 Hi, everyone. Welcome to the Addiction Recovery Channel. I'm Ed Baker and I am your host producer. I couldn't be happier today. I'm actually very thrilled today to have as our guest Sam Kinones. Thank you, Sam. Great to be with you, Ed. Thanks very much for having me on. Yeah, thank you so much. Thank you so much. I know your schedule is a little bit tight to put it mildly. Sam Kinones is a Los Angeles-based freelance journalist. He's been a reporter for over 35 years. He's the author of four acclaimed books on narrative nonfiction and I've had the good fortune of reading two of his books and I cannot I can't even recommend them too highly for anyone who's interested in what's happening in America today, specifically with regard to overdose death. First, we have Dreamland. Dreamland, the true tale of America's opioid epidemic, was published in 2015. Dreamland ignited awareness of the epidemic that has caused the United States hundreds of thousands of lives and become the deadliest drug scourge in our nation's history and I might add in my state's history in Vermont. Dreamland won a National Book Critics Award for the best nonfiction book of 2015. In 2019, Dreamland was selected as one of the 10 best true crime books of all time. Congratulations, Sam. Thank you. Sam's latest book released in November 2021 is The Least of Us. True tales of America and hope in the time of fentanyl and meth and we'll go into this a little bit later. Hope in the time of fentanyl and meth. The Least of Us was nominated for a National Book Critics Circle Award for best nonfiction book of 2021. Sam, I can't even congratulate you enough. I'm just you know just it's beautiful what you've done. Thank you very much. It was very nice for you to say that. I appreciate it. You know I just like to, I like to set the stage for the show today for the audience. What we'll be focused on today is what Dan Ciccaroni. Dan Ciccaroni is a researcher at the University of California San Francisco. He's called what we're in the midst of today a syndemic, a synergistic quadruple wave of vortex of overdose death. Almost unspeakable. It's almost impossible to describe. Basically there are four hurricane force winds feeding into the storm and a confluence today that Sam is going to go into. The prescription of pharmaceutical opioids heroin, fentanyl and what we call MOS or methamphetamine and other stimulants. So Sam I'd like to I know we can't really separate these four things out you know really separate them because they're they're combined but let's try to take them one at a time for the viewers comfort. So first a prescription and pharmaceutical opioids. Let's let's begin with that. Yeah well I think that began because well several factors in it I have my opinion. One was that a pain specialist began to think hey we do a poor job of treating pain which we did. Some of them began to fasten on the idea that we should be making greater use of opioid pain killers morphine but then also the branded ones at the time those Percocet, Lortab, Vicodin, etc. Hydrocodone, Oxycodone pills, branded pills. They were joined by the pharmaceutical industry who made those pills to push this idea. They began I think part of it began really because they began to make kind of in their messianic fervor to deal with a very real problem which was under treatment and poor treatment of pain. They began to make unfounded claims for what was possible using these drugs. These drugs have been used in medicine but in very very tight circumstances very scrutinized and so on and they were pushing for a much more liberal use of these drugs all across medicine and into dentistry too you know removal of their wisdom teeth and so on. They began to make the claim that these pills were now science now knew that they were virtually non-addictive when used to treat pain. That was not true science did not know that but it was pushed as kind of this idea pain became the fifth vital sign pain's not really a vital sign at all a vital sign of something you can measure to see if you're alive like a pulse but now they were proposing a vital sign that what they really wanted to do was reduce to zero you know if you'd reduce your pulse to zero you're dead right well pain was so pain was kind of confusing to a lot of doctors but there was a lot of economic pressures on doctors they wanted to kind of get rid of their pain patients their pain patients took out lots of time they had managed care now so those two you know one patient would be 12 13 minutes of time and that was about all a lot of doctors had so you began to see this movement towards this I think a very important part of this I have to say is that is us American health consumers wanting to be cured quantity a quick fix we go to the doctor who we don't know increasingly you don't know he's an urgent care doc or something a managed care doc you don't really know who they are too much not like the family doc used to have him and and the idea was doc I don't want to be told what I need to do what I need to do to take accountability responsibility for my own wellness eat better drink better get more exercise don't smoke don't you know get lose weight etc all these we push back against that and so you began to see this real move and increasingly beginning in 1996 when oxy cotton comes out yeah you begin to see this enormous increase over many many years of prescriptions of opioid painkillers nationwide it's a national thing because it's doctors all across the country who are pressured or and get into this really reluctantly or many who embraced it eagerly it takes all kinds of course talk talk a little bit about that talk a little bit about the pressure on the medical profession namely the third family Purdue pharmaceuticals and how that that whole opportunistic greed really began to influence this process well what I think began to happen was this coincided very directly with an expansion really I would I call a sales force arms race in the pharmaceutical industry where you get more and more and more people being hired as drug reps drug sales reps now used to be drug sales reps were