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For a deeper read on this subject, check out Sam Quinones "Dreamland"[1]:

"Ground zero for the pills is southern Ohio, West Virginia, Kentucky, places like this. In the mid-'90s, at that same time, across the Mississippi is coming the vanguard of a group of heroin traffickers out of a small town called Xalisco in the state of Nayarit in Mexico who are taking their drugs and looking for new markets. All of this kind of coincides."

"[Mexican drug cartels] used customer service, they deliver just like pizza delivery, and it really appeals to this new class of addict who were white, really kind of unfamiliar, maybe, a lot of times with the drug world."

"They don't want to get involved in Skid Row or some housing projects where everyone has always bought dope. A drug addict wants one thing above all and that's reliability. And these guys provided that above all. They relied on being very low-profile. They did not spend their money lavishly. They looked like the day workers outside your Home Depot. They drove old cars, they never used gunplay, drive-by shootings, any of that kind of stuff because, they didn't need to."

...

"All these guys don't like selling heroin. But here's the thing: Back in the town where they're from they have been humiliated all their lives. Their jobs are dead-end jobs. They work as bakers, they work as farm boys, they work as butchers — they don't have anything pushing them ahead."

"As this business model began to take hold, the effects were immediately seen in the town. People began to do better. They began to build big houses, they began to have nice trucks, nice cars. And all around them young men saw this. They saw that this was a route to real economic progress. One of the strangest things I encountered when I was doing this book was how Levi's 501s were these huge forces in pushing this system across the United States."

"They're these very well-made, very expensive jeans. Well, this system was a system for turning cheap heroin into ... stacks of Levi's 501s. The reason was that these dealers very quickly noticed that these addicts they were selling to were fantastic shoplifters."

"They would give these guys lists: 'I need Levi's 501s this size, this color,' because they would then take those jeans back home and act as Santa Claus. It was like this huge redemption: 'I left poor. And here I am bringing Levi's 501s for everyone.' And there was nothing cooler than walking around town during the fiesta or late at night on a Friday in your beautiful dark, blue Levi's 501s. For a person who comes from the smallest, most humble origins in these towns — that is a narcotic itself." [2]

I don't know to what extent things have changed since this 2015 book (my understanding is that the business has become more violent), but alongside with confronting China on this issue, improving the economy of our southern neighbors HAS to be part of the approach, otherwise, we'll just be playing Whack-A-Mole as the industry shifts around geographically, but there's still demand for the product and the jobs for young men supplying that demand.

[1] https://www.nytimes.com/2015/04/19/opinion/sunday/serving-all-your-heroin-needs.html

[2] https://www.npr.org/2015/05/19/404184355/how-heroin-made-its-way-from-rural-mexico-to-small-town-america

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The two I've know who used it are deceased. They were the children of friends and relatives.

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