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.
Published: April 21, 2015
My Review: ★ ★ ★ ★ ★
This book is a fascinating and disturbing look at the connection between the use of prescription opiates and heroin addiction. The author blends facts with real life stories, pulling us into this world where pharmaceutical companies and pill mill doctors are knowingly creating addicts.
Much of the story centers around Portsmouth, Ohio, a blue-collar town where families once thrived. We follow its history, through an economic collapse, the burgeoning pain clinics and Oxycontin push, and the subsequent onslaught of heroin dealers and addicts.
About the only new folks who came to Portsmouth then were merchants of the poor economy. Portsmouth got its first check-cashing places and first rent-to-owns. Pawn shops and scrap metal yards opened. And David Procter expanded his practice.
But the problem is certainly not limited to this one area of Ohio. Quinones takes us through the country, where opiate and heroin addictions go hand-in-hand.
We also learn about the Xalisco Boys, a loosely formed group of Mexican immigrants who take advantage of the new opiate addiction by providing a cheaper alternative. Black tar heroin comes from Mexico, not Afghanistan, and it is a far worse problem than the white powder has ever been.
Think of it like a fast-food franchise, the informant said, like a pizza delivery service. Each heroin cell or franchise has an owner in Xalisco, Nayarit, who supplies the cell with heroin. The owner doesn’t often come to the United States. He communicates only with the cell manager, who lives in Denver and runs the business for him.
Throughout this book, we meet the addicts and their families, the dealers, the doctors, and the DEA agents who are trying to make sense of this fast-growing epidemic.
Oxycontin, Oxycodone, and heroin all come from the morphine molecule. One is not safer than the other. They are all highly addictive drugs. Quinones uncovers the lies told to doctors and to patients about the supposed safety of the Oxy product, with pharmaceutical representatives calling it nonaddictive and pushing doctors to prescribe in increasing dosages. The pharmaceutical company here is worse than the street dealer, as they purposely and knowingly create a nation of addicts all in the name of profit. Yet no one is locking them away for their crime.
In 1998, Purdue sent out fifteen thousand copies of a video about Oxycontin to doctors around the country without submitting it to the FDA for review, contrary to the agency’s regulations.
This is a book that needs to be read by the masses. We have become a nation of drug addicts. Putting it in pill form and labeling it ‘medication’ only means our dealers are now pharmaceutical companies instead of drug cartels. That is, until the doctor cuts us off or we can’t afford the pills anymore. Addiction doesn’t go away because the doctor stops writing prescriptions or because the pills cost too much. When that happens, we just turn to the cheaper alternative. Whether we call them ‘legal medications’ or ‘illegal drugs’, it’s all the same and it’s all destructive.
So as the movement to destigmatize opiates and use them for chronic pain gained energy, the seeds of discontent were already being sown. These drugs were advertised mostly to primary care physicians, who had little pain-management training and were making their money by churning patients through their offices at a thirteen-minute clip.
*Neither I nor the author make the claim that pain meds should not be prescribed and used appropriately – only cautiously.*
Thanks for reading. 
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