Rating: 4 Stars
Two forces collide at a vulnerable time in America.
After a couple of decades of globalization, there are broad swaths of the country economically depressed. Trapped in small towns where all manufacturing has left and main street businesses have been destroyed by Wal-Mart, all that’s left is low wage jobs at places such as Wal-Mart. People want to work but can’t get work and ultimately give up wanting to work.
At the same time, in slightly more successful towns, there are middle to upper middle class kids that are bored with pot and want to experiment more dangerously.
Into the void steps the small Mexican city of Xalisco in the small state of Nayarit. The people there are mostly poor, doing back breaking work growing sugar cane. The farmers in the hills have a long history of growing poppy and there is a local tradition of cultivating it to grow black tar heroin.
Starting small, a few of the local townspeople cross into the US and start a modest drug operation. Unlike the more famous Mexican drug cartels, they eschew violence. In fact, they intentionally stay away from those cities where gangs are already established. They set up bases in modest places like Columbus, Ohio, or Santa Fe, New Mexico.
They bring up young Xalisco men to serve as their delivery drivers. These young men are paid a straight salary and must not use drugs themselves. They haunt methadone clinics and give out free samples. They hand out business cards. If an addict calls, the drivers will deliver to the addict’s home. If an addict complains of bad service, he/she will be given free drugs. Since heroin addicts are used to having to go to the rough part of town and try to negotiate with street dealers, this is obviously a huge step up in customer service. They’re basically the Domino’s of heroin.
And like Domino’s, they quickly franchise. They seek out any mid-size city that does not already have a gang presence and that has a methadone clinic. That’s the signal to them that there are heroin addicts there and that they are not being well served. They quickly fan out to many cities spanning many states.
In the one instance where racism actually helps out the black community, the men from Xalisco are unsophisticated country boys from Mexico and believe that black men are violent, so they have another rule of never selling to a black person. All of the addicts that they serve are white.
Since they’re dealing almost directly with the farmers that grow the poppies, the heroin is essentially uncut, so it’s significantly more powerful. Just that fact alone makes the heroin more dangerous and causes more overdoses.
Along with what the author calls the ‘Xalisco Boys’, there’s another development. In 1979, a Dr Jick, who kept a database of medical records, noticed that very few patients that were prescribed opiates became addicted. He thought that was interesting, so he and a graduate student named Jane Porter submitted a letter (one paragraph) to the New England Journal of Medicine stating that fact. Dr Jick forgot about the letter and went about his business.
Later, a scientist at Purdue Pharma figures out a way to create a pill comprised of oxycodone that coats the pill in such a way that the drug is released over time. Hence OxyContin was created.
Along with this was a revolution in pain management. People began to study pain and wanted pain to be listed as the fifth vital sign (along with the normal body temperature, pulse, respiration rate, and blood pressure).
Purdue Pharma then sent an army of sales people out to doctors. Doctors, who previously were very reluctant to prescribe opiates, were now effectively being told that not treating pain could be considered malpractice (since pain was so vital to a patient’s health). Also, that one paragraph letter by Porter and Jick was now being called a ‘landmark study’ proving that, for people in pain, that opiates are not addictive. Since this was in the 90’s, the letter wasn’t online, so no one apparently decided to check up on the details of this ‘landmark study’. There was some pseudo-mystical explanation that somehow pain prevents the euphoria of addiction (and no, I’m not making that up).
So, there was an explosion of opiate prescriptions. But that was OK because opiates are not addictive and because of the time release nature of OxyContin, right?
So…it took addicts about 5 minutes to realize that if you crush the pill, that destroys the time release shell of the pill and then you’re left with pure oxycodone. Even worse, the makers of OxyContin actually placed a warning on the box that crushing the pill would increase the dose.
From that knowledge, an entire underground drug industry was built. Pill mills quickly cropped up. Doctors that could get no other jobs (convicted of crimes, lost their licenses in other states, themselves addicted) set up clinics where they did nothing but prescribed pills and only accepted cash. Some of the clinics served as pharmacies as well. Entrepreneurs would round up a car full of addicts and drive them from doctor to doctor to get prescriptions, would give the addicts half of their prescription and then sell the rest. Senior citizens sold their prescribed pills to supplement their retirement income. At one point, the town of Portsmouth, Ohio had an underground economy based upon pills, where addicts shoplifted or sold their possessions in exchange for a fixed amount of pills.
However, over time, even the OxyContin pills would not be enough to feed a person’s addiction. At that point the Xalisco Boys would step up and start selling the addict heroin.
Young white men and women, high school age, looking for a little danger, found themselves addicted, and often dead. The children of policemen, the children of bankers, football players, cheerleaders, they all found themselves addicted. Children would die of an overdose and the parent, ashamed, thinking they were the only ones, said that it was a heart attack. This secret shame let the epidemic continue on unabated.
There were more deaths in Ohio due to this epidemic than Americans killed in Iraq. More people died than in the crack cocaine epidemic. More died during this time than died of HIV.
If there is anything approaching a silver lining to this is that, at least in the Southern and Appalachian states, there is a growing awareness that drug addiction is not just a black problem. After a couple of decades of draconian drug sentences, there is now an understanding that drugs are a problem for all of us, and perhaps addicts should be treated instead of imprisoned.
This was a sobering work, obviously. It was well researched and well written.
The only glitch that kept it from being a pure five star review is the afterword. After all of the talk about the forces (economic, social, global) that led us to this point, Quinones makes the odd point that maybe the root cause is that kids don’t play in public parks anymore. I guess that you can make an argument that social isolation is not great, but to close with that statement, after laying out all of the other forces at work, seemed, well, I’m sorry to say, kind of asinine. The afterword, at least in my edition, is written in a slightly different font than the rest of the book, which almost led me to the paranoid suspicion that this was somehow covertly inserted into my copy. Such was the difference in tone and style between it and the rest of the book.