For Amy Kapczynski, the turning point came in Durban. When she arrived in the South African city for the World AIDS Conference last July, she was greeted by 5,000 demonstrators demanding access to medications that could prolong or save their lives. Blacks and whites walked side by side — an image of how in a country once separated by apartheid both races have come together to fight a common enemy. They marched behind a banner emblazoned with the words that have come to symbolize the struggle against the deadly disease in South Africa: “Pity” crossed out, with “Medication For All” printed beneath.
“It was amazing, there was incredible energy,” the 26-year-old law student recalls. “South Africa is such an astounding place — you can still feel the living history of the revolution taking place in their country. The people are incredibly politically literate, active and motivated.” The activists’ slogan, with its appeal to justice and rejection of pity, fired Kapczynski’s imagination. “It’s not about feeling bad and doing things out of guilt,” she says. “People have a right to medication. They have a right to dignity and to have their own lives and the highest attainable standard of health.”
Kapczynski attended a shadow conference for women that brought together participants from the United States, Europe and South Africa. It was at those meetings, Kapczynski says, that she was viscerally jolted into an awareness of the gulf that separates the reality of AIDS in the industrialized world from that in impoverished countries like South Africa, where the vast majority of people live in abject poverty. As the panel discussed the side effects of taking dozens of anti-retroviral drugs each day, it suddenly dawned on her that many of the women listening to the discussion didn’t have access to any drugs whatsoever. HIV-positive participants from Germany and the United States might suffer nausea and fatigue, but most of them were going to live for years or decades. Those from South Africa were going to die, some of them very soon. “The divide was jarring and disturbing,” she says. “It was an ethically and emotionally impossible feeling. I just had the feeling that this can’t continue. It’s unjust.”
The crowning irony of the whole situation, Kapczynski realized, was that the few South African women at the meeting who were actually receiving treatment were on clinical trials that had been set up by pharmaceutical companies — the very companies that were trying to sue the South African government to keep it from importing or producing cheap generic versions of patented drugs.
Kapczynski returned from the conference to start her first year at Yale Law School. But along with plunging into textbooks on torts with the rest of her classmates, she took on a bigger project. Working with the Nobel Prize-winning organization Doctors Without Borders, she achieved something that had never been achieved before: She helped launch a campaign that ultimately led Yale and Bristol-Myers Squibb, one of the largest pharmaceutical companies in the world, to pledge not to enforce the patent on d4T — a crucial drug in HIV treatment, sold commercially under the brand name Zerit — in South Africa.
It was a monumental victory: No pharmaceutical company had ever relinquished a patent on an AIDS medicine. Even more crucial, perhaps, was the effect on other pharmaceuticals. The 39 leading companies, worried at the prospect of losing control of their patents — and terrified at the possibility that providing drugs free or almost free to Third World countries would eventually undercut drug prices in developed nations — had filed a lawsuit against the South African government, seeking to force the government to overturn an unenforced 1997 law allowing the public health ministry to override drug patents in the event of a national health emergency. Since passing the law, the South African government has never declared such a state of emergency. But even as it pressed the lawsuit, Big Pharm, as the pharmaceutical industry is known, knew that public opinion could turn harshly against it if it was seen as preventing access to lifesaving drugs in the name of corporate greed.
That, in fact, is exactly what happened. Battered by criticism, on April 19 the pharmaceuticals announced they were dropping their lawsuit against South Africa. Yale and Bristol-Myers Squibb’s decision was critical in turning the public relations tide. With a major pharmaceutical having accepted the principle that normal corporate behavior should not be maintained in the face of the devastating scale of the AIDS epidemic — more than 4.7 million people are HIV positive in South Africa alone — it had simply become too damaging for the other companies to continue their legal battle.
The battle over d4t is just one skirmish in what is becoming a monumental showdown over the future of global healthcare. On one side stand activists and critics who say that giant pharmaceutical companies have a moral responsibility to provide their medicines at reasonable prices, not just in the Third World but in developed nations. Their opponents, like conservative journalist Andrew Sullivan, argue that these critics are really anti-capitalists in humanitarian garb, and that the profits the pharmaceutical companies make are needed to finance the costly R&D that brings new drugs into the market. It’s a confrontation whose emotional stakes are raised by the AIDS nightmare, which has killed 22 million people in Africa alone.
Toby Kasper, the head of the Access to Essential Medicines Program for Doctors Without Borders who worked with Kapczynski in her fight, said, “The developments at Yale could not have happened without Amy Kapczynski. She was driving things there and did a great job just getting out there and talking to the right people.” Speaking from his office in Cape Town, he hailed the decision as “historic. A company has never given up its patent for a drug like this. Universities make a lot of money on these patents, so they’re hesitant to give up their right. But Yale acted out of fear of public relations and the fear of a student uprising. Besides, AIDS is a graveyard for corporate P.R., and it’s an area that could cause potential harm to a university’s P.R.” With her close-cropped brown hair, pierced eyebrow and penchant for wearing Carharrts and T-shirts, Kapczynski looks more like a prototypical activist than a lawyer. But it was her research ability, media savvy and negotiating skills that helped broker the deal. Kapczynski is no newcomer to the field of AIDS-related legal issues — she worked for an AIDS organization in London after studying at Cambridge as a Marshall scholar and worked as a researcher on a CBS “60 Minutes II” special on the AIDS epidemic in Africa. She had seen the devastation AIDS has wrought in South Africa during a trip there on behalf of a human rights organization at Bard College.
Doctors Without Borders’ Kasper met Kapczynski at the AIDS conference in Durban. His organization had sought permission from patent holders of AIDS drugs for South Africa to import or produce generic versions, using Brazil as a model. In Brazil, less restrictive intellectual property laws allow for the generic production of HIV drugs: More than 100,000 patients there are being treated with a generic cocktail manufactured by Brazilian companies. The Indian generic drug manufacturer Cipla has said it could produce a three-drug cocktail for $1 a day per patient in South Africa. The cocktail, which is made up of a generic version of Zerit and two other anti-retroviral drugs, would cost $350 a year per patient — a fraction of the $10,000 to $15,000 that patients in the United States or Europe must pay for the treatment. DWB’s strategy was to press its case directly with the universities and corporations that hold the key-use patents for the drugs it needed.
Kasper learned that Kapczynski was in law school and was interested in working with the organization on legal issues that people with HIV or AIDS face — family law, rights, access to healthcare, intellectual property and other problems. After Kapczynski returned to New Haven, Kasper contacted her and another Yale student he knew from his undergrad days at Harvard, Marco Simons, by e-mail, alerting them that he planned to send a letter to Yale requesting that they grant a d4T license to his organization. He asked them to help mobilize faculty and students.
Kapczynski’s first move was to identify potential university allies. Of these, the most crucial proved to be the compound’s inventor, Dr. William Prusoff. Going into the meeting with him, she had no reason to be wildly optimistic. The 80-year-old pharmacologist, who had discovered that d4T was an effective AIDS medicine in the 1980s, had made millions off the patent, and often scientists are unwilling to pressure pharmaceutical companies, which provide them with funding and revenue opportunities. “We didn’t expect him to be as friendly and receptive as he was,” she recalls. But Prusoff turned out to be not only receptive but downright outspoken in his support of the students.
Meanwhile, Yale had rebuffed Doctors Without Borders’ request. Jon Soderstrom, managing director of the Yale Office of Cooperative Research, which manages patents held by the university, sent a Feb. 28 letter to the group stating, “Yale has granted an exclusive license to Bristol-Myers Squibb, under the terms of which only that entity may respond to a request.” The d4T patent has been a cash cow for Yale, which nets about $40 million a year from its licensing agreement — almost all of that money coming from developed nations like Germany, the United States and France.
Kapczynski began doing legal research, trying to find out the terms of Yale’s licensing agreement with Bristol-Myers Squibb. She met with School of Public Health dean Michael Merson, who formerly headed the AIDS program of the World Health Organization and, Kapczynski believed, would be sympathetic to DWB’s request. Through another professor, Kapczynski requested a copy of the contract the university had with Bristol-Myers Squibb, which officials declined to release. At the same time, she put reporters at the Yale Daily News on the trail of the story. The student paper published its first story on the subject on March 2. “The story had a strong mobilizing effect,” says Kapczynski. A group of students in the Graduate Student Union — which had already been campaigning against Yale’s relationship with corporate sponsors — circulated a petition calling on the school to ease its patent. They managed to collect 600 signatures from students, professors and researchers on campus. The students also assailed Yale for its close ties with BMS — the company donated $250,000 to the school in 1999.
