New York is Great, Opioids are Not
I think about New York City constantly. I don’t necessarily sit around considering macro issues like the unbalanced budget, zoning, and encroaching shore lines. But a running ticker tape of thoughts of my own New York constantly streams behind my eyes. I take in the faces that are just a few inches from my own on my crowded subway commute. I think about what it would like to live in neighborhoods right next door to and far from my home. I weave around slow walkers and acknowledge my automatic feelings of superiority. Repeating these and other actions day after day has exposed me to an innumerable amount of faces and places that have since become a part of my story. A New York Story that belongs to me, and no one else.
That’s what makes New York so special, within its frenetic and loosely defined boundaries exists 8 million parallel universes. My New York is different than that of every New Yorker I pass. We navigate the grids and knots that cascade across our boroughs in a way that makes sense to us. We choose to walk down certain blocks, while avoiding others- either intentionally or subconsciously zigzagging with the turn of a walk sign. We regularly make note of the same landmarks and completely bypass others. In our pedestrian travels we carve out concentric circles of familiarity within a city that often feels overwhelming. These circles are worn down under the heels of our relentless pursuit for what’s just a few steps ahead of us. They become paths marked by familiar storefronts and a rotating cast of characters with a few taking up permanent residence. And these circles change. They are picked up and dropped off blocks away as we start new jobs, move to new neighborhoods, mature into trendier or trendless nightlife, spend the night at new apartments. Every time we relocate to a new circle we add a new chapter in our own New York novel, or we abandon existing circles and start a new story completely.
This idea is also what makes yesterday’s attack so horrible. It stripped New York’s visitors and residents of their ability to add to or complete a rotation of one of their circles. The bike path on the West Side Highway is part of many New Yorker’s set of circles. It was part of the circle of my daily morning run when I was a student at F.I.T. in 2008. It is an expanse perfect for a midday walk or an early morning run uninterrupted by the punctuation of stop lights and crosswalks. It provides a place for high school students to enjoy their after school amnesty before they have to start their homework. It allows visitors to take in sweeping panoramas of the skyscrapers uptown, the Freedom Tower downtown and Jersey across the Hudson River. And now it’s a place that will be associated with death, hate, politics, and violence. It will likely be cut from many people’s circles or exist as a circle of sadness.
But of course, this circle deletion isn’t a deletion at all. Similar to the specter of deletion that haunted this same neighborhood 16 years ago, it is a temporary cut that will soon be repasted. Deletion will adjust the trajectory of our paths for a while but soon we will reclaim this circle as our own. We will mourn those we lost, rehabilitate those that are still with us, and thank them all for being a part of our story.
New York, I love you.
Here are two of my hundreds of circles, one past, one present:
- 2004-2006, All of 2008 and the summers of 2009: A Circle of Angsty Delusion: I spent six years of my precious youth dating someone I should have only dated for six minutes. Our “love” was separated by a river and New York City. He would come from New Jersey and I from Connecticut. In a desperate escape from the confines of a state I hated very much I would hop the Metro North and travel to a city I very much loved. I would emerge from Grand Central (which at the time I thought was a Mecca of commerce) onto 42nd street and walk three blocks West, past the lions of the New York Public Library and into Bryant Park (which at the time I thought was the Mecca of power lunching). He would usually already be there because even then I was usually late. Here I enjoyed watching business people eat expensive salads off of their laps because most of the tables had been claimed as residence by some of the city’s overlooked. I assumed I soon would inevitably join the ranks of the lap lunchers. My boyfriend would slip $5 of his caddying cash to the bellhop at the Bryant Park Hotel so I could use the bathroom (unclear if this was ever necessary, but as a 17 year old with a job this made him feel exclusive and powerful). We would then walk South on Seventh Avenue through the Garment District and past the fluorescent Mustang Sally’s sign where would often convince a bartender to serve us cheap beer. The scene grew bleaker as we approached Penn Station. We were always fighting, I was sometimes crying. In those six years, I probably lapped this circle 600 times.
