Tuesday, November 18, 2014

A Brief History of Portsmouth's Psychotropic Addictions

In the last sixty-five years or so, psychotropic (mind altering) drugs  have had a profound  impact on America and on  Portsmouth in particular.  The history of  psychotropic drugs, at least in Portsmouth, can be divided for rhetorical purposes into roughly  five  overlapping stages. Those could be called, based on the psychotropic drug that predominated in each:  (1) the chlorpromazine (2) the meprobamate;  (3) the benzoylmethylecgonine; (4) the paramorphine; and (5) the buprenorphine  stages. Except for the anti-psychotic chlorpromazine, which was marketed in the U.S. as Thorazine, all of these drugs are addictive to varying degrees. However, the withdrawal symptoms associated with Thorazine can be similar to withdrawal from addictive drugs.

The Chlorpromazine (anti-psychotic) Stage

Above: The psychotropic anti-psychotic chlorpromazine in 3D molecular structure

The first important psychotropic drug in America was the powerful anti-psychotic chlorpromazine,  marketed in the United States as Thorazine. First synthesized in 1950, chlorpromazine revolutionized the psychiatric care of psychotics, particularly schizophrenics. According to Wikipedia, “The introduction of chlorpromazine during the 1950s into clinical use has been described as the single greatest advance in the history of psychiatric care, dramatically improving as it did the prognosis of patients in psychiatric hospitals worldwide.”  In the 1950s, I worked as a psychiatric aid in mental hospitals in Massachusetts and Connecticut  and witnessed firsthand the dramatic improvement  in  the treatment of patients brought about in large measure by chlorpromazine.

I began as a psychiatric aid at Boston State Hospital where I  assisted in the use of hydrotherapy and electro-shock to treat psychotic patients. But just several years later I worked as an aid  in a private mental hospital in Hartford delivering chlorpromazine to more tractable patients. In the 1960s and 1970s, because of  the “tranquilizing” effect of chlorpromazine on psychotics, many public mental hospitals closed down, as Boston State Hospital did in 1979 and as the  Receiving Hospital did in in Portsmouth decades later. Because of advances in  anti-psychotic medications  and the subsequent deinstitutionalization of mental patients, today people are walking the streets in  American cities, including Portsmouth, who would  have been institutionalized  in the 1950s. Diversity was not a virtue in the '50s, when there was little tolerance for deviation in sex, politics, or social behavior.

The Meprobamate (tranquilizer) Stage

Above: The 3D molecular structure of the psychotropic diazepam  (Valium) 
The success of Thorazine helped set  the stage for the synthesizing of milder psychotropic drugs for the treatment of patients with emotional rather than mental problems, patients who were classified as neurotic rather than psychotic. The first tranquilizer, meprobamate, was marketed as Miltown in 1955. “Thorazine—which offered the first effective treatment for schizophrenia—had revolutionized the treatment of institutional psychiatry,” Newsweek reported in 2009, “and Miltown seemed to offer a pharmaceutical counterpart to the management of everyday nerves.” People of a certain age will remember what could be called the  Miltowning of America in the late 1950s. To quote Wikipedia again, “Launched in 1955, [Miltown] rapidly became the first blockbuster psychotropic drug in American history, becoming popular in Hollywood and gaining notoriety for its seemingly miraculous effects.” The pharmaceuticals that developed them usually touted the “miraculous effects” of new  drugs, which was the case with meprobamates. The  harmful side effects were downplayed if not denied entirely. Just as the tobacco industry covered up  the carcinogenic risks of tobacco,  the pharmaceuticals downplayed the addictive nature of tranquilizers.

Miltown was followed by Librium and then  Valium (diazepam), which,  after it was introduced in 1963, became the most widely used  tranquilizer in the world.  Valium was prescribed for everything from phobias to depression, and from anxiety to restless leg syndrome. But it became clear over  time that tranquilizers, including  Valium, were addictive, and when used regularly for a long period, became a serious problem. The  withdrawal symptoms that users experienced when they tried to stop taking Valium were  severe. I know a woman  in her nineties who was addicted to Valium for over  a half century, with only her doctors and close relatives knowing that she was. From what I have gathered, the  first prescription drug addicts in Portsmouth were not long-haired youths but respectable, responsible members of the community who were victimized by the pharmaceuticals that synthesized meprobamates and  by the  doctors who overprescribed them.