Looking back, Kapczynski says that she didn’t realize in the middle of the struggle just how big the stakes were. “[At first], the project just felt like something on our task list. It absorbed lots and lots of time. We were just trying to figure out how to make things happen, and we were doing it on the fly,” she says. “We didn’t realize how big of a deal it could potentially be.”
On March 9, armed with Kapczynski’s research into the licensing contract and with help from members of the Yale AIDS Action Coalition (of which Kapczynski is a member), Kasper wrote back to the university, arguing that the deal violated Yale’s own licensing provisions, which require that such deals “benefit society in general” and that they “protect against the failure of the licensee to carry out effective development and marketing within a specified time period.” By ignoring 90 percent of the market for d4T, Kasper argued, the university was not serving the public interest.
As the negotiations between the university and Bristol-Myers Squibb continued, Prusoff jumped into the fracas, telling a New York Times reporter in an interview on March 11 that he would “strongly support” the campaign by students to relax the patent in order to enable wider distribution in South Africa. “I wish they would either supply the drug for free or allow India or Brazil to produce it cheaply for underdeveloped countries,” he told the Times. “But the problem is, the big drug houses are not altruistic organizations. Their only purpose is to make money.”
Prusoff’s statements were the last straw. On March 15, Bristol-Myers Squibb announced that it would not enforce its patent license on d4T in South Africa. In a statement, executive vice president John McGoldrick said: “This is not about profits and patents; it’s about poverty and a devastating disease. We seek no profits on AIDS drugs in Africa, and we will not let our patents be an obstacle.” Though a BMS spokesperson would later tell the Wall Street Journal that the student protests did not compel the decision-making process, the mere timing of events suggests they did.
Kapczynski says a professor, whom she would not name, told her that the public comments made by Prusoff had embarrassed the university. “They were distraught by the editorial he wrote and how publicly he was willing to talk,” she recalls. “They had a lot to fear. Drug companies are very reluctant to discuss patents. They’re a big funder of university research, and maintaining good relations is important. The universities don’t want to be difficult to work with for the pharmaceutical companies because they want to market their compounds to them.”
Considering these factors, the speed with which the university moved astonished Kapczynski. “I didn’t expect it to happen as quickly as it did. It was bewildering, and still sounds a little too good to be true,” she says, “Still, they were thinking about a price cut anyway, so it made sense. They’re trying to save their public image. And I imagine a student movement was on the radar for them. People have been organizing to encourage universities to divest themselves of pharmaceutical interests in student groups and on e-mail lists. Students are becoming strategic in organizing around issues in which their universities are involved.”
The Yale battle is just one of several in what has become an international campaign to force universities and pharmaceuticals to change their business practices in dealing with the AIDS pandemic. A similar effort is now underway at the University of Minnesota, which holds the patent for Abacavir, sold under the brand name Ziagen and exclusively licensed to pharmaceutical giant Glaxo Wellcome. Carbovir, one of the main compounds found in Abacavir, was first synthesized by Robert Vince, a professor of medicinal chemistry, in the late 1970s. The university sued Glaxo Wellcome for patent infringement in 1998; the case was settled, and Glaxo Wellcome agreed to a one-time settlement of $7.25 million in 1999. The university expects royalties on the patent to exceed $300 million, which it wants to reinvest in AIDS research.
In March, as the debate over university patents convulsed Yale, University of Minnesota doctoral student Amanda Swarr started a campaign on the Minnesota campus, calling for it to ease its Abacavir patent. Like Kapczynski, the 28-year-old Swarr is a veteran of AIDS activism. She spent a year and a half in South Africa working on her doctoral thesis in women’s studies and volunteering as a member of the global Treatment Action Campaign.
“Students here are feeling like there’s a local connection,” Swarr says, explaining why she has been successful in mobilizing against the university. The issue, she says, goes beyond AIDS drugs and pharmaceutical companies. “We’re dissatisfied with the corporatization of the university. Corporations are giving universities more money than they ever have, and yet undergraduate education is deteriorating and students face tuition hikes on campuses.”
But pharmaceuticals, in particular, have drawn the anger of students — and other critics. The novelist and journalist John le Carré took shots at Big Pharm in his latest book, “The Constant Gardener,” and blasted the relationship between universities and the pharmaceutical industry in a recent essay in the Nation. “Consider what happens to supposedly impartial academic medical research,” le Carré wrote, “when giant pharmaceutical companies donate whole biotech buildings and endow professorships at the universities and teaching hospitals where their products are tested and developed. There has been a steady flow of alarming cases in recent years where inconvenient scientific findings have been suppressed or rewritten, and those responsible for them hounded off their campuses with their professional and personal reputations systematically trashed by the machinations of public relations agencies in the pay of the pharmas.”
On April 16, Swarr and members of the student-run Coalition for Access to Education, which opposes what they charge are the university’s sweetheart deals with corporations, sent a letter to officials demanding that the university make a binding statement that it will not enforce its patent in developing nations. Nongovernmental organizations like HealthGAP, South Africa’s Treatment Action Campaign and Oxfam America also sent letters of support, asking the university to heed the students’ demand. The university issued a statement on April 19 saying that it would “welcome a price reduction” in Ziagen. Though the statement offered praise for Yale’s decision not to enforce its patent in South Africa, it did not offer to do so itself. In an interview with the Minneapolis Star-Tribune, the university’s lawyer, Mark Rotenberg, said: “We don’t believe that giving up our royalty … is going to have much of a public health impact.”
Swarr, who is heading a petition campaign that she hopes will garner 20,000 signatures, advances the same legal argument used by DWB and Kapczynski, saying “Glaxo Wellcome’s high pricing keeps the university from fulfilling its mission of serving the public interest.” She believes the university will ultimately relent and pressure Glaxo Wellcome to abandon enforcement of the university’s patent. “I think they feel like they need to move on it. They’re getting national and international attention on the issue. Abandoning enforcement of the patent would be win-win for the university, too, because it gets almost no royalties from the sale of Ziagen in developing nations.”
Others are less sanguine. Jamie Love of the Consumer Project on Technology, who has done extensive research on patent holdings for the most crucial drugs used in AIDS treatment, says there are multiple patent claims on Ziagen, held by both the university and Glaxo Wellcome, that will be extraordinarily difficult to untangle. He points out that there’s also bad blood between the university and the corporation over the 1998 lawsuit.
The current front line in the war to make AIDS drugs affordable in poor nations is South Africa, but it will soon shift to Brazil, India and Thailand. Intellectual property laws are lax in these countries, and all three produce generic cocktail drugs. Under the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), those countries must tighten up their intellectual property and patent laws by 2005. TRIPS includes a provision that allows countries to temporarily suspend patents during a national emergency, but South African President Thabo Mbeki has so far refused to do so. Under TRIPS, it will be easier for corporations to pressure the governments of countries like the United States, which has stricter laws, to file grievances against developing nations with the WTO. During the 2000 election, according to figures supplied by the Center for Responsive Politics, Big Pharm was the 12th-largest industry contributor, pouring over $26 million into the coffers of the parties, presidential campaigns and congressional campaigns. So it wouldn’t be difficult for the pharmaceutical companies to find sympathetic ears in Congress and at the White House.
The real reason the pharmaceutical industry is trying to hold the line on its AIDS patents in impoverished nations is its fear that the Third World battle is simply the thin end of the wedge and that the activists’ real goal is universal price controls on drugs — in effect, socialism justified by overpowering moral arguments. Making AIDS drugs available at cost in impoverished nations facing one of the greatest plagues in human history would seem to be morally imperative — but, the drug companies’ defenders argue, it’s a slippery slope. Where do you draw the line? Tactically, the industry fears that once it can be shown that AIDS drugs can be produced cheaply in Third World countries, Americans will demand the same.
In fact, activist groups like the Consumer Project on Technology are fighting for the right to produce or import generic versions of d4T, at cost, for distribution in the U.S. and other industrial nations — effectively preventing Big Pharm from making any money from sales of AIDS drugs in those countries. Student groups on campuses from Yale to Minnesota to Harvard have been organizing around the issue — both on campus and through e-mail list-servs like the one maintained by Healthgap.
