A lot has been made lately of Donald Trump and his wish to build walls between the U.S. and Mexico.
This got a new bump recently when the candidate, in New Hampshire, reiterated that he’d build these walls and use them to stop Mexican heroin from coming into the U.S. – New Hampshire being one of many states suffering from huge jumps in opiate addiction.
Opiate addiction appears to be emerging as an issue in the presidential campaign, as well it should.
I’ve read a lot that does seem to be too nuanced on either side of this topic.
Here are a few of my thoughts:
Virtually all our heroin comes from Mexico, or comes from Colombia through Mexico.
Originating now in our hemisphere, heroin now changes hands less and travels far shorter distances than it did when so much of it came from Turkey or Burma (1970s).
All that means that it’s cheaper here than ever, it’s more prevalent, and it’s far more potent. And all that, in turn, has a lot to do with why people begin using it in the first place (cost), and then stay addicted (prevalence), or relapse after rehab, and then why they die more frequently (potency).
Used to be that people (addicts from the 1970s) lived for many years on heroin – when it was more expensive and less potent and more arduous to find. A lot of heroin addicts who started in those years did die, but they died during the AIDS epidemic from sharing needles, not so much from overdoses.
Now heroin addicts aren’t living long; They’re dying young and quickly. I believe that’s because so much of the drug comes from Mexico, making it cheaper, more potent and more prevalent than ever.
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We already have walls up in many parts of the border. Heroin already crosses where walls are – Tijuana (two walls) is one example.
When uncut or less cut, heroin is easy to conceal because it’s so concentrated – again because now it comes from Mexico, which is so close.
So you don’t need trucks to get a lot of heroin across – though trucks have been used. A lot of people walk it across at the border crossings hidden in a purse, or a backpack, or on their person.
There’s a market for heroin because there is a demand for it.
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That said, I believe that supply is fundamental to this issue – supply created this demand, just as it did during the cocaine days. We didn’t have a huge demand for cocaine before Colombians began smuggling tons of it up through Florida. Likewise, we didn’t have huge numbers of heroin addicts before doctors began prescribing enormous quantities of opioid painkillers such as Vicodin and OxyContin, etc. and a lot of people got addicted, then switched to heroin, which is now, as I said, cheaper than ever.
Heroin traffickers, as I hope I made clear in Dreamland, came late to this party. They followed the demand for opiates that had been created by massive overprescribing by doctors of these painkillers.
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Just as we cannot arrest our way out of this problem, we likely cannot treat our way out of it, either. Particularly with treatment costing so much and taking so long. Typical treatment that has any chance of success, from what addiction specialists tell me, is a minimum of nine months. One doc I know insists a year is the minimum.
Curtailing supply is thus essential to giving each attempt at rehab and recovery a greater chance of success. So that every recovering addict isn’t bombarded with dope at every turn, as they are in so many parts of the country today.
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That said, among the steps I think we need to take – some of which are articulated by the CDC recently – is retraining doctors to question why they prescribe these drugs and, if they’re necessary, in what quantities. For example, for wisdom tooth extraction, 60 Vicodin is common. That seems crazy to me.
Seems like 6-12 pills would be reasonable, and that the patient should return if he needs more. Doctors prescribe so many of these pills out the gate because they don’t want to see patients a second time, and they know that insurance companies often won’t reimburse for those follow-up visits, no matter how few.
So this problem will require that insurance companies change their practices, and reimburse doctors for follow-up visits for the (again) few patients who might need more of those pills after routine surgery.
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Walls have had a healthy effect on the border. Tijuana (two walls, as I said) is an excellent example of that. When it was the main crossing point – 1960s until mid-1990s – rapes, robberies, assaults and murders were common, particularly in the 1980s and early 1990s. Then the first wall went up, then the second. Now it’s calm on that border line. May be a weird symbol for a globalized world, but murders and rapes are rare now.
Despite those walls, heroin will seep in, through the cracks, in ways that seem to me impossible, or extraordinarily expensive, to stop. And that’s not the supply that caused this problem.
The “treatment” issue is a good insight into the fundamentally defective thinking that is embedded in conventional medicine. An important part of the roots of this issue go back to bad dietary practices that are guaranteed to produce dysfunctional results across a number of dimensions, in particularly poor educational outcomes (and thus impaired judgment) and strong motivations toward substance abuse (a wise man once called this “thinking with your glands”).
