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The Opioid Tragedy in Three Acts
Read by Dan Woren
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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.
Journeying through lives and communities wrecked by the epidemic, Chris McGreal reveals not only how Big Pharma hooked Americans on powerfully addictive drugs, but the corrupting of medicine and public institutions that let the opioid makers get away with it.
The starting point for McGreal’s deeply reported investigation is the miners promised that opioid painkillers would restore their wrecked bodies, but who became targets of “drug dealers in white coats.”
A few heroic physicians warned of impending disaster. But American Overdose exposes the powerful forces they were up against, including the pharmaceutical industry’s coopting of the Food and Drug Administration and Congress in the drive to push painkillers — resulting in the resurgence of heroin cartels in the American heartland. McGreal tells the story, in terms both broad and intimate, of people hit by a catastrophe they never saw coming. Years in the making, its ruinous consequences will stretch years into the future.
Introduction: An Epidemic Foretold
The first time I looked into the face of opioid addiction, it was of a heavily made-up woman in her late fifties at a food bank in eastern Kentucky.
Karen Jennings had once been a manager at McDonalds. Walking home a little the worse for drink, she fell into a creek and broke her back. The doctor prescribed painkillers to ease her through the pain of recovery.
Even as her injury healed, the narcotics drew Karen in. The drugs worked on her brain to demand ever-larger doses of opioids with the promise of a few hours of bliss. If she failed to deliver, the narcotics exacted a perverse price. They caused her body to replicate the very pain they were supposed to fight. They tortured a fix out of her.
With that, Karen’s life spiraled into a perpetual hunt for pills, costing her job, destroying marriages, and taking a harsh toll on her family. She is haunted by a suspicion that her drug use contributed to the depression endured by her son, a bank vice president, who took his own life. By the time Karen emerged from her addiction fifteen years later, she was living on the breadline and amazed to find herself still alive.
Karen Jennings’s story was a personal tragedy, but that was not how she told it. She cast herself as a survivor plucked from a sea of dead lost to a modern-day plague engulfing the communities around her. She was sucked in at the beginning, in the late 1990s, just as what was to become the biggest drug epidemic in American history was taking hold. In time, the contagion infiltrated almost every corner of the United States.
The ascendancy of prescription painkillers was driven, at first at least, by one drug, OxyContin—the most poweful narcotic painkiller ever released for routine prescribing. It wasn’t the only opioid, but it was the game changer because of its strength and because the manufacturer, Purdue Pharma, unleashed a marketing campaign like no other to make it the go-to drug for pain treatment. In the parts of rural Appalachia first blighted by OxyContin, the pills were known as “hillbilly heroin” for a reason.
The clues to the scale of the catastrophe were in the details long before the death statistics were taken seriously. The firefighters called out more often for overdoses than fires. The teachers buying food for the growing numbers of students neglected by parents spending their time and money on drugs. The pharmacies popping up in small towns where other shops were in retreat for lack of business. The surge in babies born with withdrawal symptoms and cared for by grandparents. The firms unable to find enough workers to pass a drug test.
Karen Jennings was a witness to all of this. What mystified her was that so many others seemed blind to the unfolding devastation for so long. How was it that this tragedy began when Bill Clinton was president, surged through the years George W. Bush occupied the White House, but only began to be given the attention it deserved when Barack Obama was wrapping up his second term? Even then, no one seemed to do very much about it.
In time, I heard people across the United States ask versions of Karen’s question. Men and women blindsided by a plague many did not know existed until the moment it tore into their lives struggled to understand what happened. As grief gave way to anger, the families of the dead and the survivors wanted to know why opioids were so easily prescribed, and why doctors told them these pills were safe. They asked how it was that those who Americans expect to protect them—the medical profession, the government, the federal regulators—seemed to stand idly by or worse as the bodies piled up year after year. Was no one watching and listening?
This book is an investigation of those questions and one in particular: How was the greatest drug epidemic in American history allowed to grow virtually unchecked for nearly two decades with no end in sight?
BY 2018 THE public debate around the epidemic had changed dramatically. Suddenly, everyone wanted to take the crisis seriously, or at least wanted to appear so. Politicians and the press looked for markers to convey its scale. They told us that overdoses were claiming more lives each year than AIDS at its most destructive. More in a single year than the total number of American soldiers killed in the entire Vietnam War.
