While speaking on the topic of heroin in America, I’m often asked how much of our supply comes from Afghanistan, as we’ve been in a war over there for many years.
My answer, from interviews with traffickers, cops and DEA agents, is that most of our heroin comes from Mexico.
That view was confirmed this morning by William Brownfield, the U.S. State Department’s assistant secretary for International Narcotics and Law Enforcement Affairs.
In a conference call with reporters, Brownfield estimated that 90 to 94 percent of the heroin consumed in the United States originates in Mexico, with another 2 percent or so coming from Colombia and the remainder from other countries around the globe.
That represents a massive shift in our heroin supply since roughly 1980, when a lot of our heroin came from the Far East, and had for decades.
Interestingly, Brownfield said, a lot of Afghan heroin does make it to Canada, but not to the United States, where Mexican trafficking organizations, too close by, enjoy a more advanced and efficient distribution network, and offer therefore cheaper prices.
Brownfield was talking about the just-issued International Narcotics Control Strategy Report (INCSR), which talks a lot about the heroin/opioid problem in America. Brownfield’s message was a positive one about cooperation between Mexico and the United states on issues of drug enforcement.
A wall of law enforcement cooperation is in place, without constructing an actual wall, he said. Serious problems existed, he said, “but we have a far better architecture to address them today than we did in years past.”
Nevertheless, his answer on heroin’s origin stunned even me. I would not have guessed the estimate would be that high.
I’ve written elsewhere about my belief that it’s unlikely that more border walls between the two countries will do much to staunch the flow of heroin into the United States. What’s really necessary is even deeper cooperation, frank discussion with Mexico that a wall and the emotion it provokes would do much to corrode.
Yet Brownfield’s response highlights two things worth mentioning.
One is that Mexico must truly step up to this challenge. Its unconscionable that such a high percentage of illegal highly addictive dope come from one country to another. China had a similar issue in the 1800s, when the British forced opium into that country, resulting in the massive addiction of Chinese people for decades after.
If border walls are insulting to Mexico, it must understand that they are proposed because of Mexico’s own failings – both with regard to law enforcement and criminal justice, and in channeling the desires of its most hardworking citizens, who then feel the need to migrate illegally to the United States.
Second is that U.S. demand for heroin grows organically out of doctors’ massive prescribing over the last 20 years of pharmaceutical narcotic painkillers – the subject of my book DREAMLAND — something that no border wall will stop, of course. Also, if we get into discussions with Mexico about this topic, soon that discussion will also turn to our very accessible market for guns, many of which then go south through a variety of channels and end up being weapons in that country’s bloody drugs wars. So if we ask a neighbor to behave with maturity, we better be willing to do the same.
We have almost 700 miles of walls along the border that separate the two countries. Drugs aren’t much trafficked through those areas that have no walls, most of which are in forbidding terrain. Our drugs, instead, are trafficked through ports of entry where walls already exist. They are trafficked in cars, trucks, and by pedestrians. With heroin, the problem is exacerbated, as I’ve written elsewhere, by the fact that is the most condensable drug, thus the most easily and profitably trafficked,and one that we now have a huge demand for.
All in all, the issue begs a binational, cooperative solution, seems to me.
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 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.
A DREAMLAND PODCAST – John Russell is 26 and an organic farmer, raising melons in rural Ohio, not far from Columbus. This year he ran for the Ohio state legislature as a Democrat – and lost badly.
I had the chance to talk with Russell today.
We had a wide-ranging conversation, about his decision to go into farming, about his campaign, about Donald Trump, as well as job loss and opiate addiction in America’s Heartland, PC culture, the challenges Democrats face in rural areas.
He’s one of the few, it seems, to go away to college then return to a rural community. So many towns have lost young people to the cities where the jobs are.
We talked about that as well, and about what happened to guys on his high school football team.
This is the first interview I did like this, via Skype, so I’m still working out the kinks, and there are a few buzzes and etc. So please bear with me.
