No Hiding Place Part 6: “The Biology of the Price”

It’s likely you’ve seen the picture that’s gone viral, taken by a police officer in East Liverpool, OH recently. It shows a man and a woman in an SUV who’ve passed out from opiates, with the woman’s grandchild in a car seat in the back. Videos have been posted on YouTube of people who’ve simply collapsed on the street or in a store from the drugs they’ve taken.

It’s one of the symptoms of opiate overdosing: extreme sleepiness or the inability to wake up. Other symptoms are confusion, appearing drunk, pinpoint pupils, vomiting, and extreme constipation. But the killer symptom is problems breathing. Opiates suppress body functions, including breathing. That’s how people die from opiates. They simply stop breathing.

Dependence vs. Addiction

A new player is coming on the scene – Suboxone, a drug that doesn’t give the euphoric high of prescription opiates or heroin, but helps the body to receive the physical effects of the drugs. Like Methadone before it, the idea is to support the dependence of the body on the drugs without having the person slide into addiction.

Addiction is a psychological term rather than a physical diagnosis. You can be dependent without being addicted. The classic definition of drug addiction is when the craving for the drug severely disrupts a person’s daily activities and that craving becomes all-consuming for the addict. As mentioned earlier, opiates facilitate that by changing the biology of the brain, a condition from which it can take years to recover.

It remains to be seen if Suboxone can help ween people from opiates rather than just maintaining the status quo of dependence. That’s long been a critique of Methadone treatment. What is clear is that until the root condition that led to the problem is addressed, be it physical, emotional, or psychological, users will be handicapped when it comes to kicking the drug.

The Resistance of Big Pharma

Opioid drugs bring billions of dollars into the coffers of the drug companies. With their use quadrupling between 1999 and 2010, it’s only become more of a cash generator, and the companies fight hard against any restrictions on their products. They employ a huge number of lobbyists at the state level, with some states having a one-on-one ratio between legislators and pharmaceutical lobbyists.

They have the resources to make their position heard through donations to political campaigns. Between 2006 and 2015, Big Pharma spent $880 million on campaign contributions and lobbyists. It has worked. Apart from some Northeastern States and Upper Midwest States, legislatures rarely had bills that even mentioned opioids in the past three years. Those fighting to tighten restrictions on opioid prescriptions are spending about a 220th of the amount – $4 million – and the organizations are tiny, grassroots operations. It’s like David going up against Goliath without any pebbles for his sling.

Big Pharma has another resource as well when it comes to making their pitch for their product, and that’s supposedly independent advocacy groups that are in fact funded by the drug companies. Doctor groups in several states have also pushed back against any restrictions, arguing that the legislature should not tell them how to practice medicine.

The Cost

The daily statistics about prescription opioids and heroin in this country are staggering. 650,000 prescriptions for opioids are written each day. 3900 people begin using pills illicitly. 580 people start using heroin. But the worse stat: 78 people die. As the number of prescriptions quadrupled in the first decade of this century, so did the number of overdose deaths from opioids.

I began this series shortly after the death of Prince due to a prescription opioid overdose. Since the 1990s we’ve also lost Philip Seymour Hoffman, Cory Monteith from “Glee,” Heath Ledger, River Phoenix, and Chris Farley, among others. Since 1999, the number of deaths from overdoses has totaled 165,000. And it keeps going up.

But there are other costs beyond the deaths. The child in the picture I mentioned at the beginning of this post was abandoned by his mother, a drug user, when he was 8 days old. His great-grandparents were awarded custody, but when they could no longer care for a child, he moved in with his grandmother. She was, along with her boyfriend, the others in the picture. He’s now in the temporary custody of a great-aunt and uncle in another state. The destruction of addiction goes far beyond the addict, and it will be something our society will need to deal with for many years to come.


Additional Sources

Pfannenstiel, Brianne “As Opioid Epidemic Grows, Drug Makers Resist Restrictions” Des Moines Register, September 19, 2016

Park, Alice “A New Paradigm for Opioid Addiction: More Drugs” TIME, October 24, 2016

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No Hiding Place Part 5: Reverse Discrimination

When the Xalisco distributers moved into the US, they didn’t follow the classic route. They avoided slums. In Los Angeles they stayed away from the gang turf of East L.A., Compton, and Inglewood, and instead set up shop in the more suburban San Fernando Valley. Their next move was to Hawaii. They avoided major cities like New York, Chicago, Philadelphia, and others – places that had substantial slums and a large gang population – and instead went to Albuquerque, Denver, Portland (OR), Indianapolis, Columbus (OH), and Nashville. Often they’d enter a market by finding methadone treatment centers.

