Dreamland: Review

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Drugs: I’ve always just said no to them, and honestly haven’t given them much thought. Isn’t it just life’s dregs who use them (or “hoods,” as we called them when I was in high school)?

Maybe not. In Dreamland: The True Tale of America’s Opiate Epidemic, Sam Quinones makes a startling case that a whole lot of Americans are hooked on drugs, specifically, on opiate drugs.

I found this tale horrifying and fascinating at the same time. People get hooked on these drugs when they visit a doctor for pain — back pain, pain from an accident, etc. In the ’90s, drug companies made the case to doctors (often through well-compensated sales reps who gave goodies to the doctors and wined & dined them) that opioid drugs were not addictive. Doctors prescribed them to patients, often in large quantities to avoid those same patients coming back again and again. In fact, doctors were cautioned that patients could sue them for not adequately treating their pain. Often, the people taking these drugs became hooked on them.

Another part of this was that these drugs really took off in economically depressed towns across the US. Perhaps if many of the addicts had had jobs, they would have had less time to focus on their pain and seek out relief from it. “Pain clinics” sprang up across the country, but often these were little more than pill mills handing out prescriptions to various forms of opium.

“You think you’re doing stuff the way it’s supposed to be done,” one addict said. “You’re trusting the doctor. After a while you realize this isn’t right but there really isn’t anything you can do about it. You’re stuck. You’re addicted.”

The Fifth Vital Sign

In 1998, the Veterans Health Administration named pain as “the fifth vital sign” which doctors should check patients for. The World Health Organization claimed freedom from pain was a universal human right. Never mind that pain is tremendously subjective — if a patient claims he or she is in pain, doctors were told they had the responsibility to treat it. But Quinones wonders if chasing freedom from pain is always a good idea … “man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.”

Opium Nayarit Connection

Then we have many, many young men from Xalisco, Nayarit, Mexico. The opium poppy grows there, and drug bosses help these men get into the country, send them to the town where they’re needed, and they drive around town, delivering opium to the people desperate for it. They don’t tend to be arrested for this, for a few reasons. They carry the drugs in individual portions in deflated balloons, which they keep in their cheeks. If they’re pulled over, they simply swallow the balloons. They don’t carry guns. They don’t sell to blacks, since they are often violent. Instead, they’re instructed to sell only to whites, who didn’t tend to cause trouble and who usually had ready cash. If a driver is caught, within a day the bosses have him replaced with another seller.

“When my brother went up north, my mother was saying I don’t know how you can sell that garbage,” one Mexican youth said. “But when she saw the money she was very happy.”

Selling Drugs

It wasn’t just the Mexican guys selling the drugs. Many senior citizens with prescriptions for OxyContin and other drugs realized that they could supplement their retirement income by selling their drugs to young adults. Others, on disability for some issue or other, headed to a doctor with their monthly disability check, and the doctors (who worked on a cash-only basis so they could pocket the disability cash) quickly prescribed a generous amount of “pain pills.” Medicaid health insurance covers that prescription every month, for just a $3 Medicaid co-pay. People using thousands of dollars worth of street drugs each month for just a few dollars? It’s happening — quite regularly, in fact.

“Before long, driving a major US metro area with your mouth crammed with balloons of heroin was a viable economic option — kind of like SSI in eastern Kentucky — for a much larger swath of restless young men in and around Xalisco, Nayarit.”

Purdue Pharma Connection

I don’t know much (or anything, really) about drug companies, but a ‘bad buy’ mentioned over and over was Purdue Pharma. About ten years ago, when the scope of this problem was beginning to become apparently, some pain doctors began to suspect that opiate drugs were habit-forming. A few suggested that not every pain claimed by a patient should be met by an increased opiate prescription. Purdue Pharma execs objected to capping a dose on opiates, though.

Is this freaking you out yet? It did for me. My 14-year-old recently had her wisdom teeth out, and she was prescribed 30 hydrocodone pills. This is a form of opium ranked as “highly addictive,” and I ended up not filling the prescription, instead using ibuprofen. Imagine a young adult, on their own, given such a prescription. I can easily see how they could become addicted after trying the drug 30 times.

