08/28/15 Sam Quinones

Cultural Baggage Radio Show

Sam Quinones author of The True Tale of America's Opiate Epidemic - Dream Land, Gretchen Bergman of A New PATH and Denise Cullen of Broken No More


AUGUST 28, 2015


DEAN BECKER: This is Cultural Baggage, I'm Dean Becker, and today we take a look at opiates, addiction, and death in America.

JOHNNY CASH: I hurt myself today,
To see if I still feel.
I focus on the pain,
The only thing that's real.

The needle tears a hole,
The old familiar sting.

DEAN BECKER: From the master, Johnny Cash, that's "Hurt."

The relentless marketing of pain pills. Crews from one small Mexican town selling heroin like pizza. The collision has led to America's greatest drug scourge. The true tale of America's opiate epidemic: Dreamland. Written by Mr. Sam Quinones, who is with us today. Hello, Sam.

SAM QUINONES: How you doing, Dean, what's going?

DEAN BECKER: Look, I want to say something about this book. This is something every politician in America should read.

SAM QUINONES: Oh, I was working for the LA Times in 2009, and I just, I was working on drug stories because of the drug war and the violence in Mexico. They wanted me to work on stories about how drugs are trafficked from Mexico across the United States, once it got to the United States, and I found these stories of these folks dying from overdoses to black tar heroin in the town of Huntington, West Virginia, and that really is what caught my eye. First of all, black tar heroin had never been east of the Mississippi River that I knew. Also, what was West Virginia doing with lots of heroin addicts, you know? I mean, what was it doing with enough heroin to kill so many people over a sustained period of time, I think there was a dozen fatal overdose deaths in six months in that town.

And that got me a, various phone calls later, just kind of came upon a DEA agent who kind of changed my life, really, for the next several years. He said, yeah, we had no heroin, we had zero heroin in Columbus ten years ago, and then these Mexican guys began arriving and driving around and delivering it like pizza. So, you, an addict, would call a phone number, ann operator would be standing by to take your order, and then would dispatch a driver, they had several drivers tooling around Columbus, their mouths full of little balloons of tenth of a gram doses of heroin, and they would deliver it to you, with like customer service heroin, Dominos Pizza of heroin, basically.

And they are also, he told me, very quiet, they don't use guns, they never, we'd never caught any of them with a gun, they don't show their money, they're not flashy, they've very savvy about customer service and giving discounts and giving dope away in front of methadone clinics and all this stuff. And then he told me, they're all from the same town, and that really got me going, and I eventually found guys who'd tell me that yes, this one town, Xalisco Nayarit, the town of Xalisco in the state, in the small little state of Nayarit, Mexico, had developed this system, it was a kind of franchise, heroin franchise system. And they had taken it all across the country, and it was the only drug trafficking group that I'd ever encountered that didn't sell just wholesale. Most drug trafficking organizations out of Mexico, they don't want to sell retail, it's far too risky. But these guys had developed this system for selling retail and using, you know, cheap Mexican labor, the guys around the area where they were from, would raise their hands to be, to be paid a salary to drive heroin in their mouths all around town, waiting for calls from the operator to go deliver pizza -- I'm sorry, heroin.


SAM QUINONES: And, this was all part of this system, it was like a franchise system, and they had used it to spread from the San Fernando Valley of Los Angeles, coast to coast. They were in Charlotte, they were in Columbus, and so on. And, and it was this amazing system, and I began to write about that and investigate that, talk to guys who'd been arrested for participating. But the biggest, the big question was one of those that I had originally, and that was, why was there any heroin demand in West Virginia at all? I mean, it was not a state that I associated with heroin, and that's what brought me to the pain revolution in America, and Purdue Pharma, and the acceptance by doctors that we're a country in pain and need to be treated with pain pills.

DEAN BECKER: Sam, and yeah, you're coming back to why those people from Mexico were here selling it retail, because the doctors had been led to believe that these pain pills were not addictive, that they wouldn't have to escalate their dosage, etc. etc., but most if not all of that proved to be untrue, did it not?