Methadone was developed in Germany in the 1930s as a synthetic opiate and analgesic, and was introduced to the US in 1947. It’s not a cure for heroin addiction, but its long-lasting effects make it useful as a maintenance treatment for addicts so they can function in society. Since it’s administered in a liquid or pill form, there are not the dangers inherent in regular injections, including HIV infections. Methadone’s major selling point is it blocks the euphoric rush addicts receive with heroin or other opiates. On the down side, Methadone withdrawal is more severe than other opiates and can last between four and sixteen weeks. Some see Methadone treatment as simply extending rather than fixing the problem.

The clinics, though, did allow the Xalisco distributors to find junkies. They’d single out one or two and offer them special deals on their drugs if they introduced them to other junkies. They in effect became shills for the Xalisco dealers, handing out business cards so the junkies could call for fixes. If they had contacts in other towns, the dealers would arrange for them to go there and help expand the network.

This was completely different from how drugs had been distributed ever since they were outlawed in the early 20th Century. The drug dealers staked out territories in city slums, turf that they claimed and defended. It made sense, since those on the edges of society were less restrained by society’s rules. Things that were verboten in small-town America happened regularly in the slums, simply because the imperative to survive outweighed government-imposed mores. But there was more to it as well. From the beginning of the temperance movement, those who supported it viewed alcohol and narcotics as the root problem for all of society’s ills.

In their article “Alcohol Prohibition and Drug Prohibition: Lessons from Alcohol Policy for Drug Policy,” authors Harry G. Levine and Gary Reinarman wrote  “From the beginning, temperance ideology contained a powerful strand of fantasy. It held that alcohol was the major cause of nearly all social problems: unemployment, poverty, business failure, slums, insanity, crime, and violence (especially against women and children). For the very real social and economic problems of industrializing America, the anti-alcohol movement offered universal abstinence as the panacea.” It was a comforting vision that all the problems within slums could be laid at the feet of demon rum or, later, demon drugs rather than other societal causes.

Because of this, it was easy for politicians to rail against drugs and show how tough they were by enacting draconian laws. The influx of crack cocaine in the 1980s hit the young black population of the slums hard. Between 1984 and 1994, the homicide rate for black males ages 14-17 more than doubled, and among those 18-24 it was just slightly less of an increase. Along with that, fetal deaths, low birth weights, weapons arrests, and children in foster care increased just as sharply. Significantly, the homicide rate for black males 25 and older stayed flat, and there was no similar rise for whites. By the 1990s the crack epidemic had burned itself out and the statistics began dropping until they were less than what they’d been before crack arrived. However, at that time politicians caught on to what was happening and enacted laws such as the three-strikes rule for drug offenders. It mandated life in prison for a third drug offense, regardless of the severity of the charges. Some were sentenced to life for marijuana possession, and judges had no leeway to take mitigating factors into consideration.

The push for treatment of drug offenders rather than severe sentencing has begun to change the laws, and there is a movement for the elimination of three-strikes. Strangely enough, the change can be traced to the black tar epidemic and the prejudice of the Xalisco drug dealers.

They stayed away from slums and areas of gang activity because they were afraid they’d be ripped off. Instead they set up their networks in suburban areas, small cities, small towns, and throughout states that hadn’t had major drug use problems. The Xalisco black tar rolled east and north from LA, and along the way it merged with the spread of OxyContin that moved in the opposite direction.

This time, between prescription opiates and black tar heroin, the drug abuse cut across the socio-economic strata. It wasn’t just the low-income blacks that most politicians discounted from the get-go when it came to votes. Now it was soccer moms and college students and blue collar workers and businessmen who were caught up in the abuse – what many politicians considered their base voters.

And the scourge also touched their families and friends. On the campaign stump last year in New Hampshire, the often belligerent Chris Christie spoke with deep conviction and compassion when he explained to a town hall meeting why he was for treatment of addicts by telling the story of a law school friend of his who became addicted to pain killers. In 2014, Vermont Gov. Peter Shumlin (D) devoted his whole State of the State address to the heroin problem.

But then, the painkiller and heroin epidemics began to hit home for the public in general as well-known people succumbed to their addictions.

The Next Installment: The Biology of the Price

Additional Sources

Levine, Harry G. and Reinarman, Gary  “Alcohol Prohibition and Drug Prohibition: Lessons from Alcohol Policy for Drug Policy” Amsterdam CEDRO 2004

Health Care Costs from Opiod Abuse: A State By State Analysis <>

Fryer Jr., Roland G, Heaton, Paul S., Levitt, Steven D., and Murphy, Kevin M.  “Measuring Crack Cocaine and its Impact” April 2006

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No Hiding Place, Part 4: The Pizza Method

The state of Nayarit could be called the North Dakota of Mexico: it’s not that easy to get to and there aren’t a lot of reasons to go there. The Mexican resort cities like Acapulco and Puerto Vallarta are further south, it’s the least populace state in Mexico, and its major crop is sugar cane. Poverty is a constant, especially on the ranchos – the small villages on the outer edges of the cultivated areas. There’s an innate desire on the part of young men of the area to become successful. For them, that means building a large house, having a ranch with horses rather than a sugar cane farm, paying for a band to entertain at a festival. These are the concrete signs of prosperity.

