Dreamland (30 page)

In Portland that morning, 108 officers met at a cavernous conference room at a north Portland hotel to discuss how they would hit eighteen residences and another fifteen cars. Rock Stone stayed up most the night listening to Xalisco Boys wiretaps, fearing he would miss something. By then, he had tracked these Nayarits to twenty-seven cities in twenty-two states—a massive yet diffuse corporation of drugs designed to resemble a motley collection of street dealers, and unlike any narcotics network he had ever known.

At six
A.M.
in southwest Albuquerque, Jim Kuykendall and other agents burst into a two-story adobe-style house where Enrique then lived with a girlfriend and her children. They arrested another half dozen of his drivers.

Later, Kuykendall sat down to talk with Enrique. “He just portrayed himself as a poor guy from small-town Mexico trying to make a buck—as if there was nothing too wrong with what he was doing,” Kuykendall remembered. “A family guy looking out for his family and his kids. I’d talked to too many of the girls he’d slept with to believe that. He was a farm boy . . . and a midlevel trafficker.”

Enrique spent the next thirteen years in a U.S. federal prison.

Across the country that day, 182 people were arrested in a dozen cities in Operation Tar Pit. Agents seized relatively small quantities of drugs and cash: sixty pounds of heroin and two hundred thousand dollars. Yet Tar Pit remains the largest case—geographically and in terms of manpower used—the DEA and FBI have ever mounted jointly.

“This is the first time we’ve seen a criminal drug-trafficking organization go coast-to-coast, also hitting Alaska and Hawaii,” DEA administrator Donnie R. Marshall said at a press conference.

The bust reflected the spread of Mexican immigration. Mexican immigrants were now coast-to-coast, too. They formed the working classes in North Carolina, Alaska, Idaho, Minnesota, and Nevada. Mexicans were the largest influx of foreign-born labor to the American South since slavery. They were in the biggest cities and were revitalizing parts of heartland America. The only locally owned new businesses in many rural towns were those that Mexicans started, and it was common by 2000 to find Mexican restaurants in Mississippi or an out-of-the-way burg in Tennessee.

This also meant Mexican traffickers had more places to blend in. That wasn’t true even five years before. But by the late 1990s, as Mexican immigration was now virtually nationwide, Mexican drug networks national in scope were now possible, too. Such a thing was unprecedented in the history of U.S. organized crime. Not even the Italian Mafia had done it, but Operation Tar Pit showed that the Xalisco Boys had.

They were a new kind of drug trafficking in America. The Xalisco Boys weren’t the General Motors of drugs. They succeeded because they were the Internet of dope: a network of cells with no one in charge of them all, with drivers rotating in and out, complementing each other as they competed for every junkie’s last twenty bucks, yet doing this without guns, shutting down their phones fast as a website at any hint of law enforcement’s approach.

Back in Xalisco that August, the Feria del Elote was dead. Bandas came to town and left empty-handed. Most cell owners left for Guadalajara, believing they were on some DEA or FBI list. The Man went on the lam, and returned to Xalisco just before the feria. “The town dried up,” he said. “Nobody was coming to the plaza.”

He was arrested in South Carolina two years later and sent to prison. The case against him was based mostly on wiretaps of his conversations with Hernandez-Garcia and with FedEx tracking the whereabouts of those packages of ovens stuffed with black tar heroin.

In Portland, Rock Stone would put together two more operations against the Xalisco Boys targeting a video store and a bridal shop that funneled crew money home to Nayarit, and sold the Xalisco networks their indispensable cell phones and pagers. He found an apartment that had 155 cars registered to it and shut that down, too.

Along the way, though, he came to a sobering conclusion. It wasn’t just that the Xalisco runners were endlessly replaced. It was that even if Stone kept attacking management levels of these Nayarit heroin crews, the managers, too, would be replaced quickly. He’d never seen this in narcotics. Informants told him the Tejeda-Sánchez clan alone—with the Lermas, Diazes, Bernals, Cienfuegoses, Hernandezes, Garcias, and the rest—were more than two-hundred-deep back in Nayarit, and any of them could rotate in to a heroin crew in Portland as a regional sales manager or cell supervisor.

