Reddit reviews Dreamland: The True Tale of America's Opiate Epidemic

It would need to be a multi-step approach:

• First, increasing the availability of and lowering the cost of methadone clinics and treatments centers in small towns and rural areas will go a long way. The majority of these opioid deaths are the result of black market heroin and fentanyl analogues. They are inherently more dangerous because of a lack of quality control and regulation. Providing a regulated, known dose, even if it's in the form of legal opioids like methadone, suboxone or oxycodone, will go a long way to reducing overdose deaths. That should be the first priority, along with increasing the availability of Narcan autoinjectors and nasal sprays.
  
  
• The next step would be providing treatment services to help people get clean and stay clean. More treatment centers and halfway houses would be necessary, as would cost subsidies from the government to allow low-income people to attend.
  
  
• The third step would be an increase in education about the differences between types of opioids (oxy vs. street heroin/fentanyl) and risk reduction methods for both. Preferably at the middle and high school level. And preferably not in the vein of disastrous programs like D.A.R.E. It should be done in a non-judgmental way by academics and healthcare professionals, not police.
  
  
• Finally, steps should be taken to minimize opioid prescriptions for chronic, non-terminal pain and the diversion of drugs when they are prescribed. The advent of opioids is one of the most significant advances in modern medicine. It has allowed people with acute and chronic pain to live better lives. However, opioids should almost never be prescribed long term for anything but incurable, terminal diseases. The trade off of risk vs. reward is simply too great. When long term opioid therapy is chosen, it should be handled by pain management physicians, and treatment compliance contracts should be clearly laid out and agreed upon by both the physician and the patient before therapy is initiated.
  
  There is no easy answer to this problem. Any one of these steps will likely help the problem, but it will take a comprehensive, multi-prong approach to really address the problem. It doesn't help when we have politicians arguing that opiate addicts are subhuman and should be allowed to die off. That won't help anyone. That's a good way for some areas to lose half a generation of young people.
  
  EDIT: For anyone who wants to learn more about the issue, I highly recommend Dreamland: The True Tale of America's Opiate Epidemic by Sam Quinones. This should be required reading for anyone interested in the many facets of the opioid epidemic.
  
  Amazon Link
  
  LibGen link

Dreamland is a great book that goes really in depth on the topic, but basically the current epidemic is the result of a sort of perfect storm of a bunch of causes. To name a few: the over prescription of narcotic painkillers in the late 90s, the decline of the working class (especially in the rust belt), and the growth of Heroin cartels in central america, particularly Mexico.

The book Dreamland actually spends a short amount of time on this. Once the epidemic reached middle-class white people, largely due to predatory doctors and Mexican black tar, all of a sudden legislators started caring a lot more about it. It turns out your Republican congressman is a lot more willing to spend public funding on drug courts and rehab centers when it's no longer just poor inner city minorities getting addicted, but his teenage daughter who's stealing pills from medicine cabinets.

(Disclaimer that I'm not attempting to politicize this any more than it needs to be; the book explicitly calls out Republican legislators.)

In the 1990s, a campaign emerged to treat a patient's pain level as the fifth vital sign alongside temperature, pulse rate, respiratory rate, and blood pressure. Many doctors were seeing large numbers of patients with chronic pain, and pharmaceutical companies began marketing their opioid painkillers as safe for treatment of chronic pain. As a way to get these patients out the door with a treatment, they turned to opioids. These prescriptions would be covered by Medicaid. Other things like "pill mill" pain clinics would pop up for the sole purpose of writing prescriptions for painkillers. There's a ton of articles out there, this one popped up today on Vox but if you would like something more in-depth, I would recommend Dreamland by Sam Quinones.

If you are interested in this situation the book "Dreamland" is excellent.

The book, DREAMLAND, is worth checking out

https://www.amazon.com/gp/aw/d/1620402521/

Gives a remarkable analysis of how we got here. After reading it, I’m convinced the opioid epidemic is primary cause of the division we see in America today.

With the exclusion of Baltimore (for unique reasons), no major costal city is experiencing the effects of this crisis on the same scale as middle America. All of our centers of political, economic and cultural power are removed from the front lines. It was out of sight and out of mind.