In the state of Nayarit is the small town of Xalisco. With Spanish the X, like the J, is pronounced as H, so it sounds the same as the neighboring state Jalisco, but the resemblance ends there. The state of Jalisco has the prosperous city of Guadalajara as well as the resorts of Puerto Vallarta, while the town of Xalisco is a dusty farming community. But in the mountains outside of Xalisco the natives grow the opium poppy from which they make black tar heroin.

A Different World

If you did street interviews with passersby, asking them to describe heroin, most people would likely talk about images they’ve seen in movies: brick-like blocks of white powder imported from Southeast Asia that is then cut (diluted) with other white powders like confectioner’s sugar before its weighed and put in small glassine bags for sale on the streets. Or they might talk about the DEA’s news conferences where they parade large quantities of contraband that have been taken off the streets by their efforts. The bigger the haul, the bigger the news.

The world of black tar heroin is completely different. For one thing, its name is descriptive: this heroin is sticky and dark, nothing like the powdery China White variety of the drug. There’s also a huge difference in potency. China White will be cut by middlemen and dealers all along the distribution chain. When it reaches the street, the heroin has a 10th of its pure power left. Black tar, on the other hand, can’t be cut down easily. The refinement process takes away some of its potency, but it retains 60-80% of its pure power. Rather than buying a bag an inch square filled with the powder, black tar comes in doses of a tenth of a gram, rolled into a ball about the size of a BB and put in a small balloon for sale.

There have been drug trafficking families and cartels in Mexico for decades. In the 1970s and 80s, there was the Herrera clan that sold a brown powder heroin known as Mexican Mud. The Chicago police estimated the Herreras took about $60 million dollars of drug profits out of that town alone, and the Herreras were active in Denver, Dallas, Los Angeles, and many other towns. Then there’s the Sinaloa Cartel, from the state just north of Nayarit. The Sinaloas were notable for their brazenness and their violence. The head of the Sinaloas, Joaquin “El Chapo” Guzman, has been in the news recently with his brazen escape from prison as well as his recapture. “El Chapo” sounds like a scary nickname, though it actually means “Shorty.”

Several young men in Xalisco in the late 1980s decided to emulate the Herreras and import black tar heroin from Nayarit to the United States to make their fortunes. They started in Los Angeles and jumped across to Hawaii where they had major success, and from there they crept eastward across the country until they were operating in every state. What separated the Xalisco boys from other distributors is their method, which completely rewrote the book and allowed heroin to flow into small town America.

Customer Service

They learned from those who went ahead of them. The DEA loved big busts but tended to ignore small operations. The Xalisco men applied supply-on-demand distribution to drugs. Rather than having a huge stockpile sitting around, ready to be raided by the Feds, they would import drugs as needed in small amounts. Their favorite way to get their supplies was to have the drugs stuffed into a small appliance like a toaster oven and shipped by UPS to the local distributor. It was years before the DEA realized the size and scope of the Xalisco operation.

The distributor would have an underling who received phone calls. When they entered a new city they’d get cell phones and print up business cards with the numbers. They’d search out methadone treatment centers and find a client there who’d be their introduction to the local drug addicts in exchange for a supply of heroin for themselves. The cards would be passed out, and orders would start coming in on the phones.

But the biggest innovation was how they got the drugs to their clients: they delivered. One of the most dangerous parts of heroin addiction was having to go into the worst parts of town to find dealers on the street corners. Addicts often had their drug money stolen before they could get their fix. With the Xalisco distribution, the operator at the other end of the line would schedule a meeting for the addict, usually in a public place like a strip mall, and say the driver would be there in a half hour. No more rip offs, no more danger.

The distributor treated it as a business, with discounts. If you bought your supply for the week, they might throw in the dope for Sunday for free. Each balloon would cost about $15.00 but they could offer seven or eight for $100.00. They’d also call the purchaser back to check if they were pleased with the service. If there was a problem, the distributor would try to resolve it. Without the fear factor involved, black tar heroin moved out amongst the general population. Where China White distribution was mostly limited to major cities, with black tar no town was too small to be touched by the drug.

In the classic drug distribution system, you had your turf and you’d fight off competitors. With the Xalisco system, there was no turf. You might have three or four different distributors working in a town. Instead of a single market, their business model was convenience stores. There was plenty of business for everyone. Also, since the distributors were all from the Xalisco area, they often knew each other. They’d even share product if one distributor ran short until a new supply came it.

At the street level there were plenty of young men in the Xalisco area who wanted to get into the business and would start as delivery men. The distributor would arrange for cars, often through a local client who didn’t mind registering vehicles in his name. They’d also find an apartment for their drivers to use and provide food, and they’d pay the drivers $1000-1200 a week to spend their days making deliveries. The drivers often couldn’t speak English and would have to communicate with clients through hand signals. Different from the normal image of illegal immigrants, the drivers had no desire to stay in the US. They wanted to make their money and then return to their village where they could display their new-found wealth.

