Category Archives: Drugs

Opiates & the Senate Health Care Bill

When the Senate’s health-care bill died this week, it was worth noting the few who led the revolt.

Most were senators from states hardest hit by our epidemic of opiate addiction:

Maine (Susan Collins), West Virginia (Shelly Moore Capito), Utah (Mike Lee), Ohio (Rob Portman).

“I didn’t come to Washington to hurt people,” Shelly Moore Capito said.

Let’s leave aside how the bill would have done away with basic health care for millions of working folks and provided a tax cut for wealthy people.

One of the biggest problems with it, I think, was that it would have reversed Medicaid expansion and that meant taking away coverage for drug rehabilitation from hundreds of thousands of people, maybe millions of them.

I could not understand how that was a good idea.

It was also interesting to see how, as the debate progressed through the spring to now, a lot of people began to realize what they were losing.

In so many areas where Donald Trump did best in November’s election, areas he promised to make great again, there is a documented need for massive investment in more drug rehabilitation capacity, not less. That is not an opinion. What exists is saturated. Getting into rehab takes weeks, months. Many addicts have no resources of their own with which to seek treatment.

I wrote in another post that opiate addiction was the crucial element in Trump’s victories in several states that were in turn essential to his capturing the presidency.

Eight months later, the Senate’s health-care carnival emphasized my belief that this issue is one of the most potent political forces of our time.

In the spring of 2015, shortly after Dreamland was released, I received a call from Hillary Clinton’s campaign advisor for health issues. Hillary was feeling the ferocity of parents in Iowa and New Hampshire from all walks of life, horrified at their children’s addiction and not knowing where to turn. This surprised the candidate, her advisor told me.

I spoke with her for about ninety minutes. I told her that I thought this was the great silent issue in America today and whoever truly owned it, embraced it, treated it as a thing of the heart, would have a good chance of getting votes from unexpected places, but that this probably would not be felt in opinion polls ahead of time. Mrs. Clinton did some of that, but never enough, and in the end she wrote a position paper and that amounted to most of her campaign’s attention to opiate addiction. I might be wrong, but she didn’t seem to understand the latent power of the issue. Least she didn’t act on it. That was a huge mistake.

Politicians would do well to better understand the deep well of pain and anxiety surrounding, and thus the political power within, this issue. It’s not something expressed easily in polls. People aren’t likely to admit to a pollster on a phone that a loved one is an addict.

But it’s there and dims the view of the future of so many people, the prospects of so many towns and counties, the economies of so many regions, and thus is of paramount importance to them. Right up there with jobs – connected inextricably with jobs, in fact. In so many depressed areas, huge numbers of folks can’t pass an employer’s drug test.

Nor does it take many addicts for that foreboding to spread. A few cases in a small town, I think, are all that’s needed. People see it hit almost anyone and seemingly at random – like a plague – including families who before had no connection to the drug world or the criminal justice system. Soon everyone’s view of the future turns negative.

On top of that, today we have the increasing nationwide notoriety of the issue as compared with just two years ago. An awakening has taken place in those short years – a reckoning and a truth-telling when before there was subterfuge and fabrication.

Overall, this is healthy – for the families now telling the truth and for the country, I think.

But one effect is that the knowledge, and thus dread, has spread to even families untouched by addiction.

In that room where 13 of them put that bill together, Senate Republicans didn’t seem to understand that.

That was a huge mistake.

Because in the small towns or suburbs where folks live, they now know the high school’s quarterback has landed in jail again, and that their pastor’s daughter died from an overdose and that it wasn’t a heart attack after all.

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Javier Valdez – A Month Ago

The rule of law is something to be treasured. It is precious beyond value. It has been achieved in relatively few countries and times through history. Yet little good comes without it. No real economic development, no great technological innovation, no slow march of prosperity, no public safety, no civic life.

After living in Mexico, it seems to me the rule of law is achieved through culture and a host of attitudes that give rise to prolonged (taxpayer funded) investment in infrastructure and government.

