Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop

More than 47,000 Americans died of accidental overdose in 2014. What is causing this epidemic of overdose deaths? The book Drug Dealer MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, makes a tremendous effort to explain this crisis. Unfortunately, the book suffers from a lack of cogent data analysis and leaves the reader irritated by its inconsistencies.

The author, Anna Lembke, is the chief of addiction medicine and an assistant professor at Stanford University School of Medicine. The book is published by Johns Hopkins. With such credentials behind the effort, the reader would expect a more rigorous approach to data analysis and storytelling. On that level, the book is disappointing.

Perhaps the biggest mistake the author makes in the book is the heavy use of only a small number of patient cases to illustrate the points she makes. Not only are these cases few in number, but they are not illustrative of the “average” addict, if such a person exists. Because of the case anomalies, the narrative created quickly becomes skewed. While the case studies are informative in some respects, giving flesh and breath to the lived experience of addicts, these specific stories take away from the overall points to be made.

The data analysis is also neither in line with standard medical/research interpretations nor groundbreaking or illuminating. It simply reads as strange. Countless times throughout the book, this reviewer wrote, “What?” or “No,” or “Not congruent with other research” in the margins. Specifically, the author’s ideas on recovery and possibilities for treatment, including the role of relapse, are inconsistent with the latest findings in addiction treatment. That makes the writing not just disappointing, but dangerous. There is far more hope for recovery if quality treatment is sought than the author gives credit for.

That said, there is some important information in this piece for addiction treatment professionals who can take its shortcomings with a grain of salt.

The author chronicles very well the recent history of pain treatment in the United States, particularly the ways in which Big Pharma sold doctors a bill of goods on their stock in trade. This book, though brief, has a reasonably good A to Z linear view of how the USA got into its current opioid abuse crisis.

The author also explains changing ideas about pain, that Americans no longer see pain as a useful touchstone for physical or personal/spiritual growth and now demand to be pain-free in all circumstances. This does not mean that those with chronic pain syndromes should be denied treatment. Rather, it is an important observation about changing social norms that put doctors in a bind with regard to how to treat pain. Is all pain intolerable? And who decides when enough is enough?

Additionally, the author weaves throughout the book the idea that human beings create narratives about themselves, and that these stories create our reality. With regard to substance abuse, many can develop an “illness identity” that is built around a victim narrative. This is an extremely important and often under-considered aspect of medicine, no less addiction medicine. How we see ourselves is important not only for how we use and abuse substances, but also for our recovery from addiction.

Finally, the book covers the “industrialization” of medicine, specifically the ways in which medicine has gone from being a healing art, in which patients and doctors worked together to improve patient quality of life and overall health, to an endeavor in which profit is the first order of business and getting patients in and out of treatment efficiently and effectively is the main activity of the day. It is this priority of profit and time efficiency over patient care and outcomes that has doctors from all fields shaking their heads in dismay. The same system that brought on the opioid epidemic is also what has put patient care under the boot-heel of profit.

Sadly, Drug Dealer MD misses the mark. It is suitable only for those in the addiction treatment or medical field who want to be up to date on what is being published about addiction treatment. Even for that population, it’s good for a skim at best.