When they drove, the men would keep their balloons of heroin in their mouths and have a bottle of water nearby. If they were pulled over by the police, they swallow the balloons – and away went the evidence. Even if they were caught, the small amounts of drugs they carried often meant that they were not prosecuted but simply turned over to ICE for deportation.

The drugs became a wave surging from west to east across the US. Strangely enough, though, they didn’t flood all areas.

Next: Part 5: Reverse Discrimination



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No Hiding Place Part 3: Small Town America, Small Town Mexico

In Chapter 11 of “To Kill a Mockingbird” Harper Lee presents a vile woman who torments Scout, Mrs. Henry Lafayette Dubose. She lives with a servant who nurses her, and sits on her porch in her wheelchair when she’s able, swaddled in blankets, and spew out insults at passersby. After a fit of vandalism by Scout’s friend Jem, the children end up growing close to Mrs. Dubose. When she dies a short time later, Atticus explains to Scout that Mrs. Dubose was a morphine addict and her insults came when she went through withdrawal. He explains Mrs. Dubose had real courage: “It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what. You rarely win, but sometimes you do.”

As discussed earlier, thanks to patent medicines addiction to opiates was widespread in America in the late 1800s and early 1900s. Small towns, large towns, it made no difference. The federal prohibitions on drugs left many addicts cut off from their supplies. Opiate abuse then went underground in big cities. The image of heroin abuse became the ghetto with strung-out addicts desperate for fixes who’d meet up with pushers on street corners. Movies and TV reflected this, from “The Man with the Golden Arm” to “Panic in Needle Park” to “The Wire.” Images of the overall drug trade were set with “The French Connection” through “American Gangster.” But what they all had in common was that the drug trade was an urban crime. Outside of the ghetto, it didn’t happen.

That changed, and it was pain medication that caused the change. About a hundred years after the last epidemic, opium came calling to small-town America again.

The extensive marketing of OxyContin created a multi-billion-dollar market for pain medication. Now opiates were the answer to bad knees or hurt backs or even tooth extractions. You didn’t need a pusher to get them; all you needed was a prescription and a pharmacy.

One warning sign of what was to come was when Worker’s Compensation administrators in several states began to have patients die. How could they be killed by cracked bones or pulled muscles? It took a while to realize the medicine meant to dim their pain was turning their lights off completely.

While the sales force for Oxy had trumpeted the false claim of a negligible addiction rate, the reality was making its mark. One of the worst areas hit was the Rust Belt of Ohio and West Virginia. It was there that the first pill mills sprung up in the 1990s. Some unscrupulous doctors realized with their license and a prescription pad they could make thousands of dollars a day. Addicts would line up outside the door and happily pay cash for the scrip. The doctor only saw their “patient” for a minute or two, for which they received a couple hundred dollars in cash, and then the pills were charged to their insurance. Eventually in some areas the pills became their own currency, with the size of the dosage equaling their dollar value. (The pill conveniently had the dosage side marked on them.) A 20 mg OxyContin pill equaled $20., while a 100 mg equaled $100. The pill factories were eventually shut down, but the expansion of the abuse went on.

A report by Matrix Global Investors LLC on the costs of opiate prescription addiction noted that there are an estimated 2.1 million people in the US addicted to prescription pain pills. During 2007, healthcare costs to deal with the abuse came to around $25 billion dollars, and if anything it’s gone up from there. The national average of opioid abuse rates for 2010-2011 was 4.6%, with the highest rate of 6.37% in Oregon. The other highest abuse states were Colorado (6%), Washington (5.75%), Idaho (5.73%), Indiana (5.68%), and Arizona (5.66%). One thing to consider with the $25 Billion dollar price tag – 95% of it is the cost of the drugs and excess medication. Only 5% was the actual treatment of the addiction.

The Gateway

Much has been made over the years about “gateway drugs” – ones that would lead to worse abuse. The drug that’s mostly been labeled that way is marijuana, going back to the “Reefer Madness” days of the 1930s. The lines have always been tenuous.

That changed with the opiate epidemic. OxyContin and other opiates created a taste for heroin and they often overcame people’s innate fear of needles. Addicts who used the pills discovered they could overcome OxyContin’s time-release properties by crushing the pills. The powder could be snorted to give the user the full euphoric hit of the drug immediately. It was a short step from there to dissolving the powdered drug in water and shooting it directly into s vein.

But the pills were expensive – the better to keep Big Pharma happy. According to the CDC, the majority of abusers actually got their pills for free from friends or relative, with doctor prescriptions, buying from a friend or a relative (or stealing from them) and other sources making up most of the supply. Less than 5% of the pills were purchased from a street dealer.