A look at the numbers shows why the battle over AIDS drugs has very little to do with developing countries (contrary to what media coverage suggests) and everything to do with protecting the American and European markets. According to market research firm IMS Health, of the $3.7 billion spent on AIDS drugs in 2000, the lion’s share, $2.6 billion, was paid out in the United States. The Europeans racked up $950 million in sales, while Africa, Asia and Australia spent only $108.5 million — a small fraction of the total.
Critics of the activists charge that their real agenda is gaining control of the entire pharmaceutical industry. “What’s happening on these campuses is a tragedy,” says Robert Goldberg, a healthcare policy analyst at the National Center for Policy Analysis. “Students like Amy Kapczynski at Yale aren’t really thinking about AIDS — it’s capitalism that they see as the real virus. AIDS is a glamorous disease to worry about.” Arguing that corruption and ignorance will doom AIDS efforts in South Africa, Goldberg notes that drugs were made widely available for free in Russia and Africa to treat tuberculosis and malaria, but that has done “little to stop a disease that claims 2 million lives a year.” With AIDS drugs, he argues, the outcome wouldn’t be much different: “You could dump all the AIDS drugs and cocktails for free in Africa. Half of the drugs would be stolen, a quarter unused or improperly used.” Goldberg is also concerned about generic AIDS drugs slipping across borders into Europe and the U.S. “There’s a short-term problem of these drugs showing up in Europe through gray markets,” he warns. “Government medical agencies tend to turn a blind eye toward parallel imports from Greece and Turkey. A company like [India's] CIPLA could export its generics, relabel them” and funnel them through this market.
“In this country, groups like [Consumer Project on Technology] see the South Africa campaign as a way to get lower prices here,” Goldberg goes on. “This is simply First World selfishness being manifested, using the Third World as a backdrop. As we’ve seen, minutes after the victory in South Africa [when the pharmaceutical companies dropped their case], the government said it was not going to use the cocktails.” Indeed, just days after the case was dropped, South African Health Minister Dr. Manto Tshabalala-Msimang stated that supplying AIDS drugs would not be a government priority, despite the drastic reduction in prices. Instead, the government will focus on treating opportunistic infections and improving nutrition among HIV patients. South African President Mbeki has in the past expressed concerns about the safety of cocktail treatments and even questioned publicly, to international dismay, whether HIV is the true cause of AIDS.
Critics like Goldberg, pointing to South Africa’s weak healthcare infrastructure, also fear that improper distribution and consumption of the cocktail drugs could lead to more resistant and deadly strains of HIV. Instead of emphasizing cocktails, Goldberg proposes that the African governments institute prevention and education programs and make widespread use of AZT, which is inexpensive to produce and has been shown to reduce childbirth transmission by as much as 50 percent — a plan that could certainly make the biggest difference in the long run, since it would reduce the infection rate.
Above all, Goldberg argues that reduction of pharmaceutical profits will result in diminished research and, in the end, fewer lifesaving drugs coming onto the market. “This populism is simply a U.S. domestic political effort to suck profits out of the pharmaceutical companies by reducing worldwide price through eliminating intellectual property protection,” he says. “In the short term, it sucks profits; in the long term it will result in a reduction in research funding as we saw with tuberculosis and malaria drugs when the original patents expired.”
His argument is echoed by conservative (and HIV-positive) journalist Andrew Sullivan. In an October essay in the New York Times Magazine, Sullivan wrote, “It would be wonderful if we could make the newest drugs affordable for anyone who needs them and keep the lifesaving research going. But cut prices and you cut profits. Cut profits and you cut research and development. Cut research and you slow new drug innovation. You may get cheaper and more widely available drugs in the short term, but you’ll also get worse drugs in the long term, and risk ending the greatest era in research in memory. Don’t big pharmaceuticals make enough money to take a hit? Sure, their profitability is slightly higher than some other industries — but that barely offsets the unique risks the drug industry has to take. Of more than 5,000 potential medicines tested at some point in the lab, on average only 3 get into clinical trials, and only 1 is approved for patient use. In all, only 30 percent of drugs make enough money to recoup the cost of their own research, and the average time it took to bring a new drug to market in the 1990s was close to 15 years, at an average cost, according to Boston Consulting Group, of $500 million.”
New York University professor Merrill Goozner challenges these assertions. In an online debate with Sullivan on Slate, Goozner, who covered the drug industry for the Chicago Tribune for years, described the claim that the industry spends $500 million to bring a new drug to market as “preposterous.”
“This bogus number is based on an industry-funded study that assumes all industry research is relevant and all its new drugs are clinically important,” Goozner wrote. “Nothing could be further from the truth. Much industry research is aimed at bolstering marketing claims for its existing products. And nearly half is aimed at developing minor variations of existing drugs. Indeed, one of the authors of the original study has corroborated my own estimate that in excess of 40 percent of industry R&D is aimed at producing such ‘me-too’ drugs.” Besides, Goozner argued, a significant chunk of industry research is funded by the U.S. government. “The National Institutes of Health will spend $2.3 billion in AIDS-related research next year. PHRMA, the industry trade group, proudly claims its members have 73 AIDS drugs in development and then quietly admits that most firms are receiving substantial government aid (usually through collaboration with NIH-funded researchers) as they try to move them from the laboratory to the marketplace.”
According to Goozner, the bottom line isn’t about whether pharmaceutical companies should be run as for-profit endeavors. “It’s the size of the rewards that are being questioned. And when it comes to lifesaving drugs whose price puts them beyond many people’s grasp even here in the good ol’ USA, that’s a question whose answer should be based on facts.”
Kapczynski denies that distribution of AIDS drugs in Africa will be as chaotic and disorganized as critics like Goldberg claim. “No one is offering to dump anything out of airplanes. This is a tired red herring,” she says. “There are serious discussions going on at the moment in the U.N. and elsewhere about bulk procurement and distribution systems for AIDS drugs to ensure that they get to the people who need them.”
As for the arguments that the pharmaceuticals won’t be able to do R&D and produce new drugs if they can’t maintain current profit levels, her response boils down to “Show me the money.”
“It may be true that the American people will now start to demand an honest accounting of the way prices are set in this country,” she says. “If drug companies were willing to open their books and discuss how much they actually spend on the development of particular drugs, we could start to make reasoned decisions about how to value the work they do. And it may be that they need to rethink how they organize research — we might start, for example, by addressing the fact that pharmaceutical companies spend two to three times as much on marketing as they do on research.”
The fight, it is clear, has only just begun.
A time capsule loaded with smack from the bohemian underbelly of JFK-era America, Shirley Clarke’s 1961 film “The Connection” is an illustration of how much things change, and how much they stay the same. I’d be stretching to call “The Connection” a great film — it’s mannered and edgy, in a way that’s partly deliberate but also distinctive to its period — but it’s an important one in cultural and historic terms, despite being largely unknown. Watching this ensemble drama about a multiracial group of New York jazz musicians and beat philosophers in a run-down apartment, waiting for their drug dealer to show up, is like traveling back 50 years in time, only to encounter the same people you might meet on the street today (at least, in certain neighborhoods of Brooklyn, San Francisco, Austin and so on). At one point, the characters even debate the illusory distinctions between “hipsters” and “squares.”
A Park Avenue society girl turned Greenwich Village beatnik, Clarke was the pioneering female director in the early history of American independent film, good friends with John Cassavetes, Frederick Wiseman, Jonas Mekas and other downtown legends of the period. If her name and her films have virtually disappeared from history, that’s partly due to institutional sexism, no doubt, and partly to bad luck and bad timing. Milestone Films, which is releasing this version of “The Connection” restored by the UCLA Film & Television Archive, will go on to release Clarke’s 1960s documentaries “Robert Frost: A Quarrel With the World” and “Portrait of Jason,” an interview with a black gay street hustler, along with her 1985 comeback film “Ornette: Made in America,” about jazz legend Ornette Coleman. (Clarke died in 1997.)
“The Connection,” Clarke’s first feature, was a high-profile project, the screen adaptation of a 1959 Living Theater play by Jack Gelber that had become a cause célèbre despite scathing reviews, attracting uptown artistic types like Leonard Bernstein, Salvador Dalì and Lillian Hellman to take a walk on the wild side. Clarke and her producer, Lewis Allen, funded the film’s $177,000 budget — not so meager, at the time — through the then-unknown tactic of collecting small sums from a large number of investors, establishing a model that endures in micro-budget and mid-budget filmmaking to this day. (Weirdly enough, as Manohla Dargis has reported in the New York Times, former Republican presidential candidate Rick Santorum’s parents were among the investors, along with Norman Mailer and architect Philip Johnson.)