Meanwhile, contact him at www.johnrussell.info, and follow him on Twitter: @JCruss
On Facebook, I read the simple account – I’ve broken it out into four lines – from a mother from Kentucky. I’ve posted her story, and then the comments that followed:
I lost my son in August,
and my Daughter day after thanksgiving
the only two children I had
oh it’s so hard.
COMMENTS
I have no words. I’m sorry just doesn’t seem to be enough. May
you find the strength you need to carry you through.
I’m so sorry, I lost 2 sons in three years.if i can help you add me as a friend.hugs
may God give you the strength to survive the loss of both of your children. Hugs and prayers to you mom
So very sorry for your loss prayers and hugs to sister momma I have lost two sons and no words to heal your pain
We lost my oldest nephew Joe on 7/5/16, it is terrible and sad and I’m so glad for this group. You are not alone sister 💙💙💙💙 sending hugs
Why why do we have to suffer so
God be with you.
There are no words…how can i comfort you…may God give you strength…i a truly hurt for you…my daughter continues to fight the beast…
I am so sorry. Much love to you and those who grieve with you. Praying.
This is incomprehensible and insane to think that “god doesn’t give us more than we can handle” – it’s cruel and unmerciful. I share your pain and fear that I may also lose my only other child, having lost my youngest 10 years ago. Sending hugs and more hugs – and strength for when you need it most.
I lost my son I could never imagine the thought of losing another. Hugs and prayers your way
I am so sorry and feel how you feel I lost my son one month ago yesterday my heart has been torn out I don’t know how we’re supposed to go on like this
I lost my only child in 2013, I couldn’t imagine losing 2, and so close together! God bless
My” heart” hurts for you….Don’t know what to say….I lost my son 6-15-16 and the pain is unbearable with one… let along two.I have a daughter on heroin really bad also . I ‘m afraid I’m gonna lose her.
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.
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.
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 the 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.
We pretend we’re informed by it. In reality, we know that each network is a dealer in the drug of outrage. Each provides little information or depth. Instead they concoct a diet of heat, alarm, frenzy. Above all, they provide us a drenching isolation that separates us from our fellow Americans.
One sign of a heroin addict is that he forsakes family, old friends and community to hang out with others who use and sell dope. They talk about dope constantly and don’t understand those who don’t find that topic endlessly fascinating.
That’s what 24-Hour News has done to us, and our body politic. Forced us into little bubbles of people, all of whom think and talk alike and don’t understand anyone in the other bubbles who don’t think and talk like them. We all know this is true.
Which is why I say 24-Hour News is just like heroin.
So this election day, after we vote, let’s do another civic duty: Let’s all turn off 24-hour news, and talk radio, too, for that matter.
For good! Just block them all. Easy to do by clicking here. Each station. CNN, FOX, MSNBC, Headline News. The problem is the format, not the network itself.
24-Hour News assumes that every issue has only two sides to it, and we can neatly know what they are, and that once a position is staked out, we cannot waver from it. It picks and pricks at some topics well beyond any presumed responsibility of informing the public is fulfilled. Yet somehow it does this while rarely providing any deep or nuanced understanding. And other issues is doesn’t touch at all.
It Monday-morning-quarterbacks public servants and elected officials to death.
All because it has to fill that time.
Meanwhile, these networks bundle most issues into five-minute, in-between-the-commercials, pre-digested packets. I’ve been on several of these and I now boycott them. I was on a CNN segment once that discussed the Mexican drug war – in six minutes with two other guests. We cannot possibly learn a thing about that very important issue in so short a time.
24-Hour News is one of the most corrosive influences on our democracy. Doping it. Distracting it. Numbing it. Lowering our standards for what “news” is and how much participation is actually required of us to preserve a functioning republic.
Never has 24-Hour News failed us more harmfully than in this presidential campaign. Its anchors spent most of the pre-convention months analyzing incessantly whether Candidate X had a pathway to the nomination. The horse race is all those networks cared about. It was a narcotic that had us all distracted.
We need real journalism. We got junk food. We needed deep discussions of complicated issues. We got yammering, blather, screeching and babble – usually designed to make us feel outraged at everyone else and confirmed in the righteousness of our own behavior and thinking.
