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Last Updated on September 4, 2019, by eNotes Editorial. Word Count: 1237

Dreamland: The True Tale of America's Opiate Epidemic was written by Sam Quinones. Quinones, an investigative journalist, interviewed a wide range of people with direct connections to the opioid crisis, including incarcerated heroin dealers, addicts and their families, healthcare workers, police officers, and government workers. Dreamland shows that the opioid crisis began with the overprescription of opiates. This overprescription, with very little medical supervision, led many patients to become addicted to opiates and gave people who were not being prescribed opiates access to the drugs. As people became addicted, their tolerance grew, and consequently, these addicts needed cheaper and larger amounts of opiates. Around the same time, a network of dealers from Xalisco, in southwestern Mexico, began producing and distributing a cheap form of heroin known as “black tar.” This group strategically moved into areas where addiction was running rampant, including affluent mid-sized towns and suburbs as well as some parts of Appalachia. These areas’ pre-existing prescription opiate addictions combined with access to cheap opiates to contribute to an epidemic that has resulted in the addiction and death of millions of Americans.

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A Crisis Fueled by Financial Gain

In Dreamland, Quinones explains how the opioid crisis was fueled by financial motives. Quinones consistently notes that many different groups of people reaped enormous financial benefits from the crisis. At the highest levels, big pharmaceutical companies profited tremendously from the reckless prescription of opiates. For instance, Purdue Pharma, the producer of OxyContin®—the main drug that was overprescribed and led to addictions—more than quadrupled their revenue in a matter of years. They engaged in an aggressive marketing campaign, urging physicians to prescribe the drug. Quinones writes that Phillip Prior, a doctor in Ohio, stated about heroin addicts, “I’ve yet to find one who didn’t start with OxyContin®.” Prior continued,

They [drug dealers] wouldn’t be selling this quantity of heroin on the street right now if they [Purdue Pharma] hadn’t made these decisions in the boardroom.

Many doctors began spreading the message that opiates like OxyContin® were a safe way to deal with pain. While some doctors truly wanted to help patients, others were motivated by greed. Quinones notes that the result was that, within a few years, “opiate use in medicine had been destigmatized by crusading doctors.” Many unscrupulous doctors began to charge cash for opioids. Others prescribed opiates in order to assist patients in committing fraud in order to obtain social security disability benefits. Many of these patients lived in regions that had suffered huge economic losses and offered few, if any, jobs. Therefore, disability benefits were seen as a means to survive. Some pharmaceutical companies were aware of this desperation and capitalized on it. For instance, Purdue Pharma routinely guided sales reps to focus on physicians in areas where opioid prescriptions were being issued to aid disability cases.

With this abundance of pills circulating and numerous addicts in need, a middleman market arose, through which many people sold opiates at inflated prices, seemingly unbothered by the devastating harm the pills caused. Finally, as the addiction grew increasingly rampant, drug dealers from Xalisco, in an attempt to escape the poverty of that region of Mexico, began to exploit the addiction crisis by dealing black tar heroin in these communities. Quinones writes,

Local dealers regarded pills as a grassroots response to economic catastrophe—the way some poor Mexican villagers view drug trafficking. Dealers who could not have found a legitimate job in moribund Portsmouth bartered pills to support themselves and...

(The entire section contains 1237 words.)

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