Delivering Heroin Like Pizza: Sam Quinones on the Opiate Epidemic

Wednesday, June 17th, 2015

Sam QuinonesBlog Editor’s Note: Acclaimed journalist Sam Quinones is the author of Dreamland: The True Tale of America’s Opiate Epidemic, which details how we got to the point that millions of Americans are addicted to opioids, which include both prescription painkillers and heroin, and 44 people in the United States die every day by overdosing on prescription painkillers. The book examines the many causes that converged to create this public health catastrophe: most notably, young men from the small town of Xalisco, Mexico, delivering heroin like pizza to small town America, and the aggressive marketing of opioid painkillers as safe and non-addictive. Quinones also weaves together the personal stories of individuals and towns immersed in the epidemicespecially the blue-collar city of Portsmouth, Ohio. Hard hit first by the loss of its manufacturing jobs and then by heroin, the city became a ghost town, its devastation by addiction symbolized by the loss of the Dreamland swimming pool, once the heart of the Portsmouth community. We asked Quinones to speak with us about his unique perspective on today’s addiction crisis.

Phoenix House:  You note in your book that the opioid addiction crisis is like no other the country has ever faced. What makes this so different?

Sam Quinones:  In the post-World War II era, all our drug scourges—with the exception of cigarettes and alcohol—were pushed and promoted by the underworld. Cocaine was pushed into the country by Colombians. Then street gangs discovered the profit in crack. Finally, gangs, local users, and Mexican cartels figured out how to cheaply mass produce meth.

The opiate epidemic, on the other hand, began with a revolution in U.S. medicine that got way out of hand. It began with the idea that doctors were undertreating pain and that there was really one solution to this: opiate painkillers, particularly as insurance companies began defunding other options and favoring pills. Then doctors began getting threatened with lawsuits for not prescribing these pills.

There are far more doctors around this country than underworld drug traffickers, so when they grew convinced of this idea of how to treat pain best, and when they began massively prescribing these pills, they went to every corner of the country. The underworld dealers followed this; they didn’t lead, as they had done before.

This time we have an illegal drug—heroin—simply following the trail left by the massive overprescribing of a legal drug—opiate painkillers. We also see overdose death figures outstripping anything that’s come before.

PH:  The way you describe the business model of the Xalisco Boys is fascinating. These young men clearly have a mind for business and the drive to work hard. Is there a way to harness their entrepreneurial spirit for positive ends?

SQ:  Good question, but I believe it has a lot more to do with Mexico, and that country’s inability to channel the energies of its working-class folks. Mexico has to learn—and too much of the country has not—that it is not a good thing that so many poor people stream north. I view it as catastrophic for Mexico, for no matter how many billions of dollars immigrants send home collectively, it won’t make up for the deep loss of energy and dynamism that go with them when they leave.

I lived in Mexico as a journalist for ten years and wrote two books about the country. That’s how I got into this story, by encountering this small Mexican town where everyone works in the U.S. selling heroin like pizza.

The motivations of the Xalisco Boys are no different from those that motivate many immigrants to cross: controlling their own futures. It’s a big attraction. I sometimes thought of the Xalisco Boys story as much as an immigration story as a drug story.

There’s a T-shirt I saw once. It was in Spanish, but the translation was: “The Drug Life: Because When You’re Poor They Humiliate You.” Being poor in Mexico involves a constant humiliation. I believe ending this is what drives a lot of people north, and in the case of the Xalisco Boys, it is especially acute because after a while all around that area are people who’ve done much better by selling heroin. So that standard of how high you have to rise to not be the object of scorn and ridicule is raised.Dreamland-HCBig

PH:  You tell the personal stories of everyonethe dealers, the addicted, the drug companies, the doctorsso well that I found myself sympathizing with everybody! (Well, maybe not the drug companies….) What was it like seeing the story from so many points of view?

 SQ:  I believe the key to telling a story like this is immersion. When you attempt to immerse yourself in the world of this person or that, you come to empathize, to understand people’s motives and why they did things they did. That’s a very important thing to attempt as a journalist. If you don’t, your characters end up being very wooden, unnaturally good or evil, as if from some soap opera or cartoon.

In reality, most people have very good motives or reasons for their actions, or think they do. And all of us have serious failings, foibles, and character flaws. It’s far more interesting to try to understand all that than to sit back and judge. To do that requires a lot of work and constant reassessment of what you think you know. As a journalist, it keeps your mind open to new story possibilities and paths.

 PH:  There’s a theme of desperation in the bookthe sugar cane workers of Xalisco are desperate to escape poverty, people addicted to opioids are desperate for their next dose, and whole towns are desperate for any sort of legitimate, productive economy. You end on a note of hope for Portsmouth and for individuals who had struggled with addiction. Is that just a nice way to end the book, or do you think there’s real reason for hope on a larger scale? You can tell us the truth!

SQ:  As a writer and journalist, I’m not too interested in describing ruination and despair and ending there. But I’m also not going to be inventing rosy stuff. I don’t write for Hallmark Cards or the Chamber of Commerce.

So, yes, I wanted to find a hopeful way to end it. Much to my surprise, I found it in the place where I’d never have imagined, the place where a lot of this began: Portsmouth, Ohio. But that’s real and true and a product of my immersion.

I do believe there is reason for hope in all this. It involves us as Americans returning to our true core values that the world admires: self-reliance, accountability, community, and the sloughing off of dependency dogmas. Portsmouth had bought into dependency dogmas for decades and watched outside forces send its jobs away, cripple Main Street, and finally end the swimming pool that was the center of community life. It stood by and let something other than the town itself determine its future for too long. That’s not so different from what became the final coup—letting dope determine its future.

It was only when it took accountability for its own economic and municipal health that things began to change a bit—which is why I like the story of the shoelace manufacturer and how that was saved. It showed the town returning to a self-reliance of old.

The Portsmouth story also showed that when you ratchet back on pill supply, you do have an effect. I am very well aware of all the problems the town faces…. But there’s also a recovery culture competing with the culture of getting high all the time, and I thought that was worth noting, as were the reasons for it.

This drug turns people into self-absorbed, narcissistic, hyper-individuals and hyper-consumers, to whom nothing matters but getting and consuming their dope for the day. Children don’t matter; grandparents don’t matter. Well, the larger response to a drug that turns everyone into this kind of hyper-individual is community. Portsmouth, through fits and starts, is struggling to stitch that community back together, like a bruised boxer getting up off the mat, and it seemed to me that ought to be pointed out.

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