ABOUT THIS EPISODE

How did heroin spread beyond big cities in America? What's the connection between heroin and America's opioid problem? Sam Quinones, author of Dreamland, talks with EconTalk host Russ Roberts about the explosion in heroin use and how one small Mexican town changed how heroin was produced and sold in America. That in turn became entangled with the growth in the use of pain-killers as recreational drugs. Drawing on the investigative reporting that culminated in his book, Quinones lays out the recent history and economics of the growth in heroin and pain-killer usage and the lost lives along the way.
English
United States

TRANSCRIPT

00:00:05welcome to Aecon talk part of a library of economics and liberty I'm your host Russ Roberts at Stanford university's Hoover Institution our website is econ talked out or for you can subscribe comment on this podcast and find links and other information related to today's conversation the loss of
00:00:22finder archives we can listen to every episode we've ever done going back to two thousand six or email addresses male econ talk dot org we'd love to hear from today is December twelfth twenty sixteen I want to remind listers code econ talk dot org where you'll find a
00:00:40link in the upper left hand corner this year's annual survey of your favorite episodes now for today's guest author and journalist Sam quinone as his latest book is Dreamland the true tale of America's opiate epidemic which is our topic for today's conversation Sam welcome to come talk great
00:00:58to be here arrests are you doing doing great %HESITATION especially after reading your book more or less it Dreamland is one of the best nonfiction books I have read in a long long time effective I couldn't put it down it was deeply disturbing in many ways but incredibly
00:01:14illuminating about an issue that we have touched on a number of times here on the program which is the opioid epidemic but I would start the beginning which is actually her ones %HESITATION so I want to start with the revolution in the production and distribution of heroin out
00:01:28of Mexico that you describe and I start with the business model of what you call the police go boys at least go being a small town in day %HESITATION province attacks on the Pacific coast now read and it's spelled with an X. X. A. L. I. S. C.
00:01:45O. the police go right not to be just not to be confused with the state of Jalisco to the very very large stay with Guadalajara edit sectors of capital so talk about talk about what came out of a lease come what rate these guys %HESITATION back in the
00:01:59nineteen early nineteen eighties families from this town %HESITATION John about twenty thousand people landed and had him migrated to this of the San Fernando Valley of southern California Canoga park then eyes here in a few of these families has figured out how to cook black tar heroin from
00:02:18the opium grew the grows in opium poppies opium poppies you should know grow very nicely now for about a century in the Norton amounts of the north west of Mexico and so now you read as a state right on the Pacific coast of Mexico northwest and so they
00:02:31had actually said they began to learn how to cook %HESITATION into what's called black tar heroin Butler is a kind of a %HESITATION a sticky goo wee semi processed form of a feral much like Tootsie roll kind of %HESITATION everybody's hair of every bit heroin just like white
00:02:47powder is it's just not as processed and filtered and so on and they began to sell this this %HESITATION heroin in %HESITATION in parks in the San Fernando Valley a few these family not very many other which appalled little pieces to the addicts would would come up and
00:03:01buy from them but in time a couple of things happened one was the cost begin to get why storm they don't want to because more and more families from this town began to see this as a viable business and began to get involved in it that saturated %HESITATION
00:03:15the market now %HESITATION these guys were different %HESITATION most most times you find in the in the %HESITATION in the in the world of people %HESITATION I developed or or %HESITATION %HESITATION grab market share through the barrel of a gun %HESITATION Al Capone started that I think can
00:03:31%HESITATION and ever since that's been the way people %HESITATION and in that economy %HESITATION take market share but these guys couldn't do that because they are all from the same town they all knew each other one were related sometimes they had %HESITATION the going to school together the
00:03:43everybody knew were each other's mothers live so they couldn't use that method and they so they developed another %HESITATION mess in this really led to the system they developed which was of a form of %HESITATION showing her own resembled very much pizza delivery so you would be the
00:03:59addict would call in number day with the operator was standing by to take your order within dispatcher driver a driver would meet you at some predetermined placed in so you you're heroin this got them out of the parks the cops couldn't find them as easily they also got
00:04:15access to much larger markets %HESITATION of heroin than they would have if they were just a stationary %HESITATION in a park in in time that process %HESITATION replicated itself even with cars the the more more guys come up from this town %HESITATION more more people get into the
00:04:31business and so they have to move beyond even San Fernando Valley the kind of saturate that given the number of addicts that are in the area they need to set date that that there that the business model kind of saturates the market and they have to move to
00:04:43other cities so first it was promote Ontario which is about thirty miles east of LA %HESITATION can do when they went to San Diego %HESITATION a couple Portland gem for it began to expand very very much like any capitalists and small business or franchise would not talk about
00:05:01the ways they avoided detection up the first thing is an economist I noticed is they were very price conscious they they got similar to the crack cocaine %HESITATION distribution which was a really odd innovation in the mag the size of the does these the what we're talking about
00:05:19here with the black tar is a tenth of a gram and talk about how it's sold in balloons and how they use that to avoid detection sure they they %HESITATION they were %HESITATION very well they they were not cordial killers they were not %HESITATION on full time drug
00:05:33traffickers they were kind of guys who thought that this might and get the give some next some extra money they were very aware of not wanting to go to prison and so %HESITATION the way they began to do it was that did you also were retailers which is
00:05:45really rare in the Mexican drug trafficking world most cartel most organized groups they sell wholesale these guys a goal to reach they they realize that they had that the profit was really in retail and I began to put the the the dope in little small little balloons time
00:06:01off and they would put these ones in the miles %HESITATION so you could talk to guys who actually could put twenty twenty five balloons in their mouth they're not inflated they're just not inflated there's a little bit just wrapped around just to protect the doping case the cops
00:06:17stop and that's why they also carried a big jug of water %HESITATION cop stop him %HESITATION they they %HESITATION they they begin to switch switch on the water and then they swallow the balloons down and the cop doesn't find any any dope on them and that's that's one
00:06:30way they would a detection very important in this in this was also the never used guns %HESITATION %HESITATION day what day I think learned or %HESITATION %HESITATION or song on the bloods and the Crips %HESITATION fighting it out for territory in those years for crack territory in Los
00:06:45Angeles and heavy heavy police attack on on those folks the the you know the Colombians with the same way when they brought their dope in the Miami they were they were very %HESITATION %HESITATION much given to %HESITATION shoot outs and killing lots of people to kill one target
00:07:01of course all components are these guys they're issued guns in completely they understood personal that they were not gunman when my number to an illegal immigrant they're all illegally here in the country %HESITATION an illegal immigrant with some dope would be deported no legal emitter with some dope
00:07:17and a pistol would get ten years in prison this was very clear to them so they they really formed %HESITATION a system that relies far more on on marketing on customer service on making sure that your job was was was potent and that your your your %HESITATION customer
00:07:35got it on all on time they were also these during these early years the eighties and into the early nineties they were marketing they were working during a time when the numbers of addicts with this so the demand was really small and so they would go to a
00:07:50new town say Salt Lake report when and a few other crews free these crews will get there the compete among each other in order to take customers from each other they couldn't kill each other so they had out you know market and and do a better job of
