Dreamland, by Sam Quinones is the story of a nation gone berserk, a harrowing, fear-inducing slog through the small towns and backwater alleys of what was once as American as baseball and apple pie. On the front lines are generations of hard-working Americans, possessed of the values of the people who did make America great and who, sadly, could not forestall the destabilization of that same country in the grips of an opioid epidemic. In 2012, 259 million prescriptions were written for opioids — enough to give everyone in the U.S. their own bottle of pills. The addiction started in the heartland and worked its way outward, like ever-growing tentacles that stretched and squeezed and stretched and squeezed until we had all succumbed. Over 50,000 lives were lost to opioid addiction in 2015 and it all started with the Xalisco boys and a perfect storm of events. Those beginnings were so covert that even the medical profession that aided and abetted it could not foresee such a complete and total coup.
Dreamland would be great as a work of fiction — intense, edgy, adrenalin-inducing — if it were only that. Unfortunately, it’s for real. Whether you blame the resilient Mexicans, the ad execs that turned the pharmaceutical industry into a money-making machine, the use of the “pain index” as a fifth element in medical treatment, or a sagging American spirit that once fought for rugged individualism, but due to unemployment and loss of manufacturing jobs, among other things, now accepts the status quo like a prison inmate accepts lunch, you still come out in the same place: America likes its opioids more than it has liked any drug before, and throwing addicts in jail as a way to solve the problem is not going to work.
Quinones is the quintessential journalist, the type who goes in search of a story rather than one who sits behind a desk and waits for the internet to bring it to him. He spent years investigating the Xalisco Boys, researching, writing, following leads all the way to Mexico and back. It’s no surprise that Big Pharma comes out with egg on its face, having shoved the idea of pain as an indicator down physicians throats, sending forth wave after wave of sales team to rival an invasion and then promising to the moon and back that the oxycontin and oxycodone and other opioids were not addictive “if used properly” (what drug has ever been created that someone didn’t figure out how to use improperly?). Quinones doesn’t blame anyone, just shines a light, but Big Pharma knew, and even in the face of escalating deaths, it’s allowed the ruse to continue.
Once an addict, always an addict. Just ask anyone who’s ever smoked cigarettes and tried to quit. To this day, I won’t touch one because, despite however much I may cough at first, if I make it through one, there’s a 50/50 chance I’d have another. I know the clarity that nicotine delivers to my brain is better than a pot of coffee and my brain, especially when I’m writing, gets a bit giddy just thinking about recreating that effect. And while addicts are addicted for different reasons, they generally can’t quit for the same one: the beast of desire is a hard one to tame. When a sports injury in high school leads to a life of addiction, and in case after case, death as Quinones describes in the book, then something is wrong with the system, not the child addled because of it.
Unfortunately, there’s no easy way forward and we’re not going to get out of it without talking — a lot — because counseling is key and so is patience. But, and it’s a big BUT, that means a groundswell of a shift toward listening, not just locking people up, and in order to listen we need to stop and take a breath, suspend our judgment, and give ourselves the space to hear. Is America ready to listen? Quinones hopes Dreamland will facilitate the conversation. Our kids’ futures depend upon it.