Pistolville (2): A World of Pain
The Flight From Pain Creates an Ocean of It (part two of a three-part series)
Feeling No Pain in the Sunshine State
Maybe it’s the sunny vibe of our tourism brochures, but Floridians — wherever they started from originally — sure love feeling no pain.
And where sunshine, tall rum drinks and perhaps a little weed used to keep a tropic buzz going, twenty years ago we saw the advent of a brand new absolutely devastating feel-good pool toy: opiods.
Back in 1996, Purdue Phrama released OxyContin, a controlled release form of the narcotic painkiller oxycodone. Citing a one-paragraph note in an obscure medical report that stated that opiod painillers were not addictive when taken as prescribed, Purdue’s marketing department flooded doctors across the county with free meals and promotional videos touting the wonders of their safe new miracle drug. In 1996, Purdue spent $700,000 to advertise OxyContin; five years later Purdue was spending $4.6 million on their ad budget. Soon, Purdue had its first billion-dollar drug.
OxyContin was a time-release opiod, and its selling point was that it delivered the goods slowly, over time, in order to prevent abuse. But the instructions that the pills should not be crushed and ingested that way was a dead-giveaway to addicts seeking a workaround to glory.
And nowhere did pain pills find a more receptive — and lucrative — market than in Florida. In 2010, Florida was the leading pill-mill distributor in the country, with 93 of the nation’s top 100 oxycodone-dispensing doctors doing business in the Sunshine State alone.
“Patients” flooded into Florida from all over the country to score the opiods. By 2011, Florida had 856 pain clinics, 13 in Lake County alone.
In one Florida clinic, investigators found that in the first six months of 2010, 1,906 patients from 23 states and across Florida made 4,715 visits. Patients who paid the clinic an estimated $850,000 in fees during that span received prescriptions for more than 1 million OxyContin pills.
In 2010, seven Floridians were dying every day of prescription medication overdoses. Alarmed at the news, Mount Dora’s council voted that year to impose a moratorium on permitting any new pain medication clinics to operate in the city.
Then things began to change. Stung by lawsuits that were beginning to take a toll — a 2007 settlement for $130 million for fraudulent marketing, followed by a $600 million fine from the government — Purdue changed the formula of the drug to make it resistant to abuse. No longer could the pills be crushed and snorted or injected.
In 2011, Florida law enforcement started cracking down, and state attorney general Pam Bondi pushed several bills through the legislature to severely limit sale of the drugs and requiring pharmacists to log sales into a statewide database monitored by the Department of Health.
By 2014, sales of oxycodone had dropped from 527 million in 2011 to 313 million. The number of pain clinics reduced to 367. OxyContin overdose deaths plummeted.
Unfortunately, with the sudden restriction of prescription opiods from the state’s diet, people with legitimate pain issues found it increasingly difficult to get prescriptions filled. After Walgreens paid an $80 million fine in 2013 for allowing so many prescription painkillers to reach the black market, pharmacies around the state keep the dispensing lid very tight. Unfortunately, the miracle drug came and passed through the hands of those who needed it most.
But the other, much bigger and far less anticipated problem was that black tar heroin — potent (90 percent pure) and cheap (as low as $10 a dose) — became widely available right when all of those people who had become addicted to opiod prescription medications could no longer easliy get them, whether over or under the counter.
Enter our state-wide dance with H. Heroin overdoses in Florida have steadily grown — 60 in 2011, 199 in 2012, 292 in 2013, 447 in 2014. Other areas of the country were more impacted first — in New Hampshire, Manchester police chief Nick Willard calls the pandemic of heroin-related deaths “an apocalypse.” From 2010 to 2014 there was a 3-fold increase in the number of heroin overdose deaths in the U.S.A., with 10,574 heroin overdose fatalities in 2014.
Orlando is one of the H-hotspots in the state, with 84 heroin-related deaths last year. On one day alone, 11 people in Orange County overdosed on heroin, and three of them died. 2,000 people jailed in Orange County in 2015 admitted to heroin addiction. Yet the problems of heroin still remain too far under the radar. “Heroin is a serial killer in our community,” said Orange County Mayor Teresa Jacobs, “and few people recognize it for that.”
So far, heroin hasn’t spread through Lake County as it has in Orlando. According to Lt. Joe Iozzi, patrol services with the Leesburg police department,
We have heroin related calls/cases, including overdoses and the like. We partner with the Lake County Narcotics Task Force and maintain our own Violent Crime/Narcotics focused Task Force to remedy those problems. We continue to seek out ‘hard drug’ as a primary focus and follow trending patterns in Central Florida as well. We experience other crimes, including but not limited to burglary/theft/robbery/aggravated assault etc., that have a nexus to narcotic activity. I wouldn’t be able to differentiate which narcotics, if not all, are being abused by those who commit these crimes however.