The crude calculation is that prescription pain pills have claimed more than a quarter of a million American lives, although there are good reasons to believe the toll is higher because of underreporting and stigma. By the time the opioid epidemic has run its course, the number of deaths may well have doubled or more, compounded by a second wave of heroin and synthetic opioids such as fentanyl.
In describing the human cost to his city, the mayor of Huntington, West Virginia, predicts that the plague of opioids in all its forms will eventually claim more lives than all the Americans lost in World War II. Overdoses are now the leading killer of people under the age of fifty, dragging down life expectancy in the United States, a phenomenon unique in the developed world.
President Donald Trump appointed a commission to consider a response. Its chair, New Jersey governor Chris Christie, likened the human cost of the opioid crisis to a 9/11 every three weeks. One of the commission’s members, Dr. Bertha Madras, called it “our national nightmare.”
Trump promised action but fell back on the get-tough rhetoric of incarceration that failed so spectacularly against crack and cocaine in the 1980s, and went so far as to threaten execution for drug dealers. Members of Congress rushed to say how seriously they took the epidemic. Pharmaceutical executives, federal medical regulators, and doctors’ organizations across the country lined up to assure America they are committed to combating addiction.
From this newfound enthusiasm of those in positions of influence and power, you might be forgiven for thinking that, suddenly alerted to the epidemic, they rushed to man the pumps and tackle the inferno. But the dangers of superstrength opioid painkillers were not a secret to the medical establishment, government, or drug manufacturers. The warnings were sounded early, clearly, and vigorously within a few short years of OxyContin going on sale. By the early 2000s, pain specialists and primary care doctors, police officers and prosecutors, reporters and medical researchers all flagged the growing scourge of opioid addiction and death. They are among the heroes of this story. They pointed the finger directly at the wide and wrong prescribing of opioids and warned that it was only going to get worse. A handful of members of Congress tried to get their colleagues to take notice. But as this book shows, they were up against formidable forces.
A former head of the Food and Drug Administration 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. Even as the alarm was first sounded, some of the United States’ most powerful medical bodies forced open the doors to the mass prescribing of opioids.
The result is a largely American epidemic. The United States consumes more than 80 percent of the world’s opioid painkillers yet accounts for less than 5 percent its population. Doctors wrote more than 200 million opioid prescriptions a year. As Congressman Harold “Hal” Rogers put it, “That’s enough painkillers to medicate every American adult around the clock for a month.”
This, for the first time, is the story of how greed trumped the practice of medicine. Of bad people driven by avarice. Of good people led astray by a misguided self-belief. Of the negligent and the heroic. Together they fed the greatest drug epidemic in US history. It began small, as a series of fires before the inferno. They were lit across the country, but none burned more brightly than in a rural corner of West Virginia.
EVEN AS A teenager Henry Vinson wanted to be an undertaker. He liked the dead and the rituals for dispatching them. “My life’s overriding ambition was to become a funeral director,” he wrote years later with a turn of pride in knowing he was unorthodox.
At the age of nineteen, Vinson landed an internship at a funeral parlor in his hometown of Williamson, West Virginia, and then a place at the College of Mortuary Science in Cincinnati. Within three years, he was running his own undertakers back in Williamson, one of those places that calls itself a city even though it’s not much more than a main street with a part-time mayor’s office. Ghost shops and an abundance of storefront injury lawyers—“Been in a wreck and need a check?”—long ago supplanted the department stores and haberdasheries. An iron bridge over the Tug Fork river marks the border between West Virginia and Kentucky, a block from the old city courthouse. Where Sears once stood sentry at the turn off from the bridge onto Williamson’s main street, the New Beginnings Ministry now runs a Christian school.
Just about everyone in Williamson knew of Vinson. He was pushy in a way that didn’t go down well among West Virginia’s courtly business class. Ambition made him the state’s youngest county coroner even though he had no medical training, and it won him no friends among rival funeral directors, who frowned on his ways of snatching up business.
The undertaking dream started to unravel when Vinson was forced to quit as coroner amid a flurry of accusations of professional and criminal misconduct. He was convicted of making harassing phone calls to a rival funeral director. An elderly widow accused him of refusing to release her husband’s unrefrigerated body for six weeks because she was too poor to pay Vinson’s bill. The state investigated him for fraud over the provision of coffins for pauper funerals.
“None of that is true,” he told me years later.
Vinson said a local prosecutor gave him a choice—resign as coroner or face charges of misappropriating state funds. He quit and left Williamson, blaming his travails on homophobia, a conspiracy by rival morticians, and the hostility of a local newspaper that he said “made me out to be the Beelzebub of funeral directors.”