00:08:03customer customer service %HESITATION because because they can kill each other so the the became master marketer's first arm very early very early on in it and and this was also part of their way of of developing a market develop personal relations they give you %HESITATION fifty free balloons
00:08:21if you brought them five new customers %HESITATION if you bought for me %HESITATION sixties we we could give you a free one on Sunday these kind of come on to give an example and I kind of they were part of their part of the business they give away
00:08:32free samples are the go to not hang out from methadone clinics if they knew and give away free dope there is a new guy well enough you got out of jail had been using for three four months they meet Amar up at his house given free dope there
00:08:46again using again I mean there's a whole range of ways that they have of marketing and retaining market share that way instead of through the barrel of a gun so as a hardcore free market guy at is a certain respect you have to have for that but it's
00:09:00%HESITATION isn't really dark side to it which is an addiction is not easy to %HESITATION get out up in fact you seem to suggest that you can't period well I'm not sure it would say you can't I have known people who have it's just the torment if the
00:09:16torment like almost and unlike any other any other drugs it's a it's a drug that deprives you of rational free will I believe I don't believe that when you're falling in addiction you'll have that free will to particularly to to to to heroin so these guys guys knew
00:09:32that they they knew that they were marketing a very potent truck the other thing that that I think they knew too was says the day were one that used to come to the United States from the Far East you know the French connection's typed open the wall for
00:09:46most of the twentieth century %HESITATION a lot of it came from Turkey or from Vermont %HESITATION from Vietnam or what have you %HESITATION a lot of that job had to change hands many times by the time it got to the street it was pretty well diluted each time
00:09:59it changes hands the guy to make his money he he cuts it and he's also for double you know he makes it one kilo into two or four and is also for double makes a lot of money that would that's how you make your money and and so
00:10:10for the for many many years the D. A. always found when they did their tests on a hair when that they would she's on the street that the potency was six to maybe fifteen to eighteen percent something in in that ballpark these guys work hard were making their
00:10:25own their family members were making it they were taking it themselves up through the border parents very very easy to smuggle across because of so contemptible and would get to the United States in very very potent form %HESITATION they were not %HESITATION they were not diluting it %HESITATION
00:10:41so much as as as the doctor would come from say Burma or some place you didn't have as far to go you know everyone is a commodity it's not like a red wine or marijuana which of lot of varietals it's one thing and that the price really depends
00:10:54on how much you've deleted it and how far it had to travel in in this case they didn't deliver very much at all and it had only maybe two thousand miles to travel instead of twelve thousand miles a year and so we got your much more potent and
00:11:08much much cheaper and that's what made their own very very %HESITATION popular so I have a couple of prices in the book at one point you mentioned twenty five doses for a hundred dollars five doses for hundred obviously depend on the city and what level of competition there
00:11:22was but a boiler come much how many how many doses what a user who is in bad shape the using a day usually about a gram to to Graham and a half so it could be %HESITATION sixty two it depends %HESITATION you know I would say sixty eight
00:11:40dose of the a day perhaps something like that %HESITATION us on different different people in different states %HESITATION honestly %HESITATION within my in my book can I put it will be with god help for purpose right yeah and you so that's the thing about heroin that's what makes
00:11:55it a magnificent drugs for drug traffickers it shouldn't really has no medicinal %HESITATION argues but compared to other opiates from the same opium poppy the heroin is extraordinarily addictive and have more or less the same pain killing qualities %HESITATION here and there as others but it's far more
00:12:15addicted because it takes you up and down your your you write your your Fauria and then you crash very quickly so you need to be doing it two three four five times a day sometimes and that's what leads the dish and that's what makes it very very appealing
00:12:31to a street trafficker because you've got a customer who's going to hit him up every day there's no date on Christmas on Sundays you're not saying a well maybe I won't use today no your using every day you cannot not use this drug and sometimes it's three four
00:12:48five times a day and then it also drives people to extraordinary ends are willing to just sell anything they're willing to %HESITATION find any creek the client %HESITATION it'll get a more free dope that's that bill do it a lot of these guys spread the way they spread
00:13:04their the way they expanded to other cities was really with diets were addicts addicts were their guides you took from what sets old man you bring this stuff to Reno I know where the methadone clinic is there and then we can make a killing there and you just
00:13:17give me my free dope that's all I care about you know can can a person hold on a job as a her when user you can %HESITATION and what I found was that these guys change that though I'm not guys for example addicts who would say back when
00:13:32it was hard to get I kind of had a back on her own was more difficult to get %HESITATION bent worse there was far more expensive than was far more deluded I I was able to do more with my wife I was able to hold on the job
00:13:45more or less %HESITATION religion you know more or less channel of their family responsibilities in this kind of thing all because it was hard to get it was either really expensive or the places that I had to go to get it were dangerous like some you know homes
00:14:00for beating little bar or some %HESITATION strange %HESITATION on unappealing motel or housing project or what have you on board once it these guys made it easy that's when it just went off the road rails for a lot of these guys so so it made it easy and
00:14:15in several ways first automated cheaper they would give you Fredo from time to time to keep using and they were they all all it was was a was a was a phone call away a member talked to one guy who had no legs he had because of the
00:14:28long addiction here one day frozen how almost frozen to death in a storm of lost of legs and so before these guys showed up he had prosthetics he had to hobble around downtown Portland three times a day to get as though to get his doctor and he didn't
00:14:44know what kind of quality was going to be you thought they might people would rob I'm occasionally there's just a a torment these guys show up and it's magnificent you know these guys will get their phone call away you don't have to walk out of my motel to
00:14:57go hobble down down downtown Portland %HESITATION I will say they are cheap infrequently the give me free dope they're clean or not gonna rob me they're nice guys they're polite on on on like this and it was almost like you said of those if I died and gone
00:15:12to heaven these guys were the best dealers I'd ever seen a give me free dope I could calm him out of free dope etcetera and and and and so his his views speaking kind of went off the rails it's the the convenience the access to easy availability in
00:15:26stock cheap supply is what really really %HESITATION put push people over the edge a lot of time and of course as you mentioned the book none of these drivers %HESITATION typically young kids young man from this one town %HESITATION they're not using they're not they don't sell to
00:15:44black people that they're afraid of it for whatever reason the racist they only sell the white people to the ever Selter fella Mexicans because they need a Mexican community only to hide a long note note that no they do I know about Memphis one Mexican community the level
00:16:00of heroin addiction is microscopically small I'd I don't know too many now in the Mexican American comedians will be different but %HESITATION even so %HESITATION this is a white person's problem all across the country I mean the whole problem but it did opiate addiction problems really white people
00:16:17%HESITATION no they they are they are a rare breed in in the heroin world %HESITATION retailer that her own retailer world because most the time up to up to then and I had many cops in different cities tell me this your typical heroin dealer was an addict he
00:16:34was stationary he was in the house she was in a bar or motel or some place %HESITATION and and he was very easy to arrest and very easy to investigate the only problem with your back then no one bothered because of such a small problem these guys come
