Category Archives: 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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An Ohio Farmer: Trump, Dope, Jobs & PC

A DREAMLAND PODCAST – John Russell is 26 and an organic farmer, raising melons in rural Ohio, not far from Columbus. This year he ran for the Ohio state legislature as a Democrat – and lost badly.headshot-1

I had the chance to talk with Russell today.

We had a wide-ranging  conversation, about his decision to go into farming, about his campaign, about Donald Trump, as well as job loss and opiate addiction in America’s Heartland, PC culture, the challenges Democrats face in rural areas.

He’s one of the few, it seems, to go away to college then return to a rural community. So many towns have lost young people to the cities where the jobs are.

We talked about that as well, and about what happened to guys on his high school football team.

This is the first interview I did like this, via Skype, so I’m still working out the kinks, and there are a few buzzes and etc. So please bear with me.

Meanwhile, contact him at www.johnrussell.info, and follow him on Twitter: @JCruss

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One Mother

On Facebook, I read the simple account – I’ve broken it out into four lines – from a mother from Kentucky. I’ve posted her story, and then the comments that followed:

I lost my son in August,

and my Daughter day after thanksgiving

the only two children I had

oh it’s so hard.

COMMENTS

I have no words. I’m sorry just doesn’t seem to be enough. May
you find the strength you need to carry you through.

I’m so sorry, I lost 2 sons in three years.if i can help you add me as a friend.hugs

img_4054may God give you the strength to survive the loss of both of your children. Hugs and prayers to you mom

So very sorry for your loss prayers and hugs to sister momma I have lost two sons and no words to heal your pain

We lost my oldest nephew Joe on 7/5/16, it is terrible and sad and I’m so glad for this group. You are not alone sister 💙💙💙💙 sending hugs

Why why do we have to suffer so

God be with you.

There are no words…how can i comfort you…may God give you strength…i a truly hurt for you…my daughter continues to fight the beast…

I am so sorry. Much love to you and those who grieve with you. Praying.

This is incomprehensible and insane to think that “god doesn’t give us more than we can handle” – it’s cruel and unmerciful. I share your pain and fear that I may also lose my only other child, having lost my youngest 10 years ago. Sending hugs and more hugs – and strength for when you need it most.

I lost my son I could never imagine the thought of losing another. Hugs and prayers your wayimg_3991

I am so sorry and feel how you feel I lost my son one month ago yesterday my heart has been torn out I don’t know how we’re supposed to go on like this

I lost my only child in 2013, I couldn’t imagine losing 2, and so close together! God bless

My” heart” hurts for you….Don’t know what to say….I lost my son 6-15-16 and the pain is unbearable with one… let along two.I have a daughter on heroin really bad also . I ‘m afraid I’m gonna lose her.

No words for this heartbreak.

 

 

 

 

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Many Thanks

I’m a reporter with an earring, from L.A., a Berkeley grad who doesn’t go to church. In the last year, I’ve spent a lot of time in small American towns, meeting people from fairly traditional, church-going places in the Midwest.

On paper, on social media, or on 24-hour cable news, we would seem to have little to share.IMG_0638

Yet in these places, meeting these people, I’m struck by how much we have in common. This may sound trite, but it is true. The commonality is there if you want to look for it. Not that hard to find when you look someone in the eye.

At each place, I’ve had the great privilege of talking with folks about their lives, their jobs. I’ve been struck by the intensity of feeling of the people with whom I’ve spoken, hugging folks I didn’t know. I remember a paramedic telling me of saving overdosing addicts, and of a chamber of commerce president telling me how many people couldn’t pass drug screens. I remember a grandfather in Portsmouth who wouldn’t let my hand go as he told me how he was raising his granddaughter, that his daughter was in prison. Many had lost children, and many others were cautious yet happy that their children were doing well now.

It is a humbling and powerful thing to be brought so quickly into the intimate lives of strangers, and I hope more than anything that I’ve been up to the responsibility.

Today, I want to say how thankful I am to the people I’ve met in those places – Peoria, Van Wert, Scottsburg, Logan, South Shore, Marysville, Portsmouth, Marion, Huntington, Albuquerque, Medford, Zanesville, Knoxville, Covington, Chillicothe – for their warmth and hospitality and, above all, their willingness to share a bit of their stories with a guy from out of town.

