Sunday, December 23, 2018

THE LA RAZA HEROIN DRUG CARTELS TAUNT TRUMP AND HIS PRETEND WALL

EXCLUSIVE: Mexican Gulf Cartel Taunts Trump with Caricature on Dope Load



Trump Pot
Breitbart Border / Cartel Chronicles
2:21

MCALLEN, Texas – Cartel drug smugglers moved a 900-pound shipment of marijuana bearing a cartoon of U.S. President Donald Trump into Texas. The cartoon appears to mock President Trump and his border security comments. Border Patrol agents seized the load, preventing its delivery into the U.S.
Smugglers marked some of the drug bundles with a caricature of President Trump to not only identify the drug shipment but also to mock the politician. The Gulf Cartel, the criminal organization that operates south of McAllen, Texas, has used several different images to identify their drug loads including scorpions and popular comic book heroes. It is not known if cartons of Donald Trump have been used in the past.
Rio Grande Valley Sector Border Patrol agents seized the load this weekend in South McAllen after spotting several men on the Mexican side of the Rio Grande carrying bundles of marijuana towards the river, law enforcement sources working under the umbrella of U.S. Customs and Border Protection revealed to Breitbart News. Some of the men made their way to the U.S. side but swam back as soon as they spotted federal authorities. U.S. Border Patrol agents called Mexican authorities to request their help in capturing the men. Mexico responded, saying no one would be responding to the area.
An hour after the initial smuggling attempt, U.S. Border Patrol agents spotted a group of men in rafts trying to move several bundles of marijuana across the river. Federal agents responded to the scene and found nine men. The men quickly ran back to Mexico leaving behind a white SUV loaded with 40 bundles of marijuana.
Ildefonso Ortiz is an award-winning journalist with Breitbart Texas. He co-founded the Cartel Chronicles project with Brandon Darby and Stephen K. Bannon.  You can follow him on Twitter and on Facebook. He can be contacted at Iortiz@breitbart.com. 
Brandon Darby is the managing director and editor-in-chief of Breitbart Texas. He co-founded the Cartel Chronicles project with Ildefonso Ortiz and Stephen K. Bannon. Follow him on Twitter and Facebook. He can be contacted at bdarby@breitbart.com.



Congressional Report Finds Millions of Opioids Sent to Small-Town Pharmacies in West Virginia

BY SARAH LE, EPOCH TIMES

Nearly nine million opioids were shipped to a single pharmacy in the small town of Kermit, West Virginia, population 406, in just two years, according to a Congressional report released on Dec. 19.
In 10 years, 20.8 million opioids were distributed to pharmacies in Williamson, with a population of 3,000 people. From 2007 and 2012, drug distributors sent a total of more than 780 million hydrocodone and oxycodone pills to West Virginia.
More of these kinds of shocking examples can be found in the result of a bi-partisan investigation by the U.S. Energy and Commerce Committee into claims of “opioid-dumping,” or shipping large quantities of opioids from wholesale drug distributors to pharmacies in rural communities.
The Subcommittee on Oversight and Investigations, led by Rep. Gregg Harper (R-Miss.), spent more than 18 months investigating opioid-dumping in rural areas of West Virginia.
The state is “the epicenter of the nation’s opioid epidemic and the state with the highest drug overdose death rate in the country,” according to a statement by committee chairman Greg Walden and ranking member Frank Pallone, Jr. (D-N.J.) in a press release.






BREAKING: Committee oversight report details findings of 18-month long, bipartisan investigation into alleged opioid-dumping in West Virginia by major opioid distributors >> https://energycommerce.house.gov/news/press-release/committee-report-details-alleged-opioid-dumping-in-west-virginia/ 




The investigation, which began in May 2017, found that the sixth-largest company in the United States played a significant role in shipping massive amounts of opioids to small towns in West Virginia.
McKesson Corp. ranks 6th on the Fortune 500 list, and the company was found to have shipped an average of 9,650 hydrocodone pills a day to the Sav-Rite No. 1 pharmacy in the town of Kermit in 2007.
At a May 8, 2018 hearing, McKesson president and CEO John Hammergren said the company initially set a “reasonable monthly threshold” of 8,000 pills a month for these drugs under its Lifestyle Drug Monitoring Program. (p. 226)
The shipments of 9,650 pills per day were “36 times the threshold amount set by the Lifestyle Drug Monitoring Program,” stated the report. (page 16) “McKesson did not submit suspicious order reports to the DEA regarding orders placed by West Virginia pharmacies until August 1, 2013.”
From April 2006 to 2016, McKesson supplied almost 300 million doses of hydrocodone and oxycodone to West Virginia pharmacies.
In addition, the report called out companies AmerisourceBergen, Cardinal Health, and others for their actions.
“Our bipartisan investigation revealed systemic failures by both distributors and the DEA that contributed to—and failed to abate—the opioid crisis in West Virginia,” stated Walden and Pallone.
In a statement obtained by the Charleston Gazette-Mail, Cardinal Health said it was only an “intermediary” in the prescription drug supply chain, but the company would “continue to implement rigorous anti-diversion controls.”
AmerisourceBergen also released a statement saying, “The comparatively few examinations of AmerisourceBergen’s actions primarily focus on due diligence surrounding physicians. AmerisourceBergen has virtually no interaction with physicians and limited legal ability to gather information on their practices and prescribing behavior.”
The Gazette-Mail reported that McKesson did not respond to requests for comment.
The committee issued a number of recommendations: including that Congress should consider enacting additional suspicious order requirements; the DEA should establish a data platform with third-party experts to provide more real-time data; and distributors should perform, document, and maintain robust due diligence files for both prospective and existing customers.


