Book Review: Dreamland (Sam Quinones)

At first glance, Dreamland – Sam Quinones’s expose on the opiate epidemic that’s destroying rural America – seems like a terrible beach read. And yet, on more than one occasion this summer, I’ve found myself sitting by the water with a drink in one hand and this book in the other. Despite its tragic and at times infuriating nature, Quinones does what good journalists do: he tells a story, and a captivating and compelling one at that. So as strange as this sounds, reading Dreamland was a surprisingly pleasant experience.

It was also an (unsurprisingly) educational experience. Quinones spent years doing hands-on, in-person research for this book. Facts and statistics stand to support the evidence unearthed through hundreds of conversations, interviews, and anecdotes told by doctors, judges, coroners, activists, dealers, junkies, addiction experts, DEA agents, cops, district attorneys, and onlookers who watched people, families, and communities crumble over the last several decades. Dreamland brings together people who will likely never meet, and who have nothing in common except that they’ve been impacted by the opiate epidemic.

If you buy the book, this is what it will look like.

If you buy the book, this is what it will look like.

It would be easy and comfortable to look at this problem and simplify it, laying the blame on a single issue or group of people. Thankfully, Quinones doesn’t do that. He makes it quite clear that this is a nuanced problem caused by generations of misinformation, poverty, pain, and poor policy. There is no singular bad guy here. People don’t choose to do heroin overnight. As such, we can’t just blame Mexican drug dealers, who are portrayed here not as vicious and violent, but as clever entrepreneurs seeking the American Dream. We also can’t blame opiate-slinging doctors, who (at least initially) were simultaneously dealing with the problem of pain and a dire lack of information regarding addiction. And we certainly can’t blame addicts, many of whom started out as people seeking legitimate relief from genuine physical pain. It seems that if any single organization is to blame here, it’s Purdue Pharma – the white guys in suits who somewhat intentionally mis-marketed pain-killers, creating a generation of addicts at enormous personal and financial cost.

Other than being impressed by this nuanced analysis, there were two big things that struck me while reading about these horrifying trends and outcomes. First – and this is pretty predictable coming from me – it’s really unsettling how misunderstood the human body was in the 1980’s and 90’s, and even now. That is, I got the distinct impression that a large number of healthcare professionals regarded the body as a machine that is fixed with tools and methods. Quinones offers many stories of doctors who, when dealing with patients who experienced chronic pain, never considered treating them holistically, with things like a better diet or physical therapy. Instead they just prescribed a quick fix like OxyContin, unaware (or not really caring) that this would quite easily turn the patients into junkies.

Years later, we see a similar attitude arise in addiction treatment. I get the distinct sense that doctors and policy-makers wanted to treat addiction like any other disease, something that can be treated by a relatively standardized process. Obviously, addiction is just as mental as it is physical, and can literally take years of therapy, support, and supervision to “recover” from (it’s not uncommon to hear from addicts who have been clean for decades, but who admit that they still struggle to stay sober. This is probably why the phrase “in recovery” is more common in the addiction lexicon that “recovered”). All of this to say, I wonder if we can add the enlightenment/modern understanding of the body as a systematic machine rather than a dynamic organism to the growing list of culprits responsible for the opiate epidemic.

Additionally, I couldn’t help but read Dreamland through the lens of our nation’s current racial and social tensions (honestly, at this point it’s hard for me to consume any media without thinking about this). Dreamland’s primary focus and purpose is to detail the opiate epidemic as it relates to rural America, and the majority of it is set in places like Ohio and Kentucky – far from the bustling urban centers of the Northeast and California. The stories here are remarkable because they’re set in quiet, quaint little towns. The national attitude seems to be that it’s a given that drugs are a problem in cities, but when they ravage small towns – that’s when people start to notice and to think of it as a problem. Quinones acknowledges this in a tongue-in-cheek kind of way. Nevertheless, it’s frustrating: are poor urban minorities really intrinsically more inclined to sell and abuse drugs than anyone else?

The silver lining here is also frustrating. The perception of drugs and the war thereof have shifted dramatically and for the better, even in the past few years. But, it appears that this is largely because privileged, mid-western, white people have started to join the population of heroin addicts. While celebrating the very positive changes in policy, healthcare, and law enforcement, Quinones also acknowledges the underlying racism and classism:

The fact was that, coincidentally or not, this change of heart was happening among conservatives just as opiate addiction was spreading among both rural and middle-class white kids across the country…I’ll count this as a national moment of Christian forgiveness. But I also know that it was a forgiveness that many of these lawmakers didn’t warm to when urban crack users were the defendants…Many of their constituents were no longer so enamored with that “tough on crime” talk now that it was their kids who were involved.

By this point, most Americans have in some way been affected by our nation’s raging heroin problem. Which is why I can heartily recommend this book to just about anyone. Sam Quinones’s gentle but honest assessment of this issue is presented in a way that’s interesting, weirdly entertaining, and quite compelling.

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