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October 29, 2015

Opioid addiction & what it has done to the U.S.

“This is not a book only about heroin,” says Sam Quinones, who will speak on campus Nov. 10 about his nonfiction book “Dreamland,” which shows the rise of addictions to opiates — pain pills and heroin. “This is a book about what we have become as a country,” he says.

Sam Quinones’ book “Dreamland” chronicles the boom in opioid drugs and what that has done to the U.S.  The book was chosen for the Graduate School of Public Health’s One Book, One Community program this year. Quinones will deliver a public lecture at the University Club on Nov.  10.

Sam Quinones’ book “Dreamland” chronicles the boom in opioid drugs and what that has done to the U.S.
The book was chosen for the Graduate School of Public Health’s One Book, One Community program this year.
Quinones will deliver a public lecture at the University Club on Nov. 10.

“Dreamland” was chosen as part of the Graduate School of Public Health’s One Book, One Community program for 2015, which focuses the school on a discussion of a single piece of literature every year. “Dreamland” chronicles the boom in prescriptions for Oxycontin and related opioid drugs, which has led to addictions among a largely middle-class white population that previously felt itself immune to such troubles. Unable to get enough pain medication, many addicts turn to the chemically related drug heroin, which is cheaper and more readily available.

Quinones, a freelance writer in Los Angeles, spent time in Mexico to draw a portrait of its poor rural residents of Xalisco who produce black-tar heroin, a less potent but cheaper form of the drug that is rolled into small dark balls resembling tar when it is delivered. Dreaming of using America to make money and return home as a success, these young men traveled to many American cities, Sam quinoneswhere they invented a new way of delivering the drugs to the addicts via beeper-summoned cars that allowed buyers a new level of comfort and sellers a new level of secrecy.

It was a small-business model that made it possible for a person to open up a new drug cell in any town where there were addicts — and in America, where opiate overdoses have surpassed car crashes as the No. 1 cause of accidental death over the past few years, that is, increasingly, every town. A Mexican black-tar heroin ring was busted in Beaver Falls and Moon in 2007.

Quinones describes the epidemic from all different angles: the rancheros’ lives in Mexico and then in the U.S., running their delivery rings; the addicts who helped introduce heroin delivery cells to new towns and the law enforcement who fought them; the pharmaceutical companies that promoted their new anti-pain discoveries and the doctors who prescribed these pills indiscriminately.

He opens the book by visiting Dreamland, a once-thriving swimming pool complex in the central Ohio city of Portsmouth, whose decay symbolizes the economic downslide of small-town American life, which leads to a cascade of problems.

“Portsmouth stands in for the destruction of the community, the central community that held us together,” he says. “Once it was destroyed it left us vulnerable to this scourge. When you get a shredding of the ties that bind us, this is heroin’s natural habitat.”

Although his book focuses partly on heroin addiction, Quinones points out, it contains not a single scene of someone shooting up, concentrating instead on the causes and effects of the epidemic. “I was very cognizant of writing this from a layman’s perspective, maybe a parent who had a child addicted, or a police officer —just someone who was trying to understand,” he says.

Middle America finally is beginning to face its heroin addiction problem, Quinones believes.

“For a long time it was white parents feeling mortified that their kids were addicted and keeping silent,” he says. “That’s changing too. When I started this book, rarely did I hear people talk about this. I would get this puzzled look when I told people I was writing about it. ‘Heroin isn’t a huge problem, is it?’ Now I don’t get those looks anymore.” According to the Centers for Disease Control and Prevention, deaths from prescribed opioid pain relievers tripled from 2001 to 2013, while deaths related to heroin tripled from 2010 to 2013. Heroin addiction now is losing some of its stigma and people are realizing “it is damaging society to stay silent.”

In the last three months Quinones says he has noticed people adding heroin addiction as the cause of death in newspaper obituaries and starting Facebook support groups, realizing “they can actually help themselves in grief if they commune with others who have suffered it.”

Even law enforcement agencies are realizing that addicts need treatment, and that jail is hardly the solution to their plight. As Quinones writes in his book: “Treatment has always been more effective and cheaper than prison for true drug addicts. What’s changed … is that no longer are most of the accused African-American inner-city crack users and dealers. Most of the new … junkies come from the white middle and upper-middle classes” and from rural areas — “the people who vote for, donate to, live near, do business with, or are related to the majority of … legislators.”

Today, he says: “For drug addicts, if they have not been arrested for a violent crime, then you need to begin looking at other options. What I find interesting, and I’m working on a story on that right now, this whole scourge of heroin and pain pills have made people, in some areas, reimagine what form jail takes.” Criminals, he says, either can sit around prisons all day trading stories of their criminal exploits or, as some counties have instituted, they can attend full-fledged rehab clinics inside jails. Running all day, they may include GED preparation, physical therapy and other rehabilitative services. “It turns jail into an investment and diverts it away from being just a cost, which it is now,” Quinones says. “It’s still not very widespread yet, but I think it’s born out of necessity. So many people are in and out and in and out. By the way, I don’t see the private sector stepping up to solve this problem, though they caused it.”

Pharmaceutical companies such as Purdue Pharma, makers of Oxycontin, and other pain pill companies “need to do a whole lot more in funding treatment,” he says. “This is a classic example of where all the profits accrue to the private sector and all the costs accrue to the public sector,” from prisons and cops to affected neighborhoods and public health budgets.

“Law enforcement is increasingly doing everything they can do,” he feels. “It’s not reasonable to say the private sector can create thousands of addicts and the police departments better do something about this. The police department in your town is like some guy standing in the ocean trying to hold back the tide.”


What can physicians do? And what can we do?

“We all need to ask our doctors why we are being prescribed 60 Vicodin after a routine surgery and what’s in Vicodin and Oxycontin and how we should use it and what are the risks,” Quinones concluded. “We’re just being way overprescribed.

“Accountability is a wonderful part of our political and social culture, and it’s broken down,” he added. “We want everybody else to be accountable. We need to stop eating junk food. We need to stop smoking. And we need to stop demanding that doctors fix us, as if we had no role in the process.”


Quinones’ Nov. 10 lecture will be held 3:30-4:30 p.m. in the University Club’s ballroom A. It is open to the public.

—Marty Levine  

Filed under: Feature,Volume 48 Issue 5

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