FATAL heroin overdoses in America have almost tripled in three years. More than 8,250 people a year now die from heroin. At the same time, roughly double that number are dying from prescription opioid painkillers, which are molecularly similar. Heroin has become the fallback dope when an addict can’t afford, or find, pills. Total overdose deaths, most often from pills and heroin, now surpass traffic fatalities.
If these deaths are the measure, we are arguably in the middle of our worst drug plague ever, apart from cigarettes and alcohol.
And yet this is also our quietest drug plague. Strikingly little public violence accompanies it. This has muted public outrage. Meanwhile, the victims — mostly white, well-off and often young — are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.
The problem “is worse than it’s ever been, and young people are dying,” an addiction doctor in Columbus, Ohio — one of our many new heroin hot spots — wrote me last month. “This past Friday I saw 23 patients, all heroin addicts recently diagnosed.”
So we are at a strange new place. We enjoy blissfully low crime rates, yet every year the drug-overdose toll grows. People from the most privileged groups in one of the wealthiest countries in the world have been getting hooked and dying in almost epidemic numbers from substances meant to numb pain. Street crime is no longer the clearest barometer of our drug problem; corpses are.
Most of our heroin now comes not from Asia, but from Latin America, particularly Mexico, where poppies grow well in the mountains along the Pacific Coast. Mexican traffickers have focused on a rudimentary, less-processed form of heroin that can be smoked or injected. It is called black tar, which accurately describes its appearance. Cheaper to produce and ship than the stuff of decades past from Asia, heroin has fallen in price, and so more people have become addicted.
The most important traffickers in this story hail from Xalisco, a county of 49,000 people near the Pacific Coast. They have devised a system for selling heroin across the United States that resembles pizza delivery.
Dealers circulate a number around town. An addict calls, and an operator directs him to an intersection or a parking lot. The operator dispatches a driver, who tools around town, his mouth full of tiny balloons of heroin, with a bottle of water nearby to swig them down with if cops stop him. (“It’s amazing how many balloons you can learn to carry in your mouth,” said one dealer, who told me he could fit more than 30.)
The driver meets the addict, spits out the required balloons, takes the money and that’s that. It happens every day — from 7 a.m. to 7 p.m., because these guys keep business hours.
The Xalisco Boys, as one cop I know has nicknamed them, are far from our only heroin traffickers. But they may be our most prolific. As relentless as Amway salesmen, they embody our new drug-plague paradigm.
Xalisco dealers are low profile — the anti-Scarface. Back home they are bakers, butchers and farm workers, part of a vast labor pool in Xalisco and surrounding towns, who hire on as heroin drivers for $300 to $500 a week. The drug trade offers them a shot at their own business, or simply a chance to make some money to show off back home — kings until the cash goes. Meanwhile, in the United States, they drive old cars with their cheeks packed like chipmunks’, and dress like the day workers in front of your Home Depot.
The heroin delivery system appeals to them mainly because there is no cartel kingpin, no jefe máximo. It is meritocratic — so unlike Mexico. They are “people acting as individuals who are doing it on their own: micro-entrepreneurs,” said one phone operator for a crew who I interviewed while he was in prison. They are “looking for places where there’s no people, no competition,” he said. “Anyone can be boss of a network.” Thus the system distills what appeals to immigrants generally about America: It is a way to translate wits and hard work into real economic gain.
The money, meanwhile, helps paper over the Mexican small-town animus against drugs, and the guilt many feel at watching their product reduce kids just like them to quivering slaves.
They are decidedly nonviolent — terrified, in fact, of battles for street corners with armed gangs. They don’t carry guns. They also have rules against selling to African-Americans because, as one dealer put it, “they’ll steal from you, and beat you.”
The Boys started out on the fringes of the drug world in West Coast cities. In the late 1990s, they moved east in search of virgin territory. They avoided New York City, the country’s traditional center of heroin, because the market was already run by entrenched gangs. The city still has enormous supplies of dope coming through it, mostly imported now by traffickers from the Mexican state of Sinaloa, and by Dominicans who buy it from Colombians. But New York is no longer the country’s sole heroin hub. They also skipped cities like Philadelphia and Baltimore, where black gangs control distribution.
The Xalisco Boys migrated instead to prosperous midsize cities. These cities were predominantly white, but had large Mexican populations where the Boys could blend in. They were the first to open these markets to cheap, potent black-tar heroin in a sustained way. The map of their outposts amounts to a tour through our new heroin hubs: Nashville, Columbus and Charlotte, as well as Salt Lake City, Portland and Denver.
THEY arrived in the Midwest just as a revolution in American medicine was underway, and an epidemic of pain-pill abuse was spreading over that region.
