Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

This is the fourth of eight articles from that interview. In the first article, we discussed the role of the pharmaceutical industry in the current American opiate epidemic. In volume two, we talked about race and how drug policies in the 1980’s with crack are very different than the 21st century policies surrounding opiates. In the third edition, we discussed how Mexican immigrants became some of the key sellers of black tar heroin, does supply or demand lead to bigger drug problems, and we briefly touched upon the rhetoric of Donald Trump.

This fourth volume focuses on the Affordable Care Act, politicians and how regular Americans can influence public policy. With the New Hampshire primary on Tuesday, this is the time to publish that exchange.

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Frank Greenagel: You mentioned that the legislature in Ohio passed laws that got rid of the pill mills. Is there anything else that the state of Ohio did that you think was helpful toward bringing Portsmouth back a little bit?

Sam Quinones: Oh, most definitely. Yeah. John Kasich, now running for president, definitely deserves a huge tip of the hat for going around a Republican legislature and making Medicaid available to all Ohioans. The reason he did that was because he knew that people who were suffering with addiction, that their families most likely were tapped out. They didn’t have the ability to pay for this and the only way they were going to get people into treatment was through Medicaid. He risked a lot politically…

Frank Greenagel: …by taking the Affordable Care Act expansion of Medicaid.

Sam Quinones: Over the objection of the Republican legislature. That is amazing, so a tip of the hat to John Kasich because that guy understood what he needed to do and he didn’t play politics, and he didn’t obey the political dictates of the people in his party, many of whom did block it in other states. It’s huge! That is so big, I mean so big, that so many people now who before could not afford it, either because they were too poor initially or because addiction had tapped out all their funds, can now get treatment. I think it’s a big … Here’s another thing I think that’s coming out of this. I believe that there will be far less support than a lot of Republicans believe for doing away with Obamacare because Obamacare allows states to fund addiction treatment, rehab treatment, and that was something that was denied to a lot of people. There’s a lot of people out there for whom this issue is enormous and a lot of people who are quite conservative for whom this issue is enormous. I’m not sure that, maybe in the next Congress, that the Republicans will find as much support as they think is out there for doing away with that because that’s a huge part now of the approach in many parts of the country.

Frank Greenagel: Yeah, you see that in Kentucky. The Medicaid expansion was hugely popular and so the idea that Mitch McConnell and some of the other Republicans there have talked about doing away with Obamacare but maybe they can keep the Medicaid. But really, the Medicaid expansion was a crucial aspect of the Affordable Care Act.

Sam Quinones: Exactly right. You talk about terminology that … We’ll call it this, we won’t call it Obamacare, but we’ll keep all the major provisions of it. I don’t know, but it’s dawning on me when I get to some of these areas that people are not going to go along with that. I’d be very surprised in some areas. Now, some areas maybe the problem isn’t as bad and so these folks may not have the political voice they might have in other areas, but my feeling is, yes. States like Kentucky. And certainly Ohio, John Kasich is roundly applauded by people in very conservative parts of that state because of what he did.

Frank Greenagel: I’ve been very critical of my own state governor, Governor Christie. He got a lot of press a month ago by giving an impassioned speech about his mother’s tobacco use and his law school buddy’s drug problem. Conservatives liked it and Democrats liked it and he was praised on MSNBC. I’ve heard the speech before, but when push comes to shove, he doesn’t fund anything. He still criminalizes marijuana; I’m for the decriminalization of it. He criminalizes marijuana, he hasn’t funded treatment bills, he resisted naloxone expansion, he resisted the Good Samaritan law. There’s point after point after point, so his rhetoric soars high above his actual policies. What happened after his speech is that politicians on both sides of the aisle have been tripping over themselves in announcing that they have a friend who is an addict. Or my family member is an alcoholic. I’d like you to speak to that. I know you like what Governor Kasich did in Ohio. Is there anyone else or anyone that has any kind of policies that said anything that seems to get it or is it all just a kind of campaign bravado, like I’ve seen from Governor Christie?

Sam Quinones: Regardless of what follow-throughs he did or did not do, the mere fact that people are beginning to talk about it is really important and remarkable. I don’t know his record in New Jersey in funding programs are and passing laws. I did think it was interesting to listen to him to say that because those words spoken 15 years before would have disqualified him from the Republican nomination. His campaign would have halted right then. Now, you can see these Republicans now are, again, as you say, tripping over themselves trying to tell the most gripping story of addiction in their family, which I think is a huge step forward. I really do. I think it’s very important. I don’t know that I see anyone who has understood the issue well enough. Nor do I even think Barack Obama does. I watched him at the Charleston, West Virginia town hall meeting that he held and it seemed to me that it was an issue that was far off for him. He did not feel comfortable with it, didn’t know how to pronounce Naloxone and this kind of thing. That’s understandable. He’s got ISIS. He’s got a million other things that are important, but it seems to me that it’s still in the phase where people are approaching this, or not entirely comfortable with this topic yet.

I’m not sure how you get there exactly, but I would hope that at a certain point people would come to the idea that they need to understand this in a deeper way, but that’s just where we are as a country. We do not understand this. I really didn’t understand it too well. I still have a lot to learn, I would say. I’m not proposing myself an expert on this. I’m not an addict myself, so I don’t have a deep reservoir of experience on all this. I look around the political stage and I don’t see a lot of folks, honestly, who figured this out.

Not long after the book came out, Hillary Clinton’s health policy campaign adviser called me and wanted to ask about what do we do about this. I gave her a bunch of policy prescriptions that I thought might have been helpful. I’m not a policy expert. I’m not the guy to set policy for a major presidential candidate, but I did feel like talking about it, getting it out there, making it part of the national discussion is necessary.

