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4.11 AVERAGE
4.11 AVERAGE
+++ New outlook on how we prescribe pain medication and the proliferation of heroin.
--- Takes the clinical outlook on drug abuse. Links everything to chemical hooks rather than environmental factors as well. Wanted more explanation.
--- Takes the clinical outlook on drug abuse. Links everything to chemical hooks rather than environmental factors as well. Wanted more explanation.
PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK PLEASE READ THIS BOOK
This is one of the most important books written in the last 20 years.
I can't stress enough how essential this book is to understanding American society today. Quinones tells the story of modern opiate addiction via several narratives. There's the story of the Xalisco Boys, a brilliant criminal enterprise in supplying heroin to many American cities utilizing the eagerness of poor Mexican farm children. There's the story of Purdue Pharmaceutical, a corporation who trained pharma reps with the mantra "opiates aren't addictive" to launch the modern-day OxyContin dependent culture we have. And there's the stories of addicts and the parents of dead addicts.
In the mental health field, opiate addicts are some of the hardest to work with. They're convinced they need these pills for their back/knee/whatever pain. Even when I get the persons with addiction on board with the idea of pain management, there's no coverage for it under Medical Assistance. I feel like I'm fighting a losing battle. It's much easier to pop a pill for pain than it is to make the lifestyle changes, or attend the physical therapy necessary, to manage the pain. Insurance companies don't want to pay for the long-term, just the short-term.
Read this book.
I can't stress enough how essential this book is to understanding American society today. Quinones tells the story of modern opiate addiction via several narratives. There's the story of the Xalisco Boys, a brilliant criminal enterprise in supplying heroin to many American cities utilizing the eagerness of poor Mexican farm children. There's the story of Purdue Pharmaceutical, a corporation who trained pharma reps with the mantra "opiates aren't addictive" to launch the modern-day OxyContin dependent culture we have. And there's the stories of addicts and the parents of dead addicts.
In the mental health field, opiate addicts are some of the hardest to work with. They're convinced they need these pills for their back/knee/whatever pain. Even when I get the persons with addiction on board with the idea of pain management, there's no coverage for it under Medical Assistance. I feel like I'm fighting a losing battle. It's much easier to pop a pill for pain than it is to make the lifestyle changes, or attend the physical therapy necessary, to manage the pain. Insurance companies don't want to pay for the long-term, just the short-term.
Read this book.
challenging
dark
emotional
reflective
sad
medium-paced
challenging
dark
emotional
hopeful
informative
reflective
sad
tense
medium-paced
challenging
dark
informative
sad
medium-paced
Highly recommend this to anyone that’s remotely interested in the opioid epidemic.
challenging
dark
informative
reflective
sad
medium-paced
Highly informative and well-researched. It was a revelation for me, from not knowing much about the topic at all. My only complaint was that with the chapters jumping between perspectives, it was sometimes difficult to keep track of what time period it referred to so sometimes chapters felt disjointed. Towards the end, it was also a bit repetitive and could have undergone some editing down. But overall, wow.
Children of the most privileged group in the wealthiest country in the history of the world were getting hooked and dying in an almost epidemic numbers from substances meant to, of all things, numb pain.
“What pain?” a South Carolina cop asked.
~Dreamland, Sam Quinones
Unforeseeable factors converged on the United States in the early 1980s. Reverberations of this perfect storm continue to this day.
Pain became the “fifth vital sign” and treatment of pain, as reported by patients, was to be as important as treating blood pressure or oxygenation.
Rapid misunderstanding and erroneous citation of a well-intentioned letter to the editor in the New England Journal of Medicine (1980) became the license for and incitement to outpatient prescription of opioids in high doses. Catastrophe ensued, as these medications were not as well studied and were more highly addictive than physicians and the lay public (and the media) were led to believe.
Purdue Pharma, and indeed the entire for-profit pharmaceutical industry unleashed an army of drug reps and an artillery of lawyers to combat any contravention to the claim that opioids were non-addictive. Many physicians were complicit in this, some knowingly, many unwittingly.
Medicine continues to morph into a customer service field, in which doctors and hospitals are rewarded for giving patients what they want. In this story, many wanted chronic pain medications.
The “eat-what-you-kill” model of medical care (i.e. more pay for more patients seen and more services provided, not quality), still characterizing most practice models in the United States, led to pill-mills across the country, most concentrated in dying rust belts of Appalachia and Florida.
