Category Archives: Drugs

Coming Soon: Money For Three Addiction Research Centers

The National Institute of Health yesterday announced what sounds like a major new push to attack the opiate epidemic at the community level.

A big part of what it’s calling its HEALing Communities initiative will be to try to integrate prevention and treatment efforts for addicts while strengthening communities.

There’s more than that, though.

Two years ago, I wrote about the potential for economic development to the Ohio River Valley region that I thought could come from the region positioning itself as a center for addiction research. Northern Kentucky University, and their provost, Sue Ott Rowlands, picked up on that idea, I’m honored to say, and the Ohio River Valley Research Consortium was formed.

It now appears that within the NIH push is what is described to me as “a lot” of money (though how much is as yet unknown) to establish three research centers around the country. Here are the guidelines for applying for that money.

Sounds like it might be a good moment for folks in the tri-state Ohio River Valley, so badly hit by the epidemic and deindustrialization, to marshal some forces and look to the future of what such a center can mean for research, dollars, and attracting PhDs to the area — and what all that might mean, in turn, for regional economic development.

They might also consider, as I wrote two years ago, what such a center could mean for all those recovering addicts now studying to be drug counselors and social workers, who might be hired to help in the studies such a center would fund.

After so many years of negative behavior, many I’ve met are now eager to be part of something positive and something bigger than themselves. Harnessing them could mean a massive infusion of new energy to a region that’s lost a lot of it.

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Louisville: Jail Among The Solutions

In Louisville the other day, I wanted to see how jail was changing in America.

This epidemic of opiate addictions  calling on us to reexamine a lot about how we live, our values, culture, ideas and institutions we’ve taken for granted.

One of them is jail. Jail has always been a crippling liability in our fight against drug abuse. Jails are usually places where humans vegetate, sit around, argue, learn better criminal techniques, then get out weary and stressed and, if they’re addicted to drugs, they head straight to the dealer’s house.

This epidemic is forcing new ideas. One of them is jail turned into an asset, a place of nurturing, of communion as addicts learn to help each other.

That’s a bizarre concept. I never thought I’d write “nurturing” and “jail” in the same sentence, but it’s happening.

The state of Kentucky seems furthest along in all this. I wrote an Op-Ed column for the NY Times about a visit I paid to the jail in Kenton County, Kentucky. Yet what’s being tried in Kenton County – and a couple dozen other county jails in Kentucky — began in Louisville – in Metro Jail.

Why jail?

Well, if “we can’t arrest our way out of this,” as is so often said, then we need more drug-addiction treatment. Yet this epidemic has swamped our treatment-center infrastructure. New centers are costly to build, politically difficult to site, and entering them is beyond the means of most uninsured street addicts, anyway.

I know that jailing addicts is anathema to treatment advocates. But opiates are mind-controlling beasts. Waiting for an addict to reach rock bottom and make a rational choice to seek treatment sounds nice in theory. But it ignores the nature of the drugs in question, while also assuming a private treatment bed is miraculously available at the moment the street addict is willing to occupy it. With opiates rock bottom is often death.

Jail can be a necessary, maybe the only, lever with which to encourage or force an addict to seek treatment before it’s too late. In jail, addicts first interface with the criminal-justice system, long before they commit crimes that warrant a prison sentence. Once detoxed of the dope that has controlled their decisions, jail is where addicts more clearly behold the wreckage of their lives. The problem has been that it’s at this very moment of contrition when they have been plunged into a jail world of extortion, violence, and tedium. It’s a horrible waste of an opportunity, and almost guarantees recidivism.

With this epidemic, though, we’re seeing new approaches – jail as a place of rehabilitation, a place where recovery can begin.

Several years ago, as heroin began to grip the area, the Louisville jail saw inmates dying from overdoses.

Mark Bolton, the jail’s director, said the spate of deaths forced new ideas.

“We modeled a pod on outside treatment (centers),” he said. “It became a matter of taking the resources we had and repurposing them. We sent people [to drug rehabilitation centers on the outside] and found out how they run their peer detox program. We learned from them.”

Louisville Metro began with female inmates. Those who were just off the street and detoxing, and who normally were spread across the jail, were placed together in one pod, christened Enough is Enough. This allowed more focus on their needs, and got them away from other inmates who were angered by their withdrawal symptoms, which included vomiting, diarrhea, screaming, insomnia and more.