men they were usually doctors or ex doctors ex pharmacists so they knew a lot about what they were selling they weren't really good at selling it in fact they didn't view their job as hard sell at all they're they view their job long term because they were usually from the communities where they lived where they where they worked they didn't want to ruin a relationships and so there was a very responsible kind of check and balance on what they did well that began to change in the mid 90s and really was off the rails within a few years you began to see I think we had 38,000 sales reps in 1995 drug sales reps 2002 I think the number was 102,000 so just exploded it was a lot of people hired who didn't know anything about pharmacy or or medicine they didn't know what they were selling but they did know how to sell it you know and so you began to see this and and leading the pack and all this were really kind of setting the stage for us was Purdue Pharma which sold OxyCone it was their loan drug they were not the biggest company nor did they have the most sales reps but they employed these very very aggressive sales tactics in the pursuit of selling one drug a narcotic and selling it as if it was almost like an over-the-counter medicine right highly addictive and badgering doctors the highest bonuses ever paid in the pharmaceutical industry were paid to Purdue Pharma reps during these during these years increasingly and you began to see them particularly focusing on doctors in areas where doctors were already prescribing a lot of all kinds of different pills right it wasn't just narcotics they thought if you attack those doctors you go after those doctors aggressively they will go along and then and that proved to be true and of course once you get people on these pills it's very hard to get them off they're highly addictive unlike what they proclaim the science to be so you get by the late 90s and certainly into the 2000s this this massive kind of force a juggernaut of pressures on doctors pressures from Americans a pharmaceutical company is pressuring with their sales reps selling a very aggressive use of a highly addictive substance claiming that it wasn't virtually non-addictive when used to treat pain and that was really what caused the first phase and that led to then the second phase which was which was heroin all of this was kind of the story that I was trying to tell in in in dreamland and you tell it you tell it beautifully in dreamland and you also tell it beautifully in in the least of us and one of the things that I think is very clear is your research into you know documents from Purdue Pharmaceutical that they they were aware that the higher the dose the more frequent the dose is taken the more likely the person is to develop addiction and the more likely the person is to be like a customer for life they knew the basic truths they knew the basic truths that every drug dealer on the street knows talk about what was that abc their abc yeah always be always be closing now that's a that's a um a phrase taken from a very very great movie called glen gary glenn ross oh yeah starring al Pacino at harris like balder and i just you know kevin's basic fantastic about a bunch of kind of down on their luck real estate salesman and i hardly uh endorse recommend that movie you should watch it if you haven't seen it but but the the the phrase that they're always drummed in and straw drummed in their minds always be closing well as um um as more and more attorneys general began to subpoena records from these major companies particularly uh uh after about 2000 well i think after dreamland came out really is when it began to happen mostly you be they began to find little jottings at conferences by Purdue reps you know always be closing like that several times in Tennessee the Tennessee folks um uh attorney general's office investigators found this uh frequently that at at sales meetings they were told to kind of push always be closing always be pushing the doctor to push clients the patients up to a higher dose the higher the dose the more chance those patients are going to be using that narcotic oxycontin in this case a year to five years down down down the road and so this was all part of this very aggressive marketing that lasted for many years and and really pushed um these pills out into the pop uh the the the the the the population and began then to create unlike what they claimed began to create a subset of all those users it's it's true it's really ought to be noticed you know opioids did a lot of good for some people it did a lot of bad for some people as well and there was a collateral damage that was most likely unnecessary had they just really been more muted in how they pushed these drugs how they sold these drugs but as they did they created a subset of people nationwide again a lot of people new to drugs or a lot of people certainly new to opiate addiction who now formed a new market and when they did that increasingly the Mexican trafficking world began to take a set up and take notice i write about the first crew the first crew of heroin traffickers out of Mexico who really understood what was going on when it came to pill prescribing guys from a little town in a state called Nayarit in on the Pacific coast of Mexico and these guys are not the only drug heroin traffickers out of Mexico the reason i wrote about them is because they had this unbeatable system retail system of selling heroin retail by the 10th of a gram very much like pizza delivery so in every town they would they landed they would have an operator standing by to take the order addicts would call in the operator would dispatch a driver you know and and it was very much like pizza delivery except for it was heroin they understood this and the reason they were so important to this story was because they landed in Columbus Ohio one of them actually but then later all of them landed in Columbus Ohio just as oxycontin was taken off and becoming this major force in creating high levels of addiction and and people couldn't that couldn't people couldn't afford they were looking