I read this book because a big part of it takes place in my home state of Ohio and I’m familiar with Mexico having studied there for a time. I learned that the opiate epidemic first began around 1997 when I was a student at Ohio State and then grew from then until around 2012 when I was overseas and then here in San Francisco. As a college student I never even heard whispers about this as everyone I knew, fraternity life included was only into booze. I do recall hearing once or twice that maybe three or four of the guys in the fraternity house did drugs but they kept that a strict secret.
Thinking back I remember around 2008 connecting with an old friend and hearing him mention he was going to take a percocet or vicodin but I didn’t paid much heed not really knowing what those drugs were for. But after reading this book I wonder if he is addicted after all of these years. I even pulled up a few pictures on Facebook focusing on his eyes to see if they were perhaps a bit glassy.
This book focuses on Portsmouth, Ohio as ground zero of the epidemic as they prescribed more pills per capita than anywhere else in the USA. It tells the story of how the town really suffered economically with manufacturing moving overseas and coal mines shutting down. Walmart is pinpointed as the culprit that killed all the mom and pop shops as well as the source which funded buying all the pills through rampant theft.
This Ohio valley river town hits close to home as my mother is from a similar town in Bellaire, Ohio another coal mining town north of Portsmouth along the river. That place too is a shadow of what it once was due to the coal mines shutting down. I went there often as a kid and then twice as an adult: once for my grandmothers funeral and once to take pictures of places I remembered. Things had gotten so bad that at my grandmothers funeral the director warned people to not leave their purses or other belongings unattended.
Here are my highlights from the book as well as my thoughts.
“The Man” takes Xalisco black tar heroin east across the Mississippi River for the first time, lands in Columbus, Ohio.
‘The Man’ is not identified in the book but referenced often as he was the first to bring heroin “east across the Mississippi,” starting with Ohio. Addicts got their start on Oxycotin and then moved on to heroin as it was cheaper, more potent and didn’t need a prescription.
Xalisco black tar heroin cells are now in at least seventeen states. Portsmouth, Ohio, has more pills per capita than any U.S. town. Florida’s lax regulations make it another center of illicit pill supply.
Myles was a graduate teaching assistant and saw kids his brother’s age all the time. It seemed to him that a large chunk of Matt’s generation could not navigate life’s demands and consequences. Myles had taught English in Beijing to Chinese kids who strove ferociously to differentiate themselves from millions of other young people. American kids a world away had enormous quantities of the world’s resources lavished on them to little result; they coasted along, doing the bare minimum and depending on their parents to resolve problems, big and small.
I think of many of the beautiful high schools I traveled to for wrestling practice and tournaments. Everywhere seemed better off than my high school. The high school buildings were enormous as were the houses, the cars very nice but they were soon to hide a secret and that was the increasing amounts of addiction. It is interesting to think that even though people get richer and life becomes easier different, more complicated problems arise, especially when addiction is involved. Things may look nice on the outside but still be full of rot on the inside.
Later, I met other parents whose children were still alive but who had shape-shifted into lying, thieving slaves to an unseen molecule. These parents feared each night the call that their child was dead in a McDonald’s bathroom. They went broke paying for rehab, and collect calls from jail. They moved to where no one knew their shame. They prayed that the child they’d known would reemerge.
I went to high school not far from the rougher areas of Columbus from 1992 to 1995. The only things I heard whispers of were marijuana and maybe some other types of drugs but I never heard of any incidents and don’t believe it was all that prevalent at that time. I wonder what things look like now at schools such as West or Briggs located on the west side of Columbus. I imagine drugs became a problem.
All our black tar heroin comes from Columbus, Ohio, he told me. I called the DEA in Columbus and spoke with an especially loquacious agent. “We got dozens of Mexican heroin traffickers. They all drive around selling their dope in small balloons, delivering it to the addicts. They’re like teams, or cells. We arrest the drivers all the time and they send new ones up from Mexico,” he said. “They never go away.” He discoursed at some length on the frustration of arduous investigations ending with the arrest of young men who were replaced so quickly. They hide among Columbus’s large Mexican population, he said. The drivers all know each other and never talk. They’re never armed. They come, give false names, rent apartments, and are gone six months later. This was not the kind of heroin mafia Ohio and the eastern United States was used to.
The Mexican population really exploded around the year 2000. At Ohio State I was a Spanish major and had connections into the Latino club on campus. This led to more connections in the Mexican community, some of which I maintain to this day. I never knew about drug dealers integrating with this community, not even whispers. Perhaps it was because they just did their jobs and mostly kept to themselves.