Jail officials began allowing people in recovery into the detox pod as well. These recovering addicts mentored the new arrivals – washing and soothing them. Officers preferred it, as they no longer had to clean up vomit and diarrhea.

In addition to bathing and caring for those in withdrawal, inmates take classes in relapse prevention, understanding criminal thinking, accountability, parenting, and more; they run their own 12-step groups.

As the Enough is Enough pod began to function, there were fewer fights, less contraband. “Inmates into their recovery and into their sobriety are self-policing. The wear and tear is less,” Bolton said. “After we worked out the bugs, we began to see some of these people show progress. The inmates into their treatment appreciated the fact that they were caring for a human being that was at a place where they had been once.”

When they leave jail, they’re given a Vivitrol shot, which blocks opiates, and they were connected with housing and follow-up Vivitrol shots.

The jail now has the one women’s pod and three pods for men: 56 detox beds and 64 recovery beds, total.

I visited the pod – with about 30 women, four of whom were detoxing. The walls were covered with art work.

(Click here to hear the end of the pod’s afternoon meeting that day.)

It seemed, finally, a nurturing place in jail – far more about recovery than its connecting pod, where fights and loud noise were common until the early morning.

I spoke at length with a woman named Kara, whose addiction was more than 20 years old. This was her 17th time in jail. She had come from washing the vomit off another woman who had just arrived in the pod.

Here’s our interview:

The Louisville jail experiment isn’t a cure-all – no one thing is for this opiate-addiction epidemic. And the jail has difficulty tracking inmates who leave, so it’s unclear how well they do on the outside. What’s more, inmates by this time face a daunting uphill trudge to sobriety, hampered by family dysfunction on the outside, shredded personal relationships, a private sector wary of hiring them, and on and on.

And of course, there isn’t nearly enough in available treatment options.

“I would love to shut some of these programs down,” Bolton said. “This shouldn’t be the jail’s responsibility. [Addiction] is a public health issue. Our job is detention, protection of the public, to get people to court. When we have to become the quasi mental health facility for people who are poor and don’t have access to services, or for people who are drug addicts and who’ve created these chaotic lifestyles for themselves and can’t get treatment in the community — then we become this de facto fallback place for everybody. That’s not what jails are designed to do, nor should they be.”

Yet until a massive investment in community drug rehab and medically assisted treatment takes place, it’s likely that pods like Enough is Enough will be necessary.

It also occurs to me that with jail rethought and remade — a nurturing place — we have the chance that it will be an asset in the next drug scourge that comes along.

Either way, as with Kenton County, it seems like a better bet of public money than the way jail has been done up to now.

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A Safe Station For Addicts in Whitehall Ohio

A couple weeks ago I was in the Midwest, speaking about Dreamland.

I decided to add a couple days to the trip to spend more time in places where I was visiting than I’ve done in the past.

First stop was Whitehall, a town of about 18,000, next to the airport in Columbus, Ohio.

I got there a little early because I wanted to see a new idea the town had instituted.

Whitehall Fire Department has established its firehouse as a Safe Station – meaning that addicts can come by, no questions asked, and will be shuttled to treatment. This has been tried by police departments elsewhere, but in Whitehall they decided on the fire department, believing that most folks would be more at ease there than showing up to talk to police.

The idea had been in place about six weeks and 54 people had made use of it. Whitehall being part of the Columbus metro area, the vast majority of Safe Station drop-ins are not from the town.

One fellow who dropped by was Matt, who grew up in a fairly difficult family but in a middle-class town nearby. He played football, baseball, basketball in high school. In his town, sports were it, he said. Young men got their identity from their participation, or stardom, in sports.

Readers of Dreamland may feel where this is going.

Continue reading

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Planting Portsmouth, Ohio

Portsmouth, a small town I wrote about in Dreamland, has been slowly rebounding from years of economic decline and drug addiction.

That’s a remarkable thing. For it was Portsmouth – on the Ohio River — that led the way into our national opiate-addiction epidemic. The town was where the Pill Mill – sleazy pain clinics prescribing massive amounts of pills to almost anyone for cash – was born.

