Thanks to the cooperation of the National Book Critics Circle (NBCC) and Creative Writing at The New School, as well as the tireless efforts of our students and faculty, we are able to provide interviews with each of the NBCC Awards Finalists for the publishing year 2015.
Juliana Broad, on behalf of Creative Writing at The New School and the NBCC, interviewed Sam Quinones about his book Dreamland: The True Tale of America’s Opiate Epidemic (Bloomsbury), which is the National Book Critics Circle nonfiction winner for 2015.
Juliana Broad: How is the current opiate epidemic different from other substance abuse epidemics in the past?
Sam Quinones: In a couple of ways. One is that it is really caused not by drug traffickers and mafias and street gangs and the common ordinary street dealers, but is rooted in the way doctors prescribe prescription pills. That’s what this is all about. You’ve got many times more doctors in America than drug traffickers and many of them were convinced of the idea that we’re a country in pain and that they could prescribe these pills for all manner of issues – surgeries, etc. – and these pills would be non-addictive. There was a revolution in pain management in America. It began in the early 90s and gathered stream through that decade. Hundreds of thousands of doctors all across America bought into this idea and acted accordingly.
The other thing that really separates it from ones in recent memory - cocaine and crack - is that it is very quiet, private, and there’s no public violence. That’s key. When Colombians brought cocaine into Miami, Miami’s murder rates sky-rocketed. And then of course crack cocaine comes around and you see the Bloods and the Crips and street gangs getting involved. None of that happened with this.
The way it starts with doctors prescribing pills combined with a lack of violence means that it’s not readily apparent what’s happening for many years, from the late 90s until recently. The idea that this is actually epidemic proportions of people dying is not really clear because it’s not accompanied by the hallmarks of a drug scourge.
JB: In the book you look at two different kinds of drug providers: the Xalisco boys, a group of geographically-related Mexicans pushing heroin, and Big Pharma, plying doctors with prescription pain-killers. Both are pushing extremely addictive opioids. Both are using original business models – the Xalisco boys don’t want problems (with violence, etc.), they just want to be quiet and make money – and Big Pharma uses unprecedented force in marketing. How are we addressing both of these drug suppliers?
SQ: They both used marketing, branding, customer service, convenience, and personal connection as a way of marketing their drugs. This is no longer the old way of the Colombians and the crack dealers basically fighting for territory at the barrel of a gun. This was a very different kind of drug dealing. The similarities are what struck me. Convenience, branding, and customer service in both cases.
The main thing is, this is a supply driven problem. We had no large cocaine demand until the Colombians started shoveling cocaine into our country by the ton. That creates demand for sure. And what makes it very difficult to stop is prevalent supply. This starts with excess supply – huge, massive doses – of prescription pain pills all across the country being prescribed by doctors. Doing something about that is where we have to start. And that requires a lot of education. And that’s happening, but I haven’t seen it in the way it probably needs to.
The heroin traffickers come late to this party. You’ve got unprecedentedly cheap, potent, and prevalent heroin on the streets in many places. This has the tendency to perpetuate demand. People get out of rehab and they walk back into neighborhoods that are swimming in pills on the one hand, and-or heroin. And it’s very difficult to kick this kind of powerfully addictive substance when it’s all in front of you. You need that breathing space, separation, and that comes from reducing supply.
JB: What’s terrifying is that using heroin was the much cheaper option compared to using pills.
SQ: And that’s because it comes from Mexico. It’s so prevalent and so potent and so cheap that that’s why people are dying so quickly. It used to be that the heroin the addict had at his disposal in the 70s was about six to 12 per cent potency. Why? Because it exchanged hands a bunch of times and each guy, instead of raising the price for it, would cut it and make twice as much. It would lose its potency.
JB: You describe the history of U.S. pharmaceuticals and how the over-prescription of addictive pain-killers exploded in the 90s – the idea of pain as the fifth vital sign, a huge influx of pharmacy reps, etc. So we understand why over-prescription happened here. But what happened in Mexico during the 90s that pushed so many rural people to move into the heroin business?
SQ: I had studied immigration and how working class Mexicans from rural and semi-rural areas adapt to lack of opportunity. It’s nothing new. One thing is to do what everybody else around you is doing. One guy goes to Pasadena, and gets a job in a restaurant, pretty soon half the town’s in Pasadena working in restaurants. I see this model over and over.
