Sam Quinones has been tracking drug epidemics in the United States for decades. His best-selling books “Dreamland” and “The Least of Us” follow the dangerous expansion of opioid, methamphetamine, and fentanyl usage across the country. Sam joins the podcast to explain how substance abuse has shaped American culture, economics, and healthcare.
Learn more:
- Purchase Sam Quinones’ books
- Purchase Ending the Crisis by Dr. Holly Geyer
- Learn more about pain management and safe opioid use on our Opioid Resource Center
- Comments or questions? Email us at mcppodcasts@mayo.edu.
- If you or a loved one are dealing with a substance use disorder, visit Substance Abuse and Mental Health Service Administration.
Read the transcript:
Dr. Benjamin Lai: Hello. Welcome to Ending the Opioid Crisis. I’m Dr. Benjamin Lai.
Dr. Holly Geyer: And I’m Dr. Holly Geyer.
Dr. Benjamin Lai: This is a podcast series aimed at getting a deeper understanding of the opioid crisis that has ravaged our country.
We’re pleased to have Sam Quinones with us today. Sam Quinones is a journalist and a former Los Angeles Times reporter and author of The New York Times bestseller and National Book Critics Circle Award Winner “Dreamland: The True Tale of America’s Opiate Epidemic.” His latest book, “The Least of Us,” goes into detail on how this epidemic has evolved to involve fentanyl and methamphetamines. Welcome to our podcast, Sam Quinones.
Sam Quinones: Great to be here with you. Thank you very much.
Dr. Benjamin Lai: Sam, perhaps you can start by telling us how did you get interested in the opioid epidemic in our country?
Sam Quinones: I had lived for many years in Mexico, ten years in Mexico. I wrote two books about Mexico, and in 2004 I came back to Los Angeles, which is my home region, and I got a job with the L.A. Times. I was a reporter down in Mexico as a freelance writer down in Mexico. And when I came back within a year, the drug wars very savage things began to erupt in Mexico.
Within a couple of years, I was put on a team of reporters to cover that, to try to understand it better. And one of the things that I was doing was covering how drugs made it to the rest of the country once they crossed the border. I was in L.A., I spoke fluent Spanish, and I began to realize, doing that, that we were in the middle of an enormous new surge of heroin use.
And I could not explain that. I did not understand why that would be. I thought heroin was popular in 1970s and we’d left that behind. And as part of that, I began to write about this one town in Mexico where all the men would go north to the United States, starting first in San Fernando Valley, but then they were spreading and had mastered a system of selling black tar heroin retail in 10th of a gram doses, in balloons very much like pizza.
So, they’d have an operator standing by when an addict would call that number, and they’d dispatch a driver with the heroin to you in San Fernando Valley. And then, as time went on, they expanded throughout the west, Salt Lake, Reno, Albuquerque, various places, Portland, etc. And then in 1998, they hopped the Mississippi River and they made it to Columbus, Ohio.
And so, I spent a lot of time trying to understand this. And it was clear that they had this enormous new market. They were going gangbusters, saying they were expanding into all these new towns and all these little cells were popping up of this method of selling heroin. And so, I did a long story for the L.A. Times about that, but I still didn’t understand why they had such a large new heroin market until I was midway through that story.
I began to understand that I was really focused on the small story, and the much larger story was this enormous expansion — “the opioid revolution and pain management in American medicine” is how I kind of termed it as time went on. And this was creating an enormous new market of opioid addicted consumers all across the country. And they eventually, as time went on in their addiction, they would switch to heroin because these are all opioids — oxycodone, hydrocodone, heroin — they’re all opioids.
And so I began to realize that I was focused on a small part of the story behind that story’s much bigger one. But I was oblivious, because I lived in Mexico for most of that time, I didn’t really understand. I didn’t know what an OxyContin was, literally didn’t know what one was. I didn’t know what Vicodin, what pain management, the pain scales that you’re given in a hospital and never seen any of this.