But once completed, “The Connection” only screened twice at a single theater on Manhattan’s 45th Street before being closed by New York State’s censorship board. I’m not sure which is more amazing: the fact that New York had a censorship board in the early ’60s that could control what movies the public saw, or the reason for the seizure of “The Connection,” which was two or three uses of the word “shit” (as a synonym for drugs). By the time some edits were made and the ban lifted, public interest had faded, largely because of a swath of unrebutted hostile reviews. Bosley Crowther of the Times, a noted get-off-my-lawn crank of the time, wrote an especially peculiar one in which he praised the actors, the live jazz soundtrack and Clarke’s “bold direction,” but described the film overall as “deadly monotonous, in addition to being sordid and disagreeable.”
I won’t pretend not to understand what Crowther was talking about. “The Connection” remains much better known among jazz fans for its soundtrack album featuring pianist Freddie Redd and saxophonist Jackie McLean (who play live in the film, as they did onstage), than it is among movie buffs as, you know, a film. Clarke should certainly get credit for exploring the faux-documentary format decades before it became a film-school gimmick (the story-within-a-story premise was already present in Gelber’s play), but the first 10 minutes or so of “The Connection” are decidedly awkward. Squaresville white filmmaker Jim Dunn (William Redfield) wanders around in his high-waisted chinos, trying to convince the group of crashed-out junkie hipsters to “act natural” and “be themselves,” and assuring them that he’s studied the documentaries of Robert Flaherty and knows what he’s doing. (A dig at the old-school variety of documentary film, before cinéma-vérité, I guess.) It’s clear that the addicts would rather relate to Dunn’s hipper African-American cameraman, J.J. Burden (an early role for future Hollywood character actor Roscoe Lee Browne), who is rarely seen but makes occasional oracular pronouncements.
In the interests of art, Dunn has apparently agreed to finance a major purchase from a smack dealer named Cowboy, but for most of the movie we are obviously encouraged to ponder the similarities between drug culture and Beckett’s “Waiting for Godot,” and to wonder whether Cowboy will ever show up at all. Prowling the dingy, open flat restlessly — it looks disconcertingly like a group household I actually lived in, 20-odd years ago — Clarke’s camera introduces us to the all-male assemblage, in fragmentary interviews. Leach (Warren Finnerty), a wiry, whiny fellow who looks and acts alarmingly like the young Steve Buscemi, is the official tenant. He is troubled by a painful boil on his neck, which may symbolize the fact that the other denizens suspect him of being gay. As his black friend Sam (Jim Anderson) will tell him later, he’d be more relaxed if he could “get with the whole homosexual scene.”
There’s also Ernie (Garry Goodrow), an embittered-genius West Coast white jazzman who has hocked his horn to buy junk, and Solly (Jerome Raphael), an educated, middle-class Jewish guy who has thrown it all away for philosophical reasons, or none at all. McLean, Redd, bass player Michael Mattos and drummer Larry Richie get fewer lines, but every so often pick up their instruments to deliver angled, edgy blasts of early-’60s hard bop. Today these characters would presumably be obsessed by some other cultural form — hip-hop or Scandinavian black metal or YouTube clips or hockey fights or something else I’ve never even heard of — and they’d be able to badger Cowboy with illiterate texts every few minutes. But they’d basically be the same guys; Gelber’s characters are drawn so sharply that many 21st-century viewers will identify people they know or used to know (perhaps even people they used to be).
When Cowboy finally arrives (played by Carl Lee, who would become Clarke’s longtime partner), he turns out to be the archetypal “hip Negro” in Ray-Ban shades, sporting a blazing white outfit and a messianic mien, and bringing with him an old-lady evangelist, as comic relief and cover story. He brings other kinds of blessings too, the kind that allow this cast of semi-lovable, self-destructive losers to get through another day. The central conflict faced by the characters in “The Connection” doesn’t have much to do with heroin, though — that too is a symbol or synecdoche. It goes way back before Clarke’s time, not to mention ours. If this film has something to say to us now — and I emphatically think it does — it’s about the costs and opportunities that come with “dropping out” of mainstream society, in the name of political-cultural-aesthetic rebellion. It asks a question that has no answer, one that every disgruntled young dreamer — every potential Shirley Clarke, of every generation — must face on her own.
“The Connection” is now playing at the IFC Center in New York, with other cities and DVD release to follow.
This article originally on
The Fix.
Here’s Ernest Hemingway, dead drunk on a stool in Cuba with his face on his hand and his hand on an ever-present mojito. He’s the tormented writer, hard at work at the daily scrubbing of his sins. Like the Hard-Drinking Writer, we’ve come to expect certain personality types to have certain habits: The Morose Musician with Keith Richards’ appetite for heroin; the Insecure Starlet with Marilyn’s taste for pills; the Monomaniacal Money Manager with a nose for cocaine. They are generalizations that have been imprinted by generations of popular culture. But the types don’t necessarily line up.
The logic of associating personalities with specific drugs seems natural. A German-British psychologist named Hans Eysenck spent the mid-20th century turning the eye of the scientific community from Freud’s behavior-based theories to individualized psychology—pioneering the science of personality. He considered this pursuit of matching personalities with drugs a pet project.
Eynsenck believed the ways people are inclined to think aren’t always the ways that make us feel best. And because drugs are the easiest way to modify temperament, it’s only natural for us to seek out those substances that keep us on an even keel. For instance, he thought that introverts, whose brains are always chewing at problems, should crave depressants to quiet the incessant mental chatter. Extroverts, easily bored, should chase the rush of stimulants.
His theory condensed individualized drug cravings into an easy, logical framework—but he was wrong. Or at least, he vastly oversimplified the concepts of both “personality” and “drugs.” Worse, his theory wasn’t borne out by research. Study after study showed both introverts and extroverts drinking alcohol (a depressant) to excess. And extroverts didn’t limit themselves to uppers; it seemed they would reach for all kinds of substances.
So where does that leave us? Well, scientists kept trying to tie the two nebulous concepts together. Over the years, as new methods of personality screening emerged, researchers continued to distribute questionnaires to groups of drug addicts. One major breakthrough came when four sets of psychologists independently realized in the 1980s and 1990s that a person’s personality traits—tendencies that are partially genetic and tend to last throughout life—can be pretty reliably described using five factors.
Introversion and extroversion weren’t enough, they thought. We should also consider openness to new experiences (think Bear Grylls), conscientiousness (Haruki Marukami), agreeableness (Mother Theresa) and neuroticism (Woody Allen) when trying to understand why people act the way they do. Thus armed, personality psychologists began fitting the various personality traits they had come up with over the years into what came to be called the “Big Five.” And lo, with a more accurate representation of traits, a connection between personality and drug use began to emerge.
People who tested high on neuroticism (indicating that they tend to be impulsive, emotionally unstable and anxious), low on conscientiousness (tending to be disorganized, unambitious and lazy), and low on agreeableness (tending to be uncooperative, unhelpful or misanthropic), were more likely to have problems with alcohol or drugs than people whose scores were closer to the middle, or reversed. Perhaps more interestingly to the question of whether personality traits led their owners to cocaine over alcohol, or marijuana over mushrooms, higher scores for each risky trait were linked to higher likelihood of using “hard” drugs like heroin, amphetamines or crack.
“There is some evidence that the more ‘bad’ traits you have, the harder the drugs you’re going to use,” says Michigan State Department of Psychology professor Chris Hopwood. “So super, super-impulsive, sensation-seeking, neurotic people might be inclined to use something like heroin, for example, whereas if you’re a little bit less impulsive or have more anxiety about things maybe you wouldn’t. Maybe you would use other drugs but you would be too afraid to use heroin.”
Not all the personality factors that appear in people with drug problems are negative, however:
Sensation-seeking—a facet of openness to experience that’s common among extreme sports athletes, explorers, philanderers and roller coaster-enthusiasts—is almost always associated with drug abuse, but doesn’t necessarily scale with using harder drugs. Marijuana users, for instance, have been shown to be high in sensation-seeking, with closer-to-average levels of neuroticism.
