Sam Quinones is an American author and journalist who writes narrative non-fiction. His last two books Dreamland: The True Story of America’s Opiate Epidemic (2015) and The Least of Us: True Stories of America and Hope in the Age of Fentanyl and Meth (2021) are both critically acclaimed.
In this episode, Russ Roberts hosts Quinones for a discussion on Dreamland, which provides a pluralistic view of the key actors and underlying pressures that caused the disaster.
Consider the motivations of young men from Xalisco who come to America to sell opioids. Quinones shares the standard set by those who return after successfully selling drugs and building ostentatious homes. There is great social pressure, which Quinones compares to building a house in 9 years or 9 months for men in Mexico.
How can the pressure of coming home rich lead a man to become “addicted” to it? How does young men’s addiction to wealth compare to that of those who are addicted to the opioids they sell?
Quinones points to the close-knit nature of the drug ring in terms of similar “family” names and everyone knowing each other in the late 1990s as something that left the dealers vulnerable to the DEA. The police also learned the areas where people met to trade. In response to the problems, new families got involved, and vendors developed a pizza delivery type system where their customers called and had a driver come to bring them the pills.
What are the benefits of a loyal labor structure for illegal companies, along with its related enforcers? To what extent do you think that asked for the opioids suffered by the police locating the trading areas? What could be a new concern for sellers with the pizza delivery type system set up for opioid-money exchange?
The rise of opioids began with their success in treating pain in patients. The drug was pushed hard when pain specialists built the narrative that opioids were not addictive, and the drugs were widely marketed by major pharmaceutical organizations like Purdue Pharma.
What should be the role of opioids in the treatment of pain today? How has the sentiment of calling pain the fifth vital sign in medicine complicated the opioid epidemic?
Roberts and Quinones discuss the perfect storm of causation leading people to receive and become dependent on opioids. For example, the new provide opioids have met a great demand from patients looking for a simple solution to their pain problems. Doctors were forced to prescribe the pills due to the huge supply of pills and their role as a compromise for the large number of people trying to get Medicaid.
How did the incentives align for doctors, pharmaceutical companies, and users to drive the opioid epidemic forward? How did the doctors see a backfire from responsibility problems due to the addiction of their patients to opiates?
Quinones argues that Medicaid encourages people to become opioid sellers because they could receive the prescription drugs at an extremely low price and sell them on the street for a huge profit. Roberts equates the issue of US taxpayers covering the lion’s share of the cost of pills for Medicaid-eligible users with a huge problem. Quinones and Roberts also share that many of those people who wanted to sell ended up using the drugs before they could even sell them due to their addictions weighing them down.
What are your feelings about Medicaid and the problems it caused at the height of the opioid epidemic? Who is most responsible for the opioid epidemic?
Brennan Beausir is a student at Wabash College studying Philosophy, Politics and Economics and is a 2023 Liberty Fund Summer Fellow.