In other words, we got dope.
For that’s what heroin does to an addict: convinces him that the path he’s on is the right one and no other is conceivable.
As Americans, we spend a lot of time worrying about what we consume, avoiding processed foods, cigarettes, sodas.
Why don’t we have the same concern for our civic consumption?
Some who block 24-Hour News may suffer withdrawals at first. Shiver and shake and not be able to sleep. But that’ll pass. My bet is they’ll emerge with a fresher, brighter outlook on life. They won’t be angry or outraged at their fellow Americans all the time.
Another thing: Recovering addicts find life without dope to be complicated without that Silver Bullet to remove their worries. So, too, might folks recovering from 24-Hour News.
Just as heroin takes our cares away, the 24-Hour News Syndrome relieves us of the tough work involved in being Americans. We don’t actually have to strive to develop an opinion when 24-hour News provides it to us.
So we will have to develop our own opinions without the help of an anchor and a 5-minute expert there to enrage us and keep us tuned in through the upcoming commercial break. It may mean reading more. A wider range of opinion or news stories. Books or magazine articles. But the last place to find real information on anything worth knowing about is at a five-minute snippet of yammering talking heads. We know this is true.
But if Americans are exceptional, it’s through this work required of us in citizenship, civic participation, and in being accountable for our political and consumer choices. This is the job description of being an American, seems to me.
“A Republic, if you can keep it,” said Ben Franklin to the woman who asked what the Constitutional Convention had just created.
We got away from that, from what’s best about America. We opted for easy – easy solutions to pain, quick and easy answers to complicated problems, easy substitutes to civic participation. Convenience and comfort over all else.
In doing so, we rid ourselves of things so essential that they have no price … and in return we have been invaded by cheap crap.
So today, Be An American!
Please go vote!
Then come home and block every 24-hour new station on your TV.
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.
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.
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.
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.
These next several weeks I’ll be traveling to many parts of the country for speaking engagements about Dreamland: Dallas/Fort Worth, Huntington WV, Indianapolis (twice), Logan, OH, Salt Lake, and South Shore KY, among other places (full list below).
These follow many events over the last year. I can’t wait!
It’s been wonderful, after spending so long writing about a fairly depressing topic, to see communities like Scott County IN and Marysville OH plan to use Dreamland to begin discussions/alliances focused on combating the problem of opiate addiction, now nationwide.
I’m a storyteller not a policymaker nor an advocate, but I do feel overwhelmed at times at the intensity of the response and so honored that these towns would invite me to visit them to talk about this.
I want to say thank you to the hundreds of folks I’ve already met while signing books at numerous events – half of whom have stories so powerful that they might have ended up in Dreamland had I met them while I was writing. It’s become one of the joys of touring, meeting folks like this, going to places like these.
I note, too, that many of these place are not towns on a typical book tour. But this is not a typical book nor, I suppose, a typical time.
I love that I’ve been able to visit Peoria IL (home of Caterpillar) and Chillicothe OH (Go Cavaliers!), but it also shows you where the problems with opiate addiction are now in our country.
Anyway, here’s the full lineup:
Sept 19: Scott County, IN (Various events, including Austin High School Auditorium, 7-9pm)
Sept 20: Van Wert, OH
Sept 21: Marion, OH (Palace Pavilion, 3:30-5pm)
Sept 22: Dallas/Fort Worth, TX, Hurst Conference Center, (When the Prescription Becomesthe Problem: A community response to the Opiate Epidemic)
Sept 29: Salt Lake City, UT, Sheraton Hotel (Beyond the Needle and the Damage Done: A law enforcement and health care response to the opioid epidemic)
Oct 1: Huntington WV, Ohio River Book Festival, (12:45-2pm)
Oct 3: South Shore, KY (Recovery Works)
Oct 4: Zanesville, OH (and environs, various events)
Oct 5: Columbus, OH (North Broadway United Methodist Church)
Oct 6: Indianapolis, IN (Indiana Hospital Association)
Oct 6: Logan, OH (Hocking Middle School)
Oct 12: Marysville, OH
Oct 13: Indianapolis, IN (Indiana Attorney General’s Conference, Indiana Convention Center – Indiana Prescription Drug Abuse Prevention Task Force, public invited)
Oct 14: Des Moines, IA (Iowa Medical Examiners Convention)
Oct 24: Hillsdale MI (Hillsdale College, various events)
As I try to keep a gauge on the opiate-addiction epidemic in America, one place I go is to The Addicts Mom Facebook page, with 22,000 members, one of whom is me.
