Dreamland: The True Tale of America’s Opiate Epidemic

In the mid-20th century psychiatrist Arthur Sackler had what would prove to be a revolutionary insight about pharmaceutical advertising: While other forms of medical science were making huge strides, the advertising of those drugs was stuck in the past, “even as the new drugs it promoted were changing the world” (28). That realization led Sackler to switch careers, and he soon led an advertising campaign for an antibiotic called Terramycin. In selling the drug Sackler emphasized direct contact with doctors, including advertising in medical journals, postcards, and visits from salesmen; this revolutionary approach made the drug incredibly successful. Sackler’s strategy became relevant to this story when applied to Valium, a tranquilizer that was pitched as a panacea for stress, regardless of the root causes of that stress—much as OxyContin was later advertised for pain treatment, decades later, by the company Sackler founded: Purdue Pharma.

Throughout the book Quinones details how Purdue refined and expanded Sackler’s pioneering approach, which helped Purdue overcome a longstanding mistrust of opiates and made OxyContin into a runaway success. In the 1980s the concept of pain was changing; doctors came to see patients as having a right to be free from pain, and the makers of drugs like OxyContin benefitted hugely from this shift. What positioned OxyContin so well was Purdue’s unsubstantiated claim that its timed-release formula made it less addictive, a claim so taken at face value that the FDA allowed Purdue to put it on the drug’s warning label, facilitating widespread abuse. The warning label also functioned as a kind of advertising for addicts, as it noted that crushing pills could yield a toxic amount of the drug—a feature that allowed OxyContin to drive the opiate crisis. Finally, just as Sackler had initiated with Terramycin and Vicodin, aggressive direct advertising ensured doctors were aware of OxyContin’s benefits for all kinds of pain and almost entirely unaware of the risks. This approach, which often involved lavish gifts, dinners, and trips, as well as sponsored seminars, encouraged well-intentioned doctors to prescribe medication that would often ultimately be dangerous to their patients and the broader community. Meanwhile, sales reps for Purdue made bonuses that “bore a striking similarity to the kinds of profits made in the drug underworld” (134). Thus the sales strategy used for OxyContin was essential in creating the opiate crisis.

Purdue and other pharmaceutical companies weren’t the only players to use advertising to sell their product. Just as Quinones notes the money made by pharmaceutical sales reps resembled that of drug traffickers, the approach taken by drug traffickers to sell their product looked a lot like that of major corporations. By selling a potent product directly to addicts, courting them with free drugs, being polite and solicitous, and delivering directly to their doors, the Xalisco Boys not only sold to these clients but also had these addicts recruit new customers via word of mouth, in return for more heroin. In this way, their direct and aggressive strategy mirrored that of Purdue in marketing directly to doctors. The Xalisco Boys’ approach resembled a corporation in another way: Unlike other drugs and forms of heroin, which were often adulterated, black tar heroin was consistently potent and pure, no matter which dealer you bought it from, which created “a brand every bit as dependable as a Coke can or a Holiday Inn sign. You always knew what you would find inside” (176). This marketing approach made the Xalisco Boys hugely successful and allowed them to expand across the United States, furthering the opiate crisis.