The rule of law is accomplished through facts on the ground, through small things working well. These include courts, prisons, police, civil service, decent public-employee salaries and training, but also parks, street lamps, storm drains, clear title to property, and much more — above all at the local level.

Most of this is what Mexico lacks or has neglected.

Superimposed on that civic weakness, and growing from it, has been the venomous presence of drug traffickers who have lost any discretion they once displayed and now behave with medieval cruelty. But what allowed them to go from hillbillies to national security threats in the span of a few decades is the lack of rule of law and all that I mention above. The result is the difference between 3000 murders in Juarez a few years back while El Paso tallied only 20 or so. On one side are strong civic institutions and well-motivated law enforcement of various stripes working together; on the other, infrastructure has gone begging due to lack of budget, corruption, lack of accountability, and a general belief that local government isn’t worth the time.

All that is what got Javier Valdez killed a month ago today.

Valdez, you may have read by now, was an esteemed, brave journalist who chronicled the drug world of Sinaloa in books and his newspaper Riodoce.

He was gunned down by masked men who accosted him as he was getting into his car not far from his newspaper. To make it seem as if robbery was the motive, they took his car, ditching it not far away. The computer and cell phone he was carrying have not been found, according to his newspaper.

I met Javier in 2014. I saw him again in February. We had breakfast to talk about things in Sinaloa. In the meantime, I had provided a promotional quote to the English-language version of his book Los Levantados (The Taken) because, despite knowing him only casually, I admired the work he and his newspaper, Riodoce, did consistently.

The Taken (University of Oklahoma Press), by the way, offers an amazing view of worlds few of us will enter. You should read it. The first story is about a Mayan Indian from Chiapas who fathered six pairs of twin girls and, to support them, was recruited to do some kind of work in Sinaloa, only to find that the work he was hired to do was not in agriculture, but in something connected to drug trafficking, though he never figured out what that was because a battle between cartels consumed the region where he was sent. Just stunning stories.

In the month since Javier’s death, we’ve heard the calls for the government to do more to protect journalists, end the impunity with which the underworld rules many parts of the country. I echo those calls.

But what ails Mexico isn’t only lack of political will. It is certainly that, but it is also a systematic neglect of local government that goes far back in the country’s long history. So even with the political will to find the killers of Javier Valdez, investigators would be hampered by the lack of tools that their counterparts in other countries take for granted.

There is no way to make good on calls of better investigations without a mighty strengthening of the local and regional public institutions that go into such investigations.

As we examine all the reasons why brave people like Javier Valdez have fallen, Mexico needs to look to its local government and build up its institutions, its capacity, its ability to protect its citizens and the ability to find justice for them when it cannot.

Like all politics, justice, at its root, is local.

Ensuring that would be the greatest tribute to a brave man.

#ourvoiceisourstrength #nuestravozesnuestrafuerza

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Porter & Jick, Dreamland, and The New England Journal of Medicine

The New England Journal of Medicine startled everyone this week by a posting a one-sentence warning over the so-called Porter & Jick letter to the editor that the journal published in January of 1980.

The warning note reads:  “For reasons of public health, readers should be aware that this letter has been `heavily and uncritically cited’ as evidence that addiction is rare with opioid therapy.”

I find it remarkable that the NEJM did this, particularly so long after the letter itself was published in the journal. Apparently this kind of note is very rare.

But I think it confirms what I wrote in Dreamland – in which I interviewed the main author of the letter, Dr. Herschel Jick.

I think it’s important to reiterate the impact, as well as the intent, of the letter.

As written, it is entirely correct. That a data base of hospital patient records, that Dr. Jick ran, and still runs, found the following: of 11,800 patients given narcotic painkillers while in hospital, only four developed an addiction to those drugs.

