Dreamland : the true tale of America's opiate epidemic

by Sam Quinones

Paperback, 2015

Status

Available

Publication

New York, NY : Bloomsbury Press, 2015.

Description

Sam Quinones chronicles how, over the past 15 years, enterprising sugar cane farmers in a small county on the west coast of Mexico created a unique distribution system that brought black tar heroin-- the cheapest, most addictive form of the opiate, 2 to 3 times purer than its white powder cousin-- to the veins of people across the United States.

Media reviews

... a meticulously researched new book ... Mr Quinones tells many tragic tales, including of the deaths of teenagers drawn to heroin after they were wrongly prescribed strong opioid painkillers. He also has some more uplifting stories of policemen and district attorneys who slowly pieced together
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the Xalisco Boys’ business model and took action
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1 more
...a book that every American should read. And I state that without reservation ... Dreamland is the result of relentless research and legwork on the part of Quinones, as well as his talented storytelling. The opiate addiction epidemic was caused by a convergence of multiple, seemingly unrelated
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factors, and Quinones takes these narrative strands and weaves them together seamlessly.
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User reviews

LibraryThing member Whisper1
In Portsmouth, Ohio circa 1929, the town built a foot-ball field size pool. It became the center for generations to swim, meet others, eat french fries and hot dogs and enjoy a slice of the American dream. That was then, now the town has fallen to decay. Businesses are gone as families moved away.
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In place of a close-knit community, are major pill mills of distribution. By the mid 2000s, Portsmouth had more pill (OxyCodone, OxyContin,, dilaudid, vicodin) mills per capita than any other in the US. Difficult to believe, it was at one time a thriving community of hard working, blue-collar people who were happy.

Fast forward to today where across America, in small and big towns, cheap, easy to find black--tar heroin is the desired drug of choice. Leading to severe, almost immediate addiction, this potent drug flourishes and races with lightening like speed across the highways and byways of America.

Indeed, it is difficult to know someone who has not been impacted by the effects of drugs upon the social fabric, ripping and tearing apart any safety net imagined, heroin addiction crosses all socioeconomic classes.

The author traces the arrival and incredible snake like, fast-moving poisonous web throughout small-town America,to one major Mexican cartel. In the 1990's, The Xalisco Boys from Nayarit, Mexico were genius in their pizza-like delivery plan. in their wake, they continue to leave thousands upon thousands highly addicted and dead,

In search of the American dream, The Xalisco cartel use poor Mexicans to carry small, rolled balls of heroin in balloons in their mouth. Fanning out across the border, to fit in, they tend to choose communities with a large Mexican population already in place. As soon as they are given a cell phone, the multiple calls arrive all day long, and the young men are more than happy to deliver door-to-door.

This multi-faceted problem has many veins. Coupled with the quick, easy, cheap way to get addicted to herion, hand in hand, is American's addiction to pain killers. Narcotics industries revolutionized advertising both to doctors who dispense, and Americans willing to take mass doses of highly addictive medication.

Arthur Sackler was the revolutionary mind who unleashed the drug advertising campaigns touting the joys and benefits of pain medications. If you visit the New York Metropolitan Museum, you will find an entire wing dedicated to his art given to the met. Not only successful in accumulating art, he was just as craft in advertising opiates. So highly successful was he that In 2008 overdose from opiates outnumbered deaths by auto accident.

Researchers discovered that in the molecular structure of opiates is a compound that fits like a key in a lock, opening the feel-good high calling for larger and larger quantities.

This unlocking structure of opiates makes it so very difficult to give up the habit. Researchers found that the body is so amazing at holding on to this substance, that even the kidneys rebel against eliminating it from the system.

While the book could have been less redundant, I think the author cannot be faulted for this. In his aim to hit the mark of how very insidious this is, he needs to repeat the figures over and over. Like someone who simply cannot believe a terrible fact, he stresses over and over and over again just how very terrible the American landscape has become.

Difficult to read, but recommended.
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LibraryThing member Stbalbach
Dreamland: The True Tale of America's Opiate Epidemic is essential reading because we will all be in pain someday, and doctors will want to prescribe opiates, for example 120 pills when you might only need 10. Eighty-percent of the worlds opiates are prescribed in the USA. We live in a culture of
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no-pain and instant gratification and the end result is an epidemic. It started with Purdue Pharma which has been described as a legal drug cartel. They unleashed a wave of opiates on America starting in the 90s in Ohio and Kentucky (thus "Hillbilly Heroin"). They made ungodly amounts of money selling highly addictive Oxycontin under the false premise it was not addictive (for people in pain). When casual users became hooked, they turned to cheaper heroin - same molecule, different packaging. Enter the Mexican heroin ("black tar") dealers.

