Chapter 33 Further Reading: The Opioid Crisis

Macy, Beth. Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. New York: Little, Brown and Company, 2018. The essential narrative account of the opioid crisis, told primarily through the lens of central Appalachia — specifically, the communities of Virginia's Shenandoah Valley and southwestern coalfields. Macy, an investigative journalist based in Roanoke, traces the crisis from Purdue Pharma's marketing of OxyContin through the heroin and fentanyl waves, centering the stories of addicted individuals, their families, and the community members trying to respond. Deeply reported, beautifully written, and devastating.

Keefe, Patrick Radden. Empire of Pain: The Secret History of the Sackler Dynasty. New York: Doubleday, 2021. A comprehensive account of the Sackler family — their rise from immigrant pharmacists to one of America's wealthiest families, their ownership and management of Purdue Pharma, and their role in the opioid crisis. Keefe's reporting on the internal dynamics of the Sackler family and their strategic decisions regarding OxyContin is meticulously documented. Essential for understanding the corporate decision-making that drove the crisis.

Case, Anne, and Angus Deaton. Deaths of Despair and the Future of Capitalism. Princeton: Princeton University Press, 2020. The expanded book-length version of Case and Deaton's influential research on rising mortality among working-class white Americans. Their "deaths of despair" framework — connecting drug overdoses, suicide, and alcoholism to the destruction of economic and social structures — is directly relevant to understanding why the opioid crisis hit the Appalachian coalfields so devastatingly. Read critically alongside the chapter's discussion of the framework's limitations.

Quinones, Sam. Dreamland: The True Tale of America's Opiate Epidemic. New York: Bloomsbury, 2015. A pioneering work that traces two parallel stories: the aggressive marketing of prescription opioids by pharmaceutical companies and the rise of black tar heroin distribution networks from Xalisco, Mexico. Quinones shows how these two seemingly separate phenomena converged to create the opioid crisis, with Appalachian communities among the hardest hit. Published before the fentanyl wave, Dreamland remains essential for understanding the first two waves of the crisis.

Manchikanti, Laxmaiah, et al. "Opioid Epidemic in the United States." Pain Physician 15, no. 3 (2012): ES9-ES38. A comprehensive medical review of the opioid epidemic's causes, including the role of pharmaceutical marketing, the inadequacy of prescribing guidelines, and the failure of regulatory oversight. Written for a medical audience but accessible to non-specialists, this review provides the clinical and epidemiological evidence underlying Chapter 33's discussion of how the crisis unfolded.

Lassiter, Matthew D., and Julilly Kohler-Hausmann, eds. "Symposium: The Suburban Crisis." Journal of Urban History 41, no. 5 (2015). While focused on suburban rather than rural communities, this collection of essays provides important theoretical frameworks for understanding how drug crises interact with economic decline, racial politics, and policy failures. The framework helps contextualize Appalachia's opioid crisis within broader patterns of American drug policy and its consequences.

Allen, Scott Thomas, et al. "Syringe Services Program Utilization, Barriers, and Preferences Among People Who Inject Drugs in Rural West Virginia." Substance Abuse 43, no. 1 (2022): 540-548. An academic study examining the real-world implementation of harm reduction in rural Appalachian communities, including the barriers — geographic, cultural, and political — that participants face. Provides the evidence base for Case Study 2's discussion of harm reduction in the coalfields.

Eyre, Eric. Death in Mud Lick: A Coal Country Fight Against the Drug Companies That Delivered the Opioid Epidemic. New York: Scribner, 2020. An investigative account by the Pulitzer Prize-winning Charleston Gazette-Mail reporter who broke the story of the massive opioid pill shipments to West Virginia pharmacies. Eyre's reporting on the distribution chain — the manufacturers, distributors, and pharmacies that poured hundreds of millions of pills into small communities — provides essential documentation of the systemic failures that enabled the crisis. Rooted in West Virginia and deeply Appalachian.

Ruhm, Christopher J. "Deaths of Despair or Drug Problems?" NBER Working Paper No. 24188 (January 2018). An important academic critique of the "deaths of despair" framework, arguing that the opioid crisis was driven more by the specific characteristics of the drug supply (availability, potency, price) than by the economic and social despair that Case and Deaton emphasized. Ruhm's work provides a counterpoint to the despair narrative and underscores the role of pharmaceutical industry conduct. Essential for a balanced understanding of the crisis's causes.

Appalachian Regional Commission. "Health Disparities in Appalachia." Washington, DC: ARC, 2017; updated reports ongoing. The ARC's comprehensive report on health disparities in the Appalachian region, including detailed data on opioid prescribing rates, overdose deaths, and access to treatment. The report situates the opioid crisis within the broader pattern of Appalachian health disadvantage described in Chapter 33 — connecting opioid deaths to chronic disease prevalence, healthcare access gaps, and socioeconomic factors. Available at arc.gov.

National Academies of Sciences, Engineering, and Medicine. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press, 2019. The scientific consensus report on the effectiveness of Medication-Assisted Treatment for opioid use disorder. The report reviews the evidence for buprenorphine, methadone, and naltrexone and concludes unambiguously that MAT is the most effective treatment available, reducing mortality by 50 percent or more. Essential reference for understanding why expanding MAT access in rural Appalachia is a public health priority.

Katz, Josh. "Drug Deaths in America Are Rising Faster Than Ever." The New York Times, June 5, 2017; updated interactive data visualization ongoing. The New York Times's interactive data visualization of drug overdose deaths across the United States, broken down by county, state, and demographic group. The geographic patterns are stark: Appalachian counties appear as dense clusters of high overdose mortality. The visualization is an invaluable tool for understanding the geographic concentration of the crisis and for tracking its evolution over time. Available at nytimes.com.

Documentary: Heroin(e). Directed by Elaine McMillion Sheldon. Netflix, 2017. (37 minutes.) An Oscar-nominated documentary short following three women in Huntington, West Virginia — a fire chief, a drug court judge, and a harm reduction volunteer — as they respond to the city's opioid crisis. The film is a compassionate and unflinching portrait of community-level response, capturing both the devastation of the crisis and the determination of the people fighting it. An excellent companion to Case Study 2's discussion of harm reduction in Appalachia.