- 2015-Present: A Circle of Bliss and Resisting Capitalism: I have done yoga at Laughing Lotus almost every day for the past two years. Most days these classes come right after work and right before the rest of my evening. I’ve succumbed to every possible emotion within those studio walls under the guise of teachers who I think I know really well but in reality know me only by name and sports bra rotation. Most nights, I leave Lotus and walk directly to the 4/5 train at Union Square. I walk east on 19th street toward 5th avenue, instinctually crossing to the south side of the street somewhere between the Dough Donuts and the Soul Cycle (seemingly intentional placement). I cross 5th avenue, usually against the light and without checking the bike lane for reckless CitiBikers. I pause outside the seductively arranged Madewell storefront and actively talk myself out of going inside. I begrudgingly continue south on 5th with visions of wool sweaters and romantic ruffle blouses dancing in my head, turning left on 18th street. I pass yet another Soul Cycle and glance into engine 14 just beside it because one of the firemen who works there is incredibly attractive. I then head south on Broadway, eventually entering the confusing and confused crowds of Union Square at its Northwest corner. In no particular order, I will pass people buying $28 pies at the farmer’s market, unruly youths playing games I don’t understand, men in suits who are either trying to sell me something or recruit me into their cult, and of course, the Hare Krishnas. My body becomes my weapon as I descend into the snake pit of the USQ subway station, dipping shoulders and throwing elbows as I hurry to the 4/5 Downtown staircase- my pace dictated by the number of minutes until the next trains arrival. I always make my way to the end of the platform to ride the less crowded first car. As the departing passengers exit, I stealthily retreat backwards so I am last person to board the train in order to snag the coveted door spot. Ya know the one where you can lean on the door AND the rail- a commuter’s dream.
Opioids: Are they too big to fail?
As many of you probably know, the molten pool of spent Roman Candle we must call our President declared the opioid crisis a “national public health emergency” last Thursday. This is different than a “natural disaster declaration” which would compel the government to cough up federal funding to stymie the epidemic. (Forbes revealed yesterday that the designation of “emergency” makes only $57,000 available, about 2 cents per addict). The health emergency does prioritize expanding treatment centers and arming first responders with overdose antidotes like Narcan- which can now be purchased at your local Walgreens. While these are important measures, they are reactive band aids that don’t stand a chance of scabbing the gushing wound that is America’s opioid crisis. The declaration provides little by way of a proactive plan to limit the supply of these drugs. Trump and other officials have been reluctant to assign culpability to the domestic behemoth suppliers currently flooding (and profiting from) America’s small towns and big cities with lethal drugs. So who does our game show president blame?
The Chinese (of course) for pumping lethal fentanyl into American street drugs and weak-willed Americans who were never told “just don’t do drugs” as teens. (Perhaps he’s never heard of D.A.R.E?). In Thursday’s speech, he seized yet another opportunity to let us know that he does not drink, on the advice of his now deceased, alcoholic brother Fred. And since we know the empathy gene was long ago carved out of Trump’s 23andMe genetic analysis, he cannot understand how ANYONE could possibly become addicted to an artificial substance. He ended his speech with an uninspired call to action: WE can be the generation to end the opioid crisis. Which seems only fair because we are the ones who started it.
Which brings me to the question this week’s Haut Takes attempts to answer: Who is actually responsible for America’s opioid epidemic and why are they not being held accountable?
But first, at the risk of oversimplifying, here are a few important pieces of context to fully appreciate the article reviews:
- Opioids are a class of drugs that includes prescription painkillers like hydrocodone, oxycodone, morphine and methadone. They are sold under brand names like Vicodin, Percocet and Oxycontin. Heroin is an illegal opioid that is several times more addictive than its prescription counterparts. It is also far cheaper. The name “opioid” is derived from the drug’s source, opium poppies.
- A brief history of opioid use in the U.S. can be found here. And this clip from a 2016 episode of Last Week Tonight explains how Big Pharma kindled America’s addiction to pain pills in the 90s by convincing chronic pain sufferers they were necessary and non-addictive. Sanjay Gupta attempts to explain why opioids are so addcitive in less than 90 seconds here.