Sensation-seeking seems to be about 60 percent heritable—meaning about 60 percent of the trait comes from your genes—and appears to be related to the brain’s dopamine reward system, the same system that makes most drugs of abuse pleasurable. Sensation-seeking may even be related to where you live, through interactions with neighbors—or, in the case of, say, New York City, through self-selection. A study by Jason Rentfrow, Sam Gosling and Jeff Potter that was analyzed by Richard Florida on the Atlantic’s Atlantic Cities blog showed that Openness to Experience scaled with drug use when compared within states. And which states had the highest levels of both illicit drug use and openness? Colorado, Vermont, Oregon, Washington, Nevada, Massachusetts, New York and California.
Given the personality characteristics that seemed to split “hard” versus “soft” drugs, scientists began to wonder if—even if they couldn’t predict who would take uppers over downers—there was a way to predict who would become an alcoholic and who would abuse illegal drugs. The studies showed some remarkable similarities: One study conducted among veterans suggested that all addicts share interpersonal styles that tend toward loner, rebel and pessimist stereotypes, for example, which surprised no one who has ever seen “Leaving Las Vegas.” But there did appear to be a little something extra that could push a person into hard drug addiction.
People who use illicit drugs often have been shown to have higher rates of both extroversion and susceptibility to boredom, which may drive them into more situations where drugs appear, or simply make them more likely to crave new subjective experiences. And those who are particularly susceptible to boredom have been shown to use opiates more often.
But this is where the studies break down. Most research on the topic of how personality relates to drugs of choice is conducted among people who already have drugs of choice—addicts. And as any addict knows, once you’ve taken a shine to a drug, it can be exceedingly difficult to disentangle the personality factors that came before from the ones that came after. By the time the personality questionnaires are administered, who’s to say what caused the drug use and what the drug use caused?
“It could go either way,” says Hopson. “A person who uses heroin might end up having problems in their life. Perhaps he loses his job, perhaps then he starts stealing things. You could easily tell a story that goes, the heroin started first and then the person started doing all kinds of mean antisocial things. Or you could tell a story that says that the person was sort of a ‘bad’ person, if you’ll forgive the language, and one of the bad things they did was use heroin.”
There are also direct effects of drugs that scientists have to consider. Crack and cocaine abusers, for example, have shown personality traits related to the symptom of paranoia in certain studies, as well as depression and impulsivity and a trait terrifyingly called “psychoticism.” Because long-term crack or cocaine use can cause many of these effects, however, it’s unlikely that those traits cause people to take up stimulants. Rather, it appears that long-term crack or cocaine use might be able to alter the expression of certain traits to create a “stimulant user profile.”
Regardless of the qualms of scientists, however, quiz websites and message boards hoping to connect personality to a particular drug have popped up all over the Internet. Many focus on Myers-Briggs personality types (ENFP, ISTJ, etc.), which are commonly used by career counselors to assess how people prefer to perceive and organize information. Others skip the science altogether, selecting a drug you’re likely to use based on the clothes you wear, the events you attend, where you live, and your perceived flaws.
Will science ever reach that degree of accuracy—explaining just what it is that seems to make neurotic writers more likely to drink than use heroin? It’s certainly possible, says Hopson. “One way to think about personality is in terms of traits, which are stable and heritable. But you can also think about personality dynamics, like how do I react if you insult me, for example. That’s sort of my guess is that which drugs you use depend on the more complicated personality dynamics.”
Assuming you’ve got the traits that push you toward drug use in the first place, what else might lead you to one substance over another? Hopson says factors that play a role include what your parents use, what your friends use, and even simply what’s available where you live. Which perhaps explains Hemingway’s situation better than we could have expected: there sure was a lot of rum in Cuba.
It was sometime around 2 a.m. when I heard the car doors slam. I live on a very quiet street in Fort Collins, Colo., surrounded by working families who are usually falling asleep under the blue glow of their TVs by 10 p.m., and any noise in the night usually means that something is about to happen. And on that night I was certain it was about to happen to me.
Six marijuana plants were growing in my basement and because of shortsighted planning on my part, their odor had gotten completely out of control. Having never grown pot before, I foolishly overlooked the prominent admonitions printed in every growing guide I relied upon to help me with my harvest, that odor control was of the utmost importance. But equipment designed to mask the smell (ozone generators, activated carbon filters) is expensive. How much stench could six little plants really produce? I remember thinking. Well, a lot.
As I lay there in bed night after night praying that sealed doors and windows would at least contain the eau de cannabis indoors and not alert the neighbors to what I was up to, I inevitably questioned my wisdom. I’m not a drug dealer or suffering from some crippling illness. I don’t even smoke marijuana for fun; if I did, I’d at least have a better excuse for subjecting not only myself but my wife and son to the stress of running a clandestine suburban marijuana farm.
I’m just an author whose idea to research and write about medical marijuana laws and the legalization debate through hands-on experience seemed damned near genius when I concocted it in late 2009, while watching an episode of “Weeds.” That looks subversively fun, I thought. And profitable. And hey, I live in Colorado, one of what was at the time 13 states to approve medical marijuana use. Writing about this law and all of its attendant controversies — is it just a ploy by clever potheads to give legal cover to perfectly healthy stoners, or was there something to the whole medical benefits argument? — through complete immersion was a no-brainer. I’d be the A.J. Jacobs of pot and have far more fun than he had: Would you rather try to abide by the dictates of the Bible for a year or grow some weed and try to abide by your state’s medical marijuana laws?
Diving into the deep end of a subject is nothing new for me, even if it means breaking the law. I once tried to smuggle a diamond out of West Africa while researching diamond smuggling for “Blood Diamonds” (the rough diamond I bought on the black market in Freetown, it turned out, was a fake, but I didn’t know that until I got to the United States). I learned how to pick locks for “Flawless,” a book about a diamond heist, and I even snuck myself into the vault that was robbed so I could see what it was like. Compared to those minor crimes committed in my dedication to research, what was growing a little pot?
A lot more than I’d bargained for, as it turned out. First of all, it’s no minor crime. It’s a federal felony to grow even a single marijuana plant, with a minimum fine of $250,000 and a minimum five-year prison sentence. This is true whether you’re growing to alleviate the symptoms of chemotherapy, to get stoned watching “South Park” or for journalistic research. I knew this going in, of course, and figured that with so many people growing marijuana in Colorado at the time — in late 2009, in the wake of the Ogden memo, which signaled that the feds were going to leave state-sanctioned medical marijuana users and their suppliers alone, you were hard-pressed to find someone who wasn’t at least considering the idea — there would be safety in numbers.
While this turned out to be generally true, there were a number of worrisome developments once my plans were too far along to stop, primarily a steady stream of arrests and DEA raids on people using the medical marijuana law. The most high-profile was the case of Chris Bartkowicz, a suburban grower in nearby Denver, who was raided by the DEA and busted for growing more than 200 plants. He came to the attention of the DEA by going on the nightly news — using his real name and not bothering to obscure his face — to boast about his grow operation, an unfortunate decision compounded by the fact that his house was located within 1,000 feet of an elementary school, an automatic sentence enhancement.
I had no plans to even remotely follow his example. Once I qualified as a medical marijuana patient (with the help of a doctor whose definition of “severe pain” helpfully included my complaints about a sore back) I would only be growing six plants, the maximum allowed under state law for individual patients. My home is half a mile from the nearest school. And I obviously didn’t intend to issue a press release to the TV stations about my little project
But still. Bartkowicz faced 40 years in prison (he took a plea bargain and will serve five). I was fairly certain that the DEA wouldn’t waste its time taking down such a small-timer like me, but once the pot began to bloom in the basement and become fragrant, even I started to wonder if they’d somehow multiplied from six into 600. A Catch-22 of the state medical marijuana law is that the only way you can prove you’re in compliance with it is after you’ve been busted. If it’s the DEA that does the busting, whether you’re toeing the line or not is immaterial — federal law trumps state law.
The slamming doors in the night turned out to be nothing, of course. Just some neighbors coming home from a late dinner. Is this really worth it? I asked myself, crouched in my underwear and peering through the curtains.
The answer was yes, and for a most unexpected reason. Before this experiment, I was perfectly ambiguous about whether marijuana was legal or not. I wasn’t opposed to recreational smoking but because I don’t use it myself, I haven’t felt much enthusiasm to agitate for its legalization. If you’d pressed me, I would agree that the expense of enforcing its total prohibition — an expense borne not just by taxpayers, to the tune of some $13 billion annually, but also by those who are busted and face personal and financial ruin — makes little sense, but also that there are more pressing issues to deal with. And like many who haven’t given the matter much thought, I had some skepticism about its purported medical benefits. Without a pressing medical need prompting me to find out for myself, I was happy to let more interested parties hash it out.
