Pick a state, any state.
In California, heroin-related hospital visits are surging. In Massachusetts, more than 1,000 people died from opiate-related ODs last year. In Missouri, the number of heroin-related deaths recently doubled. In Ohio, heroin deaths are reaching record highs. Meanwhile, “Heroin deaths in Connecticut continue to skyrocket, a burgeoning, exploding crisis that requires immediate, substantial attention,” a U.S. senator recently warned.
In Oregon, former beauty queens are busted for possession of heroin, which officials call the state’s top drug threat. In Utah, authorities say a recent mammoth heroin bust represents “a real shift in the narcotics problem.” In North Carolina, magazines ask, “Why are kids…from Charlotte’s wealthy neighborhoods and good schools, turning to the deadliest drugs?” In Rhode Island, the number of babies born addicted (“most commonly [to] opioids like prescription pain medications or heroin”) almost doubled between 2005 and 2012. In Vermont, the governor spent his entire 2014 “State of the State” address talking about a single subject. ”What started as an OxyContin and prescription drug addiction problem in Vermont has now grown into a full-blown heroin crisis,” he said, as he began.
This is America in 2015, and as Sam Quinones describes in his astonishing, monumental new book, Dreamland: The True Tale of America’s Opiate Epidemic, we’re in the midst of “the worst drug scourge to ever hit the country,” measuring by its death toll. Unlike the heroin plague of the 1970s or the crack epidemic of the 1980s, however, the current disaster is “happening quietly,” he writes. This has a lot to do with the population perhaps hardest hit: middle-class and affluent white folks. Shock and shame are powerful silencers.
“Children of the most privileged group in the wealthiest country in the history of the world were getting hooked and dying in almost epidemic numbers from substances meant to, of all things, numb pain,” he writes. “Crime was at historic lows, drug overdose deaths at record highs. A happy facade covered a disturbing reality.”
Dreamland is really two stories, divided by a prescription pad. On one side is the painkiller OxyContin, which clocked a reported $3.1 billion in annual sales, even after its manufacturer, Purdue Pharma, paid a $634.5 million criminal fine in 2007 for misleading marketing practices. On the other side is a “sticky dark substance known as ‘black tar,’ a semi-processed heroin.” Chemically, the substances aren’t so different.
The story of black tar heroin traces back to a small, dirt-poor town in the Mexican state of Nayarit. Xalisco wouldn’t be noteworthy were it not a staging area for what Quinones — a former veteran L.A. Times reporter, who writes with clarity and confidence — describes as a “new kind of drug trafficking in America.” The trafficking system took root outside Los Angeles, in the late 1980s and ’90s and has since spread to San Diego, Phoenix, Denver, Albuquerque, Indianapolis, Nashville, Cincinnati, Charlotte, and other cities. If you’ve heard about heroin in your town, there’s a good chance it came from opium poppies growing in the Mexican mountains.
The Xalisco Boys aren’t the flashy, gun-slinging gangsters you’ve seen in Hollywood films, though. The network’s foot soldiers — a near-endless supply of farm boys eager to make cash to send or bring back home — are polite, nonviolent, salaried, and sober. Their product is cheap and pure, and “Their job is to drive the city with their mouths full of little uninflated balloons of black tar heroin, twenty-five or thirty at a time in one mouth,” Quinones writes. “They look like chipmunks…[with] a bottle of water at the ready so if police pull them over, they swig the water and swallow the balloons.” Quinones, who has written two previous books about Mexico, is particularly good at taking us inside the minds of these low-level dealers. “Back in the ranchos, nothing said that a man had moved up in the world like walking around in public in dark-blue [Levi’s] 501s,” he writes.
In one of the book’s more captivating chapters, he describes the establishment of a “cell” in Columbus, Ohio, from the perspective of regional manager identified as “the Man.” After arriving in town, the Man sends for more “kids from Xalisco,” finds a car lot willing to swap for new delivery cars every few months, and establishes twice-daily shifts of drivers who meet addicts at Burger King and in Kmart parking lots. Soon, the Man has to hire a tailor in L.A. to sew custom underwear for female members of his crew. “For more than a year, he sent two girls a month back to Mexico with a hundred thousand dollars in pure Columbus, Ohio, profit tucked in their corsets.”