00:16:48along and and they are they don't use they are %HESITATION %HESITATION in and out every quick they're they're not %HESITATION you know hanging out there not partying they're not causing a ruckus %HESITATION they're not calling attention to themselves and and they don't hang out in one place so
00:17:06you don't have a bar or a house or something like that where they sobered up so as you point out there's a poignancy and %HESITATION I will point and so the fact that %HESITATION it's culturally %HESITATION repugnant to these folks to to be a user idea that that
00:17:24they are helping often children high schoolers and teenagers get her when is repugnant to them because they would don't want their own children of course to be doing this and yet they come anyway because it's very lucrative and they come for very short periods of time to talk
00:17:39about the motivation of these %HESITATION the young men who come from this one town their cultural aspirations their alternatives %HESITATION will little bit about just like in the town because it's grown interesting so that's that's what I and I knew most about that when I started this book
00:17:56that they come from an area a lot of these folks when the immigrants in general when they come to the United States they are not the poorest of the poor they are people who have become a working class folks we have some resources some assets but not not
00:18:10a lot and all around them they are seeing people who are doing better %HESITATION by two by going north star in the immigrants case to work as landscapers say in this case you guys come north and sell sell sell heroin but when they when they these guys come
00:18:25back home because we gone north they set a new standard for achievement they want you in order to be seen as having %HESITATION overcome poverty you now need to do to be building yourself a house for immigrants Mexican immigrants all across Mexico they build houses and hundreds of
00:18:41thousands of house made millions of houses all across Mexico because of that and and that becomes the norm the standard by which to your judge because you were not interested in becoming American you are not interested in in doing anything more than going home and showing the people
00:18:58who humiliated you when you were young that this is what I'm really capable of this house that I'm building is what I'm really capable of now that's the immigrants impulse all across Mexico I would say a study this many years wrote two books about it I think this
00:19:12is a very very important impulse when it comes to drug trafficking the impulse is the same it's just that the risks and the rewards are many times greater and so you go north to sell dope and you come home and you build a house that might take about
00:19:28a regular immigrant nine years to build you do that nine months because you have the where with all you have the capital you don't have to build a room by room room one room a year you build it all in nine months and then you build %HESITATION people
00:19:40nice things of wrought iron and automatic garage door openers and and and that that kind of thing what that does then is set the standards set the bar very very high for the other kids were still poor in your town are still kind of scuffling and wanting something
00:19:55with no girl will talk to who is not respected their their dad's an alcoholic reviewed as just a scuffling sugar cane farmers these guys now have to reach this level not the is not the level of a house it takes nine years to build but when it takes
00:20:10nine months to build in a lot of these guys have available to them only the most dead and work in Mexico sugarcane farming bakery work job %HESITATION butchered out our %HESITATION construction %HESITATION avocado forming answer these things we know where in Mexico and they're not viewed as with
00:20:27those very respect as as of yet jobs that people really love to do so these guys all becuz of basically two generations of this town I think became heroin traffickers up in the United States and they all then went back home all brought their money back home they
00:20:46all build houses not lavish mansions we're talking about middle class houses of the system to turn you could make you transform you from a poor person into a middle class person not into some drug king pins and and everybody then %HESITATION it would it would come home and
00:21:02they would be the kings for six weeks or two months or whatever it was and all the girls and wanted to talk to him and and they they could buy a used to good use trucks and they could build a house a small house for %HESITATION %HESITATION in
00:21:14nine months instead of instead of nine years and it just became kind of what what drove these kids for it and then also wants the other thing is amazing to me I found so fascinating with that one state already they've they've they've done this once they come back
00:21:30they too will get addicted separate not to the drug it's to the feeling of coming home a king coming home a man of respect coming home with the trunk full of Levi's five oh one jeans and passing them out among the %HESITATION nephews and your brothers in law
00:21:45and what have you %HESITATION dot was there drug and so they spend their money and they'd be like a junkie without without need open they have to go back to the United States earn more money to come back and be the king for six weeks ago I was
00:21:56a fascinating %HESITATION are a peek into what really drives the drives people a lot of in psychology an aspiration and these are you young our young men typically are and puzzle I had reading it so the profits it it one point you mentioned it takes about two thousand
00:22:17dollars of of time equipment to cook a kilo of black tar heroin about fifty thousand dollars to maintain the apartment the car for the people pay the drivers so for the person who's the distributor of the of the to the driver's sort of manager of the town of
00:22:33a certain number drivers %HESITATION there's a hundred and fifty thousand roughly of revenue so there's a huge profit fifty two thousand dollars about a hundred thousand in profit so normally competition drive will drive that down of course if it's dangerous to doesn't it down very far but I'm
00:22:50wondering why other towns didn't come compete why are given that those are very good question and yeah cooking it is it but they figured out that no one else has figured out no that's more like a folk crap you can you can cook black tar hearing from opium
00:23:07the opium do the Jarvis from the opium poppy and cook it in the black tar heroin is I've seen some of those VA actually of a confiscated from what I have in which you guys cooking as if it were a barbecue is like a big barbecue grill and
00:23:21he's got a couple pots going and and and and no it's not hard at all I I'm not sure exactly I mean in in those areas a lot of people were already %HESITATION going north to work %HESITATION this is a very very heavy immigration to the United States
00:23:35so they're already involved in other other jobs Bob heroin is viewed again get back to kind of the the the way it's it's it's viewed Mexico is that the low life most low last because he is back alley drug and so getting involved in that is it %HESITATION
00:23:52you know and it just it does take I think %HESITATION a fair amount of of %HESITATION knowledge of kind of %HESITATION abreast of knowledge that is developed over many years trial in there there's no book they didn't they do use a book tour to figure out this system
00:24:07it's so we'll get you arrested let's not do that anymore and let's try something else you know I mean it was %HESITATION so I'm I'm not sure I I know I do know though that at a certain point what what started with a few families I had to
00:24:22expand to many many other family so for the first fifteen twenty years of the life of this thing %HESITATION a lot of these guys there was the same last names Hernandez to hand %HESITATION %HESITATION gosh yelling at each %HESITATION few others %HESITATION ideas were non these kinds of
00:24:37last names and they all were kind of were connected they were all related to each other central family is a big one %HESITATION but then they had the the DDA but first figure these guys out in in late ninety nine and two thousand and they held the first
00:24:53big nationwide bus was the first time in fact that when the bus of these guys in a in a thing called operation tarp that it was the first time that the D. A. N. F. B. I. it actually worked together on a on a trip and found a
00:25:04drug ring that what that was went coast because literally coast to coast from North Carolina to %HESITATION to Reno in Los Angeles and Phoenix etcetera and they arrested a mob I can't member now right now to talk to maybe two hundred people and with that the families that
00:25:20ran those crews had to find more labor a lot of those people went to prison federal prison for some for significant sentences ten fifteen years also the head of and so what they begin to to was expansion new families families it and never been involved in a two
