Dream Land: The True Tale of America’s Opiate Epidemic
q&a

Sam Quinones’ Dream Land marks the timely end of heroin’s romanticism. Where you once imagined the netherworld of junk through ‘50s jazz musicians and the literati shooting up in the Bowery, you now have cheerleaders and football players who have “shape-shifted into lying, thieving slaves to an unseen molecule,” writes Quinones.  

In Dream Land, a vast, ultra-modern, interdependent web of painkillers, Mexican heroin, aggressive marketing, pain, pill mills and dirty doctors, hangs in a time of cultural excess amidst economic depression, resulting in what we see today, which is a heroin revolution. 

How this happened is always asked next. Some people blame doctors for overprescribing. Others blame cheap heroin infiltrating the posh suburbs where kids have time, cash, and no responsibility. But these arguments, while both valid, in isolation do not explain the obscene rise in use, abuse, and mortality prevalent in America’s youth today. In Dream Land, much like the real world, everything is connected and irreducible. 

Coming to Quinones as an ex-heroin user, or humble poster-child of the phenomenon he exhaustively covered in his new book, I called him over the phone and below is our conversation which has been slightly edited for space. 

So there is this very entrepreneurial network of Mexican heroin traffickers, the Xalisco Boys, pushing their product North, up and along the West Coast. All the while Big Pharma’s pain pill campaign is making a mess out of the East. The heroin traffic moves independently, yet simultaneously, east. What happens is these two forces collide to create a massive opiate epidemic. 

This was all coincidence? Like, there isn’t some gigantic narco-conspiracy to get everyone doped up? 

Quite coincidental, there is no conspiracy theory at work. I really begin this with pain specialists who are trying to right what they see as the historic lack of use, or reluctant use, of opioids to manage pain. They viewed this as inhumane and indecent and, to some extent, they were right. 

For many years there was a real reluctance to use [opioids] for terminal cancer patients and that’s crazy. People were dying indecently and there were pills which could have helped them. Who really cares if the last six months of your life you’re an addict so long as you’re living with some amount of comfort? 

That line was picked up by Purdue Pharma, which began to fund, in a variety of ways, these pain specialists as well as Continued Medical Education (CME). At sponsored seminars and conventions, these specialists would speak of data which showed that opiates were not addictive. 

And this “data” that was cited all over, turned out to be some obscure paragraph in a 1979 issue of a medical journal? 

Exactly. It was actually a letter to the editor, which is not a study, not a report, not even really an article, but a 101-word letter. The proper interpretation of that letter, considering it was using data from the years where opiates were very restricted in their use, is that when you use opiates in a hospital and you’re being very closely overseen, then you can expect few people to become addicted to them. 

So Purdue begins to market in areas, I think, where they knew doctors were most liberally prescribing drugs and this was mostly in Appalachia and the Rust Belt. They’re busy doing that for two years and then there are the Xalisco Boys. One guy I talked to was kind of the perfect person to figure this pill market out. In 1998, he arrives first to Indianapolis and then to Dayton and finally to Columbus, where he stayed. 

Aside from the Xalisco Boys cornering the pill market, there was/is a culture that allowed heroin to flourish. This atmosphere becomes one of the large macro-factors that contributed to the opiate use we see today. And it’s this culture that becomes “Dream Land.” It’s not a place but more of a concept. Would you elaborate on that? 

Absolutely. It all comes back to one theme for me, and that’s the destruction of community. In Portsmouth, Ohio—a place that eventually became the Petri dish for the pill mill—you had this town that had really good jobs and there was this stunning community pool that was almost literally the center of life. All of that gets destroyed along with the girding that held life together. Eventually, the people leave, jobs leave, Main Street empties out and Walmart comes. The pool also closes and what you’re left with is a town that turns in on itself: people no longer go out, people don’t get to know each other. 

In that situation, then, you have this drug that turns everybody into the most narcissistic, self-absorbed, hyper-consumer. 

