In 2015, award-winning author and journalist Sam Quinones took the world by storm with his heavily lauded book Dreamland: The True Tale of America’s Opioid Epidemic, an investigative work that helped awaken the nation to the devastation wreaked by OxyContin. With his newest release, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth, Sam turns his attention to the rise of synthetic substances and the dangers posed by methamphetamine and fentanyl use.

Tune in as Sam speaks to Elizabeth about the reasons behind the explosion of fentanyl; the connections between methamphetamine and mental and physical illness; and why he believes we have yet to fully confront the realities of methamphetamine addiction.

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Episode transcript

Elizabeth Vargas:

Sam Quinones. Welcome to Heart of the Matter. Good to have you here. We’ve been wanting to have you on for a long time. You were the first, actually, person to write a book about the burgeoning opioid crisis in that groundbreaking book, Dreamland, which won a ton of awards.

It was followed by a series of other great books on the crisis. Many those people have been on the podcast. Beth Macy who wrote Dopesick and Patrick Radden Keefe, who wrote Empire of Pain. You have followed up Dreamland with the new book out called The Least of Us.

In this book, you take on the explosion of synthetic drugs like fentanyl and a scary new form of methamphetamines. Tell me how this came about.

Sam Quinones:

Well, the book really didn’t grow from the drug side of it. It grew shortly after Dreamland came out. I began to think and I had thought during writing Dreamland that a big part of what had happened to us as a country was that we had demanded magic bullet, silver bullet answers to what are very, very complicated problems.

In the case of the opioid epidemic we demanded a cure for pain and medicine came up with one pill. The one pill for everybody, and that was supposed to cure pain. The truth is it created an enormous amount of collateral damage that we’re still living with today.

As that book came out, I began to focus more on stories of people who were not involved in finding miraculous cures, all that is rather wanted to find people who were involved in the smallest, simplest, most consistent daily work ways of showing up to repair community in wherever it was that they lived, and that became my focus.

Then, along the way, as I spoke more and more as the awareness of the opioid epidemic growth and the book began to – became a guide to people of what had happened, I began to travel more and speak. As I did, I began to see that what I had written about was actually in the process of changing rather dramatically.

In fact, within a few years, it was completely transformed. That had to do with major change down in Mexico, basically. That the trafficking world down in Mexico had grown up on the land. The pioneers were ranchers and farmers, but now their children or grandchildren or whatever we’re now seeing that actually made a whole lot more sense.

If you’re going to deal drugs you can make them yourself rather than grow them. It began to evolve into the synthetic era of drugs with no plants involved. That was a natural outgrowth for a lot of these guys. They figured out this was a much better business proposition. You didn’t need land, you didn’t need farmers, rainfall, sunlight.

All you needed was shipping ports because shipping ports got you access to world chemical markets through which you could get all the chemicals to use chemicals you ever made needed to make the drugs that you were now making. The two drugs that they learned to make most immediately were – they already knew how to make methamphetamine, but then they learned how to make fentanyl.

Those two combined today to create the problems that we are seeing now really coast to coast because they’ve covered the country with supplies of these drugs that really is only paralleled by the amount of pain pills that were prescribed by doctors.

Elizabeth Vargas:

Let’s start first with fentanyl because it’s scary. It is responsible for 70% of the drug overdoses in this country. A few small specs of this fentanyl can kill you. You have said it is the deadliest drug we have ever known. First of all, do people just go out and buy fentanyl?

Is it they’re getting fentanyl inside cocaine or heroin, or even I’ve heard of it popping up in marijuana? Is that true?

Sam Quinones:

It’s both, some dealers buy it in some form of bulk and then mix it into cocaine and so on. The trafficking world now down in Mexico has taken to including putting fentanyl into counterfeit pills that look every bit like the pain pills that we used to get prescribed.

Elizabeth Vargas:

Like Percocet or Oxycontin. It looks just like a pain [crosstalk 00:04:35]

Sam Quinones:

Exactly. All of those pills now are coming with only fentanyl in them. This is all because of the enormous capacity for its production that synthetic drugs and access to the world chemical markets allow these trafficking groups down in Mexico. Yes, it’s almost like it’s so prevalent it’s like salt on food. You just sprinkle it on.

Dealers at the street level frequently now are including it in their cocaine to sometimes very deadly effect. People always ask me, “Well, why would you add a deadly drug to kill your customers paying you?” Well, there’s actually very good reason. From a dealer’s perspective, why you would do that, the main one is that if you were selling, say cocaine, cocaine buyers buy every few days, every week.

Maybe they take a couple weeks off. They don’t buy all the time and when you insert fentanyl into it and they survive they become addicted very quickly. This happens rapidly within a few contacts to the fentanyl. It’s that point that they have to buy from you every single day. There’s no taking a vacation from opioid addiction.