With the town blasted by this huge supply, and the sense of community shredded by job loss and more, widespread pain-pill addiction was a fact of life in Portsmouth by the end of the 1990s.

But a lot has happened since then. The town, each time I return, seems slightly more energetic, more invigorated, more about positivity and less about dope’s inertia and fatalism. A recovery culture has taken hold there that’s exciting to watch.

Not that all the problems are behind Portsmouth, Ohio. But there’s another story now competing with the “let’s get high” culture that gripped the town for so long. I wrote about the beginnings of this at the end of my book – the small clues of rebirth: new gyms, a coffee shop, lofts, refurbished buildings and more.

Along that line, the folks of Portsmouth – 500+ volunteers – get together this Saturday to wash, repaint, redo their downtown in something they’re calling Plant Portsmouth.

They’ll be painting light poles, scraping and painting all the curbs, replacing 120 streetlights, and more. “None of this has been done in 20 years,” said Jeremy Burnside, an attorney in town who got the idea started.

They’ll also be planting plants as a way of signaling the town’s rebirth.

Burnside’s hoping to set a Guinness World Record for the most people planting plants simultaneously.

(Folks — please send me photos from the day and I’ll post them here and on social media. #plantportsmouth)

Organizers have raised $75,000 from local businesses to pay for supplies. That itself is a sign of how locally owned businesses are now growing in Portsmouth. None of that money came from the chain stores and corporate fast-food restaurants that have dominated the town’s economy since things began to go bad in the early 1980s and the shops on its main street closed. (Btw, I bought a couple t-shirts, inspired by Dreamland and the community pool that was the source of my book’s title, from a company called 3rdand Court that began in downtown Portsmouth. Check them out.)

The antidote to opiates is not naloxone. It is community. I say this often in my speeches when I’m traveling around the country. We Americans have isolated and fragmented ourselves in a million ways – this in poor areas and in wealthy areas.  That left us vulnerable; it left us dangerously separate and disconnected from each other – strange to say in this time of technological hyper-connectivity.

The final expression of all that is our national epidemic of addiction to opiates – the most isolating class of drugs we know.

Rebuilding community (in a million different ways) is crucial to fighting it, I believe.

I’m glad to see Portsmouth leading the way on that, too.

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Purdue Pharma in Tennessee: Always Be Closing

“Always Be Closing” is the motto that salesmen live by in the movie/play Glengarry Glen Ross.

If you haven’t seen the movie, do so. It’s great: Al Pacino, Jack Lemmon, Alex Baldwin, Kevin Spacey. It’s about an office of desperate sales guys hawking shady real estate investments. ABC — “Always Be Closing” — is the way each is supposed to approach every sales call.

It’s also a motto that showed up in Purdue Pharma sales notes and notebooks in Tennessee, according to a lawsuit against the company.

The suit was filed in May by the office of Tennessee Attorney General Herbert Slatery. It alleges a lot of things, but in general that Purdue used deceptive marketing practices to push its signature drug, OxyContin. This took place, the suit alleges, between 2009 and 2012, well after the company and three of its executives pleaded guilty (in 2007) to a federal misdemeanor of false branding and paid a $634 million fine, while also committing to a series of measures to ensure they were not marketing to doctors who were prescribing unscrupulously.

The company moved to seal the lawsuit, but a judge in Knoxville recently decided against that idea, allowing the office to send me, and others, a copy.

In general terms, what I find interesting the lawsuit is how it displays the changes in pharmaceutical sales in this country, much of that coming during the life of OxyContin, though not due to it.

Up to the mid-1990s, drug salesmen in the United States were usually older men, often with backgrounds in pharmacy or medicine. They were often from the communities they sold to, knew the doctors they sold to, and became credible sources of information for those same doctors as medicine began to change rapidly.

Then the industry went another route. Those older folks were shown the door. In what can be called a sales force arms race,  drug companies hired more and more reps. These reps were usually much younger, very good looking. They didn’t know much about they were selling but they have backgrounds in sales. They inundated doctors with visits and giveaways, of pens, calendars, lunch, sometimes trips for continuing medical education seminars. The companies were aware that by massaging a doctor’s staff, the doctor would soon be an easier mark.

