Category Archives: Drugs

A Doctor’s View of Pain Pills

Here’s a letter from doctor with a long exposure to the problem of addiction and pain pills. I get lots of email letters about Dreamland. I’ve put a few up on this blog – always with names and identifying details removed.

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 I have recognized for many years, at least since the late 1980s, that the chronic use of opioid medications was typically a barrier to recovery. I am a physiatrist, a physician procter-1specializing in physical medicine and rehabilitation, since 1986.  We manage patients who have catastrophic injuries: spinal cord injury, traumatic brain injury, amputations and those with multiple and severe trauma. I also treated many patients who had less severe injuries including strains, sprains and other soft tissue trauma. We often manage patients over many years. When the use of opioids became more frequent, in the late 1980s, I was perplexed. I did my best to manage pain, if at all possible, without the use of chronic opioid therapy. I was perplexed even more so in the mid to late 1990s when Oxycontin came on the scene. Physicians no longer were afraid to prescribe opioids for non-cancer pain and did so seemingly without caution. They were duped. Drug companies and their physician spokesmen duped them.

I grew up and later practiced medicine for many years in New Mexico. New Mexico, as you may know, has always had one of the highest drug overdose rates in the nation.  Heroin had been the drug of choice, at least until opioid medications came on the scene. I worked as a house painter’s apprentice in the late 1960s while in college. I worked on one crew that every journeyman painter was an ex-con related to heroin use.  I had plenty of opportunity to use heroin but it scared me. My co-workers told me how great it was. One guy, much older than me, made it sound so appealing. “Come over and we will shoot up and listen to jazz.”  I never tried it though I had lots of opportunity.

I knew quite well how dangerous heroin was and never believed that opioid medications were any less dangerous. When I started practicing in the late 1980s many of the patients I saw were on opioid medications when I assumed their care. Most of the more seriously injured patients I saw were successfully weaned off opioids. Many of the less seriously injured, especially those with work related injuries, were much more difficult to wean. Some patients of both categories ended up on long term opioids but were closely monitored to determine if they were benefitting from opioids and whether they were abusing them. Escalating doses were typically not allowed.

The work related injury group of patients who generally had much less severe injuries, were routinely on opioid medications when I took over their care. My job as a rehabilitation physician was to get them back to their usual activities including return to work. I found that opioid medications were a barrier to their recovery. Some of my referring physicians believed the standard of care was to treat pain with opioids as long as patients complained of pain. Some patients were never going to stop complaining of pain and the reasons were frequently psychosocial in nature. I never believed the hype from drug companies regarding the safety of opioids. I saw from up close as a young man and as a doctor that they were dangerous and in general not appropriate for long term use in non-cancer pain.

I knew little about Dr. Russell Portenoy at the time of the opioid prescription explosion but I knew plenty about what drug companies were saying about the safety of opioid medications and the unlikelihood for addiction. I now understand Dr. Portenoy’s role in this public health catastrophe.  I don’t believe Dr. Portenoy and other drug company marketer’s claims that they are now surprised about the addiction potential and danger of opioids. Intuitively it did not make sense. Oxycodone and hydrocodone are so similar to morphine and heroin both chemically and by their mechanism of action. Why would you believe they are so much safer? Those guys were either just plain dumb and so drunk with drug company money and self promotion that they refused to pay attention to what was happening to patients. I am sure they are not dumb. Dr. Portenoy is a brilliant and charming guy. Just view his video presentations and interviews. He is also a successful academic physician. That is what made him so dangerous.  I am just an average doc who has never had a higher academic position than a clinical assistant professor.  I have never authored a paper that made it to a medical journal. How could I know more than them and have been so right about the proper role of opioid medications?  Why didn’t they? Certainly not because I am smarter.Grand Canyon Trip 2015

I think your book was very even handed, maybe a little too much, with Portenoy and the other opioid selling/promoting physicians. I’m telling you they knew better. Their response of “If I knew then what I know now….” just doesn’t cut it. They are responsible for the hundreds of thousands of deaths and ruined lives. They should not get off the hook. I suspect their narcissism will prevent even one sleepless night for the damage they have done. But they and their benefactors, the drug companies, have created a horrible health crisis that was largely preventable in the United States. It is almost strictly a U.S. problem caused by U.S. physician “thought leaders”, drug companies and misguided bureaucrats.

I applaud your book. Bringing the black tar heroin story into your narrative was great. You connected the dots. I wasn’t aware of that part of the story. Thanks again for your book. It may just impact our legislators and government officials even more so, to focus on rehabilitation not punishment for those young kids who got caught up in a drug problem often caused by misguided or crooked doctors.

The punishment of “pill mill” docs and drug company marketers including their corrupt physician lackeys could never be equal to the suffering they have created. Glad you spotlighted the problem and did it in such a well-researched, entertaining and cogent way. Thank you.

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Filed under Dreamland, Drugs, The Heroin Heartland, Uncategorized

24-Hour News – Just Like Heroin

24-Hour News is just like heroin.

