The new American junkie is white, suburban or rural, and got hooked on Xalisco's product and personalized service
April 19, 2015
If you happened to live near a certain clinic in
Portsmouth, Ohio, in the early 2000s, you might find yourself regularly
answering your doorbell to people asking to buy your urine. The town,
once awarded All-American City status by the National Civic League,
stands across the Ohio River from the site of America’s first “pill
mill” — a medical office, usually posing as a “pain clinic,” where
people can easily obtain prescriptions for pain-killers — opened in
1979.
By the dawn of the 21st century, Portsmouth was lousy with pill
mills, and Oxycontin tablets served as the area’s informal currency.
You could buy refrigerators with pills, pay your dentist with them, or
hire an off-duty cable guy to hook you up for a tablet or two. Obtaining
the clean urine needed to pass the clinics’ desultory random drug
tests, however, clearly required more resourceful tactics.
In
time, Portsmouth would join the epicenter of a stealthy, ongoing boom
in heroin addiction. The number of people who used heroin in the past
year doubled between 2005 and 2012, and the number of deaths from heroin
overdose have quintupled in the past decade. The vast majority of these
new junkies are white and live in rural areas and small towns and
cities in the Midwest and New England. Many are poor, but their ranks
are swelling with young people from affluent suburban families,
particularly jocks and the kids who hang out with them.
How did this happen and how did it go unnoticed for so long? The story, as related in Sam Quinones’s fascinating new book,
“Dreamland: The True Tale of America’s New Opiate Epidemic,” is
a tale of convergence. One thread is the decay of cities like
Portsmouth, who lost their 20th-century industrial base: jobs in
manufacturing, mining and other blue collar fields. Another was a
misbegotten “revolution” in standard medical practices for treating
pain, funded by a pharmaceutical company with a suite of synthetic
opiates to peddle. The third and most remarkable element was a new
system of illicit drug distribution, designed and entirely operated by
the residents of small backwater village in Mexico.
The
current upsurge in heroin addiction attracted little attention at first
because its roots lie in what Quinones describes as “voiceless parts of
the country — in Appalachia and rural America.” In the unconscious moral
mythology of America, small town and rural life is associated with hard
work, safety and wholesome virtues, while heroin is an affliction of
big cities, with their vice, crime and scary dark-skinned residents. To
admit that poverty and despair, irrespective of race, fosters heroin
abuse is to undermine entrenched, unspoken prejudices that equate this
particular addiction with the moral and cultural weakness of “other
people.”
Nevertheless, the meth plague, which flourished
in many of the same communities, drew plenty of notice. America’s smack
crisis snuck up on us by beginning as a legal, and then a quasi-legal
phenomenon. What’s most shocking about Quinones’s history of the rise of
addictive pain-killers like OxyContin is that the apotheosis of these
drugs was based on completely unfounded scientific claims.
In
the 1980s, a small contingent of physicians began to argue that doctors
were not treating patients’ pain aggressively enough. Physicians were
trained to hold back on effective drugs like morphine for fear of
causing dependency. Purdue Pharma, which was developing and promoting
OxyContin, a timed-release version of oxycodone, embraced this movement.
Purdue sponsored conferences at which advocates for a complete overhaul
of pain management protocols urged doctors to prescribe pain-killers
more readily. It made sure its sales reps reiterated the claim that only
1 percent of patients prescribed opiate pain-killers become addicted to
the drug. Addicts, this line of reason held, were people who used
opiates recreationally. Some doctors even insisted that pain prevented
addiction by keeping patients from feeling the euphoria that causes you
to get hooked.
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That
1 percent figure, often cited in pharmaceutical literature, textbooks
and medical journals, was attributed “Porter and Jick,” described in one
such publication as a “landmark report.” As Quinones establishes, there
is no such report. “Porter and Jick,” the chapter and verse of
free-handed opiate administration, was actually a letter sent to the New
England Journal of Medicine by two researchers in 1980. One paragraph
in that letter stated that an informal search of the authors’ database
of
hospitalized patients in acute pain showed that few became
addicted to opiates administered in controlled settings by doctors and
nurses. Via a flabbergasting game of scientific Telephone, this
paragraph, which no one seems to have bothered to look up and verify,
was reimagined as a full-fledged study. Authorities cited it repeatedly
to encourage an enormous increase in the prescription of opiates, all
under the mistaken belief that they were not addictive as long the
patient was actually in pain.
