Dreamland (33 page)

Now, two years into these state regulations allowing more liberal prescribing, his new chief pharmacist was in his office telling him she was seeing opiate-overdose deaths of workers with bad backs. Franklin still had questions. Were these workers dying from recreational abuse of opiates, or pills they’d been prescribed?

“We didn’t want to overcall the deaths,” Franklin told me. “Doctors had spent so much time getting people to use more opioids. I knew we were going to take a hit if we said people are dying of prescription opioids.”

More information was needed: death certificates, coroner autopsy reports, the drug prescriptions for each person who died. Over the next two years, in a back room on L&I’s second floor, Mai pored over cases of workers dying from opiate overdoses. Finding them was the first task. Some 266 people in the workers’ comp system had died since 1995. Mai whittled this down to 60 where drugs were mentioned, and ordered the doctors’ records, the death certificate, and the autopsy reports for each.

Finally, in 2005, in a paper published in the
American Journal of Industrial Medicine
, Franklin and Mai reported that forty-four people with chronic pain in Washington’s workers’ comp system had died due definitely, probably, or possibly to prescription opiate use between 1995 and 2002. Most had died after 1999, the year the state’s intractable pain regulation was written. Most were men; most were under fifty years old. They had come to workers’ comp with non-life-threatening ailments—lower back pain or carpal tunnel syndrome, say—for which they were prescribed Schedule II opiates, and were dead a short while later.

Mai and Franklin also found that prescriptions for the strongest opiates more than doubled. Prescriptions for much milder pain relievers dropped or remained the same. This was also strange. Normally, doctors would be expected to start out with the milder drugs. But faced with patient pain, doctors were going right to the heavy artillery, and that meant, beginning in about 1997, OxyContin.

Franklin and Mai’s paper was the first time anyone in the country had documented the deaths associated with the new prescribing of opiates for noncancer pain.

They wrote to workers’ comp doctors telling them this was happening. They got phone calls in return from people outraged that the state might be preparing to take away their meds. But then directors from Washington’s Medicaid and the Veterans Administration got on the phone. They were also finding opiate overdose deaths on the rise.

Mai and Franklin called Jennifer Sabel. Sabel is an epidemiologist at the state of Washington’s department of health and had just begun studying deaths from injury and violence, including fatal drug overdoses. Mai and Franklin asked whether the surge in opiate-overdose deaths was taking place not only among Washington workers but across the state’s population.

Sabel said she’d look.

Junkie Kingdom in Dreamland

Portsmouth, Ohio

Finally, inevitably, Dreamland closed.

This happened in 1993. Jaime Williams had sold it years before. The new owners couldn’t keep up the pool and the population was no longer there to support it. More people had pools in their backyards. Dreamland stood empty for two years. Residents organized to save it, but there were fewer of them now since Portsmouth had lost its steel mill and shoe factories. The city could have bought it but dallied. The owners made a deal with a developer who wanted to put in a shopping center. Dreaming of tax revenue as budgets shrank, the city council let it happen. Before anyone could sue to stall the deal, the developer brought in bulldozers late at night and crippled the pool by knocking out its filtration system.

Over two months, the bulldozers tore out the lockers and the diving boards, filled in Dreamland and covered it in blacktop. Longtime Portsmouthians couldn’t bear to watch. An O’Reilly Auto Parts and an AT&T cellular store now stand at the edge of a massive asphalt parking lot that once was Dreamland.

Tax revenue from Dreamland never much materialized. Instead, the Dreamland debacle fed the idea that city hall contained a bunch of dullards.

As the town’s decline intensified, Portsmouth opted for a strong mayor, a form of government usually reserved for large cities. It would save the town the cost of a city manager. But the mayors had no experience in, or time for, running a town’s complicated daily affairs. One mayor was a grocery store clerk. Predictably, basic municipal governance was abandoned. Trash-pickup schedules grew undecipherable. Unlit parks became prostitution hives. Police, with few officers, gave up. City politics became a street brawl and recalls grew common. City council meetings were left to gadflies infected with a debilitating negativity: Nothing would work, so why try?