We pretend we’re informed by it. In reality, we know that each network is a dealer in the drug of outrage. Each provides little information or depth. Instead they concoct a diet of heat, alarm, frenzy. Above all, they provide us a drenching isolation that separates us from our fellow Americans.

cnn

One sign of a heroin addict is that he forsakes family, old friends and community to hang out with others who use and sell dope. They talk about dope constantly and don’t understand those who don’t find that topic endlessly fascinating.

That’s what 24-Hour News has done to us, and our body politic. Forced us into little bubbles of people, all of whom think and talk alike and don’t understand anyone in the other bubbles who don’t think and talk like them. We all know this is true.

Which is why I say 24-Hour News is just like heroin.

So this election day, after we vote, let’s do another civic duty: Let’s all turn off 24-hour news, and talk radio, too, for that foxmatter.

For good! Just block them all. Easy to do by clicking here. Each station. CNN, FOX, MSNBC, Headline News. The problem is the format, not the network itself.

24-Hour News assumes that every issue has only two sides to it, and we can neatly know what they are, and that once a position is staked out, we cannot waver from it. It picks and pricks at some topics well beyond any presumed responsibility of informing the public is fulfilled. Yet somehow it does this while rarely providing any deep or nuanced understanding. And other issues is doesn’t touch at all.

It Monday-morning-quarterbacks public servants and elected officials to death.msnbc

All because it has to fill that time.

Meanwhile, these networks bundle most issues into five-minute, in-between-the-commercials, pre-digested packets. I’ve been on several of these and I now boycott them. I was on a CNN segment once that discussed the Mexican drug war – in six minutes with two other guests. We cannot possibly learn a thing about that very important issue in so short a time.

24-Hour News is one of the most corrosive influences on our democracy. Doping it. Distracting it. Numbing it. Lowering our standards for what “news” is and how much participation is actually required of us to preserve a functioning republic.

Never has 24-Hour News failed us more harmfully than in this presidential campaign. Its anchors spent most of the pre-convention months analyzing incessantly whether Candidate X had a pathway to the nomination. The horse race is all those networks cared about. It was a narcotic that had us all distracted.

We need real journalism. We got junk food. We needed deep discussions of complicated issues. We got yammering, blather, screeching and babble – usually designed to make us feel outraged at everyone else and confirmed in the righteousness of our own behavior and thinking.

In other words, we got dope.

For that’s what heroin does to an addict: convinces him that the path he’s on is the right one and no other is conceivable.

As Americans, we spend a lot of time worrying about what we consume, avoiding processed foods, cigarettes, sodas.

Why don’t we have the same concern for our civic consumption?

Some who block 24-Hour News may suffer withdrawals at first. Shiver and shake and not be able to sleep. But that’ll pass. My bet is they’ll emerge with a fresher, brighter outlook on life. They won’t be angry or outraged at their fellow Americans all the time.

Another thing: Recovering addicts find life without dope to be complicated without that Silver Bullet to remove their worries. So, too, might folks recovering from 24-Hour News.

Just as heroin takes our cares away, the 24-Hour News Syndrome relieves us of the tough work involved in being Americans. We don’t actually have to strive to develop an opinion when 24-hour News provides it to us.

So we will have to develop our own opinions without the help of an anchor and a 5-minute expert there to enrage us and keep us tuned in through the upcoming commercial break. It may mean reading more. A wider range of opinion or news stories. Books or magazine articles. But the last place to find real information on anything worth knowing about is at a five-minute snippet of yammering talking heads. We know this is true.

But if Americans are exceptional, it’s through this work required of us in citizenship, civic participation, and in being accountable for our political and consumer choices. This is the job description of being an American, seems to me.

“A Republic, if you can keep it,” said Ben Franklin to the woman who asked what the Constitutional Convention had just created.

We got away from that, from what’s best about America. We opted for easy – easy solutions to pain, quick and easy answers to complicated problems, easy substitutes to civic participation. Convenience and comfort over all else.

In doing so, we rid ourselves of things so essential that they have no price … and in return we have been invaded by cheap crap.

So today, Be An American!

Please go vote!

Then come home and block every 24-hour new station on your TV.

We need to keep this Republic for a while.

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Filed under Drugs, The Heroin Heartland, Uncategorized

just can’t do no more today

As I try to keep a gauge on the opiate-addiction epidemic in America, one place I go is to The Addicts Mom Facebook page, with 22,000 members, one of whom is me.

The posts are from mothers as they attempt to deal with the lacerating addictions of their children. Here are a few posts, with names removed, that I saw at random this morning. Those who listed a location are from Georgia, Wisconsin, upstate New York, Pennsylvania, and Alabama.

At times, it gets to almost an aching kind of poetry.