around for something else some substitute and along comes very cheap very potent black tar heroin sold by these guys from this little town in Mexico so the story in dreamland is really about how they were the first ones to recognize and then systematically exploit the coming market for heroin that massive widespread product prescribing of opioid painkillers implied they saw that first then of course and they were like the pioneers in many of these markets and Cincinnati and in charlotte and in in apple is Columbus of course etc i actually i mean i actually experienced that and saw that happen i was a a clinician in lamoille county where where daniel franklin is from right now and um there was there was no heroin really in vermont to speak of not in my practice anyway but but around 2009 10 11 12 we began seeing people with opioid addiction mostly guys who um worked in trades where pain was part of the trade yeah construction um farming yeah um you know in the woods uh you know uh landscaping things of that nature and they would they would get there was a lot of pain pills available illicitly on the street where they weren't prescribed pills they would buy pills on the street because someone told them hey you know this will work for you when it worked what happened around in my in my experience anyway i think is what you're describing around 2013 somewhere around that 2014 i began to see people in my practice who had been introduced to opioid painkillers illicitly because they had real pain and it worked for them and then one day they went to their connection and their connection said you know what i don't have any uh oxy content but what i do have is some heroin and it works yeah and they would begin by maybe snorting heroin and six seven months later because it's more efficient they'd be injecting heroin and then there was the beginning this was when governor shumlin in vermont dedicated his whole state of the state address to what heroin was i remember that yeah i think that's exactly what you're describing was that that and that story uh is the story that really took place all across the country yeah because again for your your viewers don't know i mean these opioid painkillers are opiates right they are chemical cousins all derived eventually from the opium poppy all chemical cousins to heroin they correct the same euphoria when used to abuse they also create the same withdrawals when you don't have it etc etc and so uh that story that you describe happened i mean i think it began to happen first right off the bat as soon as you know as soon as this really got going and prescribing really took off i would say by 2000 by 1998 9 i began i found people who were already switching to heroin then of course it accelerated and accelerated and even much more and and began to spread all across the country so hence you have an enormous new heroin market created on the basis of the over prescribing of these pills pain pills for all manner of things that was a crazy thing too you know i met i can't tell you how many people i met who got addicted or whose kids got addicted when they were given uh opiates for um a wisdom tooth extraction carpal tunnel syndrome i met a woman the other day who said her addiction began when a doctor prescribed uh oxycontin or hydrocodone i guess it was for for a foot rash it became see that's what happened for a lot of doctors it became kind of like the go-to medicine yeah just do it for everything no matter your problem here you go here's some opioids and that that is where you know these pills are fantastic pills when used in the proper proper way the problem is when they when they break through those boundaries and or begin to be used for all manner of things and you begin to have real serious problems of the country which is what which is the basis of all that we're facing today yes because they not only work on on physical pain tissue damage uh bone damage uh inflammation they also work on emotional pain you know post-traumatic stress adverse childhood experiences depression anxiety things of that nature and the ubiquitousness of them i think that's the thing that beautifully in your book how we kind of became inundated thousands and thousands millions and millions of prescriptions unnecessary prescriptions yeah you know you know and written by doctors by the way who you know were criminal in pill mills you could get thousands and thousands of opioids yeah you know at um i i really change my feelings on on drug issues doing this book and then the least of us initially you know i've lived in mexico and in mexico the idea is well these drug problems all are because of demand for drugs and you know i don't believe that anymore um i believe that demand and supply have a kind of a synergistic kind of a relationship but that it begins with supply yeah it begins with supply the more supply the more chance for damage and that is exactly we did not have this opioid problem to the degree that we had it by 2000 say on 2005 then or then 2010 we would never have had it not been for the the supplies that you are describing all across this country endlessly and easy to get from doctors and white coats and you know clinics with fluorescent lights not on the street you know and so is the supply that starts it and then the supply and demand kind of had this kind of mutually nourishing kind of relationship but but to me it starts with supply i i couldn't agree with you more and the the fellow the um addiction scientist uh Dan Ciccaroni i cited a little bit earlier he cites something called supply shock where usually demand determines supply but with supply shock supply determines demand and it looks like that's what you're describing first with all these then with heroin and now i'd like to and i i'd like to move into the next the next part because sure it's so important and it's such a great example of supply determining demand um you say it in your book i actually had a nightmare um about it you say the drugs came fanged now and you're describing fentanyl and fentanyl is the the prime example of and i know you go into a little bit of