Tag Archives: pain pills

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

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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Judge Moses’ Court

I was in the town of Logan, Ohio last week, at the tail end of my speaking tour through Ohio, West Virginia, Kentucky and Indiana.img_3596

Logan, pop. 7,000, is an Appalachian coal town in the county of Hocking, about 40 miles southeast of Columbus in the farmland off of state Highway 33.

The morning after my talk, I spent an hour in the town’s drug court, which is now dedicated entirely to people with opiate addictions trying to expunge criminal records and keep their recovery going.

The court is run by Judge Fred Moses, who in this court looks and sounds more like a social worker. He asks each client about his or her recovery, job prospects, children – confers with prosecutors and probation and social workers. The idea behind drug court is that clients must get into addiction recovery, begin to repair their lives, before any record expunging takes place.

What struck me was, first, that there were such a court at all in a town like Logan. And then that all the 10 or so clients I met that day were addicted to opiates, heroin mostly.

All but one started into addiction on pain pills. A few began using them after they were prescribed the pills for some medical reason. Others began using them recreationally. But all of them got into their addiction because of the pervasive, massive supply of these pills that were, and are, available.

In Logan, according to a recovering addict I spoke with (whose interview I’ll post later), pain pills and benzodiazapines, and the insistence with which clients demand them, have made docs unimaginative it seems. At least, pills appear to be many physicians’ immediate go-to response.

Judge Moses has most of his clients on Vivitrol, the opiate blocker, paid for by Medicaid, which, in Ohio, has been available to anyone since 2014. This is due to a Republican governor, John Kasich, who expanded coverage to all Ohioans, largely, from what I understand, to give people without insurance access to addiction treatment – so big was the state’s problem.

Without that, Vivitrol would be too expensive for Hocking County. Sitting there that day, I wondered if at some point every heroin addict in America will have to be on Vivitrol.img_3600-copy

Judge Moses’ drug court is a standing testament to how opiate addiction is changing minds in rural areas. I suppose there was a time when the idea of giving a drug to combat drug addiction was viewed askance in Hocking County. But this addiction is different and requires different response. Hence Vivitrol.

What also struck me, though, was that this scourge spread across the country largely due to the private sector – pharmaceutical companies and doctors, urging the aggressive prescribing of narcotic painkillers.

There’s a role we all have, as American health consumers, in what’s taken place, and it’s an important one. But it’s striking to me how this began due to the private sector – not underground drug traffickers – and how the profits have accrued to the private sector.img_3577-copy

Yet dealing with the collateral damage has been charged almost entirely to the public sector: ERs, public health departments, cops, prosecutors, jails … and drug court, like the one run by Judge Fred Moses in the small town of Logan, Ohio.

I wish his clients well, as I do the town of Logan itself, where I met a lot of nice people (and received this Proclamation), and which now must battle this kind of persistent, costly addiction along with all the other issues facing small-town, rural America.

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Dr. Procter’s House

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

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

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

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

Karen:

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

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

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

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

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

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

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

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

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David Procter was a product of that, I believe.

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

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

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

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

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

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

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

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

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

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

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

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

 

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Why I Voted Against California’s Prop. 47

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

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

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

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

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

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

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

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

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

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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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Xalisco Boys – now in northern Ohio

In case anyone thought the Xalisco Boys – the heroin traffickers from Xalisco, Nayarit, which I write about in Dreamland — were an old Screen Shot 2015-05-03 at 3.33.02 PMstory, there’s this recent bust from the Cleveland and northern Ohio areas.

The interesting part of this story is that they have apparently moved into the Cleveland market. I know they’re in Columbus, Nashville and Memphis, Indianapolis and elsewhere.

Until recently, apparently, they hadn’t made a move into northern Ohio, which seemed too close to Detroit, another heroin hotspot.

But things change in the underworld, particularly as the Xalisco Boys (delivering black-tar heroin like pizza with drivers and operators standing by) work like a lot of corporations in that they’re always competing with each other and seeking new sales territories.

Never ceases to amaze me how this system evolved and spread like a fast-food franchise – gaining special momentum after it arrived in 1998 in midwestern and Appalachian areas where pain pills were just then being massively over-prescribed.

That was the first example of a heroin distribution system discovering the market inherent in pain-pill overprescribing.

Here goes some of the above cited newspaper story:

“This group utilized numerous men to act as couriers to deliver the heroin to customers. Many of these couriers were brought illegally to the United States from the Nayarit/Tepic area of Mexico to the Painesville area with the promise of working on a farm or in an automobile garage. Once in Ohio, these individuals became couriers for the drug trafficking group, according to court documents and the FBI.”

Tepic is the capital of the state of Nayarit, which is on Mexico’s Pacific Coast. Tepic is a few miles from Xalisco, where this system started and where the guys who started the system are from.

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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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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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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:

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Dean Williams: An addict comes clean

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70 Comments

Filed under Culture, Drugs, The Heroin Heartland