The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth by Sam Quinones. 

4/5 rating. 390 pages.

Book #34 of 2023. Read August 15, 2023.

This book talks all about the US path from OxyContin to fentanyl, and finally meth: highlighting the lives of some users, people from the areas hardest hit, and then some hope from towns that have come up with ways to end the scourge and get past this horrendous time we have been living through.

I learned so much from this book about addiction, the change in the drug trade fueling things, and different experiments being taken to move past the current crisis. This book did an incredible job showing the humanity of people who have been taken over by drug usage.

The earliest large spike of opioid use came about from the supply of OxyContin available because of the heavy marketing by the Sacklers’ greed at Purdue Pharma. With the reformulation they were forced to do to make their product less easy to be abused, people who were addicted (many unintentionally, obviously many not) had to stave off the awful effects of withdrawal and looked for anything to ease this. Along came heroin, and eventually fentanyl. This synthetic opioid was so cheap to make and incredibly potent that it popped up everywhere.

The part that I had mostly missed – or at least not realized – is the final move to “new” meth. Meth has always been horrible on the body, but the old type of way of producing used ephedrine (found in medicine such as Sudafed). With the government making it nearly impossible to get ephedrine, the meth cooks moved to a form called P2P. This is made from everyday, incredibly dangerous materials – think lye. With this shift, the new meth has basically created a mass of zombies who literally are almost unable to think when they become addicted. This has led to psychosis among many users and is a large contributor to many homeless people who appear to be schizophrenic.

Sam also did an amazing job of highlighting some bright spots for hope in these troubling times of easily available, incredibly dangerous, drugs.

I think this is nearly a must-read because of the pervasiveness of addiction today. I have pages of quotes I took from this book and absolutely loved it!!!

Quotes:

“By 2018 [fentanyl] was all over the West as well. Overdose deaths shot farther north; more Americans died yearly than in the entire Vietnam War.”

“This made more sense as I read what neuroscience can now tell us: that every human brain has capacity for addiction. Isolation is part of why some people get addicted and some do not. So was trauma. Abuse, rape, neglect, PTSD, a parent’s drug use were as unspoken in America as addiction and as prevalent. The epidemic was revealing this. I also connected the epidemic to consumer marketing of legal addictive stuffs: sugar, video games, social media, gambling.”

“We had created this catastrophe, after all, by demanding one big, easy solution for a complicated problem: one pill for all pain.”

“The idea was to compare their brain reward pathways with those rats that were fed drugs of abuse – morphine, alcohol, or amphetamine. They found in those sugar-dependent rats, Avena said, ‘neurochemical behavioral changes that…you’d expect to see if an animal was dosed up with morphine. But these animals were just overeating sugar.”

“A pharmacist and a nurse practitioner in the area told her that Dr. Rhodes was a major prescriber of narcotic painkillers, and thus a major source of the pills that ended up for sale on the street. Later a woman approached a Purdue rep at a conference in Tennessee, claiming her son died of an overdose from pills Rhodes prescribed. Purdue sales reps filed reports on Dr. Rhodes with supervisors. Purdue even investigated him and found he ‘was feeding addicts.’ One addict he prescribed ninety OxyContin later died of an overdose. State authorities reprimanded Dr. Rhodes for gross negligence. Yet the company decided to allow its sales reps to keep calling on Rhodes. The reps pushed him to prescribe more OxyContin, which he did. He grew into one of Tennessee’s leaders, prescribing 319,000 OxyContin pills between 2006 and 2015.”

“On Cape Cod, every addict had had a hockey injury, or was injured on a fishing boat; either way, the doctors prescribed them opioids for pain, and years later they were addicted and buying off the street what they thought was heroin. It was fentanyl, and many died.”

“[Dr. Ortenzio’s] professors had taught him that most of what a doctor needs to know to make a diagnosis could be learned from taking time to listen to a patient. X-rays and lab tests were to confirm what you gleaned from asking questions and paying attention to the answers. Ortenzio had been trained to help his patients help themselves. Part of his jon was to teach them how to take care of their bodies. Pills were a last resort.”

“Americans got used to medical miracles that allowed them to avoid the consequences of unhealthy behavior: treatments for diabetes, high cholesterol, hypertension, and heart disease. As the country aged, patients wanted relief from pain. Doctors would suggest long-term strategies: exercise, better diet, quitting smoking. Patients didn’t want to hear that – they just wanted to be fixed.”

“Insurance companies still didn’t reimburse for a lot of pain treatment that didn’t involve pills. He had few other pain-treatment tools at his disposal; it’s unclear whether his patients would have accepted, say, exercise and other changes in behavior that those treatments required.”

“Researchers were intrigued, full of questions about the idea that administering naloxone to a sugar-dependent rat sent it into withdrawal, same as it would to a heroin addict.”

“Medical studies have found that two-thirds of patients using opioid painkillers for more than ninety days were still using them five years later.”