neuroscience in your book too which is beautiful i like in the least of us in the least of us yeah not in not in dreamland so much but in the least of us yeah drugs came fanged now talk a little bit about that if maybe start with taluka and then move move into what happened a little bit later as as the heroin world in mexico was providing heroin to the united states all these drug trafficking groups that were very sophisticated by them um in the mid-2000s the synoload elements of the synoload drug cartel discover fentanyl so up to now they're making heroin they're growing poppies that's what they know they're the drug trafficking world in mexico has always been based on the land it's always been ranchers and farmers but now this is like another generation right and they they find this out from a uh an underground chemist whom they hire right out of prison from here now he's a mexican guy grew up here in the united states learned to learn to cook fentanyl at some point no one's i'm not quite sure how went to prison for it learned how to cook fentanyl better in prison gets out gets deported and then we get deported 2004 five he's contacted by these guys from syna law hey we want you to hire you we will it start an enormous new lab all this top top glassware and equipment etc but we want you to make a fedron if fedron is the main precursor in one method of making methamphetamine that was their big drug that had kind of taught them already that it's a better idea to make your own drugs rather than grow them yeah and he but he goes he thinks to himself these guys don't know what i know i'm smarter than them he doesn't make a fedron he makes fentanyl they find out they get a little mad not a good idea to make the syna law drug cartel mad but he said someday he goes no look you don't understand i'm gonna explain something to you what i have made for you is the most potent and the most profitable drug in the history of drug trafficking it's called fentanyl they set this guy they had set this guy up in a lab in this town called toluca and it's outside mexico city a very industrial uh town uh he fit right in they they made him look like kind of uh just a general drug distributor of a chemical distributor you know and meanwhile he's making fentanyl he sits him down and goes this is synthetic heroin okay and and the lights begin to go on because they're used to okay now we we're making synthetic something you might call synthetic cocaine like methamphetamine we can make it on our own we don't need any plants or sunlight or anything like that now they've got fentanyl they've got fentanyl to replace heroin no more land we don't need land we don't need sunshine we don't need uh farmers we just make and the lights begin to go on much more he tells them and they don't believe this at first but it's true he says this drug this kilo that i just made he made a few kilos he goes this kilo i just made will take a 50 to one cut yeah unbelievable now never on the streets do you ever hear of a drug that can be cut 50 times meaning you can cut one kilo into 50 kilos and it'll still be able to be sold on the street it'll be total junk except for in this case he was right and so they learn from him now he gets busted and um and eventually and so they lose their connection but they never forget about fentanyl and then several years later the chinese chemical companies begin sending fentanyl largely to folks here in the united states who are thinking that they can make a ton of money on it and it begins to emerge and then the the trafficking world in mexico gets in on it as well and begins to make it themselves find other chemists that'll teach them but the point i was trying to make that you're asking about is that this drug changes everything it's the most deadly drug on the street now let's say medically it's fantastic drug i've had many many many people have been given fentanyl they may not even know it when they're after surgery or during surgery or what have you it revolutionized surgery because it's a quick in quick out anesthetic so you take it you're anesthetized for a bit and then they remove it and boom you're about you're lucid you're not dopey or it's a magnificent drug when used medically when it went and it's it will do that because it's so potent and it's got that quick in quick out method it's a disaster of course it's proven to be a disaster when when used by the underworld but that the point of fentanyl that i was trying to make with what you're asking is that there's the drugs on the street methamphetamine and alfantanil are all synthetic they're made without any plants in labs they're made in quantities that simply we have never ever seen on the streets of america in our history and they're they're they're cheaper than ever and they are more unforgiving as i say fang they don't come with any forgiveness you use a little bit of fentanyl a minute amount of fentanyl and it'll kill you you know and so and it's that supply issue again where i wanted to talk about too when i said that it's like it's everywhere so you can't avoid it it's in everything now and that's because it's synthetic and can be made all year round you don't need land you don't need farmers all you need is shipping ports which is what they control down in mexico to get access to the world chemical markets and that's what we're seeing now on the street but it has its roots in the opioid crisis and the heroin traffickers of mexico trying to find ways of providing a dope to the united states it's almost it's almost like a sinister metamorphosis with one level building on the prior level in a way that just contributes to you know just death in america i want to i want to make a point that i want you to go on this is a quote sam from the drug enforcement administration's drug threat assessment of 2015 okay they say quote fentanyl and its analogs are responsible for more than 700 deaths across the united states between 2013 and 2014 then they go on to say it's going to remain the threat but it's probably not going to become a big threat because users are not going to like the way it feels so 2015 