The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth

Sam Quinones writes in this 2021 book:

* The spread of this meth provoked homelessness across the country. Homeless encampments of meth users appeared in rural towns—“They’re almost like villages,” one Indiana counselor said. In the West, large tent encampments formed, populated by people made frantic by unseen demons in Skid Row in Los Angeles, Sunnyslope in Phoenix, the tunnels in Las Vegas. This methamphetamine, meanwhile, prompted strange obsessions—with bicycles, with flashlights, and with hoarding junk. In each of these places, it seemed mental illness was the problem. It was, but so much of it was induced by the new meth.
Fentanyl and this new meth were in the interest of traffickers, not their customers. Traffickers had unlimited access to world chemical markets, and the population of American drug users had expanded coast to coast. These drugs could be made year-round, in greater quantities, cheaper and more addictive than anything grown from the ground, and thus could create or shift demand.
Their meth and fentanyl ended the notion of recreational drug use. Now anything could kill or mentally maim. What started as an epidemic of opiate addiction became, as I traveled, simply an epidemic of addiction, broadened by staggering supplies of corrosive synthetic dope.

* Isolation is part of why some people get addicted and some do not. So was trauma. Abuse, rape, neglect, PTSD, a parent’s drug use were as unspoken in America as addiction and as prevalent. The epidemic was revealing this. I also connected the epidemic to consumer marketing of legal addictive stuffs: sugar, video games, social media, gambling.

* Drugs and other addictive substances increase dopamine while reducing serotonin. Desire overwhelms moderation and contentment. This may be why addicts so often suffer from depression—they’re producing less serotonin to promote contentment. It’s why, Robert Lustig said in one lecture, “the more pleasure you seek, the more unhappy you get.”
The reward pathway, finally, stands in opposition to another part of the brain that is also about moderating our me-first impulses: the prefrontal cortex. The prefrontal cortex is just behind the forehead. It is in charge of executive decisions: planning for the future, reining in impulses, delaying gratification, considering others, and learning from mistakes. It connects to the brain’s system of emotion and pleasure, acting as a brake on impulsivity. (Its connection to our system of processing emotion is why, neuroscientists neuroscientists believe, we take pleasure from solving problems.) When the reward pathway demands actions that feel pleasurable, the prefrontal cortex assesses their consequences. It develops many years after the reward pathway, which is there from birth. Before the prefrontal cortex is fully formed—in a teenager, for example—the reward pathway dominates the brain and governs behavior. Hence the me-first immaturity associated with teens.
Our brains have evolved so that when our nucleus accumbens sends signals that our survival is at risk, the prefrontal cortex is muted. This allows us split-second action to avoid immediate danger, without any backtalk from the prefrontal cortex.
Drugs take over that function. They shut down the prefrontal cortex.

* The social media giant’s algorithms are programmed to keep us engaged, which is best achieved through provoking strong emotion—especially outrage. Outrage is intoxicating. Our brains evolved to feel outrage at the transgressions of someone in our group. It was essential to survival. Enforcing social norms, correcting the misbehavior of others also made us feel noble. “When people decide to punish somebody who has behaved unfairly, we see activation in brain areas associated with reward,” Molly Crockett, a Yale University psychologist, told the podcast Hidden Brain . “There’s a visceral satisfaction in doling out punishment.”
Left unchecked, the brain’s reward system for moral indignation leads to the Spanish Inquisition, to witch trials—and to what goes on daily on Facebook and Twitter. Outrage keeps us engaged better than almost anything. This engagement allows social media apps to sell more ads, fueling their bottom line. In priming our natural outrage, an impulse that evolved to keep us alive, social media apps have us tearing each other apart. Like dope dealers—just peddling outrage.
Social media, moreover, ignites feelings of social activism, as if with every Like and Retweet we’re changing minds and the world. Instead, tweeting and Facebook likes are to social activism what heroin, meth, and other drugs are to happiness. Both are easily achieved with little lasting effect.
“Lies are more engaging online than truth,” said Yaël Eisenstat, former diplomat and CIA analyst, in a TED talk. She had worked for Facebook for six months, hoping to change it. “As long as [Facebook] algorithms’ goals are to keep us engaged, they will continue to feed us the poison that plays to our worst instincts and human weaknesses.”
Maybe, then, our mass-marketing society primes us for addiction—like those sugar-dependent rats at Princeton. Marketers understand that all of us are, or can be, addicted to their products. The brain chemistry of every one of us can be manipulated to that end. Indeed, perhaps, for the first time in human history, we are all addicted, to one thing or another.
If so, then Mexican drug traffickers and drug companies today take their place alongside video-game and fast-food engineers, soft-drink companies, developers of Facebook and TikTok, tobacco and liquor companies, pornographers, cell-phone designers, and gambling moguls, alongside Fox News, CNN, and Russian hackers that prod us to outrage, QAnon conspiracies, cancel culture, virtue signaling, and the glow of belonging to one tribe or the other.

^ In 2018, when the Los Angeles Times reported that “L.A.’s Homelessness Surged 75% in Six Years,” this made a lot of sense to Eric Barrera. Those were exactly the years when supplies of Mexican “weirdo” meth really got out of hand. “It all began to change in 2009 and got worse after that,” he told me as we walked through a homeless encampment in Echo Park, west of downtown Los Angeles. “The way I saw myself deteriorating, tripping out and ending up homeless, that’s what I see out here. They’re hallucinating, talking to themselves. Now, it’s people on the street screaming. Terrified by paranoia. These are people who had normal lives.”

