Dreamland: The True Tales of America’s Opiate Epidemic by Sam Quinones (review)

In 2010, I read the obituary of an old friend in a local newspaper. Startled and saddened by his early death, I attended his funeral and learned he had died of an overdose. His addiction emerged after an injury in which a doctor prescribed and continued to prescribe painkillers. In talking with me about his death a mutual friend who was an emergency room nurse described the ravages of Oxycontin and increases in heroin overdoses in that mid-size Florida city. Having started to work on a history of women traffickers, I was surprised to learn that heroin had regained a presence. My friends and I came of age during the Florida cocaine wars in the 1980s. Some 30 years later, a not-so-new drug was quietly taking over, with deadly consequences. Sam Quinones’ Dreamland is about that epidemic, and his timing is perfect.

A journalist who has written extensively on Mexico and the border, Quinones is a tireless collector of personal tales that call on multiple voices to tell rich and compelling stories. A complex work of nonfiction, Dreamland is about the return of opiates as a savior for a modern, yet pain-ridden, society. This tale provides historical continuity with one told over a century ago when opiate derivatives were seen as miracle drugs and heroin as a step-down treatment for morphine addiction. Quinones weaves together two distinct stories that initially seem unconnected. He explores the medical profession’s embrace of opiates to alleviate patient pain and its devastating consequences. As addiction and overdoses drew the attention of medical authorities and state legislators, greater attention was paid to doctors who were over-medicating or running pill mills. By the time those addictions and overdoses garnered the attention of medical professionals, parents, and politicians, a new class of addicts had emerged: middle and upper middle class suburbanites with money and an appetite for opiates. Those addictions contributed to the second story, the return of black tar heroin to fill a growing demand.

Black tar heroin is not a new phenomenon. In the 1970s, Mexican drug trafficking organizations distributed it to certain major US cities, using the rail system. In the 2000s, Quinones narrates, the return of black tar heroin came with perfect timing and in perfect market placement because of the shifts in which countless people, regardless of class, had developed a taste for opiates due to over-prescribing doctors. Timing is everything in business, and the Nayarit-based black tar heroin traffickers and dealers had a perfect moment due to increased demand for their product. Quinones argues that they perfected their delivery methods using relatively mundane technologies such as cell phones to arrange deliveries. Their customers were not addicts seeking the drugs in the inner city; the drivers delivered the drugs anywhere and anytime.

The Nayarit dealers used, as Quinones describes, a Walmart approach to drug distribution, keeping their overhead and costs low and enticing customers with a taste or two. They avoided big cities where organized crime already controlled the heroin trade, and they relied on junkies and addicts in Charlotte, or Columbus, or Nashville, and other mid-size cities, to find and foster a new client base. The Nayarit dealers and drivers knew that deportation would be the penalty for getting caught with their mouths stuffed with balloons filled with black tar heroin. But if a driver was deported, there was always another young man back home willing to take the risk.

In this highly readable book about a contemporary drug epidemic, Quinones offers students and scholars of drugs a series of ideas, themes, and events that call for further historical research to better understand changes over time in regard to iatrogenic addiction, the impact on families, and changing methods of drug dealing, police investigation, and treatment. Recently, US presidential candidates on the campaign trail have heard about the ravages of heroin and opiate addictions, and constituents are demanding...