Remember this was data taken from the 1960s and 1970s, a time when narcotic painkillers were rigorously controlled, and never given to patients to take home with them. So it stands to reason that patients, under such strict controls and administered the drugs only in hospital, would rarely develop addictions – as the letter’s headline in the journal read when it was published: Addiction Rare in Patients Treated With Narcotics.

They simply didn’t have access to large supplies of narcotics, and especially drugs to take home with them, as patients routinely do today. Hence they didn’t run much risk of addiction. (The whole thing, btw, helped change my mind about what ignites a scourge of addiction, which I now believe is not demand, but supply. Supply first sparks demand.)

The problem came not with how the letter was written, but how it was interpreted, then used, by others. Through the late 1980s and 1990s, it was widely cited, quoted, footnoted – as my research in Dreamland made clear and as a recent letter to the NEJM from the Canadian doctors confirmed. It was deemed to be proof that somehow science now knew that addiction was rare when opiates were used to treat pain. Through the years, it became known, through a process similar to a game of telephone, as some kind of “landmark study” that presumably refuted much about what we know about narcotic painkillers and addiction.

The Porter & Jick letter – 101 words – neither did, nor intended, anything of the kind.

It was also used, of course, by pharmaceutical companies – especially Purdue Pharma, manufacturer of OxyContin – as proof that their drugs no longer caused addiction when they were used to treat pain. The company used the statistic that “less than 1 percent” of all patients administered opiate painkillers drugs – especially OxyContin – grew addicted to it. This was not true nor supported by any science. It was not supported by Porter & Jick, which was making an entirely different observation. Yet the letter was used to convince a generation of doctors that science now knew new things about narcotic painkillers and one was that they were “virtually nonaddictive” when used to treat pain. A claim that, again, has no basis in science or the letter.

All this I wrote in Dreamland, which came out two years ago. I found the whole story to be an unsettling episode in how scientific thinking changes based on no evidence at all, but due instead to deft and relentless marketing.

I’ll add one more thing. The NEJM’s warning note was prompted, as I said, by a review of the letter and its influence in scholarly studies that was published by some Canadian doctors in the journal this week.

I read the letter these doctors wrote and I don’t see Dreamland credited or footnoted.

I’m trying to take it all in with equanimity. Yet I’ll admit to some frustration to have done so much research and storytelling that brought this to light as part of Dreamland’s larger story of how this opiate-addiction epidemic spread, and which others have read and learned from, and then not have it reflected in the work those people do. On the contrary, the Canadian doctors’ letter is presented as some new revelation, which it is not.

So I’ll just say that it would have been nice to see my work credited in the recent NEJM report by those Canadian doctors, as well as media coverage of that letter. I’ll leave it at that.

 

 

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Happiness & Heroin

One important thing my mother told me when I was growing up was that first I should find the work I loved to do in life. That if I did, or didn’t, it would affect all the other aspects of life: sleep, romance, family.

I’m lucky. I love what I do. I’ve been a journalist for 30 years and when I’m on my deathbed I’m quite sure I’ll be making deals with God, saying, I’m happy to go but just let finish this one story first. Nothing I’ve done in the last 30 years has been drudgery, tedium. It has been exciting, mentally stimulating — and it paid the bills.

That didn’t happen by chance. I worked at it very hard for many years. I was helped by several great editors who pushed me to learn the craft and forge a writing style – sometimes not so politely.

I was helped above all by my parents who did not give us what we wanted growing up. They gave us what we needed. They gave us education and experience, above all. They gave us far less stuff than other friends I grew up with were getting from their parents. Later in life, I was very happy that was true.

I bring this up because I believe it is relevant to the opiate-addiction epidemic we face as a nation and a culture.

Recovery from addiction, I believe, means finding fulfillment in some project, endeavor or work. Finding something you love to do, something that means more than dope, that stimulates your mind more.