You don’t take two weeks off. It’s every single day. And several times a day frequently with fentanyl. That’s part of this story. Again, a lot of people don’t have the tolerance for it and die. That’s why we have seen these new record overdose death rates over the last numerous months because of fentanyl.

Elizabeth Vargas:

Are you saying that it’s the fentanyl in the opioids that’s killing all these people that’s why we’re having all these record setting overdose rates?

Sam Quinones:

It’s a little bit of both. These are not opioids, these are counterfeit pills. These are pills that made to look like a Percocet. Made to look like a Xanax bar or an oxycodone generic 30 milligrams. The only thing that they have in them is fentanyl and they’re made down in Mexico. They’re pressing these things by the tens of millions I think right now.

Dramatically upping the production of those things. It’s essentially what it boils down to – either intentionally or not – it is really supply creating demand. In the case of say, fentanyl mixed into cocaine, the people using cocaine do not want to be addicted to fentanyl, but they become so very quickly and then they can’t escape it.

Elizabeth Vargas:

They don’t know. They don’t know that the cocaine they’re buying has fentanyl in it.

Sam Quinones:

Not initially. After a while everybody knows though. I think in many parts of the country after you’ve survived, your initial contact with fentanyl at first say it was mixed into heroin. Now, there’s no more heroin on the street. We’re very close in this country to being a country that is heroin-free. The fentanyl has just simply crowded it out.

Heroin is worthless in fact. Now, if you were addicted to fentanyl, you have a very high tolerance. Heroin just will not keep the dopesickness away. Over and over, you see all these regions of the country where they’re just reporting no real heroin. They may call it heroin, but it really as everybody knows what’s in it. It’s fentanyl.

This is again how it’s being spread all these folks now who survive are now addicted to fentanyl. Fentanyl, by the way, is a magnificent drug medically, surgically. I’ve had fentanyl, myself. Many of your listeners will have had fentanyl. It revolutionized surgery. Used in surgery, it’s fantastic.

Elizabeth Vargas:

As an anesthetic?

Sam Quinones:

It’s an anesthetic, it’s an opioid. It’s an opioid every bit of the same brain chemistry as morphine and heroin. Just much, much more potent. The other thing about it is though that it gets you into anesthesia and out of it very quickly. That’s what made it enormously useful in a surgical setting.

You could send somebody into anesthesia, do a quick operation, get them right back out, and that person is lucid and coherent and walking right out of the hospital. With fentanyl, because of that quick in and quick out, that makes it such a great surgical drug. It’s a curse to users because you now have to be using every four, six hours.

You begin to feel the onset of withdrawals very, very quickly. Of course, if you’re a dealer, it’s magnificence. Dirt cheap, easy to smuggle. You get folks who have to buy it from you repeatedly all the time. Again, there’s no vacation from opioid addiction. You don’t take two weeks off.

Elizabeth Vargas:

Drug dealers are putting fentanyl in other drugs knowing it will hook their customers quickly, and that those customers will then need to come back every four to six hours for more of it, because the dopesickness starts.

Sam Quinones:

They’ll have to buy more per day than they ever did with heroin. That’s generally what happens. If you were using two grams a day. Now, I talked with a guy in Maine. In Maine think of that. Guy was using two grams of heroin a day. Then fentanyl comes along, he’s strung out. He doesn’t have any of the choice he says so he switches to fentanyl.

Then he’s using seven grams a day, which – it’s just a whole other level of drug usage, which means of course, that you are participating essentially in what amounts to a game of Russian roulette every time you use. Very much different than with the case with heroin. Although that was dangerous, this is a whole other level of danger.

The mix, as you said, it’s such a small amount of the drug that will make you hooked and you are relying on the underworld to mix it properly. There’s no such thing as a consistent good mix by folks in the drug world. They just don’t know how to do it and a lot of times they don’t care.

Elizabeth Vargas:

It is driving when you say those drug overdose rates. We know that drug overdoses are up 29% just in the last year nationally. In 10 states in this country, drug overdose rates are up by more than 40%. Is fentanyl driving all of that?

Sam Quinones:

Yes, correct. That’s it. That’s the whole story right there. There’s something a little bit more to it than that. That is that fentanyl started out in 2014, ’15 in areas that had been hardest hit by the opioid epidemic. Ohio, Kentucky, Indiana, West Virginia, places like that.

That was when most of the fentanyl was coming from Chinese chemical companies. Folks here were buying it on the web. They would have it sent to them via the mail. You’re talking about a pound at a time. It really hadn’t spread that much because you just can’t send that many pounds to cover the entire country.

Then in 2019, the Chinese government put regulations on it. Now, only a few companies can make fentanyl. The companies in China though began to sell to the trafficking world in Mexico the ingredients for making fentanyl. The folks in Mexico learned how to make it during those years.

Now, you have quantities of production that surpass anything that was remotely possible sending pounds through the mail. Now, it covers the entire country. The overdose death records that we’re setting every month it seems like now are due to the fact that you have that drug being produced in Mexico.

