Dreamland: The True Tale of America's Opiate Epidemic

I grew up in Dreamland. Or rather, a town that could have been Portsmouth, Ohio, whose community pool by name of Dreamland opens this book. When I read these first pages, infused as they are with small town Midwesterness, I felt home. When I read the description of the Dreamland pool, it could have been the Ella Sharp pool where I spent so many happy childhood and adolescent hours, such were the similarities. Sadly, like Dreamland, that pool has since been filled in, and the similarities don't stop there. Like many of the Rust Belt towns that fill Sam Quinone's Dreamland: The True Tale of America's Opiate Epidemic, Jackson's employers slowly disappeared leaving the town a shadow of its former self and easy prey for the bleaker elements of society.

Quinones, as he proves time and again, knows this story too well. Dreamland gives readers an in-depth look into the causes and early stages of the opioid epidemic which have ravaged towns from Portsmouth and Jackson in the Midwest, to Albuquerque and Boise and points in-between. In a word, this book is an indictment. It is an indictment of a pharmaceutical industry eager to make a buck, of a health insurance industry that has put doctors into straitjackets by limiting the procedures they will and won't cover, of drug laws and SSI and Medicaid cards that turned too many with limited means (and a few with plenty of means and the cunning to pull it off) into small-time OxyContin dealers through Medicaid's coverage of the pills in almost unlimited quantities.

Quinones does an excellent job of laying all of this out and helping readers make sense of this tangled public health crisis. The facts and realities are event more damning than the shear number of deaths, if that's possible. Too, Dreamland, with Quinone's wide-reaching networks and research in the heart of the opium-producing and trafficking provinces in Mexico, offers a far more comprehensive account of global heroin supply chains than does Fariba Nawa's Opium Nation, which, when it takes its focus off Afghanistan, primarily looks at Asian markets and suppliers. 

This is not a book to be read when unwinding before bed. It is a hardcore, depressing read: prepare to be angry.