I was at the end of a meeting with a mother whose child is a victim of the country’s opioid epidemic. “So, I’m trying to write about how the opioid epidemic is affecting us,” I informed her. She responded immediately: “It touches everyone, it’s everywhere. I mean, how did it get to this?”
“Where do I even start?”
Muskingum County, Ohio, is a typical Midwestern community full of kind, generous, and community-minded folks. Social and volunteer organizations flourish. Local philanthropists have made it a point to invest heavily here, to the entire community’s benefit.
Zanesville, the county’s seat, weathered the storm of the Great Recession better than many Midwestern small towns, but you can still see the scars.
Even so, the county has a little bit of anything you might want. You can live in a historical district, a downtown artist colony, or so far out in the country hills that you’ve got no mobile phone coverage. There’s farm-to-table food, fast-food joints, and Tom’s Ice Cream Bowl, voted USA Today’s “Best Ice Cream Shop in America” as every proud Zanesvillian is pleased to tell you. It’s Midwestern small-town America.
It’s a good community, with 86,000 decent, hard-working people. Yet every person here knows or is acquainted with someone who is affected by what the media calls “the opiate crisis.” It is a scourge our country allows to rage on, unfettered.
It’s been several years since Sam Quinones came through Zanesville to discuss Dreamland, his seminal work discussing the rise and proliferation of America’s opiate epidemic, in large part focusing on my part of the country. Earlier this year, Javier Peña and Steve Murphy, the agents portrayed in Netflix’s “Narcos,” spent a day-and-a-half here discussing their experiences with Columbian, and then later Mexican cartels smuggling mass quantities of narcotics into the United States. Meeting them and hearing their observations was a great opportunity, and very eye-opening.
But what I actually see prosecuting felony drug cases in Eastern Ohio today bears little resemblance to Quinones’s description of overprescribed Oxycontin and specialized Mexican poppy-towns. And for what it’s worth, there are no “Breaking Bad”-style Walter Whites or Jesse Pinkmans cooking meth here anymore, either.
No, what we face is industrially produced meth that makes it all the way to low-level distributors as “big as your thumb” crystals, and uncut fentanyl so dangerous that cops don’t dare touch the drugs they confiscate.
Cheaper and Deadlier
To the uninitiated in this world, some background is illustrative. Let’s say we want to work a drug trafficking case in my county, from a law enforcement perspective. Dope comes in kilos, half kilos, nine packs (nine ounces/quarter kilo), zips (ounces), half-ounces, quarters, eight-balls (1/8 ounce or 3.5 grams), and on down to tenths of grams. An eight-ball gets you to a third-degree felony.
Four years ago, this eight-ball would cost somewhere between $300 and $350, depending on the target and the way you were working the case. Those were Appalachian Ohio prices.
It pours over the U.S. border with Mexico like a raging torrent. There are no meth labs anymore because no one can afford to make it. The combined price of the components (lithium batteries, Coleman fuel, lye, Sudafed, hydrochloric acid, etc.) is now considerably greater than the cost of the imported Mexican product.
In the early 1990s, major cities fought crack-fueled inner-city gangs. We spent much of 2018, in rural Muskingum County, Ohio, battling a meth-slinging prison gang running wild on our streets. We can strike back against these scourges when we have the will to do it.
The other new development is fentanyl and its derivatives. Fentanyl is a synthetic opioid that can be manufactured with the right chemicals—just like meth—in someone’s bathtub or garage. Fortunately or unfortunately, that’s not actually happening because much like meth, fentanyl is flowing into the country like a river. And it’s a lot more convenient than the heroin it is replacing. Smuggling one kilo of fentanyl across the border is the financial and narcotic equivalent of smuggling thirty (30) kilos of heroin. And fentanyl doesn’t require a field to grow.
Being 30 times as potent as heroin, fentanyl is administered medicinally as a fluid, or as a patch absorbed through the skin. Officers coming in contact with the substance on the streets similarly absorb it through their skin, leading to overdoses. A good friend of mine nearly overdosed after placing a bag of powder into the evidence container in the back of his cruiser and driving back to the station. He had to be “narcanned” on the side of the road.
Narcan is the common term referring to a drug called Naloxone, sometimes considered a “Lazarus” drug for its ability to immediately reverse the effects of an opiate overdose. It is so prevalent that “narcanned” has become common parlance.
Fentanyl Reigns Supreme
Drug dealers are smart and ingenious. Today, they’re using fentanyl for, and in, everything. It is so much more potent by weight and consequently so much easier to smuggle, conceal, and cut that it is showing up in a throw-back reference to the original hook of Quinones’s Dreamland, pills. Now, when you buy what is said to be a prescription pill on the streets of Ohio, the chances are good that the pill is actually fentanyl that has been pressed—properly colored, shaped, and marked—into a pill that looks just like your perc 20, (Percocet 20mg) or your Oxy.