Particularly, in the Western side of Mexico, Western and North Western side of Mexico, and in a country with which we share a 2,000-mile border and a free trade agreement. All of that stuff is coming up. We would never have achieved full coverage of the country.

From Maine to Skid Row, LA and San Francisco, and Seattle you have this massive coverage now of fentanyl in virtually every part of the country. That’s also what’s driving this, because there’s just so much more opportunity for people to add it to the dope they’re selling and therefore for people to die from it.

Elizabeth Vargas:

Is now 100% of the fentanyl coming in from these Mexican drug labs or is some of it still coming from China?

Sam Quinones:

I’m reluctant to say 100%, but certainly a vast majority of it. Now, it’s coming up from Mexico dirt cheap and relentless. Again, it becomes a little bit like salt. You could put it in anything. There are some stories of marijuana being doused with it. I’m not sure how often that happens, honestly, but it’s the idea.

Now, what you have is people all across the country who are no longer under any illusion to what they’re using, they’re using fentanyl they know it. The guy in Maine he knew it was called heroin what he was buying, but he knew he was using fentanyl. You find this all over. If they haven’t died from the initial contact or a few contacts, they develop very quickly in addiction.

That addiction takes them to whole new levels. The result of that too is they can die at any moment. They get a bad mix and they’re dead. The other result is it makes extraordinarily difficult for them to succeed in treatment. It’s a brutal withdrawal from fentanyl I’ve been told. That is also part of the mix as well.

Elizabeth Vargas:

I don’t know, I have to say the scariest part about this is that those stories of it being mixed in other things and people unwittingly buying it and unwittingly taking it, who have no tolerance for it and could succumb and could die quickly because of that.

Sam Quinones:

That’s what began to happen exactly during the COVID years. If you think about one of the great tragedies of COVID was that it came along just as the trafficking world was achieving this unprecedented event, which was to cover virtually the entire United States with not one but two synthetic drugs: meth and fentanyl.

Possible only because they have access to world chemical markets through these ports and have a vast, vast production capacity. Now, all kinds of people getting into making it down there. One of the interesting things about this is that they solved the drug dealers’ most pesky problem.

It has always been: where do I get my dope to sell? The drug war for all its faults had a wonderful tendency to always keep drug dealers off balance. They were always arresting their connections and all that kind of stuff. You were constantly having to look for the stuff. Well, now you don’t have to. That question has been answered. The question where I find my dope to sell it’s everywhere.

Now, the question is particularly during COVID, the question is where do I sell all that I can get my hands on? Where do I sell all that I can get hands on during a time when everyone’s shut in their house, and the only connection to the world that they have is through their smartphones and social media apps?

Elizabeth Vargas:

What’s the answer?

Sam Quinones:

Social media apps: Snapchat, Instagram, TikTok. You’re finding huge amounts of these pills for sale anonymous dealer selling. Frequently, of course, the buyers are young people. People who are naïve when it comes to the drug world, they don’t know what they’re buying.

They don’t really have a clue that the thing that they’re hoping will cure their depression from being shut down for a year or two is actually filled with fentanyl. They don’t know what they’re doing. What you began to see is part of the death toll was kids using their smartphone app, seeing these colorful menus.

The menus look quite colorful. Looks like an ice cream menu. All these different colors and stuff. Percocet, Xanax, Adderall, all that stuff. Frequently – I’m not sure if every place did this – but I know in Los Angeles, it was clearly the case where the dealers, because they knew their customers couldn’t leave home they were delivering.

They offered home delivery. Frequently the dealers themselves were very young. It wasn’t like they were older guys. They were 19-year-olds, some of them 16-year-olds. Social media apps became the new street corner, particularly Snapchat, Instagram, TikTok. I went to a protest in front of Snapchat headquarters in Santa Monica.

It was filled with people with posters saying, “Snapchat is complicit in the murder of my son or my daughter.” All the death dates were always 2020 and early ’21. It was just the COVID year.

Elizabeth Vargas:

When everybody was isolated and lonely and anxious and depressed. We know that everybody’s drinking more, they’re doing drugs more. Overdose rates are skyrocketing.

Sam Quinones:

That was an effect of the vast supply. Now, any schmo 19-year-old could get enough so that he could start his drug dealing business on Snapchat, Instagram, whatever, and make a decent living doing it. I talked with one DEA agent in Fresno, they were seeing massive amounts of this in Fresno he told me.

His feeling was that a lot of times the guys were doing it were looking to develop a larger drug businesses and this was their way of developing capital. Which was just they were selling it to kids. Of course, the kids were ignorant of what was in the drug and had no tolerance to deal with the fentanyl that was being included in these counterfeit pills.

Elizabeth Vargas:

Why are the social media giants not cracking down on this? Why isn’t the U.S. government, the DEA forcing them to do that?

