Overdose deaths involving opiates rose from ten a day in to one every half hour by Abuse of prescription painkillers was behind , emergency room visits in , almost triple the number of seven years before. Methadone prescriptions more than quadrupled— from under a million in to 4. It relieved pain for only a few hours. So patients took more and more of it through the day to get pain relief. The drug built up in their bodies, causing overdoses. As methadone prescriptions rose, so did overdose deaths involving methadone— from in to 4, in This is a shocking indictment of how lax drug laws, misinformation about opiates, and big bucks propaganda campaigns created an epidemic that is the worst human-generated health crisis in a generation.
It is also a symptom of the greed and lack of ethics that dominates our country. They are supposed philanthropists who essentially became a legal cartel pushing OxyContin through the notorious family-owned Purdue Pharmaceuticals.
Highly recommended story about them in the New Yorker Vox article about how pain became the "5th vital sign" and opened the way for the mass prescription of opioids A new, more powerful meth, P2P, that's made it's way into the U. Oct 19, Diane Yannick rated it really liked it. I read this book to learn more about the history of the opiate epidemic and believe me, I learned a lot. That said, it took me awhile to plow through the many redundancies.
Some aggressive editing would have made this book more palatable. However, I'm giving it 4 stars for the author's meticulous research and ability to make that information accessible to me. It simultaneously tells the stories of the Xalisco boys, who introduced Mexican black tar heroin to many communities, Purdue Pharma Compan I read this book to learn more about the history of the opiate epidemic and believe me, I learned a lot.
It simultaneously tells the stories of the Xalisco boys, who introduced Mexican black tar heroin to many communities, Purdue Pharma Company, and the docs trying to manage their patients' pain. I didn't understand how widespread the opiate economy is. People travel many hours to pill mills where "docs" write scripts for OxyContin. If they can't get there on their own, dealers take them in exchange for half of their prescribed pills.
As one example, Broward County had 4 pain clinics in and by It's an extremely profitable business. Widespread shoplifting mostly at Walmart, sometimes Lowes provides capital. Dealers and users scour Walmart parking lots for discarded receipts. They buy the items on the receipt then return them for cash. Without the receipts, they can get gift cards for their shoplifted items. Those gift cards are used as currency. Some set up stores in their apartments to sell shoplifted items.
It was widely believed in the 's that opiates would not cause addiction problems for people who used them for pain. Once that was disproven and many were addicted, heroin became a cheaper and longer lasting substituteespecially that Mexican black tar.
When you use drugs, your brain development, particularly the frontal lobe, is stalled. So, we have many older users acting like 15 year olds. For sure. Sadly the fields of pain management and addiction almost never work together.
After kicking opiates it takes two years for your dopamine receptors to start working naturally. Our American medical system seems to be "good at fighting disease but awful at leading people to wellness". In drug overdoses passed car accidents for the leading cause of death.
We all need to pay attention. Aug 01, Ed rated it it was amazing. This wide-ranging, insightful story of America's opiate crisis makes for painful and sad reading. The author keeps things moving while presenting the sobering facts. It's a lifetime struggle. I'm sure many families, including my own, have been touched by the scourge of heroin and opiate pills like OxyContin.
Big pharma comes off looking really bad in their crass pursui This wide-ranging, insightful story of America's opiate crisis makes for painful and sad reading.
Big pharma comes off looking really bad in their crass pursuit of the Almighty Dollar. The author has an engaging narrative style I found easy to follow. If you want to know more about what happened, this book might be the right one for you.
Oct 05, Kirsti rated it it was amazing Shelves: , mystery , deserves-the-hype , history , science , politics , true-crime , medicine , anger , nonfiction. Sprawly, vivid, fascinating, horrifying journalism. How can you tell if a business that calls itself a pain clinic is an actual pain clinic or a pill mill?
Check out the parking lot. If the lot is full of people standing around, wearing pajamas, getting into fistfights, and having pizza delivered, then you are looking at a pill mill. One of the doctors that Quinones interviews has a theory: America has about the same percentage of addictive personalities that it has always had, but that OxyContin Sprawly, vivid, fascinating, horrifying journalism.
One of the doctors that Quinones interviews has a theory: America has about the same percentage of addictive personalities that it has always had, but that OxyContin and similar drugs--because they are so addictive and often fatal themselves, and because they are such an effective gateway drug to heroin--are crippling and killing addicts much faster than alcohol does.
The doctor said that he sees people break down from alcoholism after about 20 years of problem drinking. With Oxy it's more like five years. I had no idea that there is a vast network of drug dealers who deliver heroin like pizza, who are paid a flat rate so they never dilute the product, who deal in small quantities and drive beater cars to avoid police attention, and who fear and avoid black people.