But Williamson was, he later concluded, “just a dress rehearsal for my sojourn to Washington, DC.”
Vinson landed a job at the biggest undertakers in the Washington area, the W. W. Chambers Funeral Home. Getting out of West Virginia meant he could be more open about his sexuality, and that offered its own business opportunity.
How Vinson got into the escort business depends on whom you believe. His own version is that he became friends with a man who told him about the money to be made in sex work. Vinson claims he saw the potential not as a prostitute but as a pimp and bought an escort service called Ebony and Ivory for $10,000 from a man dying of AIDS. He calculated that by applying the business skills he had learned in mortuary school, he would make the money back within weeks.
The owner of another escort business, Donald Schey, told a different story. He said Vinson signed up for sex work at his agency when he was told he could make $600 a day, way above his pay at the funeral parlor. Schey said Vinson became one of his busiest escorts.
Whatever the path, before long Vinson was running his own agency. He advertised in the city’s weekly newspapers as Dream Boys, Jack’s Jocks, and Man to Man and bought up the phone numbers of defunct escort services still listed in the Yellow Pages.
Once the calls started, they didn’t stop. Vinson installed a rack of phone lines in his apartment and kept a phone hidden under the lid of a casket at the funeral home. By the end of 1987, he was taking more than a hundred calls a day from clients, with twenty escorts working for him on any given night.
“At the sprite age of twenty-six years old, I was a funeral director by day and a DC madam by night,” Vinson recounted in a memoir.
Later, when his life was in free fall, Vinson blamed his woes on the prominence of some of his clients. They included politicians, and a scattering of Reagan administration and congressional officials. Vinson claimed former Central Intelligence Agency (CIA) director William Casey “was a frequent flier of my escort service.”
But by far Vinson’s most lucrative client was a former ABC reporter in Vietnam turned Washington lobbyist, Craig Spence, who spent up to $20,000 a month on escorts. On a visit to Spence’s home, Vinson noted the prominently displayed photographs of his host posing with President Ronald Reagan and Senator Bob Dole. Spence claimed off-duty Secret Service agents worked as his security guards and told Vinson he was spending vast sums on escorts to buy influence.
Spence hosted dinner parties attended by a clutch of Reagan administration officials. His influence extended to arranging a midnight tour of the White House for six friends in July 1988, including two of Vinson’s escorts.
All of this was bound to attract the attention of the guardians of the state. But when the Secret Service finally came banging on the front door of Vinson’s colonial-style house in an upscale northwestern Washington cul-de-sac, it was ostensibly over something much more mundane: credit card receipts.
Vinson had become rich fast. He bought a plane and then a helicopter. But he kept the source of his sudden prosperity at arm’s length by persuading his mother, a bus driver who also owned the ambulance service around Williamson, to run credit card payments for his escorts through her company. He told her he was in the entertainment business. Later he got Robert Chambers, a son of the family running the funeral home, to launder payments. Charges for sex were billed under “Professional Services” and listed as urns and funeral accessories. Robert took a 20 percent cut until his family found out and fired him.
As innocuous as funeral home ornamentals might seem, they still looked out of place when they started turning up on official credit cards. Unfortunately for Vinson, not only was the Secret Service responsible for the security of the White House and its orbit, but, as a branch of the Treasury Department in those days, the service also had a hand in investigating financial fraud.
The Secret Service accused Vinson of forging signatures and double billing some clients, knowing they would not be in a hurry to complain to their credit card companies. Compounding Vinson’s difficulties, the federal agents demanding entry to his house had the local police in tow after DC’s vice squad received a tip about escorts working from an upmarket hotel near Dupont Circle. The room was registered to Vinson.
A search of the house revealed lists of clients, their sexual tastes and a pile of credit card receipts.
As the scandal unraveled in public, the city’s two daily newspapers, the Washington Post and the Washington Times, went at each other over the truth about Spence and his payments to Vinson’s prostitution ring. The Times laid out a story of orgies, drugs, and blackmail. The Post claimed the investigation was no more than a fraud case and that Spence’s parties were dull gatherings of important people talking about trade policy.
In the midst of the investigation, newspapers across West Virginia published death notices for Vinson. Investigators wondered if it was an attempt to disappear with the $1 million profit they estimated he made.
Vinson needed a lawyer. Greta Van Susteren, the future Fox News presenter, came recommended, but Vinson said he began to lose confidence in her after, expecting to face relatively minor charges of running a prostitution ring and receive probation, a grand jury handed down a forty-three-count indictment typically used against organized crime with the potential for several life sentences.
