Tag Archives: Oxycontin

A Doctor’s View of Pain Pills

Here’s a letter from doctor with a long exposure to the problem of addiction and pain pills. I get lots of email letters about Dreamland. I’ve put a few up on this blog – always with names and identifying details removed.

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 I have recognized for many years, at least since the late 1980s, that the chronic use of opioid medications was typically a barrier to recovery. I am a physiatrist, a physician procter-1specializing in physical medicine and rehabilitation, since 1986.  We manage patients who have catastrophic injuries: spinal cord injury, traumatic brain injury, amputations and those with multiple and severe trauma. I also treated many patients who had less severe injuries including strains, sprains and other soft tissue trauma. We often manage patients over many years. When the use of opioids became more frequent, in the late 1980s, I was perplexed. I did my best to manage pain, if at all possible, without the use of chronic opioid therapy. I was perplexed even more so in the mid to late 1990s when Oxycontin came on the scene. Physicians no longer were afraid to prescribe opioids for non-cancer pain and did so seemingly without caution. They were duped. Drug companies and their physician spokesmen duped them.

I grew up and later practiced medicine for many years in New Mexico. New Mexico, as you may know, has always had one of the highest drug overdose rates in the nation.  Heroin had been the drug of choice, at least until opioid medications came on the scene. I worked as a house painter’s apprentice in the late 1960s while in college. I worked on one crew that every journeyman painter was an ex-con related to heroin use.  I had plenty of opportunity to use heroin but it scared me. My co-workers told me how great it was. One guy, much older than me, made it sound so appealing. “Come over and we will shoot up and listen to jazz.”  I never tried it though I had lots of opportunity.

I knew quite well how dangerous heroin was and never believed that opioid medications were any less dangerous. When I started practicing in the late 1980s many of the patients I saw were on opioid medications when I assumed their care. Most of the more seriously injured patients I saw were successfully weaned off opioids. Many of the less seriously injured, especially those with work related injuries, were much more difficult to wean. Some patients of both categories ended up on long term opioids but were closely monitored to determine if they were benefitting from opioids and whether they were abusing them. Escalating doses were typically not allowed.

The work related injury group of patients who generally had much less severe injuries, were routinely on opioid medications when I took over their care. My job as a rehabilitation physician was to get them back to their usual activities including return to work. I found that opioid medications were a barrier to their recovery. Some of my referring physicians believed the standard of care was to treat pain with opioids as long as patients complained of pain. Some patients were never going to stop complaining of pain and the reasons were frequently psychosocial in nature. I never believed the hype from drug companies regarding the safety of opioids. I saw from up close as a young man and as a doctor that they were dangerous and in general not appropriate for long term use in non-cancer pain.

I knew little about Dr. Russell Portenoy at the time of the opioid prescription explosion but I knew plenty about what drug companies were saying about the safety of opioid medications and the unlikelihood for addiction. I now understand Dr. Portenoy’s role in this public health catastrophe.  I don’t believe Dr. Portenoy and other drug company marketer’s claims that they are now surprised about the addiction potential and danger of opioids. Intuitively it did not make sense. Oxycodone and hydrocodone are so similar to morphine and heroin both chemically and by their mechanism of action. Why would you believe they are so much safer? Those guys were either just plain dumb and so drunk with drug company money and self promotion that they refused to pay attention to what was happening to patients. I am sure they are not dumb. Dr. Portenoy is a brilliant and charming guy. Just view his video presentations and interviews. He is also a successful academic physician. That is what made him so dangerous.  I am just an average doc who has never had a higher academic position than a clinical assistant professor.  I have never authored a paper that made it to a medical journal. How could I know more than them and have been so right about the proper role of opioid medications?  Why didn’t they? Certainly not because I am smarter.Grand Canyon Trip 2015

I think your book was very even handed, maybe a little too much, with Portenoy and the other opioid selling/promoting physicians. I’m telling you they knew better. Their response of “If I knew then what I know now….” just doesn’t cut it. They are responsible for the hundreds of thousands of deaths and ruined lives. They should not get off the hook. I suspect their narcissism will prevent even one sleepless night for the damage they have done. But they and their benefactors, the drug companies, have created a horrible health crisis that was largely preventable in the United States. It is almost strictly a U.S. problem caused by U.S. physician “thought leaders”, drug companies and misguided bureaucrats.

