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 1997 in Chillicothe, a town in Southern Ohio, Dr. Phillip Prior notes an influx of salesman from Purdue Pharma making the rounds at this hospital. Armed with graphics and data, these salesmen take doctors out for luxurious lunches in an attempt to convince them of the safety and effectiveness of their new drug, OxyContin. The salesmen’s pitches shock Prior, as he knows that OxyContin contains oxycodone, and his medical schooling in the 1980s taught him that large doses of oxycodone were dangerous and highly addictive.
Purdue Pharma’s strategy of treating doctors to lunch parallels the customer service of the Xalisco Boys. Both cases involve drug businesses using bribes and other incentives to attract a new market of consumers. The skepticism with which Dr. Phillip Prior regards OxyContin is becoming rarer as more doctors become falsely convinced that opiates are nonaddictive. This trend speaks to the effectiveness of Purdue’s campaign.
Themes
Purdue’s advertising campaign in the late 1990s serves as a prime example of the pharmaceutical industry’s concept of “the blockbuster drug.” During this time, drug companies fight to secure the highest grossing pill, creating their own drugs and then marketing them aggressively with an increasingly large force of salespeople. From 1995 to 2005, the number of salespeople in America grows from 35,000 to 110,000. Salespeople push their drugs using direct marketing, just as Arthur Sackler did with Valium in the 1960s. Leading the pharmaceutical “arms race” is Pfizer, now the largest drug company; in fact, doctors recall “getting visits by three Pfizer reps a day.”
The idea of “the blockbuster drug” reflects how competitive the pharmaceutical company advertising had grown by the 1990s: drug companies had to employ aggressive marketing tactics to ensure that their brand was most popular. The growth in pharmaceutical salespeople between 1995 and 2005 speaks to the growing market for opiates that occurred as a result of the pain revolution. Pharmaceutical companies exploited the increasing number of doctors who were comfortable with the idea of prescribing opiates and the increasing number of patients who came to believe it was their right to live pain-free.
Themes
Purdue motivates its salespeople to increase their sales by raising the quota for bonuses. This tactic works: in 1996, Purdue doled out $1 million in bonuses. Five years later, this number is up to $40 million. Regions like Southern Ohio and Eastern Kentucky are particularly lucrative markets for sales reps, whose earnings “bore […] a striking similarity to the kinds of profits made in the drug underworld.”
The fact that Purdue’s exorbitant profits are similar to “the kinds of profits made in the drug world” shows how similar the legitimate drug business world is to the illegitimate drug business world, suggesting that pharmaceutical executives ought to be regarded with the level of scorn usually reserved for drug kingpins.
Themes
Purdue pushes OxyContin by giving away coupons for free prescriptions that doctors can pass along to their patients, as well as through sponsoring continuing medical education (CME) seminars, which have grown increasingly depending on pharmaceutical company money. The Accreditation Council for Continuing Medical Education attempts to draw a clearer line between drug companies and seminars in 2004 by banning drug company influence. As a result, funding of CME by pharmaceutical companies drops. In 2002, the Pharmaceutical Research and Manufacturers of America and the U.S. Department of Health and Human Services banned sales representatives from bribing doctors with elaborate dinners and gifts, but by then Purdue had been able to push OxyContin on doctors for over six years.
Purdue’s tactic of giving away coupons for free samples of OxyContin harkens back to the Xalisco Boys giving away free heroin to addicts and Pfizer giving away coupons for Valium in the 1960s. Purdue’s tactic of advertising at CME seminars is particularly aggressive, as it allows them to reach large numbers of doctors at once. Because of the lack of stigma associated with the pharmaceutical industry, Purdue is able to employ these marketing tactics for years before regulations are set in place to prevent such practices.
Themes
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According to the U.S. General Accounting Office, Purdue “help[s] fund more than 20,000 education programs.” Russell Portenoy often speaks at these programs, emphasizing the “complexity” of pain. Still, he ultimately determines that pain is best combatted with opiates like OxyContin. OxyContin continues to flourish into the early 2000s.
Russell Portenoy’s well-intentioned message about the “complexity” of pain is exploited by Purdue, whose funding encourages him to endorse painkillers like OxyContin as the best solution for pain.
Themes
