Book review: Dreamland: The True Story of America’s Opiate Addiction

Dreamland is the story of a town’s collapse in America’s mid west and its battle for recovery and redemption. Cormac O’Keeffe on the grip catastrophic drug addiction — legal and illegal — had on Portsmouth in Ohio.

Sam Quinones

Bloomsbury, €14.50, ebook, €13.27

Dark forces and the All-American city

DREAMLAND is a story about one drug, but two products. One is legal, in the form of morphine, while the other, heroin, is illegal.

Both were mainlined into a fractured American society through two sophisticated distribution and marketing systems: One run by big business and the other by dealers.

The result was two devastating, and interlinked, epidemics that took the lives of young people from all classes, dragging along with them their parents and whole communities.

Sam Quinones, author and former crime reporter with the Los Angeles Times, spent the last five years uncovering and mapping the impact, which stretches like an arc across the breath of the US.

It’s a story that begins, and ends, in Dreamland, which lends the book its title.

The place of these dreams was Portsmouth, a city in Ohio, in the American mid-west.

For decades, Portsmouth seemed to be the idyllic all-American town.

Dreamland was the soul of the community: a large swimming pool and grounds around which the city’s people — blue-collar and white-collar alike — grew up, socialised and knitted together.

Two years running, 1979 and 1980, it was selected as All-American City.

But dark forces had already gathered by then.

An industrial town in the rural heartland, Portsmouth was “collapsing” with successive closures of manufacturing plants, Quinones tells us.

It was becoming part of the American Rust Belt — a region “unprepared for globalisation, competition and the cheaper labour in countries like Mexico”.

More of Mexico anon. But first, the Rust Belt and much of America was to receive relief for its pain — physical and mental — from a rapacious pharmaceutical industry.

The industry had already combined scientific advances in drugs, such as Valium, with modern Mad-Men style advertising.

That, with the emergence of new pain relief drugs, distilled from the opium plant, and a philosophy taking hold in American medicine in the 1980s — that the patient is always right — formed a perfect storm, one that carved right across the belly of America.

These medicines, such as MS Contin, which came on line in 1984 and its successor OxyContin, in 1996, were strong pain killers containing morphine.

MS Contin was marketed for cancer patients, while OxyContin was marketed for chronic pain.

“No one imagined that a pill containing a drug similar to heroin would be marketed almost like an over-the-counter drug,” Quinones says.

Advances in pharmaceutical medicine meant that these drugs were time-released, spread out over a period, supposedly limiting potential for abuse. The major pharma companies hired armies of salespeople who would aggressively target the country’s busy local GPs; the salespeople attracting massive bonuses based on sales.

Quinones says OxyContin spread like wildfire: “By 2003, more than half of the prescribers of OxyContin nationwide were primary care doctors, who had little pain-management training and were under pressure to get patients in and out of their offices.

“Oxy prescriptions for chronic pain rose from 670,000 in 1997 to 6.2 million in 2002.”

All this time, an equally aggressive force was sweeping across the country, its source a little-known state on Mexico’s Pacific coast: Nayarit.

It was within one municipality of Nayarit, called Xalisco (pronounced Ha-Lees-koh), that a sticky, dark substance known as “black tar” — a semi-processed form of heroin — was made from the opium plant.

In poor rural villages, or ranchos, of Xaliso, families “wove together in vast clans” and created an insidious and highly effective distribution system.

These clans, independent of each other, crossed into the San Fernando Valley of Los Angeles in the early 1980s.

They spread up along western United States through the early 1990s and across the states to the mid-west by the late 1990s. Xalisco black tar heroin cells were operating in at least 17 states

in the country by the mid-2000s.

These Xalisco clans were not the drug cartels, like the Los Zetas and Sinola syndicates, known to most of the world.

These clans avoided the major drug cities of the US — New York, Chicago, Baltimore and Detroit — and concentrated on the smaller cities.

They operated an intelligent system. There was a cell owner, based in Xalisco, who supplied a cell manager, based in a US city, with heroin.

Beneath the cell manager was a telephone operator, who took calls all day from addicts, who had been circulated with the number.

Under the operator were drivers, young poor men from Xaliso who were paid a weekly salary. They drove to a location, with little uninflated ballons of heroin in their mouths, and delivered them to the addicts. Their product was cheap, but always of good purity.

The cells switched drivers and cars constantly. The drivers didn’t use drugs and were courteous to their customers. And while cells competed with each other, violence was rare.

“Via pills, heroin entered the mainstream,” Quinones writes. “The new addicts were the daughters of preachers, the sons of cops and doctors, the children of contractors and teachers and business owners and bankers.”

Quinones says that these addicts were often “tenderised” to heroin through their abuse of prescribed opiates.

One cop told Quinones “They [Xalisco cells] went and took over the OxyContin Belt in America.”

The author says that kids who started on pills ended up alone and dead in their cars, slaves to the morphine molecule: “Pills were prescribed with wanton carelessness.

Then black tar heroin from the Nayarit mountains was sold to them like pizza.”

Quinones conducted extensive research over a vast geographic area for this book. He spoke to a large number of law enforcement officers, doctors, prosecutors, dealers and addicts, as well as parents.

There are too many threads and characters to summarise into even the lengthiest of book reviews.

Partly because of this, it is a struggle, even on a second reading, to follow all the names and all the places. At times, the story isn’t clear enough and doesn’t progress. There is often repetition.

But, it is the depth of research and the breath of the author’s vision, that is the hallmark of this book.

Sections with the parents of addicts are most powerful. Many parents found incredible courage in their grief and called for action.

Quinones writes that by 2014 “heroin trafficking was expanding dramatically across America” and that the death of actor Philip Seymour Hoffman, 46, in 2014 “awoke” the country to the opiate epidemic.

At the end of his story, Quinones returned to Portsmouth, which was “emerging from a 30-year narco-economic fog” and still looked “as scarred and beaten as an addict’s arm”.

He said close to 10% of the town was in recovery. But there were signs of hope.

Local businessmen had joined forces to save the imminent closure of the last shoe-industry factory in the town. It now had 300 customers and employed 40 people and more were coming.

Parents’ groups and church-based alliances were pushing for change. Needle exchanges opened.

Downtown buildings were being renovated. Police conducted major drug raids and closed half a dozen pain clinics. Addicts were now going to Portsmouth to get clean.

“So the battered old town had hung on,” concludes Quinones, and was climbing “back to that place called Dreamland.”

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