This is a powerful book about the history and current time of the opioid crisis. I live in a community that has been really hit hard by the opioid crisis so I am not unfamiliar with it but this book was an eye-opener. I really did not know how much this problem was created by money hungry people that really did not care what happens to the victims of the crisis. It is a great book that breaks down the history of the crisis to now days. I highly recommend this book.

3.5 Stars

If you want to be infuriated with pharmaceutical companies, the government, and doctors, then read this book. The blatant way that they ignore or twist data and warnings and succumb to greed is largely the reason there’s an opioid epidemic in America. Those few doctors who stood up to them (and their patients) and pointed out the harm and addictiveness of opioids were quickly dismissed and sometimes had active smear campaigns against them. This book looks largely at the crisis in W. Virginia and takes you pretty much to present.

This is a good, informative, well-written book. Would have been better if stats on ALL U.S. States and vulnerable / working class / minority areas were also given. The book also gives the impression that opioid problem predominantly exists in underprivileged segments - I don't know if that is true. Also the nature of addictive personalities and people who seek 'high for the sake of high' is not explored: it is obvious that drug use / addictive drug use / abuse existed in U.S. even in early 1900s (if not in 1800s) so what is left unexplored is why Americans think drugs are a solution to their problems - because this pattern of behavior existed long before Purdue made OxyContin!

Memorable quotes:

Dr. Hamilton Wright.: described Americans as "the greatest drug fiends in the world" and opium and morphine as a "national cruse".

Dr. Len Paulozzi, CDC (wrote paper 'Increasing deaths from opioid analgesics in the united states' with two other scientists in the medical journal 'Pharmacoepidemiology and Drug Safety'): "I guess I was naive. I expected FDA to do something. I expected the medical community to change their prescribing practices. I expected an attempt to educate patients better about the limitations and the real risks. That really didn't happen."

The three largest US drug distributors - McKesson, AmerisourceBergen, and Cardinal Health - shipped more than 400 million doses of narcotics to West Virginia, with a population of fewer than 2 million people, in the five years to 2012. Twelve million of those drugs were delivered to tiny (pop. 400) Kermit. ("9 million pills in 2 years," before the police raid: Mayor Charles Sparks) ....Drug distributors pumped 780 million doses opioid painkillers to West Virginia over a 6-year period. Enough for 433 pills for every person in the State. During that time, overdose deaths rose by two-thirds.

American Overdose: The Opioid Tragedy in Three Acts (2018) is a devastating and shocking expose of the chain of events that defines the worst drug epidemic in American history, authored by notable journalist for the Guardian Chris McGreal. As ordinary American’s use and abuse substance, suppliers/dealers of illicit drugs were included in the same category as the wellness clinics, “pill mills” (of West Virginia, North Carolina, Ohio, Florida) and the doctor’s that prescribed “astronomical” amounts of opioid’s--while keeping poor records, phoning in prescriptions, with few questions and/or never meeting patients. The chain continued up, the pharmacies that received and filled orders dispensing millions of pills without question or notifying authorities; the pharmaceutical industry responsible for the manufacture and peddling of pills in the “Disease of Despair” realizing billions of dollars in sales and profits. There were “user friendly policies and procedures” needed to keep the lucrative gravy train rolling— enter Big Pharma’s buddies in the FDA, lobbyists, experts in the medical field, and the shameless politicians that received millions of dollars in campaign donations supporting the greedy agenda of the pharmaceutical industry (names were included)! The connection of these forces that conspired together with too many government officials and policy makers looking the other way, have created a corrupt for profit medical industry that dangerously fails to serve the American people in a responsible accountable manner.

According to McGreal and other investigative journalists including Beth Macy with her informative book “Dopesick” (2018) many northeastern cities and the American Appalachia were seemingly targeted and hardest hit in this unfolding tragedy. By 2005, Big Pharma had spent billions in marketing direct to consumer advertising and education—as patients self-diagnosed and demanded prescription medication. It is now known that the probability of addiction was discounted and downplayed as “The Balanced Approach” was aggressively promoted by industry executives: suggesting the FDA make opioid’s available without restriction, and went as far to copyright “pain” as the 5th vital sign. The Veteran’s Administration was the first to accept this (outrageous) policy.
The Balanced Approach also separated “good patients” who were the real “victims” suffering pain and in dire need of treatment. Big Pharma would always deflect their responsibility and role for the drug epidemic— shifting the blame of addiction solely on the individual user rather than the drug that caused it.
Over a decade later, smug industry executives would claim that “playing the blame game would not end the epidemic.” In hearings pharma executives were blasted as “offensive” by West Virginia Rep. David McKinley (GOP) for flooding a local Mingo County pharmacy with 5.6 million opioid pills in a two year period. By this time, individual doctors and pharmacists had already been charged, medical licenses revoked, some were serving prison sentences. McKission paid a 150 million fine for failure to report suspicious drug shipments. However, with billions a year in profits the fine was labeled as merely the cost of doing business.

