In 2015, the book Dreamland hit the United States more or less like a bombshell. The research, interviews and writing of journalist Sam Quinones ripped the lid off our entire situation of addiction to painkillers and heroin. The full structure of our opioid epidemic was laid bare for anyone to see. How did we get into the situation where tens of thousands of people were fatally overdosing on painkillers or heroin each year? Did it develop willy-nilly or were there identifiable causes that could be traced? Anyone reading this book can see with unmistakable clarity that there were causes. Those causes were born in the boardrooms of Purdue Pharma and in the minds of enterprising individuals in the small Mexican town named Xalisco.
Quinones does not make these claims without substantiating them. Backed by extensive research and years of interviewing, he records the milestones along these two paths to our current level of devastation.
The founders of Purdue Pharma launched the whole mess by innovating effective methods to convince doctors to start prescribing their medications over those of other pharmaceutical companies. They had particular success with a time-release painkiller named OxyContin. It took a lot of work on professional, public relations and sales channels to persuade doctors to start freely prescribing this drug to patients with pain. Previously, American doctors carefully avoided the use of drugs like morphine whenever possible because of its addictive potential. But now, selected doctors acting as hired guns and sales reps repeated the message endlessly: OxyContin has little to no abuse potential and is not addictive.
But it was addictive. VERY addictive. Gradually, hundreds of thousands and then millions of Americans became dependent on the drug. Some learned to use it to make life’s problems fade away, indicating full-blown addiction. As addiction takes hold, most people will suffer a severe deterioration of character and quality of life followed by the individual perpetrating whatever action is needed to keep the drugs coming.
In 2007, the federal government began to push back, fining Purdue Pharma $635 million for the fraudulent marketing that triggered this trend. As a result, the world of prescribing and abusing painkillers began to change. Some doctors panicked and stopped prescribing painkillers. Some addicted people ran out of money to keep buying painkillers on the legitimate or black markets. The citizens of Xalisco stepped into this void with a new system of merchandising heroin that made it much easier for all these newly addicted people to find a replacement for their painkillers.
Heroin is chemically virtually identical to OxyContin but up to this point, a buyer would need to drive to an open-air market in a sketchy urban neighborhood to buy the drug. The Xalisco Boys, as Quinones calls them, worked out an innovative system using cell phones and text messages to deliver the product to the consumer in the suburbs, small towns and even rural areas. Suddenly, it was neither hard nor dangerous to acquire this potent drug. And a whole new and terrible day dawned in the United States.
Every family that has ever suffered a loss due to painkiller or heroin consumption should read this book. Every mother who grieved at her son’s graveside deserves to know who started this tsunami of destruction. Quinones paints the picture fearlessly and has backed it up in personal and media appearances and testimony before Congress in the three years since the book was published. If you read nothing else about the opioid crisis, read Dreamland.
Dreamland was published by Bloomsbury Press.