EconTalk |
Sam Quinones on Meth, Fentanyl, and the Least of Us
Oct 11 2021

41flPM8PgBL._SX327_BO1204203200_-198x300.jpg Author and journalist Sam Quinones talks about his book, The Least of Us, with EconTalk host Russ Roberts. Quinones focuses on the devastation caused by methamphetamine and fentanyl, the latest evolution of innovation in the supply of mind-altering drugs in the United States. The latest versions of meth, he argues, are more emotionally damaging than before and have played a central role in the expansion of the homeless in tent encampments in American cities. The conversation includes an exploration of the rising number of overdose deaths in the United States and what role community and other institutions might play in reducing the death toll.

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Explore audio transcript, further reading that will help you delve deeper into this week’s episode, and vigorous conversations in the form of our comments section below.

READER COMMENTS

Shalom Freedman
Oct 11 2021 at 8:31am

A very informative and interesting interview as all those I have listened to or read on this site have been. But one most important question I have long had was not answered.
I have never understood and still do not understand how doctors whose aim is to heal could continue to prescribe opioids once it became apparent how disastrous this is.

Russ Roberts
Oct 11 2021 at 3:08pm

Shalom,

You raise an important question that I meant to discuss with Quinones when he was discussing the moral issues surrounding the marketing of opioids by Purdue Pharmaceutical. Many people in pain use these drugs to reduce their pain and do not get addicted. Even today, opioids are still prescribed and many patients and their doctors are deeply grateful for their ability to reduce pain. So it is complicated.

Fred Lindberg
Oct 12 2021 at 8:39pm

Opiates were under-prescribed, especially in end-of-life pain. The pendulum swing toward increased prescription was magnified by a combination of well-meaning professionals, marketing, and deliberate misinformation. Pain, the 6th vital sign. Most physicians (in the US) prescribing opiates believed that opiates were non-addictive to most patients, based on a few misleading and especially misquoted studies. For a generation of them, it took a while to unlearn what they had been taught to land at a more nuanced intermedium.

To me, Chis McGreal: “American Overdose” was a very enlightening.

Mark Z
Oct 14 2021 at 10:57pm

I’m pretty sure it’s true that opiates aren’t addictive for most patients. Is it not true that the vast majority of patients prescribed opiates don’t develop addiction?

Frank Tatom
Oct 21 2021 at 11:36am

The addiction issue with prescribed opiates arose when a doctor (whose name I do not remember) began prescribing, as an experiment, low dose opioid drugs to patients with mild chronic pain. The doctor felt opioids had fewer negative side effects than NSAIDS, and would be monitored for use because they were prescribed, so there was little chance of abuse or addiction.

The patients initially felt great, but their continued use of the drugs lead to tolerance, which decreased effectiveness, and caused a need for higher doses to reduce pain. With higher doses, addiction is more likely, and he found his patients becoming addicted and refusing to cease the medication.

This doc went to a large physician conference and gave a talk on how well his patients were doing, but that was before the patients began to show signs of addiction and refusal to cease the opioid mess. So, many doctors who visited that conference began prescribing liw-dose opioid drugs, and tbe snowball of addiction began to grow.

The doc that started this practice now urges against it. He was unable to get his mother to quit taking opioids, after he prescribed them for her. She just went to another doc when he refused to prescribe them.

Most people think they alone cannot make a difference in the world. History sadly proves otherwise.

Floccina
Oct 11 2021 at 11:21am

Some people really like to get intoxicated and seek out the most intoxicating substances. I wonder, if it was all legal without requiring prescriptions would people might choose safer drugs. I at least think it is worth a try. Sam Peltzman’s work seems to show no positive effect of prohibition.

The effect of requiring consumers to obtain prescriptions for pharmaceuticals on mortality is examined for a sample of middle-income countries. In countries enforcing the requirement, infectious disease mortality is no lower and poisoning mortality is higher than in those not enforcing the requirement. A broader measure of government intervention—public expenditures on health relative to GDP—is shown to have moderately adverse effects on overall life expectancy.

The data by state does not seem to support what Quinones presents as the cause.

Chris
Oct 11 2021 at 11:35am

Really important and noteworthy episode, imho.

I did have a couple nits to pick.

30 minutes or so:
Mr. Quinones mentions that he thinks the new form of meth might be able to be stopped or the situation improved if we just regulated one of the critical ingredients. But if that would work, why not just control or outlaw meth?

56 minutes or so:
Mr. Quinones mentions that WalMart destroyed a lot of mom-and-pop stores. This may be semantics, but I think it was consumers who did that, not WalMart.

Around 57 minutes or so, WalMart supposedly making it easier to shoplift, it feels like blaming the victim.

But I still think overall an important episode. It breaks my heart when I think of people stuck in these spirals.

Russ Roberts
Oct 11 2021 at 3:10pm

Thank you for pointing out that we consumers are the ones who put the Moms and Pops out of business. I meant to make that point but got waylaid.

Dr Golabki
Oct 17 2021 at 9:39am

We are also the ones choosing not to get married or go to church/synagogue. I think Sam’s point on small-town-main-street and Russ’s point on marriage and religion are very similar. Individuals are making individual choices that, taken together, have the unintended consequence of breaking down societal connections… which then may have other negative consequences. But it’s hard for me to say how much of this is real causal connection, and how much is old-guy-nostalgia (as an old guy myself that’s not meant as an insult).

Chris
Oct 11 2021 at 7:44pm

Fascinating episode. Will probably go in my 2021 top ten. Russ’s strange ambivalence/celebration of permanent homelessness in American cities has always struck me as one of his more bizarre takes. I suppose living in Palo Alto and Fairfax County insulates one from what Western US cities like Seattle, Denver, and LA are really like these days. Not sure how Russ was out of the loop on how bad this has gotten, but glad that we all got to understand the issue a little bit better thanks to Mr Quinones.

Laurence Fitzpatrick
Oct 12 2021 at 5:17am

The intensity of Sam and Russ motoring past each other was unlike most of Russ’ cerebral exchanges with show guests. Sam’s  experience and longevity of reporting  on consecutive  scourges is like a black light shining on the full saturation of the fabric of the American community. Can you see the mass of undefined creepy bugs moving around? Would corporate America and Wall Street shop at Walmart if that was the only shop left in town? Would they go out for a Saturday stroll and brunch in Georgetown if they had to navigate a sea of tents on Wisconsin? Would they step foot in a bus depot if there wasn’t  any Uber service or an airport within miles? Or do they just pinch themselves they’re not among the dislocated and ponder flipping their FANG stocks for SPACS. It remains a big, and in some places beautiful country for sure. What was that? I left out borderless and bankrupted.

Jared
Oct 12 2021 at 12:35pm

I happened to be leaving Seattle when I downloaded this episode to listen on the airplane. It was my first visit to the city, and I was deeply disturbed and morally offended by how bad the homeless and drug problem is in the Pacific Northwest.

Like Russ, I assumed the City of Seattle had utterly failed to address the problem and is unwilling to find a workable solution. But I also had this dark feeling that something more sinister was happening — I’d never seen homelessness quite so vast and frantic before.

So much, much thanks for Sam for his reporting on these issues and thanks for Russ for, by sheer coincidence, validating my horror at this humanitarian crisis. If understanding is the first step to treating a societal problem, this episode was very important for searching for ways to help our fellow humans 🙏

Andy McGill
Oct 18 2021 at 12:37pm

I have been Seattle too and I agree with you.  Seattle decided that it will not have any safe and clean public parks, or sidewalks until it 100% solves the human problem with addiction and with mental illness.

That was their choice, and they are very virtuous people to forego all benefits of public spaces until that impossible mission is accomplished.

Madeleine
Oct 12 2021 at 3:08pm

This hurt to listen to after so many years of seeing members of my own family struggling with addiction and homelessness in exactly the manner Sam Quinones describes.

I would like to see actual data on P2P meth vs. cold medicine meth. I am not sure that the effect described by Mr. Quinones’ acquaintance is due to an actual chemical difference in the drug. It rather sounded (to me) like a case of long-term addiction. The lack of euphoria he described is due to meth frying the dopamine receptors in the brains of long-term users. Tragically, this also literally eliminates all the joy of everyday life. An addict’s life becomes bleak and entirely devoid of pleasure. Recovery from this is not simply an issue of detoxing. It takes years — if ever — for those receptors to regenerate and for happiness to be possible again.

Ajit Kirpekar
Oct 12 2021 at 4:06pm

I know Sam acknowledged the innovative aspects of capitalism, but to me, like many others, he personifies capitalism in the form of Walmart. Walmart, this heartless profit seeking machine ran down all these good mom and pop stores.

This is a strawman and we should call it out. Walmart provides low prices such that things that would cost far more in real terms if they were mom and pop are now affordable. We can go further. Cars used to be exclusively held by the rich. They aren’t anymore. Computers and phones + the internet means access to information for free(yes I know you give up your data).

I wish Russ, if he’s reading this, could push back on anyone making these claims about Capitalism by politely reminding them that innovation isn’t just Walmart and cheap pool toys; its cleaner air, longer lives, more food for the hungry. A generation of poor people no longer starve to death. Treatments in health care have extended life to the average citizen who used to die of influenza in their 40s.

I just have such a problem with people who handwave away capitalism as this soul destroying machine. Every anti capitalist still prefers the best medical treatment.

[Some spelling errors have been corrected in this comment.–Econlib Ed.]

Ajit Kirpekar
Oct 12 2021 at 6:32pm

Kudos to Sam acknowledging that homelessness as a catchall is too course a term. Someone struggling to make rent but otherwise working full time is very different from someone who is experiencing medical bankruptcy; and both are decidedly very different from individuals suffering from chronic addiction and mental health.

