America is battling a massive epidemic of heroin and its pharmacological substitutes. By 2008 drug overdoses, mostly from opioids, overtook car crashes as the leading cause of accidental death. In a related development, the number of annual users of heroin jumped from 370,000 in 2007 to 680,000 in 2013.
The epidemic, as Sam Quinones, an American journalist, outlines in “Dreamland”, a meticulously researched new book, has two root causes. One is a failure of regulation in the pharmaceutical industry; the other is retail innovation in the black market.
In 1995 Purdue Pharma, a drug company in Stamford, Connecticut, was given permission by the Food and Drug Administration to market a powerful new opioid called OxyContin for moderate pain. Doctors, wary about prescribing opioids because of their markedly addictive nature, had previously used it for severe pain only. Many patients duly became addicts and “pill mills”, pain clinics that handled millions of prescriptions, began to appear. But OxyContin and other strong opioid tablets were expensive and addicts began to turn to heroin, which was cheaper.
Where did the heroin come from? Much of the business belonged to the Xalisco Boys, a group of Mexicans from a small rural county in Nayarit state, who professionalised the business while semi-refining black-tar heroin in the early 1990s. They gave addicts phone numbers so that they could have heroin home-delivered, as if it were pizza.
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