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The Dark Dreamland of America’s Opiate Epidemic

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Dreamland is the story of a nightmare.

The book—subtitled The True Tale of America’s Opiate Epidemic—tracks a perfect storm of events, trends, innovations, and societal changes that began to coalesce in the 1990s, eventually unleashing America’s “opiate epidemic,” a stunning increase in the use and abuse of opiate-based drugs that has wrecked untold numbers of lives.

Journalist Sam Quinones tenaciously traced the varied causes of the epidemic, and in the book he explains them in heartbreaking detail. More important, he puts faces on both the perpetrators and the victims, and it’s this accomplishment that makes Dreamland so astonishing and horrifying.

In the end, though probably unintentional, Quinones’s work paints a hyper-realistic portrait of the sinful human heart, showing that man without Christ is overwhelmed with misery and desire—and more than willing to inflict pain on others in a vain effort to relieve his own.

Morphine

The story begins with the morphine molecule, the main active agent in opium, a substance found in the bulb of the opium poppy. People have cultivated the poppy for centuries and have developed some 200 drugs from opium—from laudanum to codeine to heroin.

The reasons are simple. First, the human body likes morphine. Receptors in the brain and spine are particularly welcoming to the molecule, which dulls pain and brings on intense pleasure. Second, morphine’s power seems to have no limits. While other drugs have levels of maximum effectiveness, the more morphine a person consumes, the more pain it blocks.

But morphine has a dark side. As Quinones puts it (in oddly spiritual terms), “Like no other particle on earth, the morphine molecule seemed to possess heaven and hell.” That hell includes numerous negative effects on the body and severe addictiveness. Once a person falls into its grip, morphine won’t let go.

Quinones notes that the human body can convert most drugs to glucose and expel them, but “alone in nature, the morphine molecule rebelled. It resisted being turned into glucose and it stayed in the body.” In the chilling words of Andy Coop, chairman of the department of pharmaceutical sciences at the University of Maryland in Baltimore, “Every other drug in the world—thousands of them—follows this rule. Morphine doesn’t. It really is almost like someone designed it that way—diabolically so” (emphasis added).

OxyContin

With that background, Quinones commences a fascinating excavation of the roots of the opiate epidemic:

  • A growing desire among post-World War II Americans to feel better quickly and easily, and the germination of the idea of a universal right to be free of pain.
  • The advent of aggressive marketing of pharmaceuticals, and its role in overcoming resistance to opiate-based painkillers.
  • The development and spectacular success of the opiate-based oral painkiller OxyContin, driven by inaccurate claims that the drug wasn’t addictive.

Quinones focuses heavily on OxyContin because not only did many users become addicted to it, the drug was terribly abused. When it hit the market in 1996, OxyContin was heavily marketed to doctors. Some prescribed the drug freely out of a sincere desire to help people in pain, especially in areas with high populations of welfare and disability recipients, such as the Rust Belt and Appalachia.

Other doctors, however, seized an opportunity to make a quick buck. One of the first “pill mills” was the clinic of Dr. David Procter in Portsmouth, Ohio, a small Ohio River city that Quinones effectively uses to illustrate the horrors of the epidemic. Pain sufferers flocked to Procter, who dispensed OxyContin prescriptions to walk-in patients who paid in cash. Many became addicted, then were forced to resort to all sorts of nefarious schemes to raise cash to buy their pills—from brazen shoplifting to rampant Medicaid fraud. In Portsmouth, so many people became addicted that something of an OxyContin economy developed, with pills functioning as a form of currency.

Opiate-based painkillers, then, constituted the first surge of the opiate epidemic. Heroin was the second.

Heroin

Heroin was developed in 1874 in London. Later, test subjects in Germany said the drug made them feel “heroic” or heroisch in German, hence, the name heroin. It was simple to make, cheaper than morphine, and could be diluted to increase illicit profits: “tailor-made for dope traffickers,” as Quinones writes. As the 20th century progressed, New York became the center of the heroin trade, where it was sold on the streets and, eventually, along the East Coast and toward the Midwest.

