Sam QuinonesRecensioni

I was just finishing “Dreamland” — a book published in 2015, before the Trump reign — as the returns of the 2020 election between Joe Biden and Donald Trump came rolling in. Early on there was a hint that Biden might flip Ohio from the Republicans, but that was not to be.

Dreamland is largely set in the border town of Portsmouth, Ohio, facing Kentucky on the Ohio River.

The area appears to be part of the Republican rural stronghold.

According to Quinones compelling, strange, and frightening story it was also Ground Zero for the confluence of two major trends in rural American life: the seeming endless supplies of painkillers sometimes dispensed by dubious “pills mills,” pain treatment clinics, and the growth of high grade heroine imported by an endless stream of drug runners from a small, poor, and rural Mexican community.

Not only were poor, often unemployed in rural America subject to the pill economy, but relatively wealthy suburbanites and their children were dragged into it, sometimes motivated by the same forces that kept them on top: affluence.

Even as I read this book hundreds of millions of pain killers are prescribed across America — and here in Canada — where physicians often haven’t the time nor the expertise to manage paid reduction regimens, or the expertise to wean their patients off them.

Quinones’ story begins with a small town in prosperous America enjoying the industrial expansion of the early 1900’s and ends with that same town trying to repair its footing after most of the jobs have left, the town tax rolls impoverished, and a booming business in drug rehab.

The pain and resentment of Trump followers aside, rural America is slowly making a comeback, particularly as the COVID pandemic moves a lot of those downtown urban jobs back to the hinterland.

This is a story of communities in evolution.

It’s not pretty but really relevant.

I would argue that this is essentially two books, not one. It's not that it's written that way. It's just that there is a significant portion that is quite clear and concise and important information for the average reader to know about the ins and outs of what America is dealing with regarding its current and significant drug-related morass. (What I will label the "Walmart Drug Ecosystem" was especially intriguing to me.) There is a great deal included in this book, with convincing evidence, that the typical mass media is not passing along to the public in any meaningful way. It was just yesterday that I read a news story in a Pulitzer Prize-winning newspaper that mentioned certain "truths" about current community drug issues that were known to this book's author -- and, of course, to anyone who would have read this book -- at least as far back as late 2021 when this book was first published. So, not new news. Old news that the media is just now reporting? And then there is the rest of the book, which is basically all coming from the author's personal interviews with several specific people at a handful of locations in America, locations that the author clearly has taken as a clear representative sampling of all drug-related issues. There is no effort to verify that what he has been told by individuals in these locations is universally true everywhere else. (Though, I will grant that they touch on likely issues in a lot of communities.) Indeed, especially at the end of the book, the author hands out what he regards as solutions that are not tested elsewhere or even clearly successful. I got the distinct impression I was being subjected to a classic Frank Capra movie. "It's a Wonderful Life" and "Mr. Smith Goes to Washington" immediately came to mind. I would think that even Mr. Capra, if he were alive, would agree that those movies may be inspirations for community change but would never be foundations for legislation and policy decisions to tackle problems. In my opinion, that uplifting thinking is in contrast to the hard realities presented elsewhere in the book. A point which reminds me that the author effectively never mentions the massive political barriers to acting on the "enlightenment" he seems so fond of pointing out from the individuals he interviewed. I am rating this book as highly as I am because of what is mostly reported in the first part of the book. Unfortunately, most readers, people who much prefer fiction over non-fiction, will not bother to read this book unless the "human interest" part of the book is there. They might even skim over the part I think is so important, and I don't think that will help find solutions, just empathy.

one of those books you want to share with everyone... without having to push it on anyone... and you regret the fact that the book ever needed to be written.

Sadly 5 stars is the most you can give a book.
The author of Dreamland: The True Tale of America's Opiate Epidemic which came out in 2015 was one of the best books I have ever read.
This new book The Least Of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.
If you wonder how we got where we are today, if you or someone you know, has an addiction or wants to know more about how addiction affects the brain, or if you have children this needs to be required reading.
Even something as simple as America’s addiction to sugar and how the brain way as if does to narcotics and why is fascinating.
And for people my age make no mistake today’s drugs are so much more potent and dangerous than what was available in the 70’s and 80’s, anything can easily lead to something far more dangerous.
Do yourself a favor and read this book!

