The Washington PostDemocracy Dies in Darkness

When the drugs get stronger, the stories get sadder and the solutions more elusive

Sam Quinones equates newly dangerous drug markets to under-regulated corporate capitalism in the 2000s. “Like the home-loan industry a decade before,” he writes, “fentanyl took barriers that had kept the unprepared out of the market and replaced them with incentives that enticed them in.” (Photo by Salwan Georges/The Washington Post)

Sam Quinones is perhaps our best big- picture analyst of America’s markets for addictive drugs. Many of us learned about the link between the early 21st century prescription opioid boom and the subsequent rise in heroin use from Quinones’s earlier book “Dreamland: The True Tale of America’s Opiate Epidemic.” “Dreamland,” among other things, tracked how new- ­economy Mexican heroin traffickers took advantage of pain pill crackdowns, building new supply chains to reach the largely White and relatively moneyed people with addiction who were suddenly locked out of once-plentiful pharmaceutical markets. Telling this story showed a willingness to think beyond the categories we usually apply to drugs — the ones that separate “medicines” (good) from “drugs” (bad), but also the ones that separate psycho­active drugs from other commercial goods. Quinones treated markets for drugs like markets for other goods, tracing the impact of new technologies, new business techniques, new supply chains, and a changing regulatory environment on quality, prices and consumer ­experiences.

At its best, Quinones’s new book “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth” accomplishes a similar task. Quinones explores the more ­recent shifts in drug markets: from poppy-based heroin to the much stronger laboratory-based fentanyl, and from ephedrine-based methamphetamine to a mass-producible P2P version. New, more efficient production made supply chains much simpler and cheaper. Selling large quantities of drugs no longer required acres of opium poppies or major operations to collect ephedrine-based decongestant pills. It no longer required a cartel. Instead, anyone with a laptop and an Internet connection could order large quantities of pure, highly potent fentanyl from what were essentially mom-and-pop oper­ations, first in China, then in Mexico. “With a minuscule investment of learning and money,” Quinones explains of fentanyl, “anyone — even someone in boxer shorts in his mother’s basement, without education nor connection to mafias or traffickers — could now make a killing. And beginning in about 2015, they did.”

While these commercial disrupters were rewarded with a sales boom, the new drug markets were hell on consumers. Many thought they were buying heroin, a familiar drug for which they knew their tolerance; thanks to what Quinones aptly identifies as a “ ‘failure of content uniformity’ on a national scale,” they got an unknown quantity of ultra-potent fentanyl that all too often led to a fatal overdose.

Quinones’s greatest accomplishment is to understand these newly dangerous drug markets as just one more consequence of a disastrously under-regulated corporate capitalism in the 2000s. “Like the home-loan industry a decade before,” he writes, “fentanyl took barriers that had kept the unprepared out of the market and replaced them with incentives that enticed them in.” Meanwhile, “P2P meth wiped out . . . local Sudafed [ephedrine] cooks in a market disruption resembling what Walmart did to Main Street.” In the pursuit of ever more efficient flows of capital and consumer goods, Quinones argues, we eliminated the inefficient and often frustrating stuff that makes life meaningful and that allows us to care for each other and our communities: small competitive businesses, civic cooperation and the daily work of supporting others in their times of need. Restoring our hollowed-out society will take more than just a “shift of heart,” according to Quinones. Rebuilding “the spirit of community” will take material changes “in taxation, in health care, in improved infrastructure — in other words, a shift in where the resources go.”

In the annals of American drug journalism (of which, as a historian, I have read a lot), this is a remarkable argument: that drugs are not the problem, they are just one example of our decision to favor markets over communities.

At least, that’s how a boring academic like me would put it. Quinones is anything but boring. He is a fluent storyteller who delivers his argument through a palette of affecting stories about people and communities torn apart, and about the small, step-by-step reclamations earned through patient, daily, humble work. Few readers will keep dry eyes through the entire book.

This poignant appeal is also where “The Least of Us” goes awry, unfortunately. To amp up the emotional wallop, Quinones leans on the hoariest myths that have long marred drug journalism: that once-proud if scrappy White communities are being destroyed by foreign traffickers selling a new generation of super-drugs that turn consumers into subhuman zombies. This sensationalist story is depressingly familiar to me as a historian of drugs, and it stands in stark conflict with Quinones’s brilliant analysis of America’s malfunctioning drug markets. The “super drug” myth is the true unkillable zombie, surviving a century of repeated debunking and wreaking its own distinctive political harm.

