visando leitores gerais: Lembke é uma psiquiatra e seu combate não pretende destruir o ramo da tarja preta. A crítica que ela faz é à prescrição indiscriminada desse tipo de remédio, o que é um problema multifatorial: da indústria farmacêutica, dos médicos (às vezes vilões; às vezes vítimas na realidade estadunidense onde pacientes podem difamá-los ou processá-los por não aliviarem suas dores), dos indivíduos — fracos, desesperados, farsantes — e da sociedade. Há pacientes que precisam dessa medicação pra ter alguma qualidade de vida, mas há pessoas comuns que estão buscando fuga, felicidade, fissura e superpoderes nelas.
Pela objetividade, pela descrição dum problema atual e pelas sintonias com o Brasil, vale a pena a leitura pra quase qualquer tipo de leitor. Nação tarja preta é acessível e, como mencionei, tem jeito de reportagem.
December 16, 2021
A decent synopsis of the opiates epidemic fueled by Pharma, government and healthcare collusion. There is clear regulatory capture going on with Pharma and FDA and lots of revolving doors. The author generalizes a bit too much implying that all doctors are just pawns (certainly can be true). As an ICU doctor Ive seen the pendulum swinging the other way now. Anyways, a worthwhile read.
January 7, 2022
Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, And Why It’s So Hard to Stop by Anna Lembke, MD (Johns Hopkins University Press 2016) (615.783) (3602).
I call bullshit on this book and on one of the author’s central premises.
Some reviews have taken issue with the author’s obvious bent toward assigning physicians very little blame for the opioid epidemic. The author’s position is patently absurd. Physicians, after all, wrote every prescription for every medicine ever dispensed by a pharmacy. There’s plenty of blame to go around, but that’s not why I called bullshit on this book.
My objection is to the author’s assumption as to who should decide whether a patient receives opioids.
In the last thirty years, the medical community adopted a patient’s pain as a vital sign. A ubiquitous “Pain Scale” chart hung in every doctor’s office and every hospital room. It featured a series of cartoon faces modeling increasing levels of pain. The options ranged from a happy smiley face (a “0” on the pain scale) to a grimace (a “5” on the scale) to a person screaming in pain (a ”10” on the scale). Patients were asked to identify their own levels of pain. The patient’s subjective assignment of a number to their pain level thus played a principal role in determining whether the physician prescribed opioids.
As a result of the opioid crisis, the prescribing community has supplanted the patient’s subjective assessment of pain with the physician’s opinion of - what, exactly? The patient’s veracity? Whether the patient has suffered enough or is worthy enough?
The author obviously assumes that the physician has the inherent ability to correctly discern a patient’s pain level. But this "discernment" is a purely subjective exercise by the doctor. It thus follows that a prescriber accepts the patient’s own subjective assessment if and only if their assessments agree.
And on that I call bullshit.
We have ceded to the prescribers the exclusive right to deem, at heart, whether a patient is worthy and deserving enough to receive the fruit of the poppy.
The book's title infers that doctors were duped. Someone was duped, but it wasn't the doctors.
My rating: 7/10, finished 1/5/22 (3602).
February 2, 2017
I highly recommend that ALL adults read this book so that they can be proactive with regard to their children's health care, their parents' health care, and their own health care.
Doctors here in America tend to over-prescribe opioids, and the risk of addiction is high -- EVEN IF one has significant pain levels (which are determined subjectively by the patient and at least somewhat unreliable). New studies are showing that getting hooked on opioids is a significant risk for ALL patients. As little as three months of taking prescribed oxycontin, an extremely effective pain medication developed in the 1990's, can send the patient into addiction.
Furthermore, medications for ADD and ADHD present a high risk for addiction. These ADD and ADHD medications are over-prescribed, often at the urging of schools and educators, and are placing children at risk for addiction as adults.
It is way past time for Americans to realize that there is not a pill that can solve EVERY kind of problem. This dangerous idea that we need a pill to help us solve our problems has become prevalent since the 1960s and 1970s.
Doctors here in America tend to over-prescribe opioids, and the risk of addiction is high -- EVEN IF one has significant pain levels (which are determined subjectively by the patient and at least somewhat unreliable). New studies are showing that getting hooked on opioids is a significant risk for ALL patients. As little as three months of taking prescribed oxycontin, an extremely effective pain medication developed in the 1990's, can send the patient into addiction.
