Turns out it originated in a tiny town in the state of Nayarit on the central-west coast of Mexico called Xalisco. Quinones’ quest eventually led him to write a book, “Dreamland: The True Tale of America’s Opiate Epidemic,” which came out last week.
“Dreamland” weaves together the strands that combined into the perfect storm of a massive public health problem:
- the pain revolution in which doctors were urged to treat pain as the fifth vital sign;
- aggressive and relentless marketing of Oxycontin and other narcotic painkillers for chronic pain;
- a common misperception among primary care doctors that these pills weren’t addictive;
- and the expansion from the San Fernando Valley in Los Angeles across the heroin cells from Xalisco, which developed a pizza-delivery-style system of dispensing the drug.
This kind of heroin was cheap and potent, and with prescription painkiller abuse taking off, it arrived just in time. Quinones show how pills became the gateway to heroin. The Xalisco Boys perfected customer service techniques and thrived in small cities and white middle class enclaves where heroin was previously unheard of.
“And so it went OxyContin first, introduced by reps from Purdue Pharma over steak and dessert and in air-conditioned doctors’ offices. Within a few years, black tar heroin followed in tiny, uninflated balloons held in the mouths of sugarcane farm boys from Xalisco driving old Nissan Sentras to meet-ups in McDonald’s parking lots.”
Portland figures prominently in this story. Quinones spent a lot of time here talking to addicts, police and prosecutors. A chapter entitled “We Realized this is Corporate” focuses on former Multnomah County Health Department Director Gary Oxman’s efforts to attack the epidemic. Another describes federal prosecutor Kathleen Bickers’ use of the Len Bias law to go after those responsible for a heroin overdose.
There’s also a chapter devoted to the pill addiction that spread through Portland’s Russian Pentecostal community.
Portland may not have pill mills — clinics that dispense prescriptions for Oxycontin pretty much for the asking. But even well-meaning doctors who are pressed for time over-prescribed painkillers. Oregon recently slipped to No. 2 from No. 1 in nonmedical use of prescription opioids.
Dr. Rachel Solotaroff, chief medical officer of Central City Concern, said opioid-related deaths have declined but the rate of misuse seems to be steady.
“I don’t think we have enough data yet to say we’re on a down slide,” she said.
The addict population in Portland is bimodal — people in their teens and 20s and people in their 50s and 60s. But she said there are a few reasons to be hopeful. There has been an effort to help providers better understand and responsibly prescribe opioids. Multnomah County Health Officer Dr. Paul Lewis has “been doing terrific work around that,” Solotaroff said.
And there seems to be growing openness among doctors to better understand addiction and alternative treatments for pain.
“As doctors, we can blame the system and pharmaceutical companies all we want but nobody put a gun to our heads and said we have to prescribe,” she said. “There’s a recognition that we got ourselves into this mess. It took a decade and it will take a generation to get out of it.”
Quinones and Solotaroff will speak at a private event for Central City donors this evening. Quinones is doing a reading at Powell’s tomorrow.
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