“We arrest drivers all the time and they send new ones up from Mexico. They never go away.”





Exclusive – Immigration: The Hidden Driver of the Opioid Epidemic



opiod
File Photo: Salwan Georges/The Washington Post via Getty Images
  342
3:54

More than 900 Americans died every week from opioid-related overdoses in 2017. Every American community, big or small, has experienced the epidemic’s merciless, corrosive advance across our cities and towns. It is human tragedy, a family tragedy, and a national crisis.
The issue is complicated by the fact that tens of thousands of Americans need prescription pain medications for legitimate medical reasons. Pharmaceutical companies have been innovative in creating potent opioid based medicines and they were, and remain, rewarded with successful sales.
Some patients, however, abuse legitimate drugs, lie to treating physicians, and illegally sell otherwise lawful drugs. But the real problem is not from frazzled doctors, bad patients or bad medicine. The overwhelming source of the problem is cheap but powerful drugs coming in from Mexico by way of China.
There is another core contributor to the problem that isn’t as widely known: the river of illegal aliens surging across our porous borders. As former LA Times reporter Sam Quinones’ award-winning book, Dreamland: The True Story of America’s Opioid Epidemic recounts, just as standards for the prescription of oxycodone and other painkillers were being tightened, a group of largely illegal Mexican immigrants from Xalisco, in the Mexican state of Nayarit, pioneered a new model of heroin distribution. It was in essence Uber for drug dealers, involving small franchises, with a nonviolent approach, carrying small amounts of drugs directly to addicts in their homes and neighborhoods, using a customer-first mentality and lots and lots of delivery drivers.
From Dreamland, “The delivery drivers did tours of six months and then left. If they were arrested they were deported, not prosecuted, because they never carried large amounts of dope.” With hundreds of new illegal aliens from the state entering the country every day, the police could arrest as many street-level dealers as they liked. As a DEA agent tells Quinones in another part of the book, “We arrest drivers all the time and they send new ones up from Mexico. They never go away.” There would always be new dealers, and the model could continue. An essential part of the process was the dealers returning home, where their ill-gotten gains provided them with status in their rural, poor homeland.
Another law enforcement officer recounts to Quinones, “Their system is a simply thing, reall, and relies on cheap, illegal Mexican labor, just the way that any fast-food joint does.” That flow of dealers is the linchpin of the Nayarit model, which has since spread nationwide. Illegal immigration is the lynchpin of the flow of dealers. Stop illegal immigration, and you stop the flow.
The biggest contributor to illegal immigration are the loopholes in our laws, and our lack of southern border infrastructure. The Center for Immigration Studies has estimated that in the last two years, because of loopholes, more than 250,000 illegal aliens have been caught at the border and released. If even one-tenth of one percent of those illegal aliens are drug dealers, the Border Patrol will have actually caught 600 traffickers and released them to wreak their havoc in our communities.
There is also, of course, the fact that a porous border allows drugs to flow across the border, but people are much easier to interdict than fentanyl. That is why we must also deliver on the president’s border wall–providing $5 billion in unrestricted funding this year, immediately. The funding bill is the last train leaving the station, to stop the flow of drugs and the illegal aliens that bring them from pouring into our communities. Nancy Pelosi will ensure when she takes over as Speaker of the House that nothing will be done.
More than 49,000 Americans died last year from heroin and opioid related overdoses. If open-borders liberal Democrats or weak-kneed establishment Republicans stop us from fixing the problem by closing the loopholes and building the wall, they will be accomplices to the next 49,000 deaths as much as the drug dealers of Xalisco.



PELOSI’S OPEN BORDERS FOR MORE CHEAP LABOR

The Mexican Army made two seizures in Ensenada on August 17 (1,036 pounds of meth, heroin, and fentanyl) and August 18 (1,653 pounds of meth, fentanyl, and marijuana).

The Mexican Army discovered an active drug lab on August 25 in Tecate and seized four tons of methamphetamine.

