Dreamland: The True Tale of America's Opiate Epidemic Info

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Winner of the NBCC Award for General
Nonfiction


Named on Amazon's Best Books of the Year
2015--Michael Botticelli, U.S. Drug Czar (Politico) Favorite
Book of the Year--Angus Deaton, Nobel Prize Economics
(Bloomberg/WSJ) Best Books of 2015--Matt Bevin, Governor
of Kentucky (WSJ) Books of the Year--Slate.com's 10 Best Books of
2015--Entertainment Weekly's 10 Best Books of 2015 --Buzzfeed's
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of 2015--Seattle Times' Best Books of 2015--Boston Globe's
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2015--The Guardian's The Best Book We Read All Year--Audible's
Best Books of 2015--Texas Observer's Five Books We Loved in
2015--Chicago Public Library's Best Nonfiction Books of
2015

From a small town in Mexico to the boardrooms of Big
Pharma to main streets nationwide, an explosive and shocking account of
addiction in the heartland of America.

In 1929, in the
blue-collar city of Portsmouth, Ohio, a company built a swimming pool
the size of a football field; named Dreamland, it became the vital
center of the community. Now, addiction has devastated Portsmouth, as it
has hundreds of small rural towns and suburbs across America--addiction
like no other the country has ever faced. How that happened is the
riveting story of Dreamland.

With a great reporter's
narrative skill and the storytelling ability of a novelist, acclaimed
journalist Sam Quinones weaves together two classic tales of capitalism
run amok whose unintentional collision has been catastrophic. The
unfettered prescribing of pain medications during the 1990s reached its
peak in Purdue Pharma's campaign to market OxyContin, its new,
expensive--extremely addictive--miracle painkiller. Meanwhile, a massive
influx of black tar heroin--cheap, potent, and originating from one
small county on Mexico's west coast, independent of any drug
cartel--assaulted small town and mid-sized cities across the country,
driven by a brilliant, almost unbeatable marketing and distribution
system. Together these phenomena continue to lay waste to communities
from Tennessee to Oregon, Indiana to New Mexico.

Introducing a
memorable cast of characters--pharma pioneers, young Mexican
entrepreneurs, narcotics investigators, survivors, and parents--Quinones
shows how these tales fit together. Dreamland is a revelatory
account of the corrosive threat facing America and its
heartland.


Average Ratings and Reviews
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Reviews for Dreamland: The True Tale of America's Opiate Epidemic:

5

September 3, 2015

Nicely researched, enjoyable read...but chronic pain sufferers get short shift
This was a thoroughly researched book and I enjoyed Mr. Quinones's writing style. I was able to get clear mental pictures of the places and people he describes. I had no idea of the heroin trade and while I was aware that heroin addiction had spread to the heartland alarmingly, the complex system of the cartels was certainly eye opening. I also was vaguely aware of the 'pill mills' going on in Florida and other states primarily in the eastern part of the US, after reading this book I can say I not only know but am alarmed at how easy it was to get a Medicaid card and rake in big bucks selling Oxycontin on taxpayer money. I also agree that Big Pharma hid the dangers of Oxycontin and went ahead with a big push to doctors to prescribe it.
On the other side of the coin, I have suffered from Fibromyalgia for sixteen years and the premise that pain can be controlled solely by physical therapy, nutrition, counseling, acupuncture without medication is bunk. It might help in the short run, but at the end of the day you are still in pain. Only those who have chronic pain can fully understand what others in chronic pain are going through. I do not take Oxycontin because when it was given to me as a trial I recognized its potential to be a problem, I had the unwanted and unneeded euphoria and after it wears off the pain is +1000 than what it was before. I chose to stick with my regular medication, tramadol. As much as I definitely agree that the wild and irresponsible prescribing of opioids needed some strong checking, unless you have lived a day in the life of someone who is in terrible pain, denying pain control is a cruelty in my humble opinion. Not everyone who needs pain medications is taking them for recreational fun. If Big Pharma or pain doctors came out with something that could ease pain that has no interest to those merely looking for a buzz, believe me a lot of us would gladly use it.
5

Apr 12, 2015

There are not enough stars in the rating system to accurately explain how important this book is. There isn't a home that should not have a copy. Dreamland by Sam Quinones is the single most well researched, well written, and heartbreaking account on the plague of opiate addiction. I can tell you this confidently because I am an oppiate addict, who has been clean for five years. Dreamland will take you not only through the history of opiates but to living rooms of white suburban American who has There are not enough stars in the rating system to accurately explain how important this book is. There isn't a home that should not have a copy. Dreamland by Sam Quinones is the single most well researched, well written, and heartbreaking account on the plague of opiate addiction. I can tell you this confidently because I am an oppiate addict, who has been clean for five years. Dreamland will take you not only through the history of opiates but to living rooms of white suburban American who has fell victim to this epidemic. I started highlighting passages throughout the book but had to stop because my entire kindle copy was yellow. Every word is important and every story heartbreaking. Every fact astonishing but true. I thank Sam for keeping this conversation going and for bringing research and heart to the table.

I will never forget the day I could actually announce I was free from pain pills for a year. During the height of my addiction I went to more funerals than weddings. Being in my early thirties, this is a horrible truth. When I was able to announce that I seemed to be winning my fight on opiates I did so on Facebook. The next day my message in box was full from friends and family asking me for help because they to had a problem or a loved one with a problem. I was shocked. I am a 38 year old white women from the burbs. I owned a home, have an amazing husband and child. Opiates gave me a sense of happiness I had never been able to acheive on my own. Then it slowly and systematically dismantled my life. We lost our home, our cars, my 80k a year job, but I am one of the lucky ones. I did not lose my family or my life.

Addicts are no longer the stereotypical image you have or have had and I believe this book does an amazing educating people who may judge. Addiction is a disease and does not discriminate. Please read Dreamland and let it open your eyes or if your struggling, know you are not alone.

This book does not read like a medical journal, it is not boring. It is so well written that it felt more like a conversation. It will educate you as to how it's brought to our country and put a face to both the dealers and the addicts. It's simply the best book on our opiate epidemic that I have ever read.

Thank you Netgalley and publisher for the advanced copy in exchange for an honest review. ...more
5

October 28, 2016

It's a disgrace and a cultural regression that Sam Quinones has brilliantly brought to widespread public awareness with his book
I'm an Obstetrician who is dealing with the repercussions of the opioid epidemic and countless babies struggling in the throes of neonatal abstinence syndrome (withdrawal).
A whole generation of innocent babies afflicted by Purdue Pharma., JCAHO, quacks, charlatans, and savvy heroin dealers. It's a disgrace and a cultural regression that Sam Quinones has brilliantly brought to widespread public awareness with his book.
3

Jan 26, 2019

The Spirit of Capitalism: A Case Study

Adam Smith said it first: ‘Greed is good.’ According to him and his intellectual and political descendants, the desires of individuals form a self-regulating economic system which is advantageous to everyone. The rich do get richer, but so do the poor. It’s called capitalism: having and meeting needs through honest competition without interference from bureaucrats, politicians , or government agencies.

And capitalism works. It does exactly what it says on The Spirit of Capitalism: A Case Study

Adam Smith said it first: ‘Greed is good.’ According to him and his intellectual and political descendants, the desires of individuals form a self-regulating economic system which is advantageous to everyone. The rich do get richer, but so do the poor. It’s called capitalism: having and meeting needs through honest competition without interference from bureaucrats, politicians , or government agencies.