Furthermore, medications for ADD and ADHD present a high risk for addiction. These ADD and ADHD medications are over-prescribed, often at the urging of schools and educators, and are placing children at risk for addiction as adults.
It is way past time for Americans to realize that there is not a pill that can solve EVERY kind of problem. This dangerous idea that we need a pill to help us solve our problems has become prevalent since the 1960s and 1970s.
May 21, 2023
I've read a *lot* of books about the Opioid epidemic at this point, and this one is easily the most hostile toward sufferers of addiction that I've looked at. The author seems to hold a fascinating distaste for anyone who misuses prescription medication, and that's not even touching on her weird damage about people with ADHD or other mental health conditions who dare to (gasp) seek diagnoses for these conditions. And not to put too fine a point on it, but her weird dislike for Chronic Pain sufferers is a really weird hangup for someone writing about painkiller addiction. Friendly reminder for those reading that despite her claims, the usual amount of pain a person should experience is 0.
The science might be good, but Lembke's approach to People leaves a bad taste in my mouth, and I feel bad for anyone who had the misfortune of being her patient.
The science might be good, but Lembke's approach to People leaves a bad taste in my mouth, and I feel bad for anyone who had the misfortune of being her patient.
October 20, 2020
Compared to many other books on the topic, I was disappointed. This book is mostly personal stories but not told in a particularly convincing way. The data referenced is largely outdated now as the epidemic has evolved significantly since its writing. The history of the epidemic was covered decently but books like Dreamland offer a more holistic history. Sometimes the author’s rationalizations and language regarding people addicted to opioids is a bit cold and in a few cases unfair. Overall, I didn’t get much out of this book. If you want to learn about the opioid epidemic read Dreamland or Dopesick.
January 9, 2021
Read for an Addiction Medicine Elective. This book covers the systemic and individual factors contributing to the prescription opioid epidemic. Pharmaceutical financing of studies, patient satisfaction surveys, the need to diagnose/treat any deviation from normal, the lack of coverage or reimbursement by insurance companies, the lack of medical education, the disability system in the US....so much continues to fuel the epidemic.
I recommend this for all physicians and the general public to get an idea of how we went wrong and what is continuing to go wrong.
I recommend this for all physicians and the general public to get an idea of how we went wrong and what is continuing to go wrong.
January 3, 2017
This is an EXCELLENT book for all practitioners to read. It is something we all know, but the author pulls it all together, woven in with patient stories. Not sure if there is any answer soon for this national issue.
August 10, 2019
This really should be a must-read for anyone who might EVER be in need of an opiate or love someone who might be someday. Why? Because 75% of all heroin users got their start with a LEGAL prescription for a LEGAL pain medicine.
It's hard for me not to just want to recite the whole book because it really is THAT important. But, I'll try to hit the highlights as I saw them.
First, there almost isn't any such thing as a "Family Doctor/General Practitioner" anymore. Before 2000 rolled in, 70%+ doctors were in private practice and they owned those practices. Just a few short years later, half of all US physicians were owned and operated by hospitals or "health delivery systems." What difference does that make? A LOT. Like the author points out, "No longer are doctors and patients alone in the exam room." Other entities include: Patient Relations (with a patient satisfaction survey in hand), Disability Claims, the Joint Commission, Private Insurance, the Centers for Medicare and Medicaid Services, Big Pharma, the State Medical Board, the hospital's Legal Counsel, the patient's Lawyer, etc.
Doctors are no longer able to treat their patients as they see fit but rather, are micromanaged by timekeepers and money managers. This is the reason, for example, that psychiatrists went from actually practicing therapy to doing nothing more than handing out psychological medicine. In the book, a doctor is quoted as saying about his patients who just want refills, "Those are my easiest patients. They are scheduled for ten minutes, but if I give them what they want, they're out in five. Then there's hope I can catch up and get home at night."
A young doctor who trained specifically in addiction medicine found out quickly that she couldn't do much more than hand out the medicine that her patients sometimes ended up addicted to! She gets no base salary, no benefits, no hourly salary, no retirement, etc. What she DOES get is 22% of what she bills. So, it's pretty easy to deduce that she (and anyone in her position) would want to get in as many patients as possible and get them out as fast as she could. Would she love to talk to them and find out what the issues really are? I'm sure but talking doesn't get anyone paid.
