In his 2015 book, Dreamland: The True Tale of America’s Opiate Epidemic, Quinones recounts how drug overdose deaths rose steadily through the 1990s and 2000s. Pharmaceutical corporations aggressively marketed opioid painkillers like OxyContin and told doctors the pills were not addictive. The market was flooded, and the heavy narcotic became the country’s drug of choice. Once the medical establishment realized its mistake, it was too late. People were addicted. When doctors turned off the tap, not everybody stopped using opioids. Instead, they turned to the streets. And there, an industrious Mexican gang from Xalisco, Nayarit, offered exactly what these desperate people were looking for. Just like OxyContin, heroin is an opioid. Only it is stronger, cheaper, and easier to find. Quinones, a former crime reporter for the Los Angeles Times, reveals how the “Xalisco boys” did for heroin what McDonald’s did for hamburgers: they franchised drug trafficking and made their product available on seemingly every corner.
Dreamland, for which Quinones received the National Book Critics Circle Award for general nonfiction, chronicles the subsequent downfall of Portsmouth, Ohio, and so many American towns like it. Though there was no happy ending, Quinones believed that the story he wanted to tell had come to an end. Traveling America in promotion of Dreamland, however, he found the country was not so lucky. Just as people addicted to opioids had turned from painkillers to heroin, so the 2010s saw them again discover a more potent source of the drug. With the arrival of the dangerous synthetic opioid fentanyl, the third wave of the opioid epidemic had begun.
In The Least of Us, Quinones recounts how opioid-related deaths not only continued to climb but skyrocketed to become the number-one cause of death for Americans under the age of 50. The book features vignettes from across the continent that paint a picture of a population that is hurting, but also healing, full of people who are supporting each other in unglamorous but vital ways. A bookish Mexican chemist named Ricardo Valdez-Torres is recruited by emissaries of Joaquín “El Chapo” Guzmán to cook fentanyl for the Sinaloa Cartel. A young woman from a broken family, Starla Hoss, lies in a nursing home in Elizabethton, Tennessee, after an overdose turned her into a quadriplegic. A judge named Scott Barrett establishes a drug court in conservative Hardin County, Ohio; where his predecessor simply sent drug users to prison, he sponsors a softball team, sets up an arts and crafts group for families, and in this way establishes a community for the people who pass through his courtroom addicted to drugs. “Jailing addicts is anathema to treatment advocates,” Quinones writes. “Waiting for a street addict to reach rock bottom and choose to seek treatment sounds nice in theory. But it ignores the nature of the new drugs on the street. Now, rock bottom is often death.”
Sam Quinones recently spoke to me about his new book, about fentanyl’s spread across the country, and about the failures of the War on Drugs.
TRAVIS LUPICK: In many ways, The Least of Us is a continuation of Dreamland, picking up where the earlier book left off. Could you tie the two together and talk about how one flows into the next?
SAM QUINONES: Dreamland was an analysis and chronicle of how we started down this path with pain pills, and doctors believing they could prescribe these pills without any risk of addiction. That proved untrue. It led to widespread addiction and, eventually, for many people, a transition to heroin. And the drug underworld — in Mexico, primarily — discovered that we had created — had gifted them — a brand-new market of people addicted to opioids. Pain pills were first, then came heroin, which is a chemical cousin.
Along the way, I came to believe that a crucial root of this problem was how much we had done to destroy community over the previous three or four decades. This involves things like sending jobs overseas. But it also involves an attitude toward life. “Prosperity” means being all alone, in isolation, being alone in a suburb where there are no sidewalks and no one walks outside. That’s become prosperity. That’s what we should all be aiming for. It was this destruction of community and our resulting isolation that seemed to be at the root of this epidemic. When I got into it, I began to understand that all of this story is about community versus isolation. That is also what left us very vulnerable to all of this.
In The Least of Us, I continue these themes. On the one hand, the trafficking world — out of Mexico — has taken the place of doctors, in the sense that they are now the ones supplying the drugs around our country. They have entered — probably never to return from — the synthetic era of drug production. No more plants, or much less of a reliance on plant growing. Now, it is all about synthetics. Drugs that you can make without any plant involved. Drugs that you can make in a laboratory, with chemicals. This makes perfect sense if you’re a trafficker, but not if you’re a user. If you’re a trafficker, it’s very profitable. There are no seasons anymore. There is no reliance on the sun, and land is not important. They’ve removed costs out of the supply chain and they’ve enhanced profitability. Fentanyl is the most profitable illicit street drug ever known, and methamphetamine is not far behind. And they are producing both these drugs year-round in supplies that are simply staggering — unbelievable amounts of these drugs. Because they can.
