The dual corruption
The book explains that in addition to the rise of drug cartels which could supply heroin through a network of conglomerated gang operations, another corruption was necessary to lead America to this Opiate Epidemic. That corruption is the monetary advantage that Purdue Pharma was able to attain by encouraging doctors and the public to try OxyContin, knowing that the drug would have the unintended consequence of full-blown drug addiction.
The irony of pleasure
The patients, even if they were advised about the addictive nature of opiates, were completely in the dark about the absolute bliss of chemically induced ecstasy. The pleasure experienced (especially if the drug was doubled up, as in cases of serious pain) would often lead to transcendental experiences of bliss that surpassed the patient's prior conceptions. Then, when the drug wore off, and the feeling of infinite bliss was shown to be finite, addiction was likely. Imagine going from absolute euphoria to absolute pain and suffering. The temptation becomes severe.
The wrong narrative
In addition to the ironic problems of addiction and medical malpractice, there was another issue that complicated the epidemic in a painfully ironic way. The narrative about opiate addiction was colored by worst-case scenarios, so that people with addictions were made to feel ashamed of themselves. This made addiction into a private matter, and without access to community or support, many people spiraled. A person could go to the doctor as a well-intending patient and then be a heroin addict only months later. It is still a major cause of heroin and opiate addiction today—this epidemic has continued for these reasons.
The wildfire effect
When the crisis began, it went from a minor issue to a major epidemic in nearly no time. The wildfire effect of addiction, medical malpractice, and misinformation among the media was so overwhelming that Quinones reports seeing addiction epidemics as far east as Tennessee. Entire communities were devastated. Gangs rose to power with new incomes as more people grew dependent on illegally sourced opiates and heroin. The epidemic was more explosive and powerful than could have been anticipated.
The need for community
When Quinones offers his example of a potential solution, there is an irony in the air. He says that in his studies, he encountered a community in Ohio that began a community outreach program at the pool called Dreamland. Dreamland was an example of how the epidemic of addiction could be alleviated by community support, by a refusal to shame addicts, and by offering infrastructural assistance to help people get back on their feet. Community support, which sounds like a trite truism, was actually effective.
