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“Dreamland” By Sam Quinones – True Tale of America’s Opiate Epidemic

May 31, 2017

 True Tale of America’s Opiate Epidemic

In fascinating detail, Sam Quinones chronicles how, over the past 15 years, enterprising sugar cane farmers in a small county on the west coast of Mexico created a unique distribution system that brought black tar heroin—the cheapest, most addictive form of the opiate, 2 to 3 times purer than its white powder cousin—to the veins of people across the United States. Communities where heroin had never been seen before—from Charlotte, NC and Huntington, WVA, to Salt Lake City and Portland, OR—were overrun with it. Local police and residents were stunned. How could heroin, long considered a drug found only in the dense, urban environments along the East Coast, and trafficked into the United States by enormous Colombian drug cartels, be so incredibly ubiquitous in the American heartland? Who was bringing it here, and perhaps more importantly, why were so many townspeople suddenly eager for the comparatively cheap high it offered?

With the same dramatic drive of El Narco and Methland, Sam Quinones weaves together two classic tales of American capitalism: The stories of young men in Mexico, independent of the drug cartels, in search of their own American Dream via the fast and enormous profits of trafficking cheap black-tar heroin to America’s rural and suburban addicts; and that of Purdue Pharma in Stamford, Connecticut, determined to corner the market on pain with its new and expensive miracle drug, Oxycontin; extremely addictive in its own right. Quinones illuminates just how these two stories fit together as cause and effect: hooked on costly Oxycontin, American addicts were lured to much cheaper black tar heroin and its powerful and dangerous long-lasting high. Embroiled alongside the suppliers and buyers are DEA agents, local, small-town sheriffs, and the US attorney from eastern Virginia whose case against Purdue Pharma and Oxycontin made him an enemy of the Bush-era Justice Department, ultimately stalling and destroying his career in public service.

Dreamland is a scathing and incendiary account of drug culture and addiction spreading to every part of the American landscape.

 

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: The True Tale of America’s Opiate Epidemic.

 

Acclaimed journalist Sam Quinones weaves together two riveting tales of capitalism run amok whose unintentional collision has been a catastrophic opiate epidemic.


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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, Xalisco, Nayarit, on Mexico’s west coast and independent of any drug cartel, assaulted small town and mid-sized cities across the country, driven by a brilliant, almost unbeatable marketing


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and distribution system. Together these phenomena continue to lay waste to communities from Tennessee to Oregon, Indiana to New Mexico.

Finally, though, Quinones finds hope in the same Rust Belt river town that led the country into the opiate epidemic – Portsmouth, Ohio, where townspeople are turning away from dependence and toward economic as well as municipal self-reliance, and, with that, recovery.

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.

 

America’s heroin crisis

Award-winning journalist Sam Quinones combines thorough research with superlative narrative skills to produce a horrifying but compulsively readable book about opiate addiction in the United States.

At least 300,000 Americans use heroin, according to the latest statistics. From 2010 to 2013, the number of deaths from overdoses tripled from 3,036 to 8,257. Not coincidentally, since 1999 the number of prescription painkillers prescribed and sold in the United States has quadrupled, although incidents of chronic pain have not. Heroin use thrives on a disturbing symbiosis with painkiller addiction: 3 out of 4 new heroin users have reported they had previously abused prescription painkillers.  

And these twin addictions have spread in places one wouldn’t expect: Ohio, West Virginia, Kentucky, Tennessee. The face of opiate addiction is no longer the inner-city homeless or actors in Greenwich Village. It’s suburban white kids in Columbus, soccer moms in Nashville, rural men in West Virginia. 

Award-winning journalist Sam Quinones (“True Tales from Another Mexico,” “Antonio’s Gun and Delfino’s Dream” ) traces the history of opiate addiction and its spread through the nation in Dreamland, a book that every American should read. And I state that without reservation. The story Quinones tells is an illustration of the failures of medicine in the so-called free-market system, of the destructiveness of corporate venality, and of the desperate and criminal lengths to which people mired in poverty or tormented by addiction can be driven.

