Milk of Paradise

by Lucy Inglis

  Addictions are even made into apps now, in which you can see how many minutes, hours, days or months you’ve stayed clean, speak to other addicts in a forum, or try to find help. Some even geolocate your phone if you’re ‘cold-copping’ from a dealer you don’t know, in case something bad happens. In all the forums there are stories of hustling, violence, misery, loneliness, frustration, but also great kindness and human camaraderie, from the local warnings about fentanyl-spiked heroin, to a lady whose partner has been prescribed opiates for back pain, and doesn’t know if he should eat before or after his medication. Her first post was, ‘A question about high fat meals, please?’

  Generation Oxy

  ‘Change is coming, it has to’

  As the use of the Internet to buy and sell narcotics became popular in the 1990s, the pharmaceutical industry was producing better and more sophisticated synthetic opioids. In 1996, Purdue Pharma, founded in New York and with a long history of producing pain medication, brought out a new drug that was quickly adopted across the worldwide medical industry for chronic pain: OxyContin. It had already developed MS Contin twelve years before, a slow-release version of morphine. Purdue prided itself on the slow-release system of its drugs, which release over a twelve-hour period providing measured pain relief, and marketed them aggressively to doctors and prestigious medical journals. They also funded non-profit pain-management organizations and research groups with the sole aim of promoting opioids, namely OxyContin, as an all-round pain-management method. But opiate addicts can achieve a high by snorting or injecting Oxy, as it became known. By presenting themselves to different doctors, or ‘doctor-shopping’, they could obtain large amounts of pills to either sell on or use. When the medical profession began to report that they were under pressure from obvious shoppers – coupled with a negative report from an addiction monitoring body sponsored by Purdue themselves, Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) – widespread concern surfaced. RADARS found that OxyContin and hydrocodone were by far the most abused prescription opioids. However, they were followed, in order, by other oxycodones, methadone, morphine, hydromorphone, fentanyl and then buprenorphine. The report’s findings included that the OxyContin abuse was most prevalent with recreational drug users and street addicts; no surprise, given the appearance of morphine and buprenorphine on the list, raising multiple questions about how legal supplies were being diverted. But that wasn’t the whole story, and other studies found heroin addicts who had started out with an OxyContin prescription and later turned to heroin, an echo of the naive morphinated patients of the nineteenth century. ‘But they don’t think of them as drugs, they think of them as medication, and this is the problem,’ relates Cat Marnell, former New York beauty editor and drug blogger.56 There were rumours of gross overselling by Purdue, coupled with inappropriate prescriptions from doctors: from 1991 to 2011, opioid prescriptions dispensed by US pharmacies went from 76 million to 219 million. Purdue was fined over $600 million in 2007 and was put under serious pressure by the Connecticut Attorney General Richard Blumenthal to reformulate the drug. As as result, in 2010 Purdue released a gel form of OxyContin that could not be crushed and powdered, much to the disappointment of its millions of American fans. This sudden cut-off came just as massive amounts of heroin began to move from Mexico into the US, as well as coinciding with very high Afghan production. Suddenly, heroin was everywhere, and seizures by the DEA found it was high-purity, and cheap, so in lieu of the previous OxyContin pill, users turned to it. A study by the Centers for Disease Control and Prevention (CDC) found that not only had use increased in the typical user, white males aged eighteen to twenty-five, it had more than doubled in women and other non-typical user groups, such as those in the top wage bracket.57 America was suddenly under siege from the Middle East and Mexico. It became rapidly worse. The CDC found doctors in certain states, such as West Virginia, all of the Southern states and particularly Florida, had prescribed large amounts of opioid painkillers to their patients.58 In Florida, a huge number of pill mills sprung up, selling opioids without prescriptions. The pill presses are made in China, and the synthetic opiates can also be ordered on the Internet, with instructions for how to make the pills. They arrive in the mail, and are virtually risk-free; and fentanyl, or its analogues such as another street drug China White, are so powerful that they can be packed as a sachet of silica gel inside a box of urine test strips. The Chinese are making up for the addiction once thrust upon them.