And capitalism works. It does exactly what it says on the packet. Dreamland is a testament to the power of Adam Smith’s theory. The Sackler family and Purdue Pharma spotted a need - unrelieved pain - and they met that need with a ‘killer app’ known as OxyContin. They lobbied for the easing of government restrictions on its use, and employed their formidable marketing skills to sell it to every MD and health care institution in the country. A capitalist win/win success story: less misery, more wealth.

Except there is what economists call an ‘externality.’ Like so many other pharmaceutical breakthroughs in the last half century (Valium was another of the Sackler family marketing successes) OxyContin is really, really addictive. Great for the company who can count on continued rising sales; not so great for the individuals who are dependent on the stuff and have to pay for it, or for the public health and social services that have to deal with the consequences.

But once again the capitalist system demonstrated its ability to respond creatively to issues it might encounter. OxyContin is costly. Its market price has to recover some huge R&D expenses as well as equally huge corporate overheads. Global marketing, for example, doesn’t come cheap. The situation is a Harvard Business School case study in competitive opportunity. Product innovation and a radically new low cost delivery system comes to the rescue of the monopolistic market.

The product is black tar heroin, a low tech high yield pain-killer that costs peanuts to make. Conceivably anyone could have entered the OxyContin market developed over years by the Sacklers; but it was an entrepreneurial group of rancheros on the Pacific coast of Mexico who grabbed the brass ring first. Clever enough as well to avoid the established marketing channels for white heroin (a specialité de la maison of the large, and consequently dangerous, illegal cartels in the big cities), these Mexicans became the WalMart of the drugs world, spreading widely and rapidly across rural America.

Like WalMart, the Mexicans piled it high and sold it cheap. Also like WalMart, they had a fantastic logistics system to supply their nationwide network, using low wage, easily replaceable drivers from the Mexican homestead. Interruptions like police arrests and confiscations were therefore about as serious as an occasional flat tire or speeding ticket. A simple telephone call and the operation was back on the road. Writing off an occasional lost load was trivial given the minimal cost of goods sold. And even this risk was mitigated by the standard financial business tactic of ‘portfolio diversification’ through franchising - too many eggs were never in any one basket.

But unlike WalMart, customer service was a priority in the black tar heroin trade. With another phone call, the Mexicans delivered to your door, or the toilet of your nearest McDonald’s, with the speed of Amazon. Special introductory and volume discounts, periodic sales to promote turnover, local mouth to mouth advertising, incentive compensation, and other standard commercial techniques completed the value-proposition. Absence of fixed assets meant that resources could be re-allocated as required for maximum return. The market boomed and so did the business.

Of course quality control often might not be what it should have been. Product strength and purity wasn’t quite as uniform as OxyContin. But no doubt these hiccups would be ironed out over time. The casualties (mostly infections from muscular injection), deaths (dosage is hard to judge) and costs of emergency services (notably medical rather than police) for the most unfortunate customers were merely part of a business learning curve. In any case an entire sub-culture emerged across America that became increasingly savvy to the new product. Caveat emptor was never a more serious command.

America isn’t unfamiliar with illicit drug use. What makes the black tar heroin market political however is that: 1) it is dominantly white people who are its customers; 2) these people are mainly middle class from the towns and regional centers of the ‘heartland’; 3) it is a market created by pillars of the existing capitalist society - the pharmaceutical industry and the medical profession; and 4) it is organized and run not by international mobsters and terrorists but by a bunch of Mexican sugar cane farmers with a real can-do attitude and entrepreneurial spirit.

That’s the story told in Dreamland. The bulk of the book is journalistic detail, largely anecdotal, about representative ‘players,’ their victims and their families in the legal and illegal drugs game. In good journalistic style, Dreamworld is long on description of people, places and things but short on analysis and productive opinion. So the content of the book doesn’t go much beyond a television documentary. As an introduction to the issue, the book is worthwhile. But serious students of the problem will probably want to look elsewhere for actionable inspiration.

Postscript 31Jan19: Capitalism is truly irrepressible: https://www.propublica.org/article/ox...

Postscript 20Jul19: Still at it: https://www.washingtonpost.com/invest...

Postscript 20Jul19: Forget Purdue Pharma. SpecGx is 10 times bigger: https://www.washingtonpost.com/graphi... ...more
2

Feb 04, 2016

It only took me a month, but I'm finally done! Whew.

But it was the United States...that now consumed 83 percent of the world's oxycodone and fully 99 percent of the world's hydrocodone...people in the United States consume more narcotic medication than any other nation worldwide.

Dreamland is the story of the surge of opiate addiction in the mid 90s / early 2000s in the United States. Facilitated by the massive prescribing of new "miracle dug" Oxycontin, new changes in the attitudes around It only took me a month, but I'm finally done! Whew.

But it was the United States...that now consumed 83 percent of the world's oxycodone and fully 99 percent of the world's hydrocodone...people in the United States consume more narcotic medication than any other nation worldwide.

Dreamland is the story of the surge of opiate addiction in the mid 90s / early 2000s in the United States. Facilitated by the massive prescribing of new "miracle dug" Oxycontin, new changes in the attitudes around managing pain, and the surge of black tar heroin coming up from Mexico, all colluded to form a sort of perfect storm that sprouted pill mills and rampant addiction.

For those who don't know, I have worked in pharmacy for roundabouts four years. I LOVE my job. I get to play with drugs all day, help patients, and work with some pretty awesome people. I also have a pretty good idea of what Dreamland talks about when it discusses Oxycontin, overprescribing, addiction, and how it affects those with legitimate pain.


Approx street value:(view spoiler)[$12,000 (hide spoiler)]

So despite the fact that so much of this relates to my work life, I was less than impressed. Number one, this was VERY repetitive. I mean, I understand if you tell me about a concept in chapter two, go ahead and give a quick refresher in chapter twenty-three. That's cool. But this was almost like every single chapter was written without reference to each other.

I started skimming towards the end. You could cut out a good 30 or 40% of the book without losing anything of importance.


Approx street value:(view spoiler)[50¢. Reese's pieces! (hide spoiler)]

There was also a lack of characters. Not like fictional characters, but real life people that are developed throughout the book. For example, What Stands in a Storm: Three Days in the Worst Superstorm to Hit the South's Tornado Alley, is a FANTASTIC nonfiction book, in big part because you get to know the people so well. The people in Dreamland aren't given enough attention.


Approx street value:(view spoiler)[Worthless, unless you are a cat. This some quality catnip! (hide spoiler)]

I can't really recommend Dreamland. The subject matter is absolutely interesting, but the presentation is extremely repetitive.

If you can manage to get through this without skimming or falling asleep, you deserve a damn trophy. ...more
2

May 28, 2015

There are so many problems with this book.

I don't really take issue with the writing, although, as other reviewers have pointed out, it can become repetitive. And there were sides to the story that I'd never heard of in depth before, such as the rise of the "Xalisco Boys," who comprise the nation's new drug dealers, or the overzealous, irresponsible marketing of drugs. But the problem is primarily one of oversimplification. This book tells us over and over how the problem of America's opiate There are so many problems with this book.

