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.
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
Lee, Harper To Kill A Mockingbird J.B. Lippencott 1960
Health Care Costs from Opioid Abuse: A State By State Analysis <http://www.drugfree.org/wp-content/uploads/2015/04/Matrix_OpioidAbuse_040415.pdf>