Category Archives: The Heroin Heartland

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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Saints and Sinners: Growing up in Portsmouth

A letter from a reader of Dreamland:

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

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

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

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

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

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

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

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

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Our Heroin: From Afghanistan or Mexico?

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

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

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

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

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

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

 

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

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

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

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

Yet Brownfield’s response highlights two things worth mentioning.

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

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

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

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

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

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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.

____

 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.

cnn

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

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

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

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

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

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

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

All because it has to fill that time.

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

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

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

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

In other words, we got dope.

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

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

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

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

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

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

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

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

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

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

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

So today, Be An American!

Please go vote!

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

We need to keep this Republic for a while.

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Filed under Drugs, The Heroin Heartland, Uncategorized

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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