Dreamland by Sam Quinones - Read Online
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Winner of the NBCC Award for General Nonfiction

Named on Amazon's Best Books of the Year 2015--Michael Botticelli, U.S. Drug Czar (Politico) Favorite Book of the Year--Angus Deaton, Nobel Prize Economics (Bloomberg/WSJ) Best Books of 2015--Matt Bevin, Governor of Kentucky (WSJ) Books of the Year--Slate.com's 10 Best Books of 2015--Entertainment Weekly's 10 Best Books of 2015 --Buzzfeed's 19 Best Nonfiction Books of 2015--The Daily Beast's Best Big Idea Books of 2015--Seattle Times' Best Books of 2015--Boston Globe's Best Books of 2015--St. Louis Post-Dispatch's Best Books of 2015--The Guardian's The Best Book We Read All Year--Audible's Best Books of 2015--Texas Observer's Five Books We Loved in 2015--Chicago Public Library's Best Nonfiction Books of 2015


From a small town in Mexico to the boardrooms of Big Pharma to main streets nationwide, an explosive and shocking account of addiction in the heartland of America.

In 1929, in the blue-collar city of Portsmouth, Ohio, a company built a swimming pool the size of a football field; named Dreamland, it became the vital center of the community. Now, addiction has devastated Portsmouth, as it has hundreds of small rural towns and suburbs across America--addiction like no other the country has ever faced. How that happened is the riveting story of Dreamland.

With a great reporter's narrative skill and the storytelling ability of a novelist, acclaimed journalist Sam Quinones weaves together two classic tales of capitalism run amok whose unintentional collision has been catastrophic. The unfettered prescribing of pain medications during the 1990s reached its peak in Purdue Pharma's campaign to market OxyContin, its new, expensive--extremely addictive--miracle painkiller. Meanwhile, a massive influx of black tar heroin--cheap, potent, and originating from one small county on Mexico's west coast, independent of any drug cartel--assaulted small town and mid-sized cities across the country, driven by a brilliant, almost unbeatable marketing and distribution system. Together these phenomena continue to lay waste to communities from Tennessee to Oregon, Indiana to New Mexico.

Introducing a memorable cast of characters--pharma pioneers, young Mexican entrepreneurs, narcotics investigators, survivors, and parents--Quinones shows how these tales fit together. Dreamland is a revelatory account of the corrosive threat facing America and its heartland.
Published: Bloomsbury Publishing an imprint of Bloomsbury USA on
ISBN: 9781620402511
List price: $14.40
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PREFACE:  Portsmouth, Ohio

In 1929, three decades into what were the great years for the blue-collar town of Portsmouth, on the Ohio River, a private swimming pool opened and they called it Dreamland.

The pool was the size of a football field. Over the decades, generations of the town grew up at the edge of its crystal-blue water.

Dreamland was the summer babysitter. Parents left their children at the pool every day. Townsfolk found respite from the thick humidity at Dreamland and then went across the street to the A&W stand for hot dogs and root beer. The pool’s french fries were the best around. Kids took the bus to the pool in the morning, and back home in the afternoon. They came from schools all over Scioto County and met each other and learned to swim. Some of them competed on the Dreamland Dolphins swim team, which practiced every morning and evening. WIOI, the local radio station, knowing so many of its listeners were sunbathing next to their transistor radios at Dreamland, would broadcast a jingle—Time to turn so you won’t burn—every half hour.

The vast pool had room in the middle for two concrete platforms, from which kids sunned themselves, then dove back in. Poles topped with floodlights rose from the platforms for swimming at night. On one side of the pool was an immense lawn where families set their towels. On the opposite side were locker rooms and a restaurant.

Dreamland could fit hundreds of people, and yet, magically, the space around it kept growing and there was always room for more. Jaime Williams, the city treasurer, owned the pool for years. Williams was part owner of one of the shoe factories that were at the core of Portsmouth’s industrial might. He bought more and more land, and for years Dreamland seemed to just get better. A large picnic area was added, and playgrounds for young children. Then fields for softball and football, and courts for basketball and shuffleboard, and a video arcade.

For a while, to remain white only, the pool became a private club and the name changed to the Terrace Club. But Portsmouth was a largely integrated town. Its chief of police was black. Black and white kids went to the same schools. Only the pool remained segregated. Then, in the summer of 1961, a black boy named Eugene McKinley drowned in the Scioto River, where he was swimming because he was kept out of the pool. The Portsmouth NAACP pushed back, held a wade-in, and quietly they integrated the pool. With integration, the pool was rechristened Dreamland, though blacks were never made to feel particularly comfortable there.

