Dreamland by Sam Quinones

dreamlandHeroin like pizza and pills like candy.

This fascinating piece of long-form journalism details the simultaneous rise of heroin-dealing entrepreneurs from Mexico’s west coast and the gross spread of misinformation and corporate greed that led to doctors massively over prescribing oxycontin in the United States.

The scale of this problem, heroin/pill addiction, can’t be overstated. Largely white areas of the country have astounding levels of addiction and overdose death, well beyond deaths caused by car accidents. It can be easy to avoid if you live in a large city, but out in the suburbs and rural regions, it’s hard to find someone who doesn’t know someone addicted to heroin. I traveled to Michigan for work last month and there were commercials and billboards everywhere about treatment. Unlike a bunch of other drugs, a heroin addict needs their fix everyday, or they risk crippling withdrawal symptoms. This combined with the cheap potency of the drug make overdose a constant reality.

Quinones outlines two major triggers for this:

  1. Until some time in the 80s, prescribing opiates, the fruit of the poppy seed (along with heroin) was anathema. Doctors and other medical professionals were concerned with the very real risks of addiction. Slowly, as ‘patient-centric’ care became more of a focus and pain-management became an important aspect of medicine, this stance was relaxed, particularly for those with terminal illnesses (where addiction is less of an issue anyway, for obvious reasons).

The problem arose when a confluence of factors led to the completely baseless notion that somehow opiates were actually not addictive. Purdue, the manufacturer of oxycontin jumped on an oft-misinterpreted editorial claiming only 1% of patients have a risk for addiction from opiates and marshalled their enormous sales and marketing engine to drill that number into the heads of all the doctors they showered with gifts. (This was before the laws of the early 2000s put a stop to the worst marketing practices of pharmaceutical companies.)

Somewhat predictable result: Unprecedented numbers of people are suddenly addicted to painkillers.

2. Heroin, like all hard drugs, used to have the perception of something you’d need to brave a dangerous ghetto to acquire. Maybe you’ll get shot. Dealers from the small village of Xalisco changed this business completely. By cheaply farming poppy in their native mountains, they carried it over the border and sold it from their cars, using customer-friendly marketing techniques not unfamilar to US corporations: an easily accessible phone number that triggered door-to-door service (Uber for heroin), manned by savvy and eager young men who would offer discounts or drill down on those who seemed ready to quit.

Put these two together and now you’ve got patients addicted to oxycontin who easily make the switch to heroin because it’s cheaper to buy than oxy (or no one will prescribe it to them anymore).

It’s a ghastly business.

While a stunning tale, the book does have its problems. Namely, it’s extremely repetitive. Quinones repeats the same point many, many times. Sometimes in very similar language. I understand he spent five years of his life on this and wants to insert everything he learned but many chapters are retreads of another. Still, it was a startling and detailed read that I’d highly recommend.

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