Tag Archives: opiates

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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Filed under Dreamland, Drugs, The Heroin Heartland

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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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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Speaking of which …

These next several weeks I’ll be traveling to many parts of the country for speaking engagements about Dreamland: Dallas/Fort Worth, Huntington WV, Indianapolis (twice), Logan, OH, Salt Lake, and South Shore KY, among other places (full list below).

These follow many events over the last year. I can’t wait!

Grand Canyon Trip 2015

It’s been wonderful, after spending so long writing about a fairly depressing topic, to see communities like Scott County IN and Marysville OH plan to use Dreamland to begin discussions/alliances focused on combating the problem of opiate addiction, now nationwide.

I’m a storyteller not a policymaker nor an advocate, but I do feel overwhelmed at times at the intensity of the response and so honored that these towns would invite me to visit them to talk about this.

I want to say thank you to the hundreds of folks I’ve already met while signing books at numerous events – half of whom have stories so powerful that they might have ended up in Dreamland had I met them while I was writing. It’s become one of the joys of touring, meeting folks like this, going to places like these.

I note, too, that many of these place are not towns on a typical book tour. But this is not a typical book nor, I suppose, a typical time.

I love that I’ve been able to visit Peoria IL (home of Caterpillar) and Chillicothe OH (Go Cavaliers!), but it also shows you where the problems with opiate addiction are now in our country.

Anyway, here’s the full lineup:

Sept 19: Scott County, IN (Various events, including Austin High School Auditorium, 7-9pm)

Sept 20: Van Wert, OH

Sept 21: Marion, OH (Palace Pavilion, 3:30-5pm)

Sept 22: Dallas/Fort Worth, TX, Hurst Conference Center, (When the Prescription Becomes the Problem: A community response to the Opiate Epidemic)

Sept 29: Salt Lake City, UT, Sheraton Hotel (Beyond the Needle and the Damage Done:  A law enforcement and health care response to the opioid epidemic)

Oct 1:  Huntington WV, Ohio River Book Festival, (12:45-2pm)

Oct 3: South Shore, KY (Recovery Works)

Oct 4: Zanesville, OH (and environs, various events)

Oct 5: Columbus, OH (North Broadway United Methodist Church)

Oct 6: Indianapolis, IN (Indiana Hospital Association)

Oct 6: Logan, OH (Hocking Middle School)

Oct 12: Marysville, OH

Oct 13: Indianapolis, IN (Indiana Attorney General’s Conference, Indiana Convention Center – Indiana Prescription Drug Abuse Prevention Task Force,  public invited)

Oct 14: Des Moines, IA (Iowa Medical Examiners Convention)

Oct 24: Hillsdale MI (Hillsdale College, various events)

Oct 26: Pittsburgh PA (Gateway Rehabilitation)

Oct 27: Dover, DE (Various events)

 

Hope to see you at one of them!

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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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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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DREAMLAND, “Best of” lists, & New Rules for Authors

I don’t think I’ll have a nicer time, as an author, than I’ve had in the last few weeks.

For starters, one morning Entertainment Weekly selected Dreamland as among the year’s 10 best books (“like a David Simon TV Show gone cosmic”). That afternoon, Bloomberg Business ran a piece with Princeton Prof. Angus Deaton, Nobel Prize winner for economics, recommending the book as his favorite of the year.

Both ends of the culture endorsing a book on the same day – I don’t think that’s happened before.

I appreciated that because when I began this book I thought I was writing a drug-crime story. Midway through, I realized the book was really about where we are as a country, about what happens when, as a culture, we shred community, export our jobs,  build isolation and call it suburbs, claw at government and forgive the private sector its trespasses, and exalt consumption and seek pleasure and call them happiness.

Heroin is simply the embodiment of values we’ve fostered for 35 years. Isolation is its natural habitat. Doesn’t have to be that way. The antidote to heroin isn’t naloxone; it’s community.

Anyway … I thought I’d write to suggest my book to those of you looking for Christmas presents.

I know, it’s hucksterism. But the rules for authors these days are:

1) Write like hell; 2) Rewrite always; 3) Read a lot; 4) Talk to lots of different people; 5) Pay attention; and 6) Always be branding, marketing and promoting yourself because if you don’t, no one else will.

