Dreamland: How The American Opiate Crisis Was Born – Uncovering The Pandemic Through An Investigative Look At Attitudes, Corporations And Media In The Us
Dreamland gives readers the chance to really get to grips with a uniquely American crisis.
In 2015, the US Drug Enforcement Administration declared it an epidemic – one that has been fueled by US attitudes towards health care, addiction and poverty.
Sam Quinones looks at the many contributing factors, from law enforcement and scientific research to media portrayals and big businesses.
These all combine to create addition on a massive scale – but Dreamland is also full of hope.
It’s possible to see this problem fixed with the right commitment from everybody involved, from the top-level government all the way down.
In reading through Dreamland, you’ll go on a journey that illuminates what parents used to give their kids in order to calm them down; how a single letter turned into something misunderstood; and how illegal networks survive even in today’s world.
All these paths take us closer to understanding this American crisis which we must tackle head-on if we want any kind of resolution.
How The False Promise Of Oxycontin Led To The Opiate Crisis
The opiate crisis has been devastating the United States and many people are unaware that the roots of this crisis can be traced all the way back to the production of a tiny pill.
In 1984, Purdue released MS Contin – a time-release morphine pill designed to treat serious pain in dying or post-surgery patients.
The success of this drug prompted Purdue to release a similar medication in 1996 containing oxycodone as its active ingredient – OxyContin.
Because of the promise that it’s special time-release coating formula would limit addiction, OxyContin was approved by the FDA in 1995 and heavily marketed with claims of being safe from abuse.
Doctors began prescribing large doses of OxyContin for chronic pain management outside hospitals, but these pills lacked common precautionary agents such as acetaminophen or Tylenol that usually prevent abuse–leading to increased cases of addiction.
With flashy marketing campaigns and bonus payouts for sales rising from $1 million in 1996 to $40 million in 2001, Purdue had turned opioids into an industry standard prescriptive practice with very little actual training on how to manage pain properly.
While small in size, it’s impossible to overstate just how big of a role this tiny pill has played in creating and maintaining the opiate crisis we currently live in.
How The Chemistry Of Morphine Has Driven Humans To Addiction For Thousands Of Years
Morphine has been part of human history for millennia.
The ancient Sumerians called opium the “joy plant,” and it was popular in Egypt and Greece.
India and the Arab Empire also made great use of morphine derived from opium plants, as did classical Greek physicians who used it to relieve pain.
The active molecule in opium is morphine – a powerful substance that provides relief but is also highly addictive.
It wasn’t until the 1800s that scientists isolated underwater and were able to study the full effects of morphine.
Its use spread rapidly, especially during wartime due to its properties as a painkiller.
The invention of the hypodermic needle by Alexander Wood was believed to reduce drug abuse because users could now accurately measure their intake – especially with narcotic drugs such as morphine – something that had been impossible through oral ingestion before.
Unfortunately, this didn’t turn out to be true as Wood’s own wife became one of the first recorded victims of an intravenous opiate overdose.
At about the same time, marketing certain “miraculous” medicines with opiate content became big business in America, like Mrs.
Winslow’s Soothing Syrup prescribed for boisterous children!
In 1901 this reached $75 million per year in sales alone!
It was around then that Dr.
Alder Wright synthesized heroin in 1874 as an attempt to find a non-addictive alternative to morphine; however heroin turned out to be even more addictive than its predecessor and doctors began prescribing it for all sorts of ailments from coughs to menstrual cramps!
That can explain why people have grown so addicted so quickly: when opioids reach our brains’ mu-opioid receptors they are triggered into releasing intense amounts of pleasure instead of having to wait for natural endorphins produced by our bodies, hence providing drug addicts with an extremely powerful rush combined with an intense feeling of numbness – no wonder those trying desperately try whatever it takes just for another dose after the inevitable brutal withdrawal symptoms kick in!
How One Single-Paragraph Letter Changed The Way We Treat Pain
The 1980s saw a revolution in attitudes towards treating pain in the United States.
This began with the publishing of a short study by Hershel Jick and Jane Porter in the New England Journal of Medicine.
They had analyzed their data from 12,000 hospitalized patients and discovered that only four had developed an addiction to opiates while taking them.