- Fentanyl is a synthetic opioid originally created to mimic the effect of opium poppies. It is 100 times more potent than morphine and can be deadly in very small traces. International dealers (mostly from China and Mexico) have been injecting Fentanyl into batches of heroin, killing many unaware users almost immediately.
- This New York Times interactive article includes a number of powerful graphics and additional links that capture the numerical rise of opioid overdoses over the past 17 years. Preliminary data shows that 64,000 Americans died after overdosing on opioids in 2016. This is roughly 12,000 more victims than in 2015, where about 142 Americans died from opioids EVERYDAY This statistic surpasses the number of casualties at the height of the AIDs epidemic in 1994 and the total number of Americans killed in the Vietnam War.
- Opioid use and subsequent overdoses increased across every race, gender and ethnicity in the past several years in both urban and rural areas, although rural areas have experienced a far steeper rate of change. Ohio, West Virginia, New Hampshire, and large swaths of Appalachia have been hardest hit.
- Drug overdoses are now the leading cause of death of Americans under 50.
- Four pharmaceutical companies, most with over billion dollar valuations, are responsible for the wholesale distribution of the majority of Hydrocodone and Ocycodone: McKesson, Cardinal health, AmerisourceBergen, and Purdue. The companies in bold are known as the big three, and are collectively worth $400 billion. They fulfill orders placed by pharmacies big and small who then fulfill prescriptions written by doctors, ostensibly for patients who legitimately need them.
So how did we get here?
I. Big Pharma is flooding America’s smallest towns with prescription painkillers: And some places, like Mingo County, WV are literally drowning in them. This revealing two-part series in the Charleston Gazette Mail attempts to explain how drug wholesalers entrapped the state of West Virginia. The top four counties for fatal opioid overdoses are located in Southern WV, with two more rounding out the top ten. Meaning 60% of the top ten counties for fatal overdoses in this country are located in one of its least populated states. Their reporting is based on previously undisclosed drug shipping sales records sent by the DEA to the West Virginia Attorney General. Here’s what to know from both articles:
- In the past six years, drug wholesalers have shipped 780 million hydrocodone and oxycodone pills to various pharmacies in West Virginia. That is 433 pain pills for every West Virginia resident. In those six years, 1,728 WV residents fatally overdosed on these pills. The Big Three wholesalers (bolded above) shipped 432 million of those pills.
- For Perspective: 9 million of those pills were shipped to a single pharmacy in a town called Kermit with a population of 392 people. Let that sink in, 9 million pills for 392 PEOPLE in six years.
- Pharmacies across the state placed orders for an immense number of painkillers that could not plausibly be consumed responsibly by the people of West Virginia. An obvious thread has emerged leading from crooked doctors writing suspicious scripts to corrupt pharmacists ordering massive quantities to satisfy them to inhumane wholesalers who were more than happy to box and ship their tiny money machines. Cut from the thread? The people of West Virginia who became dependent on these pills.
- Obviously, the drug shipping sales records the Gazette examined revealed more suspicious pharmacy orders than reasonable ones. For example, one tiny pharmaceutical outpost in rural Oceana ordered 600 times as many pain pills as the Rite Aid just a few blocks away. The trend of independent pharmacies placing suspicious orders is prominent. In Mingo and Logan counties, ma and pop stores ordered a combined 4.7 million pills since 2014. A Wal-Mart in the same county ordered 9,500 in the same time period.
- Also worth noting, pharmacies in WV are increasingly requesting stronger doses of Oxy and Hydrocodone as consumers become increasingly numb to the standard 5 mg does. The requests for that standard size dwindled as requests for 10-30mg doses grew exponentially.
- So, the benevolent behemoths of wholesale came forward to report and deny these suspicious orders, right? Come on, Haut Takers would never be so gullible. Not only did wholesalers fail to report and continue to shamelessly fulfill exploitative orders- they denied that they had any responsibility to do so. Big Pharma attorneys (in the few cases legal action has been taken against them) rebut with some form of Don’t shoot the Messenger: The evil doctors of rural America are clearly to blame. Drug companies are simply humble businessmen giving the people what they want! The Gazette Mail summarizes their position as:
“The wholesalers ship painkillers from drug manufacturers to licensed pharmacies. The pharmacies fill prescriptions from licensed doctors. The pills would never get in the hands of addicts and dealers if not for unscrupulous doctors who write illegal prescriptions.”