The book is full of fascinating stories and insights into how the heroin world works. Nearly every preconception I had was shattered. Heroin has gone mainstream, it's middle-class and gentrified. The dealers resemble pizza delivery franchises and work in nice neighborhoods favoring only whites. No guns, no violence, only good customer service and high quality product delivered to you within the hour. Safe, cheap, reliable, abundant. All sourced to the same town in Mexico. Indeed most of the dealers are from the same town. It goes on.
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LibraryThing member Darcia
This book is a fascinating and disturbing look at the connection between the use of prescription opiates and heroin addiction. The author blends facts with real life stories, pulling us into this world where pharmaceutical companies and pill mill doctors are knowingly creating addicts.

Much of the
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story centers around Portsmouth, Ohio, a blue-collar town where families once thrived. We follow its history, through an economic collapse, the burgeoning pain clinics and Oxycontin push, and the subsequent onslaught of heroin dealers and addicts.

But the problem is certainly not limited to this one area of Ohio. Quinones takes us through the country, where opiate and heroin addictions go hand-in-hand.

We also learn about the Xalisco Boys, a loosely formed group of Mexican immigrants who take advantage of the new opiate addiction by providing a cheaper alternative. Black tar heroin comes from Mexico, not Afghanistan, and it is a far worse problem than the white powder has ever been.

Throughout this book, we meet the addicts and their families, the dealers, the doctors, and the DEA agents who are trying to make sense of this fast-growing epidemic.

Oxycontin, Oxycodone, and heroin all come from the morphine molecule. One is not safer than the other. They are all highly addictive drugs. Quinones uncovers the lies told to doctors and to patients about the supposed safety of the Oxy product, with pharmaceutical representatives calling it nonaddictive and pushing doctors to prescribe in increasing dosages. The pharmaceutical company here is worse than the street dealer, as they purposely and knowingly create a nation of addicts all in the name of profit. Yet no one is locking them away for their crime.

This is a book that needs to be read by the masses. We have become a nation of drug addicts. Putting it in pill form and labeling it 'medication' only means our dealers are now pharmaceutical companies instead of drug cartels. That is, until the doctor cuts us off or we can't afford the pills anymore. Addiction doesn't go away because the doctor stops writing prescriptions or because the pills cost too much. When that happens, we just turn to the cheaper alternative. Whether we call them 'legal medications' or 'illegal drugs', it's all the same and it's all destructive.

*Neither I nor the author make the claim that pain meds should not be prescribed and used appropriately - only cautiously.*

**I was given a free copy of this book by Bloomsbury via NetGalley, in exchange for my honest review.**
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LibraryThing member RoxieT
The decline of Scioto County hits home for me because my grandfather has lived in that area much of my adult life. In the early 2000’s, I would often hear side comments about "folks just using that stuff”, but never fully conceptualizing the extent to which narcotic pill abuse and heroin had
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permeated the area. This is a very informative book, and I gained so much insight through the manner in which the story unfolded on the pages. But this book also felt like an emotional roller coaster. At times, I was shocked, or disgusted, angry and then sad, yet thankful that the epidemic didn’t hit close to my actual home—my cousins, friends, classmates, aunts, uncles, etc. I left feeling, as a physician, bewildered by the notion that a country of physicians and healthcare providers were all duped by rather vague details. How could a country of people wanting to do good (mostly) fall prey to such corporate baiting? I remember attending pharm rep dinners during my residency training, which occurred during the years when America finally woke up to the opioid epidemic. I often joked with my peers that good steak wasn’t enough to persuade me to prescribe medications blindly. But, I wonder, would I have dug through stacks of old NEJM archives to locate one editorial…
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LibraryThing member zmagic69
This is a very scary, sad, true story, about the drugging of America. You will not forget what happened to our country as a result of greed, ignorance and incompetency!
I came across this book as a recommendation on Amazon based on past purchases. I expected a story similar to Methland, and wound up
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blown away. This is a very scary book, detailing how greed, ignorance, profit, and pure negligence on the part of doctors, big pharma, and the government went about getting a large portion of the population to take opiates for pain, ignoring hundreds of years of proof that these drugs were highly addictive.
At the same time this was happening a large number of enterprising Mexicans from a small state in Mexico began selling cheap, high purity heroin around the country.
The Mexicans set up a business plan as coordinated as a large American company seeking to rapidly grow by franchising. This was happening at the same time you had Doctors and pharmaceutical companies behaving like street corner drug dealers.
The only difference between the two groups was that the drug the doctors were pumping down Americans throats was legal. The difference between the drugs themselves was negligible.
Read this book!
Yes this book could have had a better editor, to manage the storytelling and reduce some of the redundancy, but to let this get in the way and not read what is a must read book, would be a shortsighted decision.
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LibraryThing member TheAmpersand
Dreamland is important book, and perhaps even an essential one, but it's by no means perfect. The author does a lot of things very well here. He's good on background, telling readers how both doctors' and patients' perceptions of pain, coping strategies, and opiates evolved over the course of the
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last hundred years. He provides a clear, concise description of what makes OxyContin different from the painkillers that came before it. His description of the heroin and smuggling distribution network that grew out of the out-of-the-way Mexican town of Xalisco is meticulous and fascinating, and he apparently took the time to interview a significant number of individuals that were involved in both building and combating this unusual criminal enterprise. He paints a vivid portrait of the Appalachian communities ravaged by the opiate epidemic. These parts of "Dreamland" will certainly sate the appetites of readers on the lookout for disaster porn, as will his descriptions of the wild scenes that took place inside -- and even in the parking lots of -- the notorious "pill mills" that grew up around rust-belt towns during the first decade of the new millennium. Even so, his account of the parents who chose to break their silence and discuss their children's struggle with opiates directly is both sensitive and heart-wrenching. There are places in "Dreamland" that eloquently address the social climate that facilitated the growth of the opiate epidemic, from increasing social isolation to medical malpractice to industrial decline to governmental neglect. In some ways, Quinones seems to have been writing about the opiate epidemic in real time: my copy of the book contains an afterword, but was published before the fentanyl epidemic really hit and bootleg pills became commonplace. "Dreamland" ends on a positive note, showing the various ways in which the southern Ohio town of Portsmouth has staged a brave comeback in recent years, even as its drug problem persists. But one can't help but wonder how the town fared in the years after "Dreamland" was published, when the opiate epidemic grew even worse.