In the latter case, I wish we could have a better causal understanding of what makes individuals choose to take these risks? Why is it people voluntarily go down this particular road? Its not as if addiction isn’t negatively stigmatized already. And it is hard to conjure up a worse set of negative outcomes to steer someone away – homelessness, loss of everything, degrading physical and mental health, abuse, prison!!

And yet, as can be plainly seen with one trip through San Francisco, there are so many people suffering from this. I have heavy sympathy for their situations. But it is hard to know how to help when the cause is still so hard to understand. I just wish we had better answers than arm chair theorizing with an ever changing cast of villains – capitalism, free trade, single parenthood, etc etc. There has to be a better explanation for why people voluntarily embark down this road in the first place.

john thurow
Oct 13 2021 at 2:06pm

Although correlation isn’t necessarily causation, the problems attributed to the free market should instead be assigned to the rise of large national anti poverty programs (“Great society”) that devistated families, replaced individual and religious charity and destroyed the local for the federal.  The problems described are more attributed to government replacing individual liberty.  Unless the national government stops spending trillions of dollars you will never see the local recover to solve the human connection problem.

Scott Gibb
Oct 13 2021 at 5:46pm

Great discussion.
I’ve read Dreamland and enjoyed it.

I’ve discussed this episode with my wife for about an hour.  Wrote about it for another hour.

The most important questions in this episode is…

Overall, is life getting better or worse for people?  There’s no way to know for sure, however, my intuition says better.   See the many books published in the last five years showing that things are getting better.  My favorite is Progress by Johan Norberg.

What we’re doing in this episode is shining a light on one facet of life.  It seems at first that life is getting worse overall, but it’s probably not.  We’re not looking at the big picture in this episode.  It takes discipline to look at the big picture.

We also have to remember the serenity prayer.   Is this problem something that can be fixed by me?  Sort of.  But I’m just one guy and I can only do so much.    Everyday, people are trying to fix problems, these problems, and many others.

So is there really anything new here?  Not really.  Just new problems to be solved.  New problems because things are always changing.  And people will eventually solve these new problems.  Just takes, time resources and thinking minds.  Give them time.  Please.  Give them space.

We don’t need sweeping national policy changes to prevent corporate mergers.  If people want to ban Walmart from their community I’m okay with that as long I have someplace else to be free from their ban.

What do people really want though?  Again not sure.  I know best what I want as does everyone else and we’re all working to fulfill those wants.  Let’s not blindly assume we know what best for other people.  Be careful of your solutions for other people.  Be skeptical of your policy proposals.

In the end after much thought, I come back to James Buchanan: “Man wants liberty to become the man he wants to become.”

I have faith in people, but almost none in government.  So please get government out of the way, so that people can fix the problems mentioned in this episode.

 

Jacques Kerner
Oct 14 2021 at 1:22pm

At some point in the conversation, it seemed like Russ was forgetting what drugs are. I could not understand it, especially in the face of Sam explaining how much stronger these drugs have become over the past decade. A sign of that was that Russ compared people returning to drugs to someone using weapons to kill many innocent people and asked “why would our culture make someone want to do that?”. The case of drug addiction is quite different.

Without entering into a debate on whether it is wise or not to “give people what they want”, drugs are different; drugs chemically hijack our perception of “what we want”, and very quickly so, by making it unbearable not to have it. You are no longer “free to choose”. It overrides the strongest natural instincts, such as caring for your own children. Children will be abandoned by their own mothers who used to care for them, something I had to see to believe. Not always, but in enough cases.

To be fair, it does leave the question “why would they start”. And I think the answer is that in many cases, they could get away with it, at least for a while. Maybe something in our culture told them they had a good chance to escape addiction, just like you have a good chance to survive sky diving, and are told that the thrill is worth it. But all of a sudden lacing with fentanyl or ‘weirdo meth’ trapped a much bigger percentage of drug users, still operating under old assumptions. And this explains the epidemic we are seeing.

I have kids and worry. There have been drug related deaths in the family. This episode made me want to get involved locally, as has been suggested would help. Safety will override freedom. Safety is also what people want. If we cannot fix our culture and make it unthinkable for a person to start using or producing drugs, we will deserve the restraints and increased control that will certainly come. I doubt it will be enough to convince people that more control is not the solution, even if I am sympathetic to the idea.

Ajit Kirpekar
Oct 14 2021 at 4:21pm

To me, its a startling indictment that we have to haphazard guesses as to, “Why would they start?”. No one has offered anything other than anecdotes to my knowledge.

Since no one knows why, I will share some personal stories.

I have never used drugs mostly because I wasn’t a particularly good student in high school and was already being shamed by my high achiever parents. There was a moment at a party I basically told myself, “If I go down this road, I am never going to get anywhere. I can barely keep it together as is.”

My brother who is 10 years younger(mid 20s) had admitted he has done cocaine on rare occasions. He has done(and continues) to take ecstasy on more frequent occasion. He has done acid and mushrooms a number of times. He still smokes marajuana. He is currently finishing his last two years of his Phd in Economics at a very respectable university. I still admonish him when I can, while also being aware of my own hipocrisy of enjoying alchol.

Depending on your perspectives; that’s quite a lot of drugs and he got away with it. However, he stopped short of going to the worst of them. He never took Meth or Heroin or  Fentanyl or Crack or any of those drugs that we associate with people trapped in dispair. He just knew better than to go down that road.

I am sympathetic to the idea that long time addicts simply didn’t have the information back then(10 years ago? 5 years ago?). Perhaps, as Sam argues, these were functionable drugs and its the new innovative meth that fast tracked demise from years to weeks. Fine, maybe.

But this feels incomplete because it would imply that its a one time phenomenon and there won’t be a new generation of meth addicts. It would also imply that there should be close to 0 demand for current meth by new users; who will prefer the heroin route or at least a less dangerous meth. Is that the case? Something is just missing in this whole thing.

Dennis P Waters
Oct 14 2021 at 6:36pm

What remains unclear to me is why the two versions of meth have such different effects. Aren’t they exactly the same chemical? If not, that should be made clear. Someone somewhere must have studied this.

Alfonso Guildhorn
Oct 16 2021 at 2:31am

So many issues with this. So if we had a time machine and removed Walmart then this problem would be better? I agree that mom and pop stores have value but where is the evidence that somehow this is relevant?

I read his first book and the typos and grammatical mistakes were a distraction but it wasn’t as bad as the influence it had on doctors who cut off people who had an impeccable record, including urine tests that showed no addiction issues, and could not bear their chronic pain and died by suicide? Where is the nuance? The stats? The parsing of the issue? There are times when this podcast sounded way too ratified and political.

 

Randy
Oct 17 2021 at 5:37pm

Long time listener first time commenter. I struggled with your guests indictment of capitalism or profit motive. How would he explain the drug problem in Communist countries? Further, so much time was taken talking about challenges with Mexico. Seems like lawlessness in Mexico is much bigger issue than capitalism anywhere else. Thanks for the good work

Andy McGill
Oct 17 2021 at 9:32pm

If we are going to make the only solution to the “homeless problem” to be to fix mental illness, addiction, and financial problems for everyone in society, then of course it will require vast amounts of resources and will still never be accomplished.  Even the “treatment programs” have about a 5-10% success rate, which is difficult to statistically differentiate from not intervening at all and people change themselves.

For some reason, many American local governments have turned over parks and public areas to anyone who wants to squat there, and then let the people who profit from the homeless to hold those lands hostage for ever more funding, and then act surprised that the more funding the homeless problem gets, the more homeless people appear.

Government just can’t fix every human foible, and we should not be tricked into making all their personal problems into public problems.  If that sounds harsh, it is not.  It is just refusing to make the public an enabler of self-destructive behavior.

The public should provide a range options, with rules and expectations to match, and the homeless/addicts/mentally ill will pick what they want from the options allowed.   If they want to live in a tent, then where they do that should be very limited and not infringe on everybody else’s rights and parks and safety.

Now if someone has great data proving another approach works really well, like greater than 50% success in both the short and long term, we could look at investing in that.  But not a single “solution” being offered is anywhere close to that.

Kevin Ryan
Oct 18 2021 at 5:32am

Very powerful and disturbing podcast.

One comment I would like to make relates to the discussion about the decline in marriages.

I had picked up my son in my car while I was listening to the podcast and he heard this section.

He commented that popular culture lionises women that bring up children on their own.  It does not criticise them or this practice in any way – in effect ignoring the problems that many women and their families will encounter and are not able to overcome to the same degree as the success stories it usually highlights (and are mostly aspirational fiction)

Andy McGill
Oct 18 2021 at 12:22pm

YES!  Of course two parent families have enormous advantages — twice the earning power, twice the attention to kids, twice the time to talk to and teach the kids.   Plus the resiliency and “diversity” within the family.

The statistics prove that overwhelmingly, yet they are never talked about anymore.  For those who believe in science, the statistical differences between black and white and Asian child achievement is mostly explained simply by the two-parent or one-parent family.

Funny that massively powerful and common sense statistic is never talked about for public policy, isn’t it?  Instead race is used, usually without adjustment for family parenting.  Is that an accident?

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AUDIO TRANSCRIPT
TimePodcast Episode Highlights
0:37

Intro. [Recording date: September 1, 2021.]

Russ Roberts: Today is September 1st, 2021 and my guest is author and journalist Sam Quinones. His latest book, and the topic of today's episode, is The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam was last here in January of 2017 talking about opioids and heroin and his book Dreamland.

I want to let parents know that today's episode will deal with adult themes, some of which you may want your children to hear--but you may not. That's up to you.

Sam, welcome back to EconTalk.

Sam Quinones: Great to be here, Russ. Thanks so much. I love your podcast.

Russ Roberts: Oh, I appreciate that.

1:15

Russ Roberts: I love your writing and your book. This is a very powerful book.

