By SARA ARTHURS
ADA — When it comes to fighting the opiate epidemic, “The best news is that there is no solution,” Sam Quinones told an audience at Ohio Northern University on Thursday.
There are, instead, many solutions — none of which alone will instantly solve the problem, but which can all work together.
That’s important because we as a society have been looking for one easy solution to our problems — just as OxyContin itself was seen as one pill to ease all our pain, he said.
All over the country, Quinones is seeing people who had never collaborated before coming together to combat the problem.
He calls the epidemic a “horrible, lacerating nightmare.” But he has also come to see it as a positive force for change, because “it’s pushing us to re-examine how we live.”
Prescriptions and pushers
Ohio Northern’s incoming freshmen were assigned to read Quinones’ 2015 book “Dreamland: The True Tale of America’s Opiate Epidemic,” winner of numerous awards, including the National Book Critics Circle Award for nonfiction work.
The author said the opiate problem wouldn’t have reached this size without the liberal prescribing of OxyContin — but it also wouldn’t be as immense without heroin from Latin America and Mexico becoming much cheaper.
It used to be that heroin was associated with New York, he said. It came from the East, and was diluted and very expensive by the time users got ahold of it. “All of that changed” in the 1980s, as heroin from Latin America became more prevalent. Because it didn’t have to travel as far, it became cheaper and more potent every year. At the time, “nobody noticed,” Quinones said.
Also about the same time, chemists were creating stronger prescription drugs. It was in the 1980s when fentanyl was first used in American medicine, and that a revolution took place in American pain management.
To some degree, Quinones said, those who advocated for more use of narcotics were right: Back then, there was such a fear of these drugs that some doctors would not use them even to ease the pain of patients dying of cancer. Pain management was at first comprehensive, treated through opioids, but also with methods like acupuncture, or marital counseling to relieve stress. Over time, insurance companies stopped paying for anything other than the pills, he said.
OxyContin came onto the market in 1996, as pharmaceutical sales strategies were changing. It used to be sales representatives had a medical or pharmaceutical background and “knew what they were selling.” And there weren’t many of them, Quinones said. That also changed in the 1990s, with a pharmaceutical sales force “arms race” between companies.
Quinones said the change would have been impossible “were it not for us” — Americans in general, who started demanding “a life free of pain.” Attitudes shifted to where people assumed if they ate too many fatty foods, a cholesterol pill could fix it. Consumers even began to demand antibiotics for the common cold.
There were narcotics before OxyContin, but it was harder to abuse — and become addicted to — drugs like Percocet or Vicodin in the same way. This is because these medications also include acetaminophen, which would seriously damage internal organs if taken in excess. OxyContin, by contrast, is solely opioid. It was falsely assumed to be nonaddictive, so doctors might prescribe, say, a 60-day supply, with refills.
The supply was a “fire hose blasted at this country,” Quinones said. And then the pills were sold on the black market, where they were expensive.
At that point, people finally recognized the change in the heroin market.
When he began researching the story, Quinones imagined it would be about drug trafficking and drug marketing. But he realized it was more than that, that “this is a story about who we are … what we had become as a country.”
He said America had spent the past 35 years “destroying community.” Addressing the heroin epidemic means going back to community — and addressing isolation, he said.
Children don’t play freely in the street anymore, and adults tend to talk only to people we agree with — except when we’re “yelling at them” on social media.
Heroin is “the final expression” of values we’ve fostered as a culture, like isolation, and a culture that believes buying stuff leads to happiness. After all, addiction involves narcissism, turning away from the community, and “self-gratification,” Quinones said.
“Isolation is heroin’s natural habitat,” he said.
He believes “the antidote to heroin is not naloxone. It is community.” (Naloxone, also known as Narcan, is a medication which can reverse an opiate overdose.) In isolation, problems seem impossible to solve. But one thing that “has excited me” is seeing how communities across the country have come together to address the issue.
And “nobody had to do a pilot program” or a study, he said — groups have just been “forming organically.” They’re not perfect, and sometimes they’re stumbling along, but they’re working together to find solutions.
Quinones regularly gets asked which counties are really doing the right thing. His response? “Every county I’ve been to.”
He sees communities “banding together,” as in Hardin County, which then prepares these communities to better address the next crisis, whatever it might be. This includes PTAs, chambers of commerce and churches.
“Adding your energy to it is absolutely essential,” he said.
One attendee asked about the Xalisco Boys, the group of drug traffickers referenced in the book. Quinones explained that this group had developed a new way to sell heroin retail, similar to pizza delivery, and were the first to identify and systematically exploit the market for heroin. They are still active, he said, but had been a big fish in a small pond. “Now the pond is an ocean.”
Another question was where Quinones had seen recovery succeed.
“Recovery is not a magic wand,” Quinones said, noting that he himself was a smoker for many years and “quit smoking nine times.” Similarly, someone seeking recovery from another addiction might have periods of sobriety and periods of use. There is also a great role for medication-assisted treatment like Vivitrol, methadone and suboxone, he said.
A student asked Quinones how, as college students, they could raise awareness. He encouraged her to get educated as best as she could, then to go out and talk to people.
In an interview with The Courier before his talk, Quinones said in Portsmouth, Ohio — where some of the book is centered — there are still drugs, and few jobs. But while 10 years ago there was a culture focused on getting high, “Now you have a recovery culture that’s competing with that.”
“I find that to be the great, quiet story of America,” he said.
Quinones met with university and community leaders at a reception prior to his talk. University President Daniel A. DiBiasio said having someone who’s had such “a major impact” on the issue as Quinones come to campus “ratchets up the conversation and the discussion.”
The university has created its own opiate task force, which DiBiaisio said is focusing on how to use university resources to be part of the solution.
Josh Mohn, a public health student who plans to attend medical school, is learning about what a huge public health problem opioids are, and is looking forward to taking a class on the topic next term.
“This is something incredibly important,” he said.
Hardin County Sheriff Keith Everhart said Ohio, and Hardin County, have a “tremendous epidemic.” He has been sheriff 10 years, and worked in the sheriff’s office for 25. In the past three to five years, he’s seen people coming together more than ever before.
“They were always trying to do good,” but they were doing it “on their own” and now they’re working together, he said.
Quinones said it took 20 years to get to where we are now, and yet people “wonder why we’re not solving this already. … It may take a good long time.”