Dreamland – a book about the opioid crisis, the rise of fentanyl and America’s response to the epidemic

When he began writing dreamland, he felt this was a topic that people didn’t really care about because
he had difficulties finding people who wanted to talk about it. People hid their experiences with opiates.
Since the release of the book though, the opioid epidemic has become much more of a public issue.

72,000 people died of opioid overdoses in 2017 – this is the biggest epidemic in America and caused
even more American deaths than the Vietnam war

Pivotal decade was the 1980s. Previously, NYC was the hub of heroin because that’s where all the heroin
from other countries came to, and then it was distributed across America. At that time, heroin was weak
and not that deadly. However in the 1980s, cartels in Mexico started distributing cheaper and stronger
heroin along with cocaine and marijuana, which became a huge problem. Because of the marijuana and
cocaine, the issue of heroin was often overlooked. 1980s was also when fentanyl became popularized
and was extremely potent.

Gradually, doctors wanted to use these painkillers more aggressively, even to the point that they were
saying that these painkillers were not addictive. Along with pharmaceutical companies, they pushed the
agenda of using opioid painkillers. Pain was then considered to become the “fifth vital sign,” which
pushed even more doctors to prescribe more opioid painkillers. Patients also had more agenda in that
the pain score was subjective and depended on what the patient reported. Some lawsuits happened
when patients said they didn’t get adequate pain treatment.

As a culture, Americans also wanted a quick fix to their pain which led to more use of painkillers.

In 1990s, pharmaceutical companies drastically increased sales force and Purdue came out with
Oxycontin. They sold it like it was non-addictive and paid high bonuses for sales.

Black market was selling opioids cheap, especially heroin.

Culture in America developed to being very sensitive in the sense of protecting children from pain
(physical and ideas) and danger. Culture also became obsessed with consumption of goods for
happiness, aka heroin.

Now, fentanyl has been discovered by the underworld and they like it a lot more than heroin. Fentanyl
was the pivotal change in the drug business.

Big roadblock in tapering down painkillers is insurance companies, which don’t want to taper down
therapy from opioids because opioids are cheap, efficient ways of painkilling.