In the 1990s, narcotics officers in the western United States, especially the San Fernando Valley of California, began to encounter a new form of heroin—“black tar,” so called because it was less refined than typical heroin. It was processed from opium poppies grown around the town of Xalisco in southwestern Mexico. But not only were the men of Xalisco manufacturing the drug, they were beginning to market it in the United States in a way Quinones compares to a pizza-delivery service.

A “manager” from Xalisco would find a fertile region in the United States and establish a “cell” (something like a franchise). He’d hire a phone operator and drivers, all from Xalisco, and would begin receiving smuggled heroin from an “owner” in Mexico. The operator would take phone orders from addicts, and drivers would then deliver black tar to the addicts at prearranged meeting points. The “Xalisco boys” completely eschewed violence, drove unremarkable cars, kept their heroin supplies small, and were paid a wage by the cell manager. With this system, they long remained under the radar of law enforcement.

Perhaps most important, the Xalisco traffickers avoided large cities and other areas of traditional heroin dealing. Therefore, when they eventually expanded eastward, they found markets in the Midwest. And in areas where OxyContin addiction was high, they struck gold. As Quinones puts it, the painkiller “had already tenderized the terrain.” Because addicts’ tolerance for OxyContin kept climbing, they needed more and more, making their habits more and more expensive. Black tar was far cheaper. Thus, the opiate epidemic mushroomed until, in 2016, more than 40,000 Americans died from opiate overdoses, with somewhere around 2 million addicted to the pharmaceutical or street forms.

Dreamland simply brims with details about these intertwined story lines, all supported by input from scientists, law-enforcement officers, medical officials, and addicts themselves. The depth of the research and Quinones’s skill at weaving the story together make for engrossing reading, even if the material is dark and troubling.

Illuminating the Darkness

In a way, however, the troubling nature of the story is the point of the book, and that’s why I think Dreamland is a valuable read for Christians. Its value lies in the illumination it provides—ironically, illumination about the human heart’s darkness.

I came away from Dreamland with a deeper recognition of the potency of the desires that drive human behavior. Those desires can be seen at every twist and turn of Quinones’s tale, as he vividly shows how far people will go to get what they want.

Consider the role of several powerful desires in the onset of the opiate epidemic.

1. The related desires to be free of pain and to experience pleasure.

These powerful yearnings are the root of all experimentation with opium, all development of opium-based drugs, and all addiction to painkillers and heroin. People don’t like to hurt; they like to feel good, and they can be incredibly clever and inventive to meet those desires. They will spend small fortunes, stoop to nearly any form of crime, and lie to their dearest loved ones in order to get a prescription or supply of a street drug.

One neurologist was stunned, as a young practitioner, to learn how common pain was among his patients—and how desperate they were for relief. Quinones writes, “Patients virtually clawed at his lab coat for help in managing their pain.” This desire led to the development of OxyContin and other opium-derived drugs.

One neurologist was stunned, as a young practitioner, to learn how common pain was among his patients—and how desperate they were for relief.

The other effect of opium—pleasure—is, if anything, an even stronger desire. Those who sample it are likely to be seized by the need for more. Weirdly, even the experience of buying heroin provides pleasure for some.

Quinones writes that for suburban youth, heroin “fulfilled the dream of the adventures they’d never had in their quiet towns. . . . Finding dope every day could take them on a wild ride through worlds they hadn’t known existed.”

One young addict told him, “You’re as much addicted to going and buying it as to going and using it.”

2. The desire to have results now.

This desire, which may be especially common among Americans, breaks down to little more than impatience and a sense of entitlement. It appears in Dreamland in the preference among pain sufferers for pills rather than the holistic approach advocated by early pain clinics.