It was all foreign to me. I was much more at home with the Mexican side of things, the Mexican village side. That’s what got me involved in this. And I began to realize it was a much bigger story, almost at about the time I was publishing the story in the L.A. Times, I realized this was I was about to publish a story that was only half the story, that really it was a much bigger thing.
I began to focus on the idea that this should be a book, and eventually that’s what it turned into. And “Dreamland” came out in 2015, and that was really the story of the beginnings of the opioid epidemic, focusing really in large part on this one town in Mexico, because these guys were essential to the story. They were a small group of traffickers, relatively speaking, but they were the first ones to recognize and then systematically exploit the coming market for heroin.
That wanton prescribing nationwide of opioid painkillers was going to create. And they figured this out in 1998. They were way, way ahead of the curve. And that then led me to all that happened after that. It was a long story after that. But that is an absurd question. That’s kind of how I got into this whole thing initially.
Dr. Benjamin Lai: That just illustrates the very complex history in our country and actually a transnational history. Sam, in your research, what do you think is the role that health care providers have to play in all of this? You had mentioned a little bit earlier already that patients were no longer getting the OxyContin, for example, or maybe they transitioned from prescription medications over to heroin. Was there a change in climate at some point that kind of really drove this based on your research?
Sam Quinones: I mean, I would say that initially, of course, this was all doctor driven and really it was doctor driven for a few reasons. And I think that’s where the nuance of this story comes tend to play. First of all, there are a number of pressures on doctors by them. Managed care Managed care meant that you had most primary care doctors had, what, 13 , 15 minutes per patient? Not enough time to deal with the real pesky pain patients whose problems needed more time with the doctor.
There was a lot of push to find a better way of treating pain because truth is we didn’t really do it very well and it really came to understand it was about as much an art as it is a science. Also in American culture, there was this idea like, okay, I want you, doctor, fix me. When a doctor would tell the patient, “Look, you don’t really need those pills. You need to work out, you need to walk, eat better food, hang out with people, don’t drive as much, take the take the stairs.” All these different things that fall under the heading of wellness of our own attention, personal responsibility for our own wellness. Many Americans push back against that, “No, I’m here with you. You need to fix me.”
But doctors for a lot of this did not have a fix, a miracle cure. What they did have was increasingly very aggressive promotion of pain pills by pharmaceutical companies, insurance companies, cutting back on the wide panoply of therapies that they would reimburse for for one patient for pain. I mean, used to be physical therapy, occupational therapy, marital counseling, even marital counseling was part of pain management, marriage, I guess being pain.
You get pain, you get you get marital counseling. And all this was paid for as a wide panorama of treatments for one person’s pain issues. That began to end as the insurance companies began to say, well, we have these pills. Why don’t we need to reimburse for marital counseling or physical therapy, all this different stuff. You began to see the little chinks in the wall being taken out by the insurance companies.
I would say too that there was the real expansion, frankly, of very powerful marketing of legal yet addictive substances and services. We began to see massive promotion of sugar, high fructose corn syrup, gambling, pornography, video games and, of course later, social media, smartphones, etc. We began to see this heavily and dousing the American population — that was also part of it.
It was a kind of an ecosystem of problems or issues that combined to push doctors to then prescribe. And after a while, people began to do that. In time, some doctors realized this was a huge mistake they backed off of, but a lot of doctors still kind of went along with the program, if began to be taught in medical schools as the proper approach to pain was endless refills of prescription opioids and that to not do so was somehow to be callous with regard to your patients, this kind of thing.
People began to understand, some people, anyway, began to understand that this was creating a real problem with transition to heroin addiction. At the same time, Purdue Pharma, which produces OxyContin, which is the most potent of all the opioids at the time, was about 2010 or 2011, came up with a new formulation for it so it wasn’t as easy to abuse OxyContin. That hastened the transition to heroin, which was already going on. It started almost as soon as OxyContin came out. OxyContin is a real important part of the story, too, by the way, because up until the OxyContin, which of course many of your listeners know had had only oxycodone within it, it did not have any acetaminophen or anything like like Vicodin or whatever.
