Barney Frank famously said, “Government is simply a word for the things we decide to do together.” Whatever one may say about the ultimate shallowness of that reflection, it has some application when it comes to America’s opiate crisis. Heroin, it turns out, is just a name for something we do together. Sam Quinones explains in Dreamland: The True Tale of America’s Opiate Epidemic that this epidemic now ravaging “flyover country” is the result of ill conceived policy prescriptions, some well intentioned, that have shaped contemporary America. The book is widely acclaimed for good reason.

In order to understand the increasing decay of working class, primarily white American communities, Quinones weaves together an account that looks to the transformation in medical practice regarding pain, the increasing effects in every part of the United States of uncontrolled Mexican immigration. He adds to this the decline of economic opportunity in the heartland thanks to deindustrialization, a decreasing need for middle management and small retail business (disintermediation), and globalization. Since Bill Clinton was wrong in proclaiming an end to the era of big government, big government has had a lot to do with fanning the flames of America’s opiate epidemic. Now that this crisis is ablaze, there is much that it must undo in order to help the people beat those flames down. Yet Quinones describes much while prescribing little, which may be sensible modesty in one who knows the ravages of overprescription.

As the 2016 election draws near, however, we should take what political lessons we can from Quinones’ massive and multi-faceted investigation. Ever since the invention of morphine more than 200 years ago, scientific medicine has promised that here, at last, is a pain killer we can trust is safe, effective, and non-addictive. First we had heroin, then Dilaudid, and now Oxycontin. Each has had its turn in the imaginations of doctors and patients as a wonder drug giving us all the benefits of previous opiates without the costs in addiction, drug-dependent behavior, and overdoses.

But it is as if man was cursed to labor, rather than to feed on the lotus. We have been fooled again and again. American medicine is not, most international surveys show, the best in the world; but American doctors are the most responsive in the world. If our regulations are such that they can make good livings dispensing relief from the cares of this world in child-proof bottles then enough of them, Quinones shows, will do just that.

Likewise, if we crack down on the prescription pills, a new dope peddler quickly moves to fill the gap. The old dope peddler who trafficked in opiates sold “powdered happiness,” powder heroin that was, comparatively, much-diluted. He thought in terms of “killing the competition” not through customer service or a better quality product but through turf wars. The old dope peddler wanted to belong, and if death or prison was the price of belonging to his gang, he measured his manhood by his willingness to pay that price without flinching.

That was before.

The new dope peddlers Quinones describes are the Xalisco boys: young men from Xalisco, a forsaken corner of Mexico, exceptional only in the quality and purity of the black tar heroin produced in the surrounding hills. The Xalisco boys, being hard working immigrants, get the job done. Their product is pure, they deliver quality, and it is cheap, too. Moreover, they are not attached to place or territory within the United States: America is just where they come to make money.

Quinones shows how these dealers live Poor Richard lives in the U.S. with long hours, outward conformity to the laws and mores of the U.S., and ceaseless attention to their customers. The Xalisco boys strive to make money in America in order to be big men in Xalisco, with large families, big and ever-expanding houses, and splendid local festivals. They do not bother to fight for turf. For in America they are not attached to any patch of dirt. They respond to competition from each other or from the more violent cartel or gang linked drug dealers by moving beyond their reach. And no community, no matter how isolated or homogeneously white, is beyond their reach. Whiteness, as anyone with sense has always known, is no magic prophylactic from the effects of cultural, political, and societal rot. With a car, a prepaid cellphone, and a few dozen balloons of heroin easily moved across the effectively open border, their business is portable and their supply creates its own demand. The Xalisco boys are not Mexico’s best people, but in America, apart from the fact that the make their money by selling illegal drugs, they pretty much behave as if they were.

And why are the people Americans derisively call “hillbillies” alternating between hillbilly heroin (oxycontin) and the real thing from Mexico? When work is hard injuries are common, and virtually every career ends with a diagnosis of disability. When work is unavailable, opiates offer the quickest and strongest substitute for accomplishment–especially when the bonds of family are already broken down, like so much else in our once thriving culture, by the ill-effects of a nihilistic popular culture of immorality. Increasingly unaffiliated and unchurched, as the secularism of the cities is pumped to them via media and even government intervention, flyover America finds ready comfort in opiates in place of the opiate of the people. And both varieties of heroin are so cheap and accessible that one can sustain addiction for a long time on food stamp cards and shoplifted merchandise from Walmart whose employees, like the Xalisco boys, have no turf to protect.

What does this doctor (of political science) prescribe after waking up from Dreamland? First, the Federal government needs to concentrate on the aspects of the problem which it can handle most effectively. Control the border. Keep people and products that are supposed to be out, out. Second, make sure that the regulation of healthcare focuses on health and not on consumer satisfaction, especially not the easy satisfaction that comes from pills. And, finally, even though it is hard to see how government can instill virtue in towns where good jobs for men have been thin on the ground for four decades, remember that, as Calvin Coolidge once said, “cheap goods mean cheap men,” and not every job that immigrants can do better than Americans is a job we Americans need or want to have done.