The Benzoylmethylecgonine  (cocaine) Stage

It was illegal drugs such as heroin and meth, and particularly cocaine (benzoylmethylecgonine), that became the drug of choice in Portsmouth for so-called recreational users. One of the consequences of the  cocaine stage was that the money it illegally generated remained in the underground economy. Drug dealing is a cash only business. That's especially the case with cocaine. The on-line  National Geographic News, of all soures, reported in 2009 that nine out of ten American bills show traces of cocaine. The traces get there when the bills change hands in a drug deal or when addicts use the bills to snort coke.  The coke trade  did little for the chronically depressed economy of Portsmouth. Instead of helping the economy, the money generated by  the cocaine trade  created havoc.  Another problem with cocaine, especially crack cocaine,  was that  too many of  the dealers and  their customers went to jail or died of overdoses. The high incarceration and mortality rate was not good for the coke business. If you have a business that caters to customers who end up behind bars or dead, you do not have customers you can bank on.

As a sign of the extraordinary pervasiveness of the drug problem in Portsmouth’s cocaine stage, the son of the mayor, the son of the police chief, the son of a prominent judge, the son of a prominent lawyer, and the sons and daughters of other prominent fathers became addicted, with some of those sons becoming  dealers themselves. Though more sons than daughters became addicts, the daughters were by no means closeted, for many of the  streetwalkers in Portsmouth were hooked on drugs.  Some years ago I talked to an addicted prostitute on John Street who told me she was related to a bail-bondsman. There was no escape from drugs no matter what family or which social class or which side of the law you were on, or whether your dad was a criminal or a judge. 

 During the crack stage, local, state, and federal governments spent much more money on  than for addicts, much more money arresting, prosecuting and incarcerating than  rehabilitating addicts. There was much more money to build jails to lock addicts up than there was for clinics to treat them.  In 2006,  at the tail end of the crack craze, the $12.5 million dollar Scioto County Jail opened for business with the expectation that if you built it they would come. But with the attrition of crackheads, the new jail had  trouble maintaining full occupancy. That meant the county was losing money while  still having to pay about  $350,000 or so annually to service its debt for the jail.

Jailing addicts for  crimes that were both directly and indirectly related to drugs became  a highly competitive business. The financially strapped Scioto County Jail sought to have prisoners from other counties’ crowded jails transferred to its underutilized facility. Under this arrangement, the other  counties picked up the tab. The Huntington Herald-Dispatch reported in 2014 that ten Lawrence County prisoners had  been incarcerated  at the Scioto County Jail in 2013 at an annual  cost of $230,869 to Lawrence county. When Lawrence county sought to have the empty former youth prison in  Franklin Furnace serve as a less expensive backup to its crowded jail in Ironton, the Scioto County commissioners and sheriff strongly objected, calling the Lawrence County plan not only unfair and in violation of state statutes but also “stupid.”  For competing contiguous counties to be calling each other names is just one of the indirect consequences of the drug epidemic in southern Ohio where addiction, at least for law enforcement agencies, has been  a growth industry. Much of the breaking and entering of homes and automobiles in the Portsmouth area was done by addicts desperate for money to buy drugs. Incidentally, many  drug-related petty crimes were not reported to the police during chief Horner’s stewardship, so Portsmouth’s official crime rate was probably a lot higher than statistics suggested, though those rates were already quite high.

The Paramorphine (oxycodone) Stage

Above: The 3D molecular structure of the psychotropic drug  oxycodone 

The oxycodone stage of addiction in Portsmouth was more profitable than the cocaine stage at least for the pill-mills and those connected to them. Instead of the illegal cocaine, heroin, and meth that fueled the cocaine stage, the oxycodone stage was fueled by a  less potent but  fairly expensive and widely available psychotropic prescription drug. The best selling  brand of oxycodone, Oxycontin helped alleviate pain, including the pain  associated with withdrawal from more potent narcotics, but without producing the high that addicts crave. What made Oxycontin less potent was its timed-release formula. The user did not experience its potency all at once but  gradually, over time. But the timed-release formula was far from foolproof.  An addict was able to easily unleash Oxycontin’s  potency immediately by  chewing, pulverizing, or liquefying it, in which forms it could be swallowed, snorted, or injected.  Even the addition of nalaxone to produce nausea when the drug  was taken in large doses did not stop Oxycontin addiction in the Portsmouth area from  increasing exponentially.