To addicts across the U.S., the little balloons from Xalisco Boys “became a brand every bit as dependable as a Coke can or a Holiday Inn sign,” Quinones reports. And the distribution network — which lacked a central power structure that could be easily toppled — grew resilient enough to absorb the largest joint DEA/FBI operation in U.S. history, involving more than 180 arrests in a dozen cities. After “Operation Tar Pit,” heroin deliveries in Santa Fe paused only for a day.
In the other half of Dreamland, Quinones takes readers over some of the terrain New York Times reporter Barry Meier mapped in his 2003 book on OxyContin, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death. Quinones introduces readers to the man Meier called a “scientific superstar:” Dr. Russell Portenoy, a pain expert and opiate evangelist who helped usher in an era when patients’ pain is measured as a “fifth vital sign” alongside temperature, pulse, breathing rate, and blood pressure. We also meet Arthur Sackler, the fantastically rich (and now deceased) co-owner of Purdue Pharma whom Meier described as a hybrid M.D.-adman who, many believed, “cloaked his pursuit of profit and power behind the veil of science and research.”
Dreamland picks up the same threads that Meier explored, and Quinones’s chapter-long riff on OxyContin’s rise is a masterpiece. I would reprint here it in full, if I could; it’s that important and well reported. But I’ll just quote a passage in which he frames the story:
The decade of the 1990s was the era of the blockbuster drug, the billion-dollar pill, and a pharmaceutical sales force arms race was a part of the excess of the time. The industry’s business model was based on creating a pill – for cholesterol, depression, pain, or impotence — and then promoting it with growing numbers of salespeople. During the 1990s and into the next decade, Arthur Sackler’s vision of pharmaceutical promotion reached its most exquisite expression as drug companies hired ever-larger sales teams. In 1995, 35,000 Americans were pharmaceutical sales reps. Ten years later, a record 110,000 people — Sackler’s progeny all — were traveling the country selling legal drugs in America.
Quinones adds layers of nauseating detail: the exorbitant bonuses for Purdue salespeople who peddled OxyContin to primary-care docs under-trained in treating chronic pain; the promotional videos that under-reported the pill’s addictive potential (never vetted by the FDA, as they ought to have been); the OxyContin-branded hats, toys, mugs, golf balls, CDs, pads, and pens that rained down on doctors; the Purdue lawyers who made phone calls to folks talking candidly about addiction in small-town newspapers. At one point, during a 2007 sentencing hearing for Purdue executives, the mother of an OxyContin overdose victim tells them, “You are nothing more than a large corporate drug cartel.”
Dreamland’s chapters jump in time and place from a heroin trafficker’s childhood in Nayarit to a legless addict in Portland, Ore. to a grief-stricken parent in Southern Ohio, and so on. It’s an ambitious approach reminiscent of Eugene Jarecki’s sweeping 2012 documentary, The House I Live In, which offered a devastating, pointillist portrait of the War on Drugs, through interviews with professors from Ohio State and Harvard, drug cops from Florida to New Mexico, a federal judge in Iowa, and a prisoner in Oklahoma who tells Jarecki, “I have life without parole for three ounces of methamphetamine.” In Dreamland, so many names, facts, and breakdowns of complex concepts can be overwhelming, at times; I found myself pausing to give my brain a chance to breathe.
But such a wide-reaching approach seems necessary to convey the “catastrophic synergy” when the paths of Purdue Pharma and the Xalisco Boys cross. “And so it went,” he writes:
OxyContin [came] first, introduced by reps from Purdue Pharma over steak and dessert and in air-conditioned doctors’ offices. Within a few years, black tar heroin followed in tiny, uninflated balloons held in the mouths of sugarcane farm boys from Xalisco driving old Nissan Sentras to meet-ups in McDonald’s parking lots…
“I’ve yet to find one who didn’t start with OxyContin, [a family physician in Southern Ohio] said. “They wouldn’t be selling this quantity of heroin on the street right now if they hadn’t made these decisions in the boardroom.”
