Over half a million U.S. residents are hooked on heroin and a couple of million more are hooked on prescription pills.
(For anyone curious, as I was, about terminology: heroin and morphine are derived from the opium poppy and thus are opiates. However pharmaceutical industry chemists have come up with synthetic compounds that act on the same receptors in our bodies, the opioid receptors, including hydrocodone [Vicodin], oxycodone [OxyContin, Percocet], and fentanyl. These drugs, as well as the opiates, are termed "opioids.")
Sam Quinones' Dreamland: The True Tale of America's Opiate Epidemic is a vivid journalistic account of what got us into this sorry situation. The emphasis here is on "what happened" -- he's not attempting to answer "why" so many people might have been vulnerable, though the book is a catalogue of hints. But we can't try to make sense of the "why" without a firm grip on "what happened" -- who, where, and when -- this is terrific reporting in that vein.
Quinones relates how by the 1990s doctors came to believe they ought to prescribe more drugs to relieve pain, how pharma companies, especially Perdue which invented Oxycontin, marketed to maximize profit from that worthy medical impulse, and how other unscrupulous doctors set up pill mills and made fortunes dispensing vast quantities of opioids to addicts who had started on prescriptions. Ordinary capitalist greed teed a plague up to explode.
During the '00s, public health authorities and cops gradually realized something had gone terribly wrong and that the ready availability of addictive medicines had to be curbed. New regulations reduced over-prescription. But as Quinones puts it, the change only meant that decade was "a great time to be a heroin dealer." A brilliantly organized entrepreneurial illicit drug distribution system out of the town of Xalisco in the Mexican state of Nayarit was ready, willing, and able to import their black tar heroin into areas where Oxy and fentanyl had created a plentiful supply of buyers. Their story, culled from interviews with imprisoned and/or deported drug distribution peons, is where Quinones' reporting really shines; heroin came to the heartland not through the Mafia, Central American gangs, or violent drug cartels, but by way of enterprising small businessmen originally united by family ties who thrived on offering reliability and practicing customer cultivation.
Quinones concludes with stories of what came after addiction mushroomed: of children who overdosed, of parents who retreated into shamed silence, and of other parents who became evangelists warning of the danger of drugs. And he shares stories of cops, judges and communities which fought back, which began to treat addicts as sufferers from a disease that required treatment and rehabilitation, and where some pride of place began to return.
Quinones writes a blog where he continues, beyond the Dreamland reportage, to try to explore what this plague means in our national life. He's acutely aware that the addiction epidemic is haunting our national debates, even when it's not in the foreground for many of us.
I have friends who came back from being drafted into the Vietnam war who have never overcome drug using habits acquired in that imperial folly. And I have seen a friend get so hooked on opioids prescribed by a high end pain doctor that, whenever she checked into a hospital for treatment of ongoing injuries, she was in danger of suffering through withdrawal because medical personnel would not believe she actually could tolerate the volume of drugs she was habituated to.
Addiction is not solely the story of sad white people in Ohio -- we are an addiction-prone society in which we are taught to hope we can get happiness from a bottle or a pill. It's always worth asking, who benefits when drugs are the available answer to fear, disappointment, and pain?