Cycles of History Theme Analysis

One of the tragedies of the opioid epidemic, according to Beth Macy, is that the whole thing has happened before, and that anyone familiar with the history of opioids in the U.S. could have predicted the new epidemic. Knowledge of the addictive properties of opioids has existed in some form since the Neolithic Period. Much more recently, there was a widespread opioid epidemic in the U.S. around the turn of the twentieth century, when the pharmaceutical company Bayer introduced heroin. During the current opioid crisis, history repeats itself on smaller scales, too, with families and communities often witnessing the same addiction stories again and again, rarely with happy endings. In Dopesick, Macy vividly portrays the dangers of forgetting the past and argues that a greater knowledge of history can help prevent future tragedies.

While the opioid epidemic may seem to be a very modern problem, Macy shows that actually it isn’t the first opioid epidemic in the United States, and that studying the past could have helped to prevent the present crisis. Humans have understood the effects of opioids since the beginning of history, when Neolithic humans first learned the effects of poppy. More recently, the Opium Wars between Britain and China showed that these drugs were so powerful that they could even lead to mass conflict. In the United States in particular, there were at least two clear warnings about the dangers of opioids. The first occurred in the aftermath of the Civil War. Many soldiers who were wounded in battle received morphine or other opioids from doctors in order to ease their pain. Shortly after, these soldiers became addicts. While the science of addiction was not as well understood back then, doctors knew to leave behind morphine and hypodermic needles for wounded patients, in order to spare them the pains of withdrawal. These wounded veterans continued to seek out morphine and opium, turning into haggard shells of their former selves.

The second instance of mass addiction is perhaps even more relevant to the current crisis. In the late 1800s, a researcher at the pharmaceutical company Bayer developed heroin. Initially, his goal was to create a nonaddictive substitute for morphine. This is how the drug was marketed, and it ended up being sold in 23 countries around the world, aimed at everyone from babies to the elderly. It didn’t take long for many doctors to realize the problem: that heroin was, in fact, highly addictive. Though doctors eventually stopped prescribing heroin, by then the damage had already been done. The story of heroin would end up being very similar to the story of OxyContin when it was introduced by Purdue Pharma just about one century later—but few at the time would draw the parallel.

The book doesn’t offer an easy explanation for why history is so often forgotten in the “United States of Amnesia” (as Macy titles one chapter), but Macy does suggest one important contributing factor: profit. On the one hand, the new opioid crisis can be attributed to Purdue Pharma’s reckless disregard for the addictive potential of OxyContin as they rushed it onto the market in order to make money. But there were also larger structural forces in the healthcare industry that caused many professionals to disregard the past. In the 1990s, patients were beginning to be treated more like customers, with many of them being given formal surveys to rate their healthcare experiences. Hospitals began to compete to get the best ratings, and bad ratings from patients could lead to serious financial difficulties. As a result, doctors were encouraged (either tacitly or directly) to be more liberal with painkillers, since being stingy ran the risk of bad reviews from patients. This move toward treating patients as customers came at right around the same time that pain was being recognized as “the fifth vital sign” in patient treatment (an idea that was boosted by millions of dollars’ worth of advertising by Purdue). All of these factors combined to put pressure on physicians to prescribe more opioids. While some doctors familiar with history may have had misgivings about prescribing OxyContin, they were either swayed by the hype that the new drug really was a history-defying breakthrough, or they felt that in order to keep their jobs, they had no choice but to prescribe the painkiller, since it was what patients wanted.

In hindsight, it seems obvious that an opioid like OxyContin would cause mass addiction just like heroin or morphine did. But to really understand why heroin and morphine became epidemics, Macy argues, it takes more than just a surface-level knowledge of history. Most doctors who prescribed heroin the late 19th and early 20th century were not ignorant about addiction—they simply bought into the hype that heroin was something new. In the 1990s, Purdue Pharma used similar techniques to convince physicians to prescribe OxyContin, preying on the natural human tendency to believe “this time is different.”