The question always is: what is it that Portsmouth, Ohio, has in common with other towns like Charlotte, N.C., where it is very affluent? And my feeling is, that our age of excess has also done a lot to destroy communities, particularly in wealthy areas. People are now indoors, they don’t go out, the houses are too big and the gadgets are too accessible. People don’t have connections with each other. On the contrary, the kids get cellphones, cars, private bedrooms, and a lot of money. Those are all the things that add up to easy access to heroin particularly when the Xalisco Boys are in town. And my feeling is, and this is kind of a hunch, but what Charlotte and Portsmouth both have in common (besides a heroin problem) is a lack of community. 

At the same time, of course, you have massive prescribing going on. Every time you go in for surgery, you take home 60 Vicodin or OxyContin

So where I grew up is probably not unlike Charlotte, where there is excess and little community. Around 2007, I started to do 80mg OxyContins, once the source dried up and I was supremely addicted, the switch to heroin was a no-brainer. 

That’s what I saw. It happens among kids who you wouldn’t think have a need for a drug that numbs pain. It appears these kids have everything. In Portsmouth, Ohio, you might understand the pain, but suburban Charlotte? Not at all, there is no pain in these communities unless you dig. What you’ll find is that the kids are often alone and the parents are overworked or divorced.  

The book is about heroin, but only superficially. It’s really about the end result of the Reagan Revolution. The Reagan Revolution was about the exaltation of the consumer, of the individual, and of the free market. This served to destroy what we did not know to be very, very valuable until we lost it. 

The result of this revolution is a drug that turns everybody into a hyper-consumer. 

In my early 20s, I felt a kind of extreme dread where nothing was real. I had no meaningful connection to or anchoring in the world I lived in. All the while I’m doing massive quantities of heroin, which I thought was the utility by which I can say “fuck you unreal world” and keep to the fringe. In the end, though, it’s all a story. In the end, it’s totally conformist and thoughtless. It’s a sad trap, really. 

You’re right on the money. You had Charlie Parker, Sid Vicious, Lou Reed, and Burroughs and then what this opiate epidemic has shown is that heroin is about the most middlebrow, conformist thing in American culture. It’s about commerce, business, selling, consuming, and that’s it. All the romantic outsider stuff, those guys I mentioned who allowed the romantic ideas to advance, were just victims of it. But now we’re seeing the truth about heroin: it’s all about consumption. 

I want to talk about an implicit Drug War criticism I picked up on with respect to policing the Xalisco Boys’ network. There are huge busts spanning across several cities all the way down to Mexico. Hundreds get arrested or deported and the very next day there are new drivers zooming around selling product. It all seems so futile to me. 

That is true, and I began to feel sorry for the police. The police are standing in the sea trying to keep back the tide. What do you do if you’re a police officer, arrest these guys or not? In either case, you’re not doing much. 

And this is the problem: we’re asking the police to just stand in the place of where doctors, public health officials, politicians, and even all of us in the community, ought to be standing in. "Why aren’t you arresting these guys so they stop? Well, because every time I turn around there are 10 more addicts because they’re taking these pills." On top of that, there is a big labor force of Xalisco Boys back home who are raising their hand to serve. 

Cops can do one of two things, arrest in these big operations and investigations or don’t. And my feeling is, given the problems they face, that they have to arrest. But the problem is this is not a police or criminally caused problem. This really came out of modern medicine. Because there are so many more doctors across America than there are ever going to be drug traffickers, that means this problem is all over the country. To say that the police are in charge of dealing with it is a cop out. 

And it’s really deeper than that. It’s us, as in Americans, as in medical patients, saying we will find other ways to treat our own pain. We will make better life choices. We will not smoke, we will walk more and eat less crap. That is part of the solution. 

You touch on this in one of the later chapters called “The Treatment is You,” which I especially enjoyed. Because it’s saying, "Look, doctors might be great at curing diseases but when it comes to complex human problems, they’re not so good at treating those, and you have to take up yourself as a concern, you have to care about your own health."