The General Counsel for McKesson Puts it this way:
“The two roles that interface directly with the patient — the doctors who write the prescriptions and the pharmacists who fill them — are in a better position to identify and prevent the abuse and diversion of potentially addictive controlled substance.”
- Of course, corrupt pharmacists and doctors play a role. But, duh, reporting and refusing to fill suspicious orders would cause a significant collapse in the supply chain. I leave you with two significant pieces of evidence to suggest why they may be unwilling to remove their link in the chain: One, the CEOs of the Big Three collected a total of $450 million in salaries and compensation over the past four years. Two, McKesson’s CEO made $89 million in 2015- way more than the 1,728 West Virginians who overdosed on his product made combined. The theory is yours to make. (For more on the absurd amount of wealth pharma execs accumulate, read Esquire’s expose on the Sackler family- founders of Purdue Pharma and eponymous donors of the Met’s Temple of Dendur)
So why don’t wholesalers report suspicious orders?
II. The Law says they don’t have to: In a brilliant series of investigative journalism, The Washington Post teamed up with 60 Minutes (still relevant!) to expose Congress’ nearly unanimous decision to hobble the DEA’s ability to oversee and obstruct big pharma’s unfettered dumping of death pills into American markets. This very, very long read (October 17th, The Drug Industry’s Triumph over the DEA) summarizes the investigation’s findings, complete with a number of timelines and other fun! visuals. Here are the finer points:
- In April 2016, Congress passed the manipulatively named Ensuring Patient Access and Effective Drug Enforcement Act. This bill purports to protect the rights of millions of Americans who suffer from chronic pain. It was labelled a “noncontroversial bill” that was unanimously approved by congress and signed into law by President Obama. In reality, it makes it nearly impossible for the DEA to freeze suspicious and illegal shipments from drug companies to pharmacies. Previously, drug companies were required to report suspicious pharmacy orders (think the disproportionate deliveries to Mingo county) to the pharmacy’s local Attorney General’s office or drug regulators. If they did not, the DEA could freeze the drug company’s operations and investigate why those orders went unreported while keeping drugs off the streets. Under the new act, the DEA does not have the power to freeze any operations unless they pose an “imminent danger” to society. A term so vague literally no one seems to be able to define it. Implication: Drug wholesalers can now fulfill and profit from unreported suspicious orders that suffocate America’s small towns without consequence.
- Now, you may be asking yourself How could a bill that amputates our country’s Drug Enforcement Agency at the knee be passed unanimously through our legislature? Money, of course!!! (And also the poaching of DEA employees by pharmaceutical companies, but more on that in a second). The drug industry spent $102 million between 2014 and 2016 lobbying congress about the merits of the bill- the biggest contributors include CVS, Rite Aid, and the Big Three. The 23 lawmakers who sponsored the bill received $1.5 million from PACs supporting the drug industry. The lucky recipient of 100,000 of those dollars was Trump’s former nominee for Drug Czar- Tom Marino. He was forced to withdraw from consideration after his ties to the drug industry were deemed a conflict of interest. Marino was the chief advocate for the bill.
- The bill was supposedly passed to the DEA and White House Office of Management and Budget, but senior officials for both committees deny this. The DEA, Justice Department, Loretta Lynch, and President Obama have refused to comment on the passage of the bill. WaPo and 60 Minutes have requested documents under the Freedom of Information act, and have been repeatedly denied. The Post is currently suing the Justice Department for those documents.
- The third and fourth (and final) version of the bill were written by Linden Barber. Barber served as the associate chief counsel for the DEA from 2006-2011. Along with former chief DEA official Joe Rannazzissi (who is now consultant to team of 41 former Attorney Generals suing the opioid industry- this story is also about his vigilante quest for vengeance), Barber led the DEA’s harshest crackdowns of the drug industry. In an unexpected turn of events, Barber went to work for the pharmaceutical industry in 2011. In 2014, Barber wrote the first version of the Act and passed it to Tom Marino to present to Congress. In a complete rotation of this circle jerk, Barber was the chief expert witness testifying in favor of the legislation during a congressional hearing. He is now a chief executive at Cardinal Health.
