In this masterful work, Beth Macy takes us into the epicenter of America's twenty-plus year struggle with opioid addiction. From distressed small communities in Central Appalachia to wealthy suburbs; from disparate cities to once-idyllic farm towns; it's a heartbreaking trajectory that illustrates how this national crisis has persisted for so long and become so firmly entrenched. At the heart of the story is a large corporation, Purdue - whose owners are celebrated for their sponsorship of art galleries and museums - that targeted areas of the country already awash in painkillers and encouraged small town doctors to prescribe OxyContin, a highly addictive drug. Evidence of its capacity to enslave its users was suppressed. Macy tries to answer a grieving mother's question - why her only son died - and comes away with a harrowing story of greed and need. From the introduction of OxyContin in 1996, America embraced a medical culture where overtreatment with painkillers became the norm. In distressed communities of ex-miners and factory workers , the unemployed use painkillers both to numb the pain of joblessness and pay their bills, while privileged teens trade pills in cul-de-sacs, and even bright students fall prey to prostitution, jail, and death. Through unsparing, yet deeply human portraits of the families, cops and doctors struggling to ameliorate this epidemic, each facet of the crisis comes into focus.

Beth Macy shows that the only thing that unites Americans across geographic and class lines is opioid drug abuse. But in a country unable to provide basic healthcare for all, Macy still finds reason to hope that there may be a decent future for people so abandoned by their political leaders.