“Dreamland” is the result of relentless research and legwork on the part of Quinones, as well as his talented storytelling. The opiate addiction epidemic was caused by a convergence of multiple, seemingly unrelated factors, and Quinones takes these narrative strands and weaves them together seamlessly. He takes us from pharmaceutical laboratories to the trailer parks of West Virginia, and from the poppy-growing regions of Northwestern Mexico to the streets of the Rust Belt town of Portsmouth, Ohio, without a moment’s confusion or narrative misstep. He knows the perfect moment to leave one topic and move on to the next.

For decades US pharmaceutical companies had been trying to create a non-addictive drug that could effectively control chronic pain. The 1995 FDA approval of Oxyontin, a drug almost chemically identical to heroin, occurred when insurance companies were increasingly reluctant to cover long-term treatment of chronic pain via effective but expensive techniques such as physical therapy and counseling. Purdue Pharma, which owned the patent to Oxycontin, reassured everyone it was non-addictive. When the company sales representatives cited non-existent studies demonstrating that Oxycontin could be used safely to treat chronic pain, doctors were all too willing to listen. Soon patients were hooked. Then people who didn’t suffer chronic pain but had heard about Oxycontin’s effects were eager to try it. And retirees who could get prescriptions began selling the pills to supplement their retirement income. Scams for getting and selling the drug multiplied.

Then the Xalisco Boys came to town. One of the finest narrative and journalistic accomplishments in this book is Quinones’s portrait of this drug-dealing network whose members are both business paragons and criminal geniuses. They all come from a poppy-growing region of Northwest Mexico and sell black tar heroin, which is cheap, potent, and easy to make. Their dealers are paid a salary, so they have no incentive to dilute their product to maximize sales. Since violence almost always draws the attention of cops, the dealers seldom carry guns.  And since police and the press like big drug busts, large quantities of heroin in one location or with one dealer are rare. And they have a customer service ethos that matches Apple’s or Trader Joe’s, along with a delivery policy similar in spirit to “Domino’s 30 minutes or less:” Did a customer feel overcharged? Was the driver late? You’ll get free extra heroin next time. Was a driver unfriendly? Expect an apologetic phone call from his boss.

The Xalisco Boys also multiplied their return on investment in superior product and customer service by seeking out territories where there were no competitors. They avoided the American Southwest and the biggest cities, which were overflowing with drug dealers. The untapped markets were in places like the dying industrial Midwest, where members of families deep in second-generation unemployment were desperate for something that would make them feel like (in the words of one drug user) “king of the world.” They had already discovered Oxycontin and doctors who would write a prescription without asking questions. And if that doctor got caught, the Xalisco Boys were ready to step in with a product that gave the same high. And no more waiting in line at the pharmacy: The Xalisco Boys delivered.

The story of how opiate addiction spread is fascinating enough, but “Dreamland” is also peppered with bitter ironies. Heroin was invented by Bayer. The wife of the inventor of the hypodermic needle was the first person to die of an injected drug overdose. The dirty, worn clothes of a Mexican looking for farm work make him an automatic target for the Border Patrol, while a well-dressed drug dealer in a nice car can cross the border with ease.

This book is as much of a page-turner as a good mystery, as well as being thoroughly and disturbingly illuminating about a national crisis.

 

How Heroin Made Its Way From Rural Mexico To Small-Town America

Dreamland

To understand how heroin took hold in rural America, you need to go back two decades and look at the surge of prescription drug use in Portsmouth, Ohio, according to journalist Sam Quinones.

A Rust Belt town that had fallen on hard times by the 1990s, Portsmouth became a place where doctors dispensed prescription drugs more freely than anywhere else in the country, Quinones writes in his new book, Dreamland: The True Tale of America’s Opiate Epidemic.

There was a “widespread kind of addiction that affects an entire generation in the town of Portsmouth,” Quinones tells NPR Morning Edition host Renee Montagne.

Many of the pills are synthetic opiates, similar in their molecular structure to heroin, Quinones adds. As a result, many of those who originally became addicted to pills eventually wound up on heroin.

“Heroin is the fallback drug,” Quinones says.

Mexican drug cartels then stepped in, providing reliable home delivery for the addicts in a model similar to the pizza delivery business, and replicating it far beyond Portsmouth.


Interview Highlights

On Portsmouth as a place to get prescription drugs

Portsmouth was the pill mill capital of America, really. They had more pill mills per capita in that town than anywhere else in the country. Pill mills are where a doctor prescribes pills for cash without almost any diagnosis of any pain problems or anything like that. Pill mills usually have long, long lines — Portsmouth had a dozen of these, and they prescribed millions of pills a year and was one of the main reasons why so many people got addicted there.

