This summer, a sculptor built a steel, 11-foot, 800-pound bent heroin spoon. With the help of an gallery owner, he put it on a trailer and drove it to the headquarters of Purdue Pharma, the manufacturer of OxyContin.
The bent-spoon protest of the country’s opiate epidemic by Massachusetts sculptor Domenic Esposito and Fernando Alvarez, owner of a Connecticut art gallery, stayed in front of the company’s Stamford, CT offices for only two hours before police impounded the sculpture, but it gained worldwide attention.
Alvarez was arrested and eventually convicted of a misdemeanor charge of blocking free passage.
I was in Boston recently and had a chance to meet and talk with Esposito about the episode and what brought it on.
Our conversation ended up including his brother’s addiction, drug marketing, Americans’ pain, and #thespoon movement they hope to ignite.
Great story. Take a listen. Share it if you like it:
From 2006 to 2015, Dr. Michael Rhodes was one of the top prescribers of OxyContin in the state of Tennessee.
His practice had many of the signs of what had come to be called a “pill mill.” Lines of people outside. A knife fight in front of his office. Investigators found he often prescribed without proper physical examinations or knowing the medical histories of his patients. Over those years, Rhodes, of Springfield TN, prescribed 319,000 OxyContin tablets. In May, 2013 had his license placed on restrictive probation by the Tennessee Board of Medical Examiners.
Still, representatives from drug-maker Purdue Pharma continued to call on him urging him to prescribe more OxyContin, their signature drug, according to a lawsuit filed by Tennessee Attorney General Herbert Slatery.
“In spite of this disciplinary action by the board (of medical examiners) and direct knowledge of his patient’s death from OxyContin, Purdue continued to call on Dr. Rhodes,” the Tennessee complaint states. They continued to “pressure Dr. Rhodes to prescribe more and more opioids, even when he expressed concerns regarding his own ability to competently do so.”
According to the lawsuit, Purdue reps called on Dr. Rhodes 126 times, include 31 times after his license was restricted.
They did so during the years after the company signed an agreement in 2007 with the federal government to be vigilant for abuse and diversion of the pills and look out for doctors prescribing in unscrupulous ways.
Part of the Tennessee complaint against Purdue catalogues alleged attempts by the company to get high-prescribing doctors and nurses to prescribe even more of their product, despite signs that those medical professionals were behaving in unethical ways and that their prescribing habits were out of control. Cultivating high-volume prescribers, the complaint alleges, was seen as crucial to the company’s business. The complaint alleges the company called on several such nurse practitioners, three now-shuttered pain clinics, and 13 doctors, who’ve retired or had their licenses revoked or placed on probation.
Among them was Dr. James Pogue, of Brentwood, TN, who prescribed 562,000 OxyContin 80mg pills between 2006 and 2013, making him one of the largest prescribers in Tennessee even three years after he stopped practicing medicine. He generated $655,000 in revenue for the company during one six-month period in 2009, according to the complaint.
Company sales reps called on him 53 times between 2005 and 2012, “more than half of those occasion coming after his license was reprimanded in 2009.”
The Breakthrough Pain Therapy Center, in Maryville TN, was known to have none of the typical diagnostic tools associated with pain clinics: examination tables, gloves, urine screens “or providers who performed independent pain diagnoses.” It also included “scant” office records and pre-written prescriptions often dispensed “without a physician present.”
While placing some staff on no-call lists, the complaint claims Purdue continued to call on other staff members at Breakthrough Pain Therapy, whose owners were federally indicted in December 2010. This included Buffy Kirkland, a nurse practitioner who worked there for several years. Between 1998 and 2017 as a nurse practioner in Tennessee, she prescribed 68,000 OxyContin tablets, of which two-thirds were of 40mg or stronger, according to the complaint.
The Tennessee complaint is one of numerous lawsuits filed in the last year or so against Purdue and several other drug companies that make opioid painkillers. The plaintiffs include Native-American tribes, small towns like Everett, WA and large cities like Los Angeles and Chicago. Most state attorneys general have filed lawsuits, as have at least 300 counties in a suit that alleges a “public nuisance” by these companies. That suit is consolidated in a federal court in Cleveland.
When I was writing Dreamland in 2013-14, I remember only three such lawsuits against makers of opioid painkillers. This was a time when the issue was largely hidden, those affected largely silent. Families were ashamed and wanted to obscure the truth of the addiction and manner of death of their loved ones. Thus the media paid scant attention and elected officials, outside those in a few states, paid less.
But the awareness has expanded in the last three years. One result is that many more lawyers across the country have turned to examining legal theories that might prosper in court.
Public agencies have been hammered by the cost of the epidemic. Indeed the epidemic’s costs have largely been borne by the public — by coroners and public health offices, police and sheriffs departments, jails, county hospitals, foster children agencies and more. Meanwhile profits have largely accrued to the private sector, mostly to pharmaceutical companies.
Thus, today, most state and county officials have to be seen by their constituencies as doing something dramatic about this epidemic, and a lawsuit has become an option to recoup some of those costs. None of the new lawsuits has yet gone to court.
“Always Be Closing” is the motto that salesmen live by in the movie/play Glengarry Glen Ross.
If you haven’t seen the movie, do so. It’s great: Al Pacino, Jack Lemmon, Alex Baldwin, Kevin Spacey. It’s about an office of desperate sales guys hawking shady real estate investments. ABC — “Always Be Closing” — is the way each is supposed to approach every sales call.
