One significant aspect of the opiate epidemic Quinones highlights is how, unlike other drug epidemics that had come before it, it involved many middle- and upper-class white Americans, a good number of them young people. Introduced to opiates through liberally prescribed painkillers, this new group of addicts would often resort to cheaper, readily accessible black tar heroin when they were strapped for cash. According to Quinones, this addiction model resulted from a lack of stigma associated with prescription drug use as opposed to hard street drugs. It was comparatively easy for this demographic to become addicted to prescription drugs, particularly if the drugs were prescribed to them by a trusted family physician. Quinones’s analysis shows first how this new class of addicts (often white, privileged, and suburban) was created by virtue of their biased assumption that opiates prescribed to them by a doctor were legitimate and could do them no harm. Then, when these new addicts eventually turned to heroin to fuel their addiction (as so many did), the social stigma surrounding black market drugs forced these new addicts into shame and silence, which allowed the opiate epidemic allowed to grow more powerful and far-reaching without much public notice. In this way, both the lack of stigma associated prescribed narcotics like OxyContin and the substantial stigma associated with underground narcotics like black tar heroin perpetuated the opiate epidemic.
The lack of stigma attached to prescription drugs allowed opiates to affect a new demographic of Americans, and for “heroin [to] enter[] the mainstream” through pill abuse. In particular, Quinones emphasizes the large number of suburban high school students who developed opiate addictions after being prescribed painkillers for shockingly innocuous ailments. To emphasize this, he writes, “the new addicts were football players and cheerleaders.” The first case study Quinones explores in Dreamland’s preface involves the death of Matt Schoonover, a young man from a middle-class neighborhood in Columbus, Ohio. Matt began experimenting with alcohol and various drugs, including the prescription pills OxyContin and Percocet, as a young adult. By the time he returned home after his first year of college, “he had become a functional addict.” When Matt’s parents found out about the pills, “they were worried, but the pills [he] had been abusing were pharmaceuticals prescribed by a doctor. They weren’t some street drug you could die from, or so they believed.” The Schoonovers were concerned for their son, but the lack of stigma attached to prescription drugs and the doctors who prescribed them caused them to doubt the legitimacy of their concerns. Unable to afford prescription drugs, Matt turned to black tar heroin and eventually died of an overdose. “Across America,” writes Quinones, “thousands of people like Matt Schoonover were dying.” Suburban America’s trust in the medical and pharmaceutical industries caused it to downplay the seriousness of their children’s prescription drug addictions.
Compared to prescription painkillers, heroin—and the people who sold and used it—was perceived in a different, more judgmental light, despite the similar chemical makeup of the drugs (they are both opiates) and despite the similar markets that sell and promote them. The true extent of the opiate epidemic didn’t largely come to light until those addicted to painkillers, like Matt Schoonover, turned to black tar heroin when they could no longer afford prescription drugs. Quinones reinforces America’s stigma against underground drugs by putting himself in the mindset of parents of this new demographic of opiate addicts: “Most of these parents,” writes Quinones, were products […] of the 1970s, when heroin was considered the most vile, back-alley drug. How could they now tell their neighbors that the child to whom they had given everything was a prostitute who expired while shooting up in a car outside a Burger King?” Quinones’s language borders on the hyperbolic, but it accurately expresses the hysterical fear and biased conceptions these parents held toward underground drugs, and the preconceived notions they had about the supposed types of people who used them.
Ultimately, many addicts’ parents were shocked and full of shame when their children died of heroin overdoses. Quinones sees silence as a quintessential feature of the opiate epidemic, particularly when compared to the “blight, violence, and outrage [that] accompanied” the rampant cocaine and crack usage in the 1980s, or the later appearance of methamphetamine. These prior epidemics were visual and noticeable: the Colombians who brought in cocaine “shot up Miami strip malls,” and meth “[was] made in labs that exploded.” In comparison, the opiate epidemic that ravaged so much of Middle America grew largely without notice. Quinones writes that “most grieving families retreated in shame and never said a public word about how a son died in a halfway house with a needle in his arm.” Fearing the stigma attached to illegal narcotics, these families kept silent, and “opiates quietly killed unprecedented numbers of kids.” Quinones believes, in part, that the silence of these parents and of so many others allowed opiate addiction to swell to monstrous, uncontrollable numbers. If these parents could manage to share their children’s supposedly shameful, fateful ends, they might use their grief for “something good,” as Ellen Schoonover (Matt Schoonover’s mother) puts it. According to Quinones, silence and stigma made the opiate epidemic possible in the first place. The best that victims’ surviving relatives can do, he argues, is to push back against stigma and provide honest, helpful information to others who may be suffering in shame and silence.