Before you had these pills that had a small amount of of opioid and a much larger amount of acetaminophen, like Vicodin, for example. And it was very difficult for you to develop a serious habit on those without also doing great damage to your internal organs on those drugs. But then OxyContin comes out and not only does it have no abuse deterrent, it also comes in very large doses of oxycodone, 40, 80 for a while, 160 milligrams.
It takes people up to very high daily tolerances on oxycodone, and with that, what happens is then you get the doctors freaking out, “Oh, my God, what am I done?” And they they take them off or they lose their insurance. Variety of stories take place, but eventually people have to switch. They go to the street, but the pills are going for a dollar a milligram on the street, 200 milligrams a day.
That’s 200 bucks a day, you can’t do that. So, people begin to switch to heroin. And it’s then that the group of Mexican guys that I wrote about become part of this story. They are seeing this happened first in Columbus and then various parts in the Midwest, Nashville, Indianapolis, Lexington, Louisville, Cincinnati, etc., and then eventually just nationwide.
Dr. Benjamin Lai: You mentioned this just briefly already, the addictive nature of certain foods or social media, essentially our culture. I think in your book, “The Least of Us,” you also kind of mentioned that as well. And I think you’ve interviewed quite a few experts and especially those studying mice where they were given naloxone, mice who were on sugar.
Can you just describe that very briefly for our audience and make that link between things like process foods and drugs?
Sam Quinones: Yes. And I think that there’s been a lot of interesting research into the similarity and response of the human brain to processed foods, sugar being a main one, and things like heroin. The one experiment you mentioned was out of Princeton, where they put a group of rats, made them dependent on sugar cane sugar water, 10 hours a day for a month or something like that, and then they gave them naloxone, which of course, to those who don’t know, is opioid overdose antidote revives you very quickly, kicks the opioid receptors free of the thing that’s attaching to it. They’ve found that sugar attaches to the opioid receptors just as way kill the heroin molecule, whatever you call it, and it does from heroin. And very quickly, those mice displayed symptoms of withdrawal.
And this was measured by excessive grooming, shaking, chattering, the teeth, all these kinds of things. These mice went into withdrawal the same as any addict would and, when given naloxone quickly, were sent into withdrawals off of heroin. I found it just fascinating to talk to a lot of folks about this. There’s Ashley Gearhardt at the University of Michigan, who has an entire food lab designed as a fast food restaurant with all those bright oranges and reds and all that stuff, and does experiments on the human response to consuming a lot of these fast food products and so on.
What I found is that there is this connection between these products. There is an addictive element to these products. Nicole Avena at Princeton was also extraordinarily helpful, very interesting woman, and to me this was important to highlight because it seemed to be part of the same story. There was a long history that begins almost in the womb, but certainly in childhood, of addiction to these kinds of things and then leads to other harder drugs.
But there is also this feeling of kind of a preparation for addiction almost in our culture, where it’s kind of viewed as okay, and fast food or other companies are allowed to market with the same language – the language of addiction triggers. These burgers will trigger your cravings and all this kind of stuff. To me, that sounds very much like addiction.
The key thing, though, is, again, supply. The supply of pills was explosive for 20 years. Still it’s really too many, if you ask me. Now we’re seeing synthetic drugs out of Mexico, methamphetamine and fentanyl, just explosive growth covering the country. Well, the same is true of a lot of these addictive substances and services, even more so.
I mean, there’s so many things that contain sugars. Cell phones are constantly at our beck and call; highly addictive video games and gambling, of course, now you’re seeing it on sports shows and sporting events, these apps that are doing that. To me, I wanted to draw those connections because we live in a toxic soup of addictive stuff, seems to me as a culture, and it goes beyond the Sinaloa drug cartel is all the way out here.
But you get there, you go through the Facebook software designer, and you go through CNN and Fox News selling outrage, which is also highly addictive, and sugar, and cell phones, and pornography, and video games. And finally, all the way out at the end is the Sinaloa drug cartel. And so to me, it felt like we needed to understand America today, not that this is an outlier and no connection whatsoever to this other stuff.