We are Americans and a crucial part of our system of government and society is accountability. And here, I believe, American patients have held everybody accountable except themselves. I think that’s true in a lot of ways. People are out there saying, "Why hasn’t the doctor fixed my pain?" or "Why don’t the cops do more?" Well, why don’t you learn what’s in your medicine cabinet? Why don’t you ask the doctor, "Why? Why are you giving me this? Why are you giving me 60 of this? Why should I take these home?" 

I want to be really clear that there are people who do need opiates and that these drugs do help them. It’s crucial for them to regain their lives because they have been mangled by pain. 

There are a lot of us out there who want to find someone to blame. Law enforcement and doctors need to be held accountable, that’s very important, but it’s also important to point the finger of blame back at ourselves.

Lastly, in your coverage, what did recovery look like for ex-opiate users? What did you see working and what did you see that wasn’t working? 

That’s actually a topic I don’t have much of an opinion on, which may sound strange. We tried to deal with pain with one solution, which was with pills. What we need is a wide panoply of options that can be adapted for the enormous variety of human beings that exist. 

People are different. We tried to treat pain one way and that didn’t have a good result. I don’t believe that one way to treat addiction is going to be any more successful. What those ways are—I’m a layman. I’ve never been addicted except to nicotine and I kicked it on my own, cold turkey. I’m sure people can kick heroin the same way, while others cannot. 

Zachary Siegel, is a regular contributor to The Fix. He recently interviewed Ethan Nadelmann and wrote about how "he" didn't quit heroin. Follow him on twitter.

Author of the book Dream Land: The True Tale of America’s Opiate Epidemic talks with The Fix
By Zachary Siegel
wrongscience.jpg
fallacy

Recently, in December 2014, graduate student Michael LaCour, at UCLA, and distinguished Columbia University professor Donald Green published a study showing that gay canvassers were highly effective in converting antagonistic voters to a pro-same-sex-marriage position. Their study in the prestigious journal Science was highly publicized in the New York Times, Washington Post, and Wall Street Journal.

It now appears, however, that LaCour made the study’s results up. Science seems likely to retract the study. Green—who says he never saw the actual data—has requested that the journal do so. This seems to be a case where people in a field wanted something to be true, and so they made it happen. Who knew that supposed scientific findings are subject to cultural fads and wish fulfillment?

The same players—UCLA and Science—were involved in perhaps the most harmfully erroneous study to ever appear in the addiction field. In 1982 Mary Pendery and UCLA professors Irving Maltzman and L. Jolyon West published an article in Science showing that alcoholics could never control their drinking. The Pendery et al. study “found” that psychologists Mark and Linda Sobell had misstated the results of research they had published showing that alcoholic subjects treated at a San Diego-area VA hospital with controlled drinking (CD) techniques fared better than subjects undergoing the standard abstinence, AA-oriented treatment at the VA.

The 1982 Science study was strange from the start. Pendery et al. sought to disprove the Sobells’ results by following up the 20 CD subjects during the eight years after the intervention, but not the subjects treated by the VA’s abstinence program. The “researchers’” supposed purpose was to detail relapse events. Of course, Pendery, Maltzman, and West were trying to show that alcoholics could never hope to modify their drinking. But the original study by the Sobells, which demonstrated what we now call relapse prevention, had reported that relapses did occur for CD subjects. Only these relapses were less likely than they were for the abstinence-treated subjects. So how could a follow-up study that only examined the one group disprove the original, comparative results?

Several subsequent neutral inquiries revealed that the Sobells had reported all of the relapses for CD subjects. These investigations questioned the purpose of Pendery et al.’s research—and of Science’s publishing its results—which I wrote about in Psychology Today in 1983. Why conduct a study that didn’t prove anything? But the Pendery et al. study had a major impact on the field of alcoholism and, by implication, addiction. It delayed the appearance of harm reduction in the United States for two decades.  

Ethan Nadelmann declared in The Fix

Where the 12-step thing has the most to own up to is its role in impeding harm reduction interventions to stem the spread of HIV/AIDS. Why was it that Australia and England and the Netherlands were able to stop the spread, and keep the number for injecting drug users under 5-10%, and the U.S. was not? It's that notion that abstinence is the only permissible approach, that we are not going to "enable" a junkie by giving him a clean needle. There has to be a kind of owning up to that role in hundreds of thousands of people dying unnecessarily.

