The Least of Us

August 15, 2021
Quinones sounds an alarm about a rapidly spreading form of meth in a follow-up to his award-winning Dreamland. Buried in this overstuffed book lies an urgent story the author sees as overshadowed by the opioid crisis: the explosive growth of the potentially lethal form of synthetic methamphetamine known as P2P (phenyl-2-propanone). Through extensive but rambling interviews with people ranging from dealers to Drug Enforcement Administration agents, Quinones found that unlike earlier types of meth, made with hard-to-get ephedrine, P2P meth could be more easily made from "legal, cheap, and toxic" chemicals in Mexican labs and shipped north by traffickers. P2P, he learned, could cause intense paranoia and terrifying hallucinations and faster and worse harm than ephedrine-based forms: The new meth "was quickly, intensely damaging people's brains." Quinones maps the wreckage nationwide, including that it drew Black dealers to what had been "a working-class white drug." What he learned is genuinely alarming but embedded in background material on topics that have been extensively covered elsewhere: the neuroscience behind addiction, the pre-P2P shifts from prescription painkillers to heroin to fentanyl, the toll opioids have taken in West Virginia, and the Sackler family's disastrous stewardship of Purdue Pharma. The author also describes effective community-based responses to the crisis, such as church shelters for homeless addicts and "drug courts" that offer substance abusers an alternative to prison. Quinones concludes that the nation has forsaken "what has made America great" and that "when drug traffickers act like corporations and corporations like drug traffickers, our best defense, perhaps our only defense, lies in bolstering community." After his account of the corporate missteps of the Sacklers and others, readers may be unpersuaded that the "best defense" might come from hard-hit communities themselves rather than from remedies such as tighter government regulation of rapacious corporations like Purdue Pharma. A valuable but overlong overview of an underappreciated drug crisis.

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September 1, 2021
In a clear follow-up to Dreamland (2015), Quinones further delves into stories of America's meth and opioid crises. Yearly deaths from overdoses continue to climb due to fentanyl and a new type of meth made more cheaply and easily without ephedrine. Quinones chronicles the devastation wrought by these newer synthetic drugs, while also showing how corporate marketing and Americans' desire for a quick fix combined with our addictive nature tie into the problem. But he also writes of hope; towns that have completely revamped the system to encourage recovery not punishment, a sheriff who helps addicted people by employing them, a woman dedicated to providing free tattoo removal for those in recovery. Quinones introduces a lot of people in a lot of places, and does a good job of keeping everyone straight. He is always engaging, though some information feels rehashed and his conclusions don't always seem clear. Regardless, readers looking for the latest take on the drug trade and recovery as well as those who flock to well written journalism will dig into this.

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Starred review from September 13, 2021
Journalist Quinones follows Dreamland with a sweeping portrait of the destruction wrought by pharmaceutical companies, Mexican cartels, and other drug profiteers, and an inspirational call for a renewed sense of community to combat the isolation of addiction. Quinones reports from Mexican meth labs, Ohio treatment centers, federal prosecutors’ offices, and the Stamford, Conn., headquarters of OxyContin makers Purdue Pharma, where sculptor Domenic Esposito displayed an 800-pound “Opioid Spoon” in 2018. Quinones also delves into the history of fentanyl, a synthetic opioid first manufactured in the 1950s that began to appear in significant quantities in the U.S. in the mid-2010s. More addictive and profitable than previous opioids—and also far more likely to result in a fatal overdose—fentanyl has largely displaced heroin in the street trade, according to Quinones, who lucidly explains how opioid usage rewires the brain’s dopamine receptors, making it impossible to achieve a feeling of happiness without the aid of the drug. Vivid character profiles of drug runners and abusers, their family members, and social workers and addiction treatment counselors make the scale of the tragedy clear, while providing persuasive evidence that the battle against the opioid crisis can be won by “breaking down silos,” fostering interpersonal connections, and believing “that the least of us lies within us all.” This is a richly rewarding report from the front lines of an ongoing emergency.

Starred review from October 1, 2021

Quinones follows up Dreamland: The True Tale of America's Opiate Epidemic (a 2015 National Book Critics Circle Award winner) with new reportage on drug trade and addiction in the United States. The book profiles individuals and communities to illustrate how the illicit drug trade has shifted from opioids to the far more dangerous fentanyl and new methamphetamine formulations; he makes the case that the nation is saturated with these potent fentanyl concoctions and homemade meth. His data demonstrates that fentanyl kills a steadily increasing number of people in the U.S., while the new meth can cause methamphetamine psychosis, with huge impacts for people experiencing homelessness. Quinones also interviews neuroscientists about addiction's effects on the brain and learns that sugar and addictive drugs follow the same neural pathways. He writes that legal prescription opiates fueled the illicit drug trade, which he compares to American capitalist culture and powerful consolidated markets that promote consumerism. He also posits that the American culture of individualism leaves people with addiction on their own. VERDICT Highly recommended for those interested in social justice and the strength of communities. Quinones argues that community can and must save "the least of us."--Caren Nichter, Univ. of Tennessee at Martin

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