700 deaths in 2013 and 2014 my you know i follow this so in 2021 there were over 100 000 deaths by overdose in america 68 000 deaths are attributable to fentanyl yeah but from 700 to 68 000 yeah i want you to i want you to focus on that because you do eloquently yeah in the least of us how how did i think you say users turned kingpins well here's the thing here's the thing that what the dea said was true that users don't really like fentanyl for a couple of reasons number one the high is not as as rich i guess and it lasts much shorter period of time that in and out that i was talking about is real for addicts is what meaning you have to use more often you're always kind of facing the prospect of drug withdrawals the withdrawal sickness but but again that's my point they supply it with the idea they'll use it and that's what ended up happening people began getting addicted to it and when they began getting addicted to it they didn't have any choice whether they liked it or not that was what was for sale heroin is now fentanyl is kind of crowded out heroin pretty much nationwide i mean i think a couple more years we won't see any thing testing positive for real legitimate heroin at all because it doesn't give you the same protection from the dope sickness that fentanyl does if you're addicted to fentanyl you cannot have this kind of level of opioid if you're up here with your tolerance and so that was a perfect example of how the supply creates a demand that didn't exist nobody wanted fentanyl fentanyl kills you it lasts a short period of time you got to shoot up all day long i spoke with a woman yesterday a few days ago in eastern Tennessee who said with heroin i shot up twice a day i used two grams a day and and it was fine with fentanyl i'm using five four five grams a day and i have to shoot up four five times a day as well it's so it's makes your life much more difficult plus every time you shoot up you're taking your life in your hands because you're relying on somebody to mix it properly and you don't know that that's true of course at all that's why so many people are are dying of it so yes but those those figures you just um a site yeah which while the DEA was right about it people addicts don't really like fentanyl but it's the supply that creates the demand you are going to be given this then you're going to get addicted and then we are not going to sell you anything but because from a dealer's perspective it's much better that if someone buy five grams a day from me than two grams of heroin you know it's just more profitable all the way all the way around and so that is and all those deaths are a direct result of that massive supply hitting people who do not have the tolerance for whatever mix they happen to encounter as they bought it on the street could be that they have very high tolerance but there's going to be a mix that's higher than their tolerance and they'll die could be they have no tolerance at all they'll buy it the same and and die that's what's been happening tell us about the magic bullet phenomenon i was i was really shocked by that i didn't really know that well early on early on in the life of fentanyl in the elicit fentanyl in the united states uh the traffic the chemical companies from mexico from i'm sorry china would be sending over you know they people that order it like a pound at a time or a half kilo you know that kind of thing and it comes through the mail well they were it was coming to people who realized that fentanyl offered them you know lottery size profits you know this is their lottery ticket oh my god the problem is they needed to know how to mix it because fentanyl's so potent the equivalent of only a few grains of salt will get you high a couple more will kill you so you cannot sell on the street a few little tiny grains of salt you have to mix it so that you can actually sell it as a product the problem is that the people they were buying this stuff didn't have a clue how to mix the stuff and then on top of that not only did they not know but the myth spread early on that the best way particularly in the states that were first got these drugs like that were most hard hit by the opioid epidemic initially Ohio was virginia kentucky indiana places like that you would find this a lot in those states at the the myth spread that that the best way to mix your fentanyl with some some other inert powder cheap whatever powder was with a magic bullet blender the kind that you see in target for 2995 and on infomercials now let me say this that's a fantastic product i own one and it's a magnificent product for for small scale salsa or smoothies or whatever that's how we use it in my house it is a uniformly awful machine for mixing fentanyl because it mixes with a blade it mixes liquids very well but not powders powders don't mix at all and so what began to happen was people believing this was a good way to mix believing that with the little plastic bubble they would avoid breathing the fumes all of that convinced so many people and narcotics agents would find that these different houses and apartments they'd find this this magic bullet blender in many many places they would but they would but one of the effects of that was to have a bad mix so you began to see early on in fentanyl's life in the united states 2014 1516 you remember mass overdoses in like a certain g like 70 overdoses in Cincinnati huntington was virginia 50 i think it was i can't remember but that was largely because the mix was so bad and and the the problem was that the people who were thinking that fentanyl was their next meal ticket didn't have a clue how to actually mix powders well and so they began to sell this stuff that some of it had no fentanyl in it others had a catastrophic amount of fentanyl and you began to see those early overdoses and that's largely due to the bad mixing and to some degree to the magic bullet blender used to mix the stuff yeah and and um the the the the fentanyl is measured in what's called mcg micrograms rather than milligram so a milligram is a thousandth of a gram fentanyl is measured in millions of a