I admire Quinones's dogged reporting and his compassion for the parents, grandparents, and children of addicts. Aug 15, Ms. Shelves: nonfiction. It wasn't the cartels. It wasn't a big city criminal class. It wasn't apathetic law enforcement or inept parenting. This is the story of how a rural sugar cane growing village in the Pacific coastal state of Nayarit and Purdue Pharma, the aggressive marketer of OxyContin, a time-released opioid pain-killer, formed an unwitting symbiotic relationship.
OxyContin was approved for sale in In just over a decade it had outpaced automobiles as the leading cause of accidental deaths nationwide. OxyContin had already tenderized the terrain, sold not to tapped-out old junkies but to younger kids, many from the suburbs, most of whom had money and all of whom were white.
Their transition from Oxy to heroin Oxy addicts began by sucking on and dissolving the pills' timed-releast coating. They were left with 40 or 80 mg of pure oxycodone. At first, addicts crushed the pills and snorted the powder. As their tolerance built, they used more. To get a bigger bang from the pills, they liquified and injected it.
But their tolerance never stopped climbing As they reached their financial limits, many switched to heroin, since they were already shooting up Oxy and had lost any fear of the needle Later Columbus, Nashville and Charlotte became new hubs for distribution.
These are the places Quinones visits. He interviews still grief stricken families about their frantic efforts to rescue their addicted children. These were people who heard rumors, combed through statistics, tried to make sense of what they learned and tried to warn the public.
Quinones has done ample research, but this is not a book about timelines and numbers. It is a book about stories. A pill mill in Portsmouth, Ohio set up by David Procter became a template for selling prescriptions across the region.
A suspicious rise in Medicaid recipients became a screen for a secondary market of opioid pill sales. Toxic consumerism destroyed local businesses in the wake of Walmart mega-stores, which in turn became shoplifting paradises. High school and college sports churned out injured athletes who, in their quest for success, became hooked on pain-killers.
Florida became a drug mecca because until it had no prescription monitoring system. And throughout the period, Xalisco Boys with hustle became part of a decentralized network that relied on market expansion and excellent customer service. It was capitalism in action. After a 6 month stint they would return to Xalisco only to feed a village culture of parasitic relatives and outsized conspicuous consumption. They would return to the states to continue the cycle.
They wouldn't be selling this quantity of heroin on the street right now if they hadn't made these decisions in the boardroom. Jun 25, Jeanette rated it really liked it. This is thorough to progress for this horrific opiate epidemic that has lead to numerous "black tar" heroin overdose deaths. At times in places within the USA that never had a single heroin related problem before this progression of the last fifteen years. This quite beyond the huge number of addictions to opiate pills which ignite the need for more of the same class.
It holds 's of anecdotal stories, bu This is thorough to progress for this horrific opiate epidemic that has lead to numerous "black tar" heroin overdose deaths. It holds 's of anecdotal stories, but beyond that it has startling stats. I was horrified to see how long that this particular cause of death had risen above accidental car collision death in several different states.
The poor families, the money spent on every level. But the suffering! This is a terrible problem and I don't feel you could impart it without all these repetitions or the numerous personal records in the print. So many people avoiding pain! And finding far more where that came from.
This book hit me like a stack of bricks. Although packed with hard facts, Quionones also follows individual actors in this narco-drama to humanize the supply, demand, and regulatory sides of this horrific market. What emerges is an appalling picture of an opiate epidemic in America - and in my home state of Kentucky in particular - orders of magnitude wors This book hit me like a stack of bricks.
What emerges is an appalling picture of an opiate epidemic in America - and in my home state of Kentucky in particular - orders of magnitude worse than I had ever imagined. I did some of my own research to see how the opiate epidemic was playing out in my hometown of Louisville, Kentucky. What I found shocked me.
That's twice the number of people that died in car accidents in that same time period. The book points out how unusual this is: "Since the rise of the automobile in America, vehicle accidents sat unassailed atop the list of causes of injury death in every state" - other causes weren't even close. Now drug overdoses are double auto accidents.
I saw stories like "Overdose deaths in increased by 17 percent in Kentucky, 31 percent in Louisville" and just months ago "Dozens overdose from mystery heroin mix". And this is from quiet, family-friendly Louisville!
