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The Addicts Next Door
I’m not sure if everyone will be able to read this; it isn’t paywalled for me, but I think that’s because you’re allowed to read a certain number of New Yorker articles for free every month, and I haven’t hit that limit yet. If you can read it, I recommend it. It’s called The Addicts Next Door, by Margaret Talbot, and It’s the best journalism I’ve read about the opioid epidemic:
One Thursday in March, a few weeks before Michael Barrett responded to Angel Holt’s overdose, I rode with him in his paramedic vehicle, a specially equipped S.U.V. He started his day as he often does, with bacon and eggs at the Olde Country Diner, in Martinsburg. Barrett, who is thirty-three, with a russet-colored beard and mustache, works two twenty-four-hour shifts a week, starting at 7 a.m. The diner shares a strip mall with the E.M.T. station, and, if he has to leave on a call before he can finish eating, the servers will box up his food in a hurry. Barrett’s father and his uncles were volunteer firemen in the area, and, growing up, he often accompanied them in the fire truck. As they’d pull people from crumpled cars or burning buildings, he’d say to himself, “Man, they doing stuff—they’re awesome.” When Barrett became a paramedic, in his twenties, he knew that he could make a lot more money “going down the road,” as people around here say, referring to Baltimore or Washington, D.C. But he liked it when older colleagues told him, “I used to hold you at the fire department when you were a baby.”
Barrett’s first overdose call of the day came at 8 a.m., for a twenty-year-old woman. Several family members were present at the home, and while Barrett and his colleagues worked on her they cried and blamed one another, and themselves, for not watching her more closely. The woman was given Narcan, but she was too far gone; she died after arriving at the hospital.
We stopped by a local fire station, where the men and women on duty talked about all the O.D. calls they took each week. Sometimes they knew the person from high school, or were related to the person. Barrett said that in such cases you tended “to get more angry at them—you’re, like, ‘Man, you got a kid, what the hell’s wrong with you?’ ”
Barrett sometimes had to return several times in one day to the same house—once, a father, a mother, and a teen-age daughter overdosed on heroin in succession. Such stories seemed like twisted variations on the small-town generational solidarity he admired; as Barrett put it, even if one family member wanted to get clean, it would be next to impossible unless the others did, too. He was used to O.D. calls by now, except for the ones in which kids were around. He once arrived at a home to find a seven-year-old and a five-year-old following the instructions of a 911 operator and performing C.P.R. on their parents. (They survived.)
I don’t think I have anything of wisdom to add to it, beyond encouraging you to read it. It’s what journalism ought to be. I’ve of course read hundreds of articles about opiate addiction crisis, and read the statistics, but I’ve never before been able to visualize how completely devastating this is to American small towns.
Some passages struck me, particularly:
Michael Chalmers is the publisher of an Eastern Panhandle newspaper, the Observer. It is based in Shepherdstown, a picturesque college town near the Maryland border which has not succumbed to heroin. Chalmers, who is forty-two, grew up in Martinsburg, and in 2014 he lost his younger brother, Jason, to an overdose. I asked him why he thought that Martinsburg was struggling so much with drugs. “In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.” There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.” He added, “That’s really hard to live with—when you look around and you see that seven out of ten of your friends from high school are still here, and nobody makes more than thirty-six thousand a year, and everybody’s just bitching about bills and watching these crazy shows on reality TV and not doing anything.”
And this leaves me with questions. Why exactly do people in Martinsburg feel they have no purpose? What’s so shameful about making less than thirty-six thousand a year? (I consider that a “pretty good year,” personally.) Why do people stay there if they feel the place doesn’t given them anything? Why are they watching crazy shows on reality TV and not doing anything when they’re citizens of a superpower, free to go anywhere in the country — and to many other countries, too, if they feel like it — to start new lives?
What’s keeping people, in other words, in a mental prison?
So many questions come to my mind: Talbot intimates, but doesn’t explicitly state, that this is a disease of industrial decline. Do the data really confirm this? If we map towns and cities to regions that have experienced de-industrialization, do we see an invariable connection? Or do we see that some towns stay clean? If so, why?