Here’s what needs to happen, though. All the people with a lot of stake in this game, and I mean counselors, public health people, and coroners, and judges, but above all, parents, need to make this, need to push this issue to the forefront. They’re the only ones who are going to do it. Candidates oftentimes follow what they perceive as the interests or the desires of whoever they seem to be talking to or whatever state they happen to be in. If you are not at a town hall meeting, if you are not at the campaign rally with signs saying, “What about addiction?”, “What are we going to do about the heroin problem?”, “What are we going to do about the doctors who prescribe this for wisdom teeth extraction?”, these pills, then it’s never going to be the issue that it ought to be. I think I would say that at the end, that basically this needs to be something really that is pushed by those actors who really feel it, who have to deal with it day-in, day-out, who have dealt with it day-in, day-out maybe for a decade or more now. They need to be the ones pushing that. If they don’t, I would say that I would find it hard to imagine it becoming the issue that it ought to be.

Next week: We discuss the collapse of American towns and communities, social isolation and what a friend of mine called “the American soul sickness.”

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Some final thought before the New Hampshire primaries tomorrow. Governor Christie was deemed by many to have won Saturday night’s debate, particularly in the way he dressed down Senator Rubio and exposed him as someone with canned, robotic statements. Christie hammered Rubio on the fact that he doesn’t answer questions, but rather digresses onto other topics. A few people that are up in New Hampshire wrote me and said that Governor Christie has sounded great all week and that he spoke movingly about addiction. I can not stress enough how he does not follow through with actual policy or significant funding. Here is a link to my appearance on NPR last November, where I gave very specific instances about that.

Both Governor Bush and Carly Fiorina have talked about addiction in their families. Despite their personal experiences, neither have offered up substantive policy recommendations. I wrote about that last month. Even though Dr. Ben Carson’s campaign is all but over, here is a link to his disastrous response about addiction treatment and policy.

I agree with Hillary Clinton wanting to move marijuana from a schedule I (completely illegal, no medical value) to a schedule II drug (controlled, prescribed, some medical value). Moving marijuana would allow for more research. While I disagree with the notion that marijuana can help 200+ medical conditions, I am willing to look at data that suggests it might help with 5 or 6 problems. Secretary Clinton is still woefully behind on Suboxone.

The candidate who probably has both the best understanding and track record about the Heroin Epidemic is Governor Kasich.

President Obama’s latest plan to combat heroin addiction was well received by most people in the treatment field, but I was less than pleased. You can read my reaction here.

On January 21, I attended a press conference at Damon House in New Brunswick, NJ, where Congressman Frank Pallone announced a package of bills to address the nation’s heroin problem that would be introduced to Congress a few days later (it would get lost in the shuffle of Obama’s announcement earlier this week – I’m unhappy how both of them approach Suboxone, and I’ve made my views quite clear). Joel Pomales told his story at that event, which I released here the next day. Larry Redmond, a veteran in long-term recovery, also spoke there and told a moving story about how his cancer treatment was paid for without question but that he had to fight every few days to get his son’s addiction treatment covered. He has graciously typed it up for me to publish here.

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My name is Larry Redmond. I am person in Long Term Recovery. In 1968, while serving in the United States Army, I was introduced to various drugs including heroin. Needless to say I became addicted to the heroin very quickly. In November of 1971, I entered my first rehab (Discovery House). In those days, the Therapeutic Community model was used. Programs like Discovery House, Daytop Village, and Integrity House all used a similar model of breaking the addict down and rebuilding their character. The length of time you spent in treatment was usually 18 months. Twelve months in the House and six months in the Re-Entry phase of the program. During the Re-Entry phase you did certain things that normal members of society did on a daily basis. You got a job, set up a budget, paid bills, and handled your other obligations.

You also had to learn to drink responsibly (editor’s note: TC’s stopped letting drug addicts drink in the 1980s). I was soon on my way to becoming an alcoholic. The next 15 years brought me to many Intensive Outpatient Programs (IOPs) and private counselors. I was put on a variety of various Valium-like drugs. At one point, I was put on methadone to treat my opiate problem. None of this kept me on the right track.

In 1986, while married to my second and present wife, I entered what was to be my final rehab. I credit my wife with saving my life. She gave me an ultimatum which brought me to a detox in Union, NJ and then to a rehab in Pennsylvania. I was there for 45 days and have been sober ever since. While in sobriety, I finished college and have built a great life with my wife and two children. I have served as an elected official: both on the Town Council and the Board of Education. I am currently the vice-chairman of the county LACADA Board and am an advocate with NCADD (editor’s note: these are both groups that deal with some aspect of addiction policy). I sponsor a couple of young guys in AA and attend two family support group meetings each week.

I could go on about my accomplishments and the depths of where I crawled out of but I would rather discuss my family situation. I first realized that my son was an addict when he was in high school. I am a cancer survivor who had a stem cell transplant (bone marrow) in 2010. While I was going through chemo in 2008, my son started getting into trouble. He also had left home a couple of times and was involved with the Juvenile Justice System. One morning, before we left for a court appearance he started throwing up. My wife thought he was sick because of the stress, but I knew. He had gotten into the pain medications that I had been given for my cancer treatment. I never even thought about locking them up. Even with all my knowledge, I fell victim to the same parental cluelessness that so many of us suffer from. Thus began our horrendous odyssey through the rehab and insurance system.

I don’t know who paid for my 1971 rehab stay. I never was asked for insurance information. I was not working and had no insurance. But I stayed in treatment for 18 months. In the beginning of our journey, our son was in Touchtone Hall in Northern New Jersey. I would have to get on the phone every 5 days along with staff at the rehab to fight for another 5 days worth of payment under the medical necessity rule. After a couple of weeks he left the rehab. He was sent there by the courts so he violated probation by leaving. Over the next few years it was the same story everywhere we went. He finally managed to get a three week stay at New Hope in Secaucus. He did not get better. He left and went to a variety of Florida rehabs. He got arrested down there. I did find that the Florida facilities found a way to take our insurance. I spoke about our issues at a parody hearing at Stockton University with Patrick Kennedy. He said he had heard our story hundreds of times before.

My son’s issues are not only drug related. He also has Bipolar Disorder. This did manage to get him on SSI and Medicaid. It was a little better than traditional insurance when it came to rehabs in NJ. He is in supportive housing for the mentally ill in Plainsboro, NJ, right now. After a stint in a mental health facility, he seems to be on the right path. He recently celebrated 90 days clean and sober and gave me my 29-year medallion last December. I still don’t know which made me happier.