What propelled me into the debate was the outrage medical marijuana laws had generated, not just in Colorado but across the country. The often ill-considered over-reaching by marijuana proponents — for many reasonable people who are undecided about pot, garish dispensaries blazing neon pot leaves from their local strip malls feel like being given the finger — was nothing compared to the militaristic hysteria unleashed by the federal government. Cops were busting into homes and blowing away the family pets looking for reefer and in many cases, turning up next to nothing. Perfectly sober businesses (to speak in relative terms) that followed the letter of their state laws were being pulverized under the heels of DEA agents. Although my personal experiences with marijuana are limited (and well in the past), I knew enough about the effects of pot to realize that the governmental reaction was far out of proportion to the actual threat.
That perception became sharply focused the more I learned about marijuana’s potential as a valid therapeutic tool in treating everything from cancer to nausea. The government’s rabid insistence that medical marijuana is as real as the tooth fairy is simply wrong. The National Institute of Cancer sees promise in its ability to attack tumors. It’s been known for decades to battle chemo-induced nausea better than oral drugs that have the obvious drawback of being vomited up before they can take effect. MS patients have used it to ease the spasticity in their muscles. Cannabinoids — marijuana’s unique ingredients that interact with specific receptors in the brain — have anti-inflammatory effects and can relieve pain. Importantly, cannabinoid receptors aren’t found in the parts of the brain that regulate breathing, which could be one of the reasons no one has ever died of an overdose, making marijuana safer than many foods we eat.
Delving further, I found that one of my own relatives, a cousin who had lost a battle with mesothelioma, had used marijuana to cope with chemotherapy. She lived in New York, where her caring friends and family members had no choice but to deal in the criminal underground to get it, while in nearly a third of the states (most of them in the West) patients could shop with dignity at their choice of dispensaries. That perfectly healthy people who’ve faked their way into the system can do so too is — to me, at least — a small price to pay for those patients to safely obtain the relief they need. It’s certainly not an abomination worthy of the crackdown that has resulted.
Medical marijuana laws are not perfect. They can indeed be easy for healthy people to abuse. Without the involvement of regulators early in the process of developing systems for sale and distribution, which requires a state government more willing to address the issue than simply by plugging its ears and covering its eyes, hoping it will go away, chaos can result. Cops and politicians are going gray overnight with impotence and confusion, usually causing them to overreact and unleash the hounds. Chronically strait-laced citizens who will never believe anyone but the government on this issue see them as evidence of moral meltdown.
But one of the unintended consequences of these laws is that it forces more reasonable folks who might never have given much thought to the issue of medical marijuana — people like me, in other words — to take the effort to sort through the hype. It sounds trite to herald my enlightenment as something newsworthy when so many have figured out long ago what an indefensible failure the war on marijuana has been and that it’s morally repugnant to continue it in the face of mounting evidence of its credibility as a medical substance. But the truth is, without medical marijuana laws and all of their attendant upheaval, I never would have been interested enough to grow my own and embark on my own process of discovery. I may never have seen the light.
In that regard, federal drug cultivation laws were the best ones I’ve ever broken.
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KERMIT, W.Va. — It takes less than a minute to drive past Kermit, five to tour the place entirely. An old coal mining town with barely 300 residents and one blinking light between the train tracks, Kermit has no supermarket, no clothing store, no main drag. Main Street is really a side street with rows of cottages, its biggest building, the Kermit community center, empty and boarded.
Yet in this tiny town, the Kermit Sav-Rite Pharmacy used to be as busy as a New York deli. Six employees worked the counter, lines at the drive-through window snaked around the square cinder-block building, and the parking lot was full day and night.
Of course, everyone in Kermit — just about everyone in the wooded hollows of Mingo County — knew the Sav-Rite was a pill mill. It handed out Xanax, Lortabs, Vicodin — all manner of the prescription painkillers and anti-anxiety drugs that are crippling Appalachia like a rogue disease — to anyone with an excuse. Kermit, which sits in the poorest, most remote corner of southwest West Virginia at the Kentucky border, was drawing pill addicts from all over the Eastern seaboard. People were throwing pill parties in the parking lot. Trading pills, buying, selling, injecting, snorting, the works.
This went on for years before the law could stop it. In February, more than two years after the DEA and FBI stormed the Sav-Rite, seizing cases of files, its owner, John T. Wooley, pleaded guilty to selling prescription pills by fraudulent means. Wooley, in cahoots with a pill mill “pain management” clinic that existed to sell scripts, was filling prescriptions as if the fate of mankind depended on it. The Kermit Sav-Rite, along with another one Wooley owned in a tiny hamlet about 10 miles from Kermit, together doled out enough hydrocodone, the main ingredient in Vicodin and Lortabs, for every man, woman and child in West Virginia (population: 1. 8 million). The Sav-Rites moved almost 3.2 million dosage units of hydrocodone in 2006, the year the U.S. attorney used to make a case, compared with the national average of 97,000. Wooley, who sold the Kermit store a few months ago (he lost the other to the feds’ raid), faces four years in prison and a $250,000 fine at his sentencing in May. At 76 years old, he could probably better afford the fine than the time. Agents who raided the Kermit store said cash drawers were so stuffed they couldn’t close.
But shutting down pill mills in these parts is like playing Whac-A-Mole: As soon as a lawless “pain management” clinic or pharmacy is smacked down, others spring up. Investigations take years before prosecutions can be secured. And pill mills are only part of the problem. Most often, pill addicts get their drugs from friends or on the street. Drug gangs from cities like Detroit, Atlanta and Columbus, Ohio, have also moved in on the action, setting up drug “stores” in residences and other fronts. Almost fondly, people here recall when Oxycontin was jokingly called “hillbilly heroin ”and pill addicts were “pillbillies.” No one is joking now. What is happening in Appalachia, about 10 years into an explosion of prescription drug abuse, is so pervasive a problem that law enforcement officials say they cannot solve it alone.
The West Virginia newspapers offer daily examples of what the Mingo County sheriff, Lonnie Hannah, calls the “spinoffs of drug abuse”: Murders, assaults, robberies, burglaries, domestic violence, child abuse, child neglect, elder abuse, DUIs, overdose deaths. West Virginia, the ninth smallest state, has the highest rate of prescription drug overdose deaths in the nation.
Hannah estimates that two-thirds of the crimes and incidents his department handles are related to pill abuse. Chasing down pill dealing is more than enough work by itself. “It’s all over the county,” Hannah said, at his headquarters in the city of Williamson (nickname: Pill-iamson), the Mingo County seat. Authorities keep busting pill mills and dealers in the city of 3,000 residents, only to see them start up again. “Whenever we move in,” Hannah said, “they move around to someplace else.”
People in these parts have a word for pill abuse: “pilling.” So much of it goes on that everyone has a story. They know someone who has abused or is abusing pills. They know parents who have lost custody of their children or neighbors who have lost good jobs or friends who have died because of them. They are shocked to hear that in some places in the country, say, San Francisco, pilling is neither a word nor a fact of life.
But that could be changing. As the Centers for Disease Control and Prevention keeps warning, prescription drug abuse is spreading. Pills, especially Xanax, the anti-anxiety drug manufactured by Pfizer, and Vicodin, Loracet and Lortabs, highly addictive opioid painkillers familiar to anyone who has had a wisdom tooth removed, are being abused more and more, all over. What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.
You can find pockets of pill abuse from Orange County, Calif., to Staten Island, NY (sometimes now called Pill Island). Nationally, the abuse of prescription pain relievers, as evidenced by treatment submissions, has gone up 430 percent in the last decade, according to a new report by the Substance Abuse and Mental Health Services Administration in Washington, D.C. The report says states with the highest rise in prescription painkiller abuse include Maine, Vermont, Delaware, Kentucky, Maryland, Arkansas, Rhode Island and West Virginia.
Last June, pill addiction on Long Island raged into the headlines when a 33-year-old Army veteran, David Laffer, shot and killed four people in a Medford pharmacy while he robbed the store for hydrocodone. A Vicodin addict, he had been getting the drug through doctor shopping — going from one doctor to another to sidestep the monthly limit for scripts — until he lost his job and his insurance.
“If there is a discussion of doctor shopping and prescription pill abuse,” Laffer said upon his sentencing to life without parole, “then perhaps some good can come from this.”