The word “epidemic” is a metaphor. Obviously, opiate addiction isn’t contagious the way chickenpox is contagious — you don’t catch it through a virus or a similar physical vector; you can’t catch it just from being in physical contact with the afflicted person or their bodily secretions. But it does seem to behave, in some important ways, like a contagious disease: Being around addicts does seem to make you much more likely to become one; some cities and towns experience “outbreaks” — and your risk is much higher if you’re in a place that’s having an “outbreak.”
Shepherdson, Talbot says, “has not succumbed to heroin,” but that’s all she says about it, apart from noting that it’s “a picturesque college town.” (I found a photo of Shepherdson and posted it on the right.) I looked it up: It’s a tiny town with a population of 1,734. (The population of Martinsburg is 17,227.) Based on what she says, it’s hard readily to pronounce people in Martinsburg characterologically or even spiritually flawed, because it seems clear that if they were living in Shepherdstown, instead of Martinsburg, they wouldn’t be addicts.
It sure doesn’t sound as if there’s much more to do in Shepherdson than there is in Martinsburg, or as if life is in any obvious way more full of promise and hope. It really does sound as if heroin addiction is more like a standard epidemic disease than a spiritual one: If you’re around it, you catch it.
When I looked up Martinsburg, I saw that it, too, is “picturesque,” which made me abandon my first thought — that perhaps something about a town being “picturesque” is really important here, that perhaps seeing ugliness around you rots your soul and robs you of hope. Martinsburg is shown above, on the left. The photo of the derelict Interwoven mill in the New Yorker made me think the town itself must look like an abandoned wasteland, but to judge from other photos of the place, it’s only the mill that’s depressing to look at. The rest of the town looks very attractive. Martinsburg has four colleges and universities, which means it too could have just as easily been, and been described as, a “picturesque college town.”
The author and the people she interviews seem strongly to suspect that it’s the loss of industrial jobs that’s causing this. But I’m not sure what the mechanism is. The Interwoven mill closed in 1971. Most of the people who are now addicts were born long after the mill closed. I’m not saying they’re wrong to think there’s a connection: I trust that they’re the experts about what’s wrong with their town. I’m just wondering how it works, exactly, and why it takes so long for a town to go from de-industrialization to heroin addiction.
I find it mystifying: It is like a disease, but it isn’t really a disease. I personally wouldn’t be afraid of catching heroin addiction if I went to Martinsburg. It’s connected to something about contemporary American life, but it skips over towns like Shepherdson. Almost everyone who talks about it describes it as an affliction of hopelessness, yet it’s hard for me to see any objective reason for such hopelessness: People in Shepherdson, obviously, don’t find their lives so hopeless. No one is bombing Martinsburg. There’s no war, no famine. No one is preventing people from making friendships, falling in love, starting families, going to church, starting new businesses — and above all, no one is keeping them from leaving.
Yet unquestionably, something is keeping them there — and it’s killing them, in numbers you’d associate with war or famine.
It’s so depressing and dystopian that it’s hard to believe it could be happening: It’s like something out of the Twilight Zone.
What do you think is really going on?
Published in General
Hey Claire. You caught me at the end of a long night at the end of a long day. I’ve been obsessively listening to Jordan Peterson and Camille Paglia of late and they have both touched on this subject; there’s no way I can relay their insight.
But I think industrial jobs are a living metaphor for meaning. My dad never made much money, but it was enough to raise a family. And on days where he was feeling hopeless (if he had any) he could drive by the Queen Mary and admire the work he’d done.
Today, there’s no way someone with his education (or lack thereof) could have achieved what he did. A stay at home wife, five kids, a nice retirement.
It’s easier if you’re a woman: you take care of your mom and/or have a baby. You might be broke, but you’re important.
If you’re a man with limited education and fewer opportunities, where do you find meaning?
And don’t discount the difficulty of leaving. My husband and I should have left Cali long ago. First we stayed because of our parents; now we stay because of our kids and grandchildren. My parents were adept at pulling chocks. Their children: not so much.
That seems possible to me — but it begs the question. Why are they a metaphor for meaning? They shouldn’t be. No religious teaching supports that idea. Many people without industrial jobs find meaning in life. People found meaning in life before the industrial age. There is nothing about an industrial job, per se, that’s obviously more meaningful than a job as an EMT, a job in sales, in services.
If the issue is jobs, per se — being able to support a family — it makes much more sense to me. Of course it gives life meaning to be able to stand on your own two feet, not to need help from anyone, to be able to support your children. But throughout American history, people moved where the economic opportunities were. That’s the story of the Gold Rush. It’s the story of my family, which moved over and over. It’s the story of most American families I knew when I was growing up.