The U.S. will never solve its deadly opiate epidemic if we don’t first admit we have a problem. And Dreamland is one of those rare books that’s big and vivid and horrifying enough to shake up our collective consciousness. In that sense, its comparable to Nick Reding’s 2009 book, Methland: The Death and Life of An American Small Town, which landed on the cover of the New York Times Book Review thanks to a Walter Kirn review quoting Reding’s description of what it’s like inside an exploding meth lab: “His skin was dripping off his body in sheets…His nose was all but gone now, too, and he ran back and forth among the gathered neighbors, unable to scream, for his esophagus and his voice box had cooked inside his throat.”
Methland covers different ground than Dreamland, chemically and geographically. But it’s a similar attempt to sweep startling images into readers’ minds. Consider these passages from the books’ introductions. First, an excerpt from Dreamland, after Quinones describes the heroin overdose death of a private-school-educated 21 year old from Columbus, Ohio:
Drug overdoses were killing more people every year than car accidents…Kids were dying in the Rust Belt of Ohio and the Bible Belt of Tennessee. Some of the worst of it was in Charlotte’s best country club enclaves. It was in Mission Viejo and Simi Valley in suburban Southern California, and in Indianapolis, Salt Lake, and Albuquerque, in Oregon and Minnesota and Oklahoma and Alabama. For each of the thousands who died every year, many hundreds more were addicted.
Via pills, heroin had entered the mainstream. The new addicts were football players and cheerleaders; football was almost a gateway to opiate addiction. Wounded soldiers returned from Afghanistan hooked on pain pills and died in America. Kids got hooked in college and died there. Some of these addicts were from rough corners of rural Appalachia. But many more were from the U.S. middle class. They lived in communities where the driveways were clean, the cars were new, and the shopping centers attracted congregations of Starbucks, Home Depot, CVS, and Applebee’s. They were the daughters of preachers, the sons of cops and doctors, the children of contractors and teachers and business owners and bankers.
This section from Methland, meanwhile, follows an idyllic description of Oelwein, Iowa, (population 6,772), where much of the book is set:
And yet, things are not entirely what they seem. On a sultry May evening, with…temperatures approaching ninety degrees at dusk, pass by the Perk and Hub City on the way into Oelwein’s tiny Ninth Ward. Look down at the collapsing sidewalk, or across the vacant lot at a burned-out home. At the Conoco station, just a few blocks south of Sacred Heart [Catholic Church], a young man in a trench coat picks through the Dumpster, shaking despite the heat. Here, amid the double-wides of the Ninth Ward, among the packs of teenage boys riding, gang-like, on their Huffy bicycles, the economy and culture of Oelwein are more securely tied to a drug than to either of the two industries that have forever sustained the town: farming and small business. This is the part of Oelwein, and of the small-town United States, not visible from the plane window as the flat stretch of the country rolls by. After sundown in the Ninth Ward, the warm, nostalgic light that had bathed the nation beneath a late-afternoon transcontinental flight is gone.
Against the oppressive humidity, the night’s spells begin to take shape. Mixed with the moist, organic scent of cut grass at dew point is the ether-stink of methamphetamine cooks at work in their kitchens. Main Street, just three blocks distant, feels as far away as Chicago. For life in Oelwein is not, in fact, a picture-postcard amalgamation of farms and churches and pickup trucks, Fourth of July fireworks and Nativity scenes, bake sales and Friday-night football games. Nor is life simpler or better or truer here than it is in Los Angeles or New York or Tampa or Houston. Life in the small-town United States has, though, changed considerably in the last three decades…Main Street was no longer divided between Leo’s and the Do Drop Inn, or between the Perk and the Bakery: it was partitioned between the farmer and the tweaker.
There is a David Lynch-y vibe to both of these passages, where, like in Twin Peaks or the opening sequence of Blue Velvet, we zoom in on wholesome archetypes to find them broken, corrupted — a Norman Rockwell painting on a rotting canvas. But there’s a key difference between Lynch’s work and Pain Killer, Methland, and Dreamland, which, together, make a searing nonfiction triptych of 21st-century American life. Switching off the TV won’t make these stories disappear.