RENEE MONTAGNE, HOST:
This week we're taking a deep look at the addiction to opiates, such as heroin and prescription painkillers, that's sweeping across the country. Since 2001, the number of Americans who die annually from heroin has risen fivefold, according to the National Institutes of Health. The number of those who die each year from painkillers, like OxyContin, has more than doubled. In his new book, "Dreamland: The True Tale Of America's Opiate Epidemic," Sam Quinones chronicles this crisis. The title comes from a community pool in Portsmouth, Ohio, Dreamland it was called, the gathering place at the center of life in the town when America's Midwest epitomized prosperity and promise.
SAM QUINONES: That began to end with the deindustrialization of the Rust Belt, which Portsmouth is a part of - began to fall apart. Jobs began to leave. People began to leave. And finally, Dreamland is closed in 1993, and by about the mid-to-late 1990s, prescription pills are now everywhere. It's a widespread kind of addiction that affects an entire generation in the town of Portsmouth, Ohio.
MONTAGNE: Well, Portsmouth has a probably unhappy designation as the place where the biggest pill mill in the country operated.
QUINONES: Exactly. Portsmouth was the pill mill capital of America, really. They had more per capita in that town than anywhere else in the country. Pill mills are where a doctor prescribes pills for cash without almost any diagnosis of any pain problems or anything like that. Pill mills usually have long, long lines. Portsmouth had a dozen of these, and they prescribed millions of pills a year and was one of the main reasons why so many people got addicted there. The godfather of all that was a guy by the name of David Proctor. And by the 1990s, when the main painkiller in all this, OxyContin, is released, he sees this as basically a business model. You can prescribe these pills and people will pay you $250 every month to get that prescription, and you will always have your clinic full. He also taught a lot of doctors who came to work for him how to run these pill mills. So he became kind of the Ray Kroc, the McDonald's of pill mills, in the words of one Kentucky cop. And all these doctors went out on their own and spread this pill mill phenomenon to Eastern Kentucky, to parts of West Virginia, other parts of Ohio. It was a big part of how this epidemic got going early on.
MONTAGNE: So now one can be addicted for sure to these prescription drugs, and that's a bad thing in and of itself. How did this problem turn into a heroin problem?
QUINONES: These pills contain drugs that are molecularly very similar to heroin. They are opioids. They are synthetic opiates. People would get addicted to the pills believing that, well, this is OK because it's a doctors - you know, prescribing this and this comes from a drug company and this kind of thing, but at a certain point, they would no longer be using it for their pain. They would be using them because they're addicted. Frequently, the doctor would cancel the prescription or simply they just couldn't get the pills with the regularity they needed. And so heroin is the fallback drug.
MONTAGNE: So, as it happened, these places crossed paths with a tiny, mountainous region in Mexico and its ability to send in cheap black tar heroin.
QUINONES: Ground zero for the pills is southern Ohio, West Virginia, Kentucky - places like this. In the mid-'90s, at that same time, is coming the vanguard of a group of heroin traffickers out of a small town called Xalisco in the state of Nayarit in Mexico who are taking their drugs and looking for new markets. All of this kind of coincides. These two fronts, weather fronts, meet over Columbus.
MONTAGNE: And key to their success is that they were unlike the sort of gun-toting, violent Mexican drug cartels.
QUINONES: Right. They use customer service. They deliver, just like pizza delivery. And it really appeals to this new class of addict who are white, really kind of unfamiliar maybe a lot of times with the drug world. They don't want to get involved in Skid Row or some housing projects where everyone has always bought dope. A drug addict wants one thing above all and that's reliability. And these guys provided that above all. They relied on being very low-profile. They did not spend their money lavishly. They look like the day workers outside your Home Depot. They drove old cars. They never used gunplay, drive-by shootings, any of that kind of stuff because they didn't need to.
MONTAGNE: You profile one of these dealers in the book, Enrique. He's from a poor farming family in Xalisco. You quote him as saying to himself, "I'm leaving my soul in these fields." Did he ever convey the sense that a deadly drug like heroine was also selling his soul?
QUINONES: All these guys don't like selling heroin. But here's the thing - back in the town where they're from, they have been humiliated all their lives. Their jobs are dead-end jobs. They work as bakers. They work as farm boys. They work as butchers. They don't have anything pushing them ahead. As this business model began to take hold, the effects were immediately seen in the town. People began to do better. They began to build big houses. They began to have nice trucks, nice cars. And all around them, young men saw this. They saw that this was a route to real economic progress. One of the strangest things I encountered when I was doing this book was how Levi's 501s were this huge force in pushing this system across the United States.
MONTAGNE: And they're jeans, of course.
QUINONES: They're jeans. They're these very well-made, very expensive jeans. Well, this system was a system for turning cheap heroin that was very easy to make and very cheap into stacks of Levi's 501s. The reason was that these dealers very quickly noticed that these addicts they were selling to were fantastic shoplifters. They would give these guys lists - I need this size, this color - because they would then take those jeans back home and act as Santa Claus. It was like this huge redemption. I left poor, and here I am bringing Levi's 501s for everyone. And there is nothing cooler than walking around town during the fiesta or late at night on a Friday in your beautiful, dark blue Levi's 501s. For a person who comes from the smallest, most humble origins in these towns, that is a narcotic itself.
MONTAGNE: Thank you very much for joining us.
QUINONES: My pleasure. Thanks for having me.
MONTAGNE: Sam Quinones. His new book is "Dreamland: The True Tale Of America's Opiate Epidemic." Tomorrow - fighting heroin addiction in Indian country.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.