I applaud your book. Bringing the black tar heroin story into your narrative was great. You connected the dots. I wasn’t aware of that part of the story. Thanks again for your book. It may just impact our legislators and government officials even more so, to focus on rehabilitation not punishment for those young kids who got caught up in a drug problem often caused by misguided or crooked doctors.

The punishment of “pill mill” docs and drug company marketers including their corrupt physician lackeys could never be equal to the suffering they have created. Glad you spotlighted the problem and did it in such a well-researched, entertaining and cogent way. Thank you.

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Filed under Dreamland, Drugs, The Heroin Heartland, Uncategorized

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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Filed under Drugs, The Heroin Heartland

Dreamland: A Mother’s Story

I’ve been getting amazing, intense email letters in the two weeks since Dreamland was released. I hope to be adding some of them to my blog. Here’s one.

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I almost lost my beloved 23-year-old son (he is now 26) to heroin addiction, which had progressed from OxyContin to black tar heroin.  We are a family of hard working professionals in a university town.

Like most families, we cherish our kids and do everything we can to help then live an honest successful life. When this happened, my son was a pre-med college student. I was and am very close to him, and he had always been a very good Dreamland-HCBigstudent and loving son and brother. He was kind, funny, highly gifted, devoted to music and passionate about becoming a doctor.   He was also prone to depression at times.

When I found out, he was in his 4th year of college, and getting As and Bs in hard science courses such as organic chemistry, but could not seem to manage on his college budget. He kept running out of money.  He started having vague physical symptoms, like constipation, malaise and abdominal discomfort. His grades in his last year of college started to slip.  At Christmas, we visited my sister’s family in Midwestern farm country. Later, my sister, bless her heart, confided in me that her Oxy pills that had been prescribed for shingles had disappeared from her medicine cabinet when we were staying with her. She was reluctant to tell me as she did not want to make anyone uncomfortable or blame anyone. I am so very grateful that she told me this.

I immediately put together that my son had stolen the pills and had a life-threatening problem. I knew it in my gut to be true beyond any doubt. Perhaps because I am a child of the 60s and knew too many friends who were lost to drug addiction: classmates who were drafted and came back from Vietnam addicted to heroin, and 2 college roommates who went to federal prison for smuggling cocaine as an airline stewardesses.  We also have a family history of alcohol abuse and addiction, which my mom told me way too many times.

I freaked out! I knew that he had to be addicted to do something so desperate as steal my sister’s pills. This explained everything – his money problems, dropping grades, and vague feelings of being sick.  I could not sleep for fear he would soon be dead. I confronted him in tears and said I knew he had stolen the Oxy. He of course denied it, but finally admitted he had stolen the pills. He admitted he was addicted to Oxy pills, which he had started using after being given a script for narcotic pills after a foot laceration.

I immediately called an addiction doctor I know and, in tears and panicking, offered to pay her anything if she could please help save my son.  She drove in from out of town and (at a high hourly rate) met with him and helped him realize he was an addict. She personally went with him to an NA meeting (she is a former cocaine addict and involved in NA). I would have paid anything for any chance to save him.

He went to the NA meeting and started to see addiction therapists, which we paid for, but he remained in denial. He kept saying it wasn’t a big deal and he could kick the habit. He went to some NA sessions, but over the course of 18 months he relapsed 3 times, each time worse than the last. During one of the relapses, he called his father to say goodbye after injecting what he thought was a fatal suicidal dose of black tar heroin in his arm. He had started getting the heroin from a “friend” – a former college football player who had been selling him Oxy and was now selling him heroin once he could no longer afford the street price of Oxy.

His father found him in his apartment unresponsive, but he survived.  He was so ashamed that he could not defeat the problem that he said he couldn’t live with the shame and did not find life worth living. We did family interventions and told him we would not give up on him and brought him to more therapists.

He almost died three more times. After the first relapse, I demanded to know his dealer’s name as I wanted to kill him.  I traced his phone calls (I was paying for his cell phone) and had repetitive thoughts about killing the demon who sold him the drugs and taught him to inject heroin.  I wasn’t sure how I could go on living if I lost him.

