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

by Sam Quinones

wasn’t always true: that virtually every pain patient could be prescribed bottles of narcotics without risk of addiction. This, in turn, led to the idea that pills could be prescribed in large amounts for long periods to almost anyone. As a species, we have five thousand years of experience with the opium poppy. It contains a substance that is both the best painkiller we know and the most intensely addictive. Yet beginning in the mid-1990s and for years after we decided that only one of those was true.

Opioid pain relievers in unprecendented number year after year were prescribed from coast to coast. They were overlaid on American populations riven by trauma or generational poverty, or well-to-do areas with large houses and barren sidewalks. They spilled over a culture in which so many addictive legal substances and services were already finely tuned to attack our brains. Predictably, narcotic pain relievers turned out to be addictive for a lot of patients the longer they used them. The pills sloshed across the country and onto street black markets, where many others grew addicted. Some of these newly dependent users moved on to heroin.

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.

Philadelphia had long been a heroin town, but by 2019 90 percent of 1,150 fatal overdoses were due to fentanyl.

Fentanyl and this new meth were in the interest of traffickers, not their customers. Traffickers had unlimited access to world chemical markets, and the population of American drug users had expanded coast to coast. These drugs could be made year-round, in greater quantities, cheaper and more addictive than anything grown from the ground, and thus could create or shift demand.

In the postwar years, ephedrine was used legally as an antihistamine in the over-the-counter medicine Sudafed. The ephedrine method for meth, though, lay dormant for a long time. It was rediscovered by the underworld in the United States in the early 1980s. It democratized methamphetamine. One place this happened was in the San Diego area, largely due to a man by the name of Donald Stenger.

“In the early 1990s, the cooks were monkey see, monkey do. Like using a cookbook,” said Larry Cho, who, as a federal prosecutor, took down a supply and stash house operation run by the Amezcuas out of the Orange County town of Placentia. “They weren’t using anyone trained in chemistry. All these meth labs were exploding because they didn’t know what they were doing.” But they learned, and with the Amezcua brothers’ ephedrine, the new Mexican meth cooks scaled up their operations. Hells Angels cooks took three days to make five pounds of meth. Mexican crews soon learned to arrive at cook sites like NASCAR pit crews, with premeasured chemicals, large vats, and seasoned workers. They produced ten to twenty pounds in twenty-four hours in what came to be known as “superlabs.” Soon the biker gangs were buying their meth from the Mexicans.

Hovering at the edges of the racing industry, the director explained, was a shady class of people constantly looking for chemicals that could “hop a horse or stop a horse”—make it run faster, or slower. Fentanyl, he said, did the former. The drug was a narcotic when administered to humans; it doped them, slowed them, sent them into a stupor. But it threw horses into a manic rage—cats, too, for that matter. Opioids, in fact, tend to produce strange effects in mammals other than humans. Fentanyl will turn a rat stiff, to the point where you can stand him on his head. A horse on fentanyl will tear up a stall. On the track, the drug pushed the horse to extremes.

One kilo of the fentanyl he brewed up, he said, had to be cut—diluted—into fifty kilos. At a fifty-to-one dilution, he said, it wouldn’t kill anyone. He knew this, he said, because he’d tested his product on mice and found that, at fifty to one, the mice didn’t die. He relayed this information to the people who took his powder, but whether these crucial instructions traveled to the streets he had no idea. Investigators in Chicago, in fact, found that street dealers, thinking they had heroin on their hands, were reluctant to dilute it. Weak heroin was a constant complaint among customers, who were now hearing that an especially potent batch was circulating. Nobody on Chicago streets believed that this stuff could be cut fifty to one. “They thought it was a sales tactic,” Rapaszky said. “It was inconceivable that you could dilute it that much.” Many dealers sold it into the street drug world without cutting it at all.

Back in the United States, meanwhile, overdoses were now the leading cause of accidental death. People addicted to prescription pain pills began switching to cheap, potent Mexican heroin. In 2016 Rapaszky took over the DEA office on Cape Cod in Massachusetts. He watched as street fentanyl became the opioid epidemic’s third phase, crowding out heroin—just as it had briefly done in south Chicago in 2006. The national death toll consequently set new annual records. 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 the pain, and years later they were addicted and buying off the street what they thought was heroin. It was fentanyl, and many died.

The new reps had no background in medicine or pharmacy. They were athletes and cheerleaders, former computer salesmen, and ex-military. They were, above all, genial, easy to talk to. They were often the only people Lou Ortenzio saw all day who didn’t have something that needed fixing. Many of them didn’t know what they were selling, but they did know how to sell it. They did this, mostly, by giving stuff away. In the literature of psychology, giving stuff away is a quick route to getting people to like you. These new reps came armed with pens, stress balls, calendars, notepads—all the tinsel of the new pharmaceutical sales world, each emblazoned with the pill’s name and company’s logo.