Sam Quinones: Thank you.

Russ Roberts: It is heart-breaking in many parts. It's incredibly informative. I learned somethings that I'd been puzzled about that really helped me understand some of the things that are going on in America; and it forms something of a trilogy with recent episodes with Johann Hari and Noreena Hertz. And, maybe as Sam, you yourself suggested, Michael Easter. I hope to pull some of those themes together in talking today.

I want to start with the magnitude of the drug overdose problem in the United States. How serious is it?

Sam Quinones: Well, I think it's quite serious. We are hitting record levels of overdose deaths, and that is a deep and profound tragedy that is coast to coast. I would say, that's what differentiates this opioid epidemic from the one that we had in the 1970s, which was really just a heroin overdose. And, that was very isolated with certain urban areas, really New York, Los Angeles, San Antonio--places like that. This is far, far more widespread and grows from the beginnings of the opioid epidemic, which starts with, of course, what we talked about in our last conversation. Which was: overprescribing--wanton prescribing, really, is to what it was--by doctors from coast to coast of narcotic opioid painkillers for pretty much all manner of variety of things and lots of refills, and a huge, huge supply of opioid painkillers unleashed on the country.

This next book really deals with what's going on now, which is, the underworld has taken over willingly, very eagerly; and their supply is also pretty much coast to coast. And so, you're no longer seeing those isolated pockets that we saw during the heroin problem of, say, the 1970s. You're seeing it, really, in rural areas, suburban areas, urban areas; in North Carolina, in Portland, Oregon, in Maine, in Phoenix, and Los Angeles. You don't find that kind of separate kind of area. So, pretty much every part of the country is facing this with record death. But, the overdose death is just really, I hate to quote a cliche but it's really kind of the tip of the iceberg.

But, beneath that is widespread, I would say, very damaging addiction and horrible costs placed on families, on schools and businesses, on county governments, particularly. So, you're seeing this as really, unlike any other, it seems to me, in just in terms of how widespread it is and the death that it's caused.

Russ Roberts: I looked at the numbers. Obviously, it's not easy to measure and with any precision, but what I saw is that in 2020, something like 93,000 Americans died of drug overdose, up from 70-something the year before. Some of this is a response to COVID and isolation, no doubt, but a lot of it is on the supply side, as you're talking about. And, it's really, as you point out, the addiction and the paralyzing effect of that on communities, human beings, families, and so on. I mean, an overdose-death, I assume, is not easy to count. Do you have any feel for that?

Sam Quinones: Right. No I would say, we're undercounting by perhaps anywhere from 20-30%. And, one of the reasons for that is that we have, across the country, a very, very uneven system for counting and for tabulating, but describing as well, drug overdose deaths. Even among counties with lots of money--large city, large urban counties--even there you find doctors--in the past, anyway--have not really been able to get their heads together and find a common vocabulary, a common way of counting. But, then when you get out to the rural and smaller counties with much weaker tax base, you are finding that frequently counties don't have money to do all the blood work, all the toxicology tests that every autopsy ought to have if there is a suspected overdose.

So, I think that because of all that and many other things we could talk about, but it has to do with really a kind of a creakiness, an underfunded way of dealing with death investigations in this country, that probably means that we're under-counting by 20 to 30%, something like that.

Russ Roberts: The part that's I think hard for people who are not drug users to understand, though, is: how does an overdose happen? Is it a mistake? Is it somebody who has been increasing their dosage because the high isn't what it used to be? Is it a suicide attempt that worked?

Sam Quinones: It could be all of those. It could be that they are getting dope that they don't know the potency of, which is very common. Most addicts, I would say, don't mean to die necessarily. It's not a suicide, although some certainly are. But, the problem is, once you get to a point where you're addicted, there is a wide bit of caution that you throw to the wind. And so, at the moment of wanting to shoot up, that is not really top of mind, I would say. And, what you're actually shooting up or what you're smoking sometimes, too--now, it's so potent. The dope is so potent nowadays that you can actually--don't have to shoot it up: you can smoke it. You can still overdose because you're in the middle of this idea, 'Got to get high, got to put off those withdrawals, that sickness,' and so on. And so, it could be all of that.

7:34

Russ Roberts: Let's start with fentanyl. First, tell us what's fabulous about it, because it has some wonderful applications in surgery. And then talk about how it became a drug of choice, and then a drug that got introduced into other drugs, which--it's incredibly potent. Very, very, very small amounts of it can be fatal. And try to answer the question which I thought about, which I don't think you talk in the book about: It seems like everybody should die from this who's using it. It seems so dangerous. So, talk about the good side, and then some of the downside, and what determines how dangerous it is.

Sam Quinones: Right. Fentanyl revolutionized surgery. It's not an exaggeration to say that. It was invented by one of the great scientific minds of the 20th century, in my opinion. Paul Janssen, Belgian man, who invented numerous drugs and that have helped all of us. I had a heart attack four years ago, and they gave me fentanyl. I'm very, very happy that they did. It's magnificent drug for surgery because it very quickly enters the brain. That's the key to it. Unlike morphine, even heroin, which takes a good deal longer, fentanyl very quickly enters the brain. But it also--its effects are short. So, for surgery, that's perfect. You can bring somebody into anesthesia very quickly, do the operation, and take them out with almost no effect.

And so, it really transformed surgery. It allowed for all kinds of surgery in a much safer environment. It's actually a much safer drug in the surgical context than many of the things that they were using back before fentanyl was invented, which was in 1960.

However, as Paul Janssen well understood, and many others have well understood, because it enters the brain so quickly, because it attaches to our brain receptors--the opioid brain receptors--so quickly, that's what makes it potent. It is a very quick acting and very powerful drug. And, if used incorrectly, it can very quickly kill people. In a matter of seconds you drop off; in a matter of perhaps a minute or two you're you're dead. Whereas, in heroin overdoses, this takes minutes--perhaps 15, 20 minutes, it's possible for that to take effect. With fentanyl, it's much quicker. People are found dead kind of with their heads on their laps on a toilet or having collapsed. They don't have time to react. Their head hits the floor like that.

So, fentanyl was really a surgical tool for many years. On occasion, there were cases of rogue chemists out there in the United States who figured out that they could make this and sell it. And you see little outbreaks, occasional outbreaks in the 1980s and 1990s. And, no one quite knows who they are. A couple of times these guys are arrested.

But it does not really find its way into the enormous drug underworld until about beginning in 2006, a case I talk about in the book, which is the case in which the Mexican drug-trafficking world discovers fentanyl for the first time.

A chemist down in the town of Toluca, Mexico--which is outside Mexico City, an industrial town--puts together a lab with funding from apparently the Sinaloa drug cartel and Chapo Guzman and all those folks, and puts together a lab in which he makes kilos of fentanyl. He discovers through testing on mice that this fentanyl has to be cut 50 to 1. So, one kilo will make 50 kilos. Now, in the drug world, no one believed that. No one thought that was remotely possible. He did, but everybody else didn't. So, they began to sell it as, if that's a joke. 'That's a lie. Someone is trying to sell me this fentanyl, this drug, when I know that no opioid on the street can be cut 50 to 1.'

Russ Roberts: It would be too watered down. It wouldn't have any effect.

Sam Quinones: There's no point in selling it. No one would buy it. Yes, exactly. Word would spread and no one would buy this stuff.

So, they begin to sell it far less adulterated, and it begins to kill hundreds and thousands of people in the year 2005 and 2006. First in Chicago, where the dope first goes, but then also St. Louis, Detroit. Then it goes east with street gangs that are selling it to Philly and Camden and a variety of other towns. And, within a period of about a year, many thousands of people die. It's this big loop of a death curve.

And, then they bust it in April of 2006. They take this fellow to prison. He spends 15 years in prison. He is now out, somewhere; I'm not really sure where he went. But, with that, fentanyl kind of died off. You saw the importance of supply reduction with that one case. Death, and then when the thing is busted, no more death.

Right, you know, the traffickers in Mexico were in the process of discovering our new, enormous opioid-addicted market due to the widespread proliferation of these narcotic pain killers. It was only a matter of a time before they figured out we just needed to mass produce or find resources of where we can buy mass quantities of this stuff, fentanyl. They first found it in China. And, you would see this mainly beginning in about 2014-15, right in there. They begin to buy fentanyl directly from many, many chemical companies in China. But, then they learn to make it. And, when China eventually curtails its fentanyl, its companies from selling fentanyl and cracks down on that about 2000 and I think 2019, you begin to see the Mexican drug world produce this stuff.

The benefits of fentanyl are--basically, what they've done is: They've taken a supply chain that is very populated--lots of people involved--and very costly, and they just merely cut the cost out of the supply chain. Fentanyl is made much easier than heroin. You don't have farms to worry about, sunlight, irrigation, land. It's just a chemical in a lab with some folks who know how to make it. And then you send it north.

And so, it's part of this kind of increasing kind of corporatization almost, the sophistication of the trafficking world down there, that they have figured out that this far, far more profitable. Easier, far less risk. And, far--easy to get it to the United States, and is a perfect substitute for heroin. Heroin market and opium poppy market in Mexico is now, frankly, in depression. There's no market for it anymore because of fentanyl.

15:05

Russ Roberts: So--and you also talk about how other drugs get laced with fentanyl as a way to jazz them up, give a bigger hit. But why doesn't it kill more people? I mean, are they that good at--obviously, you don't want to kill your customers. Again, to take a purely profit-driven perspective on this--

Sam Quinones: No individual trafficker or dealer really wants to do that, but I think what's happened is that there is a Wild West market down in Mexico that has taken hold. And, what I mean by that is, once one person figures out--it's not that hard to make your own fentanyl or first to buy it from China, but now to make your own is very easy. All you have to have is ample access to world chemical markets in the trafficking world, certainly on the Western side of Mexico has that through two various large ports on the Pacific Coast. First in the town of Lazaro Cardenas, and Michoacan. And the other one is in Manzanillo in Colima. Well, they control a lot of the chemicals that go through there. They can make all the stuff that they want. And what ends up happening is, the people who are selling those chemicals, don't want to sell it to as many people as possible. The people who are making this stuff are different from the folks, by and large, who are bringing the chemicals in. They don't care. They want to make stuff, to make money. They don't really care where it ends up. They don't care how it's used.

