Dreamland: A book review

Dreamland:  The True Tale of America's Opiate Epidemic, Sam Quinones, 2015

For some great background on how the US ended up in the current opioid epidemic, I strongly recommend Dreamland by Sam Quinones.  Its a non-fiction account that ties together Mexican heroin suppliers, the prescription opioid market, as well as a long-list of characters of users, doctors, pushers and manufacturers.

The narrative creates three sets of supply villains:

  1. Mexicans from the small town of Xalisco who produce and distribute black tar heroin,
  2. Perdue Pharmaceuticals that patents and then aggressively markets OxyContin, and
  3. Doctors who create pain clinics to profit from the intense demand for narcotic opioids

The combination of these three groups, creates a network of opioid supply that crawls across the country, enmeshing millions of people into a web of addiction that he describes as "brainwashing".

He describes how the soft inside of a poppy plant can easily be turned into heroin and how the families in Xalisco were able to make it easily and cheaply.   The molecule that is almost pure in heroin, is morphine, and its the same basic ingredient that is in all prescription opioids, percocet, oxycontin, etc.

But the supply is only one half of the story.  The other half is of course the demand for opioids. How did that become so ravenous?  He has a few villains here too:

  1. The morphine molecule that overwhelms the brain's receptors and provides an intense euphoria,
  2. A medical system in the US that was looking for ways to boost patient satisfaction and minimize discomfort, and 
  3. Challenging economic conditions for millions of Americans in areas that were hit hard by de-industrialization.

Quinones does a masterful job of intertwining personal stories and the relentless movement of opioids through the US.   Its an amazing story, sadly the results are all too familiar to anyone reading this.