nonfiction
How Fentanyl and Meth Took Over America
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THE LEAST OF US
True Tales of America and Hope in the Time of Fentanyl and Meth
By Sam Quinones
American pain. This is the territory of Sam Quinones, a masterly reporter and vivid, lyrical writer, whose last book, “Dreamland” (2015), won a National Book Critics Circle Award and awakened readers to the problem of opiate addiction in the United States. In it, Quinones traced connections between pill-pushing doctors in Portsmouth, Ohio, and heroin dealers from a town in Mexico. It was Quinones who showed us that doctors had laid the groundwork for the influx of black-tar heroin by getting patients so hooked on OxyContin that they were desperate enough to turn to cheaper dope, any dope, when those pills ran out.
In “The Least of Us,” Quinones applies a similarly kaleidoscopic approach to “designer drugs” like fentanyl and methamphetamine. But his new work lacks the cohesion of “Dreamland,” a problem one senses early on. This, he tells us, is a book about fentanyl and methamphetamine and also about community efforts to combat addiction. Then why, one wonders, are we reading so much — five chapters — about OxyContin and the Sackler family, whose company, Purdue Pharma, produced it, material that would have been at home in his last book? (The answer seems to be that since Quinones published “Dreamland,” lawsuits against Purdue have revealed the tactics by which the Sacklers made their billions.)
When Quinones tackles the newer problem of designer drugs, he does so with his usual depth, describing in one case the shipments of fentanyl from a father-and-son team in Shanghai to American customers who placed their orders on the internet. “An immensely profitable drug, easy to smuggle, cheap and highly addictive,” he writes. “Anybody could be a fentanyl kingpin.” Over the last decade, fentanyl has shown up everywhere in the United States, sold on its own, but also sprinkled into other street drugs like cocaine, heroin and meth. “Fetty” is such an enticement that to keep up with competition, “dealers didn’t dare not mix it in.” Overdose fatalities keep rising, overtaking car crashes as the leading cause of accidental death.
In the 12 months ending in September 2020, that number hit an all-time high of 87,000 deaths by overdose, according to the Centers for Disease Control and Prevention. Fentanyl can be so deadly that it almost makes heroin look mild. Micrograms can kill. A dart full of fentanyl can quite literally “stop an elephant,” according to the Belgian chemist who invented it in 1959. Meth, though less deadly, is now being churned out in mass quantities through a manufacturing process that frequently includes toxic chemicals. “Meth users dragged themselves through the nighttime streets, howling, hysterical, starving,” Quinones writes. While the opiate crisis raged, giving way to a surging demand for fentanyl, meth crept in and took hold in communities where it had never been seen before.
Though he understands growing calls for decriminalizing drugs, Quinones is ultimately in favor of policies that reduce the available drug supply in the United States. After all, he points out, the opioid epidemic followed an outpouring of legal drugs prescribed by doctors beginning in the 1990s. As synthetic drugs now proliferate like variants of a virus, Quinones calls for cracking down, not easing up.
Quinones depicts his subjects affectingly, but along with his rich reporting is the problem of excess. A natural storyteller, he applies those skills to such an array of characters that it is difficult to register their true significance to his larger narrative. There is Lou Ortenzio, a practicing doctor who became addicted to his own free samples of Vicodin, lost his medical license and wound up delivering pizzas to his former patients, until he reinvented himself as an organizer helping addicts in his community. But there is also the story of “Bird,” a neighborhood fixture in Muncie, Ind., whose vices are junk food and soda, whose death is due to cancer and whose lengthy inclusion here, while poignant, is less easy to explain.
The least of us, Quinones is quick to emphasize, is in all of us. What he means is our searing vulnerability, simply by dint of being human. And that’s the point and the power of his work: to shine a bright light not only on the pathways by which drugs traverse this country, but also on the desperate pain that so many among us are in.