Dreamland (23 page)

A doctor in the video again made the claim—erroneously lifted from Porter and Jick—that narcotic painkillers were shown to cause addiction in less than 1 percent of patients.

In addition, the company sent out fourteen thousand copies of a video intended for doctors’ office waiting rooms—
From One Pain Patient to Another: Advice from Patients Who Have Found Relief
—encouraging patients to report their pain to physicians, and aiming to relieve concerns about taking opiate painkillers, claiming again that the pills caused addiction in less than 1 percent of patients.

Purdue funded pain societies and websites promoting pain treatment. These organizations appeared to be informational, but were funded by pharmaceutical companies. Partners Against Pain was founded in 1997 to offer consumers information about pain treatment options, including OxyContin, and providing a list of doctors around the United States who treated pain. One Purdue-funded website, FamilyPractice.com, offered doctors listings of free continuing medical educational programs on pain management.

The American Pain Foundation, a Baltimore organization that promoted the use of opiates for both acute and chronic pain, was funded by Purdue. The foundation organized e-mail campaigns to media outlets it accused of biased reporting on opiates and pain treatment. ProPublica, an investigative journalism nonprofit, reported that the foundation sided with Purdue in a 2001 class action case brought by Ohio patients who claimed to have become addicted to, or dependent on, OxyContin. (The APF would disband in 2012 as a U.S. Senate committee announced it was investigating the group’s role in promoting the use of opiate painkillers.)

Purdue donated money for website development to established groups, such as the American Chronic Pain Association and the American Academy of Pain Medicine.

The company was widely criticized for its campaign. Eventually, it would be prosecuted criminally. Yet Purdue’s marketing couldn’t have found an audience without the pain crusaders who tenderized the terrain for years before that, convincing primary care doctors that in this new age opiates could be prescribed to pain patients with virtually no risk of addiction. In many cases, hospital lawyers advised doctors that patients could sue them for not adequately treating their pain if they didn’t prescribe these drugs. Had that not happened—had there been no insistence that pain was undertreated and that pain was now a fifth vital sign—OxyContin would likely not have found the market it did.

By 2003, more than half of the prescribers of OxyContin nationwide were primary care doctors, who had little pain-management training and were under pressure to get patients in and out of their offices. Oxy prescriptions for chronic pain rose from 670,000 in 1997 to 6.2 million in 2002. Those for cancer pain rose from 250,000 to just over a million over the same time.

Phil Prior soon noticed colleagues prescribing OxyContin for chronic ailments—back and knee pain, for example, or the fibromyalgia that the salesmen had mentioned.

In southern Ohio, few people had ever come to drug treatment strung out on opiates. By 1998, however, Chillicothe and the surrounding towns were awash in hundreds of patients addicted to OxyContin. Indeed, patients would go to doctor after doctor with stories of pain and requests for more of the new drug. Dealers who sold meth or cocaine on the street started pushing Oxy. Addicts learned to crush it and snort it, or inject it, obtaining all twelve hours’ worth of oxycodone at once.

Seniors realized they could subsidize their retirement by selling their prescription Oxys to younger folks. Some of the first Oxy dealers, in fact, were seniors who saw the value of the pills in their cabinets. “It’s like hitting the Lotto if your doctor will put you on OxyContin,” Prior said. “People don’t even think twice about selling.”

OxyContin sales shot up. They surpassed Purdue’s goals every year, until they exceeded one billion dollars in each of 2001 and 2002. Rampant abuse accompanied those sales figures. News reports coined the nickname “hillbilly heroin” and chronicled the devastation caused by addiction to OxyContin. How many addicts began as recreational users and how many had once been pain patients was never quite clear.

Not far from Chillicothe, at West Virginia University in Morgantown, Dr. Carl “Rolly” Sullivan watched his drug rehabilitation clinic fill with OxyContin addicts. Alcoholics had been the clinic’s stock-in-trade. But West Virginia towns now teemed with opiate addicts to the point where alcoholics couldn’t find a bed at Sullivan’s clinic. He was seeing people on spectacular doses of OxyContin every day—300 mg and more. He couldn’t tell the difference between them and a heroin addict.