00:25:36thousand the year two thousand just as the United States and developing a very healthy healthy appetite for for opiates %HESITATION focus of all kinds they have to now expand throughout in a so it's not so much just police go in a few the little villages around there they
00:25:51sometimes have to take labor from towns in other counties and and people that they know and and and I shot a few of those as well but if it be it happened because their labor source their labor supply was was in one fell swoop center sent to sent
00:26:07to prison and so they needed to kind of %HESITATION fill the ranks with with new folks are you went to Jalisco under cover of pretend you were not a journalist up rest %HESITATION so time I've ever done that by the way and you know and see for may
00:26:21I say I'm a journalist except for there I was %HESITATION you're scared to do that there is an ugly %HESITATION so you've you went to lease co you've talked to these drivers %HESITATION I think you've talked to users incidents of incredible bit of reporting and that's it that's
00:26:36half the book that would make a fantastic book but it's so it just gets more interesting because there's an intersection with the opioid problem so let's talk about let's switch gears let's talk about pain killers are %HESITATION how did to of pain killers become a problem what it
00:26:56seems like there was this great new set of pain killers out oxycontin others why did they end up getting %HESITATION misuse and abuse yeah that was the you know I've backed into the story because of my background in Mexico I really focus first on the heroin traffickers but
00:27:13then of course I was left with the question why is it that there are so they have so much new demand because they were in now by down by the by Thomas and they were now in Ohio let's Virginia was like that was the end and so that
00:27:25got me on to this other story is really the first story really far larger story and that begins really in the in the in the nineteen eighties as well but the same time when %HESITATION %HESITATION pain management is just beginning to be %HESITATION under a new kind of
00:27:39a new %HESITATION discipline within medicine that you study NO a whole group of pain specialist began to %HESITATION our form a collective consciousness and begin to believe that the we were not treating pain correctly that there were these pills opiate pain killers out there and doctors all across
00:27:58the country were on on %HESITATION we're we're we're we're on willing to use theirs and that this was not a reasonable %HESITATION proposition that these bistros ought to be far more liberally used and then at first they made the argument %HESITATION we need to use these for a
00:28:14hospice care folks people dying of cancer whatnot %HESITATION in order to improve their last months on owner is %HESITATION %HESITATION what does it matter if they're addicted to these pills who cares of the addictive these pills if they also live the last three months of the lives pain
00:28:28free and I've made a lot of sense that was a very logical argument to folks would die in utter pain because doctors were afraid they would be addicted but these folks made a different argument they however kept pushing and that's probably %HESITATION that's why we're here today %HESITATION
00:28:44they they didn't stop which is hospice care are they said they begin to make the argument that virtually all of these pills these pills aren't we now know science now knows that you know five thousand years of %HESITATION experience with the opiate PA opium poppy be down we
00:28:59now know that these pills are virtually non addictive when used to treat pain and so they began to push they were joined in this after a while by certain pharmaceutical companies were producing some of these bills main one being %HESITATION %HESITATION %HESITATION Purdue pharma which makes the pill
00:29:16oxycontin and David took up the the call of these guys I had one doctor say if it had if it hadn't been for the pharmacy for the pain specialist the pharmaceutical companies would have had nobody to to you it's a footnote to use a point to the say
00:29:30this is why we're doing these were producing these bills but it had not been for that had it not been for the pharmaceutical companies there with these transmissions would want open without a megaphone and and so they become combination of those two together but particularly as the mid
00:29:44nineteen nineties progress was very very %HESITATION Bob potent they they begin to argue the work country in pain %HESITATION virtually non addictive now when used to treat pain we need to to to revolutionize our treatment of pain and then in the game changer comes with our as you
00:30:01say oxycontin oxy Khan was a game changer for a couple reasons men want one was that that it was promoted by produce pharma almost the way you would promote on all over the counter medicine to doctors with lots of giveaways and discounts very much as I got into
00:30:17my research very much reminiscent of the the the come on's and discounts and stuff the police go boys would use to sell their heroin %HESITATION to their patients and keep income to their %HESITATION Spencer customers here as for and and so the a lot of these kinds of
00:30:33come ons in this kind of thing and and %HESITATION %HESITATION they had a CD they gave away call swing in the right direction with oxycontin there was a bunch of swing band tunes you know and %HESITATION it was this new kind of approach to marketing a truck but
00:30:48it was an opiate a highly addictive but they were using the the idea that these drugs were virtually non addictive which was gaining credence in medicine they were helped also by medical establishments %HESITATION Jaco that accredits hospitals came up with the idea that now doctors should use pain
00:31:06should consider paying to be the fifth vital sign so these are treated just as you would treat Paul server hard for you to that kind of thing but %HESITATION restaurant they are you do you all these things should be treated the same in there for pain is something
00:31:20you should always treating there was a %HESITATION patient evaluation so there was this whole culture around the idea that we were first a country and pain and what's more than we were not treating it properly and finally we have the tools but we had just been afraid to
00:31:36use them and that were that I was vis vis opiate painkillers and of course the new one was %HESITATION oxycontin and as you point out millions of people who were in horrible pain weren't anymore so that was that was the good side the bad side was the promise
00:31:54non addictive aspect of oxycontin which was the slow release part the idea that was Khandan continuous was supposed to dampen the addictive part %HESITATION the two things happen one up people figure out a way to get around that by sucking off the coding that slow the religious or
00:32:11hitting with a hammer us I was problem number one from number two is I think correct me if I'm wrong that %HESITATION there were people who get addicted anyway even though was slow release yes right they were following doctor's orders and they would still get get it get
00:32:24addicted and %HESITATION %HESITATION and and part of the problem too was that along with the idea of these tools were no longer %HESITATION %HESITATION addictive %HESITATION when used to treat pain came the corollary what was which was sent that there's no limit on does so you began to
00:32:40see all across the country doctors for example prescribing enormous quantities of these pills for patients to take home with them after cute surgery after acute for Q. pain after surgery now this is paying that probably gonna last you %HESITATION no more than three to five days of last
00:32:58one five days or something else wrong but they would prescribe thirty days worth of life I could in our core %HESITATION oxycontin these are common you know a regular is another common %HESITATION opiate painkillers and %HESITATION and so what happened is you an enormous enormous without having all
00:33:15across the country an enormous new supply was of opiates was created all across the country and %HESITATION Bob fair amount about a good amount of that leaked out into the black market %HESITATION I believe this is %HESITATION %HESITATION when I when I was in Mexico I believe that
00:33:31all drug stories were demand driven and the drug scourges queer created by demand for those right now when I did this project this change my mind honestly that I became the became the thanks it really most drug problems began because of excess supply easy cheap availability of a
00:33:48of a drug and that's exactly what happened what happened here we have a new a massive new supply of of it %HESITATION of opiate painkillers on from from coast to coast all across the country because it's doctors who buy into this idea as a as a couple generate
00:34:06again a couple generations of doctors buy into the idea that they now need to very aggressively %HESITATION prescribe these things to treat our pain and then some somewhere pushed or pressured legally you have to do this if you don't treat pain you can be sued some it's it's
