Dreamland: The True Tale of America's Opiate Epidemic

by Sam Quinones

In a statement on its website, the American Pain Society claimed that risk of addiction was low when opiates are used to treat patients in pain.

In fact, pain was really not a vital sign, after all, for unlike the four real vital signs it cannot be measured objectively and with exactitude.

“The way you’re reimbursed in a day, if you actually take the time to treat somebody’s pain, you’d be out of business,”

Years later, in fact, there still is no evidence of how many chronic-pain patients can be successfully treated with opiates without growing dependent, then addicted.

Selling heroin was just easier than growing sugarcane;

“it was more about the jeans than anything,”

“The way you deal with that is you disassociate yourself from that animal. You don’t let it get to you. You put up that barrier. That’s what they do. They do that with people.”

The heroin cells were like ants in a garden: You didn’t see them unless you got close enough and knew what to look for.

That shorthand, in turn, lent prestige to the tiny thing and the claim attributed to it: that less than 1 percent of patients treated with narcotics developed addictions to them.

That “less than 1 percent” statistic stuck.

Jick’s database consisted of hospitalized patients from years when opiates were strictly controlled in hospitals and given in tiny doses to those suffering t...

It was a bizarre misinterpretation, for Jick’s letter really supported a contrary claim: that when used in hospitals for acute pain, and then when mightily c...

a one-paragraph letter to the editor,

Patients, too, were hard to motivate when the treatment required behavior changes, such as more exercise. Pills were an easier solution.

Usually, a patient demanding ever-higher doses of a drug would be proof that the drug wasn’t working. But in opiate pain treatment, it was taken as proof that the doctor hadn’t yet prescribed enough.

Build trust and “aggressively” increase the dose of opiates until pain was relieved, Weissman wrote.

The point is if it were working, you wouldn’t need more.”

Nevertheless, a movement was born, radiating out from a simple one-paragraph statement in 1980.

“The next job I have is going to be for love of the work, not for need,” he promised the foreman.

But heroin did that: it made everyone equal.

Oxman had learned to listen to the community and also that when it came to drugs, a few people could create a public health catastrophe.

Heroin became a lot more potent and a lot more deadly.

For female junkies, hardened by daily exposure to the worst of human nature, this occasional dose of tender attention was welcome.

Empathy for her Xalisco dealers made it doubly difficult for Ellis to kick heroin, which she did years later.

Even now, as much as I hate heroin, I don’t hate those guys who were my dealers.”

“it wasn’t a new wave at all.”

Unbeknownst to anyone, heroin overdoses had become Multnomah County’s second cause of accidental death among men twenty to fifty-four years old—after car crashes.

It meant they had rules and practices in place so they’d never be caught with any of that. And they did this relentlessly, over and over, across the country.

Every trafficker who handles the dope steps on it—expands the volume by diluting it—before selling it.

Salaried employees were unheard-of in the drug business.

OxyContin is a simple pill. It contains only one drug: oxycodone, a painkiller that Germans synthesized in 1916 from thebaine, an opium derivative. Molecularly, oxycodone is similar to heroin.

Pain was now considered a vital sign, measured by a subjective scale between 1 and 10, and treated aggressively.

Later, Purdue officials would say that what

happened with OxyContin surprised them because MS Contin ...

I spoke to remembered that MS Contin was sto...

Moreover, no one had imagined that a pill containing a drug similar to heroin would be marketed almost like an over-the-counter drug.

1996, the year OxyContin was released.

Purdue positioned OxyContin as the opiate of choice in the World Health Organization’s Ladder of pain management.

The doctors needn’t worry because the oxycodone was released slowly over many hours.

Thus, OxyContin did not create the steep highs and lows that created cravings.

the news that opiates had been “shown” to be addictive in less than 1 percent of pain patients.

With consistent supply from Nayarit, the system offered addicts reliability, convenience, and safety.

Less than 1 percent of patients ever grew addicted, they said in their presentations.

Prior had attended medical school in the early 1980s, where he had learned opiates were generally to be avoided.

Purdue’s sales force tripled to more than a thousand as OxyContin gained momentum.

The rules now prohibit pharma company influence on content and speaker selection, as well as limitations on how grant funding can be used.

Now a lot of CME is online, where the risk of improper influence through resorts, dinners, and golf outings is removed.

Purdue donated money for website development to established groups, such as the American Chronic Pain Association and the American Academy of Pain Medicine.

Had that not happened—had there been no insistence that pain was undertreated and that pain was now a fifth vital sign—OxyContin would likely not have found the market it did.

Sinaloa, the state streaking up the coast north of Nayarit, is the birthplace of Mexican drug trafficking.