Dreamland: The true tale of America’s Opiate Epidemic (2015) by Sam Quinones describes the remarkable rise in opiate abuse, addiction and overdoses in much of the US. It’s an incredibly dramatic story. The book looks primarily at two related things, the rise of opiate prescriptions and the rise of sales of black tar heroin from Nayarit in Mexico to the US.
The book describes the rise of opiate prescriptions for chronic pain and in particular the role of Oxycontin and the Purdue pharmaceutical company that produce it. Various people and companies, but in particular Purdue, pushed the idea that only a very small percentage of people who are get opiates for chronic pain become addicted. This is presented as a big change in medical thinking from the past where opiate’s were prescribed with great caution because the threat of addiction was viewed as so serious. However, abuse came in with big rises because of ‘pill mills’ where doctors would prescribe Oxycontin to anyone who wanted it and because many of the users had Medicaid cards so they could get Oxycontin worth $1000 for a copayment of $3.
The other side to the opiate epidemic was the arrival of Nayarit dealers across the US. In a poor, hilly part of Northern Mexico opium poppies were grown and heroin made. They would then sell this heroin, virtually uncut, in parts of the US. Initially in parts of the West Coast they would sell heroin in their own way. They would give addicts a number to call and then a driver with a small amount of heroin in bags in their mouth would drive to meet them. They targeted whites, believing that blacks were more dangerous and not worth selling to. The drivers if caught would receive a fairly limited sentence because they wouldn’t carry much product and because they wouldn’t carry guns. The way it was sold also made it much easier to get a hold of. There was no need to go to dangerous parts of town and meet dangerous dealers. Instead a polite, punctual driver would appear with powerful heroin and sell it. The model was incredibly successful first in Los Angeles, then Portland and then across the US. The Nayarit would also not engage in turf wars with other dealers, keeping things non-violent enabled them to keep their cover as well.
These two trends crossed. Many people who became addicted to pain killers transitioned to cheaper heroin that was now available.
The result has been a public health epidemic across the US. It has also effected middle class whites in a way that hasn’t been seen before. Adolescents who got pain prescriptions for sporting injuries wound up dying of heroin overdoses.
The book presents this phenomenal story fairly well. However a few too many characters are presented that become difficult to keep track of and also the book is repetitive to the point where certain phrases are reused. The book also lacks sufficient statistics on the epidemic and comparisons with other countries where Oxycontin is also used and abused. However it’s a pretty incredible read that provides a great view into a remarkable public health crisis.