Just a year and a half ago, in February and March of 2018, 17 people died in Muskingum County from overdoses related to fentanyl. Many of them I knew as names common from police reports and investigations. One of them I knew as the son of a dear friend, a friend so bent by grief that he died of a heart attack just two weeks later.
With some of the overdoses, the bulk trafficker of fentanyl to my area sent uncut product to his customer, and that man—the dealer selling the poison from a hotel in my community—wasn’t smart enough to compound it correctly in his heroin. This resulted in a string of overdoses among his users. Perversely, in these circumstances word spreads among the opiate addicts that the dealer with the strongest heroin has “the best stuff” creating a greater demand for the most dangerous drugs. Herein lies one of the moral hazards of narcan.
Some of the other overdose deaths had a separate, equally distressing cause, and one related to efforts to treat opiate addiction. Vivitrol is a monthly shot developed to combat opiate addiction. While expensive, vivitrol works pretty miraculously to block the effects of opiates on a person. Much as narcan reverses the effects of opiates acutely, vivitrol makes it so you cannot get high from opiates for up to a month at a time. Unfortunately, it still lets you get high from meth.
And addicts are not so much addicted to a specific drug as they are addicted to getting high.
So when an opiate addict can’t get high from opiates, getting high from meth is the next best thing. Worse, dealers have started making their meth “better” by cutting it with fentanyl. Without a prolonged medical discussion, when a person stops taking vivitrol, or relapses out of a period of recovery, they are significantly more opiate naïve than when they started treatment, and a lesser quantity of opiates than they are in the habit of taking will cause them to have a fatal overdose. For instance, the amount of fentanyl now mixed in with their methamphetamine might kill them, or the fact that they started vivitrol before fentanyl was on the streets might mean their first hit of “fetty” is deadly.
By the end of February 2018, we had the first of several multiple-overdoses in the county jail when an inmate—having hidden fentanyl in his rectum during a traffic stop and arrest—distributed to other inmates the fentanyl he smuggled into the jail.
In March 2018, my office laid down the first indictment for involuntary manslaughter against a dealer we could prove had sold the fentanyl that killed one of his customers. Such prosecutions are exceedingly difficult given that the addict is no longer alive, and fellow addicts tend to steal the evidence, tamper with the scene, and act to defend their drug supplier. Citizens and juries do not seem to be excited about the charges either, given that the drug is something an addict “chose to put in their body.” In contrast, my office views the charges as an opportunity to increase the risks inherent to dealing drugs, provide closure for survivors, and rid the streets of dangerous individuals.
In 2016, my office indicted 420 felony cases. In 2017, it was 500. In 2018, it was 758.
Now we are eight months into 2019, and what a difference a year makes. At this point, opiate users aren’t buying heroin cut with fentanyl anymore. They’re seeking out and buying straight fentanyl.
We made narcan over-the-counter, and we even give it away for free. Overdose deaths are down. But now addicts are having narcan parties. I am not making this up. Everyone gets their narcan together and sees how close they can get to dying, knowing the narcan is there to save them. EMS crews routinely have to utilize 10 or more doses of narcan to revive an addict for a single overdose, and just as routinely they have to revive the same addict more than once in the same 24 hour period. As I said, it’s creating a moral hazard.
In social circles, and more often in social media, it is not uncommon periodically to hear the refrain that “narcan should be illegal” or that it should be limited to a single use or application. Of course, serious discussion always leads to an acceptance that no decent person could live with allowing someone to die in front of their eyes if it were in their power to stop it from happening. But the expression exposes a deep frustration held by many about the intractable problem created by a cycle of synthetic opiate and methamphetamine abuse by persons with no interest whatsoever in reform, recovery, treatment, or rehabilitation.
The courts are not the solution to addiction. They’re a tool that sometimes helps certain addicts find their bottom, when family, friends, and self-interest have not been enough. Alternatively, the courts can shuffle off those who feast on the sores of addiction to be warehoused in a place where society is protected from their actions.
Cases aren’t just mounting in felony court. They’re mounting in juvenile court where my office takes custody of more and more children every year. They’re mounting at Job and Family Services, where more and more children have a single living functioning parent, or none. Another generation is being raised by grandparents. Children injured or killed due to the actions of their drug-intoxicated parents and caregivers used to be an unfortunate anomaly on the docket. Now it’s a routine problem. Another child died two weeks ago at the hands of a meth-addled assailant.
People take it in stride. Ohioans are hardy and good-natured. Two years ago, one community initiative opened a restoration park including communal gardens, fountains, and green spaces for public movies and entertainment. The gardens are a hit, growing every year. Yet recently, caretakers have had to add the weekly chore of removing the needles and detritus left by voluntarily homeless addicts who treat themselves to the free vegetables. As in California, scores of voluntarily homeless people are a new and growing phenomenon in this place. It’s not acceptable. Is this to be the way of things?
