Book Review – Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

In our emergency department, we have begun to refer to different practices in the ED as “BD” and “AD” - “Before Dreamland” and “After Dreamland”.  Colorado ACEP helped to host a conference called “Dreamland in Denver”, and Sam Quinones, the author of the book Dreamland: The True Tale of America’s Opiate Epidemic, has become a “go to” speaker for everyone from the AMA to the United States Senate. Therefore, in this first Medical Directors newsletter, we bring you some reflections on Dreamland: The True Tale of America’s Opiate Epidemicby Sam Quinones.  

The book is a fact based, well written, and researched book about the opioid epidemic. It parallels the illicit drug trade, with the growth of use and abuse of opioids, and the role of the medical community.  The beauty of Dreamland is its ability to tell the complex and fascinating story of the growth of the opioid epidemic in a way that is available and interesting to many audiences. It resonates with physicians, patients and families, and policy makers.

I first came across Dreamland when a physician in another community hosted a book club. She shared how she read it, took it to her medical staff, and how it took off like wildfire. I took it back to our group, and the same thing happened. Within months, most of our ED groups and many of our medical staff had read the book. Soon, we were having much different conversations with our patients, and quickly we were seeing a change in the opioid prescribing patterns in our department. We would look back on charts and say, “that must have been “BD” given the prescribing patterns.”

Soon, both state and national legislators started to talk more about the opioid crisis, and we took Dreamland with us, gave away copies, and helped to spread information about how the opioid epidemic happened, as well as potential solutions. Within six months, our legislators were quoting the book, and the wildfire of information grew. 

We were trained to care for our patients - we were told how to reverse an opioid overdose. However, to really care for those same patients, we must be involved in the larger ecosystem of that immediate clinical interaction. That may be understanding group prescribing patterns or hospital policies that prevent outpatient addiction treatment or social factors encouraging that patient to reuse. I believe this is why many of us are medical directors. It is a chance to truly care for our patients beyond the immediate bedside interaction, and we can start to transform, in our own ways, the ecosystems we practice to better help our patients. When it comes to transforming the ecosystem around the opioid crisis, Dreamland is a powerful tool. It can be used both personally and professionally to help understand the opioid epidemic and create ecosystems within our own departments and beyond. In the face of a 30% increase of opioid overdoses in the country, Dreamland is a must read for every medical director.

Anne Zink, MD, FACEP