Dreamland did wash away class distinctions, though. In a swimming suit, a factory worker looked no different from the factory manager or clothing-shop owner. Wealthy families on Portsmouth’s hilltop donated money to a fund that would go to pay for summer passes for families from the town’s East End, down between the tracks and the Ohio River. East End river rats and upscale hilltoppers all met at Dreamland.

California had its beaches. Heartland America spent its summers at swimming pools, and, down at a far end of Ohio, Dreamland took on an outsized importance to the town of Portsmouth. A family’s season pass was only twenty-five dollars, and this was a prized possession often given as a Christmas present. Kids whose families couldn’t afford that could cut a neighbor’s grass for the fifteen cents that a daily pool pass cost.

Friday swim dances began at midnight. They hauled out a jukebox and kids spent the night twisting by the pool. Couples announced new romances by walking hand in hand around Dreamland. Girls walked home from those dances and families left their doors unlocked. The heat of the evening combined with the cool water was wonderful, one woman remembered. It was my entire world. I did nothing else. As I grew up and had my own children, I took them, too.

In fact, the cycle of life in Portsmouth was repeated over and over at Dreamland. A toddler spent her first years at the shallow end watched by her parents, particularly her mother, who sat on a towel on the concrete near the water with other young moms. When the child left elementary school, she migrated out to the middle section of Dreamland as her parents retreated to the grass. By high school, she was hanging out on the grass around the pool’s ten-foot deep end, near the high dive and the head lifeguard’s chair, and her parents were far away. When she married and had children, she returned to the shallow end of Dreamland to watch over her own children, and the whole thing began again.

My father, a Navy Vet from WWII, insisted that his 4 children learn not only how to swim but how not to be afraid of water, one man wrote. My younger sister jumped off the 15-foot high diving board at age 3. Yes, my father, myself & brother were in the water just in case. Sister pops up out of the water and screams … ‘Again!’

For many years, Dreamland’s manager, Chuck Lorentz, a Portsmouth High School coach and strict disciplinarian, walked the grounds with a yardstick, making sure teenagers minded his three-foot rule and stayed that far apart. He wasn’t that successful. It seems half the town got their first kiss at the pool, and plenty lost their virginity in Dreamland’s endless grass.

Lorentz’s son, meanwhile, learned to swim before he could walk and became a Dreamland lifeguard in high school. To be the lifeguard in that chair, you were right in the center of all the action, all the strutting, all the flirting, said John Lorentz, now a retired history professor. You were like a king on a throne.

Through these years, Portsmouth also supported two bowling alleys, a JCPenney, a Sears, and a Montgomery Ward with an escalator, and locally owned Marting’s Department Store, with a photo studio where graduating seniors had their portraits taken. Chillicothe Street bustled. Big U.S.-made sedans and station wagons lined the street. People cashed their checks at the Kresge’s on Saturdays, and the owners of Morgan Brothers Jewelry, Herrmann’s Meats, Counts’ Bakery, and Atlas Fashion earned a middle-class living. Kids took the bus downtown to the movie theater or for cherry Cokes at Smith’s Drugstore and stayed out late trick-or-treating on Halloween. On Friday and Saturday nights, teenagers cruised Chillicothe Street, from Staker’s Drugs down to Smith’s, then turned around and did it again.

Throughout the year, the shoe factories would deduct Christmas Club money from each worker’s paycheck. Before Christmas, they issued each worker a check and he would cash it at the bank. Chillicothe Street was festive then. Bells rang as shoppers went shoulder to shoulder, watching the mechanical puppets in displays in store windows painted with candy canes, Christmas trees, and snowmen. Marting’s had a Santa on its second floor.

So, in 1979 and 1980, Portsmouth felt worthy to be selected an All-American City. The town had more than forty-two thousand people then. Very few were wealthy, and the U.S. Labor Department would have gauged many Portsmouthians poor. But we weren’t aware of it, nor did we care, one woman recalled. Its industry supported a community for all. No one had pools in their backyards. Rather, there were parks, tennis and basketball courts, and window-shopping and levees to slide down. Families ice-skated at Millbrook Park in winter and picnicked at Roosevelt Lake in summer, or sat late into the evening as their kids played Kick the Can in the street.

My family used to picnic down by the Ohio River in a little park, where my dad would push me so high on the swings I thought I’d land in Kentucky, another woman said.

All of this recreation let a working-class family feel well-off. But the center of it all was that gleaming, glorious swimming pool. Memories of Dreamland, drenched in the smell of chlorine, Coppertone, and french fries, were what almost everyone who grew up in Portsmouth took with them as the town declined.

