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Sam Quinones chronicles how, over the past 15 years, enterprising sugar cane farmers in a small county on the west coast of Mexico created a unique distribution system that brought black tar heroin-- the cheapest, most addictive form of the opiate, 2 to 3 times purer than its white powder cousin-- to the veins of people across the United States.… (mehr)
lulaa: Together, these provide a masterful, humanistic and even hopeful exploration of the ongoing opiate/fentanyl/meth epidemic in the U.S., its costs to families and communities.
I was just finishing “Dreamland” — a book published in 2015, before the Trump reign — as the returns of the 2020 election between Joe Biden and Donald Trump came rolling in. Early on there was a hint that Biden might flip Ohio from the Republicans, but that was not to be.
Dreamland is largely set in the border town of Portsmouth, Ohio, facing Kentucky on the Ohio River.
The area appears to be part of the Republican rural stronghold.
According to Quinones compelling, strange, and frightening story it was also Ground Zero for the confluence of two major trends in rural American life: the seeming endless supplies of painkillers sometimes dispensed by dubious “pills mills,” pain treatment clinics, and the growth of high grade heroine imported by an endless stream of drug runners from a small, poor, and rural Mexican community.
Not only were poor, often unemployed in rural America subject to the pill economy, but relatively wealthy suburbanites and their children were dragged into it, sometimes motivated by the same forces that kept them on top: affluence.
Even as I read this book hundreds of millions of pain killers are prescribed across America — and here in Canada — where physicians often haven’t the time nor the expertise to manage paid reduction regimens, or the expertise to wean their patients off them.
Quinones’ story begins with a small town in prosperous America enjoying the industrial expansion of the early 1900’s and ends with that same town trying to repair its footing after most of the jobs have left, the town tax rolls impoverished, and a booming business in drug rehab.
The pain and resentment of Trump followers aside, rural America is slowly making a comeback, particularly as the COVID pandemic moves a lot of those downtown urban jobs back to the hinterland.
one of those books you want to share with everyone... without having to push it on anyone... and you regret the fact that the book ever needed to be written. ( )
I found this book to be a fascinating read although admittedly repetitive. Quinones does a great job of researching the many factors that lead to today's opiate epidemic. I feel like this is a warning tale in so many respects because one of the big underlying causes was a media narrative that evolved that American medicine was under-treating pain supplemented by another journalistic faux pas that said opiates weren't as addictive as people thought. It didn't take much for some immoral executives to start pushing Oxycontin and creating a generation of addicts (white, suburban) that never existed before. The icing on the cake was that heroin traffickers discovered that if they delivered their goods like pizza, they'd make a lot more money and reach many new customers. All of these factors are explained in detail, and the details are interesting. I just wish Quinones had had a better editor. There's a lot of repetition in the book, and it wasn't necessary. His writing style is very accessible though, and honestly even if you only read the first half of the book, I think you'd get a lot out of it. ( )
Read this for book club. It was interesting, engaging, and educational on a topic I did not know much about. Reading about the Xalisco boys I felt like I was listening to an NPR episode of, "How I Built This" My only complaint was that I thought the book could use a bit more editing. It seemed odd that the author kept adding in paragraphs summarizing the history of the Xalisco boys as if we didn't know who they were, despite already having read 150 pages about them. ( )
"Every so often I read a work of narrative nonfiction that makes me want to get up and preach: Read this true Story! Such is Sam Quinones' astonishing work of reporting and writing" --Mary Ann Gwin. The Seattle Times
... a meticulously researched new book ... Mr Quinones tells many tragic tales, including of the deaths of teenagers drawn to heroin after they were wrongly prescribed strong opioid painkillers. He also has some more uplifting stories of policemen and district attorneys who slowly pieced together the Xalisco Boys’ business model and took action
...a book that every American should read. And I state that without reservation ... Dreamland is the result of relentless research and legwork on the part of Quinones, as well as his talented storytelling. The opiate addiction epidemic was caused by a convergence of multiple, seemingly unrelated factors, and Quinones takes these narrative strands and weaves them together seamlessly.