Sam Quinones:

Well, you’d have to ask the social media guys that. I think they don’t want to get into the set the precedent of editing. They want to be a platform. They don’t want to be editing.

Elizabeth Vargas:

They’ve already been forced to edit. They were forced to take down people who were trafficking in young girls sexually. There have been, there is precedent.

Sam Quinones:

I think at Snapchat, I haven’t talked to them really. I think you need to talk with them about this. My understanding from talking to certain parents is that Snapchat has been making certain efforts in that regard. Is it enough? You’d have to talk to parents who are more deeply involved in that particular issue to know.

Elizabeth Vargas:

Why haven’t we seen congressional hearings on this? We saw congressional hearings about the terrible effects of Instagram, for example, on young girls’ self-image and leading to eating disorders. It would seem that kids dying of drug overdoses would be even more important or at least as important?

Sam Quinones:

Well, can I say something about that? It’s going to sound horribly immodest, but I do believe it to be true. Until The Least of Us came out, I don’t remember anybody paying any attention to this topic. That was in November so it’s been three months, four months that’s going on. I’m just thinking we’ve been consumed with COVID all our focus on COVID.

Now of course, the Ukraine suddenly and all this. The story that I’ve been working on for four years comes as a total revelation to people. We didn’t know anything about that. That’s because for the last couple years, as this stuff has really spread all across the country, our focus has been on COVID. I think part of it is because the story was never told.

Elizabeth Vargas:

Well, hopefully people are going to read the story now and hear the story on this podcast. Listen, this follows your pattern here. Nobody was talking about the opioid epidemic until your book came out. Shame and stigma surrounded the disease of addiction.

Nobody wanted to admit that their loved one had died of an opioid overdose. Nobody was talking about Purdue Pharma and the Sacklers. Your book was the first to start talking about it. They were followed by many other fantastic, amazing books also delving into that.

Now, when you wrote Dreamland, the Sacklers were still naming museum wings and donating in the crème de la crème of society. They’re now outcasts with museums stripping their name from all the wings. They’re in the midst of negotiating some sort of a settlement trying desperately to hang onto their money, by the way.

Avoiding any future criminal prosecutions or lawsuits. Perhaps The Least of Us will do the same thing. Leading to, I would hope congressional hearings on this.

Sam Quinones:

I would say that I hope so. Then of course, the whole methamphetamine story too has never been told, and that is also a harrowing tale we can get into in a minute if you like, but we were so consumed by COVID that this stuff, this happened very quickly. What’s happening now was really not really the case in 2017, 2018.

It’s just happened so fast. Why are there no hearings on it? I don’t think anyone’s told the story and because we’ve been in preoccupied with COVID, as we should have been. It’s the worldwide pandemic for goodness’ sake. I’m not suggesting that it was irresponsible to do that. It’s just saying that’s where we were, that was the state of affairs in the country.

I’m certainly hoping when it comes to these how these bills are sold, then also the methamphetamine story that this book does a little bit of that pushes people to understand. “Here’s what’s going on now.” It’s a whole different story than what was going on six years ago.

Elizabeth Vargas:

You brought up methamphetamine that is the other drug that is made in a laboratory that is now sweeping across the country. This is a different form of methamphetamine though. Originally, I remember when all of a sudden Sudafed went under lockdown in the local Walgreens because people were stealing it to make methamphetamine.

They’ve now come up with the new way to make it using other toxic chemicals. You call it P2P meth. Why is this new P2P meth even more of a scourge?

Sam Quinones:

It’s a good question. I would say to that exact answer, I have to be clear and say I don’t know why. What I can tell you is that it is. If ephedrine is the drug you’re talking about is decongestant and all these pseudophed pills and the ephedrine methane they mastered down in Mexico for through the ’90s and the 2000s.

They made lots of it. They knew how to make it. It was a big body of knowledge about how to make methamphetamine in the Western Mexican states. It was a drug that was very popular as a party drug. In 2008, the Mexican government put a regulation on ephedrine importations into Mexico. Only a few companies could possess it.

The trafficking world then had to switch to this new method. Actually, it’s an old method, but it’s new to them of making methamphetamines. Very inefficient. A lot of chemicals. It smells bad. It’s not really a good way to make – you prefer to make it with ephedrine, but they switched.

This new method using this precursor and known as P2P short for Phenyl-2-Propanone, which is a common industrial thing called a P2P. The only benefit it really had and it was a crucial one for the stories we’re talking about right now – is that you could make P2P many, many different ways.

Unlike ephedrine, you can make it many different ways with all kinds of groupings of chemicals. All these chemicals turned out to be industrial, very widely available, very common in industrial processes, very toxic, easy to come by. What this means is they begin to realize, and it begins to explode almost like a meth rush down in Mexico beginning in about 2012, ’13, ’14.