The book has its weaknesses, though. I got the sense that Quinones found two interesting stories -- one involving a small town in Mexico that set up an unusually efficient and resilient drug-distribution operation and the other that involves America's disastrous addiction to potent painkillers -- and decided to combine them in the same book. As fascinating as it is to read about, the author never quite convinced me that the Xalisco Boys network was essential to the opiate epidemic and that it would not have happened had this network not existed. The author readily admits that there were big markets that the Xalisco Boys network never touched and that opiates have been a persistent problem in some American cities for generations. I tend to think that supply tends to follow demand in these situations, and, at one point, he basically admits that if they hadn't somebody else -- perhaps the already established Mexican cartels -- would have sold dope to rural Americans. Quinones also seems to put a lot of emphasis on how the demographics of heroin usage has shifted, but it's unclear whether it's he or his subjects who seem appalled that well-off white kids are getting high and dying from heroin rather than the sort of people who've traditionally been drawn to the drug, which would include poor urban black folks and artsy types. Furthermore, I was never quite convinced that the Dreamland -- once a much-loved public pool in Portsmouth, Ohio -- made a fantastic allegory for the American experience, but towards the end of the book the author really ratchets up the nostalgia in a way that I found truly exasperating, taking aim at trigger warnings and parents who won't let their kids play outside anymore. It's a shame that a book that's so frequently insightful would end with such banal musings on how Americans have gone all soft. In other words, the author seems to be requesting that the reader get off his lawn. Despite these misgivings, "Dreamland" is an eye-opening read, one of those books that you wish every American would read. Not perfect, but certainly recommended.
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LibraryThing member abycats
Almost overwhelming in its details of how legal opiates led to the heroin epidemic. As someone with several friends whose chronic is pain has been under control and who are now facing total disaster from the outgrowth of this book, I wish it had concentrated a bit more on not throwing out the baby
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with the bath water. I know of at least one suicide of a person who simply could not cope with being told they would again have to face debilitating pain simply because their doctor felt they lacked the power to prescribe. Yes, the heroin epidemic and the sale of over prescribed pills are real and rampant. But please -- a little more thought for those with chronic pain who have had long-term relief with prescribed opiates.
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LibraryThing member jlbattis
Two horrifying tales of unintended consequences, brilliantly interwoven by a master of narrative nonfiction. Powerful and important.
LibraryThing member GShuk
Great eye opening, compelling story worth reading. It could easily have been a 5 star if 1/4 of the repeated material was removed. The repetition caused confusion and made the story drag in parts.
LibraryThing member jaylcee
Very hard book to read because it is disturbing to be made aware of how widespread addiction to opiates and heroin is. I found it appalling that people do not care if they destroy other people as long as they can make a buck. This includes not just the drug dealers. It applies as well to doctors
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and pharmaceutical companies. Quinones makes some very interesting observations in his afterword which, if expanded upon, could be another book on the societal ills facing America and the breakdown of community.
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LibraryThing member dcoward
A fascinating, sobering, and at times even hopeful look at the opiate and heroin epidemic in the United States.
LibraryThing member cookierooks
Would have been better if less disjointed, wanted to know more than soundbites, jumped around a lot.
LibraryThing member crazybatcow
The most significant issue with this book is that the author repeats "facts, or summaries of events, regularly. It seems like the bulk of the 'chapters' were originally essays which had the intro, body and resolution sections in each, and when they were collated into a book, each chapter still read
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like an essay. This isn't as bad as it sounds, as long as you're not looking for a single narrative story. The content is interesting.
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LibraryThing member breic
Powerful story of the heroin epidemic. It follows both the drug dealers and the physicians, while also giving us tear-jerking stories from the addicts and their families. Quinones does a good job explaining the economics of the epidemic, from all perspectives. I found the explanation of the pill
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economy in an afflicted Ohio town interesting, although I don't entirely buy Quinones's hypothesis that Walmart to some degree enabled the economy by allowing shoplifting.