Two Portsmouths exist today. One is a town of abandoned buildings at the edge of the Ohio River. The other resides in the memories of thousands in the town’s diaspora who grew up during its better years and return to the actual Portsmouth rarely, if at all.

When you ask them what the town was back then, it was Dreamland.

INTRODUCTION

In the middle-class neighborhood on the east side of Columbus, Ohio, where Myles Schoonover grew up, the kids smoked weed and drank. But while Myles was growing up he knew no one who did heroin. He and his younger brother, Matt, went to a private Christian high school in a Columbus suburb. Their father, Paul Schoonover, co-owns an insurance agency. Ellen Schoonover, their mother, is a stay-at-home mom and part-time consultant.

Myles partied, but found it easy to bear down and focus. He went off to a Christian university in Tennessee in 2005 and was away from home for most of Matt’s adolescence. Matt had attention deficit hyperactivity disorder and schoolwork came harder to him. He started partying—smoking pot and drinking—about his junior year in high school.

The two brothers got to know each other again when Matt joined Myles at college for his freshman year in 2009. His parents were never sure when exactly Matt began using pills that by then were all over central Ohio and Tennessee. But that year Myles saw that pills were already a big part of Matt’s life.

Matt hoped school would be a new beginning. It wasn’t. Instead, he accumulated a crew of friends who lacked basic skills and motivation. They slept on Myles’s sofa. Myles ended up cooking for them. For a while he did his brother’s laundry, because Matt could wear the same clothes for weeks on end. Matt, at six feet six and burly, was a caring fellow with a soft side. His cards could be heartfelt and sweet. I love you, mommy, he wrote the last time to his mother, after his grandmother had been hospitalized for some time. All this stuff with grandma has made me realize you really don’t know how long you have on this earth. You’re the best mom I could ask for. Yet the pills seemed to keep him in a fog. Myles once had to take him to a post office so he could mail their mother a birthday card, as Matt seemed otherwise incapable of finding the place.

Myles was a graduate teaching assistant and saw kids his brother’s age all the time. It seemed to him that a large chunk of Matt’s generation could not navigate life’s demands and consequences. Myles had taught English in Beijing to Chinese kids who strove ferociously to differentiate themselves from millions of other young people. American kids a world away had enormous quantities of the world’s resources lavished on them to little result; they coasted along, doing the bare minimum and depending on their parents to resolve problems, big and small.

At year’s end, Matt returned home to live with his parents. Myles spent the next years at Yale getting a master’s degree in Judaic and biblical studies and never knew all that happened later. At home, Matt seemed to have lost the aimlessness he displayed in college. He dressed neatly and worked full-time at catering companies. But by the time he moved home, his parents later realized, he had become a functional addict, using opiate prescription painkillers, and Percocet above all. From there, he moved eventually to OxyContin, a powerful pill made by a company in the small state of Connecticut—Purdue Pharma.

In early 2012, his parents found out. They were worried, but the pills Matt had been abusing were pharmaceuticals prescribed by a doctor. They weren’t some street drug that you could die from, or so they believed. They took him to a doctor, who prescribed a weeklong home detoxification, using blood pressure and sleep medicine to calm the symptoms of opiate withdrawal.

He relapsed a short time later. Unable to afford street OxyContin, Matt at some point switched to the black tar heroin that had saturated the Columbus market, brought in by young Mexican men from a small state on Mexico’s Pacific coast called Nayarit. Looking back later, his parents believe this had happened months before they knew of his addiction. But in April 2012, Matt tearfully admitted his heroin problem to his parents. Stunned, they got him into a treatment center.

Myles hadn’t spoken to his brother for some time when he called his parents.

He’s in drug rehab, said his mother.

What? For what?

Ellen paused, not knowing how to say it.

Matt is addicted to heroin.

Myles burst into tears.

Matt Schoonover came home from three weeks of rehab on May 10, 2012, and with that, his parents felt the nightmare was over. The next day, they bought him a new battery for his car, and a new cell phone. He set off to a Narcotics Anonymous meeting, then a golf date with friends. He was supposed to call his father after the NA meeting.

His parents waited all day for a call that never came. That night, a policeman knocked on their door.

More than eight hundred people attended Matt’s funeral. He was twenty-one when he overdosed on black tar heroin.

In the months after Matt died, Paul and Ellen Schoonover were struck by all they didn’t know. First, the pills: Doctors prescribed them, so how could they lead to heroin and death? And what was black tar heroin? People who lived in tents under overpasses used heroin. Matt grew up in the best neighborhoods, attended a Christian private school and a prominent church. He’d admitted his addiction, sought help, and received the best residential drug treatment in Columbus. Why wasn’t that enough?

