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

by Sam Quinones

Fentanyl was the era’s poster drug. A wonderful medical tool, the hyperpotent synthetic emerged as the underworld’s hyperprofitable heroin substitute. Supplies of it came from China, then from Mexico, as well. Fentanyl upended the dope world the way tech disrupted business. No farmland needed—no pesticides, no harvesting, no seasons, no irrigation. It shrank the heroin supply chain—from dozens of people down to two or three, none of whom were likely to be scary cartel types. Illicit fentanyl spread first through the midwestern and eastern states. By 2018 it was all over the West as well. Overdose deaths shot farther north; more Americans died yearly than in the entire Vietnam War. Cuyahoga County, where Cleveland is located, saw overdoses double from 2014 to 2017—from 353 to 727, with almost 500 deaths involving fentanyl. San Francisco saw a similar increase between 2018 and 2020, when three times as many people died of overdoses as of COVID-19. Philadelphia had long been a heroin town, but by 2019 90 percent of 1,150 fatal overdoses were due to fentanyl. Traffickers, meanwhile, had discovered a way to make methamphetamine in harrowing new amounts. While I was on the road, their meth reached all corners of the country and became the fourth stage of the drug-addiction crisis. Opiate addicts began to switch to meth, or use both together. This made no sense in the traditional drug world. One was a depressant, the other a stimulant. But it was as if their brains were primed fo...