For years, the town had a protector in Vern Riffe Jr. Riffe ran a political machine from his post as the powerful Democratic speaker of Ohio’s House of Representatives. A son of Portsmouth, he was a prolific fund-raiser. He funneled tax money into the town and other forgotten parts of Appalachian Ohio. He had Shawnee State University built in Portsmouth. As Portsmouth’s benefactor, Riffe was a beloved figure. Yet he was part of a larger culture of dependence that Portsmouth had trouble shaking. “Everybody was looking for some outside source to come in and save us,” said Scott Douthat, a native son and professor of sociology at the university.

After Dreamland closed, the town went indoors. Police took the place of the communal adult supervision that the pool had provided. Walmart became the spot to socialize.

Opiates, the most private and selfish of drugs, moved in and made easy work of a landscape stripped of any communal girding. Kids used to get together for beers and bonfires by the river and talk all night. Bonfires seemed to fade away once the pills came around.

The factories and the shops on Chillicothe Street were replaced by the clinics David Procter pioneered, which found cheap space in the town’s abandoned buildings. Pill mills were about the only locally owned businesses to open.

By the new millennium, Purdue Pharma’s promotion of OxyContin and the crusade to liberalize opiate prescribing were seeing their first noxious effects across southern Ohio, West Virginia, and eastern Kentucky. Portsmouth for a while had a pill mill for every eighteen hundred residents.

“My daughter was addicted,” said Lisa Roberts, the city’s public health nurse. “A judge’s kid became addicted. A mayor’s kid became addicted. A police chief’s kid got addicted. The kids who came from excellent families got addicted.”

It seemed like an evil lottery, a massive brainwashing. One by one people succumbed. After a while, Roberts could recognize the look, say, in an old friend she hadn’t seen for a while. “They’re coming over to your house [with] these big elaborate stories to get money off you,” she said. “It’s like watching people being picked off one by one by one.”

Slaves to the morphine molecule, the generation born into the town’s decline set about tearing Portsmouth apart. You could see them trudging like zombies along Highway 52, which ran through Portsmouth, on missions to placate the molecule. They ripped air conditioners out of houses for the copper wire inside. They stole manhole covers. They took large spools of copper wire from behind the school district office. They stole their children’s Christmas presents.

Until finally, alone down on the Ohio River, Portsmouth became a kind of junkie kingdom and pills became currency, more valuable than cash. To a degree unlike any other town in America, a raging, full-blown OxyContin economy developed.

DVDs, refrigerators, dentist visits, cable TV installation, Tide detergent, tools, clothes, and children’s school supplies—pills bought them all in Portsmouth, Ohio.

Among the first local entrepreneurs to emerge was Mary Ann Henson, a pretty blond woman who grew up middle-class. Her adoptive parents cherished her and were very religious. She didn’t recall so much as a beer in her refrigerator growing up. She was a cheerleader at East Portsmouth High School and in the fall of 1990 she was the school’s homecoming queen. It was a bittersweet moment, as nobody knew she was two months pregnant. She started using pills not long after leaving home with her newborn daughter at the end of her senior year.

“I thought I knew everything,” she said. “I was eighteen.”

Mary Ann ended up strung out, on welfare, with food stamps and a Medicaid health-insurance card. For a while she had a boyfriend who broke into pharmacies with a group of friends. Her boyfriend went to prison and Mary Ann was strapped for cash.

One day, a friend asked, “Hon, ain’t you been to the doctor?”

The woman took her to a doctor named John Lilly. Lilly had followed David Procter’s lead and opened the area’s second pain clinic. Lilly was in downtown Portsmouth. His clinic lines stretched around the block. Lilly asked Mary Ann to lift one knee, then the other, and the visit was over. He prescribed her a month’s worth of Lorcet and Xanax. Mary Ann gave half the pills to the woman who paid for her visit and kept half. The woman then took her across the river to David Procter for the same charade. Mary Ann sold her pills and a business was formed. She began going to Lilly and Procter.