Venture near an school site and most likely soon you will find empty bags of Hot Cheetos or the Mexican knock-off Takis. Read the ingredients; there is no food in that bag. As the title of the excellent book on the issue says “Salt, Sugar, Fat” this stuff in engineered to be addictive. I see kids and teens who seem to almost live on the stuff.
Almost every addict I have known had terrible dietary practices; as the brother of the idiot savant math genius meth addict I knew back in high school articulated, “he lives on liquor store food”. If you eat this stuff for very long it will make you sick. And prone to addictive urges.
It seems few doctors even think of healthy food as part of “treatment”; in her book “PC MD” Sally Satel profiles a NY program where the first thing they do is a group talk fest where they are told “you’re all victims of a racist society” (I wonder what they are telling the white male addicts now).
In Thailand there is a free clinic run by a Buddhist monk, an ex-US Special Forces and mercenary guy; they take in anyone who is willing to follow their program, which starts with an herbal concoction purge that makes you spew from both ends for three days. A gentler path would begin with some juice fasting and adherence to clean, living foods. I wonder what these high-dollar clinics like the Malibu thing they advertise on cable TV do; but I know for sure the few I’ve known who got off drugs focused on re-establishing their health as central to the focus. Not to knock the psychological/cognitive approach entirely, but the “guts” of this issue has everything to do with what’s happening on your insides: blood sugar, brain chemistry, endrocrine function, digestion and elimination. It astounds me that we have a Surgeon Generals who seems unaware of this.
Sugar is deadly as well as all the fats and additives in junk foods. I agree that our Surgeon General needs to start a dietary awareness and education program nation wide. Sugar causes the dopamine surges in the brain, thereby reducing the receptor sites, as well as the brain’s natural procuction of dopamine, and other neurotransmitters: The result is a “Sugar High,” that in and of itself becomes an addiction, and can actually promote opiate addiction, cause relapses by those in recovery, and is so very deadly to the adrenal glands by triggering the release of cortisol, which again, creates sugar cravings. God help us because this nation, especially our young people are killing their brains and bodies by what they eat.
Addiction is the biggest problem, and gets so little attention. Living in Ontario Canada, you can find multiple drug dealers in every town. But can you find a psychiatrist, psychologist , drug counselor anyone to help your family when facing this horrible problem. My son went through the court system faster than we could get into a rehap program. When we did find one there was a 4 month waiting period, he has done well for almost a year and now is having a setback, his addiction has cost him, his home, his health, his fiance and his career as a Registered Nurse. If addiction is an illness, I pray that anyone else in my family gets a different one this has been the hardest thing I have ever been through.
“Walls have had a healthy effect on the border…,””when it was the main crossing point…,” “murders and rapes are down…” I thought the San Ysidro point of entry is still the busiest crossing in the world. Also what sources are you using for the murder/rape down statement. I live here and your lines have me scratching my head. Do you mean crime north of the Wall of Shame or south of it.
John – those who lived in Tijuana during the 1980s and 1990s can easily attest to the chaos that reigned every night at famous crossing points, such as Las Canelas, El Hoyo, and others. Preying on the vulnerable was common as hundreds, often thousands of people congregated to run across the border every night. I’m talking rape, robbery, even murder. That ended when they built the first wall in 1994.
Yes, supply is certainly one facet that needs attention. However, the rise in prescrption painkiller access is what leads quickly to addiction and to heroin use. Prescription painkillers (e.g. Vicodin, Oxycontin, Codeine, Percocet, etc) are readily available – just sitting in the medicine cabinet or your parents, your friends, your grandmother… People start out thinking they are getting a “safer” high because this was a prescribed medicine (not to them, but prescribed by a doctor nonetheless). Once they run out of an easy supply, buying these on the street is very expensive – upwards of $60-$80 a pill, and once you are tolerant and addicted, you need MANY of these pills a day to maintain your high. So, this is where the switch to heroin comes in – it is so cheap and easy to get. To complicate matters further, the drug cartel has learned that their clients prefer the prescription pills, so they are actually putting heroin in these prescription capsules so the buyers think they are getting the prescription product. Yes, the supply is a problem, but addiction often begins in the medicine cabinet. We need to work on this epidemic from many angles – a prevention standpoint (most people do not understand that codeine is an opioid just like heroin and that the more you experiment from the ages of 11-25, the more likely you are to become an addict), a disease standpoint (addiction actually causes change to one’s brain and brain chemistry), and a recovery standpoint (addiciton is long term illness that she be thought of in much the same way that Type 2 Diabetes is a long term illness).
Want to stop the Drugs coming across the border,,when they catch them crossing with drugs ,SHOOT them down where they Stand