When using, he would not see me as he knew that I would know if he was using. So he moved to LA and declined rapidly.  His father went to see him and told me that I should go visit him, as he would not be alive long.  I did. He looked like a skeleton. He was taking Suboxone, as well as additional narcotics and probably other drugs.   I kept saying that I would pay for any addiction therapy he could find, but would never give up on him and not give a penny to his habit. My life was hell.

Thank God, he found an addiction therapist in LA (a former Vietnam vet heroin addict) who he really connected with. He started seeing this therapist while still using.  I got a “call” (God how we fear those calls!), but it was not that he had died. It was that he had voluntarily decided to go into “long term” drug rehab.  We found an inpatient facility in Utah that the addiction specialist recommended. I knew the enslaving power of heroin addiction and how statistically unlikely it was that he would voluntarily say goodbye to heroin.

I don’t know how he had the strength, but he got on the plane, flew to the University of Utah hospital where he admitted himself into the psych unit for several days of detox. He then voluntarily admitted himself into a Utah inpatient facility for 30 days, then into 90 days sober living, and then underwent 18 more months of therapy and voluntary monitored UAs.

My son is now 35 months completely clean, and is in medical school. He keeps track of every single day he is sober. He says that every day remains hard work. BUT, he has done the work and gotten his life back. He started exercising, working and studying steadily. He took premed courses and passed grueling medical school exams.

My son is now successfully finishing his first year of medical school.  He wants to be an addiction doctor and find a way to help others survive this hell.

I still worry about him every day.  But we cannot talk about this, as most people do not feel comfortable with the topic. I also need to not jeopardize my son’s career. He tells some people and is doing an internship this summer at rehabilitation clinic. He was open with them when he applied for the position.  He answers all questions honestly, but does not bring the topic up with others unless they are very close friends.

I have read every book about addiction that I can get my hands on, and some are excellent, such as “Beautiful Boy.”  But no other book so skillfully and adeptly addresses this huge crisis like yours, nor does any other book touch me in terms of what I have lived with like your book.

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Filed under Books, Drugs, Streets, The Heroin Heartland, Writing

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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An interview with RWR, “…the hell you know about the 740?”

Last week, as I was busy working on my book about opiates in America, I was amazed to see the reaction to a rough-hewn video from some guys from Portsmouth, Ohio known as RWR (Raw Word Revival).

The song they put out, “What the Hell You Know About the 740?”, describes the several crises their town has lived in for decades — and describes a lot of heartland America as well.images-1

Among them, Portsmouth was ground zero in the opiate epidemic that is now sweeping the country. I’ve been there four times for the book: twice to hear about the degradation that took place with economic decline and the rise of prescription pill use; twice to hear the stories of how Portsmouth is emerging from that hell and a recovery community is forming.

I hope to return a fifth time.

What I found electric about the RWR video was that it was not a celebration of thuggery. Instead it was journalism — a description of what these guys had grown up in, using Portsmouth as the video backdrop — and a call to rebirth for their images-11hometown.

I suspect Bruce Springsteen and Merle Haggard would find a lot to value in the RWR and their song.

Plus it was DIY all the way, and, as a fan of early punk rock that pioneered DIY attitudes, I thought it looked great.

Anyway, five of the nine members of RWR  took some time to talk to me about the group, the song, the reaction and more. Portsmouth born and raised, they are: Clint “Random” Askew, Nick “Big Mung” Mungle, Donricko “D’Gree” Greene, Barry “B.E.Z.” Munyon, Justin “JLew” Lewis. (Others in the group include Lexxy “Riide R Diie” Jackson, David Packard, Arrick “Lil Mont” Montgomery and Angelo “Anjo” Jackson) rwr8

You can listen to them at the link above or download it.

Check out their story. Tell me yours. Leave it in Comments.

Meanwhile, you can read the fantastic comments so many left on earlier posts I did last week.

And follow me: On Twitter.  On Facebook.

Here’s my website: www.samquinones.com

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More posts from True Tales: A Reporter’s Blog:

From the 740: An addict talks about poetry and dope

What the Hell You Know About the 740?

Here’s what I know about the 7-4-0

Where have you seen the 740?

