coalfields, then the heroin highway to Baltimore had become one of the few avenues left for America’s small-town working class. Can’t get a job in a factory? Drive to Baltimore instead. An investment of $4,000, or 50 grams of heroin, could earn a person $60,000 in a single week.
Don’t want to drive all the way to Baltimore? Your returns won’t be as high, but you could now drive in just twenty minutes to Little Baltimore: Martinsburg, West Virginia. That’s what happens when rural America becomes the new inner city, ranking dead last behind cities, suburbs, and small metro areas in measures of socioeconomic well-being that include college attendance, income, and male labor-force participation.
“They can make all the task forces they want, but they’re never gonna stop it because the profits are just too great,” Dennis said. “And the heroin is only getting closer and closer and closer.”
Dennis’s plan, when I talked to him the summer after Santiago went to prison, was to take what some call the geographic cure. He wanted to move to a bigger city with a younger and more ingrained sober-living culture, along with better jobs. “I’ve already moved from Strasburg to Middletown thinking that would help, but I just found people there. Then I moved to Winchester, but I found people who got high there, too.” His girlfriend used to hear him talking to himself in the bedroom, “but I think he’s really talking to Jesse,” she told me.
His next move, I learned from a sheriff’s department Facebook posting, was to get hauled back to jail on a probation violation. In his mug shot, Dennis wore an orange jumpsuit, and his eyes were so squinty you couldn’t tell they were blue. He was down to 140 pounds, from his usual 185.
I had just interviewed Dennis’s girlfriend, Courtney, the mother of his children. She was attending community college to become a paralegal; her kids went to a federally funded day care facility while Dennis’s father paid for their housing. She was working at McDonald’s in Strasburg, where Jesse bought his McNuggets on the weekend of his death. One of the low-level dealers in the Jones/Shaw ring—the guy who sold them the heroin that killed Jesse—often showed up at her drive-through window for food.
*
In 2013, Jesse’s was one of 8,257 heroin-related deaths in the nation, by far the majority of them young men, an increase of a staggering 39 percent over the previous year.
Roughly three-quarters of the dead had started down the same painkiller path that led Jesse to his death, the same path as Spencer Mumpower, Scott Roth, and Colton Banks—with a single prescription pill.
A month after Jesse’s death, the FDA approved a new high-potency, long-acting version of hydrocodone, Zohydro ER, even after its own expert panel voted 11–2 against it, noting that the drug, which lacked an abuse deterrent, could lead to the same level of addiction and abuse as OxyContin had in its original form. The FDA concluded that “the benefits of this product outweigh the risks.”
It would be four more years before the FDA would ask a pharmaceutical company to withdraw an opioid pain medication because of its potential for abuse—Opana ER, and not until 2017—and by then the annual death toll for drug overdose had climbed to 64,000.
Critics pointed out the inherent conflicts of a regulatory agency that both approves drugs and is then supposed to function as a watchdog over those drugs. The Zohydro approval was the OxyContin story all over again, said Dr. Andrew Kolodny, a doctor who lobbies for stronger painkiller restrictions.
“The most damaging thing Purdue did, it wasn’t the misbranding of OxyContin they got in trouble for. It was that they made the medical community feel more comfortable with opioids as a class of drugs,” Kolodny told me. “But had the FDA been doing its job properly with regards to opioids, we never would have had this epidemic.”
Two weeks before Jesse’s death, the FDA finally notified Barbara Van Rooyan via letter that a portion of her petition had been approved—specifically, her call to withdraw its approval of the original OxyContin. The point was by then moot, of course; Purdue had already voluntarily withdrawn it, three years after the reformulation came to market. “I think my petition did ultimately help [push the reformulation], but so many more people died while we were waiting for it,” Van Rooyan said. Months later, she said, after reading a New Yorker piece on the Sackler brothers, it dawned on her that the reformulation had