Dreamland (3 page)

Via pills, heroin had entered the mainstream. The new addicts were football players and cheerleaders; football was almost a gateway to opiate addiction. Wounded soldiers returned from Afghanistan hooked on pain pills and died in America. Kids got hooked in college and died there. Some of these addicts were from rough corners of rural Appalachia. But many more were from the U.S. middle class. They lived in communities where the driveways were clean, the cars were new, and the shopping centers attracted congregations of Starbucks, Home Depot, CVS, and Applebee’s. They were the daughters of preachers, the sons of cops and doctors, the children of contractors and teachers and business owners and bankers.

And almost every one was white.

Children of the most privileged group in the wealthiest country in the history of the world were getting hooked and dying in almost epidemic numbers from substances meant to, of all things, numb pain. “What pain?” a South Carolina cop asked rhetorically one afternoon as we toured the fine neighborhoods south of Charlotte where he arrested kids for pills and heroin.

Crime was at historic lows, drug overdose deaths at record highs. A happy façade covered a disturbing reality.

I grew consumed by this story. It was about America and Mexico, about addiction and marketing, about wealth and poverty, about happiness and how to achieve it. I saw it as an epic woven by threads from all over. It took me through the history of pain and a revolution in U.S. medicine. I followed the tale through a small town of sugarcane farmers in Nayarit, Mexico, and a town of equal size in the Rust Belt of southern Ohio. The story transported me through Appalachian Kentucky and the gleaming suburbs of the cities that most benefited from our age of excess that began in the late 1990s. I met cops and addicts, professors and doctors, public health nurses and pharmacists, as I tried to follow the threads.

And I met parents.

On New Year’s Day 2013, I was in Covington, Kentucky, and beginning full-time research on this book. The only place open for lunch was Herb & Thelma’s Tavern—a cozy, darkened place for chili. Inside were a dozen members of a family celebrating a girl’s birthday. I sat in a corner, eating and writing for an hour in the glow of the college football games on TV and the neon
BAVARIAN
BEER
sign on the wall.

I rose to leave when, seeing the Berkeley sweatshirt I wore, the grandmother in the group asked, “You’re not from around here, are you?”

I told her I was from California. She asked why I was so far from home. I told her I was just beginning to research a book about heroin and prescription pill abuse.

The party stopped. The tavern hushed.

“Well, pull up a chair,” she said, after a pause. “I have a story for you.”

Her name was Carol Wagner. Carol went on to tell me of her handsome, college-educated son, Chad, who was prescribed OxyContin for his carpal tunnel syndrome, grew addicted, and never got unstuck after that. He lost home and family and five years later lay dead of a heroin overdose in a Cincinnati halfway house. Carol’s daughter-in-law had a nephew who’d also died from heroin.

“I no longer judge drug addicts,” Carol said. “I no longer judge prostitutes.”

I left Herb & Thelma’s and drove the streets, stunned that so random an encounter in America’s heartland could yield such personal connections to heroin.

Later, I met other parents whose children were still alive, but who had shape-shifted into lying, thieving slaves to an unseen molecule. These parents feared each night the call that their child was dead in a McDonald’s bathroom. They went broke paying for rehab, and collect calls from jail. They moved to where no one knew their shame. They prayed that the child they’d known would reemerge. Some considered suicide. They were shell-shocked and unprepared for the sudden nightmare opiate abuse had wreaked and how deeply it mangled their lives.

Among the parents I met were Paul and Ellen Schoonover. I found them anguished and bewildered a year after Matt’s death.

“I kept trying to figure out what just happened. Why did our lives become devastated?” Paul Schoonover said to me the day we first got together at his insurance agency in Columbus. “How could this have happened?”

Here’s how.

PART I

Enrique

Yuma, Arizona

One hot day in the summer of 1999, a young Mexican man with tight-cropped hair, new shoes, a clean cream-colored button-down shirt, and pressed beige pants used a phony U.S. driver’s license to cross the border into Arizona.