The Mexican Federal Police seized 350 pounds of methamphetamine in an active drug lab in Tijuana on August 26.
The Mexican Federal Police seized 20,000 fentanyl pills in an active lab in Mexicali on September 10.

The Mexican Federal Police seized 550 pounds of methamphetamine in Tijuana on September 12.

The Mexican Army seized 1,055 pounds of methamphetamine near the Arizona border on September 14.

A.G. JEFF SESSIONS DEFENDS U.S. BORDERS AGAINST THE DEMOCRAT PARTY AND MEXICO’S INVASION.

"Some of the most violent criminals at large today are illegal aliens. Yet in cities where the crime these aliens commit is highest, the police cannot use the most obvious tool to apprehend them: their immigration status. In Los Angeles, for example, dozens of members of a ruthless Salvadoran prison gang have sneaked back into town after having been deported for such crimes as murder, assault with a deadly weapon, and drug trafficking." HEATHER MAC DONALD

 “Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com 

A.G. JEFF SESSIONS DEFENDS U.S. BORDERS AGAINST THE DEMOCRAT PARTY AND MEXICO’S INVASION.
"Some of the most violent criminals at large today are illegal aliens. Yet in cities where the crime these aliens commit is highest, the police cannot use the most obvious tool to apprehend them: their immigration status. In Los Angeles, for example, dozens of members of a ruthless Salvadoran prison gang have sneaked back into town after having been deported for such crimes as murder, assault with a deadly weapon, and drug trafficking." HEATHER MAC DONALD
 “Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com 

CJNG is one of the most powerful cartels in Mexico and the Department of Justice considers it to be one of the five most dangerous transnational criminal organizations in the world — responsible for trafficking tons of cocaine, methamphetamine, and fentanyl-laced heroin into the United States.
BEHEADINGS LONG U.S. OPEN BORDERS WITH NARCOMEX: The La Raza Heroin Cartels Take the Border and Leave Heads

http://mexicanoccupation.blogspot.com/2018/05/highly-graphic-la-raza-heroin-cartels.html

AMERICA: MEXICO’S WELFARE STATE

… and in exchange we get 40 million Mexican flag wavers, homelessness, a housing crisis, heroin & opioid crisis and jobs for legals crisis…. ALL THANKS TO THE DEMOCRAT PARTY

http://mexicanoccupation.blogspot.com/2013/08/how-cheap-is-staggering-cost-of-mexicos.html

“Thirteen years after welfare reform, the share of immigrant-headed households (legal and illegal) with a child (under age 18) using at least one welfare program continues to be very high. This is partly due to the large share of immigrants with low levels of education and their resulting low incomes — not their legal status or an unwillingness to work. The major welfare programs examined in this report include cash assistance, food assistance, Medicaid, and public and subsidized housing.”  Steven A. Camarota


THE LA RAZA MEXICAN DRUG CARTELS REMIND AMERICANS (Legals) THAT THERE IS NO (REAL) BORDER WITH NARCOMEX!

SHOCKING IMAGES OF CARTELS ON U.S. BORDERS:
“Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com


LOS ANGELES – GATEWAY FOR THE LA RAZA MEX DRUG CARTELS

NARCOMEX in LA RAZA-OCCUPIED LOS ANGELES – Western gateway for the MEXICAN DRUG CARTELS and MEXICO’S SECOND LARGEST CITY.


Federal agents raided Q.T Fashion and numerous other businesses in the downtown fashion district Wednesday, cracking down on a scheme that cartels are increasingly relying on to get their profits — from drug sales, kidnappings and other illegal activities — back to Mexico, authorities said.

Nine people were arrested in raids targeting 75 locations, and $90 million was seized — $70 million in cash. In one condo, agents found $35 million stuffed in banker boxes. At a mansion in Bel-Air, they discovered $10 million in duffel bags.

"Los Angeles has become the epicenter of narco-dollar money laundering with couriers regularly bringing duffel bags and suitcases full of cash to many businesses," said Robert E. Dugdale, the assistant U.S. attorney in charge of federal criminal prosecutions in Los Angeles.



LOS ANGELES: MEXICO’S SECOND LARGEST CITY AND  GATEWAY FOR THE LA RAZA HEROIN CARTELS          




Every CEO in every company sees the business opportunity: Will I earn higher profits by replacing my American staff with cheaper H-1B workers? The answer is an obvious yes.
The Washington-imposed economic policy of economic growth via mass-immigration shifts wealth from young people towards older people by flooding the market with foreign labor. That process spikes profits and Wall Street values by cutting salaries for manual and skilled labor offered by blue-collar and white-collar employees. The policy also drives up real estate priceswidens wealth-gaps, reduces high-tech investment, increases state and local tax burdens, hurts kids’ schools and college education, pushes Americans away from high-tech careers, and sidelines at least 5 million marginalized Americans and their families, including many who are now struggling with opioid addictions.