But across America, thousands of people like Matt Schoonover were dying. Drug overdoses were killing more people every year than car accidents. Auto fatalities had been the leading cause of accidental death for decades until this. Now most of the fatal overdoses were from opiates: prescription painkillers or heroin. If deaths were the measurement, this wave of opiate abuse was the worst drug scourge to ever hit the country.

This epidemic involved more users and far more death than the crack plague of the 1990s, or the heroin plague in the 1970s; but it was happening quietly. Kids were dying in the Rust Belt of Ohio and the Bible Belt of Tennessee. Some of the worst of it was in Charlotte’s best country club enclaves. It was in Mission Viejo and Simi Valley in suburban Southern California, and in Indianapolis, Salt Lake, and Albuquerque, in Oregon and Minnesota and Oklahoma and Alabama. For each of the thousands who died every year, many hundreds more were addicted.

Via pills, heroin had entered the mainstream. The new addicts were football players and cheerleaders; football was almost a gateway to opiate addiction. Wounded soldiers returned from Afghanistan hooked on pain pills and died in America. Kids got hooked in college and died there. Some of these addicts were from rough corners of rural Appalachia. But many more were from the U.S. middle class. They lived in communities where the driveways were clean, the cars were new, and the shopping centers attracted congregations of Starbucks, Home Depot, CVS, and Applebee’s. They were the daughters of preachers, the sons of cops and doctors, the children of contractors and teachers and business owners and bankers.

And almost every one was white.

Children of the most privileged group in the wealthiest country in the history of the world were getting hooked and dying in almost epidemic numbers from substances meant to, of all things, numb pain. What pain? a South Carolina cop asked rhetorically one afternoon as we toured the fine neighborhoods south of Charlotte where he arrested kids for pills and heroin.

Crime was at historic lows, drug overdose deaths at record highs. A happy façade covered a disturbing reality.

I grew consumed by this story. It was about America and Mexico, about addiction and marketing, about wealth and poverty, about happiness and how to achieve it. I saw it as an epic woven by threads from all over. It took me through the history of pain and a revolution in U.S. medicine. I followed the tale through a small town of sugarcane farmers in Nayarit, Mexico, and a town of equal size in the Rust Belt of southern Ohio. The story transported me through Appalachian Kentucky and the gleaming suburbs of the cities that most benefited from our age of excess that began in the late 1990s. I met cops and addicts, professors and doctors, public health nurses and pharmacists, as I tried to follow the threads.

And I met parents.

On New Year’s Day 2013, I was in Covington, Kentucky, and beginning full-time research on this book. The only place open for lunch was Herb & Thelma’s Tavern—a cozy, darkened place for chili. Inside were a dozen members of a family celebrating a girl’s birthday. I sat in a corner, eating and writing for an hour in the glow of the college football games on TV and the neon BAVARIAN BEER sign on the wall.

I rose to leave when, seeing the Berkeley sweatshirt I wore, the grandmother in the group asked, You’re not from around here, are you?

I told her I was from California. She asked why I was so far from home. I told her I was just beginning to research a book about heroin and prescription pill abuse.

The party stopped. The tavern hushed.

Well, pull up a chair, she said, after a pause. I have a story for you.

Her name was Carol Wagner. Carol went on to tell me of her handsome, college-educated son, Chad, who was prescribed OxyContin for his carpal tunnel syndrome, grew addicted, and never got unstuck after that. He lost home and family and five years later lay dead of a heroin overdose in a Cincinnati halfway house. Carol’s daughter-in-law had a nephew who’d also died from heroin.

I no longer judge drug addicts, Carol said. I no longer judge prostitutes.

I left Herb & Thelma’s and drove the streets, stunned that so random an encounter in America’s heartland could yield such personal connections to heroin.

Later, I met other parents whose children were still alive, but who had shape-shifted into lying, thieving slaves to an unseen molecule. These parents feared each night the call that their child was dead in a McDonald’s bathroom. They went broke paying for rehab, and collect calls from jail. They moved to where no one knew their shame. They prayed that the child they’d known would reemerge. Some considered suicide. They were shell-shocked and unprepared for the sudden nightmare opiate abuse had wreaked and how deeply it mangled their lives.

Among the parents I met were Paul and Ellen Schoonover. I found them anguished and bewildered a year after Matt’s death.

I kept trying to figure out what just happened. Why did our lives become devastated? Paul Schoonover said to me the day we first got together at his insurance agency in Columbus. How could this have happened?