  The people who are cutting the fentanyl with other drugs, including heroin, often misjudge the dosage, because a fatal dose is so small. There is also a new demand for another Paul Janssen creation, a synthetic opioid analogue far more powerful than fentanyl, known as carfentanil, whose brand name was Wildnil: an elephant anaesthetic. It has been found by the narcotics police in New Hampshire, where overdoses and deaths from synthetic opioids are becoming unmanageable for the state services. In 2015, every two out of three drug deaths was due to fentanyl. In two weeks in March, the police department of Manchester, New Hampshire were called out to sixty-four overdoses, which were either fentanyl or carfentanil.59 Police and paramedics are carrying naloxone, known as Narcan, on their standard issue equipment. Naloxone, when injected – or sprayed into the nose of someone who has overdosed – blocks the opiate receptors, but it must be administered quickly. New Hampshire has a high rate of opioid prescriptions, coupled with the second-lowest substance and addiction assistance spending in the country, so perhaps it’s hardly surprising they are only second behind West Virginia in terms of opioid deaths. Fentanyl, the painkiller that had proved its worth to countless cancer and spinal-surgery patients, as well as on the battlefields of the Middle East, has become a popular recreational high among the rural poor of America.

  Owing to deaths in or around libraries, which are seen as a safe place to inject, librarians in San Francisco, Denver and Philadelphia are now trained to administer naloxone. But the numbers are still rising, and in 2016 there were 20,000 American deaths from fentanyl alone, exceeding heroin for the first time, including the musician and long-term opiate user Prince Rogers Nelson in the spring of 2016.

  America’s drug epidemic has been born not only out of Mexico, the Middle East or China, but its own pharmaceutical industry and poor healthcare support. Two decades of rampant over-prescription of opioid medications in the US, reaching a high of 255,207,954 in 2012, and equating to 81.3 prescriptions for every 100 people, directly preceded the start of the current American heroin epidemic which commenced the following year.60 Some counties, such as Walker County, Alabama, saw rates as high as 335.1 opioid prescriptions per 100 persons.61 By 2014, Walker County had also seen a vast spike in incarceration for drug-related offences, and had the highest rate of drug overdose deaths in the state.62 From 2012 to 2016, US physicians cut the prescription rate for opioids to just under 215 million nationwide, but deaths from illegally obtained opioids continue to rise, and by the end of 2016 total opioid overdose deaths were five times higher than in 1999.63 For many, such as the State’s Attorney for Lake County, Illinois, Michael Nerheim, ‘The source of this crisis is not on street corners; it’s in boardrooms’.64 Some of the biggest names in the business are currently defending their actions in opiod scandals, and in the year leading up to September 2017, more than thirty US cities, states and counties either filed law suits, or began the process of filing them, against manufacturers and distributors of opiod medication.65

  Atul Gawande, the renowned American surgeon and public-health specialist, has stated that ‘We are running out of ways to emphasize how dire the opioid crisis has become,’ and placed the blame at the door of doctors and pharmaceutical companies in an article in April 2017. America’s current opioid crisis is more complicated than the short soundbites put out by public commentators and politicians might indicate, and it will not be resolved quickly, if at all. The appetite for bigger, better, faster and stronger, to the point where there is now an active trade in opioid t
hat will sedate elephants, indicates a deeper malaise in the American psyche, as does the inability to take any sort of effective action. Yet dissent is rising, with high-profile experts such as Gawande in the vanguard. As he says, ‘We cannot sit idly by. We surgeons turn out to be suppliers of the excess prescription opiates fueling addiction and death by overdose. We have to change that. And we now know how we can.’66

