Tag Archives: addiction

Can We Treat Our Way Out of This?

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

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

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

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

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

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

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

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

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

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

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

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

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

The last couple years have shown how dangerous that is.

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House Republicans & Heroin

Governing is the opposite of dope.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s like governing.

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

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Filed under Culture, Dreamland, Drugs

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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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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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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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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Dr. Procter’s House

I’m speaking today in a mansion near Portsmouth Ohio built by a doctor named David Procter – known around here as `The Godfather of the Pill Mill’ – whose story I told in Dreamland.

A reader I’ll call Karen, who grew up in Portsmouth, wrote to me a while ago:

“For some reason I feel compelled to tell you that Dr. Procter was the catalyst that destroyed my family.

The house, in South Shore, Kentucky on the Ohio River, has been converted to a procter-2drug rehabilitation clinic run by a company called Recovery Works.

Karen:

“My dad worked at the prison as a guard. He hurt his back, falling from a ladder during some sort of training assignment.

“I only knew that my dad got hurt at work, and [Procter] was his doctor. And that my mom hated him with a passion. I can remember going to his office and my mom coming out so upset. I found later that it was because she would go there and beg him to stop giving my dad pills. Lines out the door. I can still remember my mom and my aunt and my grandmother in the car discussing all the people.

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Pharmaceutical companies and pain specialists viewed the pain-pill revolution that transformed American medicine as a boon to doctors. They sold the opiate painkiller pill as a way of addressing the lack of time doctors had with patients, and pain patients in particular.

That doctors accepted them so readily tells us how serious were the time pressures they felt.

The more you prescribed them, though, the more the pills became a curse – just like morphine molecule they contained. They wore down a doctor. A doctor known as an easy touch was soon overwhelmed with patients who filled his waiting room, waving cash in front of him, insisting. Soon he was accepting only cash – addicted to it, accepting the lies his patients told him, believing too that nothing was wrong.

From this emerged the medical mutation known as the Pill Mill. Nothing showed the corrosive effects of for-profit medicine like the pill mill.procter-1

David Procter was notorious in Portsmouth for prescribing large amount of pain pills to patients, with almost no diagnosis.

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“The day my parents marriage finally ended, was the day my mother threw all of my dad’s pills Down The Gutter and he removed the manhole cover and crawled down to get them. I remember her taking her wedding ring off then and telling him that she wanted a divorce. His head was literally sticking out of the manhole. Sad time.”   Karen

___

David Procter was a product of that, I believe.

He had come in 1977, and been beloved. Amid economic decline, doctors held the key to life strategies like worker’s comp and SSI. Procter became the quickest doc around in preparing worker’s comp papers.

In 1988, the Kentucky Board of Medical Licensure investigated him for the first time. Those reports seem to describe a man losing his bearings but still trying to maintain some semblance of medical and moral rectitude, still looking for second opinions and trying to find alternatives to pills for his pain patients.

Ten years later, a second investigation, and that doctor had vanished.

In the interim, OxyContin and the Pain Revolution had come. Jobs were gone, Main Street was an empty shell. Ohio River towns had lost huge population. Dreamland pool had closed.

As a doctor in a desperate place, he had been unaccountable for too long and grown corrupt, the Kentucky public record documents. Now, investigators found a man who extorted sex for pills from vulnerable and addicted women, who preyed on girls tormented about abortions. His waiting room was a corral of drug addicts, all there with eyes downcast, desperate. He stayed open well past his posted business hours. His records were shoddy or nonexistent.

After a car accident, he began hiring doctors with drug and alcohol problems to run his clinics. This is what gave him lasting importance to this story, for those doctors in turn left to start their own pain clinics.

The problem metastasized like a cancer. Procter became the Ray Kroc of the Pill Mill.

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Drugs have hit my family hard. My uncle’s stepdaughter and her daughter were both murdered in Lucasville. They still haven’t found their murderers. The daughter was a beautiful sixteen-year-old girl who didn’t deserve anything that she got. Apparently her mother was selling Oxycontin. My aunt’s step-daughter is doing life right now for murdering another girl in a town near Portsmouth. I have two uncles who both died of heroin overdoses in the last 6 years.