Simultaneously, a new model for black tar heroin distribution and sale flooded the entire country. Home delivery, dealers carrying only small doses, avoidance of larger cities with established crime families/cartels, and loosely connected franchise-model of heroin sale became (and remains) difficult to encircle with law enforcement. Opioid addicts turned to (often cheaper) heroin when needed. The scourge spread to “white” and “upper-middle class” populations, perhaps the ultimate reason it has entered our collective consciousnesses in a way that the troubles of unseen, disadvantaged peoples never seems to.
This work by Quinones was earthshaking, soul-shaking – I found it fascinating and harrowing and beautifully written. I am a physician and surgeon, and have prescribed high dose opioids in the not-too-distant past for situations in which I would not today. A time when our understanding of mu receptors and dependence was more immature. Hopefully, today will look similarly unsophisticated in a few short years. “Dreamland” provides an unparalleled insight into our current crisis, and could not come with a higher recommendation.
“What pain?” a South Carolina cop asked.
~Dreamland, Sam Quinones
Unforeseeable factors converged on the United States in the early 1980s. Reverberations of this perfect storm continue to this day.
Pain became the “fifth vital sign” and treatment of pain, as reported by patients, was to be as important as treating blood pressure or oxygenation.
Rapid misunderstanding and erroneous citation of a well-intentioned letter to the editor in the New England Journal of Medicine (1980) became the license for and incitement to outpatient prescription of opioids in high doses. Catastrophe ensued, as these medications were not as well studied and were more highly addictive than physicians and the lay public (and the media) were led to believe.
Purdue Pharma, and indeed the entire for-profit pharmaceutical industry unleashed an army of drug reps and an artillery of lawyers to combat any contravention to the claim that opioids were non-addictive. Many physicians were complicit in this, some knowingly, many unwittingly.
Medicine continues to morph into a customer service field, in which doctors and hospitals are rewarded for giving patients what they want. In this story, many wanted chronic pain medications.
The “eat-what-you-kill” model of medical care (i.e. more pay for more patients seen and more services provided, not quality), still characterizing most practice models in the United States, led to pill-mills across the country, most concentrated in dying rust belts of Appalachia and Florida.
Simultaneously, a new model for black tar heroin distribution and sale flooded the entire country. Home delivery, dealers carrying only small doses, avoidance of larger cities with established crime families/cartels, and loosely connected franchise-model of heroin sale became (and remains) difficult to encircle with law enforcement. Opioid addicts turned to (often cheaper) heroin when needed. The scourge spread to “white” and “upper-middle class” populations, perhaps the ultimate reason it has entered our collective consciousnesses in a way that the troubles of unseen, disadvantaged peoples never seems to.
This work by Quinones was earthshaking, soul-shaking – I found it fascinating and harrowing and beautifully written. I am a physician and surgeon, and have prescribed high dose opioids in the not-too-distant past for situations in which I would not today. A time when our understanding of mu receptors and dependence was more immature. Hopefully, today will look similarly unsophisticated in a few short years. “Dreamland” provides an unparalleled insight into our current crisis, and could not come with a higher recommendation.
This is a nonfiction book about Purdue Pharmaceuticals creation of Oxycontin and the subsequent marketing of it to millions of Americans, creating inadvertent drug addicts. At the same time, this book is also a story about black tar Heroin and how it came to be sold in the United States by a Mexican company with striking similarities to a pizza delivery service. The author writes about the boardroom decisions at Purdue, and the small town in Mexico where decisions are made and the doctors prescribing the medicine as well as the delivery drivers for the Heroin.
This book would have been much better if he had not insisted on describing the Mexican town of Xalisco and Nayarit no less than 4 or 5 times at least. He writes about the Mexican men returning to town in Levi's 501 jeans because some of the addicts paid for their drugs in jeans. And then he tells the reader again and again and again about Mexican men returning to their Mexican town in Levi's 501 Jeans, and hosting a big party and buying a big new house. Really, if I had to read one more time about these Mexican men returning to town I would have thrown the book across the room! Like, I got the point already, you don't have to keep telling me. I came so close to just putting this book down and not finishing it. I am giving this book two stars.
This book would have been much better if he had not insisted on describing the Mexican town of Xalisco and Nayarit no less than 4 or 5 times at least. He writes about the Mexican men returning to town in Levi's 501 jeans because some of the addicts paid for their drugs in jeans. And then he tells the reader again and again and again about Mexican men returning to their Mexican town in Levi's 501 Jeans, and hosting a big party and buying a big new house. Really, if I had to read one more time about these Mexican men returning to town I would have thrown the book across the room! Like, I got the point already, you don't have to keep telling me. I came so close to just putting this book down and not finishing it. I am giving this book two stars.