I who am your Mother … The Virgin of Guadalupe

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Filed under Culture, Drugs, Podcast, The Heroin Heartland

Here’s what you know about the 740

The response to the video by RWR, the Portsmouth, Ohio rap group, has been extraordinary.

So I sifted through the comments for some excerpts that tell the story of a small American town that is beaten down and rising up.

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“…I’m 60 yes old….have lived here since I was 9. I cry when I see what had become of the town I grew up in. I remember a downtown that was filled with stores and restaurants. Christmas shopping was magical. Shoulder to shoulder, bellsIMG_4113 ringing… You could find anything you wanted! There were no Kmarts, Walmarts or malls. …”

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“…We never locked doors and never had to worry. Now we live behind closed locked doors with alarms on them. The working class is worried about keeping what they have while the others steal to get what we work for. Kids being raised by grandparents because of the drugs here….”

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“Drugs have been prominent as early as Dr.Lily and Dr.Proctor. With a steady and fast decline ever sense then. With businesses shutting down. No work around the area….”

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“…Watched the girl next door go from straight A’s to prison in just two years from the first O/C. watched my son’s friend go from valedictorian to living in his own filth, without any utilities. … At one point the estimate was that of every 10 adults in Scioto county, 7 were addicted to oxycontin. think about this. you go to the store, the clerk is high. you take your dog to a vet, you see the pinprick pupils. you stop at the post office, you see the obvious proof of addiction, it is … as if someone crop dusted the county. with opiate.”IMG_0637 - Version 2

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“… knew our town was on trouble when people young and old were lined up down Chillicothe (the main street in Portsmouth) to see the pain pill doctor. Or maybe it was when I bought pills from friends Grandmother. Or how about when I saw a former high school cheerleader walking the stro….’

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“…I got pregnant I was unable to stop so my son was taken from me n I went to treatment immediately after five weeks of treatment my father was shot and killed robbing theCarry out…”

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“…You can’t leave the house alone without fear of coming up missing to never be heard from again….”

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“…You got to survive the 740 is what the hell I know….”

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“…My daughter is an addict in early recovery. She was in the top 10 of her graduating class, and on the dean’s list at SSU…until the dope got to her. She went from pain pills, to heroin, to meth. … She got busted and sent to jail. … Maybe I never paid enough attention, maybe I was just to busy trying to work to survive. Maybe I just didn’t want to believe that things were so bad in our town….”

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“…I’ve only been free from prison since May 31st,2013 and I know I can’t go back to living in Portsmouth….”

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“…I noticed an out-of-towner at a coffee shop and asked what brought her to town. She was on a boat trip down (and back) the entire length of the Ohio River. In all her trip preparations, no one had ever mentioned Portsmouth. She had pot lucks and stops scheduled in towns all along the river, but stopped in Portsmouth by accident, to pick up supplies. She added a couple of days to her itinerary to look around. “What happened here?” she asked. “This was a real city once,” she said. “All the buildings are taller than a lot of places I’ve stopped. But it seems like a ghost town.”

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“…7-4-0 reminds me of my hometown, Elkhart, Indiana (574). Elkhart was built on the pharmaceutical, band instrument, and musical instrument manufacturing industries. Because of the mobile home industry, it tags along with the fortunes of Detroit. Don’t know about heroin, but backpack meth and home meth labs (one blew up across the street from the high school) are everywhere….”

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“…WTH do I know about the 740? I was born and raised here I watched it go from a quiet little town, where you didn’t have to be afraid to go out at night, or lock your doors, to a poverty sticken, low job rate, drug capitol. Portsmouth is starting to fight back finally …”IMG_4083

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“…went to prison cause I couldn’t stay clean my mom did a lot by raising my oldest most of her life,sometimes it’s like a never ending battle,but we do have recovery in our town,an once again back in treatment…”

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“…am a mother who use to addict to pain pills been to prison twice and finally went to treatment in the 740 which changed my life for ever.Now I have been working full time for 5 years going back to school to finish my degree and have overcome a lot trying to stay clean and sober it is possible in the 740…”

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“…I’m currently involved with a group of people who are looking to start a worker cooperative in the city as a IMG_0659 - Version 2means of providing work and education for the unemployed. …”

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“…here are 2 options: be the change you want to see, or change your surroundings & the people you spend your time with!…”

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“…I am finishing my Master’s in natural resources and environmental science so I can publish research on this post industrial town and its resulting drug addiction….”