* Will Pfefferman makes his bed every day.
He yanks the sheet drum-tight across his king-size mattress. He fluffs the pillows just right, throws the bedspread over them, and pulls it tight, too, leaving it wrinkle-free. Then he’s ready for the day.
The importance of this exercise was made clear to him not long before I met him, after he’d seen his buddy Mike on the street. Mike was a recovering addict Will met when Will was rehabbing from heroin in a treatment center in the Northern Kentucky town of Covington, near where Pfefferman grew up. Mike had visited the center to talk about his own recovery from dope. Now, though, Mike was shooting up again.
What happened? Pfefferman asked him.
“I quit making my bed,” Mike told him. With that, Mike said, his discipline frayed, and he began to slouch in other parts of his life as well, until he was back on the streets. “He quit answering his door and his phone and quit making his bed,” Will told me. “He didn’t want to be bothered. He died a few days ago.”

* On Skid Row in Los Angeles, crack had been the drug for decades. Dislodging it took some time. But by 2014 the new meth was everywhere. When that happened, “it seemed that people were losing their minds faster,” Los Angeles Police Department beat officer Deon Joseph told me. Joseph had worked Skid Row for twenty-two years. “They’d be okay when they were just using crack,” he told me. “Then in 2014, with meth, all of a sudden they became mentally ill. They deteriorated into mental illness faster than I ever saw with crack cocaine.”
Dr. Susan Partovi has been a physician for the homeless in Los Angeles since 2003. She noticed increasing mental illness at her Skid Row clinic s around the city starting about 2012; schizophrenia and bipolar disorder, which typically afflict the young, were showing up in people in their forties and fifties, too. She also worked at the L.A. County women’s jail, treating women in their thirties for meth-induced heart failure. On Skid Row by 2014, meth was everywhere. “It was crazy how many severely mentally ill people were out there,” Partovi told me. “Now almost everyone we see when we do homeless outreach [on the streets] is on meth. Meth may now be causing long-term psychosis, similar to schizophrenia, [that lasts] even after they’re not using anymore.”

* The new meth has also promoted hoarding, which is why so many homeless encampments are filled with seemingly purposeless junk.

* On the Sunday morning of Thanksgiving weekend of 2020, the sun breaks sharply across the cloudless blue sky over tent encampments dotting the areas around some of the best-known streets of Los Angeles—Hollywood, Sunset, and Santa Monica boulevards.
For all its beauty, its weather, and its wealth, Los Angeles is also the nation’s homeless capital. It’s been so for years. But homelessness is different now—more prolific, more stationary, less transient. Much of it now is rooted in the voluminous supplies of meth that Mexican traffickers’ switch to the P2P method made possible. As that happened, another change was taking place that made the drug even more damaging, at least in Los Angeles.
Tents. They protect many homeless people from the elements. But they have another, far less benevolent role. Tents and the new meth seem made for each other. With a tent, the user could retreat not just mentally from the world but physically. Tents often became pods of exploitation where people used dope, sold dope, or performed acts that allowed them to procure it.
In Los Angeles, the city’s unwillingness, or inability under judicial rulings, to remove the tents has allowed them to stay for weeks, sometimes months. Encampments resembled Third World shantytowns. The tents went from gifts of compassion to hives of crime, addiction, disease—and now pimping.
Just as Airbnb allows anyone with a house to run a hotel, anybody with a tent can start up a sidewalk bordello. No need for a motel room or an apartment. A pimp just needs a woman he can control. Plentiful methamphetamine achieves that goal. Its effects created a woman sufficiently numb and removed from reality to do tricks in a tent on the sidewalk.
In Los Angeles, transgender women proved particularly vulnerable. They came from other parts of the country looking for surgery, therapy, drugs, stardom. They came friendless, lost, pretty, and young, and often without family to return to. A meth-addicted transgender woman was thus easier than most to control.

* As an outreach worker, though, Eric walked among others—the visible homeless, the addicts living in encampments along freeways, taking up entire sidewalks. In L.A. County, this was well over half the unhoused population. Drugs turned their brains against them, had them abandon any survival instinct in the pursuit of dope. Their very visibility was an expression of their addiction, of what meth did to the prefrontal cortex and the locus coeruleus. So often this meth rendered them impossible to live with, incapable of simple life responsibilities. They rebelled against following rules and thus refused, were thrown out of shelters. They were utterly unwilling to seek treatment. Above all, he thought, it made them not care. He had felt this as well. On the new meth, “I remember wanting to care, but I couldn’t,” he said.
The encampments seemed to him to be enabling communities, places where meth addicts felt at home because there they could find camaraderie and dope together, they could feel the warm approval of others relenting to it as well—they could not care. There, he said, “nobody’s going to look at you weird.”
When asked how many of the people he met in those encampments had lost housing due to high rents or health insurance, Eric could not remember one. Meth was the reason they were there and couldn’t leave. Of the hundred or so vets he had brought out of the encampments and into housing, all but three returned. Eric grew weary of wanting recovery for the people he met more than they wanted it for themselves. Such was the pull. Some were addicted to other things: crack or heroin, alcohol or gambling. Most of them used any drug available.

* Yesteryear’s myths about illegal drugs are coming true, largely due to their prohibition and lack of regulation. One hit of “heroin” has killed many people; so, too, has a line of coke. Meth does turn people mentally ill. Pot sends people to emergency rooms with psychotic episodes.

About Luke Ford

I've written five books (see My work has been noted in the New York Times, the Los Angeles Times, and 60 Minutes. I teach Alexander Technique in Beverly Hills (
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