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The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth

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Longlisted for the Andrew Carnegie Medal From the New York Times bestselling author of Dreamland, a searing follow-up that explores the terrifying next stages of the opioid epidemic and the quiet yet ardent stories of community repair. Sam Quinones traveled from Mexico to main streets across the U.S. to create Dreamland, a groundbreaking portrait of the opioid epidemic tha Longlisted for the Andrew Carnegie Medal From the New York Times bestselling author of Dreamland, a searing follow-up that explores the terrifying next stages of the opioid epidemic and the quiet yet ardent stories of community repair. Sam Quinones traveled from Mexico to main streets across the U.S. to create Dreamland, a groundbreaking portrait of the opioid epidemic that awakened the nation. As the nation struggled to put back the pieces, Quinones was among the first to see the dangers that lay ahead: synthetic drugs and a new generation of kingpins whose product could be made in Magic Bullet blenders. In fentanyl, traffickers landed a painkiller a hundred times more powerful than morphine. They laced it into cocaine, meth, and counterfeit pills to cause tens of thousands of deaths-at the same time as Mexican traffickers made methamphetamine cheaper and more potent than ever, creating, Sam argues, swaths of mental illness and a surge in homelessness across the United States. Quinones hit the road to investigate these new threats, discovering how addiction is exacerbated by consumer-product corporations. “In a time when drug traffickers act like corporations and corporations like traffickers,” he writes, “our best defense, perhaps our only defense, lies in bolstering community.” Amid a landscape of despair, Quinones found hope in those embracing the forgotten and ignored, illuminating the striking truth that we are only as strong as our most vulnerable. Weaving analysis of the drug trade into stories of humble communities, The Least of Us delivers an unexpected and awe-inspiring response to the call that shocked the nation in Sam Quinones's award-winning Dreamland.


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Longlisted for the Andrew Carnegie Medal From the New York Times bestselling author of Dreamland, a searing follow-up that explores the terrifying next stages of the opioid epidemic and the quiet yet ardent stories of community repair. Sam Quinones traveled from Mexico to main streets across the U.S. to create Dreamland, a groundbreaking portrait of the opioid epidemic tha Longlisted for the Andrew Carnegie Medal From the New York Times bestselling author of Dreamland, a searing follow-up that explores the terrifying next stages of the opioid epidemic and the quiet yet ardent stories of community repair. Sam Quinones traveled from Mexico to main streets across the U.S. to create Dreamland, a groundbreaking portrait of the opioid epidemic that awakened the nation. As the nation struggled to put back the pieces, Quinones was among the first to see the dangers that lay ahead: synthetic drugs and a new generation of kingpins whose product could be made in Magic Bullet blenders. In fentanyl, traffickers landed a painkiller a hundred times more powerful than morphine. They laced it into cocaine, meth, and counterfeit pills to cause tens of thousands of deaths-at the same time as Mexican traffickers made methamphetamine cheaper and more potent than ever, creating, Sam argues, swaths of mental illness and a surge in homelessness across the United States. Quinones hit the road to investigate these new threats, discovering how addiction is exacerbated by consumer-product corporations. “In a time when drug traffickers act like corporations and corporations like traffickers,” he writes, “our best defense, perhaps our only defense, lies in bolstering community.” Amid a landscape of despair, Quinones found hope in those embracing the forgotten and ignored, illuminating the striking truth that we are only as strong as our most vulnerable. Weaving analysis of the drug trade into stories of humble communities, The Least of Us delivers an unexpected and awe-inspiring response to the call that shocked the nation in Sam Quinones's award-winning Dreamland.

