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Honolulu. They were working full-time in seventeen states. They’d been in another seven or eight states at one time or another. He went on. The cities he mentioned all had large white middle classes that benefited hugely from the economic booms of the previous dozen years, and now had large Mexican immigrant populations as well. I hardly associated these cities with heroin. Were there heroin markets in these towns? I wondered. Yes, he assured me, they were big and getting bigger. He hadn’t even mentioned America’s traditional heroin capital, I noticed.
    “No, in New York are gangs, with guns,” he said. “They’re afraid of New York City. They don’t go to New York.”
    Mexican traffickers afraid of gangs and gunplay? From one tiny town? Selling tar heroin in not just Columbus, but as much as half the United States, including now a bunch of cities east of the Mississippi River for the first time?
    Right there, I was hooked.
    Cops say they’re from Tepic, I said finally.
    “No, they’re not from Tepic,” he said. “That’s what they say, but they’re not.”

Liberace in Appalachia
    South Shore, Kentucky
    In tiny South Shore, Kentucky, huddled next to the Ohio River, Biggs Lane amounts to a rural strip mall.
    For its entire hundred yards, Biggs Lane hugs Route 23. Wright Pharmacy has been on Biggs a long time. Near Wright’s is a dentist’s office and a chiropractor, a gas station and a Subway sandwich shop. Farther down is a flooring shop. Next to that stands a good-sized beige metal-framed building.
    To the south of Biggs is a street named Tootsie Drive and a neighborhood of small white wood houses that would be called quiet except that would be redundant. Everything in South Shore, Kentucky, population 2,100, is quiet, including the majestic Ohio River a hundred yards north. Across the river is Portsmouth, Ohio, wedged onto land where the Scioto River angles into the Ohio. In Portsmouth and South Shore is where another part of our story begins.
    In 1979, the same year that Hershel Jick up in Boston wrote his letter to the New England Journal of Medicine , a doctor named David Procter moved into that beige metal-framed building on Biggs Lane in South Shore and called his new clinic Plaza Healthcare.
    Procter had come to South Shore at the behest of Billy Riddle, the town’s family doc. Billy Riddle had been in South Shore for years. He delivered many of the kids in town, and treated every ailment as best he could. He had trouble turning down patients and needed help. Somehow he found Procter, a Canadian, who’d just completed an internship in Nova Scotia, and enticed him to South Shore in 1977.
    But within two years, Riddle had separated his practice from Procter’s and changed the locks on his doors. Not long after that, in 1979, Billy Riddle died of a heart attack and then only David Procter remained.
    Procter was a talkative and easygoing fellow. But he was flashy in a way foreign to the Ohio River valley. He wore diamond rings. He wore fur jackets. He drove a Porsche. “He dressed like Little Richard or Liberace,” said one nurse.
     
    Portsmouth is an industrial town in the rural heartland, an outpost on the Ohio River far from other towns. In their glory days, river towns were places for rambunctious men to explode after days cooped up on barges. Portsmouth once felt it necessary to outlaw swimming naked in the river. Back then, seven shoe factories and the country’s largest shoelace manufacturer were in downtown Portsmouth. A brickyard, a foundry, and the massive Detroit Steel Company attracted people from Ohio and Kentucky and employed thousands. Detroit Steel made bombs during World War II. Hundreds of people attended the inauguration of its new blast furnace in 1953, marveling at its size and happy with the jobs it would provide. Meanwhile, railroads took Portsmouth’s steel and shoes to the rest of the country. For years, sons took jobs at the factories where their fathers worked, and,