Valium was marketed above all to women, pitched as a way of bearing the stress of lives as wives and mothers. Before the feminist movement, women were presumed to need that kind of help for the rest of their lives, thus there was no worry then about its addictiveness.
My grandmother was a pharmacist, very rare for her generation. We have a family friend here in San Francisco who moved from Ohio in the late ’70s and he tells me stories of being sent to my grandmother’s pharmacy quite often to pick up a package. I imagine this package was valium or whatever comes in those “little pills” that songwriters sing about. I’ve learned over time that thousands and perhaps millions of women of my grandmothers generation, those that were confined to the home, needed a little ‘help,’ whether that was alcohol or ‘medicine.’
In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain. But man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.
It seems to me that America has been in a state of decay for a while. The manufacturing base has been hollowed out leading to economic distress. I believe this is what has given rise to MAGA and Trumpism. Things just aren’t going well and with loss of status and something to be proud of people will turn to demagogues. This is a recurring theme throughout history and America is not immune. So people turn to slogans and want to waive flags. I’ll always remember Barack Obama saying America is “exceptional,” which to me seems like trying to put a bandaid over a gaping wound. Words cannot heal lost jobs and dying towns. Then Trump comes in and through his vitriol energizes people who are feeling rather rotten. He gives them something to cling to. Go buy a gun, go wave a flag, hate liberals. By aligning themselves with someone in power, someone with wealth and a pretty wife they can make his identity their own, it gives them a group to be a part of and a purpose.
Excess contaminated the best of America. Caltech churned out brilliant students, yet too many of them now went not to science but to Wall Street to create financial gimmicks that paid off handsomely and produced nothing. Exorbitant salaries, meanwhile, were paid to Wall Street and corporate executives, no matter how poorly they did. Banks packaged rolls of bad mortgages and we believed Standard & Poor’s when they called them AAA. Well-off parents no longer asked their children to work when they became teenagers.
Again, signs of decay. I’m shocked at how Republicans can advocate the dismantling of the public education system, of healthcare and those that need those things most will root for it.
But had Portenoy not had Purdue’s money behind him, he would have published some papers, made some speeches, and his influence would have been minor. With Purdue’s millions behind him, his message, which dovetailed with their marketing plans, was hugely magnified. He was a godsend for Purdue. All you need is one guy to say what he was saying. The other guys who are sounding a warning about these drugs don’t get funded. They get a journal article, not a megaphone.
A friend of mine put it best when he said “America is more of a business than a country.” Money talks and the country is run by the corporations for the benefit of those corporations. Sometimes they do good things but in the end it isn’t to make America a better place but to increase their own profits.
In the 1980s, Jaime Kuykendall moved to Mexico. He was Guadalajara station chief for the DEA in 1985 when traffickers kidnapped, tortured, and murdered his agent, Enrique “Kiki” Camarena, a killing that was covered up by Mexican government officials in league with traffickers. The murder traumatized the new DEA and intensified its focus on Mexico. The episode was the topic of a classic book, later made into a movie, called Desperados, by journalist Elaine Shannon. Jaime Kuykendall wrote his own book on the Camerena episode, O Plomo o Plata? Silver or Lead?
Living in Mexico I was shocked to discover just how corrupt the place is. The best example I learned about was the recent president Enrique Peña Nieto. I remember reading an article where a woman said she would vote for him because he had “good hair.” I also remember how he was paid a hundred million dollars by the Sinaloa drug cartel and if I recall the USA distancing themselves from him due to the enormous corruption. The bribe is mentioned in the Wikipedia article and is most likely true. A 100 million dollars or refuse and then have to fear for your life? One would hope that a president would want what is best for the country but that is wishful thinking. People vote based on the hairstyle and the politicians retire rich from drug cartels. It is depressing to think about.
In the hollowing out of small-town America, the pill mill doc was a kid of coup de grâce. In so many towns, locally owned businesses had expired. Family diners were replaced by Applebee’s and town hardware stores by Home Depot. Then esatz pain physicians replaced family docs and became about the only health care some towns had. Around northern Kentucky and southern Ohio, Procter’s docs were initially hailed for coming to the area. In truth, they were vinegar in the mouth of a crucified region.
