How a Nation Is Destroyed,
And How It Can Save Itself
Sam Quinones, Dreamland: The True Tale of America’s Opiate Epidemic
Bloomsbury Press, Paperback Edition 2016,
353 pages, $18.00.
Attorney General Jeff Sessions, after creating a Justice Department task force targeting prescription drug manufacturers and distributors of prescription opioids, was interviewed May 1 by the Washington Post. Sessions asked his interviewer: “Have you read Dreamland? For the first time, you get a glimpse of how it [the American opioid addiction epidemic] really developed.”
When crime reporter Sam Quinones testified to the Senate Health, Education, Labor, and Pensions Committee on Jan. 9, 2018 on one of the greatest crimes against America in its history, he had already gone beyond the extraordinary understanding of the nation’s drug addiction epidemic “glimpsed” in this book, published in 2016. He now knew that new national missions, like a “new Apollo Project” for the space program and a “new Marshall Plan” for Appalachia, were needed to lift Americans back up out of the mud of depression, personal isolation, and addiction.
But when writing Dreamland in 2014-15, Quinones had already grasped that deindustrialization—the collapse of the American industrial heartland—, along with loss of belief in the goodness of government and of community of shared values, had driven this continuing mass crime, now killing 65-70,000 Americans each year and degrading the lives of millions.
Judging from the reactions of the Senators who heard his testimony, most of whom had read Dreamland, many are so struck by the details of his amazing “true tale” of U.S. mass addiction, that they choose not to hear what Quinones says about the real American values lost. These include the sense of productiveness, the value of creative participation in strengthening community and government, the ability to work through stress and pain for the sake of something better for future generations.
Quinones’ true tale of the addiction epidemic is much stranger than fiction; and it can, in itself, be depressing without the idea of a national mission to reverse it. He clearly knows this.
Anything for Money, Morphine
Quinones has been reporting on crime, mostly for the Los Angeles Times, for more than two decades; for nearly one decade around the turn of this century he lived in Mexico, found out how trafficking actually works there and lived to tell the story in two earlier books.
Only by reading this book can one take in, slowly, the literally month-by-month riveting details of 25 years of this great crime, which Quinones learned over a decade from many, many law enforcement sources, addiction experts, local elected officials and business people, physicians of many disciplines, addicts at all stages of addiction and withdrawal, heroin dealers imprisoned and at large, and others.
We can simply summarize its sequences and consequences.
• Beginning in the later 1980s, a huge campaign by some major pharmaceutical companies succeeded in corrupting the morality of large sections of the American medical community. Big Pharma rather suddenly deployed massive sales forces to doctors, employing what Wall Street has made familiar as mis-selling and fraudulent practices, on behalf of their blockbuster painkillers Oxycontin (Purdue), Vicodin (Pfizer), etc. The myth of a 100% effective but “non-addictive” analgesic—morphine after 1900, synthetic heroin from 1930 through WWII—arose again. Quack theories were published and taught, which would inspire envy in Wall Street traders and investment advisors at the peak of a bubble. Large numbers of doctors bought it.
• Big pharma also thoroughly corrupted the fields of medical training, continuing education, and consulting, entrenching the idea of “pain as the fifth vital sign” which physicians must measure and treat. Measuring it was a fool’s errand, but treating it was deceptively easy and made virtually mandatory with the coercive complicity of the health insurers. Most doctors were swept along, and some came to operate “pill mills.” The worst few even sold opioids for odd jobs, favors, or sex from patients, and/or even became addicted themselves.
• What made this moral corruption “succeed” was deindustrialization of the American manufacturing and mining heartland. It robbed the Middle West and Appalachia in the East and Southeast of steady, productive, well-paid employment—for many places, a“community keystone” employment—and relatively impoverished many in the Southwest, West, and New England as well. As towns and urban neighborhoods lost keystone work and fell apart, hard workers lost their pensions and looked to disability and workman’s comp as long-lasting unemployment insurance. Formerly productive people became isolated with their aches and pains, and had little to show for them except disability insurance, and deep worries about their children.
• The “anything for money” moral decline was demonstrated in what was actually the leading edge of the prescription opiate epidemic in the 1990s: Seniors in towns and cities in Appalachia, with generous painkiller prescriptions for their medical conditions covered by Medicare or Medicaid, sold their extra oxycodone to high school and college students to make ends meet. In effect, grandparents dealt drugs to their grandchildren to supplement their sole income, Social Security.
• The glorification of sports at all levels—compensatory for the loss of a productive future for youth—made colleges, cities, and towns lavish money on sports facilities, and created “star” athletes who need not study for more than a barely passing grade. Professional, college, even high school teams handed out opiates free, with or without prescriptions, to their athletes for the injuries from increasingly hypercompetitive sports.
By the end of the 1990s in towns and smaller cities in West Virginia, Kentucky, Ohio, Indiana, Michigan . . . grandparents were dealing oxycodone; quarterbacks and soccer stars were dealing it; unemployed ironworkers were dealing; popular kids in middle-class high schools were dealing. Even some doctors, besides prescribing it, were dealing.
• Other parts of the country, like the Southwest, had their own peculiar forms of spread of the habit. What all had in common was that oxycodone, by 2000 or so, had passed from being a prescription painkiller which was often abused by individuals, to an addictive drug prescribed and dealt through networks, for money, by tens of thousands, to millions.