I don't really take issue with the writing, although, as other reviewers have pointed out, it can become repetitive. And there were sides to the story that I'd never heard of in depth before, such as the rise of the "Xalisco Boys," who comprise the nation's new drug dealers, or the overzealous, irresponsible marketing of drugs. But the problem is primarily one of oversimplification. This book tells us over and over how the problem of America's opiate addiction began with treatment of pain, and it not-so-subtly places a good chunk of the blame at the feet of both sufferers of chronic pain and the doctors who treat them. In about 350 pages, there are only four or five sentences suggesting that pain is as desperate a problem as addiction, or that patients suffering from chronic pain should be treated for it.

The author describes the system of selling black tar heroin at great (great, great) length, describing the young men who come from one rancho in Mexico to the U.S. to sell it and how ingenious their system is. I found it troubling that he clearly has compassion and respect for these men as trying to achieve a better life for themselves and their families, as just working hard, and (over and over) as not being seen as the stereotypical bad-guy dealer by the addicts they provide with heroin. It's troubling because, in direct contrast to the way these hardworking, organized groups sell heroin, at the same time, the greatest blame for addiction is placed at the feet of people suffering from chronic pain -- which is continually described as "back pain, headaches, fibromyalgia," as if 1. all types of back pain were alike, 2. ordinary headaches are the same as migraines or cluster migraines (if you don't know, the best description of this difference is Mark Twain's famous simile about a lightning bug and lightning), and 3. everyone knows and understands fibromyalgia, which most doctors will tell you they do not.

Pain patients are stigmatized from the start as patients who "wear doctors down" with their needs and complaints, who pester them at all hours, who play fast-and-loose with their pain medications and become addicted as a consequence, followed by, inevitably, the jump from medication to heroin. I find it interesting that while the author spoke to heroin sellers, addicts and former addicts, grieving parents, concerned law enforcement, and scrupulous and unscrupulous doctors, he could not be bothered to find a single patient with chronic pain and ask that patient what his or her life is like. That would've resulted in a different, and perhaps larger, book, but it also would've contradicted the thesis the author set up, which is that pain meds are responsible for most American drug abuse.

Who gets very little of the blame? I don't want to blame addicts here, because they're suffering as surely as people with severe chronic pain, and because they need help rather than incarceration in many cases. But over and over, the author describes patients who either don't take their medications properly in the first place or suddenly decide to crush and snort or liquefy them, which invariably leads to heroin use. I find this astonishing. That's a huge jump -- it's the equivalent of wading in a backyard inflatable pool and then jumping directly off a pier into the ocean. This is not a step that most people will take, or even consider, but it's presented here as a natural step for patients with severe pain: of course they'll abuse this drug, and they're probably malingerers, too. (There are plenty of those in the book as well.)

Something else that comes up over and over, and more truly lies at the heart of the interest in addiction in America: when young people take pain medications recreationally, even the author notes over and over that they try them at a party, or for a quick rush. This is completely glossed over, again probably because it doesn't fit the story he's trying to tell: it doesn't come across as such a tragedy if people took drugs they weren't prescribed for fun, would it? Someone other than pain patients and the doctors worn down by them would have to accept a share of responsibility. It's also worth noting that over and over, people refer to young addicts as "good" kids from "excellent" families, the sons and daughters of middle- and upper-class parents who were seduced by this very dangerous drug, which most of them had no reason to take in the first place. The kids affected by heroin addiction are overwhelmingly presented as good, white middle-class kids. And that's why addiction suddenly matters to so many people: it's not a poor kid of color from an inner-city tenement who's shooting up and stealing from Mom and Dad for drug money, it's a popular kid with a well-off family. No wonder so much blame is placed on those in chronic pain: it certainly can't be placed on these nice white kids from excellent families.

I would strongly suggest that, if you read this book, you also take the time to read A Nation in Pain by Judy Foreman, which will provide a clearer understanding of pain and how it affects people, including the nation's hundreds of thousands of people who suffer or have suffered chronic pain -- none of whom was interviewed for this book. But I know most people aren't going to read that. My fear is that people will read this book, accept its thesis as fact, and chronic pain sufferers are going to be stigmatized further than they already are. While addiction is now widespread enough that addicted young people, especially if their excellent, white, affluent family has good insurance, can seek and find helpful treatment, people in pain have to wade into a swamp every time they seek medical help. An emergency room is very likely to give them an ineffective, inadequate drug, or just categorize them as drug-seekers and send them home. A new doctor may do the same. The irony is that people who get addicted after recreational use have made it harder for the patients who actually need the drugs addicts abuse to get them.

The title, "Dreamland," comes from a metaphor comparing a public pool in a rust-belt town, which had a lovely heyday and then fell into disrepair and closed. And that would be an apt metaphor, except it suffers from the same problem as the book's thesis: those good old days when kids played kick-the-can and parents left their doors unlocked and everyone went to Dreamland weren't so good if you weren't middle-class and white. Then, you found the pool segregated for years, and probably had less recreational time because you worked from a young age. Those good old days weren't so good. Similarly, if you have pain, now it's going to be even harder for you to seek help for it. No parent of a chronic pain sufferer goes to Washington to lobby for his or her child, wearing a colorful button with a photograph on it. Very few patients themselves could do this, because you are constrained when there are days you can't get out of bed due to pain. But laws are being written by politicians who are affected by parents who lost their children to a drug that was abused either in its use or by being taken recreationally. I dread to think of the assumptions that will be made if lawmakers read this book and treat it as unchallenged fact.

...more
5

January 10, 2017

Stunning.
This book rocked my world. Shocking to me in many ways. The combination of misinformation, desire for monetary success, and ingenuity in "beating the system" created such havoc in this country. I won't be be able to forget this book.

I spent half my childhood in Portsmouth, and visited it occasionally in the 1990s and 2000s. I saw the changes, but was unaware off the depths of corruption. I was stunned. Completely stunned.

The author closes with news that Portsmouth is in recovery; I hope they defy all the "coasters" and cynics. I'll be looking for a way I can help even if in a small way.

On the downside, I do wish the author hadn't referenced the delivery system as "like pizza" so many times; I got the point and the repetition made me hungry for Domino's.
5

May 29, 2017

This Should Be Required Reading--For Everyone
This should be required reading--for everyone.

"Dreamland: The True Tale of America's Opiate Epidemic" is the tragic, frightening and prescient story of the heroin and opiate epidemic in the United States. And if you think none of this applies to you, that is all the more reason to read this book. Although it's especially corrosive in the heartland of Ohio, this is a nationwide problem, and we all need to be educated.

Reading more like a novel or a detective story, this cross between journalism and storytelling traces the "perfect storm" that led so many people--from professionals to prostitutes, teachers to cheerleaders--to became hooked on painkillers. Occurring in tandem was the uptick in heroin addictions, led primarily from high-quality "black tar heroin" from Mexico with dealers following business models that rival the nation's best-run corporations and delivery methods as efficient as your favorite pizza parlor. And then all hell broke loose when the paths of opiates and heroin crossed.

For five years author Sam Quinones did prodigious on-the-ground research to write this book that is on the one hand the most fascinating tale I have read in ages and on the other scarier than anything Stephen King could dream up--because this is real. And it's in your community. Find out how young men from Xalisco, Nayarit, a tiny village on the Pacific Coast of Mexico, became heroin entrepreneurs in the United States using methods that confused and confounded local law enforcement. Find out how Big Pharma embraced nefarious marketing methods for painkillers, especially OxyCotin, to convince family doctors to write millions of prescriptions. Find out how doctors, who were taught in medical school to be wary of prescribing addictive painkillers, found their hospitals' accreditation was at risk if patients were not aggressively treated for pain. Find out about quack MDs, who set up pill mills in hard-hit communities in southern Ohio and eastern Kentucky, became extremely wealthy off the residents' addictions. Find out how Walmart became an unwitting accomplice in the scourge of opiate addiction.