“Purdue and the pharmaceutical industry were saying that addiction in OxyContin is really rare,” said Sullivan. “The incidence of addiction was far higher than they indicated. But there was an enthusiasm for using [opiates] that was not borne out by science.”

As news reports recounted rising OxyContin abuse and addiction, Purdue called Sullivan and asked him to speak to its sales reps. Twenty of them met Sullivan at a hotel in Charleston. He saw they were concerned. He spent a couple hours with them, describing the foot traffic at his clinic, the amounts of their drug that addicts, some of them former pain patients, were consuming.

“We were told this was safe,” said one sales rep.

Sullivan brought along a woman from his clinic recovering from addiction to OxyContin. One sales rep asked her how long she would need to score OxyContin on the street outside the hotel.

“About twenty minutes,” the woman replied. “But that’s only because I don’t drive.”

Sullivan thought the visit sobered the sales reps, who’d been charging hard into doctors’ offices for five years by then. But he noticed that Purdue kept selling OxyContin the way it had. The pill now made up 90 percent of the company’s annual revenue.

Six months later, the woman Sullivan brought to the meeting died of an OxyContin overdose.

The Man at Home

Xalisco, Nayarit

The state of Nayarit lies along 180 miles of Pacific Ocean coastline, and stretches inland into the western Sierra Madre Mountains.

In the centralized politics of Mexico, Nayarit was an afterthought. Following Mexican Independence, the small territory remained part of the state of Jalisco for a century. Even when it was separated from its larger neighbor, Nayarit remained a military district. Only in 1917 was it made autonomous—becoming the fifth smallest of Mexico’s thirty-one states. Its population didn’t top one million people until 2010. The state is surrounded by some of Mexico’s behemoth states; Zacatecas and Durango are nearby. Sinaloa, the state streaking up the coast north of Nayarit, is the birthplace of Mexican drug trafficking. Tiny Nayarit rarely made the news.

Just south of the state capital of Tepic lies the town of Xalisco. Originally, the town spelled its name with a
j
—Jalisco. To avoid confusion with the state, town officials changed the spelling to Xalisco, and many residents refer to it as Xalisquillo—Little Xalisco.

Xalisco is bisected by a road that heads out of Tepic and south eighty miles into the resort of Puerto Vallarta. Xalisco’s San Cayetano Catholic Church was built in 1812, and this looks to be about the age of the cobblestones that stud the narrow street around the town’s central Plaza Hidalgo.

The municipio, or county, of Xalisco, with a population of 49,000 people, comprises a necklace of small villages surrounding the county seat. To the east is Pantanal, with its view of the Sangangüey volcano, and where authorities placed Tepic’s airport. To the south, along the Puerto Vallarta highway, is hilly Testerazo, followed by Emiliano Zapata, where a bust of the Mexican revolutionary marks the entrance to town. Farther south is Aquiles Serdán. There are other villages—La Curva, El Malinal, Adolfo López Mateos, El Carrizal.

The Man arrived here for the first time in August 1993 and found a humble place, looking like so many other Mexican small towns. Xalisco’s plaza held a basketball court and bandstand, and was surrounded by a market, a small city hall, a few clothing stores, an ice-cream shop. Old men in straw cowboy hats and sandals gathered to kibitz about town life. The trucks were few and old, and the houses were narrow—row houses that opened right onto the sidewalk. Outside the town center was undeveloped land that separated Xalisco from the capital city a couple miles north.

Early August is the time of the town’s Feria del Elote—the Corn Fair. Like Xalisco itself, the fair the Man attended was picturesque but humble, with basketball and soccer tournaments pitting neighborhood and village teams against each other. There were modest carnival rides, cotton candy, a horse parade, and every night bands, for hire by the song, played in the plaza.

That year, he and the Nayarit and others who were dealing heroin in the United States sponsored soccer teams in the fair’s tournament for the first time. The Man sponsored the team from La Talega, a neighborhood on Xalisco’s south end, buying them uniforms and balls, then betting with the Nayarit and other dealers on who would win. The loser paid for six hours of banda music in the plaza that night.

