
How Mexican heroin cartels are targeting small-town America - pmcpinto
http://www.washingtonpost.com/sf/national/2015/09/24/pellets-planes-and-the-new-frontier
======
jnbiche
I read the Washington Post comments and am discouraged. I read the HN comments
- here where I see evidence of higher than average reason and compassion - and
am depressed.

First, if you believe that the crack down on prescription narcotics have first
and foremost hurt addicts, you're very mistaken. Addicts easily moved on to
heroin, as this piece shows. People with cancer and debilitating nerve
disorders like chronic shingles, CPRS, trigeminal neuralgia, and some kinds of
neuropathy, who total over a million in the U.S. alone, are the ones who have
suffered greatly even though opiate painkillers are safe and effective when
used correctly. These are the kinds of diseases than make grown men cry in
pain and bring on suicidal thoughts in previously happy, non-depressed
individuals (I know, I've seen it up close).

Second, if you believe that the US can some how magically win the drug war by
cracking down on the southern border, I have a bridge to sell you. Drug
smugglers come in by boat to Washington State, by plane across Canada to
Montana, and by submarine into the Florida coast. Wasting billions building
some "impregnable" fence across our southern border will only increase the
number of smugglers coming in from our other borders. And then what? We shut
down all our borders?

Seriously, when I read these comments coming from HN, bastion of rational
thought, I just want to curl up in a corner and cry.

~~~
alphaoverlord
As a physician, I find comments like this disturbing. Barring special
circumstances (cancer related pain), there is almost no need for chronic
opiates. In fact, the body rapidly becomes accustomed to opiates and will
require higher and higher doses that can become dangerous. The united states
uses orders of magnitude more opiates than all other countries, and that often
comes from potentially a cultural aversion to pain, but also many patients
specifically seek out and ask for pain meds.

In fact, the scenarios you mention, of post herpetic neuralgia, trigeminal
neuralgia, and neuropathy should NEVER be treated with opiates. There are
highly effective neuroleptics and medications like carbamazepine, gabapentin,
and TCAs that are first line and highly effective for these syndromes. While
painful, given that it is neuropathic pain, often with rapid onset and offset,
opiates, even PRN medication, is not appropriate management and does not help
with its treatment. Adjuvant therapy including topical creams like capsaicin
as well as minor procedures like nerve blocks and injections are pursued if
first line treatments do not work. Often I see people in clinic who were
aggressive about opiates and got opiates for these syndromes and spiral into
addiction and problems while the underlying problem is untreated.

Opiates are not a panacea for all pain, and its troubling with patients see it
that way, and often insist on opiate medications.

~~~
jnbiche
> The united states uses orders of magnitude more opiates than all other
> countries,

[https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...](https://en.wikipedia.org/wiki/List_of_countries_by_prevalence_of_opiates_use)

------
jMyles
I can see no reason why heroin and opioid maintenance clinics can't exist in
every decent sized city in the USA.

People go in, receive a clean injection of unadulterated drug from a medical
professional, have access to counselors and job recruiters, etc.

Requiring a payment for the dose to make the clinic self-sustaining can still
create availability that far undercuts the cartels. Or, through donors, it can
be provided for free.

People who are seriously addicted will no longer need to steal to feed their
habits. The cartels will lose their best source of income. And very, very few
people are going to go to a heroin clinic to use heroin for the first time.

"Hey man, what do you want to do this weekend?"

"Well, I was thinking of going to the clinic and claiming to be a heroin
addict. I've always wanted to try that."

~~~
vfdfv
Ugh, I'll just continue to buy drugs on the black market and use them at home.
No one wants to go lay in a hospital bed after shooting up. Addicts can safely
manage their own addictions, if they are provided consistent doses and clean
needles.

Legalize it, tax it, and use the proceeds of the taxation for needle exchanges
and rehab clinics.

~~~
chrischen
Legalizing will undoubtedly increase usage, unless you can find another way to
keep on the pressure. The reason why usage levels are what they are right now
is because there is pressure against using it.

~~~
kombucha2
People who use drugs do not factor in potential punitive measures when
using/beginning to use let alone addicts. "Pressure" doesn't matter one bit.

~~~
chrischen
Yes they will factor in. That's disingenuous. Forget whose side of the debate
you and I are in. Let's analyze the fundamental consequence of your assertion
here.

If I held a gun to a drug addict's head, you think that will not pressure them
to stop, even if just for that moment when the pressure is applied?

