’I found myself drawing experiences of patients I have met throughout my career in healthcare and how “addicts” as we categorise them, adopt the same behavioural characteristics’
Title: Drug Dealer, MD
Author: Anna Lembke
Publisher: Johns Hopkins University Press
Reviewer: Charlotte Stocker, community staff nurse
What was it like?
Drug Dealer, MD is a book written by Anna Lembke, who is a medical practitioner within the US. This book discusses the rising and ongoing epidemic of addiction within the US, but not just illegal substance abuse, which we are hearing more of through the tabloids. No, this book instead looks at a much more taboo subject, that of prescription medication.
Discussing the use and abuse of prescription medication is a tricky subject to tackle, but what is interesting in this particular book is that it doesn’t focus on how prescription medications are obtained via the street corner or local dealer; it looks at the root cause – the prescribing practitioner. And how they (the doctors, the “professionals”) are too blame for this huge issue that affects a large amount of Americans.
I found this book interesting and once I started reading it, I couldn’t put it down. I found myself drawing experiences of patients I have met throughout my career in healthcare and how “addicts” as we categorise them, adopt the same behavioural characteristics. The author listed in one chapter, the different strategies of how drug seeking patients obtain medication from the unsuspecting, unassuming practitioner. It was fascinating to read, thinking that at some point, a medical person reading this book would have seen at least one of these strategies.
I think what helps this book gain a hold of the reader is the fact the author herself is highly qualified within medicine; she has dealt first hand with the issues she is discussing and as a prescriber, knows how easy it is to fall into the trap of aiding a prescription addiction.
Within the first few chapters, the author continually asks the same question, is childhood and upbringing to blame for addiction. I would answer quite simply, no. After reading this book and the evidence that Anna Lembke uses to withstand her argument, that no, upbringing is not the sole factor for why people abuse drink, drugs, or any substance they may acquire.
The use of case studies, actual patients that the author knows and has treated are included throughout the book, all from varying backgrounds and situations but who all have thing in common – prescription addiction. Anna uses these to breakdown the stigma attached to addiction, explains why these people and many others like them, find themselves addicted to medication from a physician.
The author also discusses how pharmaceutical companies contributed to the epidemic of opioid addiction amongst patients, leaving me wondering whether these huge, corporate companies manipulate practitioners to achieve one thing, money. Has a proportion of the US population suffered due to manipulation and money? Quite possible yes, but how are practitioners supposed to overcome these issues if they are liable and potentially could be sued by a patient who feels stigmatised? This is where Anna Lembke discusses the boards and societies who are supposedly there to protect the patient and practitioner. Anna mentions the Federation of State Medical Boards (FSMB), The Joint Commission of Accreditation of Healthcare Organisations (JCAHO) and The Food and Drug Agency (FDA).
What were the highlights?
For me, this whole book was a highlight. It wasn’t a chore to read, nor did it have pages of statistics or medical jargon. The author, where possible, applied an asterisk to anything that she perceived may need further explanation, then at the end of that page, there would be a simplified or more thorough explanation if you wish to read it. I found this useful as reading this in the UK, some of the terminology or medication is slightly different and the author used this to generalise for non US readers.
I also found the case studies throughout the book interesting, and how the author referred back to a particular case study in a later chapter.
Strengths and weaknesses:
The book only had 10 chapters, which makes it a manageable amount, without falling into that heavy textbook category. I personally give this book more credit because the author is knowledgeable in her chosen subject and has experienced first-hand what she is discussing. No, this book isn’t going to stop prescription abuse, but it certainly leaves its mark and makes you question whether that particular patient does really need all that medication. If every other prescribing physician who reads this feels that way, then maybe they will stop and think before writing another opioid prescription.
Who should read it?
Anyone who has direct contact with patients would be the simplest answer to this question. The whole point of this book is to do away with the stigma of “addicts”, and how we as society, assume that an addict has a particular “look”. It may not be the person sitting in the doctor’s waiting room, who is from the poorer end of town with dirty clothes. The addict may well be the person sitting there in their suit from the more privileged area of town.