The other part of the of the book is about community care. I really set about finding those stories. We need to understand that we got into this because we wanted a big, sexy answer to a complicated problem to pain and pain management. And because we decided that one magic answer was going to solve all our problems. We need to move away from that. And so, this half of the book is taken up with stories — the least noticed, least sexy, most unheralded stories that I could find, of Americans involved in community repair.
The word “hope” in the subtitle lets readers know that this book is going to include possible solutions. Tell me about what you found traveling the country.
It’s a hard thing to find, if what you’re dealing with is fentanyl and methamphetamine, but I’m actually very optimistic. I am hopeful. Because what the opioid epidemic is telling us is, “Let’s reexamine how we’re living. Let’s reexamine what our priorities are. Let’s get back to what made us really strong as a country.” Which was a sense of community, which was a sense of knowing your neighbor. It sounds pollyannish. On the other hand, it’s extremely, extraordinarily powerful. And it’s particularly powerful when it’s done in small, unheralded steps, steps that are not going to be covered on the national news. So, I began to look for those kinds of stories.
There’s a story of a woman in Kentucky who removes tattoos. She removes a tattoo from a woman’s inner thighs, a brand that her pimp had put there. There’s the story of a small county sheriff — a crew-cut, Fox News–watching sheriff — who comes to a different understanding of what he should be doing and decides to reach out and give a job as a janitor to one of the more notorious heroin addicts in town, as he’s beginning to go through recovery. It’s the small stuff like that. It’s a man in a small neighborhood in Muncie, Indiana, a town bombed out by the departure of about 10,000 jobs over the last 30 years. And this fellow, as the neighborhood that he grew up in declines, he takes it upon himself to keep the local community center open. Even though the city has stopped funding it, even though the city believes it’s closed, he still has the key, and he keeps it open, to allow kids a place to play when everything is crumbling all around them. I wanted to tell stories that seemed to me to have some kernel of truth of where we needed to go as a country.
In several places, The Least of Us suggests that the drug war is a failure. But the book also largely relies on interviews with law enforcement, recounts their efforts to arrest drug dealers, and presents incarceration as a necessary push to get drug users into treatment. Some people will argue that this book follows a pro-drug-war narrative and thus embraces prohibition-centered drug policies. What are your personal views? Where do you position this book in discussions about America’s War on Drugs?
When I was writing Dreamland, this doctor was talking about pain pills, and he said to me, “We don’t understand pain very well, so we went through this period when we thought one solution would be the magic solution.” The same is true of the drug war. The drug war failed, not because of law enforcement, but because it was only law enforcement. There was no other real approach to it. We didn’t understand it very well. I was a crime reporter during the crack years. I cannot remember anybody in town — including in the Latino and Black communities — who were at all interested in more treatment, for anybody.
The point is not to say that, because law enforcement failed, it therefore has no role. That’s absolutely untrue. I can see no evidence that that’s true. On the contrary, law enforcement is essential. If this had been a treatment, War on Drugs — a War on Drugs that only used treatment — it would have failed, too. For a multifaceted, complex system like the brain and addiction, you cannot use one approach. You have to have it all. First of all, and most important, would be prevention. But I do feel, very strongly — and I believe the evidence shows, very clearly — that when you don’t have law enforcement involved, you are going to have some very difficult problems. People will get out of treatment and they will go right back to a place where the drugs are astoundingly deadly. And they will die, very quickly. We may not be able to arrest our way out of this. I certainly believe that. But we won’t be able to treat our way out of it, either. It needs a combined, community response.
Many times, I’ve heard from addicts, “I was safe because I was arrested. I got off the street.” Does that mean that it’s a good idea to send someone whose main problem is addiction to prison for 10 years for possession of stolen property? It does not. What it does mean, though, is that, together, law enforcement, probation, judges, and recovery communities — I talk about Hardin County, Ohio — can come together to be part of the solution. There’s no such thing as a long-term fentanyl user on the streets today. It is a very scary thing. And so, you need all the tools — a community of tools. And law enforcement is absolutely a major part of that.