Note: AS means addicted son; RAS recovering addicted son

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Well my almost 21 year old AS will be spending another birthday in jail I am sure! Please pray for his healing and mine!IMG_9349

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I always knew it was going to be my child one day. On the Fourth of July I found my addicted daughter unresponsive and blue. I breathed for her until paramedics came. They saved her life this time. She spent three days in Icu and was released with no help at all. I live in Florida and I was wondering if this is enough for a marchman act? Doc is Xanax and snorting oxicodone. Any advise is appreciated. God bless all of us Mothers. I just can’t take much more.

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I love having a place where people actually listen when I talk bout my addict children. Most people in my town don’t want to hear that there are children addicted in their town people need to wake up sad for the addicts who are outcast. Having trouble getting police to put narcan in there cars also

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UPDATE: His PO is coming to see him tomorrow– I will let y’all know how it goes.
My Birthday overall was a good day. Thanks for the wishes and prayers. Blessings to you all.

Dilemma- my 18 almost 19 AS was released from jail last Friday to serve out his probation-14 months (it’s a joke; very seldom face to face visits with his PO). On Sunday he apparently used LSD; when I confronted him he said ‘no worries Mom; it won’t show up on a UI.’ He had no where else to go but our house and the court said our house is not an option for him to stay (we have a younger child at home). He was told the rules- no drugs or drug use. A small issue he flat out refuses to pick up his clothes (drives me crazy) states he’s just defiant; like I’m supposed to be ok with that answer.
Suggestions??? Oh yeah; today is my Birthday- I feel like hiding in a hole not celebrating life

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Last night my phone rang at 11:30 my heart automatically started racing. Then I seen the caller I.D it was my RAS instantly worry washed over me, I picked up the phone and the first words out of my mouth was ” what’s wrong? Are you okay?” His reply was ‘Yes ma’am I was just on my way to work and I seen a shooting star and it was the brightest most beautiful one I’ve every seen, and just wanted to call and share with you”.

Four years clean, still suffer from shell shock but feeling blessed.

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So another week and another dirty urine at probation. Told me he wants suboxone, I suggested vivitrol. Someone on the MAT (medically assisted treatment) site posted a link for a slide show on all the meds used. I sent it to him privately. He wants to do vivitrol now and I sent him the local dr name and address. He swears he wants to be sober. I asked him, you know how awful detox is, why isn’t that enough to not pick up? He CANNOT deal with stress. No coping techniques. We all have stress but you have to learn to cope. I get the whole disease thing I truly do, but I also struggle with the you know it’s not good for you, you know what you are running away from is gonna still be there and you are making more problems to deal with when you sober up. I know my mind doesn’t function as an addicts but they are all smart kids or adults. Dang fight for your sobriety hard the way you chase that freaking drug. He looks terrible. Lost weight again. And all he keeps saying is everyone is judging me and that makes me want to use. No that gives you a lame excuse to use. We aren’t judging we love you and are worried. I know my dealer he wouldn’t do that yadda yadda yadda. Won’t be long and he is gonna end up in jail, then maybe I can sleep:( I am ANGRY this time.

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My soul is tired, my heart hurts, I just can’t do no more today😥

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Filed under Dreamland, Drugs, The Heroin Heartland, Writing

“My father went to a pain doctor…”

I received this note from a reader. I print it here as it came over the transom, though a few things were added at my prodding, wanting to know more. Has a feel like a beat poem somehow, just one long run-on sentence of how addiction comes to those aren’t looking for it.

No one in this reader’s family was on drugs before “my father went to a pain doctor.”

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Hi I know you get alot of people asking you things I think what your doing is great IMG_4113my father went to a pain doctor in Ohio and he was getting 224 80mlg oxy take four four times a day plus perk 15 I dont know the dose on them he was a drywaller and I have a old bottle so ppl wouldnt think I was crazy when I tell them what he got he would go every two weeks to pick up I just now am realizing how bad that was for him when u have a family of addicts and myself feel into that same pattern you dont wake up and do homework till ur own mind is right

when he got them thats when everyone got bad bc he got so many my mother and sister got them handed to them when he was alive I didnt do anything I did after the fact

he ended up passing Oct 2010 due to finally trying to use a needle to inject those pills and getting a blood infection my mother still is on dope and my sister was and has been clean for almost three years now I was did buy pills and dope on street for three years after my dad passed I then back in 2014 put myself in the Methadone clinic till Jan 28th 2016 in South Eastern Indiana I have been clean since and wanted to say we live in Tri State of Cincinnati and its bad in this 275 loop and see you came very close to NKY to speak I hope to see u when u come back but wanted to tell my past and I always thought for my dad that was way to much a Dr was giving a man who just had back problems thank you

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Just Tired

From a Facebook page that I’m a member of. Don’t think I’ve read anything recently that better gets to the heart of the weariness so many American moms and dads are feeling:

Hi Moms, I guess I need your advice today. My recovering addicted daughter called last night from Nashville, she said her daughters father beat her up. She sent pictures. It broke my heart. She has supposedly been clean for 3 months. We’ve been going through this nightmare with her for over 13 years. She always has huge drama in her life, every man she gets involved with she says ends up abusing her. She’s also bipolar and has been arrested in the past for also abusing some of these men. She wants me to fly to Nashville to get my grandaughter ASAP, before DCF takes her. I know this should be a no brainier but I am tired and it always affects my husband and our marriage.

