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

by Sam Quinones

In human brains, behind each ear and just above the brain stem, lies a blue spot that has helped guarantee our survival. It’s known as the locus coeruleus (Latin for “blue spot”), though those who study it just call it the LC. In humans, the LC evolved early, as it had to. The main job of the LC is to send a chemical—called noradrenaline—to other parts of the brain that ignite warnings of life-threatening menace. Noradrenaline helps sound the alarm, pushes the panic button, in a sense. Without it, we would have died off long ago. Opiates change a lot in our brains. One thing they do is stifle the LC. They shut it down. Under their influence, the LC can no longer send the chemical igniting panic. Smothered so completely, the LC, product of millennia of evolution, is muted, even as the drug sends the body into overdose. In fact, like some menacing extraterrestrial, opiates convince the LC that doing without them would be the life-threatening event. With opiates removed, the now-unbound LC leaps into action. Studies of the brain of an addict entering withdrawals show that the LC gets agitated, releasing outsize amounts of noradrenaline that produce alarm, panic, anxiety, and insomnia. The result amounts to, in effect, a chemical shriek that the addict must have the drug immediately or all is lost. I submit the bizarre case of the tiny locus coeruleus because, in the smallest of ways, it illustrates how drugs of abuse, and opiates in particular, change the chemistry of our bra...