He took a cab to the Yuma International Airport, intending to fly to Phoenix.

Also in the airport, waiting for a plane, stood a dozen Mexican men. Short and brown, they wore dusty baseball caps, jeans, and faded T-shirts. They looked weather-beaten and callused—just like their hands, he imagined. He figured them for illegals, maybe construction workers, proud of their capacity for hard work, but without much else on their side.

He sometimes went by the name Enrique. He was tall, light-skinned, and handsome. The calluses on his hands, there since childhood, had softened. He had grown up in a hovel on the outskirts of a village in the Mexican state of Nayarit, fifteen hours by car south of Arizona. His father was a sugarcane farmer. His village depended on sugarcane, and thus it was poor, and life there was violent and mean. His relatives were split by a feud that began before he was born. He didn’t know its cause, only that the two sides didn’t get along.

But he had moved on; he had a business now, with employees and expenses. It allowed him to buy his first Levi’s 501s and pay for his fade at the barbershop. His false U.S. ID allowed him to cross the border posing as another man, Alejandro Something.

Still, it wasn’t hard for Enrique to see himself in those men at the airport in Yuma that day.

As he waited for his plane, he watched an immigration officer in the airport spot the men and make the same calculation he had. The officer asked them
for identification. There was a discussion Enrique couldn’t hear. But in the end, the men could produce none. As the other passengers watched, the officer led them off single file to be, Enrique assumed, deported.

Growing up in a poor Mexican village had attuned Enrique to the world’s unfairness. Those who worked hard and honestly got left behind. Only those with power and money could insist on decent treatment. These facts, which he believed had been proven to him throughout his life, allowed him to rationalize what he did. Yet moral qualms still came like uninvited guests. He told others that he hadn’t been raised to be a heroin trafficker and believed it when he said it, though he was one. Scenes like this convinced him that he was doing what he had to do to survive. He didn’t make the rules.

Still, as the officer paraded the men by, he thought to himself, “I’m the dirtiest of them all and they don’t ask me anything. If I’d have come to work
derecho
—honestly—they’d have treated me badly, too.”

A while later he boarded a plane that took him to Phoenix and from there to Santa Fe, New Mexico.

Dr. Jick's Letter

Boston, Massachusetts

One day twenty years earlier, in 1979, a doctor at Boston University School of Medicine named Hershel Jick sat in his office pondering the question of how often patients in a hospital, given narcotic painkillers, grew addicted to these drugs.

He would not remember, years later, exactly why this question had occurred to him. “I think it was maybe a newspaper story,” he said.

Hershel Jick was in a better position than most to gather findings on the topic. At Boston University, he had built a database of records of hospitalized patients. The database charted the effects of drugs of all kinds on these patients while they were in the hospital. The database grew from the thalidomide scandal of 1960, when babies were born with defects after their mothers were prescribed the drug. Only anecdotally did doctors discover the risk of thalidomide. In the early 1960s, Dr. Jick was asked to begin building a database of drugs used in hospitals and their effects.

The database grew as computers became more accessible. Today the Boston Collaborative Drug Surveillance Program, as it's known, includes millions of patients' hospital records in four databases. Yet even by the late 1970s, the database was a substantial thing, holding the records of three hundred thousand patients and the drugs they were given while hospitalized. Dr. Jick grew used to entertaining his curiosity with forays into the data. The doctor years later would say, “I don't even know how to turn on a computer.” But he did have the sense to hire a bright computer technician, who had built the database and to whom Dr. Jick turned often with these requests.

This time, Dr. Jick asked for the numbers of patients in the database who had developed addictions after being given narcotic painkillers. Soon he had the data in hand. Figuring others might find it interesting, he wrote a paragraph in longhand describing the findings. Then he gave it to his secretary to type. The paragraph she typed said this: Of almost twelve thousand patients treated with opiates while in a hospital before 1979, and whose records were in the Boston database, only four had grown addicted. There was no data about how often, how long, or at what dose these patients were given opiates, nor the ailments the drugs treated. The paragraph simply cited the numbers and made no claim beyond that.