I found this book to be a fascinating read although admittedly repetitive. Quinones does a great job of researching the many factors that lead to today's opiate epidemic. I feel like this is a warning tale in so many respects because one of the big underlying causes was a media narrative that evolved that American medicine was under-treating pain supplemented by another journalistic faux pas that said opiates weren't as addictive as people thought. It didn't take much for some immoral executives to start pushing Oxycontin and creating a generation of addicts (white, suburban) that never existed before. The icing on the cake was that heroin traffickers discovered that if they delivered their goods like pizza, they'd make a lot more money and reach many new customers. All of these factors are explained in detail, and the details are interesting. I just wish Quinones had had a better editor. There's a lot of repetition in the book, and it wasn't necessary. His writing style is very accessible though, and honestly even if you only read the first half of the book, I think you'd get a lot out of it.

Read this for book club. It was interesting, engaging, and educational on a topic I did not know much about. Reading about the Xalisco boys I felt like I was listening to an NPR episode of, "How I Built This" My only complaint was that I thought the book could use a bit more editing. It seemed odd that the author kept adding in paragraphs summarizing the history of the Xalisco boys as if we didn't know who they were, despite already having read 150 pages about them.

Nowhere near as effective as "Dreamland," perhaps because there is much less new information here. Also, Quinones's tales of hope are completely lost in the despair. Perhaps he has to talk about hope to sell the book, but it doesn't seem sincere. I did like that Quinones takes and defends a political stand on how to address the drug epidemic; he argues the downsides of legalization.

> Carfentanil was ten thousand times more potent than morphine. It had no valid use on humans, they believed, but they saw that it sedated elephants, rhinoceroses, and other large mammals. In the United States, later, carfentanil was made legal only for zoo veterinarians to possess. (UK scientists concluded that in 2002 the Russian government used carfentanil to attack Chechen rebels who had taken over a Moscow theater, dispersing it through the building’s air duct. At least 170 people died, including 121 hostages. The UK scientists based their conclusions on tests of items of clothing and blood belonging to British citizens who were near an exit and thus among the hostages revived by a Russian assault team that day

> OxyContin, flogged by Purdue sales reps, did a lot to create our new wide market for heroin, which never existed when the opioids on the street were Vicodin, Percocet, and others. Those pills were mixed with acetaminophen as an abuse deterrent. Those who abused them did enormous damage to their internal organs, so their habits remained minor. They rarely grew desperate enough to make the leap to heroin

> alcohol and cigarettes kill more than any other drug by far, because they are legal and widely available. Alcohol also drives arrests and incarceration more than any other single drug. Our brains are no match for the consumer and marketing culture to emerge in the last few decades. They are certainly no match for the highly potent illegal street drugs now circulating.

> Decriminalizing drugs also removes the one lever we have to push men and women toward sobriety. Waiting around for them to decide to opt for treatment is the opposite of compassion when the drugs on the street are as cheap, prevalent, and deadly as they are today.

> Thanks also to Freedom.to, the software that allows me to shut down social-media apps and as much of the internet as I need to and focus.

"Every so often I read a work of narrative nonfiction that makes me want to get up and preach: Read this true Story! Such is Sam Quinones' astonishing work of reporting and writing" --Mary Ann Gwin. The Seattle Times

This wide-ranging, insightful story of America's opiate crisis makes for painful and sad reading. The author keeps things moving while presenting the sobering facts. One thing that struck me is the mistaken belief some parents had that a 30-day therapy/detox would "fix" their kids' addictions. It's a lifetime struggle. I'm sure many families, including my own, have been touched by the scourge of heroin and opiate pills like OxyContin. Big pharma comes off looking really bad in their crass pursuit of the Almighty Dollar. The author has an engaging narrative style I found easy to follow. If you want to know more about what happened, this book might be the right one for you.

For the past couple decades, pharmaceutical companies have pushed prescription pain relievers leading to their misuse. An Opioid Crisis has emerged leaving over 50,000 Americans dead and millions suffering from substance use disorders.

Read the recently published nonfiction young adult book, then learn more at the website:

DREAMLAND: THE TRUE TALE OF AMERICA’S OPIATE EPIDEMIC by Sam Quinones is a young adult adaptation of the popular adult book. Using a community in Ohio as an example, the author explains the rise of painkillers in America, their promotion by pharmaceutical companies, and the increase in illegal drugs from Mexico.

The Opioid Overdose Crisis website from the National Institute on Drug Abuse provides an overview of the epidemic, summaries by state, and related resources including reports, plans, videos, and infographics.