Another issue in health care today as it relates to the addiction crisis is the idea of "Patient Relations" in hospitals and clinics. They are responsible for making sure the patients all get surveys to report how well (or how poorly) their provider served them. In many hospitals, lower ratings on patient surveys means lower reimbursement (smaller paycheck). So, if a patient comes in seeking opiates and the doctor is concerned he or she might be an addict, how would that doctor proceed? If she tells the patient she's not comfortable prescribing the meds he's asking for, he could get her back via a survey, which could mean her paycheck would get smaller, or Yelp or any number of ways a customer can retaliate these days. The author points out, "In a study published in 2012 in the 'Archives of Internal Medicine' higher patient satisfaction was associated with higher consumption of health care services, higher prescription drug use, and increased mortality." Wait, WHAT? To make a patient happy, and therefore get good reviews, a doctor is in the position of having to prescribe medicine that might not be needed or that could be furthering an addiction (great for Big Pharma), order tests, etc., that are unnecessary and potentially dangerous (happy hospital) and people DIE more when there's more "highly satisfied" patients? The only people who likely AREN'T happy about this (aside from the dead folks) are the doctors who don't feel like they can do their jobs!
So, after patients are addicted to opiates, now what? Well, they have a disease, right? There's help available to them, right? Nope. The US Health Care System/Insurance Companies have made SURE that addiction is not classified as a disease because if it was, they would have to pay to treat it. Many rehabs are about $50,000 a month; I know exactly 0 people in my life who could afford that for more than a month or so; many people I know make that amount of money in a year. But, the US government DOES end up paying for addiction, just not the treatment of. "For every dollar the federal and state governments spend on addiction, ninety-five cents goes toward treating the medical consequences of addiction, and only two cents goes toward addiction prevention and treatment."
While this book focuses on addiction and certainly shines a light on the desperate situation patients are put in, often by no fault of their own, I also think it's the strong foundation for an expose on the whole US Health Care System. Dr. Lembke is thorough, precise, well-researched and kind; she's exactly the kind of person we need on an issue as big as the one we're facing.
It's hard for me not to just want to recite the whole book because it really is THAT important. But, I'll try to hit the highlights as I saw them.
First, there almost isn't any such thing as a "Family Doctor/General Practitioner" anymore. Before 2000 rolled in, 70%+ doctors were in private practice and they owned those practices. Just a few short years later, half of all US physicians were owned and operated by hospitals or "health delivery systems." What difference does that make? A LOT. Like the author points out, "No longer are doctors and patients alone in the exam room." Other entities include: Patient Relations (with a patient satisfaction survey in hand), Disability Claims, the Joint Commission, Private Insurance, the Centers for Medicare and Medicaid Services, Big Pharma, the State Medical Board, the hospital's Legal Counsel, the patient's Lawyer, etc.
Doctors are no longer able to treat their patients as they see fit but rather, are micromanaged by timekeepers and money managers. This is the reason, for example, that psychiatrists went from actually practicing therapy to doing nothing more than handing out psychological medicine. In the book, a doctor is quoted as saying about his patients who just want refills, "Those are my easiest patients. They are scheduled for ten minutes, but if I give them what they want, they're out in five. Then there's hope I can catch up and get home at night."
A young doctor who trained specifically in addiction medicine found out quickly that she couldn't do much more than hand out the medicine that her patients sometimes ended up addicted to! She gets no base salary, no benefits, no hourly salary, no retirement, etc. What she DOES get is 22% of what she bills. So, it's pretty easy to deduce that she (and anyone in her position) would want to get in as many patients as possible and get them out as fast as she could. Would she love to talk to them and find out what the issues really are? I'm sure but talking doesn't get anyone paid.
Another issue in health care today as it relates to the addiction crisis is the idea of "Patient Relations" in hospitals and clinics. They are responsible for making sure the patients all get surveys to report how well (or how poorly) their provider served them. In many hospitals, lower ratings on patient surveys means lower reimbursement (smaller paycheck). So, if a patient comes in seeking opiates and the doctor is concerned he or she might be an addict, how would that doctor proceed? If she tells the patient she's not comfortable prescribing the meds he's asking for, he could get her back via a survey, which could mean her paycheck would get smaller, or Yelp or any number of ways a customer can retaliate these days. The author points out, "In a study published in 2012 in the 'Archives of Internal Medicine' higher patient satisfaction was associated with higher consumption of health care services, higher prescription drug use, and increased mortality." Wait, WHAT? To make a patient happy, and therefore get good reviews, a doctor is in the position of having to prescribe medicine that might not be needed or that could be furthering an addiction (great for Big Pharma), order tests, etc., that are unnecessary and potentially dangerous (happy hospital) and people DIE more when there's more "highly satisfied" patients? The only people who likely AREN'T happy about this (aside from the dead folks) are the doctors who don't feel like they can do their jobs!
