They’re Bringing Drugs

Sam Quinones’s brilliant investigative history of the opioid crisis, Dreamland, has two main villains. Neither of them are people: Quinones is relentlessly compassionate towards the Mexican farm boys who smuggle home-made heroin across the U.S. border and deliver it to junkies and soon-to-be junkies all across the country, and even the worst of the pill dispensing doctors he profiles, Dr. David Procter, comes across as a nastily comic weasel rather than a force of evil unto himself. Nor are the public health officials responsible for the “pain revolution” that expanded the prescription of opiates for chronic pain themselves bad guys- they honestly if foolishly believed that they could avoid spreading addiction if opiates were targeted to people in pain, and several of them revised their views and worked to stop the expanding epidemic once they realized what was going on.

Closer to a purely malevolent force is Purdue Pharmaceutical, which earned over a billion dollars in sales in 2002 on 6.2 million prescriptions for Oxycontin, the most widely-prescribed morphine derivative, and which ignored evidence for the addictiveness of their product while distributing highly misleading studies that claimed to prove opiates were safe. Purdue spent tens of millions of dollars on direct marketing to doctors- junkets and gifts and enticements that stopped just short of bribing doctors to prescribe their pill. As Quinones narrates:

oxycontin marketing

And yet not only did nobody go to jail (Purdue paid fines and settled civil cases, and some executives paid fines and were sentenced to community service) it is harder to make the case that individual executives should be behind bars than that the organization as a whole behaved in a hugely destructive manner. As in the housing bubble and subsequent financial crisis, the amount of individually criminal and fraudulent behavior was far less than the harm caused by pharmaceutical companies as a group. Even more like the housing bubble, individual consumers of opiates were overwhelmingly state-subsidized; pharmaceutical companies were less destinations for private funds than conduits for public spending from Medicare, SSI, Medicaid, and the VA. Our hybrid public-private health care system, like our hybrid housing system, seems almost uniquely prone to abuse, as consumers do not bear the costs of their health care decisions while the government enjoys a kind of “plausible deniability” about the dangers and costs of the services for which it pays.

This corrupted  (and ever-expanding) health care system is thus one of the main villains of Quinones’s story, I think he would agree. Where he might disagree with my characterization of his book and the story it tells is in the identification of the other main villain as the uncontrolled Mexican border. Although he sadly notes how it is easier for heroin dealers to get through customs than it is for Mexican men who want to work direcha (the right way, in law-abiding ways) in the United States, he is sometimes reluctant to examine why exactly it is so easy for individual Xalisco teenagers to make their way to the states and start pushing heroin on an American population already primed for addiction by pills, and why it is so very easy for small time producers to ship their low cost but highly pure black tar heroin to the States. The Xalisco boys are polite and friendly, fearful of violence, and without any large-scale criminal organization-  they are you might say the exact opposite of the ruthless cartels profiled in Sicario or, for that matter, the black-dominated heroin gangs that are the focus of The Wire.  The Xalisco boys, as Quinones names them, are amateurs who fall into heroin production and dealing because it allows them to buy Levi’s blue-jeans for their families and show off on the town plaza for a few weeks, not hardened criminals.

But ironically, as Quinones shows over and over, it is precisely this lack of hierarchical organization and avoidance of violent disputes over territorial control that made the Xalisco boys so devastatingly effective at bringing dirt-cheap heroin to the States in the quantity and purity necessary to kill tens of thousands of people. With hundreds of independently operating cells and a largely undifferentiated but highly pure product, Xalisco boys are like an economist’s dream of perfectly competitive markets:

Competitive
From Yoram Bauman’s The Cartoon Guide to Economics

The boys earn just a few hundred dollars a week, limit their personal costs to a bare minimum, and return to Mexico to show off for a few weeks before venturing back out again.  Without barriers to entry in production, distribution, and sales, new cells of drug dealers enter the market until the price is pushed down to marginal costs- and the supply of both drug dealers and their product is in practice almost perfectly elastic, able to expand or contract easily in response to demand.