Enter ‘the Internet for Heroin’
• During the 1990s a new heroin “cartel” spread its operations from southern California eventually right across the country, to become the United States’ biggest heroin-dealing force. Although these heroin dealers from the small Mexican state of Nayarit paid “protection” to the Sinaloa and Zetas cartels in order to operate—and though the big money flowed through a half-dozen extended families in Mexico—the dealers coming into the United States were unarmed youth, directed by city “cell leaders” not much older than themselves, driving tiny amounts of extremely pure and potent heroin to addicts, like pizza delivery boys. Quinones never calls them the Nayarit cartel, but rather a new type of monster, “the Internet for heroin.”
• Quinones’ chronicle of the spread of this larger and larger network of 20-year-old heroin delivery boys is the most surprising part of his “true tale”; it carries an almost macabre interest for the reader. With clean-cut non-violence and addict-friendly service, avoiding gang-ridden big cities, avoiding black Americans and targeting middle-class whites, the Nayarit dealers became more proficient killers than the most violent drug gangs of New York, Baltimore, or Los Angeles.
• Finally, by the first decade of this century the leaders of “the Internet for heroin” had realized that the “chiva” they were selling, was essentially the same product as the oxycodone already being prescribed by the millions. Their version was illegal, but could be made much less expensively, while pure and potent enough to bring euphoria, or to kill. Methadone treatment centers took on particular significance for “heroin capture” of oxycodone and other opioid addicts.
The nationwide epidemic then became more and more deadly. Despite some more or less effective efforts to bring doctors, pill mills and pharma distribution companies under control; despite bigger and bigger Federal cases busting scores of heroin dealers at a time, the number of Americans dying of opiate overdoses continued to rise. And in the most recent year studied, 2016, when 65,000 died of overdoses, a full two-thirds—42,000—were killed by heroin.
What Was Destroyed
Already in writing Dreamland, Sam Quinones identified certain basic, bottom-up values which he thought were being wiped out by the decades of deindustrialization and privatization, replaced by forms of moral corruption.
He considers the search for an ultimate, “non-addictive” painkiller to be morally questionable and futile, and the demand to be completely free of pain as a sign of social isolation. He postulates that working through stress, and overcoming pain are a part of accomplishment, productiveness, and creativity.
He believes that working for community benefit, social and political activism, perhaps even what used to be derided as “boosterism,” is also an American form of creativity. He describes community cohesion as a basic value strongly linked to places of long-lasting keystone employment, and of public recreation.
And he thinks the essential belief that government—including national government—has great potential power for the common good, has been lost in the lionization of supposed unmatched abilities of private corporations.
The question not raised in Dreamland, however, was: What should that potential power for common good be used to do in this crisis—even assuming renewed community activism against the ravages of addiction?
Quinones began his 10-minute Senate testimony Jan. 9 by talking about the devastation of the American heartland by free trade, globalization, privatization, and multinational corporate priorities, which have “wrought a second Gilded Age.” He said the widespread addiction was “ignited by supply.”
Then he proposed to the Senators:
What To Do
“View this as an opportunity to revive those regions hammered by globalization and free trade. The roots of our national epidemic of narcotic addiction lie there, while the epidemic itself, in turn, stands in the way of their revival.
“I believe American history offers us two templates for actions, from which you might take guidance and inspiration.
“The first is the Marshall Plan to rebuild Europe after World War II. The second is our space program. Each involved government and the private sector acting in concert over many years, bringing money, brains, energy, and of course long-term focus to bear. Each achieved an unalloyed good for our country; although they were both things that seemed, at first blush, far beyond our own, short-term self-interest.
“The Marshall Plan was about building up ravaged regions to allow them to function independently. . . . It allowed reborn countries to prosper and contribute to the world again. A Marshall Plan for American recovery might focus on rebuilding those regions that have been caught in dependence on dope, and ravaged by economic devastation, to contain the viral spread of addiction.” [China’s West Virginia investmentsirresistably come to mind.]
“Through our space program we were inspired as a people, to spend years and dollars, all to achieve something no previous generation ever thought possible. We ended up far beyond the Moon. The spillover in economic benefit, increase in knowledge, and simple human inspiration, is beyond calculation.
“It seems to me that we might profitably apply these examples—the Marshall Plan, and the space program—to regions of forgotten Americans where this [addiction] problem began. Let’s do it, not because it is easy, but as JFK said, because it is hard; because that’s what Americans do, and have always done, at their greatest.
“Like our space program, I believe such an effort will have to last for years to be effective, focused far beyond the immediate goal of drug addiction, and on the more profound problems of community destruction and the hollowing-out of stretches of this country.”
“It offers an opportunity to reinvest in areas that need it most, a chance to inspire us as Americans again, to something great. . . .
“Do not miss this opportunity. It does not come around often. . . . You will be remembered for acting, when acting was not easy to do.”
In two full rounds of questioning Jan. 9, involving 18 Committee members, many with Quinones’ book in front of them, and many speaking at length as Senators will, no one recurred to his two “big ideas.”
It is up to American citizens, above all those moved by Lyndon LaRouche’s movement and his ”Four New Laws to Save the Nation” with which Quinones’ proposals resonate, to realize them.