When supply of pills became a problem, addicts turned to heroin. While the lines of other drugs leading to heroin abuse might be questionable, there is no doubt how prescription opioids opened people to using heroin. Fully 80% of heroin addicts these days started on painkiller pills.

In a devastating synergy, at the same time opiates were creating addicts throughout America, a new model for supplying heroin moved into the country. It first landed in the San Fernando Valley area of Los Angeles, but from there is expanded rapidly throughout the rest of the country until it was in all 50 states.

The source of this heroin business was a small town in Mexico: Xalisco.

The Next Installment: The Pizza Method


Additional Sources

 Lee, Harper To Kill A Mockingbird  J.B. Lippencott 1960

Health Care Costs from Opioid Abuse: A State By State Analysis <>

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No Hiding Place Part II – The Marketing of Addiction

Once opioids found acceptance for pain management, several versions of the drugs were introduced. The premier brands were Demerol, Vicodin, and Percocet. Demerol is given by injection but the other two were prescription pills, made by blending hydrocodone or oxycodone (respectively) with acetaminophen. The abuse of Vicodin or Percocet was dangerous since acetaminophen can cause liver damage when overused which can lead to death. To extract it from the pills so you only got the opiates was a hard process.

Purdue Pharmaceutical had used oxycodone, a drug that mirrors heroin on the molecular level, in their first pain medication MS Contin in 1984. Twelve years later the company introduced OxyContin. By that time the prescribing of opiates had become common place. Purdue hired an advertising agency that had pioneered the marketing of drugs to help make Oxy the prescription choice for pain relief. While it didn’t rely on direct-to-consumer advertising (DTCA), this change to consumer-driven health management has had an effect on the expansion of opioids throughout America.

Across the board, advertising of drugs has expanded like a wildfire in the last 25 years. The amount spent by pharmaceutical companies went from $166 million in 1993 to over $4 billion in 2004. Congress had put through legislation allowing DTCA in 1997, and now in almost every commercial break you have some advertisement for some medicine that spends half of the commercial warning about side-effects but then tells you to ask your doctor if fill in the blank is right for you. There is a move by the American Medical Association to rescind this legislation. If you wonder why drug prices have risen so precipitously, figure in that about 40% of a drug company’s expenses now are for advertising. As stated, you don’t have DTCA of opioids (just for Linzess which helps with the main side-effect of opioids, constipation) but the consumerism inherent in DTCA is enshrined in the rating surveys by which doctors are judged. Pain management is part of it; if you want opioid pain medication and the doctor doesn’t provide it, the survey of his provision of care can be negative, and that has real world consequences for the doctor. So their impetus becomes give you what you want, even if there are major side-effects as well as the chance for addiction.

Lies, Damn Lies, and Statistics

In the marketing of OxyContin, the literature produced for doctors quoted a study that had appeared in the prestigious New England Journal of Medicine in 1980, authored by Jane Porter and Hershel Jick, which found that of almost 12 thousand patients treated with opiates only 4 became addicted – less than one percent. The data suggested that it was safe to treat pain with opiates, and Purdue was more than happy to trumpet the study to justify using OxyContin.

There was a problem, however: this wasn’t a study, it was a one paragraph letter to the editor. Jick ran the Boston Collaborative Drug Surveillance Program, which had been founded in the 1960s after the Thalidomide crisis. In response to a question, Dr. Jick had had Porter, a graduate student, pull raw information from the program’s database of over 300,000 cases. How many were treated with opiates, and of those cases how many developed an addiction that was noted in the records – that’s it. There were no details in regard to what was prescribed or how long. Jick thought the data might be interesting so he passed it along. He gave Porter the first place on the signature line since she’d dug out the data, so the letter became known as Porter/Jick.

Before the archives of the NEJM were computerized, it was a major undertaking to find old articles, so the publicists at Purdue Pharma could call the sixteen-year-old letter a study and no one could easily call them on that deception.

Full Court Press

Purdue Pharma got FDA approval for OxyContin in 1995, with the selling point that the company’s time-release formula could reduce the number of times a person had to take the drug and that it would dull the euphoria that was thought to drive people to addiction. The person in charge of the approval later left the FDA to work for Purdue. That claim became the lynchpin of the company’s marketing strategy, even though the warning label stated that if you crushed the tablets the time-release factor was destroyed. It basically told addicts how to abuse the drug.

While MS Contin was marketed as treatment for post-operational or cancer patients, Purdue sold OxyContin to doctors as a panacea pain relief. If patients were injured on the job or the sports field, if they had headaches or a bad tooth, then Oxy was the drug with which to treat them, and since there was a less than one percent chance of addiction and the time-release formula dulled the euphoria, then Oxy should be a long-term treatment option.

