#fascinating read

On the legal side, Quinones interviews doctors, researchers, nurses, clinicians, patients-cum-addicts, Oxycontin dealers, and families of the lost; he has chapters on the poppy plant, opium, and morphine; he discusses Arthur Sackler and the rise of pharmaceutical marketing, which included the wooing of doctors; and he traces the history of pain treatment---the medical treatment of pain being one of the largest enablers of the opium epidemic.

It’s hard to call what occurred in the medical establishment an overt conspiracy since, outside Big Pharma, most intention was good. Most. 

It began because opium derivatives are pain killers---and the pain-killing properties of opium are ancient news. Also well-known was the fact that opioids are addictive, and use was restricted and monitored. Cancer changed that, with doctors advocating the use of morphine, etc. for end-stage cancer patients who were dying in horrible pain. At that point, it was a quality-of-life issue, and the campaign was successful.

Unfortunately, around the same time that pharmaceutical companies were honing their marketing skills, and developing opium-derivatives, medicine decided to extend the quality-of-life logic to all forms of pain. Injured? Opioid. Chronic back pain because you don’t lift with your legs? Opioid. Whatever the pharmaceutical company had, that was the solution.

And as for that habit-forming problem of opium-derivatives? Turns out, according to an infamous “study” referred to as Porter and Jick, opioids aren’t really that addictive after all. That Porter and Jick was really just a letter to the editor noting one pattern in a limited pool of data either didn’t matter, or, more probably, was never known by the people who cited it (a couple of whom Quinones interviews). Yes, bad science became a major contributor to our opioid crisis. No one checked the “study” that was repeated ad nauseam, and few paid attention to the data at hand concerning the high rates of addiction in patients who were prescribed Oxycontin.

Insurance companies didn’t help matters. They’d pay for prescription medication, but not for physical therapy, psychotherapy, nutritionists, or holistic/ multidisciplinary approaches to pain treatment. So doctors who wanted to use those non-pill approaches were put out of business.

But that’s just the legal opioids. On the illegal side, Quinones focuses on Black Tar Heroin, a viscous, dark-colored substance that’s as pure as heroin can get. He interviews cops, dealers, DEA agents, addicts, lawyers, and community organizers. And because he follows the Black Tar, he discusses Xaliso, a city in the state of Narayit in Mexico, where the heroin was grown.

Black Tar heroin dealers changed the game. Just about everything about them confounded police. The dealers didn’t carry guns, didn’t fight turf wars, and feared local gangs. They didn’t use, and they didn’t adulterate their product by cutting it---they didn’t need to as there was no multilevel distribution line. They delivered to their customers, carrying a minimum of heroin, so if caught, D.A.s rarely felt they were worth the time, and they were just deported.

Deportation was not a deterrent. The Xalisco Boys, as Quinones calls them, dealt heroin in order to make money and be the Big Man struttin’ around town back home. In the United States, their lives were spartan---the point was to go back home to their sugarcane-farming town, having struck it rich. Unfortunately, the dealers spent too lavishly, didn’t invest or save, so money ran out, and they had to return to the U.S.

The system the Xalisco Boys had was capitalism at its finest. No corporate headquarters, no cartel bigwigs, just small entrepreneurs competing in an open market. They had excellent customer service. Not only did they deliver like pizza, they offered samples, and deals. Addicts would get extra heroin for introducing a new customer. The Xalisco Boys would pay (in heroin) for an addict to hand out samples at the local methadone clinic. They’d exchange drugs for your name on an apartment or car lease. And when word got back to Narayit of ripe territory, a gold-rush mentality set in, and more cells would show up in town to compete for the same customers. Prices dropped.

Besides being non-violent in general, in Xalisco, the culture included webs of long-standing family feuds that few wanted to challenge. Because if anything untoward happened in the U.S., it *would* get back to Mexico.

Thus the more adventurous dealers would strike out for new territory. If an addict happened to know of another possibly-lucrative town, they’d introduce the Boys. 

One dealer Quinones interviews, called The Man, was actually born in the U.S., and entered the Xalisco system from the outside. Of Mexican descent, he spoke English and Spanish, and recognized the relevance of Oxycontin to heroin sales (most of the Xalisco Boys didn’t bother learning more than functional English, so didn’t see the bonanza). He was arrested before he could really pave the way, but others did so after him.

Part One of the book ends with the arrest of numerous dealers in multiple states in one of the largest, most coordinated operations in drug-enforcement history. But the insidiousness of the Xalisco system is that it’s self-renewing. Arrest one guy, someone else will take his place. As long as there’s demand.

As I stated above, there is a lot in this book. Quinones manages this plethora of information by “braiding” or “juggling” it: he tells the story of the family of a young man who od’d; introduces a dealer called Enrique; moves to Dr. Herschel Jick wondering about rates of narcotic addiction in patients at his hospital; reveals how Dr. David Proctor came to Portsmouth, OH (he wasn’t able to interview Proctor in person); Enrique again; a cop in Denver; the morphine molecule; Proctor; Enrique; a cop in Idaho; Xalisco culture---this is not the actual order he goes in, but it is the gist of his technique. He touches base with each thread, showing how they interweave. It’s an interesting approach that I think works well for the material, but it did get difficult sometimes to remember who was who. I’d use the index in those cases.

Two limits before I end this already long review. First, the heroin angle is limited to the Black Tar out of Xalisco. Other heroin dealers, gangs, cartels, etc. are mentioned only when relevant to Black Tar and the Xalisco system. So, for example, the Xalisco Boys avoided New York City like the plague, so not much about the presence of heroin there in Dreamland.

Second, racism is prevalent throughout, but not explicitly explored (this is a limit, not a detraction). The Xalisco Boys would not deal to blacks if they could help it---mostly out of fear derived from prejudice. But the far more subtle forms of racism, especially in the predominantly white middle-American towns exist like smog---it’s there, it’s not good, but those immersed in it stopped noticing. Quinones points it out a couple of times, but the degree to which it’s relevant is up to the reader (since his topic isn't the various connections between racism and drugs, he may have decided to just let instances of racism stink up the background and not turn Dreamland into a doorstop).