“Region Zero did not refer to a geographic area. It was instead Purdue’s term for a collection of some 1,800 doctors nationwide whose prescribing the company tracked. That data led Purdue staff to suspect these doctors of uncontrolled prescribing, diversion of the pills, and abuse. Bitt neither did Purdue report them to the government, as its 2007 agreement required. One reason might have been that Region Zero doctors accounted at one point for 10 percent of company sales.”

“It seemed to me, after traveling the country chronicling the opioid epidemic, that the Avondale neighborhood was finally getting what a lot of the country needed. No splashy, magic answer. Instead, just folks moving in their own quiet ways toward community rejuvenation.”

“In the world of opiate-addicted brains, an overdose is not a warning; it’s an advertisement. Dealers broadcast the fact.”

“As years passed, the Sacklers did not diversify Purdue, either through R&D or through acquisitions. Instead, they voted to have Purdue pay the family $4 billion between the 2007 conviction and 2018. This included more than $500 million in both 2009 and 2011, and more than $800 million in 2008 and in 2010. Another $6 billion was sent to Purdue affiliates. In all, investigators determined, some $10 billion was sent out of Purdue to the Sacklers or affiliated companies during these years.”

“McKinsey also estimated how many customers might develop addiction to, or die from, OxyContin. At one point the consultant suggested Purdue pay its drugstore distributors rebates of $14,000 for every addiction and fatal overdose OxyContin caused, to ensure that chains like CVS and others would keep distributing the pill.”

“An internal memo noted: ‘There is an opportunity to expand our offering as an end-to-end pain provider’ from pain treatment to addiction treatment. This was possible because – contrary to what Purdue had insisted publicly and in sales calls to doctors – opioids used to treat pain, the mom read, are ‘naturally linked’ with addiction.”

“‘A lot of these people have the potential for coming out of it, and you protect the community best by getting them into sobriety,’ he said. ‘It is so exciting when they gradually learn that it’s going to take little steps. That they’re going to have to prove themselves – and they do.’”

“It took a year and a half. Deputies watched it happen, day by day, this strange fog lifting only slowly inside a man’s mind. Along the way Rob Burd became the first addict many cops in the department got to know without handcuffs; they watched his struggle, saw that he didn’t quit, and came to feel for his befuddlement. ‘It softened us up a bit,’ said Holbrook. ‘Once you see somebody, knowing them personally, you start looking at other people and you see them a little bit differently, too.’”

“Now almost everyone we see when we do homeless outreach [in LA’s Skid Row] is on meth. Meth may now be causing long-term psychosis, similar to schizophrenia, [that lasts] even after they’re not using anymore.”

“I spoke with two recovering meth addicts who said they had to relearn how to speak. ‘It took me a year and a half to recover from the brain damage it had done to me,’ one of them said. ‘I couldn’t hardly form sentences. I couldn’t laugh, smile. I couldn’t think.’”

“Still, my reporting found that P2P meth in massive quantities is damaging minds, perhaps irreparably, across the United States. The growing homeless encampments in many cities and rural towns are meth’s deadening creation, I’m convinced. Though other drugs and alcohol are part of the mix, many encampments are simply meth colonies.”

“For all the mistakes teenagers make, it seemed to Alexander that the drugs and how they were purveyed now ensured that they received no forgiveness.”

“‘There are,’ [former Purdue CEO Craig] Landau wrote,

‘Too many Rxs being written

Too high a dose

For too long

For conditions that often don’t require them

By doctors who lack…training

In how to use them.’”

“Recovery ‘is different for everybody; it means any positive change,’ Merrick said as we sat in his office at the jail one day. People failed out of Unit 104 and the LLC all the time; some took several tries to get it right. The trick was to show that while all this was complicated to orchestrate, it was cheaper and produced better long-term effects on addiction and crime than how jail had been run.”

“I came upon a YouTube video of a speech in which Dr. Robert Lustig contrasts pleasure and happiness. Pleasure, Lusting said, is fleeting; happiness is long-lived. Pleasure comes from taking or getting; happiness comes from giving. Pleasure is achieved alone; happiness with others. Pleasure comes from substances or things; happiness does not. Pleasure releases dopamine in our brains, the constant search for more; happiness releases serotonin, producing feelings of contentment, an end to consumption. All of which means, Lustig said, that pleasure can prod our reward pathways into addiction; happiness cannot.”

“In the United States, all this is etching and twisting our brain reward pathways in ways unknown even a few decades ago. The United States is the world’s leading per capita consumer of both opioids and sugar.”

“[Homeless e]ncampments resembled Third World shantytowns. The tents went from gifts of compassion to hives of crime, addiction, disease – and now pimping.”

“We need to again make policy of the belief that we can’t go it alone. The spirit of community needs to be built out, collectively, not just in a shift or heart, which is necessary, but in taxation, in health care, in improved infrastructure – in other words, a shift in where the resources go.”

“The addiction crisis has been telling us that to defend ourselves we’d be wise to reexamine how we live. To rethink what we eat and drink. To limit or block social media and disconnect twenty-four-hour cable news, reducing the firehose of narcotic outrage and changing our ‘junk-food media diet,’ per Nebraska senator Ben Sasse.”

#theleastofus #opioids #mustread

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