So, given No. 6, I’ll just quietly let you know that, in addition to EW and Bloomberg, in the last few weeks Dreamland was selected in “Best Books of the Year” lists by … Amazon.com, Slate.com, the WSJ, Seattle Times, Boston Globe, St. Louis Post-Dispatch, and Audible.

(In the two weeks after posting this, Buzzfeed, Daily Beast, Texas Observer, and the Guardian also added Dreamland to their Books of the Year lists. My thanks to each of them.)

Drug Czar Michael Botticelli named it his favorite book of the year – that was nice of him. So did the governor of Kentucky, Matt Bevin. Nice of the governor to do that, too.

You can see links to all this at my website.

Okay, so that’s done. Please have a happy holiday season, walk a lot, and take care of yourself and others you love.

 

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Heroin & Hyperconsumption – A Poem

Ever since beginning work on my book, Dreamland, I’ve been struck by the way opiates isolate those addicted to them.

As I wrote and researched, they grew into a metaphor for modern American life.

Opiate addiction, seems to me, is some kind of final expression of our own destruction of community, our lack of connection across the country – both in poor communities and wealthy ones. cropped-Virgin-of-Guadalupe-dec-12-2012-La-Placita-11.jpg

We exalt consumption and the individual over community and have for a long time now.

These drugs seem to fit that; they turn everyone who abuses them into self-absorbed, lonely hyper-consumers.

The poem below was written by Andrew Smith, one of the thousands of Americans who died in 2014 of a heroin overdose. He was 24.

His mother, Margie Borth, discovered it after his death.

“There were several writings, this one is about scoring heroin and the lonely world that became his life,” she wrote, sending me the poem. “His brilliance still shines in his dark, sad words. His best friend described this as `hauntingly beautiful.’  I knew nothing of his addiction until just five weeks before he died. I was in a blur of grief when I first read it.  But now I do see the beauty of his writing.  I miss him so much, just like the thousands of other parents who are thrown into this nightmare. “

Simulate the Static

by Andrew Smith

____

The waiting, oh god

The waiting

The parking lots, the bathrooms, the empty parks that close after dark

The driveways, the bus stops, the car backseats

The posh bank lobbies, flea bag motel rooms, gas station pumps

Oak trees, palms, and retention ponds meant to beautify

The ditches, the swamps, and one off dead roads that lead to nowhere

And the loneliness of that trap.

The broken windows,

The made for TV dinners

The busted speakers blaring bass on a burner cell phone

The children going hungry, ignored in the corner

Staring at a broken television; simulating static.

The characters

The hangers-on, the worn out, the washed up

The good, the bad, the ugly

and the pretty young white girls with the blank eyes

Staring in awe at this newfound world.

The sun is setting and it’s starting to rain

My eyes are closed and I’m wishing I’m somewhere else.

When I hear a tap on my passenger window

Within 30 seconds, he’s gone

And the wait seems like a thousand centuries ago.

                  In this moment, I rest my eyes a second

Breathe a sigh of relief and know that all is right with the world

At least for these brief few hours.

The rain falls and my windows are up

It casts shadows across the dashboard

And the radio plays a news story

From a country whose language I do not speak

And a land I do not know.

                  Life is a quest

And we all search for something:

Money, fame, power, an identity.

For most they never find it;

And like a mirage in the desert,

it wavers in allure on their weary walk forward.

For others, they do.

And what’s worse,

They’re left in the emptiness of what it means.

But in this moment a fleeting comfort comes to me

And I know I’m not alone.

(Feb 2014)

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Filed under Dreamland, Drugs, The Heroin Heartland, Uncategorized, Writing

That NY Heroin

I was interested in knowing more about that huge heroin bust in New York City last week.
The seizure totaled 154 pounds  (and $2 million in cash), the largest ever in that city – larger even than the legendary French Connection bust of the 1970s (100+ pounds). Which is saying something, as New York was the U.S. heroin hub for most of the last century.heroin20n-1-web

I was surprised to see the traffickers were from Mexico.  Virtually all the heroin coming into NYC and New England has been, since the 1980s, from Colombia – that’s what I understood.