This is a crisis on an enormous scale. This is insane. I was particularly infuriated by the failure of our regulatory and scientific apparatus. Most egregiously, "FDA examiner Dr. Conflicted much? And just as bad - the negligence of the scientific establishment in putting so much weight on the "landmark" Porter and Jick study which turned out to be a paragraph letter to the editor - not even a peer-reviewed study!
We have to do a better job than this. Quinones doesn't offer much in the way of hope. He does spend a little time on what I suspect is the underlying cause of the epidemic - cultural bankruptcy. Our cultural reorientation towards hedonism and moral relativism has made our society profoundly vulnerable to this opiate epidemic. As one of his interviewees says, "In a culture that demanded comfort But it hurts because it's true.
We can't use poverty or lack of economic opportunity as an excuse - after all, hardly anybody in Xalisco is doing heroin. When we don't believe in anything, the siren song of empty, addictive pleasure is impossible to resist.
The beliefs and institutions that once held white America together are falling apart. If we're going to fix our opiate addiction problem, that's not a bad place to start. May 14, Jenna rated it it was amazing. A comprehensive investigation of the pain pill addiction in America and how it led to a new wave of heroin abusers and overdose deaths, this is powerful reading for anyone who works in healthcare, addiction treatment, or has been affected by this crisis.
As soon as I heard about Dreamland, I knew I would want to read it. My career in pharmacy spans much of the time period Quinones covers in the book. I remember Purdue reps and their assured certainty that for patients who truly had chronic pain, OxyContin was not addictive.
And they handed out coupons for free Senokot a laxative to give to patients who were experiencing constipation as a side effect of the chronic high, prolonged treatment. Looking back now, it seems absurd that we all swallowed this as gospel. It was reassuring to read that the doctors and nurses Quinones interviewed feel the same way.
I started my career as a pharmacist in in a large hospital in Dallas, TX. Then I moved to mail order pharmacy for a couple of years, and then began working in retail community pharmacy in I was just in time to see the tremendous upswing in prescriptions for opiates, usually combined with benzodiazepines and muscle relaxants. The pharmacists knew what was happening.
We KNEW that most of the prescriptions were not legitimate. We KNEW these patients were addicted. There is no reporting mechanism in place for this problem. If you call the doctor or clinic and they say the prescription is legitimate, your hands are tied. Now, thanks to the misrepresentation of OxyContin by Purdue, we have a legacy of pain pill mills still in existence, addicts who turn to heroin as a cheap alternative when the prescriptions run out or they are cut off.
I had no idea, as almost no one outside of a handful of law enforcement officers did, that one small region of Mexico was able to make heroin a mainstream illegal drug choice in the United States out of this public health debacle.
It was the perfect storm and they were in the right place at the right time. Quinones does a masterful job at interweaving these story lines and revealing bit by bit the entire complex web that has been spun out of discrete trends and changes in healthcare, the economy, and the American culture. It is a fascinating read and I highly recommend it. Apr 30, Terri rated it it was amazing. Quinones deserves all manner of credit for writing this book.
It could have done with a bit of editing, as it does get repetitive at times, but this doesn't get in the way of the story he is telling about how the marketing of opiates by Big Pharma and their resulting overprescription by physicians "tenderized" the market for heroin provided by the Xalisco Boys, heroin runners from the small town of Xalisco in the Mexican state of Nayarit, whose innovative way of dealing allowed them to take over Quinones deserves all manner of credit for writing this book.
It could have done with a bit of editing, as it does get repetitive at times, but this doesn't get in the way of the story he is telling about how the marketing of opiates by Big Pharma and their resulting overprescription by physicians "tenderized" the market for heroin provided by the Xalisco Boys, heroin runners from the small town of Xalisco in the Mexican state of Nayarit, whose innovative way of dealing allowed them to take over the heroin markets in mid-size US cities like Denver; Portland, Oregon; Columbus, Ohio,and operate there virtually undetected.
The book examines medical attitudes toward pain, and how those attitudes were shaped by pharmaceutical companies in their attempts to build a market for opioids like OxyContin. It also looks at how the rise of managed care contributed to the overprescription by refusing to reimburse physicians for spending the time required to assess a patient's pain and develop a holistic approach to treatment that likely would have included things like weight loss, physical therapy, and massage, encouraging instead a ten-minute consult and a prescription for opiate-based painkillers.
It's not a dry, clinical book, though, as Quinones includes descriptions of life back in Xalisco as the heroin money begins to change things in the previously impoverished town, interviews with opiate abusers who became heroin addicts or family members who lost loved ones from opiate overdoses.
These overdoses were on the rise for years, but no one noticed, so the book also has an element of the detective story to it as law enforcement and public health officials around the country begin to realize what has been going on in their midst.