Related Themes from Other Texts
Stigma, Shame, and the Opiate Epidemic ThemeTracker
Stigma, Shame, and the Opiate Epidemic Quotes in Dreamland
In the months after Matt died, Paul and Ellen Schoonover were struck by all they didn’t know. First, the pills: Doctors prescribed them, so how could they lead to heroin and death? And what was black tar heroin? People who lived in tents under overpasses used heroin. Matt grew up in the best neighborhoods, attended a Christian private school and a prominent church. He’d admitted his addiction, sought help, and received the best residential drug treatment in Columbus. Why wasn’t that enough?
But heroin was never about the romantic subversion of societal norms. It was instead about the squarest of American things: business—dull, cold commerce. Heroin lent itself to structured underworld businesses. Addicts had no free will to choose one day not to buy the product. They were slaves to a take-no-prisoners molecule. Dealers could thus organize heroin distribution almost according to principles taught in business schools, providing they didn’t use the product. And providing they marketed.
Some Purdue reps—particularly in southern Ohio, eastern Kentucky, and other areas first afflicted with rampant Oxy addiction—were reported to have made as much as a hundred thousand dollars in bonuses in one quarter during these years. Those were unlike any bonuses ever paid in the U.S. pharmaceutical industry. […] Whatever the case, the bonuses to Purdue salespeople in these regions had little relation to those paid at most U.S. drug companies. They bore instead a striking similarity to the kinds of profits made in the drug underworld.
Many of these methods—premiums, trips, giveaways—were time-tested strategies that grew from the revolution Arthur Sackler began and were refined over time by many pharmaceutical companies. Only this time, the pill being marketed contained a large whack of a drug virtually identical to heroin.
In Portsmouth, it began with what came to be called pill mills, a business model invented in town, but growing from the aggressive nationwide prescribing of opiates, particularly OxyContin. A pill mill was a pain-management clinic, staffed by a doctor with little more than a prescription pad. A pill mill became a virtual ATM for dope as the doctor issued prescriptions to hundreds of people a day.
As the pain revolution was taking hold across the country, however, Procter and his physician progeny showed a beat-down region a brand-new business model. Before long some of the first locally owned businesses in years opened in Portsmouth, known to folks in town as the “pain managements.”
“It was not only okay, but it was our holy mission, to cure the world of its pain by waking people up to the fact that opiates were safe. All those rumors of addiction were misguided. The solution was a poppy plant. It was there all along. The only reason we didn’t use it was stigma and prejudice.”
Amid this madness, the sons and daughters of Portsmouth’s business owners, the children of sheriff’s captains and doctors and lawyers, saw a future in OxyContin. Some regarded pills as a grassroots response to economic catastrophe—the way some poor Mexican villagers view drug trafficking. Dealers who could not have found a legitimate job in moribund Portsmouth bartered pills to support themselves and feed their kids.
The signature location of this drug scourge, meanwhile, was not the teeming, public crack houses. It was, instead, kids’ private suburban bedrooms and cars—the products of American prosperity. The bedroom was the addict’s sanctuary, the shrine to the self-involvement dope provokes. It was their own little dreamland, though quite the opposite of Portsmouth’s legendary community pool, where kids grew up in public and under a hundred watchful eyes. Each suburban middle-class kid had a private bedroom and the new addicts retreaded to them to dope up and die.
Most of these parents were products, as I am, of the 1970s, when heroin was considered the most vile, back-alley drug. How could they now tell their neighbors that the child to whom they had given everything was a prostitute who expired while shooting up in a car outside a Burger King? Shamed and horrified by the stigma, many could not, and did not.