And some of my friends from high school, their daughter has been missing for about 6 years. Due to drugs as well, I’m sure of it. I could go on and on. I’m so glad that I left that area in 1989 and made a better life for myself. However the county that I am living in and have been living in for 27 years is starting to feel the sting. It’s happening.    Karen

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David Procter eventually went to prison for 12 years. He was released in 2014 and, being Canadian, was procter-3deported. He leaves behind a strange painting of a monkey looking into a mirror, with Dr. Procter’s reflection looking back at him, and a seven-bedroom, six-bath, seven-car mansion on 34 acres that is now occupied by 16 addicts working on their recovery.

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My dad OD’d in 2009, but he really died years before. He was a good dad once. I’m glad that I have those happy memories.

I know Procter’s house well. We always called it the house that pills built. Beautiful place. Fitting that it’s now a rehab.   Karen

 

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Trump, Heroin & Mexico

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

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

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

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

Here are a few of my thoughts:

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

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

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

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

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

* *

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

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

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

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

* *

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

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

* *

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

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

* *

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

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

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

* *

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

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

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Heroin and the Super Bowl

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

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Thanks Kentucky Gov. Bevin

          Back from a busy trip and I wanted to thank Kentucky Gov. Matt Bevin for his kind words recommending my book, Dreamland, during his first budget address to the Commonwealth and Kentucky state legislators last week.Matt Bevin
 
          I’m very honored and touched by what he said, and that he followed those words with a commitment to increase funding for opiate-addiction treatment over each of the next two years.  [Click here to view his speech. The part I’m referring to begins about 59:30.]
         When I began writing the book that became Dreamland, I occasionally received strange reactions from people wondering what on earth I was thinking writing about heroin. Didn’t that, after all, belong to the 1970s?
          I didn’t think so. I felt it rumbling beneath the surface and ready to explode, just no one was talking about it in 2012 and 2013, and even in 2014. Most of those who knew about it from personal or family experience were ashamed to speak.
          So it feels satisfying that the book is helping people in a position of public influence, among them the governor of Kentucky, a state overwhelmed by this scourge, understand it, talk openly about it, and make policy to address it.
          Storytelling will do that. That’s what I’ve long believed. Thanks, governor!

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A Mother’s Story: Sam Chappell

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

 

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

Sam Chappell


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

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

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

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

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

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

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


Nancy Chappell

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Forcing Pharma to Pay To Take Back Drugs

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

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

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

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

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

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

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

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

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

 

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Sad for 60 Minutes

I grew up admiring 60 Minutes for its storytelling and investigative reporting.

So many original stories. No one on television was doing what 60 Minutes was doing then. It looked so exciting and that was part of why I became a journalist.60 Minutes Logo

So six months after the publication of my book Dreamland: The True Tale of America’s Opiate Epidemic, it saddened and appalled me to watch the show last night.

Last night, 60 Minutes ran a piece about heroin in Ohio. I’m very happy that these Ohioans, who I know and like and respect, are getting this megaphone. Their story needed telling.

But I have to stand my ground.

Months ago, my publisher and I pitched 60 Minutes on stories from Dreamland: first, the Xalisco Boys heroin traffickers, and then a story about heroin in Ohio.

Over the span of several months and several phone calls, 60 Minutes decided against both ideas.

The Xalisco story wasn’t doable, they concluded, after I convinced them that it was unrealistic to assume that they could show up and in 3-4 days have someone magically open up a heroin lab for them to film. I argued that there were other ways to tell the story. I found them sources, people with years of experience in the drug underworld who trusted me. That wasn’t good enough. They wanted traffickers who spoke English. I told a producer that the traffickers in the Xalisco system were working-class guys from Mexico without even sixth-grade educations and that they spoke only Spanish. He also insisted that 60 Minutes had to have film of dope being made, and had to have it accessible after three days of reporting on the ground.

The Ohio story that we then pitched 60 Minutes had no such cost/danger/language concerns. The state was awash in heroin now. America’s opiate ground zero – for many reasons I made clear in Dreamland. Pills had taken hold there first, and heroin had come sooner than it had anywhere else. Over lunch, a 60 Minutes producer even asked me what story I would do in Ohio. I gave her some ideas.

60 Minutes did go to Ohio. Made it look as if they had figured out who to talk to, and what questions to ask, all on their own. No mention of what led them there and what explained the whole story to them. When I asked them whether they were going to refer to my book, one producer said they wanted to focus on the personal stories of local folks. They could have done the personal stories of local folks in Alabama, or anywhere else in America, but then they wouldn’t have had a book telling them specifically where to look, whom to talk to, and what the story was.

