Opiate Epidemic

The following are excerpts from the cover story in National Review dated February 29, 2016, titled From Oxy to Overdose: How Prescription-Drug Abuse Unleashed a Heroin Epidemic, by Kevin D. Williamson.

Ground Zero in the opiate epidemic isn’t in some exotic Taliban-managed poppy field or some cartel boss’s fortified compound. It’s right there at Walgreen’s, in the middle of every city and town in the country.

The author begins with an interview of a heroin addict he conducted in Birmingham, Alabama. The addict described several street names for heroin. “Sand, because it’s brown. Or diesel. Or killa or 911…the 911 they call it because they want you to know it’s potent, that you’ll have to go to the emergency room.”

That’s a weird and perverse and nasty kind of advertising, but then dope-buying psychology isn’t very much like Volvo-buying psychology. Crashing is just another part of the ride. One spiteful dealer boasts about spiking his product with excessive amounts of fentanyl, an all-business pharmaceutical analgesic used for burn victims and cancer patients, that particular dealer’s plan being to intentionally send overdosed users to the hospital or the morgue…for marketing purposes. Once the word got out about the hideous strength of his product, addicts were scrambling to try it.

The young man being interviewed is barely old enough to buy a beer. He describes the past several years of his life “dope-sick and stealing,” going from job to job. Eight jobs in six months. Robbing his employers blind, alienating his family, descending. He was an addict on a mission. “You’re always chasing that first shot of dope, that first high. And the first one for me almost killed me. I was 17 or 18 years old, and I met a guy who had just got out of prison, doing a 13-year sentence for heroin possession and distribution…I was snorting heroin when I met up with him, and set him up with my connection. He offered to shoot me up, and I wanted to do it. And I remember him looking me in the eyes and telling me, ‘If you do this, you’ll never stop, and you’ll never go back.’ And I said, ‘Let’s do it.'”

This particular opiate odyssey starts off in a Walgreen’s. What seems to be killing what used to be the white working class isn’t diabetes or heart disease or the consumption of fatty foods and Big Gulps from 7-Eleven, but alcohol-induced liver failure, along with overdoses of opioid prescription painkillers and heroin. The use of heroin has increased dramatically in recent years as medical and law-enforcement authorities crack down on the wanton overprescription of oxy and related painkillers. Which is to say: While we were ignoring criminally negligent painkiller prescriptions, we helped create a gigantic population of opioid addicts, and then, when we started paying attention, first thing we did was take away the legal and quasi-legal stuff produced to exacting clinical standards by Purdue Pharma (maker of OxyContin), and other drug manufacturers. So, lots of opiate addicts, but fewer prescription opiates available.

The clerks the author encountered at the Walgreen’s in Birmingham are super friendly, but the place is set up security-wise like a bank. That’s to be expected. This particular location was knocked over by a young white man with a gun the summer before last, an addict who had been seen earlier lurking around the CVS down the road. This is how you know you’re a pretty good junkie: The robber walked in and pointed his automatic at the clerk and demanded oxy first, then a bottle of cough syrup, and then, almost as an afterthought, the $90 in the till. Walgreen’s gets robbed a lot. In January, armed men stormed the Walgreen’s in Edina, Minnesota, and made off with $8,000 worth of drugs, mainly oxy. In October, a sneaky young white kid made off with more than $100,000 worth of drugs, again, mainly oxy and related opioid painkillers, from a Walgreen’s in St. Petersburg, Florida.

In 2013, Walgreen’s paid the second-largest fine ever imposed under the Controlled Substances Act for being so loosey-goosey in handling oxy at its distribution center in Jupiter, Florida that it enabled untold quantities of the stuff to reach the black market. The typical pharmacy sells 73,000 oxycodone pills a year; six Walgreen’s in Florida were going through more than 1 million pills a year at each location. That’s six million doses of oxy. A few years before that, Purdue Pharma was fined $634.5 million for misleading the public about the addictiveness of oxycodone.

The current spike in overdoses is related to a couple of things. One proximate cause is the increased use of fentanyl to spike heroin. Heroin, like Johnnie Walker, is a blend. The raw stuff is cut with fillers to increase the volume, and then that diluted product is spiked with other drugs to mask the effects of dilution. Enter the fentanyl. Somebody, somewhere, has got his hands on a large supply of the stuff, either hijacked from legitimate pharmaceutical manufacturers or produced in some narco black site in Latin America, for the express purpose of turbocharging heroin. Fentanyl, on its own, isn’t worth very much on the street. It might get you numb, but it really doesn’t get you high, and such pleasures as are to be derived from its recreational use are powerfully offset by its tendency to kill you dead. But if the blend is artfully done, then fentanyl can make stepped-on heroin feel more potent than it is.

In high places, there are stirrings of awareness about heroin’s most recent ferocious comeback, but it has taken a while. Congress recently held hearings, and Senator Kelly Ayotte, the charismatic young New Hampshire Republican, introduced the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015. The bill is currently on ice in the Judiciary Committee. One of the key aspects of the bill would convene a task force.

The public perception of heroin is like that of AIDS a generation ago. It is seen as a problem for deviants. AIDS was for perverts who liked to have sex with men at highway rest stops, and heroin is a problem for toothless pillbillies who turn to the needle after running out of oxy, and for whores and convicts and menacing black men in ghettos. Heroin, this line of thinking goes, is a problem for people who deserve it. Nobody seems to care because of who is affected. There are two problems with that. One, it’s unethical. Two, it isn’t true. It isn’t just the born-to-lose crowd and career criminals and deviants and undesirables. It’s working-class white men and college-bound suburban kids too.

There are 8,173 Walgreen’s locations filing 894 million prescriptions a year, and that big record-breaking fine doesn’t look so big up against $77 billion in sales a year. CVS does $140 billion a year, filling one-third of all U.S. pharmaceutical prescriptions. In a country of 319 million, there were 259 million opiate-painkiller prescriptions written last year. There were 47,000 lethal overdoses in the U.S. in 2014, almost 30,000 of which were prescription painkillers and heroin. Some 94 percent of heroin users told researchers that they got into heroin because the pills they started on became too expensive or too difficult to find. Heroin was cheap and plentiful. How do we keep up with all those pills? Where do they go? Somebody knows. It’s time we address this rapidly growing health concern head on.