But there is hope. A lot of hope. The book ends on a positive note about all that is being done--finally--to fight the opiate epidemic, especially in southern Ohio.

"Dreamland" is compelling , riveting and eye-opening because it is not only the story of what has happened, but also the tale of the people--the individual lives--who got caught up in it. I gave this book five stars, but I would give it 10 if I could.
5

May 30, 2017

5 Stars!
One of the MOST important and riveting books I've read in a long time - and that is not an exaggeration! I rarely give 5 stars but this one deserves it. An incredible journey and comprehensive telling by perhaps one of our best living journalists of what went wrong leading to the opiate-heroin-drug-overdose-death epidemic in America, how easily opiates evolved into a heroin epidemic, ravaged small town America and then spread well beyond into comfortable communities of privilege.

I came upon this book delving into trying to understand what has been going on in this country (starting with Hillbilly Elegy), and why despite reading broadly than most, I was so taken aback by the Nov'16 election outcome. The factors are myriad - and that journey continues - but what became obvious to me was that the opiate crisis particularly in places like Portsmouth Ohio or the Appalachia created much of the senseless destruction that contributed to it. It's only when that crisis reached "us" with the death of people like Philip Hoffman Seymour in 2014 did we even begin to pay attention. But it was too late. Given the garbage heap of non-essentials that the media shoves at us they largely missed the urgency of this story. Death due to drug overdoses exceeded those from car crashes as early as 2007!!! YES you read that right - 2007 - nearly a decade before we paid attention. How broadly was that publicized, and how deeply investigated? Thankfully for us there are journalists out there like Sam Quinones who researched it for 5 years and then wrote this tome.

Besides being a great read because of his fantastic narrative style and passion for getting to the bottom of it, Quinones brings together a complete picture of all that played here. The opiate-heroin crisis resulted from a PERFECT STORM of varied factors coming together -
-- the drastic swing in the pain management pendulum with a change towards prescribing opiates starting in the '90's willy-nilly to one and all under the misguided - and to some extent deliberate - notion that they are not addictive when prescribed for pain "pain soaks up the euphoria"! There was no "data" or "study", instead a small paragraph in a letter to an editor of a medical journal that set this off. No one asked questions or asked to see the source! The man who wrote the paragraph had no intention nor data to support what was inferred.
-- unethical companies like Purdue Pharma taking advantage of this new fad, pushing their drug(s) esp. OxyContin on anyone with ANY pain creating drug addicts who would never have gotten there. Purdue knew the "data" was faulty and that new addicts were being created everyday yet they pushed it hard until the end,
-- unethical, often "quack" pill doctors who appeared at mushrooming "pain clinics" everywhere to provide willing Rx for OxyContin; they only took $250 in cash per visit!
-- unlimited and unchecked Medicaid card, SSI, disability benefits that funded the pills; a medicaid card enabled you to get pills with a $3 copay that you could resell for thousands of dollars. One reason for the millions who are not employed nor looking for work...
-- the appearance of black tar heroin from Mexico for which OxyContin happened to be the perfect gateway drug a lot cheaper and better quality (high potency) than the white powder; OxyContin traveled west and black tar heroin traveled east and the invasion was complete!
-- a new business model for selling heroin via near unbreakable Mexican drug dealing cells where the heroin is delivered like pizza to customers along with great service by salaried drivers!
Yes that's how crazy it got -- and we are only now beginning to understand and unravel let along address! Read on for an amazing book and incredible journey of learning.
5

May 16, 2018

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 rancho Xalisco marketers came up 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 rancho 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 caused paradoxically 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 available 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. ...more
5

May 02, 2015

Extraordinary Investigative Journalism

I have been an American cardiologist for many years. I've had little awareness of the many thousands of deaths caused by the narcotic epidemic described so well in this book. The strangling web of causes, you will learn, includes misinterpreted medical research leading to deadly malpractice, shady doctors, the rusty economic meltdown, the easy penetration of Mexican heroin into the U.S., the economic desperation of Mexican small town culture, highly Extraordinary Investigative Journalism

I have been an American cardiologist for many years. I've had little awareness of the many thousands of deaths caused by the narcotic epidemic described so well in this book. The strangling web of causes, you will learn, includes misinterpreted medical research leading to deadly malpractice, shady doctors, the rusty economic meltdown, the easy penetration of Mexican heroin into the U.S., the economic desperation of Mexican small town culture, highly effective just-in -time drug marketing techniques and even low pay at Walmart. This is insightful sociology told in the form of brief biographies. While sometimes repetitive, the overall effect of the book is devastating. This should be required reading for health professionals, law enforcement officials and legislators. The problem is far from over. This book will shock many awake.
The author has done brave work -- the Waltons, Pharmacy execs, and the cartels will not be happy readers. ...more
5

Mar 02, 2018

Quinones weaves together two themes to help explain today’s opiate and opioid epidemic. He uses the term opiate throughout to refer to both so I will too. Theme one is the story of the dramatic spike in the use of painkillers, particularly oxycodone. This culminated in pill mills that devastated many communities. Theme two is the spread of black tar heroin taking advantage of those already addicted to prescription painkillers. The heroin comes from a Mexican sourcing and distribution network Quinones weaves together two themes to help explain today’s opiate and opioid epidemic. He uses the term opiate throughout to refer to both so I will too. Theme one is the story of the dramatic spike in the use of painkillers, particularly oxycodone. This culminated in pill mills that devastated many communities. Theme two is the spread of black tar heroin taking advantage of those already addicted to prescription painkillers. The heroin comes from a Mexican sourcing and distribution network dubbed the Xalisco Boys. Quinones, a journalist, builds his narrative through many short vignettes alternating between his main themes. These profile addicts, parents, dealers, doctors and law enforcement.

The ascendance of painkiller addiction begins with a change in accepted medical practice in the late 1980s. In response to an institutional reluctance to prescribe opiates even when clearly indicated, doctors swung to the opposite extreme. The drug companies, particularly Purdue Pharma, played a major role in this movement. Arthur Sackler, whose name graces many museums and medical facilities, founded modern drug marketing in the 1950s using extensive advertising and direct sales force calls on physicians. His first campaign for Pfizer, then a small chemical company, catapulted terramycin into widespread use. In the 1960s and 70s Sackler made valium the first billion dollar drug.

Then along came Purdue in 1996 with its continuous release oxycodone called OxyContin. This powerful opiate came just as prescribing opiates for all types of chronic pain, not just surgery and cancer, became accepted practice. Purdue marketed OxyContin as non-addictive and it backed up this claim with slick presentations given by a well-trained sales force. With a huge potential market of people suffering from everything from bad backs, fibromyalgia, toothaches, minor injuries, etc., Purdue spared no effort or expense in getting its message to doctors. The message was that continuous delivery blunted the highs and lows that fostered addiction.