We have 4 addict children and a total of 7 adult children. This daughter, Amber, has chosen to live far away for years as she doesn’t like our advice. We’ve had to take other grandchildren from another daughter for 3 years.

We’ve been parents for 38 yrs, and we are just exhausted.

Our lives revolve around helping kids get into treatment, or visiting them in treatment, or going to court or trying to visit or help grandchildren that are effected by parents addiction. We are currently in NH, and we are suppose to go to Boston Sunday to celebrate our 30th anniversary, we have reservations, and tickets to the Redsox game. Now I’m sitting here trying to figure out what to do. And I am actually afraid to go to Nashville, if my daughter is not telling me the whole truth which happens often, I could get into a mess and I feel like I’m just getting to old for all of it. I’m so tired. I just laid in my bed last night crying, and my husband told me we may have to just let it all go and whatever happens is Gods will.

I am posting mostly because you moms are the only ones that understand and when we can’t think for ourselves because of our overwhelming exhausting emotions, I feel that you all may help me see this more clearly. Thank you for being here Moms, I don’t know what I would do without you.

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Filed under Dreamland, Drugs, The Heroin Heartland

Carthage, IL: Frozen Yogurt & Kids Who Fear of Summer

In the farming town of Carthage, Illinois, a lot of kids are afraid of summer.IMG_1205

Ada Bair told me this. Ada runs a rural hospital in Carthage, population 2700, in Hancock County in western Illinois. I met her in Springfield, where I spoke this week to a conference of rural hospital administrators.

Half the kids in town are eligible for free or reduced lunches. So many Carthage kids rely on school for food, she said, that the idea of summer terrifies them. This is the byproduct of rural poverty, unemployment and now widespread drug addiction.

Yes, kids in America’s farm belt don’t have enough food for the weekend. There’s something very messed up about that.

A few years ago, Ada started Food For Thoughts, which sends home weekend lunches with these kids. Her hospital also now funds free lunches for kids 18 and under through June and July. I’m not sure about August and was afraid to ask.

Six weeks ago, Ada’s husband, Charlie, opened a frozen-yogurt shop in what had been a long-abandoned drive-in bank that he’d bought and remodeled. He calls it Lilly’s, for Ada’s late mother, who helped bag theIMG_1113 lunches for the kids before she passed at age 102 last year. The shop is at Wabash and Madison in downtown Carthage.

“He wanted to do something on a micro scale that could be replicated in other communities to help revive dying downtowns,” Ada said.

Lilly’s operates in an economic desert of shuttered storefronts. It offers chocolate, vanilla, and a flavor that changes periodically; salted carmel pretzel was a big hit. The profits go to Ada’s Food For Thoughts.

Carthage has been thinning out for years now, Ada says. Methode – a company that makes batteries – has finished moving most of what was several hundred jobs down to Mexico, in a process that took 15 years. Farms are consolidating, too. They’re still family farms, but where there was four or five farms and families working them, there is now one. Where there were four or five farm houses on one road, there’s now one. A farm that size is the only way to afford the kind of massive farm equipment they’re selling these dIMG_1115ays.

So there’s just fewer people in Carthage, fewer people to support grocery stores, churches, to form the critical mass to move projects of all kinds. Less community. Made it feel almost like a desert – at least where people are concerned. With that comes isolation and a deep poverty.

Seems to me this also has a lot to do with the opiate-addiction epidemic in America. Isolation – in suburbia or in tiny farming towns. Either way, we’re cut off from each other. Opiates feed on that. As drugs, they create the idea that being alone is preferable. But in a small town or county, they also create the feeling that we’re powerless against them. It’s true; when we work in isolation, all problems are insoluble. Sometimes I get depressed.

But then I meet folks like Ada Bair — a little like Narcan for the soul.

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Filed under Dreamland, Drugs, The Heroin Heartland

Good Day in Chillicothe

In Chillicothe, Ohio, the way I understand it, school janitors are heroes.

Many kids are growing up in families of addicts and have no place to go, their home studded with neglect and jagged edges; so they hang around after school. There, janitors have befriended them, bringing them food, IMG_1525giving them a sober adult to talk to and a calm place to hang out.

My family and I spent Thursday in Chillicothe, a southern Ohio town (pop. 21,000) bedeviled, as so many are, by the opiate-addiction epidemic.

I spoke all day long – a radio interview at 6:30 am, meetings with three groups through the day, and a 7 pm public talk at the Majestic Theater, the oldest (1853), continuously operated theater in America. Yet by the end I wasn’t exhausted; I was instead exhilarated by theCHILLICOTHE STUDENTS electric, intense response of people I met.