The accountability of Big Pharma executives continued at an all-time low for their role in the drug epidemic that led to drug related deaths of over 72,000 Americans (2017). While McGreal doesn’t offer solutions to the vast problems created by the epidemic, his book offers an urgent message related to education and understanding of powerful forces that shape American society and medical structure; and the lasting profound impact on humanity. ** With thanks and appreciation to Hachette Book Group via NetGalley for the DDC for the purpose of review.

I'll admit that I was a bit arrogant about this book when I sat down to read it: I've taught Dopesick, studied Dreamland, and live in ? Huntington, WV. It wasn't that I fancied myself an expert, just that I figured I had heard all I really needed to know. Appalachians abuse opioids because we are poor. There is an inherent racism to the attention given the opioid epidemic when the crack epidemic was largely ignored. What more could American Overdose really add to the conversation?

It turns out, it added a lot. To me, the thing really missing from those other books that was much more present in American Overdose was intimacy. I felt like the people interviewed for this text were treated in a much more human, compassionate look. I don't mean to say the other texts (particularly Dopesick, which is beautiful) are cold: just that the time and attention given to individuals in American Overdose created a kind of bond between the reader and the "character" (I used quotations because these are actual people) that deepened the understanding of this epidemic. I will definitely use this book in my class and would encourage anyone else teaching freshman composition to do the same.

As someone who works in the field of addictions I was very interested in this book. I found it to be very well researched and really found it interesting hearing the timeline of this crisis. Watching this crisis unfold has just been heartbreaking. Learning the impact that pharmaceutical companies, doctors, FDA and other agencies had in this crisis is really upsetting. This book does a good job at outlining what was happening at the high level and all the money these pharmaceutical companies and agencies were making off of peoples lives. I wish there could have been more stories of the people directly impacted and the tragedy that has become the opioid crisis. I also wish more of a conversation on fentanyl was in this book, The world has seen nothing like this horrible manufactured drug that is killing so many. I think books like this are really important to educate people on what is happening out there, what the new face of addiction is and how it does impact everyone. I can only hope things will turn around soon.

This book reiterated a little more than I thought it needed to, and I had a little trouble keeping up with the sequence of events while reading (thankful for the timeline in the back); however, this was a necessary read.

McGreal helps spotlight the triggers for our opioid crisis and all the players (professional and political) who stayed out of the way to line their coffers. It was truly disheartening to see how many chances there were to stop it early and easily, and it broke my hear to see all the shrugged shoulders about what to do to fix it.

As a warning, this is a "what went wrong" expose with no real ideas on how to fix things, which makes it a very bleak read.

This book was somewhat unique in that it focused mostly on the perpetrators of the opioid epidemic - the pharmaceutical companies, the FDA, the doctors and pharmacies - rather than the victims. It was really interesting and frightening to learn about how drugs like OxyContin were approved and marketed as "not addictive" (!!!) and "safe for long-term use at ever-increasing dosages." Just WOW. And then reading about the unscrupulous doctors and pharmacists who ran the pill mills that both created and sustained thousands of addicts...it made me sick.

As someone living with a chronic pain illness, I felt super conflicted when I read about how this sort of started as some doctors pushed for more recognition of pain in patients, and then big pharma took that and ran with it in order to push opioids on prescribers dishonestly. I'm so thankful that chronic pain conditions are now recognized as legitimate and worthy of treatment, but how awful that it came with the price of this terrible epidemic.

One criticism I have of the book is that at times it seemed like McGreal was inserting his own opinion and amping up the melodrama unnecessarily. I think simply laying out the facts is more than enough to prove the case that these companies, providers and government officials acted negligently at the least, if not purposefully harmful, and blinded by greed.

I received an ARC from Netgalley in exchange for an honest review. My first Netgalley!

