I admit, I’m a Jack Reacher fan. A fairly recent one, but I’m caught up. I just finished his latest, The Midnight Line, in which the opioid crisis plays a role. I realize these books are fictional. I also think they are well-researched, realistic fiction. The rest of this blog is a quote from that book. The character Noble is a DEA agent.

Noble cooked, and talked about heroin. It was both his paycheck and his passion. He knew its history. Once upon a time it was a legal ingredient. It was in all kinds of stuff, branded with famous names still known today. There was heroin cough syrup. There was heroin cough syrup for children. Stronger, not weaker. Doctors prescribed heroin for fussy babies and bronchitis and insomnia and nerves and hysteria and all kinds of other vapors. The patients loved it. Best health care ever. Millions got addicted. Corporations made a lot of money. Then folks got wise, and by the start of World War One, legal heroin was history. 

But the corporations never forgot. About the easy money. … The corporations took eighty years to get back in the heroin business. They came in the side door. By that time in history heroin itself had negative PR. … So they made a synthetic version. A chemical copy. Like an identical twin… Exactly the same, but now it had a long clean name. All bright and shiny. It could have been a toothpaste. They put it in neat white pills. What were they for? Getting high, baby. Whatever you want. Except they couldn’t put that on the pack. So they said they were for pain. Everyone has pain, right?

Not really. Not at first. Pain was not yet a thing. Institutes had to be funded, and scholarships endowed. Doctors had to be persuaded. Patients had to be empowered. Which all worked in the end. Pain became a thing. Self-reported and untestable, but suddenly a symptom as valid and meaningful as any other. As a result, America was flooded with hundreds of tons of heroin, in purse-size blister packs, backed with foil.

… [Noble] said, “Let me emphasize two very important things. First up, most of this stuff goes to the right people for the right reasons. No one could deny that. It does a lot of good. But equally, no one could deny enough has fallen out around the edges to also cause a lot of harm. Because second up, no one should ever underestimate the appeal of an opiate high.”

… He said, “These are regular folk I’m talking about. American as apple pie. They like the ball game on the radio, and country music. Not the Grateful Dead. They were seduced by the clean white pill. It made them feel real good. Maybe for the first time in their lives. These are plain people. But smart. They soon figured out ways it could make them feel even better. They got the time-release version, and broke it up, so they got the whole hit at once. Couple times a day. Maybe three. Then they discovered the patches. You stick them on your skin. Like when you’re quitting smoking. A long clean name on the pack, but it’s the same stuff your great-great-grandma lined up for. … By that point these folks are already hopeless addicts. But not in their own minds. It’s partly a pride thing. Addicts are other people, with a dirty needle in a toilet stall. What they have is a pharmaceutical product, made in a lab, by pretty girls in masks who hold test tubes up to the light…But in fact they’re running worse risks. … Fifty thousand people died last year. Regular folk. Four times as many as got killed in gun crimes.”

[Noble explains that the opioid distribution war has been won.] “… the black market is virtually dead, and the medical market is heavily scrutinized. Total success. Except the previous bonanza left us with millions of addicts. … When we bit down, the price of pills went up, because of supply and demand. What used to be ten bucks was suddenly fifty. It was a crisis. Suddenly regular cartel powder up from Mexico looked like an irresistible bargain. Remember, deep down it’s the same chemical. These folks are canny shoppers. None of them ever paid sticker for a car. And numbers don’t lie. Even when they factored in the cost to their dignity, with the dirty needles and the toilet stalls and all, hey, the powder was still a bargain. We swapped one problem for another.”