I learned a lot from reading this book. Overall thoughts: I did not realize the opioid epidemic was such a big problem in the United States. In terms of raw information, I learned a lot about the Xalisco Boys, Big Pharma (especially Purdue and Oxycontin), the morphine molecule, and the scary addictive qualities of heroin. I liked that Quinones followed several different storylines, although that felt a little lost as I got near the end. I liked that he ended on a note of hope — that opiods, as an agent of change, has the potential to bring about positive changes in America, such as bringing about new communities.

I was also impressed about the Xalisco Boys' system in general. I was impressed that it was the "internet" of drug selling, and how they sold heroin "like pizza." Their decentralized system reminded me of blockchain and reminded me of all of the ideas about using blockchain for government.

Quinones did a great job tying in several different themes through the book - the genius of the Xalisco Boys' system, the morphine molecule's addictiveness, middle America's growing isolation and loneliness crisis, and the very close ties between prescribed opiods from pill mills and heroin.

The book ends with a note about how in Portsmouth, Ohio, after Dreamland (the pool/public area) was abandoned, a strip mall was built over the abandoned site. This made me think of Season 3 of Stranger Things, when the mayor builds a new mall, in order to hide the monsters that lie beneath it.

Notes

• Mexicans from small towns in Nayarit, Xalisco would make their money selling heroin then come back showing off their wealth with Levis 501s and designer clothing. The point was not to stay in America - the point was to come back to their small communities and show off their wealth.
  • "immigration was powered by what a poor man felt when he returned home with new boots, anew car, better clothes. That he could buy the beer int he plaza that night, pay for his daughter's quinceanera equal to taht of the daughter of the merchant ... that was a potent narcotic to any poor man." (21)
  • "Returning home to the rancho was THE point of going north. The homecoming had no power in anonymous big cities"
• Xalisco Boys' System
  • Like Uber for Heroin!
  • They cared a LOT about customer experience
    • Took advantage of middle class white people who want service and convenience. so delivered all of the heroin via cars, make it safer for the white kids so selling drugs moves off from the street
  • Sold smartly. Sold consistently good and potent heroin that wasn't watered down (because the drivers didn't use it and didn't care about watering it down). Sold small quantities. Sold exclusively to white people
  • Corporate
• Porter and Jick's 1980 letter to New England Journal of Medicine
• Excess in America as paving the road for heroin to take the place as the child of consumerism
  • "Excess contaminated the best of America." (37)
  • Morphine molecule as emblematic of USA's age of excess.... "poster molecule for an age of excess" (39)
• The Mexicans were literally just taking advantage of pure cold capitalism. "The Xalisco heroin system was a lot like the United States in that way. America fulfilled the promise of the unknown to rancheros, and an escape from humiliation for Mexico's poor from villages..." (72). Xalisco heroin system is like the American dream - you have to take risks, be hardworking, creative to find the right markets, but then you can make bank
• 1980s, doctors push back against the serious stigma against using opiods. They want to use opiods to manage pain.
  • Bonica - wants multidisciplinary approach to dealing with pain. Insurance doesn't want to pay for this. And a lot of other doctors are looking more for the universal pill that will cure everything. Opioids look like they can be that solution!
  • Poternoy - opiods only affects "certain kind of brain." Cites Porter and Jick, opiates are not inherently addictive, depends on the type of person taking them (92)