Dreamland The True Tale of America’s Opiate Epidemic The Morphine Molecule in America 2012 or so: “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.” Pg 6 Paul and Ellen Schoonover are dealing with the grief and guilt after their son, Matt, died of a heroin overdose. They believed people who lived in tents under the freeways used heroin, not kids who grew up attending private Christian schools. Pg 7 “Later I met other parents whose children were still alive, but who had shapeshifted 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.” Pg 9 Porter and Jick: “Addiction Rare in Patients Treated with Narcotics” 1980 In more rural towns in America, the work was becoming more taxing on the body and worker’s compensation/disability was skyrocketing. One doctor, David Proctor, helped to process many claims: “At Portsmith’s small Southern Hills Hospital, where Proctor had privileges, nurses remembered him as the top admitter to the psych ward mostly in an attempt to make patients eligible for disability.” Proctor was also an early and aggressive adopter at prescribing opiates for all types of pain. Pg 25 Proctor prescribed Randy OxyContin after he got into a fight with an inmate at the prison he worked at: “”Looking back on it, {the injury} was nothing was warranted that harsh of a drug…” Thirty days later, Randy figured he was better and didn’t return to Proctor for a refill. Soon he was gripped by what he thought was the worst flu of his life. He ached, couldn’t get out of bed, had diarrhea, and was throwing up. He talked to some friends. One suggested he might be going through withdrawal.” Pg 26 In the 1970s, methadone clinics opened up in America: “methadone… was the only opiate whose addicts did not demand increasing doses every few hours… Methadone addicts could actually discuss topics unrelated to dope. This was not true of heroin addicts, whom Doles found tediously singleminded in their focus on the drug… these clinics showed how a narcotic might be dispensed legally in a safe, crimefree environment. Methadone stabilized an addict and allowed him to find a job and repair damaged relationships.” Pg 63
Many addicts were arrested and sent to prison at “The Farm.” There they were used as lab tests for different drugs (this was where Methadone research was conducted). The inmates would volunteer to participate since they were given dope. Pg 78 WHO: “It claimed freedom from pain as a universal human right… If a patient said he was in pain, doctors should believe him and prescribe accordingly… Worldwide morphine consumption began to climb… But a strange thing happened. Use didn’t rise in the developing world, which might reasonably be viewed as the region in the most acute pain. Instead, the wealthiest countries, with 20 percent of the world’s population, came to consume almost all more than 90 percent of the world’s morphine.” Pg 82 It was believed in America that we were undertreating pain: “A 2001 survey of a thousand people living at home with pain due to a medical condition reported: Half couldn’t remember what it felt like to not be in pain, 40 percent said pain was a constant, and 22 percent said they suffered severe pain. Only 13 percent had seen a pain specialist.” Pg 95 The Recovery Association Project noticed in the 1990s that detox patients had dramatically fallen. They wondered how they’d be in business until they started seeing many, new young people in their clinic: “We were used to seeing fortyyearold addicts at the detox center. Then we were seeing twentythreeyear old heroin addicts. This was 1994, 1995. We’d been detoxing heroin addicts for years, but it was always pretty stable: five to ten percent of our patients. Then it went up. By 1996 to ‘97, it was over fifty percent heroin.” Pg 116 Gary Oxman started looking into death certificates. They found that autopsy physicians had different ways of describing heroin overdoses: “The numbers had been growing steadily, hidden in the tall weeds of inconsistent language.” Pg 119 “If heroin was the perfect drug for drug traffickers, OcyContin was ideal for these pill mill doctors… First, it was a pharmaceutically produced pill with a legal medicinal use; second, it created addicts, and not just among those who looked to abuse it, but among many who came in search of pain relief. Every patient who was prescribed the drug stood a chance of needing it every day… That meant a monthlyvisit fee from every patient $250 usually. And that kept waiting rooms full and cash rolling in.” Pg 155 Back to Doctor David Proctor: “Three women reported they repeatedly had sex with Proctor in his office at his insistence in exchange for prescriptions… On some days, he saw patients for ninety seconds at a time, and issued fortysix thousand controlledsubstance prescriptions for a total of 2.3 million pills in nine months.” Pg 259 UGHH. Previous to the heroin boom, “each dead junkie had been viewed as one less problem.” Pg 169
