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Thursday, August 25, 2016

Dreamland: The True Tale of America's Opiate Epidemic

I have been reading a lot on the opiate epidemic as of late, and I have quite a few feelings on it. It has hit close to home as it has for many people I know. Chances are good you know someone who is addicted, or at the very least you have a friend who does. I picked up the award winning Dreamland: The True Tale of America's Opiate Epidemic by Sam Quinones.

In case you missed it, this country is facing an opioid epidemic of massive proportions. We could talk details all we want about how this is now labeled as such because it's affecting affluent populations, but this post is squarely focused on the theme of the book.

The statistics on this extensive problem are everywhere, but this is a good resource for the basics; the truth is that they are almost too staggering to believe. According to the Department for Health and Human Services (see the hyperlink above), 3,900 people begin taking prescription opioids for non-medical reasons each day -- 78 people each day die from this addiction. It is not necessarily worse for those family members and friends of opioid addicts than other types of addicts, but it is certainly an epidemic that is hitting home for a large swath of the American population. An interesting subset of this problem is the black tar heroin underground market which provides a much cheaper alternative to prescription opioids that have to be acquired through different channels. This incredible piece of reporting examines the epidemic from two sides -- a macro and a micro. The macro side looks at the epidemic as a whole, including where it started and the ever changing prevailing beliefs of doctors about pain management in patients. The micro side looks at the intricate system of the black tar heroin market that is almost exclusively run out of a small town in Mexico and focuses on wealthy white customers around the country -- the country of America, that is.

I would joke with people while carrying this book around that it wasn't an upper, and the truth of the matter is that the situation as a whole is absolutely not a happy one. Drug addiction is a dirty business, and one that has far reaching consequences not just for the addict but for his or her intimate and extended networks, and even for the country at large. This epidemic is costing us all dearly. The alternation of the macro and micro perspectives was a great structure for me as a reader; once the information got too close to home, I was able to switch out of personal mode and enter into professional mode. The story of the Jalisco boys, the cartel essentially owning the black tar heroin market in the United States, was utterly fascinating from both a business perspective as well as a human one. Their business felt so cold and impersonal -- it was about the supply and demand and not personal at all. The stark honesty that they provided regarding their business -- particularly the notion that they specifically avoided people of color and poor areas not just to avoid detection but also to avoid non-payment (and, conversely, targeted white, wealthy ares) -- was astounding, painful (on many levels), and, I hate to say, brilliant. It was a fascinating in-depth study of not just a general problem, but on the people who are feeding the beast.

The professional side of me loved (if I can say that) the history of opioid procurement, prescription, and subsequent addiction in this country. From an academic perspective the throughline makes complete sense, and it's a comprehensive roadmap of where we are coming from, where we are, and, quite possibly, where we are going. The background on pain management -- we originally thought it was no big deal, then we realized that humans deserved more -- and how we got here, to the overprescription of pain pills, is not quite a direct line, but it's pretty damned close. The original academic piece that claimed there was no connection between prescribing opioids and subsequent addiction is surprisingly short (it was more of a letter than an article) and the sample was incredibly specific, as were the reported findings. In fact, to this day the original scientist remains flustered by the co-opting of his findings to a generalization that has had massive consequences. But as every social scientist knows, sometime the tiniest seed can stolen and planted in highly fertilized soil. (The long and much debunked myth that vaccines cause Autism, anyone?) Quinones traces that line for his readers and in turn creates a masterpiece that anyone who has an interest in this subject should dive into.

It's not a pretty read, and it's especially not for anyone that is trying to navigate the world of addiction. It is, however, a vital and necessary piece that should exist in more than just the National Book Award nominee cannon. This should be required reading for human beings so that we can begin to understand from whence we come and how to avoid getting into this mess again. I was recently in the ER with a sprained ankle (I fell off the back of a bus -- I'm not sure what I can tell you that sounds less stupid than that), and I was prescribed five Percocets. Five. On one hand, I was grateful after reading this tome and knowing the havoc that opioids can wreak on lives. On the other, I was in pain and needed these to function. It's still a balance that is being sought in the medical field, but at least we are moving in the right direction.

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