Many companies did this. The numbers of sales rep rose through the 1990s from 35,000 nationwide to over 100,000 by the end of the decade. But other companies were selling blockbuster drugs to deal with cholesterol, hypertension and others. Purdue was among the few that used these techniques, and this enhanced salesforce (numbering eventually 1,000), to sell a narcotic painkiller.

“Always Be Closing” was, apparently, part of that push at Purdue. So, allegedly, was mention of the movie. All of this coming after the 2007 criminal lawsuit.

In Tennessee, (pop. 6.6 million people), the company made 300,000 sales calls to health care providers in the 2007-17 decade, during which time doctors prescribed more than 104,000,000 OxyContin tablets; more than half of those tablets were at the strongest doses the company made: 40mg and above.

Those of you who’ve read my book Dreamland know that, to me, supply is the crucial factor in this, and really in any drug scourge. What the lawsuit describes is a company hard at work at creating a vast new supply of opioids.

Company instructional materials pushed sales folks to “expand the physician’s definition of the appropriate patient” to which opioids might be prescribed; to “never give someone more info than they need to act”; and to develop a “specific plan for systematically moving physicians to move to the next level of prescribing.”

“We sell hope in a bottle,” said one guide for incoming salespeople, who were also instructed to encourage doctors to increase patients’ daily doses.

The lawsuit goes on to claim that Purdue sales reps in Tennessee were urged to make frequent sales calls, as evidence showed that that increased the number of prescriptions. According to the lawsuit, the company urged its salespeople to “focus on doctors who had more patients, less likely to have pain management expertise, and have less time to appropriately monitor patients on opioids.”

During these years, Purdue sales reps, according to the lawsuit, focused their efforts on primary care doctors, nurse practitioners and physicians assistants, whom the company “knew or should have known … had limited resources or time to scrutinize the company’s claims.” Together, people in those three profession prescribed 65 percent of all OxyContin tablets in Tennessee during these years. By 2015, Tennessee had the third highest prescription rate of opioids in the country.

A major part of the lawsuit goes on to discuss specific examples of Tennessee doctors who were leading the state in opioid prescribing, often with signs that their practice was out of control or they were incompetent or unscrupulous, yet who were nonetheless aggressively marketed to by Purdue salespeople.

More on that tomorrow.

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the Original SoCal Mexican Mafia Godfather Dies

Los Angeles never had a mafia in the way that many East Coast cities did.

Regional organized crime never really took root out here. So we never had the mafia dons, running the large crime syndicates that made the headlines in, say, Cleveland or New York.

About as close as we came was Peter “Sana” Ojeda.

Ojeda, the oldest active member of the Mexican Mafia, died June 7, according to the federal Bureau of Prisons website, which lists him as 76 years old.

Sources tell me he apparently suffered a heart attack during an operation in a federal prison medical facility. YouTube memorials are already up.

To understand Ojeda’s importance, it’s important also to understand that the Mexican Mafia is neither Mexican nor was it, for many years, a mafia, strictly speaking. It is a prison gang, controlling Latino gang members in the state prison system. It took its name as a way of inspiring fear in others. Ojeda was part of that formation early on, as well as the spread of the Mafia’s influence across the state prison system.

The Mexican Mafia had no connection (until recent years) to the underworld in Mexico. Its members were, to begin with and for many years, like Ojeda’s, Mexican-American, who spoke only halting Spanish, if any at all, and whose families had been in the United States for generations.

For many years, in fact, the Mexican Mafia only ran prison yards and its influence was barely felt outside those walls.

But in the early 1990s, all that changed. The man who ushered in that change was Peter “Sana” Ojeda, a long-time member of the Mexican Mafia who had grown up in Orange County.

Ojeda, who was then on the streets, organized a meeting of O.C. street gangs at El Salvador Park in Santa Ana, filmed by law enforcement, during which he stood on bleachers dressed in a black-and-white long-sleeve shirt and told them all to stop with the gang killings and the drive-by shootings. He urged them to tax drug dealers in their neighborhoods as a way of funding neighborhood defense.

This stunned many in the Mexican Mafia, and they began to follow his lead, often using emissaries to organize meetings from San Bernardino and Pomona out to Elysian Park in Los Angeles, where one of the biggest meetings was held.

The Peace Treaty, as all this came to be known, sounded great. Gang leaders doing what law enforcement could not. But it evolved into something sinister and lasting: A system whereby gang members would indeed tax drug dealers in their area and funnel the proceeds to Mafia members, many of whom were in prison for life.

