The Least of Us

This is extremely well written and it’s interesting to read. This gives an in depth understanding of these drugs, their histories and the politics that surround them. This opened my eyes to why we have such challenges with drug addiction in our society. The personal stories were heartbreaking and riveting at the same time.

Wow Sam! Did we ever imagine sitting in Chemistry class that a lab set up could produce more death and destroy cities, families and kill souls? Chronology and background are magnificent and scientific details appropriate and compelling. The drug war has begun, started by China, in the shape of a pill, not a nuke.

The author has done detailed research and interviews and has gotten to the bottom of some of the issues in the opioid supply chain and the biology of opioids and especially the life of addicts.I think this is an important book. I learned things from it and found it useful especially since this opioid epidemic has touched my extended family.However, the author repeats himself a lot — repeating statistics, his opinions, and more. Plus, he periodically goes off on tangents against sugar as pretty close to opioids on the spectrum of addiction-I think he overreacts here! The stories of individual addicts interspersed throughout the narrative are very powerful. And often heartbreaking.I found the information about fentanyl especially useful; the historical information also provided context.I wish the author or his editor had tightened up this book, then it would be even better. It is worth a read if you want to understand more of what is going on with the opioid crisis, as well as some emerging solutions for communities and some paths to recovery for addicts.

The Least of Us is Sam Quinones' second venture into the epidemic of drugs and death that began with the prescription opioid epidemic that grew under the national radar for so many years. I read Dreamland after hearing Quinones speak at a medical conference. While I felt like I knew a lot of the background of of Dreamland due to my employment in the workers' compensation industry (as a non-clinician), I nonetheless found it helpful in filling in my knowledge gaps. As more recent developments related to fentanyl and meth have greater involvement of street drugs, my knowledge is not as extensive. This book proved extremely helpful in bringing me up to speed.Quinones weaves individual stories of abuse, addiction, and enablement with analysis and additional tales that offer hope. While the book does offer stories of individuals and communities that are learning to respond helpfully to the crisis, many of the accounts are sad and tragic -- don't read this while depressed. Quinones does not flinch at the enormous toll of cheap, highly addictive, and harmful drugs on individuals, families and communities. He also does not flinch in placing much blame on the start of the pandemic (the prescription drug part) on pharmaceutical companies. He is rightly scathing with regard to the role of Oxycontin maker Purdue Pharmacy and the Sackler family in laying the groundwork for all that has followed.That said, there are heroes in this book. Interestingly, this is not a political work. Other than a brief mention of added resources made available via Obamacare, Quinones seems uninterested in what is happening in state or federal capitols. Instead, the heroes tend to be in communities where diverse groups of people realize what is happening around them and creatively begin to address them. Quinones never reveals his own political biases (he mentions the benefits of a capitalism reined in by a moral sense), but I would guess him to be center-left. This is interesting in that he goes out of his way to praise the work of political conservatives who get things right and make progress in this fight in their communities.Quinones also describes himself as a non-Christian, but again he goes out of his way to praise Christians and churches that are making positive efforts to help individuals and families. Much of the narrative takes place in Appalachia, where there are plenty of Christians and conservatives to talk about. That he finds helpful stories, perhaps from people that he disagrees with on other things, shows Quinones to be more interested in promoting solutions than tribes. I consider this to be a strength of the book.The author is on shakier ground when he extends the findings of neuroscience to reveal a widespread addiction problem across broad sectors of American life. Regardless of what one thinks about his conclusions in this area, the development of this narrative is not as well researched or compelling as the rest of the book.That weakness aside, this is a work that I will highly recommend to friends and colleagues. I have previously recommended Dreamland to anyone interested in this crisis, and The Least of Us stands as a worthy successor.

Excellent read and certainly an eye opener! I simply had to send a copy to my loved one. I hope they enjoyed it as much as I did!

This is an excellent follow-up to the book, Dreamland. Written in layman’s terms and from personal stories, this book expertly explains how the earlier opioid epidemic has evolved into the new synthetic P2P meth and fentanyl epidemics. The neuroscience (brain chemistry) of addiction was especially enlightening, presented in easy-to-read descriptions.Homelessness is a sad epidemic within the drug addiction epidemic and Sam Quinones brings it home to us in real-life human samples. I was shocked when I read, “We used to believe people needed to hit rock bottom before seeking treatment…” and that this addiction crisis takes people to a new low, often death. The new treatment methods Sam describes offer some hope, but lots of time and work.As a pharmacist, I saw the opioid addiction epidemic from a front-line viewpoint. Frustrated, disgusted, and often feeling helpless from the number of people I saw abusing the health care system and pain medications, I retired from practicing retail pharmacy in 2014 just as Vicodin was being made a Schedule II narcotic in Oregon, in an attempt to curb the raging overuse. This book explains how making a drug more difficult to legally obtain can backfire. When doctors cut patients off abruptly, desperate addicts who became dependent on prescription medication turn to seeking street drugs, often beginning with heroin and moving on to scarier synthetics.This is a must-read book for everyone—we all know someone who is addicted to drugs or has died from an overdose. There is hope if we all get involved.

Also terrifying. New drugs come in waves. Quinones analyzes the waves, what they’re made of and why Americans love them, can’t quit. Wonderfully done.

good intro into the opioid crisis in America