One way we, as a culture, have failed our kids is that too often we believe the stuff they get (and have demanded) without working for it, and that we give them, is somehow going to help them be happy. We as a culture have avoided pain, run from it. And we want our kids to be spared any pain at all – even hard work. But no one find’s his calling in life without hard work, sometimes demeaning work.

I hated all the years I spent washing dishes in cafeterias and restaurants while I was in high school, but I’m plenty happy I did it for it taught me to do things I didn’t want to do, taught me how important education is, and that fulfillment comes from finding the work you love and spending your life trying to get good at it.

So many kids I see have been given far too much without working for it. Too many haven’t learned that through hard work, pushing yourself to seek that calling, you actually learn and achieve and feel good about what you’ve done.

On the other hand, heroin, seems to me, is simply the final “stuff” for a culture that believes that more stuff leads to happiness. (Writing about heroin these days is really another way of writing about America, who we are and what we’ve become, I’ve grown to believe.)

My mom was right. It’s through hard work in something you love that you achieve fulfillment.

I began to think about all this again when I read snippets from the philosopher John Dewey about how we find happiness.

Here are a couple:

“To find out what one is fitted to do and to secure an opportunity to do it is the key to happiness. Nothing is more tragic than failure to discover one’s true business in life, or to find that one has drifted or been forced by circumstance into an uncongenial calling.”

And …

“The opposite of a career is neither leisure nor culture, but aimlessness, capriciousness, the absence of cumulative achievement in experience, on the personal side, and idle display, parasitic dependence upon the others, on the social side.”

Interesting stuff, and relevant more than ever to today’s America.

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Grunge, Heroin & Conformity

The passing of grunge rocker Chris Cornell this week means that of the five major bands to emerge from the early 1990s’ grunge scene, Soundgarden, Alice in Chains, Stone Temple Pilots and Nirvana all have lost lead singers to early deaths.

Only Pearl Jam has not. 

Mostly, these were singers whose lives were mangled by heroin/opiates, whether they died from it or not.

As I read the news, it occurred to me how deeply the grunge scene of the late 1980s and early 1990s swallowed the greatest drug scam ever sold, which is that heroin use is somehow a sign that the user is a rebel, an outsider, an artist finding his own tormented path on the margin of a claustrophobically conformist society.

The reality is that the drug, more than any other, is about commerce – about cold, hard business — and about enslavement to consumption. All of which, needless to say, is about as low-brow conformist as it comes.

Heroin should have been forgotten not long after it was invented for it has few medicinal benefits that other opiates don’t provide with far less addictive risk. It survived because it was a great drug for traffickers. It was easy to conceal, easy to cut, and it created customers that had to buy the product several times a day. A businessman’s dream.

The drug got its underground cachet beginning with Charlie Parker, the legendary saxophonist in the 1940s, who died in 1955 at the age of 34, having wasted much of his prodigious creativity in the pursuit of smack, while bringing an entire generation of younger musicians to dope. (Trumpeter Clifford Brown was staking out another path for jazz musicians – one of great devotion to art and improvisation combined with a sober lifestyle – when he was killed in a car accident at age 25.)

Beat writer William Burroughs helped solidify the drug’s reputation as an outsider’s substance.

Heroin got a bigger cultural boost from the Velvet Underground’s first album in 1967 and Lou Reed’s “Heroin,” followed as the years passed by notably addicted rockers like Johnny Thunders, Sid Vicious and, of course, Keith Richards. So that by the late 1980s, heroin was fully established as the go-to drug for anyone – often a pasty-faced white kid with a rocknroll heart — wanting a personal image as a non-conformist.

To the extent of few others before it, the grunge scene bought this fiction with gusto. Heroin, moreover, seemed the perfect drug for grunge’s nihilistic, dirge-like sound. So an entire scene was created that seemed to emerge from the swamp of the Velvet Underground’s first album. Many others died from it. Grunge did, too.