gram and in in in medical use the difference between a therapeutic dose and a fatal dose is invisible you can't see it right exactly the idea that this drug is being mixed by magic bullets you know and and people on the street just selling it is crazy what what we do the harm reduction people in vermont but we advise people who are currently using opioids and injecting opioids we advise them to use a fentanyl detection uh strip in in each dose not each bag because even in a little bag the difference between one corner and the other corner can can be can be fatal because of yes it was mixed i would say though that you got to be careful on the fentanyl test strips though because now that people are out there addicted to fentanyl if you are if you are using cocaine and you know on the streets now it's become a practice common practice to use cocaine and mix it with fentanyl because it'll boost your cocaine but also because eventually if you do that enough you will get in place of that cocaine casual kid cocaine user you will get an opioid addict who must buy from you every day so dealers who do this understand that there's a business reason for mixing cocaine into a mixing fentanyl in into cocaine and this is happening again all across the country because the supply is fentanyl a fentanyl is just massive it can it can be done it's like salt it's about as common in the drug world as as salt we put it on food and so but so when you get people addicted frequently those test strips then serve another use those test trips then become a way of making sure that you have fentanyl and what you're buying because you're now addicted to fentanyl nothing else will do so you use the test strips i've heard this now anecdotally don't know how common it is but nevertheless it makes total sense if you think about it i would want to test the drugs that i'm buying because if i get anything that doesn't have fentanyl in it i am not i'm going to be in withdrawal so you better have it um but but yeah i mean that's that's for someone who's not addicted to fentanyl those strips can be a kind of a warning like don't do this one and one of the one of the other things we're doing is we're trying to get people who cocaine users to carry an anoxone because cocaine and methadiene do like you say have fentanyl sometimes in them but imagine that that's an amazing change don't you think i mean think about it cocaine users now need to have naloxone and that is again all of this again i harp on it maybe too much but but all of this comes from this just idea that there's so much supply out there that now people are mixing it into cocaine or methamphetamine or whatever one one of the other things is there was a study done one of these ethnographic studies like an interview study with users trying to get at what why are we finding so much of a concurrent use of methamphetamine and um fentanyl and a couple of the things they said was that um they they don't like fentanyl because it's much briefer they don't like fentanyl because there it was described as being more like a sedative with tranquilizing effects whereas heroin is more like a dream-like state a euphoric state with what but can also be energizing so they don't like that tranquilizing sedative effects so they're mixing methamphetamine on purpose in with fentanyl to counteract the sedative effects which i mean when you when you think of it how can how can it get get much worse so people are using two potentially fatal drugs at the same time well yeah and i mean that gets to the other problem that we're facing which is methamphetamine methamphetamine in my reporting is now more prevalent than ever because of a new way a new way of kind of an old way but new to the trafficking world in mexico of making it that allows them to make it in in long story but along allows them to make it in just again catastrophic supply so so what we've seen is it's an amazing idea they have covered the country with methamphetamine there's almost no region there are few regions that where it's not the case but effectively covered the country with the methamphetamine and dropped the price by almost 80 percent i'm in nashville tennessee you know and in nashville five years ago a pound of methamphetamine was 19 thousand dollars pound of methamphetamine in nashville today is three thousand dollars this kind of price drop has happened all across the country all those shake and bake those small time little meth cooks that you used to see about to read about and and so on they don't exist anymore they've been out competed they're not in the market at all it's it's a totally a market made up of methamphetamine coming out of mexico entirely isn't the remarkable remarkable change and same time the methamphetamine coming out of mexico and my reporting anyway has found that it is accompanied by severe symptoms very rapid onset severe symptoms of schizophrenia and then homelessness and then i believe the ten encampments of today that we're seeing in many parts of the world of the country are really just a direct outgrowth of all the methamphetamine that has really marched across this country since about 2012 13 so last nine 10 years and and and gone to places where it never was before is this the result of this uh the p2p is that is that what that is it makes a different type of methamphetamine um yes right and it's it's well it's it's it's unclear what exactly is causing it because there's no neuroscience on it yet but there is it's clear that it's accompanied by this new way of making methamphetamine that is as i said a really an old way but new to mexico allows them to make it in very high potency and again in enormous supply like we have never seen all across this all across this country hence the enormous supply uh the enormous price drops we're seeing all across uh uh uh the the country and p2p meth came about because the mexican government you remember i spoke of effedron this one that this one guy was supposed to make in that lab well effedron was the way they made meth for many years done the government mexico put controls on effedron control the importation