Even the FDA chimed in approving a label stating OxyContin’s delay feature meant less risk of abuse. Accepted for many years, we now know these claims are wrong. Taken as prescribed OxyContin does deliver a hefty high and for those in a hurry it was easy to dissolve the outer coating in water or suck it off to remove the continuous release feature. Then to get the entire dose at once simply smash it and snort it or mix with liquid and inject – voilà. In 2001 OxyContin sales exceeded a billion dollars. Sales weren’t broken down between recreational and medical users. “Hillbilly heroin” took over Appalachia. Rehab clinics filled with OxyContin users whose addiction was indistinguishable from heroin users.

At first addiction increased through well-meaning doctors following Purdue’s advice and prescribing OxyContin for a wide variety of pain. But quickly the pain clinics turned up and most were pill mills with doctors who wrote prescriptions for cash. In some states they could also operate pharmacies and fill the prescriptions themselves. With all the pills floating around, recreational users got into the action, particularly high school and college kids. Appalachia became an epicenter of the pill mills. Contributing to this were all the people who had sought disability income as a replacement for their lost jobs.

Quinones illustrates with the southern Ohio town of Portsmouth and the pain clinic run by David Proctor. Everyday outside Proctor’s clinic were long lines of disheveled people stretching out through the parking lot and into the street. Proctor was full service. He would file workman’s comp claims and had his own pharmacy. Just have the cash and everything’s taken care of. It takes very little time to become addicted so repeat business is good and every time patients return they need even more pills.

Eventually Proctor lost his medical license. Having sex with patients in his office in trade for prescriptions didn’t help his case. But even though he could no longer work at the clinic, he still owned it. He hired 14 doctors who were desperate for jobs and grew his business. As clinics spread, a number of them were owned by people with no medical background who hired willing doctors often with spotty records. Eventually the law caught up with Procter and he served eleven years in prison.

Other ways to make money off the pills proliferated. Those with a little cash in their pockets could pay for the visits of others taking half the pills in return. They could either sell or use their share. One enterprising individual named Mary Ann repeatedly reproduced an MRI of an injured person changing the name on each copy to give to those she drove to the clinics. To reduce the cost of the drugs she sought out individuals with Medicaid cards. As the pill mills grew so did those applying for Social Security Disability. With these credentials non-addicts could make good money selling pills. Someone making $500 a month could sell their pills for thousands each month.

Those who built businesses paying for addicts visits could support a very comfortable lifestyle making thousands on each trip. In places like Portsmouth and other parts of Appalachia OxyContin pills became currency at one dollar per milligram. OxyContin came in 40 and 80 milligram doses. Junkies stole to support their habit trading merchandise for pills. Half the store tag price was the accepted value in trade for pills. Entrepreneurs like Mary Ann would place orders with junkies for what she wanted and pay in pills. She even bought a car and paid her dentist with pills. The most successful pill entrepreneurs were not addicts.

The U. S. became the world leader in per capita narcotic medication consumption. And much of it was for recreational use with 25 million non-medical users of prescription narcotics in the first decade of the 21st century. The average age was Twenty-two. In 2011 there were 488,000 emergency room visits in the U. S. for from prescription painkiller abuse. In 2012 one person died every half hour from opiate overdose.

In 2006 the U.S. attorney for the western district of Virginia, Republican John Brownlee, brought a case against Purdue for criminal misbranding taking on Purdue’s claim that OxyContin was not addictive. But first he was contacted at home by a Department of Justice official. This was during the Bush presidency. The official told Brownlee to slow down his case against Purdue. Brownlee refused and immediately found his name on a list of U.S. attorneys to be fired. Brownlee kept his job but believed he was listed for not caving to political pressure. Purdue agreed to a plea deal paying $635 million and a felony count of misbranding. Some executives were placed on probation. As one witness who lost a son to OxyContin said at the sentencing, “You are nothing more than a large corporate drug cartel.” This makes a good segue to the second theme.

The Xalisco Boys, as Quinones calls them, came from rural villages around the town of Xalisco in the Mexican state of Nayarit. This was a very poor area where young people faced a bleak future. Everyone was related in networks of interwoven clans. In the nearby mountains Cora Indians grew poppies. Some enterprising Nayriot residents learned to cook the poppy goo into black tar heroin. It was pure, potent and consistent. The black tar was taken to the U.S. and distributed in a unique and brilliant operation that could be called corporate except there was no hierarchy only individual cells with individual bosses. Since everyone involved knew each other or had relatives in common, there was no violence within and between cells and their methods were consistent.

In the 1980’s, the Xalisco Boys began drug trafficking in the San Fernando Valley. In the 1990’s they spread across the country to handpicked cities, choosing ones without established drug gangs and with Mexican communities to blend in with. They established cells in Reno, Portland, Salt Lake City, Boise, Denver, Santa Fe, Columbus, Nashville, Charlotte and many other similar sized cities. They never went to New York, Baltimore, Philadelphia or the like where they would have faced violent drug gangs.

The cell boss hired drivers, usually 17 to 30 year old relatives from the same village. The boss paid to get them across the border. He provided them with “company” cars, “company” apartments and food. They were provided beepers or cell phones when they became available. Each driver would carry small balloons filled with a single dose of black tar heroin. He kept these in his mouth and swallowed them if approached by police. If swallowed they would pass through his system. After a few months’ work the boss replaced them sending them home with the salary they earned, clothes they bought and gifts for their family and friends. The bosses would switch out too and go home with their money and fancy gifts, live it up and spend to impress, and then return to the same or new cell in the U.S. They were not moving to the U.S. They were building big homes back in Xalisco.

The cells would start up by giving out free samples in front of the local methadone clinic or other addict hangout. Included with the sample was a phone number to call for more. The price was reasonable, the product potent and uncut, and delivery to your street corner free. Because the drivers were salaried they had no incentive to mess with the price or the drug. They marketed like a corporation, giving free doses to addicts who brought them new customers. They gave away free heroin to get addicts to take them to new areas, even new cities, and introduce them around.

Prior to the Xalisco Boys the heroin available in the U.S. was powder cut down many times from source to addict. It was unreliable, expensive and available typically in dangerous places run by gangs and watched by police. The Xalisco system was much safer for the addicts. Drivers were never armed and avoided violence. The Xalisco model avoided trouble with police. Even if a driver was caught the small amounts were considered petty and below the radar of the DEA. The driver who was related to the boss would remain loyal and would be deported. It was many years before police and federal agents finally put the pieces together and realized how these cells worked and how far they had spread. One thing that ensured their success was the explosion of OxyContin. Black tar heroin was even better, cheaper and more convenient to get. Why pay $40 or $80 for an OxyContin pill when a $10 balloon of black tar heroin would do the job?

Besides avoiding cities with drug gangs, the Xalisco Boys avoided African Americans, who they believed would rob them. They sold exclusively to whites who were already rapidly becoming addicted to prescription pills providing them with a dependable source of supply. Reliability and low cost helped the black tar spread through schools making new addicts. The explosion of white addicts, many from good homes in the suburbs, had a political impact. Legislators who had never cared all of sudden called for criminal justice reform. The sharp change in attitude was particularly notable among Republicans in Appalachia and other areas hit by the opiate epidemic. All of a sudden “their people” were getting the stiff sentences.

