The book covers the origin and evolution of the opioid epidemic in the United States beginning primarily with the 1996 release of the drug OxyContin, and examines its effects on small town America and the Appalachian region in particular.

[4] The book goes back to the Civil War and the widescale distribution of morphine to wounded soldiers, followed later by Bayer's marketing of heroin as safe and effective, in displaying the history of careless treatment of opiates by many in the medical and pharmaceutical fields.

[4] Purdue was successful in having the drug approved for less serious ailments than opiates were typically prescribed due to the company's claim that its extended release (the "-Contin" in its name being short for "continuous") made it safe from recreational users and addicts seeking a quick fix.

[5] This discovery resulted in drug dealers taking advantage of the medical field's readiness to prescribe OxyContin to create "pill mills", the effects of which were felt hardest in rural America.

[6] Macy interviewed Nora Volkow, the director of the National Institute on Drug Abuse, who remarked that "[a]ll studies – every single one of them – show superior outcomes when patients are treated" with buprenorphine and other maintenance medications.

"[11] Brian Volck of The Christian Century praised the book's thoroughness but likened its portrayal of so many affected people and their heartbreaking stories to a "mass of indistinguishable misery like characters in a 19th-century Russian novel.

[15] She was also an advocate for the show's inclusion of the benefits of medication-assisted treatment, which Patrick Radden Keefe said was "hugely important" in helping the American viewing public begin to talk about such measures in combating the epidemic.