In drug policy circles, there’s a growing push for people-first language and greater sensitivity around how we discuss people who use drugs. Using the phrase “people addicted to drugs” instead of “drug addicts,” for example. You acknowledge this in the book. But The Least of Us still uses the word “addict” throughout, and even “junkie” in a few places. Elsewhere, it describes people addicted to drugs as “stinking” and “stained.” I acknowledge that some of this language is used to share a specific town’s stigmatizing perceptions of people who use drugs, and that it’s not representative of your own views. But I also suspect you will receive some criticism, and that people will call the language you’ve used dehumanizing. Have you anticipated pushback on this? How would you respond to such criticism?
Sure. Let’s talk about the word “addict.” The word addict is in no way a pejorative term. The word addict is in no way a demeaning term. It is simply a description of someone’s state and part of that person’s life at a certain point, or perhaps a long part of that person’s life. In the same way, it’s no more pejorative than “migrant.”
On the contrary, it is extraordinarily important to use this word. Because the only way you get to reduce stigma around addiction is by telling stories. That’s what I’ve done with my books. Dreamland brought awareness that never existed before it. And the way you get there is not by diluting language. A six-letter, two-syllable word is infinitely better, in a storytelling context, than a phrase like, “person who suffers from a substance use disorder” — eight words. There’s no way you are going to tell powerful stories — which will be the key to reducing stigma — unless you use direct, concise language.
You traveled the country for The Least of Us. Tell us about your reporting journey.
It really grew from Dreamland. When I wrote Dreamland, I remember traveling the country, in 2013–’14, and nobody wanted to talk about this topic. No families with addicted loved ones wanted to talk about this topic. It was extraordinarily difficult to find people who wanted to do that. And when the book came out, my family and I just assumed that it would die, that there would be no interest in it. Because nobody wanted to talk about it. The experience was everywhere. It was all over the country. And yet there was this deafening silence surrounding the topic. Then the book came out, and all of a sudden, awareness began to emerge. Little by little — small steps; unheralded, unnoticed small steps — people all across the country came out of the shadows, where they had been living since their brother or their mother or their son had died of an overdose. They began to come out of the shadows. They began to be heard. At council meetings, at the state legislature, at governors’ offices, etc. And you began to see increasing awareness and changes in thinking. All across the country.
What happened was, after a while, very gradually, beginning in September 2015, three months after the book came out, we began to see this enormous, growing wave of invitations to come speak. And then, every year, it was more. I did 235 speeches in a four-and-a-half-year period. For small towns, conferences on public health, nurses, judges, and so on and so forth, from Syracuse to L.A. and Anaheim to North Carolina to Florida. It was an amazing thing. And that allowed me, as I budgeted a few days here and there, to see what was going on with the opioid epidemic.
I thought the story was done. Who moves on from heroin? All of a sudden, the underworld begins to figure out: “Fentanyl.” Fentanyl will kill anybody. Why would the underworld do it? Because it is so damn profitable. Why would you kill your own customers? Because it is so damn profitable. That’s why. This is not about demand. This is about supply creating demand. And about supply creating an enormous new problem, coast to coast. That is where The Least of Us was born. And along the way, I began to realize, “This is a very important story.”
I’m not Christian, but I started reading the Bible. I read Matthew, which is the most powerful, I think, of the Gospels. He says, “That what you do for the least of our brethren, you do for me.” I thought, “That is exactly what the opioid epidemic is teaching us.” It is saying that we’ve gotten away from that. We’ve been so isolated and so in our own little bubbles, in our little worlds, in our own little suburbias, that we’ve gotten away from the simplicity of life. It’s time to reexamine how we live.
I realized during Dreamland, when you’re writing about heroin, you’re really writing about America. You’re writing about Americans, and what we have become as a country. All of these problems are saying to us, “Stop. Think about how you’re living. Think about how you deal with others. Think about what your role is in the community.” All of that is so important. So, as I traveled the country, talking to people, I began to say, “I’m going to write about the smallest, least sexy stories of community repair, of people focusing on the least of us, that I can find.” And that’s where the book comes from.
Travis Lupick, a journalist based in Vancouver, is the author of Light Up the Night: America’s Overdose Crisis and the Drug Users Fighting for Survival (2022) and Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction (2018). Follow him on Twitter: @tlupick.