00:34:21insurance pressures information we don't push people through our our our clinic we won't be able to to to reimburse enough to make the keep the lights on %HESITATION but but whatever the case doctors all across the country come to this idea they need to do this and that
00:34:38is what creates in a massive and continuous %HESITATION new supply of opiate painkillers for the last twenty years from coast to coast so couple of %HESITATION of important for notes this the same molecule really is her went correct all of these are just all these drugs are derived
00:34:55from the opium do the opium poppy they do that they'll be opium poppy produces so they all have molecularly molecular structure is more or less the same they have the same they they do a very good job killing pain and there extraordinarily addictive and they have with you
00:35:12you know when you get off of the meat because withdrawals have the same effect on the brain chemistry no matter whether it's hydrocodone oxy code own heroin there's some differences but Bob but by and large they are all come from the same party there are derived from the
00:35:26opium poppy the the idea which sounds reasonable %HESITATION was that if you're in pain the drug merrily covers the painting and doesn't produce euphoria if you continue to take the drug after the pain then you can get addicted but it turned out of course that we weren't we
00:35:44really don't understand why PPL rejected the first place so it's not just the pain is not sufficient to avoid addiction to these drugs %HESITATION evidently it is for some people enough for others it is and this is the problem the the the we we we apply the fire
00:36:01hose approach for you just blast everybody with opiates and for some that's fine in a lot of people probably %HESITATION listens as now go yeah I didn't have any problem with them is probably true but there's an awful lot of people who do and it's figuring out who's
00:36:14who before hand that's the tricky question like is this a person who wanted to %HESITATION to get this month ends and and doctors were not doing that a lot of doctors didn't have time to do that time is the crucial thing that we have lost in modern American
00:36:30medicine you do not have time as a primary care doc mall in most parts of America to sit down and %HESITATION stricter up a patient all the questions it really will allow you to come to a really clear idea whether or not this person should get this quantity
00:36:44and then if that person should get this quantity over a period of time they have shown I think there are studies that show that there is a %HESITATION very high incidence of a risk of addiction if you were given these drugs exposed to these rugs matter who you
00:36:59are over I believe is more than ninety days if you get a hundred milligrams a day more than ninety days something like that %HESITATION they don't have in front of me right now but but did did that the risk of addiction is very very high no matter who
00:37:12you are but but you know the problem is we do we we applied the fire hose approach but this is a very new wants no one's problem pain is a very very nuanced issue and you got to spend to it's the individual and every person is different and
00:37:25it does not %HESITATION it when when you try to play a fire hose to everybody things just don't go well so just a couple of %HESITATION data points from wikipedia which you can I think %HESITATION consist with the one you mentioned the book it says in the U.
00:37:38S. more than twelve million people use opioid drugs recreationally in two thousand and ten sixteen thousand and six hundred and fifty two deaths were related to opioid over overdose %HESITATION in two thousand seven about forty two thousand eight hundred merchants he room visits occurred due to episodes involving
00:37:58oxy coat on so it's a serious problem in particular at odd prickly tragic all young people in particular geographic areas where usage was access was much easier %HESITATION %HESITATION just thousands of lives were ruined and eventually a continue to be a continuous or something that you know the
00:38:19the CDC just put out information that shows that we have now now more heroin related deaths %HESITATION then gun homicides in two thousand fifteen as a country mess with a spectacularly tragic outcome of your tractor you just mind blows my mind so talk about %HESITATION talk about how
00:38:39the heroin distribution started to interact with the opioid %HESITATION distributor the reason I write about the dome Holly's go boys these but as I call them these guys to develop this system for selling heroin while a lot like pizza delivery is not because of the only heroin traffickers
00:38:57from Mexico %HESITATION nor is it really that they're the only black tar heroin traffickers from Mexico the reason I do I wrote about them was two reasons one was really that the date develop this kind of a new way of trafficking that was based on marketing now very
00:39:12heavy on marketing almost no violence no violence at all just the violence of bad can get a lot of prison years we've got about that %HESITATION but the other reason is because they as they expanded as they were going through this kind of a capitalist expansion %HESITATION %HESITATION
00:39:28mode through the nineteen nineties stayed jump the Mississippi River they're the first ones to bring miss black tar heroin east of the Mississippi River in the history of that drug %HESITATION Korean G. A. they're the first ones to trump the Mississippi River and they do this one died
00:39:42of one died one interview in the book does this in nineteen ninety eight now that's a crucial yeah because it's just at that moment when this pain this revolution in pain management is really taking calls and when in the area of Columbus to the north Cincinnati to the
00:39:57west West Virginia eastern Kentucky though that very very roughly drawn that is the area were produced farmer is first very aggressively promoting and marketing oxycontin and you're finding now lots of people beginning to get addicted and all of a sudden they land in an area pure coincidence or
00:40:17knows conspiracy here they just happen to land in an area where for the first time they find a huge number of growing population of of addicts in in a growing demand they don't and so %HESITATION so they are the first ones to recognize and then systematically exploit the
00:40:34common market for heroin it this massive kind of fire hose approach to a to to %HESITATION prescribing %HESITATION opiate pain fills out implies an end date just hang out in Columbus in the in the the %HESITATION made a this guy told me you know at first it was
00:40:51amazing I was just doing this business I had to guide to kids of their driving for me and I was I was lying to all my friends back home %HESITATION sand no %HESITATION I'm in New York City %HESITATION I was telling him all kinds allies about where it
00:41:03was a blessing I wanted to know them to know was that I was in Columbus Ohio within these kids go back home they come back home with lots of money for the parties there showing off from the girls are pretty soon everybody gets the idea of Columbus is
00:41:16a place to go in and within a year or two I think by two years of of his first arrival in in in in the summer of nineteen ninety eight are you know Columbus's is beginning to get one crew after another and I think lately I mean if
00:41:31it comes and goes I think they got ten or twelve crews working %HESITATION from this one town in in %HESITATION in %HESITATION in Columbus or had the last record anyway and %HESITATION also so deep and they begin to bring you know it is a fascinating it's a fascinating
00:41:46story RT con is a game changer because for for another reason but just how its marketed but because before I see Khan people would mess around with lotos bike it in a participant does have acetaminophen and they have Tylenol in a if you develop a large %HESITATION tall
00:42:04objection to to those you will destroy your your internal organs oxycontin has none of that so it takes people up to very very large %HESITATION addiction %HESITATION levels daily addiction level so you have to be doing a hundred two hundred three hundred milligrams a day of these pills
00:42:20at the dollar in a milligram on the street so it's a hundred two hundred three hundred milligrams a day we can't sustain that you can there's no way you can can continue with that so you begin to look this up for something very cheap and just of potent
00:42:33and cheap Mexican heroin fills that bill perfectly and there are one fills that bill absolutely and it's easy to get in its %HESITATION available and they'll do give you free time on some discounts etcetera and so is that kind of encounter between the heavy marketing of pain pills
00:42:53and produce farm on the pill mills were beginning in that area as well and then the encounter of these these new heroin traffickers with this new system and it's very cheap very potent dope that creates the first examples of what we're now seeing all across the country almost