So I reached out to a law enforcement source in the NYC metro region who works heroin. The source said that while the traffickers were Mexicans, the heroin was from Colombia: “Colombians have almost totally removed themselves from the distribution directly in the US.”

This is because:

“1. Colombian communities have matured and the criminal elements have for the large part been killed, jailed or been deported.
2. The Colombian drug-trafficking organizations (DTOs) can make money still selling it to other DTO’s in Colombia and/or in Mexico and parts nearby without the fear of the long arms of US authorities. Example: If they sell to Mex DTO they make $5,000 with minimal exposure. If they sell in US directly they make $10,000, but with possible major problems.
3. For Colombians, they can make major profits if they can get it to Western Africa and/or Europe with less exposure.
4. In today’s world, post 09/11, the Achilles Heel entry point into the US is over the southwest border. That area is within the realm of the Mex DTO’s. The Colombians feel they have more control if they conduct business in their area of operation and have less problems.”
All of which is to say that what happened to cocaine in the late 1980s – Mexican DTOs took over the trade from Colombians and, fueled by those profits, began the growth into the organizations they are today – is now happening with heroin as well.
If that’s so, it’s likely there’ll be more busts like this one, given the nationwide demand nowadays for the drug generated by widespread addiction to opiate painkillers.
LINKS:                                                    #Dreamland
Photo: DEA

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Hillary Clinton, Heroin, and the Time to be Heard

Three weeks ago, Hillary Clinton’s health-policy advisor called me to discuss the opiate epidemic, its causes and what could be done about it.feed-image-1

The advisor said she was reading my book, Dreamland, and that Mrs. Clinton had read my NY Times op-ed column of April 19 about the issue.

The advisor told me Mrs. Clinton had been hearing a lot of very passionate comments from parents with addicted children as she campaigned in Iowa and New Hampshire.

We spent an hour on the phone, talking about policy, about pain pills, pill mills, Mexican heroin trafficking, and about the quiet surrounding this epidemic that had allowed it to spread.

So I’m glad to see that Mrs. Clinton is now coming up with policy proposals to address it, one of which is to begin talking about it and end the stigma and silence surrounding addiction.

This epidemic is neither a red nor a blue issue. Thus I hope candidates from both parties will respond as well. I’ll be happy to chat with them, if they want to call.

I’d hope, moreover, they would focus not only on heroin, but on the broader problem of overprescribing of opiate painkillers, which so often provide the gateway to heroin. (Pain pills have their legitimate role in medicine, but too often are massively and unnecessarily prescribed.)

But there’s another important point in this. I believe parents of addicted children need to use this approaching presidential campaign as a way of magnifying their voices.

As a longtime journalist, I know that the most poignant stories are the ones that can have the most impact. Sadly, many parents up to now have kept silent, ashamed or simply worn out by their children’s addiction.

That is changing. More are stepping forward, as Mrs. Clinton was hearing on the campaign. Some are mentioning heroin overdose as a cause of death in their children’s obituaries – an act of enormous, and necessary, courage.

But these stories are still not being heard the way they need to be.

During past drug scourges, public violence aroused public ire. The crack years, for example, saw drive-by shootings and carjackings. I was a crime reporter during those years and saw this first hand.

None of that public violence has happened during this epidemic. So the job of arousing public attention falls almost entirely to parents.

I believe this presidential campaign offers an opportunity to be heard, to magnify voices. Make opiate abuse (pain pills and heroin) and overprescribing a point of presidential debate.

To do that, parents in particular need to step forward and tell their stories the way no one else can.

Photo: Hillary For President website

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Another Family Steps Up – D.J. Wolanski RIP

Another family has stepped up to acknowledge in an obituary that a child has died of a heroin overdose.4318752_300x300_1

Daniel Joseph “DJ” Wolanski, of Mahoning County in Ohio, died April 20. Read his obituary.

It must be so difficult for this family to come forward and say this publicly. But this scourge has spread because so many people before them have kept quiet, allowing the rest of us to imagine that the problem really isn’t as bad as it has become.