Quinones tells the story of John Bonica, who wrestled professionally as “the Masked Marvel” in the 1930s and 1940s, a career that left him with chronic pain. He later became an Army anesthesiologist and went on to open the first pain clinic in the United States in 1960. Bonica championed a multidisciplinary approach that linked numerous specialists to devise a unique therapy for each patient, often with marked success. “We were trying to teach [patients] they were the ones who controlled whether they were well or not well,” said Dr. John Loeser, one of Bonica’s successors. “The patient has to do the work.”

But that lesson was tough to get across. “There is a philosophy among many patients—‘I’m entitled to be free of pain,’” Loeser added. “People are entitled to health care. . . . But they are not entitled to pain relief. The physician may not be capable of providing them with pain relief. Some problems are not readily solvable. . . . But usually the patient says, ‘I come to you, the doctor. Fix me.’ . . . The population wants to be fixed overnight.”

It’s not hard to see how opiates—even with all their negative side effects—were quite attractive for those eager to feel better.

3. The desire for material gain.

If Dreamland does nothing else, it unveils the greed behind so much of the evil that people do. It can be seen in Quinones’s story in everyone from the unscrupulous doctors who dispensed OxyContin prescriptions for wads of cash to the middlemen who acquired pills and sold them at inflated prices to the impoverished Mexicans who found innovative ways to market and deliver heroin to needy addicts. Again and again in the story of the opiate epidemic, greed drove people to take advantage of situations to the disadvantage of others.

If Dreamland does nothing else, it unveils the greed behind so much of the evil that people do.

Perhaps nothing illustrates the greed at the heart of the story like Quinones’s paraphrase of the possibility that one Xalisco immigrant held out to another while both were in a Nevada prison: “I can supply all the dope you need. We could get rich like you wouldn’t believe.” They did, and so did the manufacturers of opium-derived prescription drugs—and all the middlemen, legitimate and otherwise, who marketed them.

How Should Christians Respond?

Dreamland almost seems to make the case that the opiate epidemic is unsolvable, given the iron grip opiates can have on users (though Quinones offers a sliver of hope by closing the book with an account of Portsmouth’s efforts to recover). What, then, can evangelical churches or individuals do, given that they lack specialized medical knowledge and the deep resources of government agencies?

As a first step, look for pain. It’s surely nearby. Your neighbors, co-workers, and even family members are hurting. They may have physical pain, of course, but they also may be hurting due to a lost job or long-term unemployment, financial struggles, broken relationships, marital discord, or strains with a wayward child. Pain is a universal human experience, to one degree or another, and where there is pain, there’s the temptation to dull it or even to turn it to pleasure—an open door for opiates.

Keep in mind, too, that no place is immune. The opiate problem is on our doorsteps—that is, the victims of opiates are there. This isn’t a social problem from which we can excuse ourselves because it seems remote. It’s not. It’s devastating people, families, and neighborhoods in the inner city, the suburbs, and rural America. Quinones writes eloquently about touring an upscale neighborhood near Charlotte, North Carolina, where “crime was at historic lows, drug overdose deaths at record highs. A happy façade covered a disturbing reality.”

If you know someone struggling with opiate addiction, or relatives of an addict, there’s much you can do. First, pray for them. Second, live transparently as a Christian. Let them see your own pain and how you trust Christ to work through it. Let them see you patiently enduring difficulties rather than seeking quick escapes. Let them see you giving of yourself to benefit others rather than causing harm to benefit yourself. Let them see the power of your affection—your “desire”—for your Lord.

Third, and most vital, offer Christ. It may seem trite and even pointless to share the gospel with someone going through the miseries inflicted by the morphine molecule. But we dare not guess at what the Lord will do in any given case. The bottom line for us is that victims of opiates are perishing not just temporally but eternally; that is, they’re not just in an opiate hell, but are in danger of the literal hell. Let us offer Christ with the sincere prayer that he’ll save them from the latter, and that they will turn to him for rescue from the former.

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