More and more people begin to get into making it. They learn how. It’s a little bit more difficult. They learn from other chemists and so on. The key thing is they get all the chemicals they need from the world chemical markets. Some of them are made in Mexico. You begin to see just an explosion of meth production down in Mexico.

Beginning, as they said, about 2012, ’13 right in there. It’s a drug that begins to March across the country now. Before, without ephedrine, they could never get more than enough to cover parts of the Western United States. The Mexican ephedrine meth never went east of the Mississippi River.

Now, what you see is this drug, the new way of making it allows for such enormous production that it marches across the west, covers the west, jumps to Mississippi. Goes through the Midwest by 2017, ’18, definitely all through Kentucky, Ohio, West Virginia, Tennessee, et cetera. Gets up into New England, which never had any meth to speak of in 2019.

At the same time, the amazing story part of this, I thought, and initially, as I was writing this was that the same time they cover it so completely that the price collapses. It’s not just that they cover it. I’m in Nashville right now. The Nashville Narcotics stations told me that five years ago, meth went for $19,000/a pound, today it goes for $3,000/a pound.

That’s like 2,000, 1,800 miles from Mexico you’re still getting an 80% price drop. This is the same all across the country. Not only they cover it, the price drops and it becomes very, very, very prevalent. Then, I discovered another story that I thought was just stunning, blew me away.

That is that as this drug spread across the United States, it is most certainly accompanied by rapid onset symptoms of profound mental illness, schizophrenics, heightened paranoia, delusions, hallucinations. You’re thinking everybody’s after you. You think cheetah’s coming out of the walls, all kinds of very antisocial behavior now it promotes.

Unlike the ephedrine meth, which is all about partying with other people now you’re just alone constantly. You’re terrified of everybody. There’s no more partying on this drug. This is a very psychosis inducing thing. It very quickly creates mental illness and from there homelessness because you can’t live with anybody and nobody can live with you.

From there, I believe very strongly now that it is one of the perhaps the main driving forces behind the tent encampments we’re seeing all across the United States. It’s a perfect place. A tent encampment is a perfect place if you are in deep psychosis, terrified of the world, but then addicted too.

It’s a strange thing, because it’s tormenting, but it won’t let you go either. You have to use it. What’s more – this methamphetamine, according to many people I’ve talked to, makes it easier to be homeless. It may create your homelessness or not, but whatever the case, once you are homeless it makes it easier to be. You separate from your grim reality.

Elizabeth Vargas:

You’re in your own little world.

Sam Quinones:

That’s what we’ve also seen as this meth has marched across the country. You’re seeing this advance. People say, “No, no, no. You’re wrong. Homelessness is about the high cost of housing.” That’s true that’s an important part of what goes on in the whole story of homelessness in many areas.

We’re seeing homelessness now in tent encampments created in areas where Rust Belt towns and Appalachian towns, and rural towns with no remotely a rising cost of housing. This is accompanying the methamphetamine almost all across the country. Of course, it’s a company there’s other drugs involved too.

There’s fentanyl, there’s cocaine, there’s alcohol, and marijuana, et cetera. It seems that the meth is the real driving sinister force behind it. The other thing that it does is a very scary thing too. It makes you unwilling to leave this little world that, which you have found friends through meth or found a community, so to speak.

I’ll put those word in quotation marks because it’s really not that, but you found this connection through methamphetamine. You find people freezing to death rather than leaving the tent encampments. Just in Southern Indiana about a month ago and that’s what an ER doctor told me.

He says, “We saw tenfold increase in frostbite cases last very mild winter last year, tenfold increase in frostbite because no one would leave the tents.” He told me a woman froze to death in a tent camp. I spoke with the mother, the mother said, “Please.” She went to the tent encampment, “Please come with me your five-year-old son’s at home. You have a warm home.”

The woman would not leave and I hear this over and over and over. It’s a scary thing that’s accompanied by this methamphetamine as they say as it marches across the country.

Elizabeth Vargas:

You spoke to one homeless advocate who said she finds meth in every single homeless encampment that it’s everywhere.

Sam Quinones:

Sorry, I call them meth encampment. It’s a slip of the tongue, but it’s Freudian slip I think. The tent encampments are outgrowth – symptom barometers, I guess, of our meth issue. That’s what they exist for. That’s why they exist. The housing prices in LA shot through the roof beginning in 2012 in San Francisco and all along. They never shot through the roof in Clarksburg, West Virginia. Yet you have the same problems.

Elizabeth Vargas:

It’s accompanied by these simple observation that a lot of times when you see homeless people, especially in New York City, it’s born out by statistics – at least in this city – that homelessness is accompanied by mental illness. Your argument is that a lot of that mental illness is being driven by methamphetamine use.

Sam Quinones:

A lot of it depends on the area in which you live and how prevalent the meth is. I think what’s going on now is that the meth is so prevalent all across the country. It’s covered the country as I said that you’re finding it. Boston was an area with high housing costs.