- Barber is not the only former DEA official to jump ship to the prosperous lure of the drug industry. Since 2000, 56 DEA and Justice Department officials have gone to work for Big Pharma, bringing with them invaluable knowledge of the DEA- both it’s strengths and Kryptonitic weaknesses. The industry’s poaching increased sharply in both 2005 and 2010 when the DEA’s enforcement of the industry also increased.
- In summation, Rannazzissi has this to say:
“[The pharmaceutical industry] are just drug dealers in lab coats. They are no different than those slinging crack on the corner, THEY just don’t have ivy league class rings on their fingers.”
Understood about the pills, but where is all the Heroin coming from?
III. Don Winslow’s answer? The Cartel: Winslow is an investigative journalist who is an expert in the underworld of the Mexican drug cartel. He has written a number of investigative pieces and novels on the topic (Read The Power of the Dog if you are into this kinda stuff). In this article for Esquire, Winslow argues that the proliferation of Mexican heroin is a reaction to America’s legalization of weed (along with an extensive summary of El Chapo and how he probably never would have let this happen). My initial reaction was also, huh? Weed used to be the Mexican cartel’s number one American money maker. Now that American growers are providing a superior, legal product- the cartel needed a new drug to distribute. Enter, heroin. Being a business driven by profit, the cartel was well aware that they U.S. was filled with people addicted to opioids- but could no longer procure them. To fill this hole, they dipped into their massive crop of opium and shipped heroin into the U.S. market that is far cheaper and stronger than previous American versions. The cartel also ruthlessly began injecting their product with fentanyl to increase the likelihood of addiction/ gaining a return customer.
IV. Remember, real people are dying: In the end, the information above is so important because people are dying at increasingly alarming rates. Many of us have family members, friends, and neighbors who have sunken into the quicksand of an opioid addiction. They are the puppets at the bottom of the supply chain, the drug industry and their medical henchmen constantly toying with their strings. Below are just three of the litany of personal, human stories that deserve to be told:
- October 27th’s episode of NYT’s The Daily allows a former addict named Aaron Pope from Lexington, KY to tell his story. It includes details of his near deadly overdose at the age of 22 and how his friends and family members (including his mom) were able to easily procure drugs from Florida pharmacies. At one point, Pope was peddling pills for $30 a pop, making up to $1,500 a day. He has been clean for nearly two years.
- In a powerful photo essay published in the New Yorker, Phillip Montgomery and Margaret Talbot let their vivid images of overdoses and their effects in Montgomery County, Ohio tell a story that words are often incapable of capturing.
- The Bronx, whose residents are plagued by heroin, asks, what about us? Many critics rightfully note that pain pill addicts, who are largely white, are often portrayed as victims while their minority counterparts are labelled helpless degenerates. This NYT article exposes the humanity behind the suffering and considers why the borough’s mostly black and brown residents are not being treated with the same empathy and compassion as rural and suburban addicts.
TV: Broad City cuts a few punchlines and more closely resembles reality
I’ve loved the ladies of Broad City since their web series days. Their version of New York, one rife with professional failures, invasive roommates, botched drug deals, utter social humiliation and strong female friendships more closely resembles the New York of my 20s than any of the other fictionalized iterations (no, not all white women in New York can be categorized as a Samantha, a Carrie, a Charlotte, or a Miranda-reply all if you disagree or are confused about this). These women are wholly relatable in their attempts to be totally cool and likeable but often end up chasing a St. Marks punk who stole your purse on your birthday into the Washington Square Park brownstone where he actually lives with his mom while the tree man waits outside- ending the night eating dollar pizza while sitting on the sidewalk under this comforter.