Not only that, though. On the horizon hovered a specter even more disturbing than rotating squads of heroin-franchise upper management, bizarre as that idea might seem. As Tar Pit took place, out of the east was swelling a wave of opiate abuse creating vast numbers of new addicts as it swept west across America.

PART II

Two-Thousand-Year-Old Questions

Boston, Massachusetts

One spring day in 2000, Dr. Nathaniel Katz left his Boston pain clinic and crossed the Charles River to a hotel in Cambridge. Awaiting his arrival were three hundred physicians and researchers attending a conference on infectious diseases.

Katz had been a practicing pain specialist for almost a decade. He’d agreed to speak to the conference on how to manage pain in AIDS patients. He walked through the Royal Sonesta Hotel in his best suit, a name tag affixed, and a carousel of slides under his arm.

“I was nervous. A pretty young woman was there. I was half noticing her. She comes up to me and says, ‘Dr. Katz?’ I’m thinking, great, my first fan and she’s a pretty young girl. I’m ready for adulation. ‘Nathaniel Katz?’ she says. That’s right, I say. She says to me, ‘I’ve been waiting for ten years to tell you this. You killed my brother, Peter.’”

Nathaniel Katz had grown up in a Coney Island apartment near the elevated tracks. His parents, Eastern European Jews, survived the Holocaust and came to New York City in 1948. His father worked as a chemist with the city’s transit authority. Katz finished high school at sixteen, college at twenty, and went on to medical school. By 1986, he had graduated and was interested in studying the nervous system. He did a three-year fellowship in neurology. He had no tutelage in pain management. No one did in medical school. “Just because it’s a problem every doctor faces every day,” he said, “doesn’t mean that it’s something you would run into in medical school.”

He was surprised, as a young neurologist, to find pain everywhere. Back pain, neck pain, headaches, muscle pain, pain associated with MS, Parkinson’s, or strokes. Patients virtually clawed at his lab coat for help in managing their pain.

“I kept on seeing these patients and not knowing what to do with them,” he said.

As it happened, Katz got his training in the first years of the debate within American medicine over opiates and pain. Everywhere people quoted the notion, pried unwillingly from Hershel Jick’s one-paragraph letter years before, that less than 1 percent of pain patients who were prescribed opiates developed addiction.

By the time Katz was well into his medical training, a new conventional wisdom on opiates had emerged. It went something like this, Katz remembered: “It was not only okay, but it was our holy mission, to cure the world of its pain by waking people up to the fact that opiates were safe. All those rumors of addiction were misguided. The solution was a poppy plant. It was there all along. The only reason we didn’t use it was stigma and prejudice. Once it became ‘clear’ that pain patients weren’t going to become addicted, now we were liberated to use that solution that had been in hand the whole time.

“My fellowship director even told me, ‘If you have pain, you can’t get addicted to opiates because the pain soaks up the euphoria.’ Now you look back and it sounds so preposterous. That’s actually what people thought. You can think what you want in the face of ten thousand years of reality.”

But, young and dutiful, Katz prescribed opiates. Sure enough, some patients did well on the drugs—as his instructors said they would. But he noticed that just as many did poorly. They were running out of the drugs before the month was up, asking for more.

“The real problems were things I couldn’t see. What was that patient doing with the medication when they left?”

Then Katz met Peter. Peter was incontinent and had numbness in his legs, the result of an injury to his lower spinal cord. Peter was also unemployed and an alcoholic.

At the time, pain specialists and addiction specialists rarely crossed paths. Even today, despite a national movement to treat pain with addictive drugs, the two specialties, remarkably, still don’t have much contact; there are no joint conferences where the two specialties might meet.

So despite Peter’s history of substance abuse, Katz prescribed opiates. Before long, Peter was asking for more before the end of the month. Katz hesitated. But Peter was a loquacious fellow. He charmed the doctor and each month walked out of Katz’s office with more medication.

“I was faced with the dilemma that prescribers have,” Katz said. “What is the nature of the problem? If it’s an abuse problem, the patient’s not going to tell you.”