That’s how it’s been everywhere lately.

Writing Dreamland wasn’t arduous; it was engrossing. But it was also about a tough topic in which the worst of human behavior was on display. So I’m thrilled to see towns like Chillicothe using the book to come together, form alliances, leverage talent, talk about this problem in a way that hasn’t happened before, and do something hopeful.

Heroin seems to be having the opposite effect in Chillicothe that it has on users. If heroin isolates addicts into self-absorption and hyper-consumption, the drug also seems to be bringing people together to fight against it. I see this elsewhere as well and that’s encouraging. I know the problem is big. A new sporting-goods store delayed its opening in Chillicothe for months, I’m told, because it couldn’t find enough workers that could pass a drug IMG_1514test.

I wish I had a better answer to those who asked what to do about families where drug addiction is now generational, where the grandparents on down are using, where great-grandparents are raising their grandchildren’s kids. Kentucky Gov. Matt Bevin, the day before in Louisville, told me that his state is on the verge of losing an entire generation, swallowed up in a morass of dependence, unemployment and now opiates. Kentucky has more able-bodied, working-age people who aren’t working than those who are, he said. That feels scary.

Heroin, it seems, is the final nausea to afflict small towns and rural communities already crushed by the farm crisis, downsizing, outsourcing, the loss of local retail, depopulation, and more. It seems that heroin has IMG_1591pushed many places to a life-or-death moment.

Knowing that, though, I also can’t help but recognize the energy I’ve been encountering in the people I meet.

In manufacturing, as I understand it, innovation happens through immersion in the work, people knowing the production process so well that together they find new, small, better ways to improve on how to make something.

Fighting heroin, I believe, is the same. When people come together, work together, knowing their community and its problems, when they leverage their talents and energies, the solutions specific to that place will emerge. I believe that.

And just as manufacturing processes improve incrementally, in small steps, so this problem has no sexy silver IMG_1592bullet, I suspect, but will be best fought with a combination of tiny efforts, many partial solutions, none of which is perfect, but together amount to something powerful. That’s good. Haven’t we had enough, after all, of the one sexy solution to solve all our problems: Didn’t `one pill for all people and every kind of pain’ do enough damage?

While I was writing Dreamland, people seemed to work in isolation, cut off from each other. Parents of addicts seemed hidden, silent. That’s the biggest change I’ve seen. People have now started talking about this issue, forming new alliances, comparing notes.

In Chillicothe, we stayed in the Carlisle, a beautiful brick building, restored after many years empty due to a fire. A hospital group decided to move into downtown and refurbish the building, believing apparently that it served the community best by being part of the revival of its core. The Majestic Theater will soon get a renovation. Luckily, the town never tore down its old beautiful brick buildings, which are being repurposed. New retail businesses are opening downtown. A t-shirt shop sells shirts of companies that have left town. My daughter now has a shirt proclaiming “Chillicothe, Ohio.” So the town seems to be rebounding, even as it battles this debilitating scourge. Maybe that’s the story – complicated, and not easily or neatly told.

I want to thank the people of Chillicothe for so hospitably welcoming my family and me. Thanks to Hudson Ward, at the Carlisle.

Thanks especially to Nick Tepe, the county’s head librarian, for organizing folks to bring us to town. Librarians ought to be playing exactly this kind of role in communities, and Ross County, Ohio seems to be blessed with a talented one.

Next, I’m heading to Knoxville, for the International Tuba and Euphonium Conference. And from there to Springfield, IL to speak to a conference of that state’s rural hospitals.

Meanwhile, Chillicothe had an annual street fair going while we were there, known as The Feast:

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Filed under Dreamland, Drugs, Storytelling, The Heroin Heartland

Trump, Heroin & Mexico

A lot has been made lately of Donald Trump and his wish to build walls between the U.S. and Mexico.IMG_4841

This got a new bump recently when the candidate, in New Hampshire, reiterated that he’d build these walls and use them to stop Mexican heroin from coming into the U.S. – New Hampshire being one of many states suffering from huge jumps in opiate addiction.

Opiate addiction appears to be emerging as an issue in the presidential campaign, as well it should.

I’ve read a lot that does seem to be too nuanced on either side of this topic.

Here are a few of my thoughts:

Virtually all our heroin comes from Mexico, or comes from Colombia through Mexico.

Originating now in our hemisphere, heroin now changes hands less and travels far shorter distances than it did when so much of it came from Turkey or Burma (1970s).

All that means that it’s cheaper here than ever, it’s more prevalent, and it’s far more potent. And all that, in turn, has a lot to do with why people begin using it in the first place (cost), and then stay addicted (prevalence), or relapse after rehab, and then why they die more frequently (potency).

Used to be that people (addicts from the 1970s) lived for many years on heroin – when it was more expensive and less potent and more arduous to find. A lot of heroin addicts who started in those years did die, but they died during the AIDS epidemic from sharing needles, not so much from overdoses.