On 9 April 2011, a New York Times reporter wrote of Portsmouth, “This industrial town was once known for its shoes and its steel. But after decades of decline it has made a name for itself for a different reason: it is home to some of the highest rates of prescription drug overdoses in the state . . .” Things got so bad in the Portsmouth area that Governor Kasich said publicly that, when it came to pill-mill prescription drug abuse, “The devil is in control in Scioto County.” One public health official reported one in ten babies born in Scioto County were addicted. The police chief reported that more people had died in Ohio from drug overdoses in 2008 and 2009 than had died in the 9/11 World Trade Center attack. What the police chief, Charles Horner, did not report was that his addicted, drug-dealing son was one of those responsible for the overdose deaths. I was told by someone in a position to know that Horner’s  son brazenly dealt drugs in a restaurant directly across the street from the police station.

Typically, the local  media at first  turned a blind eye to the pill mills as chief Horner had to his son.  In the same downtown office building and on the same floor as the local radio station WNXT, one shady  out-of-town doctor opened a pill-mill office with patients from the tri-state region lining up like customers at  the popular DariCreme on 2nd Street. When a veteran WNXT newscaster learned  a  pill-mill down the hall had been raided,  its existence was news to him.

The doctors who indiscriminately prescribed and the people who owned and operated the pill-mills made  millions of dollars, and in doing so gave a boost to the  local economy, but at  what a cost. Oxycontin became so  widely used and abused that Portsmouth became known as the Oxycontin capital of the nation with one Portsmouth doctor reportedly writing more prescriptions than any other doctor in the country.  The Portsmouth pill-mills became so out of control in their pursuit of profits that they were finally raided by federal, state, and local federal law enforcement agencies. Some of the pill-mill owners and doctors  were arrested and convicted, bringing a reduction, though certainly not an end, to Oxycontin  addiction in Portsmouth.

The Buprenorphine (Suboxone) Stage

Above: The 3D molecular structure of the psychotropic buprenorphine (Suboxone) 

Much more savvy and public-relations oriented, and much better connected politically, the counseling centers in the Portsmouth area, were ready to take up the slack created by the closing of the pill-mills.  While some addicts have been helped by the centers,  profits and politics, not the Hippocratic oath and humanitarianism,  have been dominant in the   buprenorphine stage of Portsmouth’s drug history.  The cost of treating addicts in counseling centers has been paid for primarily  by the government and ultimately by the  taxpayers through Medicaid and since 2014 by the Affordable Care Act, which Republicans have dubbed Obamacare. The cooperation and  collusion between pharmaceutical executives,  U.S. government officials, and unscrupulous professionals,  who were involved in a revolving door arrangement, account in part for the success of counseling centers in the Portsmouth area.

The Counseling Center, Inc. and the Community Counseling and Treatment Services (CCTS), operate clinics and halfway houses in Portsmouth where what they euphemistically call “clients” are treated. A key component of that  treatment of addicts now includes the psychotropic drug buprenorphine,  of which Suboxone became the most  controversial example.  Outselling even Viagra, Suboxone generated $1.5 billion in American  sales in 2010. Suboxone was developed not by an American pharmaceutical but by a British company,  Reckitt and Benckiser (RB), that specialized in health and household products, such as Clearasil and Lysol. The U.S. government spent $89 million to help RB develop and market Suboxone  on the grounds that it was safer than methadone. Safer? A  firefighter  whose son became fatally addicted to Suboxone remarked that  the difference between more potent drugs and Suboxine was like the difference between Budweiser and Bud Lite, meaning an alcoholic who switched to Bud Light was still a drunk and an addict who switched from Oxycontin to Suboxine was still an addict. Reckitt and Benckiser tried to  discourage addicts from abusing Suboxone by adding  nalaxone, an “abuse deterrent,” to it. If addicts crushed and injected Suboxone, the nalaxone was supposed to produce excruciating pain and nausea, but that apparently was  not enough to stop addicts from abusing it. Suboxone  is one of the drugs that has made overdoses rather than car accidents the leading cause of accidental death in the U.S.