Opioid Overdose Crisis https://bit.ly/2j6YEE1

ARC courtesy of Bloomsbury.

Great book on the rise of Purdue Pharma’s OxyContin followed by the Jalisco black tar explosion. What was especially interesting to me is how differently the Jalisco crews operated compared to previous drug smuggling organizations — they were high service, no violence, and basically corporate.

I’m left hating Purdue and the Medicaid/insurer complex more than the Mexican criminal gangs somehow. I would probably jury nullify any action taken against any of the above, though.

It seems like there is basically going to be a lost generation (or 2-3 generations) due to this. Arguably maintenance-dose opiates might be a better solution for these people than any other alternative, but avoiding new addictions is important as well. It is one of the biggest domestic policy problems of the next 50 years.

This book struggles to get pacing right. Many titles use the strategy of having multiple story lines that are happening at different points in time, in which the author switches back and forth to keep the reader's interest. But the handling by Quinones is clumsy and ends up making the book very repetitive, to the point where I had to check my audiobook timestamps to make sure I didn't somehow accidentally jump back to a chapter I had already listened to. He's always seemingly introducing concepts that have already been introduced (how many times can you tell me where Nayarit is located?)

I also thought the book could have done a much better job of connecting the reader to individual characters in the story. In some chapters, particularly the ones on drug marketing, Quinones accomplishes this pretty well by giving more backstory to executives, or tracing the use of a specific piece of research through time. Other times, he is not as successful, and the storytelling suffers.

Ended up listening to ~40% before having to stop.

Eye opening peek into how America ended up in the midst of a battle over Opioids.

This is an informative and engaging book on the roots of America's opiate problem, linking the rise of OxyContin with the sale of Mexican black tar heroin in rural areas. Quinones highlights the racial elements at play quite proficiently, though a sense of resolution regarding the fates of the Xalisco Boys remains uncertain. There are some repetitive word choices that lessen the writing quality, but it's a worthwhile and fast read.

The most significant issue with this book is that the author repeats "facts, or summaries of events, regularly. It seems like the bulk of the 'chapters' were originally essays which had the intro, body and resolution sections in each, and when they were collated into a book, each chapter still read like an essay. This isn't as bad as it sounds, as long as you're not looking for a single narrative story. The content is interesting.½

In Dreamland, former Los Angeles Times reporter Sam Quinones expertly recounts how a flood of prescription pain meds, along with black tar heroin from Nayarit, Mexico, transformed the blue-collar city of Portsmouth, Ohio, and other American communities into centers of addiction. Using exhaustive detail, Quinones chronicles the perfect storm of circumstances that cleared the way for the Mexican narcotic to infiltrate our small and midsize communities over the last two decades.

The story of the black tar heroin epidemic across the United States that began in the 1980s parallels the sweeping prescription opiate epidemic in America because their clientele was the same group. And the product, whether natural like heroin or manufactured like Purdue opiate pill, is the very same companion to all those Americans who wanted Better Living Through Chemistry. But heroin was cheaper, Quinones observed, and the opiate prescriptions had already "tenderized" those who would want heroin.

In 1980 the New England Journal of Medicine published a short letter to the editor from Hershel Jick, MD, a Boston University School of Medicine physician, with his comment that patients in severe pain and under close observation had not become addicted to the given narcotic opiate. From that brief unsubstantiated paragraph other medical journals went on describe it as a "landmark report."

Quinones’s book and the world it describes is already dated. Around the time it was published another chemical, fentanyl, began killing heroin users in North America. Fentanyl does not require a poppy harvest to produce and it is far more potent than heroin, which means that it can be smuggled in small quantities. It is also far more dangerous, and its appearance in the drug supply has been accompanied by a sharp uptick in the rate of overdose.

I was absolutely fascinated by this story. Admittedly, I don't know anyone who is caught up in the opiate epidemic or is addicted to any pain killer. I realize, now, that puts me in a small minority.