The posts are from mothers as they attempt to deal with the lacerating addictions of their children. Here are a few posts, with names removed, that I saw at random this morning. Those who listed a location are from Georgia, Wisconsin, upstate New York, Pennsylvania, and Alabama.
At times, it gets to almost an aching kind of poetry.
Note: AS means addicted son; RAS recovering addicted son
__________
Well my almost 21 year old AS will be spending another birthday in jail I am sure! Please pray for his healing and mine!
___
I always knew it was going to be my child one day. On the Fourth of July I found my addicted daughter unresponsive and blue. I breathed for her until paramedics came. They saved her life this time. She spent three days in Icu and was released with no help at all. I live in Florida and I was wondering if this is enough for a marchman act? Doc is Xanax and snorting oxicodone. Any advise is appreciated. God bless all of us Mothers. I just can’t take much more.
___
I love having a place where people actually listen when I talk bout my addict children. Most people in my town don’t want to hear that there are children addicted in their town people need to wake up sad for the addicts who are outcast. Having trouble getting police to put narcan in there cars also
___
UPDATE: His PO is coming to see him tomorrow– I will let y’all know how it goes.
My Birthday overall was a good day. Thanks for the wishes and prayers. Blessings to you all.
Dilemma- my 18 almost 19 AS was released from jail last Friday to serve out his probation-14 months (it’s a joke; very seldom face to face visits with his PO). On Sunday he apparently used LSD; when I confronted him he said ‘no worries Mom; it won’t show up on a UI.’ He had no where else to go but our house and the court said our house is not an option for him to stay (we have a younger child at home). He was told the rules- no drugs or drug use. A small issue he flat out refuses to pick up his clothes (drives me crazy) states he’s just defiant; like I’m supposed to be ok with that answer.
Suggestions??? Oh yeah; today is my Birthday- I feel like hiding in a hole not celebrating life
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Last night my phone rang at 11:30 my heart automatically started racing. Then I seen the caller I.D it was my RAS instantly worry washed over me, I picked up the phone and the first words out of my mouth was ” what’s wrong? Are you okay?” His reply was ‘Yes ma’am I was just on my way to work and I seen a shooting star and it was the brightest most beautiful one I’ve every seen, and just wanted to call and share with you”.
Four years clean, still suffer from shell shock but feeling blessed.
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So another week and another dirty urine at probation. Told me he wants suboxone, I suggested vivitrol. Someone on the MAT (medically assisted treatment) site posted a link for a slide show on all the meds used. I sent it to him privately. He wants to do vivitrol now and I sent him the local dr name and address. He swears he wants to be sober. I asked him, you know how awful detox is, why isn’t that enough to not pick up? He CANNOT deal with stress. No coping techniques. We all have stress but you have to learn to cope. I get the whole disease thing I truly do, but I also struggle with the you know it’s not good for you, you know what you are running away from is gonna still be there and you are making more problems to deal with when you sober up. I know my mind doesn’t function as an addicts but they are all smart kids or adults. Dang fight for your sobriety hard the way you chase that freaking drug. He looks terrible. Lost weight again. And all he keeps saying is everyone is judging me and that makes me want to use. No that gives you a lame excuse to use. We aren’t judging we love you and are worried. I know my dealer he wouldn’t do that yadda yadda yadda. Won’t be long and he is gonna end up in jail, then maybe I can sleep:( I am ANGRY this time.
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My soul is tired, my heart hurts, I just can’t do no more today😥
In Chillicothe, Ohio, the way I understand it, school janitors are heroes.