Weaknesses: Not all areas get equal depth, particularly the drug companies. Quinones gives us more anecdotes than numbers, so it is not clear how much we can trust his conclusions.

Timeline:

> 1980: The New England Journal of Medicine publishes letter to editor that becomes known as Porter and Jick. [Of almost twelve thousand patients treated with opiates while in a hospital before 1979, and whose records were in the Boston database, only four had grown addicted.] Early 1980s: First Xalisco migrants set up heroin trafficking businesses in the San Fernando Valley of Los Angeles. 1984: Purdue releases MS Contin, a timed-release morphine painkiller marketed to cancer patients. … Early 1990s: Xalisco Boys heroin cells begin expanding beyond San Fernando Valley to cities across western United States. Their pizza-delivery-style system evolves. 1996: Purdue releases OxyContin, timed-released oxycodone, marketed largely for chronic-pain patients.

> only in 2010 did the NEJM put all its archives online; before that, the archives only went back to 1993. To actually look up Porter and Jick, to discover that it was a one-paragraph letter to the editor, and not a scientific study, required going to a medical school library and digging up the actual issue, which took time most doctors didn’t have.

> … A small town of sugarcane farmers grew by the early twenty-first century into the most proficient group of drug traffickers America has ever seen. The first migrants from Xalisco settled in the San Fernando Valley—in Van Nuys, Panorama City, and Canoga Park… The Xalisco Boys supplied these junkies' habits in exchange for help in moving into a new area, and in renting apartments, in registering cellular phones, and buying cars … avoiding the biggest cities where heroin markets were already controlled, and by following the OxyContin. … Northern California was controlled by traffickers from the Tierra Caliente, a humid and notoriously violent part of west-central Mexico; no Xalisco Boy ever stepped foot in Northern California.

> Yet Purdue's marketing couldn’t have found an audience without the pain crusaders who tenderized the terrain for years before that, convincing primary care doctors that in this new age opiates could be prescribed to pain patients with virtually no risk of addiction. In many cases, hospital lawyers advised doctors that patients could sue them for not adequately treating their pain if they didn’t prescribe these drugs. Had that not happened—had there been no insistence that pain was undertreated and that pain was now a fifth vital sign—OxyContin would likely not have found the market it did.

> Pill abuse was a minor subculture back then. Abusing Vicodin or Lortab was hard work. They contained only small doses of opiates, and included acetaminophen or Tylenol to discourage their abuse. People who used them usually developed serious liver problems from the acetaminophen. But they didn’t often overdose on the weaker pills. Once OxyContin arrived, however "it went from people strung out on dope to people strung out and dying on dope," …

> pills and pain clinics had altered the classic welfare calculus: It wasn’t the monthly SSI check people cared so much about; rather, they wanted the Medicaid card that came with it.

> It helped that OxyContin came in 40 and 80 mg pills, and generic oxycodone came in 10, 15, 20, and 30 mg doses—different denominations for ease of use as currency.

> The opiate scourge might never have spread as quickly had these rural areas where it all started possessed a diversity of small retailers, whose owners had invested their lives in their stores, knew the addicts personally, and stood ready to defend against them. Walmart allowed junkie shoplifters to play Santa to the pill economy, filling dealers' orders for toys and presents in exchange for dope.

