Macy articulates the central question of Dopesick: How did an epidemic of heroin dealing and addiction sweep through rural towns in Appalachia and the suburbs? She introduces key informants in her quest to answer that question: grieving mothers, those affected by drug overdoses, and Jones, an incarcerated heroin dealer credited with opening up the heroin market in rural Virginia after a prison-release program brought him to town. Macy’s thesis is that this epidemic began when people became addicted to legal prescriptions and moved on to heroin to avoid becoming “dopesick” (3), a term that describes the physical pain, vomiting, sweating, and disorientation that result from withdrawal from synthetic and natural opium-derived drugs.

Addiction to opioids is nothing new in the United States. Macy provides historical context to prove her point. Despite some early opposition to a liberal prescription policy, doctors treated wounded and disabled Civil War veterans with the opioid morphine, allowing soldiers to self-administer their drugs with needle kits the doctors left with them. Doctors and society at large normalized the resulting addiction as “iatrogenic” (23), a supposedly benign form of addiction to legally prescribed drugs. In the 1870s, the Bayer Company created an even more potent opioid called “heroin,” the use of which became so normalized that it was available in pharmacies and was an ingredient in popular products like infant cough syrup.