30 review for The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth

  1. 4 out of 5

    Michelle

    The Least of Us: True Tales True Tales of America and Hope in the time of Fentanyl and Meth (2021) is the incisive follow-up to Dreamland: The True Tale of America’s Opiate Epidemic (2015) written by bestselling award-winning author Sam Quinones, who is recognized for his compelling storytelling narratives in investigative journalism. Staggering amounts of cheaply manufactured Mexican crystal methamphetamine “P2P” are smuggled into the US that flood American streets across the nation. The new syn The Least of Us: True Tales True Tales of America and Hope in the time of Fentanyl and Meth (2021) is the incisive follow-up to Dreamland: The True Tale of America’s Opiate Epidemic (2015) written by bestselling award-winning author Sam Quinones, who is recognized for his compelling storytelling narratives in investigative journalism. Staggering amounts of cheaply manufactured Mexican crystal methamphetamine “P2P” are smuggled into the US that flood American streets across the nation. The new synthetic chemical compounds are highly addictive, toxic, and corrosive. Virtually anyone can order the chemicals on the internet from internationally operated Chinese labs. Unlike the black tar heroin or the ephedrine meth, the “Shake and Bake” derived from farming the soil provided addicts with a euphoric high. The new drug, P2P, has entirely eliminated the concept of recreational drug use, easing the pain of withdrawal until the next dose. The symptoms that addict’s eventually exhibit seem similar to people with SMI's (serious mental illness): schizophrenia, extreme paranoia, hallucinations, fixation and hoarding of useless junk. Rehab counselors report that many addicts are impaired by brain damage that leave them devoid of personality, unable to eat, speak, or comprehend situations around them. The story of Starla Hope Hoss (1986-2019) is relatable to such observations: Starla was cared for in an Elizabethton, Tennessee nursing facility in a permanent vegetative state after a near fatal overdose. The daughter she delivered afterward was adopted by Angie Odom (and her husband), a social worker that ran a homeless shelter. Comparisons between the Sackler’s and Purdue Pharma that made billions of USD grossly profiteering from the sales of OxyContin and the Mexican drug trafficking operations are extremely slim. The “Oxy Sackler’s” were connected to the “era of opioids” and responsible for the aggressive marketing techniques that targeted overworked physicians and nurse practitioners pressuring them heavily prescribe Oxy without considering the consequences that left millions of Americans addicted to Purdue's opioid substances. The Sackler’s have denied any responsibility, and blamed addicted individuals for their affliction. Over 500,000 Americans have died from opioid related conditions since 1999. Courageous individuals join the fight against addiction and are restructuring their communities with outreach and new business: from Bakersfield California, to Muncie Indiana, to Portsmouth Ohio. Lou Ortenzio, a physician from Clarksburg, W. Virginia lost his license to practice medicine due to addiction, and is currently invested in helping addicts. Rashad Martin, from Columbus Ohio, currently incarcerated, gave away his drug money to help needy families in his community. The new drug courts are designed to quickly separate clients from their drugs freeing them from the torment of addiction. Everything from the Covid 19 pandemic, to Black Lives Matter, force examination of our individualism in American culture and how we relate to others in an “equally impolite fashion” according to Quinones; and we must consider our most vulnerable people as we share in any measure of success.

  2. 4 out of 5

    Jim

    This is a book every American should read whether they live in cities being overrun by the homeless on meth or opioids or whether they live in the country where much the same phenomenon is occurring. Sam Quinones's The Least of Us: True Tales of America and Hope in the Age of Fentanyl and Meth tells of a pernicious infestation of Americans by opioids (now frequently laced with fentanyl) and meth. Sam Quinones is a Los Angeles based journalist who is known for his reportage on opioids and Mexican This is a book every American should read whether they live in cities being overrun by the homeless on meth or opioids or whether they live in the country where much the same phenomenon is occurring. Sam Quinones's The Least of Us: True Tales of America and Hope in the Age of Fentanyl and Meth tells of a pernicious infestation of Americans by opioids (now frequently laced with fentanyl) and meth. Sam Quinones is a Los Angeles based journalist who is known for his reportage on opioids and Mexicans in the US. This book has just been released, and I predict it will send shock waves across the country. One problem I have seen over and over again is just how to describe the problem of homelessness. People act as if we found some housing for most of the homeless, they would gladly abandon the tents surrounded by piles of garbage in which they live. In fact, most of the homeless population couldn't handle the responsibility of being housed. Why? There is a brutal combination of mental illness, alcoholism, and drug addiction that feeds upon itself in a tight loop. With the prevalence of cheaper and more dangerous synthetic drugs such as fentanyl and meth, addicts become schizophrenic and paranoid and would prefer to be left alone. We are, I feel, just at the beginning of being able to understand what is happening on our streets. This is an excellent book, other than a few problems regarding the organization of the material. The message, however, comes out clearly: We can't rely on the police and the correctional system to solve the problem.

  3. 4 out of 5

    Holly

    This review comes a good two months before the publication date because I received an eBook Advanced Reader Copy. Sam Quinones is an amazing journalist and storyteller. On November 8, 2017 I was able to see him up close at my old high school, which was the venue for his speech that evening. Fentanyl was creeping in already, especially in a border county to Cook County/Chicago. There is no room for mistake anymore, as Quinones thoroughly details. But this is a book review, eh? This book is great This review comes a good two months before the publication date because I received an eBook Advanced Reader Copy. Sam Quinones is an amazing journalist and storyteller. On November 8, 2017 I was able to see him up close at my old high school, which was the venue for his speech that evening. Fentanyl was creeping in already, especially in a border county to Cook County/Chicago. There is no room for mistake anymore, as Quinones thoroughly details. But this is a book review, eh? This book is great even though it's about some rough topics. I really enjoyed how Quinones ended his chapters; the writing was very well done. I am a professional librarian who is also way into harm reduction on the side. I have read many, many books about this general topic. The specific topic of fentanyl is a little more sparse, though if you're seeking more check out Fentanyl, Inc. by Ben Westhoff (he goes undercover in a Chinese lab, it's WILD). Quinones discusses China but he is more focused on Mexico. He also brings up some tough questions regarding the myriad & patchwork, trial & error solutions to the opioid epidemic. A lot of it is make-it-up-as-you-go and that is important to consider, especially as it continues to move into different directions. You don't have to read Dreamland to read this book, however this book does call back to Dreamland periodically. They compliment one another.

