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Dreamland

The True Tale of America’s Opiate Epidemic

By Sam Quinones
21-minute read
Audio available
Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

Dreamland (2015) tells the story of how the opiate crisis in the United States went from being a problem only among social outcasts and the urban poor to one of the leading causes of accidental deaths in the country. The background and science of the crisis are rooted in socioeconomic factors that are distinctly American.

  • Non-Americans left nonplussed by the United States’ opiate problem
  • Health care professionals
  • Policy wonks

Sam Quinones is an American journalist and author, known for his work at the LA Times, as well as his books on Mexico, which include True Tales from Another Mexico and Antonio's Gun and Delfino's Dream.

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Dreamland

The True Tale of America’s Opiate Epidemic

By Sam Quinones
  • Read in 21 minutes
  • Audio & text available
  • Contains 13 key ideas
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Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones
Synopsis

Dreamland (2015) tells the story of how the opiate crisis in the United States went from being a problem only among social outcasts and the urban poor to one of the leading causes of accidental deaths in the country. The background and science of the crisis are rooted in socioeconomic factors that are distinctly American.

Key idea 1 of 13

A tiny pill has played a major role in the current opiate crisis.

The opiate crisis is being felt all over the United States – but it didn’t come out of nowhere. It’s a been a slow process, the foundations of which were laid back in the early 1980s.

In 1984, the drug company Purdue released a new product called MS Contin. It was a time-release morphine pill designed for treating pain in patients who were dying or who had just been released from surgery.

It was highly successful, so much so that the company released a similar drug in 1996. This new drug had oxycodone as its active ingredient, rather than MS Contin’s morphine. Oxycodone is an opium derivative not dissimilar to heroin, and once more Purdue used its time-release coating formula. The name of this pill was OxyContin.

The FDA approved OxyContin in 1995, as they believed Purdue’s big claim about the pill: supposedly, their time-release coating would limit addiction by preventing the sorts of rapid highs and lows usually associated with opiates.

The consequences of this decision were serious: now Purdue could market OxyContin with a unique safety label that stated the drug had less potential for abuse than other painkilling drugs on the market.

It was this claim that became the cornerstone of OxyContin’s marketing. This wonder drug would purportedly be the only painkiller a doctor would ever need to prescribe. It was to be an almost risk-free solution to chronic pain; unlike other opiates doctors had been prescribing for pain, this new drug had been shown to be addictive in less than 1 percent of patients.

But there was a very specific reason these rates of addiction were so low: MS Contin was being used in carefully controlled hospital conditions. Conversely, OxyContin was marketed to doctors outside hospitals. And these doctors were used to dealing with chronic pain in their patients by prescribing opiates.

Now, these old opiates were quite weak, their dosages were small, and they contained agents such as acetaminophen or Tylenol designed to prevent abuse.

Oxycontin was different. It contained large doses of oxycodone and was only deemed safe because of the special time-release coating designed to supply the active ingredient over a long period.

Purdue soon began pushing its new product. Its representatives visited doctors several times a year and took them out to lavish lunches, attempting to drive home the merits of the time-release coating and how it ensured addiction was not an issue.

It didn’t stop there: mountains of OxyContin merchandise and medical seminars at luxurious resorts were quite the norm.

And it was a success: Purdue’s sales tripled. In fact, bonuses for sales rose from $1 million in 1996 to a whopping $40 million in 2001. By 2003, OxyContin was predominantly being prescribed by primary care doctors with very little pain management training. Purdue had successfully transformed the entire industry: prescribing for pain had become the norm, not the exception.

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