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Part 3: A Parent’s Soul Pain
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
Five years after Quinones first stood along the Ohio River contemplating where his research would lead him, the opiate epidemic has finally become visible. Heroin addiction is no longer singularly associated with “the back alleys of New York City and William Burroughs’s Junky”—it is everywhere. America’s supposedly “safest” towns are full of overdosing kids.
The opiate epidemic has transformed the American public’s mindset toward addiction, lifting many of the stigmas with which it was previously associated.
Themes
Philip Seymour Hoffman’s death of a heroin overdose at 46 was met with national attention: media outlets across the country spread the message that opiate abuse was real and widespread, and people were dying. Heroin abuse ensued in addicts who started on prescription painkillers. U.S. Attorney General Eric Holder proclaimed a “public health crisis.”
The death of a public figure resulted in public outcry. By extension, if more individuals could go public with their stories of addiction, perhaps even more steps can be taken to address the epidemic across the U.S.
Themes
America responded to the epidemic, but not soon enough. By the mid-2000s, there was a consensus that prescription opiates were addictive. Purdue Pharma reformulated OxyContin in 2010 to make it harder to inject, which worked, but not before the drug company had created a nation of addicts. When OxyContin could no longer be abused, these addicts turned to heroin. The pharmaceutical “arms race” was over by 2014, and salespeople no longer swarmed doctors’ offices with exaggerated claims and free samples. In their place arrived lawsuits and criminal cases. Major drug companies like Pfizer and Purdue were accused of “misbranding and false advertising.”
The shame, stigma, and misinformation that went unchecked from the mid-1990s onward allowed the opiate epidemic to grow in size and strength. By 2010, Purdue’s reformulation of OxyContin was too little too late. The “arms race” of the legitimate business world might be over, but the underground markets for opiates that this indirectly developed continue to spread drugs and addiction. As of June 2019, 48 states have sued Purdue Pharma for the role they played in the opiate epidemic. As of Dreamland’s publication, Pfizer had paid over $300 billion in fines for misbranding and false advertising.
Themes
Multidisciplinary pain treatments are now reentering common practice, with emphasis on therapy and lifestyle choices. The FDA requires drugs to release addiction risks associated with painkillers to doctors and patients.
The resurrection of multidisciplinary pain treatments suggests that humanity is less sure it will ever find a “Holy Grail” drug to treat pain: in reality, pain is too complicated to be treated with a single pill.
Themes
Get the entire Dreamland LitChart as a printable PDF.
However, American medicine now stigmatizes opiates to a degree reminiscent of the stigmatization that existed before the pain revolution began, and patients who legitimately need opiates for pain are running into roadblocks to getting adequate pain relief. On top of this, there simply aren’t enough primary care doctors to provide the time and personalized care necessary to treat these patients. Ultimately, pain is still a mystery to doctors, as are the forces that lead to addiction, and doctors live in constant moral conflict: should they alleviate their patients’ pain and risk addiction, or allow them to suffer indefinitely?
America struggles to settle on a happy medium: either painkillers are overprescribed and addiction runs rampant, or painkillers are under-prescribed and vulnerable patients are left suffering. The shortage of primary care doctors shows that the business side of healthcare remains an obstacle to responsible, effective pain management, as well. At the end of the day, pain is complicated, and it’s naïve to believe in a simple solution to a complicated problem.
Themes