Now heroin addicts aren’t living long; They’re dying young and quickly. I believe that’s because so much of the drug comes from Mexico, making it cheaper, more potent and more prevalent than ever.

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We already have walls up in many parts of the border. Heroin already crosses where walls are – Tijuana (two walls) is one example.

When uncut or less cut, heroin is easy to conceal because it’s so concentrated – again because now it comes from Mexico, which is so close.

So you don’t need trucks to get a lot of heroin across – though trucks have been used. A lot of people walk it across at the border crossings hidden in a purse, or a backpack, or on their person.

There’s a market for heroin because there is a demand for it.

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That said, I believe that supply is fundamental to this issue – supply created this demand, just as it did during the cocaine days. We didn’t have a huge demand for cocaine before Colombians began smuggling tons of it up through Florida. Likewise, we didn’t have huge numbers of heroin addicts before doctors began prescribing enormous quantities of opioid painkillers such as Vicodin and OxyContin, etc. and a lot of people got addicted, then switched to heroin, which is now, as I said, cheaper than ever.

Heroin traffickers, as I hope I made clear in Dreamland, came late to this party. They followed the demand for opiates that had been created by massive overprescribing by doctors of these painkillers.

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Just as we cannot arrest our way out of this problem, we likely cannot treat our way out of it, either. Particularly with treatment costing so much and taking so long. Typical treatment that has any chance of success, from what addiction specialists tell me, is a minimum of nine months. One doc I know insists a year is the minimum.

Curtailing supply is thus essential to giving each attempt at rehab and recovery a greater chance of success. So that every recovering addict isn’t bombarded with dope at every turn, as they are in so many parts of the country today.

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That said, among the steps I think we need to take – some of which are articulated by the CDC recently – is retraining doctors to question why they prescribe these drugs and, if they’re necessary, in what quantities. For example, for wisdom tooth extraction, 60 Vicodin is common. That seems crazy to me.

Seems like 6-12 pills would be reasonable, and that the patient should return if he needs more. Doctors prescribe so many of these pills out the gate because they don’t want to see patients a second time, and they know that insurance companies often won’t reimburse for those follow-up visits, no matter how few.

So this problem will require that insurance companies change their practices, and reimburse doctors for follow-up visits for the (again) few patients who might need more of those pills after routine surgery.

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Walls have had a healthy effect on the border. Tijuana (two walls, as I said) is an excellent example of that. When it was the main crossing point – 1960s until mid-1990s – rapes, robberies, assaults and murders were common, particularly in the 1980s and early 1990s. Then the first wall went up, then the second. Now it’s calm on that border line. May be a weird symbol for a globalized world, but murders and rapes are rare now.

Despite those walls, heroin will seep in, through the cracks, in ways that seem to me impossible, or extraordinarily expensive, to stop. And that’s not the supply that caused this problem.

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Tacos and Dope Culture

A new L.A. taco restaurant has a narco theme to it.

Tacos Los Desvelados in Maywood, California named its food for notorious Mexican and Colombian drug traffickers. Chapo Guzman gets a taco, Pablo Escobar gets a burrito, and so on.

That’s pretty funny, and possible only because of Maywood’s safe remove (it’s a small town southeast of Los Angeles) from the real and sinister violence that these guys have created.

Here’s something else that’s not so cute:

Mexico’s Attorney General’s office reports finding 662 bodies in 201 clandestine graves in 16 Mexican states from 2005 to the present. Of those, 380 have been so decomposed that investigators can’t tell if the bodies are of men or women.

In Iguala, Guerrero alone, 63 graves with 133 bodies have been found.

Let’s go get some tacos!

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Filed under Drugs, Mexico

Heroin and the Super Bowl

“H-E-R-O-I-N – what’s that spell?”
 
This 60-second ad about heroin addiction, filmed at a high school in Missouri, will air during the Super Bowl.
 
A drug that once was associated with jazz musicians, pick-pockets, East LA gang members, NY street hustlers and punk rockers is now featured on our secular holiday, interrupting pizza and guacamole as it’s piped into American homes from Alabama to Alaska.
 
That’s a stunning event for this country.
 
What’s more, millions of people will know someone like that girl.
Post Script: Sadly, the Super Bowl came and went and this spot did not run. Not sure why. If anyone has an idea, please let me know.

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L.A. Murder – Not The Real Story Any More

It would have been easy to miss some stunning news a few days ago.

It came buried in the back pages of a December 30 LA Times article on how crime was rising. Rising across the board! First IMG_7311time since 2003! Yikes!

The real stunning story, though, was this:

The city will register only 280 homicides for all of 2015. That would seem sad, and for 280 victims and their families and friends, it most certainly is – I can say this as a reporter who has covered hundreds of murders in his career. I know how murder can destroy not just one life, but the lives of the surviving family as well.

