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 October 2006, four years after he ordered an investigation into Purdue Pharma, John Brownlee, the U.S. Attorney in Western Virginia, receives a call on behalf of the drug company. By 2006, Brownlee believed he had enough proof to testify against Purdue for criminal misbranding. Despite never providing the FDA with supporting studies, Purdue had for years claimed that OxyContin was nonaddictive. The company produced graphs that supposedly showed that the pill’s “timed-release formula” resulted in fewer highs and lows; federal investigations, however, would suggest that these graphs were erroneous and exaggerated. Similarly, Purdue claimed that patients on smaller doses of the drug could stop without experiencing withdrawal; this, too, proved to be false.
Purdue’s logic that OxyContin’s “timed-release formula” caused fewer highs and lows and, thus, was less likely to cause addiction has its roots in earlier arguments pushed forward in the pain revolution. At the height of the pain movement, for example, Dr. Russell Portenoy expressed confidence in the comparative nonaddictiveness of timed-release opiate painkillers.
Themes
In 2005, Hershel Jick was subpoenaed to testify before a grand jury at a federal prosecution against Purdue. Meanwhile, in Abingdon, John Brownlee’s case against Purdue moves forward, and the company pleads guilty to felony misbranding of OxyContin and “pa[ys] a $634.5 million fine,” of which $34.5 million is paid by Purdue executives. Each executive also pleads guilty to one count of misdemeanor misbranding, and each is placed on probation and assigned community service hours. When the Purdue executives are sentenced in federal court in 2007, a mother whose son had died of an overdose says, “You are […] nothing more than a large corporate drug cartel.”
Jick’s letter to the editor published in the New England Journal of Medicine in 1980 speculated that patients treated with opiate painkillers were unlikely to become addicted to the drug. The letter’s findings were exaggerated and used by drug companies like Purdue to claim that their prescription drugs weren’t addictive. The overdose victim’s mother’s comparison of Purdue to “a large corporate drug cartel” reinforces the corporate power that perpetuated the opiate epidemic and suggests that corrupt drug companies like Purdue should be stigmatized just as much as illicit drug cartels.
Themes
Meanwhile, Dr. Phillip Prior of Southern Ohio moves from family medicine to specializing in addiction at the Veterans Administration hospital in Chillicothe, where he is shocked to see that heroin has arrived in Southern Ohio, peddled easily to “a region where OxyContin had already tenderized a generation of folks to opiate use.”
Again, Quinones reinforces how the opiate epidemic created a new demand for heroin in areas where OxyContin addiction was now common.
Themes