In fact, I would say there's like a fervent competition among them to make that stuff and get it out. And, when all that stuff is not regulated, there's no oversight. And, also, you are removed as a producer, two or three levels, at least from the--

Russ Roberts: from the customer--

Sam Quinones: person who is selling it on the street.

Russ Roberts: But, let's go back to that, the dilution part of it. A dealer in the United States--well, give me the supply chain. You've got the chemist, manufacturer in, say, in Mexico.

Sam Quinones: You've got the lab in Mexico, which may or may not have a chemist. Probably at one time had a chemist showing them how to do it, but now maybe some trained assistant or what have you.

Russ Roberts: It produces some amount, and that amount gets smuggled across the border in its raw form at that point?

Sam Quinones: Yes. There's two ways. It can be several ways, but in its raw form, just like a brick of fentanyl, like a kilo of straight fentanyl. It's then probably not opened until it gets to the destination--let's just say, Chicago or Indianapolis or Nashville, where I'm living right now, or Los Angeles. And, there it's broken up into smaller packets and then sold to dealers, who then probably there's maybe another level down who are selling it to the street level dealers.

It's unclear to me, and I don't think you can actually know this, who is actually adulterating, who is actually putting fentanyl in whatever is eventually sold. It could be the street level, it could be one level up, maybe two levels up. This changes radically.

But, what isn't clear is how much you need to adulterate it. And this is often--you're told, 'This will take a five to one hit,' meaning you can make five kilos out of this one kilo. It's possible that that's the case, but you are taking the word of someone you don't trust and don't know. And, who has no reason to tell you the truth most of the time.

And so, and then you get to the point where it's actually mixed. And, that's also where a big, big problem comes, because most of the people who are doing it are addicted to something--money, or dope--and they are not pharmaceutical companies who study how to properly mix this stuff and write Ph.D.s on it and that kind of thing, you know.

So, you get these guys who are just mixing it, sometimes in their kitchen, in their basement, in their bathroom. One chapter, in the book talks about how early on a lot of guys were using Magic Bullet blenders. You can buy these at Target for $29.95. The Magic Mullet was--kind of spread--the underworld really relies a lot on mythologies that spread rumors. 'You know, this is the best thing to use. You should use this Magic Bullet.' One of the benefits, perceived benefits of Magic Bullet blenders was it's in that little plastic dome. So, you're not going to be inhaling the stuff as you would if you mixed it in a bowl. I guess that is a benefit.

The problem is you can't mix powders with a blade. A blade mixes the powders right around the blade. In order to mix well, the blade has to be in liquid. But, most of those guys were just mixing. And they thought they were doing a good job but what they were doing was really creating a potent mix in which part of the mix was absolutely without fentanyl, and other parts were deadly to almost anybody who would use it. Even those who had developed a high tolerance.

Russ Roberts: But, just to be clear: in that kilo, my guess is that if you put your finger in it and licked it, it would kill you. Is that correct?

Sam Quinones: It's almost entirely fentanyl. Yeah. It's very high amount of fentanyl, initially.

Now, you do see some variations. Obviously, this is the underworld: all kinds of possibilities there. You could see half the kilo is fentanyl, half the kilo is some kind of cut. But I think by and large, what they're sending up with one kilo of fentanyl is just straight a kilo of fentanyl, because you don't want--if you're going to make the same amount, you'd rather just send one kilo of fentanyl rather than two. It's bulkier.

Russ Roberts: And, you want to have a relationship. You say, you don't trust the person, but ideally it's an economic transaction. There's no--brand names are tough, but you do want repeat business. And so, you want to have that person sell that to their customers down the supply chain and eventually come back and buy more.

Sam Quinones: Sure. That's presumably the idea, but now, the problem--the producer really almost has no connection whatsoever down in Mexico with the guy who's actually selling the stuff. And, maybe the last two levels before it hits the street.

Russ Roberts: There's middle people. There's middle people.

Sam Quinones: It's just like, connections that are mid-level and it's unclear how often people actually know what precisely they're selling.

Russ Roberts: It's true.

Sam Quinones: Again, this is the underworld. It's a Wild West economic free market, where just everyone's selling and buying whatever they can get. And, that is also where--the reason for adding fentanyl now to other drugs. Almost like we add salt to food to kind of give it a boost. Fentanyl is now, they've discovered, being added to--primarily, I would say, methamphetamine and cocaine. Occasionally, I've heard reports of marijuana. I don't think that's too common yet. Who knows? Maybe later. But certainly methamphetamine and cocaine.

And there's a few reasons why you might do that. In the case of cocaine, it comes from Columbia. You need something to boost it because by the time it hits you, gets to you, the dealer, on the street, it's probably passed through four or five hands and it's probably been cut a few times. So, it's going to be a little diluted. So, you need something to boost. But, the buyers of cocaine and methamphetamine, because those drugs don't have the same kind of withdrawals that opioids have, the buyers of those things are not daily, desperate, almost religiously daily buyers of this stuff. Right? They're the occasional users--'Oh, I'll buy it for the weekend,' or that kind of thing. If you add fentanyl to the mix, what you eventually are going to get is an opioid-addicted customer, almost as if it were a heroin addict; and that customer is going to buy from you every single day. Maybe sometimes more than once a day.

And, that is the other benefit. People understand this very well on the street now. And, they know what they're doing. And, there is that boost that they give the drugs. Sometimes they charge more. I talked to a woman whose boyfriend sold meth laced with fentanyl and he charged double. So, his meth without fentanyl was one price; his meth with fentanyl was twice that. And, it's different in every region because we're not talking about a corporation here. We're not talking about the same rules applying to everybody.

23:43

Russ Roberts: Let's talk about meth. This was the single most fascinating piece of the book for me. So, talk about meth generally, and then talk about its relationship to the homeless encampments that are now--I won't say they're common around America, but they're not rare. I noticed this maybe, I don't know, a few years ago, not many, in the last five. I took a trip to Seattle and there's like a camping--it looks like a camping project. There's 10, 20, 30 tents on an exit from the interstate. And, I'm thinking, 'Oh, wow. That's weird. That's homeless people evidently.' But, they're not out outside, they're in tents. It's become sort of an accepted thing. Then I was in San Francisco a year or two ago, and there's tents on the sidewalk. It's not like there's one. There's many.

I have incorrectly--I would say after I read your book, I know it's incorrect--I had sort of attributed most of this--it's part of it--but most of it to an increased tolerance by city governments in certain locales, like San Francisco and Seattle, for homeless people who often have psychiatric issues. And, they don't want to be part of the safety net or the county services or the city services. And so, there's something--it's hard to say it, I'll come back and talk about this later. But, tell me what meth has to do with that. Because, who knew? It's crazy.

Sam Quinones: Yes, it absolutely is. And, the fullness[?] of the story didn't occur to me until I was very close to finishing the book. The Mexican trafficking world has always been earth, land-based, plant-based. That's because most of those folks came from the little ranchos, the little villages. They were already farmers. And so, they grew into drug trafficking through marijuana and secondarily through opium poppies. They learned, or their children--maybe even their grandchildren learned, the third generation of traffickers--the second and third generation learned that all of that is a waste of time. Again, as I was saying earlier, why have land? Why have irrigation? Why have farming and all that stuff when you can just--

Russ Roberts: Weather--

Sam Quinones: Yeah. Why rely on the seasons? You've got ways of making drugs, and the first drug--now, fentanyl reinforced that idea. But, really the first drug they learned that with was methamphetamine. The Mexican trafficking world on the Western side of Mexico, figured out, perfected, industrialized methamphetamine product beginning in the late 1980s. They had labs both in California, then, and in Mexico. As the 1990s progressed into the 2000s, law enforcement in the United States got very aggressive and began curtailing easy ability to make the stuff. So, by the mid-2000s, all those labs are going south. But they made methamphetamine very, very well, very expertly. And, they did so because it was very easy to do. And, they made it from one specific chemical. That chemical is known as ephedrine. It's an antihistamine. You find it in Sudafed tablets and all that. And, they used--

Russ Roberts: And, that's why Sudafed became a--something that you used to buy off the shelf. And, all of a sudden, it's behind the counter. You got to sign for it. It's being regulated--not regulated, so much as monitored, your usage of it. But that's the reason.

Sam Quinones: Precisely. And, you'd see guys go to Walmart, to Costco and come away with boxes of little boxes of Sudafed pills, because they wanted to extract ephedrine.

In the Mexican world, they were able to get it on the world chemical markets. They were also able to get tons and tons of pills. They could extract it that way. But they--ephedrine had a benefit in that it was very easy to make it. So, if you didn't know anything about chemistry, you could do it anyway. And, number two, you could find it easily on the market. And so, all you had to really do was tweak an ephedrine molecule a little bit, and it became methamphetamine. And, that's what they did.

And, the issue that they always had though, was they could not get enough ephedrine to properly kind of, I guess, cover the entire United States. The meth that they made was a lot, because there was hundreds of tons of ephedrine legally available in Mexico every year. But, that was really only enough to cover the Western United States and even not all of that.

And so, you found in other areas, particularly like the Midwes, people going, as you said, and getting Sudafed pills and through a complicated method, extracting the ephedrine; and making maybe a few grams, or at the most, maybe a couple ounces of this stuff. You're not seeing enormous, enormous supplies come from this stuff.