They are all about hitting our brain chemistry, our receptors in our brain that push us to impulse, the dopamine receptors and all that that push us to impulse. And what they are all about is investing money and selling products that fine tune and promote that impulse behavior. To me, that was why I wanted to get into this, and I thought it was very important to do that. We’re in a great era of neuroscience research right now, learning more about the brain than we ever thought possible 20, 30, 40 years ago.
Dr. Benjamin Lai: Yeah, absolutely. So, I mean, it sounds like we are primed really for this epidemic. We have the perfect environment, fast food, the social media, the news and so forth.
Sam Quinones: I would totally agree with that. And I would say too, that we have some other things that make us prime for that. Two things that are really important to all of us: one is that there’s a nationwide unspoken, but nevertheless deep, reservoir of trauma nationwide of all kinds – of neglect, and violence, and sexual molestation, and abuse, and on and on like that.
I think what the opioid epidemic has done is lifted the lid on that. And then the other is, and these are all important to this story, it seems to me, you cannot tell the story without this, the other is just a remarkable isolation on American culture. Fragmentation, shredding of community that is, I believe, debilitating. We have evolved as a species, rather, to not find community a good thing; it’s that too, but also really require we survive because of our need to be around each other.
In the United States, in the last 40 years, we’ve turned our back on that. We’ve decided, well, that’s not really necessary. We’re prosperous enough so that we can live our lives with almost no human contact, and that is devastating to the human organism, it seems to me. So those two things, too, are part of all this mix that leads us to, in this country, have an especially profound and intense problem with addiction and opioids nowadays in particular.
Dr. Benjamin Lai: Sam, you wrote “Dreamland,” and several years later, in , you published the Least of Us. What’s changed? What’s evolved since that time? I think you mentioned very nicely in your new book, fentanyl and methamphetamine. How do those come into play?
Sam Quinones: Yeah, those are simply the trafficking world saying, “We’ll take it from here,” in a sense. The trafficking world, long ago figured out that synthetic drugs, meaning drugs made only with chemicals, no plants involved, were actually far superior from their perspective than growing plants, growing drugs – marijuana, poppies, all that kind of stuff.
The drug that first taught them that was methamphetamine in the nineties. They industrialized its production, essentially, in Mexico and into parts of the United States, then really almost exclusively in Mexico after that. And then along the way, we created this new opioid addicted consumer population with our wanton prescribing of these pills. And they, along the way, discovered then fentanyl, which they initially called synthetic heroin – they used that term for it, initially – which was amazing to them.
They thought, “Oh my God, we don’t have to grow poppies anymore.” And so, the synthetic evolution or revolution of drug trafficking down in Mexico begins with methamphetamine, dovetails with the opioid epidemic nicely with fentanyl. But in both cases, it’s all about what benefits traffickers. They are not thinking about consumers. This is not demand-driven. It’s supply driven almost entirely because synthetic drugs benefit only traffickers. They don’t benefit users at all.
So, if you’re a trafficker, you don’t need land, rainfall, sunlight, big legions of farmers. You can do it all on a small lab, and there’s no seasons anymore either. So, you can produce according to how many ingredients you get. And they have control of shipping ports on the western Pacific side of Mexico, and they can get all the ingredients they’d ever need to make methamphetamine and to make fentanyl. And, of course, you get Mexico City Airport and a variety of ports, particularly on the western side.
You can produce quantities of drugs that simply dwarf anything possible by growing plants. You reduce the risk, increase the profit. I mean, there’s no reason why if you were a drug trafficker, you would ever want to grow anything ever again. I mean, you have all these drugs you can make yourself very easy to manage, not hard to learn.
There’s now a wide body of knowledge and a trained labor force on the Pacific side of Mexico, particularly in the central part, Michoacán, Sinaloa, Durango, and places like that, Nayarit – those states where people know how to make this stuff commonly. And so, you’re getting supplies that simply boggle the mind. So now, instead of widespread prescribing of pain pills covering the country, now what covers the country are two illegal drugs and methamphetamine and fentanyl.