A NATION DIES OF OPIOID ADDICTION
AMERICAN BIG PHARMA, RED CHINA and NARCOMEX PARTNER FOR THE BIG BUCKS
“The drug epidemic is the product of capitalism and the policies of the capitalist parties, both Democrats and Republicans. There is, first of all, the role of the pharmaceutical companies, which have amassed huge profits from the deceptive marketing of opioid pain killers, which they claimed were not addictive. Prescriptions for opioids such as Percocet, Oxycontin and Vicodin skyrocketed from 76 million in 1991 to nearly 259 million in 2012. What are the numbers and profits now?

OPIOID AMERICA: CHINA AND MEXICO PARTNER TO ADDICT AMERICA

http://mexicanoccupation.blogspot.com/2018/08/the-opioid-war-on-america-chin

 

PRINCETON REPORT:
American middle-class is addicted, poor, jobless and suicidal…. Thank the corrupt government for surrendering our borders to 40 million looting Mexicans and then handing the bills to middle America?

OPIOID MURDERS BY BIG PHARMA

“While drug distributors have paid a total of $400 million in fines over the past 10 years, their combined revenue during this same period was over $5 trillion.”

“Opioids have ravaged families and devastated communities across the country. Encouraging their open use undermines the rule of law and will do nothing to quell their continued abuse, let alone the problems underlying mass addiction.”

THE LA RAZA INVASION:


The Washington-imposed economic policy of economic growth via mass-immigration floods the market with foreign laborspikes profits and Wall Street values by cutting salaries for manual and skilled labor offered by blue-collar and white-collar employees. It also drives up real estate priceswidens wealth-gaps, reduces high-tech investment, increases state and local tax burdens, hurts kids’ schools and college education, pushes Americans away from high-tech careers, and sidelines at least 5 million marginalized Americans and their families, including many who are now struggling with opioid addictions.   NEIL MUNRO


Opioid Nation

Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic (Expanded and Updated Edition)

