The Least of Us

This book by Sam Quinones is a sequel to Dreamland in the way that a history of Weimar Germany is a sequel to a history of The Great War. It was not intended, no plot threads were left intentionally dangling. But the perpetual nature of history ("Nothing ever ends," in the words of Dr. Manhattan) means the story continued anyway.

However, this time, Quinones clearly has two purposes: to inform as well as to encourage. As he says, during his tour supporting the first book, he received many invitations to speak far and wide about the nationwide crisis being hushed up by embarrassed family members. And at many of these places, people asked him for hope. Was there anywhere that had figured out how to handle the addicts? How to handle the radical shift from chronic addiction of yore--where the addict stayed housed, employed, and provided, however imperfectly, for a family--to the new world of bombed-out, toothless addicts committing an endless stream of petty crime to support their habit living on the street?

To that end, he documents many examples. Not nationwide, top-down programs but bottom-up, hyper-local ones that slowly spread county to county as news of their success travelled. Counties opening drug courts as diversion programs, churches with dwindling attendance finding new purpose, and prisons opening dedicated units to those wanting to stay on the path to recovery.

Along the way, he also documents and tells the story of the phase change in the drugs themselves hitting the market in the months after his previous book was published: the change from heroin derived from field-grown poppies to lab-synthesized fentanyl (discovered in a Belgian lab 40 years hence) and of the change in meth production to evade legal crackdowns on ephedrine that began creating and distributing a product, cheaper and more addictive than ever, that also caused psychosis and hallucinations.

All of this crashes against the shores of post-industrial red states. The decriminalization and "harm reduction" strategies of blue cities and states are mentioned briefly near the end, once enough stories of crushing and often fatal addiction make it subtextually obvious that such approaches would be doomed from the start, as well-intentioned as they may be. But this is not a book of pointing and laughing at isolated incidents. Instead, it is many stories of quiet desperation in working-class towns trying to solve the seemingly intractable.

Reflecting on the book as a whole, Quinones rarely sermonizes or posits a thesis. He has one penultimate, obligatory chapter where he also somewhat haphazardly tries to weave in larger topics like climate change and gun control, but the whole thing has a sort of perfunctory tone. Instead, he leaves it to the reader to derive a thesis, which I would phrase thusly: the epidemic of fentanyl and P2P-meth addiction is fundamentally unlike previous naturally-derived addictions like alcohol, sugar, nicotine, old-school weed, and even heroin. They thoroughly hijack the human brian, having been iteratively perfected to do so by the fast-moving anything-goes black market, that the reliance on typical criminal justice reform strategies based on self-preservation and rational consideration of long term interest just fail.

Addicts to these drugs ease their way into a destroyed life and are left with no way to dig out as an individual. They have nowhere to stay, no bank account, no options for employment, and hijacked brian chemistry that takes 3-9 months to re-regulate. If they can detox (such as during a short jail sentence) and stay clean for months while slowly rebuilding a life, they have a path out. But that path is heroically difficult to complete alone, once someone reaches the phase of having no home, estranged family, and a contact list containing only other users and dealers.

The government does not have to solve this problem, but they must at least not stand in the way with counter-productive sentences that just continue the cycle of reoffending. Communities must come together and support initiatives to help addicts stay clean and build a new life, because sentencing them to prison will not. When you keep trying the old way and it doesn't work, it's time to try something different. This book isn't a blueprint for what works, but tries to provide some ideas and start the conversation, and show there is some hope.