The godfather of all that was a guy by the name of David Proctor. And by the 1990s when the main painkiller in all this, Oxycontin, is released, he sees this as basically a business model. You can prescribe these pills and people will pay you $250 every month to get that prescription, and you will always have your clinic full. And that’s what happened for many years in that town. He also taught a lot of doctors who came to work for him how to run these pill mills.

So he became kind of the Ray Kroc, the McDonald’s of pill mills with one Kentucky cop — and all these doctors went out on their own and spread this pill mill phenomenon to eastern Kentucky, parts of West Virginia and other parts of Ohio. It was a big part of how this epidemic got going early on.

On how a pill problem becomes a heroin problem

These pills contain drugs that are molecularly very similar to heroin. They are opioids, there are synthetic opiates. People would get addicted to the pills believing that well, “This is OK because it’s a doctor’s orders,” you know, prescribing this and this comes from a drug company and this kind of thing.

But at a certain point, they would no longer be using it for their pain, they would be using it because they’re addicted. Frequently the doctor would cancel the prescription or simply they just couldn’t get the pills with the regularity they needed. And so heroin is the fallback drug.

On the link to Xalisco, Mexico

Ground zero for the pills is southern Ohio, West Virginia, Kentucky, places like this. In the mid-’90s, at that same time, across the Mississippi is coming the vanguard of a group of heroin traffickers out of a small town called Xalisco in the state of Nayarit in Mexico who are taking their drugs and looking for new markets. All of this kind of coincides.

[Mexican drug cartels] used customer service, they deliver just like pizza delivery, and it really appeals to this new class of addict who were white, really kind of unfamiliar, maybe, a lot of times with the drug world.

They don’t want to get involved in Skid Row or some housing projects where everyone has always bought dope. A drug addict wants one thing above all and that’s reliability. And these guys provided that above all. They relied on being very low-profile. They did not spend their money lavishly. They looked like the day workers outside your Home Depot. They drove old cars, they never used gunplay, drive-by shootings, any of that kind of stuff because, they didn’t need to.

Enlarge this image

Journalist Sam Quinones’ other books include Antonio’s Gun and Delfino’s Dream and True Tales from Another Mexico.

Courtesy of Bloomsbury Press

On how the drug dealers operated

All these guys don’t like selling heroin. But here’s the thing: Back in the town where they’re from they have been humiliated all their lives. Their jobs are dead-end jobs. They work as bakers, they work as farm boys, they work as butchers — they don’t have anything pushing them ahead.

As this business model began to take hold, the effects were immediately seen in the town. People began to do better. They began to build big houses, they began to have nice trucks, nice cars. And all around them young men saw this. They saw that this was a route to real economic progress. One of the strangest things I encountered when I was doing this book was how Levi’s 501s were these huge forces in pushing this system across the United States.

They’re these very well-made, very expensive jeans. Well, this system was a system for turning cheap heroin into … stacks of Levi’s 501s. The reason was that these dealers very quickly noticed that these addicts they were selling to were fantastic shoplifters.

They would give these guys lists: “I need Levi’s 501s this size, this color,” because they would then take those jeans back home and act as Santa Claus. It was like this huge redemption: “I left poor. And here I am bringing Levi’s 501s for everyone.” And there was nothing cooler than walking around town during the fiesta or late at night on a Friday in your beautiful dark, blue Levi’s 501s. For a person who comes from the smallest, most humble origins in these towns — that is a narcotic itself.

On the situation today

I think these guys continue to do their job. You arrest a bunch in Denver, new guys are there to take their place — this is not a very easy system to eradicate, particularly if you have widespread prescription of pills that are creating new addicts, also, every day.

And so families, parents and loved ones of these addicts are just thrown into this nightmare. Whole houses and college savings have been maxed out because the family is trying to find some way of getting this kid off this dope that started with, perhaps, an elbow injury in a football field or something like that. Then they went to a doctor and they got these pills. And the end is four or five years of nightmarish attempts to get rehab for this kid, relapse over and over — it’s a tough situation we’ve kind of painted ourselves into.

 

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