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Part 1: Enrique
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 1979, 20 years before Enrique will arrive at the Yuma International Airport, Hershel Jick is a doctor at Boston University School of Medicine. Jick starts a database of patient hospital records in order to record the effects of different types of drugs on hospitalized patients. He is curious about what percentage of patients will become addicted to the narcotics they receive at the hospital.
Before the pain revolution that began in the 1970s, use of narcotics was highly stigmatized in the medical community due to narcotics’ addictive quality. Jick’s curiosity about addiction rates among patients reflects the beginning of a shift, in which doctors would become more open to using narcotics to treat pain patients.
Themes
Jick publishes his findings in a single paragraph: of nearly 12,000 patients who were administered opiates before 1979, only four became addicted to the drugs. The paragraph contains no specific details concerning the how often or how long patients were given drugs, or what types of drugs were administered. It didn’t claim to be a thorough study. Jane Porter, a graduate student, helps Jick assess the data. On January 10, 1980, the findings are published in the New England Journal of Medicine, under the title “Addiction Rare in Patients Treated with Narcotics.” After this, Jick forgets about the short paragraph.
The paragraph Jick published suggests that addiction is rare in patients treated with narcotics, but his findings are misleading, as these patients were administered narcotics in a controlled, highly regulated environment. In contrast, doctors who prescribed OxyContin in the mid-1990s would often prescribe large quantities to patients under minimal supervision, allowing for a higher likelihood of abuse and dependency. Despite this, Jick’s findings would be used by doctors and pharmaceutical companies alike to defend the use of narcotic painkillers in the treatment of pain.
Themes