We have a crisis in our state right now. There are nowhere near enough beds for the people who need detox and treatment and even less ways to pay for them. John Brooks Recovery Center in Atlantic City is scheduled to close this April. They account for 42% of the South Jersey beds and 33% of the NJ’s detox beds. If we want to save our state this needs to change. Let me put this in perspective for you. While my son was suffering from a life threatening disease, I had to fight for his treatment every five days and sometimes I lost the battle. When I was in the foremost cancer hospital in the world for my stem cell transplant for 32 days, that same insurance company paid a quarter of a million dollars for my treatment. I never had to pick up the phone. Stigma is the problem. Until we change that we will never solve the addiction crisis.

My three favorite disaster movies of the 1990’s were Jurassic Park, Independence Day and Armageddon. In two of them, Jeff Goldblum plays a scientist who furiously warns those in power about the impending doom that awaits all of them if they continue to ignore the reality of the situation.

The modern opiate epidemic has been with us since 2005 and has been in full force since 2010. It continues to get worse every year (I am simply defining worse here as more deaths and am not looking at other rampant problems such as declining academic performance, workplace productivity issues, a glutted criminal justice system, or over-crowded, poorly performing treatment programs).

The opiate epidemic has been covered in the media, has led to the deaths of several high profile celebrities, has caused law enforcement to change their strategies and policies, and it has become the current fad for politicians on the local, state and federal levels to talk about. More people died from opiate overdoses in 2013 than in 2012. More died in 2014 than in 2013. When the numbers come in, I expect this to hold true for 2015.

I get it. People are concerned and those in power are trying. We have made important strides in the areas of prevention, treatment, recovery support and policy development. I am extremely appreciative of all the media attention that has been given to the opiate epidemic. And the money that has been set aside is far better than it was in the past.

It’s not enough. It’s not enough.

Today, the White House announced a $1.1B spending increase to “address the prescription opioid abuse and heroin use epidemic.” There are numerous programs and policies that are going to be established, funded or improved upon, and many of them are really good ideas. If you break down the money, it works out to be $11M per state for two years. It’s not enough.

There are three key points that the Federal Government could address but have not so far:

1) Before we increase the number of buprenorphine scripts that MDs can write, we must mandate the urine screens and counseling along with it. I’ve written about this, most recently for Hazelden (in an article that has already become the one most ever read on their site).

2) Sober homes and recovery housing (and whatever else people want to call it) must be regulated. There should be no exemptions (Oxford Houses have avoided regulation). Regulations include adequate and clean living space, reasonable access to transportation, reasonable access to treatment, reasonable access to 12-step meetings, minimum staffing guidelines, supervision and regular urine screens. A majority of sober homes and recovery houses do not meet these basic standards, and several cases, they are causing harm.  They fight regulation claiming that these standards are too arduous and that they won’t stay open. Tell that to the parents of Chris Pesce, who died in a substandard sober house.

3) 49 of the 50 states have a prescription drug monitoring program (PMP or PDMP). Missouri does not. Only a handful of those programs are mandated, which means that the prescribers that are the worst actors with overprescribing are not checking the PMP nor entering information into it. I have told policymakers and politicians for years about the importance of having mandated PMPs in all 50 states and have them interconnected, so that as a clinician in NJ, I can check to see if my clients have gone to doctors or pharmacies in NY, CT, PA, DE, or MD.

We’ll finish with the immortal words of Richard Dreyfuss (Dr. Hooper) to the town mayor in Jaws (1:18 for those you that want to skip to it):

I think that I am familiar with the fact that you are going to ignore this particular problem until it swims up and bites you in the ass.

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

This is the third of eight articles from that interview. In the first article, we discussed the role of the pharmaceutical industry in the current American opiate epidemic. In volume two, we talked about race and how drug policies in the 1980’s with crack are very different than the 21st century policies surrounding opiates. In this third edition, we discuss how Mexican immigrants became some of the key sellers of black tar heroin, does supply or demand lead to bigger drug problems, and we briefly touch upon Donald Trump.

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Frank Greenagel: I appreciate your giving a contrast between the areas and the nuance of the violence issue. I want to stick with the race, though. You spent a lot of time discussing Mexican immigrants from the town of Xalisco. They are the major traffickers of black tar heroin, so anti-immigranters and Trumpsters would have a field day with that information. How should our drug policy address immigration issues?

Sam Quinones: Wow. I don’t know. That’s a good question. It’s possible that they will have a field day with it. My feeling is if I as a reporter, if reporters spent all their time worrying about how certain people might use the stories that they write, they’d never write anything. I just felt like I don’t bind myself that way.

Frank Greenagel: You just want to get the information out there.

Sam Quinones: I want to tell a story and I want to get the information out and these guys are, they’re not the only ones, but they are among the most important black tar heroin traffickers from Mexico. Particularly, years ago, before everyone figured out the market, they were really important. I’m not sure if I know what to propose with regard to immigration policy. I’ll tell you a couple of things. First of all, we have had a lot of arguments over the years, over the decades, about what comes first. What’s more important in igniting these drug scourges, is it demand or is it supply? My feeling is truthfully that it is supply. Supply creates demand, it’s not the other way around. This one was created by doctors prescribing way too much. Way too much. That massive increase in pills out there, and very, very liberal and aggressive prescribing, and a variety of things like that, all helped create new addicts. They were not addicted before they had an abundant supply available to them of these drugs and constantly having them pushed on them. It’s unclear to me that we would have much of a heroin problem if there wasn’t so much heroin splashing around the United States. Think again. My feeling, I’m not sure I had an answer to that question before, but after this, I definitely believe supply helps create demand. Then, demand goes wild. It’s also true with the Colombians and cocaine. We didn’t really have a big market for cocaine until the Colombians in the early 1980s forced all that coke through Miami and into south Florida, etc. Then, of course, there became a demand for it, but they, like all these drug traffickers, like great marketers, understand if you provide it and market it in the right way, you will find that people respond to it. For me, honestly, this latest one starts with doctors, doctors overprescribing way, way, way overprescribing for all kinds of things. You know probably as well as I do, wisdom teeth extraction, minor surgery, all this stuff that you used to get ibuprofen for, now you’re getting basically opiates for. That being the case, we have to keep in mind that traffickers will take this. That’s really what happened. The heroin traffickers follow the market for pills. I think that we need to understand that we have a border … We now have essentially a sealed border. I do a lot of immigration reporting along the border and stuff and I’ve been down to Tijuana several times. I know that city fairly well.

