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
David Procter’s Plaza Healthcare is closed, but his influence lingers. Procter showed how simple it is to open pain clinics, and new establishments continue to pop up across the U.S. Scioto County, Ohio, boasts the most clinics per capita, and Portsmouth becomes the pill mill capital of the country. Soon, “plain old drug dealers got in on the scam,” as well.
Because there were minimal guidelines in place to regulate pain clinics, even convicted felons could open pill mills. Shady clinic owners would hire doctors on locum tenens lists (doctors for temporary hire) to dispense pills for them. These temp doctors were desperate for work as they frequently had issues obtaining malpractice insurance substance abuse problems of their own. Pill mills illustrate the extent to which the legitimate pharmaceutical industry was corrupted by money-making schemes.
Themes
In Southern Ohio, Quinones comes across a lawyer named Joe Hale, a defense attorney who made most of his money in Lucasville, near Portsmouth. Lucasville, also known as “the Bottoms,” is a run-down town that consists mainly of residents on disability. Hale learned that many of the Bottoms residents were abusing OxyContin. One day, a Bottoms resident whose daughter had died of an overdose asked Hale to file a lawsuit against Purdue. In May 2001, Hale filed “the first OxyContin wrongful-death lawsuit against Purdue Pharma.” Hale ended up dropping the suit, but he would regard the Bottoms “as an early warning sign that Ohio and the country ignored at their peril.” Quinones suggests that the Lucasville Bottoms, Portsmouth, and similar “forgotten places of America […] acted like canaries in those now shuttered Appalachian coal mines.” But nobody was there or listening to heed their warning.
America’s failure to notice the “early warning signs” exhibited by the Bottoms speaks to the opiate epidemic’s silent quality. Many addicts were silenced by stigma and shame.
Themes