This book made me so mad. As a substance abuse counselor the personal stories are not new to me, but how Oxycontin was pushed on doctors from the drug companies and marketed as safe was ridiculous. This went on for so many years before enough people stepped up and said enough. Unfortunately the damage has been done in so many says. I highly recommend this book to everyone.

This book is as informative as it is infuriating. There are few Americans whose lives haven't been touched in some way by the opioid epidemic. Without reporters like this author, it would be easy enough to dismiss this scourge as just a byproduct of modern times. But McGreal digs deep and traces the epidemic all the way back to Purdue Pharmaceutical's determination to get their cash cow, Oxycontin, to market, in spite of the dangers. Even further, he follows the money trail to the FDA and Congress and shows how pill mills became so common. It's impossible to read this and not be infuriated, but it's a cautionary tale and one that will hopefully prevent this kind of tragedy from being repeated.

A former head of the Food and Drug Adminsitration has called America's opioid epidemic, "one of the greatest mistakes of modern medicine." It is neither a mistake nor the kind of catastrophe born of some ghastly accident. It is a tragedy forged by the capture of medical policy by corporations and the failure of institutions in their duty to protect Americans.

Guardian journalist Chris McGreal's American Overdose is the latest narrative look at the opioid epidemic overwhelming the US, and it's a well researched, emotionally intense one that combines personal perspectives of users and families with medical industry background and the inaction of lawmakers to tell the story of crisis. It shows how frighteningly easy it's been, and is, for opioid addiction to take hold and how politicians and government have been lobbied and bought by drug companies, allowing addiction to burgeon unchecked.

In comparison to a previous book on the epidemic, Dreamland, this focused more on the culpability of pharmaceutical companies, Purdue with its deceptively, aggressively marketed OxyContin in particular, the unscrupulous doctors running pill mills, and the politicians, especially in Congress, willing to look the other way when supporting drug companies benefited them financially. We see some of the extreme lobbying on behalf of the drug companies  that goes into this as well, which is just horrifying. Especially when juxtaposed with the voices of the people affected - sometimes of users and former users, and very affectingly, from their families, especially when their loved ones didn't survive their addictions.

In contrast, Dreamland is an excellent look that focuses more on the Mexican cartels who moved in when they saw opportunity massively increasing in the opiate market. American Overdose better explores how the problem exploded in the first place. It also covers territory like the drug companies' development of prescription opioids, including stronger ones despite knowledge of abuse. McGreal also covers the dangerously skewed research that was cited claiming opioid safety. For example:

They homed in on the statistic showing that only two of the patients became addicted and probably because they had previously abused drugs.

[ArtVan Zee] was among the first doctors to raise the alarm, but he struggled to be taken seriously against the arrayed forces of the opioid makers' money, a Congress unwilling to challenge the industry, and a federal medical establishment that showed little interest in addressing its wider responsibilities to the public health.

My qualm is that the book feels somewhat like a magazine article. A well written and extensively researched one, no doubt, but it didn't read as cohesively or even as compellingly as I'd prefer. The sections detailing maneuverings in Congress and other government bureaucratic measures and missteps were tough to slog through, as important as these failures of policy were were. And some stories stuck out, like this one:

After sporadic legislation to tax and limit opium imports, the US Congress passed the Harrison Act in 1914 to restrict distribution to prescribing physicians. Because the law involved taxation, the Treasury Department was left to enforce it. Drawing on its absolute lack of medical expertise, the Treasury made a moral judgment that addiction was not a disease but a human failing. It ruled that doctors would not be permitted to prescribe narcotics to people who were hooked even if it was to help them shake their addiction. The Supreme Court upheld that position, and it prevailed for half a century.

It explains so much.

But the policy stories also left me with questions. There are several mentions of the Obama administration, and Obama himself, being uninterested in addressing the opioid crisis. But not enough explanation of why and I wanted to understand more of that.

When breakthroughs are made, such as strides in recognizing addiction as disease, it's often tangled with other thorny issues like the crack epidemic, which was criminalized and disproportionately affected African American communities. Now that a drug problem is affecting white people, it's labeled an epidemic and beginning to receive political attention instead of criminalization.