Frank Greenagel: That’s what your first couple of books were about, was about Mexico and some of the immigrant and border issues, correct?

Sam Quinones: Exactly. My feeling is that the border is sealed. The reason I say that is it now costs an immigrant $6,000-$10,000 depending on where they go and that kind of thing to cross, whereas not so long ago, it was in the $300-$500 range and then it got up to maybe $1,000 or $2,000, which was still fine, but now it’s well beyond a lot of immigrants’ ability to pay. The border is now effectively sealed. However, we have to always keep in mind that we will never really, really be able to seal the border, not if we want to have trade with Mexico. It simply won’t happen. I mean, there will be ways people and substances will leak across so it behooves us to understand that when we are designing new policies and drug policies in particular. When the FDA decides that this is a really good idea to market this stuff and to make this stuff available, they might want to take into consideration that there is going to be a black market in it. I just find it amazing that no one would have thought that. They might have, but they didn’t put enough emphasis on it. Getting back to your original point, I’ve had that question asked to me before and my feeling is that I really don’t care. I like stories not based on whether it makes a certain group look good or bad and I write stories that I think are great, great tales that need to be told that no one’s telling, and that’s what I think I did with this book. You can see my other books and see how that might reflect on Mexico and make your own decisions about the country, but I lived there for 10 years. I didn’t live there because someone put a gun to my head. I love the country, but I’m also not going to shy away when I see a huge story, no matter what Donald Trump or anybody else says or how they might use it. Otherwise, I’d never write a thing.

The Rutgers University Student Assembly (RUSA) passed a resolution on 1/28/16 that supported the sale of alcohol at campus athletic events. The story was reported on the cover of the Daily Targum the next day. The resolution does not immediately allow for the sale of alcohol at athletic events – this is something that needs to be discussed and approved by the athletic department, President Barchi, the Board of Governors and the Board of Trustees (I believe that the Rutgers Police Department has a vested interest as well).

RUSA stated that this would be a new source of revenue and that some of it should be directed at other campus programs, including the Counseling Center (an underfunded part of Rutgers Health Services that I worked at for 5 years). It’s a proposal that is not specific about the percentage of money that would go to campus programs, nor how many years that allocation should last. It’s an old trick. When a politician wants to pass a controversial measure, he will say that part of the revenue will go to support some underfunded venture that will benefit the public. This has happened with tobacco and the lottery in many states. It also happened quite famously with the casinos in NJ in the early 70’s – they were approved by voters only after the NJ citizens were promised that some casino revenue would go to fix NJ infrastructure and support public schools. It didn’t happen, and casino revenue eventually became an expected part of the government’s revenue stream and was cut up and applied to wherever those in power wanted it to go. This will happen if alcohol sales on campus become a reality. It will not go to the programs that are proposed.

Alcohol sales at college sporting events has been a topic that has appeared a few times in the news over the last couple of years. There was a quality article in the New York Times last fall which discussed the deliberation that eventually led to the sale of alcohol at West Virginia University’s sporting events. The following quotes are from an August 2014 ESPN story about selling alcohol at college football games:

“I know why the question is relevant for some,” Nebraska athletic director Shawn Eichorst said. “For me, the bottom line does matter. But at what point does it outweigh what you’re trying to do, trying to keep the civility?”

Using an oft-repeated sports marketing catchphrase, Akron athletic director Tom Wistrcill said offering beer is a way to “enhance the fan experience. You do it because, yeah, we want to make some money on it,” Wistrcill said. “But in this day and age, we’re going to fight the 60-inch high-def TV since every game is available on an ESPN broadcast or on the high-quality Internet. How do we keep people coming to the stadium for the in-stadium experience?”

I tend to agree with Mr. Eichorst and the desire for civility. I’ve attended well over 600 professional sporting events in my life, and the atmosphere has often been greatly diminished by the presence of multiple drunken louts. Granted, some of them showed up drunk from their tailgate parties, but a lot of them either got smashed or worse because of the alcohol they bought at the event. That said, the view of Mr. Wistrcill will ultimately win out on most campuses: pack ’em in and raise money.

So, universities are becoming more and more like corporations and politicians. It’s all about money. At least with whores you know who is paying and who is getting screwed.

From 2009 to 2014, I oversaw the day to day operations of the Rutgers Recovery House. It was both a pleasure and honor to do so. Rutgers was the first school in the world to offer specialized housing for students who are in recovery from alcohol and/or drugs. Immediately after I was hired, I began collecting data on the outcomes of our students. Three facts are particularly impressive

1) Students that live in the Rutgers Recovery House have a 95% abstinence rate from alcohol and drugs

2) Students graduate or return the next semester at a 98% rate.

3) The average GPA of a students in the Rutgers Recovery House is around 3.2.

The data is spectacular and those numbers hold true almost two years since my departure from that program. But the data does not capture the tremendous amount of fun that students have in recovery (hiking, going to plays, late night pancake dinners, biking trips along the canal, karaoke and softball events with alumni), nor does it capture the amount of service work that they engage in. The Rutgers students speak at a number of high schools each year about their experiences, and the hope is that those that hear them either (a) avoid abusing alcohol and drugs or (b) know that they can get help at an early age and rapidly turn their lives around. Some of the students engage in advocacy work and public service announcements. Two students appeared with me on 101.5 FM back in the summer of 2012 when we discussed the problems with prescription drug abuse. I have not figured out how to accurately collect long-term data on the Recovery House Alumni, but they are an extremely impressive group that have long term sobriety (multiple years, multiple decades), a plethora of graduate degrees, high powered jobs, and happy and stable families.

