The reporter who predicted the opioid epidemic is sounding the alarm on the next wave

An alley in Huntington, West Virginia, the epicenter of the opioid epidemic, in 2017. (Brendan Smialowski / AFP via Getty Images)

When journalist Sam Quinones set out to find a buyer for the book that became “Dreamland” ten years ago, there was little interest. Only one publisher was interested in the story of a town in Ohio ravaged first by Purdue Pharma, which sold pain relievers, and then by the Mexican black-tar heroin cartels.

“No one really knew what an opioid was,” recalls Quinones, who was a writer for the Los Angeles Times at the time.

The 2015 book went on to become a commercial and critical success, winning a National Book Critics Circle award. Others followed with work on the opioid epidemic, including Beth Macy’s “Dopesick,” now a Hulu series, and Patrick Radden Keefe’s “Empire of Pain,” on Purdue owners, the Sackler family. The business eventually collapsed under the weight of thousands of lawsuits.

Quinones’ latest book, “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth,” is – despite its somewhat upbeat subtitle – an equally scary read. Mexican drug traffickers have discovered how to make more harmful drugs more cheaply, effectively controlling the lives of addicts and communities across the United States

Quinones cuts the news from the traffic with stories about innovative drug treatment programs, drug courts, and drug addicts getting sober. But these victories seem derisory in the eyes of the traffickers, who count their victories by the ton or in the hundreds of millions of dollars.

One of the subjects of Quinones, a longtime drug addict in Kenton, Ohio, kicks the heroine and gets a job as a 911 operator. It’s “a good story” for the book, he admits. . When the man relapses, he seems to beg the reader not to give up hope: “This is not a Hollywood movie. That’s life and it’s hard.

Quinones spoke to The Times last week from Nashville, where he now lives, about the current state of addiction, how a new type of methamphetamine may explain LA’s homeless problem, and why he’s still hopeful. The conversation has been changed.

A heroin user displays a needle

A heroin user shows off a syringe in a southern Bronx neighborhood with the city’s highest heroin overdose death rate on October 6, 2017. (Spencer Platt / Getty Images)

When you finished “Dreamland”, were you planning to write another book on drugs?

No, because I was still thinking about the old school, and I was thinking about what could be worse [than heroin]? I also didn’t think anyone would read [“Dreamland”]. I had a terrible, terrible time finding people … who wanted to talk about it. And so I thought, nobody really cares about it. Then what happened was the book really helped raise a lot of awareness. More and more people felt the courage to come out of the shadows. I saw the fentanyl take hold. I have seen the methamphetamine problem become very sinister. So it all made me feel like it was a new era.

The general public didn’t quite understand the opioid epidemic when “Dreamland” was released. Now, after “Dopesick” and “Empire of Pain”, the Sacklers are public enemies. You might feel a sense of justification.

I remember visiting this very, very poor neighborhood in southern Ohio where OxyContin addiction was just rampant. It was just awful what he had done in this little place. These are people who already live in trailers. And I remember thinking to myself that there is no way this company so powerful, so rich and so far away, could ever be held to account for it.

At the time of rendering the manuscript, there were three lawsuits against these drug companies. Now there are – I can’t remember – 2,600, 3,000. I’ve spent the last five years just stunned by what has happened.

As this new book makes clear, the drugs in your first book are now a thing of the past. It’s like landlines in the drug world: no one uses them anymore.

We awakened this very sophisticated giant of an underground industry in Mexico to this new consumer base that we had created with the opioid epidemic. Fentanyl is in all respects superior [to heroin] if you are a trafficker. No need for land, growing seasons, farmers, harvest. You only care about the shipping ports.

Conventional wisdom has it that if demand in the United States were to stop, Mexican traffic would end. You say no.

Yeah, the vendors are running the show now. They have flooded the country from Vermont to LA so much with this very potent and extraordinarily inexpensive meth. Now you find people who were addicted to opioids [who] switched to methamphetamine. The trafficking world saw that there was this massive new consumer base of drug addicts who would buy anything cheap, powerful, and relentless. So they changed demand with supply.

You theorize that the Los Angeles homeless explosion can be attributed to a change in methamphetamine formulation in Mexico 15 years ago. I had never heard this before.

I believe that is most certainly what happened. In 2008, the Mexican government decided to make ephedrine [a stimulant long used in making meth] effectively illegal. And the world of trafficking had to switch to another form [known as the P2P method]. By 2012, 2013, tests [on seized meth] of the DEA [Drug Enforcement Administration] showed that everything was done with P2P.

What only becomes clear now is that P2P methamphetamine has profound symptoms of schizophrenia, primarily paranoia and hallucinations. Ephedrine meth was a popular party drug in the gay community. A sort of euphoria. But now this methamphetamine is plunging people into their own brains. There aren’t a lot of people who want to be with other people.

So when you drive through LA and see people who are naked, people crawling on the ground, what you see is P2P meth?

Yes. Also when I see big piles of bicycle frames, shopping carts. This stuff seems to generate hoarding in a spectacular way. It seems to drive people crazy and unable to live with other people, very quickly.

It’s not what I would call an optimistic book, yet the subtitle refers to hope. Were you worried that people wouldn’t want to buy more bad news?

It’s a complicated answer. I have been a journalist for 34 years and yet I am not cynical. I started to believe, as I worked through all of this, that what really got us into this problem was that we wanted magical, sexy answers to very complicated problems. It appears to be a damaging narcotic in itself and creates all kinds of unintended consequences.

The real way to make change is to work in small steps, in small steps, without looking for credit. I set out to find the smallest, least noticed, and least sexy stories of Americans involved in community repair that I could find. It has become as or more important to me than this very sinister story about methamphetamine and fentanyl.

You had a heart attack while writing this book and were treated, ironically, with fentanyl. Writing this kind of book seems to be really stressful. Why are you doing this?

Well, this is one of the great stories of our time. Very early on, I thought I was writing about drugs, drug dealing, and drug marketing. And really, I was writing about America. It is about who we are, what we have been, what we have become as a country. I would also say that everything interests me. The stories that fascinate me could be very dark [or] very optimistic. But they fascinate me just as much. That’s why I became a journalist. That’s why it’s the best job in America.

This story originally appeared in the Los Angeles Times.

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