Until this meth arrived you never saw big tent encampments where people were just an area known as the Mass and Cass are of Boston. You never saw that before. Again, you’re seeing it in areas of Southern Indiana and places that really do not have anything remotely close to a rising overheated housing market like you’re seeing in some towns.

Elizabeth Vargas:

You say that users call it weirdo dope.

Sam Quinones:

Some do in LA, that became among the gang members and among the folks that I talk to, a lot of them were. I talked with this one guy who’s an old gang member. He’s now a barber. He years ago stopped being part of the gang. He still hangs out in the neighborhood.

He’s still in the area and he still sees the old homies and stuff. He says it was amazing. Once they started with this new dope and the ephedrine dope, they stopped making the ephedrine dope, I remember them very vividly. He says, “You can’t even talk to them anymore. They’re eating from the trash. They’re wandering around screaming at something.”

These were guys I hung out with. They were part of the same gang. They have the same tattoos, and now they’re out of their minds. They’re not even able to control it. They don’t they to take care of themselves of course, they’re on the street sleeping wherever. It’s a remarkable thing. Once you talk with people who are on the street who are at the very ground level, you hear these stories.

What’s amazing is that the stories are all pretty much the same. Albuquerque, Clarksburg, West Virginia, Southern Virginia, rural Indiana, Portland, Skid Row, LA the stories don’t change. The tent encampments look so much almost standalone developments now.

Elizabeth Vargas:

How do you recover from a meth addiction? Is it harder?

Sam Quinones:

See with opioids, there are certain drugs that you can take that will alleviate the cravings. There’s methadone. There’s a brand, a thing called Suboxone, buprenorphine within it, Vivitrol. They will help you. It will help the craving subside so you can control that while the idea is you focus on recovering your life.

There is no such thing for meth. The only treatment for meth is separation from the dope. There’s no pill you can take there’s no treatment or anything. It’s just simply separation from the dope, letting the brain heal, which apparently now takes quite some time on this meth.

Just allowing your body and your mind to return to normal. The problem is and in the words of some of the folks I talk to who deal with this daily, getting to that point can take months and sometimes it’s unclear whether it ever takes place. You’re talking about brain damage. The longer people use, the more chance they’ll have of permanent or at least semi-permanent brain damage.

Complete stripping of the memory. A part of the ability of this meth addiction gets you so used to homelessness that you don’t remember much. This is very frequent. A stripping of the personality, that kind of thing. You’re walking around in a daze. If you’re not in complete psychosis, running from all the monsters that are trying to kill you, you’re sitting there stuck. Your brain’s just locked and you can’t really think much.

Elizabeth Vargas:

You interviewed a couple people who were meth users who said it took them a year or two to learn how to speak again.

Sam Quinones:

Yes, one guy said he couldn’t really speak. Another guy said, “I would try to speak and by the time it came time to formulate to say what I had formulated in my mind the conversation around me was way past it. I just never said anything.” I remember another conversation with a woman. By the time I talked to her she was two years clean.

She had been barking like a dog. She had been screaming. It was a terrible, terrible thing she got into. She gets into one of the few that I talked to that actually had made it into sobriety. Her teeth were just almost melted. She had two years worth of dental work to return her teeth to what they had been.

She remembers, she said, “It took me six months before I finally felt empathy. I was in with my roommate in the sober living house and she was watching a movie Maid in Manhattan with Jennifer Lopez. A cornball romcom kind of thing. I watched it with her, this roommate and middle of the movie I just began crying. It was almost tears of happiness because I suddenly began to feel something for the characters in the movie.”

It was a powerful story. I was like, “Wow.” I talked to her a year and a half after that moment and she still knew that her brain had not returned to what it had been before, pre-meth, pre-P2P meth I should say. I can’t remember the exact quote in front of me, she said something like, “I wish they would do research on what more we can do. I’ve been using yoga and meditation, but I want to know what more I can do to heal my brain.”

She knew that she had not recovered, returned to any real normality even two years after her last use.

Elizabeth Vargas:

Sam, why do people pick up this drug? What makes somebody say, “I want to try meth.”

Sam Quinones:

I spoke with a guy recently who had some light to shed on that. He was a gay man who began using meth in the ephedrine days 17 years ago or something like that. Again, he used it because it was a party drug and he had felt bullied and ostracized his entire life as a gay young man. Now, he found this drug – it became part of who he was.

He always felt great, elated, friendly with everybody. It just broke down all inhibitions. He used it very much. Then he told me. “Then, on a Friday in June 2012, Friday night, the meth radically changed. It was never the same after that. I developed an intense terror of everything around me. I was running out of the house. Took my car, racing through the streets, get to this gas station. Leave them car at the gas station and run off.”