I thought the reporting was strongest when the people affected in the epidemic spoke for themselves, because the impact of their stories and the trajectory of how they even occurred is what really pushes the ugliness and horror of this pharmaceutical-sponsored epidemic to the fore. It exists because of a perfect storm of drug companies pushing their product through aggressive and persuasive pharmaceutical reps, doctors and insurance companies more willing to treat symptoms than root causes, and people legislation unwilling to budge to address medical regulation or insurance issues. It is, in a word, infuriating.

A story that gets central play here, opening the book quite compellingly, is the bizarre one of Henry Vinson, a former mortician arrested in a prostitution scandal in Washington, D.C. He eventually made his way to Williamson, West Virginia and opened a clinic, employing doctors Diane Shafer and Katherine Hoover, who would make thousands of dollars a day, cash, writing opioid prescriptions. Patients were encouraged to not even see the doctors during their appointments. These two demonstrate a strange but sadly not uncommon story of extreme greed and total lack of ethics, but a deep-dive look at how pill mills work and how they affect the towns where they spring up.

McGreal also does excellent work in showing that addiction knows no socioeconomic boundaries whatsoever. That should go without saying at this point and yet there are those who persist in believing addiction is a choice, not to mention heartbreaking stories from parents who, thanks to long-entrenched prejudices, too late understood the depth and seriousness of what their children were suffering from. He interviews people across the spectrum who succumbed to opiate addiction, including doctors themselves. The slippery slope from being desperate to manage pain sufficiently to keep living everyday life normally into full-fledged, all-consuming addiction is not nearly as lengthy or rare as many believe.

The stories from grieving parents are the hardest. To know the story behind why this is happening - how many legislators and medical professionals that were supposed to have human best interest at the core of what they do and who instead have created, allowed, and added fire to the flames of this epidemic is beyond reprehensible. American Overdose covers the details but it doesn't offer much hope - only the reality that there is no easy or quick solution.

Thank you NetGalley for a free eARC in exchange for an honest review. American Overdose is well researched and well written. This book exposes the opioid epidemic and the corrupt pharmaceutical companies and doctors who profited at the expense of rural Appalachian citizens. I have heard of the pill mills in Southern WV, but I was unaware of how unscrupulous the pharmaceutical companies were in their marketing schemes for OxyContin. This book is an excellent read.

Thank you to NetGalley and Perseus Books/PublicAffairs for providing me with an ARC in exchange for an honest review. Chris McGreal's American Overdose is a must-read for anyone concerned with the current opioid crisis in the United States. And who should be concerned? Everyone.

Having read another opioid crisis expose, Dopesick by Beth Macy, already this year, I was interested to see what new material McGreal could bring to the table. This book provides more of a structural overview of the topic than Dopesick and then dives into specific pieces to flesh out the narrative.. The investigation is split into three parts, Dealing, Hooked, and Withdrawal. Though the two books understandably share many central characters, they are not repetitive and McGreal's work dovetails perfectly with other research studies already completed on the topic.

Overdose is the leading cause of death for people under the age of fifty, McGreal writes. Poor, rural people are not manufacturing these drugs. This crisis is not due to street heroin or cocaine or meth, though people turn there when their prescriptions run out. These drugs are being funneled into the hands of a vulnerable American public through the greed of big pharma and the negligence of the FDA. Doctors have been brought into the fray through money and gifts, with others doctors fighting against their medical brothers and sisters to save patients.

Pills have been peddled to Americans as the panacea for every ill and now generations of Americans are growing up thinking that relative pain is a vital sign and pills are magic. We are in a dangerous zone and people are dying daily because of it. McGreal makes a great case that while pain should be taken seriously and is certainly real for many people, opioids are not the answer; just the cause of more pain. He has thoroughly convinced me that pharmaceutical companies should not be allowed to advertise on television. It is a recipe for disaster.

Written in an engaging style with thorough research and clear stances, American Overdose is highly recommended.

"Tragedy" is an apt word for the way opioids have been managed by pharmaceutical companies, doctors, and our government. I've read several books on this topic, and American Overdose is right up there with the best.

One aspect that makes this a standout read is that Chris McGreal addresses the FDA's absolute failure in oversight, and perhaps even complicity in the false and dangerous claims about a prescription drug that led to nationwide addiction. If you happen to come to this book with the belief that the FDA works to protect the public, you'll find it difficult to hold on to that belief by the end.

American Overdose is an exceptionally well written and researched narrative. McGreal takes us through the madness of the pharmaceutical company's lies, doctors' ignorance and arrogance, FDA's negligence, and, ultimately, the human tragedy caused by a drug that should never have been allowed for such broad use. We're given an inside view on all counts, keeping us invested and making the story feel personal.