My music was punk rock and the grunge thing happened later. My focus in life was by then on writing and storytelling and not so much on the latest wrinkle in rocknroll. Grunge was too slow, too hopeless and depressing. Also, I lived in Seattle during this time, and didn’t like the city and left as soon as I could and moved to Mexico. So all in all, grunge didn’t do much for me. (Stone Temple Pilots were a bit different, and appealed to me more, in that the music was less grungy and they weren’t from Seattle, though their singer’s story is the same.)

There was, nevertheless, a do-it-yourself ethos to the scene that I found attractive. Bands were especially afraid of “selling out,” thus many of them first signed with the local Sub Pop label.

It’s a sad epitaph to the scene that the folks who created it fought mightily to avoid the taint of commercialism in their music and conformity in the way they lived — and ran, as they did, to the embrace of a drug that embodied everything they were fleeing.

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Big News From Nayarit: Edgar Veytia arrested

In fascinating news from Mexico’s heroin world, Edgar Veytia was arrested Wednesday at the San Diego-Mexico border.

Veytia is the Attorney General for the state of Nayarit, and a figure bigger in the public mind than the state’s governor – which is rare in Mexico.

He was charged under an indictment out of New York alleging that he conspired to smuggle heroin, cocaine and methamphetamine into the United States.

Those who’ve read Dreamland know the importance of Nayarit in our heroin supply. Many have alleged that Veytia protected the heroin trade, in an alliance with a large and new cartel known as Jalisco New Generation, who has taken control of the region over the last six years.

Proceso, the Mexican new weekly, recently published this article calling him the “dark Prosecutor,” and repeating allegations that he had protected the drug trade.

Veytia began his career simply enough, as an attorney handling the taxi concessions for the city of Tepic. But in time, he was place in charge of the state’s anti-kidnapping squad and from there elevated to Attorney General.

(Stay tuned for a blog post later today about my own (brief) encounter with Edgar Veytia.)

In Nayarit, he has promoted an image of himself as a tireless, almost God-like, fighter against crime, subduing the violence that racked the state during 2010 and 2011. The governor of Nayarit named him government official of the year.

Veytia has several corridos – ballads – written about him, promoting this image. The words to one song read, in part:

“Nayarit was a war zone, body mounted and the state needed a miracle sent from the Lord above.

Edgar Veytia is the name of this miracle, who returned peace to the land, risking his life

He’s been able to let people feel better, in a peaceful state and for that I thank God.”

In February, the Mexican Marines shot it out with – and killed – a wanted leader of the Beltran Leyva Cartel — Juan Francisco Patron Sanchez, aka H2 – who lived a few doors down from Edgar Veytia in the city of Tepic, Nayarit’s capital.

A businessman in Los Angeles who is from Nayarit, in an interview in 2014, told me Veytia had him kidnapped. (More on that interview later.)

So far, it’s unclear how Veytia was at the border and able to be arrested. I suppose we’ll hear  more on that as the case unfolds.

Leaving aside the charges against Veytia, the Mexican drug trade since its origins in the 1970s has depended on political protection, collusion and corruption.

More later today when I have time to write.

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Can We Treat Our Way Out of This?

I was reading the obituary of a young woman named Isabella Sammartano from suburban St. Louis, Missouri, who died from a heroin overdose suddenly after being clean from opiates for 16 months.

Her obituary doesn’t provide a lot of detail, but it does provide some. It sounded as if she spent a lot of time in rehab, then relapsed each time. Finally, when she looked to be putting the worst behind her, she relapsed again and overdosed and died.

It’s an extraordinarily sad story – and it must have been very difficult for her parents to write the obituary.

It made me think of what her death can tell us. First, all addiction seems to involve relapse. I quit smoking (and started again) nine times before I finally quit for good – at 37.

But I lived through my cigarette relapses. With opiates, particularly given the amount of supply of dope on the street, getting out of treatment is like Russian Roulette. People go in, detox, get clean. Their tolerance to narcotics drops. They leave rehab and do well, then they relapse. With these drugs, and their prevalence and potency on the street, relapse too often means death.