00:43:08in every state in the union which is people getting addicted first details and then transitioning to very cheap Mexican heroin is not always the holy school boys to a someone in every state but that's where you first see it that's ground zero that whole region around south of
00:43:23Columbus Ohio so there's a lot of things to talk about here but I just want to make sure I get this question and because it's %HESITATION it's haunted me while I was reading your book which is %HESITATION I have very limited experience with %HESITATION opiates of any kind
00:43:39and so I can't really I once had a root canal and I had codeine afterwards with with Tylenol and it was really pleasant I really and it was blissful dot the pain went away I slept incredibly well that's that's really about it for me so I'm not a
00:43:51very good data point but after I read your book I did find myself are because you're so many teenagers and young people who could is live zero under who died tragically in this book it on a tell listeners not a sensationalist book at all one of the great
00:44:06reasons it's such an effective book is it it's not sensational %HESITATION imagination does a lot of the the %HESITATION work and it it's really a it's a it's a police %HESITATION kind of %HESITATION book it Sir what what's the right word it's a %HESITATION can't member the word
00:44:22but anyway or try not to use adjectives yeah exactly %HESITATION it's procedural book so I I found myself calling my kids are bought the collagen and telling him I can %HESITATION try to avoid these drugs if you need them and my question is and and certainly stay away
00:44:40from her if somebody off through a balloon of a black tar heroin for free don't take it %HESITATION which is obviously pretty good advice but I found myself wondering if they had surgery of some kind and you give any examples as were some kid in football team gets
00:44:54shoulder separation any gets prescribed drugs by a doctor to take care of the pain and the ends up dead of it and so would you counsel your children would you yourself take these opioids in the aftermath of surgery well look you know first what have you it's incumbent
00:45:12upon doctors to know the person %HESITATION and know what they're in them and so that is a big thing and no insurance for the third them to know no other kids with with work with regard to athletics you're absolutely right she %HESITATION %HESITATION this pain revolution has transformed
00:45:27football in to a gateway trader on addiction because football is a sport that creates a marked increase the pain and %HESITATION also if they along with that though there is very often the intense desire to get back on the field and this is not just the the the
00:45:45coach this could be very easily the player and could be very easily the the friends and the parents some other siblings and all and my feeling is if there is a %HESITATION if there is that kind of injury before your body knows we all know if you get
00:46:00a shoulder separation so much there's there's one way of curing that and that is time and you just have to make sure that you understand that you cannot continue for months to take these pills %HESITATION they they are not close to be taken from and they are magnificent
00:46:15I think doctors will tell you they are magnificent for post surgery surgery pet that last three or four days and they just are well that's what they're made for real if you ask me am for hospice care and some some small part of chronic pain but but but
00:46:29if the doctor is saying as L. somebody told me when I had my appendix out here's sixty Viking on thirty days worth of I can take thousand needed that that you need to ask questions you need to say what would soon bye can tell me that doctor would
00:46:46you know and and and why it is sixty one not fix if this is the acute pain one on three days' worth instead of thirty days worth say you know I want to emphasize one of us is not a medical program of course anything we're showing here folks
00:46:59out there %HESITATION take with many grains of salt but %HESITATION I would just start I would counsel everyone listening to be careful and to ask questions and to not take anything for granted it's sight was it's a daring and you also understand that we need to be one
00:47:14of the great things about the story of that I learned was this story doctor doctors get a lot of blame for for you know a big part of why this happened was because we Americans didn't want to be accountable we don't want to be accountable for our own
00:47:28consumer choices for our own %HESITATION %HESITATION %HESITATION behavior we didn't doctors would say are you to talk to any doctor any doctor primary care doctor give you service Amazing Stories on those %HESITATION people come in one opinion doc well doc says well you need to eat better you
00:47:43need to exercise more you need to start swimming you need to stop smoking at center it's our bunch bunch of things like that do yoga do act you know whatever and %HESITATION and people do not want to do that that's why pills were so appealing I check these
00:47:57opiate painkillers are so appealing as a solution because most the patients wanted the easy way out so I and I want to talk about we need to be accountable I went on a number of another part of the problem yeah I certainly agree that we have a certain
00:48:10cultural problem here with %HESITATION suffering delayed gratification you name it we don't what about it we want to we want to avoid it which is human we all understand that's part of the curses of being wealthy but there there's a piece of the story that was just extraordinary
00:48:26to me I'm gonna try to spend it on you can then fill it in so there were these doctors and by the way I've I fell to get done this interview by myself Sam I've I've told this X. excerpts from your book to way too many people as
00:48:38make my family about it they're they're getting a little tired of Dreamland but which of the majors you've got these doctors oracle pill mills particularly in areas out Ohio and Kentucky West Virginia depressed areas economically people having trouble finding work and the doctor set up shop they're going
00:48:55to dispense the prescription every three minutes %HESITATION because they wanna make money their credit they're not reliable honest doctors are just gonna write prescriptions they're gonna say are you in pain yes good here's a prescription the precipitates three minutes so you're doing about twenty patients and our people
00:49:12are lined up addicts and others are lined up to get these drugs the drive to see the doctor concerned about the financial side is to see the doctor is a two hundred fifty dollar cash payment right no insurance accepted correct so you show up you give the doctor
00:49:27turns dollars a baby of stolen or Fenster whatever from whatever and then that gives you the the piece of paper the doctor gives you gives you the opportunity to buy oxycontin a supply it's going to cost about a thousand dollars for I forget how long supplies just three
00:49:49months or three months I can't remember but it along supply to be a month a month let's say a thousand dollars we don't have a thousand dollars but you do have a Medicaid card in the current pay for Medicaid is three dollars which seems like a very nice
00:50:02thoughtful thing but what it means is is that the taxpayer is going to cover nine hundred and ninety seven dollars to this the accent cover three and then the punch line that's interestingly about interesting by itself and is a contest is often talked about the value cash I
00:50:18can't help but note the irony that we give people Medicaid because we don't want them to have cash as a way to use it on drugs and alcohol so there's an incredible tragedy here so they take the three dollar copay they get a thousand dollars worth of drugs
00:50:33in it's worth ten thousand dollars on the street something like that right so actually you know this is the this is the %HESITATION %HESITATION the the this is what happened in in many parts of that area that I first that I talk about his ground ground zero rust
00:50:48belt area Appalachian area and I believe one of the reasons for that was because it was because %HESITATION produce figured out it was in those areas when they were first starting a market or %HESITATION %HESITATION %HESITATION oxycontin your nose areas doctors were already prescribing a lot of drugs
00:51:04and the reason for that was because doctors had become the the connection the crucial element in navigating economic catastrophe you needed a doctor to get workers comp you needed a doctor's going off on you disability all those forms a disability now for a long time disability was desirable
00:51:27because you've got %HESITATION you know SSI so desirable could you get a five hundred dollar check every month so not a lot of money but I mean that's what people want to kill the pill revolution transform the calculus of why you would want SSI irises tier which idea
00:51:42because you gave you as you said the Medicaid insurance card and all of a sudden you if you could find a doctor to prescribe you a long list of of of drugs biking and marks the cotton St access shattered Sir one one on another day you could make