To understand, however, why that number could actually be encouraging news, a remarkable event, you need the context. Here’s some:

Pitched as a 10 percent increase, 280 homicides is actually the city’s third lowest homicide figure since 2000 and part of a drop in crime that has been going on since roughly 2007. In fact, apart from 2013-2014, the city hasn’t had that few homicides since 1967, when L.A.’s population was a third smaller than it is today (roughly 2.4 million people then compared with 3.8 million today).

You’ll remember, perhaps, that in August there was a collective freak-out at the increase in homicides that month. I thought folks should have maintained some calm and context, and dealt with it seriously and professionally, which is what it appears LAPD proceeded to do. The rest of the year saw monthly homicide numbers fall again.

My guess is that in a heavily armed culture, and a very large city, we won’t see homicides dropping to, say, 200 a year. So it’s possible that we’re at about the lowest crime levels a city the size of L.A. can reasonably produce. I’d love to be proved wrong, but barring a deep change in our permissive gun culture or a massive tax increase doubling the size of the LAPD, I’d bet against it.

If those numbers crept up consistently year after year, that would be cause for great concern. But at this point, if crime figures rise 10 percent, or drop by that much, from one year to the next, it’s worth understanding and addressing with calm and context — but not frothing over.

I say this after, again, years as a crime reporter, and fully aware that some areas of the city, and of the region, still have serious problems and that these need attention.

Nor am I saying murder is okay if it’s below a certain number. Just that there are stories we ought also to pay attention to.

The real story is not that crime or homicide rose 10 percent.

The real story is that, while we witness blooms of intercultural savagery around the world, in our region of races, languages, and religions from every corner of the globe, crime has become negligible – a minor part of life and not just for wealthy folks, but, importantly and especially, for working people.

Some notorious headlines notwithstanding – yes, Rodney King, we can all get along and, by and large, in Southern California, we are. In the end, the 2015 homicide figures, as painful as they are for some families, did reflect that.

(Hate crime, btw, is almost nonexistent, certainly compared to the volume and the sheer violence of those crimes in the early and mid-2000s, most of them committed by Latino street gangs against blacks, which you can read more about in a chapter essay that I wrote for this anthology.)

The real story is that this drop in crime began during the country’s Great Recession, and is taking place in a region where poorly paid service jobs have replaced so many good-paying union jobs with solid benefits; where dense apartment complexes have replaced so many single-family homes.

The real story is how many working-class neighborhoods, where murder once stunted life and commerce, are now mercifully at peace, and property values are reflecting that.

And, above all, the real story  is that gang violence has dropped so precipitously. (Remember: L.A. used to have way more than 280 gang-related homicides, in years when total homicides topped a thousand.) And so has gangs’ public behavior that did so much to blight those working-class neighborhoods that could least afford their crap. Gangs no longer have the run of the region.

This morning I was out on a street that was notorious for its gang in the 1990s. I found it quiet, pleasant, unscarred by graffiti. On the contrary, the houses seemed improved, freshly painted – one of many such neighborhoods all across Southern California.

Later, I was in Lincoln Park, talking with Braulio Garcia, a Mexican immigrant who has owned La Guadalupana Market (pictured above) since 1988. Up to about decade ago, he said, gangs were everywhere in Lincoln Park. A few blocks away is a gang mural, apparently from the 1990s, that lists the members of the neighborhood crew, and giving an RIP to a few friends who didn’t make it. Now, Mr. Garcia told me,  he doesn’t see gangs or their graffiti at all.

Certainly lifted my spirits.

So on that note I’ll leave you, while daring to suggest that things are looking up, and hoping, meanwhile, that we have a Happy New Year, one and all.

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The Dayton Heroin Bust

Cops in Dayton, Ohio this week took down a reputed major Sinaloan trafficker, along with a bunch of cash and a million dollars worth of dope.

What this bust shows is that the larger Mexican cartels, which for a long time ignored heroin as a revenue generator, have in the last few years figured out the new market that exists in the U.S., created by the overprescribing of narcotic pain pills nationwide, and shifted priorities.

Through the 1990s and into the last decade, these cartels didn’t dabble too much in heroin. Other drugs were more popular and profitable. Plus, in Mexico heroin is viewed as about as scuzzy a thing as it in the United States.

That’s changed in the last few years. Mexican cartels, which already dominated on the western side of the U.S., have recognized the widespread opiate addiction among Americans and moved to take control of the markets on the eastern half of the U.S. that once were served mostly by Colombian heroin traffickers back to the 1980s — the same way Mexican cartels wrested the cocaine market from the Colombians in the 1990s.

Pills to heroin to Mexican drug cartels in areas that never had much of any – all in the space of 15+ years.

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A Mother’s Story: Sam Chappell

I continue to receive letters from parents whose children have been consumed in America’s opiate epidemic. Here is one:

 

Your book, Dreamland, does an excellent job of outlining how the convergence of the pharmaceutical environment with heroin trafficking from Mexico over the last two decades provided the avenue for the addiction that killed my son. I believe his story is the third leg of your book.

