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For the fifth year in a row, the state of West Virginia’s indigent burial-assistance program was about to exhaust its funds from interring opioid-overdose victims.
It is now the leading cause of death for Americans under the age of fifty, killing more people than guns or car accidents, at a rate higher than the HIV epidemic at its peak.
I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame.
a pill marketed as both a cough remedy and a cure for the nation’s soaring morphine epidemic, known as “morphinism,” or soldier’s disease.
heroin. It was sold widely from drugstore counters, no prescription necessary, not only for veterans but also for women with menstrual cramps and babies with hiccups.
which the economists later referred to as “diseases of despair.”
statistically significant enough to reverse “decades of progress in mortality.”
This money would go on to build many of the nation’s first railroads, mines, and factories.
for eight years you could buy heroin at any American drugstore or by mail order.
The addicted were now termed “junkies,” inner-city users who supported their habit by collecting and selling scrap metal. The “respectable” upper- and middle-class opium and morphine addicts having died out, the remaining addicted were reclassified as criminals, not patients.
pain as “the fifth vital sign,”
patients as health care consumers
treat pain liberally or risk losing reimbursements.
“I can remember telling my residents, ‘A patient can’t get hooked on fourteen days’ worth of [opioid] pills.’ And I was absolutely wrong.”
prescribing physical therapy, anti-inflammatories, biofeedback, or acupuncture as a first-line measure
American insurance companies in the age of managed care were more likely to cover opioid pills, which were not only cheaper but also considered a much quicker fix.
the higher the milligrams a doctor prescribed, the larger the bonus.
“nerve pills,”
New patients were given OxyContin “starter coupons” for free prescriptions—redeemable for a thirty-day supply—
Since the first piece of coal was chiseled from the first mountainside rock by a large out-of-state corporation, the region had suffered from a pattern of exploitation,
FDA regulators and Big Pharma executives had been quietly holding private meetings at expensive hotels at least annually since 2002,
allowed drug companies to weed out people from their studies who didn’t respond well to their drugs, therefore tipping the balance toward FDA approval of new drugs—and away from science.
Giuliani’s job was to convince “public officials they could trust Purdue because they could trust him,”
Being fit brought Spencer a feeling of confidence as he left for prison, where he hoped to finish his bachelor’s degree. After his release, he planned to dedicate himself to helping young people with addiction, in memory of Scott Roth.
the invisible hand manifested in soaring crime, food insecurity, and disability claims.
well-intentioned but ultimately disastrous way of incentivizing poor people to stay sick, with mental illness and chronic pain
mental health and substance use disorders—prompting the majority of disability awards.
some parents coaxed their children’s doctors toward ADHD diagnoses, knowing that such behavioral problems could help make them eligible for Social Se...
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A hospital administrator I know from nearby eastern Kentucky recalled a Drug Abuse Resistance Education officer asking her high school classmates what they wanted to be when they grew up. “A drawer,” one young man said. “You mean an artist?” “No, a draw-er.” Someone who draws disability checks. It was the only avenue he could imagine for himself, the only way to get himself and his family fed. Well over half of Lee County’s working-age men—a staggering 57.26 percent—didn’t work. (The trend line was somewhat better among women, around 44 percent.)
By 2016, for every unemployed American man between the ages of twenty-two and fifty-five, an additional three were neither working nor looking for work. Having dropped out of the workforce entirely, they had numerically vanished from the kind of monthly jobs reports touted by politicians and reporters.
Many turned up instead in disability statistics, which were largely ignored in headline-grabbing economic reports.
meth keeps you going if you need to run the streets to go get your next dose of heroin or pills, to keep you from getting sick. It allows you to function. There’s a reason they call it ‘high-speed chicken feed.’”
Our culture seems to excuse drug- and other risk-taking in white middle- and upper-middle-class kids, especially young men.
The same liberties, when taken by rural poor whites or people of color—wherever they live—come across as more desperate, born of fundamental wants or needs that can’t be satisfied.
People whose parents or grandparents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, with genetics accounting for 50 to 60 percent of that risk,
especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities,”
Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today
the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.
users had ready access to money.
That made them a valuable currency, tradable for money and/or other drugs.
Between 1991 and 2010, the number of prescribed stimulants increased tenfold among all ages,
“In the short term, kids and parents and even teachers may feel better” about Adderall’s ability to enhance memory and attention, Lembke said. “But studies show that over the long term those kids don’t do any better in school than people who don’t receive stimulants.”
After snorting the crushed-up Oxys, inhaling the heroin powder was easy—and the heroin was cheaper, more intense, and, increasingly, it was everywhere
You don’t yet know that the first time is the best.
After that, you’re just chasing that first high.”
“The cellphone is the glue that holds it all together for the modern drug user,”
“I stayed away from my other friends because what do you say when people ask you, ‘How are your kids doing?’”
A 2017 New Yorker profile of Martinsburg by Margaret Talbot opened with the synchronous thud of two Little League parents who had fallen from the bleachers after overdosing at their daughter’s softball practice, their younger children running around and frantically screaming, “Wake up! Wake up!”
But to get the worst offenders off the streets, investigators typically need witnesses in the form of user-dealers.
his real name was Ronnie Jones.
