Dreamland

"One of several good books I’ve read on the opiate epidemic in the US. This one is incredibly well researched to the point where it’s almost like a textbook. It can be hard to follow at times though because it jumps around to many different stories of people and geography."

"I have read this three times. This book lays out how this country fell into the opioid crisis. I can’t tell you how many times I said, “WHAT!?”"

"This book hit me like a stack of bricks. "Dreamland" tells the story of the rise of OxyContin and the Xalisco heroin operation that have destroyed so many lives in heartland America. Although packed with hard facts, Quionones also follows individual actors in this narco-drama to humanize the supply, demand, and regulatory sides of this horrific market. What emerges is an appalling picture of an opiate epidemic in America - and in my home state of Kentucky in particular - orders of magnitude worse than I had ever imagined.<br/><br/>I did some of my own research to see how the opiate epidemic was playing out in my hometown of Louisville, Kentucky. What I found shocked me. <a href="http://odcp.ky.gov/Documents/2015%20KY%20ODCP%20Overdose%20Fatality%20Report%20Final.pdf">1 out of every 1,000 people in Jefferson County</a> (my home county) has died of a drug overdose in the last 3 years. That's twice the number of <a href="http://transportation.ky.gov/Highway-Safety/Documents/Daily_Fatality_YE_2015.pdf">people that died in car accidents</a> in that same time period. The book points out how unusual this is: <i>"Since the rise of the automobile in America, vehicle accidents sat unassailed atop the list of causes of injury death in every state"</i> - other causes weren't even close. Now drug overdoses are <b>double</b> auto accidents. I saw stories like <a href="http://insiderlouisville.com/metro/overdose-deaths-in-2015-increased-by-17-percent-in-kentucky-31-percent-in-louisville/">"Overdose deaths in 2015 increased by 17 percent in Kentucky, 31 percent in Louisville"</a> and just months ago <a href="http://www.courier-journal.com/story/news/crime/2016/08/31/heroin-overdoses-slam-louisville-ers-tuesday/89641768/">"Dozens overdose from mystery heroin mix"</a>. And this is from quiet, family-friendly Louisville! This is a crisis on an enormous scale.<br/><br/>Here are some of the biggest "oh wow" moments I had reading this book:<br/><br/>* More Americans die each year of heroin overdoses than car crashes (true since 2008). <b>This is insane.</b><br/>* Exploding rates of opiate addiction in white America, particularly in the Rust Belt - <i>"virtually all the new addicts were rural and suburban white people"</i><br/>* Opiate overprescription epidemic (primarily OxyContin) enabled by apparent scientific negligence and corporate marketing pressure<br/>* OxyContin to heroin transition fueled by rapid acquisition of opioid tolerance and cheap, high quality Mexican heroin<br/>* Dominance of decentralized, pizza-delivery-style operations of vertically-integrated, highly entrepreneurial and adaptive cells from Xalisco<br/>* Explicit targeting of middle-class whites by Xalisco cells - <i>"They sell almost exclusively to whites"</i><br/>* Complete ineffectiveness of "catch-and-deport" policies<br/>* Changing attitudes among Republicans towards addiction policy - primarily driven by increasing prevalence of personal connections to addicts.<br/><br/>I was particularly infuriated by the failure of our regulatory and scientific apparatus. Most egregiously, "FDA examiner Dr. Curtis Wright, supervisor of the agency’s team that examined Purdue’s [OxyContin] application.. later left the FDA to work for Purdue". Conflicted much? And just as bad - the negligence of the scientific establishment in putting so much weight on the "landmark" Porter and Jick study (which turned out to be a paragraph letter to the editor - not even a peer-reviewed study!) is unacceptable - apparently no one could be troubled to go back and actually read this thing that they were all citing. Disgusting. We have to do a better job than this.<br/><br/>Quinones doesn't offer much in the way of hope. He does spend a little time on what I suspect is the underlying cause of the epidemic - cultural bankruptcy. Our cultural reorientation towards hedonism and moral relativism has made our society profoundly vulnerable to this opiate epidemic. As one of his interviewees says, "In a culture that demanded comfort... heroin was the final convenience." This observation hurts - a lot. But it hurts because it's true. We can't use poverty or lack of economic opportunity as an excuse - after all, hardly anybody in Xalisco is doing heroin. When we don't believe in anything, the siren song of empty, addictive pleasure is impossible to resist. The beliefs and institutions that once held white America together are falling apart. If we're going to fix our opiate addiction problem, that's not a bad place to start.<br/><br/>Full review and highlights at <a href="http://books.max-nova.com/dreamland/">http://books.max-nova.com/dreamland/</a>"

"I liked how informative this book was. It wasn't just statistics but real life accounts and it dives deep into the heart of the opioid epidemic "

"Very interesting topic that I knew little about - I was intrigued through the first few chapters. After that it became repetitive and there was little new information given through the remainder of the book. An in-depth article may have sufficed! <br/><br/>The brief vignettes about addicts/families/dealers/researchers/doctors/counselors were helpful at first but quickly lost their effect because there were SO MANY. I would have preferred a few people's stories woven throughout the book because they all started to mesh together for me in the end. <br/><br/>I also was taken aback at the number of times the author pointed out that "these people are all white!" as if that should be utterly shocking and make this epidemic more horrifying than any addiction in the black community. <br/><br/>Finally, I found the afterword irritating and preachy. (My kids do ride their bikes in the neighborhood and play outside quite a bit ... and I'm guessing they'll be just as susceptible to issues like this as any other teenager.)<br/><br/>I'm glad I have more of an awareness about opiates, but I can't recommend the book."