There may be solutions. But we don’t appear ready to pursue them.
Give Addicts Shelter
It is rational to accept that drug addicts have an addiction but it is not rational to permit or enable their addiction. In a related matter, as a society, we have come to accept that victims of domestic violence struggle mightily to break free from the pressures of all types which keep them trapped in a hostile, dangerous and oftentimes deadly environment. They know the dangers and still stay. Even so, almost all communities have and maintain domestic violence shelters. These are places safety and confidentiality where a person can go to escape on perhaps the one day they have the strength to leave.
Without a waiting list, without judgment, without barriers, without court orders, and without others who have been ordered by the courts to be there, these shelters offer a haven. These shelters are, importantly, a place of refuge where no one can send a person, and where no one can force a person to stay. We have nothing like this for drug addicts.
This type of no-judgment, non-compulsory, no-wait narcotics shelter is an asset we desperately need. But it’s not as easy to set up a place like this as it is to establish a domestic violence shelter. There are medical needs. It’s far more expensive. Most importantly, people have a natural sympathy for victims of domestic abuse that is often absent in cases of drug abuse. That is to say, people feel a genuine desire to reach out and volunteer their time and effort—the real currency of intervention—to lift up women who have suffered at the hands of an abuser. Moreover, former victims of domestic abuse can intervene to assist others who are struggling to escape without risk of re-entering the danger. Most of these factors do not apply to the opiate epidemic.
Readers, social-media commenters, voters, and legislators believe it is the “right thing to say” that drug addicts should get treatment and care, but few and far between are those with a selfless interest in the vocation. It’s one thing to muse in an academic way over what could be useful in combating this crisis, but someone needs to pick up and carry the flag, and it’s not the type of work that draws out the passionate volunteer.
Addicts aren’t puppies, and if they were, Ohio would be experiencing an opiate rescue, not an opiate crisis. Addicts are liars, thieves, and fiends during their addiction. They will tell you so in recovery. So there’s no wellspring of sympathy or empathy for that.
Ohio’s approach to the opiate epidemic and the roaring return of methamphetamine—like much of the nation’s—has echoed the banal appeal to “treatment” as a cure. Budgets and legislation repeatedly throw money at politically-connected, court-subsidized, compulsory treatment facilities and “specialized docket” courts. The specialized docket courts, which meet weekly with a judge, and more often with counselors and probation officers, are considered the most successful approaches Ohio courts currently use for drug treatment. “Most successful” means at best a 15 percent rate of not returning to drug use or crime within three years. Fifteen percent is better than nothing, but it is not “success.”
What the Crack Epidemic Taught Law Enforcement
When it comes to law enforcement and the courts, we actually already know how to defeat the opiate epidemic. We’ve done it before. We beat the crack epidemic. We drove out the violent insanity which was destroying Ohio neighborhoods and families. And we did that by utilizing the criminal courts to treat people who were caught committing crimes as criminals; by treating people who sold crack as violent poison-pushers, not misunderstood future collegians; and by stemming the tide of drugs flowing into the country with concrete action, rather than spreading out a red carpet along all of our borders for drug cartels to bottom out the price of poison everywhere in the country.
We don’t have crack houses all over the place anymore because we took the people who ran the crack houses and we put them in prison for so long that not only would the crack crisis have passed before they got out of prison, but everyone else was forced to stand up and take note of their sentence. Economics is economics. If you are actually going to attempt to ban a substance that has high demand, you must make the risk/reward calculus obvious and simple. The risk of apprehension multiplied by the likely punishment must exceed in value by orders of magnitude the anticipated reward in light of the alternative opportunities. And in order to make that message heard by all, a multiplication factor must be applied.
Basically, the punishment for selling drugs needs to seem unfair, draconian, and very scary to those likely to deal drugs. It must be sufficient to cause them to forego easy money and choose a life either of legal hard work or, as is the sad reality of our nation, government-funded dependency. In the United States, we did that once, and we won the crack epidemic with a combination of punishment and economic opportunity.
In contrast, today federal lawmakers bicker over palace intrigue and leave the barn doors open while Mexico and China flood our streets with dirt-cheap poison. Ohio lawmakers seem intent on singing kumbaya in a drum circle, hoping it will all go away if we just love the addicts enough. It will not. So, we put on our latex gloves, pick the needles out of the cuke bed, head off to work, and do our best to clean the streets while too many of our friends and neighbors die.
The opiate epidemic is real and it connects with everyone, but the community here is stronger than the dope. Most people here probably rarely give it a thought, until it touches home again.