Before Katz had a chance to find out, Peter died from an overdose of the medication the young doctor was prescribing. His death was a turning point for Nathaniel Katz.

“He was dead and I liked him and I wanted to help him.”

Katz had two questions: Are opiates safe when used to treat chronic pain? Are they effective in treating that pain? Katz searched the medical literature and found nothing.

“There’s not a shred of research on the issue. All these so-called experts in pain are dedicated and have been training me that opioids aren’t as addictive as we thought. But what is that based on? It was based on nothing. I felt I’ve just uncovered the problem of our age, and of 500
B.C
.: What are the risks of opioids? There was no answer to those questions, despite the fact that people have been asking them for twenty-five hundred years.”

By the 2000s, the American pain revolution was complete.

Most of the country’s hundred million chronic-pain patients were now receiving opiate painkillers, as it was accepted on faith that virtually none of them would grow addicted. They usually weren’t receiving prescriptions from pain specialists. Their prescriptions came instead from general practitioners with little time and little training in pain management—the kind of docs Purdue Pharma targeted in its sales campaign. Doctors prescribed pills for wisdom teeth extraction, carpal tunnel syndrome, bad knees, chronic back pain, arthritis, and severe headaches. Football and hockey players were given them for separated shoulders. People were sent home with bottles full of ninety Vicodin or sixty OxyContin pills. In many cases—patients recovering from surgery—a half-dozen pills might have sufficed, but doctors often wanted to avoid further patient visits. Why not prescribe more if the pills were now virtually nonaddictive when used for pain?

Americans were enjoying an era of amped consumer spending based on massive debt and towering real estate values that appeared to rise endlessly. It was a time when the country seemed a dreamland where the old rules, constraints, and knowledge no longer applied. At the same time a culture of opiate use grew from a medical revolution that believed these narcotics now could be used to treat pain without fear of addiction—that the old rules, constraints, and knowledge, in other words, didn’t apply.

Worldwide pharmaceutical opiate production rose steadily. But it was the United States, the country where the Englishman Robert Twycross once smelled “the fear of addiction” as he stepped from an airplane, that now consumed 83 percent of the world’s oxycodone and fully 99 percent of the world’s hydrocodone (the opiate in Vicodin and Lortab). “Gram for gram,” a group of specialists wrote in the journal
Pain Physician
in 2012, “people in the United States consume more narcotic medication than any other nation worldwide.”

Drugs containing hydrocodone became the most prescribed drugs in America (136 million prescriptions a year, as I write), and opiate painkillers the most prescribed class of drugs. U.S. sales of opiate painkillers quadrupled. Sales of oxycodone—the drug in OxyContin, but also sold in smaller-dose generic pills—rose almost ninefold between 1999 and 2010.

A rising sea level of opiates spread to every corner of the nation. Before long, a black market for pills emerged larger than anything the country had seen. OxyContin very quickly had a street price: a dollar a milligram—so forty dollars or eighty dollars per pill. Between 2002 and 2011, 25 million Americans used prescription pills nonmedically. Amid all this, opiate abusers began to get younger. In a 2004 survey by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), 2.4 million people twelve years or older had used a prescription pain reliever nonmedically for the first time within the previous year—more than the estimated numbers using marijuana for the first time. The pain-pill abuser’s average age was twenty-two.

Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012. Abuse of prescription painkillers was behind 488,000 emergency room visits in 2011, almost triple the number of seven years before.

Generic methadone, for years strictly an addict-maintenance drug, suddenly started killing, too. As media reports of OxyContin abuse and overdoses spread, some doctors began prescribing methadone for pain instead. Most doctors knew that methadone remained in the blood-stream for up to sixty hours. An addict on methadone could lead a daily life without the gnawing cravings every few hours of the far-quicker-acting heroin. Thus some doctors figured that methadone was an equally long-lasting painkiller. Plus methadone was generic and cheap; insurance companies covered it. Methadone prescriptions more than quadrupled—from under a million in 1999 to 4.4 million in 2009 nationwide—mostly for headaches and bodily pain.