Vinson saw that as determination on the government’s part to prevent him from telling what and whom he knew. His suspicions were reinforced by the judge’s refusal to allow Van Susteren to name Vinson’s clients in open court.
His fears of a judicial lynching, and fading confidence in Van Susteren to get him off the hook, led to a plea deal. Vinson admitted lesser charges and agreed to cooperate with the government, including a long debriefing session with the Secret Service, which, by then, was interested in talking about a lot more than credit card fraud.
Vinson said Van Susteren made reassuring noises about probation and encouraged him to placate the judge by going into rehab. The judge was not inclined to show leniency. He sentenced Vinson to five years and three months in federal prison.
The case had devastating consequences for some of his former clients; careers were ruined, and one White House liaison caught up in the scandal committed suicide. Spence moved to New York, living in an Upper East Side hotel with a twenty-two-year-old male escort. A few weeks after he was arrested in possession of cocaine, a gun, and a crack pipe, Spence killed himself in a Boston hotel room.
HENRY VINSON’S FOUR-YEAR tour of the federal prison system came to an end at a medium-security facility in Kentucky in July 1995. His parole officer signed off on the newly released felon moving in with his mother, Joyce Vinson, but balked at letting him work as manager of her commercial properties in Williamson.
An old friend of Joyce’s stepped up. Dr. Diane Shafer had known Henry as a teenager and offered him a job as the file clerk at her downtown practice. It put Vinson back exactly where he did not want to be, in a small town where his recent past had done nothing to change minds about his character. But he was trapped. The parole officer gave his approval to the plan with, apparently, little scrutiny of Shafer’s own record.
Shafer had been an orthopedic surgeon in neighboring Kentucky until its state medical board suspected she was running a scam, by overprescribing drugs and overcharging the government under a workers’ compensation scheme.
The board appointed Gregory Holmes, a Kentucky assistant attorney general, to investigate. Shafer set about getting to know Holmes. Before long they were taking trips to Las Vegas, the Caribbean, and Mexico and living together on weekends. The couple married even though Holmes already had a wife—his secretary at the attorney general’s office. Shafer’s wedding gift to her new husband was $42,000. Ten days after the marriage, Holmes submitted his official report dismissing the accusations against his bride as unfounded.
The medical board was not persuaded and so began an investigation of the investigator. “Holmes later denied the relationship and the travels, but witnesses were able to easily identify the pair because he was blind and stocky, and she was over 6 feet tall,” a court observed.
The police raided Shafer’s home and found the marriage certificate. Holmes claimed to know nothing about it and accused his unlawful wife of forgery. Prosecutors concluded Shafer wrongly thought a wife could not be charged with bribing her husband.
They were both convicted of bribery, and Holmes of bigamy and theft, and sent to prison. The medical board revoked Shafer’s license to practice as a doctor.
In 1995 an appeals court overturned the convictions on technical grounds. Rather than face a new trial, Holmes pleaded guilty to lesser charges and was barred from practicing law. Shafer rejected a plea deal and was not tried again. But Kentucky refused to reinstate her medical license, so she moved to West Virginia, where she was still permitted to practice, and opened a clinic in a two-story house on Second Avenue in Williamson, just down from the city’s courthouse.
Shafer probably did need a file clerk because business was brisk from the beginning. She worked long hours, beginning each day at the local hospital, where she typically saw a couple dozen patients before facing the lines at her practice downtown.
Many of the faces were familiar. A large and loyal clientele followed Shafer from her clinic in Kentucky, where she was regarded as a generous prescriber of the painkillers a lot of men working in the mines or in logging relied on to get them through the day. Over-the-counter drugs such as ibuprofen didn’t cut it. Tylenol 3, with a dose of an opioid, codeine, was a good first stop on the prescription route, but Shafer’s patients were usually looking for something stronger after a few months, so they were moved onto hydrocodone.
Shafer’s patients assumed prescription drugs were safe. People passed around the over-the-counter aspirin, ibuprofen, and Tylenol all the time. The prescription drugs, they calculated, were the same—only better.
The Drug Enforcement Administration (DEA) classifies each drug according to how dangerous it is. Vicodin and similar hydrocodone pills were placed in a lower category than painkillers made from another opioid, oxycodone, even though there was little practical difference. That created a perception among some doctors that hydrocodone was more effective than over-the-counter medicines but safer than oxycodone and so a natural first stop for prescribing. The classification also allowed doctors to write scripts for a supply of up to six months and renew prescriptions by phone. Vicodin rapidly became the go-to painkiller for doctors alongside another hydrocodone pill, Lortab.