Many kids are growing up in families of addicts and have no place to go, their home studded with neglect and jagged edges; so they hang around after school. There, janitors have befriended them, bringing them food, giving them a sober adult to talk to and a calm place to hang out.
My family and I spent Thursday in Chillicothe, a southern Ohio town (pop. 21,000) bedeviled, as so many are, by the opiate-addiction epidemic.
I spoke all day long – a radio interview at 6:30 am, meetings with three groups through the day, and a 7 pm public talk at the Majestic Theater, the oldest (1853), continuously operated theater in America. Yet by the end I wasn’t exhausted; I was instead exhilarated by the electric, intense response of people I met.
That’s how it’s been everywhere lately.
Writing Dreamland wasn’t arduous; it was engrossing. But it was also about a tough topic in which the worst of human behavior was on display. So I’m thrilled to see towns like Chillicothe using the book to come together, form alliances, leverage talent, talk about this problem in a way that hasn’t happened before, and do something hopeful.
Heroin seems to be having the opposite effect in Chillicothe that it has on users. If heroin isolates addicts into self-absorption and hyper-consumption, the drug also seems to be bringing people together to fight against it. I see this elsewhere as well and that’s encouraging. I know the problem is big. A new sporting-goods store delayed its opening in Chillicothe for months, I’m told, because it couldn’t find enough workers that could pass a drug test.
I wish I had a better answer to those who asked what to do about families where drug addiction is now generational, where the grandparents on down are using, where great-grandparents are raising their grandchildren’s kids. Kentucky Gov. Matt Bevin, the day before in Louisville, told me that his state is on the verge of losing an entire generation, swallowed up in a morass of dependence, unemployment and now opiates. Kentucky has more able-bodied, working-age people who aren’t working than those who are, he said. That feels scary.
Heroin, it seems, is the final nausea to afflict small towns and rural communities already crushed by the farm crisis, downsizing, outsourcing, the loss of local retail, depopulation, and more. It seems that heroin has pushed many places to a life-or-death moment.
Knowing that, though, I also can’t help but recognize the energy I’ve been encountering in the people I meet.
In manufacturing, as I understand it, innovation happens through immersion in the work, people knowing the production process so well that together they find new, small, better ways to improve on how to make something.
Fighting heroin, I believe, is the same. When people come together, work together, knowing their community and its problems, when they leverage their talents and energies, the solutions specific to that place will emerge. I believe that.
And just as manufacturing processes improve incrementally, in small steps, so this problem has no sexy silver bullet, I suspect, but will be best fought with a combination of tiny efforts, many partial solutions, none of which is perfect, but together amount to something powerful. That’s good. Haven’t we had enough, after all, of the one sexy solution to solve all our problems: Didn’t `one pill for all people and every kind of pain’ do enough damage?
While I was writing Dreamland, people seemed to work in isolation, cut off from each other. Parents of addicts seemed hidden, silent. That’s the biggest change I’ve seen. People have now started talking about this issue, forming new alliances, comparing notes.
In Chillicothe, we stayed in the Carlisle, a beautiful brick building, restored after many years empty due to a fire. A hospital group decided to move into downtown and refurbish the building, believing apparently that it served the community best by being part of the revival of its core. The Majestic Theater will soon get a renovation. Luckily, the town never tore down its old beautiful brick buildings, which are being repurposed. New retail businesses are opening downtown. A t-shirt shop sells shirts of companies that have left town. My daughter now has a shirt proclaiming “Chillicothe, Ohio.” So the town seems to be rebounding, even as it battles this debilitating scourge. Maybe that’s the story – complicated, and not easily or neatly told.
I want to thank the people of Chillicothe for so hospitably welcoming my family and me. Thanks to Hudson Ward, at the Carlisle.
Thanks especially to Nick Tepe, the county’s head librarian, for organizing folks to bring us to town. Librarians ought to be playing exactly this kind of role in communities, and Ross County, Ohio seems to be blessed with a talented one.