One recent alumnus (that engaged in the aforementioned PSA work) has anonymously written his story. He is the first of my Recovery Housing students to appear on this site, and I am ever so grateful for it. Without further ado, here he is:

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I was raised by a lovely family who instilled a sense of morals and values into me; if you looked at my upbringing, you never would have guessed that I would wind up addicted to drugs – either prescription or illicit. Aside from the fact that my parents divorced when I was 10, I couldn’t have asked for a better childhood. When the divorce happened and my life changed, I no longer felt like a normal kid. I was now the new kid in school. I didn’t fit in, I didn’t make friends very easily, and I didn’t know how to cope. I turned to what was familiar, what was comfortable, and what felt good.

At first it was food, then fantasy books, video games, porn, women, and a combination of all of the above. The problem was that each comfort stopped working and I had to find something new and exciting to get that ‘rush’ that would make me forget about what it felt like to be me for a few minutes. I was peer pressured into my first drink at 14 and I loved the effect. Shortly thereafter, I tried marijuana and loved that even more. I experimented with whatever I could find in anyone’s medicine cabinet that the internet told me would get me high.

My family life fell apart and I found myself slitting my wrists at 16 not as a cry for help, but as a malicious act intended to hurt those who loved me. I couldn’t love myself, and if I couldn’t, then nobody should. After some therapy and a particularly bad prescription drug abuse episode, I promised myself I’d stop drinking and using for good, which lasted about a month.

Despite my moral failings, I always performed well in school. I didn’t have to try as hard as other kids – I put in a few minutes of work and got good grades. As a result, my subpar effort landed me in the school of my dreams – the #1 party school in the country at the time of my application. I white-knuckled my way through high school and let loose in college. I smoked marijuana and drank every single day, and after a month or so I was regularly using Xanax, ecstasy, prescription painkillers, prescription amphetamines (Adderall), and cocaine. I was arrested twice for possession and I skipped more classes than I went to, although I was somehow able to maintain good enough grades to make dean’s list every semester.

Making money to support my thrill seeking habit became difficult – I had to lie, cheat, and steal on a more and more regular basis. Shortly after my 18th birthday, I found myself using heroin because prescription painkillers were too expensive and I needed higher and higher dosages to achieve emotional and cognitive equilibrium. I was arrested in the spring of 2010 for felony burglary, felony theft, criminal trespass, and criminal mischief. I went to jail, had a family member bail me out, and got high the minute I got home. The thought of not getting high had never crossed my mind as the thought had very literally never occurred to me that I might have a problem with substance abuse. My life spiraled out of control and I found myself reaching out for help when I feared for my cognitive ability because of the lingering mental effects of a methamphetamine overdose.

I withdrew from school, went to a 28-day rehab (most of which was spent stabilizing my drug-induced bipolar demeanor), and enrolled in a one-year extended care/transitional living recovery facility. I got a sponsor, attended 12 step meetings, and didn’t work the steps. I found myself in the psych ward when I was suicidal with a few months sober. I got a new sponsor, worked a few steps, got a job, attended classes, stopped taking medication, and my life improved incrementally. At about 10 months sober, I enrolled at Rutgers University and was accepted into the Recovery Housing program. I attended meetings, got a new sponsor, worked a few steps, and my life improved yet again.

I became able to form meaningful relationships with other human beings, perform with academic excellence, and rebuild relationships with my family. Through recovery and through the 12 steps, I learned how to live as a productive member of society. I showed up to every class, attended funerals for those I got sober with who relapsed, and learned that addiction necessitates (for me anyway) that the 12 steps are a life and death errand. Like a good alcoholic, I postponed the difficult steps. I studied abroad in a European country and had experiences I wouldn’t trade for the world. I attended 12 step meetings in a dozen countries, and met fantastic people.

I graduated Summa Cum Laude with two-hundredths-of-a-point away from a perfect grade point average and a technology job in hand. I received a plaque at graduation for having the highest academic achievement in my competitive major. This is a far cry from the young man who feared that he had permanently fried his brain as the result of drug abuse. I drove a nice car, had a phenomenal girlfriend, great relationships – everything external was ideal yet internally I was still unhappy and unsatisfied with myself. What gives?

I started my new job and showed up to a 12 step meeting and heard a well-accomplished man talk about his experience with finishing his stepwork and the fourth dimension of existence. I made a commitment to finish my steps as thoroughly as possible, and asked this man to sponsor me and guide me through the steps at 3 ½ years sober. Having had my own spiritual experience as the result of finishing my steps, I have had the distinct pleasure of sponsoring over a dozen guys who are just like me. I have been to an international 12 step conference, gone on 12 step calls in Asia, been promoted after one year in my career, competed in powerlifting at the national level, and have found the true and deep meaning of happiness and freedom.

Happiness is not what we have – it is giving to others what they wouldn’t have otherwise and might not know that they need. Today I have over 5 years of continuous sobriety and have accomplished quite a bit at the young age of 24. I look very much forward to what the future holds, because the more that I give, the better my life gets – and I couldn’t imagine life being any better than it is right now.

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Without treatment, stable housing and recovery support services, this man’s life and story would be very different. The story of his family would have been radically altered as well, because he possibly would be on the streets, incarcerated or dead. Instead of attending another court hearing or a funeral, his parents were able to attend his graduation from college (it wasn’t the year in the link, but the story gives you a strong idea of what the recovery graduation ceremony looks like). Because of early intervention, treatment, housing and recovery support services, this man has been sober for over 5 years. He has not been arrested in that time. He helps other people get and stay sober. He has a job and pays taxes. His recovery has been an awesome return on the investment of those services. People don’t just get better; they can become extraordinary. 

Ever since I started working in this field, I’ve talked to people who have had their treatment determined and dictated by insurance companies rather than health care professionals. When I began to engage in policy work at the state level, I was astounded by the number of people who told me horror stories about the limited amount of care (too short), different (wrong) level of care than was professionally recommended, or altogether denied.

