Review of Dreamland By Sam Quinones
December 28, 2022
Why does the United States have such an unshakable drug addiction problem? Drug addiction and overdoses are a uniquely American issue. No other large, developed nation has nearly the rate of drug overdoses and deaths as the United States. What are the historical and societal conditions that led to the prevalence, and continued increase of, overdose deaths in the United States? In Dreamland, Sam Quinones shares one part of the complex, tangled, story.
The United States healthcare industry has a notable emphasis on drug treatments as the primary vector of care. Treatments such as surgery and drugs are often favored over those involving diet and lifestyle changes. Furthermore, the United States is one of the only countries to allow pharmaceutical companies to advertise directly to consumers. These factors reinforce one another and create an environment in which people demand quick solutions to their ailments, with doctors feeling obligated to provide them. Quinones highlights this fact in his discussion of pill mills. These were medical offices that prescribed copious amounts of opioids to patients, with little care given to the condition of the patient or whether medication was genuinely the best way to treat their pain. Most patients would spend less than 10 minutes with a doctor before being given a prescription for painkillers.
Of the prescription drugs that played a role in the opioid crisis, OxyContin is one of the most important. Beginning in the early 2000s, multiple states sued Purdue Pharma, the creator of OxyContin. As a result of the lawsuits, the owners of Purdue Pharma, the Sacklers, were ordered to pay $6 billion, but will remain billionaires and have not been charged with any crimes. It is estimated that the Sacklers made $10 billion in profits from OxyContin. While this outcome is better than a total lack of accountability, it makes clear that large pharmaceutical companies can avoid the most punitive aspects of the justice system, and can profit off the suffering of others with few consequences.
Purdue Pharma is one contributor, but I believe the root cause of America's drug problem is deeper. Notably, drug overdoses have not slowed despite a decrease in opioid prescriptions and an effort to make these drugs harder to abuse. Instead, there has been a rise in overdoses involving heroin and stronger drugs like fentanyl. These drugs are easy to obtain on the street and easier to overdose on than prescription painkillers. It is clear that those in poverty, those lacking economic opportunities, and the homeless are more likely to use drugs. In recent years, the strife of the poorest Americans has only been exacerbated by rising income inequality and challenges brought on by the pandemic. With a lower availability of prescription painkillers, those in despair now turn to dangerous illegal drugs that are unregulated and unsafe. This synergistic combination of factors helps explain the large increase in overdoses in the United States in recent years.
While Sam Quinones does not provide a comprehensive explanation of the opioid crisis in Dreamland, he introduces many of the concepts and characters that are still important today. Dreamland aided me in thinking about the opioid crisis and the complex history behind it. Solving the problem of drug use in America appears roughly equivalent to solving many social problems. While a daunting conclusion, this tells us that drug abuse is not amenable to temporary solutions, but needs to be addressed at a more fundamental level.
Soft White Underbelly is a fascinating YouTube channel featuring interviews with many people affected by the drug addiction crisis in the United States. Hearing firsthand accounts of the suffering adds color to what can sometimes be an opaque topic.
Here is an academic article exploring some of the causes of the opioid crisis. It highlights the intertwined nature of the aspects of the issue and how difficult it is to solve.
Here is a literature review from the FDA concerning the effects of the reformulation of OxyContin in 2010 on public health for those interested in this event.