It also details the incredible toll opiate-overprescription took on these towns, many of them in the Rust Belt and declining in opportunity and hope as their primary employers closed up shop and moved away, the result of globalization. This is an incredibly important book, impressively meticulous and compelling. Readers also enjoyed. About Sam Quinones. Sam Quinones. Sam Quinones is a long-time journalist and author of 3 books of narrative nonfiction.
He worked for the LA Times for 10 years. He spent 10 years before that as a freelance journalist in Mexico. His first book is True Tales from Another Mexico: The Lynch Mob, the Popsicle Kings, Chalino and the Bronx , published in , a collection of nonfiction stories about drag queens, popsicle-makers, Oaxacan ba Sam Quinones is a long-time journalist and author of 3 books of narrative nonfiction.
His first book is True Tales from Another Mexico: The Lynch Mob, the Popsicle Kings, Chalino and the Bronx , published in , a collection of nonfiction stories about drag queens, popsicle-makers, Oaxacan basketball players, telenovela stars, gunmen, migrants, and slain narco-balladeer, Chalino Sanchez.
In this volume he tells stories of the Henry Ford of velvet painting, opera singers in Tijuana, the Tomato King of Jerez, Zacatecas, the stories of a young construction worker heading north, and Quinones' own encounter with the narco-Mennonites of Chihuahua. His third book was released in Using expert storytelling and exhaustive detail, Quinones chronicles the perfect storm of circumstances that cleared the way for the Mexican narcotic to infiltrate our small and midsize communities over the last two decades.
Such is Sam Quinones' astonishing work of reporting and writing. In most cases, the reviews are necessarily limited to those that were available to us ahead of publication. If you are the publisher or author and feel that the reviews shown do not properly reflect the range of media opinion now available, please send us a message with the mainstream media reviews that you would like to see added. Any "Author Information" displayed below reflects the author's biography at the time this particular book was published.
Reader Reviews Write your own review. Sam Quinones is a journalist, author and storyteller whose two acclaimed books of narrative nonfiction about Mexico and Mexican immigration made him, according to the SF Chronicle Book Review, "the most original writer on Mexico and the border. More Author Information. A daring first novel—both buoyant comedy and devastating satire by the author of Say You're One of Them.
There are two kinds of people in the world: those who divide the world into two kinds of people, and those who don' Click Here to find out who said this, as well as discovering other famous literary quotes!
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Add to basket. Add to wishlist. Ebook help. You must sign in to add this item to your wishlist. Please sign in or create an account. Close Preview. About the contributors. Author Sam Quinones Sam Quinones is a journalist, author and storytell….
The most original writer on Mexico and the border out there. Related Titles. Sam Quinones. Laurie Winkless. What Dogs Want. Mat Ward. The Least of Us. Can We Talk About Israel? Daniel Sokatch. Whatever Happened to Tradition? Tim Stanley. John-Paul Stonard. The Next Great Migration. Sonia Shah. Pragya Agarwal. Chasing Me to My Grave. Winfred Rembert. It is impossible to discuss closing this gap without recognizing causative factors and you describe the most blatant cause.
Thank you for your years of investigation and brilliant writing! I look forward to hearing from you. Thank you for telling the compelling and heartbreaking story of the opioid use disorder and overdose epidemic and for giving us a glimmer of hope that together we can turn the tide. Thank you for all you are doing to give voice to those who are struggling and to speak truth to those of us who have been indifferent or even hostile toward those whose lives have been shattered by opioid addiction.
I would like to think earlier spiritual contact and support might be helpful but I am puzzling on what that would look like on the ground or how it might be done. Thank you for your work, and any ideas you, or you readers, might have. Peace, and blessings, tom nesbit. Thank you for your time and patience sir. Sam, I felt like you nailed it with the way you put your research together. I live in Kentucky only about 70 miles from Portsmouth.
The trigger man was an OxyContin addict. I did a couple years worth of in depth research on the whole thing. Quinones: I liked your book, although it is depressing. But that is the real world. I wonder where do they process their products. Do they have labs in here?
I just wondered if you did research on that. Also I wondered how these Nayarit guys got to pass the border to the US so easily. I know it is not easy for illegal persons.
On another subject, I have read comments on your book that patients that suffer from chronic pain will be limited because they will have a limited access to the drugs they need, on account of all these addicts. The same happened here in Guatemala; pseudoephedrin was retired from the market because it was used to cook methanphetamine, and the patiens suffering from bronchial spasm, allergic rinnitis, etc.
