The New Opiate Epidemic
This report first appeared on TCF.org
INTRODUCTION
On the subject of narcotics, American public discourse is prone to alarmism, but it is not an exaggeration to say that the United States is currently experiencing an epidemic of opiate addiction. To be exact, we are in the grip of two related epidemics: one involving legal, regulated prescription painkillers, and the other involving black market heroin. Chemically, these two types of drugs have a great deal in common, and both are devastatingly addictive. But the rise in pill addiction and the rise in heroin addiction are linked on a deeper causal level, as well.
Drug overdoses now kill more Americans than car accidents, and most of those overdoses are from opiates.
Drug overdoses now kill more Americans than car accidents, and most of those overdoses are from opiates. Heroin-related deaths have quadrupled since 2000, leading to what the New York Times has suggested may be “the worst drug overdose epidemic in United States history.” Former attorney general Eric Holder described the rise in heroin addiction as a “public health crisis,” with heroin overdoses leading to 10,574 deaths in 2014 (see Figure 1).
Figure 1.
But in fact, the spike in heroin abuse is an outgrowth of a much broader and in some ways more pernicious problem — the widespread addiction to prescription painkillers. Pharmaceutical opioid overdoses have also quadrupled since 2000, leading to 18,893 deaths in 2014 (see Figure 2) — almost double the number of heroin overdoses for the same year. The suppliers of these drugs are not street-corner dealers, but ostensibly respectable physicians, and behind them, multibillion-dollar pharmaceutical companies, with squadrons of lawyers and lobbyists.
Figure 2.
According to the Centers for Disease Control (CDC), in 2012, American health care providers issued 259 million prescriptions for opioid painkillers, the equivalent of a bottle of pills for every single adult in the country. According to the journalist Sam Quinones, a hundred million Americans suffer from chronic pain, and most of them receive prescription opiates. Quinones has written a book, Dreamland: The True Tale of America’s Opiate Epidemic, which is a landmark work of reporting and storytelling that brings together the licit and illicit strands of this story and illustrates, in vivid detail, how pharmaceutical painkillers and heroin from Mexico are linked on a continuum of addiction.
XALISCO BOYS
As a longtime reporter for the Los Angeles Times, Quinones has decades of experience on America’s southwest border and in Mexico. The most arresting and unfamiliar parts of Dreamland are the chapters that chronicle a generation of young heroin dealers who hail from the same small corner of Mexico, a rural area around the town of Xalisco, in the western state of Nayarit. The “Xalisco Boys,” as Quinones calls them, pioneered an unusual business model.
Most Mexican drug cartels are in the business of producing and exporting narcotics like marijuana or methamphetamine, or smuggling cocaine from the Andes. As such, they tend not to play a major role in retail distribution inside the United States, preferring to sell to regional wholesalers who then assume the risks and exposure of dealing with gangs and with a strung-out, unreliable clientele in local drug distribution networks. But the Xalisco Boys were vertically integrated “from the farm to the arm,” as drug agents sometimes say: they produced their own heroin in Mexico, shipped it across the border, and then operated retail distribution cells that sold directly to addicts in communities across the United States.
By interviewing Xalisco Boys, the customers they sold to, and the cops who pursued them, Quinones is able to elucidate their unusual methods in unusually vivid detail:
Each heroin cell or franchise has an owner in Xalisco, Nayarit, who supplies the cell with heroin. The owner doesn’t often come to the United States. He communicates only with the cell manager, who . . . runs the business for him. Beneath the cell manager is a telephone operator. . . . The operator stays in an apartment all day and takes calls. The calls come from addicts, ordering their dope. Under the operator are several drivers, paid a weekly wage and given housing and food. Their job is to drive the city with their mouths full of little uninflated balloons of black tar heroin, twenty-five or thirty at a time in one mouth. They look like chipmunks. They have a bottle of water at the ready so if police pull them over, they swig the water and swallow the balloons.
The Xalisco Boys are purely a delivery operation: like any other retail business, they discovered that there can be distinct advantages to foregoing a brick-and-mortar storefront. Rather than assume the risk of keeping heroin at a single house where junkies (or the cops) will know where to find it, the Xalisco Boys come to the customer. Each driver hits the streets with a small enough volume of heroin in his car that if the authorities pull him over, they will not be able to make a major case (because criminal charges in these cases are generally tied to the volume of product the dealer is arrested with).
The Xalisco Boys tend to be young and clean cut, Quinones explains. They drive anonymous sedans, and after working in a given market for a few months, they cycle out of the country and return to their home village in Mexico, with a small fortune in earnings. Each departing driver is replaced by a new anonymous face, with no criminal record, which further compounds the challenges for law enforcement officers trying to make a case.
Whereas retail distribution of illegal drugs is often characterized by violent turf wars, the Xalisco Boys never carried guns. They competed among themselves, driving down prices, but did not engage in bloody gang wars. During the 1990s, they targeted small and mid-sized cities in the American heartland, avoiding large cities such as New York where there was already an entrenched hierarchy of heroin suppliers. According to Quinones, they tended as a rule to avoid doing business with African Americans, preferring to sell to whites. “Guys from Xalisco figured out what white people — especially middle-class white kids — want most is service, convenience,” he writes. At any hour of the day, an addict could telephone a number and know that within thirty minutes, a polite driver would meet them in a nearby parking lot or show up at their door, ready to make a sale.
When the Xalisco Boys set up shop in a new area, they would identify potential customers through a devilish but ingenious device: they would target methadone clinics, where they were sure to find people coping with heroin addiction, and offer them free samples. Most of these dealers lacked much formal education, but they proved remarkably adept at marketing their product, and at developing relationships with customers. Quinones relates harrowing stories of addicts summoning the strength to quit the drug and informing their dealers that they were done with heroin, only to have the dealers arrive at their house, minutes later, to express support for the decision — and to offer one last hit, for free.
Gradually, as Dreamland relates, the Xalisco Boys expanded from Southern California to cities and towns across America. The type of heroin produced in Mexico — black tar heroin, known as such because it has more impurities than white powder heroin, but is just as addictive — was originally found only on the West Coast, but eventually it began to appear east of the Mississippi, with increasing regularity.
You might think that the fact that heroin is typically injected would pose a challenge for dealers looking to attract new customers. Many people have a phobia of needles. But as the Xalisco Boys continued to expand, they found out that this did not seem to be a problem — because someone had prepared the territory ahead of them, creating a vast marketplace of opiate consumers, hungry for more.
…continue reading the remainder of the story on The Century Foundation’s website.
Patrick Radden Keefe is a senior fellow at The Century Foundation where he researches and writes on emerging international security issues, espionage, and transnational crime.
