I didn't quite know what to expect when reading Quinone's book about America's drug epidemic, Dreamland, but probably the last thing I would have anticipated is that it felt very much like a business book. The suppliers of drugs have evolved to emulate something like a highly efficient pizza delivery business, and this is their story.
Pizza is probably also killing its customers, but that process is much more drawn out. The opiates that drug dealers are delivering cause deaths much sooner, and have much stronger other negative impacts (e.g. some consumers turn to theft, as some brains become single-mindedly focused on doing whatever it takes for the next hit).
Several changes to the way the drugs are physically delivered to its consumers resulted in strong growth for this product. Extremely poor (foreign) workers were brought in to make local deliveries at low cost. This way, a rich white kid would not have to venture to skid row to try something new; he can meet his dealer at the nearest Burger King. These workers were family friends with the operation's owners, resulting in low theft and little violence. Workers were also forbidden from using the product, resulting in higher quality. (Previously, along each step in a supply chain, the product would be diluted as each supplier needed to keep some for himself.)
Deal amounts were also kept low, to avoid law enforcement that was increasingly chasing a big score. The lack of violence also allowed talented individuals to start up their own competing businesses, further driving down prices.
As do most successful businesses, these ones also had some luck in their favour as well. A combination of an unchecked big pharma marketing campaign coupled with some bad science resulted in a dramatic increase in legal prescriptions for addictive pain medications. In its extreme, this policy resulted in unethical doctors' offices whose sole purpose was to collect cash in exchange for handing out prescriptions to junkies. The now super-efficient illegal businesses got to scoop up all these addicts with a cheaper, more potent product.
Based on some of the stupefying numbers in the book, I wouldn't at all be surprised if this epidemic was a leading factor into why America's labour force remains smaller than expected relative to history. I also have a new appreciation for the devastating effects of what these drugs can do.
The good news is that the tide does seem to be turning. Pill mills have been shut down. Perhaps as a result of a change in the demographic of junkies (i.e. rich white kids are now seriously affected), there is more political will than in the past towards helping junkies kick the habit rather than tossing them in jail. But it's not easy to become un-addicted; there will have to be a lot of money/effort spent to make progress in this domain.
The narrative is told very well, in my opinion, except that there is a lot of repetition and jumping around. Some of the repetition is helpful as a reminder though, since this is a long book. Nevertheless, I highly recommend it.