And so, meth became part of American culture in a way that it probably hadn't been by the 1990s. You began to see those mugshot posters, where you'd see one person over a six- to eight-year period, kind of mugshots of that person, six to eight years through. And, you see that person--excuse me, kind of decline and decay, and by the sixth year, pock marks and wild looks and disheveled. And that's the effect of methamphetamine over a six-year period.

But, then the meth changed and that's what we are dealing with today. The change really came because finally, Mexico--not sure if this is the wisest step--but nevertheless, Mexico made ephedrine completely illegal except for a few licensed pharmaceutical companies to possess. And, that, in the midst of this bonanza of meth production that the Mexican traffickers are in the middle of realizing and these concentrations of real skill and technical, innovative ability in certain parts of Mexico, all of a sudden it throws them into kind of this new moment, where they have to say, 'Dang, we were making tons of money with this all year round,' because there's no seasons when it comes to laboratory drugs; and then all of a sudden Mexico--so now they have to find a new way.

Well, it turns out there is another way of making methamphetamine. It was way practiced by California, Hell's Angels and biker gangs. They used to control it back in the 1960s. It's very messy. It stinks and in, and it leaves a--and, it requires, I should say, a whole bunch of chemicals to do what ephedrine before was just doing.

And, it relies on the precursor known as P2P, phenyl-2-propanone. P2P, it can be made though--it had one benefit. The benefit was this, the only benefit that this had was this, and that is: that you can make P2P with so many different chemical hacks, different ways--

Russ Roberts: So, they're really hard to stop the flow--

Sam Quinones: You can't regulate it, the way you could--if you have only one chemical that's kind of like the bottleneck, government can regulate that. Pay close, close attention to it. And, basically you have a difficulty going forward with it. And, that's what happened with ephedrine.

With this stuff, if you use one way to make P2P and they crack down on some of those chemicals, well, you can find another. And, it turns out according to organic chemists and DEA [Drug Enforcement Agency] chemists I've spoken with, that there's really almost--not to say there's no end to the numbers of ways you can make P2P, but there are many, many ways. And, they all use very common chemicals, chemicals that are common in the industrial world and legal industrial processes.

These chemicals turn out to be extraordinarily toxic, many of them: lye, cyanide, sulfuric acid, hydrochloric acid. That's just a few. There are many that occasionally used for all these things. The benefit of this new method is that--

Russ Roberts: To the supplier--

Sam Quinones: Well always, this is the benefit to the supplier. If you have control of ports, which they do in Mexico, those two ports on the Pacific Coast, in Lazaro Cardenas and [?], you can get access to the world chemical markets and import that stuff by the ton, and nobody can really stop it. And, certainly governments can't regulate it.

And, that's what began to happen after the Mexican government made ephedrine more than just regulated, and really made it illegal, except for in a few cases. The supplies dried up; and all of a sudden the trafficking world had to shift. But, they had control of these ports, so they begin to bring in these other chemicals and beginning in about 2009, 2010, 2011, 2012, you begin to see the expansion of the P2P method of making methamphetamine.

Along the way, a couple of key figures are killed. One guy, Ignacio Coronel, who was basically the meth lord of Mexico, was shot to death by Mexican military in 2010. Another guy, a kind of a local guy in Sinaloa, who was very important in bringing in ephedrine for a long time, from all over the world. He is murdered.

And, with that, though, again, you see this explosion. All the controls that these men may have exerted in one form or another are gone. And, pretty soon what you begin to see is just an explosion of people making methamphetamine. Because they can. And, all year round, because they can: they can get access to those chemicals. They don't rely on seasons. And so, you begin to see the supply begin to just explode. And, it's a remarkable thing to watch.

33:29

Russ Roberts: So, this innovation of an alternative production process for meth comes with a terrible price for users and mental [crosstalk 00:33:43].

Sam Quinones: Initially, what I thought was, was my story was, initially what I thought was, 'This is amazing. They are behaving like any consumer product corporation now.'

Russ Roberts: Sure.

Sam Quinones: They can make it year round, just like Oreo cookies or whatever. It's a whole new evolution. And, the supply is staggering.

Russ Roberts: And, you can take advantage of economies of scale. You can build--not just a guy in a basement, you can build an enormous warehouse and you describe a number of them that are really extraordinary, frightening.

Sam Quinones: Exactly. And, what you also have--if you control the ports, and of course, crucially, if you control law enforcement.

The size of those labs and the permanency of those labs is really just a testament to the fact that these guys are operating with impunity. They have all the guns they need from the United States. They have law enforcement in their pocket. They have politicians frequently on their side in some clandestine way or another, and so they begin to supply. And so, initially, I thought this was just a story about the enormity of the supply and the prices dropping. In Kentucky, where they before were doing that Sudafed pill reduction method--known as 'shake and bake,' is what they used to call it--now, that's gone. All of that is just gone. All those little suppliers, like what Walmart did to Main street in America, that's what Mexican meth does to all those small suppliers. And, it's pretty much all Mexican meth now.

I was about to finish the book, I was closing in on finishing the book, when I realized that there was another story that was, I think, even bigger than the one I was working on, when it comes to methamphetamine, this new P2P method of making it. And, that is that the P2P meth--unlike the ephedrine meth--was creating symptoms of schizophrenia, as it passed across the country among everyone who used it.

Ephedrine meth was like a party drug. It took six or seven years for you to decay to the point where your picture would be all pocked and everything like that on those posters. It was a party drug. You could normally kind of more or less hang onto your life. You had a house, you had a job. I knew many people who did this. It was very big in the gay community, because it was this party drug and this kind of thing.

P2P meth was nothing like that. It was a very sinister drug. It brought you inside. You didn't want to be around other people. You wanted to just kind of be alone with whatever bizarre thoughts your mind was now cooking up, and conspiracies. You began to not want to be around people. You began to speak babbling, what they call 'word salad' in psychology. It began to create mental illness as it marched across the country, beginning in the Western side, of course, all the way to now Vermont and New Hampshire, which never had any meth of any kind, really to speak of, ever. Now, now it's got a very serious meth problem.

Russ Roberts: And, I want to get to the homeless part of this in a second.

The part that I was puzzled by as I was reading this--and, it's horrifying. In this conversation so far, Sam and I are talking about the chemical process and so on. But, the book itself is filled with the human tragedy, alongside these kind of, what I think of as market-based phenomenon. Markets are really good at giving people what they want. A lot of people want this and the other side finds ways to make it more cheaply. The incentives are there and that's what we're talking about. The puzzle for me is that this more sinister version of meth, which you describe again--we're not going to be able to do it here, justice in the program; it's an incredibly heartbreaking set of stories in the book alongside the chemistry is: It sounds really unpleasant. Like, how do you sell that to customers? Why would anyone take this stuff? It turns you into this paranoid person who can't hold a job. Now, I understand, once you're addicted, you're in trouble. But, how do you move from that to that world? I don't get.

Sam Quinones: Part of that is because a lot of the people who are already involved in it, were already doing some form of meth. The guy, I learned this from, the guy who first told me about this was a guy named Eric Barrera[?]--great fellow, a Marine who is now several years sober and is now working a homeless outreach coordinator in Los Angeles. And, he told me, we had this conversation when I met him. And, he said, 'I was a meth user for seven, eight years. And, then all of a sudden, one night, the meth changed.' And, he went insane. He was always able to hold down a life more or less--never with meth is it good, but it's always kind of more or less a life, right?

Well, with this stuff, all of a sudden he was at his girlfriend's house, absolutely convinced that she had a man hidden in the mattress, or then in the walls. He took a butcher knife and began stabbing the mattress frantically, then stabbing the walls, out of his mind. And, he said, he never, once again, felt the euphoria that he used to feel with the ephedrine meth. Ephedrine meth was like, 'Oh, yeah. Let's party. I'm on my game. I want to meet everybody and jabber and jabber away all night long.' It was not that; it was a sinister thing. Being alone with his pornography. And, he lost his job, lost his apartment, mom, dad, girlfriend, all his friends, kick him out of their houses. And, he's on [crosstalk 00:39:26].

Russ Roberts: But once that happens, do you keep taking it because the chemical compulsion?

Sam Quinones: Yes. In his world, is because he was just addicted to it. He told me, 'I never, once again, after the meth changed'--and, he told me, 'The reason I got onto this was because,' he told me, 'this happened in 2009.' Well, I had already been working on a story that said meth was made--ephedrine was made illegal in 2008. So, actually in Los Angeles, by 2009, they would be getting this meth, which all his buddies used to call 'weirdo meth.'

Russ Roberts: So, this is one guy though, this is one guy.

Sam Quinones: Yes. And, what I end up saying is--I begin to think to myself: If this is happening here, I knew now that by 2020--2019, 2020--meth was everywhere. So, it stood to reason that, if it was the case with him, I would have to call people all across the country to find out: Is this meth really--'What are you seeing?' You, the cop on the beat; you, the narcotics officer agent?

Russ Roberts: Emergency room--

Sam Quinones: The emergency room doc, the emergency room psychiatrist. One was extraordinarily helpful. Megan Shabbing[?] in Columbus, Ohio. But also, recovery and treatment counselors and some recovering addicts. People who had been on this stuff.

The truth is, I found only one woman apart from Eric, only one other person who really had been able to recover from this stuff, because this stuff so mangles the brain. I met people who actually almost lost the ability to speak, absolutely completely addicted. One treatment counselor said, 'I knew a guy who had spent so much time outside during the cold looking for meth, that he literally had a gangrenous hand.' And, put him in the hospital a few days. He escapes with a gangrenous hand he's most likely going to lose, to find more meth. Why? Because it's the hijacking, the complete hijacking of the brain that drug abuse perform on human brains.

Russ Roberts: And, we don't give medical advice on this program, but it seems like a bad idea to take meth. And, we're going to put that to the side.