Quinones can be misty-eyed about the struggling White communities he visits, which, in his telling, used to be near-utopias in a vaguely defined “before” time. They were inhabited by stoic, creative, respectful, Christian, entrepreneurial spirits who may have cut up from time to time but who also stayed married, worked hard and, in general, “embodied the aspirations of small-town twentieth-century Americans to a life of modest but steady improvement.” Even the drugs back then were relatively harmless and worthy of sepia-toned nostalgia. “They’d be ok when they were just using crack,” a Los Angeles police officer explains. “Ephedrine meth was a euphoric, social drug, a party drug” a user recalls. According to Quinones, P2P meth is far worse, “intensely damaging people’s brains” and producing “violent paranoia, hallucinations.” Meth customers, once “solid people,” were now “suddenly babbling, out of their minds.” Quinones blames police shootings and homelessness on this meth-caused insanity. “We knew when the Mexican meth hit because people went crazier,” a defense attorney tells him. “Before that, police shootings were not common.”

Quinones has no laboratory or epidemiological evidence that P2P meth is different from ephedrine-produced meth — the “super-meth” theory is based entirely on anecdotes. Journalists were writing equally terrifying things about “crack” cocaine and ephedrine-based meth (and heroin) back in the 1980s and 1990s.

The new “super drug” story, combined with an oversimplified version of addiction neuroscience, leads Quinones to a dark vision of people with addiction. In their brains, he ­argues, “a raging primitive reward system has silenced the prefrontal cortex’s wise counsel.” They have become a “zombie-esque . . . caste of people deprived of memory and personality,” who have “abandon[ed] any survival instinct.” Addiction is a disease, he allows, but one whose symptoms are “a brainwashed slavery that deprives the user of free will and turns him toward self-harm in the search for dope.”

People in such a condition must be forced into treatment for their own good, Quinones suggests. With the drug supply fatally toxic, “waiting around for them to decide to opt for treatment is the opposite of compassion,” he writes. He approves of “drug courts” which use the threat of jail to coerce people into rehab, and sees therapeutic value in jailing people as long as the jails are re-envisioned as treatment programs. Once forcibly “sober and thinking more clearly,” people with addiction have “a chance to step toward change.” This logic can lead Quinones to some uncharacteristically harsh positions. For example, he worries that even the meager comforts of “camaraderie” and “warm approval” make life in a homeless encampment “enabling,” allowing drug users to “not care” about their degraded state. Quinones does not pursue it, but there is a destroy-the-village-in-order-to-save-it spirit here: People with addiction must be isolated and in an abject state to incentivize their recovery from isolation and abjection.

It should not need to be said, but: People who use drugs, even ones who are addicted, are not biological sub-humans incapable of making decisions, only redeemable through forced ­abstinence. (Indeed, to the extent that old- fashioned heroin, “crack” and ephedrine meth markets were safer, it was because consumers consciously developed practices to protect themselves and their communities — practices upended by new and unfamiliar drugs.) Nor did drugs cause major social problems such as homelessness, police shootings and community decline. Quinones knows this: his own book provides a brilliant analysis of the broader economic and political causes of those problems. Yet he distracts from and undermines his own most perceptive insights with his story of a drug-fueled fall from grace. He also endorses punitive responses to addiction that have ­repeatedly failed in the past. People are dying because the drug supply is poisoned; whatever else they may be good for, jails won’t fix that problem.

At a deeper level, Quinones wants to rebuild America’s idyllic communities of yore, this time for everyone instead of just White people (he mentions his support for Black Lives Matter, for example). But this is a thorny political project — indeed, it is perhaps the defining challenge of our era. For the racial exclusions of the lost communities Quinones mourns were not accidental. For decades after World War II, U.S. policy encouraged public and private investment in segregated White areas. This led to economic development and stable communities built on a bedrock of dependable, if often grueling, jobs in manufacturing and other industries. Non-White communities enjoyed no similar protections, and people categorized as non-White were excluded, often violently, from those oases of economic stability. This situation began to change in the 1970s, when American policymakers turned away from ­restraints on capital. Many White communities found themselves exposed in new ways to capitalism’s sharper edges, as employers ­decamped in an increasingly globalized hunt for cheap (i.e., less politically powerful) labor. One of these “sharper edges,” Quinones points out, was a newly liberated market for illicit drugs that posed unfamiliar risks and further harmed already struggling White communities.

The question on my mind when I finished reading Quinones was, how do we acknowledge what White communities lost in this transition — how do we respect what they built in those partially sheltered days — while also reckoning with the way racial exclusions were central to the policies that made them possible, and with the hardship and suffering those exclusions meant for so many Americans?

These should not be mutually exclusive. Our imagination must be able to contain them both at the same time. This is especially urgent at a moment when some of the loudest voices calling for new restraints on global capitalism are white nationalists who see white racial solidarity as the best bulwark against a soulless market. We need better and more inclusive stories. On this front “The Least of Us” seems divided: sometimes romanticizing an implicitly White past, and sometimes providing the foundations for a broader vision of how to protect all communities from the excesses of corporate capitalism. I hope that readers will see beyond the former to learn from the latter.

The Least of Us

True Tales of America and Hope in the Time of Fentanyl and Meth

By Sam Quinones

Bloomsbury. 407 pp. $28