This publication set off a chain reaction that saw an increased focus on addressing chronic pain as well as patient rights when it came to adequate treatment.
In response to this, the American Pain Society declared that “pain is the fifth vital sign” and organizations such as California’s Board of Pharmacy started advocating for more opiate use with statements like “studies show an extremely low potential for abuse” when used correctly.
At the same time, doctors became fearful of giving pain relief options due to potential lawsuits; however, Porter and Jick’s letter was misinterpreted and treated as gospel science without being properly read, leading practitioners to believe that overdoses were largely responsible for what was actually pseudoaddiction or inadequate levels of dosage resulting from doctors being too cautious.
As such, they aggressively increased dosages when needed, resulting in a new way of looking at treating long-term pain in America.
How The Pill Mill Economy Turned Desperation Into Subeconomies In America’S Rust Belt Cities
In the 1990s, pill mills spread like wildfire across the American Rust Belt.
Originally started as a way for doctors to make money in places where jobs were scarce and Medicare cards easier to come by, these clinics quickly took over as drug dealers found out a new way to make money.
The number of people collecting Supplemental Security Income in Scioto County, Ohio (which includes Portsmouth) nearly doubled between 1998 and 2008.
People would travel far and wide to stock up on OxyContin from these pill mills and then trade them on the black market for other goods and services.
Since these pills were now worth so much money, an entire underground subeconomy emerged around them.
Entrepreneurs began driving groups of addicts to the clinic in exchange for half their drug prescription – clean urine also became especially valuable, with child’s urine selling at up to $40 per bottle!
The success of these pill mills depended largely upon unscrupulous medical professionals known as “locum tenens”.
These were desperate doctors who potentially had problems with licensing or substance abuse and due to this could not acquire malpractice insurance.
With the help of these shady practitioners, drugs quickly flooded the region- leaving behind an indelible mark on many rust belt towns throughout America in its wake.
The Rise Of The Xalisco Boys: How A Mexican Village Revolutionized America’S Heroin Trade
The tiny Mexican village of Xalisco has had a huge impact on the lives of millions of Americans.
In the 1980s, while drug use was on the rise in the Rust Belt, a family from Xalisco began selling black tar heroin in the San Fernando Valley.
These were called the Xalisco Boys and their business model was very different from other big-time heroin dealers: Instead of wholesaling their product, they chose to sell it retail.
The Xalisco Boys used black tar heroin which had much more potency than the powdered kind that was available at that time; this was because it was made from actual poppies grown in and around Xalisco itself.
Moreover, their organization operated somewhat like franchises; one part of their family would harvest the poppy flowers, another would refine them into black tar heroin and a third would handle the sales side with small independent cells run by managers, phone operators, and drivers.
The drivers would then drive around all day mouthfuls of tiny balloons filled with concentrated doses of heroin; if caught by police they could quickly swallow them before disposal.
This method allowed for quick and efficient distribution without adding any cutting or loss to its potency– ultimately leading to greater earnings for each cell within an incredibly short time period.
Thanks to this invention by the Xalisco Boys, countless people have been able to access higher quality drugs without putting themselves at risk due to multiple parties intervening between production and hit street level.
While there are undoubtedly some negative aspects to consider here as well, it cannot be denied that this once quiet Mexican village has had an immense effect on people’s lives across America.
The Xalisco Boys Showed The Deadly Toll Of Using Methadone Clinics For Weaning Addicts Off Heroin
The Xalisco Boys were a notorious drug-dealing organization based in San Fernando Valley, California.
They soon expanded into new markets across the United States and by 1997 they had already made their mark in many cities with their heroin trade.
This quick growth of the Xalisco Boys was largely due to their unique business model: handing out free samples of heroin to addicts who had just come from methadone clinics.
When addicts became too used to their prescribed amount at these clinics, they took advantage of the Xalisco offers for more potent drugs.
The Xalisco Boys’ strategy proved effective as it allowed them to build up a large client base and take advantage of dissatisfied methadone clinic users.
One notable place where this had an effect was Portland, Oregon where 50% of Central City Concern’s patients had become initially hooked on Xalisco dope by 1997.
It took until 1999 for officials to notice that an epidemic of heroin overdoses had occurred with 111 deaths in the same year alone.