41:41

Russ Roberts: But, I want to talk about the connection to the homeless population because, it's--in the 1980s--this is one narrative, and I've told it myself many times--the 1980s, we closed a lot of psychiatric facilities in the United States. We used to take people who were schizophrenic, not because of drugs--they just were schizophrenic. And, we locked them up and we gave them shock treatments and we gave them other types of drugs. We sedated them.

And, I found that somewhat--well, I found it very disturbing, actually. And, others did as well. And we changed that. And, we basically said to people who were severely, mentally disabled, through psychiatric problems, we said, 'You're on your own. You can live on the street because you're probably going to not be able to hold a job. We're going to tolerate that.' Again, there's something almost beautiful about it. We don't lock people up anymore. On the other hand, we kind of leave them alone and stay away from them because they scare us. It's the person talking to themselves on the street, screaming obscenities. Often, sometimes naked or nearly naked in the case of San Francisco. And, we sort of say, 'Well, everybody's different.'

And, we don't even heard them into social service facilities and say, 'You need food. You need to come to the soup kitchen.' They're on their own. They don't want to have an address. They live on the street. And I've written about this. It's both tribute to our respect for another human being and to me, a tragic failure to really connect to another human being--that we sort of say, 'You don't have a family or no one wants to talk to you. I'm just going to pretend you don't exist. I might give you a dollar on the street, but that's it.'

But, you're saying, it's something else now. And, it's part of this tent phenomenon. So, talk about that.

Sam Quinones: Right. And, I think that this has changed significantly. I would say maybe since 2013, 2014, which is when you begin to see the supplies of meth expand geometrically, almost, with a widespread knowledge of how it's made. And, hundreds and hundreds of labs now, each with capacity to make a ton or more, whatever, every time they cook.

What this ends up doing, because it turns people mentally, schizophrenic, paranoid, horrible hallucinations--you know, cheetahs coming out of the walls, the government inside my brain, people unable to speak, speaking to other to counselors that they may find in numbers--answering every question with a number--incapable of basically living in a regulated society. Those folks end up basically, with what looks to everybody like schizophrenia.

In fact, that's a big problem right now, is trying to figure out: Is this person schizophrenic, or is this person on meth? And therefore, ought to be detoxed for several weeks, maybe even months. And, then maybe we'll find out that the guy is--like what happened to Eric. Once he stopped using the new meth, he was fine. He had some certain issues, but they were manageable and all the bad stuff kind of went away.

And, what this means is, that all these folks have transitioned. Many of these folks, I should say, have transitioned to the street, have become homeless. Because you cannot hold down a job or an apartment, or even live with other people who aren't on meth. If you are wandering around the house at three in the morning, screaming about cheetahs coming out of the wall. Or anything--and, if you have a knife or anything--excuse me, you cannot live with somebody like that.

And they're, as you said, we did not go the next step, after closing the mental institutions, by building community-based housing for folks. There would be three people to a house, four people to a house, instead of 300 or 400 as the institution. And so, we have abdicated that role. We left it, frankly, if you ask me, we in a very childish way as a society: we decided, 'Well, the police are going to handle that.' Why? Because they have guns, they're on the job 24/7, and they're all over the city. So, they're going to handle it.

Russ Roberts: If a person starts to be, quote, "anti-social," in a way other than just living in their own world. By the way, the other part you talk about, which I've read about and didn't really fully understand is: we've turned a lot of hospitals into [?] police jails because the people who come in are violent, they can't be restrained. So, all of a sudden the medical community isn't curing or healing people necessarily: They're doing more of what we would call restraining from self--

Sam Quinones: Managing people with severe psychological and psychiatric disorders, but caused by meth.

The other thing that I find having lived in Los Angeles--I'm from LA, moved to Nashville recently for a bit but my upbringing is there--is that frequently, the conversation when it comes to homelessness is about the high cost of housing. It's almost never about methamphetamine. You could read entire newspaper stories for weeks and they will never mention--about homelessness--and they will never mention methamphetamine. What they will talk about is--and it's without a doubt, the housing costs in Los Angeles, San Francisco have risen frightfully. There's no doubt, but the idea that you are just going to put a meth-addled person in housing without first, months, most likely, of treatment and bringing that person back to some mental sanity, is crazy. The idea you're just going to put them in a house--they will destroy those houses. That's not a way of dealing with it.

What also seems to me, is that we are afraid, overly afraid of the stigma, which is very strong and needs to be addressed. But, you can't be willfully myopic. You cannot be willfully blind and think that you're doing anything about stigma, because everybody knows--it's very, very common. People know that this is a meth problem. The huge encampments on Venice Beach, which were such an outrage, such a horrible sore and festering sore in that community on Venice Beach in Los Angeles, was known as Methlehem. That's what they called it, Methlehem. People were on meth in those areas. And, this is also, I should say, this new meth, this P2P meth coming in--staggering, just staggering quantities--out of Mexico has created homelessness in rural areas that never had them before.

I talked to three separate areas, West Virginia--well, four areas--Eastern Tennessee, rural Indiana, and Central Oregon, and each place, there were really occasional homeless people. Very rare. Now, you've got enormous tent encampments. The tent is part of that story, too.

Russ Roberts: Yeah, go ahead. So, talk about that.

Sam Quinones: Well, tents and meth almost go together like hand in glove. Like, this new meth is not a party drug, right? This new meth takes you into your brain--it's like you are almost shattered mentally. And, the only place you can really reside is within your own brain, all alone. It's unlike meth; it's very much like opioids, which used to bring everybody into their own little world, you know.

Russ Roberts: So, why would you want to be in a tent encampment?

Sam Quinones: Because--well, first of all, you want to be in a tent because the tent is where you can just be alone. You don't have to be around everybody else. But, an encampment particularly made up of many people who are using meth is almost like--I kind of look at it as like Friends at the bar--and I'm sorry in Cheers, rather, not Friends. Where everybody knows your name, where everybody kind of accepts you as a meth user; where there's this warmth in using meth; that everyone's doing it together. You don't feel weird. You don't feel like people look at you strange. And so, these encampments are a direct result of that.

First of all, they're a direct result of the sheer numbers of people. I'm really convinced that most of the people in those encampments are damaged by methamphetamine. Homeless does [is?] a difficult thing. And, I'll call it one thing--there's all kinds of homelessness. There's the shredded safety net kind of homeless person who has an operation that he needs and loses his job and he can't afford a house and the operation. That's a very different person than the person who is in a tent encampment. That person probably has family, a garage, a sofa he can sleep on, ways of dealing, ways of coping with this new world he finds himself in; and they don't tend to remain homeless very long.

Whereas on meth, the folks who are on meth are homeless for quite a while. That's a totally different form of homelessness. And so, the tent becomes the community: the encampments then become the community, where the common denominator is drug use. Nowadays, it could be you're using anything you can get your hands on. If it's crack, you use that. If it's alcohol, whatever, weed. But for so many of those folks, meth is what brings them there, meth is what keeps them there. And, it's where they run. It gives them an outlet when they want to escape treatment. They're in treatment, they can leave. They run back to the tent encampment because there, they feel kind of accepted for their meth use.

And, that is one of the reasons for the massive growth and expansion. There are others, but the massive growth and expansion of these tent encampments is that simply, folks are on meth and they need a place to be around all the other folks who are on meth.

51:42

Russ Roberts: But, how do you reconcile that with the fact that they're inside their own head? Why do they want to be around other people who are using meth?

Sam Quinones: Well, I mean, it comes and goes. You want to be around people; you can have easy access to your dope. Particularly, if you're a woman nowadays on the street, you probably don't pay very much for dope. It's given to you frequently, maybe for sex, maybe for all kinds of other things--but you want to be near the supply. You want to be near people who use it. And, then of course, you want to be able go into your tent and your tent becomes this kind of little meth world. I think that's kind of common, what's going on right now, all across the country, these large tent encampments.

People view these tents as benevolent things, as keeping people from the cold weather and tents have done that. Clearly, we need to point that out. But, frequently, I think now combined with meth, they are just simply enabling spaces for folks with horrible, horrible psychiatric problems now created by this staggeringly, potent and prevalent methamphetamine that's coming out of the Mexican trafficking world.

Russ Roberts: As you mention, the tent facilitates prostitution and other problems. We're going to leave it unspecified how widespread this is. We obviously, don't know. We don't have any clear measurements of it, but it's an aspect of this social phenomenon that I'd never heard of and had not thought about.

53:13

Russ Roberts: But, I want to take us in a different direction now. We're mainly talking about urban issues, but much of your book is about small town America. As was your previous book. It's about towns in Ohio, Kentucky, West Virginia, used to have economic stability, used to have social stability, used to have community stability, that's been lost. The phrase I think of is: people are unmoored. They've lost a sense of self. They've lost a sense of mattering, of belonging. And, I'm generally a free trader, a pretty hardcore free-market person. We understand that economic change has costs that can be disruptive to people's lives. My first book, The Choice was all about how small town America responded to the increased trade from Japan. And, a lot of people left those towns and they found more opportunity elsewhere because trade enabled good things to happen in lots of other places.

A lot of people left--moved to the city. Cities grew, small towns shrunk. We could debate what was lost or gained.

But, I think what's clear--and the cause of this we can talk about in a minute, because I think we disagree about the underlying cause--but, this is an issue that Chris Arnade has written about in his book Dignity and on the program. The just disruption, the severing of ties that used to keep people together. This is why, I mentioned at the beginning of the program the connection to the episode with Johann Hari or Noreena Hertz: People are lost, to some extent.