Sam Chappell


Sam was born in 1994. The next year, OxyContin was approved. Sam was a sweet toddler when Purdue began its aggressive and misleading marketing campaign for the drug. Meanwhile, Sam’s dad was writing a masters thesis on heroin production in Colombia — it was becoming so pure, he pointed out, that it could be snorted or smoked, avoiding the stigma of needles and making its way into the mainstream.

By 2000, when Sam was six and entering first grade, revenues from OxyContin had quadrupled. The initial 80 mg pill had given way to a 160 mg pill to account for increasing tolerance among patients. Purdue’s sales force had doubled and salespeople were receiving annual bonuses of $70,000 and above.

In 2001, when Sam was seven, Purdue was spending $200 million in marketing and had pinpointed doctors who tended to prescribe lots of pain medication for aggressive marketing campaigns. Sam began to face some bullying in school.

By 2002, Purdue knew of doctors who were recklessly prescribing its drug. Sam continued to struggle to fit in at school. It began to affect his mood and motivation.

Between 1999 and 2010 (the year Sam turned 16) Oxycontin prescriptions and overdose deaths quadrupled. Swapping pills became the new form of partying in the schools. Sam found a way to fit in and feel good all at once.

Meanwhile, heroin from Mexico had been making its way north, poised to fill the gap when opioid pharmaceuticals became harder and more expensive to obtain. Sam found his way to that solution.

My beautiful and beloved son, Samuel Logan Chappell, died of a heroin overdose in Columbus, Ohio, on Sept. 7, 2015.


Nancy Chappell

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Forcing Pharma to Pay To Take Back Drugs

The Los Angeles County Department of Public Health is today holding hearings on a proposal that would force pharmaceutical companies to pay to “take back” their drugs and needles that are not used by consumers.

Los Angeles County is following the lead of Alameda County in northern California, which enacted an ordinance requiring pharmaceutical companies to provide funds to collect and dispose of unused pills. The ordinance survived Supreme Court review last spring, and is now in place under the concept of Extended Producer Responsibility (EPR).

According to the L.A. County department’s website, “EPR is an environmental protection policy approach that recognizes the responsibility of a manufacturer or producer of a product to steward that product through the post-consumer stage of its lifecycle.”

This has become an issue due to overprescribing of addictive narcotic painkillers over the last two decades – often following routine surgeries. Frequently patients are prescribed 60 or 90 Vicodin, Percocet, or Oxycontin pain pills, of which they often use only a small fraction, leaving the rest in their medicine cabinets. Many of those pills have been discovered by kids in the home, their friends, by workers doing jobs at houses, or otherwise entered the black market.

These overprescribed and unused pills have added enormously to the street supply of pills and are a large part of why the country is in the midst of an unprecedented scourge of opiate addiction.

Profits from the sale of these pills have accrued to pharmaceutical companies, while the costs of dealing with that addiction have been borne by taxpayers – cities, counties, jails, coroners, police and public health departments.

One response has been Drug Take-Back days, which have spread nationwide. In 2014, 5 million pounds of drugs were taken back during these events nationwide, according to the National Safety Council. (LA County’s interim health director estimates some 200 million pounds remain of these drugs remain in medicine cabinets around the country.)

Of course, the problem is who pays to take back these drugs, and to then dispose of them. Up to now, again, public agencies, typically cities, counties or the DEA, have foot the bill.

The move to push pharmaceutical companies to contribute is new. Counties and cities across America might want to look into this new kind of ordinance as they cast about for ways to pay for taking back the enormous quantities of highly addictive painkillers still out there.

 

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Why I Voted Against California’s Prop. 47

Last year, Californians were asked to approve Prop. 47, which made misdemeanors of several felonies.

The idea was to send fewer people to prison and a majority of Californians voters approved it. I wasn’t one of them.

I voted against Prop. 47 for exactly the reason mentioned in a recent op-ed piece in the LA Times: that addicts frequently need the threat of jail or prison to get their minds around the idea of entering rehab.

The threat of prison was, in other words, a rock bottom from which some could achieve recovery.

cropped-IMG_0910.jpgThis comes from interviews with many recovering addicts whose lives were saved by being arrested, by going to jail and facing prison time.

The idea that government or society should play no role in pushing addicts into recovery is foolish, dangerous, too. It does no one any good to remove that threat.

But that’s what Prop. 47 does, to the detriment of folks addicted to drugs, I believe.

The op-ed makes the point that it’s leading to an increase in crime. That may be true. But from my standpoint, having written Dreamland, and seeing widespread addiction to pain pills and now heroin across America, it is the former reasoning that makes most sense, particularly given how horrifying difficult it is for so many to kick their habits.

Prop. 47 couldn’t have come at a worse time. Addicts need any kind of impetus they can get. Unfortunately, for many in California, it no longer exists.

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Filed under California, Drugs, The Heroin Heartland, Writing