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The True Tale of America's Opiate Epidemic

Sam Quinones

AMERICA is battling a massive epidemic of heroin and its pharmacological substitutes. By 2008 drug overdoses, mostly from opioids, overtook car crashes as the leading cause of accidental death. In a related development, the number of annual users of heroin jumped from 370,000 in 2007 to 680,000 in 2013.

The epidemic, as Sam Quinones, an American journalist, outlines in 'Dreamland', a meticulously researched new book, has two root causes. One is a failure of regulation in the pharmaceutical industry; the other is retail innovation in the black market.

In 1995 Purdue Pharma, a drug company in Stamford, Connecticut, was given permission by the Food and Drug Administration to market a powerful new opioid called OxyContin for moderate pain. Doctors, wary about prescribing opioids because of their markedly addictive nature, had previously used it for severe pain only. Many patients duly became addicts and 'pill mills', pain clinics that handled millions of prescriptions, began to appear. But OxyContin and other strong opioid tablets were expensive and addicts began to turn to heroin, which was cheaper.

Where did the heroin come from? Much of the business belonged to the Xalisco Boys, a group of Mexicans from a small rural county in Nayarit state, who professionalised the business while semi-refining black-tar heroin in the early 1990s. They gave addicts phone numbers so that they could have heroin home-delivered, as if it were pizza. The deliveries were made by Mexican migrants who were paid handsome salaries and did not take drugs, and so had no incentive to adulterate the product (the invariable practice in most heroin dealing). Quality remained high. The migrants carried small amounts at a time, so when caught they were deported rather than imprisoned. The Xalisco Boys skirted large cities with established drug dealers and focused instead on small towns and rural America.

Portsmouth, Ohio, is one such town, and this is where Mr Quinones begins and ends his story. Its large open-air swimming pool, the eponymous Dreamland, was once the town's social focus. When local industry declined, the pool closed. Soon afterwards, America's first pill mill opened nearby and the Xalisco Boys arrived close behind. Mr Quinones tells many tragic tales, including of the deaths of teenagers drawn to heroin after they were wrongly prescribed strong opioid painkillers.

He also has some more uplifting stories of policemen and district attorneys who slowly pieced together the Xalisco Boys’ business model and took action. As for Purdue Pharma, eventually the company and three executives were fined $634m for false branding, and OxyContin was re-engineered and made more difficult to abuse.

Mr Quinones draws several lessons from all this. Clearly, the state must be vigilant about the prescription of opioid painkillers. But where dependency does arise, it needs to be dealt with by doctors rather than criminals. Prohibition funnels addicts towards dealers, and the addiction becomes much harder to tackle. Meanwhile many Xalisco Boys got long prison sentences, but the gang is still in business.

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