Ultimately, the financial penalty imposed on a handful of those responsible means nothing to the millions of people whose lives were ruined by or lost to opioid addiction. The best we can do is arm ourselves with knowledge and question everything, so that maybe we can keep anything like this from ever happening again. Reading American Overdose is a great place to start.

5 stars

“A comprehensive portrait of a uniquely American epidemic--devastating in its findings and damning in its conclusions. The opioid epidemic has been described as "one of the greatest mistakes of modern medicine." But calling it a mistake is a generous rewriting of the history of greed, corruption, and indifference that pushed the US into consuming more than 80 percent of the world's opioid painkillers. “

This book is eye-opening and very maddening to read. The sheer magnitude of this epidemic is horrifying, added to the fact it should have never happened. The FDA’s role in this epidemic is just mind-blowing. I cannot get over how much greed played a part in this crisis. Money over people! Ugh!

This book needs to be read by every high school student, every college student and anyone else whose lives have been affected by opioids (which is everyone!) This is a very important book with a shocking look at how greed and politics trumped common sense. I will not soon forget what I have read in American Overdose.


I received a complimentary copy of this book from the publisher and NetGalley. The views given are my own. #AmericanOverdose #NetGalley #

Perseus Books

OxyContin: “Industrial-Scale Delivery of Death”

Opioids came to my attention a few years ago when a report came out that New York State doctors had written more than 24 million prescriptions for opioids the previous year. Unstated in the story, but obvious to me, was that there are only 19 million people in the state, total. Doctors were flooding the state with narcotics. That can’t be right. Chris McGreal’s American Overdose details how very wrong it was and continues to be. It’s capitalism, greed and amorality at their finest.

Opioids are narcotics. The big three, Vicodin, Percocet and OxyContin are the most prescribed. A movement began in the 1980s to free up narcotics for any kind of pain relief at all. Doctors began prescribing them for the slightest pain, on the basis that they hadn’t been doing enough to relieve pain in general. And, incredibly, that opioids weren’t really addictive after all.

The story of OxyContin and the opiate crisis is the story of one family’s quest to provide unfettered freedom for narcotics in the USA. The Sacklers, with a long history of hustle and living just over the edge of legitimacy, built an empire in Purdue Pharma, making narcotics available to all, addicting them for life, shortened though it would be. Chris McGreal investigates the players, the history and the fallout in the thorough, gripping and excellent American Overdose. He spoke to all the key players and plugged in all the missing parts. The timeline at the end is invaluable – for some Congressional hearing that will never take place. At some point, this has to stop.

“OxyContin was not the result of good science or laboratory experiment. OxyContin was the child of marketers and bottom-line financial decision-making,” says John Brownlee, then a southwestern Virginia federal prosecutor. He considers Purdue Pharma a criminal enterprise.

In 1999, deaths from legal drugs overtook deaths from illegal drugs, and have not looked back. Deaths are increasing 18% a year, and the average age of death keeps declining. It’s the number one cause of death for those under 50. Ironically, the old and dying are the only group where opioids are not increasing the death rate. Mass prescribing was driving the epidemic. Addicts ravaged savings, relatives, homes – anything – to keep renewing prescriptions. The pain of withdrawal is that fearsome. Death can come suddenly in an instant, or drag out over days of agony. Even the most drug averse can find themselves hooked without knowing it.

American Overdose is a litany of failures. McGreal has chapters focused on doctors, on the police, on politicians, on drug distributors, and of course, on the manufacturers. Each is as bad as the next. It is astonishing how deeply criminal it was, and how little was done to stop it. Those who tried were squashed like bugs. Judges and police were purchased. Doctors became Mafiosi. Roadkill in this story are the children of addicts. Hundreds of thousands across the country have fallen into state care, because their parents were incapacitated, imprisoned or dead from opioids. Babies of addicted mothers are born addicted.

The relentless pressure from big pharma had the desired effect. Uniquely in America, doctors all over the country firmly believe that narcotics are necessary and appropriate for any kind of pain, for any age of person, in any kind of need. They believe that OxyContin is not addictive, because someone declared the resurgence of pain as the drug wears off is proof there is no addiction. And of course, they believe they need no educating on narcotics and that no one can tell them what to do. They’re doctors, after all. The result is a nationwide epidemic, where overdose deaths have bypassed illegal drugs, alcohol, auto collisions and gunshot fatalities. The grand total long ago eclipsed the number of deaths in the Vietnam war, and it is the only area of mortality that is skyrocketing. By itself, it has lowered the life expectancy of Americans.