by Barry Meier
Random House, 223 pp., $27.00

Dopesick: Dealers, Doctors, and the Drug Company That Addicted America

by Beth Macy
Little, Brown, 376 pp., $28.00

American Overdose: The Opioid Tragedy in Three Acts

by Chris McGreal
PublicAffairs, 316 pp., $27.00

American Fix: Inside the Opioid Addiction Crisis—and How to End It

by Ryan Hampton, with Claire Rudy Foster
All Points, 290 pp., $27.99
Jerome Sessini/Magnum Photos
A man who has just taken heroin, Philadelphia, April 2018
The National Institute on Drug Abuse estimates that 72,000 Americans died from drug overdoses in 2017, up from some 64,000 the previous year and 52,000 the year before that—a staggering increase with no end in sight. Most involved opioids.
A few definitions are in order. The term opioid is now used to include opiates, which are derivatives of the opium poppy, and opioids, which originally referred only to synthesized drugs that act in the same way as opiates do. Opium, the sap from the poppy, has been used throughout the world for thousands of years to treat pain and shortness of breath, suppress cough and diarrhea, and, maybe most often, simply for its tranquilizing effect. The active constituent of opium, morphine, was not identified until 1806. Soon a variety of morphine tinctures became readily available without any social opprobrium, used, in some accounts, to combat the travails and boredom of Victorian women. (Thomas Jefferson was also an enthusiast of laudanum, one of the morphine tinctures.) Heroin, a stronger opiate made from morphine, entered the market later in the nineteenth century. It wasn’t until the twentieth century that synthetic or partially synthetic opioids, including fentanyl, methadone, oxycodone (Percocet), hydrocodone (Vicodin), and hydromorphone (Dilaudid), were developed.
In 1996 a new form of oxycodone called OxyContin came on the market, and three recent books—Beth Macy’s Dopesick, Chris McGreal’s American Overdose, and Barry Meier’s Pain Killer—blame the opioid epidemic almost entirely on its maker, Purdue Pharma. OxyContin is formulated to be released more slowly and therefore lasts longer. The company claimed that the drug’s slow release would make it less addictive than ordinary oxycodone, since the initial euphoria—the high—would be muted. Based on this theory and little else, the FDA permitted OxyContin to contain twice the usual dose of oxycodone and carry on the label this statement: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” (The FDAofficial who oversaw OxyContin’s approval later got a plum job at Purdue Pharma.)
The company launched an extraordinarily aggressive and successful marketing campaign to convince physicians that they had the holy grail of a nonaddictive opioid. It sent hundreds of sales representatives to doctors’ offices to tout OxyContin, and offered doctors dinners and trips to meetings at luxury resorts. And it paid more than five thousand doctors, pharmacists, and nurses to train as speakers to tour the country promoting OxyContin. But like all opioids, OxyContin is addictive. And soon enough, users found that they could crush the pills or dissolve the coating, then snort the drug like cocaine or inject it like heroin. Each pill would then become essentially an instantaneous double dose of oxycodone.
OxyContin almost immediately became a blockbuster—that is, a prescription drug with annual sales of more than $1 billion. It was widely used not just by those for whom the prescriptions were written, but by their relatives and friends. The pills were also sold or stolen or otherwise diverted to street use. In addition, “pill mills” sprang up, where unethical physicians wrote innumerable prescriptions for OxyContin and refilled them automatically without ever seeing the patient. McGreal describes “one of the most productive pill mills in the country,” which operated in the small town of Williamson, West Virginia—known locally as “Pilliamson.” The town, he says, “was awash in pills,” and people came by car and bus to line up at the clinic and cooperating drugstores. “Investigators calculated that in 2009 alone, the clinic pulled in $4.6 million in a town with a population of little more than three thousand people.”
It’s impossible to know how many new prescriptions were obtained in each of these ways, but one way or another, OxyContin addiction grew into an epidemic. The epicenter was central Appalachia, and its victims were mainly white people in small, economically depressed coal-mining communities in southern West Virginia and parts of Kentucky, Tennessee, and southwestern Virginia.1
The three books that focus on Purdue Pharma are in a sense the same book. Barry Meier first published Pain Killer in 2003. The new edition (released by a different publisher) is much the same, with some updating and re-arrangements. The two new books, Dopesick and American Overdose, cover the same story as it unfolded in the same region of the country. Both Macy and McGreal refer to the 2003 edition of Meier’s book (but not the new edition, probably because they could not have known of it at the time their books were written). All three books are gripping and well written, with detailed accounts, one after another (perhaps too many), of families decimated by the epidemic. And they all tell the story of Art Van Zee, a physician in southwestern Virginia, who in 2000 became aware of the growing epidemic of OxyContin there and tried heroically to get Purdue Pharma and the FDA to take responsibility for it.
Purdue Pharma and the Sackler family that founded it are very hard to defend. By aggressively marketing OxyContin, even after they knew it was being widely abused, the family became enormously wealthy. But the FDA was also guilty. It permitted OxyContin to be sold as a relatively nonaddictive opioid without good evidence to support that claim, and it should have been obvious that the pills might be crushed or dissolved to make them even more addictive. Van Zee, along with Beth Davies, a nun who ran the local substance abuse clinic, saw Lee County, Virginia, blanketed with OxyContin prescriptions and watched the deaths mount, particularly among young people. They informed Purdue, which simply stonewalled. Over the following year, Van Zee devoted himself completely to the cause, meeting with company and FDAofficials and testifying before a Senate committee, trying to get Purdue to reformulate the drug or even withdraw it from the market.
In 2007 Purdue pled guilty to criminal charges of fraudulently marketing OxyContin and settled for $600 million in fines and penalties. Three executives pled guilty to misdemeanor charges and were sentenced to four hundred hours of community service and lesser fines. The company’s fine was trivial in comparison with its profits from OxyContin. In fact, almost every other major pharmaceutical company has had to settle both civil and criminal charges of fraudulent marketing for much more (the record settlement is now GlaxoSmithKline’s $3 billion, for a variety of violations, including falsely promoting drugs and failing to report safety data). These kinds of fines are just the cost of doing business. And so it was for Purdue Pharma, although the fraudulent marketing stopped and a warning was added to the label.
The problem with these three books, and it’s a big one, is that they treat the Purdue story as though it were the whole story of the opioid epidemic. But OxyContin did not give rise to opioid addiction, although it jump-started the current epidemic. Heroin has been a common street drug ever since it was banned in 1924. Morphine has also been widely abused.
Nor would taking OxyContin off the market end the epidemic. The overwhelming majority of opioid deaths are caused not by OxyContin but by combinations of fentanyl, heroin, and cocaine, often brought in from China via Mexican cartels, and frequently taken along with benzodiazepines (such as Valium or Xanax) and alcohol. These drugs are cheaper and stronger, particularly fentanyl. Fentanyl was first synthesized in 1960, and soon became widely used as an anesthetic and powerful painkiller. It is legally manufactured and highly effective when used appropriately, often for short medical procedures such as colonoscopies. The illicit production and street use is relatively new, but it is now the main cause of most opioid-related deaths (nearly 90 percent in Massachusetts).