This accountability also must occur in the case of alcoholism treatment. According to the Drug and Alcohol Findings Effectiveness Bank description of yet another study confirming the benefits of brief interventions aimed at reducing drinking for even diagnosed alcoholics, now called dependent drinkers: 

Commonly presumed unsuitable for dependent drinkers, the evidence is stacking up that brief advice after screening can lead even these drinkers to cut back. This study of heavy drinking Taiwanese hospital patients provides one of the most convincing demonstrations yet that brief intervention can work in this setting, and the drinking reductions were particularly steep among dependent patients.

In other words, it is possible—with relatively modest investments of time and effort—to assist alcoholics/dependent drinkers in moderating their drinking. This is not to say that all—or most—can become social drinkers. But, recall, HR is about how both drug addicts and alcoholics can make beneficial changes in their use and in their lives that may or may not culminate in full recovery, but which can currently save their lives. Yet, in the field of alcoholism in America, even more than with drug addiction, such HR approaches aren’t permitted. They are now declared impossible by the NIDA’s “chronic relapsing brain disease” theory that is being promoted by Science, as well as by the Drug Czar, Michael Botticelli, who is himself “in recovery.”

In Nadelmann's words, there must an “owning up to that role in hundreds of thousands of people dying unnecessarily" in alcohol as well as in drug treatment. In America, those who fail at AA and abstinence are simply left to experience their own negative consequences with no attempt to help them make incremental or life-preserving improvements. Remember George McGovern's daughter, Terry, who froze to death, drunk in the street, freshly out of a halfway house? Terry McGovern is an example of a human being who could be alive today if we concentrated on helping her even though she periodically relapsed. 

A first step towards practicing HR as national policy for drugs and alcohol in America would be the retraction of the ideological, useless, indeed harmful alcoholism treatment study Science published by Pendery et al. 33 years ago.

There is one last tragic result in the aftermath of the Pendery et al. study. Some time later, Pendery engaged in a relationship with a former patient at the San Diego VA. I described what followed:

On April 10, 1994, Mary Pendery was murdered by an alcoholic lover. Pendery left the alcoholism treatment program at the VA Hospital in San Diego which she headed to move to a VA hospital in Sheridan, Wyoming in 1992. In January 1994, Mary recontacted George Sie Rega, whom she had first known while he was being treated at the San Diego VA. Mary apparently was rekindling an old flame. By the time Sie Rega joined Mary in Wyoming in April 1994, he was deep in alcoholic relapse. Extremely intoxicated (his BAL was >.30), Sie Rega shot Mary dead and then turned his weapon on himself.

And, so, one more victim of the myths that alcoholism treatment is all about forcing people to never drink again, and that this approach is highly effective, was Mary Pendery.

Stanton Peele, Ph.D., is the author (with Ilse Thompson) of Recover! Stop Thinking Like an Addict. He is the recipient of career achievement awards from the Center for Alcohol Studies and the Drug Policy Alliance. His Life Process Program for treating addiction is available online. He last wrote about our dysfunctional national alcohol policy.

A 1982 study published in Science is an affront to science and the addiction field.
By Stanton Peele
Jack Kelly
run on

Who says that a recovering drug addict can’t run a marathon? Or create a recovery app? Or run for city hall? The only thing that restricts a person in recovery are the restrictions that they put on themselves. If you have the right mindset, then the sky is the limit. It's all about focusing, admitting you have a problem and overcoming the addiction. People in recovery come from all walks of life and success is not a given, but with hard work and the clarity that comes from living sober, anything within reason is achievable. 

Jack Kelly, a Charlestown, Boston native, knows the dark recesses of addiction. He fought them for many years, but now he’s been clean and sober for 11 years, since October 12, 2003, and his life has taken him on a most amazing and intriguing journey. No one would have ever thought that the kid from Charlestown, strung out on OxyContin, would have turned his life around, but Jack didn’t take life for granted and now he has a wonderful life and remarkable story that he’s decided to share with The Fix. 

