Monday, November 21, 2016

Dreamland: The True Tale of American's Opiate Epidemic

Book:  Dreamland: The True Tale of American's Opiate Epidemic
Basic Information : Synopsis : Thoughts : Evaluation : Book Group  : Book References : Good Quotes

Basic Information:
 Author:  Sam Quinones
Edition:Hardback from the Mountain View Public Library
Read:November 21, 2016
345 pages
Genre: Drugs, Heron, Oxycotin 
Rated: 3.5  out of 5

  • This book has several threads to it:
  • Medical Community, including Pain Management
  • Pharmaceuticals
  • Law Enforcement
  • Addicts-both of Oxycontin and Heroin
  • The people/pushers from Nayarit
  • A mysterious informant named The Man

Quinones weaves the stories of each showing how opiates got to be easier to get because they were not reported to be addictive and how with the ready availability of heroin, the two became related.

He explores, first how the Perdue Pharma created what they initially thought was an addiction proof opiate called Oxycontin. Then marketed aggressively as addiction resistant. This got doctors hooked as an easy way to treat pain.  As acceptance for opiates grows amongst the medical profession, the prescriptions for them grow-without any oversight.

In parallel, there are sugar cane workers in Nayarit which have figured out how to effectively market heroin with low risk. This first gets perfected along the affluent West Coast clients. The pushers do not sell to African-Americans or Latino's, but to whites. They are safer. As the networks grow more efficient, they move to the East, but avoiding places where there is already a large gang presence-they prefer to go into virgin territory.

How the two forces come together is that as heroin becomes easier to come by than the opiates, addicts switch. Eventually whole towns are decimated through these two drugs. Law Enforcement has a hard time figuring what is happening, except deaths through overdose rises. Eventually people put the correlations together and realize that Ozycontin is addictive and that many of the Oxycotin addicts become heroin addicts.

One of the most interesting parts of this book is how one doctor's astute observation became medical fact. A doctor by the name of Jick had an early database of patients. He noticed how a group of patients, under 30 people, seemed to be doing better with powerful opiate pain medications. In addition, out of the 30, there was only one who became addicted. He wrote up a paragraph in a medical journal and sent it in as a letter. Eventually, this letter became the basis that opiates were the solution to pain with little chance of addiction.  You would have thought that this would have been something which someone would have used as a stepping stone to a larger and more rigorous study before it became fact that opiates could be used without fear of addiction.

Quinones does get a bit snarky about Republicans and their Christianity when he  says that he will count it as Christian forgiveness now that there is a softening of Republican hearts towards what to do with druggies (pg 274). This is because the he drug abusers are now their own voters or even in their own families.

“places that those with aspirations left.” (287) I like the phrase, but hate the abandonment. I think Quinones captures what happens when the drive behind a place leaves. It shrivels up and dies. This is similar to what Jesus says when he casts out demons-if there is a void, something will fill the void and it is not good.

“The front of the brain needs to develop through mistakes.”(293) Is this true? I know we mature through the mistakes we make,  I guess that drugs deaden it and the lust for drugs overpowers anything else.

“Once people get addicted they really lose the power of choice.” (328) Drugs do not give you freedom; they are tyrants.

Sam Quinones has written an eye opening non-fiction book about the usage of opiates in America and the accompanying heroin problem.  In general, I am not a fan of the  interspersing different stories to make a unified whole. One stands a good chance of losing the reader. In this case, each true story is interesting, but because of the complexity of stories, the reader is easily lost in the details.

But stay with Dreamland. It shows how at least one, and probably more, pharmaceuticals decided that making a profit was more important than the health of its clients. How taking a note from American business, a small group of poor Mexicans could streamline operations and make a whole boat full of money with low risk. But before you think, that is just druggies, Quinones brings the problem home to affluent America.

Read this book to understand how easy it is to get addicted by safe medicines. Read this book to understand how hard it is to break an addiction. Read this book to understand how drugs are in your own neighborhood and not in ways you expect.

Notes from my book group:

OSHER Book Group (Kay had asked that we come up with some questions for the group):
  • Was it greed or the push to get a new product to market which made Oxycotin so  prevalent?
  • What role do Levi's 501 jeans play in this whole saga? (LA Times)
  • What did you learn about how legal drugs are sold illegally?
  • Do you think the opiate epidemic is here to stay or is there a vanishing point in sight? (LA Times)
  • Do you see any symmetries between the pharmaceutical companies and the Mexican heroin dealers in terms of business practices? (LA Times)
  • From Academic Life in Emergency Medicine
    • What role do we as Emergency Physicians play in the responsible stewardship of opioid medications?
    • Portions of the medical community were implicit in the initial propagation of prescription opioid use. What actions can we now, as an entire community, do to help combat this epidemic?
    • How can acute care providers, like Emergency Physicians,  fit into a comprehensive multi-disciplinary long-term approach to addiction treatment?
    • How do we combat prejudice, both internal and external, when dealing with a population of patients that rarely engenders sympathy?
  •  From my perspective thre is three big problems: 1) The Xalisco Boys were able to get top grade heron cheap; 2) The economic conditions in their home areas were so depressed and the work was so hard that peddling heron was attractive, despite the risk; 3) there was not adequate controls on how OxyContin was prescribed. Are there other major problems? What would be your solutions to each of the problems?

Book References:

Good Quotes:
  • First Line: In 1929, three decades into what were the great years for the blue-collar town of Portsmouth, on the Ohio River, a private swimming pool opened and they called it Dreamland.
  • Last Line:Back to that place called Dreamland.