  4. 5 out of 5

    Debbie

    Quinones does a great job of explaining how many in our society succumbed to fentanyl and meth - often accidentally and too often fatally. There are many to blame for the opioid epidemic - from pharmaceutical companies, to physicians, to government, to drug cartels and street dealers. It is a scary story that strikes at the heart of American society. However, Quinones also gives us hope and shows how communities and individuals have embraced the task of finding a solution one neighborhood, one c Quinones does a great job of explaining how many in our society succumbed to fentanyl and meth - often accidentally and too often fatally. There are many to blame for the opioid epidemic - from pharmaceutical companies, to physicians, to government, to drug cartels and street dealers. It is a scary story that strikes at the heart of American society. However, Quinones also gives us hope and shows how communities and individuals have embraced the task of finding a solution one neighborhood, one community at a time. The Least of Us shows us both a terrible past and a hopeful road to the future of innovative ways to overcome this crisis. A must read for anyone who cares about the least of our brothers and sisters and wants to be part of building a better future for all of us.

  5. 4 out of 5

    fer_reads

    ** I won this book from a Goodreads giveaway. ** What a roller coaster of emotions this was! I don’t think I’ve ever read a nonfiction book that has made me feel sad, afraid, shocked, furious, intrigued, and hopeful the way that this book has done. Going into this book, I thought I was going to read some personal accounts of what Fentanyl and Meth addiction looks like today in America. However, I got so much more than that. Not only did this book pull at my heartstrings, it also contained some e ** I won this book from a Goodreads giveaway. ** What a roller coaster of emotions this was! I don’t think I’ve ever read a nonfiction book that has made me feel sad, afraid, shocked, furious, intrigued, and hopeful the way that this book has done. Going into this book, I thought I was going to read some personal accounts of what Fentanyl and Meth addiction looks like today in America. However, I got so much more than that. Not only did this book pull at my heartstrings, it also contained some educational information. This book discussed how prescribed pain pills (along with greed) helped boost the opioid epidemic, the neuroscience behind addiction, how incredibly accesible these illicit drugs were, and what is being done to help addicts rehabilitate. This book has accounts from a wide range of people directly affected by this epidemic, including; doctors, law enforcement, dealers, former addicts, and kind-hearted, selfless people who want to help those afflicted by this epidemic. Definitely a heavy topic but a must-read! (Because I did receive an advance reading copy, I found an abundant amount of editing errors. Almost all of these being a missed space in between two separate words. A bit annoying, but not too distracting.) 5 ⭐️

  6. 5 out of 5

    Rosemary

    The Least of Us by Sam Quinones is an insightful follow up to his previous book, Dreamland. Whereas the previous book focused on opium and heroin, this book explores how fentanyl and methamphetamine have spread and destroyed lives throughout the United States. Through personal stories, Quinones explains how fentanyl was developed and spread. He also details different ways in which communities have addressed this crisis. Recognizing that it will take time and various methods, Quinones reminds us The Least of Us by Sam Quinones is an insightful follow up to his previous book, Dreamland. Whereas the previous book focused on opium and heroin, this book explores how fentanyl and methamphetamine have spread and destroyed lives throughout the United States. Through personal stories, Quinones explains how fentanyl was developed and spread. He also details different ways in which communities have addressed this crisis. Recognizing that it will take time and various methods, Quinones reminds us that recovery may not mean abstinence forever but means positive change. This is an important book for anyone who wants insight into the drug issues plaguing the country and the job of recovery facing all of us.

  7. 4 out of 5

    Pete

    The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth (2021) by Sam Quinones is a gripping revelation of how hard drugs in the US have changed over the past 15 years. Quinones chronicles the rise of meth and fentanyl made chemically. The book also describes more of how Purdue Pharma pushed the opiod Oxycontin in the US. The book is a follow on to Quinones also excellent book Dreamland. The best non-fiction combines engaging personal stories as well as factual revelation The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth (2021) by Sam Quinones is a gripping revelation of how hard drugs in the US have changed over the past 15 years. Quinones chronicles the rise of meth and fentanyl made chemically. The book also describes more of how Purdue Pharma pushed the opiod Oxycontin in the US. The book is a follow on to Quinones also excellent book Dreamland. The best non-fiction combines engaging personal stories as well as factual revelation and The Least of Us does this very well. There are a number of characters whose story Quinones tells while going through statistics of drug overdose deaths and the impact of drugs in modern America. The stories of Angie and Starla, Eric and Mungo and Doc O are vivid and moving. Quinones descriptions of cities across America, particularly in the US Rust Belt are also excellent. As well as being very informative the book is engrossing and is a real page turner. Along with Dignity by Chris Arnade and San Fransicko by Michael Shellenberger, The Least of Us provides a dramatic view of things that have gone badly wrong in America. There is a very good interview on the Econtalk podcast with Quinones about the book. US drug overdose deaths have gone from under twenty thousand in 1999 to ninety three thousand in 2020. This is approaching double the number of US combat fatalities in Vietnam every year. It’s a staggering increase. The US now has death rates from substance abuse that are among the highest in the world and that are three times the rate of Europe, Canada and Australia. In 1990 these death rates were about the same. In The Least of Us Quinones looks at why. He explains it by the high rate of opioid pain prescriptions which was driven by various drug companies, in particular Purdue Pharma and their owners the Sackler family. Quinones carefully explains how the Sacklers on the board pushed Oxycontin. In addition Quinones describes how methamphetamine made from Phenylacetone, known as P2P in this context, took over from meth made from ephedrine. This changed the manufacture of meth from something that was done in small cookhouses to something that was done on an industrial scale. Ironically it was the suppression of ephedrine that led to the switch in the process. P2P meth has a much bigger mental impact on users than ephedrine meth did. It makes people schizophrenic and makes treatment much harder. Similarly Fentanyl, a synthetic opioid first derived by the Belgian chemist Paul Janssen in 1960 it was very successfully used medically in anesthesia before illicit chemists began to manufacture it on a large scale and sell it to the US. It made the production of opioids vastly simpler. Growing and harvesting drugs from opium poppies is much harder and slower. Mexican drug deals began to ship huge amounts Fentanyl. Initially the strength of the drug would often kill addicts and also kill them extremely quickly often without the time to give them Nalaxone. US drug deals also began to add Fentanyl to other drugs and thus got more people addicted. Quinones looks at the rise in opioid use, the rise in P2P based meth use and the combination of the two that causes so much destruction in people’s lives. The number of towns where the factories closed, people got injured and got on to opioid pain killers and then switched to other opioids is substantial. Many sad stories are in the book. The book also makes the argument that addictions to sugar, bad food and bad habits set people up for addictions to narcotics. It’s an interesting point. Finally Quinones looks at how many addicts, after years of drug abuse do manage to turn themselves around. These stories are really uplifting and Quinones also combines the stories with descriptions of how some entire towns are managing to come together and confront their narcotic crises. The Least of Us is a really excellent book that combines stories of individuals with an over arching picture of the impact of meth and fentanyl in America. It’s a fine read.

