Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.

Sam Quinones is the author of the 2021 book The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth, as well as its bestselling predecessor Dreamland: The True Tale of America’s Opiate Epidemic.

We talked about overdoses during the pandemic, the trouble with calculating the costs of meth addiction, and small-scale community change, below.

Olivia Weeks, The Daily Yonder: The Least of Us is your second book about the opioid epidemic. I’m wondering what moved you to keep reporting on this topic six years after the success of your first book Dreamland.

Sam Quinones: Initially, I didn’t want to keep reporting on this. I was so burned out. It’d been so much work. Early on, I was thinking like an old school crime reporter and I didn’t understand what might come after heroin. What could be worse than heroin?

Quinones’ latest book, The Least of Us, was published in November 2021. (Image courtesy of Quinones.)
Dreamland was published in April 2018. (Image courtesy of Quinones.)

It was the success of Dreamland across the country that allowed me to see what was coming. Because as the book was published, and then the paperback a year later, I began to get enormous numbers of invitations to come speak in all kinds of different small places all over the country, at conferences, but also small towns, libraries, etc. And along the way, I began to see that the story was really changing in fundamental ways. And that change was an enormous supply that ignited new populations of addicts. Drugs that had come from pharmaceutical companies and from doctors had been replaced by stuff coming out of the Mexican trafficking world, primarily synthetic drugs. These are drugs made without any plant involved, particularly methamphetamine and fentanyl. And I saw that these came with a whole new batch of problems—challenges to old ways of thinking of new, very serious consequences on the ground, including overdose deaths, mental illness, and homelessness. So all of that made me see that while the supply was just as vast, the problems were much different. And the urgency was also even more intense. If you can believe that. I thought nothing really could be more urgent than that switch from painkiller prescriptions to heroin.

DY: Do you think that in general, the media class and our government has caught up to this new drug trafficking landscape?

SQ: Only slowly, and in part that’s understandable. Covid-19 has dominated the headlines. And I’m not sure that’s necessarily wrong either. One of its effects though, was to quiet the urgency and energy that was growing before Covid regarding the opioid epidemic and overdose deaths and all the rest. I think one of the great tragedies of Covid, among many, was that it hit at the very moment when the drug trafficking world of Mexico had effectively covered the United States with methamphetamines and fentanyl. Isolating is, of course, the last thing you want to do when you’re recovering from addiction.

DY: I’ve perceived a real lack of attention to methamphetamine as an issue. It seems clear that people are waking up to it, but I’m wondering where you think the roots of that inattention lie or if you see that same inattention that I do.

For instance, you look at opioid medication-assisted-treatment, and there are tons of options. Obviously, there are accessibility issues there, but there are a lot of people doing work to try and make the recovery process easier for opioid users. Maybe there are just scientific barriers, but you don’t see the same kind of attention for methamphetamine addicts, and in a lot of ways, it just feels like we don’t know what to do with those people. I’m wondering if you have a perspective on that.

SQ: I would say that that’s part of the reason why it doesn’t get much attention. We don’t know what to do. The only thing you can do begins with separating the addict from the drug. There’s nothing else, there’s no medical approach, no choice that you can give people that will subdue those cravings. I would also say that methamphetamine, when it’s not mixed with fentanyl, doesn’t kill people very often. It’s not common that there’s a meth overdose death. Meth degrades you, it decays you, it doesn’t kill you. We, understandably, take death numbers as the most serious indicator of the problem. In this case what’s actually more of a problem, I would say, is the widespread emergence of symptoms of mental illness like paranoia, hallucinations, and antisocial behaviors leading to homelessness.

It’s tough because we don’t know what to do with it. People aren’t dying. But methamphetamine is presenting itself graphically on the streets in every ER and every homeless encampment. That drug is now effectively everywhere in the United States. It’s in New England where they never had any methamphetamine to speak of, and now it’s there.

DY: In your book you go to lengths to describe the corruption of the Sackler family and Big Pharma, but your real critique doesn’t stop there. It’s a much bigger critique of the loneliness and atomization of American society. And yet, I found that the ending of the book, and different parts of the book are quite hopeful. I’m especially thinking of the section where you’re describing in detail the addiction resources that have sprung up in the town of Portsmouth, Ohio. And so I’m sort of wondering how you square your really fundamental critique of American society with that sense of hope that you find in different projects.

SQ: Maybe it’s because despite being a reporter for 35 years, I’m not cynical. I always see a reason for people to do things together in a productive way. I think one thing that keeps me very hopeful is what’s happened in the town of Portsmouth, and some other places, which is that nobody has come up with a magic answer. And that’s good. You find small stories of people figuring out how to work daily towards some small piece of progress with each other.

Author and Journalist Sam Quinones. (Photo courtesy of Quinones.)

Again, the opposite of addiction is connection, right? They’re just doing small stuff and that small stuff is where the real progress comes from. In this country we have almost an addiction to big magic answers that will solve all our problems. I think that’s very dangerous and it’s what got us into the opioid epidemic. We wanted one solution to the mystery of human pain. Pills became the answer that the doctors had to our insistence that somebody else fix us. 

So in contrast with that, I think it’s very interesting to watch examples where in small ways, towns are coming together to work on these problems. They’re stumbling, yes, failing sometimes, sure, but that’s normal, that’s natural. We shouldn’t be upset about that. So to me, that’s what this epidemic is showing us: there’s a very clear way forward. The pandemic is showing us that as well, that we’re only as strong as the most vulnerable. We’re only as strong as the least of us, hence the title for the book. That’s where that happens. And the more we get away from the idea that there’s some one big solution to all our problems, the better off we’ll be.

This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.

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