It feels good to say, `We can’t arrest our way out of this.’ I agree. We do need expanded treatment. But, frankly, that also feels too easy.

My feeling is, when it comes to opiates, we have to arrest our way out of this before we can treat our way out of it. That’s a bit discombobulated, I know. What I mean is that we need to address supply on the street. That comes only with arrests. It seems to me dangerous to assume that in modern America people can get out of rehab and go home to areas awash in dope and be expected to stay alive, given the likelihood of relapse and the potency and controlling nature of opiates. It’s not cigarettes people are relapsing on. It’s pain pills and, especially now, heroin and fentanyl.

This is a supply story and has been from the beginning. Huge amounts of very potent opiates were unleashed on the country – first in the form of prescription opiate painkillers. When millions of people grew addicted to these pills, a lot of them looked for cheaper alternatives. Heroin traffickers, mostly from Mexico, slowly realized that these folks were a growing market and expanded their offering.

But it all has to do with supply. No treatment has much chance against a cheap and plentiful supply of potent dope.

It’s why doctors and the medical establishment need to continue reassessing how they prescribe opiate painkillers.

It’s also why we need to make Mexico a sustained priority. I’ve written elsewhere that I don’t think building a wall — or rather, more walls — at the U.S.-Mexico border is likely to do much to slow heroin trafficking. That doesn’t mean we shouldn’t seriously address Mexico’s continued production and exporting of this drug. Ninety percent of our heroin comes from Mexico, according to the U.S. State Department. It’s unconscionable that one country should export so much of this junk. China fought a war with England in the 1800s, twice, over this issue. We don’t need wars with Mexico, but it does seem to me that we need to make this the priority it deserves to be – and walls are a distraction from the real work that needs doing.

This young woman’s death also shows why we probably need to make much greater use of what’s known as medically assisted treatment – the use of drugs as replacements, as shields. These include methadone, Vivitrol and Suboxone – they either take away the craving for heroin or block overdoses.

It’s unreasonable, I think, to assume that addicts can go back to these same neighborhoods, where opiate supply is plentiful, without some sort of protection, some kind of shield.

The last couple years have shown how dangerous that is.

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House Republicans & Heroin

Governing is the opposite of dope.

It’s real world. It’s working the program. Accepting blame and accountability, breaking with fantasy. It’s hanging out with people who don’t think like you. It’s reminding yourself that life is full of constraints and you can’t just do whatever occurs to you. It’s realizing that you are not perfect and there are others whose opinions matter in this world.

That said, the recent health-care fiasco displayed House Republicans behaving like heroin addicts.

It’s easy to go on Fox News for years, blame someone else for everything when you don’t have to be accountable for finding solutions. It’s easy to rant about the endless failures of those people who do. Ranting is a narcotic; so is outrage; so is complaining and destroying. It gives us a big blast of dopamine to the brain. As does spending a lot of time insisting on all the nifty ways you’d do things better when you are king of the world. Feels so luxurious. Feels a lot like heroin, I suspect.

Being an opposition party means never having to put an idea to a constituent smell test. You get used to it – your tolerance for fantasy rises like an addict’s tolerance for a narcotic. Like addicts, you hang out with folks who think like you, talk like you, and never force you to face anything resembling reality, or the necessity of compromise.

Living without compromise is a nice idea in theory, but it’s possible only when you’re high on, and surrounded by, ideology — or dope.

A heroin addict brooks no compromise. He wants a world his way only. No messy complications, no one telling him no. Ask any parent of an addict.

What I think we saw was people addicted to a warm, euphoric ideological fantasy world in which they’ve lived for the last several years. Addicted to the idea that they could do it alone, didn’t need anybody, didn’t need to compromise. This Freedom Caucus seemed dead-set on depriving anyone but the wealthiest of what most would deem civilized health care: maternity care, ER visits, not to mention addiction-treatment coverage.