These are not towns typically on most authors’ book tour itinerary, and I feel so lucky that I was able to get there.

I’ve met folks at conferences of associations I didn’t know existed two years ago: Kentucky Association of Counties, National Association of Community Health Centers, Indiana Hospital Association, Ohio Association of School Nurses, Illinois Rural Hospital Association, Oregon Narcotics Officers Association, West Virginia Medical Association, National Association of Medicaid Directors, and the Iowa Association of County Medical Examiners, among them.

Meeting people at these conferences has been a real light of the last year as well. The Kentucky Association of Counties a couple weeks ago was an amazing event, as the state has 120 counties for four million people. So it was really like a small-town convention. Folks with strong Kentucky accents and me with my earring – yet I felt so welcome, and their reception to what I had to say was overwhelming.

I’m thankful for my family, who has been so important in all that’s happened. They were able to accompany me on a trip to Chillicothe, Ohio, which we’ll never forget.

I’m thankful that my wife and I are in good health, happy with our lives. My daughter is a cheerful, intelligent girl, healthy and polite to others. My wife and I are thankful for that.

It’s been a good, full year and I hope it was for you, too.

Happy Thanksgiving.

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Donald Trump & Opiates in America

This fall I traveled a lot to Heartland areas to talk about a book I’d written about opiate addiction in America, and this provided me with a close view of the rise of Donald Trump’s candidacy.

The areas where I spoke were particularly hard hit by narcotic abuse — rural Michigan, southern Indiana, West Virginia, Kentucky, and several towns in rural Ohio.

The prevalence of Trump/Pence yard signs in these areas, particularly by mid-October, was stunning. As I traveled, it seemed palpable, this connection between Trump support and opiate addiction.cropped-IMG_4841.jpg

Not that there weren’t other reasons people supported him. A suffocating political correctness on the left is another factor in his appeal, I believe.

But nothing darkens your view of your present and future prospects quite as thoroughly as addiction to opiates (pills or heroin) in your family, on your street, or in your town. With opiates comes a fatalism and negativity that clouds a town or a family’s feeling about its world, even as unemployment falls and the economy improves.

In theory, addiction knows no race. In reality, though, our national opiate scourge is almost entirely white. Very few non-whites are among the newly addicted to prescription pain pills, then heroin. In three years of book research, I met one.

Though this scourge has affected every region of the country, it is felt most intensely in rural, suburban – Heartland – areas of America where Donald Trump did extraordinarily well.

Some of these areas did not fully rebound from the Great Recession of 2007 (southern Ohio). Others fared much better (North Carolina). A common denominator, I think political scientists will find, is that in these areas since the last presidential election the incidence of opiate addiction spread, grew deadlier, more public, and went from pain pills to heroin. In southern Ohio, where heroin has hit like pestilence, particularly Appalachia, Trump trounced his opponent in counties that Mitt Romney barely won four years earlier – though unemployment in many of these counties is at its lowest level in years, sometimes decades.

Shannon Monnat, a rural sociologist and demographer at Penn State I talked with, found strong correlations between suicides and fatal drug overdoses in counties where Trump’s increase was larger that the share of the vote compared to Romney’s four years earlier – this in six Rust Belt states, another half-dozen state in New England and all or part of the eight states comprising Appalachia.

One place I spoke was Hocking County (pop. 28,000). Hocking has lost coal mining jobs in recent years, though its unemployment rate dropped this fall to 4.5 percent, the lowest in more than 20 years. (It hit 14 percent in 2010.) But Hocking has also grown far more aware of its pill/heroin problem. Overdose deaths are up. Its drug court is among the first in the state to use Vivitrol, the opiate blocker. Trump earned 66 percent of the vote in the county Romney carried with 49 percent four years ago.

Opiate addiction – to pain pills or heroin — is the closest thing to enslavement that we have in America today. It is brain-changing, relentless, and unmercifully hard to kick. Children who complain at the slightest household chore while sober will, once addicted, march like zombies through the snow for miles, endure any hardship or humiliation, for more dope.