So it’s important to acknowledge the courage of those who do step up, speak publicly.

The obituary reads….

“Over the course of DJ’s life, he made many bad decisions including experimenting with drugs. Unfortunately, his five year addiction and battle with heroin took over. His family and friends truly loved him and tried everything from being supportive to tough love as he struggled with his own inner demons and heroin. …

“DJ often talked about the growing number of friends that he had lost to this destructive drug and how it destroyed families. They used to say it takes a community to raise a child. Today, we need to say that it takes a community to battle addiction. Someone you know is battling addiction; if your “gut instinct” says something is wrong, it most likely is. Get involved. Do everything within your power to provide help. Don’t believe the logical sounding reasons of where their money is going or why they act so different. Don’t believe them when they say they’re clean.”

Profound words – the way to attack a drug that turns every addict into a silo, a loner wrapped in a cocoon – is through community.

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Why Pain Pill Addiction? One Nurse’s View

I’m on tour to promote Dreamland, and along the way I’ve have had conversations with parents of addicts, doctors, public health employees, and the public in general.

Often the conversation revolves around why this is a problem, and why it continues to be — if we see that massive Dreamland-HCBigprescribing of pain medication has clearly led to heroin addiction.

This letter from a nurse practitioner at a chronic-pain clinic in a  mid-sized town in the western United States helps explain.

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The clinic I work at has a reputation for liberal opioid/opiate prescribing and there is a culture of  dependency and codependency that has been instilled by the owner. Prior to coming to this clinic I worked in a psych and drug rehab hospital in a rural part of the United States for five years. I saw all the patients that became addicted first by pain medication or other means. It is a struggle for me everyday to know that I now contribute to this problem.

Every day I try to have the conversation with patients on what it would be like to get off the medication. Most patients tell me no one has ever had that conversation with them. It makes it that more difficult because then I look like the jerk that wants them off their meds when every provider before me told them they would be on pain medication their entire life.

I have developed a reputation as being a terrible provider by many of the clinic’s patients. The front desk asks my medical assistants what it is like working with me since all they hear is terrible things about me.

Many people talk about going after to the doctors to stop this opioid epidemic. The problems I see are patients with terrible insurance that doesn’t cover comprehensive pain management. What I am stuck with is a person with limited resources and a 20-minute appointment and sometimes all I have left is medication. Most of my patients get upset with me, and laugh when I give them breathing exercises to perform.

I don’t start many people on pain medication but I have kept many people on medications that I sometimes don’t feel comfortable prescribing. I go out of my way to try to find alternatives to pain medication for my patients. My hope is that one day pain management is taken out of primary care completely. Pain is too complex to dealt with in a 20-minute appointment.

The other issue is patient satisfaction. That is a huge issue in emergency departments. I have spoken with many ER docs and it seems a lot of the care is driven by customer satisfaction. Doctors fear bad reviews from patients. I think this drives a lot of the pain medication prescriptions in EDs. Because of this, I have seen some of my patients get opioid/opiate prescriptions for relatively minor medical issues.

I have found some positives. Most patients I discharge for multiple violations of their medication agreements never come back. The ones that do often turn out to be my favorite patients. When I don’t worry about prescribing controlled substances with patients then we often get to work on lifestyle changes like better management of their chronic conditions or quitting smoking.

Anyways… I probably have a lot more to say but that seems like enough. Thank you for your time.

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The Normalcy of Addiction

I’m in Little Rock for the Arkansas Literary Festival, a very nice book festival held downtown.Dreamland-HCBig

So here’s what happened yesterday. Flew in, met my fellow panelists, learned that Southwest lost my bag, went to the hotel, took a quick nap, went to a festival reception, met someone with an opiate addict in the family (the family member is a woman in her 60s or so).

Little Rock is no different from every other part of the country I’ve visited recently.

Researching our national addiction to pain pills and heroin to write my book, Dreamland, I’ve been struck by the normalcy of addiction nowadays. Everywhere, strike up a conversation, you find someone with a family member or friend or co-worker addicted to opiates.

It’s far more prevalent than crack use was, I believe, and certainly infinitely more deadly.

I remember starting the research, flying to Dallas a couple years ago. On the plane was an elderly couple from rural Oklahoma. We got to talking and before long, they were telling me of their oldest son, addicted to OxyContin.

Not long after that, in a tavern on New Year’s Day in Covington, KY, I met a family, celebrating a young girl’s birthday. Before long, we’re talking about two people in that extended family dead from heroin overdoses.

There are many reasons why this is so.

First: the massive over-prescribing of pain pills nationwide. We often debate whether supply or demand drives drug plagues. This one is supply driven. Pain pills eventually lead to heroin addiction – as the pills are molecularly similar to heroin and much cheaper; in some areas, like those serviced by the Xalisco Boys I write about in Dreamland, heroin is easier and more convenient to obtain the pills.

But this is also driven by silence. There’s no violence to fuel public ire. Meanwhile, though, parents are loathe to talk about their children’s addiction. When they die, they camouflage it in some palatable cause of death. Some parents are going public. But far too few given the huge numbers.

The result is silence, and stories you never hear until you’re sitting next to someone on a plane, or chatting with them at a cocktail party.

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Filed under Books, Business, Drugs, Storytelling, The Heroin Heartland

DREAMLAND – At Last!

Been a very long time, and lots of hard work, but finally my third book of narrative nonfiction is out.Dreamland-HCBig

Dreamland: The True Tale of America’s Opiate Epidemic was released this week by Bloomsbury Press.

When neck-deep in writing a book, I’m never sure if it’s any good. Too much time spent laboring over every phrase, whether one clause should be separated by a comma or a semicolon, which adjective best describes a person’s mood – on top of all the facts that, like cats, need to be corralled and herded in one direction or another.

And new facts you learn every day that may change everything.

Then there’s the rewriting – which is what writing is all about.

So I’m thrilled to hear reaction to the book – that people couldn’t put it down. Love hearing that, I have to say.

I’ve had great appearances at the LA Times Bookfest and at Vroman’s, with more to come at Powell’s Books in Portland, Elliott Bay Town Hall in Seattle and Bookstore West Portal in San Francisco, not to mention the Arkansas Literary Festival in Little Rock, where I’m heading as I write.

Amazon.com chose Dreamland one of its Best Books of the month, alongside books by Toni Morrison, TC Boyle and others. That was nice of them.

The NY Times ran a column of mine on the front page of its Sunday Review opinion page. Nice of them, as well.

Salon.com wrote this terrific review of the book. Kirkus Review ran a long story on it. Willamette Week published a review, and an article on Dreamland. Mother Jones, where I was once an intern (1984), reviewed it as well. Thanks, you guys.

KPCC in LA aired an interview i did on their show, Take Two, and CSPAN did the same with an interview at the Bookfest, then covered the LA Times Bookfest panel I was on with some terrific nonfiction crime authors  – Ruben Castaneda, Barry Siegel, and Deanne Stillman, and Tom Zoellner doing a bang-up job moderating.

All in all, an exhausting but fulfilling first few days to a book’s life.

Thanks to all who’ve bought the book, and especially to those who’ve written me about it with such feeling.

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DREAMLAND … in two weeks

Two weeks from today, my third book, Dreamland: The True Tale of America’s Opiate Epidemic (Bloomsbury Press), is officially Dreamland-HCBigreleased.

The story of this epidemic involves shoelaces, rebar, Levi’s 501s, cellphones, football, Walmart, American prosperity, with marketing, with Mexican poverty and social competition, and with the biggest swimming pool in the US and what happened when that was destroyed.

It’s about the marketing of prescription pills as a solution to pain of all kinds, and about a small town in Mexico where young men have devised a system for retailing heroin across America like it was pizza.

The tale took me from Appalachia to suburbs in Southern California, into one of the biggest drug-abuse stories of our time – and one of the quietest, and whitest as well.

Until April 21, you can buy the book presale, at a discount, at Amazon here … or at Barnes & Noble here.

It’s been a long haul, and I thank the many people I met and spoke to along the way as I put together this American saga.

Hope you like it.

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