Next, I’m heading to Knoxville, for the International Tuba and Euphonium Conference. And from there to Springfield, IL to speak to a conference of that state’s rural hospitals.
Meanwhile, Chillicothe had an annual street fair going while we were there, known as The Feast:
Opiate addiction appears to be emerging as an issue in the presidential campaign, as well it should.
I’ve read a lot that does seem to be too nuanced on either side of this topic.
Here are a few of my thoughts:
Virtually all our heroin comes from Mexico, or comes from Colombia through Mexico.
Originating now in our hemisphere, heroin now changes hands less and travels far shorter distances than it did when so much of it came from Turkey or Burma (1970s).
All that means that it’s cheaper here than ever, it’s more prevalent, and it’s far more potent. And all that, in turn, has a lot to do with why people begin using it in the first place (cost), and then stay addicted (prevalence), or relapse after rehab, and then why they die more frequently (potency).
Used to be that people (addicts from the 1970s) lived for many years on heroin – when it was more expensive and less potent and more arduous to find. A lot of heroin addicts who started in those years did die, but they died during the AIDS epidemic from sharing needles, not so much from overdoses.
Now heroin addicts aren’t living long; They’re dying young and quickly. I believe that’s because so much of the drug comes from Mexico, making it cheaper, more potent and more prevalent than ever.
When uncut or less cut, heroin is easy to conceal because it’s so concentrated – again because now it comes from Mexico, which is so close.
So you don’t need trucks to get a lot of heroin across – though trucks have been used. A lot of people walk it across at the border crossings hidden in a purse, or a backpack, or on their person.
There’s a market for heroin because there is a demand for it.
* *
That said, I believe that supply is fundamental to this issue – supply created this demand, just as it did during the cocaine days. We didn’t have a huge demand for cocaine before Colombians began smuggling tons of it up through Florida. Likewise, we didn’t have huge numbers of heroin addicts before doctors began prescribing enormous quantities of opioid painkillers such as Vicodin and OxyContin, etc. and a lot of people got addicted, then switched to heroin, which is now, as I said, cheaper than ever.
Heroin traffickers, as I hope I made clear in Dreamland, came late to this party. They followed the demand for opiates that had been created by massive overprescribing by doctors of these painkillers.
* *
Just as we cannot arrest our way out of this problem, we likely cannot treat our way out of it, either. Particularly with treatment costing so much and taking so long. Typical treatment that has any chance of success, from what addiction specialists tell me, is a minimum of nine months. One doc I know insists a year is the minimum.
Curtailing supply is thus essential to giving each attempt at rehab and recovery a greater chance of success. So that every recovering addict isn’t bombarded with dope at every turn, as they are in so many parts of the country today.
* *
That said, among the steps I think we need to take – some of which are articulated by the CDC recently – is retraining doctors to question why they prescribe these drugs and, if they’re necessary, in what quantities. For example, for wisdom tooth extraction, 60 Vicodin is common. That seems crazy to me.
Seems like 6-12 pills would be reasonable, and that the patient should return if he needs more. Doctors prescribe so many of these pills out the gate because they don’t want to see patients a second time, and they know that insurance companies often won’t reimburse for those follow-up visits, no matter how few.
So this problem will require that insurance companies change their practices, and reimburse doctors for follow-up visits for the (again) few patients who might need more of those pills after routine surgery.
* *
Walls have had a healthy effect on the border. Tijuana (two walls, as I said) is an excellent example of that. When it was the main crossing point – 1960s until mid-1990s – rapes, robberies, assaults and murders were common, particularly in the 1980s and early 1990s. Then the first wall went up, then the second. Now it’s calm on that border line. May be a weird symbol for a globalized world, but murders and rapes are rare now.
Despite those walls, heroin will seep in, through the cracks, in ways that seem to me impossible, or extraordinarily expensive, to stop. And that’s not the supply that caused this problem.
This 60-second ad about heroin addiction, filmed at a high school in Missouri, will air during the Super Bowl.
A drug that once was associated with jazz musicians, pick-pockets, East LA gang members, NY street hustlers and punk rockers is now featured on our secular holiday, interrupting pizza and guacamole as it’s piped into American homes from Alabama to Alaska.