made sure only a few companies could possess a pharma company could possess it and the trafficking world switched to this other method this other method is actually very inefficient it's not a really great method for making meth but it does involve one benefit and that is you can make the crucial precursor which is a chemical called as you say p2p phenol 2 propanone you can make that precursor in with all kinds of different chemical combinations it's almost unlimited but certainly there are many and and and so that allowed them to make a whole lot of it and a lot of these chemical precursor chemicals that go into it are industrial very widely available very common and very toxic illegal as well and so you began to see them doing that and enormous supplies just began to flood the areas just incredible and and and they began almost giving it away too i mean i remember talking with people who are drug dealers you get these guys these deals like man sure i'll buy some damn it's like almost free then along the way though what we have been seeing in region after region as this methods march across the country is this very florid hallucinations paranoia immediate paranoia psychosis method do psychosis that looks every bit like schizophrenia but isn't but nevertheless lasts right and so you've got all the and then along with that homelessness because people cannot they don't want to follow rules nobody can live with them i mean there's all kinds of reasons why people end up homeless once you're homeless using meth on the street it's like almost free again on the street it makes it very difficult for you to get back into the real world once you're using meth on the street and you're seeing this in la san francisco in the west coast all over the west coast you're also seeing it where housing costs are very high but you're also seeing it in rural areas appellation areas rust belt areas where there is no high cost of housing i believe that one of the major drivers if not the major drivers certainly one of the major drivers of homelessness in america tent encampments in america is the methamphetamine that's been coming out of mexico since as i say about 12 2012 13 14 right on there but we're seeing it we're seeing it more and more in brahmant northeast was kind of behind the curve thank god for many years when it came to methamphetamine but we're seeing it more and more in brahmant and i think you you make a point in the book as far as historically there have been waves successive waves opioids and then methamphetamine now we're having uh or opioids and then cocaine historically one will transcend and the other will fade and then the pattern will repeat itself but right now we're having simultaneous waves of opioids and and and stimulants it's unprecedented thank you so much for your work sam i really appreciate it thank you out now we're in in all of this so it we have like a you know it's like a like a quadruple wave of uh uncontrollable uh drug supply um we have uh prescription drugs and heroin kind of decreasing in death toll while we have fentanyl practically on a like a vertical escalation and now methamphetamine joining it in a vertical escalation of death you know it's pretty pretty bleak um one of the one of the things that i love so much about uh the least of us is that it is it is a hopeful book that that you manage to focus on the resilience of america the resilience of communities and i think most importantly the resilience of of people with addiction so i'd like to i'd like to just read a quote from this section of your book and then we'll go into that um so you say jason merrick imagined now what he called recovery ready communities towns geared toward help towns towns geared toward helping people with addiction to recover and then you say he said this is what rehabilitation looks like it's full of a continuum of care not just punishment well thanks very much ed i appreciate you asking about that because frequently when i'm on interviews people ask only about the drugs and uh i don't believe that's the most important part of the least of us i believe in fact the heart and soul of the book is really my attempt to tell stories from around the country about um about you know americans involved in the small unnoticed unsexy work of community repair and i focused on getting those stories because as i wrote dreamland and as i prepared to write this book i began to realize that i realized that one of the things that got us into the opioid epidemic was we wanted big magic answers to all our still all our problems we had stripped ourselves we'd shredded community all across the country for year decades many many ways and we would go on quite a long time about how we did that and why um and you know that was a devastating thing to do because when you think of it think about our brains our brains evolved to not think the community is a good thing but to think of it as an essential thing that's reason why we survived as a species is because we hung together through thick and thin because you know even though we don't like each other etc all these things there was never a time in the in the history of the world when people in isolation didn't die quicker today tape man times all the people die when they're alone much more easily so we have understood that i think throughout the millennia that we've been on this earth but in the last 40 years in america we kind of turned our back on that idea and decide wait we don't we don't need it it's messy i don't like them they don't vote like i do they believe in another religion their different race whatever all the different reasons why we don't want to be around other other other people i began to think that that combination of like shredding community together with this big idea of we always want magic answers easy answers the very complicated problems was what i had to address or i wanted to at least i wanted to find stories of the opposite of all that people working towards finding community repairing community in the smallest little way nothing that's saving the world they're not interested in saving the world