From 1995 to 2005, the number of sales reps for drug companies tripled to well over a hundred thousand. Purdue had enough reps for Oxy that doctors could get visits from different reps three times in a single day. But that was only part of the story. Another part was wining and dining. The company would underwrite Continuing Medical Education (CME) conferences at luxurious resorts and cover all the costs for doctors to attend – flight, room, food, everything. The company also funded the creation of foundations or supported existing ones that promoted the use of opiates. In five years (1997-2002) the prescriptions for Oxy for chronic pain multiplied by 10 to over 6 million scripts, with an additional million for cancer patients.

Thanks to the full-court press by the company, OxyContin became one of the first billion dollar drugs. In the 2000s, it grew to yearly sales of $3 Billion. But it also had a different cost involved: deaths from overdoses. And in a perfect storm scenario, the widespread addiction to opioid pain medicine paved the way for heroin to spread into small town America.

The LA Times published an article 2 days ago (May 5, 2016) with further information about Purdue and OxyContin. To read it click here.

Next: Small Town America, Small Town Mexico

Additional Sources

WebMD “Opioid Pain Medications”

The Milbank Quarterly “A History of Drug Advertising: The Evolving Roles of Consumers and Consumer Protection” Dec 2006

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No Hiding Place – The Opiate Epidemic in America

Note: For the manuscript I’m currently writing, I’ve been researching the heroin epidemic that has stretched into almost all corners of America. Then this week came news that the death of Prince may be linked to prescription opiates. I thought it might be helpful to share what I’ve learned about this problem with a series of posts about how this came to pass. The factors are complex, but they combined to lead to a perfect storm of abuse, ruined lives, and deaths. First, some history…

 Part 1: The Holy Grail of Pain

In 1913, John D. Rockefeller established the Bureau of Social Hygiene (BSH) to promote research on that subject, particularly from a criminology standpoint. A BSH subcommittee in 1919 estimated that there were 100,000 addicts in the US, most of them addicted to cocaine. In 1929 the BSH rebranded itself as the Committee on Problems of Drug Dependence. (They’ve had other name changes and exist today as the College on Problems of Drug Dependence.) Along with research into the subject and publishing information on addiction, there was a clinical arm of the CPDD that sought the holy grail of pain relief – a medicine that could kill pain but that wasn’t addictive.

Opium has been around almost as long as civilization. It’s mentioned in Sumerian writings from 2000 BCE for a plant called hul gil, the plant of Joy. Homer may have been referring to opium in The Odyssey when he mentions a drug that, when dissolved in wine and drunk, would rob grief and anger of their sting. It was used medicinally from the time of the Greeks on for all manner of disease and symptoms. A major change came in the 1500s with the introduction of Laudanum, a liquid form of morphine. By the 1800s, laudanum and straight opium were available at grocery stores in England, and in 1860 almost 300,000 lbs. of opium was imported, mostly from Turkey but also from India. The British East India Company was hugely involved in opium importation, and it led to the Opium Wars with China. China had outlawed opium importing, so the British went to war to force the Chinese government to allow them to sell Indian opium there. (Not the history you usually learn about in school.) In the US, many people grew the opium poppy in their gardens, including Thomas Jefferson.

The addictive nature of opium was known, and so there was a push to find a non-addictive version of the drug. Strangely enough, morphine, which was developed in the early 1800s, was viewed as non-addictive, especially when it was injected following the invention of the hypodermic syringe. Missionaries in China handed out what was known as “Jesus Opium” pills as a remedy for opium addiction; the pills were made of morphine. In the 1880s, the medical community embraced cocaine as a miracle cure, including a treatment for addiction. (Coca Cola, invented by Atlanta chemist John Pemberton, was originally a medicine.) In 1898, a former dye manufacturing company that moved into pharmaceuticals – by the name of Bayer – introduced Heroin as a cough medicine. The introduction was actually delayed so that Bayer could copyright the name throughout worldwide markets. The chemist who created it, Heinrich Dresser, promoted it while preventing the production of other promising pain relievers. One compound he rejected: acetylsalicyclic acid, now known as aspirin.

Temperance organizations not only campaigned against alcohol but also against drugs, and they were supported by missionary organizations that worked in China and wanted to see opiates outlawed. Their efforts led to the Harrison Narcotic Act of 1914. Interestingly, a major part of the selling of the act was steeped in racial prejudice, with warnings that blacks under the influence of drugs were killing whites, while degenerate Mexicans were smoking marijuana and Chinese men were using drugs to seduce white women. While Southern legislators were usually opposed to more federal power, the racial argument swayed them and they supported the act. So drugs passed from commonplace in America to hiding in back alleys apart from medical use.

The criminalization of narcotics, though, had a chilling effect on their use even by doctors. It was enough to ruin a doctor’s reputation if he regularly prescribed opiates. That began to change with a major shift in how pain was viewed. Where it was originally counted as a symptom of disease, there was a push beginning in the late 1970s and early 1980s to view pain as something to be treated in and of itself. Pain clinics were started that preached a multi-discipline approach to relieving pain: counseling, exercise, and diet were components. But there was also a re-evaluation of opiate use. Why allow, say, a terminally ill patient go through agony when morphine could dull the pain. It eventually crept down to acceptance for treating chronic pain and then simply any pain.

