Book Buzz: Dreamland

Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

It is difficult to turn on NPR these days and not hear a story about the opiate epidemic, recently declared a national public health emergency. In local news, Washington state filed a lawsuit against the makers of OxyContin for downplaying the risks of addiction to doctors and consumers. Opioid overdoses take the lives of more than 140 people every day in America, according to the Centers for Disease Control and Prevention.

How did we get here? In Dreamland: The True Tale of America’s Opiate Epidemic, journalist Sam Quinones searches for the epidemic’s taproot and maps a perfect storm of events and opportunities that, when taken together, equal a force capable of destroying entire communities.

One of the threads in Quinones’ study is the conception and treatment of pain by the medical profession. Pain was recognized as the fifth vital sign in 2001, increasing the expectation that having pain treated, almost by any means, is a patient right. Around the same time, Purdue Pharma launched an aggressive marketing campaign for OxyContin, encouraging the treatment of pain and assuring doctors that when used for pain, OxyContin was not addictive.

Doctors who questioned the addictive nature of opioid pain medications were referred to a “pain study” by two doctors published in the New England Journal of Medicine stating that addiction was rare in patients whose pain was treated with narcotics. When questioned by Quinones years later, medical professionals still remember many references to this “study,” which was, in fact, nothing more than a letter to the editor. But the tide had already turned, and doctors were confidently prescribing OxyContin and other opioids for pain, satisfied that they were effectively and ethically treating their patient’s symptoms.

Inevitably, some less ethical doctors saw this as a moneymaking opportunity, and “pill mill” clinics opened, spawning generations of addicts and in some cases, local alternative economies based on OxyContin tablets and stolen goods from Walmart.

As demand increased, OxyContin costs skyrocketed and it became unaffordable for some users, many of whom were white, middle-class workers. Heroin was a cheaper alternative, but required venturing into the hardcore culture of drug gangs and needle use. In another perfect marriage of demand and opportunity, enter the Xalisco Boys and their unique black tar heroin delivery system.

Xalisco, one of the smallest Mexican states, was very good at growing poppies and the rural farming rancheros were full of young men eager to make a name for themselves with money made from peddling heroin in the United States. Distribution cells had no interest in competing with drug gang dealers; their delivery drivers did not carry guns and the workplace culture advocated nonviolence. This was business, pure and simple.

Dealer cells sought out white, middle-class communities with a large enough Hispanic population for the drivers to be able to blend in. Often, a local junkie was employed to make introductions to addicts. Sometimes, they infiltrated methadone clinics to create clients. A quick phone call was all that was necessary to have a fix on the way; cheaper fixes and this “pizza delivery” model of drug dealing were hugely appealing to white OxyContin addicts.

Quinones does a great job spelling out the synchronistic timing of these and other events, and as the pieces fit together, there is a mounting feeling of horror at the devastation that will be left in their wake. Dreamland provides an extremely readable education about this crisis that will likely touch the lives of most of us, if not personally, then certainly in the impact it has on our community.

Lisa Gresham is the Collection Support Manager for Whatcom County Library System, where she selects adult nonfiction, eMaterials, and Hot Picks for county readers.

(Originally published in Cascadia Weekly, Wednesday, November 29, 2017.)