One mother has had enough, and she has found a lawyer that is willing to bring a class action lawsuit against the insurance companies. She needs to hear from others who have dealt with similar problems. Her message, form, and email address is below.

I am not part of this lawsuit because I want to be able to write, speak and testify on behalf of it. I am sharing this information to help Valerie get this started. It is a worthy cause that I hope hundreds of people take part in. This is America. You can get justice.

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DO YOU KNOW OF SOMEONE WHOSE ADDICTION AND/OR MENTAL HEALTH TREATMENT WAS DENIED OR CUT SHORT BY THEIR HEALTH INSURANCE COMPANY? INSURANCE COMPANIES FREQUENTLY VIOLATE FEDERAL AND STATE PARITY LAWS BY DISCRIMINATING AGAINST PEOPLE WITH ADDICTION AND/OR MENTAL HEALTH PROBLEMS.

PARITY LAWS REQUIRE THAT PEOPLE NEEDING TREATMENT FOR ADDICTION AND/OR MENTAL HEALTH ARE TREATED IN THE SAME WAY AS A PATIENT NEEDING TREATMENT FOR A PHYSICAL ILLNESS SUCH AS DIABETES, CANCER OR HEART DISEASE.

Four years ago, when our sons were teenagers, they became addicted to opiates and other substances. We tried to get them into the programs their addiction specialist recommended but their treatment was denied by our health insurance which claimed that their conditions did not meet the medical necessity criteria. We have been working through the lengthy and exhausting appeals process since then. We feel very grateful that we were able to find the funds to pay for their life-saving treatment but we know that many others cannot do this and as a result, without treatment their or their loved one’s disease progresses with outcomes such as jail or death. We believe that our sons’ treatment was denied wrongfully and we know there are many others who are in our position.

We have found an attorney who is willing to bring these denials to the attention of the New Jersey Attorney General’s office, (at no cost) so that an investigation of these denials can begin. Hopefully changes will be put in place to ensure that treatment is provided properly by insurance companies in compliance with Federal and State Parity Laws. Please let me know if your or your loved one’s treatment was denied also, by answering the questions below and returning them to me at:

[email protected]

Every life is valuable. Together we can make changes to save lives.

Thank you,
Valerie

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Type of treatment denied: Outpatient______ Inpatient________
Was treatment denied _________ or cut short________________ (how many days/weeks were approved?) ____________________
Was treatment for addiction? _________ mental health? ______________ both? _________
What year was treatment denied? ______________
Which State do you live in? ____________________
Name of health insurance which denied treatment: _________________
What happened to the patient as the result of the denial of this treatment? _____________________
How may I contact you? First Name: _________________ Email address: _________________
Phone #_______________________

click here for word version of this letter and form

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

This is the second of eight articles from that interview. In the first article, we discussed the role of the pharmaceutical industry in the current American opiate epidemic. In volume two, we talked about race and how drug policies in the 1980’s with crack are very different than the 21st century policies surrounding opiates.

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Frank Greenagel: Heroin has plagued minority communities for years and neither the media nor the government said or did much about it. It kind of reminds me of Richard Pryor, who had a stand up bit in the early ’80s where he talked about how white people would drive around black neighborhoods and say, “Look at those people. I can’t believe that.” Then they’d go home and find their 15-year-old son using cocaine and saying, “Oh my God, it’s an epidemic!” I found the same thing with prescription pain killers. They introduced a wave of suburban whites to opiates and they began to die in droves. Now, the media and the government in this century have really started to address it. When you combine this with the fact that blacks and Hispanics have higher rates of drug arrests and lower rates of treatment, some would argue that our drug policies are still, today in 2015, intensely racist. Any comment on that?

Sam Quinones: Let me put it this way. Heroin is no longer a problem in the black or Latino community. It has not been a problem in those communities for many years, so if we’re just talking about heroin, part of your analysis isn’t quite right there. However, what is correct is that conservatives, middle of the road even, maybe even some Democrats, in many parts of the country did enact very stringent drug laws back when the majority of the people who were involved either as users as dealers in those drugs, primarily cocaine and crack, were African American. I’m talking about of course the Reagan years and after that. I have found it interesting, let’s put it that way, to see people at meetings and speeches I’ve given and public events that I’ve been at or sometimes when I’m speaking stand up and say, “My son is addicted and the only thing he has available to him is the street or incarceration, jail or prison.” My response to that is that is exactly the approach that we have decided to take as a country dating back to the mid-1980s. Nowhere in those years did you find a huge amount of support for treatment, though a lot of folks were addicted to crack cocaine. They were perceived to be not worth our treating, apparently. We now have an entire population of the country that has come to realize that the policies which either they, or their parents, or their representatives for many years supported are actually now having an enormous negative effect on their own families because their families really don’t have ability to put their addicted loved ones into treatment of any kind. Now, there are a couple other caveats, though, and this is how this is a little different. This is not easy. This is not easy, so I hesitate agree entirely with that analysis. Whenever I think I have an easy answer when it comes to this problem, I know I’m wrong.

There’s another few things that influenced what was going back in the late ’80s and early ’90s dealing with crack cocaine. Crack cocaine caused probably the biggest eruption of public violence since probably Chicago during the 1920s during prohibition, or Miami in the early ’80s when the Colombians came through. I was a crime reporter during the crack years in a town that was mightily effected by that in Stockton, California. I can tell you it was … It went through neighborhoods like a hurricane and those were not white neighborhoods. They were black neighborhoods who were mightily effected by this. Kids getting killed; gangs forming that had never formed before; drive-by shootings; bullets whizzing through apartments killing kids, paralyzing kids. Those laws were largely in response to the massive destruction caused by public violence related to the crack trade that was taking place in primarily black but also Latino neighborhoods, certainly in the town that I was in. It was there where you had long rows of dealers out on the street selling very blatantly. Every house that was rented, if it remained vacant for two weeks, it was overtaken by crackheads. There were a lot of reasons why draconian laws were put in place and one of them was that the crack years created public violence that was extraordinarily horrifying. Those crime rates have dropped significantly. I live in Los Angeles. We have the lowest crime rate since the 1960s, since Leave It To Beaver was on the TV. That motivation of “we need to put people in prison because our crime rate’s out of control” is no longer there. This epidemic has been characterized for the first time since I can remember a complete lack of public violence, very very little. You don’t find drive-by shootings. You don’t find carjackings. You don’t find any of that. It’s all very quiet. People are mortified, they don’t talk about it, there’s no public violence to outrage the public, to motivate public officials, any of that. There’s quite a bit of a difference here.