Doctor Nathaniel Katz: “There’s not a shred of research on the issue. All these socalled experts in pain are dedicated and have been training me that opioids aren’t as addictive as we thought. But what is that based on?” Pg 189 “Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012.” Pg 190 Joe Hale filed the first wrongful death lawsuit against Purdue Pharma: “Purdue Pharma has unleashed a pharmaceutical atomic bomb into the free flow of commerce with absolutely disastrous consequences that they should have foreseen.” Pg 201 Jaymie Mai started noticing how these drugs were used for pain. She dug in and found that people were regularly dying when their original compliant had simply been a sprained ankle, etc. Pg 203 Over the next two years, she dug into the data and published a paper detailing workers compensation patients definitely, probably, or possibly dying from opiate overdoses. Pg 204 “A black market in urine emerged, in which the fluid was exchanged like water in the desert. Addicts bought false bladders they strapped to their stomachs with tubes leading down into their pants… Kids’ urine was coveted for its purity and was worth an Oxy 40 in Portsmouth.” Pg 213 Ed Socie noticed that poisoning deaths were climbing in Ohio in 2005: “Sitting at his desk one day, Socie saw that deaths coded for unintentional injury were heading up. He dug further and found that most were coded as accidental poisonings.” Pg 248 Seth Norman runs the only drug court attached to a longterm treatment center: “He takes addicts accused of drugrelated nonviolent felonies theft, burglary, possession of stolen property, drug possession and puts them in treatment for as long as two years as an alternative to prison.” Pg 273 Len Bias: a person who supplies drugs that causes a fatal overdose may be charged as a conspirator in that death. This helps investigators work their way up the drug supply chain. To save oneself from a Len Bias charge, you need to burn the dealer ahead of you. Pg 278279 “As heroin and OxyContin addiction consumed the children of America’s white middle class, parents hid the truth and fought the scourge alone. “When your kid’s dying from a brain tumor or leukemia, the whole community shows up,” said the mother of two addicts. “ They bring casseroles. They pray for you. They send you cards. When your kids on heroin, you don’t hear from anybody, until they die. Then everybody comes and they don’t know what to say.” Pg 290 Footballs were hit hard on the OxyContin path. They sustained injuries and needed to keep the pain at bay to keep playing. Pg 292
VHA Multidisciplinary Pain Clinics: physical therapy, acupuncture, massage, social workers aid, psychological counselors aid. Pg 308 The Science / Background Behind the Morphine Molecule “Like no other particle on earth, the morphine molecule seemed to possess heaven and hell. It allowed for modern surgery, saving and improving too many lives to count. It stunted and ended too many lives to count with addiction and overdose.” Pg 36 “As the mature poppy’s petals fall away, a golfball sized bulb emerges atop the stem. The bulb houses a goo that contains opium. From opium, humans have derived laudanum, codeine, thebaine, hydrocodone, oxymorphone, and heroin.” Pg 38 The use of OxyContin by middle and upperclass white people led to widespread use of heroin. It changed the market it was no longer just older addicts using the drug. Pg 91 The FDA let OxyContin claim on the bottle that it had a lower potential for abuse due to the time releasing formula. Pg 126 Purdue Pharma pleaded guilty to “misbranding” OxyContin and paid a 634.5 million dollar fine. Pg 267 The Xalisco Boys of Nayarit Ranchos were villages on the outskirts of civilization. Throughout history, rancheros had moved to the outback to escape the towns’ stifling classism. They formed outposts and tried to carve a living from tough land that no one else wanted. Rancheros embodied Mexico’s best pioneering embrace. They were dedicated to escaping poverty, usually by finding a way to be their own bosses.” Pg 20 