The substitute approved, phenilefrine, was not as strong as pseudoephedrin to dilate the bronchia. I am a pharmacist, and I witnessed myself when those products were retired from the pharmacies in this country. A very interesting issue, congratulations for your work. One must be informed , not blind to avoid an evil by being aware of how that evil manipulates , stealthily manifests like a cancer. Quinones , Your book is a MUST read for every parent , physician , health care professional , educator , politician.
I understand you lost a son to overdose and nothing can take that hole in your heart away. Your book bores me and the fact that you depend on the government and internet for a majority of your theme, you fail to address how fucked up it is to live with pain. Your book is boring, with all due respect. Kolodny is a self serving shrink. Not your enemy. For the record, I support methadone maintenance therapy as well as buprinorphine, for whom that molecule is beneficial.
Pain management is not one size fits all and neither is addiction medicine. How can you deny a 70 yr old coal miner from Virginia with multiple ailments from some pain relief? I urge everyone to take part in the pain conversation. Quinones, Thank you for writing this readable and informative book about the opiate crisis in this country. I am an addiction psychologist in Northeast Ohio. As you so accurately describe in the book, our area has been hit hard by the opiate epidemic.
What is beyond troubling now is the deadliness of the heroin on the street, now that we are seeing it mixed with fentanyl and now increasingly, carfentanil. There are so many unanswered questions about fentanyl and carfentanil and I fear that we have only just begun to see the full impact. Since reading your book I have recommended it to patients and non-patients alike, and plan to include a review in our next patient alumni newsletter.
Thank you for all of your hard work. Best, Ashley. Upon taking an English composition II class our professor had us read and now the research begins. This book was difficult for me to read, as a mother, as a health care professional and as an addict with 6 year of recovery. Though my reality was never heroin, I can verify that OC was no walk in the park. Having zero other addictions that I know of, and still struggling everyday to remain on this path, opiates are the devil.
Reading this book was just surreal. Narcotics anynomous was rough seeing people with many years relapsing some dying. I chose to remain on a low dose of suboxone yes even 6 years later to be safe. The reality of relapsing is just too real and this book was a hard reality for me. I have been to FL pill mills, mail order Docs, and pain management where eventually I did own up- I have been encouraging many younger people to read this.
Even my own children. Right now as i prepare my angle on your book, I have to say Perdue Pharma bothered me so much more than the Xalisco boys. In today I see this epidemic and zero solutions.
I sympathize with those who were not as fortunate as I. I just want to thank you for this eye opener. I believe every High Schooler should read. This drug should never be a reality but for so many it is. I have many issues with the unsympathetic who still demonize — or people who think they are above this, if you knew my background I would be the last one expected to fall on this. I pray that people even more change attitudes this is a real threat for our young esp in an age which parenting has changed so much.
Thank you Thank you I would love a sequel. I somehow missed this on netgalley — I guess you can say NOW reading is my escape. Writing as well, but nothing has touched me as this book has.
Right out the gate I was in the thick of this tale. You were able to keep it accessible as well as informative. For many years, I literally actually was.
Thank you for writing this book. Nurses, friends, lawyers, librarians counselors etc. Out of pure coincidence I came across your book while I was researching something else online!
I was raised in a very loving family, my father and grandfather both were police officers , church every Sunday and so on and so forth!!
This city in which I moved to is very different from where I grew up and I actually detest it, but continue to stay because of my immediate family being here!! I unfortunately got involved in the party scene which I may add is very easy to fall into in this transient place I now call home!!
I did become an addict although the street drug I use is not as addictive as the opiates but all in all its still a drug! I have and still see many people friends or fellow addicts who switch their drug of choice to opiates and now black tar heroine. I see what they go through just to get another dose and it sadness me!!
They get severely dope sick where I can just go to sleep for a couple days and all is well!! I just thank God I never tried the opiates! I also may add Iam a functioning addict that goes to work five or six days a week for 10 hours a day doing manual labor Iam 47 -with that said Iam sure you can guess my drug of choice! I love and respect them to much to let them know!
I also have to work to make my car payment , car insurance, and my rent south Florida is not cheap to live by any means! All the rehabs are in south Florida and the most drugs are also here just about on every street corner and some right in your face , like these pill mills.
I never heard of such a thing until I moved to South Florida! The police just add to the conflict-they keep arresting addicts and not the source of the problem which would be the doctors writing the scripts!!
My speculation of why this is happening is very simple -they have money to afford an attorney to get them out of trouble!! Picture this-you are dope sick , you score some dope, you get caught, and are arrested -now you are a felon! All this B. I have seen it time and time again!
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