Dreamland: The True Tale of America’s Opiate Epidemic

Recommendation: Meh, it’s fine but it really depends on what you’re after

Where to read: At the lunch table (if you want co-workers to worry about how you choose to spend your free time)

Read with: Prior knowledge

In brief: Who the fuck sits around writing opioid prescriptions for carpal tunnel…


I am quite clearly on another one of my phases (and hey, this is only slightly less depressing than my infectious disease phase), because here we are with another book about the opioid crisis.

Dreamland‘s rather rapturous critical reception is probably due partly to first-mover advantage because it is very much not the best explanation of the crisis. The main reason for that Quinones’ slightly weird approach to the structure. Relating a couple of individual stories or introducing key characters right at the start is a fairly common rhetorical device, hooking the reader in with some human interest and provides an immediate reason to care about the broader story the book goes on to explain, but Dreamland is almost nothing but vignette. I expected the “narration” to kick in after a few chapters introducing various places and characters but it never happens. There are some through-lines and recurring characters but the overall effect is somewhat disjointed unless you’ve already got enough of a background to put the pieces together yourself.

It’s an interesting contrast to something like Evicted, which melds overarching narrative and case study brilliantly. That is definitely the key here though – do your background research first so you already know the broad strokes, watch a couple of Frontline reports, then read this to fill in the rest of the story.

All that said, Quinones’ gets at the heroin stage of the crisis brilliantly. There has, understandably, been significant focus recently on the prescription drugs which initiated the crisis but this goes a long way to explaining how the street heroin so many users turned to became so widely available. It’s a very different picture to that painted in popular, New York-based portrayals of drug dealing and it is definitely fascinating reading.

The format also allows for a slightly deeper examination of what I suppose you could call the sociology of the whole thing. Quinones does spend a fair number of pages on the demand-side of the drug economy, writing about addicts and addiction and the kinds of communities where the crisis hit the hardest. It’s an interesting contrast to more supply-side versions of the disaster.

Having mentioned first-mover advantage, I should probably note that Quinones was writing before the big raft of lawsuits against Purdue Pharma in 2017-2018. It’s obviously much easier to write about corporate (mis)conduct during or after litigation because a) documents are much more likely to be available and b) you’re much less likely to get sued yourself. If it feels like the analysis of big pharma is slightly undercooked, this probably has something to do with it.

In short, if you’re really interested in this topic and looking to read a range of sources, this is definitely a good choice. If, on the other hand, you’re looking for a one-and-done overview, look elsewhere.

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