1122

Dreamland is important book, and perhaps even an essential one, but it's by no means perfect. The author does a lot of things very well here. He's good on background, telling readers how both doctors' and patients' perceptions of pain, coping strategies, and opiates evolved over the course of the last hundred years. He provides a clear, concise description of what makes OxyContin different from the painkillers that came before it. His description of the heroin and smuggling distribution network that grew out of the out-of-the-way Mexican town of Xalisco is meticulous and fascinating, and he apparently took the time to interview a significant number of individuals that were involved in both building and combating this unusual criminal enterprise. He paints a vivid portrait of the Appalachian communities ravaged by the opiate epidemic. These parts of "Dreamland" will certainly sate the appetites of readers on the lookout for disaster porn, as will his descriptions of the wild scenes that took place inside -- and even in the parking lots of -- the notorious "pill mills" that grew up around rust-belt towns during the first decade of the new millennium. Even so, his account of the parents who chose to break their silence and discuss their children's struggle with opiates directly is both sensitive and heart-wrenching. There are places in "Dreamland" that eloquently address the social climate that facilitated the growth of the opiate epidemic, from increasing social isolation to medical malpractice to industrial decline to governmental neglect. In some ways, Quinones seems to have been writing about the opiate epidemic in real time: my copy of the book contains an afterword, but was published before the fentanyl epidemic really hit and bootleg pills became commonplace. "Dreamland" ends on a positive note, showing the various ways in which the southern Ohio town of Portsmouth has staged a brave comeback in recent years, even as its drug problem persists. But one can't help but wonder how the town fared in the years after "Dreamland" was published, when the opiate epidemic grew even worse.

The book has its weaknesses, though. I got the sense that Quinones found two interesting stories -- one involving a small town in Mexico that set up an unusually efficient and resilient drug-distribution operation and the other that involves America's disastrous addiction to potent painkillers -- and decided to combine them in the same book. As fascinating as it is to read about, the author never quite convinced me that the Xalisco Boys network was essential to the opiate epidemic and that it would not have happened had this network not existed. The author readily admits that there were big markets that the Xalisco Boys network never touched and that opiates have been a persistent problem in some American cities for generations. I tend to think that supply tends to follow demand in these situations, and, at one point, he basically admits that if they hadn't somebody else -- perhaps the already established Mexican cartels -- would have sold dope to rural Americans. Quinones also seems to put a lot of emphasis on how the demographics of heroin usage has shifted, but it's unclear whether it's he or his subjects who seem appalled that well-off white kids are getting high and dying from heroin rather than the sort of people who've traditionally been drawn to the drug, which would include poor urban black folks and artsy types. Furthermore, I was never quite convinced that the Dreamland -- once a much-loved public pool in Portsmouth, Ohio -- made a fantastic allegory for the American experience, but towards the end of the book the author really ratchets up the nostalgia in a way that I found truly exasperating, taking aim at trigger warnings and parents who won't let their kids play outside anymore. It's a shame that a book that's so frequently insightful would end with such banal musings on how Americans have gone all soft. In other words, the author seems to be requesting that the reader get off his lawn. Despite these misgivings, "Dreamland" is an eye-opening read, one of those books that you wish every American would read. Not perfect, but certainly recommended.½

A big sprawling (too sprawling for my taste) narrative about the oxycontin epidemic followed by the Xalisco black tar heroin epidemic. I found this book interesting as 50% of the situations and companies in the book are from Ohio, my home state. Sadly, these two epidemics plague Appalachia, where sometimes there isn't a lot of hope. I was just shocked that establishments like Urgent Care (who I thought were well respected) saw patients at a rate of one every 96 seconds in Portsmouth, Ohio. One doctor alone prescribed 1.6 million oxycontin's. When oxycontin became too expensive ($70 per pill), addicts went to cheaper black tar heroin imported from Mexico. Just a scathing review of unscrupulous doctors as well as Purdue Pharma. For example, if doctors prescribed x amount of oxycontin pills in a year they could win cars, vacations at exotic locales, etc. Just wow! 400 pages

Powerful story of the heroin epidemic. It follows both the drug dealers and the physicians, while also giving us tear-jerking stories from the addicts and their families. Quinones does a good job explaining the economics of the epidemic, from all perspectives. I found the explanation of the pill economy in an afflicted Ohio town interesting, although I don't entirely buy Quinones's hypothesis that Walmart to some degree enabled the economy by allowing shoplifting.

Weaknesses: Not all areas get equal depth, particularly the drug companies. Quinones gives us more anecdotes than numbers, so it is not clear how much we can trust his conclusions.

