Dreamland is well-reported and consistently interesting, but its chapters are chopped into tiny pieces that interrupt narrative flow—the word dream is disrupted. Many if not most chapters are around 800 to a thousand words, yet the book covers several important threads: the rise and marketing of Oxycontin maker Purdue Pharmaceutical; the drug sales practices of Xalisco natives who figure out how to game the U.S. legal and immigration systems; and the insatiable love Americans have for drugs.

Despite the chopped narrative problem, however, Dreamland covers important developments around opioid addiction and its origins. The better sections are arresting; for example, the description of the Xalisco traffickers could be from a business case study, as the Xalisco organizations respond to a number of different factors: supply and demand, a difficult regulatory environment, and unique managerial challenges (the best business case studies are themselves little novels, with the artistry that implies).

In many forgotten cities, most of the wealthy top has left or disappeared, most of the productive middle has moved to a relative handful of cities and suburbs, and many of those who remain are poor. While elite cities accrue service-sector advantages and develop information economies, many other places that existed for agriculture or manufacturing are suffering, and there’s no real way to help them. As a result, “Remaining behind was a thin slice of educated people. They found work in the schools or the hospitals, in some way or other tending to those for whom the factory closings were the beginning of an American nightmare.” “Nightmare” is too strong a word here—one thinks of Behind the Beautiful Forevers—but the challenges seem insurmountable over the short term.

“Nightmares” is not the only linguistic misfire. Some of the writing is cliché: “Two Portsmouths exist today.” You will have heard the “two [geographic area]” terminology. Some sentences are merely banal. Too many say things like, “I learned, too, that envidia—envy, jealousy—was a destructive force in the rancho.” Is there any society for which that is not true? Every society experiences envy, hate, jealousy, striving, signaling, and so on.

In the Two Portsmouths,

One is a town of abandoned buildings at the edge of the Ohio River. The other resides in the memories of thousands in the town’s diaspora who grew up during its better years and return to the actual Portsmouth rarely, if at all.

Heroin remains a statistical phenomenon for me, maybe because of where I live. I’ve never known anyone who has admitted to doing it and I’ve never been offered it. No one I know has died from it. It’s just… out there, somewhere, mostly in the media (which is maybe a reason to read less news, not more). Yet it’s killing tens of thousands of people a year. Dreamland takes this data from statistical abstraction to specific people.

Be ready to notice more after you’ve read Dreamland. For example, the Wall Street Journal just published “For Small-Town Cops, Opioid Scourge Hits Close to Home,” this time about a common drug named fentanyl.

Dreamland’s ending disappoints, maybe because there is no real solution short to the problem. Decriminalization and better treatment options may help but will not cure. The policy recommendations Quinones offers amount to “more of the same.” We may see improvements at the margins but are unlikely to see a solution to the problem of humans liking mind-altering substances.

Here is Isaac’s take on Dreamland. Here is Tyler Cowen on rural America, suggesting we “Support a voluntary temperance movement for zero alcohol, zero drugs.” It’s not for me but I take the reasoning seriously and it’s clear that large numbers of people can’t handle alcohol or drugs, for whatever reasons, and that the pharmacological utopians of the ’60s and ’70s were wrong, or wrong about the experiences of many people.