Opiate crisis? I confess I was only vaguely aware of the dimensions of this public health catastrophe before I started this book. Dreamland: The True Tale of America’s Opiate Epidemic does a great job of laying the whole thing out, with not only numbers but also names and faces brought forward to show the cost, and a whole cast of actors and attitudes named as contributors to the crisis. Author Sam Quinones’s thesis is that American medicine’s approach to opiate prescription began to evolve just as, and in many cases helped along by, the pharmaceutical industry’s enthusiastic marketing of time-released opiate products—specifically, Purdue Pharma’s OxyContin. Purdue’s sales pitch was based on flimsy and incomplete scientific evidence purporting to show that OxyContin was not addictive, which was at best misleading and at worst a flat-out lie. In fact the drug managed to addict thousands, possibly tens of thousands, of Americans. In the face of this massive marketing push, even responsible doctors began to lean on opiates to solve pain problems that required far more extensive, and more nuanced, treatment. The worst physicians flat-out operated as drug dealers, prescribing millions of pills through “pill mill” operations that were especially effective in depressed Rust Belt states like Ohio, Kentucky, and West Virginia. When OxyContin became too expensive, addicts turned to a new and distinctive drug to take its place: black-tar heroin from a tiny Mexican state called Nayarit on the country’s west coast. Drug dealing cells from in and around Xalisco infiltrated small and mid-sized American cities affected by the OxyContin craze and fueled a secondary wave of heroin addiction. The result was thousands of overdoses, many fatal, and public health costs that will probably never be fully reckoned. Oh, yes, and grief. Oceans of it. Author Sam Quinones does a good job of introducing members of the families who have lost loved ones to opiates, legal, illegal, or in combination, and helping us understand the strangely “normal” face of addiction. There’s much more to the book than my little sketch can cover, including some hard thinking about the corrosive effects of quick-profit capitalism and the scourge of outsourcing U.S. industry. Quinones also speculates that recent attempts to liberalize punishment for drug possession offenses has been fueled by the fact that most victims of the opiate crisis have been white and suburban—that, in effect, the victims look a lot like the men and women in our state legislatures. This isn’t a perfect book. The narrative tends to circle rather than advance, and there’s one (or two) too many references to the pizza delivery-like business model of the Nayarit dealers. Still, the details are worth getting, even if we get them more once. The problems described in Dreamland continue, of course, and the opiates of choice (the Houston Cocktail, for example) are different in other parts of the country. The book makes clear there are no easy fixes. If you want to know where at least some of the problems came from, though, Dreamland is a good place to start.