How heroin came to middle-class white America

DREAMLAND: The True Tale of America’s Opiate Epidemic by Sam Quinones is the story of how heroin addiction spread through rural and suburban white America.

Dreamland was the name of a popular swimming pool in Portsmouth, Ohio, a small city on the Ohio river that once was the center of the U.S. shoe manufacturing industry.

The pool closed as the shoe industry declined, but Portsmouth gave birth to a new industry—the mass prescription of  legal but addictive pain medications such as Purdue Pharmaceuticals’ OxyContin.

Regular practitioners were misled into thinking that OxyContin, a biochemical twin of heroin, and related were harmless, but industry really took off with the spread of “pill mills”—medical practices that were limited to the prescription of pills for alleged pain/

DreamlandQuinones51pEBThe business of addictive prescription drugs is one part of the story Quinones told.  The other more startling part is how poor people in the small Mexican town of Xalisco (population about 20,000) created a nationwide distribution franchise system which spread their locally-cooked black tar heroin across the United States.

The Xalisco Boys, as police came to call them, did not carry weapons, did not use drugs themselves, and never sold to black people (whom they thought were violent).   They emphasized product quality, good customer service and competitive prices, with discounts for new customers.

They created an equivalent to a pizza delivery franchise, in which customers could call a certain number and have heroin delivered to a certain spot.   The drivers were inconspicuous, kept out of trouble and drove nondescript vehicles.

They put heroin in balloons, which they kept in their mouths.  When police stopped them, they swallowed the balloons, which they were later able to recover, with the heroin intact.

As they moved out from their original base in the San Fernando Valley, they avoided areas where violent drug gangs operated. Instead they moved into areas where prescription painkillers such as OxyContin were heavily sold, and offered their product as a cheaper and easier-to-obtain substitute.

The Mexican drug cartels and urban criminal gangs are responsible for much of the heroin sold in the United States, Quinones wrote.  They control the heroin trade in Chicago, Atlanta, northern California and many other urban centers, he said; very little heroin comes from Asia any more.   The Xalisco Boys took heroin where the established traffickers never thought to go.

Quinones concluded his book with the story of how Portsmouth, like a drug addict, may have hit bottom and begun the process of recovery.  Pill mills are being shut down, and rehabilitation centers opening.  Local businessmen bought the city’s last factory, a shoelace manufacturer, to keep it from closing, and, as of now, are hiring workers and exporting product.  That’s not to say things have turned around, but there’s hope.

Source: Centers for Disease Control

Source: Centers for Disease Control

Quinones told a remarkable story.  I am amazed at the people he was able to get to talk to him.  His book raises questions about many issues.

Drug Legalization

Many Americans, myself included, think the war on drugs is a terrible mistake.  But Quinones’ reporting indicates that hard drugs have been sold legally in the United States for a long time, and the consequences have been devastating.

Deaths due to drug overdoses now exceed deaths due to auto accidents.

Portugal had a good experience with drug legalization, but that is because the Portuguese took the resources they had formerly used for drug enforcement and put it into drug rehabilitation.

Quinones said most people underestimate the the difficulty of drug rehabilitation.  Few addicts go through a rehab program and are cured, once and for all.   Rehabilitation requires a new purpose in life, moral support from friends and loved ones and often a lifetime commitment to going to meetings of 12-step groups.

The addiction epidemic described in his book is an example of what would happen if drugs are legalized, and nothing else changes.

Medical Practice

Quinones said modern Americans, unlike their ancestors, avoid taking responsibility for their own health.  Instead they want physicians to prescribe a pill to fix their problem, not to prescribe changes in diet, exercise and lifestyle.

He said insurance companies and the Medicaid and Supplemental Security Income programs are willing to pay huge sums for pain medications, but begrudge anything for other pain therapies, even though they may be more effective and less costly in the long run.

He said it’s necessary to accept the fact that a certain amount of pain may be part of life, and that there might not be a cure for everything.

Contemporary American medicine is highly specialized.  Pain management is one medical specialty.  Treatment for addiction is another.  The two for years were not on speaking terms.

Free Enterprise

A free enterprise system is based on giving customers what they want.  In their different ways, this is precisely what both Purdue Pharmaceuticals and the Xalisco Boys did.

Both were models of entrepreneurialism—finding a market niche, and then finding innovative ways to serve it.  The Xalisco Boys, unlettered rural Mexicans, were, in a perverse way, model businessmen.  They were innovative risk-takers with sound management practices and a good work ethic.  Yet they ruined thousands of lives.

Quinones pointed out that almost everyone who took the lead in fighting the heroin epidemic was a government employee—a police investigator, a DEA agent, a public health administrator, a judge, a federal prosecutor, a VHA physician.

I can think of an exception—the pharmacists who refused to fill prescriptions for excessive amounts of addictive drugs.  But his general point is right.   A healthy society cannot be based on the profit motive alone.

The American Dream.

Sam Quinones

Sam Quinones

Purdue’s OxyContin and the Xalisco Boys’ black tar heroin found some of their biggest markets in some of America’s most prosperous communities—Charlotte, N.C., for example, and Portland, Oregon.

It’s understandable that people might take drugs to escape from chronic pain or hopelessness.  But what is the pain of the sons and daughters of affluent doctors, lawyers, bankers, minister and state legislators?

Maybe the worst pain of all is the pain of not having a purpose in life.  For poor and struggling people, like the Xalisco Boys, simply escaping poverty can seem a sufficient purpose.  That was their Dreamland.  But once you have all the material possessions anyone could ever want, then you need something more.

LINKS

How America Got Addicted to Heroin, an interview of Sam Quinones by Adam Raney for Aljazeera America.

The Tragedy of the American Dreamland by Rod Dreher for The American Conservative.

‘And then he decided not to be’ by Marc Fisher for The Washington Post.  Heroin addiction in Maine.

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