And these are in Vermont. They’re in Skid Row, L.A. They’re in Oklahoma. They’re in rural parts of the country, urban parts. I mean, they’re pretty much all over the country with some places, maybe not so much as others. But the fascinating thing is, with massive supplies that they were able to create out of Mexico, they have now done what no trafficking group has done ever and we’ve never seen – that is to essentially cover the country, more completely than even cocaine in the eighties, with two illegal drugs, and those are fentanyl and methamphetamine, both of which are about the most potent, cheapest, and most damaging, devastating drugs we’ve ever seen.
It comes about because they gradually come to understand that these drugs are available. First, they already knew about methamphetamine and then they realize, in the story I tell in “The Least of Us,” they are made aware of fentanyl by an underground chemist who they actually hire to make ephedrine, which is a precursor to one of the ways you make methamphetamine.
They wanted to secure an ephedrine source in case the government eventually cracked down on importations of ephedrine, which it did later, and we can talk about meth later. But, they figured out fentanyl because they hired this one guy and he knew how to make fentanyl better than he knew how to make ephedrine, and he did it and clued them in.
All of a sudden, the light goes on: bing! No more poppies. We can just make this stuff and huge, huge profits, staggering profits, for fentanyl. So, all of this is kind of part of the story of what happens when we open the door with widespread opioid addiction and opioid prescribing that leads to addiction, because many of the folks now who are addicted to fentanyl started their drug use with a car accident, athletic injury, some exposure to legitimate, legal, prescribed opioid painkillers.
Dr. Benjamin Lai: I see this in my clinical practice all the time, and you mentioned it in your book as well. People are taking both fentanyl and meth.
Sam Quinones: It happens because those supplies are everywhere. If you read the history of drugs in our country, historians have noted cycles: first stimulants, then depressants, then back to stimulants. And generally these cycles take ten, 15 years. Those cycles are gone. It’s fentanyl and meth, it’s a straight line. It’s all across the country and there’s no more cycles. Both are available now in staggering quantities, not because of a demand, but rather because the trafficking world figured out this was what benefited them most.
That’s the key motivator. They could easily be providing heroin if they wanted to. You can grow poppies in Mexico very nicely. They don’t want to grow poppies because it’s very risky and it’s very time consuming. And it’s only by season, on and on and on and on like that. Fentanyl makes so much more sense. And, if some people die along the way, well, okay, whatever. That’s tough and not a big deal.
Dr. Holly Geyer: The CDC estimates that nearly 2.7 million people in the United States have dealt with opioid use disorder. If you were a loved one or managing opioid use, my book, Ending the Crisis can be your guide through addiction with resources for those struggling with addiction, information about interventions and treatment centers of much more. This book is a how to guide to navigate opioid use.
Visit the link in the notes of this episode or visit mcpress.mayoclinic.org/opioids to get your copy today.
Dr. Benjamin Lai: Sam, I want to move a little bit towards how do we eventually get out of this. And I think you mentioned this in several stories in your book, “The Least of Us,” communities gathering together again, building the communities again that we’ve lost. You mentioned in Kenton County Jail in Kentucky, for example, there is a special unit in the jail where it’s really targeted for people who are motivated to be in recovery.
And then you get volunteers coming in to remove tattoos from people. With all of this in the background, what do you see the role in family and social support and community and what we in medicine termed the biopsychosocial-spiritual model in recovery? How important is that?
Sam Quinones: Well, I believe that’s essential to recovery. It does seem to me that you need that community part of it. That was why COVID was so damaging, for example, because people were isolated. And that’s the one thing you’re told never to do when you’re in recovery from drug addiction is isolate. All of this is extraordinarily important. I think before COVID, we were seeing some very interesting things happen.
One was in virtually every county I went to speak, there was some kind of organized coalition, task force, community group, whatever you want to call it. They were all kind of the same, though. They’d formed up without knowing what to do, exactly, and they came together and it was much beyond the normal approach to drug problems. It was much beyond law enforcement, judges, and sheriffs, and probation, and cops, and all that.
It was also service groups, and clergy, and PTA, and hospitals, and universities. All these different groups kind of were forming and I began to notice this when the book came out, I began to get a lot of speaking engagements. All across the country this was happening, almost like without being taught what to do or told what to do, Americans were doing it and they were forming up in ways to strengthen their communities without knowing what to do.