SAM QUINONES: So, it varied. It wasn't that it was 100 percent untrue, but it certainly varied enough, they were, in this pain revolution that really took place in the late 80s and accelerated dramatically in the 1990s, the idea was that we were a country in pain, that doctors had a moral duty to treat that pain, and at the same time, coincidentally or not, insurance companies were ratcheting back on the variety of treatments that they would reimburse, leaving doctors who were now being told that they wanted to treat pain with very few tools with which to treat it. At the same time, as you say, the idea emerged, coincidentally or not, I think it kind of all kind of meshed together in some big juggernaut that was very difficult to stop, that said, we now know that these are narcotic opiate pain killers, we now know though that they are non-addictive when used for pain, to treat pain.

And the truth is that for some people that's true, and it just, the problem is, trying to figure out who's who is extraordinarily difficult. And so, and particularly when these pills were accepted as non-addictive, I believe the term was less than one percent of all pain patients get addicted to these pills. That was nonsense, that was based on the shabbiest of evidence, they now recognize, but that was what was accepted. And it was accepted by doctors from coast to coast, every part of America, doctors accepted this idea, that this was, that they now could risk-free prescribe these pills, these narcotics, these opiate pain killers, for all manner of pain, and so people began getting opiate pills after, I mean, their wisdom teeth extracted, say, or for an appendix operation, and on and on like that.

And the problem is, there was a huge run-up in supply of pills, and that created also more recreational use, so you had two forms of addiction taking place simultaneously. One was people using it recreationally because there were so many pills in medicine cabinets all across America, a lot of that leaked out into high school kids' parties and what not, a lot of those kids got addicted, and then the other way was, contrary to the belief, people getting addicted by using the pills precisely as they were prescribed for pain, and still they got addicted, and there's a significant number of those folks as well. And the thing is that those pills are molecularly, they're all opiates, they're all opiate pain killers, they're molecularly very similar to heroin. And so when those pills, either the supply gets cut off, or the price rises so much that you can't afford it, you're spending all your money, the pills on the street were a dollar a milligram, then the transition to heroin became very quick. And that's, that's what we're seeing. We've been seeing that for twenty years, really, it's been hidden.

But, it's accelerated in the last three or four years, and that's what we're seeing all across the country now. That's why you have now heroin addiction in Alabama, and heroin addiction in Vermont, and Tennessee, and places like that where you never would have associated heroin, states you never would have associated with heroin like West Virginia, perfect example. And now you've got it everywhere, and that is why, in the book, it's a great day to be a heroin dealer in America. I think what's happened here is that, you know, first of all, heroin is a drug that turns everyone who gets addicted to it into a narcissistic, self-absorbed, individual, just enclosed in on him or herself, a hyper-consumer, it's a person who thinks only about one thing, and that is buying something that will make him feel good, every day, three or four times a day.

The way this really emerges is it, when there is, frankly, a shredding of community. Community is the antidote to heroin, and the way it spreads is, is in a lack of community, and the town that I focused on had this community shredded for 25 years. Opiates made just quick work of a town where community has been shredded. And that is really a larger point of Dreamland, of my book, to say that that is how you create a widespread heroin epidemic, by shredding community, and that's what's happened. It's not only happened in poor communities, though. If you go to wealthy communities where this is a problem as well, you see people don't, you know, congregate, they don't know each other, they have very large houses, they don't even see each other in the middle of the day probably sometimes, with the houses sometimes they're so large. You know? There's not a lot of community feel to it, and when you have that, you have a very, it's already a very isolating life, well then heroin can creep in there as well very easily.

DEAN BECKER: You know, and meantime, the Purdue Pharmaceutical company is literally making billions of dollars off of these pills.

SAM QUINONES: Yeah, right, Purdue was a key part in this pain revolution. For a couple of reasons. One was, it ran with the idea, that these pills were non-addictive. It had, there were pain specialists who were saying that, the pill companies were not the first to say this, pain specialists were the first to say, when used for pain, these pills are virtually non-addictive, or less than one percent non-addictive. Purdue just happened to be the company in the mid-90s to come out with a pain pill that was time release. And so, you didn't need to, and for pain specialists, it looked like fantastic news. You didn't, you no longer needed to take six or eight vicodin a day, one every two or three hours, you could take two Oxycontin and it would be time released into your system over the next, you take one in the morning and one in the evening, and that was all you needed. That was not a trivial thing, I mean, people did, you know, have their lives dominated, pain patients did have their lives dominated by having to watch the clock and always take the pills on time, and this kind of thing. So it was an important thing.