Here’s how.

PART I

Enrique

Yuma, Arizona

One hot day in the summer of 1999, a young Mexican man with tight-cropped hair, new shoes, a clean cream-colored button-down shirt, and pressed beige pants used a phony U.S. driver’s license to cross the border into Arizona.

He took a cab to the Yuma International Airport, intending to fly to Phoenix.

Also in the airport, waiting for a plane, stood a dozen Mexican men. Short and brown, they wore dusty baseball caps, jeans, and faded T-shirts. They looked weather-beaten and callused—just like their hands, he imagined. He figured them for illegals, maybe construction workers, proud of their capacity for hard work, but without much else on their side.

He sometimes went by the name Enrique. He was tall, light-skinned, and handsome. The calluses on his hands, there since childhood, had softened. He had grown up in a hovel on the outskirts of a village in the Mexican state of Nayarit, fifteen hours by car south of Arizona. His father was a sugarcane farmer. His village depended on sugarcane, and thus it was poor, and life there was violent and mean. His relatives were split by a feud that began before he was born. He didn’t know its cause, only that the two sides didn’t get along.

But he had moved on; he had a business now, with employees and expenses. It allowed him to buy his first Levi’s 501s and pay for his fade at the barbershop. His false U.S. ID allowed him to cross the border posing as another man, Alejandro Something.

Still, it wasn’t hard for Enrique to see himself in those men at the airport in Yuma that day.

As he waited for his plane, he watched an immigration officer in the airport spot the men and make the same calculation he had. The officer asked them for identification. There was a discussion Enrique couldn’t hear. But in the end, the men could produce none. As the other passengers watched, the officer led them off single file to be, Enrique assumed, deported.

Growing up in a poor Mexican village had attuned Enrique to the world’s unfairness. Those who worked hard and honestly got left behind. Only those with power and money could insist on decent treatment. These facts, which he believed had been proven to him throughout his life, allowed him to rationalize what he did. Yet moral qualms still came like uninvited guests. He told others that he hadn’t been raised to be a heroin trafficker and believed it when he said it, though he was one. Scenes like this convinced him that he was doing what he had to do to survive. He didn’t make the rules.

Still, as the officer paraded the men by, he thought to himself, "I’m the dirtiest of them all and they don’t ask me anything. If I’d have come to work derecho—honestly—they’d have treated me badly, too."

A while later he boarded a plane that took him to Phoenix and from there to Santa Fe, New Mexico.

Dr. Jick’s Letter

Boston, Massachusetts

One day twenty years earlier, in 1979, a doctor at Boston University School of Medicine named Hershel Jick sat in his office pondering the question of how often patients in a hospital, given narcotic painkillers, grew addicted to these drugs.

He would not remember, years later, exactly why this question had occurred to him. I think it was maybe a newspaper story, he said.

Hershel Jick was in a better position than most to gather findings on the topic. At Boston University, he had built a database of records of hospitalized patients. The database charted the effects of drugs of all kinds on these patients while they were in the hospital. The database grew from the thalidomide scandal of 1960, when babies were born with defects after their mothers were prescribed the drug. Only anecdotally did doctors discover the risk of thalidomide. In the early 1960s, Dr. Jick was asked to begin building a database of drugs used in hospitals and their effects.

The database grew as computers became more accessible. Today the Boston Collaborative Drug Surveillance Program, as it’s known, includes millions of patients’ hospital records in four databases. Yet even by the late 1970s, the database was a substantial thing, holding the records of three hundred thousand patients and the drugs they were given while hospitalized. Dr. Jick grew used to entertaining his curiosity with forays into the data. The doctor years later would say, I don’t even know how to turn on a computer. But he did have the sense to hire a bright computer technician, who had built the database and to whom Dr. Jick turned often with these requests.

This time, Dr. Jick asked for the numbers of patients in the database who had developed addictions after being given narcotic painkillers. Soon he had the data in hand. Figuring others might find it interesting, he wrote a paragraph in longhand describing the findings. Then he gave it to his secretary to type. The paragraph she typed said this: Of almost twelve thousand patients treated with opiates while in a hospital before 1979, and whose records were in the Boston database, only four had grown addicted. There was no data about how often, how long, or at what dose these patients were given opiates, nor the ailments the drugs treated. The paragraph simply cited the numbers and made no claim beyond that.

That’s all it pretended to be, Dr. Jick said later.