Overdoses have surpassed car crashes as the leading cause of accidental death.

Overdoses have become the leading cause of death for people under 50

With over 70k deaths last year, more people die from overdoses every day than have died in all school shootings since 1990.

Unlike the crack epidemic, there are no juicy news angle. No shootouts in the streets. No crazed users disrupting society. There is just a steady stream of people dying in their homes and their childhood bedrooms. Those left behind have have only their own tragedy to speak of and they often don’t because of undeserved feelings of guilt and shame.

Edit: a word

Oxycontin was released a few years before the start of your graph (1996). Doctors believed it wasn't addictive and started prescribing it for basically anyone who was suffering from any kind of pain. Turns out it's extremely addictive and essentially the same thing as heroin, which is much cheaper. That's the extremely tl:dr version anyway, if you want the full story read this book.

• Dreamland: The True Tale of America's Opiate Epidemic
  
• Methland: The Death and Life of an American Small Town
  

You want to play a game of statistics? I have a four shot revolver and only one of the barrels is loaded. Take a spin, put it to your head. Will you pull the trigger? You only have a 25% chance of dying.

To answer your question, no, I don't believe opiates should be banned because I do believe they have their uses in modern medicine. But I do believe they should be more tightly regulated than they were in the late 90s and early 2000s, when the conditions for this epidemic were being set.

The pill mill doc in my story wasn't a fictional creation. There are hundreds of them all over the country. Check out Dreamland: The True Tale of America's Opoid Epidemic. This goes beyond the surface statistics and into the realm of gross negligence among the companies responsible for these drugs.

I highly recommend Dreamland by Sam Quinones. It describes this exact situation. Pharma companies pushing opioid pills on doctors, with promises that they are non-addictive, who in turn push them on their patients, who in turn are targeted specifically by heroin dealers (who often hang out around pain clinics for that very purpose).

Quick plug for [Sam Quinones Dreamland,] (https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521?crid=29MSYNE1T8Y91&keywords=sam+quinones+dreamland&qid=1536342509&sprefix=sam+quinones+&sr=8-1&ref=mp_s_a_1_1) reads like fiction.

It's from the explosion of Opiates

https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=

They come from a particular region in Mexico. The young people move up here, sell heroin to earn some money, then move back to their village with a king's ransom.

There was a book written about it:

https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521

Anyone read Dreamland? Thoughts?

Dreamland by Sam Quinones is also very eye opening about big pharma and the heroine epidemic.

I did read, thanks! I'd love a deeper dive. I should probably just read this, which is supposed to be great:

https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=&dpID=51-xMXv12FL&preST=_SY344_BO1,204,203,200_QL70_&dpSrc=detail

read this. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521

Not yet, but it's on my list!

I thought of a couple others: Evicted, Dreamland, and Missoula. While they're by no means m favorite nonfiction books, I think they're all incredibly important books to read.

https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=sr_1_1?ie=UTF8&qid=1480991080&sr=8-1&keywords=dreamland

It's more fulfillment than poverty--lots of rich people are addicts, but have the resources to keep a rough over their head. UBI is still poverty, and doesn't solve the problem of what to do when someone uses the given income. I've seen this with family--they've got to help themselves or they never get better.


https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521

I live in Missouri and if it wasn't on the news I wouldn't know it's happening - don't know anyone who has been affected. It's really bad though, if you're interested in a good book on it I would suggest Dreamland.

Dreamland

This is part of it. Several other factors played a part and formed quite a "perfect storm" that ended up as "The Opioid Crisis".

I strongly recommend anyone curious to read the book Dreamland, which not only is very informative on all these points, but is also devastatingly well written!

If you're not a reader and/or crave immediate satisfaction, this Econtalk episode with the author is a decent substitute.

sure!

The New Jim Crow: Mass Incarceration in the Age of Colorblindness
Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck
Evicted: Poverty and Profit in the American City
Dreamland: The True Tale of America's Opiate Epidemic
Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right
Democracy in Chains: The Deep History of the Radical Right's Stealth Plan for America
The Working Poor: Invisible in America
Another Day in the Death of America: A Chronicle of Ten Short Lives
Clothing Poverty: The Hidden World of Fast Fashion and Second-hand Clothes