In the book Dreamland, by Sam Quinones, Quinones tries to strengthen our inadequate classroom focus on opioid addiction, and pain management. The teaching of these topics are limited across U.S. medical schools. Yet, in the past year, the subject matter of opioid addiction has come up many times. Throughout Quinones’s book, he weaves together two national stories that collide in Ohio, in the small city of Portsmouth. Quinones tracks the rush of heroin harvested in Mexico, while at the same time also tracking the rise of opioid prescriptions. As dealers were coming up with new ideas, and working in the 1990s to find new markets for uncut heroin, prescriptions for opioid to deal with chronic pain was growing in its influence in many areas such as :pharmaceutical companies, doctor offices, and medical conferences. In sum, through Quinones’s telling of opioid history, he illustrates a story that warns us of the practice of medicine in modern history.
I was really interested to read Quinones’s chapter called Two Thousand year Old Questions, where he discusses opioid overdose, and he incorporates numbers, and statistical evidence, which helped me get a better understanding of opioid overdose rates (Pg. 190-192). I never realized how big of an issue opioid overdose really is, but after reading the numbers I understood how prevalent of an issue it really is, and got a better understanding of how quickly the rates of overdose are increasing. For example, Quinones writes that “ Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012.” (Pg. 190) I find this scary how the rates of opiate use is increasing so dramatically. Quinones goes on to write that “Abuse of prescription painkillers was behind 488,000 emergency visits in 2011, almost triple the number seven years before.” Quinones later on, also explains that as opioid prescriptions escalated, overdose deaths followed. I was shocked to read that in 2007, Purdue paid $634.5 million in federal fines for misrepresenting OxyContin’s potential for misuse and addiction. This was one of the largest penalties charged on a drug company at the time. Since then, prescription opioid overdose death rates continue to rise, and heroin overdose death rates have increased four times as much since 2010 because the drug has become an easier and cheaper alternative. (Pg. 192) I found it frightening that drug companies sometimes misrepresent what they are selling, and do not warn consumers of the potential risks that they may later on have to deal with, such as addiction. Addiction is not a small issue, and is instead a matter of life and death because if one is so strongly addicted they can overdose and possibly die.
Throughout the book, I kept wondering how physicians, who tried to do what was best for their patients, ended up facilitating in their affliction. I think that this question falls under one of the most important ideas in Dreamland, which is the lesson of misrepresented scientific evidence, and the huge role it plays in its impact on us. The common idea that opioids are a minimally addictive treatment for chronic pain, was only based on a few small studies. These studies had a huge influence as the pain revolution began joining with the fortunes of the opioid prescription industry.Quionenes mentions this idea when he describes that in 1980 there was a letter to the editor in The New England Journal of Medicine called “Addiction Rare in Patients Treated With Narcotics.” Quinones notes how the letter’s reputation grew into a “landmark study” showing that “less than 1 percent” of patients treated with narcotics become addicted (Pg. 107). This letter, however, was not completely accurate because the letter referred to only hospitalized patients, and not outpatients in chronic pain, so the letter was inadequate and yet, was repeatedly cited in seminars and conferences worldwide. I found this concept of how false information can circulate so easily frightening. Often times we believe things because we think that all studied are accurate, but as clearly seen with this letter, this is not the case, or we have to pay very close attention to specifics. I overall found this book really interesting because I’ve never realized how big of an issue overdose really is in today’s society, and how drastically the rates of overdose are increasing. This is definitely a problem that needs to be fixed.
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