It has to do with the insular environment of the rancho, where everyone grows up poor, and there’s a work ethic and a sense of envy. People see each other getting ahead - they come home and show off what they made and show how well they did in the United States. There’s an intense desire to show how well you’ve done, and of course when you do that, that’s a recruiting poster for all the other kids who are back home. The difference here is that these guys came back after selling heroin and they had more profits than working landscaping, and more risk.
This had more to do with these little villages and this one little town where everybody saw an escape from poverty that probably had existed since their grandparents, and a lot of them began to opt in.
JB: So it’s more a quirk of history – people realized that there’s a good opportunity with heroin and, lo and behold, there was an amazing market being cultivated in the states because of opioid over-prescription.
SQ: There’s a million other things they could’ve done, it’s just that this business model took hold. Crucially, because this was not a top-down hierarchy with a few people in control from the top, it was a business model that allowed everybody to do fairly well. It was a very democratic system. And that made it very popular among a whole generation of young men.
JB: How American of them.
SQ: Oh, completely.
JB: The profits, the free-market capitalism, the competition, it has this extremely American feel to it.
SQ: And it turns out that the free market capitalism combined with marketing, customer service, and convenience of a very addictive drug turns out to be far more effective than gun-slinging.
JB: To what extent is this epidemic getting attention because it’s mainly affecting white, middle-class communities?
SQ: Oh I would say the opposite is true. This has been quiet for so long because it’s been a quiet community problem. There’s no public violence associated with this drug. There’s no people getting shot in the streets, very little of that. What does is happen is because these folks are all white, white communities were mortified about this, and ashamed. And that was because so many people had grown up in a period of their parents, when heroin was so stigmatized and that they were so mortified by the fact that their kids, in middle class suburbia, were addicted to and dying of it, and in the most disgusting ways – you know, in a McDonald’s bathroom with a needle stuck in their arm on the toilet. That kind of thing. It was just too much for people to handle, so they kept it quiet and that’s why it spread.
It’s only in the last 9 months, or maybe a little longer, that this has really gotten the notoriety it requires and ought to have given the numbers of people who are dying. The number of people who were dying of this stuff surpassed traffic accidents a while back. It’s because it’s been allowed to spread to every community – it’s hit a critical mass now.
I don’t agree with the premise of your question that this is only getting notoriety because white people are involved. What is different is the way of addressing it now. I remember in the crack years, it was all about throwing people in jail. Now the idea is find treatment for people. That is a direct outgrowth, I believe, of the fact that most of the people involved in it are white. And so there’s a lot to it. There’s been a period of really low crime rates. If we had really high crime rates there would probably not be this feeling like we need to treat people. There probably would still be this idea of ‘Let’s throw them in prison.’ If budgets weren’t so tight in so many states, people would not be looking critically at how much money we spend on prisons.
This story is all about isolation. One approach to a drug problem, which was prison of some sort or another - a lot of those people who supported that and voted for politicians who would then enact that as policy - a lot of their kids are now getting addicted. And they are finding that there are very few options for their children. There’s prison and a criminal record, which is about as life-mangling as an addiction, and there’s the street.
To me, the way it has worked is that those folks have been making themselves heard. This starts at the state legislature. That is what is different. This epidemic has gotten nowhere near the notoriety, the coverage, that crack got. We’ll see how long it goes. That’s been the problem: that it’s quiet, and that’s why it spread.
JB: There isn’t as much notoriety, but the legislative response in recent years has been enacted by mainly white Republican lawmakers who saw this opiate addiction touching their own families and communities. To me that’s a major difference in the response.
SQ: Basically the difference is that people are looking for another approach that people didn’t support 25 or 30 years ago with crack. Back then, they didn’t know a lot of people who dealt crack, and so the idea of putting everyone in prison was fine. No one really questioned it. Twenty-five years later, people are finding that their children have no options either. The white community is larger in number, more wealthy, and more connected, you could say, and so their voice is now being heard on that topic.
That’s the way it’s different, not the notoriety it’s getting. There was no notoriety. This has been going on for 15 and no one has been paying attention to it.
Sam Quinones is a journalist, storyteller, and former LA Times reporter. His previous books include True Tales From Another Mexico: The Lynch Mob, the Popsicle Kings, Chalino and the Bronx and Antonio’s Gun and Delfino’s Dream: True Tales of Mexican Migration. He and his family live in Southern California. Find him on Twitter @.
Juliana Broad is a transfer student in the Riggio Honors Program: Writing and Democracy at The New School. She has a background in being a person and looks forward to continuing that as her life's work. She enjoys writing about immigration, mental health issues, and social policy, and doesn't mind that she doesn't have a Twitter to promote.