The Opioid Crisis as Told From the Streets to the Clinics and Its Unintended Consequences

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The history of drug addictions and epidemics in the United States dates back to the Civil War, when morphine was introduced as a pain medication for wounded soldiers. Regular off-label use of morphine quickly spread from war hospitals to the general public. It is estimated that more than 400,000 Americans suffered from morphine addiction during the war and postbellum period. We saw an explosion of illicit drug use in the 1960s counterculture revolution. Then there was the crack cocaine epidemic in the 1980s, which devastated inner cities and created what’s now called the prison industrial complex.

Americans have long had a love affair with things that produce euphoria. According to national law enforcement data and health-care entities such as the Centers for Disease Control and Prevention and the American Medical Association, America slowly slid into an opioid epidemic in the 1990s, which progressively intensified until the Acting Secretary of Health and Human Services, Eric D. Hargan, declared a public health emergency. Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones was published several years ago, but it is worth revisiting here, given its relevance in an ongoing narrative about opioids, an essential component in cancer care.


Title: Dreamland: The True Tale of America’s Opiate Epidemic

Authors: Sam Quinones

Publisher: Bloomsbury Press

Publication Date: April 2015

Price: $25.95, hardcover, 384 pages

Rust Belt Hard Hit

Sam Quinones is an acclaimed journalist and a first-class storyteller, as evidenced by Dreamland’s propulsive pacing. The title is lifted from a community swimming pool in Portsmouth, Ohio, which serves as a metaphor to highlight the opioid crisis. According to the author, Portsmouth was an ideal town to raise a family, until, that is, the industries moved off shore and the opioids moved in. It’s a story that Mr. Quinones follows across the country, detailing the broken lives of people addicted to painkillers, prescribed, in large part, by unscrupulous doctors.

The book is organized into five sections, and readers of The ASCO Post will find several of special interest, such as the chapter on the evolution of oxycodone and the now much-maligned Sackler family that founded Purdue Pharma. The author talks at length about oxycodone, at times a bit pedantically, following the script about the devious sales techniques used to promote the drug. He cites a former Purdue sales manager for West Virginia who said that the company urged its salespeople to emphasize the safety of oxycodone.

Blaming the Drug, Not the Person

When Mr. Quinones treads into the science of addiction and pain medications, he sometimes misses the mark. The reader gets the overriding impression that the author lays the lion’s share of blame for the opioid epidemic on inanimate pain control substances, instead of the socioeconomic issues that prevail in the areas of the country most affected by illicit drugs.

Some readers of The ASCO Post might bristle at a chapter titled “The Revolution,” when Mr. Quinones cites a paper published in the journal Pain by noted oncology pain specialists Russell Portenoy and Kathleen Foley. The author writes: “Drs. Portenoy and Foley published a paper in what became a declaration of independence for the vanguard of pain specialists interested in using opiates for chronic pain…. Other researchers had been issuing papers saying that many chronic patients using opiates invariably ended up addicted.”

“Invariably” means in every case, which is not only absurd but, by not backing it up with data, it tarnishes the book’s credibility. There are multiple studies looking at opioid prescribing and addiction, but he did not include them.

“By skillfully introducing a memorable cast of characters, Mr. Quinones illustrates that the opioid epidemic is part of a complex human mosaic.”
— Ronald Piana

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Best When Telling a Story

Mr. Quinones hits his stride when he moves away from the science of addiction and chronicles how a group of Mexican farmers capitalized on the thriving U.S. opioid market, ultimately building a heroin distribution network that extended to the American Midwest. His deft description of this venture is seamlessly woven into the overall theme of the opioid epidemic.

By skillfully introducing a memorable cast of characters—pharma pioneers, young Mexican capitalists, narcotics investigators, as well as drug survivors and their parents—Mr. Quinones illustrates that the opioid epidemic is part of a complex human mosaic, and we should be careful when we try to find convenient bad guys on whom to lay the blame. This book, a good read, despite some hiccups, is recommended for readers of The ASCO Post.