In many of these regions, folks were unprepared for it and, what’s more, believed they had done nothing to deserve it. Kids with no criminal record, star athletes, pastors’, cops’, and mayors’ kids all got addicted. Parents who’d imagined some glowing life script for their newborns years before were, as those kids reached young adulthood, confronted instead by late-night collect calls from jail, lying, stealing, conniving and that child’s body seemingly occupied by a mutant beast. Then came a felony record. Suddenly parents were co-signing for apartments, providing money and transportation for their addicted beloved, now 24, to take a GED class.

Though the number of actual addicts is small, the epidemic’s political impact has been substantial.

First because the states where the epidemic is most intense were crucial to the victor – whoever it was going to be.

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Also, though, the opiate addiction rippled far beyond each individual addict. Addiction colored the lives of siblings, grandparents, uncles and aunts, friends and neighbors, pastors, teachers. As parents lost their fear of speaking out in the last two years, the problem emerged from the shadows, media coverage expanded, and now everyone for miles around was aware of it. County budgets buckled. Merchants saw theft increasing.

In several counties I visited, employers reported that more than half their job applicants couldn’t pass a drug screen. So though unemployment numbers fell, a good chunk of that was because many people were too hooked to seek work. Imagine what that does to a county’s productivity, and its buoyancy of spirit. It explains how a declining unemployment rate could create not optimism, but the foreboding that seemed to motivate many voters.

People also grew to understand that virtually all our heroin comes from or through Mexico – which is why it is cheaper and more potent than ever in our history. That did nothing to engender love for our southern neighbor in regions that had lost factories as well as kids. Nor did it make them feel that we have a serious and modern partner in Mexico when it comes to criminal justice and law enforcement.

This story plays out today with intensity in several of the states crucial to Trump’s victory – Ohio, North Carolina, Pennsylvania. It does the same in states he was assumed to win: West Virginia, Oklahoma, Utah, Kentucky, Indiana, Alabama, Georgia, Tennessee, and others. That these states – largely rural, religious, and white – are now our heroin beltways amounts to a stunning change in our national culture and one that most people in those areas became aware of only recently.

Equally stunning is that New York, California and Illinois – including New York City, Los Angeles, Chicago, once our heroin hotspots – are well down the list of states ranked by addiction rates. Hillary Clinton won each of them.

In many of the most affected regions, moreover, people, by and large, have taken as self-evident Ronald Reagan’s dictum that “government is the problem” — the starkest threat to personal freedom. The private sector and the free market are, therefore, to be exalted; government starved. (This despite a deep reliance on government programs: Medicaid, Medicare, SSI, SSDI, worker’s compensation, food stamps, welfare, farm subsidies, etc.) Confederate flags and 2nd Amendment bumper stickers were common amid the Trump signs I saw.

The irony is that behind this drug plague is a story of how the private sector introduced the most serious widespread threat to personal freedom in America today – opiate addiction. All profits from the massive prescribing of narcotic pain pills have accrued to the private sector, mainly pharmaceutical companies; all costs of addiction to those pills, and then heroin, are borne by IMG_4113the public sector. Indeed, for years, about the only people fighting the opiate scourge, my research showed, were government employees: cops and prosecutors, public health nurses and CDC statisticians, county social workers, judges and ER doctors, DEA agents, coroners and others.

The Sackler family, which owns Purdue Pharma, the company that makes OxyContin, has been estimated by Forbes magazine to be now one of the country’s wealthiest, with an estimated net worth of $14 billion, due to $35 billion in sales of the drug since it was released in 1996.

All this, I believe, helps explain the reception to Donald Trump’s populist message – including rejection of free trade and other sacred cows of Republican elites and conservative theorists. (“Worst Election Ever” proclaimed a post-election article from the conservative Hoover Institution.)

In these areas, too, the “throw away the key” approach to drug addiction was unquestioned dogma until the opiate scourge. That is changing. Democrats may still not get elected in a region like northern Kentucky, for instance, but Republicans who talk only tough on crime now have a hard time there, too – so harsh is the pill and heroin problem.

It’s likely that many of the regions where Trump enjoyed such support will require massive investment in drug treatment before they can be great again. (Ohio Gov. John Kasich realized that and went around his Republican-led state legislature a couple years ago to mandate Medicaid coverage for all Ohioans — largely because it gave people coverage for drug treatment.)