In Portland Oregon in 1990 there were 10 heroin overdose deaths. In 1999 there were 111. In 2000 in Washington State 600 addicts were under treatment. In 2010 there were 8600. In Ohio in 2007 for the first time deaths from drug overdoses exceeded those from car accidents. In 2008 for the first time overdose deaths exceeded those from car accidents for the entire U.S. Current statistics from the National Institute on Drug Abuse show 64,000 Americans died from drug overdoses in 2016, far exceeding the deaths from auto accidents. The National Highway Traffic Administration reports 37,461 deaths from auto accidents in 2016.

Quinones also details law enforcement initiatives, arrests and crackdowns but the Xalisco Boys network is resilient. Quinones points out that a major DEA bust in Santa Fe called Operation Tar Pit disrupted the heroin network for exactly one day. New cells immediately are formed to replace those taken down. Quinones shows how the one two punch of readily available prescription drugs followed by cheaper illicit drugs has created an epidemic with no end in sight.

Left out in this review are the many individual stories Quinones tells. These make this a book of personal tragedy as well as crime and national emergency. The book is well researched and convincing. It is filled with first hand interviews of dealers, addicts, police and doctors. Sam Quinones, an American, lived in Mexico for ten years and speaks fluent Spanish. His knowledge of Mexico and ability to converse with traffickers and Xalisco residents adds credibility. His repeats himself a bit much and he abruptly skips from one topic to the next but in spite of shortcomings in style his message is well delivered and important. Highly recommended.
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4

May 18, 2015

Frightful Look at the Catch-22 'twixt Controlled Opioids & Outlawed Black Tar Heroine

This is an ominous, but illuminating, exploration of the scourge in the U.S. of controlled opioids (overprescribed or sold on the streets) and the outlaw opioid heroine, and what has led us here, i.e., the interplay between controlled opioids (lortab, norco, oxycontin, etc.) and the cheaper outlaw substitute that opioid addicts turn to when they cannot afford the opioids' high street price: black tar Frightful Look at the Catch-22 'twixt Controlled Opioids & Outlawed Black Tar Heroine

This is an ominous, but illuminating, exploration of the scourge in the U.S. of controlled opioids (overprescribed or sold on the streets) and the outlaw opioid heroine, and what has led us here, i.e., the interplay between controlled opioids (lortab, norco, oxycontin, etc.) and the cheaper outlaw substitute that opioid addicts turn to when they cannot afford the opioids' high street price: black tar heroine, which is sold mostly by a loose-knit Mexican marketers' mafia.





If you enjoy documentaries touching on human nature, you should find this book intriguing for its review of how regular people get hooked on pain pills and exploration of the pain pill cycle (from manufacturers, pushers, pain med mills/docs who prescribe for kickbacks, and the blowback when the poorer addicts, who can no longer afford the opioids at street value (after the gov't targeted these drugs), turn to a killer of a substitute in the cheaper black-tar heroin. This black-tar heroin flows in mainly from El Chapo's Sinaloa cartel in the mountainous Sinaloa region of Mexico. While I was aware of the opioids dilemma, I wasn't of black tar heroine.

I recommend this book if anyone in your circle of family and close friends is or has been addicted to pain pills, or you're fascinated by documentaries on human nature, addiction or the war on drugs.

I've seen the needle and the damage done,
A little part of it in everyone,
But every junkie's like a settin' sun
Neil Young, "Needle and the Damage Done," 1971 ...more
1

February 28, 2017

What About the Severe Pain Patient?
Like most sensational writing on this subject, this book pushes home the boogieman of opiates. But for pain patients, who are already suffering under new prescribing 'guidelines' (just love it when the govvy plays dr), it is devastating. Not everyone is chasing the buzz (and not all opiates have one and all wear off with use) or an addict or future addict. Opiates are easier to reduce or get off of than many, many other meds in my experience. Using non-drug methods exclusively, for severe pain, is like using a stick to fight a war. True, it is very hard for people who don't suffer severe pain to understand how bad (suicidal) it is, but that is no excuse, at the end of the day. Any time I see or read anything claiming that the 'heartland' is in danger is a big red flag. They want you to think that you, too, will be swept away by this epidemic. Same with so many things, both past and present: Communism, Islam, crystal meth, satanism, immigrants. The heartland is under siege! While I acknowledge there are addicts and ODs and I feel much sympathy with victims of those things and their families, that is not the whole story. There are millions of people using opiates responsibly but that is boring, so you don't hear about that. Big Pharma wants to sell more drugs, so they are making theirs out of this (brand name, uncrushable pills and combinations like Subaxone). They also first marketed Vicodin as the perfect drug, non-addicting, non-sedating, great pain reliever. Then pushed OxyContin on us. Everyone needs to count to 10 and get a reality check on this. You drs who are reading this book and sucking it all in...please think critically and don't be taken in by another panic. First, do no harm!
3

May 17, 2017

Interesting but too long
Cons: Excellent writing but not disciplined enough editing. By page 230 I felt that the story, with some variations, was being told repeatedly and unnecessarily. Pros: I love how the stories of the individuals profiled are interwoven throughout various chapters. His writing beautifully provides the perspectives of everyone participating in the opiate trade without judgment. The number of individuals profiled make clear how much effort the author invested to create a comprehensive, historical record as to how the exponential increase in drug dependence, addiction and overdoses became suddenly commonplace. The reader is left to make his or her own judgments which is appreciated.
3

Apr 23, 2015

Really important to get this information out, and the book is very well researched. From a writing perspective, though, I agree with the reviewer who said the structure doesn't build a narrative and feels very repetitive. The piece Quinones published in the NY Times a few weeks back covered most of the key points quite well in a more compact format.

The last 20% or so brings in some of the solutions to the problem and covers more topics.

In the acknowledgements section the author seemed to say Really important to get this information out, and the book is very well researched. From a writing perspective, though, I agree with the reviewer who said the structure doesn't build a narrative and feels very repetitive. The piece Quinones published in the NY Times a few weeks back covered most of the key points quite well in a more compact format.

The last 20% or so brings in some of the solutions to the problem and covers more topics.

In the acknowledgements section the author seemed to say that his editors each had worked on sections of the book, which definitely would explain why it felt like a lot of magazine pieces stuck together.

Overall a good and important book, but lacking a cohesive voice or narrative. ...more
5

Jun 18, 2015

Read this book. I'm going to say that again: READ. THIS. BOOK. If you live anywhere in middle America, but especially if you live in Southern Ohio, you have to read this book to see where the scourge of narcotics has come from. The origins of the opiate epidemic are laid out as clearly as possible for all to see. One of the most significant problems in our society over the last 20 years, and the perfect storm that led to it called out in black and white. But probably most significant is how Read this book. I'm going to say that again: READ. THIS. BOOK. If you live anywhere in middle America, but especially if you live in Southern Ohio, you have to read this book to see where the scourge of narcotics has come from. The origins of the opiate epidemic are laid out as clearly as possible for all to see. One of the most significant problems in our society over the last 20 years, and the perfect storm that led to it called out in black and white. But probably most significant is how clearly you can see that the issue is not one of moral failings on the part of drug addicts. It is the result of our society's delusional pursuit of wealth at all costs, and the desire to live some absurd dream life that is not only unrealistic, but isn't even life. Not only in the desire to eliminate pain with a magical pill, but also to make huge amounts of money selling those pills no matter the human cost. How clearly you can see that it's not just the "junkies" pursuing that delusion, it's the heroin pushers, the drug reps, pharmaceutical companies, Walmart, and the unrealistic expectations placed on middle class America.