The Xalisco traffickers spent as little money in America as possible as their dream was generally to move back to Mexico to build larges houses and provide for their families. Pg 46 Enrique’s uncles had him running the business: “roll the heroin into balloons, take calls, direct drivers on the street. The phone rang all day until he shut it down at eight P.M. As he turned 15, he was taking orders for five thousand dollars’ worth of heroin a day.” Pg 49 The first Xalisco migrants landed in the San Fernando Valley of California illegally working jobs in construction, restaurants, etc. Back in Xalisco Mexico, sons didn’t want to continue working in the sugarcane fields and saw that heroin was a prosperous business and left. Opium grew really
well with their climate and they perfected the art of creating black tar heroin which was easy to conceal as the quantities were small and were extremely potent. Pg 59 The Xalisco boys didn’t want to interfere with street gangs so they took their business off the street and started a call service they gave out a phone number to addicts and were told a meeting place. An added benefit to this plan? It was less noticeable to the police. Pg 61 They used heroin users to help them expand beyond their own Nayarit connections. Pg 62 The Xalisco boys found and targeted Methadone clinics. Pg 64 The Xalisco network used justintime supply to avoid large police busts. This made their operation look small and less sophisticated. If drivers were caught, charges were always light since the drivers were never found with large quantities of the drug. Pg 69 The Xalisco heroin was tested by the FBI and came up 80 percent pure. Most street heroin was about 12 percent pure (it’s most likely been sold a halfdozen times and diluted each time). Pg 120 The Xalisco boys were specifically told to steer clear of black people and only sell to white people. Pg 163 Operation Tar Pit: 182 people were arrested in a dozen U.S. cities. Pg 182 “One Albuquerque addict told me this story: He called his Xalisco dealer, who he considered his friend, to say he was going to rehab. Good idea, the dealer said. This stuff’s killing you. An hour later the dealer was at the addict’s door with free heroin. Now that you’re quitting, the dealer said, here’s a goingaway present as a way of saying thanks for your business. The addict kept using. A woman in Columbus told me her dealer welcomed her home from jail with a care package of several balloons of tar heroin to get her using again.” Pg 224 Pedro, a Xaslisco driver: “ To most of ranchero Mexico, Chiva was a disgusting thing… when my brother went up north, my mother was saying I don’t know how you sell that garbage. But when she saw the money she was very happy.” Pg 260 Operation Black Gold Rush: 138 arrests of the Sanchez clan in fifteen U.S. cities: “That said, federal court looked like a hospital ward. Junkies throwing up, sweating, and falling off their benches… Marshalls rushed doctors to court. Several junkies had arraignment postponed because they weren’t fit to understand the judge.” Pg 262 Discussion Questions
Discuss the importance of the Porter and Jick article published in a 1980 edition of the New England Journal of Medicine. How did the morphine molecule take over America in such a short time period? What role did 501 Levi’s have on the Xalisco network? How did the denim impact their business and life back home? “Addicts and pain patients were two different things.” Pg 109 Discuss. How did Purdue go about marketing OxyContin? What conflicts of interest did the doctors encounter? “Each dead junkie had been viewed as one less problem.” Pg 169 How has society changed its view of heroin use/users? Does the demographic change in heroin users have anything to do with that changed view? Has this research changed your level of trust in Doctors? What about pharmaceutical reps/companies? How are pills used as a form of currency? Discuss the systemic issues that lead one to start dealing drugs. Include professional dealers, Medicaid dealers, addicts assisting dealers, etc. How can we, as a society, increase treatment time over prison time? What did you make of the authors focus on blacktar heroin from Nayarit over other forms of heroin? Related Links CSpan: Sam Quinones Testifies on Opioids Crisis Stay Tuned with Preet: Inside the Opioid Crisis Podcast NPR: How Heroin Made Its Way from Rural Mexico to Small Town America LA TImes: Sam Quinones Outlines the Path of Addiction from Painkiller to Heroin