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To my girls
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In 1929, three decades into what were the great years for the blue-collar town of Portsmouth, on the Ohio River, a private swimming pool opened and they called it Dreamland. -Preface
In the middle-class neighborhood on the east side of Columbus, Ohio, where Myles Schoonover grew up, the kids smoked weed and drank. But while Myles was growing up he knew no one who did heroin. -Introduction
One hot day in the summer of 1999, a young man with tight-cropped hair, new shoes, a clean cream-colored button-down shirt, and pressed beige pants used a phony U.S. driver's license to cross the border into Arizona. -Part I
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West Virginia was one of the seven states with no known Mexican drug-trafficking presence, according to a U.S. Department of Justice 2009 report I had seen. Police had a simple reason for this: There was no Mexican community in which to hide. Mexican immigrants followed the jobs, functioning as a sort of economic barometer: Mexicans in your community meant your area was growing. Huntington and West Virginia had no jobs, no Mexicans either.
Like no other particle on earth, the morphine molecule seemed to possess heaven and hell. It allowed for modern surgery, saving and improving too many lives to count. It stunted and ended too many lives to count with addiction and overdose. Discussing it, you could invoke some of humankind’s greatest cultural creations and deepest questions: Faust, Dr. Jekyll and Mr. Hyde, discussions on the fundamental nature of man and human behavior, of free will and slavery, of God and evolution. Studying the molecule you naturally wandered into questions like, Can mankind achieve happiness without pain? Would that happiness even be worth it? Can we have it all?
“No physician would simply go on with the same unsuccessful treatment, but that is what happens with opioids,” said Loeser. “Patients come and say, ‘That’s great, Doc, but I need more.’ The doctor gives them a higher dose. Then, three months later, they say the same thing, and so on. The point is if it were working, you wouldn’t need more.”
FDA examiner Dr. Curtis Wright, supervisor of the agency’s team that examined Purdue’s application, thought OxyContin might well possess addictive side effects and thought its only benefit was to reduce the number of pills a patient had to take every day. “Care should be taken to limit competitive promotion,” Wright is quoted as writing in an FDA report by the New York Times’s Barry Meier in his 2003 book on OxyContin, Pain Killer. Wright later left the FDA to work for Purdue.
The FDA approved a unique warning label for OxyContin. It allowed Purdue to claim that OxyContin had a lower potential for abuse than other oxycodone products because its timed-release formula allowed for a delay in absorbing the drug. “No other manufacturer of a Schedule II narcotic ever got the go-ahead from the FDA to make such a claim,” Meier wrote. “It was a claim that soon became a cornerstone of the marketing of OxyContin.”
In Pain Killer, Barry Meier describes at length Purdue’s sales techniques and training. The company put its sales reps through several weeks of training. One question they addressed concerned the risk of addiction to pain patients when treated with narcotics. “The correct answer was ‘less than one percent,’” Meier wrote.
A pharmaceutical Wild West emerged. Salespeople stampeded into offices. They made claims that helped sell the drugs to besieged doctors. Those claims also led years later to blockbuster lawsuits and criminal cases against their companies.
Purdue increased the sales quota of OxyContin needed to make bonuses. Even so, salespeople surpassed every goal. In 1996, Purdue paid one million dollars in bonuses tied to Oxy sales, and forty million dollars in bonuses five years later. Some Purdue reps—particularly in southern Ohio, eastern Kentucky, and other areas first afflicted with rampant Oxy addiction—were reported to have made as much as a hundred thousand dollars in bonuses in one quarter during these years.
...the bonuses to Purdue salespeople in these regions had little relation to those paid at most U.S. drug companies. They bore instead a striking similarity to the kinds of profits made in the drug underworld.
Purdue offered OxyContin coupons to physicians, who could in turn give them to patients for a onetime free prescription at a participating pharmacy. By the time Purdue discontinued the program, thirty-four thousand coupons had been redeemed.
Oxy prescriptions for chronic pain rose from 670,000 in 1997 to 6.2 million in 2002. Those for cancer pain rose from 250,000 to just over a million over the same time.
By the 2000s, the American pain revolution was complete. Most of the country’s hundred million chronic-pain patients were now receiving opiate painkillers, as it was accepted on faith that virtually none of them would grow addicted. They usually weren’t receiving prescriptions from pain specialists. Their prescriptions came instead from general practitioners with little time and little training in pain management—the kind of docs Purdue Pharma targeted in its sales campaign.
Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012. Abuse of prescription painkillers was behind 488,000 emergency room visits in 2011, almost triple the number of seven years before.
...a government survey found that the number of people who reported using heroin in the previous year rose from 373,000 in 2007 to 620,000 in 2011. Eighty percent of them had used a prescription painkiller first.
Finally, in 2005, in a paper published in the American Journal of Industrial Medicine, Franklin and Mai reported that forty-four people with chronic pain in Washington’s workers’ comp system had died due definitely, probably, or possibly to prescription opiate use between 1995 and 2002. Most had died after 1999, the year the state’s intractable pain regulation was written. Most were men; most were under fifty years old. They had come to workers’ comp with non-life-threatening ailments—lower back pain or carpal tunnel syndrome, say—for which they were prescribed Schedule II opiates, and were dead a short while later.
He was immediately shocked at the patients in the UW clinic. “These were people on tons of opioids for a long time, completely broken and abused. We’re talking hundreds of milligrams of morphine-equivalent doses. Doses I’d never seen in my life: four hundred, five hundred, six hundred milligrams a day.” What’s more, no one tracked the effects of opiates on a patient’s pain, function, depression, sleep. He called colleagues elsewhere and found this to be true across the United States.
An insurance company would reimburse thousands of dollars for a procedure. But Cahana couldn’t get them to reimburse seventy-five dollars for a social worker, even if it was likely that some part of a patient’s pain was rooted in unemployment or marital strife.
His political career showed promise. He was being mentioned as a potential candidate for state attorney general, even governor. Still, he saw no reason to postpone the long and complicated case. That afternoon, he had received approval from DOJ higher-ups to proceed with it. He said he told Elston to “go away.” Brownlee signed the plea agreement with Purdue the next morning. Eight days later, his name showed up on a list compiled by Elston of federal prosecutors recommended to be fired. Nine were fired. In the end, John Brownlee was not one of them. But, he testified the next year, he believed his inclusion on the list was retaliation for not delaying the Purdue settlement. The Purdue episode lingered amid the Bush administration controversy in which top attorney general officials were accused of political meddling in the work of their far-flung prosecutors and recommending some be fired for not complying with what were perceived as political orders. Elston later resigned. An attorney for Elston told the Washington Post later that there was no connection between the phone call that night and Brownlee’s name appearing on the list of prosecutors recommended to be fired. John Brownlee spent another year as the U.S. attorney from western Virginia. In 2008, he resigned to seek the Republican nomination for state attorney general and lost in the primary. Talk of a future gubernatorial bid wilted. His political career stalled. He is now in private practice
OxyContin first, introduced by reps from Purdue Pharma over steak and dessert and in air-conditioned doctors’ offices. Within a few years, black tar heroin followed in tiny, uninflated balloons held in the mouths of sugarcane farm boys from Xalisco driving old Nissan Sentras to meet-ups in McDonald’s parking lots.
Treatment has always been more effective and cheaper than prison for true drug addicts. What’s changed, Norman said, is that no longer are most of the accused African American inner-city crack users and dealers. Most of the new Tennessee junkies come from the white middle and upper-middle classes, and from the state’s white rural heartland—people who vote for, donate to, live near, do business with, or are related to the majority of Tennessee legislators.
Let’s just say that firsthand exposure to opiate addiction can change a person’s mind about a lot of things. Many of their constituents were no longer so enamored with that “tough on crime” talk now that it was their kids who were involved.
As opiates quietly killed unprecedented numbers of kids, it was as if the morphine molecule narcotized public ire as well. That it began in voiceless parts of the country—in Appalachia and rural America—helped keep it quiet at first.
Heroin had spread to most corners of the country because the rising sea level of opiates flowed there first. The story resembled the heroin scourge a century before, ushered in on the prescription pads of physicians, the vast majority of whom were sincere in intent. Drug traffickers only arrived later, and took far less profit than did the companies that made the legitimate drugs that started it all.
