More Thoughts on Dreamland

Last week, we finished reading Dreamland, by Sam Quinones. Dreamland is about the opiate epidemic -- the black tar heroin trade, specifically -- that has taken over America during the last two decades. Overall, the book was really interesting to me because of the normality of it all. The heroin trade wasn't some scary back alley transaction in hostile New York City, but rather something seen in suburban side street with middle class high schoolers.
The scary part was that these kids weren't deviants who grew up fighting, surrounded by all kinds of negative influences, and considered unlikely to go to colleges. These were kids who studied hard and got grades, played a sport, tutored on the side, spent time with their friends. Kids like me. (Yes, I know I'm not white, but I too had a middle class upbringing). It was sad to me that the towns with places that were once considered worthy of the name "Dreamland" were now defined by shoplifters at Walmart trading their stolen goods for heroin. Everyone knew someone that was addicted, dead, or was addicted themselves. Kids who had the potential to live real, successful lives were dying from heroin overdoses. This wasn't some weird alternative reality movie. This was real life. The black tar heroin epidemic is not isolated either. The epicenter may be Portsmouth, Ohio, but it's in Portland, Boise, the San Fernando Valley -- almost every big city that isn't already over run by drugs (i.e. New York, cocaine in LA). The business wasn't run by some crazy thugs either. The drug sellers were just honest young men from Nayarit, Mexico looking to make some money to send home to their families. They never used the drugs, possibly because they saw how debilitating addiction would be, and seemed to come from a never ending supply of other honest young men.
The book also focused on the rise of prescription pill abuse, and how doctors would literally set up clinics with the sole purpose of prescribing pain relief opiate pills to make money. One physician in particular, David Proctor, set up several pill mills that took fake medical records and papers, large sums of cash, and sent people home in 5 minutes with hundreds of pills. It was really horrible to me that doctors would use their credentials to hurt people, not help them. Being pre-med, I talk to a lot of people who want to become doctors, and everyone I've talked to says something along the lines of "I like science and I want to help people." Never once have I heard "I want to make a lot of money," or anything along those lines. Believe me- there are easier routes to go if your primary objective is money. I realize (from my vast experience watching Grey's Anatomy and Private Practice) that medical ethics is not black and white, but pill mills are 100% unethical and just plain wrong. Getting people addicted to, and in some cases, ultimately killed by prescription drugs, is a horrible thing.
Overall, I really appreciated how Quinones told the story from multiple angles. This provided a more complete picture of the opiate scene in America, and showed how blame is never easy to assign. It was hard to blame the Nayarit drug dealers, who were just trying to make money for their families. They realized that it was near impossible to succeed doing things the right way (this also frustrates me to no end), and so they played into the system. It's hard assign blame to addicts, because while they made the choice to do drugs in the first place, they were then surrounded by people encouraging them to go down the wrong path. Even when they were trying to get clean, the dealers would come by with "gifts" of free heroin balloons. The police were doing the best they could, but were taking away someone's life and livelihood. Just like everything really important, this is so vastly complicated.
I'm a sucker for happy endings (maybe this is why I have a stuffed Olaf on my bed and cry incessantly when a patient dies on Grey's), so I was glad to see at the end that Portsmouth has become something of a haven for addicts in recovery. I know that it's not going to be all happiness and roses, but it gives me hope for the future.
That's all for now!