  8. 4 out of 5

    Mrs. Danvers

    Sam Quinones never disappoints. You know what Ilhan Omar said about not being able to hate people when you learn who they are -- he gets so close to his subjects that you can really see how easy it would be to have become an addict, homeless, delusional. If you read nothing else, read the chapter "The Least of Us." Sam Quinones never disappoints. You know what Ilhan Omar said about not being able to hate people when you learn who they are -- he gets so close to his subjects that you can really see how easy it would be to have become an addict, homeless, delusional. If you read nothing else, read the chapter "The Least of Us."

  9. 5 out of 5

    Penny Adrian

    Compassionate urgently important book about "the least of us" in America. Those who demand simplistic answers (like "Defund the Police" or "Legalize Drugs") will find themselves deeply challenged by this book. I know it challenged me, and I learned a great deal about what compassion and help truly mean. We need to be open minded and humble when it comes to this horrific health and social crisis. Most of all, we must prioritize the well being of the "least of us" no matter what it takes. Compassionate urgently important book about "the least of us" in America. Those who demand simplistic answers (like "Defund the Police" or "Legalize Drugs") will find themselves deeply challenged by this book. I know it challenged me, and I learned a great deal about what compassion and help truly mean. We need to be open minded and humble when it comes to this horrific health and social crisis. Most of all, we must prioritize the well being of the "least of us" no matter what it takes.

  10. 5 out of 5

    Caroline Gerardo

    Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin. Innocent enough: just stick-on grandmother’s arm for 72 hours, and Medicare pays for it. Fentanyl is also diverted for recreational abuse, theft, burglary... Fentanyl is added to heroin to increase potency or disguised as heroin. Illegal fentanyl is manufactured in Mexico. Sam takes us on a journey through the logistics across the North American landscape and ride right into the Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin. Innocent enough: just stick-on grandmother’s arm for 72 hours, and Medicare pays for it. Fentanyl is also diverted for recreational abuse, theft, burglary... Fentanyl is added to heroin to increase potency or disguised as heroin. Illegal fentanyl is manufactured in Mexico. Sam takes us on a journey through the logistics across the North American landscape and ride right into the Little League field where your boys practice. This is not an expose the USPS where someone throws away sorting machines in the night. It is written with a crisp prose and tense anxiety. There is no happy ending. What I learned from this is to ask at the CVS counter for Narcan. For a few minutes of my time, I might save someone’s life, I don’t know someone who secretly uses, but I’m ready. (FYI Narcan/Naloxone is a medicine that can treat a fentanyl overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs.) Treatment is no easy fix. Drugs like sublocade may help you or a loved one layered with years of counseling and love. I received the book as an ARC. I highly recommend this as a factual account, as non-fiction, and also a thriller. Six stars