The steady increase in opioid deaths after OxyContin came on the market has been supplanted by a much faster increase starting around 2013, when heroin and fentanyl use increased dramatically. We now have two epidemics—the overuse of prescription drugs and the much more deadly and now largely unrelated epidemic of street drugs. By concentrating on the first, we are closing the barn door after the horse is long gone.
Efforts to deal with the epidemic have been all over the map—literally. Possession of illegal drugs (and legal drugs illicitly used) is still a federal crime, and prisons are still full of people whose only crime was that. But many states, counties, and cities have begun to regard opioid addiction as a public health issue, not a police issue. They are opening centers in which people who seek help are shifted to less powerful opioids like methadone and buprenorphine (Subutex)—a method known as “medication-assisted treatment,” or MAT. Naloxone (Narcan), the antidote for an opioid overdose, is now sold over the counter in almost all states. If used immediately, it can prevent an otherwise inevitable death from a drug overdose. And drug courts, which may drop criminal charges in return for an agreement to submit to treatment and monitoring, are becoming more common.
Nan Goldin/Marian Goodman Gallery
Nan Goldin: Withdrawal/Quicksand, Berlin/NY, February 2016, 2016
Most controversial are facilities called “safe injection sites,” or SIFs, where drug users can come to use drugs without fear of arrest. The staff provides clean needles to reduce the risk of HIV and hepatitis C infections, and is prepared to resuscitate addicts who overdose. This approach is called “harm reduction.” The problem is that addicts must still buy drugs illegally, and it’s almost impossible to know exactly what is in them.
In a recent New York Times Op-Ed, the deputy attorney general, Rod Rosenstein, came down hard on SIFs. He warned that “it is a federal felony to maintain any location for the purpose of facilitating illicit drug use,” and that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.” He was referring to plans to operate SIFs in San Francisco, New York City, and Seattle, and similar options now being considered by Colorado, Maine, Massachusetts, and Vermont. Later in the same article, however, he softened, saying we should “help drug users get treatment and aggressively prosecute criminals who supply the deadly poison,” suggesting that perhaps he doesn’t believe simple possession is so bad, after all.
But the proposed solutions to this epidemic range from the extreme of “lock ’em up” to “drug abuse is no less a disease than cancer or diabetes” and should therefore be met with the same solicitude. Ryan Hampton exemplifies the latter view in his angry book, American Fix. A former drug user himself and now an impassioned advocate and activist, he insists that drug abuse should be regarded like other diseases. He doesn’t acknowledge that for most users there was a moment of choice in becoming addicted that is not the case for people with cancer or diabetes. After receiving Dilaudid for a painful ankle, Hampton decided to ask for more, and then more. I think one can make the argument for sympathy with drug users and for understanding how the quest for drugs ceases to be under their control without claiming an analogy to diseases like cancer or diabetes.
Hampton paints a vivid picture of the downward spiral of addiction. When he “leveled up to IV heroin,” he explains, “it was cheaper than pills, easier to get hold of, and a quarter the cost. More important, nobody was tracking us in a database.”
Where Hampton is at his best is in his exposure of the profiteering and corruption in the burgeoning addiction industry—what he calls “the treatment industry swamp.” In the swamp, he found
lack of effective treatment, exorbitant costs, and ridiculous twenty-eight-day vacations disguised as medical help, fed by patient brokers who run a completely legal, high-end human trafficking cartel to push tens of thousands of patients through the broken system.
He was referring to the panoply of treatment centers, both residential and outpatient, and detox facilities, where users are supposed to be weaned from drugs before entering “sober living houses.” As in so much of American medicine, even nonprofit insurers like Medicaid outsource the actual delivery of care to for-profit companies that charge whatever the market will bear. According to Hampton, “one of the most expensive treatment centers in America, Passages Malibu, costs more than $60,000 per month.” Costs are settled by a crazy quilt of payers, including state and local governments, Medicaid, other federal programs, private insurers, and often by desperate families. Not surprisingly, only a minority of users are ever treated.
In 2017 the Aspen Institute’s Health Strategy Group, led by two former secretaries of health and human services, Tommy Thompson and Kathleen Sebelius, and consisting of twenty-four members from various health-related fields (I am among them), met for three days to examine the opioid epidemic. The deliberations were preceded by four presentations by experts in the field. In the final broad and comprehensive report, the group made a strong case for decriminalizing drug addiction and instead regarding it as a public health issue. Among the five major recommendations was a call for more research into nearly all aspects of the epidemic. It’s startling how little we know, given the immensity of the problem and the media attention it receives.2
We need to know, for instance, how effective opioids are for different kinds of pain, including long-term treatment for chronic pain. We need to know how opioids compare in effectiveness and side effects with acetaminophen (which can cause liver failure) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (which can cause gastrointestinal bleeding). We need to know how the death rate in the opioid epidemic compares with the rate of use. We know the death rate is soaring, but does that mean the rate of use is, too, or is it simply a result of the lethality of the drug mixtures obtained on the street? We need to know how much diversion there is now from legitimate treatment to abuse. That includes diversion of methadone and buprenorphine, which are also opioids and can be sold on the street or added to the user’s illicit intake. According to Macy, “Buprenorphine is the third-most-diverted opioid in the country, after oxycodone and hydrocodone.”
We need to know how many addicts want to quit, since most don’t seek treatment. Why don’t they? And finally, we need to know the best approach to treatment. There is concern, for example, that detox might be dangerous, because the first dose after a relapse can be deadly if the user is no longer tolerant to the drug’s effects. Is providing methadone or buprenorphine indefinitely, even for life, the best treatment among bad choices? There is plenty of speculation about all of these questions, and suggestive findings about some of them, but little solid evidence.
We also need to remember an essential and crucial fact: opioids do have a legitimate purpose, and it’s an enormously important one. They treat severe pain, often when no other treatment is effective. Patients suffering from cancer are sometimes completely dependent on opioids for relief, as are some patients with other forms of severe pain. As the authors of the books acknowledge, pain was systematically undertreated throughout most of the twentieth century. After centuries of free and easy use of opioids, there was a sudden reaction in the United States at the start of the twentieth century, which had much to do with anti-immigrant sentiment, particularly animus toward Chinese immigrants who were widely assumed to be opium addicts. (It also paralleled the growing reaction against alcohol that resulted in Prohibition.) The 1914 Harrison Narcotics Tax Act imposed strict regulations on the use of opioids; they had to be prescribed by physicians, and then only for patients not already taking them. Prohibition lasted for only thirteen years, but the dread of opioid addiction stayed with us until the 1980s and caused cruel suffering for generations of patients.