Indianapolis, the capital of my state, was mentioned as one city the Mexican boys sell from. It was mentioned that many customers come up from IU (where I went to college, and where my daughter now attends). “The kids Pedro sold to were all white, always ready to try out their high school Spanish. ‘Hola, amigo. Como estas? Me gusta mucho la cerveza.'”

As to lessons to take from all this, I like what pharmacology profession Martin Adler says: “Living without pain is a horrible thing. (You can) die young because pain is the greatest signaling mechanism we have.”

The Scioto County, Ohio, coroner felt doctors had failed the public: “They visited incredible harm on the people of America as a profession. Pharmacists did also. Every single pill that was killing people in my county was legitimately prescribed, legitimately filled, legitimately paid for.”

Also read this month:

Remember My Beauties: Review

At the Edge of the Orchard: Review


The Overachievers: The Secret Lives of Driven Kids

What have you been reading lately? I get many of my book recommendations from online friends, so I appreciate your ideas.

You can see what others have been reading at 5MinutesforBooks.

7 thoughts on “Dreamland: Review

  1. Dreamland sounds like a disturbing but important book. I’ve not heard of it, so I’ll click on the sample and start reading that for now. Thanks for sharing!

  2. Well, my goodness, I am total freaked!! I knew the drug problem was bad and your review was very enlightening. A couple of years ago, my surgeon prescribed Hydrocodone for me. After two doses I was itchy all over. Surgeon said to never take it again and to put it on the list of meds to which I am allergic. I found that Extra-Strength Tylenol worked just as well. I wish doctors wouldn’t be so quick to prescribe pain killers. A lot of pain clinics here in Florida have been shut down.

  3. What’s odd is that I know of people in chronic pain with no relief. I wonder if they have doctors who err on the side of not prescribing these kinds of drugs. It seems like there would be a happy medium, but I guess pain’s subjectivity makes it hard to diagnose and treat. I was given hydrocodone, too, after having a tooth pulled a little over a year ago. The thought of it scared me, so I decided to just try Tylenol and see if I could get by with it, and it worked fine – no need to try the other. But I wish there was a better solution for those in chronic pain.

  4. I could easily get hooked on opiates. I have enough chronic conditions so that I could ask for it regularly. And I’m not opposed to taking one or two when I need them. But thankfully, I realize how addicting they are and have been able to get by on Extra Strength Tylenol. I recently met someone in the health care industry who says her son, an upstanding young, Caucasian man has gotten addicted and just doesn’t know how to get off it. She told me he has considered suicide many times. It all goes back to self-discipline. One must control oneself.

  5. Good review. As this weekend showed, I’m living in an area highly impacted by these drugs. Every vacant billboard has been re-done by the government with Heroin Kills and the like. Ixy and Meth were the scourge 7 1/2 years ago when we moved here. Today it’s heroin and probably something newer. Meth-mouth is a common sight. So sad. So needless. I sometimes say that my Mom and I are the only non-tobacco users in the county (tobacco is still grown here), let alone the worse stuff. I’ll read the book, but I honestly don’t expect to be too shocked. Nearly ever arrest in a 3 county area is drug-related in some way. Either drug–induced violence, drug-induced stupidity or drug-induced greed gone bad.

  6. This dreamland review is a good one- I want to read this- such a pervasive, and important issue for anyone, anywhere!

  7. I found your blog when I was looking for new books to read. I also live in an area highly impacted by the narcotic trade. We just had an entire family slaughtered in S. Ohio probably because of the drug trafficking in the area. I had a shoulder repair a year ago and my surgeon gave me Oxycontin and Morphine. I asked why the heavy drugs and she told me I would need them. I never needed them. When I went in for my stitch removal, the nurse started writing out the Rx for more pain pills. I told her I hadn’t taken any of the first batch. She was surprised. No one asked me if I needed them. But I know people in my family with cancer that can’t get pain medication because doctors are afraid of addiction. Even though they are terminal. The entire medical system needs overhauled and doctors retrained. The world has gone crazy.

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