I remember because I was a crime reporter during those years. It was a scary damn thing to go into a crack neighborhood. You never knew what was going to happen. Every kid had a gun, they were all selling dime bags of crack. It was out of control and that was a black neighborhood. The black residents of South Stockton were some of the most conservative, as I remember, when it came to issues regarding incarceration because they had to live with it. They had to live with it every day and it was their kids who were getting chewed up by that crap. The laws that were passed back then I think missed the boat significantly, completely, when it came to treatment, but it’s also true that these were laws that were in large part, I believe in areas where I was, brought on by demands from the black community to get tough on the issues related to crack and crack-related violence and gang violence.

I can imagine that if there were a lot of public violence associated with this epidemic that you would not be seeing the move to change the laws the way we’ve seen. That said, it’s also very, very true, as you say, that there is a movement among suburban and rural whites, often in very conservative areas, to find new approaches, non-incarceration approaches to people who are addicted. That is because, as you correctly say, all their kids and their neighbors and their people they know from church, etc, etc, quarterbacks from their high school are the ones getting addicted now. They see it. It touches them. No longer is it somebody in some black neighborhood in the middle of the city that’s getting effected. It’s the pastor’s kid. It’s the insurance salesman’s kid, the doctor’s kid, the farmer’s kid. That has ignited a real strong interest in what is available for those folks. Again, as I say, so I often hear people say the only thing that’s available for my son is incarceration or the streets and that’s because that’s the system we have created over the last 30 years. Now people are saying we need more.

I attended a press conference today at Damon House in New Brunswick, NJ today where Congressman Frank Pallone announced a package of bills that he would be introducing to the floor of the House of Representatives on Monday. His bills address heroin and opiates and not only provide some new laws and programs, but also real funding for existing programs. I’ll provide my reaction to those proposals in a future piece. Mr. Pallone also acknowledged the pioneering work of my former boss and mentor, Lisa Laitman. Ms. Laitman spoke about the Rutgers Recovery House and the need to continue to provide recovery support services. Joel Pomales also spoke at the press conference about his own addiction and recovery. I was immensely pleased with his speech, and he has agreed to let me publish it here (with a few edits). I’ve known this young man for a few years, and I’m pleased to call him a friend and colleague.

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My name is Joel Pomales and I am a recovery advocate here in the state of NJ. I am an advocacy leader with NCADD-NJ and YPR-NJ. I am also a person in long-term recovery since July of 2011. Which means I have abstained from using alcohol as well as all other illicit substances. Recovery for me also means replacing old negative attitudes and behaviors with positive healthy new ones.

Recovery was the solution to my problem and I didn’t know it existed for a long time. This is because I was misinformed and uneducated on Substance Use Disorders (SUD). It was not until I was in treatment for the second time at 25 years old that I learned that I had an illness that needed to be treated. For most of my life I thought drugs are bad, people who use drugs are bad, and I must be a bad person because I use drugs.

A big part of addressing the epidemic our society is facing today is education on SUD across the board, from medical professionals, to elected officials, law enforcement, community leaders, educators, parents and students.

Now I was asked to come share a bit of my personal experience and also talk about the need for expanded access to treatment and recovery support services. One of the major problems with access to treatment is the lack of parity we face with insurance companies not providing necessary coverage for treatment. My first time in treatment I was 15 years old. The health insurance my family had only covered me for 8 days out of the recommended 28 day treatment stay, surely not enough to treat my illness adequately. When I was discharged I was told to go to 12-step meetings and was provided with no other recovery support services. I maintained recovery for 40 days and relapsed.

I wish there had been a recovery high school for me to go to rather than my old school. I wish there had been a recovery community center that I could have connected with to help me in my recovery. But there wasn’t.

I was introduced to recovery again 10 years later. Unfortunately, during those ten years I went on to get arrested nine more times. I was arrested twice before my first stay at treatment. I was never arrested for anything other than either possession or possession with intent to distribute. The distribution came from me having to support the amount I was using. I was never arrested for a violent crime. Not assault, not theft or burglary. Nothing other than drug charges. Not once during my many arrests was the option given to me to go to treatment. Never the option, let alone was it ever even suggested. It was always fines, probation, or serving time in the county jail.

We need to continue moving toward treating this illness as a public health issue rather than criminal justice issue. I was a sick person who needed treatment, not a bad person who needed punishment.

There are a few major problems we need to address, I touched on insurance parity and SUD education. We also need oversight of treatment facilities to ensure quality care is being provided, this issue doesn’t fall solely on insurance providers. A major issue we face is on the back end here. The majority of individuals who are in treatment at this very moment, easily 70%, have already been to treatment before. Which means they are either not receiving appropriate treatment, or they are not being provided the recovery support they need when they leave. We need to move towards a recovery oriented system of care.

The length of inpatient treatment needs to be increased, and we need long term aftercare programs combined with recovery housing for individuals for up to one year. The acute care model of treatment needs to be abandoned for a long-term care model which is going to empower individuals to sustain long term recovery form their illness.

We need recovery housing for individuals. We also need recovery high schools in every county. We need recovery community centers, where individuals will be provided with services which will equip them with the tools to sustain long-term recovery.