What is it about industrial jobs? I’m not arguing with the idea that there was something about those jobs that afforded a satisfaction that was different from any other kind of job, I’m asking: What was it? And why? Is it possible that unionization gave people a feeling of community and political involvement? Is it possible that there’s a satisfaction in building certain kinds of things that can’t be found in other kinds of jobs?
The last sentence seems significant: being able to see what you’ve done. Perhaps jobs in services or trade don’t give people that kind of satisfaction.
Are we right to think that only industrial jobs make that possible?
Is it impossible to find meaning in doing these jobs? They’re mostly in the service sector. Most require some education, but not an unattainable, unimaginable amount. Some say, “High school or GED required.” But they’re in Houston, not Martinsburg. You’d have to be able to imagine moving somewhere new, and doing something unlike what your parents did. That said — isn’t that what Americans have always done?
I don’t. I know all about how hard it is to leave, especially when your parents get older. Still, throughout our history, it’s been what we’ve done. I don’t at all say it’s easy. But if the alternative is the kind of hopelessness and despair that leads people to kill themselves at this rate — and that’s what we’re seeing, mass suicide — I’d have predicted people would do it. Suicide isn’t natural. Look at refugees who clamber onto dangerous, unseaworthy boats in frantic efforts to reach Europe: that’s natural, it’s what people do to try to escape hopelessness and places where they have no prospect for a better life. The instinct to live is so powerful. Yet something is killing people’s most fundamental instinct: to stay alive.
What stuns me about what’s happening is the sense of despair that’s out of proportion to reality. Yes, it’s definitely harder to earn a good living in America than it used to be. That’s reality. But it’s not impossible. It’s not realistic for an able-bodied person to think, “I have no hope” in America in 2017.
What I’d expect to see is tons of internal migration, people leaving these places in droves. So I think something’s going on that I don’t fully understand. It’s a bit like at the beginning of the AIDS epidemic, before the virus was identified: We see a disease killing people in devastating and terrifying numbers, but just don’t know, exactly, what’s causing it.
Assembly line jobs were not great rewarding jobs, like being a craftsman, member of the guild, the community, and extended family, but all those jobs were destroyed by industrialization and those people who lost a way of life even more than jobs, were then crowded into urban squalor. What happened to them? It’s a sincere question, I don’t know. Employment is far more than a source of income. Now we replaced many of those sources of income with money, food and other support. Is that support transportable? Does it keep a certain number of these people from making the major effort it takes to start over? How difficult is it to find a new job or move? What are the barriers to finding jobs and moving? The drug business that is also killing these people is also lucrative, or presents kids with the appearance of being lucrative even though they may have to work for little or nothing until they learn the brutality that moves them up in the business. That business isn’t very transportable either. Whenever we saw a major shift like industrialization, deindustrialization, modernization of agriculture, mass demographic change, people faced even greater dislocations than today but they eventually adjusted. What’s different? Or is it? Were there always people left behind that simply died and weren’t noticed? What do we know about that? We know many of the barriers to job creation, skill acquisition, but we can’t seem to do anything about them. If we could would it make a major difference or are there a certain percent of the people who just won’t and cant adjust. As our families spread out over the country and world, or simple disintegrate is lack of supporting family part of the problem? What do we know about the impact of these things on people of faith and people who aren’t active members of a faith. What do we actually know?
What we see at work, is a link between family breakdown and drug use. While this is not one to one, it is a risk factor. Unemployment in men is also linked to drug use. And yes, we pick up the behavior of those around us. So if everyone we know uses drugs, there is a greater chance that we develop drug use. Fat friends can lead you into weight gain too.
As far as hopelessness goes, tunnel vision goes along with it. While someone who is functioning well may see many options, the depressed person cannot. They are at the bottom of a pit. And if a family member modeled the behavior of suicide, it makes acting on that behavior more likely in an individual. Two things are required though: A lack of fear of death, and thinking there is no other solution. This is why military and para-military individuals are at such great risk.
The social contract with men has been destroyed. It used to be that working hard at a lower level job was still honored. Providing for a family was honored. No longer. We, as a society, tell men not making the big bucks they are worthless. No longer is being a provider good enough. Dr. Helen has a lot on men’s issues. If the ratio of women killing themselves to men were reversed it would be a national emergency.
