Dreamland: The True Tale of America's Opiate Epidemic

by Sam Quinones

In 1986, Russell Portenoy, then thirty-one, and his mentor, Kathy Foley, published what became a declaration of independence for the vanguard of pain specialists interested in using opiates for chronic pain, though Portenoy hardly intended it as such. Other researchers had been issuing papers saying that many chronic-pain patients using opiates invariably ended up addicted. Portenoy and Foley hadn’t seen that. They reviewed the cases of thirty-eight of their cancer patients with chronic pain who used opiate painkillers. Only two grew addicted, and they had histories of drug abuse. The rest functioned well and most of them without pain, to boot. Portenoy and Foley wrote a paper reporting those observations and submitted it to a medical journal called Pain. Opiates themselves were not inherently addictive, the authors suggested; a lot depended on the people taking them. Cited among the footnotes supporting the paper was a letter to the editor, by Jane Porter and Dr. Hershel Jick out of Boston, in a 1980 edition of the New England Journal of Medicine. It was headlined “Addiction Rare in Patients Treated with Narcotics.” The idea in the Pain paper, Portenoy said later, was that “these drugs have certain characteristics, which, when interacting with a certain kind of brain, can lead to bad outcomes; but it’s not inherent in the pill such that everybody given that pill becomes an addict.” From that gradually grew the idea that opiates might be prescribed not only to people dying...