Dreamland: Part 2: Two-Thousand-Year-Old Questions Summary & Analysis

In Cambridge in 2000, Dr. Nathaniel Katz arrives at the Royal Sonesta Hotel to deliver a speech on pain management in AIDS patients. There, a young woman confronts and accuses him of killing her brother. Katz graduated medical school in 1986 and eventually specialized in pain management, where he was immersed in rhetoric inspired by Porter and Jick. Katz would go on to prescribe many opiates, including to Peter, the young woman’s brother, who eventually died of an overdose.

The American pain revolution was over by the 2000s. By this point, most pain patients were prescribed painkillers—not by specialists, but by general practitioners. In a time Quinones considers to be characterized by excess consumerism, pain patients were met with an excess of prescription pills. Overdose deaths were on the rise.

In response to reports of opiate abuse, doctors tried prescribing methadone instead, as it stayed in the system for longer and wasn’t craved in the same way as OxyContin. But methadone, though chemically long-lasting, didn’t provide long-lasting pain relief. As a result, addicts took more methadone and overdosed on that instead. Unlike milder opiates abused by addicts in the past, like Vicodin, OxyContin’s large doses of oxycodone meant it was a more feasible “gateway” drug for heroin use. As the Man had predicted when he arrived in Wheeling, West Virginia, OxyContin addicts turned to heroin when their habits became too expensive to support; in fact, 80 percent of new heroin users had started on a prescription painkiller.