Your mind’s obviously doing what mine is in response to this story. I just can’t think of an answer that I’d find satisfying, no matter what the answer is. Mass suicide isn’t natural — no matter the time, circumstances, or place.
Is the ratio that skewed? Aren’t women dying of overdoses at about equal rates?
I feel the need to point something out: By trying to “help” these people with pill problems, the pezzanovanti and busybodies who insisted on trying to “fix” things ended up killing more people.
It was a “problem” that these people were taking “too many” pain pills. Pressure was applied, crackdowns took place, and then it became harder to get the pills. Addicts turned to street heroin. And we see the results.
I’m not saying that people hooked on prescription pain killers are in a great place. I’m saying addicts are objectively better off (and we all suffer fewer costs, in terms of negative consequences) when they are able to get and take pills manufactured in a factory by a legitimate pharmaceutical company with quality controls than when they start taking street heroin supplied by international gangsters, and cut with something by their local dealer.
By suicide. An overdose is not usually on purpose. With the drive to push pills out of the market, people have turned to IM Heroin. As such, overdose is more likely, because the illegal nature of the drug means the quality and shape varies. Further, one’s body prepares for the dose. If you get out of your ritual, an OD is more possible. This was true in the 70’s, but because this time middle class people are taking up the habit, it is bigger news.
In that respect, it is like crime: As long as the lower classes are killing themselves there is little concern. If middle class people start to feel the crime, “Something must be done!”. I’d rather worry about everyone, but, then again, that is who we serve at work.
Agree.
And they have made it vastly more difficult for people with real pain problems to get relief. What people do not understand (and I think I have seen you make this point before Fred), is that with chronic pain, the pills not not get people high. The body responds differently. We have been so against opiate abuse that we punish the people for whom the medication was designed.
I know people tire of hearing, “it’s the breakup of the family” but doesn’t that play a part here along with the job loss? I see it in the small town I grew up in. The textile mill closed in the late ’70’s. The “candy factory” (Russell Stover), closed in the ’80’s. The people doing well in town are from 2 parent families and drive an hour to work or work for themselves (Mike Rowe type jobs). The ones that aren’t doing well are from broken homes and get their “draw” from the rest of us taxpayers. Of course, you can never paint with a broad brush, but the majority fall in this category. I also notice the absence of religion from the New Yorker piece. Somewhere we have to break the cycle. It will not be easy or nice. It’s like ripping off the bandaid because that’s all it is, a bandaid not a fix. You will never be able to save everybody. Government intervention seems to always create a bigger problem than the one they are claiming to fix.
Maybe they are just bums? It’s not popular or pc to suggest this but while an addict may have no control because of their addiction no one is born an addict. At some point all of these junkies chose to engage in this behavior. I highly doubt all of them started with a legitimate perscription. Their parents raised them poorly and now they raise their kids poorly. Putting the blame on lack of industrial jobs is just a way to avoid responsibility for themselves. If you opened up a factory in these town these people would be too high to work in them.
Those asking what did we do the last time the economy was up ended by technology, well we passed all sorts of safety net programs. That is what we will do this time too, I bet. We will give them Medicare for all and free college. Then the old generation will die off and new ones will adapt their expectations and habits to fit the new economy. Until then don’t expect to improve anything.
Pessimistic enough for you? Or is it optimistic? The problem in time will solve itself through generational turn over.
No one becomes an addict who is healthy and happy.