Timeline:

> 1980: The New England Journal of Medicine publishes letter to editor that becomes known as Porter and Jick. [Of almost twelve thousand patients treated with opiates while in a hospital before 1979, and whose records were in the Boston database, only four had grown addicted.] Early 1980s: First Xalisco migrants set up heroin trafficking businesses in the San Fernando Valley of Los Angeles. 1984: Purdue releases MS Contin, a timed-release morphine painkiller marketed to cancer patients. … Early 1990s: Xalisco Boys heroin cells begin expanding beyond San Fernando Valley to cities across western United States. Their pizza-delivery-style system evolves. 1996: Purdue releases OxyContin, timed-released oxycodone, marketed largely for chronic-pain patients.

> only in 2010 did the NEJM put all its archives online; before that, the archives only went back to 1993. To actually look up Porter and Jick, to discover that it was a one-paragraph letter to the editor, and not a scientific study, required going to a medical school library and digging up the actual issue, which took time most doctors didn’t have.

> … A small town of sugarcane farmers grew by the early twenty-first century into the most proficient group of drug traffickers America has ever seen. The first migrants from Xalisco settled in the San Fernando Valley—in Van Nuys, Panorama City, and Canoga Park… The Xalisco Boys supplied these junkies' habits in exchange for help in moving into a new area, and in renting apartments, in registering cellular phones, and buying cars … avoiding the biggest cities where heroin markets were already controlled, and by following the OxyContin. … Northern California was controlled by traffickers from the Tierra Caliente, a humid and notoriously violent part of west-central Mexico; no Xalisco Boy ever stepped foot in Northern California.

> Yet Purdue's marketing couldn’t have found an audience without the pain crusaders who tenderized the terrain for years before that, convincing primary care doctors that in this new age opiates could be prescribed to pain patients with virtually no risk of addiction. In many cases, hospital lawyers advised doctors that patients could sue them for not adequately treating their pain if they didn’t prescribe these drugs. Had that not happened—had there been no insistence that pain was undertreated and that pain was now a fifth vital sign—OxyContin would likely not have found the market it did.

> Pill abuse was a minor subculture back then. Abusing Vicodin or Lortab was hard work. They contained only small doses of opiates, and included acetaminophen or Tylenol to discourage their abuse. People who used them usually developed serious liver problems from the acetaminophen. But they didn’t often overdose on the weaker pills. Once OxyContin arrived, however "it went from people strung out on dope to people strung out and dying on dope," …

> pills and pain clinics had altered the classic welfare calculus: It wasn’t the monthly SSI check people cared so much about; rather, they wanted the Medicaid card that came with it.

> It helped that OxyContin came in 40 and 80 mg pills, and generic oxycodone came in 10, 15, 20, and 30 mg doses—different denominations for ease of use as currency.

> The opiate scourge might never have spread as quickly had these rural areas where it all started possessed a diversity of small retailers, whose owners had invested their lives in their stores, knew the addicts personally, and stood ready to defend against them. Walmart allowed junkie shoplifters to play Santa to the pill economy, filling dealers' orders for toys and presents in exchange for dope.

> " … found a 0.979 correlation between prescription pain pills dispensed and the number of overdose deaths from opiates." This was preposterous. Never in thirty years of statistical mechanics had Orman Hall heard of a correlation that close to 1.0, which was almost as if the charts were saying that dispensing prescription painkillers was the same thing as people dying.

> insurance companies gradually stopped paying for the services that made the clinics multidisciplinary. Prescription pills were easier and cheaper, and at least for a while they worked well.

> "Let's, as a society, watch all of our potential alcoholics become opiate addicts instead. Had these opiates not appeared, I think we'd have seen a similar number of alcoholics, but later in life. My field used to be middle-aged alcoholics. It usually took twenty years of drinking to get people in enough trouble to need treatment. But with the potency of these drugs, the average age has dropped fifteen years and people get into trouble very quickly with oxycodone, hydrocodone, and heroin."

> the most selfish drug fed on atomized communities. Isolation was now as endemic to wealthy suburbs as to the Rust Belt, and had been building for years

The decline of Scioto County hits home for me because my grandfather has lived in that area much of my adult life. In the early 2000’s, I would often hear side comments about "folks just using that stuff”, but never fully conceptualizing the extent to which narcotic pill abuse and heroin had permeated the area. This is a very informative book, and I gained so much insight through the manner in which the story unfolded on the pages. But this book also felt like an emotional roller coaster. At times, I was shocked, or disgusted, angry and then sad, yet thankful that the epidemic didn’t hit close to my actual home—my cousins, friends, classmates, aunts, uncles, etc. I left feeling, as a physician, bewildered by the notion that a country of physicians and healthcare providers were all duped by rather vague details. How could a country of people wanting to do good (mostly) fall prey to such corporate baiting? I remember attending pharm rep dinners during my residency training, which occurred during the years when America finally woke up to the opioid epidemic. I often joked with my peers that good steak wasn’t enough to persuade me to prescribe medications blindly. But, I wonder, would I have dug through stacks of old NEJM archives to locate one editorial…