  11. 5 out of 5

    Russel Henderson

    I highly recommend this book. He updates his groundbreaking Dreamland, one of the first and perhaps the best popularly accessible works to describe the pain pill crisis and the heroin crisis that followed on its heels. This describes the rise of fentanyl and other synthetics and their role in the incredible spike in overdose deaths. It also profiles the inroads of P2P meth into American cities and the attendant mental health and homelessness crises that have been exacerbated by meth. Quinones sh I highly recommend this book. He updates his groundbreaking Dreamland, one of the first and perhaps the best popularly accessible works to describe the pain pill crisis and the heroin crisis that followed on its heels. This describes the rise of fentanyl and other synthetics and their role in the incredible spike in overdose deaths. It also profiles the inroads of P2P meth into American cities and the attendant mental health and homelessness crises that have been exacerbated by meth. Quinones shines in connecting the upstream (producers and large-scale distributors) to the downstream (addicts and their family members), with profiles of both the CJ folks trying to stop the trafficking and the recovery workers trying to minister to its victims. Quinones tells the macro stories with recourse to the micro stories - the people behind the statistics. He tells hopeful stories alongside tragic ones, recovering addicts and their outcomes, good and bad. He eschews the silver bullets - MAT or decriminalization or whatever politicized hobby horse is at issue - in favor of community and resilience. If Quinones has a flaw it’s that he connects dots a little too easily - heroin was plenty lethal before fentanyl, Naloxone made headway against fentanyl before the derivatives popped up - but it’s a story few others have told well, and he updates it for new developments. Well worth the read if you want to understand why we lost 93,000 of our brothers and sisters last year and stand to lose a comparable tally this year.

  12. 4 out of 5

    Jennie

    Halfway through & can't put this down. Mr. Quinones has come into his own since Dreamland, a book that was good, but not the powerhouse that this one is! The war between the forces of good & evil of the world, the war between the exploited & exploiters is vicious & savage as I imagine addiction is. can't put this down, but I don't want it to end! Halfway through & can't put this down. Mr. Quinones has come into his own since Dreamland, a book that was good, but not the powerhouse that this one is! The war between the forces of good & evil of the world, the war between the exploited & exploiters is vicious & savage as I imagine addiction is. can't put this down, but I don't want it to end!

  13. 5 out of 5

    Bliss Kuntz

    The Least of Us is a systematic discussion of the history and recent climate of the opioid crisis in America. Sam Quinones brings perspectives on addiction, the switch to synthetics, and the legal challenges facing any entity desiring to make change. I really appreciated this book because my knowledge of the topic was so limited. I was unaware of many of the nuances that contribute to the crisis and found every story and explanation extremely helpful for my own understanding. Sometimes, I did have The Least of Us is a systematic discussion of the history and recent climate of the opioid crisis in America. Sam Quinones brings perspectives on addiction, the switch to synthetics, and the legal challenges facing any entity desiring to make change. I really appreciated this book because my knowledge of the topic was so limited. I was unaware of many of the nuances that contribute to the crisis and found every story and explanation extremely helpful for my own understanding. Sometimes, I did have to backtrack to remind myself of people mentioned previously, but I also liked the snatches of stories that are woven through the book.

  14. 4 out of 5

    Amy Strother

    As someone who operates within the world of recovery, I have found Sam Quinones’ work to be insightful and thoroughly researched. While reading this book, I felt like I was stopping to highlight passages on every page. I’m so impressed with the depth at which he pursues information in order to get it right, and I’m grateful someone finds these stories worth telling no matter what the cost. Sam, you could have been done with Dreamland, but you didn’t stop there. Thank you for this book.