Laffer’s story lingered for barely more than a news cycle. But the spread of pilling may be the saving grace for Appalachia and the other mostly poor, mostly rural parts of the country where little white pills are leveling entire communities.
They offer the cautionary tale: Political leaders, health professionals and community groups in these parts who have been crying for help can show the rest of the country what can happen when pilling runs rampant.
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Once, maybe just a few years ago, domestic mayhem like the kind described in the March 28 Williamson Daily News would have been the talk of Mingo County for days on end.
A 911 call brought sheriff’s deputies to unincorporated Dingess, a cluster of houses off a gutted path that can only generously be called a road. A couple had been fighting over pills.
Officers found 32-year-old Charles Earnest Chapman bleeding from stab wounds over his left eye and his abdomen, blood all over the house, a small white pill and pill residue by a children’s play area, and two kids, barely toddlers, hanging out of wide-open windows. In the yard lay an empty bottle of Lortabs, 90 mg. April Dawn Vance, 24 years old, had stabbed Chapman and fled the house, she told officers, after Chapman had knocked her to the ground, beat her and choked her. The children became wards of the state, the couple wards of the county jail.
The story did not prompt a single comment in the local news. Nor did this home invasion, reported the same week: In Williamson, Mingo County’s big city, with 3,000 residents, a man arrested for robbing a house admitted to another robbery where he and a cohort stalked an 85-year-old man, busted into his house, beat him to the floor and stole $340 from his wallet. Police said the man admitted he used the money he stole from the elderly man to buy pills. The Williamson police chief advised residents to lock their doors and windows and be vigilant.
Shootings have become news briefs. On April 2, a 33-year-old Mingo County woman, an admitted pill addict, was sentenced to 40 years in prison for shooting her husband to death during an argument.
Too many pill stories have knocked the shock out of the populace. Southwest West Virginia in the age of pilling is like a country that has been living with war for so long, people could barely remember peace.
Ask people how pilling started and most blame coal mining and Oxycontin. Miners spend much of their time in backbreaking positions, crouched, bent and folded over, and men anxious to keep their jobs have long relied on strong painkillers to keep going. Oxycontin began making the rounds here in the late 1990s. Its maker, Purdue Pharma, touted it aggressively to doctors as a safer alternative to hydrocodone-based pills like Percocet or Vicodin because of its time-release formulation.
That proved a boon to Purdue Pharma, which sold over $1 billion worth of Oxycontin a year. It also proved a lie: In 2007, Purdue Pharma pleaded guilty in federal court in Virginia to misleading doctors and patients by making false claims about Oxycontin’s safety. It paid a $600 million fine, the only time that Big Pharma has been publicly implicated in the pill abuse epidemic.
These days, the coal mining industry in West Virginia is rife with pilling. In March, a lobbyist for the West Virginia Coal Association told state lawmakers that the association suspects that miners from Kentucky and Virginia who were suspended after failing mandatory drug tests are now working in West Virginia. West Virginia is considering mandatory drug testing as well, especially after several incidents. In one recent accident, the lobbyist said, a miner high on prescription drugs crashed a locomotive into a mine car, killing a co-worker.
Oxycontin, public health experts and addicts themselves will tell you, is not the most-abused prescription drug in West Virginia. In 2010, the drug was reformulated to make it harder for addicts to crush, snort and inject it. But public health experts say that even before then, by the mid-2000s, hydrocodone-based pills like Vicodin and Lortabs, and Xanax (generically, alprazolam), a benzodiazepine used to treat anxiety and panic disorder, were the drugs of choice in the dirt-poor areas of Appalachia, along with methadone and Percocet. Research on why points to “social determinants” such as poverty, lack of education and lack of opportunities, said Robert Pack, a public health expert at the East Tennessee University College of Public Health who has been studying pill abuse since 2002.
Mingo County (population.: 27,000), which became famous for the Hatfield-McCoy feud of the late 19th century and the Matewan union-busting massacre of 1920, is second only to its neighboring county, McDowell, for the highest rate of overdose deaths from pills in West Virginia. Both counties are poor, McDowell the poorest in the state.
But the women at Crossroads, a kind of halfway house for recovering addicts in the town of Gilbert, at the southern end of Mingo County, come from very mixed backgrounds. Some come from broken homes and awful childhoods, others from loving parents. Some never finished high school, others are college graduates.
They consider themselves lucky. They landed in jail or committed to mental wards and were forced to go clean.
Crossroads, run by the Mingo County STOP (the Strong Through Our Plan Coalition, a nonprofit community organization focused on drug prevention and treatment), requires a 90-day commitment. But many of the women end up staying longer, some longer than a year, as they earn high school equivalency diplomas and, often, try to regain custody of children they lost to the state.
Crossroads is a white single-wide trailer with a big sign on it; the whole town knows what it is and why its residents are there. But that has not hurt their job prospects. Every woman at Crossroads has a job. Local employers like hiring them, they say, since they know the women are clean and routinely drug-tested.
On a recent visit, the women were buzzing over the break-in, the night before, of one of Gilbert’s four pharmacies. The thieves had sawed through concrete dividing the building’s cinder blocks, the same break-in technique used at the Kermit Sav-Rite some months ago.
Long discussions with six of the eight women, who ranged in age from 21 to 37, found few patterns. Several had started using pills after doing other drugs. Others were given a pill by a friend. One had become hooked after receiving a legitimate prescription.
Most ended up on the Oxy Express, driving 15 hours with others, every two weeks, to central Florida to obtain scripts from pill mills there. Until recent crackdowns in Florida, it was the go-to place for pill heads from Appalachia to get their drugs. They’d buy cheap prescriptions and come up and sell them for five times what they paid. The general price on the street for pills is $1 per milligram, so that a 30 mg. Lortab costs $30. But in rural southern West Virginia, because of the demand, the pills cost more: 30 milligrams for $40, 90 milligrams for $100.
Now, the women said, more pill users are heading to Georgia and other states.
Several of the women became criminals: thieves, armed robbers. One of them had just found out that her best friend and pill partner, 21 years old, had been sentenced to 30 years in prison for armed robbery.
Christine, a 35-year-old recovering opioid addict from Charleston — she did heroin, pills, “anything I could shoot up” — works as a bookkeeper at a local company. She had done drugs all through college and for years on end afterward, supporting her habit by selling pills and manufacturing methamphetamine. She was saved, after two overdoses in a month, when her mother and brother had her committed to a hospital. Now, a year and a half after entering Crossroads, she is a sponsor to other women and to inmates at the county jail.
Gilbert, with 450 residents, is not exactly a haven from pilling. Its nickname is Pillbert. The former executive director of Crossroads was forced to quit when she confessed that she herself was in active addiction. Her husband, a church pastor, was fired from the church after he was spotted at a methadone clinic, receiving treatment for his pill addiction.
But the women at Crossroads tend to come from other parts of the county, or outside it altogether. For them, Gilbert is safer than returning to their own towns.
Christine said she thinks Gilbert will be a great place to raise her son, now 3 years old. She is hoping to get him back from her sister in Columbus within a year. “Of course,” she said, “nowhere is completely safe.”
Two years ago, Bill Clegg’s first memoir dropped like a bombshell on the New York media world. “Portrait of an Addict as a Young Man” chronicled the handsome and hugely successful book agent’s descent into a harrowing crack addiction that cost him his career, his boyfriend and his savings — and left him broke and in rehab. In one harrowing part of the book (excerpted in New York magazine) Clegg decides to blow off a first-class flight to Berlin after a week without sleep for a crack binge and sex with the cabbie driving him to his airport hotel. Staring at his pile of drugs, he wrote, “I wonder if somewhere in that pile is the crumb that will bring on a heart attack or stroke or seizure. The cardiac event that will deliver all this to an abrupt and welcome halt.”
In the years since the events of the first book, Clegg has rebuilt his career as an agent and become one of the best-known faces of addiction recovery. (He is also the rumored muse for “Left-handed,” a recent book of poetry by Jonathan Galassi, and the supposed inspiration for one of the lead characters in “Keep the Lights On,” Ira Sachs’ well-reviewed new film about a troubled gay relationship).
Now Clegg has written a follow-up, “Ninety Days,” a tumultuous chronicle of his early sobriety. The book begins with Clegg’s release from rehab and follows him as he struggles to keep clean for 90 days, a milestone for those in recovery. Over the following weeks, he tries to rebuild his shattered life — befriending other recovering addicts, searching for a new apartment and shuttling from meeting to meeting — but before long, he is once again drinking, smoking crack and having anonymous drug-fueled sex. Thus begins a dramatic series of relapses.
