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
OxyContin is “simple”—its only active ingredient is oxycodone. On a molecular level, it is similar to heroin. The drug is a spinoff of MS Contin, manufactured by Purdue. MS Contin worked by releasing morphine into the bloodstream continuously and was used primarily by post-op patients. It came in large doses of 15, 30, 60, 100, and 200 mg. OxyContin also comes in large doses (40 and 80 mg) that are released continuously into the bloodstream. Despite OxyContin’s very legitimate pain-relieving uses, its emergence in 1996—at the height of America’s “opiate revolution” results in massive over-prescription. By the mid-1990s, pain is seen as a “vital sign,” and many insurance companies reimburse pills rather than therapy. After the reality of OxyContin’s addictiveness sets in, Purdue spokespeople claim ignorance, citing the relative success of MS Contin, which hadn’t resulted in such widespread addiction.
OxyContin is similar to the Xalisco Boys’ heroin: both are potent narcotic painkillers. Despite this, heroin remained a stigmatized drug while OxyContin was greeted with open arms by doctors and patients in whom the “opiate revolution” had instilled both an exaggerated overconfidence in the safety and usefulness of painkillers in treating various illnesses, as well as a notion of the “right” patients had to pain relief.
Themes
Advertising for OxyContin began when Purdue hired William Douglass McAdams to market the drug. From the start, Purdue marketed the drug as an alternative to MS Contin, presenting it “as a virtually risk-free panacea for chronic pain. Such marketing was accepted enthusiastically by American doctors in the mid-1990s who’d grown accustomed to treating chronic pain with opiates.
William Douglass McAdams is the firm with whom Arthur Sackler had begun his career in pharmaceutical advertising in the 1950s. Purdue’s decision to market OxyContin as “virtually risk-free” exploited the medical industry’s overzealous desire for a “Holy Grail” drug for pain treatment.
Themes
“Pain crusaders” lauded Purdue’s new drug as the long-awaited “Holy Grail.” Researchers believed that that OxyContin’s continuous release of oxycodone prevented the patient from experiencing the highs and lows that would lead to addiction. In 1996, Kathy Foley suggested that oral morphine (in the form of OxyContin pills) got rid of the need for the “silly elixirs and cocktails” of the past. OxyContin would change the lives of pain patients who, for so many years, could do nothing but think about their pain and look forward to their next dose.
Foley’s comment that OxyContin pills eliminated the need for “silly elixirs and cocktails” of the past speaks to the efficiency and simplicity that doctors and patients wanted out of pain treatment. Pills were easy and provided instant relief: they didn’t demand diligent work out of their patient in the way multidisciplinary approaches did.
Themes
Still, in analyzing Purdue’s application, FDA examiner Dr. Curtis Wright believed OxyContin to be addictive, and that its only benefit was in its convenience. Wright later left the FDA to work for Purdue. The FDA approved OxyContin in 1995, in doses of 10, 20, and 40 mg, and later in higher doses of 80 and 160 mg. The FDA allowed Purdue to claim that OxyContin’s continuous-release properties made it less addictive than other opiate painkillers. Purdue’s approved warning also instructed patients “not to crush the tablets,” as it would “release ‘a potentially toxic amount of the drug,’” which essentially provided addicts with step-by-step instructions for how to abuse the supposedly nonaddictive pill (though the FDA later claimed that they didn’t know OxyContin would be liquefied and injected).
Wright’s decision to frame OxyContin’s convenience as a benefit speaks to America’s desire for pain treatment to be easy and efficient. Wright’s later move to work for Purdue alludes to the economic corruption and exploitation at play in the opiate epidemic. Purdue’s warning that essentially provided addicts with instructions to abuse OxyContin might be compared to the “Joe Camel” ads referenced earlier in the book, wherein a cigarette company indirectly and illegally created ads directed at minors.
Themes
Get the entire Dreamland LitChart as a printable PDF.
Purdue’s marketing strategy for OxyContin differed most notably from that of MS Contin in that it aimed to convince doctors of the drug’s success in treating noncancer pain, chronic pain, and even moderate pain, such as that resulting from standard dental procedures and headaches. Thus, “a vast new market for an opiate painkiller” was created.
OxyContin’s advertising campaign was geared toward expanding the market for potential buyers. Whereas before only the terminally ill would be considered potential consumers, now patients with less serious illnesses (even headaches) were in the market to be prescribed opiate painkillers.
Themes