The city of Columbus, Ohio, in many ways is a fine replica of the United States. Its income and age distribution, its racial demographics and diversity of opinion, make Columbus a microcosm of America, and one that marketers especially prize. There’s a large white population, and moderate numbers of blacks. Unlike other parts of Ohio, Columbus has sizable immigrant groups – from Mexico, Somalia, Nepal, and other parts of Asia – who flocked to town to fill the low-end service jobs. A large college-student population at Ohio State and other schools has kept it vibrant and edgy.
Columbus has always had a population of white and black people. Again this changed with a lot of migration from Mexico around the year 2000. Then we started noticing a sizable Somalian population, especially at the airport where many got jobs. I personally never noticed a large group of other immigrants but I guess times have changed.
For years before his arrival, in the entire city of Columbus, Ohio, heroin was sold at precisely one street corner: Mt. Vernon Avenue at North 20th Street.
I had to look up where this place was as it was an area of town I’d never been. Looking at Google Street View you can see a few shady characters still hanging out at the intersection.
But that’s how it was as the opiate epidemic took shape in southern Ohio beginning in the late 1990s. Portsmouth, the Lucasville Bottoms, and other forgotten places of America nearby acted like the canaries in those now-shuttered Appalachian coal mines. Just no one in the country listened much until more respectable types sounded the same alarm and famous people died.
Towns that were forgotten. I remember driving through a few of them and wondering what those people did? NAFTA and later China hollowed out their manufacturing and many just seemed so depressing. That is such a shame when I see photos of the ‘typical American Main Street’ of the 50s. Greed by politicians and corporate America killed them. But being from Columbus I never spent much time in any of them, just driving through from time to time or in high school for wrestling meets.
Whether the company knew that, Purdue did have information on the doctors who prescribed drugs most liberally. Many of them were in areas, not coincidentally, where the numbers of welfare and federal disability recipients were comparatively high – like southern Ohio and eastern Kentucky.
Some large though immeasurable amount of the merchandise supporting addiction, as the opiates settled on heartland America, was mined from the aisles of Walmart, where Main Streets had gone to die.
He was given certain rules, No blacks. His boss feared African Americans. Once a customer brought a black customer along. The boss pulled a gun and told them both to get out and never come back. The kids Pedro sold to were all white, always ready to try out their high school Spanish. “Hola, amigo. Como estas? Me gusta mucho la cerveza.”
Athens County, ninety miles southeast of Columbus, had seen almost no heroin ever. By 2008, 15 percent of the admissions to treatment center there were related to heroin, and almost all were injecting it. In 2012, the center was treating more heroin addicts, mostly for black tar, than alcoholics.
I highlighted this paragraph because I used to go to Ohio University to visit a friend, especially on Halloween for which the university is legendary. The only small town we drove through was Nelsonville which the college kids called “hickville” and we were advised not to stop there. College kids weren’t welcome.
The cost savings weren’t what did the trick, though. Treatment has always been more effective and cheaper than prison for true drug addicts. What’s changed, Norman said, is that no longer are most of the accused African American inner-city crack users and dealers. Most of the new Tennessee junkies come from the white middle and upper-middle classes, and from the state’s white rural heartland – people who vote for, donate to, live near, do business with, or are related to the majority of Tennessee legislators.
These parents made avoidable mistakes and when a son died or entered rehab for the fourth time they again hid the truth, believing themselves alone, which they were as long as they kept silent. This pervasive lie was easily swallowed. It often lay buried beneath lush lawns, shiny SUVs, and the bedrooms of kids who lacked for nothing.
I remember these neighborhoods, many of which seemed so fancy and rich to me growing up. Nowadays I’ll put on my VR and stroll through them wondering how many were nice on the outside but broken on the inside. As an adult I hear story after story of families I knew growing up that had many problems us kids didn’t know about. Divorce usually followed and I cannot imagine what drugs have done to many of those rich suburban areas with their manicured lawns and mansion like houses.
It was true about much of a country where the streets were barren on summer evenings and kids no longer played Kick the Can as parents watched from porches. That dreamland had been lost and replaced, all too often, finally, by empty streets of bigger, nicer houses hiding addiction that each family kept secret.
This is sad but very true. The loneliness has certainly been exacerbated by the pandemic. Now, kids come home and go directly to their computers instead of wanting to venture outside or go to a friends house. That seems like something that just isn’t done anymore. No random kid has ever rung by doorbell looking to play with my boys. That has been replaced by iPads where my youngest’s will ring nonstop on evenings and weekends from his friends looking to play games together. It takes a real effort to make a playdate when in my day it was nothing more than hopping on a bike and riding to a friends house.