They made a lot of mistakes, but the most important thing was not that they made a lot of mistakes, it was that they actually were doing something. They were moving towards something, and in time they realized that it needed to go beyond just the county and then a couple of counties would form up and those kind of things.
It was a remarkable thing to watch. And I began to realize that as I began to speak – COVID did away with all that. That was one of the most damaging things about COVID, it seems to me, was it really kind of crushed this new movement towards community repair and rebuilding that was going on and really hitting some good strides, and getting a lot of budget, and getting a lot of funding, and getting a lot of social support, media coverage and all that kind was really remarkable to watch.
It was not very well noticed because it was on the small scale in every county. There was nobody who was issuing press releases on behalf of all these groups. It was just little groups all over. But nevertheless, I found it to be extraordinarily healthy and also interesting because nobody taught people what to do. They just did it.
They would say, “I don’t know what we’re doing.” People would ask me all the time, “Where in the country are they doing things well?” And and I say, “Don’t worry about that. You’re doing things well just by matter-of-factly coming together, beginning to work together to break this down.”
I mean, small counties, you think everybody knows each other, but they don’t. They’re all working in different directions. And, you know, you bring them all together and all of a sudden they begin to make some difference in a way that’s really important. And the other thing is that a lot of this stuff began to prompt new ideas. And one of the most important new ideas was the one you mentioned, which was rethinking jail.
Jail has always been, if you even thought about it at all – and most people in a county, any county you want to mention, don’t even give it a second thought. They just know that you have to have a jail and we have to pay for it. Most jails are just places where people go to vegetate. It can be very counterproductive. It can be sometimes life mangling, very traumatic. It depends, but frequently it could be used better. And that’s what people, particularly in those states where the opioid epidemic has really been hitting longest and hardest, that’s where you really find some of the most interesting experiments on how to rethink jail.
So, jail becomes a place for recovery, not just sitting around playing cards, watching TV, sleeping, and then get out and go back to the same old life. You wake up in the morning, you make your bed, you’re in class all day long, you’re signed up for Medicaid so when you get out you have health insurance and dental insurance, which is very important for an addict in recovery to have to get work on his teeth because his teeth are almost like emblem of what he’s been up to the last three, five, eight years, whatever it’s been.
All of this is really important because too, we have now on the street the two most deadly mind-tangling drugs we’ve ever known in scandalous, staggering quantities coast-to-coast, and that’s fentanyl and methamphetamine. We need a place where people can be yes, arrested, yes, taken into custody and not leave when the dope insists that they leave, right? Which you can do in a treatment center.
You go, “Okay, I’m gone because I got to go find my dope.” Well, the problem with that is that on the street, nobody lasts. Everybody, in time, dies. There’s no such thing as a long term fentanyl user – everybody dies. With heroin, it was very common. You would use 30, 40 years. People did that all the time. I met many who did that. Not a good life, but nevertheless they lived.
And so, it’s fascinating to me to watch and why I wanted to write about this in the book, these different approaches that began to emerge. And one of them was force on counties. We’ve got to rethink how we do jail, and that is now becoming a little bit of a movement in the country and many places are trying it.
Columbus, Ohio, is about to open, maybe already has actually, a jail that I take to be kind of like state-of-the-art with all kinds of new services for people who want to focus on recovery from their addiction. There’s another part of the jail where if you want to misbehave, you want to be a jerk, you want to you want to cause problems? You can be put in that other part of the jail, too.
There’s a different idea about how to make a fixed cost, something we’ve never thought about, into a place where recovery can begin and it presupposes them services on the outside that are very extensive as well. And that’s part of what’s happening in a lot of those communities too.
Dr. Benjamin Lai: Sam, we have a large number of listeners who are physicians, nurses, pharmacists, midwives, nurse practitioners, physician assistants. What is your take away, based on your research: What can we do as a medical community to help support some of these community efforts and to really slow this down and hopefully to put a stop to this?