A graduate student named Jane Porter helped with his calculations in some way that Dr. Jick could not remember years later. As is the practice in medical research papers, she received top byline, though Dr. Jick said he wrote the thing. The secretary put the letter in an envelope and sent it off to the prestigious New England Journal of Medicine, which, in due course, in its edition of January 10, 1980, published Dr. Jick’s paragraph on page 123 alongside myriad letters from researchers and physicians from around the country. It bore the title Addiction Rare in Patients Treated with Narcotics.

With that, Hershel Jick filed the paragraph away and gave the letter scant thought for years thereafter. He published dozens of articles—including more than twenty in the NEJM alone. Jane Porter left the hospital and Dr. Jick lost track of her.

All from the Same Town

Huntington, West Virginia

One Monday in September 2007, Teddy Johnson, a well-to-do plumber in Huntington, West Virginia, visited the apartment of his son, Adam.

Adam Johnson was a chubby, redheaded kid. As a fan of alt-rockers like the New York Dolls, Brian Eno, and Captain Beefheart, he was a bit of a misfit in socially conservative West Virginia. He played the drums and guitar and grew up in a wealthy neighborhood. He was twenty-three and just starting college at Marshall University in Huntington. He already had a radio show, the Oscillating Zoo, which featured his eclectic taste in music on the school’s station. Adam’s mother was an alcoholic and he had used drugs off and on for several years. He started with cough syrup, but quickly moved on to other substances, including prescription painkillers, his friends said.

Adam had dropped out of high school, gotten his GED. He cast about for something to do with his life. He worked for Teddy. It seemed to Teddy that Adam was turning things around. He was playing music with friends and seemed sober. Teddy was heartened when his son enrolled in Marshall, planning to major in history.

Then, that Monday morning, Teddy came to Adam’s apartment and found his son dead in bed.

Adam’s autopsy showed a heroin overdose; police said Adam was using a sticky, dark substance known as black tar, a semiprocessed heroin that comes from Mexico’s Pacific coast, where opium poppies grow. That stunned Teddy almost as much as Adam’s death. Heroin? That was for New York City. Huntington was in the middle of Appalachia.

I had no clue, he said later. We’re a small town. We weren’t prepared.

Two other men also died of black tar heroin overdoses in Huntington that weekend: Patrick Byars, forty-two, a Papa John’s Pizza employee, and George Shore, fifty-four, former owner of an antique store. One black tar heroin overdose after another racked Huntington over the next five months. The town had seen only four heroin deaths since 2001. But twelve people died in five months; another two had died the previous spring. Dozens more would have died had paramedics not responded quickly.

We had scores of overdoses occurring—medics finding [people] unresponsive, said Huntington police chief Skip Holbrook. Police in Huntington had never seen black tar before 2007.

Two years later, I stood on the southern banks of the Ohio River on what is uncharacteristically flat land for West Virginia. To the north is Ohio and to the west, Kentucky. Huntington lies in a long, narrow grid next to the flat, quiet river. The town was founded as a western terminus for the Chesapeake and Ohio Railway. Railcars carried the coal the region mined to Huntington, where river barges shipped it to the rest of the country.

The city is at the nexus of America’s North and South—much like West Virginia itself. Democrats ran the state like a Tammany Hall. They created a legal and political system supportive of coal and railroad interests. The name of the state’s best-known senator, Robert C. Byrd, is on a dozen public buildings in Huntington alone—including a bridge over the Ohio River. Yet West Virginia sent its raw materials elsewhere to be transformed into profitable, higher-value products. Parts of the South threw off this third world model of economic development. West Virginia did not. Resource extraction mechanized and jobs left. Railroads declined and economic turbulence set in. But the state’s political system prevented a robust response or new direction. Poverty intensified. Marijuana became the state’s number one crop. In 2005, the state produced more coal than ever, but with the fewest workers ever.

Immigrants avoided West Virginia. Only 1 percent of the state’s population is foreign-born, ranking it last in that category in the United States. West Virginians with aspirations streamed north, thinking always of returning. The state does significant business in family reunions. Many of the families who remained lived on government assistance.

Huntington’s population fell from eighty-three thousand in 1960 to forty-nine thousand today. The three R’s became reading, writing, and Route 23 as people headed north on the famous highway to Columbus, Cleveland, or Detroit. In 2008, the city was selected as the fattest in America; it had, the Associated Press reported, more pizza places than the entire state of West Virginia had gyms and health spas.

Through all this, what grew steadily in Huntington, besides the waistlines of its dwindling population, was drug use and fatalism. Dealers called the town Moneyington. Dealers from Detroit moved in and cops grew suspicious of any car with Michigan plates.

