Sam Quinones on Heroin, the Opioid Epidemic, and Dreamland

Sam Quinones is an American author and journalist who writes narrative non-fiction. His two most recent books Dreamland: The True Tale of America’s Opiate Epidemic (2015) and The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth (2021) are both critically acclaimed.

In this episode, Russ Roberts welcomes Quinones for a discussion of Dreamland, which provides a pluralistic view on the key players and the underlying pressures which caused the disaster.

Consider the motivations of the young men from Xalisco who are coming to America to sell opioids. Quinones shares the standard set by those who come back after selling drugs successful and build ostentatious homes. There is a great amount of social pressure, which Quinones likens to building a home in either 9 years or 9 months for the men from Mexico.

How can the pressure of coming home wealthy build a man to become “addicted” to it? How does the young men’s addiction to wealth compare to those addicted to the opioids they sell?

Quinones points to the close-knit nature of the drug ring in terms of similar “family” names and everybody knowing each other in the late 1990’s as something which made the sellers vulnerable to the DEA. Police also learned of the areas where people would meet to make their exchanges. Responding to the issues, new families became involved, and the sellers produced a pizza delivery type system where their customers would call and have a driver come to bring them the pills.

What advantages do a loyal labor structure have for illegal businesses, with its executors being related? To what extent do you think the demand for opioids suffered from police officers locating the areas of exchange? What could be a new concern for sellers with the pizza delivery-type system put in motion for the opioid-money exchange?

The rise of opioids began with their success in treating pain in patients. The medicine was pushed hard when pain specialists built the narrative that the opioids were non-addictive, and the drugs were marketed heavily by big pharmacy organizations like Purdue Pharma.

What should be the role of opioids in treating pain today? How did the sentiment of qualifying pain as a fifth vital sign in medicine complicate the opioid epidemic?

Roberts and Quinones discuss the perfect storm of causation leading to people receiving and becoming addicted to opioids. For example, the new supply of opioids met a great amount of demand from patients looking for an easy fix to solve their pain issues. Doctors were pressured into prescribing the pills because of the immense supply of pills and their role as a middle ground for the vast number of people trying to get Medicaid.

How did the incentives line up for doctors, pharmaceutical companies, and users to further the opioid epidemic? How have doctors seen a blowback of liability problems due to their patients’ addiction to opioids?

Quinones argues that Medicaid encourages people to become opioid sellers because they could receive the prescription drugs for extremely cheap and sell them on the street for a huge profit. Roberts ties the issue of American taxpayers covering the lion’s share cost of pills for Medicaid eligible users as a huge problem. Quinones and Roberts also share that many of those people who wanted to sell ended up using the drugs before they could even sell them because of their addiction weighing them down.

What are your feelings on Medicaid and the issues it caused during the height of the opioid epidemic? Who is most responsible for the opioid epidemic?

Brennan Beausir is a student at Wabash College studying Philosophy, Politics, and Economics and is a 2023 Summer Scholar at Liberty Fund.