Rebecca K. Nathanson is Criminal Justice Program Manager at Lake-Sumter State College. She told me in an email,
I don’t have access to current information regarding (heroin-related) arrests, medical calls etc. that might support an answer to your question. But I can tell you that the uptick in heroin related crimes and deaths is here in Lake County if it is evident in the greater Orlando area. It is a direct result of the OxyContin/oxycodone/pill mill over prescription problem of several years ago. If the numbers aren’t large here yet, they will be. This is a growing problem everywhere, Lake County will be no exception.
Why should Mount Dora care about this? The city sees very little violent crime, and drug overdose deaths are rare. However, burlgaries and car break-ins are becoming more routine, and you have to wonder whose need our city is supplying, and how close to home it may be.
Also, it’s getting hard to find anyone in Central Florida who doesn’t know of someone who has gotten snared in opiods and got lost down that road. When one of my cousins maimed his hand in a garage-door accident in 2004, he was prescribed opiod pain pills and became addicted. That began a ten-year spiral that ended with divorce, homelessness and then death. Last year, another of my cousins’ son died of a drug overdose so sudden heroin was surely the culprit, although the family has never said.
That’s part of the problem — the family shame. Where others might have benefitted from their witness, their fate is largely kept secret.
Only those secrets are getting harder for communities to hide.
Turning Your Brain Back On
Pastor Gary Ridgway runs Spirit of Life Recovery, a 60-bed faith-based recovery center for men in Mount Dora right next to Lake Ola. Currently men aged 24 to 74 are in treatment, which usually lasts for 9 months.
“98 percent of the guys we see are cross-addicted to both booze and drugs,” he says. “They’ll take anything they can get their hands on.”
Ridgway says that when he opened the center 17 years ago, heroin was nowhere on the radar. “Back then, it was all cocaine and pot and alcohol. Heroin was expensive and heavily stepped on (impure). “
Back in the late ’90s and ’00s when pain pill clinics appeared all over the state, Oxycontin drug addiction took off. “People who used pain pills were looking for any way to turn their brain off.”
After Governor Scott saw to the closing of Florida’s pain pill clinics, black-market prescription pills got so expensive that opiod addicts looked for other solutions. The black tar heroin from Mexico is cheap, easy to find, and 30 times stronger than it used to be. And now there’s the synthetic drug fentanyl which is 50 times more potent than heroin. He says he’s even heard of pot getting laced with fentanyl.
Heroin has yet to take over Lake County’s current drug of choice, crystal methamphetamine. According to Ridgway, “Lake County is the meth capital of Florida. “
“Meth used to be only for bikers, and scoring it was fraught with difficulty and danger,” he says. “Now you can buy it off the Internet. Housewives started taking it because it livened up their day. Husbands found out about it and started taking it too.”
Meth is manufactured in “superlabs” in Mexico, but a home brew of it can be made in kitchen and car labs using over-the-counter medications and noxious chemicals like acetone, ammonia, and ether — chemicals which can poison spaces long after the labs have been shut down.
The downward spiral of meth addiction is exceptionally steep and dire. Chronic users suffer insomnia, mood disturbances, and violent behavior; they become psychotic; they lose weight, their teeth fall out, and their skin becomes filled with sores. There are permanent mental effects. “The best you can hope for with a recovering meth addict is diminished capacity,” Ridgway says.
For all the addicts who make it through Spirit of Life Recovery’s doors, most have gone through detox in hospital facilities (“a very dangerous process”). Recovery at Ridgway’s center means immersion in 12-step recovery programs and finding deep roots in the church. Patients attend counseling and attend classes in things like parenting and GED preparation.
“They have to get settled down emotionally,” he says,”and they have to get a job. Real recovery means real work.”
The Dark Side of White America
Over the past 15 years, middle-aged white people in rural America — folks in their 30s, 40s, and 50s — are dying at significantly higher rate than in the past. For rural white women in their 40s, the rate is up by 30 percent. For all other groups — African Americans, Hispanics and even older white Americans — death rates continue a historic decline.
Big cities and suburban communities — where economic opportunity is the strongest — are demonstrably healthier than their rural peers. There the mortality rates for middle-aged white people are declining at the same rate all other races are seeing across the country.
So what’s killing rural white folk? Opiod prescription and heroin overdoses. Alcoholism (deaths from cirrhosis of the liver for rural white women in their early 50s have doubled in 15 years). Suicide among these people is rising, and obesity is taking its toll.
Beneath the spike in death statistics is a monstrous underworld of suffering, says Princeton University economist Anne Case, lead author of the study late last year that first drew attention to the alarming trend. “It’s not just mortality — it’s also morbidity. there are million of people underneath these graphs who are in pain.”
