Pubdate: Thu, 26 Jan 2017
Source: Courier-Journal, The (Louisville, KY)
Copyright: 2017 The Courier-Journal
Author: Madeleine Winer


Like most of small town America, Southern Indiana was unprepared for the
opioid crisis.

That's what Sam Quinones said, who is an expert on the roots of America's
heroin and prescription drug crisis.

"It's bad all over the country, but I would say it's probably particularly
unkempt in areas such as Southern Indiana," he said.

Smaller towns "never had to deal with the issues that come along with
opiate addiction like how hard it is to kick, all the ancillary effects of
having an addict in the family, aE& the lying, the destruction of family

Quinones is the author of "Dreamland: The True Tale of America's Opiate
Epidemic," which follows people from all walks of life who found
themselves as actors in the opioid crisis.

He is in town to speak at an event during Drug Facts Week 2017, a week of
addiction awareness, where he'll discuss how the nation's opioid epidemic
is related to that of Kentuckiana. His speech is set for 10 a.m. Saturday
at St. Augustine Catholic Church in Jeffersonville.

Ahead of the event, the Courier-Journal caught up with Quinones to learn
more about his take on Kentuckiana's heroin and opioid crisis.

Courier-Journal: What seems to be the root of the problem in Kentuckiana?
In what areas should there be change?

Sam Quinones: The root of the problem is that we convinced out doctors
through a variety of marketing strategies from both the medical
establishment and pharmaceutical companies that we were a country in pain,
which may or may not have been true. But the one way to treat that was
with a tool that had never been used before and that was opiate

That began in the '90s and that gradually put down roots and became
conventional wisdom and was taught in medical schools. It was the new
conventional wisdom that convinced an entire generation of American
doctors from coast to coast that they needed to be very aggressively
prescribing those pills.

. A lot of people got addicted to them and eventually sold them to the
black market. And then those became too expensive for them, and they
switched to heroin, which was now coming not from the far east, but from

In the 1980s, that's when it all changed. Mexico became one of our
suppliers of heroin ... That is what created the problem today.

This is the first time in our modern history that we have a drug scourge
not created by mafias and drug dealers and street drug peddlers, but by
pharmaceutical companies and strategies that those companies use. That's
the root of it.

CJ: What is the difference between the prevalence of heroin in rural and
urban environments in the U.S.? Where does Kentuckiana fit into that in
terms of its heroin and opioid use?

SQ: I don't think inner city areas have this problem. In my experience,
this is an entirely white problem. It is people in rural areas and
suburban areas. It could be wealthy areas. It could be poor Appalachian

CJ: Both Clark and Floyd counties in Southern Indiana saw significant
increases in drug overdoses last year. In Clark County, emergency room
visits for overdoses tripled. Clark County opened a needle exchange
program this week, where people can exchange dirty needles for clean ones.
Do you think needle exchanges are helping reduce the use of heroin?

SQ: I would say that we have run out of choices on that. ... But the
problem is that we now have widespread addiction, and you need to
understand that the alternative is very high rates of HIV, AIDS and
Hepatitis C. There are no easy answers. This (needle exchanges) is
something the counties have found necessary because they don't want to
explode their budgets for the next 20 years in dealing with public health

It also happened to be, if done well, the only time during their (an
addict's) day or their week where they encounter someone who is not
addicted. It's also an opportunity for a user to encounter someone who
could give them access to treatment or (pull) them in a direction away
from addiction. But there isn't one answer to this.

CJ: What would you tell doctors who see an increase in heroin overdoses
per day about treating opioid addicts and users?

SQ: One thing doctors need to do is to reassess how much pills they
prescribe. They're valid medical tools, but they've been way overused. But
we need to work together and figure out that this isn't a one solution
problem. Law enforcement needs to be heavily involved, churches, PTA,
chamber of commerce, public health ... all of these things need to gain
muster in this fight.

CJ: What is the most important thing community groups and individuals can
do to reduce the use of heroin in their communities in order to eliminate
the chance of someone dying from an overdose?

SQ: There's only one way to defeat this and that is by coming together as
a community. If you feel like you live in a small town, and you feel like
you're all alone, to me, that's part of the problem. These are small towns
.. supposedly everyone knows each other and everyone works together. But
that's actually what you need to do.

The important thing is not to do this alone. That's what heroin wants.
- ---
MAP posted-by: