by Kenneth M. Hale

The misuse of prescription drugs and the resulting effects on our society is one of our most serious public health problems. This phenomenon has a bearing on the development of substance use disorders, worker productivity, personal relationships, the rising epidemic of heroin use, drug overdose deaths, and more. Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones (Bloomsbury Press, 2015) does a masterful job of elucidating an important aspect of this problem – factors driving the misuse of opioid pain medications and their relevance to the upsurge in the use of black tar heroin. This book is a must-read for anyone wishing to understand the influence of pressures to enhance treatment regimen for chronic pain, marketing approaches within the pharmaceutical industry, unscrupulous prescribing practices in so called “pill mills,” and a different business model for providing black tar heroin to those becoming dependent on these substances. Underlying all of this is a change in our culture, signaling a departure from “Dreamland” and the strength of our communities which can serve as a deterrent to this opiate epidemic that thrives in the isolation of our citizens.

Sam Quinones, author of “Dreamland”

I had the opportunity to interview Sam Quinones for a short podcast to be posted soon by the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery (HECAOD.osu.edu). I asked him about the significance of the Dreamland story for our college campuses. After all, we know that the traditional college student is at the average age when the misuse of prescription medications begins. So the lessons learned through his exhaustive research surely have relevance to our prevention efforts among college students. His response and his stories, like the fundamental theme of his book, relate to culture. How can we return to a collegiate dreamland were more of our students focus on the excitement of learning as opposed to the misuse of alcohol and drugs? How can we ensure that student athletes are not exposed to potentially dangerous pain medications in the interest of keeping them on the playing field? How can we make sure that more of our students have access to collegiate recovery communities to support their successful navigation of the college experience?

As Mr. Quinones spoke, our need for more holistic environmental approaches to prescription drug misuse prevention was on my mind. We certainly need to use resources such as those provided through the Generation Rx Initiative (GenerationRx.org) to educate our students about safe medication practices, but “Dreamland” will be built around other efforts as well. We must establish policies to guide our use of medications and consequences for misuse. We must partner with law enforcement, counseling services, student health, residence and Greek life, and disability services. We must engage well-trained peer educators. We must incorporate screening, brief interventions, and referral to treatment (SBIRT) models relating to prescription drug misuse. We must provide safe alternatives for our students to prevent recreational drug misuse or self-medicating tendencies. We must limit student accessibility to medications that are not prescribed for them by educating those who have prescription drugs legitimately about secure storage and by providing drug disposal options. And we must consider mechanisms for making naloxone available on our campuses to help prevent opiate overdose deaths.

Mr. Quinones has chronicled how Portsmouth, Ohio, has come “up from the rubble” to emerge from their status as “ground zero” in the opiate epidemic. Together, through the use of a more holistic approach to medication safety, we can help keep our campuses and our students out of the rubble as well.

Kenneth M. Hale, RPh, PhD, serves as Co-Director of the Generation Rx Initiative, Associate Director of the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery at The Ohio State University, and clinical professor in the Department of Pharmacy Practice and Administration at The Ohio State University College of Pharmacy. His professional interests and specializations include prescription drug misuse prevention. He recently was awarded Cardinal Health’s Pillar of Strength Award for his work with the Generation Rx Initiative.