  Change will not be as simple as that. Gawande’s statement is only the repetition of a fact that has been evident for over a century. Doctors will always seek to doctor, and the pharmaceutical companies and banks with their gigantic profits are unlikely to abandon their revenue without a fight. Organized crime has responded in step with the threats to their business. The Mexican cartels are working, no longer in competition, but in collaboration with each other to supply the rapacious demands of the continental United States for cheap heroin. Where previously they would have staged street battles over turf, they have adopted the franchise model to profit from a seemingly bottomless market. No amount of empty talk about ‘The Wall’ will deter them. The Italian-Americans of the East Coast, although no longer in their heyday, are now working to protect their territories in Italy with West African street gangs of such brutality it shocks even the hardened Neapolitan police. The Triads continue to make their way quietly, but surely, in the heroin kitchen and the laboratory. As the Middle East destabilizes, heroin and the funding it brings will become ever more important to whichever group comes next to destroy everything in its path. The drugs are getting more powerful, and the criminals are too. On both sides of the line.

  It seems like the obvious answer, but it is unlikely in the extreme that the poppy fields of Afghanistan, the Shan states of Burma or the Sinaloa mountains will be brought under any significant governmental, let alone international control. The world is finding its medical-grade opiates through legally grown poppies in Australia and Tasmania, some of the world’s best, as well as India, Turkey, France, Spain, Britain and Hungary. The main production is poppy straw, produced from mashing the whole plant, which is less time-consuming than the traditional scarifying method. Figures regarding production and quality vary as wildly as the estimates for Afghanistan, but it appears things are changing for the better, and we may soon have enough high-quality pain relief for people all around the world. This is not the will of people who would control one resource after another, pretending that it isn’t about money and ever-greater power, or for the welfare and safety of their people. No one seeking to control the world’s poppy fields is in it for the greater good, whichever side of the political or economic fence they are on. But one thing is for sure, under capitalism or communism, the opium poppy will thrive. It will be there when we most need it. It always has been.

  Ultimately, we must never forget that this is a battle fought only with ourselves. From those Neolithic settlements at the edge of Swiss lakes, to Brooklyn street corners and end-of-life care in quiet, anonymous hospitals across the world, the poppy has held humanity’s hand and will continue to do so. Papaver somniferum remains one of the greatest global commodities there is, and we must seek to mitigate the harm it can do while retaining our faith in the marvels it can achieve. This will be our endless opium war.

  Papaver somniferum: a white opium poppy (Stedman’s Shorter Medical Dictionary, 1942).

  Scarified opium poppy heads during the harvest in Kandahar, Afghanistan, May 2002.

  The terracotta figurine of the Poppy Goddess, divinity of sleep or death. From the sanctuary of Gazi, Crete. 1350 B.C.

  Fresco detail from the garden room of the House of the Golden Bracelet, Pompeii, depicting opium poppies growing with roses on an ornamental frame.

  The medical school at Salerno, showing the arrival of Robert, Duke of Normandy, seeking treatment for wounds sustained during the First Crusade, 1099.

  The Mercator projection, as published by Gerardus Mercator in Duisburg, 1596.

  Thomas Sydenham, who created the first commercially successful and widely available preparation of laudanum.

  Paracelsus, who mixed exotic ingredients such as musk and ambergris to create the mysterious preparation “laudanum.”

  The Engel-Apotheke of Friedrich Jacob Merck, Darmstadt, shown here c.1790.

  Robert Clive, 1st Baron Clive of Plassey. He was a long-term user of laudanum and died in his home in Berkeley Square, London, after an overdose.

  ‘The Stacking Room’ of the British East India Company’s opium factory, Patna, India, c.1820.

  The British East India Company’s iron steam ship Nemesis, with boats from the Sulphur, Larne, and Starling, destroying Chinese war junks in January 1841, by E. Duncan, 1843.

  Hong Kong, c.1850, depicting the early settlement and the harbour.

  Signing of the Treaty of Tientsin, 1858.

  Mrs Winslow’s Soothing Syrup, trade card, 1887.

  Two examples of Alexander Wood’s hypodermic syringe, the first in a chased silver case with glass barrel and silver fittings; the second in a leatherette case, with glass barrel and ivory fittings. Latter part of the nineteenth century.