But not only can you see exactly how we got here, you can also see how we're beginning to wake up and get out. The first step to recovery is admitting you have a problem, and that applies not just to the "junkies" but to all of us as well. This isn't a problem just for criminal lowlifes who are hooked on drugs. This is a problem for all of us. When you look at that "junkie" you have to see a brother or a sister, not some morally corrupt non-being. We have to stand up and say "no more." We have to accept that alleviating pain is hard work, and there is no short cut. We have to recognize that our salvation is not in a pill or a doctor or a corporation or a bigger house or a better car. It's in ourselves and in our connection to other human beings. I swear I got choked up at the end of the book because in Portsmouth's recovery I saw the recovery of Chillicothe and Columbus and so much more of middle America. A recovery that I've witnessed again and again as individuals stand up and say I'm going to make a difference in my community. A recovery that is based in reaching out to each other, speaking the truth to each other, pulling each other up, and saying to anything or anybody who would put us down that we're better than that, and we'll prove it. ...more
4

May 27, 2015

there's more at my online journal nonfiction page, so feel free to click here to go there if you'd like.

If you are someone who pays attention, it is no secret that there is a massive heroin epidemic in this country. Dreamland takes its readers into examining the burgeoning heroin problem. Mr. Quinones charts how the "realities of American medicine and medical marketing of the 1980s and 1990s" came to be "connected to why, years later, men from a small town in Mexico could sell so much heroin there's more at my online journal nonfiction page, so feel free to click here to go there if you'd like.

If you are someone who pays attention, it is no secret that there is a massive heroin epidemic in this country. Dreamland takes its readers into examining the burgeoning heroin problem. Mr. Quinones charts how the "realities of American medicine and medical marketing of the 1980s and 1990s" came to be "connected to why, years later, men from a small town in Mexico could sell so much heroin in parts of the country that had never seen it before." Several things come together here: 1) the clever methodologies of these small-town dealers, 2) a huge unprecedented push by a leading pharmaceutical company trying to market and sell their opioid wares, most importantly for this book, OxyContin, 3) economic decline in formerly industrial areas, and 4) the changes in how doctors treated pain among their patients (along with changes brought by managed health care).

For anyone at all interested in this topic, Dreamland is a work of investigative journalism that explores the roots and the spread of our modern heroin epidemic, with Quinones taking a very wide-ranging approach to his examination. Whether or not you agree with his conclusions, it is a fascinating book and I for one, couldn't put it down. Looking at what other readers had to say about it, a lot of people zone in on the repetition that is found throughout and I can understand their complaints -- the number of times he uses the phrase "delivering heroin like pizza" is frankly annoying. But this is a very minor complaint that seems pretty irrelevant in comparison to what a reader will come away with after finishing this book.

I highly, highly recommend this very eye-opening book. ...more
4

Mar 03, 2019

This is an intense, chilling account of how the parallel forces of Purdue Pharma (with the support and ignorance of the medical community) and entrepreneurs in the town of Xalisco, Mexico pushed millions of Americans into becoming addicts of oxycontin and black tar heroin. I was familiar with the outlines of the "opioid crisis" but there was so much I didn't know until reading this book. I really appreciate how Quinones laid out his research in an engaging and riveting manner. Like many This is an intense, chilling account of how the parallel forces of Purdue Pharma (with the support and ignorance of the medical community) and entrepreneurs in the town of Xalisco, Mexico pushed millions of Americans into becoming addicts of oxycontin and black tar heroin. I was familiar with the outlines of the "opioid crisis" but there was so much I didn't know until reading this book. I really appreciate how Quinones laid out his research in an engaging and riveting manner. Like many non-fiction books, there is too much repetition - some of his chapters seemed almost duplicates of other chapters - just set in another town with different players. Overall, a very important book. ...more
5

Apr 26, 2017

This book was incredible. I had only vaguely heard about it and needed something new to audiobook, and wound up having my mind blown.

It's a story of the opioid epidemic told through fascinating characters and a history of capitalism over the past few decades--everything from the disappearance of factory jobs to the retailing of heroin sales to the birth of pharma advertising to the role of Walmart in small towns and so much more.

It occasionally slides into some sort of weird bootstrappy ish This book was incredible. I had only vaguely heard about it and needed something new to audiobook, and wound up having my mind blown.

It's a story of the opioid epidemic told through fascinating characters and a history of capitalism over the past few decades--everything from the disappearance of factory jobs to the retailing of heroin sales to the birth of pharma advertising to the role of Walmart in small towns and so much more.

It occasionally slides into some sort of weird bootstrappy ish when talking about alternatives to opioid prescriptions for chronic pain, but it's such an amazing work of journalism that I'll forgive the author not being a commie like me. Because it turns out, when you do in-depth journalism of this magnitude, you do wind up at the conclusion that it's the "free market" at fault.

...more
5

May 11, 2017

A brilliant, fascinating account of the rise of opiate addiction in America. This is a masterwork of research and writing that traces the factors —from pharmaceutical marketing to the invasion of black tar heroin —that created a perfect storm and ruined the lives of millions. More frightening than anything I could ever write.
A brilliant, fascinating account of the rise of opiate addiction in America. This is a masterwork of research and writing that traces the factors — from pharmaceutical marketing to the invasion of black tar heroin — that created a perfect storm and ruined the lives of millions. More frightening than anything I could ever write.
...more
3

Jan 18, 2016

My first job as a nurse was on a surgical floor. I routinely gave people narcotics, both intravenously and as pills. I had patients who had undergone radical surgeries that required high doses of course, but as any healthcare provider can attest, there were also plenty of patients demanding narcotics for even minor procedures. I remember one patient, in her early twenties, who refused to be discharged unless her doctor gave her a prescription for fifty percocets! He did, of course, so she would My first job as a nurse was on a surgical floor. I routinely gave people narcotics, both intravenously and as pills. I had patients who had undergone radical surgeries that required high doses of course, but as any healthcare provider can attest, there were also plenty of patients demanding narcotics for even minor procedures. I remember one patient, in her early twenties, who refused to be discharged unless her doctor gave her a prescription for fifty percocets! He did, of course, so she would finally leave. I assumed that over prescribing and elevating pain as the 5th vital sign were the major factors contributing to opiate addiction. I could never imagine however, how the epidemic is really a confluence of so many societal factors - the economic downturn of heartland America, the entrepreneurial ingenuity of Mexicans in the small state of Xalisco, false advertising and zealous marketing by pharmaceutical companies, pill mills, and the structure of Medicaid, among other things. This book very thoroughly discusses all of these factors, interspersed with personal stories, on how opiates and eventually heroin came to quickly dominate regions of the country where street drugs were previously unknown. It also discusses how prosecutors, DEA agents, public health officials, and social workers are working to try and get a handle on the epidemic. I gave the book three stars because I thought the book repeated itself a lot and was too long. I also almost didn't finish it because part of it was just too depressing. It ends on a positive note, even as it acknowledges that society has a long way to go before we approach a large scale resolution. ...more
5

Aug 06, 2018

This is a remarkable book explaining the forever changing and evolving drug trade in the United States (which also influences Canada). There are two aspects that the author analyzes in detail and how they became tied to each other.