Care to leave 60 Minutes a few of your thoughts? Here’s the comment page to the episode, and here’s the show’s Facebook page.

Parents and others in Ohio and elsewhere are understandably thrilled that major media like 60 Minutes are finally taking an interest in this topic. I’m glad for them and very happy that the issue is now getting attention. Wayne, Brenda, Tracy, Jenna, Rob and others spoke with eloquence and force, and in my opinion saved the piece.

I hope they won’t see this as raining on their long-overdue parade … but I have to say something to defend myself, my family’s sacrifice, and my work. If I don’t, who will?

I spent years working on this story, interviewing hundreds of people, poring over documents, taking collect phone calls from Mexican traffickers in prisons. Before doing it, I lived and wrote for 10 years in Mexico, which made me distinctly prepared to see a part of this story that 60 Minutes producers, judging from our phone calls, knew only because of me.

I took a leave of absence from the LA Times, where my book’s story began (as I note several times). I finally resigned from the paper to finish this book. I went all over the country. Each trip meant time away from my wife and daughter; each trip meant scrimping on meals and motels. When few people were talking about heroin, when most folks I met looked at me askance for researching the topic, I risked my professional career and my family’s financial future: all to find a story that I believed to be profound in its nationwide impact, and in what it says about our country.

I’m thrilled to receive emails like this one, from a retired undercover narcotics officer, who helped in my heroin education:

“The 60 minutes Heroin story last night was the “CliffNotes” version of your book, they needed to have you on that piece! … These news stories are great but they are quickly becoming “old news”. They need to go a few layers deeper. It’s time to talk about solutions! Thanks to guys like you the nation now knows very clearly what the problem is, now it’s time to move the national narrative towards developing real solutions through accountability. … Keep up the good fight Brother …Be Safe!”

It isn’t often that a book more or less scoops radio, TV, and print. But I believe that, to a large degree, is what Dreamland did.

Since its release, I’ve been disappointed to see Time, Sports Illustrated, Washington Post and now the New York Times publish stories on topics that I dealt with first in Dreamland and not mention it. (Btw, my book clearly cites several books to which I am indebted, both in the text and in the acknowledgements.) But 60 Minutes seemed to me to cross a line.

And even after the months of dealing with them, I might not have written this blogpost had not Sunday’s show itself seemed to involve so little original reporting and seemed to rely so heavily on my book.

Is that what it means to be 60 Minutes these days? Just riff off the work of an independent reporter and do nothing to recognize it?

The whole episode reminds me that 60 Minutes is no longer a standard bearer of anything except cost containment. Shows like 60 Minutes no longer set the national debate. They’re followers, imitators, People Magazinenow, where once they were leaders.

Yet I’m also invigorated, exhilarated even, by this experience. For it means that I and many independent colleagues have wide-open spaces now where we can harvest stories. That if we’re willing to put in the work and take the risks, that important stories will be ours to find. It means it’s a great time to be an independent journalist.

The Daily Show made fun of TV cable journalists, and gave respect to real reporters. It taught a generation to be skeptical of what was reported to them on television. The next step is to elevate real independent journalism.

As desiccated titans collapse, abdicating any role in maintaining standards of journalism, we now have this terrain to ourselves. We must work it, push at it, be relentless. But it’s there. People want it, thirst for it, as I’ve found in the reaction to Dreamland. When we find these stories – as now only we are equipped to do – they will probably mean more than ever.

Remember, too, that if you want risk-taking, on-the-edge, original, independent, red-blooded American journalism, then you have to look pretty far past 60 Minutes. The Atlantic is doing some good stuff. As is the Atavist. Might check out the Marshall Project. I thought Grantland looked good before ESPN pulled its plug. I’m sure there are many places I don’t know of – and I invite them to chime in.

I’d also strongly suggest that the books recently written by my friends and former colleagues Gerry Hadden, Alfredo Corchado, and Jill Leovy are well worth your time.

And if you want to read the full story of America’s opiate epidemic from a journalist with no one but his wife and daughter standing behind him, then I’d suggest my own book, Dreamland.

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Why I Voted Against California’s Prop. 47

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

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

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

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

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

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

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

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

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

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