So, after patients are addicted to opiates, now what? Well, they have a disease, right? There's help available to them, right? Nope. The US Health Care System/Insurance Companies have made SURE that addiction is not classified as a disease because if it was, they would have to pay to treat it. Many rehabs are about $50,000 a month; I know exactly 0 people in my life who could afford that for more than a month or so; many people I know make that amount of money in a year. But, the US government DOES end up paying for addiction, just not the treatment of. "For every dollar the federal and state governments spend on addiction, ninety-five cents goes toward treating the medical consequences of addiction, and only two cents goes toward addiction prevention and treatment."
While this book focuses on addiction and certainly shines a light on the desperate situation patients are put in, often by no fault of their own, I also think it's the strong foundation for an expose on the whole US Health Care System. Dr. Lembke is thorough, precise, well-researched and kind; she's exactly the kind of person we need on an issue as big as the one we're facing.
November 2, 2017
As a 25 year Nurse Practitioner who has prescribed many narcotics & has worked addiction medicine this was a great book!
October 1, 2021
Man. This book gave me an education whether I wanted it or not
September 10, 2022
Kind of hacky for a book from a med school prof. Stakes out some weirdly maximalist positions on things like managed-care organizations and patient autonomy.
January 3, 2023
Empire of Pain did it better...
No new information and it didn't have that same je ne sais quoi that nonfiction books written by journalists do.
No new information and it didn't have that same je ne sais quoi that nonfiction books written by journalists do.
December 30, 2022
I came across this book after reading reviews for "Dopesick" once I had finished reading it. Many of the reviews noted that "Drug Dealer, MD" took a more scientific approach to the topic and was more worth the read.
I'd completely agree with the above assertions now having read both. While "Dopesick" begins with some good background on opiates, it quickly devolves into a human interest story. Lembke, being a doctor, takes a methodical approach supported by science to explain what went wrong and offers some solutions for solving this crisis. She explains scheduled drugs in detail, and never becomes derailed by the patient examples that she provides.
If you have time and interest, read this and Dopesick together. If you are looking for one book on the opioid epidemic, I'd suggest this one.
I'd completely agree with the above assertions now having read both. While "Dopesick" begins with some good background on opiates, it quickly devolves into a human interest story. Lembke, being a doctor, takes a methodical approach supported by science to explain what went wrong and offers some solutions for solving this crisis. She explains scheduled drugs in detail, and never becomes derailed by the patient examples that she provides.
If you have time and interest, read this and Dopesick together. If you are looking for one book on the opioid epidemic, I'd suggest this one.
September 7, 2017
FASCINATING. I ❤️ my book club because I read things I might have never thought of myself, and this is one example. Lembke's writing is very readable and intelligent in just the perfect way -- not too overwhelming, too dry, or watered down. She does an excellent job of destigmatizing addiction. I had a ton of insights into myself as a patient and an audiologist. Not very long and I couldn't put it down.
December 31, 2022
Dr. Kemble does a great job at describing the underlying deeper cause of the opioid epidemic and how doctors, insurance companies, drug companies are all apart of the ongoing cycle. I like her individual personal cases she describes to get a closer look of what addiction is and how we can help. I also just saw the documentary “Dope sick” which talks about the Purdue Pharma scandal which Dr. Lembke touches on, which compliments this book greatly.
October 13, 2023
This was a very insightful read that shows all the ways our broken healthcare system has contributed to the proliferation of opioid prescriptions and the epidemic as a whole. The personal stories that are used as through lines are just as upsetting as the ones highlighted in Dopesick. The author's background as a physician provides an interesting perspective.
October 13, 2024
Wasn't as interesting as other books I've read on the topic, but unique perspective forsure
March 22, 2018
Very good book, explains all the factors that contribute to the current mess. Including The role Press Ganey plays in doctors decision. As well as insurance companies that cover pills but won't adequately cover therapy and alternatives to pills.
August 23, 2021
A succinct book about the prescription-drug endemic in US. I am waiting to read the author's new book "Dopamine nation" and decided to check this one out. It got a bit personal experience of patients but mostly informative in a brief way.
