One of the most interesting and informative books I have read about the origins of the opioid crisis in the United States is Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones.
Sam Quinones is an experienced investigative reporter from the LA Times. Dreamland is the name of the community pool in Portsmouth Ohio where from 1929 to 1993, the community gathered. There, rites of passage occurred, children grew, and generations swam with their families. Quinones uses the Dreamland pool to center his narrative about how the opioid epidemic came to dominate the United States.
Quinones weaves together story from the vantage points of the history of Oxycontin, the story of black tar heroin, and the factors of economic downturn. He details the rise of Purdue Pharm and the resulting over-prescription of opioid pain-killers. He explains the influx of heroin brought to the United States by the Mexican Jalisco boys. Quinones also investigates poverty in the Rust Belt of Ohio and coal mining areas of West Virginia.
We are first taken back to the 1980s, when Purdue Pharm developed and patented the new drug Oxycontin as a “miracle pain pill.” Quinones explains that Purdue Pharm falsely claimed its non-addictive qualities, and aggressively marketed Oxycontin to physicians in the economically depressed Appalachian Mountains of West Virginia. Quinones emphasizes the young, attractive sales force that knew how to sell, plying physicians with free merchandise, meals and trips. OxyContin sales grew from $48 million in 1996 to almost $1.1 billion in 2000. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)
Black tar heroin is in many ways the opposite of Oxycontin. Black tar heroin gets its name because of its dark, sticky appearance, looking much like roofing tar. It is crudely manufactured in the mountains of Mexico, containing many impurities that, when injected, can cause life-threatening infections and vein disease. It is more potent than white powder heroin. (White powder heroin is cut many times by various levels of dealers before it reaches users.)
Black tar heroin gained a foothold in the southwestern United States through its delivery system. The Jalisco boys revolutionized drug dealing by delivering their product to customers, much like a pizza delivery. Customers call a phone number; a delivery place is determined. Drivers and customers meet at the designated location to make the sale. Deliveries were followed up by phone calls checking the customer satisfaction.
Once hooked on opioid pills, customers found it cheaper and easier to obtain the more potent black tar heroin. Many users made the switch from white powder, facilitated by the service-oriented Jalisco delivery system. Quiniones tells how law enforcement agencies cooperated beyond state lines to piece together the puzzle of how the Jalisco network worked across the nation. Quinones describes of the doctors and researchers who noticed the increase of overdose death and investigated them looking for patterns. He reveals pill mills that distribute thousands of opioid pain pills a day. And yes, we read about the lives of the addicted and the devastation to themselves and their families.
Dreamland tells a well-researched and well-written story of the multifaceted events that came together to create the opioid crisis we know today.