“Recovery is the most amazing state to be in,” Jack tells The Fix. “It has peaks and valleys and life isn't always easy, but life isn't easy for anyone.” That is the old-fashioned truth, plainly spoken. Life is full of wrong turns and detours, something an addict knows firsthand. But when an addict gets on the right road and stays balanced, life can be both exciting and enjoyable.

“Recovery has given me many gifts,” Jack says. “I ran the Boston marathon, I worked for former Boston Mayor Tom Menino, and was an elected President Obama delegate to the National Democratic Convention in Denver in 2008. I received a college degree, ran for Boston City Council At Large and received the endorsement of Boston's biggest paper—The Boston Globe.” Tremendous accomplishments for anyone, but especially for a former addict.

“And more recently, I created a mobile app called iRecover that will connect people in recovery to meetings and others in recovery based off of their location,” Jack says. “But more importantly than the material success has been finding myself and being able to be a good person again. I see life in a much more spiritual light. I try and live today like an asteroid is coming; meaning, enjoy everyday and be good to people.” Simple keys to success and a solution to a life that could have ended in tragedy.

“I never used drugs and only drank beer a few times at or around the age of 15,” Jack tells The Fix. “It wasn't until I suffered a major injury to my shoulder that required surgery that my drug use began. I was prescribed opiate pain medicine and within several months was using the painkiller OxyContin on a regular basis. From there it progressed to sniffing heroin and then injecting it. By the age of 19, I was a full-blown heroin addict.” The shoulder injury and subsequent addiction derailed a once promising hockey career. Jack was on a downward spiral and dove into drug use headfirst. In sync with his addiction, he didn’t look back.

“At 17, after several months of taking OxyContin ‘recreationally,’ I knew almost immediately that this particular drug was dangerous,” Jack says. “After several months of regular use, I would suffer withdrawal symptoms. I was 17 years old and I knew I was in trouble. I didn't know the exact extent and still could never envision turning to heroin and being homeless years later, but instinctually, I understood I was in trouble.” Like many addicts, Jack recognized the grip that the disease had on him, but he couldn’t do anything about it. 

“On one particular night, my skin was crawling and I couldn't sit still. My stomach was upset and I was compulsively sweating. I was unaware of what was happening to me. I called an individual who told me I was ‘dope sick.’ I was perplexed. I never viewed myself as a heroin addict, or an addict in any form. But this person made it very clear that I was addicted to OxyContin and if I took more, I would feel better. That night, I sniffed an Oxy and immediately felt better. From that moment forward, I knew internally, I was an addict.” Jack relates to The Fix. He came to the conclusion that many addicts come to, but at that point he wasn’t ready to do anything about it, except take more drugs. In retrospect, he has come to other conclusions.

“I believe I had a predisposition to addiction,” Jack says. “My father is a recovering alcoholic as well as other family members. So when I hurt my shoulder playing hockey and was prescribed a powerful pill such as OxyContin, I was instantly ‘hooked’ before I truly understood what being ‘hooked’ was. Articulating an exact reason ‘why’ I became a heroin addict is complex and varies with each individual. In my case, I believe it was a perfect combination of nature and environment.” And the science backs that assessment up, environment and a genetic predisposition to addiction determines the course of many drug users as they delve into drug abuse.

Addiction leads to rampant drug use where the addict doesn’t have a care in the world about the consequences of his actions. The only thing that matters is getting that next hit. And this singleminded recklessness leads to many problems. Jack had his share of dilemmas created from his addiction to drugs. 

“The more pertinent question would be: what problems did they not cause me?” Jack tells The Fix. “I lost a potential hockey scholarship, got arrested several times and have a three-page criminal record. I was kicked out of my parents' house. I caught hepatitis C as a result of being an IV drug user. I lived on the streets and was officially homeless. Essentially, I lost every material fiber within my life and lost ‘myself’ completely, in every way one can lose themselves.”

