“One Nation, Overdosed”. That’s NBC’s catchphrase for this mess. Clever, isn’t it? The nation sits in the easy chair and shakes the collective head—those of us that aren’t piled on the street corner waiting for the body-wagon. “Bring out your dead!”
After OxyContin was relegated for use on patients that were essentially “goners”, the huge numbers it created dwindled almost overnight. I’ve haven’t seen an OxyContin OD in well over ten years, probably longer. “Hillbilly Heroin” became an archaic term in my part of the world. But, as said in the previous post, the roster of Opioid deaths did not diminish. From that point on, overdose casualties were easily the most predictable COD (cause of death) in our Office for anybody under forty-five years old. It became such that when the cops called in a death and you were given a date of birth that was in the 1960s or more recent, you automatically thought, “Hells bells, another one.” It became trite. Passé. Boring. Annoying. “Can’t these people find another way to kack?” A traffic death became manna from Heaven. You delighted in a good ol’ gunshot and wanted to shake a man’s hand for hanging himself. If your partner was going out to pick up an old lady who’d taken an unfortunate tumble into the basement, you were jealous, because you knew fucking well the next phone call would be a thirty-year old, unemployed brick layer with a pillar of foam rising out of his mouth.
After a while, it wasn’t just the standard opiates and their derivatives, but any substance that’s origins could be traced to a poppy field. Methadone, for crying out loud, the stuff that’s supposed to get you off the “hard stuff,” had become a popular conveyance to the graveyard. Then another, rather well-known substance was added to the list. “Smack,” “skag,” “H,” “horse,” “tar,” “brown sugar.” Heroin, man… The Grandaddy. Big Pharma had an old-but-new competitor, and with it a distributorship that didn’t have the FDA fucking with the product. Can’t blame the hippies this time around.
My first honest-to-god heroin OD was something of a hippie, a man in in his early thirties, living in a loft-style apartment, walls covered with his own artwork and a few guitars lying about. This was back in the OxyContin days, and was perceived as something of an anomaly. He was found on the floor next to his couch, insulin syringe still sticking out of his left forearm, a spoon and a candle on the coffee table. He hadn’t even gotten the tourniquet (a bandana) off his bicep. Old School, ya dig? But, there was something decidedly un-Old School sitting on his kitchen table. It was a FedEx envelope, addressed from a town near San Diego. The PD investigator told me that was “a new one on him.” He added “this stuff has been showing up, but it’s pretty rare.” When I brought the decedent back to the Office, it caused a bit of a stir. It had been the first one we’d seen in years, long before I’d shown up. Since then, the cases were heroin was the culprit have increased exponentially. One of the last ones I’d picked up, less than a year ago, was no hippie. He was barely into his twenties, discharged the day before from his third inpatient rehab stint, and hadn’t spent a minute away from his parents since they’d picked him up. The only time he was out of sight was in his bedroom. His kissed his mom g’night the evening he was home again, and was found dead in his basement bathroom the next morning. He’d never left the house, because his father had sat up all night fearing he’d sneak out and score, like he had the last time. There was a bindle of gritty brown powder in the key pocket of his jeans. Where’d he get it? That question triggered a little brainwork. He’d been strip searched when he was admitted to the facility, and spent the first week in a scrub suit. His clothing had been searched, then washed in an industrial/ commercial machine—one that would destroy any contraband no matter how well hidden or packaged. It was searched again once he’d earned them back. The only place he could have copped had to have been the facility itself, and just before he was discharged. I’ve heard that this has been an incident that’s not uncommon. Cartels and other bigtime organizations have been seeding treatment facilities for years. I’ve gotten word that treatment centers have clamped down on how much cash a client was allowed to have. Foolproof? A stopgap at the very least? Great on paper, bad in practice. I know a guy that sells weed who takes credit and debit cards.
“Why heroin?”, you may ask. Great question. Unlike those in the market for stimulants, thousands of opioid addicts didn’t acquire a dependence by seeking out a thrill. They got it by ending up in an emergency room or a doctor’s office. It’s a story everybody knows by now. Jim shatters his wrist after slipping on the ice. Jeanie’s back is knocked all to shit when she gets rear-ended coming home from the grocery store. Both go home with a bag from the pharmacy. Two months later, they’re back in the office or the ER, trying to convince a doctor that physical pain is still unbearable and they need that Percocet or Vicodin just to lead a normal life. This game works for a while, but eventually Jim’s doctor says “No more,” and Jeanie has found herself on the “professional patient list” at the local emergency room. The Doc giveth, and the Doc taketh away. Now they have something in common with the crackheads and tweakers. They have to find an alternate supplier.
They can get the same stuff, quality controlled, legitimate lab produced pills on the street, but their insurance company’s not about to help in footing the bill. A few years back, I was informed a single, 5 milligram tablet of Oxycodone sold on the street for anywhere from ten to twenty-five dollars. That much for a dose that has long been inadequate for your average abuser. An addict is taking three to five times that much—and not just once a day. Crushing and snorting, dissolving and injecting (needles and syringes require a prescription as well), and smoking it were an unpleasant and risky means of keeping the cost down. It doesn’t do much for enhancing a person’s self-image, either. Enter heroin.
Supply and demand, folks. Smack is back, and supplied by people with no regard for the consumer’s safety, or a concern for consistency in the quality or potency for the product. All it had to be was cheap. Here’s the breakdown. Jim now needs five Oxy’s to sufficiently “feed the monkey.” That’s gonna cost anywhere from fifty to one hundred twenty-five dollars every time that monkey gets hungry. A milligram of heroin—a reasonable, if not better, substitute for five mgs of oxy or hydrocodone—sets him back only five to ten bucks. That makes for one stuffed monkey. And you didn’t need to have it flown in from San Diego, either.
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More, oh, much more, in a couple days. Big Pharma hasn’t been asleep at the wheel. And I’ve yet to give you my take on how I see the gov’t is handling this from my particular seat at this show.
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