Summary of the book:
This book, written by an investigative journalist, explores why heroin has made such a big comeback and hit new communities (especially predominantly white, mid-sized) so hard in the last 20 years. The author explains that it was the convergence of these 3 factors:
1. A new kind of heroin dealer network:
- Dealers sold a newly developed type of heroin from Mexico that was much cheaper and more potent than heroin had ever been before.
- Instead of operating out of a centralized house or neighborhood and threatening violence to people who opposed their territory, these dealers operated a non-violent, customer service based model - they would drive the drugs to you, pizza delivery style, and they wouldn't carry weapons. This made the actual purchasing of drugs seem more accessible to a wider range of people.
- They knew how to beat the police system (only carry a small amount of drugs, have a decentralized franchise system where no one has too much power anywhere up or down the chain, don't carry weapons - then busts aren't worth police time and energy).
- They sought out communities where Oxycontin use was already big.
2. The "pain revolution" in the medical community -
-In the last few decades, a new belief gained popularity in the medical community that doctors should be aggressively treating pain with narcotics,
- This combined with the erroneous belief that Oxycontin is non-addictive for the vast majority of people, so doctors prescribed it freely.
- The discovery that there was a huge profit to be made on Oxy, both in a "legal" way (pill mills where doctors would accept cash only and write prescriptions for hundreds of patients a day) and on the black market.
3. The close relationship between Oxy and heroin, which are both morphine-based. Many people first started using morphine-based drugs through a pain pill prescription. Through this, they developed an addiction. When they could no longer get a prescription, and if Oxy got too expensive or too difficult to find, heroin was a good alternative for prescription pill addicts. (They both satisfy the same addiction.)
These factors combined to bring heroin to mid-sized communities that had never had serious trouble with heroin abuse before, and it made black tar heroin overdoses a public health epidemic in these communities.
The most important thing I got from this book:
- I am still blown away by how much difference marketing and context can make. I had no idea that heroin was so closely related to Oxycontin, a drug which Joshua has taken at least half a dozen times (as a baby!) while in the hospital for surgery. I would make the same decisions for him because you need heavy duty pain relief after major surgery, but it's just interesting how something can seem so clearly good in one context (doctor prescribed in a medical facility for pain relief) and so clearly bad in another (bought illegally by a dealer in the street for an addiction), even though it's essentially the same drug.
- I'm sure medical associations are way ahead of me on this observation, but certainly doctors are now thinking about the major risks before writing a script for narcotics that might eventually lead to a heroin addiction. (And we as patients should also be weighing that risk before filling a script that might become addictive.)
- I've written before about mass incarceration and drug laws - it will be interesting to see the political implications as heroin and pain pill addicts are increasingly white, middle and upper class, and suburban / rural. I think it would be great to see drug laws shift towards a more treatment focused approach for non-violent addicts, regardless of the racial composition of users.
- It's interesting to think about what new strategies law enforcement can use as dealers are figuring out ways to decentralize their operation so nobody can get big-time busted.
Two things I didn't like about this book:
- Repetitive: this book was originally a series of articles, which the author eventually strung together as chapters and turned into a book. Consequently, there were pieces of background information that must have been repeated at least 20-30 times - a more stringent edit could have cut down on the length substantially, but it's also easy enough to skim past repeat information.
- Demonization of certain programs - this book criticizes Walmart and Medicaid for enabling users by providing broke addicts the financial means to score drugs. And while each of these beheamoths certainly has its share of legit problems, I think it's really unfair to criticize an institution when it's actually individuals using the system illegally who are the problem. In the case of Walmart, it was people stealing goods and then returning them easily, thanks to Walmart's liberal return policy, then using that money to buy drugs. In the case of Medicaid, it was doctors helping people get qualified as disabled so that they could be Medicaid recipients, then prescribing drugs that Medicaid would pay for, and sometimes those drugs were then illegally dealt to others. If doctors are wrongly helping people qualify for disability, or wrongly writing scripts, or if individuals are fradulently seeking these things out, or illegally selling their meds - none of these things are the fault of the insurance company.
Other than those two things, I would recommend this book. It's educational, it's got a true crime vibe (you get to see the inner workings of a drug ring!), and it's relevant to some of our major domestic issues (mass incarceration reform, the pain pill epidemic, the "war on drugs").
