Dreamland (34 page)

In hilly Floyd County, Kentucky, a hundred miles south of Portsmouth, the story had to do with mining. When the deep mines were working years ago, Floyd County had a lot of jobs. A man would work down in the mines for twenty years, pay into his disability—a federal program known as Social Security Disability Insurance (SSDI)—and be out of the mines with black lung by age forty-five with a monthly check large enough to support a family. That became a life strategy in Eastern Kentucky.

But when the deep mines closed, strip mines took their place, using far fewer workers. Those who worked weren’t so easily injured. They didn’t qualify for workers’ compensation. As jobs disappeared, so did the disability income people could receive. Eventually, entire families grew up on SSI, which paid only a few hundred dollars a month. SSI, however,
did
come with a Medicaid card, and that made all the difference when OxyContin appeared.

“Twenty years ago they were drawing SSDI and full workers’ comp—say, eighteen hundred dollars a month,” said Brent Turner, the commonwealth prosecutor for that part of eastern Kentucky, whose career began in 2000, just as OxyContin became a business for impoverished families across Appalachia.

“The checks were higher because they’d go work in the mines and pay into their [SSDI] disability. Now we’ve got people who aren’t working, who are drawing SSI, maybe five hundred dollars a month. We’ve got people who have kids and wives and the whole family trying to survive on five hundred dollars. I’m not making excuses for them. Many haven’t had a job. But it is what it is. When you don’t work, and never have had a job, or paid into the system, you don’t qualify for much. We have boatloads of people who qualify only for SSI. You wouldn’t believe the number of people we see, twenty or thirty years old, have never had a job and are drawing checks since they were teenagers.

“That was one of the driving factors when pills exploded. We can talk morality all day long, but if you’re drawing five hundred dollars a month and you have a Medicaid card that allows you to get a monthly supply of pills worth several thousand dollars, you’re going to sell your pills.”

As the pain revolution took hold, “decent family docs were real liberal about prescribing them,” Turner said. “You have the easy availability of all these narcotics and you put it all together and they just exploded. When it comes to pills, it’s the aggregation of all those small-time people is what’s killing everybody. If the only people we incarcerate are Scarface, we won’t incarcerate anybody. It’s a cultural thing and everybody’s doing it.”

Much like the Xalisco heroin system, OxyContin didn’t have kingpins. Instead, the market was moved by a bunch of small-time operators relying on newly relaxed attitudes regarding pain pill prescribing, a new pill with a huge whack of dope, and the Medicaid card. Medicaid cards had been around for years. With OxyContin, they became licenses to print money.

“We always assumed that Purdue Pharma knew that so many people [in the area] had Medicaid cards,” Lisa Roberts, the Portsmouth city nurse, told me. “And that’s why they marketed OxyContin so hard around here.”

Whether the company knew that, Purdue did have information on the doctors who prescribed drugs most liberally. Many of them were in areas, not coincidentally, where the numbers of welfare and federal disability recipients were comparatively high—like southern Ohio and eastern Kentucky.

Every pill Mary Ann Henson harvested from the addicts whom she took to a pain clinic she could sell for a dollar a milligram—eighty dollars for one Oxy 80 mg pill, in other words. At those prices, and taking half the pills from each addict, she could make five thousand dollars from each patient she took to a doctor. She sold the pills from her house with her husband, Keith Henson. Years later they remembered their operation resembling a McDonald’s drive-through. Four people on the porch waiting while ten more were doing business in the living room.

Portsmouth once had the industrial ingenuity to invent the shoelace machine. Now it invented the modern pill mill. The clinics and OxyContin made Portsmouth, Ohio, a destination again. People flocked to the pain clinics from southern Ohio, eastern Kentucky, West Virginia, and Indiana. People in line to see John Lilly ordered pizza while they waited. They drank beer and snorted pills and puked in the bushes. Fortune Williams, out in Kentucky, hired security guards to direct traffic. From her flooring shop next to David Procter’s clinic, Karen Charles watched fistfights among patients in line.