In its fourth season, the ladies have continued to round themselves into whole humans by weaving worries about mental health, aging, women’s rights, and rejection into tales of American Ninja waitressing, mushroom trips that end in dead cats, and TRAINING SHAINIA TWAIN. Here are a few (mostly) spoiler-free highlights:
- In episode 2, Abbi and Ilana serve as clinic escorts outside of a Manhattan Planned Parenthood. Ilana wears a pink pussy hat as the two stroll through a barricade as protestors hurl secular stupidities like “these are God’s children” at them. Weed is prominently featured in this scene, of course.
- In episode 3, Ilana full on social media stalks Lincoln and his new girlfriend after running into him at a party, and she is straight up sad about it. Ilana also sings a song about her “White Guilt”.
- In episode 4, Abbi’s mom comes to visit and fully confesses that being a middle aged married woman is hard. Ilana is suffering from SAD (Seasonal Affective Disorder is fucking real y’all- Sunday’s impending time change has dialed up my anxiety like 17 notches). Ilana ends the episode by admitting she needs to increase her dose of anti-depressants during the Winter months, adding “so I get sick sometimes and need medicine, who cares”. You expect this to be rolled into a classic BC joke (they are in a sex shop after all), but it isn’t- it’s a mere statement of fact.
- EPISODE 6 WAS A GOLD MINE. I wish I had seen it before last week’s issue because of its WITCH theme. After Abbi panics over the discovery of a grey hair, the episode pivots to celebrate the magic of women of all ages (aka witches). It’s other main story is Ilana’s T***p Related Pussy Constipation (watch episode for more details) that quickly spirals into a montage of clips of the hateful horror of the 2016 election and its subsequent shit storm. The episode includes a slideshow of famous Witches including everyone from mybadgalriri to Gloria Steinem to the 2 Dope Queens to Malala. It ends with a coven of magical women fire dancing in Central Park.
- All the while, the “human skin tag” that is our president becomes our very own Voldemort. His name is bleeped in every episode. Here’s the backstory.
Let’s wrap it up:
This past week, two of my famous favorites celebrated birthdays. Frank Ocean turned 30 on October 27th and celebrated by catwalking in these glitter tights. Hillary Clinton turned SEVENTY on October 26th and continued her tour of NYC’s hippest restaurants with a dinner at Estela in the LES. To honor these two prospectors of my cultural gold mine, I give you the following completely subjective tributes:
Top six Frank Ocean lyrics:
- “Taxi driver, I swear I've got three lives, balanced on my head like steak knives.” Bad Religion, Channel Orange
- “Shut the fuck up I don’t want your conversation.” Nights, Blonde
- “I know you don’t need me right now, and for you it’s just a late night out.” Good Guy, Blonde (Honorable Good Guy mention: “Here’s where I realized you talk so much more than I do.” This song is one minute and seven seconds long and contains more emotional honesty than most can convey in an entire album- or a lifetime.)
- “Sensei replied, ‘What is your woman? Is she just a container for the child?’” Pink Matter, Channel Orange (worth mentioning here is standout Pink Matter guest Andre 3000’s standout interview with GQ.)
- “I'm about to drive in the ocean. I'ma try to swim from somethin' bigger than me.” Swim Good, Nostalgia Ultra
- “First wedding that I’ve been in my 20s, thinking maybe someone isn’t something to own.” Biking
Top five reasons Hillary Clinton will always be the Queen of the Coven:
- Introducing the catchphrase, “Women’s rights are human rights” into our feminist lexicon.
- Publicly acknowledging more than once that America does not accept anger as a valid emotion in women.
- She was the first First Lady to hold a postgraduate degree. She graduated from Yale Law School in 1973, where she was one of 27 women in a class of 235.
- To circle back, her cameo in a September 2016 episode of Broad City still fills me with hope.
- She says she first fell in love with Bill because he “wasn’t afraid of me.” PREACH.
And in case you’re wondering who Vanity Fair considers the New Establishment, their list of 100 of the world’s most powerful and influential people is here.
Lastly, the opening essay was inspired by New York Magazine’s (aka My Bible’s) 50th anniversary issue entitled “My New York” featuring personal essays written by New Yorkers both famous and not. Check some of them out here.