And, I think you blame a lot of it on capitalism. I don't. And you blame it somewhat on corporate greed, the case of the Purdue Pharmaceutical and the Sackler family. Make that case, and I'm going to give you an alternative--which I know you're somewhat sympathetic to, because I read the book. But, I'm going to put an emphasis on something else. But, you go first. Talk about why you think this is a statement about capitalism and corporations.

Sam Quinones: I just think we got away from--and don't confuse me with an expert on Adam Smith here on this show. I think one of the things I'm going to do after this is all over is, I'm going to read more. But, I think Adam Smith outlined it well, as I understand it in his--oh, what's the--moral, the one he wrote [crosstalk 00:55:42]--

Russ Roberts: The Theory of Moral Sentiments. Yeah.

Sam Quinones: There we go.

Russ Roberts: The Theory of Moral Sentiments.

Sam Quinones: Capitalism today has lost that in America. He viewed it as essential, the moral moorings of capitalism. That you couldn't have a really--if self-reliance, a supremely beautiful idea in American culture, I can say, becomes crippling isolation, then we've lost something. Even though, we may have prosperity.

A perfect example, I think, of what's happened to our country is in the big box stores. Primarily Walmart. You know? Walmart came in and destroyed a lot of mom and pop main streets, locally owned folks, people with lonely stores for sometimes generations. I think the whole opioid problem is largely, is rooted in part in that. Those stores before, the owners would've been very, very careful who walked into their store. And if they knew someone was a shoplifter, they would come at them and they would get--because they owned the store. Those folks contributed to the local middle school theater program and the local Little League and the churches, and they held those communities together. They were essential.

Walmart comes in, under-prices all of those folks; all of those folks are leaving, begin to leave. Maybe they also leave because a lot of those jobs depart. I mean, there's a lot of reasons.

But Walmart comes in, and Walmart turns itself into the biggest source for drug revenue in those communities--

Russ Roberts: Yeah, this is--by the way, for people who haven't read your book, that sounds like a crazy statement to make.

Sam Quinones: No, it's absolutely the truth.

Russ Roberts: I know: you've got to flesh it out just a bit. Because [?] people, have no idea what you're talking about.

Sam Quinones: Walmart, particularly during the opioid epidemic was cutting back. Lee Scott was cutting back. The chairman brought in, or head honcho for a long time was brought in. And, what they did was begin to cut back on staff and the self-charge--what are those machines, where you check yourself out? All that kind of stuff, you could go an entire shopping trip to Walmart and not see a Walmart employee. It happens all the time.

They became very well known in the drug world locally for a place where you could rip off with impunity. And, that's what people began to do. And I've heard endless ruses on how they did this. You go through the parking lot. You find a receipt. You go into Walmart. You steal the stuff that's on the receipt.

Russ Roberts: Yeah. I think we talked about this in the last program, and it's in your first book, but it does come again into this book. But, basically, the idea is that, Walmart became an easy place to shoplift and help fund some of the drug [crosstalk 00:58:34].

Sam Quinones: Exactly. And so you have--you did get those low prices, but you paid another cost as a community, hugely absorbing the time of your police officers and becoming really a place where everybody just knew, you could rip off them. Yeah. There may be other stores, Lowe's or Krogers you could rip off, but nothing as easy, nothing with the wide selection as Walmart.

And, to me, this feels like a perfect example of our prizing low price and just that kind of, like, easy access to stuff over anything that really can't be valued, but is far more valuable. Like, having locally-owned stores, where the people are going to be on the ball watching. And, therefore, your drug market will never grow to the size that it has grown many times in small communities, all across this country because of--it's easy shopping, and Walmart, it's also easy shoplifting.

Russ Roberts: Yeah. And so, interesting point. I'm not sure it's true. Walmart doesn't really like to be stolen from. You point out that they cut back on some resources, then tried to use the police to monitor it, which is not very effective. I understand that.

59:54

Russ Roberts: But I'm want to try a different approach.

Sam Quinones: Yeah.

Russ Roberts: I don't agree--I mean, I don't disagree that morality is struggling in America. I don't want to put that on capitalism's shoulders. I would certainly agree with you that a capitalism that is supported by moral people is going to be more effective and better than one that isn't. So, there I think we totally agree.

Sam Quinones: Yeah.

Russ Roberts: But, I think there's something else going on. You mentioned it in passing--the other two books and authors I interviewed, again, they might mention, a paragraph or so--I think it deserves more attention. So, let me try to lay that out and you can react to it.

Sam Quinones: Sure.

Russ Roberts: Somewhere in the 1970s, marriage started to become a less healthy institution.

Sam Quinones: Sure.

Russ Roberts: I'll call it traditional marriage. The so-called nuclear family became less common. There's an enormous growth in children raised in homes with only one parent. The divorce rate starts to rise quite dramatically in the 1970s. The marriage rates starts to fall. There are two different things. They're related. So, it's not just that people who marry get divorced, people aren't marrying, or they're not remarrying. And so, we get into a situation, particularly for people with low levels of education--so, all levels of education have had a drop in the marriage rate, but it's quite extraordinarily, larger. It's larger for low-education levels.

So, for example, I was looking at the data before our conversation: Forty, fifty years ago, there may be women--I think I was looking at the chart--women 40 to 45. What proportions are married?

Well, if you're highly educated, it might have been in those days, I think it was something like 80%. And if you've only gone to high school, it's 70-something [percent--Econlib Ed.]. It's lower, but not much lower.

Those rates have plummeted since then. The data I was looking at were for 2014. I'm sure it's even stronger now. 2014, only half of women, 40 to 45 are married, who only went to high school--or maybe dropped out of high school--I can't remember. But if you've gone to college, it fell and then it started to rise again. It's still lower than it was 30, 40, 50 years ago, but it's enormous. It's dramatically higher than low-educated Americans.

So, Americans with less education are increasingly detached from an institution that evolved over time to civilized human beings and raise their children. It had a lot of negatives about it. I'm not going to defend it is a perfect institution. But, the interesting thing is that over the last 50 years, it has decayed. It has deteriorated.

At the same time, religion has become less attractive, particularly in the last decade to young people.

So, two places where people found a sense of meaning and community--either their local church, synagogue, or mosque, or their nuclear family, their children, and their spouse--those are increasingly less common.

And, I would suggest that we have not been able in America to find a way to cope with that social disruption.

One way we cope with it is--I would argue in fact, that the 'me,' the narcissistic part of our culture is actually not the cause of things, but more of the response. The drug usage that we're talking about in this episode and the rise in depression that Johann Hari talks about, these are coming from a desperate, inadequate way to satisfy the basic human needs of belonging, of loving, of connecting.

And, you talk about it quite eloquently in your book. If we don't smile at each other, touch each other, unite with each other--and there's many, many ways to do that. And, we're going to have to find those ways, I think, going forward. Because, without the traditional ones of marriage and community and religion, this alternative of, say, a quick high on a Wednesday night is really not a good substitute.

Sam Quinones: Now, you know, I would agree with everything you said, Russ. I don't see--in fact, you know, that's one of the reasons I named the book, The Least of Us. It's a reference to where we need to return to: To caring for the least of us. But also maybe, the smallest kind of gesture, you know, on the street. A barbecue, a getting outside and saying hello to your neighbor. These small things have been corroded along with our interest in the person who is eating from the trash, or the grocery store clerk who may or may not have health insurance and may have to with COVID go to work. It's these kinds of things that have been shredded.

And, within all that, if you ask me, [inaudible 01:05:06] lies our economic system of capitalism, which has also shown the same shredding, if you ask me. And, maybe it's part of capitalism to move in that direction, this kind of concentration of power, of enormous wealth and just community power that we see now in many corporations and stores and what have you.

It seems to me to be kind of--it stands to reason that all of that would kind of be part of the same whole. And, I think that is kind of what I'm trying to point out, that we have allowed ourselves to think that big is better. So, long as the price is low--if the price is low, it doesn't matter how big stuff is. It doesn't matter how much economic power they wield in the local or the regional or the national marketplace for ideas or their own stuff.

You know, to me it feels like, we've gotten away from that. So, that's one of the reasons, or many reasons, why I named the book, The Least of Us, but it's that idea that we need to understand the power of walking down Main Street and seeing the guy who fixed your shoes, you know, a year ago, and say, 'Hey, how you doing?' Be a part of a community

A lot of that--and as you say, in small towns that's been shredded, but if you ask me a lot of that has been shredded, too--in wealthy areas, too. I see these enormous houses and there are three people living in them. It seems to me like, capitalism can't help but be a reflection, both a reflection and a cause of a lot of that, particularly as we just--since, in the last 40-plus years have just said, 'Any merger that comes along, you guys just merger up. It's not a problem.' I think we need to--my own personal feeling is, we're through with mergers. That stuff is so big right now.

Russ Roberts: There's an episode coming out--

Sam Quinones: That's whole other question, of course.

Russ Roberts: Yeah. It's a whole 'nother thing. That's okay. We've got an episode coming out. It hasn't come out yet, but Glen Weyl--

Sam Quinones: Okay, fine. You can get to that later.

Russ Roberts: No, by the time yours comes out, it'll be out with Glen Weyl, about what to do with large increases in corporate power.

Sam Quinones: Yeah, great. I will listen to it avidly.

1:07:16

Russ Roberts: But, I think that's a little bit of a--what I want to argue and I'd love to get your response. I want to say first, by the way, I live Jerusalem now--

Sam Quinones: Yes, you do--

Russ Roberts: And this beautiful haircut I got, is from the barber who--the hair salon that's the closest to my apartment. I walk by him every day on my way to the bus. And, I'm really glad that I like the haircut because I enjoy saying hi to him, and it would be weird that I would go to a place on the other side of town, because it was 10 shekels cheaper.

In fact, I even enjoy--I hope this doesn't scare listeners--I even enjoy maybe paying a little bit of a premium to go to my local--even when it might be less efficient--coffee shop or market. So, I value all that, but I think it's a little bit of a red herring, because I think those connections--which are lovely and I enjoy them; they're fine and they add to the quality of life--I don't think they're deep and abiding in the way that real community is.