The multi-discipline approach was successful, but it was also expensive. Eventually it was killed off by insurance companies who saw that pain could be treated cheaply simply by using drugs.

Next: The Marketing of Addiction


May, Everette & Jacobson, Arthur, “The Committee on Problems of Drug Dependence: A Legacy of the National Academy of Sciences. A Historial Account.” Drug and Alcohol Dependence, 23 (1989)

“How Asprin Turned Hero”  Sunday Times, 13 September 1998

McNamara, Joseph D “Commentary: Criminalization of Drug Use” Psychiatric Times September 2000

Quinones, Sam  Dreamland: The True Tale of America’s Opiate Epidemic Bloomsbury Press 2015

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When Bad Books Attack

Have you ever read a book that not only disappointed you but it put you off reading for a while?

I suffered through one such book that I was reading to review. Worse for me, it also put me off my writing. I won’t give the name of the book, since someone else might like it. It was a later book in a series, originally published in the UK but that was now being imported to the US. I kept struggling through it in the hope the author could pull off a satisfying ending, but she didn’t. I’d spent months forcing myself through her verbage, and I ended up giving the book a tepid review. Here I’ll go into my problems with it, specifically where it broke the rules of good writing. (You can of course break any writing rule, but the key is you have to improve the story by breaking the rule. In this case it reinforced why the rule is taught.)

Let’s Get It Started: Alfred Hitchcock famously described an instigator of a plot as the MacGuffin. It was something that was of vital interest or value that got the story started. Not all mysteries have them, nor did Hitchcock use them in all his films. “Rear Window” and “Strangers on the Train” are two examples of MacGuffin-less stories. Probably the most famous MacGuffin was the black bird in “The Maltese Falcon.” But the key with a MacGuffin is it must not seem false or artificial to the reader/viewer. In this book, there’s an unusual circumstance that attracts the attention of the heroine and gets the story moving, but it’s quickly dismissed and has no more bearing on the book. It turns the MacGuffin into a cheat – in effect the author got me to read under false pretenses. For an excellent dissection of the MacGuffin, click here.

Who’s Line is it Anyway?: A key writer’s rule is not to change narrative perspective mid-stream of consciousness. If you’re telling the story from the viewpoint of one character, don’t switch to another character without an obvious change such as a new chapter or a space-break within a chapter. Otherwise the reader can become lost trying to keep track of who is talking. In the book I read, there were a half-dozen or more viewpoints used, and they sometimes changed in the same paragraph. It ruins the flow of the story if you lose track of who’s speaking.

Stereotypes (and Bad Ones at That): The majority of the story took place in a small town, with a major subplot revolving around a young newspaperman, his hypochondriac and harridan of a mother, and the young nurse who’s in love with the newspaperman. If this roughly sounds familiar, that’s because it’s been used multiple times in books and movies throughout the years. In this book, though, the mother has no redeeming qualities and the son is completely cowed by her, so much so that it affects his work. The biggest mystery in the whole book is why it takes the nurse 300 pages to understand that if she marries the son, she’d be inheriting the mother as well. There’s also an art expert in the story and of course he’s portrayed as an over-the-top artiste. You find yourself wishing you were actually in the story, simply so you could slap the characters for being so frustrating.

I Could Tell You But Then I’d Have to Kill You: There’s an espionage plot grafted onto this story that ties in with the Cambridge spy ring that almost fatally damaged British Intelligence in the 1950s. This has already been a fertile ground for writers – most notably John LeCarre with “Tinker Tailor Soldier Spy.” In the end you find that the central mystery is a cheat tied in with British Intelligence, but the author skips on illuminating the story by using the Official Secrets Act. While it would have some basis in reality, the reader never signed on to keep the secret. It comes off as a cheap way to forego research.

The editor I write reviews for has told me that if it happens again, simply to let her know and stop reading the book. Lesson learned. It is frustrating though that this book was published where other authors struggle to get better books accepted.

My antidote for this experience was to read several books by authors I enjoy, to cleanse my palate as it were. I read a recent John Sandford Prey novel as well as “The Dirty Secrets Club” by Meg Gardiner. If you haven’t read her books and you like thrillers, you need to read her. Her stories race along with twists and turns that surprise; your heart will beat faster. (Meg’s also a gracious person whom I’ve had the privilege of meeting a couple of times now.) Right now I’m finishing “X” by Sue Grafton. I also read an excellent non-fiction book about the heroin epidemic in the US entitled “Dreamland” by Sam Quinones. I’m planning to write more about this in the next couple of weeks. I also got back to the novel I’m currently writing and have started a new short story.

I saw I hadn’t put a new post here in quite a while. My apologies for that.