Those lines were the addict Internet. News spread along the line about what doctor prescribed which drugs, who had a car stereo for sale. It may have been in those clinic lines where OxyContin first emerged as an economic currency in Portsmouth, Ohio.

Addicts of the morphine molecule valued dope above everything, including children and cash. Pills could not be altered or diluted. Pills held their value, and that value was printed on each pill. It helped that OxyContin came in 40 and 80 mg pills, and generic oxycodone came in 10, 15, 20, and 30 mg doses—different denominations for ease of use as currency. The pill mills acted as the central banks, controlling the “money supply,” which they kept constant and plentiful, and thus resisted inflationary or deflationary spikes.

By the late 1990s a critical mass was achieved and for about a decade the value of most goods in Portsmouth, and many services, was measured in pills.

Armed robbers in Portsmouth hit dealers’ houses, took the pills, and ignored the cash. Mary Ann once bought a car with OxyContin. She paid an off-duty cable TV worker in pills to install service. She paid a dentist visit with pills. She ransomed Keith from drug-addicted kidnappers with pills. She bought steak and diapers and laundry detergent with pills. Shoes for pills. Purses for pills. Perfume for pills.

Crucially, pills also bought children’s love. Junkies, whose main relationship was with dope, could briefly emerge from the fog to buy their children the toy, video game, or bracelet they coveted with pills—usually buying it off a shoplifter.

Part of the economy was a pulsing network of people putting out feelers—kind of a junkie Craigslist.

“Someone says, ‘Hey, I’m looking for a chain saw,’” Mary Ann said. “Then some guy comes by with a chain saw. You buy the chain saw for an oxycodone thirty you paid almost nothing for [thanks to your Medicaid card], and you call the other guy and sell him the chain saw for a hundred dollars cash.”

Something like that had evolved with Lorcet years before, but on a tiny scale. OxyContin, with so much dope in each pill, bought big stuff. Stone-cold, teeth-gnashing, mainlining junkies like Mary Ann now had big-screen TVs and computers, nice furniture and power tools.

Even urine leaked into the OxyContin economy. As authorities scrutinized Scioto County doctors, some clinics began requiring occasional urine tests. Probation officers always wanted them. So a black market in clean urine emerged, in which the fluid was exchanged like water in the desert. Addicts bought false bladders they strapped to their stomachs with tubes leading down into their pants. Neighbors of one pain clinic near downtown got used to people knocking on their doors asking if they wanted to sell their urine. Outside the pill mills stood people who charged in pills to pee in a cup, promising clean urine as they chugged water. Veteran clients would crumble oxycodone into the purchased urine, because doctors wanted to see that patients had no drug in their system other than what they prescribed. Kids’ urine was coveted for its purity and was worth an Oxy 40 in Portsmouth for several years.

Meanwhile, a sophisticated opiate class system emerged. At the top were the people who never used, but sold pills and bought anything a junkie brought in.

The late Jerry Lockhart was one of the elite. He lived on a promontory dubbed OxyContin Hill in West Portsmouth. Lockhart also took people monthly to see pill mill doctors, paid for their visits, and then took half the pills they were prescribed. These people were street rats—the lowest in the opiate class system.

Street rats were addicts who could never accumulate the capital to pay for their own doctor’s visit, much less anyone else’s. They scavenged scrap metal or stole lawn ornaments from front yards. They had a million hustles to get well through the month. The town had hundreds of street rats, and more crowding in from elsewhere on day trips to Portsmouth pill mills.

The relationship between street rats and distributors like Lockhart resembled sharecropping. One way street rats made it through the month was to ask dealers like Jerry Lockhart to front them pills. By the time their monthly doctor’s appointment rolled around, they owed most of what they were going to be prescribed. “If we were getting a hundred and eighty of them, we already owed him a hundred,” another addict said.

I talked to an addict named Donnie. In the Marines overseas, Donnie had been badly wounded, for which he was given morphine. He carried the taste for opiates with him when he returned to Portsmouth, which by then was bathing in them. As an Oxy addiction took hold, Donnie began selling his garage tools. He figured he sold almost all those tools to Jerry Lockhart.