The difference was though, I think that Purdue marketed this as if it was, oh this is over the counter medicine. It was an opiate, but they marketed it as an over the counter medicine, and they, really to doctors, they wanted to convince doctors that it was now okeh for you, doctor, to prescribe this pill to almost any -- almost any kind of pain that you encountered during the day. And it was, they did this through a variety of mechanisms, the first five, six years of Oxycontin's life, you know, they had phone pads and pens and caps and, in Scottsdale and Florida, they had a CD called Swing The Right Direction With Oxycontin, and it was a collection of swing tunes, Count Basie and Woody Herman, and that kind of thing.

They marketed this heavily, but really what they were doing was marketing on the idea that these pain specialists, who are viewed rightly or wrongly as independent, were saying look, this is what we need, we need to treat pain, and we need tools to treat pain, the insurance companies are cutting back on a variety of other, more holistic ways of treating pain, very expensive therapy, acupuncture, etc., sometimes they weren't paying for these kinds of things. And so what are we left with? We're left with only pills, and these pills, Oxycontin comes along right at that time. And there now are, they're still selling billions, you know, the Forbes, I believe it was, or Fortune, listed the Sackler, the lone Sackler brother. Three brothers bought Oxycontin in the 1950s, and now it's a multi-billion dollar corporation based entirely on Oxycontin really. And one of the, the lone remaining brother is now one of the world's, one of our top billionaires. I believe he is number sixteen or fourteen, in the number of billions that he has accumulated because of this.

The company has reformulated Oxycontin, but the problem is that this is still an attitude in the United States, that pain needs to be dealt with no matter what the cost, and that when you go in for a surgery or something like that, you are given, you're, this is a problem and many of them have had this happen. Go in for a minor surgery, an incision, I had an appendix out a while back, they gave me 60 vicodin in a bottle to take home with me. Now the message in that bottle is that message of the pain revolution, which is these pills are non-addictive when used to treat pain, and the truth is, you don't know that. Everybody's different. For me, I didn't have a problem. I took two, and left them in the medicine cabinet for three years then realized what I had and I threw them away. But not everybody is like that. A lot of people get addicted to these things very quickly, and I've met many who've had that happen.

DEAN BECKER: We've had many treatment centers pop up, purporting to cure these people of their problems, but in many cases that's just not true. Right?

SAM QUINONES: Well, treatment of addiction is a mysterious thing, it's not, again, it depends on the human being, and there's a variety of ways of addressing it. I think, as a country, we'd be well served to not say that there's only one way to treat addiction. On the other hand, there are treatment centers that pop up offering suboxone, which is a, it's a new combination drug that kind of prevents you from getting, from overdosing, and now this drug has got an opiate in it as well, but it's also, it's a drug that can be abused, if you don't regulate it, if you don't watch it closely, and that's what's happened. Sometimes it's been abused, on other hand sometimes people can't find it legitimately, and they're trying to stay away from heroin and so they buy it on the street.

One thing I have noticed, learned from all this, is that the more you treat a problem with only one solution, the more likely you are to create serious, significant problems for yourself. That's what we tried to do with pain, a doctor in the books said, if you treated cancer in only, all cancers in only one way, it would mean you really didn't understand the difference -- the specific cancer that you were trying to, trying to treat. And I think that the same is true of pain, and the same is also true of addiction. We need a wide variety of responses to this problem now, we also need to start holding the private sector accountable for what they've started.

Remember, this is the only drug scourge since the, since World War II that was not started by drug mafias, by street gangs and street dealers, it was started by legitimate medicine, well-meaning doctors many of them, who, who made a fundamental error, brought on by, encouraged by pain specialists and the pharmaceutical companies, but it was started by legitimate medicine, not by the street underworld, that's why it's such a difficult thing to change because so many people still think that way, that we should treat this pain with only one solution. It, those, they can be part of a solution, there's no doubt, but when it's the only thing that you provide to everybody, then you get the situation where we find ourselves in today, and the rise of heroin is now directly related to that.