Even in hospitals where cancer patients lay dying in agony, opioids were administered reluctantly, in small doses, and at infrequent intervals. When I was in training in a teaching hospital in the 1960s, there was an awful ritual to it. The drugs were administered according to a pro re nata (prn) regimen (ostensibly “as needed”) that required the patient to wait out a four-hour interval, no matter how severe the pain, and then request the next dose. Those who badly wanted the drug had to keep track of the time and have the strength and endurance to summon a nurse if one was nearby. Patients were sometimes inhibited in asking for the next dose by a desire to please the medical staff and not be a nuisance, or by their own belief that taking morphine was somehow wrong or reflected weakness. The extent to which nurses and physicians shared the common fears of addiction influenced their readiness to respond. Desperate patients would count the minutes toward the end of the interval, hoping they could flag down a nurse. Many doctors and nurses interpreted the anxiety and clock-watching as a sign of growing addiction, not inadequate pain relief. These patients were labeled “drug-seeking” and often punished for it by being denied the very help they needed.
During the 1980s there was a welcome change in that attitude, partly due to the hospice movement that had begun in the United Kingdom. The prn system became more flexible, or was eliminated altogether. There was a realization that because pain is entirely subjective, there is no way to measure or verify it, and even patients with the same condition could differ in their experience of pain. Instead of having to flag down nurses, patients were asked at shorter intervals whether they needed pain relief, and how much. In 2001 the Joint Commission on the Accreditation of Healthcare Organizations proclaimed pain the fifth vital sign, to be assessed in every patient, along with heart rate, respiratory rate, temperature, and blood pressure. Although the motivation for this move was laudable, it presented problems, since, unlike the other four vital signs, pain can’t be objectively quantified.
The authors of the books under review recognize the history of inadequate treatment of pain throughout most of the twentieth century, but they don’t give it its due. They concentrate instead on the reaction of the 1980s, which they consider excessive and an underlying cause of the opioid epidemic. In 1982 I wrote an editorial in The New England Journal of Medicine, which began, “Few things a doctor does are more important than relieving pain.” I still believe that. I ended with these words: “Pain is soul-destroying. No patients should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here, of all places, it should not be strained.”
The opioid epidemic, while horrifying, is still outweighed by alcohol deaths, which are also increasing, according to the Centers for Disease Control. Hampton writes, “If my first drug of choice came with a prescription, the second one, alcohol, was culturally embedded and used to celebrate at every turn of events.” In 2016, when there were 64,000 deaths in the US from the drug epidemic, there were 90,000 from alcohol (including accidents and homicides caused by inebriated people, as well as direct effects, mainly cirrhosis of the liver). Cigarette smoking is estimated to cause 480,000 deaths a year. I do not intend to minimize the opioid epidemic. Far from it. What I want to underscore is the differences in these three epidemics. Alcohol and cigarettes have no medical or practical uses of any kind. Yet we permit their use if regulated. In contrast, opioids do have medical uses, and they are important.
The opioid epidemic is usually seen as a supply problem. If we can interdict the supply of prescription opioids, the thinking goes, we can stanch the epidemic. But that is unlikely to work for two reasons. First, as I pointed out, this is no longer mainly an epidemic of prescription drugs but of street drugs. And second, it creates an onerous obstacle for doctors and outpatients who require pain treatment. More and more, they have to satisfy regulations expressly designed to restrict access to prescription opioids. Some make sense. For example, it’s reasonable to monitor opioid prescriptions to detect pill mills. It’s also reasonable to flag users who “doctor-shop,” that is, see several doctors at once to try to get multiple doses of opioids.
But other requirements are meant simply to inconvenience both doctors and patients until they give up. For example, in Massachusetts doctors must limit their first-time opioid prescriptions to seven days. That can be more than an inconvenience for ill patients in pain. Macy quotes a letter from a friend with severe back pain from scoliosis. “‘My life is not less important than that of an addict,’ my friend wrote,…explaining that her new practitioner requires her to submit to pill counts, lower-dose prescriptions, and more frequent visits for refills, which increase her out-of-pocket expense.” Even more serious is a new shortage of opioids for injection in cancer centers.
For physicians, who are already weighed down by innumerable bureaucratic requirements, these restrictions present one more hoop to jump through, and many simply won’t do it. Instead, they’ll send the patient away with some Advil and hope it does the trick, even though they know it probably won’t. The regulations are having their intended effect. In Massachusetts, opioid prescribing has decreased by 30 percent. Meanwhile, the epidemic of street drugs continues apace. McGreal raises the possibility that reducing access to prescription opioids might feed the demand for heroin. Macy quotes an addiction specialist who laments that “our wacky culture can’t seem to do anything in a nuanced way.”
I believe the modern opioid epidemic is now more a demand problem than a supply problem. Three years ago, the Princeton economists Anne Case and Angus Deaton published an explosive paper about the surprising rise in mortality, starting at the turn of this century, among middle-aged white non-Hispanic men and women. The increase was greater in women than in men. They found three main causes: drug and alcohol overdoses, suicide, and alcohol-associated liver disease. They later called these “deaths of despair,” because they were most common among workers in tenuous jobs, with only a high school education or less, who were struggling to stay afloat in isolated regions of the country. Dragged down by these deaths, in the past three years overall life expectancy in the United States has started to drop.
It’s not hard to see reasons for the despair. Most working-class Americans have not benefited from our booming economy, the fruits of which have gone almost entirely to the richest 10 percent. For the bottom half of the population, income has scarcely budged since the 1970s, while expenses for necessities like housing, health care, education, and child care have skyrocketed. In Appalachia, where the opioid epidemic first took hold, many coal miners were unemployed and would probably remain so. People expected they wouldn’t live as well as their parents had, and had little hope for their children. It is true that African-Americans still have higher overall mortality rates than whites, but that gap is closing rapidly for people under the age of sixty-five, particularly for women. By 2027, white women will have higher mortality rates than African-American women. Mortality for African-American men is falling even faster than for African-American women; it is projected to be equal to that of white men by 2030. But the epidemic has extended to all parts of the country and to all ethnic groups, so it’s unclear how the effects will be distributed in the future.
By the middle of this decade, the grotesque inequality in this country began to get the attention it deserves. And the growing awareness of that inequality fed the populist passion that, when twisted and distorted, produced the election of Donald J. Trump. It’s probably not coincidental, then, that the opioid epidemic got its second wind at about that time. It certainly marks the time when the opioids of choice changed from prescription drugs to the witches’ brew of street drugs. Did the epidemic explode because people were becoming aware that the American Dream was no longer theirs to dream?
As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape. This increasingly seems to me not a legal or medical problem, nor even a public health problem. It’s a political problem. We need a government dedicated to policies that will narrow the gap between the rich and the poor and ensure basic services for everyone. To end the epidemic of deaths of despair, we need to target the sources of the despair.