The suit was filed in May by the office of Tennessee Attorney General Herbert Slatery. It alleges a lot of things, but in general that Purdue used deceptive marketing practices to push its signature drug, OxyContin. This took place, the suit alleges, between 2009 and 2012, well after the company and three of its executives pleaded guilty (in 2007) to a federal misdemeanor of false branding and paid a $634 million fine, while also committing to a series of measures to ensure they were not marketing to doctors who were prescribing unscrupulously.
The company moved to seal the lawsuit, but a judge in Knoxville recently decided against that idea, allowing the office to send me, and others, a copy.
In general terms, what I find interesting the lawsuit is how it displays the changes in pharmaceutical sales in this country, much of that coming during the life of OxyContin, though not due to it.
Up to the mid-1990s, drug salesmen in the United States were usually older men, often with backgrounds in pharmacy or medicine. They were often from the communities they sold to, knew the doctors they sold to, and became credible sources of information for those same doctors as medicine began to change rapidly.
Then the industry went another route. Those older folks were shown the door. In what can be called a sales force arms race, drug companies hired more and more reps. These reps were usually much younger, very good looking. They didn’t know much about they were selling but they have backgrounds in sales. They inundated doctors with visits and giveaways, of pens, calendars, lunch, sometimes trips for continuing medical education seminars. The companies were aware that by massaging a doctor’s staff, the doctor would soon be an easier mark.
Many companies did this. The numbers of sales rep rose through the 1990s from 35,000 nationwide to over 100,000 by the end of the decade. But other companies were selling blockbuster drugs to deal with cholesterol, hypertension and others. Purdue was among the few that used these techniques, and this enhanced salesforce (numbering eventually 1,000), to sell a narcotic painkiller.
“Always Be Closing” was, apparently, part of that push at Purdue. So, allegedly, was mention of the movie. All of this coming after the 2007 criminal lawsuit.
In Tennessee, (pop. 6.6 million people), the company made 300,000 sales calls to health care providers in the 2007-17 decade, during which time doctors prescribed more than 104,000,000 OxyContin tablets; more than half of those tablets were at the strongest doses the company made: 40mg and above.
Those of you who’ve read my book Dreamland know that, to me, supply is the crucial factor in this, and really in any drug scourge. What the lawsuit describes is a company hard at work at creating a vast new supply of opioids.
Company instructional materials pushed sales folks to “expand the physician’s definition of the appropriate patient” to which opioids might be prescribed; to “never give someone more info than they need to act”; and to develop a “specific plan for systematically moving physicians to move to the next level of prescribing.”
“We sell hope in a bottle,” said one guide for incoming salespeople, who were also instructed to encourage doctors to increase patients’ daily doses.
The lawsuit goes on to claim that Purdue sales reps in Tennessee were urged to make frequent sales calls, as evidence showed that that increased the number of prescriptions. According to the lawsuit, the company urged its salespeople to “focus on doctors who had more patients, less likely to have pain management expertise, and have less time to appropriately monitor patients on opioids.”
During these years, Purdue sales reps, according to the lawsuit, focused their efforts on primary care doctors, nurse practitioners and physicians assistants, whom the company “knew or should have known … had limited resources or time to scrutinize the company’s claims.” Together, people in those three profession prescribed 65 percent of all OxyContin tablets in Tennessee during these years. By 2015, Tennessee had the third highest prescription rate of opioids in the country.
A major part of the lawsuit goes on to discuss specific examples of Tennessee doctors who were leading the state in opioid prescribing, often with signs that their practice was out of control or they were incompetent or unscrupulous, yet who were nonetheless aggressively marketed to by Purdue salespeople.
Here’s a letter from doctor with a long exposure to the problem of addiction and pain pills. I get lots of email letters about Dreamland. I’ve put a few up on this blog – always with names and identifying details removed.
I have recognized for many years, at least since the late 1980s, that the chronic use of opioid medications was typically a barrier to recovery. I am a physiatrist, a physician specializing 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.
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.
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 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.
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.
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 student 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.
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 prescribing 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.
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.
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 hometown.
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)
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.
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.
“…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, bells ringing… You could find anything you wanted! There were no Kmarts, Walmarts or malls. …”
“…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….”
“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….”
“…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.”
“… 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….’
“…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…”
“…You can’t leave the house alone without fear of coming up missing to never be heard from again….”
“…You got to survive the 740 is what the hell I know….”
“…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….”
“…I’ve only been free from prison since May 31st,2013 and I know I can’t go back to living in Portsmouth….”
“…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.”
“…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….”
“…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 …”
“…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…”
“…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…”
“…I’m currently involved with a group of people who are looking to start a worker cooperative in the city as a means of providing work and education for the unemployed. …”
“…here are 2 options: be the change you want to see, or change your surroundings & the people you spend your time with!…”
“…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….”
“…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…”
“…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!!!…”
“…I really dont like rap i usually listen to country but i loved this song n so proud of them….”
“…What I know about the 740 is good people are doing something about it….”
“…The people here need to save our “740″. No one is going to do it for us….”
“…I’m still here and I recently just got out of rehab….”
“…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….”
So that’s Portsmouth’s story, folks. Share it if you like it.
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….)
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?
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.