DEAN BECKER: Many of these treatment centers get the insurance money, or they get all the money that the parents may have available, and that many times, the patient is kicked out or released before they have actually learned how to get off these pills, right?

SAM QUINONES: You know, there's -- what we're learning in a sense, that the old solutions that would have served for alcoholism or maybe other drugs do not work so much for opiates and heroin. And that is because those drugs change the brain in fundamental ways that perhaps these others do not. In fact, I believe now, after talking with numerous recovering addicts, and doctors, and what not, that, this really, you need about a year of treatment, and that's isolation from the drugs, to let your brain rebound. I've found a few people who need more like two years, that's kind of what we've gotten ourselves into now. To get people off these drugs, 28 days is a joke. There's no care. Three months is also similarly is, it's impossible, it won't happen. Six months you're beginning to see some possibility. Really it might take nine months or a year, year and a half, that's how long it takes to fully kind of get your, your brain and your behavior patterns away, back them off of all the damage that you've done by using these drugs, by blasting them daily with huge doses of opiates.

And that's kind of what we're seeing, this has overwhelmed, yes it's true that there's some, some scandalous treatment centers out there, it's also true though that people have a surreal, unrealistic expectation of how quickly someone should be able to "recover," in quotes. It's just a huge amount of expense that we've gotten ourselves into, and yet, the other option is basically just continue a life of addiction, of enslavement, the best you can hope for is a life of, is life, it is low expectation, the worst of which is overdose. And so, it's a tough situation we find ourselves in.

DEAN BECKER: All right, friends, we've been speaking with Mr. Sam Quinones, he's author of Dreamland: The True Tale Of America's Opiate Epidemic. Sam, any closing thoughts, website you'd like to share?

SAM QUINONES: You can find more about my work at my website, which is SamQuinones.com.

DEAN BECKER: It's time to play Name That Drug By Its Side Effects. Birth defects, miscarriage, premature birth, feeling sad, anxious or empty, irritability, anger, loss of pleasure or interest. Sleeping too much or too little, depression, trouble concentrating, suicide. Time’s up. The answer: Accutane. For Acne. Another FDA approved product.

Really proud to have with me the director of A New Path, Ms. Gretchen Burns Bergman.

GRETCHEN BURNS BERGMAN: It's A New Path, and the path stands for Parents for Addiction Treatment and Healing, and we actually started in 1999 at the time that I had a son who had addiction problems, and he had been incarcerated for possession of marijuana, which started an eleven-year cycling in and out of jail, prison. As his addiction developed, he actually learned to shoot heroin behind bars. So we knew, and it was a group, there were three parents that started this, we knew that our kids were not getting the help that they needed, but instead they were being treated by a criminal justice system that absolutely exacerbated the problem, and really stole years of their lives, and in some cases, you know, led to, you know, overdose deaths, and loss of, you know, if you've been convicted of a felony, loss of all kinds of rights, including some types of housing and education, and that kind of thing.

So, we started with the idea of therapeutic justice. We wanted to treat rather than incarcerate, and then developed a whole host of more harm reduction strategies to reduce the harm rather than criminal policies. And developed a deep belief that we have to stop stigmatizing people for using drugs, or for being addicted to drugs, and that we have to stop criminalizing them, certainly. We're losing generations of people to mass incarceration and to overdose deaths because so many people are afraid to call 911. We started in 2010 a national campaign called Moms United To End The War On Drugs, as a way of really expanding our work and working with partners, family members, mothers, and others, who were doing this work or who were of like mind and needed a vehicle to really speak out.

And we're seeing that parents are really making some changes by not sitting by silently as our families and our loved ones are being destroyed, lives are being destroyed, but instead speaking out. So, that's the nature of the organization, stop the stigmatization, criminalization of people who use drugs or who develop problems with drugs.

DEAN BECKER: Many of these treatment centers, if you will, are set up in essence to fleece the parents, or the subjects. They set them up for a 30 day treatment, a 60 day treatment, but as soon as that money runs out, they're out the door, and that's not the true solution to this, is it?