Once only legitimate businessmen—large landowners often—spent heavily at the fiesta. But as the new heroin traffickers grew in numbers and in confidence, they never missed a feria and the chance to relax and spend money ostentatiously.

Their free spending boosted Xalisco’s economy. People watched who was spending a lot, with an arch of an eyebrow at a new truck or recently purchased house or the guy who was suddenly paying the banda in the plaza. The fair became a kind of convention for tar heroin traffickers in the United States. At parties around town, they would show off, talk about how well they were doing, share tips on avoiding cops, or complain about the arrest of a trusted driver.

The Man never missed a Feria del Elote after that. In 1996, he bought a half-built house from a woman whose bank-robber husband was doing fifty years in prison in Sinaloa. He added on to it, with grass in the front yard, resembling houses in California. He added a bar, a music room, wide hallways, and two bathrooms. He met a woman and they shacked up. Every year, after the fair was over, the Man returned to the United States.

In Reno, he hung out in the sports betting room of the Cal Neva Casino, where he sated his other addiction: gambling on NFL games. There he met a card dealer, a large, husky black man named Daniel. Daniel and his wife were longtime heroin users from Columbus, Ohio. Daniel, it turned out, loved black tar heroin. It was a revelation. Back east there was nothing like it. In Columbus, any heroin they could get was weak powder, stepped on to the point where it qualified as bunk. An addict had to spend a hundred dollars or more daily just to not get dope sick.

Daniel took the Man aside one day at Cal Neva.

“You should take this out to Columbus, man,” he said. “You’d become a millionaire. There ain’t nothing like this out there. I got an uncle I could hook you up with.”

He thanked Daniel.

“I didn’t even think of Columbus until he put a bug in my ear,” he told me many years later.

Meanwhile, his woman in Nayarit was complaining that he was taking the risks, running everything in the United States. The Nayarit was back in Mexico doing nothing and getting money he didn’t deserve, she said.

“You know what it’s like once you get a woman involved,” he later told me. “She said, ‘You’re doing everything. I don’t see him doing nothing.’”

He had to admit that keeping track of businesses in Portland, Reno, Salt Lake, Hawaii, and Denver was distracting. The small details of retailing drove him nuts: keeping the kids working hard and not straying into partying; replacing a seized car in Denver or a driver arrested in Portland. When two drivers in Hawaii killed their cell bosses, the Man claimed the bodies at the request of the family and sent them back to Mexico.

He wanted a break. His friend pleaded with him.

“You’re breaking up when we’re going strong,” the Nayarit told him. “We’re doing good.”

“It’s time I got out on my own.”

It was 1997. The Man was fully integrated into Xalisco, thinking of the town as home now. He owned property there. He had a woman, livestock, and respect. In the plaza, parents whose sons he had hired came up to him and shook his hand. One even gave him a pig, another a cow. He now had the contacts to bring in his own supply up north.

The Man contacted Daniel, that card dealer in Reno, who produced a telephone number for his uncle, Chuckie, in Columbus.

“Call him,” Daniel said. “He’ll help hook you up with everyone you need.”

The Man returned to Xalisco. He bought a house near the beach in San Blas, Nayarit’s main tourist town. He relaxed for six months. But no money was coming in and his woman was spending a lot. So, after six months of kicking back, he returned to the United States in 1998, thinking it was now time to expand east. He looked at a map and saw three cities in a row: Indianapolis, Dayton, and Columbus. He figured he would try his luck.

On June 11, 1998, he flew into Indianapolis and found a cheap motel off Washington Street, the hooker stroll on the east side of town.

“Watch out, man,” said the motel clerk as he checked in. “There’s a tornado comin’. Stay away from the window and look for a place to get low.”

The Man had never seen a tornado. He watched with special concentration that afternoon as the sky got dark and a wind attacked. The wind blew the rain sideways and it hit his window like volleys of BBs; it was not cool, like the rain in California, but eerily warm. Then a massive dark funnel a quarter-mile wide, roaring like a jet plane, came right down Washington Street. He watched it rip roofing off a Pizza Hut, and shred a day-care center. A man parked his car and scurried his family indoors. A moment later, the car was gone. They found it three blocks away.