Sam Quinones

from Erin:

A thoroughly engrossing read detailing the history of opiate use in America, and the explosion of opiate pill use in the late 90s, which coincided with a new model of heroin trafficking created and run by one small town in Mexico. Quinones obviously spent years researching and interviewing individuals on all sides of the issue: Mexican traffickers, parents of kids addicted to opiates, pioneers in the pain management field which unwittingly began the over-prescribing of opiates, show more civil servants in municipal and state health offices who first noticed the disturbing uptick on opiate-related deaths, law enforcement at all levels, and addicts themselves. The book's title comes from Portsmouth, Ohio, which became an epicenter for the epidemic as the "pill mill" capital of the US. The old swimming pool known as Dreamland represented for many people growing up in Portsmouth a symbol of a successful middle class life, a place for the community to come together, take care of each other, and watch the town's children grow. Children who, in the late 90s, began to die at alarming rates from opiate overdoses. Pill abuse moved west from Appalachia and rural Ohio just as the incredibly successful Mexican trade of cheap black tar heroin moved east. Medicaid unwittingly paid for millions of dollars of pills that replaced case as the basis of the economy of Portsmouth. A very well-written and engaging read, which ends with a bit of hope for the town of Portsmouth. Quinones' summary of the roots of the issue stuck with me after I read it: "That it began in voiceless parts of the country - in Appalachia and rural America - helped keep it quiet at first." A must-read. show less

An absolutely fantastically well researched and timely book. This book, made me so angry and so aware of the origins of America's opiate epidemic. As a Hoosier I am quite familiar with heroin and pills. It's everywhere. Not only do I read the arrest records, but I deal with the public in my job, have been trained to use Narcan, and years ago dated someone who was an addict. Everything I knew about opiates fit neatly into this tome and helped explain the bigger picture. It's infuriating. This show more book made me so mad at the pharmaceutical companies, doctors, lawmakers, coaches, and parents. how did we all let this happen?! An eye opening book that helped me view our country in a new light. show less

I am not at all surprised by anything I read in Dreamland, being that I grew up in a small town that easily could have been profiled in this book.

What strikes me most was how many tendrils of policy that have been hallmarks of Republican politics led to the opiate epidemic (and yes, I *AM* going to blame this on Republicans).

Classism and white supremacy meant that nobody dealt with drug problems when they were killing poor people, people of color, or the mentally ill. Republicans didn't show more mind if Black people were getting killed over drugs or overdosing (let 'em die, or throw 'em in jail), but as soon as white people, and specifically, middle and upper class white people, were doing so, it became a BIG PROBLEM. Well-off white people can't go to jail! Let's send them to treatment centers instead! Maybe the problem wouldn't have gotten out of hand if they had treated everybody, instead of sitting on their hands until the problem had the same color skin as they did.

Allowing pharmaceutical companies to market to doctors and the public allowed medications to enter the public consciousness in a way that had been unheard of previously; a watered-down FDA meant that not enough vetting went into drug approval (it still doesn't). And allowing the insurance industry to continue getting away with murder meant that patients were unable to get comprehensive help for their injuries, leading doctors to overprescribe instead.

Finally, the Republican politics that resulted in so many jobs disappearing from the US just hammered the nail in the coffin. Rural towns often had little else going on. The youth of those towns had to while away their time in boredom until they were old enough to finally leave. Unfortunately, abusing opiates, which certainly mitigated boredom at first, had the ironic side effect of leaving them chained to those very same rural towns.

In all, Dreamland was a very interesting look into the opioid epidemic, although at times I felt the narrative to be too meandering and repeated itself too much. I believe it is an important story to be told. I would be interested in reading follow-up; to find out what steps have been taken since the book was published to help deal with the problem. show less

Dreamland is important book, and perhaps even an essential one, but it's by no means perfect. The author does a lot of things very well here. He's good on background, telling readers how both doctors' and patients' perceptions of pain, coping strategies, and opiates evolved over the course of the last hundred years. He provides a clear, concise description of what makes OxyContin different from the painkillers that came before it. His description of the heroin and smuggling distribution show more network that grew out of the out-of-the-way Mexican town of Xalisco is meticulous and fascinating, and he apparently took the time to interview a significant number of individuals that were involved in both building and combating this unusual criminal enterprise. He paints a vivid portrait of the Appalachian communities ravaged by the opiate epidemic. These parts of "Dreamland" will certainly sate the appetites of readers on the lookout for disaster porn, as will his descriptions of the wild scenes that took place inside -- and even in the parking lots of -- the notorious "pill mills" that grew up around rust-belt towns during the first decade of the new millennium. Even so, his account of the parents who chose to break their silence and discuss their children's struggle with opiates directly is both sensitive and heart-wrenching. There are places in "Dreamland" that eloquently address the social climate that facilitated the growth of the opiate epidemic, from increasing social isolation to medical malpractice to industrial decline to governmental neglect. In some ways, Quinones seems to have been writing about the opiate epidemic in real time: my copy of the book contains an afterword, but was published before the fentanyl epidemic really hit and bootleg pills became commonplace. "Dreamland" ends on a positive note, showing the various ways in which the southern Ohio town of Portsmouth has staged a brave comeback in recent years, even as its drug problem persists. But one can't help but wonder how the town fared in the years after "Dreamland" was published, when the opiate epidemic grew even worse.

The book has its weaknesses, though. I got the sense that Quinones found two interesting stories -- one involving a small town in Mexico that set up an unusually efficient and resilient drug-distribution operation and the other that involves America's disastrous addiction to potent painkillers -- and decided to combine them in the same book. As fascinating as it is to read about, the author never quite convinced me that the Xalisco Boys network was essential to the opiate epidemic and that it would not have happened had this network not existed. The author readily admits that there were big markets that the Xalisco Boys network never touched and that opiates have been a persistent problem in some American cities for generations. I tend to think that supply tends to follow demand in these situations, and, at one point, he basically admits that if they hadn't somebody else -- perhaps the already established Mexican cartels -- would have sold dope to rural Americans. Quinones also seems to put a lot of emphasis on how the demographics of heroin usage has shifted, but it's unclear whether it's he or his subjects who seem appalled that well-off white kids are getting high and dying from heroin rather than the sort of people who've traditionally been drawn to the drug, which would include poor urban black folks and artsy types. Furthermore, I was never quite convinced that the Dreamland -- once a much-loved public pool in Portsmouth, Ohio -- made a fantastic allegory for the American experience, but towards the end of the book the author really ratchets up the nostalgia in a way that I found truly exasperating, taking aim at trigger warnings and parents who won't let their kids play outside anymore. It's a shame that a book that's so frequently insightful would end with such banal musings on how Americans have gone all soft. In other words, the author seems to be requesting that the reader get off his lawn. Despite these misgivings, "Dreamland" is an eye-opening read, one of those books that you wish every American would read. Not perfect, but certainly recommended. show less