FIGHTING THE RICH, DEMOCRAT AND GOP POLS FOR OUR JOBS AND BORDERS.
Amnesty is all about keeping wages depressed and passing the true cost along to what is left of the America middle-class.
The huge inflow of migrants and asylum seekers forced officials to issue 400,000 work permits in 2017. That is roughly one new migrant worker for every 10 Americans who entered the workforce that year. The huge inflow has also jammed the immigration courts, ensuring that new migrants can work for a few years before a judge decides their case.
The inflow of asylum-seeking migrants, nonetheless, is far smaller than the inflow of legal immigrants and temporary visa-workers, which added roughly 2 workers in 2017 for every four Americans who entered the workforce.
Nationwide, the U.S. establishment’s economic policy of using legal migration to boost economic growth shifts wealth from young people towards older people by flooding the market with cheap white collar and blue collar foreign labor. That flood of outside labor spikes profits and Wall Street values by cutting salaries for manual and skilled labor that blue collar and white collar employees.
The cheap labor policy widens wealth gaps, reduces high tech investment, increases state and local tax burdens, hurts kids’ schools and college education, pushes Americans away from high tech careers, and sidelines at least five million marginalized Americans and their families, including many who are now struggling with fentanyl addictions.
Immigration also steers investment and wealth away from towns in heartland states because coastal investors can more easily hire and supervise the large immigrant populations who prefer to live in coastal cities. In turn, that investment flow drives up coastal real-estate prices, pricing poor U.S. Latinos and blacks out of prosperous cities, such as Berkeley and Oakland. NEIL MUNRO

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