Since the dawn of the Twenty-first Century, two trends have defined the American marketplace for addictive drugs. One trend has been marked by constant change, the other by an almost constant record of more of the same.
The changes have been in Americans’ addictive drugs of choice, from prescription Benzodiazepines — tranquilizers like Valium and Xanax, to prescription opioid pain-killers like OxyContin to street drugs like heroin, methamphetamines and cocaine, to the king of all addictive drugs, fentanyl.
Where the statistics published by the CDC, the Federal Centers for Disease Control, show the constant pattern of more of the same are in the numbers of Americans addicted to drugs and the numbers of people killed by them.
Over the past 20 years, only in 2018 did the death count actually go down, but only slightly, and in the not quite three years since, the numbers of American dead from drug overdoses has spiked upward. Counting backward one year from April 2021, the death toll passed, for the first time, 100,000 — more Americans killed by drugs than by car crashes and guns combined.
Along the timeline of changing causes of drug fatalities two other years stand out: 2015 and 2016. In 2015, the Princeton University economists Anne Case and her husband, the Nobel Prize-winner Angus Deaton published a powerful academic paper on what they called “deaths of despair,” lives lost to drugs and alcohol and related accidents and suicides. The surge of these deaths hit so hard at white Americans aged 25 to 54 that they lowered the whole American nation’s statistical life expectancy.
2015 was also the year when what Case and Deaton had noted in numbers, Sam Quinones’ book Dreamland explained in human terms, reporting in detail where the deaths were occurring, why these communities were so vulnerable and how they turned despair into death. As Deaton himself put it: “Sam Quinones is the indispensable ground-level guide to the epidemics of addiction that plague so many Americans.”
Then came 2016, when, not only did deaths from addiction shoot upward, but the driver of the death count could be definitively identified, a class of synthetic opioids called fentanyls.
Late in 2021, Sam Quinones was back, with a new book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth, which again took us way beyond the numbers, the what that is happening to addicted people, but the how and why. Far worse drugs, far wider distribution, once again returned to underworld control.
It’s a terrible story, but Quinones sees in it some reasons to hope. Not only are some communities pushing back against drugs and old-fashioned approaches to treating addiction, but slowly, governments, too, are rethinking how they can prevent people from becoming addicts and how they can help those already addicted to find paths to better lives.
Sam Quinones is a Los Angeles-based freelance journalist, former LA Times reporter, and author of four books of narrative nonfiction. In 2015, he published his bestselling book, DREAMLAND: The True Tale of America’s Opiate Epidemic, which awakened the country to the nationwide scourge of addiction to opioids and heroin. His latest book is THE LEAST OF US: True Tales of America and Hope in the Time of Fentanyl and Meth, which chronicles how the epidemic has evolved from opioids into illicit synthetic drugs, was released in November 2021.
Dreamland won a National Book Critics Circle award for the Best Nonfiction Book of 2015. It was also selected as one of the Best Books of 2015 by Amazon.com, the Daily Beast, Buzzfeed, Seattle Times, Boston Globe, St. Louis Post-Dispatch, Entertainment Weekly, Audible, and in the Wall Street Journal and Bloomberg Business by Nobel economics laureate, Prof. Angus Deaton, of Princeton University.
In 2019, Dreamland was selected as one the Best 10 True-Crime Books of all time based on lists, surveys, and ratings of more than 90 million Goodread.com readers. Also in 2019, Slate.com selected Dreamland as one of the 50 best nonfiction books of the last 25 years.
For Dreamland, Quinones has testified before the US Senate’s Health Committee, numerous professional conferences of judges, doctors, librarians, hospital administrators and at more than two-dozen town hall meetings in small towns across the country.