Sometimes you're at the library and choose a book at random and it turns out to be great. This is one of those. I first thought it was going to be a true-crime story with an interesting hook: Why is all of this heroin being sold in the Midwest coming from the same tiny village in Mexico? But Dreamland is about so much more. Everyone can play the Six Degrees game and get to someone (a colleague, a friend's kid, a neighbor's cousin) who has battled addiction to pain pills--but until I read Dreamland, I assumed that an inability to quit was due to about 60% individual will and 40% chemical dependency. Not any more. I also assumed that heroin was something used more often in cities by actors, prostitutes, and musicians. That assumption was quickly destroyed. The other narrative thread about the marketing of opioids was likewise all new territory. Some reviewers note that there are repetitions in the book--fair enough, but an extra 40 pp or so doesn't ruin the book. Others complain that Quinones makes addicts into martyrs to Big Pharma--but that's not true. His approach is always neutral. He doesn't come down on an addict for ruining his life--he knows that an addict's life is already his own punishment.

The heartbreak that runs through Dreamland reminded me of the Daryll Scott song, "Out Among the Stars." Look it up and read this book. Highly recommended.

Almost overwhelming in its details of how legal opiates led to the heroin epidemic. As someone with several friends whose chronic is pain has been under control and who are now facing total disaster from the outgrowth of this book, I wish it had concentrated a bit more on not throwing out the baby with the bath water. I know of at least one suicide of a person who simply could not cope with being told they would again have to face debilitating pain simply because their doctor felt they lacked the power to prescribe. Yes, the heroin epidemic and the sale of over prescribed pills are real and rampant. But please -- a little more thought for those with chronic pain who have had long-term relief with prescribed opiates.

I am not at all surprised by anything I read in Dreamland, being that I grew up in a small town that easily could have been profiled in this book.

What strikes me most was how many tendrils of policy that have been hallmarks of Republican politics led to the opiate epidemic (and yes, I *AM* going to blame this on Republicans).

Classism and white supremacy meant that nobody dealt with drug problems when they were killing poor people, people of color, or the mentally ill. Republicans didn't mind if Black people were getting killed over drugs or overdosing (let 'em die, or throw 'em in jail), but as soon as white people, and specifically, middle and upper class white people, were doing so, it became a BIG PROBLEM. Well-off white people can't go to jail! Let's send them to treatment centers instead! Maybe the problem wouldn't have gotten out of hand if they had treated everybody, instead of sitting on their hands until the problem had the same color skin as they did.

Allowing pharmaceutical companies to market to doctors and the public allowed medications to enter the public consciousness in a way that had been unheard of previously; a watered-down FDA meant that not enough vetting went into drug approval (it still doesn't). And allowing the insurance industry to continue getting away with murder meant that patients were unable to get comprehensive help for their injuries, leading doctors to overprescribe instead.

Finally, the Republican politics that resulted in so many jobs disappearing from the US just hammered the nail in the coffin. Rural towns often had little else going on. The youth of those towns had to while away their time in boredom until they were old enough to finally leave. Unfortunately, abusing opiates, which certainly mitigated boredom at first, had the ironic side effect of leaving them chained to those very same rural towns.

In all, Dreamland was a very interesting look into the opioid epidemic, although at times I felt the narrative to be too meandering and repeated itself too much. I believe it is an important story to be told. I would be interested in reading follow-up; to find out what steps have been taken since the book was published to help deal with the problem.½

Heartbreaking, raw and honest. Tough to see the pain that pain-alleviation has created.

Fantastic writing and even better job of editing a fun and informative read paralleling America's opioid and black market heroin trade and subsequent addiction problem. I will definitely be checking out more of Quinones' work.

Random thoughts:
Dream Land is the perfect follow up to Methland.
It is amazing how fast Republican lawmakers get empathy and compassion when heroin jumps racial lines.
(possible legislation) if you can create a law holding drug dealers accountable for an overdose, does that include drug companies and overprescribing Docs? [just posting the question. my thoughts on that issue go way more than available screen space to write]
drug companies and their leadership should be held accountable; VERY accountable.