Wednesday, May 16, 2018

Dreamland: The True Tale of America's Opioid Epidemic by Sam Quinones

Hardcover, 384 pgs, Pub Apr 21st 2015 by Bloomsbury Press (first published April 15th 2015), ISBN13: 9781620402504, Lit Awards: PEN/John Kenneth Galbraith Award for Nonfiction Nominee for Shortlist (2017), Los Angeles Times Book Prize Nominee for Current Interest (2015), National Book Critics Circle Award for General Nonfiction (2015)

The spectacular public service reporting Sam Quinones does in this nonfiction is so detailed and many-faceted that it left me feeling a little voyeuristic, not having been visited by the scourge of opioid addiction myself. Good lord, I kept thinking, so this is what we are dealing with. I knew something was different, I just didn’t have any conception of the size, scope, method, and means of this problem.

Quinones starts his story in the early 1980s when the first ranchero Xalisco marketers came up from Mexico with an innovative method for just-in-time drive-by selling of drugs to rich white kids in the suburbs. They explicitly avoided cities and black people because they admitted they were afraid of them, their violence and their gang activity. Besides, the thinking went, blacks never had any money. They’d just as soon steal from a dealer as pay him. The white kids had money and wanted convenience above all.

At almost the same time, and a cultural habitat away from small-time drug dealers of black tar heroin from Mexico, a drug company owned by the Sackler medical empire released an opiate derivative in pill form meant to alleviate pain. Early on, it is possible that creators, marketers, and prescribers of this plague did not know what they had unleashed. But within a couple of years, it is difficult to avoid the conclusion that great numbers of people within and without the company sold the product in full knowledge of its wicked potency and addictive properties.

Quinones has been researching and reporting on this topic for a couple of decades, and lived in Mexico for ten years, observing the supply-side. Before having a comprehensive understanding of the subject, Quinones thought the heroin problem began with U.S. demand for drugs. After researching the situation in the heartland United States, he has decided that our problem now with heroin and fentanyl overdoses was paradoxically caused by a huge supply of opioid pills, prescribed by doctors in legal clinics, and condoned at every level of society and government in our country.

The story Quinones shares is un-put-down-able and truly remarkable, particularly his discussion of the marketing techniques for black tar heroin used by the small farmer-seller systems first set up by residents of Xalisco. Their method of growing-packaging-selling expansion into the heartland of America should make us sit up and pay attention. Ground zero for the meltdown of middle America is identified by Quinones as Portsmouth, Ohio, a middle class town at the center of a web of major cities like Cincinnati, Cleveland, Louisville, Indianapolis, Pittsburgh. The first known vector of the opioid infection was an unscrupulous doctor who overprescribed pills, knowing they were addicting his patients. Aided by ordinary well-meaning doctors who listened to marketing spiels by the drug makers, and who believed the pills to be non-addictive, the infection spread rapidly. Quinones tells the tale as it unfolded, involving Medicaid scams and cross-state purchases and sales.

What Quinones tells us gives us lessons for many other supply-side problems (marijuana? guns?) we may face in our society, now or in the future. When asked in an interview why restrictions on Class A prescription pills or opiates of any sort would produce the better outcomes, Quinones points out that when prohibited liquor was once again allowed to be sold openly, it was classified as to strength and sold differently. He warns that we are rushing to sales of marijuana with potency levels unknown fifty years ago and may wish we’d instituted some restrictions or controls before it becomes socially acceptable.

This nonfiction is dispassionate enough to allow us time to adjust our thinking around the problem of young people—entire families, really—losing their place in a productive society, with almost no way out. Now, with the recognition of the problem being forced upon our politicians, teachers, medical personnel, and law-enforcement officers, some changes are being instituted which may help after the fact of addiction, never a good time to try and solve a problem. With discussion and buy-in by ordinary citizens it may be possible to attack this problem before it begins.

There are at least seven interviews with Quinones free on Soundcloud, ranging in length from 15 minutes or so to an hour and a half. You have to hear some of these stories. It's mind-blowing. I listened to audio version, very ably read by Neil Hellegers, and produced by Bloomsbury. It is a must-read, must-listen.

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