This taxation system far outlasted the Peace Treaty and is still in place today across Southern California, described in dozens of federal RICO indictments and in interviews I’ve done with dozens of gang members.

It amounts to the only regional organized crime syndicate that Southern California has ever known.

Taxation transformed Latino street gangs from scruffy neighborhood territorial entities into money-making ventures, though these were often fairly rag-tag. It gave career criminals, doing life terms in prison, access to a labor force — youths on the street who would do their bidding and admired them the way little leaguers look up to major league ball players. The Big Homies, as they were known on the street, could change life in a barrio with only a few words smuggled from prison in microprint on small pieces of paper.

It’s worth noting that their organizations on the streets, too, were often inept, bumbling, hampered by limited communications, by greed, envy, betrayal, rumor and gossip and drug use, as well as the constant return to prison of anointed emissaries of incarcerated Mafia members. One trial I sat in on involved a mafia member trying to organize three gang members to kill a rival, a man who rarely drove but was often walking in his Pomona neighborhood. Dozens and dozens of cellphone calls on how to do this and it still didn’t happen.

But Mafia taxation changed a lot about Southern California street life.

For a decade, Latino street gangs became the leading race-hate criminals in Southern California, a culture that grew from orders by many members of the Mexican Mafia that gangs should now rid their areas of black street gang/drug sales competition. As they were interpreted on the street, far from direct Mafia control, those orders often became directed at any black person, and thus in some neighborhoods campaigns were waged to get all black families to leave, which included murder, firebombings, assaults, racist graffiti and more.

Taxation made Mexican Mafia members equal in many communities to the town mayor or city council, at least with when it came to their ability to affect life in those areas. Now with the obedience of thousands of gang members on the street, many of whom were too young to have ever laid eyes on the incarcerated men they were obeying, Mafia members could, and did, ignite crime waves from maximum-security cells merely through letters smuggled from prison or via liaisons who transmitted their orders to the street. They drained city budgets, mangled lives, and forced young gang members to commit crimes that landed them in prison for life. I’ve interviewed several young men in such situations.

Ojeda was a contemporary of the pioneers of the Mexican Mafia (he’s far lower left in this photo). Among them was Joe Morgan (standing above him in the photo), whose story is also fascinating. Morgan was a Serbian-American who grew up in Boyle Heights/East LA and became culturally Mexican-American, and helped found the Mexican Mafia. Morgan died many years ago.

Ojeda was the last surviving member of that generation of the Mexican Mafia, made a member in 1972 in Tehachapi. Here’s a photo of him from those years (top right).

Throughout his life, but especially following the Salvador Park meeting, he would remain a household name in the Southern California Latino street-gang world. Meanwhile, he was in and out of prison.

In 2016, he was convicted a final time of conspiracy, largely on the basis of testimony from a former protégé, and sent to prison for 15 years, which most people figured was a life sentence.

But his control over Santa Ana and much of Orange County Latino street gang life seemed to me mostly unquestioned. So, too, his reputation as the Godfather of Orange County.

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Filed under California, Drugs, Gangs, Los Angeles, Prison

Dirty Thirds: Cops, the Mexican Mafia & LA’s disappearing gangs

Los Angeles has seen gang violence plummet in the last decade.

Some of the reasons why were on display in two federal criminal conspiracy cases announced this afternoon at a press conference at the L.A. office of the U.S. Attorney.

The cases involved the Mexican Mafia prison gang controlling drug taxation and trafficking in two places: The LA County Jail, largest jail in America, and in the city of Pomona.

The Mexican Mafia is a prison gang that runs the Latino gang members in the state’s prison system. About 25 years ago, it extended that power to the streets, ordering those gang members to tax neighborhood drug dealers and funnel the proceeds to MM members. Drug taxation thrives and amounts to the first regional organized crime system in the history of Southern California.

One case involved a Mafia member who controlled drug trafficking in the entire jail, according to the indictment: Jose Landa-Rodriguez, who grew up in East LA,  a member of the South Los gang. He’s apparently been in county jail for many years, during the reign of the now deceased Lalo Martinez, a controversial MM member. Through those years, and after Martinez died, Landa-Rodriguez allegedly grew to control the drugs entering and for sale across the jail system.