Will such an investment come from a president whose election seems to have so much to do with the opiate epidemic, yet who appears to have thought little about how to expand drug treatment?

How will people in these areas react to dismantling Obamacare, which provides coverage for addiction treatment that they didn’t have before?

In counties where half of job applicants fail drug screens, will the chambers of commerce line up to do away with the system?

Like so much that sprang from those Heartland yard signs, I guess we’ll see.

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Community and CEOs

Folks who have heard me speak know that that community-building behavior by CEOs is something I admire and long for more of, nowadays particularly. Jack Brown, CEO of Stater Bros. Markets, is now my
hero.

A story in today’s LA Times reports the death of Mr. Brown, though folks in Southern California will recognize his comstater-brospany as a household brand name. We lived near a Stater Bros. Market when we were growing up and shopped there all the time.

Sadly, before his death, I was unaware of Brown’s story, of his philanthropy and decision to not move the company HQ from its base in San Bernardino, a tough town that didn’t need any more companies leaving. He founded the Boys and Girls club of San Bernardino and the Children’s Fund of San Bernardino.

Too often CEOs have their own wealth lining in mind. I’m reminded of the behavior of the CEO of Wells Fargo, who oversaw a lot of unethical stuff, then fired the mid-level folks who were allegedly ordered to perpetrate it, then retired with a $124 million paycheck.

The story of U.S. capitalism over the last generation or two is replete with guys behaving in this way. Shredded communities are the result. So is, if you ask me, our national opiate epidemic.

Communities, seems to me, are built by many people. But an important part of that are the decisions made by company owners and managers. Those decisions can crush, or enliven, a community. Too often, in the recent history of our country, it’s the former.

Sounds like Jack Brown retired fairly wealthy for doing the right thing. That’s the way it should be.

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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.

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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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Cab Calloway High School

Tomorrow (Thursday) I’ll be speaking at Cab Calloway High School of the Arts in Wilmington, Delaware.

The speech is open to the public and I’ll be talking about opiate addiction, America and Dreamland. Delaware, like so many parts of the country, is awash in opiate addiction and all its consequences.

But I love the idea that the school is named for Cab Calloway, an orchestra leader I’ve loved since I was a kid and first heard “Minnie the Moocher” (I was in junior high, I think). Here he is with the Nicholas Brothers, stunning tap dancers.

The school’s first board president was his daughter, Cabella Calloway. He had moved to Delaware shortly before the school was founded in 1992 and was involved in its formation before his death in 1994.

By the way, the school’s marching band has won the championship in its area six of the last seven years. Nice! Next Sunday, they’re in Hershey PA competing in the Atlantic Coast Tournament of Bands.

Good luck to the Cab Calloway High School Marching Band! A name like that, you better win! How could you not?

I’d love to see a marching band named for Cab Calloway.

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Judge Moses’ Court

I was in the town of Logan, Ohio last week, at the tail end of my speaking tour through Ohio, West Virginia, Kentucky and Indiana.img_3596

Logan, pop. 7,000, is an Appalachian coal town in the county of Hocking, about 40 miles southeast of Columbus in the farmland off of state Highway 33.

The morning after my talk, I spent an hour in the town’s drug court, which is now dedicated entirely to people with opiate addictions trying to expunge criminal records and keep their recovery going.

The court is run by Judge Fred Moses, who in this court looks and sounds more like a social worker. He asks each client about his or her recovery, job prospects, children – confers with prosecutors and probation and social workers. The idea behind drug court is that clients must get into addiction recovery, begin to repair their lives, before any record expunging takes place.

What struck me was, first, that there were such a court at all in a town like Logan. And then that all the 10 or so clients I met that day were addicted to opiates, heroin mostly.

All but one started into addiction on pain pills. A few began using them after they were prescribed the pills for some medical reason. Others began using them recreationally. But all of them got into their addiction because of the pervasive, massive supply of these pills that were, and are, available.

In Logan, according to a recovering addict I spoke with (whose interview I’ll post later), pain pills and benzodiazapines, and the insistence with which clients demand them, have made docs unimaginative it seems. At least, pills appear to be many physicians’ immediate go-to response.