Yet Mexican drug traffickers avoided the town, police told me. This made Huntington rare. Mexican traffickers operated all over America—in Tennessee and Idaho and Alaska. But not in West Virginia. West Virginia was one of the seven states with no known Mexican drug-trafficking presence, according to a U.S. Department of Justice 2009 report I had seen. Police had a simple reason for this: There was no Mexican community in which to hide. Mexican immigrants followed the jobs, functioning as a sort of economic barometer: Mexicans in your community meant your area was growing. Huntington and West Virginia had no jobs, no Mexicans either.

So, I wondered, how is it black tar heroin from Mexico could have killed so many people here over so many months? And what’s more, since when did West Virginia have heroin of any kind?

I began my journalism career as a crime reporter in Stockton, California. Up to then, I knew heroin only from the 1970s movies about New York City: The French Connection, Serpico, and Prince of the City; the drug was always white powder. New York City was our national heroin hub. But in Stockton I saw only this stuff called black tar. Narcotics officers told me black tar was made in Mexico. It was semiprocessed opium base. Like other forms of heroin, it could be smoked or injected, and was just as potent as the more refined white powder I’d seen in The French Connection. The difference was that it had more impurities. Also, they said, black tar was a West Coast drug, sold in California, Oregon, and Washington. Denver had a lot, as did Arizona. But it was unknown east of the Mississippi River. For years, DEA reports showed that as well.

So what was black tar heroin now doing east of the Mississippi River?

Those questions brought me to Huntington and that Ohio River bank. I was a reporter for the Los Angeles Times on a team covering Mexico’s drug wars. My job was to write about Mexican trafficking in the United States, a topic no one covered much at all. Searching for a story to do, I had come upon reports of Huntington’s 2007 black tar outbreak and called a Huntington police narcotics sergeant.

All our black tar heroin comes from Columbus, Ohio, he told me.

I called the DEA in Columbus and spoke with an especially loquacious agent.

We got dozens of Mexican heroin traffickers. They all drive around selling their dope in small balloons, delivering it to the addicts. They’re like teams, or cells. We arrest the drivers all the time and they send new ones up from Mexico, he said. They never go away.

He discoursed at some length on the frustration of arduous investigations ending with the arrest of young men who were replaced so quickly. They hide among Columbus’s large Mexican population, he said. The drivers all know each other and never talk. They’re never armed. They come, give false names, rent apartments, and are gone six months later. This was not the kind of heroin mafia Ohio and the eastern United States was used to.

Crazy thing, he said. They’re all from the same town.

I sat up in my chair.

Yeah, which one’s that?

He called over a colleague. They talked in muffled tones for a couple minutes.

I had lived in Mexico for ten years as a freelance writer after I left Stockton. I spent a lot of time in small towns and villages writing about people who migrated north. I wrote two books of nonfiction stories about Mexico. Many of the stories took place in the smallest villages, known as ranchos.

Ranchos were villages on the outskirts of civilization. Throughout history, rancheros had moved to the outback to escape the towns’ stifling classism. They formed outposts and tried to carve a living from tough land that no one else wanted. Rancheros embodied Mexico’s best pioneering impulse. They fled the government’s suffocating embrace. They were dedicated to escaping poverty, usually by finding a way to be their own bosses.

Rancheros had little access to education. They learned a trade from relatives—farming or ranching, mostly. But I also knew villages where all the men were itinerant construction workers. Families from one village in the state of Zacatecas I knew started tortilla shops all over Mexico; in another, men hired out as cops around the state. I wrote about Tocumbo, Michoacan, where everyone learned to make popsicles, and run popsicle shops, known as Paleterias La Michoacana, that spread across Mexico, transforming the town and the lives of these rancheros. I had also been to Tenancingo, Tlaxcala, where the young men are all pimps, exporting country girls to Mexico City and to Queens, New York, and building garish mansions back home.

The DEA agent came back to the phone.

Tepic, he said.

No, that’s wrong, I thought. Tepic is the capital of one of Mexico’s smallest states—Nayarit, on the Pacific coast. But it’s still a big city, population 330,000. The agent wasn’t lying. But my hunch was that the family and personal connections crucial to the system he was describing would only be forged in a small town or rancho. By the time I got off the phone, that prospect had me mesmerized. I imagined some rancho of heroin traffickers expert enough to supply a town the size of Columbus.

It helped that I loved ranchos. They were lawless, wild places, full of amazing tales of family feuds, stolen women, pistoleros, caciques (town bosses), and especially the tough guys—valientes—rebels who backed down from no one, and thus leapt like superheroes from the rancho into a place in Mexican movies, novels, and ballads.