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Truly a Detective

Recently I – along with almost everyone else who watched – was disappointed by the second season of HBO’s True Detective. The first season had riveting performances by Matthew McConaughey, Woody Harrelson, and Michelle Monaghan, and while it required an investment to follow the convoluted plot that was spread out over more than a decade of time, it rewarded the viewer with a fascinating portrait of two flawed detectives trying to do what’s right. With the second season, though, the convoluted plot became positively opaque, with plot twists that cheated the audience. None of the characters were sympathetic or all that interesting, while some of the dialogue was cringe-worthy, especially with Vince Vaughn’s character. It followed the form of the first season like it was the old dance instructions you could get, where you put down sheets with shoeprints on them to show where to place your feet. You might hit the marks but you won’t have any emotion or intelligence, and there’s no involvement between dance partners. I turned off the show after struggling though five episodes; even that far in I couldn’t be bothered to see how the show ended.

Thankfully, I found a remedy for the bad taste the show left in my mouth. Bosch, a 10 episode adaptation of the bestselling novels of Michael Connelly, was produced by Amazon for streaming on-line. If you have Amazon Prime, it’s free, but even if you have to pay it’s well worth a viewing. Saying it’s based on the novels is correct, since it combines elements of three of Connelly’s books: “City of Bones,” “Echo Park,” and “The Concrete Blond.” However, the blending is seamless so it plays as one story. Connelly created the series along with Eric Overmyer, who has produced Homicide: A Life on the Streets, The Wire, and all three interations of Law & Order. The scripts are intelligent and tightly plotted, with sharply drawn characters, just as they should be in adapting Connelly’s works.

Visually this is one of the best police procedurals ever. The sets look like they were lifted from the actual Hollywood division police station, with miniscule cubicles for the detectives. When the detectives go to the morgue, it’s not all chrome and tile and sterile like you see on most shows, but rather it’s a basement with institutional green paint on the wall and pipes that show. But best of all is when the show films at night. The digital cameras capture Los Angeles in all its neo-noir glory. There’s never true darkness in the city because of all the fill light of neon signs, constant traffic, and buildings that never close, but that only makes the shadows deeper.

Harry Bosch is one of the more fascinating characters in crime fiction. He’s the son of a prostitute who named him for the 15th Century Dutch painter known for his nightmare depictions of Hell. When Harry was still young, his mother was murdered and he ended up in the child welfare system until he escaped, first into the Army and then the LAPD after he returned to the city. He’s a cop who feels responsible to the victims, and he’ll follow a case wherever it goes, even if it means stepping on the toes of LA’s power elite. (For the sake of the show, they’ve made Bosch younger than he is in the novels, where he’s a Vietnam veteran who is now past retirement age but has been retained under a special contract program within the department.)

Titus Welliver wears the role of Bosch like a surgical glove. He’s had a long career as a character actor and is probably best known as the Man in Black on Lost, but here he gets to shine in the spotlight. I’ve read all of the Bosch novels and had a different picture of the character in my mind, but from now on whenever I read one of the books I’ll hear Welliver’s voice when Bosch speaks.

The supporting cast is first-rate as well, with Lance Riddick as Deputy Chief Irvin Irving, Jamie Hector as Bosch’s partner (and clothes horse) Jerry Edgar, and Amy Aquino as Detective Lieutenant Grace Billets, the head of the Hollywood detective bureau. Annie Wersching (24) plays Officer Julia Brasher, with whom Bosch engages in an ill-advised affair, and Jason Gedrick plays Reynard Waits, a serial killer who latches onto Bosch as the ying to his yang.

The second season is currently filming and will be released next year. In the meantime, if you like mysteries check out the first season. It’s well worth it.

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Read a Short Story for Free

A while back I had a short story done as a podcast by Crime City Central. You can now read a text version of that story for free at Inkitt. I published “The Extra Postage” as part of a contest they have called Fated Paradox. If you’d like to read the story, please click here. I hope you enjoy it.

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A Different Voice

Today I learned that Ellery Queen Mystery Magazine has purchased a short story I submitted to them in October. That’s a pretty quick turn-around time actually, considering the volume of submissions they receive. I signed the contract and sent it back in the afternoon mail.

The story is quite a bit different from my previous ones, in that my heroine is a teenage video blogger (or vlogger). The story is entitled “Viewfinder” and tells of the adventure she stumbles into when she’s looking for a subject for her vlog.

When I was acting full-time, it was a joy to slip into different characters, to become someone that I am not and embody that person. While I’m not doing it on stage anymore, writing is the way I can still experience that thrill, and in a wider way that I ever could before. In acting, you’re still bound by your physical body, but writing lets you slip into characters that you could never do on stage – like, for me, a teenage girl. Through imagination you can hear the character’s voice and then record it in the story.

That’s the joy of writing: authors get to live many different lives, and if we do our job well, the reader gets to experience those lives as well.

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