Themes
Key
LitCharts assigns a color and icon to each theme in Dreamland, which you can use to track the themes throughout the work.
Pain Management and the Normalization of Narcotics
The Drug Business
Stigma, Shame, and the Opiate Epidemic
Community as a Remedy to Addiction
Summary
Analysis
In the late-1990s, David Procter, unlike much of the rest of Portsmouth, is doing well: he owns a mansion, a pool, and fancy cars. Despite being investigated by the Kentucky Board of Medical Licensure in the late 1980s for aggressive prescription of opiates, he is able to keep his license, as he hadn’t technically broken any Kentucky laws.
The former industrial businesses that were the center of Portsmouth’s economy are dead, but the new market for OxyContin has allowed Procter to flourish as a local businessman in Portsmouth and in South Shore, Kentucky.
Themes
In the beginning, it seemed as though Procter wanted what was best for his patients: records suggest he consulted with other doctors and discontinued medications “just as frequently” as he prescribed them. But a decade later, Procter is exhausted by his pain patients. A second investigation suggests that he regularly prescribes patients painkillers and sedatives “with almost no diagnosis or suggestions for other treatment, such as physical therapy.” Procter’s time spent catering to “vulnerable […] and manipulative people who used drugs and the government dole to navigate economic disaster” has “corroded” his “medical ethics.”
Procter seems to have started off with good intentions, wanting to honor the new, “patient is always right” doctrine promoted during the pain revolution. But greed, excess, and convenience have corrupted Procter, and he no longer practices medicine with any degree of moral integrity. Some of Procter’s patients have also been corrupted by the pain revolution, having observed how easily they can fake pain and be guaranteed a prescription for narcotics. The philosophies of the pain revolution have been exploited for convenience and economic gain.
Themes
“If heroin was the perfect drug for drug traffickers,” explains Quinones, “OxyContin was ideal for these pill mill doctors.” OxyContin is “ideal” because it is legal, and it creates addicts who need to become regular customers to support their habit. Procter is one of the first doctors take advantage of the “business model” OxyContin presented. Jeremy Wilder was an addict from Aberdeen, Ohio who also took advantage of the business opportunities OxyContin presented. Wilder collected OxyContin prescriptions from doctors around Ohio and Kentucky and, by the mid-1990s, had become “the biggest pill dealer in Aberdeen.” Jeremy would pay for appointments at pill mills and the prescriptions themselves and then sell the pills for a profit. He started abusing the pills before ultimately turning to the newly-arrived black tar heroin.
OxyContin created a stable market: consumers (addicts) would always be willing to purchase a product (opiates), regardless of cost, because their addiction required them to do so. Business-savvy individuals like Jeremy Wilder recognized and took advantage of this flexible market, much like the Xalisco Boys would later recognize and take advantage of the new market of opiate addicts that had been created by the opiate epidemic and OxyContin.
Themes
In the late 1990s, the Kentucky Board of Medical Licensure receives complaints pointing to the complete lack of medical knowledge involved in Procter’s prescriptions and diagnoses. Three female patients apparently exchanged sex with him for prescriptions. In 1998, Procter suffers a car accident that ended his career as a physician. He forfeits his medical license but hires other medical staff—often questionable doctors with “histories of drug use, previously suspended licenses, and mental problems”—to run his clinic. Some of these doctors end up opening their own pill mills.
Procter’s decision to trade illicit sexual acts for pills shows the extent to which wealth and greed have destroyed his moral integrity as a medical professional. The quality of doctors Procter hires to continue running his pill mill businesses after his accidents will become common: there aren’t strict legal restrictions for who can operate a clinic.
Themes
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Eventually, the DEA investigates Plaza Healthcare, Procter’s original clinic. Procter “fle[es] to Canada” after “plead[ing] guilty to conspiring to distribute prescription medication.” Canada returns him to Kentucky, where he testifies against other pill mill doctors in exchange for a lighter sentence. He is eventually sentenced to eleven years in federal prison. Rather poetically, Procter serves his time at the facility in Lexington, Kentucky that once housed the Narcotic Farm. Procter and other pill mill doctors provided economically depressed industrial towns with “some of [their] first locally owned business in years,” effectively demonstrating a “brand-new business model.”
Procter might have been arrested, but not before his pill mill model was able to spread across many other economically depressed industrial towns throughout the American heartland. In an area utterly destroyed by the new global economy, pill mills are “some of [their] first locally owned business in years.” Again, Quinones shows how the opiate epidemic was propelled forward, in large part, by business and economics.
Themes
