Dreamland audiobook cover - The True Tale of America’s Opiate Epidemic

Dreamland

The True Tale of America’s Opiate Epidemic

Sam Quinones

★ 4.5 / 5(33 ratings)
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Society & CultureHistory

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Dreamland
The Corporate Catalyst (Purdue Pharma)+
The Medical 'Pain Revolution'+
Rust Belt Pill Mills+
The Xalisco Cartel (Black Tar Heroin)+
The Epidemic's Escalation+
Pushback and Justice+
Recovery and Aftermath+

Quiz — Test Your Understanding

Question 1 of 10
Why was OxyContin initially marketed by Purdue as having a lower potential for abuse than other painkillers?
  • A. It contained acetaminophen to prevent users from taking large doses.
  • B. It utilized a special time-release coating designed to supply the active ingredient slowly.
  • C. It was formulated with a synthetic opioid that did not bind to the brain's mu-opioid receptors.
  • D. It was exclusively prescribed and administered in strictly controlled hospital settings.
Question 2 of 10
What was the 'Porter and Jick' letter, and how did it influence the medical community?
  • A. It was a short paragraph about hospitalized patients that was later widely cited as a 'landmark study' proving opiates were rarely addictive.
  • B. It was a comprehensive, multi-year clinical trial that convinced the FDA to approve OxyContin's safety label.
  • C. It was an exposé written by journalists that first alerted the public to the dangers of pill mills in the Rust Belt.
  • D. It was a government mandate declaring that pain must be treated as the 'fifth vital sign' in all medical practices.
Question 3 of 10
What medical term was coined to explain away addiction-like behaviors in patients, leading doctors to 'aggressively' increase their opiate dosages?
  • A. Phantom pain syndrome
  • B. Tolerance escalation
  • C. Pseudoaddiction
  • D. The opiate paradox
Question 4 of 10
How did the economic decline of Rust Belt towns like Portsmouth, Ohio, contribute to the opiate crisis?
  • A. Pharmaceutical companies offered high-paying jobs to locals to sell drugs illegally.
  • B. Unemployed factory workers began manufacturing synthetic opiates in their homes.
  • C. Local governments legalized the sale of prescription drugs to boost tax revenue.
  • D. A lack of jobs led to an economy based on pill mills, disability fraud, and trading OxyContin on the black market.
Question 5 of 10
What was a key innovation of the Xalisco Boys' heroin business model compared to traditional drug cartels?
  • A. They operated like a retail franchise, delivering highly potent black tar heroin directly to users like a pizza delivery service.
  • B. They sold their heroin wholesale to large street gangs to ensure rapid distribution across the country.
  • C. They heavily armed their drivers to eliminate rival dealers and take over territories violently.
  • D. They primarily sold their product through corrupted doctors and pill mills.
Question 6 of 10
How did the Xalisco Boys initially expand their customer base in places like the San Fernando Valley?
  • A. By advertising on the dark web directly to middle-class teenagers.
  • B. By partnering with doctors who had lost their medical licenses.
  • C. By targeting dissatisfied addicts outside of for-profit methadone clinics with free samples.
  • D. By taking over the local marijuana trade and forcing buyers to try heroin.
Question 7 of 10
What historical irony is shared by the inventors of the hypodermic needle and heroin?
  • A. Both inventions were initially created to treat soldiers in warfare but were rejected by the military.
  • B. Both inventors believed their creations would reduce drug abuse and addiction.
  • C. Both inventors died from overdoses of their own creations.
  • D. Both inventions were intended to be highly profitable recreational products, but failed commercially.
Question 8 of 10
Why did many OxyContin abusers eventually transition to using heroin?
  • A. Heroin was legally easier to obtain than OxyContin after the FDA banned prescription opiates in 2010.
  • B. OxyContin was reformulated to be completely non-addictive, forcing addicts to find a new high.
  • C. Cartels began lacing OxyContin pills with black tar heroin to intentionally hook users.
  • D. Users learned to bypass OxyContin's time-release coating to inject it, making the switch to cheaper injectable heroin very easy.
Question 9 of 10
What was the outcome of US attorney John Brownlee's criminal case against Purdue Pharma?
  • A. Purdue executives were sentenced to 20 years in federal prison for drug trafficking.
  • B. Purdue was found innocent because the FDA had previously approved all of their safety labels.
  • C. Purdue pled guilty to criminal misbranding and agreed to pay a $634.5 million fine.
  • D. Purdue was forced to completely halt the production and sale of OxyContin in the United States.
Question 10 of 10
What grim statistical milestone did accidental drug overdoses reach in Ohio in 2008?
  • A. They surpassed auto accidents as the number one cause of accidental death.
  • B. They became the leading cause of death for teenagers.
  • C. They accounted for more deaths than all violent crimes combined in the state's history.
  • D. They surpassed heart disease as the leading cause of death overall.

Dreamland — Full Chapter Overview

Dreamland Summary & Overview

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.

Who Should Listen to Dreamland?

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

About the Author: Sam Quinones

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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