It was bizarre to watch them line up to take away benefits needed by so many who had just elected them and their president, and give them to our aristocracy.

Harold Pollack noted in this article in Politico that Democrats working to forge Obamacare held hearings over months and accepted more than 150 Republican amendments to the bill they passed. House Republicans this time took 18 days and “the payout to the top 400 families [in America] alone was estimated to exceed total ACA subsidies in 20 states and the District of Columbia.”

How do you come to the conclusion that thinking like the upper classes of pre-revolution France is okay?

Well, perhaps because House Republicans lived in a bubble for seven years, voting to repeatedly repeal Obamacare knowing it would be vetoed. Then the fantasy ended and they finally had the power to do it. They had nothing to replace it with. (John Boehner is, I’m sure, happy to be away from all that.) What they came up with would have savaged the very people who put them in office.

The word `compromise’ gets a bad rap these days, but it’s actually another way of saying something else. It’s saying, we’re behaving like adults. We’re not going to act like petulant children who want a world run according to their whims alone, which is, in turn, another way of describing how a heroin addict thinks.

Something like this, I suspect, is what Ryan was referring to when he spoke of House Republican “growing pains.” Getting off the dope of viewing compromise as a dirty word.

A big part of addiction recovery is relating to others again, accepting that your views are not the only ones that matter, that you have to modify your behavior, answer to others who may not think like you.

It’s like governing.

It’s messy and ragged; it’s hard and far from perfect. It’s adult, in other words, and it’s the opposite of dope.

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Saints and Sinners: Growing up in Portsmouth

A letter from a reader of Dreamland:

I was living in South Shore when Dr. David Proctor arrived in 1978.  I had just come back from college and was working at the local brickyard.  For a few years I was still apart of the local drug crowd but slowly moved away from it because I found it scary and upsetting.  I did not like buying from biker dudes I did not know and I did not like the small dealers that sold drugs to kids.

In small rural towns there are the “saints” and “sinners” and the doctors in any town normally are in the “saint” category.  One of my local small dealer friends went to Proctor while he was still apart of Dr. Riddle’s office. Proctor told him he would write him a script for any drug he wanted.  When my friend told me this I will never forget the stunned and serious look on his face, even though he got a prescription for Black Beauties.  My friend knew in the back of his sinner brain that something was very wrong.

Once my extended Pentecostal rumspringa was over, I returned to church.  I got married and left the area.  However, my husband was an abusive man and I returned to my mother’s home in South Shore with a small child.  It did not take me long even in my state of mind to see that Dr. Proctor along with another doctor had done major damage to my small town.  Even in my mother’s church there were five people that I knew about that were addicted to prescription drugs.

 Your book focused on the opiates but there was a doctor who ran a “diet” clinic who was free with the amphetamines. I would walk around the corner to see his lot filled with cars from Hamilton, Franklin, Pike and other counties in Ohio plus cars from counties in Kentucky and West Virginia.  The people I saw were lean not obese.  So South Shore was a one-stop on the small time dealer network for both opiates and amphetamines.

 There is one thing I would like to say about kids raised in fundamentalist churches. This is about the saint and sinner perspective.  They will be zealously saint or zealously a sinner and there seems to be no middle ground. This especially applies to rural areas.  If you are trained to live your life a religious zealot then when you turn away from your religious upbringing you live your worldly life just as fervently and passionately in the negative. However, when these same people turn back to their religious roots from the addictive life they are not ashamed to help others to do the same.

I left South Shore in the middle nineties with my middle school aged daughter.  I went back to Morehead State and cleaned up my mess from the 70’s and graduated with honors just in time for my daughter to start college. My daughter went on to get her masters at UK.  After reading your book I am glad we left the area for I can see decades of destruction manifest in South Shore when I go back to visit.