in some virtuous way what they're doing is trying to say what it makes a difference to work in this one place in this one block daily showing up and that really became the heart and soul of the book what is our defense from this these fanged drugs as i say what is our defense from all this stuff that's legally marketed to us it's equally just extraordinarily addicted my belief is repairing community coming together in small ways getting out of the house right finding people with whom we can work and and then doing it showing up every day there's no magic answer there's no silver bullet to all this stuff it simply is about that and so it was those stories so i've just mentioned one and go ahead in particular and i uh real quick and that is the story of a guy named bird who lived in the southern uh south a neighborhood in south muncie indiana an area that had survived on based on these enormous factories making transmissions those factories began to decline classic rust belt to begin a lose job lose job over many years finally the city decides we cannot have we do not have budget to keep open the community centers in each of the major neighborhoods of our city one of them they were going to close was right across the street from this guy who is known as bird he had in fact worked at this community center for a while so the city leaders in fact closed the thing shut down the thing no budget etc and they think that's it except for that bird keeps the key right he keeps the key and every day he opens it for the kids to play you know in and the the older folks play cards there's a wedding reception he opens up for them a birthday you know he becomes a community center unto himself so just a profound profound story that i just what it just caught me uh and and it was that kind of idea he allows that neighborhood very small neighborhood to weather not just the economic devastation but then also the opioid problem as well it becomes a uh an again a lighthouse in the storm in a sense this community center he fixes the toilet he replaces the light bulb he mows the lawn he keeps that thing going for several years when that neighborhood most needed it and one of one of the i mean i read about bird and and i was i was moved by bird and a couple of other of your examples but one of the things about bird that that struck me was that not only did he do that but he did it in spite of of significant you know personal limitations yeah he saw beyond himself right so the good that he could do in the community beyond his significant uh limitations was yeah yeah his limitations were that he was psychologically incapable of leaving and now he never in a car town he never drove you know it's it's an amazing story of a guy and he had died by the time i i i got to know his story later on he had had medical medical he had met some medical problems too he developed a horrible i mean he ate horribly he drank way too much soda never went to see a doctor never gotten a car never went beyond certain intersections he just was kind of like the guy who was always there who hung things to get hung things together for that neighborhood in spite of these very significant psychological issues that he that he that he had but he did so in these certain years that were crucial after they closed the thing for several years they reopened it now now it's functioning again and he's he died a few years back but his he was like this bridge to keep the neighborhood kind of together until it got to a point where it could kind of function a little bit better on its own it was a beautiful beautiful story but exactly the kind of story that i wanted to tell not because i have any answer for your county or any other county in america i don't live in those counties i'm just trying to say this is how we might approach things i'm not trying to say i know what you should do i'm just trying to say this maybe give this some thought the idea that maybe you know small scale ways getting outside getting to know more people because there are no solutions in isolation everything looks insurmountable and we can't do anything about it the solutions come through the synergy and innovation that come from being a community again and we have done so much to destroy that's you know that to destroy that that's that's where the um the title of the book came from i'm not a christian but i was reading the gospels kind of almost looking for a way to direct the book early on i read the gospel of matthew i'd read it before but i read it again and it struck me again that what you do for the least of my brethren you do for me well it seemed to me that jesus understood speaking to his disciples understood the enormous essential power the most powerful force that we have is more powerful than any drug is this desire to need essential need to come together the problem is in this country we've done so much to shred that to isolate ourselves you know that is that to me and and i'm sure to all my viewers is is so beautiful sam and so essential that that out of this darkness will be the friction to cause that little light that'll help us to move as a culture to move forward so sam i know that you have to scoot um let's let's have just a few final words um well i would just say i'm looking yeah i'm looking forward to this event um uh on uh on april fourth uh and johnson once people find common ground to attack one thing i think other attacking other parts of other afflictions that may affect a town or a neighborhood or a region or what have your county become easier become more kind of second nature and and the connections are made and to me that's an essential part of what i was writing about and what i'm decided to uh to um well i've written these two books uh is just is to make that case that that that is when we do that we just haven't done it enough you know so anyway i'm looking very much forward to getting up up to vermont in april i'm looking forward to this whole event and i hope to see you guys uh there when i when i arrive yes you will we can't thank you enough sam thank you so much thank you my pleasure see y'all bye bye