‘Dreamland: The True Tale of Opiate Epidemic’ by John Allen Paulos

The most interesting system linkage that I learned about in Dreamland was that the rise of opiate addiction in rural and regional America (first oxycontin, then heroin and now fentanyl) had three pillars, not two.

I had understood that the first pillar of the epidemic was the emergence of the painkiller industry and the formation of pill mills where doctors were highly incentivized to prescribe painkillers. This over prescription significantly expanded the addicted user base for opiates.

The second pillar was the emergence of new business model for dealing heroin. Mexican drug dealers were not loud and armed but drove around in old model cars, delivering small, highly potent bags. This delivery model, along with new sources of heroin in Mexico, supplied the previously painkiller addicted populations and reduced the effectiveness of reduced painkiller prescriptions in reducing overall addiction rates.

However, I had didn’t understand how any of the addicted people were able to finance their addiction which could run to hundreds of dollars per day. These cities and towns throughout the US mid-west are not overly wealthy places as many had experienced significant reduction in employment as manufacturing shutdown. There was not the level of income and opportunities that are available in the larger cities.

Dreamland proposes that the third pillar of the addiction crisis, particularly in paying for heroin, was the emergence of big box retailers like Wal-Mart. These big box retailers are blamed for a number of societal issues but I find the link to rising addiction to be quite interesting.

The author notes that, prior to big box stores, a series of smaller stores (either mom ‘n’ pop or regional retailers) would cater to the local population. These stores were manned by managers and staff who were incentivized to stop shoplifters and generally engage with the local population. If someone shoplifted, then there name was added to a list of people who were not allowed in the store.

But the big box stores had different operating procedures. Wal-Mart managed store losses across many stores so it was less concerned with losses in specific stores and viewed a certain level of losses as part of business. Employees may not have been sufficiently compensated to stop shoplifting. Addicts seemed to be able shoplift with relative impunity at big box retailers compared to previous stores, enabling these addicts to finance their addiction.

While there are some long leaps in logic in this system linkage (such as Wal-mart caring about losses less than previous stores), it is interesting that this third pillar may help us understand how the addiction has run so long and gotten so big in a place where there is relatively little money.

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