That’s a stunning event for this country.
What’s more, millions of people will know someone like that girl.
Post Script: Sadly, the Super Bowl came and went and this spot did not run. Not sure why. If anyone has an idea, please let me know.
Back from a busy trip and I wanted to thank Kentucky Gov. Matt Bevin for his kind words recommending my book, Dreamland, during his first budget address to the Commonwealth and Kentucky state legislators last week.
I’m very honored and touched by what he said, and that he followed those words with a commitment to increase funding for opiate-addiction treatment over each of the next two years. [Click here to view his speech. The part I’m referring to begins about 59:30.]
When I began writing the book that became Dreamland, I occasionally received strange reactions from people wondering what on earth I was thinking writing about heroin. Didn’t that, after all, belong to the 1970s?
I didn’t think so. I felt it rumbling beneath the surface and ready to explode, just no one was talking about it in 2012 and 2013, and even in 2014. Most of those who knew about it from personal or family experience were ashamed to speak.
So it feels satisfying that the book is helping people in a position of public influence, among them the governor of Kentucky, a state overwhelmed by this scourge, understand it, talk openly about it, and make policy to address it.
Storytelling will do that. That’s what I’ve long believed. Thanks, governor!
I don’t think I’ll have a nicer time, as an author, than I’ve had in the last few weeks.
For starters, one morning Entertainment Weekly selected Dreamland as among the year’s 10 best books (“like a David Simon TV Show gone cosmic”). That afternoon, Bloomberg Business ran a piece with Princeton Prof. Angus Deaton, Nobel Prize winner for economics, recommending the book as his favorite of the year.
Both ends of the culture endorsing a book on the same day – I don’t think that’s happened before.
I appreciated that because when I began this book I thought I was writing a drug-crime story. Midway through, I realized the book was really about where we are as a country, about what happens when, as a culture, we shred community, export our jobs, build isolation and call it suburbs, claw at government and forgive the private sector its trespasses, and exalt consumption and seek pleasure and call them happiness.
Heroin is simply the embodiment of values we’ve fostered for 35 years. Isolation is its natural habitat. Doesn’t have to be that way. The antidote to heroin isn’t naloxone; it’s community.
I know, it’s hucksterism. But the rules for authors these days are:
1) Write like hell; 2) Rewrite always; 3) Read a lot; 4) Talk to lots of different people; 5) Pay attention; and 6) Always be branding, marketing and promoting yourself because if you don’t, no one else will.
So, given No. 6, I’ll just quietly let you know that, in addition to EW and Bloomberg, in the last few weeks Dreamland was selected in “Best Books of the Year” lists by … Amazon.com, Slate.com, the WSJ, Seattle Times, Boston Globe, St. Louis Post-Dispatch, and Audible.
(In the two weeks after posting this, Buzzfeed, Daily Beast, Texas Observer, and the Guardian also added Dreamland to their Books of the Year lists. My thanks to each of them.)
Drug Czar Michael Botticelli named it his favorite book of the year – that was nice of him. So did the governor of Kentucky, Matt Bevin. Nice of the governor to do that, too.
What this bust shows is that the larger Mexican cartels, which for a long time ignored heroin as a revenue generator, have in the last few years figured out the new market that exists in the U.S., created by the overprescribing of narcotic pain pills nationwide, and shifted priorities.
Through the 1990s and into the last decade, these cartels didn’t dabble too much in heroin. Other drugs were more popular and profitable. Plus, in Mexico heroin is viewed as about as scuzzy a thing as it in the United States.
That’s changed in the last few years. Mexican cartels, which already dominated on the western side of the U.S., have recognized the widespread opiate addiction among Americans and moved to take control of the markets on the eastern half of the U.S. that once were served mostly by Colombian heroin traffickers back to the 1980s — the same way Mexican cartels wrested the cocaine market from the Colombians in the 1990s.
Pills to heroin to Mexican drug cartels in areas that never had much of any – all in the space of 15+ years.