Now here’s a scary fact: If you take a map of the country and color in those areas where Donald Trump has done the best in his effort to win the Republican nomination for president, those areas will correspond closely to those areas where the middle age white death rate is soaring the highest. (Source: Washington Post)
That research also showed those counties where middle-aged whites had fewer bachelor’s degrees than the norm, had fewer employed on average and had lost manufacturing jobs.
Donald Trump’s message — fighting free trade deals, closing the door on immigration, repealing Obamacare, reforming the Veterans Administration, protecting guns while going after criminals, reforming the tax code and, above all, making America Great (read $$Rich$$ again) — is tailored to the Republican base who has yet to see much economic benefit promised by the Republican Party.
While Trump’s proposals are short on substance — they aren’t affordable nor have any practical means of achieving — they go long on taking all that rural white middle class pain and effectively balling it up into political rage. It’s justified in way that that only the hopeless could embrace — anything in Pistolville would be an improvement — and worse than the “separate but equal” arguments heard round Mount Dora in the segregationist 1950s.
The enthusiasm of poor white workers for a flamboyant millionaire might seem strange unless you recall that 200 years ago wealthy plantation owners pitted indentured white servants against African American slaves, offering the servants a vision of equality with their wealthy masters by dint of their white skin. Racial violence by poor whites against African Americans became a way of keeping the poor at odds with each other and preventing them from turning a united front on the Man. It doesn’t take much to translate Trump’s “Make America Great Again” into “Make America White Again.” (See Jonna Ivin’s “I Know Why Poor Whites Chant Trump, Trump, Trump”)
The inherent racism and misogyny of Trump’s populist message has proved bulletproof against criticism (which he calls political correctness), and followers say he’s just saying out loud what everyone is thinking anyway. (Which makes one wonder how toxic is the the general thought.) Violence at his rallies have just been under the threshold of a Rolling Stones concert at Altamonte. The anger is hot, hot, hot.
The Republican establishment has been helpless in staving off Trump’s hostile takeover of the Party, and the elites have been slow so far in throwing their support behind the the presumptive Republican nominee. Democrats should not be too smug about going up against Trump in the fall, what with their destiny either in the hands of an unlikeable centrist or a popular socialist.
No one outside of Trump’s zealots thinks he cares much at all for his base — as some have said, he is riding high on the shoulders of his supporters to get into the White House.
It’s very important here to note that even while deaths among middle aged rural whites are spiking, they are still far below the death rate for African-Americans, who suffer shorter life spans and greater health challenges due to racial discrimination. The statistical bump is important, but the larger context is somewhat tempering.
How hard really is the fate of rural, undereducated, poor white men and women? Certainly the changes in the American economy lie heaviest upon them; not because they are suffering the worst economically — minorities are still by far at that bottom — but because they are losing ground faster than anyone else.
And they have lost something even worse than privilege: the illusion that they ever had it in the first place. (Though they might call it the death of the American Dream.) They have become largely invisible to us because they don’t fit anywhere in the new vision for America.
Democrats aren’t wooing them. By standing up for Black Lives Matter, gay marriage and innovation reform and the elite end of the economy charged entrepreneurialism and innovation, “rural white” is becoming a euphemism for “done.”
But worse, the Republican elites which had successfully wooed these po’ white folk into supporting their big-business causes in the past through love of guns and social conservatism have been upstaged by the usurper Donald Trump and his uncut message of venom and braggadocio.
Now those elites are furious that all those blue collar rats have fled their floundering Republican ship. Kevin Williamson, a columnist for the National Review, couldn’t have exercised more surgical precision in eviscerating this base in a March 13 column, “The Father Fuhrer”:
The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles. Donald Trump’s speeches make them feel good. So does OxyContin. What they need isn’t analgesics, literal or political. They need real opportunity, which means that they need real change, which means that they need U-Haul.
Ouch. And for all the woebegone small towns where hope has become a shot of vodka or a needle’s whiteout? He continues,
The truth about these dysfunctional, downscale communities is that they deserve to die. Economically, they are negative assets. Morally, they are indefensible. Forget all your cheap theatrical Bruce Springsteen crap. Forget your sanctimony about struggling Rust Belt factory towns and your conspiracy theories about the wily Orientals stealing our jobs.
In short: We never wanted you po’ white trash at our party anyway, you or your sad little useless home towns.
Your Springsteen Rust Belt citrus bust dope dens.
Your Pistolvilles.
— David Cohea (djcohea@gmail.com)
Next: Pistolville Comes Home
“Pistolville” is a three part series:
1. Finding Pistolville
2. A World of Pain
3: Pistolville Comes Home