Thanks to skilled drivers, access to methadone clinics, and a unique business model, the Xalisco Boys rapidly grew their presence all over America and made themselves known as drug kings in many cities.
The Xalisco Boys’ Business Model: How To Succeed At Selling Heroin
The Xalisco Boys were incredibly successful in selling their product due to their clever approach to marketing.
They understood that, in order for a good business to thrive, its customers had to be happy and it had to be convenient to buy the product.
In order to succeed, they used different methods than other dealers.
Instead of waiting around on street corners for customers like other heroin dealers, they would frequently approach potential buyers with free samples and discounts.
And they followed up with their regular customers via phone calls or check-ins– ensuring that those who weren’t returning had entered rehab.
They also supplied recently released prisoners with free heroin packs to keep them coming back as customers plus even elicited addicts help in spreading the word about their business in exchange for free heroin!
With this strategy of customer satisfaction and convenience, The Xalisco Boys’ competitive advantage was seen through every step of their process– from differentiating themselves duress competition between cells; pushing into less saturated markets; offering price breaks and follow-ups service for good clients; aiming at the middle-class white kids demographic; using non-violent drivers who didn’t carry guns; giving going away presents etc.
This agile yet calculated method was essential for their success as a whole organisation across multiple states- demonstrated by The FBI and DEA’s Operation Tar Pit busts which were not able to get rid of the problem completely as demand remained strong after the busts took place.
The Opiate Painkiller Epidemic: How We Got Here
The ‘pain revolution’ of the 2000s had made opiate-based drugs a regular part of pain management in the United States.
Best evidence of this was seen in higher rates of prescription and ingestion.
By the early 2000s, there were already 100 million chronic pain sufferers throughout the country who were being prescribed opiate medications.
Out of these, 86 percent used oxycodone and 99 percent used hydrocodone.
In fact, hydrocodone is now the most prescribed single-drug in America; with 136 million doses per year!
Furthermore, recreational use began to rise too; between 2002 and 2011, an estimated 25 million Americans took these pills for reasons other than their intended purpose.
Additionally, usage age dropped drastically too – from 2004’s Substance Abuse and Mental Health Services Administration study showed that 2.4 million people aged 12 or above had taken these drugs illegally for the first time within a single year.
That’s more than marijuana!
The implications soon began to show: overdose deaths rose from ten per day in 1999 to 48 per day by 2012; while there was roughly a tripling in emergency room visits caused by opioids by 2011 when compared to 2004 figures.
Even more shocking was this statistic: 10 years after OxyContin’s release, it had been abused by 6.1 million people all around America – representing around 2.4 percent of its population!
This dose was much higher than other similar drugs like Lortab or Vicodin due to its time-release coating being stripped away easily through sucking, allowing users to snort or inject pure oxycodone for greater highs instead – leading some even down towards heroin addiction due to its greater availability and affordability compared to traditional opioids .
From 2007 onwards, this led to an overall increase from 373 thousand heroin users in 2007 up to 620 thousand heroin addicts come 2011 nationwide!
Joe Hale’s Quest For Justice Reveals The Link Between Painkiller Prescriptions And Overdose Deaths
As early as the late 1990s, it was becoming increasingly clear that opiate abuse in the United States was getting out of control.
But it wasn’t until a few people noticed and started to speak up that a backlash against unnecessary opiate prescriptions really began to gather momentum.
One of those people was Joe Hale, a public defender from Lucasville, Ohio.
In 1999, he became aware of a lot of conversations about ‘OCs’, or OxyContin, and realized many were injecting them too.
So he filed the first wrongful death lawsuit against the producer of OxyContin – Purdue – in 2001.
However, this legal battle wouldn’t last long; eight sharply dressed Purdue lawyers quickly put him off his course and Hale dropped his suit soon after.
It wasn’t until 2005 when Ed Socie, working in Ohio’s department of health , had noticed deaths from accidental poisonings were on the increase that real progress began to be made in addressing opiate abuse in America.
Eventually, with Christy Beeghly’s involvement as supervisor at Ohio Health Department it was discovered that overdoses were about to overtake car accidents as the number one cause of accidental death in Ohio by 2008 – truly an astonishing feat considering cars had been the leading contributor for so many years prior.