Through it all, Purdue Pharma continued to lie. Its training video for doctors states there is “no evidence that addiction is a significant when persons are given opioids for pain control.” It got the Food and Drug Administration to label OxyContin as actually reducing the risk of addiction. Its reps guilted doctors into prescribing more because their competitors were. It bribed them with pizza and swag. It paid some of them for papers or speeches. It produced millions of pills to saturate small localities where people would drive for hours to get instant prescriptions, only fillable at co-opted pharmacies that would not report them.

-Doctors could make $20,000 a day writing scrips. They did them in advance, so receptionists could just fill in a name. No checkup necessary. Just $150-$250. Cash.
-Florida permits doctors to both prescribe and sell narcotics, saving a step in spreading narcotics to all. So hundreds of dispensaries popped up to take advantage of the flood of cash. By the end of the 2000s, Florida was number one in opioid prescriptions.
-As for Washington, its first act to tame the epidemic was to pass a law in 2016 handcuffing the Drug Enforcement Agency, basically preventing it from enforcing existing narcotics laws on distributors.

The Mexican drug cartels are entrepreneurial enough to know a good thing when they see one, and promoted heroin as a far cheaper substitute for OxyContin. Then an artificial opioid, Fentanyl, solved the import problem. Fentanyl is 50 times as powerful per gram, so far less of it has to be made or shipped or delivered. Fentanyl has overtaken heroin and OxyContin in the death race, but heroin and OxyContin are not fading either. A single badly mixed Fentanyl pill can kill by itself, without all the agony of addiction.

In 2018, Purdue Pharma finally said it would no longer promote OxyContin to doctors, and laid off all its sales staff. But the snowball is still rolling down the hill. The Centers for Disease Control estimates it will take another 15 years for the OxyContin epidemic to run its course. Purdue Pharma is all but guaranteed billions of dollars annually until that time. The current estimate of opioid addicts in the USA is at least two million.

McGreal ends with the whistleblowers finally making some progress. They are nibbling away at the edifice of prescription narcotics. A law here, a prosecution there, a help service, a publicity campaign. Incredibly, there is still a narcotics lobby working Washington for all its worth. Because it’s worth billions.

David Wineberg

Fascinating book. Tracked the crisis from beginning to present, offered accounts from many different perspectives, a great and extremely relevant book.

Unconsciousable, if there is one word I would use to describe the greed I read about in this book, this would be the word. One would have to be completely out of touch to have not heard on the news, or read in the papers, about the opoid epidemic striking our nation. Untold deaths, families, lives ruined. A documentary about West Virginia, which was literally a opoid mill, was shown a few months back, towns completely taken over by addiction. What I didn't realize was how this was accomplished. A literal pill mill.

This book explains how this happened, how it was allowed to happen. The greed of drug companies, basically pushing to doctors, what they tooted as the newest pill in pain relief, from cooked doctors, clinics, and pharmscies. Taking advantage of the pain those with injuries or previous trauma experienced,to addict them to a pill that they needed more and more of I increasing dosages. Hard to believe this is happening in my country, but it is and it is deplorable.

So many lives ruined, even those who had seen this becoming a problem seen what it did to people, find themselves after an accidental addicted. This book explains in three separate sections how this was done, how greed and the love of money, addicted so many. A very important read and one that is easy to read but explains things very well.

ARC from Netgalley.

This book is amazing. I tore through it after NetGalley approved my advanced reader copy in exchange for a review.

I am about as involved as a librarian can be in this issue without actually working in the substance abuse field. I have read a plethora of other related texts such as Dreamland, Pill City, American Fix, and Chasing the Scream. This book, American Overdose, is unique in that it provides and extremely comprehensive history on how Americans got addicted to opioids starting with pills and presently with heroin and fentanyl. The research that went into writing this book is deeply impressive. You will learn more, even if you think you already know it all.