The U.S. government tried to control the abuse of Suboxone  by allowing only designated doctors to prescribe it and by limiting those doctors to thirty patients, but that number  was later raised to 100. In spite of these controls, the illegal use of Suboxone proliferated.  In 2011, the number of emergency room visits resulting from the illegal  use of Suboxone were well over 21,000, which was nearly five times what they had been five years earlier.  The doctors who prescribed Suboxone were far from simon-pure and some of  them had even been law-breakers. Rather than the Hippocratic, they appeared to have taken the hypocrite oath. Their primary objective was not to help the addicted but to get rich. As reported in the New York Times  (15 Nov. 2013), Dr. Robert L. DuPont, the first director of the national drug abuse institute, said that at  a recent meeting of the addiction medicine society, “the buprenorphine sessions were all packed with doctors who wanted to get in on the gold rush.” Too many of the doctors who became Suboxone  prescribers did so because they saw it as a bonanza for their faltering practices. Among them were doctors who had been sanctioned for drug addiction; or convicted of Medicaid fraud and of smuggling steroids from Mexico; or of conducting an “excessive number of invasive procedures”; or of failing to report a case of rape of a pediatric patient and of  having intercourse with patients in the office. The government’s screening process was clearly lax. In Ohio, it turned out that nearly 17 percent of the doctors given permission to prescribe  Suboxone had been previously disciplined by authorities whereas only 1.6 percent of Ohio doctors in general had been. If it was 17 statewide, it is easy to believe the percentage was even higher in Portsmouth, one of state’s most addicted cities.

The Treatment Services (CCTS) recently had its clinics in Portsmouth raided by police. According to channel WNXT, CCTS owner Paul Vernier and his employees had been engaged in trafficking in drugs, laundering money, and defrauding insurance companies and the U.S. government by forging prescriptions. In addition to searching for evidence in Vernier’s Portsmouth clinics, the police also used a search warrant to look for incriminating records and papers at his palatial hillside house in West Portsmouth. The other Portsmouth operation, Counseling Center, Inc., which has influential friends in the county government and in the state legislature, continues doing  business as usual in Portsmouth. The raiding of Vernier’s clinics removes Ed Hughes’ chief competition. Business for Counseling Center, Inc., with its motto “We believe in miracles,” is prospering and expanding, especially in the historic Boneyfiddle district.

When I began my blog River Vices in 2004, I said Mark Twain felt river cities had more than their share of vices and I thought that Portsmouth was no exception. I never knew a city that had more religion and less morality than Portsmouth, which calls to mind  Twain’s remark that “religion began when the first con man met the first fool.” The  slogan of Counseling Center, Inc., suggests Hughes might be using the Almighty to cloak his lucrative business in religion, as Vernier seems to have done by naming a real estate business he owns Blessed Realty, L.L.C. Blessed are the realtors in spirit for they shall profit from the First Commandment of Portsmouth politics (click here). That reminds me that Tammy Faye Bakker and her convicted televangelist husband Jim Bakker named their profitable non-profit televangelist racket PTL, short for "Praise the Lord!" That's what she used to exclaim tearfully and often on the Jim and Tammy Show, heavy mascara running down her rouged cheeks.  Incidentally, it may not be coincidental that Tammy Faye turned out to be addicted to Valium. Whether or not  Ed Hughes’s Counseling Center turns out to be a racket, he has become a multi-millionaire, according to Austin Leedom, the dean of Portsmouth's investigative reporters. What I will explore in my next post is the possibility that Hughes may be addicted not to any of the five drugs discussed above  but to the most powerful and pervasive drug in the world. What is that drug? Stay tuned.

Relevant Posts

"From Pill Mills to Counseling Centers" (click here).