00:51:59a ton of money and get high all month to and yes it was it was %HESITATION it was %HESITATION %HESITATION the taxpayer money was kind of the funding %HESITATION was funding this instant in certain areas among among among certain people as a big way that it began to
00:52:12spread early on I think it's still use stuff %HESITATION in some areas it was because doctors were so used to the if you were almost economic our counselors from settles our job counselors themselves doctors in the certain point because all the people who were coming to them were
00:52:30were being laid off or when Stratton to be laid off there was all these this grave concern about how my going to navigate economic disaster in catastrophe in our region well doctors were it and they were already used to prescribing a lot of drugs and so when produced
00:52:45came along it was if it meant a very fertile you know tender terrain there and and and that's why the debt that's why that area I believe that's one of the reasons why that area was kind of ground zero for all this and this you mentioned earlier that
00:53:00that these drugs were cheap like the like the heroine they were shipped to the user they weren't they were expensive but said there was this really unhealthy symbiotic relationship between the drug company and the doctors who were benefiting from this and the users or basically funding this habit
00:53:19out of this structural process of disability and Medicaid payments right and all of it dealing with a primarily in my opinion dealing primarily with with economic cataclysm I mean these are areas were losing mainstage jobs never coming back and %HESITATION this was a way of navigating %HESITATION that
00:53:39I would also say this but you know what was interesting about this too I thought was a these pills were first presented and marketed as a boon to doctors stocks here's the solution to those patients who take up all your time that you don't have and and were
00:53:54you know this is going to be a great thing for you guys on this and it turned out really good and along with it was a it was a horrible curse for doctors first of all in a lot it uses it made doctors lazy just throw pills of
00:54:06the problem and get him on the way and forget about it you know that's the kind of approach but also %HESITATION it's really really did after a while particularly in some of these areas that we're talking about undermine any any scruples the doctor brought to his profession and
00:54:20so a certain point you find docks you know kind of taking a horrible advantage of these very vulnerable addicts %HESITATION %HESITATION because they can you know and it's just available to them and and and you find people getting into very very sticky legal problems %HESITATION we just had
00:54:36a woman out you're convicted murder a doctor out your complete for murder of for a for the US so it turns into a curse it seems like a simple silver bullet solution to all these very complicated problems of how do you treat patients pain and what really turns
00:54:50into as most silver bullets do in my opinion in rebel curse billions of destroying lots of careers and really %HESITATION you know when you do make a lot of money at it for a for a while but after awhile it all kind of everyone knows require act and
00:55:07and and and you're really not huge you don't get the reasons you may have gotten into a true it's a medicine or somehow clouded in the in the this big fog of money and dope and and and desperate people you point out a lot of went to jail
00:55:19%HESITATION fraudulent dispensation is still do there still would die there's two doctors or several doctors and in Los Angeles area to point to who were on going to jail or or about to go to jail %HESITATION %HESITATION because because of the US you know one of the most
00:55:34poignant is just heartbreaking parts of this book as you talk about the fact that after a while the local pharmacy might not take the doctor's prescription because they know it's not real the users have to start driving to three hundred miles to get there fix of legal destructive
00:55:54drugs these opioids painkillers and on the way there fantasizing about the fact that that three dollar payments going to get him ten thousand because they're going to be able to sell it on the street but they end up of course using it on the car on the way
00:56:08back and never really get it out of the shower only this is but this is the most most complete form of personal slavery opiate addiction that I think we know %HESITATION %HESITATION in in America %HESITATION today apart from just present itself %HESITATION you know it's there if people
00:56:25think I have all these dreams and then watched Roach really true is that this is just it just deprives as I said earlier of all rational free will and so you have the Dover from you just gonna use it %HESITATION you know that's the only way to really
00:56:41explain how a kid who would complain all soberly before his addiction will complain about doing the most minor household chore gets addicted and and Wallace thinks nothing of walking two miles in a snowstorm to give his dope %HESITATION it you know it's it's it's an amazing %HESITATION %HESITATION
00:56:59%HESITATION %HESITATION deprived of personal liberty unlike any other substance %HESITATION that I mean where else anyway so we had Chris are not in the program talking about some of these depressed areas in an Appalachian elsewhere and winning a state non as well %HESITATION talking about the rise in
00:57:17the death rate which is for the first time in American history in a long long time anyway that we've since been measure probably the or tally rate for certain age groups has been rising particularly of the the most surprised when racing was women forty five to fifty four
00:57:34and get your book is is maybe it's because it's the most heart wrenching partners is young people dying and I was the question for listeners who remember those episodes and I said this these people killing themselves out of economic dinner malaise or is it what's it mean a
00:57:51drug overdose it pretty clear from your book a drug overdose is %HESITATION people are trying to get high to realize how much you're taking a venture just stop your heart and of course there's a there's a corner problem some the corners don't recognize those a heart attack is
00:58:05because the death when it's really a drug induced heart attack of there's a lot of silence around this but don't talk about what do you think the significance of this is it for the E. R. %HESITATION assessment of these economic problems I was one one more variable which
00:58:22is all of these towns that you're right about some of them particularly in the in the Appalachian region in the episodes mention before the very depressed economically the best jobs of laughed a lot of the factories are gone what are the people stay there why did take why
00:58:38don't they leave in Asia okay thanks stay they take they find this comfort and it some of them I assume survive but but it tell some of them it's it's a terribly well I mean I'm not sure I I understand because rationally there is no reason why you
00:58:54would stay but there is more to just as I learn from my Mexican immigration is more to Mexican immigration them pure %HESITATION cost benefit analysis and dollar and sense there's a lot of %HESITATION of psychology that goes into it and and what makes me feel like a big
00:59:10man when I go back home that's a big part of it might think there's must be a lot of psychology goes into white folks don't leave are horribly depressed economic areas they don't know anything they about and they don't know anything about any other area they'll feel at
00:59:24home %HESITATION they feel lost elsewhere %HESITATION Mister sister one of that you know goes into why they stay thank yeah Mr family but do you think this is a problem is this a particularly a female problem forty five to fifty four your book doesn't seem to suggest that
00:59:42%HESITATION I think I think this is a weight problem this is a white bread is not I've we've been talking a lot about %HESITATION Appalachian but but really the places where you find most this mostly I would better are in very nice %HESITATION %HESITATION well to do areas
00:59:56like %HESITATION Charlet Portland Salt Lake Indianapolis Minneapolis these are areas that have done really really well and the various economic expansions and boom so we've had over the last say %HESITATION %HESITATION well since the mid nineties basically and %HESITATION so no I mean I think this is a
01:00:13white %HESITATION problem that that study that you referenced by professor de it's white was but yeah yeah I mean it's it's white men and women and it's it's basically if you'll note that that that transformation that that up turn begins in nineteen ninety eight nineteen ninety eight there's
01:00:30only one thing really that happened about that time in in in the United States that affected white people all across the country that would create a new increase in mortality among folks and that is the expansion of opiate painkillers as as the go to bill for almost any
01:00:46kind of pain mass of supply of new opiates a big black market and a and a very very %HESITATION scary rise in in opiate addiction that we're now seeing I mean us if you look at that study it's it's ninety eight the crucial year and there's only one