Inmates not with the Mexican Mafia had to get his permission to sell. Only way to do that was by funneling a third of their product to the gang — hence the name of the case, Operation Dirty Thirds — then waiting while Mexican Mafia associates sold the stuff. That’s one way of controlling your competition. Violators were often beaten. That’s another.

They were helped, prosecutors allege, by Gabriel Zendejas-Chavez, a local attorney whom investigators say helped facilitate the trade, passed notes back and forth between Mexican Mafia associates, and that kind of thing. They were also helped by a slew of go-betweens who would get arrested with drugs in their bodies.

The other indictment involved a Mexican Mafia member named Mike Lerma, who has controlled Pomona for many years from his cell in solitary confinement at Pelican BayState Prison maximum lockdown. Crews of members from 12thStreet, Cherryville and Pomona Sur street gangs were working together under Lerma’s command, the indictment alleges. The indictment alleges Lerma’s crews did kidnappings, robberies, identity theft. These are Pomona gangs that have harbored animosity against each other for years, but have repressed the urge to go after one another due to orders from Lerma, according to officers I spoke with.

(Btw, I briefly met Mike Lerma one time, in his cell in Pelican Bay State Prison. We were separated by Plexiglass and he was cooking a cup of cocoa on his hotplate in his pale-yellow concrete cell where he spent 23 hours of every day. He was small, a wan and bent fellow, wearied by years on solitary confinement. From behind the glass, he waved, said how you doing? I said fine.)

The mafia’s system has forced gangs to abandon what made them local neighborhood scourges because it leads to unwanted police attention.

“Years ago, they were about turf,” said one. “Now they’re about protecting their business.”

For decades, they waged wars over turf. They defended street corners, parks, markets, apartment buildings like they actually belonged to them.  They were very much street gangs, and their activity — graffiti, shootings, car jackings, simple hanging out through which they did their recruiting — blighted working-class neighborhoods across Southern California.

These days, though, they are absent. They have retreated into the shadows. Doesn’t mean they’re gone for good. Just that they’ve disappeared from the streets, no longer are out in public, damaging neighborhoods that can least afford it, spraying up mom-and-pop markets. Homicides are way down because gangs don’t have easy rival targets to shoot at. That’s one reason anyway. In Pomona, the once-notorious Sharkey Park – from which Pomona 12thStreet earned its name the Sharks (members often had shark tattoos) — hasn’t had a shooting in who knows how many years. Some Pomona cops at the press conference couldn’t remember the last one. As if to exorcise the past, the park has been renamed Tony Cerda Park, in honor of a Native-American activist and tribal leader; pow-wows are held at the park.

Gangs are just not evidence in Southern California. It’s a remarkable, profound change in culture and crime, and one that benefits cities, neighborhoods, and working-class residents most of all. Parks are once again places for kids to play. This is part due to dictates in the underworld, from organizations like the Mexican Mafia, who want their business protected.

But it’s also due to an unprecedented amount of collaboration among law enforcement. In the 1980s and 1990s, this didn’t exist. Agencies fought each other for credit, turf, budget, as the gangs grew fierce and brazen. But the last decade or more has seen a remarkable change and that too you could see at the press conference.

At the press conference, cops of all stripes assembled to thank each other for working together. The feds thanked the locals. The locals thanked each other and the feds.

“I want to give special thanks to our law enforcement partners,” said Pomona Police Chief Mike Olivieri.

(For the record, apart from Pomona PD, that includes the FBI’s San Gabriel Safe Streets Task Force, the LA County Sheriff’s Department, ATF, the DEA, Ontario Police Department, the IRS Criminal Division, the U.S. Immigration and Customs Enforcement’s Homeland Security Division.)

“Today’s action is not an isolated event. Southern California law enforcement is united in its fight against violent criminals and street gangs,” said U.S. Attorney Nick Hanna, continuing the theme.

I’ve been to a dozen of these gang-conspiracy press conferences and I always like it when they thank each other. Because it wasn’t always that way.

Speaking with a prosecutor outside the press conference, we marveled at the change and wondered how the trauma of the 1980s and 1990s might have been avoided had this kind of collaboration been more common

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Filed under California, Drugs, Gangs, Southern California

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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