The Least of Us is Sam Quinones' second venture into the crisis 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 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.