And lastly we need to address the stigma associated with this illness. We need an entire shift in public perception. It is crucial for people to know SUDs are an illness and not a behavioral or moral issue. We all need to work together: law enforcement, community members, insurance companies, and treatment providers. Once we have people properly educated on this illness, and when people have access to treatment as soon as they need it, once we have recovery become part of the culture and a part of society, then you will see a major shift in the epidemic we are facing. We need people in the public eye living and promoting drug free lifestyles, making it attractive, making it cool, and we will see change.

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

I had originally intended to have Addiction Professional publish this, but they said it was too long (just under 10,000 words) and too steeped in policy. I offered it to Hazelden, but they said it conflicts with their own publishing house. After some thought, I have decided to publish it as a series on my site throughout the winter of 2016. This is the first of eight articles from that interview. We discussed the role of the pharmaceutical industry in the current American opiate epidemic.

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Frank Greenagel: The history of pharmaceutical marketing and the work of Dr. Sackler was fascinating. It’s astonishing that he was able to use the money he made from marketing to buy a drug company. Years after his death, his company released Oxycontin in 1996. When I present on opiates, I talk about how Purdue Pharma, which clearly overstated the benefits and understated the side effects of Oxycontin, had to pay a $600B+ fine in 2007 but did not really change their behavior. I also mention that Purdue makes Subutex strips and I leave it up to the audience to form their own opinion about that. How much blame, and I know you can’t put a percentage here, but how much blame should be placed on Purdue and Big Pharma for the current opiate epidemic in America?

Sam Quinones: If it was only one company doing this, we would not have the problem we have today. Let’s put it that way. They were greatly helped by pain specialists who appeared to be independent, who were saying that we were a country in pain, an epidemic pain. They stated that these pills were now virtually non-addictive when used to treat pain. I really believe had it not been for that message being broadcast by pain specialists, Purdue would never have been able to convince doctors that these pills were virtually non-addictive. That said, it’s also very clear to me without the money, essentially the megaphone of Purdue Pharma, without use of techniques that are probably far better suited to over-the-counter medication, that the message of the pain specialists would also never have gone anywhere. Let me just say this also, though. I believe they happen to hit at a time when Americans really, really wanted to hear the message, which was that we were entitled to a life without pain. Americans, health consumers, patients, really wanted to hear that. It sounds great when a doctor says “now we know that these are non-addictive, so don’t worry. You can take these for any pain that ails you.” Americans also did not feel the need to be accountable for our own health decisions. A doctor might say part of your pain comes from the fact that you’re obese and you don’t get enough exercise and you eat poorly and you smoke. It was easier not to hear that and hear that “now we have a pill that will take care of your problem and we know now that it’s virtually nonaddictive.”

Frank Greenagel: The marketing of the pill, do you think that the benefits were pushed so much that the doctors were encouraged to not even look at the behavioral issues? Or do you think that ignoring the behavioral issues was just a fallout of the fact that they were overworked and didn’t have enough time to work with the patients and patients didn’t want to hear that anyway?

Sam Quinones: I think all of that is correct. I hate to be skimping or shrinking from the question, but it’s true. All of that is correct. There were patients with pain problems that were taking huge amount of time from doctors, time that doctors didn’t have. There was a feeling that this was a way of getting them out of the office, it was what the patients wanted to hear. I’ve got a solution for pain. Thank God, finally, I’ve got a solution for my pain. Let me put it this way. This is a nationwide thing. It goes from Maine, to southern California, to Alaska, to Atlanta. The only way you’re going to be able to create that kind of blanket response and therefore blanket problem that we’re now facing today is when a whole lot of factors come to play. It’s not one boogeyman. What I set out to say in my book was that there are a lot of factors in this. Hollywood is used to showing us one bad guy who is very easily identified. That’s not the way, I think, a lot of social problems work, particularly not one that goes all across the country and effects millions, if not tens of millions. That doesn’t mean that individuals don’t play an extraordinarily important role, and I tried to find that as well, but I’m also not believing that a problem of this magnitude, this widespread, is caused by one small factor. It’s a combination of factors, all of them working together to produce what we’ve got here.

Frank Greenagel: One follow-up on the Purdue question is that I’m sure you’re aware of the law suits that were filed by Santa Clara and Orange County and then the City of Chicago last year. Basically, they sued the biggest five pharmaceutical companies, of which Purdue Pharma is one of, for exaggerating the benefits and understating the harms of these drugs. It seems like the government’s come out at least with a boogeyman and I think part of it’s that city and county and state budgets are all suffering and they’re saying our workman’s comp costs are really over the top and our healthcare costs are over the top, so we’re going to go after you. Do you have an opinion on those law suits or do you have any thoughts about what’s going to happen with them?

Sam Quinones: I don’t. I was waiting to see what would happen, if they proceed. At that point, I was going to find out more about them basically. To me, it felt like I’d seen this before and they’d all been stymied. Frequently, they’ve been stymied, these law suits, and so I was just going to wait and see. Here’s the issue. This is a classic example of corporate welfare, where the profits accrue to a small number of private companies and the costs are borne by the public sector, coroners, jails, courts, public health offices, county hospitals, etc, etc. You can go on and on. Therefore, I would imagine that they will see more of those kinds of law suits I would think.

Frank Greenagel: Now, when someone says corporate welfare, conservatives get very upset about that notion and they’re not able to hear it, so is there another way that we can phrase this so that members of that party would be able to hear it and address it better or do you think it only gets addressed when…

Sam Quinones: No I don’t care. I really don’t care how they want to hear it. Really. This is a classic example of capitalism twisted, where the real price … Here’s the issue. If you’re a true conservative, you want truth in pricing. The real price of those drugs is astronomical if you consider the cost of what’s happened because of their marketing in this way. These are not cheap drugs. They may be cheap … Their price looks cheap, but their real cost, if we were to really factor in all the costs that have been borne by people who had to pay in a variety of ways, taxpayers and other folks, who had to pay for what this has created. It’s a classic example of the risks being pushed onto the public sector and benefits being accruing almost entirely to a few companies in the private sector.

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Part two will be published next week and is entirely on the topic of race and drug policies. Mr. Quinones talks at great length about how the current heroin epidemic is very different from the crack epidemic of the 1980’s.