During the month, he went frequently to Lockhart for pills. Lockhart would give him two, expecting four after the doctor’s visit. By his doctor’s visit, Donnie usually owed Lockhart almost all of what he was going to be prescribed.

Lockhart traded pills for stolen goods, which he sold out of a large garage on his property. He gave addicts pills for their food stamp cards and bought groceries with the cards. One addict said he gave Lockhart his card and didn’t see it again until Lockhart died two years later. An addict who said he worked for Lockhart told me Lockhart built virtually his entire house with material purchased with Lowe’s gift cards. All these cards came via merchandise addicts stole from the store: They returned the shoplifted stuff for gift cards; then they brought the cards to Lockhart for pills.

Shoplifters, in fact, were the wandering peddlers in Portsmouth’s junkie kingdom, providing the goods central to daily life in the OxyContin economy and taking only pills in payment. They stole groceries or tampons or detergent or microwaves on order.

Shoplifters’ importance to the OxyContin economy grew, in turn, from a new and indispensable rural institution.

In Portsmouth, as in much of rural America, most of what there is to buy is sold only at Walmart. In this case, the Walmart is in the neighboring town of New Boston, on the land where the coke plant once stood, and the smokestack remains. Everybody shops and socializes there.

I live in Southern California, a market that Walmart has not penetrated as completely. When I lived in Mexico, the Walmarts were only in Mexico City’s far-off suburbs. I entered my first Walmart in 2003 while visiting a southwest Kansas meatpacking town for a story about a high school soccer team. I came with a set of embarrassingly naïve images of what I expected from southwest Kansas. Few areas had contributed so many icons to Americans’ history: pioneers, cattle trails, family farms, Dodge City, and even the Wizard of Oz. All of it pivoted around, I imagined, the Main Street of small-town America.

I instead found ghost towns. My footsteps echoed down small-town Main Streets. On one, a pharmacist left a note in the window of her store. She had enjoyed serving the town, she wrote, but couldn’t hang on anymore and she hoped they’d understand why she was leaving like all the rest. She left no forwarding address.

Walmart was often the only place to buy most of life’s essentials in these heartland towns. Strolling their Walmarts, I imagined its aisles haunted by the ghosts of store owners who once sustained small-town America. On one aisle was the departed local grocer, down another the former hardware store owner, next to that, the woman’s clothier or that long-gone pharmacist.

So maybe I should not have been surprised to learn that in Portsmouth’s OxyContin economy, when the new rural junkies needed to get well, like everybody else, they turned to Walmart.

Before OxyContin, it wasn’t much to scrounge up four or five bucks to buy a Lorcet or a Vicodin to get well.

“You could find that in your couch,” said one addict.

Then Oxy came around, with its large dose of dope, high cost, and much stronger withdrawals. Suddenly dope-sick junkies needed a place where they could quickly come up with two hundred dollars in merchandise to sell.

“The more money you need to get the pill, the more product’s got to be had,” said Keith Henson, Mary Ann’s husband. “You could go to Walmart and spend a half hour in there and get enough for a pill or two.”

Of course, users could also con loved ones; they sold dope themselves; they broke into gun shops or robbed drug dealers. Lashed on by the morphine molecule, they did that and a lot more. But for many, the enormous blue retailer drew them like a magnet. Barred from your local Walmart? Another was twenty-five miles away in almost any direction.

Some large though immeasurable amount of the merchandise supporting addiction, as the opiates settled on heartland America, was mined from the aisles of Walmart, where Main Streets had gone to die.

In Portsmouth’s Oxy economy, junkie shoplifters had to be flexible. On any given day, they might get orders for boys’ shoes and a power saw and car stereo speakers and a T-bone steak. Once upon a time, that might have meant visits to four shops on Chillicothe Street. No longer.

“Walmart has such a big variety,” said Angie Thuma, a former nurse who stole from Walmart for years as a street addict. “I had people I would sell [shoplifted items] to on a daily basis. Everything was in one spot. If you need men’s clothes, it was at Walmart. If you needed shoes, I stole hundreds of pairs of shoes from Walmart. It was everything a person would want in one store.”