Sam Quinones: I think one thing is that I have used people in the professions you just named as sources for my information: ER docs, addiction physicians, nurses of all kinds. I mean, really, really helps. And paramedics, too, by the way. I think one thing, especially important, is to make yourself heard. Too often, people in the medical profession believe it’s not their place or I guess or they don’t have time – I understand that, it’s very, very busy profession – to go to meetings and be public with the very immense body of knowledge that they possess because of the jobs that they do. That’s very important to hear them and too often you don’t. I began to urge doctors to get involved in those community groups I was mentioning because I thought that too often they were not part of that mix.
Maybe the hospital administrator was, but the E.R. nurse? They were not involved so much. And I think that’s one thing because it leaves people at the mercy of this most deadly and powerful stuff that is on the streets. And you can see that in tent encampments, where people won’t leave despite how lethal the temperatures get.
So, to me, all of this is part of maybe what doctors and nurses and other medical professionals need to talk about, need to write opinion pieces in the local newspaper, go on radio and talk about publicly and say, “This is what we’re seeing.”
We’re seeing now huge numbers of people with endocarditis, and this is another example of what I’m talking about. These drugs blunt the basic instinct for self-preservation that we all possess. One proof of that is what I’m sure your listeners who have dealt with endocarditis patients are seeing all the time where people will near death get this extraordinarily expensive operation, very expensive treatment.
And in middle of all that, they help someone sneak them in drugs or they’ll sneak out to the street, and then they’ll have to start that whole process all over again, each time, of course, risking death because their heart’s already in trouble due to the endocarditis, the bacteria from shooting up and all. But anytime you use on the street is another threat to your life, and nevertheless, people are still doing it.
Why? Because the drugs are in control. There’s no rational, free will decision making going on here. I’ve been stunned. I remember when I first heard the term endocarditis. I’m a crime reporter, you know, I’m a layman when it comes to this stuff. I remember in eastern Tennessee, a state legislator at a lunch who is also a surgeon said, I think he said, “I have now have five cases of endocarditis.” Before it was like once every two years, he told me, maybe three years, I would get such a case.
This in the middle of the opioid thing, heroin, and all that. Well, now, I think he’d love it if he only had five. I don’t know how many he’s got, but other hospitals I talked to there are dozens and dozens of these cases. People have not enormous numbers of endocarditis cases and all of them repeatedly kind of self-defeating.
Why? Because the drugs are in control. There’s a hospital in Columbus where literally they have drug sniffing dogs looking for people, visiting patients with endocarditis, not smuggling in dope. So in the middle of this very serious, life-threatening condition, people are still opting for dope.
Why? Because there is no rational free will going on here. And that’s why people need to be in a place where they can’t leave until they have separation from the dope long enough, until they have this ability just to opt-in to treatment, to find that readiness that they’re never going to find on the street. To me, a big thing that doctors and nurses can do is just tell these stories.
These stories are out there and you guys see them all the time and they need to be heard. These kinds of things, I think health professionals can provide an enormous amount.
Dr. Benjamin Lai: We often talk about this amongst ourselves. How do we provide better treatment for patients? I know there’s a push in some of the bigger academic institutions in the country to even start addiction treatment for patients who just had valve surgeries or who are still in the ICU for getting treated with infective endocarditis. We get them connected right away from that start and into hospital, you know, at discharge and outpatient care, but I agree. We really need to kind of speak to the public a little bit more on this.
Sam, I want to kind of give a final few moments for you as reflection. What are some of the big takeaways with writing the books and perhaps some of the more poignant stories? What would you like our audience to leave listening to this podcast with?
Sam Quinones: Well, I guess that this is, of course, a very, very serious problem. I remain hopeful. I know I’m a reporter, 35 years on the job, and I should be all cynical and stuff. I don’t, and I’ve covered the thing that would seem to be intractable, but I don’t feel that way. I don’t feel crusty and cynical and so on.
I feel like this epidemic of addiction – the opioid epidemic, and then you got meth involved, I just think that’s a term that that was true and now kind of is not really so much, it’s just simply a long, prolonged epidemic of addiction all across the country – is really teaching us. It’s a teachable moment, in a sense, of something that has lessons.