I can’t let any discussion of narcotics pass without commenting on the war on drugs. The war is separate than the issue Claire is addressing. Addiction and overdoses would exist with or without the war on drugs. There are other deeper problems involved with this epidemic. However, we also have to acknowledge that we are exacerbating the problems with our war on drugs by diverting attention to police and the criminal behavior associated with the war on drugs and the brutal atavistic folks it creates in it’s wake. And we have created powerful incentives to hook new users. It is one of the most successful retail efforts in modern life. The cocaine or heroine can be grown, harvested and turned into paste for a few hundred dollars per final kilo of product, then sold wholesale as final product for about $2000, that’s already a 1000% mark up (my numbers are old numbers I don’t know them now) . The final powder once it leaves the source country and enters the US can be sold on the street for about $20,000. That’s the highest profit margin available anywhere on anything. It’s marketed through pyramid schemes, and now has some new groups doing home deliveries. But think! what is the elasticity of demand of an addict or almost addict? It is so low (the lower the elasticity the bigger the price response to decreases in supply) that even huge police busts of thousands of kilos of cocaine have not affected the street price. That means that the returns are so high and the warehousing and availability so pervasive it rivals Amazon deliveries. That’s not all. The wholesale product is sold to hundred of small time mules and other more serious smugglers for their 1000% profit. Then, to keep relations with the drug warriors good, some of these folks are ratted on. This keeps our warriors busy with busts, statistics showing their success and helps sustain the high street prices. The major operators move tons through infinite and ever changing means of delivering a product that can be reshaped into anything. It has been shaped as aspirin and shipped as bottled aspirin, dissolved as starch in suites, swallowed, stuffed in frames of large and small boats planes cars and trucks, babies, live and dead returning americans, sunk in oil barrels, injected in anything that is hallow. Flown, boated, floated in clandestinely, in small and large vessels, submarines and major airlines. it is impossible to stop it. We can’t even stop illegal immigrants who are considerably larger than a kilo of cocaine or heroine and can’t be reshaped and stuffed in small places and die if they don’t get water. The drug business is powerfully lucrative for our drug warriors as well and that is part of the reason we can’t bring ourselves to acknowledge its total failure and the damage it has done to us and dozens of less resilient countries.
Claire asked:
I’ve come to the conclusion that there are people just looking for excuses. People in major cities from well off families are just as lost and they give all sorts of other excuses. the common denominator is providing excuses.
That said, I agree that with family break down and loss of blue collar jobs, we have destroyed a person’s ability to acquire an identity. Loss of a positive identity, not such as identifying with gangsters or rock musicians, creates a consciousness open to nihilism. Or if not nihilism then despair, and that leads to an attempt to fill that void.
Anyway, I still can’t understand how people can argue with a straight face that the legalization of recreational drugs is a good thing.
Does it seem reasonable to think that people in Martinsburg are bums, but people in Shepherdson aren’t? If so, again, the important question is why are people in Martinsburg bums?
Whether we say, “They’re just bums,” or, “it’s de-industrialization,” or, “it’s the breakdown of the family,” or “it’s because for some other reason, they’re not happy and healthy,” I’m left with the same question: Why has this decimated Martinsburg but left Shepherdson untouched?
But none of these drugs are legal.
I feel lucky to be naive enough to ask this question: What’s IM Heroin?
Fentanyl, a high potency synthetic opioid, is part of the problem too. As noted by Fred and Bryan, people are losing access to legitimate pain medication and are medicating themselves with street drugs whose makeup is not controlled. A lot of accidental overdoses are the result.
This is one of the most depressing comments I can recall reading on Ricochet. Depressing because I think you’re right, depressing because we seem determined to double down on these policies, depressing because I have no idea what to suggest instead of these policies.
When I read a story like this, I fully understand the left-wing reflex: Something must be done. We can’t just allow people to die like this, in numbers like this, in the United States. It’s intolerable. But what, exactly, would fix this? Everything we’ve tried, so far, seems to have made the problem worse.
Don’t re-invent the wheel. Portugal. (Maybe.)
My sister who works in social services in a small picturesque American town with so much amazing history has a drug epidemic, including opiods and heroin. When I finished HS there, it wasn’t like that. There was industry, jobs, many families, a thriving downtown. It’s all gone. The jobs are in the federal prison now. Downtown is mainly boarded up for the mall. Churches have had to close up. I blame the state, for not attracting industry. They push state benefits like candy. There is hopelessness.
When we had local elections, we got new blood finally. One woman just got back from serving in Iraq and was shocked how the northern part of our county has dried up – businesses shuttered – nothing there, just in the last couple years. She ran for commissioner, knocked on my door and every door in my neighborhood. I voted for her. She won.
I got in my car the other day, and on the radio the local headline in NW Fl is how drug deaths and overdoses have rapidly increased. Maps and statistics may not always tell the truth, but its rampant across every small town and state. Drugs are cheap and flowing in from South America, the Middle East, and we have a youth population who are growing up without the opportunities we had, in broken families, and without faith.