He reveals how the drug companies have always searched for an elusive elixir that could remove pain. The trouble was that in many people in caused addiction. But with production of OxyContin this was advertised as being non-addictive, but based on very little research. This is a remarkable book explaining the forever changing and evolving drug trade in the United States (which also influences Canada). There are two aspects that the author analyzes in detail and how they became tied to each other.

He reveals how the drug companies have always searched for an elusive elixir that could remove pain. The trouble was that in many people in caused addiction. But with production of OxyContin this was advertised as being non-addictive, but based on very little research. The author points out that pain (or pain control) became a significant part of the medical process starting in the 1980’s and that a pill could successfully resolve this. However this removed other aspects of healing from the curative health process – like changing your lifestyle, doing more exercise, eating better foods and taking into account psychological and social issues (like stress). Pain relieving pills became the “be all and end all”.

And this hit hard in the heartland of the U.S. where there was high unemployment. Pill mill clinics started to proliferate as addiction grew. And the “high’ spread to teenagers. For example it became popular with school athletes to control or subdue their pain from injuries – one can easily imagine how these pills (OxyContin) were spread around to friends. Addiction became rampant.

Into this entered black tar heroin which was grown and distributed in an impoverished region of Mexico from the town of Xalisco in the province of Nayarit. This was a “non-violent cartel” who marketed their product brilliantly. It was cheaper than OxyContin and it was delivered to your door (think pizza delivery with no delivery charge!). The “Xalisco boys”, as they were called, focused on new markets of white middle class kids who were fast becoming junkies. The “Xalisco boys” would work only a few months in towns like Columbus and Portsmouth, Ohio and Boise, Idaho, and then return to Xalisco with their American dollars. There were always many willing recruits to go to El Norte – and they sometimes would set-up their own delivery system competing with other Xalisco boys. They would use junkies to locate and establish a new market.

The author delineates the growth of both of these – the pharmaceutical and the Xalisco boys. There has now been more legislative controls set-up for pain killers and prescriptions. OxyContin has been confirmed as being highly addictive. Rehabilitation is back in vogue, as opposed to prison sentences. This is a little hypocritical because now it is white kids becoming addicted and it is not seen as proper to send them to jail. On the other hand far more have died from OxyContin overdoses than during the worst days of the crack-cocaine epidemic.

This book is most enlightening on the spread of pharmaceutical drugs and its relationship to heroin. ...more
5

Oct 29, 2015

As the mother of both a medical student and of a recovering (? Part of the pain - you can never be completely sure) addict, I found this impeccably researched book on the creation of opiate addiction (in large part by doctors who were fed and believed lies by the pharmaceutical companies pimping their wares) in the US compelling, fascinating, terrifying, heartbreaking, and scary af.

The book itself could stand a bit of editing; at times it feels like Quiñones spent so much time investigating he As the mother of both a medical student and of a recovering (? Part of the pain - you can never be completely sure) addict, I found this impeccably researched book on the creation of opiate addiction (in large part by doctors who were fed and believed lies by the pharmaceutical companies pimping their wares) in the US compelling, fascinating, terrifying, heartbreaking, and scary af.

The book itself could stand a bit of editing; at times it feels like Quiñones spent so much time investigating he couldn't bare to leave any detail out. But his descriptions of how cheap black tar heroin infiltrated the suburbs and then more insidiously how prescription opiates took hold were chilling. My daughter in medical school assures me the stories of Big Pharma repeatedly citing a "study" proving opiates were not addicting and encouraging doctors to increase doses under the idea in the 1990s and early 2000s that pain was something no one should have to deal with; while the "study" was merely a half page letter to the editor and not a study at all - is completely true. I am relieved medical schools now are teaching their students about other ways to manage pain - like lifestyle changes. And realizing that some pain is just part of life. I would like to see more of this explored - what is it about this time period in the US where we believe life ought to be and can be sunshine and unicorns all day every day and completely pain free?!

Highly recommended reading - everyone should be aware of how this epidemic which currently takes more lives than auto accidents - came about. When the medical industry is consumer driven and people demand freedom from pain even well meaning doctors get worn down. And people believe what they want to believe. It seems asinine now to think anyone could ever have believed opiates weren't addicting... Makes you wonder what craziness we are currently believing because we want to believe...


...more
5

December 30, 2017

Our government failed its citizens
Purdue Pharma peddling OxyContin and Mexican heroin dealers both ended up destroying America for profit. The only difference is that the board of directors and executive staff of Purdue aren't serving time.

Welcome to American addiction.

What a wonderful, informative and depressing book.

What I learned was that Opioid deaths have skyrocketed as five things changed.

First, the medical profession embraced "pain as the fifth vital sign". With very little evidence doctors convinced themselves that prescribing opioids for pain had a minimal chance of causing addition. They were very, very wrong.

Second, dealers in the town of Xalisco in Mexico pioneered a "cut-out-the-middleman" strategy for delivering 80% pure heroin directly to a customer just by dialing a number. And they targeted non-urban (read "white") customers. As the author describes it turned buying heroin from scoring in a dark alley to as easy as having Pizza delivered.

Third, Purdue Pharma developed a pill - Oxycontin - which was essentially legal time-release heroin. They then marketed it to patients and doctors for every-day pain relief (bad backs, torn ligiments, etc) promising that it wasn't addictive.

Fourth, insurance companies refused to reimburse pain managment clinics - those that recognized that pain could be better controlled via diet, exercise, therapy, etc. Instead insurance found pills to be an easy short-term reimbursable answer.

Fifth, some doctors became drug dealers as they set up "pill mills" and they dispensed millions of pills solely for profit.

The book also raises a few more questions for me.

Where was the American Medical Association? Rather than policing their own profession or at least owning up to and shaming the small number who have turned into drug dealers, and even after 60,000 people died from opioids, in a mind-blowing statement in 2017 the American Medical Association Opioids Task Force said, "it has always been that the decision about a specific treatment alternative is best left to the physician and their patient."

The government failed its citizens. If there was ever a case for the role of government in protecting our citizens this was it. (More people died from opioids-related deaths in 2016 then died during the entire Vietnam War.) Yet each institution that could have slowed this epidemic lacked the moral and political courage to do so. First and foremost, the nation's drug safety watchdog, the Food and Drug Administration (FDA). Buckling under political pressure (from both parties as drug companies now pay for almost half the FDA budget,) they approved OxyContin in 1995 and continued to approve its every increasing dosages. And in 2013, after 18 years of creating an epidemic, the FDA was still approving new extended release opioids (Zohydro.)
.
And it just wasn't the FDA. The Centers for Disease Control (CDC) didn't issue opioid prescription guidelines until 2017. And for 15 years the Federal Trade Commission (FTC) sounded like crickets as drug manufacturers, distributors, and pharmacies advertised opioids as non-addictive pain relief.

And even as, hard-working Drug Enforcement Agency (DEA) field agents were trying to break up Mexican heroin rings, their senior leadership let the cases against drug distributors, manufacturers, pharmacies and doctors drop.

While the DEA was trying to break up the dealer network I'm surprised the author never asked, "Given all the money the DEA has pumped into drug eradication programs in Mexico how come the Mexican government hasn't destroyed the opium fields?" It's not like we don't know where they are. Hyperspectral scanners on UAV's, aircraft and satellites can find these fields.
If the DEA is frustrated by corruption in Mexico that refuses to take out the growers, at least they could put the fields up on their web site and let the public see what our neighbor is protecting.

A real eye-opener of a book. Well worth the read.

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