Furthermore, it became definitively undeniable that overdose deaths rose far greater than prescribed painkillers between 1999 and 2008 (the correlation being 97.9 percent).
John Brownlee Takes On The Opiate Crisis By Taking On Big Pharma Companies Like Purdue And Pfizer
The opiate crisis was reaching a fever pitch, and something had to be done.
That’s when John Brownlee stepped up to the plate, as he became one of the first US attorneys to take on the growing epidemic in 2001.
He began by focusing on the pill mill doctors, but it soon became apparent that this strategy wasn’t getting anywhere.
It was then that he realized there was only one way forward: filing a criminal case against Purdue for their false ads about OxyContin.
And so, in fall 2006, Wilson filed a case accusing Purdue of criminal misbranding.
He provided evidence that showed that despite Purdue’s marketing claims, they had submitted no proof to the FDA showing OxyContin was less addictive than other medications; plus, their sales reps were falsely claiming that users could stop using OxyContin at any point without suffering withdrawal symptoms.
Ultimately, Purdue pleaded guilty and paid a $634.5 million fine– avoiding prison sentences for its executives–to avoid prosecution.
And this marked the start of many more successful cases by Brownlee against drug manufactures; with Pfizer ultimately paying $3 billion in fines for false advertising relating to several drugs.
With Wilson’s victory in Virginia paving the way for justice to be served against opiate manufacturers across the country, it is clear that this landmark case has had profound repercussions and indeed sparked an era of change in how we approach dealing with such difficult issues.
The Pain Of Loss Prompts Action: How Grieving Parents And Creative Activists Take On The Opiate Epidemic
It took time, but gradually, victims of the opiate epidemic began to speak out, determined to make a difference.
Jo Anna Krohn was one such person – her son had been high on Oxy and shot himself in the head while messing around with a gun.
Sitting by her comatose son’s bedside for his last few hours of life spurred Krohn into action.
She created SOLACE, a group for parents mourning the loss of their children to opiates, and began speaking at schools about her experience.
Soon, SOLACE had multiple chapters across 16 counties.
Brad Belcher found another creative way to spread awareness about the issue in Marion, Ohio: He ordered 800 large signs with “HEROIN IS MARION’S ECONOMY” printed on them and started hanging them up all around town late at night only to be caught early morning by city authorities – but still managed to make an impact as the sing was shared online and received viral attention.
The death of beloved actor Philip Seymour Hoffman in 2014 was further proof that this was an increasingly pressing problem that could not be ignored any longer; media outlets across the country suddenly came to terms with what had been an ongoing crisis 15 years in the making.
The Pain Revolution: How Unchecked Opioid Use Led To A Public Health Emergency And The Remarkable Comeback Of One Forgotten American Town
The pain revolution of the past two decades has been proven to be misguided, as more and more people have come to realize that opiates are not always necessary for treating pain.
In fact, studies conducted in 2007 suggested that up to 24 percent of patients taking opioids may be at risk for “aberrant” use.
Purdue Pharma, manufacturers of OxyContin, responded by adding an abuse deterrent to the drug in 2010 – however this was unfortunately too late to prevent the damage that had already been done.
Fortunately, progress is beginning to be made.
The FDA has mandated drug companies to educate practitioners and patients on the risks of addiction linked with time-release painkillers – though still too late – while numerous initiatives like counseling centers and gyms are opening up in towns previously suffering from opioid addiction across the American Rust Belt – like Portsmouth – where people can break their addiction cycles and start a new life.
These towns are finally starting to bounce back from their dark situation thanks to these help efforts.
In Dreamland, Sam Quinones exposes the truth behind the deadly opiate crisis in the United States.
He traces this epidemic back to when OxyContin was introduced in the 1980s and forced as a safe drug on patients who were neither warned of its risks nor monitored after being prescribed it.
This drug was then quickly abused, leading to an increase in heroin use.
Simultaneously, drug networks became more sophisticated with better access to heroin, all while efforts by regulatory bodies and law enforcement branches alike failed to address or even acknowledge the severity of the problem.
As a result of these events, overdose is now officially recorded as the number one leading cause of accidental death in America.