A positive note:  I loved your description of Chillicothe Street especially during the holidays.  I was not part of the middle class but was raise by a single mom with three children and no welfare. We would take a taxi to Portsmouth to shop on Christmas Eve.  I can remember the Salvation Army Santa ringing his bell in front of Kresges’ and my mom singing “Silver Bells.”  We would go to Kresges, Greens Five and Dime, Kobacher’s and to Martings to see their window display and buy hot peanuts from their candy area and play on the escalators.

All of this is etched into my childhood mind as well as all the great times swimming at Dreamland with my brothers and the neighbor kids who took us with them.  I thought all city pools were like Dreamland.

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Our Heroin: From Afghanistan or Mexico?

While speaking on the topic of heroin in America, I’m often asked how much of our supply comes from Afghanistan, as we’ve been in a war over there for many years.

My answer, from interviews with traffickers, cops and DEA agents, is that most of our heroin comes from Mexico.

That view was confirmed this morning by William Brownfield, the U.S. State Department’s assistant secretary for International Narcotics and Law Enforcement Affairs.

In a conference call with reporters, Brownfield estimated that 90 to 94 percent of the heroin consumed in the United States originates in Mexico, with another 2 percent or so coming from Colombia and the remainder from other countries around the globe.

That represents a massive shift in our heroin supply since roughly 1980, when a lot of our heroin came from the Far East, and had for decades.

Interestingly, Brownfield said, a lot of Afghan heroin does make it to Canada, but not to the United States, where Mexican trafficking organizations, too close by, enjoy a more advanced and efficient distribution network, and offer therefore cheaper prices.

 

Brownfield was talking about the just-issued International Narcotics Control Strategy Report (INCSR), which talks a lot about the heroin/opioid problem in America. Brownfield’s message was a positive one about cooperation between Mexico and the United states on issues of drug enforcement.

A wall of law enforcement cooperation is in place, without constructing an actual wall, he said. Serious problems existed, he said, “but we have a far better architecture to address them today than we did in years past.”

Nevertheless, his answer on heroin’s origin stunned even me. I would not have guessed the estimate would be that high.

I’ve written elsewhere about my belief that it’s unlikely that more border walls between the two countries will do much to staunch the flow of heroin into the United States. What’s really necessary is even deeper cooperation, frank discussion with Mexico that a wall and the emotion it provokes would do much to corrode.

Yet Brownfield’s response highlights two things worth mentioning.

One is that Mexico must truly step up to this challenge. Its unconscionable that such a high percentage of illegal highly addictive dope come from one country to another. China had a similar issue in the 1800s, when the British forced opium into that country, resulting in the massive addiction of Chinese people for decades after.

If border walls are insulting to Mexico, it must understand that they are proposed because of Mexico’s own failings – both with regard to law enforcement and criminal justice, and in channeling the desires of its most hardworking citizens, who then feel the need to migrate illegally to the United States.

Second is that U.S. demand for heroin grows organically out of doctors’ massive prescribing over the last 20 years of pharmaceutical narcotic painkillers – the subject of my book DREAMLAND — something that no border wall will stop, of course. Also, if we get into discussions with Mexico about this topic, soon that discussion will also turn to our very accessible market for guns, many of which then go south through a variety of channels and end up being weapons in that country’s bloody drugs wars. So if we ask a neighbor to behave with maturity, we better be willing to do the same.

We have almost 700 miles of walls along the border that separate the two countries. Drugs aren’t much trafficked through those areas that have no walls, most of which are in forbidding terrain. Our drugs, instead, are trafficked through ports of entry where walls already exist. They are trafficked in cars, trucks, and by pedestrians. With heroin, the problem is exacerbated, as I’ve written elsewhere, by the fact that is the most condensable drug, thus the most easily and profitably trafficked,and one that we now have a huge demand for.

All in all, the issue begs a binational, cooperative solution, seems to me.

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Filed under Border, Drugs, Mexico, The Heroin Heartland

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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Filed under Dreamland, Drugs, The Heroin Heartland

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