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opiates for neck, leg, and lower back pain, arthritis, and lower lumbar spine pain. He combined them with benzodiazepines—anxiety relievers, of which Valium and Xanax, Procter’s favorite, are the best known. In Portsmouth, people had anxiety and they had pain. Appalachia had a long history of using benzodiazepines—dating to the release of Valium in the early 1960s. Little old ladies used it. In this part of the country, anything that relieved pain was welcome. But opiates and benzos together also led quickly to addiction.
    By the mid-1990s, Procter was also known to prescribe a lot of diet pills and stimulants, even to those who weren’t fat. A modest industry evolved in and around Portsmouth of scamming prescriptions for diet pills from willing docs like Procter, then selling the pills for a profit. His Plaza Healthcare clinic boomed.
    In 1996, one who went to visit him was a man named Randy, a guard at the state prison in Lucasville ten miles north of Portsmouth. Randy suffered deep bruises to his back in a fight with an inmate. He was given a list of approved doctors to see. One was David Procter.
    “Several guys from the prison went there because his office could take care of the [workers’ compensation] paperwork,” Randy remembered.
    Procter took him off work for six months and, sure enough, handled all the paperwork, charging him two hundred dollars cash. He also prescribed a drug called OxyContin—40 mg, twice a day, for thirty days. The drug was a new painkiller, he said, and they were having good results with it.
    “Looking back on it, [the injury] was nothing that warranted that harsh of a drug,” Randy recalled. “But at the time, you’re thinking this is great because I don’t feel my back.”
    Thirty days later, Randy figured he was better and didn’t return to Procter for a refill. Soon he was gripped by what he thought was the worst flu of his life. He ached, couldn’t get out of bed, had diarrhea, and was throwing up. He talked to some friends. One suggested he might be going through withdrawal.
    Then it hit him: You’ve got to go back.
    Procter prescribed him more of the same. Randy returned every month, paying two hundred dollars cash for a three-minute visit with Procter and an Oxy prescription. Procter’s waiting room overflowed. People fought over space in line. Only a handful of patients were there for injuries. The rest were feigning pain, scamming prescriptions, with the doctor’s connivance. Randy saw six fellow prison guards in the waiting room. He kept his head down, got his Oxy prescription, and left.
    “You’re seeing people who you know are probably going to be locked up in one of your cellblocks,” he said. “It really humbles you. You think you’re doing stuff the way it’s supposed to be done. You’re trusting the doctor. After a while you realize this isn’t right but there really isn’t anything you can do about it. You’re stuck. You’re addicted.”
    Before long, he found street dealers he could go to if he ran out during the month. He returned to his prison job. But by then fully addicted to an opiate, he began arriving late and making excuses. Desperate, he finally went to a deputy warden. He got into treatment and got clean. Three and a half years after going to David Procter the first time, the addiction was over for Randy.
    For the Ohio River valley and America, it was just beginning.
     

The Adman
    New York, New York
    In 1951, an adman named Arthur Sackler from a little-known marketing firm met with the sales director of a small hundred-year-old chemical concern named Charles Pfizer and Company in New York City.
    Arthur Mitchell Sackler was thirty-nine and already had a career of achievement as a psychiatrist behind him.
    He and his brothers, Raymond and Mortimer, had grown up in New York, the sons of eastern European Jewish immigrants. They attended college during the Depression and all three passed briefly through the Communist Party, according to