In the recovery world, they call it hitting rock bottom. Many addicts like Jack hit rock bottom several times before they decide it's time to quit drugs, if they even get that far. Some addicts never admit that they're powerless over the drug, or they just don’t care. But Jack finally got to the point where enough was enough. “I hit ‘rock bottom’ many times. I lost all contact with my family and every possible friend. Heroin took it all away,” Jack tells us. “Rock bottom seemed to keep transpiring. But sleeping outside on a cold night in October in Boston was the last ‘rock bottom’ I have had.”

Jack Kelly (right) with his mother and father. Photo via Jack Kelly.

From that point on, Jack has been drug free. In recovery, he’s had time to think back and realize things that he never knew before. We asked him what advice he would give to his younger self to avoid the pitfalls of drugs and addiction. “A very loaded question,” Jack surmises. “I think the question should not be directed towards a younger me, but more of a policy statement to prevent younger people like me, or a younger version of me, a preventative tool that would halt the inception of addiction.” Remember, this is the man that created the recovery app, he is always thinking about society’s ills, instead of his own personal demons.

“It's a complex and varied answer that combines both medical and community reforms to give the appropriate answer or policy shift,” Jack continues. “I believe pediatricians should ask parents detailed questions about their family history concerning substance abuse and provide a guide, based on those results, [on] how to address experimentation with drugs and alcohol. If someone has the predisposition I had, then prescribing opiate pain medicine as a default after surgery should be reformed. My doctor would have understood, if such policies were in place, that based on my family history, I have a higher possibility of addiction and should not be prescribed addictive pain medicine. Simple reforms like this would improve prevention tactics.” An admirable and reasonable solution that should be effective immediately. But Jack offers more.

“I want people to understand that experimenting with drugs can be a dangerous game,” he tells The Fix. “However, I understand part of the allure is to do things adults deem dangerous. I'm not now, nor will I ever tell a young person what to do in their life. I would simply ask them to be honest with themselves when engaging in experimentation with drugs and alcohol. If you believe your actions are being negatively affected because of drugs or alcohol, listen to that inner voice and seek help or simply stop and engage in other activities.” Another wise solution from Jack, but where is he now? On a personal level? With his life and his recovery?

“I have been blessed to have an opportunity to have a second chance at life,” Jack answers. “I have known thousands upon thousands of people who have been lost because of addiction. I lost my cousin Meaghan to a heroin overdose. This disease has deeply troubled me. I believe I have a purpose. Not many people can be clean from heroin for over 11 years and did it at 22 like I did. As I contemplate my past, I know my purpose is to try and make the world a better place and that starts with me, on a daily basis.” To facilitate all this, and his recovery, Jack uses the tools at his disposal to keep a balanced lifestyle.

“I attend 12-step meetings regularly and have from my inception to recovery,” Jack relates. “Additionally, I have periodically sought outside help for my underlying depression issues. I attend therapy for my depression and exercise to combat more negative moments in my recovery.” The strategies are there for addicts to recover. What works for Jack might not work for you, but how do you know until you try. Success can be achieved by living sober, that much has been proved. An addict can turn his life around.

“As I've previously stated, I have had tremendous professional success,” Jack says. “I own property in Boston, drive a nice car, and have met actors and other celebrities and have worked for, or with, high-profile politicians. Additionally, as already stated, I created a mobile app to help connect those in recovery.” But all those successes mean nothing if Jack doesn’t stay off drugs and he realizes this.

“I don't quantify my success solely in terms of professional endeavors,” he tells The Fix. “It is certainly a part of what I conceive to be ‘success.’ However, success is a balanced approach of both personal and professional. Finding balance in life is how I interpret true success. When I'm balanced, I’m successful.” And that, in reality, is what recovery is about. It's about finding balance and staying on kilter. As addicts, our extreme natures knock us out of balance daily. It’s our job to seek perspective by getting our lives in check. Finding balance is the key. That’s the solution to true success in recovery as Jack has shown.

Seth Ferranti has been a regular contributor to The Fix since 2012. He most recently wrote about his relapse. He also writes for Vice. He has a book out—The Supreme Team.

Who says that a recovering drug addict can’t run a marathon? Or create a recovery app? Or run for city hall?
By Seth Ferranti

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