To go from ‘I can do anything’ to ‘I deserve everything’ is very quick. “All of a sudden, we can’t go to college without Adderall; you can’t do athletics without testosterone; you can’t have intimacy without Viagra. We’re all the time focused on the stuff and not on the people.
Pills had been prescribed with wanton carelessness. Then black tar heroin from the Nayarit mountains was sold to them like pizza. More and more parents continued on without their children. They suffered pain as chronic and life mangling as any those doctors and Purdue Pharma decided should be treated with opiate pills.
Years into the opiate scourge, the prospect was weirdly real in some areas that if you wanted treatment help, you would have to go to jail.
Where we stand as a country has a lot to do with the nature of drugs containing the morphine molecule. By the time I began research for this book in 2012, we had, I believe, spent decades destroying community in America, mocking and clawing at the girdings of government that provide the public assets and infrastructure that we took for granted and that make communal public life possible. Meanwhile, we exalted the private sector. We beat Communism and thus came to believe the free market was some infallible God. Accepting this economic dogma, we allowed, encouraged even, jobs to go overseas. We lavishly rewarded our priests of finance for pushing those jobs offshore. We demanded perfection from government and forgave the private sector its trespasses.
Part of the private sector developed a sense of welfare entitlement. Certainly, in this opiate scourge, it is the private sector that has taken the profits; the costs of dealing with the vast collateral damage have fallen to the public sector.
We seemed to fear the public sphere. Parents hovered over kids. Alarmed at some menace out in public, they accompanied their kids everywhere they went. In one case, a couple was actually charged with allowing their nine-year-old daughter and her sister to go to the park alone.
It doesn’t surprise me to hear that in universities, students, raised indoors on screens, apparently lived in some crystalline terror of any kind of emotional anguish. A 2015 story in the Atlantic called “The Coddling of the American Mind” reported on the phenomenon of college students—kids who grew up in the era of hyper-protection from physical pain—demanding to be protected as well from painful ideas. They were demanding professors provide “trigger warnings” in advance of ideas that might provoke a strong emotional content—for example, a novel that describes racial violence.
Heroin is, I believe, the final expression of values we have fostered for thirty-five years. It turns every addict into narcissistic, self-absorbed, solitary hyper-consumers. A life that finds opiates turns away from family and community and devotes itself entirely to self-gratification by buying and consuming one product—the drug that makes being alone not just all right, but preferable.
Letzte Worte
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And if it is, and for all it has taught us and forced us to recognize about ourselves and how we live, as one woman told me, "we may thank heroin some day." -Afterword
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▾Buchbeschreibungen
Sam Quinones chronicles how, over the past 15 years, enterprising sugar cane farmers in a small county on the west coast of Mexico created a unique distribution system that brought black tar heroin-- the cheapest, most addictive form of the opiate, 2 to 3 times purer than its white powder cousin-- to the veins of people across the United States.
)
Google Books — Lädt ...
1
Dreamland is largely set in the border town of Portsmouth, Ohio, facing Kentucky on the Ohio River.
The area appears to be part of the Republican rural stronghold.
According to Quinones compelling, strange, and frightening story it was also Ground Zero for the confluence of two major trends in rural American life: the seeming endless supplies of painkillers sometimes dispensed by dubious “pills mills,” pain treatment clinics, and the growth of high grade heroine imported by an endless stream of drug runners from a small, poor, and rural Mexican community.
Not only were poor, often unemployed in rural America subject to the pill economy, but relatively wealthy suburbanites and their children were dragged into it, sometimes motivated by the same forces that kept them on top: affluence.
Even as I read this book hundreds of millions of pain killers are prescribed across America — and here in Canada — where physicians often haven’t the time nor the expertise to manage paid reduction regimens, or the expertise to wean their patients off them.
Quinones’ story begins with a small town in prosperous America enjoying the industrial expansion of the early 1900’s and ends with that same town trying to repair its footing after most of the jobs have left, the town tax rolls impoverished, and a booming business in drug rehab.
The pain and resentment of Trump followers aside, rural America is slowly making a comeback, particularly as the COVID pandemic moves a lot of those downtown urban jobs back to the hinterland.
This is a story of communities in evolution.
It’s not pretty but really relevant. (