01:00:59thing that how and that but that is not just in Appalachia that is not just you know and %HESITATION %HESITATION %HESITATION you know one of the rust belt areas it said many many well well to do areas are are are the are the same way it's a white
01:01:13problem let's close on a somewhat optimistic now which is your book does which is the which is the following %HESITATION the war on drugs been remarkably %HESITATION ineffective Hyatt has it brings with it many many many negative things besides the fact that it it fails and so it's
01:01:33very difficult to stop people from doing what they want to do and it's very difficult to stop entrepreneurial folks from doing what they can do and so the supply of black tar heroin is still out there the opiates on the street it's not quite is they're not as
01:01:48available as they were before there are new formulations being created that are they're trying to reduce the likelihood of of abuse the breaking open I mentioned earlier etcetera it's all kinds of efforts to try to make the magic %HESITATION the holy grail of the non addictive painkiller which
01:02:06of course it's probably doesn't exist and you mention that in the book that it's probably just a pipe dream to use a bad metaphor but the the the optimistic side of this is that there's a cultural problem too it's not just the fact that there's drugs available or
01:02:21that there's pain killers available that we have a certain emptiness at a record times as human beings in this fills it what's again point in a moving and inspiring at the end your book are the what we would call civil society the attempts of parents and others to
01:02:39band together to try to create efforts to rehabilitate to get their kids out of this problem to try to get their kids from getting started on the problem up talk about certain things are going on the you see is hopeful even in these depressed areas that somewhat cheerful
01:02:56this is a story about isolation versus community really this of these drugs are the most isolating drugs they thrive on because we are as Americans are culturally so isolated from each other whether in poverty or in wealth doesn't matter I don't think really %HESITATION into these drugs are
01:03:13almost like the book heroine certainly the poster drug for our era %HESITATION %HESITATION win in which we are superficially connected to each other through social media and internet and and and truly not connected in any human sense or %HESITATION disconnected very very widely I would say across across
01:03:31this country and so %HESITATION %HESITATION I see at the end of %HESITATION of my of after which might paperback book that fit if there's some you know heroin may be actually a call to a kind of a community renewal we have spent thirty five years in this country
01:03:47exalting the private sector destroying community allowing the private sector in my view to Kent to destroy community in many many areas jobs go overseas a variety of things the complicated story but I mean we can talk about that but I I think what's happened the last thirty five
01:04:01years as we have seen communities destroyed a we've we've for we've built a brand new suburbia %HESITATION this extraordinarily isolating we call that prosperity %HESITATION we have %HESITATION demonized government and laughed at government in called incompetent not trade %HESITATION taxes to support it and we have a system
01:04:19of situation now in my opinion where %HESITATION yet yeah having done all that have exalted the private sector demonized government what what we now have is a story in which the private sector has visited upon the United States of America that's people the most %HESITATION devastating our threat
01:04:39to personal liberty is that we know today which is opiates opiate addiction and for a long time the only ones were fighting that were %HESITATION were government officials corners jailers cops public health nurses %HESITATION etcetera that's changing what you're seeing is that here one is actually forcing us
01:04:56to come to recognize our own isolation our own a lack of community and actually ends those areas where it's hit hardest in some of those areas where it's it's hard it's hard it has pushed people to crew begin to create those bonds of community again at their halting
01:05:13the terms they don't always work there they the people seem to be up against a lot of very potent forces that are keeping that this from happening but nevertheless use I I begin to see this as I've been traveling around talking about Dreamland very small communities in America
01:05:28I begin to see this kind of idea that that that we need to kind of get to know each other again that we need to %HESITATION do things in public not always be afraid of the what's outdoors and outside but but you get the kids outside with them
01:05:41also skimmer needs within so afraid of the kids feeling any pain at all for decades a couple decades now and it all leads to is believed these kinds of problems so in in the town of Portsmouth Ohio has been a lot of time %HESITATION %HESITATION for this book
01:05:58I mean are you know people is that there's a new cast say there's there's work out spaces that people are developing there is %HESITATION %HESITATION there's a new recovery movement in that town after years and years of so many people being addicted a lot of the right now
01:06:12in recovery doesn't mean that there's no problems imports when still faces a lot of economic hurdles and and bad jobs basically %HESITATION but what you kind of find in those areas that heroin is really visited and pummeled and opiates to pummel the deer is this recognition that day
01:06:28yeah our communities have been devastating in and it's now time to kind of work back towards us of feeling of community and getting to know each other once again that's that's the positive I guess that I would take out of all the well I don't think you might
01:06:43be surprised to know that I agree with much of that I agree with the last part a lot %HESITATION and I would say is to listers at only found about two paragraphs in this book that I didn't agree with which which is a very small number for for
01:06:58the average okay read like this so I would just add that I don't think that the exaltation the private market in the just respect for government is is the root of the problem %HESITATION it hasn't stopped government from getting bigger since our last thirty or forty years and
01:07:15I don't think it's really the cost I think the deeper problem is the cultural problem the suggests and I don't I don't think we should look to Washington or Columbus which is the capital of Ohio for that feeling of community I think we have to create it ourselves
01:07:28from the bottom up rather from the top down so I'd I would agree with that as well I think that that's certainly true that that that I I I was just telling a woman %HESITATION who wanted to come help me speak in a %HESITATION in a in a
01:07:38part of Ohio in fact a saying you know my feeling is that the people in these counties they have the answers but still for so long they been laboring with a loan or are unaware of Wilson's working on these things are maybe not with proper budget or a
01:07:53variety of issues and it's coming together kind of finding that common ground is a crucial and and in the community feeling getting to know sometimes for example public health and cops don't know each other that's crazy in one county you know you'll find people don't really know each
01:08:11other that well we won't know how to work together well clearly there's there's there's ground for those folks to come together and work on this topic in really really and it's true then bear it's there where where is the %HESITATION the solutions I believe are are already there
01:08:28%HESITATION I don't want to give my speech as I make sure I don't say well if you want to solve this problem my policy prescriptions are one two three I don't ever do that I just say work it seems to me that a drug that is created and
01:08:41thrives on isolation that's the way to a to a casket is is defeating it through community and and that this is a problem that we have in our own isolation is a problem that we have been we have created for ourselves or many years now and forming a
01:08:57community total fight it can actually lead to enormous benefits not just in the fight against dope but in but in many many other ways %HESITATION %HESITATION steps does my message frequently when I'm when I'm out in these areas I guess today's been Sam going on is the book
01:09:11is Dreamland %HESITATION it's an extraordinary book %HESITATION I recommend it highly Sam thanks for being part of a Kantakouzenos affection was for the job this is econ talk part of the library economics and liberty for Marty contacted econ talk dot org or you can also comment on today's
01:09:36podcast and find links in readings related to today's conversation sound engineer free Cantacuzino yet I'm your host Russ Roberts thanks for listening talk to you on Monday

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