The book, which is written in straightforward, readable prose, is an often-vivid testament to the difficulties of overcoming addiction and the value of companionship. Despite occasional moments of cattiness (Clegg can be ungenerous in his description of other meeting attendees), Clegg comes across as a deeply troubled but a perceptive and sympathetic man, learning lessons about addiction in some very difficult ways.
Salon spoke to Clegg over the phone from Manhattan about the fallout from his first book, the unique appeal of recovery memoirs and why he won’t be writing another book.
It’s been a long time since the events of this book happened, and now you’re doing interviews and publicity about them. Does it feel strange to be rehashing all this stuff?
I wouldn’t say it’s strange, because one of the ways I’ve stayed sober is to stay very close to the things that happened, both when I was using and also in early recovery. I can’t talk enough about those early days of getting sober, because it’s the things I did and the lessons I learned — and the things suggested to me in those early days — that keep me sober today. The more comfortable I get and the more I forget it, the more vulnerable I am to relapse. And it’s pretty simple. Those experiences in those first 90 days are ones I never want to get away from and never want to forget.
Your first book was about your descent into drug addiction and alcoholism. This book is about your recovery. Why did you write it?
It came from a sense of not being finished when I completed the writing of “Portrait of an Addict.” During the three years it took to write that, I felt tethered to this live thing that needed my care and attention. I had this expectation that when I was done I would feel severed from that and I didn’t. So I just kind of didn’t stop writing. But I don’t feel connected to it, or any writing, at this point. I feel completely done.
In what sense?
Finishing this book, the process definitely stopped. I was reading the audio book a couple weeks ago and I hadn’t seen the text in a while. Reading from beginning to end, I almost couldn’t identify with the person who wrote the book. I identified with the person who lived the experiences, but I couldn’t really identify with somebody who would sit for six hours at a time and see that [book] to completion. I just don’t have it in me right now; it’s beyond my imagination that I’d be able to write anything longer than an email. Which is a relief, let me tell you. These books just sort of bullied their way into existence. I have a pretty busy day job as an agent, so I’m kind of amazed that they exist, these things.
What do you think is the overall message of this book?
I thought that once I got out of rehab that if I just stayed away from drugs and alcohol and followed a few simple suggestions there would be a clean narrative of getting sober, that there’d be a before and after that would be clearly defined. And that process for me was a lot messier than that. So if there’s a message in there, it’s that the only way that, in my experience, I’ve gotten sober and seen other people get sober is by asking for help and getting involved deeply in a community of addicts and alcoholics in recovery.
The first book was such a huge success. How did you deal with the sudden fame that came with it? The book included some pretty shocking scenes.
I guess I dealt with that in the same way I dealt with every difficult or wonderful thing, which is one day at a time. If I step back and regard any aspect of my life, whether that be my relationship with my family, or my job, or that publication, or this one, I will probably get overwhelmed and driven to my knees in exhaustion and despair. I was busy at that time doing my job so I just did everything that I always do but maybe with a little bit more desperation. I didn’t stop and look around and try and make meaning of any of it. I just kind of showed up to what I needed to show up to — whether it was an interview or working on the copy-edited manuscripts or whatever — and then moved on to the things that crowd my life.
Do you think your disclosures from “Portrait of an Addict” have changed the way people interact with you?
Because my collapse and the revelations of my alcoholism and drug addiction were so known to people in the book publishing world, it sort of mediated or affected every interaction I had professionally when I came back to work, whether that was with prospective new clients or colleagues. I think because that history was informing so many of my interactions and relationships, I got used to it as a kind of third person in the room. In terms of people outside the sphere of book publishing, it was challenging. I’m a self-conscious person by nature, and there were certainly uncomfortable moments.
Is there one big moment is “Ninety Days” that stands out to you as being particularly meaningful?
When I look back and try and locate some moment where a great shift occurred, it was the feeling [at one point during the recovery period covered in the book] when I was walking toward a place where I did drugs all the time. I was walking towards the door and thought of Polly (this woman I got sober with who is still very close to me) who was not sober at the time. She was, at that point in her recovery, pretty dire — like life or death. I felt like if I went in and got high and went down that rabbit hole, she might show up to a meeting and find out that I had relapsed and that that would keep her out of there.
My involvement in her recovery and connection to her was the thing that stopped me from walking through that door. Somehow the pull of my feeling of usefulness and responsibility to Polly was greater than my desire to use. That was the first time anything stood between me and a drink or a drug. And I turned around and walked away. Very soon after that, the obsession to use and to drink lifted, which was something that hadn’t happened in all of the time that I had tried to get sober.
To me that reminds me how important it is to stay connected to other people in recovery. To me recovery is sort of moving from the first-person singular to the first-person plural. For me as an addict, I can get very consumed with my own anxieties and worries and struggles and ambitions. And if I get too wrapped up in those thing and lift away from my usefulness to other addicts, I’m most vulnerable to relapsing.
In the book, you enter a lot of spaces in which people are meant to be anonymous. There must have been tension between describing the people and wanting to preserve their privacy.
I felt very comfortable talking about my experience getting sober without naming the program of recovery that I’m involved in. And in the instances where there are people in the program that I got sober with and who are still in my life, I spoke to them about the fact that I was going to describe our experience and went to lengths to protect their anonymity and their privacy and followed their lead in terms of what they were comfortable with and what they weren’t. The main point is to transcribe my struggle to get a toehold in sobriety and maintain it. I didn’t feel that the focus of the book is on anyone else’s recovery necessarily, outside a handful of relationships that I had and still have.
One person in the book about whom this question arises is the character of Asa, whom you describe extensively as he helps you during your early sobriety. I’m assuming you weren’t able to get his permission to write about him.
I didn’t think so. He was, he made it clear at a certain point that he didn’t want to have any contact with me because he was no longer sober. But I’m very happy to report that he’s come back into recovery and is sober. He knows that he is in the book, and that he is well masked. I went to great lengths to protect his privacy.
You’ve been the rumored “muse” of a few projects that have gotten coverage in the media in the last few months. How does it feel to be the subject of that kind of attention?
I don’t really have anything to say about that.
One of those projects, the film “Keep the Lights On,” recently got a distribution deal. Did you have any participation in that?
I guess I can’t really speak to any books or films that any other people wrote that I may or may not be connected to by speculation in magazines and elsewhere. It’s not my place.
Fair enough. Going back to your book, the most famous recovery memoir in recent years is the controversial “A Million Little Pieces,” by James Frey, which you allude to in the book. Did other recovery memoirs affect your way of thinking about this book?
You know I haven’t read, probably very consciously, other books of addicts and recovery — but particularly in the last seven years, when I’ve been involved in working on these two books. People I got sober with would use this phrase, “compare and despair.” I probably internalized that while getting sober and set out not to read other books about addiction and recovery when I was writing these. I would probably think they were better writers than me, or be affected by it so I just felt like in the writing of these books, I just had to follow my own instincts.
What do you think is the appeal of the addiction and recovery memoir for readers?
I think there are a lot of alcoholics and addicts in this world. And they touch a lot of people. It’s a disease that cuts through all class and age and race, and affects many, many people. I certainly myself felt very lost when I was first trying to get sober, and other people in my life felt incredibly lost. Both experiences are very isolating, so when reading an account of somebody getting sober — or in the case of David Sheff’s book “Beautiful Boy,” reading an account of a parent whose kid is an addict — I think identification is a powerful thing. It makes the struggle feel less singular, and it shows at least one particular path which one may choose to take or not take in any of those circumstances, whether you’re an addict yourself, or the father of an addict, or the daughter or son. I think people look to books to find answers, separate from addiction and alcoholism, they look to stories to illuminate their lives more clearly, to more clearly find their way.
I think there’s also the appeal of witnessing someone’s downfall and redemption.
Perhaps. People tend to make mistakes, and the reading of how someone may prevail against those mistakes may be encouraging to some people. If it is, that’s one use of those books.
Ernest Hemingway (Credit: John F. Kennedy Presidential Library & Museum) 
(Credit: Yellowj via Shutterstock) 
(Credit: iStockphoto/Salon) 
Bill Clegg (Credit: Brigitte Lacombe/Little, Brown & Co.) 