Pill abuse was a minor subculture back then. Abusing Vicodin or Lortab was hard work. They contained only small doses of opiates, and included acetaminophen or Tylenol to discourage their abuse. People who used them usually developed serious liver problems from the acetaminophen. But they didn’t often overdose on the weaker pills. Once OxyContin arrived, however “it went from people strung out on dope to people strung out and dying on dope,” said one Portsmouth addict who by then was taking so many Lortabs that he permanently damaged his liver.

In Portsmouth, OxyContin did something else: It turned pill scamming into big business for the town’s generation of decline. Mary Ann bought the MRI results of a person with a sprained lumbar. She scanned the pages into a computer, and used the MRI repeatedly, changing the name on it over and over. Next, she recruited street addicts. She paid them to go to the doctor, each armed with that MRI in their names. The docs of Portsmouth charged $250 cash per visit. In time, Mary Ann was driving several addicts at a time to one clinic one day, and another group of addicts to another clinic the next, waiting while they got their prescriptions.

Usually, each addict left the clinic with scripts for ninety 80 mg OxyContins—three a day, for a month. The doctor also prescribed 120 generic oxycodone 30 mg pills and 90 Xanax bars. Mary Ann took half of the haul in exchange for driving the addict to the clinic and paying the $250 doctor’s fee.

This became a classic business model in Portsmouth and elsewhere. Thousands of people procured dope and made money this way.

The weak link in this pill scam was pharmacists. Many local Portsmouth pharmacists soon caught on and wouldn’t fill prescriptions from notorious clinics. So addicts crowded into cars, driven by dealers like Mary Ann, and set off rummaging through rural towns for hours looking for willing pharmacists. The whole time they talked about dope like gold miners about all they were going to do with their pills this time. This time, they vowed, they weren’t going to use them. Rather, they were going to sell them and accumulate some cash. Then
they
would be the ones to drive junkies to clinics and pay their visits. Those dreams evaporated on the long ride home as they snorted or injected their pills and were left again with nothing.

Once a pharmacist was found, another problem presented itself: how to pay for the prescription. The price of each patient’s prescribed drugs was between eight and twelve hundred dollars. Paying cash was certainly an option. But for junkies, and even for dealers with more discipline, coming up with that kind of money was hard. And so the Medicaid card entered our story.

The card provides health insurance through Medicaid, and part of that insurance pays for medicine—whatever pills a doctor deems that the insured patient needs. Among those who receive Medicaid cards are people on state welfare or on a federal disability program known as SSI (Supplemental Security Income).

In Scioto County, annual SSI applicants almost doubled in the decade ending 2008—from 870 to 1,600. An untrained observer of
Portsmouth’s bleak economic landscape might have understood; jobs, after all, were scarce. People needed money and that check helped. That was true, but by then pills and pain clinics had altered the classic welfare calculus: It wasn’t the monthly SSI
check
people cared so much about; rather, they wanted the Medicaid card that came with it.

If you could get a prescription from a willing doctor—and Portsmouth had plenty of those—the Medicaid health insurance cards paid for that prescription every month. For a three-dollar Medicaid co-pay, therefore, an addict got pills priced at a thousand dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.

Combined with pill mills, the Medicaid card scam allowed prolific quantities of prescription medication to hit the streets. The more pills that sloshed around the region, the more people grew addicted, and the bigger the business grew, and the more people died. The Oxy black market might never have spread and deepened so quickly had addicts been forced to pay for all those pills with cash at market prices.

More isolated parts of Appalachia had other stories to tell about OxyContin, stories not connected to pill mills, but just as related to economic decline, and thus to SSI and Medicaid cards.