Judge Moses has most of his clients on Vivitrol, the opiate blocker, paid for by Medicaid, which, in Ohio, has been available to anyone since 2014. This is due to a Republican governor, John Kasich, who expanded coverage to all Ohioans, largely, from what I understand, to give people without insurance access to addiction treatment – so big was the state’s problem.

Without that, Vivitrol would be too expensive for Hocking County. Sitting there that day, I wondered if at some point every heroin addict in America will have to be on Vivitrol.img_3600-copy

Judge Moses’ drug court is a standing testament to how opiate addiction is changing minds in rural areas. I suppose there was a time when the idea of giving a drug to combat drug addiction was viewed askance in Hocking County. But this addiction is different and requires different response. Hence Vivitrol.

What also struck me, though, was that this scourge spread across the country largely due to the private sector – pharmaceutical companies and doctors, urging the aggressive prescribing of narcotic painkillers.

There’s a role we all have, as American health consumers, in what’s taken place, and it’s an important one. But it’s striking to me how this began due to the private sector – not underground drug traffickers – and how the profits have accrued to the private sector.img_3577-copy

Yet dealing with the collateral damage has been charged almost entirely to the public sector: ERs, public health departments, cops, prosecutors, jails … and drug court, like the one run by Judge Fred Moses in the small town of Logan, Ohio.

I wish his clients well, as I do the town of Logan itself, where I met a lot of nice people (and received this Proclamation), and which now must battle this kind of persistent, costly addiction along with all the other issues facing small-town, rural America.

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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.”

____

 

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

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

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

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Just Tired

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Good Day in Chillicothe

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

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

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

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

That’s how it’s been everywhere lately.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Obama, Elkhart & the Dope of 24-Hour News

Elkhart, Indiana sounds like a town that needs to stop watching 24-hour news.

This Jackie Calmes story in the New York Times reports that the town once on its back, having lostIMG_0638 many jobs and about to lose thousands more should Chrysler have gone under in 2009, has rebounded from the depths of the Great Recession and now is near full employment (3.8% unemployment down from 23%).

This has a lot to do with Barack Obama’s auto bailout and stimulus package passed to resuscitate the ravaged economy he inherited upon taking office.

Obama visited this town as a candidate and as president and did not forget it, but instead helped save it. Yet support for him is weak in Elkhart, Indiana. Yet somehow they find something to support in Donald Trump, and can only fault the president.

The problem here goes pretty deep, I think. If nothing – not even solid political performance – is good enough for us any more, who are we then?  Has the great American ideal of accountability been taken to such absurd extremes? Will only perfection suffice?

It used to be common for people to have mixed allegiances, because their politics were born of their towns and the solutions people saw locally, which stretched quite naturally across party lines. Today we’ve grown into bubbles, even locally, obeying the stark divides in Washington and in the broadcast media. We view politics as some sports contest and we’re fans of one team or another. I’ll admit it: nothing the Dallas Cowboys do is going to make me their fan. But that’s not how politics, governing should be.

We  excoriate government, but government is our way of coming together, in community, to solve problems.

Why imitate our national political leaders who live captive to politics as sport? And what about some courtesy? How about saying thank you?

I’ve written a lot about my belief that our heroin and pain pill-addiction problem stems from years of destroying community in this country, leaving us without the social immune system to combat a drug as isolating as opiates. Elkhart is one place where that happened. Now it appears that this town is forming community again, becoming a place where people are working and putting their lives back together. I assume it’s not perfect and that much remains to be done.

But this attitude expressed by people in Elkhart now that things are better, to me, feels childish, feels unserious. Above all, it feels as if they’ve downed too much of the dope of alarm, frenzy and anger dealt by 24-hour cable news and talk radio, which traffic in all that and never heard of a solution to a problem, nor reported on one.

We luxuriate in complaining about politicians, yet won’t support those who follow through and who help create community out of destruction?

Seems to me that if we believe the alarmism of 24-hour cable news despite the evidence looking us in the face, then we’ve become infantile, hardly deserving of our world-power status, and we deserve the loonies we get.

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Filed under Dreamland, Global Economy, The Heroin Heartland