VINSON OBSERVED THE lines outside Shafer’s clinic and quickly grasped that there was a tidy profit in painkillers. The business skills honed in the mortuary trade and applied so effectively to running escorts were now turned to what looked like the perfect money spinner—turning doctors into drug dealers. Best of all, as far as Vinson could see, it was all legal because it involved a physician, a patient, and a prescription.
Vinson just needed doctors and somewhere to put them. Happily his mother, Joyce, owned a cavernous old warehouse a couple of blocks from Shafer’s office. Henry Vinson continued to run Shafer’s clinic while converting the warehouse into medical offices. Before long the Williamson Wellness Center was born. Then he began scouting for doctors. Vinson had a nose for the right kind.
Among his first recruits was Dr. Katherine Hoover. She had been practicing in Florida but was in a legal battle with the state medical board after it suspended her license for prescribing exceptionally large numbers of opioids, some of them to indigent patients whose bills were paid by welfare programs. Several pharmacists in Key West gave evidence against her. Two doctors who reviewed her prescribing record said she gave patients potentially lethal doses of narcotics. But an appeal court sided with Hoover and overturned the medical board’s decision in part because it said she had acted within accepted medical practice. By then she’d settled back at the family home in Lost Creek, West Virginia, and was practicing at a nearby clinic. But she got into trouble there too after the state medical board took up a complaint that she solicited a seventeen-year-old female patient to have sex with her son and even went so far as to demonstrate sexual positions the young woman might use. That’s when Vinson came knocking.
He also called up a physician he got to know while serving part of his sentence at the federal institution in Morgantown, on the other side of West Virginia. Bill Ryckman was the prison doctor. “I was friends with Bill Ryckman,” Vinson told me years later. “Bill had an office in Pennsylvania, and he was looking for a different opportunity.”
The two men disagree on how the doctor came to be in Williamson. According to Vinson, Ryckman decided of his own accord to set up a medical practice in a former warehouse in rural West Virginia. The former prison doctor characterizes it differently. He said Vinson hired him on contract as a “consultant” after flying him down to Williamson on a private plane. All Ryckman needed to do was show his face in the clinic once or twice a week. What Vinson needed more than the doctor’s presence was use of the number issued by the Drug Enforcement Administration that each physician required to write prescriptions for narcotics.
Years later, Ryckman was asked under oath if the setup at the Williamson Wellness Center was that of “an undertaker that hires doctors to run clinics.” He agreed that it was.
Vinson completed the collection of doctors with another physician with an impeachable reputation. Armando Acosta had been convicted of fraud for hiding property from creditors after he declared bankruptcy. The West Virginia state pharmacy board had warned as early as 1996 that Acosta was “prescribing controlled substances excessively,” and his license was suspended a year later for failing to keep records on his patients. He was a perfect fit for Vinson.
The finances of the Williamson Wellness clinic were straightforward, at least on paper. The doctors rented consulting rooms fitted out with medical equipment. Vinson provided the staff—he hired Myra Miller, the wife of a policeman, as office manager—and ran the administration. He also handled the money, and there was a lot of it.
The clinics charged $250 cash for a first appointment, which included the taking of vital signs and a consultation to diagnose a condition requiring an opioid prescription. After that, it cost $150 a month to renew the script. Patients were discouraged from asking to see a doctor after the first appointment by being made to wait for hours for any follow-up visits.
Before long, the doctors were getting through hundreds of patients a day. There were simply not enough hours for them to see all the people for whom they were writing prescriptions, so to speed things up, the doctors presigned hundreds of scripts, leaving the date blank. The receptionist filled it in when the patient came in and handed over the money.
At Williamson Wellness, there was so much money changing hands that Vinson installed a chute for the cash to a counting desk. Shafer took to stuffing the money into drawers and cupboards and carrying it home in great bundles.
Vinson was a savvy businessman. He saw opportunities, but the experience in Washington, DC, taught him to also look for risks. He realized he had no control over what happened to the prescriptions after they left the clinics, and that carried dangers. What if pharmacists were bothered by the scale of the prescribing? They might refuse to fill the scripts or, worse, notify the DEA or state medical board. Vinson didn’t need that kind of scrutiny.