It’s recovered at a tow lot three or four days later. I asked him that, “You now know that this meth is devastating mentally.” He said he kept on using it looking for that elation, that euphoria, that he knew from experience had been there. He never really found it again. He kept using it. I say, “Well, why would you use again and again, and again?”

He says, “I use it many times each time it was a terrifying thing. I knew what it was like. I know what it’s like to know you’re about to die.” Even though, of course he wasn’t ever about to die. It was just his own psychosis creating that. He says that is the insanity of addiction. It made a lot of sense to me.

If you’re willing to live in a tent in the winter, if you’re willing to steal from the grandmother who read you books, when you were a child, if you’re willing to part up all the love and trust of every family member you know, then you’re willing to do almost anything. Using this dope make some twisted sense.

It just shows you, Elizabeth, I think the extent to which drugs of abuse, particularly nowadays and their prevalence, and their potency change, divert, and hijack the basic survival instincts that we evolved as species and all animals evolve to possess in our brains. It just completely does that and it reverts it hijacks it, and turns it.

Tent encampments are exact representations of people who have lost all ability to commandeer their basic survival instincts. It’s all about finding and using dope no matter what the cost.

Elizabeth Vargas:

Your story about that one young man, he started using the ephedrine form of meth.

Sam Quinones:

Yes.

Elizabeth Vargas:

Why would anybody start to use the P2P form of meth? Don’t you go right straight to paranoia, schizophrenia, and hallucinations?

Sam Quinones:

I think you are addicted to the meth by then and it’s a strange thing. I’m still interviewing people to find out their perspectives on this. You are addicted to it and you can’t let it go. Again, it’s this insanity of meth. In all cases, people who that I’ve spoken with, people who are using it, did not know anything about the meth that they were about to use.

They didn’t know. In fact, it was remarkable, they remember the date or the specific time.

Elizabeth Vargas:

That it changed.

Sam Quinones:

I remember I was sitting in a pizza place with Eric Barrera, the guy I think you’re referring to in the book who was a former Marine, had used ephedrine meth. Had basically a life more or less together for about eight years. He had a job, a house, a car, a girlfriend, and so on. Then one night in 2009, he said it, the meth just changed and it never became different.

“I was out of my mind. I was believing that my girlfriend had hidden a man.” This is a frequent hallucination, by the way. I’ve heard this numerous times now. “My girlfriend has a man hidden on the walls or the mattress or under the rug or someplace.” I’ve heard this so many times. It’s a remarkable common hallucination. He begins stabbing the mattress. He begins stabbing the walls.

He goes out of his mind for a long time. He said for the next four or five years until he got sober, he never ever felt that euphoria again. He was always looking for that euphoria. That’s what drug addiction is. You’re always looking for that first great high that you can’t even believe is possible to experience and it never happens. Well, he kept looking for it.

Meanwhile, he’s out of his mind. Meanwhile, all his friends disowned him. His mom kicks him out. Dad doesn’t want to see him. His girlfriend kicks him out. His life just spirals down into the point where he is just living out of his car. Watching lots of porn and selling meth because he doesn’t have a job anymore. He doesn’t have anything anymore.

Elizabeth Vargas:

Does somebody using P2P meth for the first time get that euphoria?

Sam Quinones:

I haven’t heard of people getting that, no.

Elizabeth Vargas:

It can’t be creating new addicts it must be all the old meth addicts who are suffering-

Sam Quinones:

I have to say, I think it is. I think it’s a strange situation where you start using, and then you can’t stop using it.

Elizabeth Vargas:

Even though, it’s terrifying.

Sam Quinones:

Yeah. It’s a weird thing. Frequently, I think a lot of times that people are using it for the first time around the street already, sometimes it creates homelessness. Sometimes you’re homeless for another reason, but it ends up being basically your crutch, the way you handle homelessness.

Again, the way you feel part of something when you’re all alone. I don’t pretend to know all the answers to this. I think these are excellent questions. Sometimes I just don’t. I have those same questions all the time and I’m still groping for answers. I do think it’s pretty clear that people are using meth for the first time and I’m just going off the rails and keep on using it because now they’re addicted to it.

Elizabeth Vargas:

You also spend some time in this book talking about the neuroscience of addiction. You’ve touched on this already a little bit, but I was surprised and I thought this might be a bit of a controversial thing. You say and maintain that everyone has the capacity to be addicted to something, everybody.

Sam Quinones:

We all as human beings, all have the same brain chemistry, the same reward pathways that drugs of abuse or sugar or social media apps, or nicotine, all these different-

Elizabeth Vargas:

It might be something else.

Sam Quinones:

It’s an addiction to something maybe less potent and methamphetamine maybe less potent than fentanyl, certainly. Nevertheless, it’s the same reward pathways in our brains that were some of the more primitive parts of our brain. First parts of our brain to evolve saying, “I want, I need. I got to have that. I need this. Must have that.”