In, just, in defense of your argument, your book has a lot of fantastic examples of where--what de Tocqueville called Civil Society--where people have come together in desperation to try to deal with some of these problems because they can't solve them with money. They can't solve them with government. They're solving them with time and devotion, to the least of us. And, I salute it. I think that's a huge part of the problem.

I wrote a piece--let me take it in this direction and then you can respond. Your analysis a little bit reminds me--I don't want to be unfair--but it reminds a little bit of the gun-violence issue.

A lot of people look at gun violence and they say, 'We got to stop the supply.' Not a bad idea. You can debate whether it's Constitutional or not; I'm worried about that. Many people aren't. That's fine. But, I think it's strange that we don't look at why it becomes normal for a person to kill a bunch of strangers. And, if we don't deal with that problem, we're fooling ourselves.

And, similarly, I think in this case, if people can't come together in family or in religious community, there'll be things we can come up with to make things better and to help the most desperate, the least among us. But, I think we're going to have to look at this as a more systemic cultural problem and not just say a financial or economic problem--

Sam Quinones: You know, I don't disagree with any of that. I agree with all it. You're absolutely right. It's a complicated thing. Nor would I say that--I understand the enormous power of innovation and wealth creation that capitalism represents. It's indisputable.

I just see this as part of the mix. The one that I tend to highlight, because I'm dealing with capitalists. You know? I'm dealing with drug traffickers. I'm dealing with Walmart. I'm dealing with--it's where I see this coming down.

I would say the decline in marriage rates, rise in divorce, children born out of wedlock--the rise of the box store is at the expense of mom-and-pop places, has all of that. There's reasons for it, I know. Sure, it destroys stuff. Basically, not entirely, but certainly the gradual disappearance of community banks. Those community banks were huge in the development of a community. They knew what housing prices ought to be. They would donate money to the local middle school theater group. Whereas, Bank of America, I don't think, really does.

So, you're getting this enormous trade off, away from community stability, from all these things that we've just mentioned. They're all part of the mix.

And then, you're right: I've never viewed drug addiction as--it's a cause of some of it, for sure. It's really the symptom of so much of what we've talked about. And, of course, we could continue talking about and other authors you've brought on your podcast have highlighted. And I think that's completely legitimate. I'm just--when you're dealing with drug trafficking, you are dealing with capitalists, right? Free-market capitalist of the most brutal sort.

Russ Roberts: Oh, that's true. That's true. As I suggested earlier, what capitalism is really good at is giving people what they want. And, what I'm suggesting is, why is this what they want? Something is wrong. There's a hole somewhere, not just in the [crosstalk 01:11:52] the soul.

Sam Quinones: I would argue this: Fentanyl and meth, we basically now, or as I say in the book--we're now in the synthetic era of drugs, probably never to return, I would suspect. Why? Not because it's what people and drug users want, but rather it's because it is what drug traffickers find most easy, risk free, and profitable. It's entirely in their interest to go to the synthetic drugs and away from the real interests of people who use the drugs, because they can be mightily damaged as we are seeing all across the country today.

1:12:32

Russ Roberts: So, let's close with a question that I think we all want to think about, which is: What might we do about this? One argument says this is a personal problem. If you struggle with addiction, you need to get help from your friends, from your family, from your community, and so on. Many of us are blessed not to have that issue with our own challenges. And, we just say, 'Well, it's somebody else's problem.'

But, as you point out, it's very destructive in many, many ways, beside just the tragedy of human devastation. Is there anything we could do about it that is--especially, given what you've just said: that the natural forces of trying to give people what they want have pushed this into a more efficient mode? It's really scary.

Sam Quinones: It's a tough question. And, when I think about it, I just--at times, I think, 'Wow, you're just being such--.' What I'm about to say is so Pollyannaish--it's so naive--and it might be. It might be. I say this because--

Russ Roberts: Who cares? Bring it on, Sam.

Sam Quinones: I'm a reporter who has been 34 years on the job. You're supposed to be all cynical and crusty and all that. And, I guess I'm not. Yet. Okay.

Russ Roberts: Good for you.

Sam Quinones: So, we'll see. But, I still believe, that when we are faced with enormous economic forces, like those in Mexico--but also, those here in the United States--that produce all kinds of addictive processes and substances and goods that are highly addictive and might well be considered, as I think, are considered almost as addictive as those drugs of abuse--some differences, of course, we can talk about. But, we are facing a time when corporations behave like traffickers and traffickers behave like corporations. That's what I write in the book.

And, what must our response be then? Well again, the book's title, The Least of Us, seems to me to be the appropriate one, where we return to local--focus on our neighbors, focus on our streets, focus on our churches, synagogues, mosques, what have you. Focus on our local business, patronize our local business. Get outside, for God's sake.

So, many times, go through these neighborhoods rich and not, and I'm telling you, there's, like nobody outside. There's nobody being part of a community--actively behaving in that way.

Russ Roberts: Yeah. And we haven't talked about technology, but of course, our cell phones help bring us into that isolation.

Sam Quinones: What you end up doing, what I realized doing Dreamland, and of course, in this book even more so, iss that they are absolutely going--when you write about this topic, you're really writing about America: what we've become as people, what we've become as a country. It's a very--I thought I was biting off this small little thing to chew, and it turned out to this enormous topic that you could not ignore.

Anyway: I think, to me, that's kind of part of this, and we need to focus on those human connections that we have done our best to ignore or shred, or what have you. The community destruction that we have actively participated in, sometimes. The neighborhoods that get driven by, you know, whatever--a lot of different things. People indoors a lot. People without jobs. People without good jobs. You know, this kind of stuff.

I think one of the great things that may of COVID, of the few perhaps, is that we will find people commuting far less. And, I'm certainly hopeful that that's the case, because those folks can then spend time at home in the places where they, you know, are around other people. They don't have to spend an hour and a half, in the case of LA, driving one way to work and then another hour and a half on the way back. So, three hour hours away from your neighbors.

I mean, to me, it feels like all of that is part of where we go. And, yes, I'm not a religious man. I'm not a Christian. I do see, though, the power of this. I took the title from the Book of Matthew. I broke down reading the Bible during the writing of this book and Matthew--Jesus says, 'Is that what you do for the least of my brethren then you do for me for me?'

To me, that made me start thinking of where we need to go as a country. Is it a panacea? Of course not.

One of the other things I realized, is that we are looking for simple, easy solutions to very, very, very complicated stuff. And I think: No, taking the small stuff, small, dinky, little steps, unnoticed, unheralded, non-sexy, non-splashy steps towards community rebuilding, everybody beginning to do that, they will have an effect. It's already had an effect. Look at those lawsuits, prying billions of dollars away from drug companies to help small, rural, poor, devastated counties pay for what the opioid epidemic cost. Well, that is because all across America, I think frankly, after Dreamland came out, this began. I certainly saw it after Dreamland came out, because before it was not happening--people come out of their shadows. They begin to go and tell their mayors and their state legislators and their chambers and their churches: 'Hey, my son didn't die of a heart attack. He died because of this drug thing.'

And, you begin to see small steps taken by millions of Americans, out of the shadows. Giving power and encouragement to Attorneys General and other lawyers to go after these companies, pry away billions of dollars.

It's a remarkable thing that's taken place because all across America, millions, I suggest--certainly hundreds of thousands of Americans--came in small ways out of the shadows and began to make themselves heard.

So, to me, that feels like a good thing, a way forward in all this. I'm just a naive, crusty, old reporter.

Russ Roberts: No, I'm not sure I agree with that about the--I don't think you're a naive, crusty old reporter. I don't think you're naive at all. Any man who's been in that town in Mexico where they were growing the poppies is not naive anymore. Which I know you did for your first book.

I'm not sure that's the right policy approach to go after those drug profits, the pharmaceutical profits. That's a longer story. But the part I agree with you on, the part that I agree with you on, is that, the stories you tell in the book of those small steps that people take to feed a person who's on the street, to take them in when they're cold, to convert a church and to a homeless shelter for people who are addicted to meth, those are beautiful. Yeah, those are beautiful.

I think we all can be inspired and should be inspired by them. And, I think we'll all be better for it--not just the people who are the least of us, but as you point out in the book, the least of our own selves, we'll be ennobled by it. So, I think there's much to be said there, we need more entrepreneurs in that space.

Sam Quinones: Absolutely.

Russ Roberts: But, they're stepping forward because there's a problem.

Sam Quinones: No, I think that's what I began to realize. The story that really inspired me most and all that was the story of Angie Odom, who was kind of [?] spread throughout. And, this woman adopts the child of a drug-addicted prostitute, who was in a vegetative state, who she at one time in her life promised she would help if she ever needed it. I began thinking of those questions after hearing and fully reporting out the story of Angie Odom and how she then adopts this woman's child, and then almost adopts the woman herself, who is in a vegetative state--can't talk, can't really say anything. Can't see, can't really feed herself. Her story, the reason I had it in six chapters in all the parts of the book is because I thought this is the kind of thing--it's not policy, you're right. And it's not a panacea, but it is something that we might look to as we deal with these major forces that are arrayed against us. I don't have a better answer--maybe that's the other thing I could say.

Russ Roberts: Yeah. But, it's something to aspire to, is to help a fellow human being the way she did. It made me cry. I think it's an incredible story and it's not the only one. It's a very powerful book.

Sam Quinones: Thank you, so much.

Russ Roberts: My guest today has been Sam Quinones. Sam, thanks for being part of EconTalk.

Sam Quinones: Russ, as always, it's been great. I love your podcast and this has been a fantastic conversation. So, appreciate it.

Russ Roberts: Thank you.


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