  15. 5 out of 5

    Bookreporter.com Biography & Memoir

    In 2015's DREAMLAND, Sam Quinones chronicled the start and rise of America’s opioid epidemic. It began with Oxycontin, created by the Sackler family’s Purdue pharmaceutical company, and morphed into an all-out drug war as users turned to heroin, resulting in harrowing nationwide death tolls and a booming drug trafficking market. But a new "star" has emerged in the epidemic’s third phase: fentanyl. Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more pote In 2015's DREAMLAND, Sam Quinones chronicled the start and rise of America’s opioid epidemic. It began with Oxycontin, created by the Sackler family’s Purdue pharmaceutical company, and morphed into an all-out drug war as users turned to heroin, resulting in harrowing nationwide death tolls and a booming drug trafficking market. But a new "star" has emerged in the epidemic’s third phase: fentanyl. Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. Unlike its sisters, heroin and morphine, fentanyl is relatively easy to come by, requires no growing season (and therefore no farmlands or farmhands), and is as instantly addictive as it is deadly. In the first part of THE LEAST OF US, Quinones explains how fentanyl emerged as the leading player in the opioid epidemic, starting with, surprisingly enough, methamphetamine. Drug traffickers were primed to accept lab-created fentanyl as the next big thing after streamlining meth production --- which once required store-bought medications like Sudafed --- in order to cut back on expenses and wasted time. This change sparked rapid growth in the meth industry, but more surprisingly, it also paved the way for heroin traffickers to ask, “How can we do the same thing?” Enter fentanyl. At 100 times more potent than heroin, fentanyl poses obvious benefits to traffickers: it can be diluted many more times, resulting in exponentially greater sales, and as a “designer drug” it can turn even average Joes into community kingpins. With a lucrative market, rising demand (and, curiously enough, death tolls), fentanyl seems like an unbeatable enemy for the epidemic’s third --- and hopefully final --- round. In THE LEAST OF US, Quinones once again dives deep into America’s drug culture, but this time he takes his investigation a step further to shine light on the ways that communities are coming together to fight addiction. With his usual kaleidoscopic approach, Quinones divides the book into five parts, returning each time to the topics of individual users; mill, factory and Appalachian towns that have been both decimated and bolstered by opioids; the Sackler family; the production of fentanyl and meth; and, of course, the neuroscience behind it all, the psychologies of addiction, abuse and community. In each chapter, he strives to unpack not only the simpler stories --- how meth is synthesized, how addiction rewires our brains --- but also how each of these stories fits in to the tapestry of the epidemic at large. Through Quinones we meet Starla Hoss, a former user who lost almost all brain function after an overdose; Lou Ortenzio, a beloved small-town physician who now delivers pizzas after suffering his own battle with addiction; Mike “Bird” Kissick, an agoraphobic man who single-handedly formed a community center for struggling children and adults after his city’s budget collapsed under the weight of a poor economy and too-readily-available drugs; and more memorable characters, all of whom have been touched in one way or another by the epidemic. As Quinones explains it, fentanyl is unlike its predecessors in that it is so cheap to produce, so easy to smuggle and so immediately addictive that it has turned users of even other varieties of drugs (who so rarely cross the upper vs. downer boundary) into addicts. We are in a new era where Oxycontin has ushered in heroin, which opened the door for fentanyl, which has come riding on a wave of meth addiction that is creating an entirely new epidemic of homelessness, mental illness and users of more drugs than ever before. Writing on fentanyl’s ability to cut or enhance other drugs, like cocaine, Quinones says that for a while, “dealers didn’t dare not mix it in.” This demand turned users of cocaine into opioid addicts often without their knowledge, and certainly without their consent. But opioids --- and especially fentanyl --- can rewire a user’s brain so successfully that they can never stop chasing that initial high, bypassing all of the brain’s self-preservation mechanisms, the pleadings and warnings of their loved ones, and often their own reality. The chapters on neuroscience delivered some of the most shocking takeaways of the book, most notably the neuroscience researcher who learned that rats fed with sugar water not only act exactly like addicted humans, but even demonstrate the same results when treated with naloxone (or, more commonly, Narcan), a drug used to stop an overdose. Just as traffickers were primed and ready to accept a new synthetic drug, so too were Americans primed and ready to become addicts. But, as Quinones points out, one cannot become addicted to a drug without trying it, and so he argues often for the enactment of policies that restrict the availability of drugs, rather than the criminalization of users. This brings us to the driving argument behind the book: America’s desperate need for bolstered communities. Just as DREAMLAND was the story of pill-pushing doctors and heroin traffickers, THE LEAST OF US is also a story of two ends of a spectrum: the global economy producing catastrophic amounts of potent opioids, and the quiet, groundbreaking attempts of individual Americans and communities to save their addicted neighbors, friends and family members. Both storylines are, in Quinones’ hands, hard, stark examples of the message that “the least of us lies within us all,” and clarion calls for Americans to speak up and take new approaches to the opioid epidemic (which could really be called the “pain epidemic”) --- be they honest obituaries, thriving community centers, or a stronger focus on mental illness and treatment. Quinones loves a good story, and his excitement at meeting a new character leaps off every page. But I thought some chapters would have been better suited for DREAMLAND (most notably his history on the Sackler family, which already has been adequately explored and chronicled in his and other books, like EMPIRE OF PAIN), and others cut altogether. Though some chapters feel like they stray from his central narrative, THE LEAST OF US reads like the final puzzle piece to the mystery of opioids and their hold on America. Quinones finishes what he started in DREAMLAND by offering not only warnings for the future phases of the epidemic, but the beginnings of a new era of hope. Reviewed by Rebecca Munro

  16. 4 out of 5

    Maureen

    Apparently I forgot how repetitious Quinones’ writing is- I had the same issue with Dreamland- I believe that this habitual repetition makes his books overly long without saying anything new. Nevertheless, I would have likely given this book 5 stars simply for how much I learned reading it. The drop to 4 stars is because he quotes Ben Sasse (really? If ever there was an empty suit of a politician it would be Sasse), and the author expounds the merits of Cross-Fit ad nauseum. I know exactly zero Apparently I forgot how repetitious Quinones’ writing is- I had the same issue with Dreamland- I believe that this habitual repetition makes his books overly long without saying anything new. Nevertheless, I would have likely given this book 5 stars simply for how much I learned reading it. The drop to 4 stars is because he quotes Ben Sasse (really? If ever there was an empty suit of a politician it would be Sasse), and the author expounds the merits of Cross-Fit ad nauseum. I know exactly zero people who have done Cross-Fit and come away without injury- injuries severe enough to require pain pill therapy. A bit ironic, or just myopic?