  A scene in an opium den depicting a Chinese man offering a pipe to an American woman. The caption read, ‘He often made an honest dollar teaching American women how to smoke “hop.”’ 1900.

  Studio portrait of Fee Lee Wong, his wife, six children and their maid (standing behind them), 1889–1907.

  The molecular structure of diacetylmorphine.

  Songs of the Temperance Movement and Prohibition (M. Gray, 1874).

  Advertisement for Bayer Pharmaceutical Products by mail order, c.1900.

  The Battle of Manila, the first and largest battle fought during the Philippine–American War, was fought on February 4–5 1899 between 19,000 Americans and 15,000 Filipinos.

  Du Yuesheng, Green Gang mobster and Shanghai godfather (1887–1951), as a young man.

  The opium man of Mehrangarh Fort, Jodhpur.

  Mugshot of ‘Lucky’ Luciano as taken by the NYPD on his arrest for running a prostitution racket in 1936.

  Frank Lucas wearing a chinchilla coat and hat outside Madison Square Garden before the Muhammad Ali vs Joe Frazier fight in New York.

  A shell-shocked, wounded marine being bandaged in a muddy jungle during OP Prairie, South Vietnam.

  First Lady Nancy Reagan speaking at a ‘Just Say No’ rally, Los Angeles, 1987.

  An ambulance waits to receive a casualty from a Chinook helicopter at Camp Bastion, April 2011.

  US Marines walk through a poppy field in Helmand Province, 2011.

  OxyContin tablets at a pharmacy in Montpelier, Vermont, 2013.

  AFTERWORD

  At dusk on a still and dry day, farmers of the opium poppy walk from the narrow mud alleyways and secluded sun-baked compounds of their villages to their fields, or they climb in cheap rubber boots to jungle terraces, armed with a machete and sweat. They begin work. Three months earlier, the same farmers, and often their wives and children, were in the fields and terraces, planting. They share-crop, which gives them enough labour without impacting profit, or introducing outsiders, idlers or welchers. These bonds stretch through generations and are webbed with intermarriage, fraternity and tribal hierarchy. Planting is hard, hurried work, and the subsequent months of constant weeding, particularly as the seedlings establish themselves, is intensive. Large extended families who are already short of food knit tighter, and work as a unit.

  They have waited out the tense days when the poppies have announced their presence, through their brightly coloured petals, to anyone in the vicinity, and now it is time for the harvest. These skilled workers slice each green seed capsule three to four times with a small, sharp knife. The slashes exude a white substance, poppy milk. The men, women and children work carefully and methodically, to keep their clothing and bodies from brushing the capsules, thus sealing them back up with a smear of latex like a sticking plaster and stopping them producing their tears; many favour walking backwards while working, to prevent this
happening. Often, they will tie a coloured thread around the neck of the most productive poppies. Those capsules will be harvested when their opium gum is exhausted, and their seeds saved for next season’s crop. An acre of poppies is a decent harvest for a family group, and usually the fields are also planted with maize, which protects the vulnerable young plants, both from the climate and from prying eyes, and which along with the poppy stalk is a reliable food for the hardy livestock of the village. They work as quickly as caution will allow; not only will dark soon be upon them, but spending too long among the clacking and rustling stems stirs up the fumes of the gathering milk. In more than one sense, poppy-harvesting is heady work.

  Overnight, the milk gathers in rapidly darkening teardrops in the capsule and by morning has solidified into a latex ready for harvesting. In the dawn light they scrape the gum from the capsule with a crescent-shaped spatula, often shiny with generations of use, and lay it out to dry in open wooden boxes. Over the next three to five still days, the process is repeated. When the gum has dried a little, it may be boiled to allow capsule scrapings or bits of stalk to come to the top, before being strained through cheesecloth or sieves. Then it is ready to be packed into marked bags or moulded into balls which are stamped with the farmers’ own identifying marks. The opium is now ready to depart on the first step towards its final destination.