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“…we are recovering like crazy down here in little ole Portsmouth!!! I also know one of the men in the video, watched him grow into adulthood and become a GREAT man, a father, and a caretaker despite all of the hurdles that he faced, and he really did beat the odds…”

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“…I personally have overcome my past, and will not let the downfalls of MY hometown get me down or pull me back! I did it and so can you Portsmouth!!!! All you need is a lil inspiration, and thats what these men are!!!…”

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“…I really dont like rap i usually listen to country but i loved this song n so proud of them….”

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“…What I know about the 740 is good people are doing something about it….”IMG_3327 - Version 2

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“…The people here need to save our “740″. No one is going to do it for us….”

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“…I’m still here and I recently just got out of rehab….”

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“…No longer does this have to be a “junkies town”, or “drug infested” … she is inching herself back to be the home I grew up in. A place where doors are left unlocked at night. A place where its okay to send your children to the store. … It doesn’t come easy. It will get better though. (progress not perfection) I’m an addict. My story and the stories of many of my fellow addicts are similar to the story of our city. We can/do Recover. Today I am proud, honored, and happy to say that I am living in the solution and not in the problem….with that I pass….”

–Θ–

So that’s Portsmouth’s story, folks. Share it if you like it.

Tell me yours. Leave it in Comments.

And follow me: On Twitter.  On Facebook.

Here’s my website: www.samquinones.com

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More posts from True Tales: A Reporter’s Blog:

Here’s what I know about the 7-4-0

Where have you seen the 740?

I who am your Mother … The Virgin of Guadalupe

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Filed under Culture, Drugs, Global Economy, The Heroin Heartland

What the hell you know about the 740?

Working on my book about America’s opiate epidemic, I’m just back from rural southern Ohio, along the Ohio River, and a town of 20,000, with a lot of abandoned buildings that once housed factories that employed people, called Portsmouth (area code 740).

This is rural heartland America, and it’s looking very rough. Lots of dope.

Heroin in the heartland. Who’d have thought? Depleted white culture. Tough to watch.

I’m not the biggest rap fan, but this video, put out by some Portsmouth kids known as RWR (Raw Word Revival), is pretty much journalism. The new town criers with a post-industrial, post-rural apocalyptic kind of groove.

(Turns out they filmed the whole thing on an iPhone. How punk rock/DIY of them….)

(Add: Here’s what you know about the 740 — an excerpt of many comments to this original post.)

What they came up with is certainly truer than all those Nashville country songs about small towns, shit-kicking good old boys working hard and drinking beer on Saturday and in church on Sunday out there in God’s heartland — all of which sounds to me like propaganda.

Actually, I found Portsmouth to be an optimistic kind of place these days, with a lot of new energy and recovery.

But more on that later. For now, I’ll just leave you with the RWR video.

Share it if you like it….

While you’re doing that … TELL US: What do you know about the 7-4-0? Tell us a story of the strongest or weakest person you know. The day you knew things were getting bad or getting better?

Read what others have said in Comments.

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Follow me on Twitter and on Facebook.

My website: www.samquinones.com

More posts from True Tales: A Reporter’s Blog:

Narco Mennonites arrested again

Dean Williams: An addict comes clean

Latinas and Transgender style

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Filed under Culture, Drugs, The Heroin Heartland

THE HEROIN HEARTLAND: We Have Red Belly Piranhas, and other photos

I’m in Portsmouth, in southern Ohio, a region that has taken a beating from so many corners in the last 30 years.

Farm crisis, factory jobs going overseas, and lately, the hyper-marketing of prescription painkillers, which led to the nation’s first pill mills (unscrupulous docs selling prescriptions like candy for cash).

That led, before many years had passed, to great amounts of addiction to Mexican black-tar heroin delivered by guys from the town of Xalisco, Nayarit — a massive and quiet epidemic, and what the book I’m working on is all about.

The heartland of America — who knew?

This area is showing a few signs of coming back. I just today had conversations with two women today who give me hope. But it’s slow and there’s a long way to go, for having fallen so far.

By the way, the pet store said the people by Red Belly Piranhas to raise in aquariums. They get about as big as a human hand.

 

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