GRETCHEN BURNS BERGMAN: Not at all, and you're talking to a mother who knows this firsthand because, you know, as a parent you're willing to do anything, anything and everything to save the lives of your kids, and you, I mean I knew that this was a life threatening disease. My son survived overdose a couple of times, and I actually have two sons who both developed heroin addiction. And my, I think between them, I've probably sent them to 12 -- 12, 14 different facilities, and of course, you know, that's a lot of money. I could have sent them to the best colleges in the country, you know? I can't say that I resent the money that I've spent, because I feel like each, each time there was at least another tool in their toolbox for them to try to find recovery, and my eldest son has been in recovery for almost 13 years, and my younger son has seven months right now, so there's a lot of people making money without really having solid answers or reasons why they should be charging so much money.

And of course, you nailed it. You can't do this in 30 days, and because of insurance, and all the players in this, they've reduced the time so drastically that it's almost impossible to sustain recovery after you get, you know, clean, if you will, abstinent for a month.

DEAN BECKER: All right, folks. We've been speaking with Gretchen Burns Bergman of A New Path. Gretchen, please, closing thoughts and your website.

GRETCHEN BURNS BERGMAN: Our website is www.MomsUnited.net. And you can link to the PATH website through that.

DEAN BECKER: From the organization Broken No More, this is their director, Denise Cullen.

DENISE CULLEN: Well, we do several things. Broken No More is an advocacy organization, where we're trying to stop the drug war and to change punitive policies about drugs. We are working on reducing the stigma, which will enable us to do much more, when people start thinking of people with addiction and substance use disorder, and even people who just use drugs, as humans instead of as something other. And we, a big part of what we do is working with families and friends of people who have died from substance use or overdose.

August 31st is the actual day for International Overdose Awareness, and every year, we and other people that are interested in this issue across the world hold events and on August 30th, we are going to have a vigil and a rally to not only mourn and remember the people that we love that have died, but to bring awareness to the epidemic and to all the failed policies, to try to improve things, you know, for all of else, even those of us who have not been touched yet. It will be on the Huntington Beach Pier in Orange County, California, probably about 200 of us at this, and we'll have a candle-light vigil, we'll walk the length of the pier. It will start with a press conference, several people making remarks, initially from many organizations that will be represented. The goal is to get people to understand the severity of this problem, in addition to a way for all of us who have lost someone to remember them.

DEAN BECKER: You lost your son, correct?

DENISE CULLEN: Right. My son, Jeff, was 27 years old when he died in 2008 of an overdose of morphine and Xanax, after he had been released from jail. He had been there four months on a non-violent drug charge, and he died two days later. And part of the reason these things are happening is, it's a very common story, out of treatment or out of jail, any period of sobriety, and your tolerance just is not the same. And when people use again, they often die, and it, they think they know what they're doing and oftentimes they don't. The issue is now, we have naloxone availability and we have good samaritan laws that can help prevent these needless deaths, but no one talks to people about this.

The treatment centers, they don't seem to want to discuss it, because maybe it looks like a failure on their part, that they're expecting the person to go out and use. And in jails, I think the people in the jails just don't care. They should have an exit interview by a medical person who knows what they're talking about, a nonjudgmental person that can educate them about overdose, about tolerance, about naloxone, you know, teaching their family and friends, you know, with literature, however they want to do that, to recognize an overdose, so we can stop all these people from dying needlessly.

DEAN BECKER: Please, your website.

DENISE CULLEN: It's Broken-No-More.org, and the grieving part of what we do is Grasp Help, that's GRASPHELP.org. And also I'd like to say that we are at 100 chapters, over a hundred chapters across the US and Canada, for our grief support face to face groups. So, please go there and check that out.

DEAN BECKER: Last week, we carried a segment featuring Dr. Sue Sisley, who spoke about the 22 US veterans who take their own lives every day in America. This week, it struck close to home. An Afghan veteran, former Marine, who was a fellow firefighter at my son's firehouse, took his own life. Jason M. Anderson died on August 23rd. His family requested donations be made to his favorite charity, the JJ Watt Foundation.

That's about all we have time for. I'm hoping that this show helps you comprehend just how stupid this drug war is, and as always, I remind you, because of prohibition you don't know what's in that bag. Please be careful.

JOHNNY CASH: If I could start again,
A million miles away,
I would keep myself,
I would find a way.