TShirts

 

If you legalized drugs without regulation on suppliers, you probably couldn’t do a better job delivering it to junkies cheaply and at high purity than the Xalisco boys have managed to do, and (as was imagined in season 3 of the Wire, when police captain Bunny Colvin unofficially legalized drugs in the abandoned “Hamsterdam” section of his West Baltimore beat) the result is a very low level of drug trade-related violence but a very high level of overdose and increased addiction. The story that Quinones tells has none of the horrific violence associated with the cartels or the cartel-associated gangs like MS-13, but it does have lots of overdosing addicts.

Without the Mexican supply, there would still be heroin in America, but the heroin would be significantly more expensive and more difficult to obtain. The collision of this ideally competitive supply of highly pure, very cheap heroin and the demand created by our corrupted and hybrid private/public health care system is what creates the tragedy of Dreamland, and sets the stage for the explosive growth in opioid-related deaths we have seen in recent years.

ageovertimemedstatusrecentwhitefemaleaa (1)

I share Gabriel Rossman’s sincere enthusiasm and admiration for Quinones’s book- it is one of the most impressively researched and absorbingly written non-fiction books I have ever read, and I’m not surprised that Angus Deaton, who has been tracking the quantitative side of the explosion of white American mortality, named it as his favorite book of 2015. But it still upsets me that Quinones himself, in penning an LA Times op-ed arguing against Trump’s immigration policies earlier this year, doesn’t spare a single word for the opioid epidemic and the role of the unpoliced border and Mexican heroin and heroin dealers in spurring it on, a topic which he has just spent several years exhaustively researching and on which he is now perhaps the foremost expert. Quinones’s sympathy for the dealers and interest in the details of their operations is no doubt in large part responsible for his book’s artistic success. But without a square accounting of immigration’s costs alongside the benefits he claims in his op-ed, the country is being misled.

8 thoughts on “They’re Bringing Drugs

  1. I haven’t read Dreamland, but Quinones’ take on the Mexican drug dealers as plucky entrepreneurs comes through loud and clear in the Econtalk podcast interview he gave in January of this year. Worse yet, he implies that they sell drugs primarily for the money to get laid by impressing the women back home and oh, the irony, they get “addicted” themselves to the high of being the big fish in a small pond (until the money runs out, and they have to take another hit and go sell again).

    Russ Robert’s, the interviewer, didn’t push back, he was too busy admiring their customer service skills as proto-capitalists [who should have been able to come to the U.S. legally]. The ruined lives were just a negative externality of a market system at work. Well, that’s a bit harsh, as they admitted how bad the drugs are in ruining lives, but if that’s the case, how about acknowledging the people who provided them as being bad guys? If I break laws and ruin lives for sex, that’s evil, if you believe such a thing, and Russ Roberts as an observant Jew most certainly does and he hasn’t hesitated to moralize at other times. As per your post here, I scanned the transcript and the harshest condemnation of wrong is reserved for the drug companies, when in actuality, individually the people at the corporations were the least culpable.

    I think with regards to the drug companies, the term “administrative evil” is the one your looking for. It is the diffusion of responsibility through rational and bureaucratic organizations that take incremental steps and long term towards an evil goal. Here’s a good summary of the concept: https://us.sagepub.com/en-us/nam/unmasking-administrative-evil/book7111

    The interview made me re-think my support of drug legalization at the very least.

    Liked by 2 people

  2. “…the country is being misled.”

    Eh. It’s more that he’s coming across as disingenuous. Remember that Trump won.

    There are 2 problems with Quinones take. One is that he seems unable, at least when talking about immigration, to empathize with white Americans in the same way he does with, well, foreigners. It doesn’t bode well for the future cohesion of the country.

    The second is the somewhat Puritanical streak running through his work about pain relief. He seems sightly outraged at people who want relief from pain at all, rather than sucking it up. He sees it as a weakness.

    Reading the NYT comments section on articles on trying to reduce use of/addiction to opioid painkillers is illuminating. These are registered NYT readers, who you can assume tend a certain way politically, and they are spitting nails at the idea that people should not get the medication they need because a minority will abuse it.

    Liked by 1 person

  3. I was also curious about the immigration. The book made it seem like our border is swiss cheese, and while I was never naive enough to think it was impossible, but Quinones made it seem like no one was ever turned away.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s