This, of course, proved to
be utterly untrue. Outpatients were prescribed long courses of opiates
for conditions and injuries that never would have merited it before —
including high school athletes, who are often urged to play through
injuries. Many became addicted and began to seek the drugs from shady or
downright illegal sources. Chronically unemployed people on dwindling
benefits used prescriptions from pill mills and their Medicare cards to
buy discounted pain-killers and resell them at a considerable profit to
addicts. But OxyContin and its pharmaceutical brethren remained fairly
expensive — $20 to $60 dollars per pill, depending on the dose. And it
was at this point, in the late 1990s, that cheap, plentiful supplies of
high-quality heroin became easily available in dozens of mid-sized
American cities.
The dealers of this dark, sticky
black-tar heroin all hailed from a set of clans out of the obscure
Mexican state of Nayarit, specifically from the vicinity of a town
called Xalisco (not Jalisco, which is another Mexican state). Xalisco is
a rancho, an outpost settlement inhabited by rugged frontier types
fleeing the “stifling classism” of Mexico’s cities. Quinones, who knows
rancho culture well and confesses to a “romantic infatuation” with it,
describes these settlements as “lawless, wild places, full of amazing
tales.” The ranchos also foster a tenacious entrepreneurial spirit, and
rancheros have founded chains of tortilla shops and paleta (popsicle)
stands that extend all over Mexico, funneling the money back home to
their villages to build impressive mansions they like to lord over their
neighbors.
The genius of the Xalisco Boys, as Quinones
calls this new group of heroin dealers, was to run their drug business
like a popsicle stand franchise. A central manager parceled out single
doses of black-tar heroin into small balloons. Drivers, typically young
men from the farms around Xalisco and often relatives of the rest of the
crew, stuffed their mouths with the balloons and delivered orders to
customers at home. All you had to do to get your fix was telephone, and a
polite, clean, peaceable Xalisco Boy would shortly appear at your
doorstep. They dealt only in small amounts. The Boys never used the
product, and no one carried a gun; that would have meant jail instead of
deportation if a driver were picked up by the cops. The heroin the Boys
sold was exceptionally pure because instead of having passed through
(and been stepped on by) a series of middlemen, it was usually made by a
relative back home, from poppies harvested in the mountains above
Xalisco.
It’s difficult not to admire the Xalisco Boys
just a little bit. They embody the sort of independent industrious
spirit that we consider quintessentially American. Unlike the big,
vicious, borderland Mexican drug cartels, with which they have sometimes
been confused, the Boys were nonviolent and low-profile, preferring to
target smaller cities without established dealers or prominent gangs.
When another clan came to town to open up a rival tiendita, or store,
they didn’t fight over territory. This was a business of return
customers, not turf. Instead, they competed on service or — having
gotten the drug cheaply, direct from the source — on price. To the
amazement of every junkie who bought from them and every cop who tried
to roll them up, the Xalisco Boy drivers were on salary, and much of
their earnings were sent directly back to their families. All they
dreamed of was going home to their villages to impress their neighbors
with their wealth.
One reason why the current heroin
epidemic is so white is that the rancheros apparently were fearful of
African-Americans, who they associated with gangs and the sort of
extravagant violence destined to attract police attention.
Eventually
the big-time cartels did move in on the Xalisco Boys’ action a bit,
although tienditas still exist in many small American cities. The heroin
that helped kill actor Philip Seymour Hoffman in New York City last
year, for example, was a brown powder, most likely supplied by a Mexican
cartel instead.
Nevertheless, black tar heroin, however
unobtrusive and pacifist its distributors may be, still ruins and takes
lives. Despite their gumption, the Xalisco Boys spread a scourge.
Strikingly, Quinones found that the only watchmen who noticed the
mounting toll, who spoke out about it and and fought it, were people
working for the government. “We’ve seen the demonization of government
and the exultation of the free market in America over the previous
thirty years,” he writes. “But here was a story where the battle against
the free market’s worst effects was taken on mostly by anonymous public
employees.” The flip side to American individualism is a strong sense
of communal responsibility, and that, thank god, has not perished with
the factories and mills.