In the ’90s, some doctors came to believe that opioid painkillers were virtually nonaddictive when used for pain, and they prescribed them freely — not just for terminal cancer patients, but for chronic pain sufferers, too. Many patients were in pain. But instead of pursuing more complicated pain solutions, which might include eating better, exercising more and, thus, feeling better, too many saw doctors as car mechanics endowed with powers to fix everything quickly.
Too often, opioid painkillers were prescribed to excess; after I had my appendix removed a few years back, I received 60 Vicodin, when four might have been enough.
A result has been a rising sea level of prescription painkillers that continues today, of opioids such as Percocet, Vicodin and OxyContin. Sales of these drugs quadrupled between 1999 and 2010. Addiction followed. And this has given new life to heroin, which had been declining in popularity since the early 1980s.
In places like Columbus, the Xalisco Boys stumbled onto multitudes of new addicts, many of whom were already hooked on opioid pills that doctors had prescribed. Their heroin was cheaper than the pills, yet provided a similar high. And their delivery system made heroin conveniently available to suburban white kids who possessed the trinity of American prosperity, essential to the Xalisco system: their own cellphones (to call the dealer), cars (in which to meet the dealer) and private bedrooms (in which to shoot up and hide the dope).
Prescription pain pills have created a new home for heroin in rural and suburban Middle America. Thanks to them, the Xalisco Boys built what the justice department called the first coast-to-coast distribution networks, which also included Hawaii and, for a time, Alaska.
They have kept their edge by betting not on guns but on marketing. Just as pharmaceutical companies promoted prescription pills to doctors as the solution to demanding chronic-pain patients, the Xalisco Boys promoted their system as the safe and reliable delivery of balloons containing heroin of standardized weight and potency. The everyday solution for white suburban addicts afraid of rummaging around Skid Row for dope. Only a phone call away; operators standing by.
Today, they are our quietest traffickers. And our most aggressive. Other heroin dealers wait for customers to come to them. The Xalisco Boys drive after new ones. They hang out at methadone clinics offering patients free samples. They offer price breaks and occasionally make customer survey calls: Was the dope good? Was the driver polite? Any customers showing signs of quitting get a visit from a driver plying them with free hits.
They are the only network of Mexican traffickers I know of that manufactures its own product, exports it wholesale into the United States and then retails it on the street in tenth-of-a-gram doses, thus controlling product quality, price and customer service.
The police try to combat them, but they are like the Internet of dope — a crew can shut down as quickly as a website. One strategy is to arrest drivers, confiscate their cars and apartments. That raises the business costs of the crew owners back in Xalisco, who continue to oversee drug production and recruit new drivers from Mexico. Arresting these owners would be more effective, but we’d have to depend on Mexican law enforcement — which is hobbled by corruption, and stretched thin by far more violent drug networks — for that.
What we can do is improve our rehabilitation options for those trapped in addiction. Some argue that we should also legalize heroin. But we already have a legal opioid for addiction maintenance. Methadone, when administered properly, is cheap, safe, crime- and needle-free and, unlike heroin, requires one daily dose, thus allowing addicts to live relatively normal lives. Of course, methadone can also keep an addict tethered to dependence. Besides, both of these responses address only the symptoms of the epidemic.
The tale of the Xalisco Boys, indeed the spread of heroin across America, really gets back to prescriptions for pills to kill our pain.
Traveling the country to write a book chronicling this story, I was struck by how much agony we create in pursuit of numbed pain. It also occurred to me how un-American this is. America’s greatest idea is self-reliance. That we can take charge of our lives and not have them determined for us. This idea inspires immigrants who come here. It is, in essence, what the Xalisco Boys are about, despite their diabolical behavior. But opiate addiction is the opposite of that American idea. Opiate addicts relinquish free will, enslaved to the pursuit of painlessness.
Some places have gained ground on the epidemic. Portsmouth, Ohio, was among the first to see a generation addicted, and pill mills — pain clinics where doctors prescribed pills for cash and without a proper diagnosis — were virtually invented there. Portsmouth, like a junkie who has hit rock bottom, has found within it a spirit of self-reliance that has helped kindle a culture of recovery. The town shuttered the pill mills. Narcotics Anonymous meetings are now everywhere; recovering addicts are studying to be counselors. And after years of watching jobs go abroad, in 2009 townspeople stepped in to save one of Portsmouth’s last factories — a shoelace manufacturer, which now exports shoelaces to China, Mexico and Taiwan.
Like Portsmouth, we need to take accountability for our own wellness. There is a time and a place for pain pills, of course. But we need to question the drugs marketed to us, depend less on pills as solutions and stop demanding that doctors magically fix us.
It will then matter less what new product a drug company — or the drug underworld — devises.
Sam Quinones is the author of “Dreamland: The True Tale of America’s Opiate Epidemic.”