  17. 4 out of 5

    Ben

    Nowhere near as effective as "Dreamland," perhaps because there is much less new information here. Also, Quinones's tales of hope are completely lost in the despair. Perhaps he has to talk about hope to sell the book, but it doesn't seem sincere. I did like that Quinones takes and defends a political stand on how to address the drug epidemic; he argues the downsides of legalization. > Carfentanil was ten thousand times more potent than morphine. It had no valid use on humans, they believed, but Nowhere near as effective as "Dreamland," perhaps because there is much less new information here. Also, Quinones's tales of hope are completely lost in the despair. Perhaps he has to talk about hope to sell the book, but it doesn't seem sincere. I did like that Quinones takes and defends a political stand on how to address the drug epidemic; he argues the downsides of legalization. > Carfentanil was ten thousand times more potent than morphine. It had no valid use on humans, they believed, but they saw that it sedated elephants, rhinoceroses, and other large mammals. In the United States, later, carfentanil was made legal only for zoo veterinarians to possess. (UK scientists concluded that in 2002 the Russian government used carfentanil to attack Chechen rebels who had taken over a Moscow theater, dispersing it through the building’s air duct. At least 170 people died, including 121 hostages. The UK scientists based their conclusions on tests of items of clothing and blood belonging to British citizens who were near an exit and thus among the hostages revived by a Russian assault team that day > OxyContin, flogged by Purdue sales reps, did a lot to create our new wide market for heroin, which never existed when the opioids on the street were Vicodin, Percocet, and others. Those pills were mixed with acetaminophen as an abuse deterrent. Those who abused them did enormous damage to their internal organs, so their habits remained minor. They rarely grew desperate enough to make the leap to heroin > alcohol and cigarettes kill more than any other drug by far, because they are legal and widely available. Alcohol also drives arrests and incarceration more than any other single drug. Our brains are no match for the consumer and marketing culture to emerge in the last few decades. They are certainly no match for the highly potent illegal street drugs now circulating. > Decriminalizing drugs also removes the one lever we have to push men and women toward sobriety. Waiting around for them to decide to opt for treatment is the opposite of compassion when the drugs on the street are as cheap, prevalent, and deadly as they are today. > Thanks also to Freedom.to, the software that allows me to shut down social-media apps and as much of the internet as I need to and focus.

  18. 5 out of 5

    MountainAshleah

    Goodreads Giveaway. I wasn't sure what to expect, but this book turned out to offer an important education in a subject matter I'm (fortunately) not directly impacted by...sort of. As someone who struggles with "soft addictions" of sugar + fat, compulsive online news watching, and FOMO on the latest barage of Netflix bingefests...I greatly appreciated the author's inclusion of those issues, while understandably subordinating them to the bigger issues of cheap synthetic drugs, their widespread us Goodreads Giveaway. I wasn't sure what to expect, but this book turned out to offer an important education in a subject matter I'm (fortunately) not directly impacted by...sort of. As someone who struggles with "soft addictions" of sugar + fat, compulsive online news watching, and FOMO on the latest barage of Netflix bingefests...I greatly appreciated the author's inclusion of those issues, while understandably subordinating them to the bigger issues of cheap synthetic drugs, their widespread use, horrific addictive powers, and frightening consequences. This quote sums up the book and my reading experience: "In a time when drug traffickers act like corporations and corporations like drug traffickers, the forces looking to manipulate our brains for profit are frightening to behold. So many more synthetic blasts compete for our brain receptors--from chicken nuggets and soda to cellphones and social media apps, methamphetamine and fentanyl" (page 360). The Least of Us is an important book, well worth the time and emotional energy it takes to read. The writing is clear, straightforward, free of chemical formulas, technical jargon, lengthy footnotes, and academic digressions. I would have preferred a single narrative rather than many different tales, but in the end this approach highlighted the widespread nature of the problem. I highly recommend this book and am thankful for its receipt through Goodreads.

  19. 4 out of 5

    Zach Powell

    This book feels like a patchwork quilt sewed together by someone's grandmother to document the phases of a child's life. Each square is unique, put together with care, and arranged to tell a broader narrative. But, if one steps back to examine the quilt, it's a garish looking thing. Quinones' quilt serves its intended purpose; it tells a story, keeps you warm, and offers many opportunities for one to grow curious and learn more about unique topics. At the end of the day, it's still a quilt and an This book feels like a patchwork quilt sewed together by someone's grandmother to document the phases of a child's life. Each square is unique, put together with care, and arranged to tell a broader narrative. But, if one steps back to examine the quilt, it's a garish looking thing. Quinones' quilt serves its intended purpose; it tells a story, keeps you warm, and offers many opportunities for one to grow curious and learn more about unique topics. At the end of the day, it's still a quilt and any number of blankets can serve the same purpose. The book isn't bad but it doesn't fill a void. If Mr. Mackey summarized the book, he'd probably say: Drugs are bad, m'kay America is primed for addiction to drugs because we're a society who seeks out addictions, m'kay Food addiction primes people for drug addiction, m'kay Addiction stories are sad and terrible, m'kay Drug cartels/dealers evolve to new trends, m'kay Consequences are necessary, m'kay Consider the consequences and morals behind capitalism, m'kay

  20. 4 out of 5

    Paige McLoughlin

    Depressing stories and voices around the Opioid and Meth crisis. I know it has hope in the story but the hope is a Hollywood happy ending slapped on a disaster movie or dystopian novel. Some of the characters find palliative remedies and partial reconstruct the lives or make a discovery or sleuth a network of drug dealers but it is a depressing story how Big Pharma, Rust Belt despair, and dead-end lives bring about a drug overdose crisis that killed hundreds of thousands of people and destroyed Depressing stories and voices around the Opioid and Meth crisis. I know it has hope in the story but the hope is a Hollywood happy ending slapped on a disaster movie or dystopian novel. Some of the characters find palliative remedies and partial reconstruct the lives or make a discovery or sleuth a network of drug dealers but it is a depressing story how Big Pharma, Rust Belt despair, and dead-end lives bring about a drug overdose crisis that killed hundreds of thousands of people and destroyed communities and shows little sign of abating. You will see the contours but the hope is meager.