It develops a well before our prefrontal cortex, which is the part of our brain just behind the forehead where you govern actions and it’s all about consequences and determining whether or not this is a good idea, and that kind of thing. Everybody, every human being has this capability. It’s who gets addicted and who doesn’t frequently depends on life experience.

Trauma is a big, big factor in all this. Also, just supply. What you come on contact with what your environment is like. How much support, how much familial support you have. That kind of thing is a big part of it as well. There’s a lot factors, but we all have the ability.

That’s why with the opioid epidemic they would say, “Well, there’s studies that show that it doesn’t matter what your genetic disposition is. After 100 days, I think it was, I have to see these studies again, but something like after 100 days, everybody has the disposition of constant use of 100 days.

These pills, that everybody has the ability to be addicted to them. That’s why the pharmaceutical companies pushed mightily for doctors to prescribe for three to six months, because eventually that person who may be able to take two, six Percocets without any problem – I had an appendix operation. No problem leaving those pills after that. That’s what happened to me. I took two and I was done and I was fine. After 100 days of that with refills, easily refills, and that discount cards to get them cheaper and all that kind of stuff, you will not have that ability to get over them so much.

Then pretty soon by then your life is sliding into complete unraveling. It’s the prolonged exposure to that will do it. That’s because those drugs, opioids are so, so potent have such a powerful effect on our reward pathways.

Elizabeth Vargas:

We see a lot of headlines now and a lot of discussion about the opioid crisis. President Biden just talked about it in his State of the Union address. By the way, that wasn’t the case when your first book Dreamland came out.

Sam Quinones:

That’s for sure.

Elizabeth Vargas:

Do you think that in a couple of years we’ll see more people talking about the meth crisis and the fentanyl crisis? You say meth doesn’t get as much attention as opioids, because it doesn’t kill people. It just degrades them and decays them.

Sam Quinones:

Think about it, Fentanyl kills people. There’s a weird thing going on. With death, we’re able to express remorse, flowers, condolences, thoughts, and prayers on Facebook and all that kind of stuff. Meth is more like the raw unvarnished face of our worst addiction fears and it’s terrifying.

That’s what I think keeps us from actually confronting it because it is such an extreme example of people behaving in utterly dangerous ways, utterly out of mind, incapable of governing themselves. That is the far extreme of addiction. We all have it in us, everybody. We all know we have it in us.

We all have that brain chemistry, we all have it in us. It’s also something we think of like, “Oh my God.” We don’t know what to do about it. I don’t blame people for being overwhelmed by it. I don’t know what to do about it either. It’s a scary, scary thing to behold. I just had a meeting with the staff of the mayor of Denver.

Very interesting conversation with those folks. I’ve had conversations with folks at the city levels, primarily city and county where these issues are really hitting home badly. All of that makes me feel like, “Now that COVID maybe somehow receding in our consciousness, maybe it’s now time where we pay attention to this stuff.”

I think a lot of people at the city level, county level have already been paying attention to this. It’s just hard to galvanize the public around it. I’m hoping that’s what happens because I was stunned that the first part of the book as I was writing it, I thought the only part about meth I was going to write about was how much capacity for production they have and how they’re able to cover this.

As I was in the middle of all this, I meet Eric Barrera. We have that conversation at the pizza place in Pasadena, in California. After that, that was about a month I think before I was supposed to turn in the manuscript and I put everything on hold. I said, “Wait, time out.”

For the next three months, I began to call people all over the country. People who would know. People who were homeless outreach, ER docs, drug counselors, people who ran residential treatment clinics. Those kinds of folks who would see this daily. I was struck, the more people I talked to, the more the story was the same.

Just what Eric had told me – versions, variations on that, riffing on that idea in their own ways, but it’s the same story over. I was stunned because I’d never heard anybody talk about this. In fact, nobody has except in this book I think. It’s just overwhelming because everything made sense then.

The tent encampments made sense. The tent encampments in LA. What about the 10 cams in Clarksburg, West Virginia or in rural Indiana or places like this? What is the common denominator?

The massive quantities that they were producing down there had this effect, created this effect in all kinds of regions of the country, not just areas where the cost of housing was through the roof.

Elizabeth Vargas:

Sam Quinones, it’s an amazing book, The Least of Us, you sounded the alarm once right on the precipice of the opioid epidemic. You are sounding the alarm again about fentanyl and meth, and the importance of connection, which we know is what is key to recovery from anything and everything.

Whether it’s drugs, alcohol, sex, gambling, social media at a time when we’re hopefully emerging from the COVID pandemic and reconnecting. Once again, it’s really, really important. Thank you so much, congratulations on this groundbreaking book. We really appreciate you being on Heart of the Matter.

Sam Quinones:

Well, it’s great of you to have me on, Elizabeth. I so appreciate it. Very, very grateful for your kind words. Thank you very much.

Elizabeth Vargas:

Thank you.

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