Reading report: Dreamland by Sam Quinones

Dreamland: The True Tale of America's Opiate EpidemicDreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

My rating: 4 of 5 stars

This fast-paced book follows two interlinked aspects of opiate abuse in America. In the first part we see how the small Mexican town of Xalisco worked its way out of poverty by sugar cane farmers reinventing the trafficking of heroin in the United States as a retail affair much like pizza delivery. “For years, though, no one could conceive of such a thing: a system of retailing street heroin that was cheaper than, as safe as, and more convenient than a methadone clinic. But in the mid-1990s, that’s exactly what the Xalisco Boys brought to towns across America.” [p64].

The Xalisco Boys started in the San Fernando Valley area of Los Angeles; but selling on the street corners was dangerous as the Mexican cartels tried to “tax” the new sellers or run them off by force. Technology was on the side of the Xalisco Boys. They simply went inside; a user would call a number to order his dope and the call center would page a young man driving around with a mouth full of heroin filled balloons would meet the buyer. This heroin was strong – 80% pure. “These street dealers were selling tenth-of-a-gram heroin doses that when tested by the FBI came up 80 percent pure. Street dealers don’t ever consistently sell addict-ready doses that pure. The traditional heroin trade made it impossible. In the typical heroin supply chain, the drug moves from wholesalers through middlemen down to street dealers. Every trafficker who handles the dope steps on it – expands the volume by diluting it – before selling it. Usually by the time heroin makes it from the poppy to the addicts’ arm, it’s been sold a half-dozen times, stepped on each time, and is about 12 percent pure.” [p120] Why could the Xalisco boys sell stronger dope at a cheaper price? Simple, “‘It’s because they’re salaried,’ … ‘The runners are up here, nephews of the regional sales manager, and just coming to do a job, paid five hundred dollars a week. They didn’t care what the potency was; they made the salary no matter how much they sold.’ Salaried employees were unheard-of in the drug business.” [p 121] However safe to buy, heroin is still a killer. “heroin overdoses had become Multnomah County [Portland, OR area] second cause of accidental death among men twenty to fifty-four years old – after car crashes.” [p 119]

As young men from the small town in Mexico prospered; the clan stayed away from big cities where the cartels dominated the trade and instead moved into towns like Fresno, Portland, Boise and even as far east as Portsmouth Ohio.

The Xalisco Boys’ success also built on the burgeoning legal opiate business as the medical business started to take pain management more seriously. In 1980, Dr. Hershel Jick wrote a short letter entitled “Addiction Rare in Patients Treated with Narcotics” to the New England Journal of Medicine. “That ‘less than 1 percent’ stuck. But a crucial point was lost: Jick’s database consisted of [i]hospitalized[/i] patients from years when opiates were strictly controlled in hospitals and given in tiny doses to those suffering the most acute pain, all overseen by doctors. These were not chronic-pian patients going home with a bottles of pain pills. It was a bizarre misinterpretation, for Jick’s letter really supported a contrary claim: that when used in hospitals for acute pain, and then when mightily controlled, opiates rarely produce addiction. Nevertheless, its message was transformed into into that broad headline ‘Addiction Rare in Patients Treated with Narcotics.'” [p 107]. This short letter was held up as full research and the opiate business was on its way.

Big Business knew a big seller when they saw it. the drug company Purdue Pharma pulled out all the stops: “the company urged salespeople, meanwhile, to ‘attach an emotional aspect to non-cancer pain so physicians treat it more seriously and aggressively.” [p 127]. “Some Purdue reps – particularly in southern Ohio, eastern Kentucky, and other areas first afflicted with rampant Oxy addiction – were reported to have made as much as a hundred thousand dollars in bonuses in one quarter during these years. Those were unlike any bonuses ever paid in the U.S. pharmaceutical industry.” [p 134]

The eased access to narcotics resulted in the opening of pill mills in places such as Portsmouth, Ohio. “If heroin was the perfect drug for drug traffickers, OxyContin was ideal for these pill mill doctors. The drug had several things going for it, as far as they were concerned. First it was a pharmaceutically produced pill with a legal medical use; second it created addicts, … Every patient who was prescribed the drug stood a chance of soon needing it every day. These people were will to pay cash. They never missed an appointment. … That meant a monthly-visit fee from every patient – $250 usually. And that kept waiting rooms full and cash rolling in” [p 154]. After manufacturing fled areas such as Portsmouth, an underground market around the OxyContin trade took over.

And the Xalisco Boys moved in. As addicts couldn’t afford the black market price for OxyContin, cheap and strong black tar heroin moved in. “So, the contours of the Xalisco heroin nation took shape, based largely on the territory the Man [one of the central characters of the book] carved out by avoiding the biggest cities where heroin markets were already controlled, and by following the OxyContin.” [p 167]

The retail selling made it difficult to stop the trade. “They were a new kind of drug trafficking in America. The Xalisco Boys weren’t the General Motors of drugs. They succeeded because they were the internet of dope: a network of cells with no one in charge of them all.” [p 183]. When a cell was broken up a new group came up from Xalisco to take over the business.

“And so it went. OxContin first, introduced by reps from Purdue Pharma over steak and dessert and in air-conditioned doctors’ offices. Within a few years, black tar heroin followed in tiny, uninflated balloons held in the mouths of sugrar cane farm boys from Xalisco driving old Nissan Sentras to meet-ups in McDonald’s parking lots…. Phillip Prior [family physician in southern Ohio] was now knee-deep in what was unthinkable a few years before: rural, white heroin junkies. ‘I’ve yet to find one who didn’t start with OxyContin,’ he said. ‘They wouldn’t be selling this quantity of heroin on the street right now if they hadn’t made these decisions in the boardroom.'” [p 270]

Sam Quinones started as a newspaper reporter and his news style is fast-paced and succinct, written in short chapters. That makes for a quick read. If you want a shorter discussion check out episode 757 of Marc Maron’s WTF podcast (which can be heard here…

One takeaway from this book in more evidence that what is good for business is not necessarily good for the public. The marketing of these powerful drugs helped the ruin of many cities and lives. There are also passages showing how insurance companies would rather pay for quick treatment such as injections or pill prescriptions rather than holistic pain management.

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2 thoughts on “Reading report: Dreamland by Sam Quinones

  1. I just finished this and hillbilly elegy too, and I live on the border, and spend a lot of time in West Virginia so it’s good to see the region get some national attention. I thought this one had great insight, although in my area, most of the heroin still comes from Baltimore. I knew a lot about the purdue pharma side, but that quote from the mom at the trial about them being a drug cartel made me shudder.

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