Individually we should reexamine what we eat – I don’t drink soda anymore. I don’t really eat anything from the center part of the grocery store, very rarely, let’s put it that way. Very rarely. I get lots of exercise. I’m about to go work out after I talk with you. I swim, I walk. I’m going to walk over to the park where I do my exercise, that kind of thing.
When I was growing up, Southern California in the 60s, 70s, kids were outside constantly. Nobody was indoors. My mom knew this and she had a farm bell, and every afternoon at six on our street, she’d go to the sidewalk and ring that farm bell to get her boys, four boys, home for dinner. Why? Because she didn’t know where we were, right? We could be anywhere. Just up and down the street, there was a park two blocks away, that park was packed all afternoon, and so being around other people was normal. And the families were bigger, the houses were smaller, so everyone wanted to be outside, etc. There’s all kinds of reasons for this, and we have lost all of that almost entirely.
It’s a scary thing to drive through most American neighborhoods today and see nobody on the street. Four people living in an enormous house when six used to live in a house a third of the size, nobody on the street, nobody communing, nobody being around. And again, we have decided as a culture, we don’t need this most essential thing.
So, I believe in intentionally planning for things outside with other Americans on your cul-de-sac, or on your street, or through your church or synagogue or house of worship, or through your school, or through your business, getting together. We have to relearn that, as Americans, it seems to me, sadly, but nevertheless. And so do things, plan things, a barbecue, a get together at your church, a potluck or something like that, bringing people out of the house together. We all want the same thing.
We did a thing in my neighborhood. My daughter and I organized this called Street of Heads, and Street of Heads was a week before Halloween. There’s a cul-de-sac around the corner from where we live, and we put tables up. We invited all the kids. We began this when she was seven or eight, and she was in elementary school.
So, we invited many, many kids from all over and all the parents, Oh, it’s a great idea. And we brought them all together, bought a bunch of wig heads for $1.49 on the Internet, and kids brought all this art material and they decorated all these wig heads, arrows through them, and beads ,and spray painted them with spray paint – except for that styrofoam, when you spray it with spray paint kind of disintegrates and it looks very cool if you’re seven – and so they would do that. It would look really, really ghoulish and all that. And we put these heads up on stakes and put them around the street. And it was an open air art gallery for about a week before Halloween.
And the effect of that was just transformative, in my opinion. We’re not living there right at the moment. We still own property on that street. We’re living elsewhere in Nashville. That street, last October, had its eighth or ninth Street of Heads. And people now know each other. People routinely come out of the house. People routinely ask if they can feed my cat for the week or whatever.
All of these things that used to happen organically are now happening on this one part of this block because of Street of Heads. People are in contact, know each other first names. It is a community made solid by simple, getting out of the house and being together once a year. That’s all it took. Now you do more of that and it gets better.
So I think these kinds of things, this is what I was taken with. It’s not high tech solutions, it’s low tech. It’s stuff that we already knew what to do. And we’ve just lost it.
Dr. Benjamin Lai: And we’ve been doing for years and we just forgot how to do it.
Sam Quinones: Oh, I think we’ve been doing it since the caveman days, you know? Caveman, who wanted to be on his own, just go off and be on his own and march to the beat of a different drum – he got eaten.
Dr. Benjamin Lai: Sam Quinones, author of “Dreamland” and “The Least of Us.” It’s been a pleasure.
Sam Quinones: Pleasure’s mine, Ben. Thank you very, very much. I’m easily available to all your listeners online. My website is samquinones.com and I am happy to be in touch with anybody who wants to write.
Dr. Benjamin Lai: Thank you very much. Thank you for your time.
That is all from us on today’s episode of ending the opioid crisis. You can check out our website at mcpress.mayoclinic.org/opioids for more episodes of our podcast series and other resources for safe opioid use.
If you or someone you know are struggling with an opioid or another substance use disorder, we recommend speaking with your health care provider or going to the Substance Abuse and Mental Health Services Administration website.
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Ending the Crisis
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