  21. 4 out of 5

    Ami

    This is a story that strikes at the heart of American society. Sam Quinones provides some hope and shows how communities and caring people have embraced the task of finding a solution one step at a time in each individual community. This fentanyl crisis impacts all of us. Sam's book, The Least of Us, shows us both a terrible past and a hopeful path forward to the future of innovative ways to overcome this crisis. This is a story that strikes at the heart of American society. Sam Quinones provides some hope and shows how communities and caring people have embraced the task of finding a solution one step at a time in each individual community. This fentanyl crisis impacts all of us. Sam's book, The Least of Us, shows us both a terrible past and a hopeful path forward to the future of innovative ways to overcome this crisis.

  22. 4 out of 5

    Rick Mathis

    This book treads the familiar path so many others have taken with true stories of how drug use destroys lives. I was hoping more for promising treatments or therapies that might help addicts recover and families cope. There was some of this in the book, but far too little. We need to get beyond recitations filled with the usual victims and villains to specifying how we can combat this scourge. I have seen far too many lives lost to meth, heroin, and fentanyl.

  23. 5 out of 5

    Julie

    A huge fan of Dreamland, Quinones other book on this subject. This one kind of missed the mark for me. Maybe because I read Dreamland which was incredible and then also read Empire of Pain by Patrick Radden Keefe, which covered a lot of this. There wasn't much I was surprised by. However I did really like the way he wove in personal anecdotes, as well as anecdotes of hope and inspiration. A huge fan of Dreamland, Quinones other book on this subject. This one kind of missed the mark for me. Maybe because I read Dreamland which was incredible and then also read Empire of Pain by Patrick Radden Keefe, which covered a lot of this. There wasn't much I was surprised by. However I did really like the way he wove in personal anecdotes, as well as anecdotes of hope and inspiration.

  24. 5 out of 5

    B.

    I received an ARC of this one from the publisher. I wasn't a big fan of all of the personal anecdotes interwoven throughout the book. It felt like the author was trying to make it about them instead of focusing on the issue. I also wasn't thrilled with the overly familiar tone of the book. While the topic is a worthwhile one, this author is not for me. I received an ARC of this one from the publisher. I wasn't a big fan of all of the personal anecdotes interwoven throughout the book. It felt like the author was trying to make it about them instead of focusing on the issue. I also wasn't thrilled with the overly familiar tone of the book. While the topic is a worthwhile one, this author is not for me.

  25. 5 out of 5

    Scott Schluter

    Very interesting book. I wasn't sure when I picked it up if I would be interested in the content, but it grabbed me and pulled me in. I'll be seeking out Dreamland now, and some of Mr Quinones other books, I like his writing. This was an advanced copy so there were many typos - mostly spacing missing between words, hopefully they catch all of them (there are so many) for the final print. Very interesting book. I wasn't sure when I picked it up if I would be interested in the content, but it grabbed me and pulled me in. I'll be seeking out Dreamland now, and some of Mr Quinones other books, I like his writing. This was an advanced copy so there were many typos - mostly spacing missing between words, hopefully they catch all of them (there are so many) for the final print.

  26. 5 out of 5

    Sheila Tully

    Rarely do magazines or books scoop the MSM but The Least of Us does just that--Quinones explains the rise in homelessness and mental illness. This is journalism at its finest. What is more remarkable is that he manages to tell this dark story with such poignancy and hope. Incredible reporting, sublime writing.

  27. 5 out of 5

    Kerry

    I think "True Tales of America and Hope in the Time of Fentanyl and Meth" is a perfect book if you are interested in how Fentanyl and Meth became so prevalent in the US. There are many interesting and scary stories of how people became addicted to drugs, especially these. I think "True Tales of America and Hope in the Time of Fentanyl and Meth" is a perfect book if you are interested in how Fentanyl and Meth became so prevalent in the US. There are many interesting and scary stories of how people became addicted to drugs, especially these.

  28. 4 out of 5

    Judy

    Exhaustive account of the progression of drug use in the US, focusing on individuals and their stories. While there is enormous work to be done and long odds against success, Quiones highlights success stories as a starting point for action. There's a lot to chew over in this book. Exhaustive account of the progression of drug use in the US, focusing on individuals and their stories. While there is enormous work to be done and long odds against success, Quiones highlights success stories as a starting point for action. There's a lot to chew over in this book.

  29. 5 out of 5

    Steve Hahn

    Parts of this book would be included with”must read” for the civic minded. Scary and sad stories but also promise and hope “—that we are strongest in community, as weak as our most vulnerable, and the least of us lie within us all.”

  30. 5 out of 5

    Bookends

    There has been a crack epidemic for decades, I guess that does not shock the nation! 🤬🤬🤬

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