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 December 2005, Jennifer Sabel, Washington State’s epidemiologist, stands before a panel of doctors to present the dismal findings she and her team have uncovered: just as Jayme Mai and Gary Franklin found in the state’s worker’s comp system, Sabel confirms that the entire state of Washington has experienced unprecedented increases in fatal overdoses over the past decade. Doctors meet Sabel’s claims with anger and skepticism. In an interview with Quinones in 2013, Sabel states that doctors became convinced by drug companies that it was appropriate and safe to prescribe painkillers to chronic pain patients. Now, these doctors refuse to hear the truth.
Sabel’s research speaks to the effectiveness of pharmaceutical advertising techniques first employed by Arthur Sackler in the 1950s. Companies like Purdue were so good at selling their product that they were able to convince doctors to forget much of what they learned about the addictiveness of narcotics in medical school. On a more cynical level, doctors’ acceptance of opiates could have also been the result of their desire for a faster, easier way to deal with patients’ pain.
Themes
According to Jaymie Mai, increased overdoses are the direct result of increased prescriptions: the pills aren’t “stolen in pharmacy holdups.” In response to its troubling discovery, L&I publishes better, more responsible guidelines for doctors to use when prescribing opiates: for example, if patients don’t respond to a certain dose, doctors should consult a specialist before increasing the patient’s dosage. Such guidelines are reasonable, but in light of the pain revolution, Mai and Franklin anticipated skepticism. Thus, they organized the conference at the Warwick Hotel, at which Jennifer Sabel delivers findings to which the audience of doctors respond unfavorably.
Mai’s observation that the pills causing increased overdoses weren’t “stolen in pharmacy holdups” emphasizes the very legitimate, condoned way that pills entered the underground drug market: they were prescribed by doctors who were accepted and trusted by society.
Themes
Before L&I can publish these new guidelines, they are contacted by Purdue Pharma executives who question their validity. Purdue accuses L&I of undertreating patients in pain. In the meantime, more workers die of drug overdoses. Still, L&I’s guidelines lead to the beginning of a shift in Washington’s attitude toward opiates. In 2011, legislators repeal regulations that prevent limits on opiate dosing.
Purdue’s accusation that L&I was undertreating pain patients is the company’s attempt to frame an economic concern as a moral concern: Purdue is likely more concerned that L&I’s guidelines will cause them to lose money than that the guidelines will result in the undertreatment of pain patients.
Themes
