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A review by mburnamfink
Dreamland: The True Tale of America's Opiate Epidemic by Sam Quinones
4.0
Dreamland is a true capitalist success story. In The Wire, Stringer Bell's animating force is a drug trade of pure economics; heroin to cash via the arms of addicts (and please ignore the human wreckage). No corners, no soldiers, no gangster bullshit, just money. Stringer Bell died a failure, shot down by players he tried to play, but in the real world, two very different groups succeeded at this dream, with horrible costs for the rest of us.
The first was the sales team at Perdue Pharmaceutical. Perdue manipulated standards of care and safety evidence through the 80s and 90s to push two points. First, pain was the fifth vital sign and patients have the right to be free of pain. And second, Perdue's new drug OxyContin was non-addictive and perfectly safe even in high doses. In towns across America, but especially prominent in the Appalachian Rust Belt, pill mills sprang up, staffed by unscrupulous doctors who prescribed ever higher doses to their patients.
Small-town Oxy addicts were the perfect target markets for the Xalisco Boys, a franchise operation of Mexican heroin dealers. Traditionally, heroin has been defined by long international chains where everybody steps on the product. These complex hierarchical structures are worthy targets for major busts by law enforcement. The Xalisco Boys played by different rules. Addicts would call a cell phone number, and within a few minutes a driver would be on the way, pre-measured balloons of heroin in his mouth. Xalisco Boys avoided confrontation, and since they carried only a few grams of drugs, they'd be deported rather than charged. They worked on salary, their shit was pure, and in the unstable world of junkies, they were reliable. They were basically like any other Mexican immigrant working in agriculture or construction or food, reliably doing a job White Americans won't, except that the product was drugs.
Two different business models for "clean" dope; doctors and easy prescriptions orchestrated by pharmaceutical marketers, and an "internet of drugs" run by Mexican gangsters. Together, it meant that by 2008 drug overdoses were exceeding automobile accidents as a cause of death.
Quinones has a real fondness for ranchero culture and the world of the Xalisco Boys, as exhibited by a couple of prior books on the subject of rural Mexico, so those parts are incredibly well done. By comparison, the story of the white coat epidemic feels pro-forma, without much venom for the people who twisted the medical system to their ends, or much detail on how an epidemic of pain mismanagement was created. The third part, the sociology of addiction, again falls into hoary generalities. Unlike prior heroin epidemics or the ongoing War on Drugs, this wave hit middle class white kids hardest, the valedictorian-star athlete-cheerleader child of professionals and civic pillars. It's easy to castigate other heroin users as avante garde degenerates or the products of failing families, but this time around it was people just like us. Quinones has some phrases about a wall of respectable silence that kept people from acknowledging the epidemic until it was far too late, and about the loss of community in places like Portsmouth, Ohio.
But I keep thinking about the thick description of The Corner, and about how Burns and Simon let junkies and junk speak for themselves. And while Quinones has plenty from dealers, cops, public health officials, and grieving parents, he shies away from the addicts and the drugs, from what it's really like at the center of epidemic. And this flinch weakens the book.
Addicts are people just like us. But they're not us.
We're better.
So far.
The first was the sales team at Perdue Pharmaceutical. Perdue manipulated standards of care and safety evidence through the 80s and 90s to push two points. First, pain was the fifth vital sign and patients have the right to be free of pain. And second, Perdue's new drug OxyContin was non-addictive and perfectly safe even in high doses. In towns across America, but especially prominent in the Appalachian Rust Belt, pill mills sprang up, staffed by unscrupulous doctors who prescribed ever higher doses to their patients.
Small-town Oxy addicts were the perfect target markets for the Xalisco Boys, a franchise operation of Mexican heroin dealers. Traditionally, heroin has been defined by long international chains where everybody steps on the product. These complex hierarchical structures are worthy targets for major busts by law enforcement. The Xalisco Boys played by different rules. Addicts would call a cell phone number, and within a few minutes a driver would be on the way, pre-measured balloons of heroin in his mouth. Xalisco Boys avoided confrontation, and since they carried only a few grams of drugs, they'd be deported rather than charged. They worked on salary, their shit was pure, and in the unstable world of junkies, they were reliable. They were basically like any other Mexican immigrant working in agriculture or construction or food, reliably doing a job White Americans won't, except that the product was drugs.
Two different business models for "clean" dope; doctors and easy prescriptions orchestrated by pharmaceutical marketers, and an "internet of drugs" run by Mexican gangsters. Together, it meant that by 2008 drug overdoses were exceeding automobile accidents as a cause of death.
Quinones has a real fondness for ranchero culture and the world of the Xalisco Boys, as exhibited by a couple of prior books on the subject of rural Mexico, so those parts are incredibly well done. By comparison, the story of the white coat epidemic feels pro-forma, without much venom for the people who twisted the medical system to their ends, or much detail on how an epidemic of pain mismanagement was created. The third part, the sociology of addiction, again falls into hoary generalities. Unlike prior heroin epidemics or the ongoing War on Drugs, this wave hit middle class white kids hardest, the valedictorian-star athlete-cheerleader child of professionals and civic pillars. It's easy to castigate other heroin users as avante garde degenerates or the products of failing families, but this time around it was people just like us. Quinones has some phrases about a wall of respectable silence that kept people from acknowledging the epidemic until it was far too late, and about the loss of community in places like Portsmouth, Ohio.
But I keep thinking about the thick description of The Corner, and about how Burns and Simon let junkies and junk speak for themselves. And while Quinones has plenty from dealers, cops, public health officials, and grieving parents, he shies away from the addicts and the drugs, from what it's really like at the center of epidemic. And this flinch weakens the book.
Addicts are people just like us. But they're not us.
We're better.
So far.