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Last Updated on September 4, 2019, by eNotes Editorial. Word Count: 645

While working for the Los Angeles Times, veteran journalist Sam Quinones spent five years researching the two main sources of the opioid epidemic that has plagued the United States for the past two decades. His 2015 book, Dreamland: The True Tale of America's Opiate Epidemic, is the result.

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One of those sources is a new form of semi-processed Mexican opium called black tar heroin, which originated in the small city of Xalisco. Relatively cheap and extremely potent, it was distributed with entrepreneurial flair and delivered as conveniently as the average pizza. Given such ready availability, the drug soon appeared in mid-level cities, suburbs, and rural areas, which suddenly began to experience a tremendous growth in heroin addiction and related fatalities.

The other source, which has been more widely documented, is the Purdue Pharma drug OxyContin®. Since its release in 1995, it has swept through the country like a tsunami, leaving hundreds of thousands of addicts and overdose victims in its wake. To quote Quinones,

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A government survey found the number of people who reported using heroin in the previous year rose from 373,000 in 2007 to 620,000 in 2011. Eighty percent had used a prescription painkiller first. But all this took years to become clear.

Why did so many physicians so readily prescribe such a dangerous drug? The perks so freely lavished on physicians in a position to promote the new drug certainly had their intended effect. A veritable army of pharmaceutical representatives sprung up, and as Quinones puts it,

a pharmaceutical wild west emerged . . . as salespeople stampeded into [doctor's] offices.

Some made as much as one hundred thousand dollars in one quarter. As he aptly describes the situation,

Purdue bonuses in certain areas had little relation to those paid at most U.S. companies but bore instead a striking similarity to the kind of profits in the drug underworld.

Quinones discovered a seemingly obscure New England Journal of Medicine article from 1980 that ultimately had an influence far greater that its claims merited: it allowed even honest, well-intended physicians to prescribe the drug more freely than was wise. The crux of the article (written by Hershel Jick, a physician at the Boston University School of Medicine) was actually only one paragraph under the subheading "Addiction Rare in Patients Treated with Narcotics." These are the key sentences:

Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well-documented addiction in patients who had no history of addiction. . . . We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.

The provisional claims from this clinical study, although never replicated elsewhere, were inflated by physicians from Harvard and Johns Hopkins in a monograph on pain for the NIH and called "an extensive study" by Scientific American. One pain specialist says his Harvard Medical School instructors told him people can't become addicted because pain absorbs the euphoria. That paragraph from the Jick article, he says, "gives you relief from your inner conflict. . . . All of a sudden the comfort washes over you." He eventually came to the grim realization that "It was all rubbish. . . . We wanted [it] to be true."

It's perhaps cold comfort to those who have lost friends and relatives to opioids that a number of physicians went to prison for their violation of the Hippocratic oath to "do no harm" and that several drug companies, including Purdue Pharma, have had to pay millions of dollars to settle lawsuits. But they can be grateful for the relentless persistence of journalists like Sam Quinones, who have shone a deservedly harsh light on the greed and ignorance which have dominated the behavior of the medical profession and pharmaceutical industry in this tragic spectacle.

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