Mine was a romantic infatuation. I didn’t have to live in a rancho. They were brutish places and received outsiders uneasily. Rancho families wove together in vast clans, where everyone was related to almost everyone else. You did not penetrate that easily. To learn their secret stories, you had to spend a lot of time. But I could sit for hours listening to old men tell how their village had, say, split in half over a family feud. The stories melded fact and myth into accounts of doomed bravery or steel-cold vengeance. One tale I included in a book was about Antonio Carrillo, who went to the United States in the 1920s, worked in a steel mill, bought a pistol, then wrote to the man who killed his father, telling him his time had come. He went home and in the town plaza he shot the man to death with that pistol.

I learned, too, that envidia—envy, jealousy—was a destructive force in the rancho. That people were related didn’t mean they got along. Families split over what one had and another did not. In the rancho, I saw that immigration was powered by what a poor man felt when he returned home with new boots, a new car, better clothes. That he could buy the beer in the plaza that night, pay for his daughter’s quinceañera equal to that of the daughter of the local merchant, and act the magnanimous don if only for a week; that was a potent narcotic to any poor man. A have-not’s success was sweeter if he could show it off to the backbiters back home. Thus few Mexicans started out aiming to melt into America. Returning home to the rancho was the point of going north. This homecoming had no power in anonymous big cities. Migrants wanted to display their success to those who’d humiliated them years before. In the rancho.

I’d learned too that venturing into the unknown was in rancheros’ DNA. The United States was the one place where the promise of the unknown had paid off. In turn, the Mexican rancho had become a huge influence in American life. It gave rise to millions of our new working class. Mexican immigrant customs and attitudes toward work, sex, politics, civic engagement, government, education, debt, leisure—they were forged in the rancho. They arrived intact in the United States, and changed slowly.

I ponder this all that day after the chat with the Columbus DEA agent. Only a small town or rancho could forge the connections that sustained the kind of heroin business the agent described. A village of master heroin retailers. Could it be?

I wrote to a dozen of the drivers arrested in Columbus who were doing time in federal prisons. I asked if they wanted to talk to a reporter. Weeks passed. I heard nothing from them. I was about to turn to other stories when one of them called collect. He’d worked, and was arrested, in Columbus. He was now doing many years in prison. He had lots of information. Most startling: Columbus was not the only town they worked, he told me.

They’re in many others. All over the country, he said. Salt Lake, Charlotte, Las Vegas, Cincinnati, Nashville, Minneapolis, Columbia, Indianapolis, Honolulu. They were working full-time in seventeen states. They’d been in another seven or eight states at one time or another. He went on. The cities he mentioned all had large white middle classes that benefited hugely from the economic booms of the previous dozen years, and now had large Mexican immigrant populations as well. I hardly associated these cities with heroin. Were there heroin markets in these towns? I wondered. Yes, he assured me, they were big and getting bigger. He hadn’t even mentioned America’s traditional heroin capital, I noticed.

No, in New York are gangs, with guns, he said. They’re afraid of New York City. They don’t go to New York.

Mexican traffickers afraid of gangs and gunplay? From one tiny town? Selling tar heroin in not just Columbus, but as much as half the United States, including now a bunch of cities east of the Mississippi River for the first time?

Right there, I was hooked.

Cops say they’re from Tepic, I said finally.

No, they’re not from Tepic, he said. That’s what they say, but they’re not.

Liberace in Appalachia

South Shore, Kentucky

In tiny South Shore, Kentucky, huddled next to the Ohio River, Biggs Lane amounts to a rural strip mall.

For its entire hundred yards, Biggs Lane hugs Route 23. Wright Pharmacy has been on Biggs a long time. Near Wright’s is a dentist’s office and a chiropractor, a gas station and a Subway sandwich shop. Farther down is a flooring shop. Next to that stands a good-sized beige metal-framed building.

To the south of Biggs is a street named Tootsie Drive and a neighborhood of small white wood houses that would be called quiet except that would be redundant. Everything in South Shore, Kentucky, population 2,100, is quiet, including the majestic Ohio River a hundred yards north. Across the river is Portsmouth, Ohio, wedged onto land where the Scioto River angles into the Ohio. In Portsmouth and South Shore is where another part of our story begins.

In 1979, the same year that Hershel Jick up in Boston wrote his letter to the New England Journal of Medicine, a doctor named David Procter moved into that beige metal-framed building on Biggs Lane in South Shore and called his new clinic Plaza Healthcare.

Procter had come to South Shore at the behest of Billy Riddle, the town’s family doc. Billy Riddle had been in South Shore for years. He delivered many of the kids in town, and