“Each [sales rep] had their turn every three weeks to bring lunch for the office,” Monica said, “that’s how many reps there were.”

That year, 371 West Virginians died from narcotic overdoses, double the national rate. Statewide, physicians were writing 130 opioid prescriptions for every hundred West Virginians.

In Clarksburg, Lou Ortenzio was the first doc prosecuted for charges connected to overprescribing of narcotic pain relievers; he was the first to show residents that this was a new kind of American plague, with the drug supply not flowing from street dealers but from doctors and drug company reps. He embodied the new addict: a respected professional with a plaque on the wall, not a toothless back-alley user.

The director of the ward was Jim Thorp, a doctor who had worked with pregnant, drug-addicted women as the pain revolution in American medicine spread. For years now, the casualties of that revolution had streamed through his ward—women giving birth to drug-dependent infants. But the most serious case Jim Thorp ever saw was Starla Hoss.

Fentanyl’s greatest advantage to dealers was its potency. Very little of the drug was enough to get people high. That, in turn, made it easy to smuggle. Fentanyl’s potency was also its drawback. If minute amounts of the drug could get you high, even a tiny bit more could kill you—the equivalent of a few grains of salt. To be handled and sold to users, it had to be mixed with larger quantities of other powders, each white like fentanyl. Indeed, never before had the drug underworld seen its profit, and so much profit at that, tied to the delicate task of mixing powders, particularly one as potent as fentanyl. Use of the Magic Bullet was a sign of how little each dealer knew about drug mixing—or cared.

A while later, Tommy had his wisdom teeth removed. Dentists, too, were prescribing large bottles of narcotic painkillers—thirty days’ worth of pills for pain that dentists knew would last two or three days. This was standard now. Every year, 48 million routine surgeries took place in America. Virtually every patient during those years left with renewable prescriptions for big bottles of thirty, sixty, or ninety pain pills of one brand or another. Thus a firehose of prescription narcotics blasted at the US public for close to two decades.

He had come from a middle-class White counterculture where drug use was a form of adventure, particularly for a young man who had intellect and a thrill-seeking soul. That culture, however, formed in a time when the drugs were more forgiving than the street offerings of the new millennium. Attitudes hadn’t changed, but the dope had. The days of recreational drug use were over in America. The drugs came fanged now:

Later, some people would claim that the opioid addiction epidemic was only getting attention because the great majority of its victims were middle-class White people. That was true. The other truth was that the plague hid for years because so many of its victims were middle-class Whites. Families seared by the loss also had to navigate the shame. They covered up, mortified at how their loved ones had died, afraid to stain their memories. Newspaper obituaries reported that a twenty-seven-year-old died of a “heart attack”; a middle-aged brother “died suddenly” at home. Amid this nationwide silence the plague festered, metastasized, and, like a virus, took on a life of its own.

Gordon Jin turned out to be a man named Fujing Zheng, thirty-five, and his father, Guanghua Zheng, sixty-two—both of Shanghai. They were nobody’s Scarface—no diamond-encrusted pistols, no revenge feuds. Fujing, the son, had hopscotched from job to job before landing in a chemical company where he apparently discovered the bounty of selling synthetic drugs online. His father was listed as a warehouseman, and from his photo he seems a man of humble beginnings. They employed no gunmen, no bodyguards, no drivers. They relied on encrypted communications and currencies. Drug traffickers for the twenty-first century.

Occasionally he recalls that early in the case he searched Google Earth for the addresses where Bin Wang’s fentanyl packages were headed. Up sprung photos of apartments in Atlanta, a trailer park in Tennessee, a boarding house in Reading, Pennsylvania, occupied by people who, he imagined, nurtured dreams of jackpot profits untethered to any realistic idea of how to handle or mix what they’d ordered. In the past, buying large quantities of such potent dope required months, maybe years, of cultivating contacts within a drug gang or mafia.

The company’s focus had changed, too. No longer were its targets the relatively few pain doctors and anesthesiologists. The new targets were family doctors, general practitioners, nurses, and physicians’ assistants who prescribe pills. Purdue had created fifty smaller sales territories, allowing reps to spend more time with these professionals, who were generally overworked and untrained in pain management. The smaller doses, 10 mg and 15 mg pills, allowed reluctant family doctors to begin prescribing OxyContin more cautiously—and would lead to higher-dose prescriptions in the future, the company hoped.

In the end, the company strategy that Rowland and Harrell described in the criminal complaint prized short-term profits above all else. It could be distilled into a philosophy that was, it seemed to me, simple enough for any street dealer to understand. “Their whole push was to keep people on [OxyContin] and get them to a higher dose because then they were more likely to stay on it,” Rowland said. “It seemed that everything was driven by the [Purdue] marketing team.”