Anna Lembke is a psychiatrist at Stanford University School of Medicine in California with a particular interest in treating patients who have become addicted to prescription drugs such as opiates. Her book combines case studies from her practice with an analysis of the reasons for the prescription drug epidemic in the United States, where deaths involving opiates quadrupled between 1999 and 2013.
Pharmacist readers will find little new in Lembke’s account, the main elements of which have been described many times elsewhere — patients who demand a quick-fix pill for every ill; manipulative ‘professional patients’; overprescribing doctors; pharmaceutical companies being selective with their data to promote their products; and medical bureaucracies that measure business outcome over wellness.
Writing from a doctor’s perspective, the author says that most prescribers were just trying to do their best for their patients but were not only poorly trained to recognise or treat addiction but were duped by both patients and ‘big pharma’. However, while the author concludes that the prescription drug epidemic is a symptom of a faltering medical system, she offers no useful thoughts on how to improve it.
Lembke does add some life to the text by using patients’ stories to illustrate various aspects of drug misuse and addiction. The story of one patient introduces each chapter as he drifts from sharing three martini lunches with his alcoholic father as a teenager via his misuse of various drugs and the means he employed to obtain them to his decision to try rehabilitation. Then the author lost track of him so we do not know if he succeeded.
The book includes some technical and medical terms concerning the drugs involved, the science of addiction, and the relationships between doctors, health organisations, pharmaceutical companies and (this being the United States) insurance companies, but it is written in a clear, easy-to-read style with lay readers in mind. It is they who are most likely to find it worthwhile reading.
Drug dealer, MD, by Anna Lembke. Pp 192. Price £15. Baltimore: Johns Hopkins University Press; 2016. ISBN 978 1 4214 2140 7