Book review: Dreamland tells a horrifying tale of heroin in the heartland

All across America, people who used to take prescription opiates have been turning to black-tar heroin, with the calamitous results that are laid out in Sam Quinones’ book

PUBLISHED : Monday, 04 January, 2016, 3:01pm
UPDATED : Monday, 04 January, 2016, 3:01pm

Dreamland: The True Tale of America’s Opiate Epidemic

by Sam Quinones

Bloomsbury Press

Every so often I read a work of narrative non-fiction that makes me want to get up and preach: read this true story! Such is Sam Quinones’ astonishing work of reporting and writing, Dreamland: The True Tale of America’s Opiate Epidemic.

Dreamland documents how the prescription-opiate epidemic in America intersected with the heroin scourge, as a crackdown on prescription opiates turned people addicted to Vicodin, OxyContin and other opiates towards cheap Mexican heroin.

It’s a story of the American Midwest, where proud manufacturing centres in All-American states like Ohio turned into centres for “pill mills”, clinics where corrupt doctors prescribed Vicodin and OxyContin in bulk quantities. Desperate drug seekers looted Wal-Marts to pay for their habit, and an entire economy ran on the buying and selling of illegal prescription drugs.

It’s about the small Mexican town of Xalisco in the state of Nayarit, which became an international centre for the trafficking of heroin involving a vast network of towns and cities on both sides of the Mississippi River. Dealers from Xalisco spread heroin to America’s wealthier suburbs, where kids raised in affluence could easily procure and pay for ever-cheaper heroin.

Dreamland has been named a best book of the year by The Seattle Times, The Boston Globe, Slate, Entertainment Weekly (“like a David Simon TV show gone cosmic”) and Angus Deaton, Nobel Prize-winning professor of economics at Princeton, who called it “as fast-paced and compelling as any thriller”. (A recent study co-authored by Deaton showed that prescription-opiate abuse is a chief cause for a rise in death rates from both illness and suicide among middle-aged white people in America.)

With those endorsements in mind, I called Quinones, a former crime reporter for the Los Angeles Times. He said he developed his skills in the trenches, finding that “crime reporting was done best when you didn’t focus on the crime; you focused on the story behind the crime”.

One of Dreamland’s strengths is its portrayal of life in Xalisco (to research one of his earlier books, Quinones moved to Mexico and became fluent in Spanish). The heroin dealers of Xalisco fanned out all over America, from Portland to Tennessee, adopting a “home-delivery” model for heroin that spared users the danger of hitting the streets for drugs.

Some used suburban parking lots for transactions. Some helpfully supplied free heroin to users thinking about quitting. They never used the drugs themselves. Then a crackdown on prescription opiates created a new surge of customers for their cheap black-tar heroin.

Caleb Banta-Green, an affiliate associate professor of health services at the University of Washington, has read Quinones’ book. He confirms that cheap black-tar heroin from Mexico is the culprit in rising rates of heroin addiction in Washington state.

Quinones’ crime reporting was superb, he says, but he laments the author’s use of the word “addicts” in the book and again in a recent New York Times piece. “Addicts is a very, very negative word,” Banta-Green says, adding in an email: “Opioid addition … leads to serious changes in brain chemistry. While a person may behave their way into the condition, few can behave their way out of it because of biological changes in the brain.”

There are successful drug-based treatments for addiction, including methadone and buprenorphine (marketed as Suboxone), that can reduce deaths from heroin use as much as 50 per cent, Banta-Green says. The “addict” label is a problem because users “have this stigma, they want to get off the medication as fast as possible. The literature is very clear – if you get on one of these medications for months or years, your chances for recovery are much better.”

Dreamland will be out in paperback in April. Think it doesn’t affect you? Think again – of the stories you’ve heard of prescription-opiate addiction among bright young people with everything going for them. For better or worse, Dreamland is a true American story.

Tribune News Service