“That's all it pretended to be,” Dr. Jick said later.

A graduate student named Jane Porter helped with his calculations in some way that Dr. Jick could not remember years later. As is the practice in medical research papers, she received top byline, though Dr. Jick said he wrote the thing. The secretary put the letter in an envelope and sent it off to the prestigious
New England Journal of Medicine
, which, in due course, in its edition of January 10, 1980, published Dr. Jick's paragraph on page 123 alongside myriad letters from researchers and physicians from around the country. It bore the title “Addiction Rare in Patients Treated with Narcotics.”

With that, Hershel Jick filed the paragraph away and gave the letter scant thought for years thereafter. He published dozens of articles—including more than twenty in the
NEJM
alone. Jane Porter left the hospital and Dr. Jick lost track of her.

 

All from the Same Town

Huntington, West Virginia

One Monday in September 2007, Teddy Johnson, a well-to-do plumber in Huntington, West Virginia, visited the apartment of his son, Adam.

Adam Johnson was a chubby, redheaded kid. As a fan of alt-rockers like the New York Dolls, Brian Eno, and Captain Beefheart, he was a bit of a misfit in socially conservative West Virginia. He played the drums and guitar and grew up in a wealthy neighborhood. He was twenty-three and just starting college at Marshall University in Huntington. He already had a radio show, the
Oscillating Zoo
, which featured his eclectic taste in music on the school’s station. Adam’s mother was an alcoholic and he had used drugs off and on for several years. He started with cough syrup, but quickly moved on to other substances, including prescription painkillers, his friends said.

Adam had dropped out of high school, gotten his GED. He cast about for something to do with his life. He worked for Teddy. It seemed to Teddy that Adam was turning things around. He was playing music with friends and seemed sober. Teddy was heartened when his son enrolled in Marshall, planning to major in history.

Then, that Monday morning, Teddy came to Adam’s apartment and found his son dead in bed.

Adam’s autopsy showed a heroin overdose; police said Adam was using a sticky, dark substance known as “black tar,” a semiprocessed heroin that comes from Mexico’s Pacific coast, where opium poppies grow. That stunned Teddy almost as much as Adam’s death. Heroin? That was for New York City. Huntington was in the middle of Appalachia.

“I had no clue,” he said later. “We’re a small town. We weren’t prepared.”

Two other men also died of black tar heroin overdoses in Huntington that weekend: Patrick Byars, forty-two, a Papa John’s Pizza employee, and George Shore, fifty-four, former owner of an antique store. One black tar heroin overdose after another racked Huntington over the next five months. The town had seen only four heroin deaths since 2001. But twelve people died in five months; another two had died the previous spring. Dozens more would have died had paramedics not responded quickly.

“We had scores of overdoses occurring—medics finding [people] unresponsive,” said Huntington police chief Skip Holbrook. Police in Huntington had never seen black tar before 2007.

Two years later, I stood on the southern banks of the Ohio River on what is uncharacteristically flat land for West Virginia. To the north is Ohio and to the west, Kentucky. Huntington lies in a long, narrow grid next to the flat, quiet river. The town was founded as a western terminus for the Chesapeake and Ohio Railway. Railcars carried the coal the region mined to Huntington, where river barges shipped it to the rest of the country.

The city is at the nexus of America’s North and South—much like West Virginia itself. Democrats ran the state like a Tammany Hall. They created a legal and political system supportive of coal and railroad interests. The name of the state’s best-known senator, Robert C. Byrd, is on a dozen public buildings in Huntington alone—including a bridge over the Ohio River. Yet West Virginia sent its raw materials elsewhere to be transformed into profitable, higher-value products. Parts of the South threw off this third world model of economic development. West Virginia did not. Resource extraction mechanized and jobs left. Railroads declined and economic turbulence set in. But the state’s political system prevented a robust response or new direction. Poverty intensified. Marijuana became the state’s number one crop. In 2005, the state produced more coal than ever, but with the fewest workers ever.