There have been many specials about it, Lisa Ling and Anthony Bourdain have done a few powerful ones. It’s an escape. They’ll sell food stamps for drugs, or break into a house and steal what’s in the medicine cabinet. 60 Minutes did a special about it – affluent neighborhoods, kids with everything, athletes, good grades, dead from overdoses. The tearful parents had no idea.
It’s a breakdown of the basics in society, and it makes me sick.
The left wing reflex is to legalize pot, open borders, hand out benefits like candy with no accountability, tax small (and large) businesses out of business, make healthcare unaffordable. I just met a new hair stylist last week – my old one’s husband was suddenly transferred to Pentagon – she just moved here to FL from CT. She could not wait to leave – she said Danbury is a pit – rampant drugs, crime, illegal immigrants, no work. They have 3 kids and have not been able to afford healthcare for 4 years. CT has run industry out with high taxes. They were paying $7200 yr for a $270K house. She said GE is gone. There’s a migration out.
What kind of jobs *are* available in these towns? I can’t find any information on that. Can we look at that? How do you do a study like that? How do you present that question to someone capable of finding out?
Are the jobs in martinsburg filled by commuters? Are the jobs available to locals make-work or retail? Are they productive? Does the occupational profile look different in Shepardstown?
Last – do you know how expensive it is to move? Moving requires a couple of ingredients that past immigrants had in spades – nothing at all to lose (these people have that), hope for success in where they are going (most lack this), physical ability to mobilize ($$ – seems like 30k/year won’t go very far in a “booming” speculative city).
In the pioneering period, people who went west had a deed from the government giving them rights to a parcel of land. They had nothing in the cities and hoped for more out west. They didn’t move without some assurance of security (land).
What security do we offer?
Another topic on Ricochet which requires book-length analysis. For what it’s worth, here is my theory. There is a genetic predisposition to addiction whether ingestive (to alcohol and/or drugs) or behavioral (sex and/or the Anthony Weiner disease, gambling, shopping). Modernity, for the first time in all the generations of humanity, has made millions free from subsistence living. When “you don’t work, you don’t eat” prevails, addiction tends to be self-limiting. It may be that we are not genetically evolved to live in modern society, where hard work is no longer required and the inherent meaning of work= food for self and family, is removed from the equation of living. Add to that the absence of God, family or community, plus the ready availability of instant good feelings… you have many aspects of our society and its excesses: drugs, sex and rock ‘n roll.
While these are substantial factors, though, there is more to it. Molecular studies of opioid receptors in the brain have demonstrated genetic polymorphism (mutations) where some individuals require higher doses of opioids to obtain pain relief. As well, a significant percentage of addicts take opioids not to get high, but merely to feel normal. Before the era of anti-depressant medications, depression was treated – somewhat successfully for some patients – with opioids.
This successful treatment of depression with opioids has been borne out in some experiments with opioid addicts in Switzerland. Addicts were simply given their daily requirement and a very surprising thing happened. Some substantial percentage of them did not escalate their dose, went back to work and began to lead normal lives. It may turn out that this is due to genetic polymorphism and that such individuals either do not produce sufficient endorphins or lack opioid receptors which allow them to feel “comfortable in their own skins.”
Incarceration and shame do little to alleviate addiction, as the “war on drugs” does little to limit their ready availability. Maybe it is time to shift to a harm-reduction strategy – or at least try something radically different.
So we need Soma?
Understood. I can’t see how the situation would be better with legalization, but I certainly see how it could be worse.
Maybe they can afford to be bums. The question to ponder I think is are people in Shepherdson immune or have they just not fallen yet? If they are immune then they have something worth finding. If they just haven fallen yet than they will be bums soon.
Frankly I think the arguments about community sound best, the one problem I see is that you can’t build a community for people. They have to do it themselves. You could I guess take over and impose some order on them, but that would require treating all of them like children.
Here is the conundrum for us Classical Liberals. People might benefit more from order and stability and once those break down they are hard to reestablish without some sort of centralized source of authority. On its own it will probably come back, but that might take a generation or two. With modern medicine and life expectancy a generation today is a much longer time than it used to be and technology and the economy keeps moving along. How can things even out if everything is still very dynamic?
IM means intramuscular and I used it wrong. Heroin can be injected, but it is not done into the muscle. I screwed that one up. I should have said “IV”.
And dealers don’t seem to care about killing off customers these days.