No Easy Fix
The bestselling author of ‘Dreamland’ tells Knoxville leaders the solutions to the opioid epidemic begin with community.
by jesse fox mayshark • november 15, 2018
author sam quinones speaks to reporters at hotel knoxville on wednesday.
Sam Quinones remembers the dinner bell.
Seeing hope for the drug crisis in community engagement.
Growing up in the 1960s in a neighborhood in Claremont, Calif., just outside Los Angeles, he was free every afternoon to run around with his friends until he heard his mother ring the bell for dinner.
“She rang the bell,” he told a room full of local leaders Wednesday at Hotel Knoxville, “because she had no idea where the hell I was.”
But when Quinones, whose nonfiction book Dreamland has become a foundational text for understanding America’s opioid epidemic, visited his old neighborhood recently, he was struck by its stillness. There were no kids on the sidewalks. They were all, presumably, indoors. On screens.
“Now the street and the park where I grew up are empty,” he said.
Quinones’ point was that the United States’ mounting toll of opioid addiction, overdose and death has many causes beyond the obvious ones.
“It’s about drug gangs, it’s about the drug industry, but it’s about so much more,” he said. “It’s about who we have become as Americans.”
Quinones’ appearance in Knoxville was sponsored by Leadership Tennessee, Blue Cross Blue Shield of Tennessee and the Trinity Health Foundation of East Tennessee. His talk Wednesday morning was followed by a community roundtable discussion -- the kind of discussion that, Quinones said, is the best way to tackle the opioid crisis.
“There is no solution,” he said. “There are solutions, plural, like a mosaic. … Each is small, each grows from immersion in communities.”
Quinones became one of the nation’s leading experts on the subject almost accidentally. He had lived in Mexico for 10 years, mostly writing about the experiences and hopes of Mexican immigrants to the United States, when he was hired as a reporter by the Los Angeles Times in 2004. In covering the activities of Mexican drug gangs during the next several years, he noticed an unprecedented surge in heroin trafficking.
Trying to understand the phenomenon, he followed the supply to its demand, which brought him first to the Rust Belt and Appalachia and then, increasingly, to cities, counties and suburbs all across the United States.
One mark of the influence of Dreamland, which Quinones published in 2015, is that the story it tells -- hailed as revelatory on its release -- has already become conventional wisdom. He traces parallel trends in the 1980s and ‘90s that eventually intersected with tragic results.
A growing focus on pain management in American medicine pushed doctors to prescribe more opiate-based narcotics, which pharmaceutical companies (led by Purdue Pharma, inventor and marketer of Oxycontin) saw as a new profit opportunity. Meanwhile, Mexican drug cartels moved into the heroin trade, bringing a cheap and potent alternative to a niche market that had been dominated by weaker, more expensive Asian product.
"Heroin alighted on this culture of isolation that we have in this country like gasoline on a fire." – Sam Quinones, author of Dreamland
By the time rocketing levels of addiction and deaths rang public health alarms in the early 2000s, a whole population of pain-pill addicts was an easy target for heroin dealers, who could supply a high that was stronger and cheaper than the increasingly restricted prescription drugs.
“This has become a drug epidemic like no other in our country’s history,” Quinones said.
It has continued to evolve, with the even more potent synthetic opiate fentanyl now surfacing everywhere -- not only mixed with heroin, but with cocaine, methamphetamine and other drugs, Quinones said. According to the Knox County Regional Forensic Center, fentanyl and its analogs were the leading causes of drug-related deaths in Knox and Anderson counties last year.
And a book that Quinones originally feared nobody would read, because its tale is both grim and complex, has “kind of become my life, very unexpectedly,” he said.
Quinones said he has become convinced that trends in American culture -- a rapacious consumer economy, an elevation of private gain over public good, a prioritization of convenience and comfort -- made it especially vulnerable to the onset of the opioid epidemic.
“Heroin alighted on this culture of isolation that we have in this country like gasoline on a fire,” he said.
But Quinones is not pessimistic. He said the scale and reach of the epidemic, across geographic and socioeconomic bounds, has sparked collective responses across the country.
“Everywhere I go, people are coming together,” he said.
That was true of the Hotel Knoxville ballroom on Wednesday, where the attendees included city Mayor Madeline Rogero, county Mayor Glenn Jacobs, state legislators, and representatives from law enforcement, hospitals, clergy, education, business leaders and nonprofit executives.
In a joint interview after Quinones’ talk, the two mayors said it had reinforced the work already happening in Knoxville and Knox County. Jacobs and Rogero co-hosted a Mayors’ Summit on Substance Misuse last month.
“There is no silver bullet, that’s the thing,” Jacobs said. “There is no easy fix. It does take the entire community to work on this issue.”