If your assertion is true, with any degree of correctness, then we've found a
perfect way to destroy information! Simply convert data into a signal fed to a
drug addict. Because you're asserting that drug addicts can destroy such
information since regardless of what signal they're fed, they will destroy the
information.

~~~
kombucha2
Well I did say "potential punitive measures" which I thought would make it
obvious I meant legal punitive measures. Last time I checked holding a gun to
a drug addict's head to achieve a change in that addict is not only illegal
but highly unethical.

Pressure, as I took it, meant legal methods of affecting change. And even so,
widespread violence against addict's and their families certainly didn't
eradicate the problem for China. Today there are around 4-5 million drug users
in China and yet that country has laws allowing for the death penalty for
trafficking and very stringent use laws.

And certainly putting a gun to someone's head is definitely not a long term
solution to addiction but rather a very cruel way of incentivizing treatment.

------
lmg643
This is a really sad story of how America is failing the middle class. Ohio
used to be a major manufacturing hub - no longer. Now there are more deaths
from heroin overdose in Ohio than car crashes. It started with the widespread
accessibility of Oxycontin, then after the reformulation, heroin.

Chicago is the major importing hub for drugs - hence all the violence - and it
fans out from there. We have no border security in the south, and people
wonder how the drugs get in. The US is not powerless to stop any of this, but
we need to admit we have a serious problem and start implementing solutions.

~~~
stephengillie
The downfall of American industry and manufacturing didn't start with "the
widespread accessibility of Oxycontin". It started with the Globalization
movement, where poorly-paid foreign labor was combined with then-decreasing
costs of global shipping.

Since when is Chicago a major hub for importing drugs? What's your source?
From where are they imported and how - air? Why do you tangent to border
security?

~~~
lmg643
El Chapo is the head of the sinaloa cartel:

"Chicago, home of the Mercantile Exchange, has always been a hub from which
legitimate goods fan out across the country, and it’s no different for black-
market commodities. Chapo has used the city as a clearinghouse since the early
1990s; he once described it as his “home port.”"

[http://www.nytimes.com/2012/06/17/magazine/how-a-mexican-
dru...](http://www.nytimes.com/2012/06/17/magazine/how-a-mexican-drug-cartel-
makes-its-billions.html?_r=0)

"Chicago is a major trafficking route for Mexican cartels and has become a hub
for the distribution of heroin across the Midwest. The dangerous result has
been an increase in heroin overdose deaths in Illinois."

[http://www.wbez.org/news/heroin-its-cheap-its-available-
and-...](http://www.wbez.org/news/heroin-its-cheap-its-available-and-its-
dangerous-business-109304)

It's a border security issue because the drugs are coming from the south, by
gangs that can operate across the border almost unchallenged.

------
cmpxchg
The article uses terms like "epidemic," but the map graphic suggests a
national mortality rate of around 2.5 per 100,000. That's 0.0025%, or 7,500
people per year.

~~~
austinheap
NIH/NIDA supports that number:
[https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/cdc...](https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/cdcwonder2015_5.jpg)

From 2001 to 2013 there was a 5-fold increase in the total number of deaths
from heroin overdose.

Edit: I believe a 500% increase in overdose deaths qualifies under the
'epidemic' definition of "a sudden, widespread occurrence of a particular
undesirable phenomenon."

~~~
jnbiche
So if there a rare disease increases 500% from a few to a few dozen, does that
count as an outbreak?

------
rdlecler1
This is a symptom of a bigger problem. Plain and simple. Lack of opportunity
and sense of purpose in modern society, combined with a person who has had a
few bad rolls of the dice (And statistically someone will roll bad) along with
a genetic predisposition for it. You may not care about that 100iq drug
additive, but what about the potential genius offspring--where one can change
the world.

------
CharlesMerriam2
Heroin is fueled by gateway drugs, particularly oxycodone and vikodin. This
story just shows how the market will evolve to overcome barriers to sell a
profitable product in a restricted market.

~~~
aianus
It's sad the DEA would rather watch people die in the street from heroin
overdoses than just ease up on the prescription opiates.

Surely it's preferable to enable junkies than kill them and feed the cartels?

~~~
robbiep
people die in large numbers from overdoses from prescription opiates too -
easing access to prescription opiates is a terrible solution

~~~
hollerith
>people die in large numbers from overdoses from prescription opiates too

What's your evidence for this?

~~~
ctrl_freak
"Prescription drug abuse and addiction kill far more people in the U.S. every
year than all illegal drugs combined."

[https://www.psychologytoday.com/blog/wicked-
deeds/201404/pre...](https://www.psychologytoday.com/blog/wicked-
deeds/201404/prescription-drugs-are-more-deadly-street-drugs)

~~~
aianus
This is a meaningless argument if you don't normalize for usage rates. Many
times more people are on legal drugs than illegal drugs. I doubt OxyContin
kills a higher _percentage_ of its users than heroin.

~~~
jnbiche
Also surveillance bias is a problem in these data.

Also, these data include things like acetaminophen overdoses (estimates run
from 100 to 1000 deaths per year).

~~~
facetube
Those overdoses could still be secondary to opioid addiction; there are lots
of APAP/hydrocodone and APAP/oxycodone out there.