The key was to keep the big-name operations, like the Walmart pharmacy across the river in Kentucky, out of the picture. But some small pharmacies had a taste of the money to be made. Vinson and the doctors reeled them in with the lure of profits beyond the dreams of any local drugstore.
Williamson Wellness and Shafer both insisted patients could collect prescriptions only from a list of “preferred pharmacies.” Hurley Drug, a short walk up the street from the clinic, was one of them. So was Family Pharmacy, a few hundred yards across the Kentucky border in South Williamson. Later, the most notorious of them all—Tug Valley Pharmacy—opened just a couple of minutes’ walk from both clinics. It had a drive-through window, and cars were often lined up and down the street. The drugstores were later described as “both very lucky and among the most grossly negligent pharmacies in America.”
With the delivery end sorted out, Vinson focused on growing his clientele.
"American Overdoseconfirms Chris McGreal's stature as one of the truly essential reporters of our times. It is - in its investigative depth and documentary breadth - a riveting and urgent reckoning of colossal corruption that has taken such a staggering toll on twenty-first century American life."
—Philip Gourevitch, author of We Wish To Inform You That Tomorrow We Will Be Killed With Our Families
- "In this gripping account, McGreal exposes the avarice and corruption that caused one of the most shocking crises in American history. A searing expose full of extraordinary characters - heroes, villains and victims."—Katty Kay, contributor MSNBC Morning Joe, presenter BBC World News America
- "McGreal shows how the overdose crisis was driven by the pursuit of profits, not just drugs-both of which combine our instinctive craving for pleasure with our evolving capacity for denial and deceit. Fascinating, disturbing, impressively researched and elegantly written."—Marc Lewis, author of The Biology of Desire: Why Addiction is Not a Disease
- "With great reporting and compelling storytelling, American Overdose lays bare the tragedy of the opioid epidemic tearing at the soul of the United States. Those who want to understand the issue of narcotics and addiction have to read it."—Ioan Grillo, author of El Narco
- "A deftly researched account of America's opioid epidemic. McGreal's book is authoritative in tone and vernacular in style....[A] powerful narrative."—Kirkus Reviews, Starred Review
- "This urgent, readable chronicle, which names names and pulls no punches, clearly and compassionately illuminates the evolution of America's mass addiction problem."—Publishers Weekly, Starred Review
- "McGreal, an award-winning journalist, presents this grim cautionary tale of opioids, greed, and addiction in three acts: 'Dealing,' 'Hooked,' and Withdrawal'.... McGreal goes on to successfully address the question of how the greatest drug epidemic in history grew largely unchecked for nearly two decades....What can be done to reverse this? McGreal's powerfully stated indictment is a start."—Booklist, Starred Review
- "Thorough, gripping and excellent."—--The Straight Dope, Medium.com
- "[A] powerful encapsulation of that epidemic....a timely examination of hard-won lessons."—Nature
- "Staggering... Zola-esque in its dark twists and turns."—Ed Vulliamy, LiteraryReview
- "[A] searing book... Appalachian accents and anger steam off the page."—TheSunday Times
- "Compelling.... reads like a white-collar The Wire, with a cast of characters determined to exact as much money as possible regardless of the human cost."—The Observer
- "An engaging, cogently argued book."—Evening Standard
- "Astonishing... McGreal's book is forensic in its detailing and turns up some eye-popping examples."—Esquire UK
- "McGreal provides a scorching exposé....Most important, American Overdose tells the story of institutional failure and corruption: among local officials, in federal agencies, the United States Congress, and the White House."—Psychology Todayonline
- "Vivid reporting... [McGreal] explains in horrifying detail how this vision of a pain-free America - pharmacologically unrealistic to begin with - was subverted by a greedy combination of pharmaceutical companies, drug distributors, doctors and pharmacists, aided and abetted by complacent regulators and politicians."—Financial Times
- "In American Overdose Chris McGreal of the Guardian looks unsparingly at the causes of the opioid crisis that kills tens of thousands of Americans a year."—The Economist
- "A fast, accessible read for those trying to come to terms with a national nightmare."—Law & Crime
- "An exposé that will have readers riveted from cover to cover."—GreenBay Press Gazette
- "[A] powerful account ... American Overdose is a tale of bad decision making, greed and malfeasance that is still unfolding, and not one about which we can afford to be complacent."—Nick Hopkinson, British Medical Journal
- "A detailed view of the corruption that enabled the spread of opiates to go unchecked by the healthcare industry, government or law enforcement."—London Review ofBooks
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- Nov 13, 2018
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