April 15, 2019
Eye-opening and well-written review of the opioid epidemic! Written in lay language so anyone can read and understand (healthcare background unnecessary!).
June 1, 2021
Dr. Lembke writes in a clear and accessible way. She cites many academic studies but is good about not getting bogged down into unnecessary details and jargon. There's lots of good information in this book on opioid prescribing and treatment.
Unfortunately, the book goes over way too many topics in too short of a book and leaves out some fundamental topics essential to understanding the opioid epidemic. Each chapter focuses on a different piece of overprescribing and addiction from Big Pharma to stimulants to opioid addiction treatments and more. Some of these chapters are much stronger than others - I liked her discussions on how medication-assisted therapy (MAT) and addiction treatment, in general, are underutilized in the U.S. healthcare system. These chapters shined likely due to her position as an addiction specialist. Other chapters suffered from being too superficial, especially her discussions of overprescription of stimulants and benzos. These sections felt out of place since the majority of the book is about opioids.
What really bothered me is her lack of discussion of race, class, and criminalization. Her clientele seemed to be mostly upper-class people who could afford expensive rehabs and not working for years while in recovery. Addiction is horrible no matter who you are, but her stories are not at all representative of what the average person goes through. She doesn't dive into this except for brief mentions of who is more likely to become addicted.
Race is important to talk about in any discussion of drugs in the U.S. since criminalization and its effects are so disproportionate. For opioids, it is a largely white problem because doctors have less trust in Black patient's reports of pain. This complicates her discussion of doctors needing to have trust in their patients, but she never mentions race except in one aside comment on a patient's experience.
https://www.ncbi.nlm.nih.gov/pmc/arti...
Finally, she never discusses the role criminalization plays in opioid use rates and treatment. She could've discussed the results of countries that decriminalized use, allow needle exchange programs, or how methadone use can still be used against pregnant women in CPS cases. Much of the stigma and barriers to addiction treatment are because we still treat it as a criminal issue.
In general, I find criticisms that only complain about what was missing lazy because books and articles can only be so long. In this case, though, Dr. Lembke tried to write a whole overlook of a giant complex topic and she missed topics that are fundamental to understanding why we are where we are today. My suggestions for books on understanding addiction, the War on Drugs, and how to treat it at a societal level include: Chasing the Scream: The First and Last Days of the War on Drugs, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, or High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society. I'm still looking for a good one on our current opioid crisis.
Unfortunately, the book goes over way too many topics in too short of a book and leaves out some fundamental topics essential to understanding the opioid epidemic. Each chapter focuses on a different piece of overprescribing and addiction from Big Pharma to stimulants to opioid addiction treatments and more. Some of these chapters are much stronger than others - I liked her discussions on how medication-assisted therapy (MAT) and addiction treatment, in general, are underutilized in the U.S. healthcare system. These chapters shined likely due to her position as an addiction specialist. Other chapters suffered from being too superficial, especially her discussions of overprescription of stimulants and benzos. These sections felt out of place since the majority of the book is about opioids.
What really bothered me is her lack of discussion of race, class, and criminalization. Her clientele seemed to be mostly upper-class people who could afford expensive rehabs and not working for years while in recovery. Addiction is horrible no matter who you are, but her stories are not at all representative of what the average person goes through. She doesn't dive into this except for brief mentions of who is more likely to become addicted.
Race is important to talk about in any discussion of drugs in the U.S. since criminalization and its effects are so disproportionate. For opioids, it is a largely white problem because doctors have less trust in Black patient's reports of pain. This complicates her discussion of doctors needing to have trust in their patients, but she never mentions race except in one aside comment on a patient's experience.
https://www.ncbi.nlm.nih.gov/pmc/arti...
Finally, she never discusses the role criminalization plays in opioid use rates and treatment. She could've discussed the results of countries that decriminalized use, allow needle exchange programs, or how methadone use can still be used against pregnant women in CPS cases. Much of the stigma and barriers to addiction treatment are because we still treat it as a criminal issue.
In general, I find criticisms that only complain about what was missing lazy because books and articles can only be so long. In this case, though, Dr. Lembke tried to write a whole overlook of a giant complex topic and she missed topics that are fundamental to understanding why we are where we are today. My suggestions for books on understanding addiction, the War on Drugs, and how to treat it at a societal level include: Chasing the Scream: The First and Last Days of the War on Drugs, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, or High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society. I'm still looking for a good one on our current opioid crisis.
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