If you are interested in the opioid epidemic, read this book. If you read Hillbilly Elegy, read this book. J.D. Vance provided his narrative on general poverty in Appalachia but Chris McGeal provides a far deeper understanding of the modern state of Appalachia that reaches all the way back to America's use of morphine in the Civil War. If you are interested in modern politics, read this book. This issue is now so large that it is impossible to ignore from every single political angle. Democrat or Republican, this issue truly transcends political parties. If you are an American, read this book.

2017 saw 72,000 drug overdose deaths. 197 Americans die of a drug overdose daily. Which is more than the entire Vietnam War, more than guns or mass shootings, more than car accidents, higher than any other sort of death -- it is the leading cause of death for Americans under 50 years old. This is not something we can ignore anymore simply due to its stigma. This book reveals how despite knowing exactly where this was all headed, members of all relevant industries - pharmaceuticals, medical, law enforcement, and government - let it happen anyways because of money. You kind of already have that inkling but this book really confirms that. American Overdose tops every opioid epidemic book from this year.

4.5 stars

(In 2012) "Doctors write more than 250 million prescriptions for opioids, enough to provide a bottle to every adult in America. The United States consumes more than 80 percent of the world's prescription narcotics."
- Scary, Scary statistic. That was 2012, not sure what the numbers are for 2018.

This was a pretty scary book. The statistics were staggering. While reading this book, I highlighted huge sections as I was blown away with the information. The Author points out how "the opioid epidemic is the deadliest drug crisis in American history; it results in 90 American deaths a day and has eviscerated communities across the country."

"The Crude calculation is that prescription pain pills have claimed more than a quarter of a million of American lives."

This book is told in three acts which highlight how Opioid use and addiction came to be. In the first section, the book examines how healthcare in the U.S. is run like a business where pharmaceutical companies profit off the pain and suffering of patients, how the policies are not strict enough and the FDA was complicit in the matter. The second section of the book, addiction is addressed. In the third section of the book, drug cartels are examined and how they exploited the market for addiction.

"For years, American doctors wrote more than a quarter-million opioid prescriptions. As Congressman Harold "Hal" Rogers put it, "That's enough painkillers to medicate every American adult around the clock for a month."

The Author writes this book using staggering statistics but also shares stories ranging from addicts, doctors, family members and those in the pharmaceutical industry. Addiction has been around for a very long time. In the "1880's, more than half of those hooked on the drug (morphine) were middle and upper class white women." Cough syrups, especially those for children and teething syrups contained morphine, cannabis and alcohol. There were no regulations back then and people could use as much as they see fit.

Pain is a part of people's lives. There are those who work very physically demanding jobs which leave them in pain day after day i.e. dancers, farmers, miners, construction workers, those in the timber industry to name a few. Painkillers help them to ease the pain, recover from injury and be able to do their job day after day. That is not to mention those who require surgery and are prescribed painkillers during their healing process. But what happens when addiction occurs? What happens when clinics pop up where an individual can pay $250.00 to see a doctor to be diagnosed with an injury so that he/she can obtain a prescription to Oxycodone? When all one needs to do is come back month after month and hand the receptionist another $250.00 and you will be given another prescription no questions asked? Shocking that such places exist.

Who is to blame for the addiction to painkillers? Prescription drug manufacturers, such as Purdue, who send out drug reps to give gifts to doctors’ offices in the form of coffee mugs, pens, food, etc., so that they can talk to the doctor about prescribing oxycodone or other medications. Are they to blame? The book states how "Purdue threw out unprecedented amounts of money into promoting Oxycontin, spending several times the advertising budgets of rivals." Are doctors to blame for prescribing or over prescribing opiates, is the FDA to blame for not having more strict rules and regulations, are addicts to blame? What can be done? What is being done?

Whoever is to blame, it is scary how addiction to prescription drugs is skyrocketing. Turn on the news and there are reports of police officers and paramedics entering homes and finding children with an unconscious or deceased parent due to overdose. It's also happening in parked cars and parks as well. Is there a solution? I don't know. Pain exists, and we need treatment for it, but where do we draw the line?

This book was educational well written. Extremely well researched and laid out. The old "Knowledge is power" saying applies here. I do believe that doctors and health care providers are cracking down on what is prescribed. Some prescriptions require that an individual show a driver’s license or some form of identification when you pick up your prescriptions. But again, there are drug cartels who can and do sell the drugs on the street. It's scary.

Thank you to Perseus Books, Public Affairs and NetGalley who provided me with a copy of this book in exchange for an honest review. All the thoughts and opinions expressed in this review are my own.