> " … found a 0.979 correlation between prescription pain pills dispensed and the number of overdose deaths from opiates." This was preposterous. Never in thirty years of statistical mechanics had Orman Hall heard of a correlation that close to 1.0, which was almost as if the charts were saying that dispensing prescription painkillers was the same thing as people dying.

> insurance companies gradually stopped paying for the services that made the clinics multidisciplinary. Prescription pills were easier and cheaper, and at least for a while they worked well.

> "Let's, as a society, watch all of our potential alcoholics become opiate addicts instead. Had these opiates not appeared, I think we'd have seen a similar number of alcoholics, but later in life. My field used to be middle-aged alcoholics. It usually took twenty years of drinking to get people in enough trouble to need treatment. But with the potency of these drugs, the average age has dropped fifteen years and people get into trouble very quickly with oxycodone, hydrocodone, and heroin."

> the most selfish drug fed on atomized communities. Isolation was now as endemic to wealthy suburbs as to the Rust Belt, and had been building for years
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LibraryThing member revslick
Fantastic writing and even better job of editing a fun and informative read paralleling America's opioid and black market heroin trade and subsequent addiction problem. I will definitely be checking out more of Quinones' work.

Random thoughts:
Dream Land is the perfect follow up to Methland.
It is
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amazing how fast Republican lawmakers get empathy and compassion when heroin jumps racial lines.
(possible legislation) if you can create a law holding drug dealers accountable for an overdose, does that include drug companies and overprescribing Docs? [just posting the question. my thoughts on that issue go way more than available screen space to write]
drug companies and their leadership should be held accountable; VERY accountable.
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LibraryThing member Olivermagnus
In Dreamland, former Los Angeles Times reporter Sam Quinones expertly recounts how a flood of prescription pain meds, along with black tar heroin from Nayarit, Mexico, transformed the blue-collar city of Portsmouth, Ohio, and other American communities into centers of addiction. Using exhaustive
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detail, Quinones chronicles the perfect storm of circumstances that cleared the way for the Mexican narcotic to infiltrate our small and midsize communities over the last two decades.

The story of the black tar heroin epidemic across the United States that began in the 1980s parallels the sweeping prescription opiate epidemic in America because their clientele was the same group. And the product, whether natural like heroin or manufactured like Purdue opiate pill, is the very same companion to all those Americans who wanted Better Living Through Chemistry. But heroin was cheaper, Quinones observed, and the opiate prescriptions had already "tenderized" those who would want heroin.

In 1980 the New England Journal of Medicine published a short letter to the editor from Hershel Jick, MD, a Boston University School of Medicine physician, with his comment that patients in severe pain and under close observation had not become addicted to the given narcotic opiate. From that brief unsubstantiated paragraph other medical journals went on describe it as a "landmark report."

Quinones’s book and the world it describes is already dated. Around the time it was published another chemical, fentanyl, began killing heroin users in North America. Fentanyl does not require a poppy harvest to produce and it is far more potent than heroin, which means that it can be smuggled in small quantities. It is also far more dangerous, and its appearance in the drug supply has been accompanied by a sharp uptick in the rate of overdose.

I was absolutely fascinated by this story. Admittedly, I don't know anyone who is caught up in the opiate epidemic or is addicted to any pain killer. I realize, now, that puts me in a small minority.


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LibraryThing member DrFuriosa
This is an informative and engaging book on the roots of America's opiate problem, linking the rise of OxyContin with the sale of Mexican black tar heroin in rural areas. Quinones highlights the racial elements at play quite proficiently, though a sense of resolution regarding the fates of the
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Xalisco Boys remains uncertain. There are some repetitive word choices that lessen the writing quality, but it's a worthwhile and fast read.
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LibraryThing member edlynskey
This wide-ranging, insightful story of America's opiate crisis makes for painful and sad reading. The author keeps things moving while presenting the sobering facts. One thing that struck me is the mistaken belief some parents had that a 30-day therapy/detox would "fix" their kids' addictions. It's
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a lifetime struggle. I'm sure many families, including my own, have been touched by the scourge of heroin and opiate pills like OxyContin. Big pharma comes off looking really bad in their crass pursuit of the Almighty Dollar. The author has an engaging narrative style I found easy to follow. If you want to know more about what happened, this book might be the right one for you.
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LibraryThing member bangerlm
Read this for book club. It was interesting, engaging, and educational on a topic I did not know much about. Reading about the Xalisco boys I felt like I was listening to an NPR episode of, "How I Built This" My only complaint was that I thought the book could use a bit more editing. It seemed odd
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that the author kept adding in paragraphs summarizing the history of the Xalisco boys as if we didn't know who they were, despite already having read 150 pages about them.
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