Fentanyl, Homeless Crisis
San Diego homeless encampment (left) and CBP officers seize fentanyl. Photo credit: Adapted by WhoWhatWhy from © Nelvin C. Cepeda/San Diego U-T via ZUMA Press Wire and CBP Photography.

Fentanyl, if left unchecked, is an almost certain death sentence for its users — and for America’s cities. A conversation with Sam Quinones.

On this week’s WhoWhatWhy podcast journalist and author Sam Quinones provides a stark examination of America’s escalating fentanyl crisis. Quinones, known for his award-winning books The Least of Us and Dreamland, delves into the unprecedented challenges posed by potent synthetic drugs, the exacerbating role of homelessness, and the systemic failures that have allowed the crisis to spiral out of control.

Quinones argues that the current approach to drug addiction — waiting for users to volunteer for treatment — is hopelessly outdated. He emphasizes that the crisis extends beyond individual addicts; it impacts communities, cities, and the very fabric of our society. The relentless supply of these potent synthetic drugs, he suggests, is creating a new high tide of drugs, eroding the quality of life in many cities and making all citizens potential victims.

The potency of synthetic drugs, particularly fentanyl and methamphetamine, is transforming the drug landscape, leading to increased mental illness and symptoms of schizophrenia. Quinones suggests that the abundant supply of these drugs is a major driver of the homelessness problem. They not only contribute to making some people homeless, but also, regardless of the original cause of homelessness, their availability tends to perpetuate the condition.

Quinones challenges the notion of “minor” drug possession cases, arguing that a person with a piece of foil, a straw, and a pill containing fentanyl is not the same as someone with a baggie of marijuana 20 years ago. The person with fentanyl, he says, is on the brink of self-destruction, highlighting the severity of the current crisis.

He also touches on the concept of “safe injection sites,” implying that the very concept of “safe” needs to be questioned in light of the deadly drugs now easily available on the street. 

 Contending that these potent substances change everything we’ve ever thought about the “drug problem,” Quinones calls for an innovative rethinking of our approach to drug addiction and treatment.

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Full Text Transcript:

(As a service to our readers, we provide transcripts with our podcasts. We try to ensure that these transcripts do not include errors. However, due to a constraint of resources, we are not always able to proofread them as closely as we would like and hope that you will excuse any errors that slipped through.)

Jeff Schechtman: Welcome to the WhoWhatWhy podcast. I’m your host, Jeff Schechtman. We are living in a time of crisis on our streets that’s unlike any we’ve ever seen before. A crisis that’s not only affecting those in the grip of addiction, but also rippling out impacting our communities, our cities and our collective quality of life. This is a crisis fueled by powerful synthetic drugs exacerbated by homelessness and magnified by its sheer scope.

My guest, Sam Quinones, a seasoned journalist and author of the award-winning books, The Least of Us and Dreamland, has been on the ground witnessing firsthand, the evolution of this crisis and the systemic failures that have allowed it to spiral out of control. In his recent article in The Atlantic, he argues that our current approach to drug addiction, which leans towards tolerance until users volunteer for treatment is failing. But this is not just about addicts. This is about our communities, our cities, and the very fabric of our society. The ever-increasing scope of this crisis is eroding the quality of life in many of our cities. The addicts and the users are not the only victims, we all are.

And here’s the thing, we can’t solve 21st century problems with a 20th century mindset. The power of these drugs and the changing times call for solutions that may have never been tried before. The old ways will not work. The old sympathies don’t solve the problems. And it’s time for a new approach. And today, we’re going to talk about this uncharted territory of America’s drug addiction crisis with Sam Quinones. It is my pleasure to welcome Sam back to the WhoWhatWhy podcast. Sam, thanks so much for joining us.

Sam Quinones: Great to be with you again, Jeff. Thanks very much.

Jeff: Well, it is indeed great to have you here. Before we talk about solutions and how we got here, talk for a bit. And you and I’ve talked a little bit about this in the past with respect to The Least of Us. Talk a little bit about these drugs, how powerful they are, and why it really changes the whole landscape of this conversation.

Sam: Sure. And I think that is the crucial point, that what we see now are two drugs, synthetic drugs made only with chemicals, no plants involved, being produced in quantities that are really unprecedented. Both of these drugs are now effectively nationwide, produced almost entirely by the Mexican trafficking world, mostly on the western side of Mexico. Fentanyl and methamphetamine are some of the two most powerful drugs we’ve ever seen. Certainly fentanyl is the deadliest we’ve ever seen on our street. Methamphetamine in the potency that it’s being made is transforming the drug world into places of just rife mental illness and symptoms of schizophrenia, that are really scary to behold.

All of this, I think, is a function of supply and the ability of traffickers in Mexico to produce the quantities that they are producing now. And that is made possible largely because they have access to several shipping ports, which they control enough to get almost unlimited access to ingredients, chemical ingredients from the world chemical markets, mostly from China. They come in through these ports, in shipping ports, but also the airport of Mexico City, where you get quantities of these ingredients that allow them to make these drugs all year round, and in the quantities that we’re seeing now, and also in the potency that we’re seeing now.

And because the supply is so unrelenting. It’s really kind of a new high tide of drugs. What you’re also finding is that in some cases, and certainly in the case of methamphetamine, I think, by and large, the meth is not being cut to any substantial degree because drug dealers on the street know that they can get it anywhere. There’s no need to cut it to extend the life of the supply that you have, because they can get it pretty much anywhere. So you’re finding enormous problems connected with the lethality of fentanyl, the mind-mangling nature of methamphetamine.

Of course, this is also reflecting, as you said, a little bit ago, in our …. These are major drivers, our homeless problem, our mental illness problem. They very clearly tend to make some people homeless, but the bigger problem probably is that no matter what the reason is that you’re homeless, the supplies of these drugs are so, so plentiful that they serve to keep you homeless no matter what their original reason was that you wound up on the street.

Jeff: And the nature of this is such that the normal response of compassion, of harm reduction, really just doesn’t address the depth of how powerful these drugs are.

Sam: I think one of the reasons for that is because the drugs themselves do a masterful job of what most drugs of abuse do, which is to blunt or squelch or redirect or hijack our basic instincts for self-preservation. So you still find people on the street. Tent encampment is a perfect example of this, I think, frankly, where you’re finding people living in squalor, filth, in a horrible daily violence, and yet, over and over, outreach workers, public health folks, cops, paramedics will tell you, the folks routinely refuse treatment, they refuse housing.

And therefore, what it means is that when they do that, our natural tendency is, “Well, they’re not ready for treatment.” The problem is, with these drugs on the street, it really defies logic to think that folks will find readiness for treatment on the street before the meth drives them mad, and fentanyl kills them. That’s the crucial thing. So waiting for people to develop a readiness for treatment on the street is a very, very dicey proposition and frequently leads to — life and death basically. The rock bottom now is death. And so what this is really calling on us to do is to rethink this because these drugs change everything.

As I was saying on the streets, fentanyl changes everything, I think the same is true, frankly, of the supplies of potent meth that we’re seeing on the street as well. They change everything. Everything we ever thought about drug smuggling and profit, but also use, addiction, overdose treatment, et cetera, we have to rethink a lot of this stuff, because these drugs are not like any others we’ve ever seen on our streets.

And I do believe that there’s no such thing now as a minor drug possession case. When you have a person who’s got a piece of foil and a straw and a pill containing fentanyl, that’s not the same as a baggie of marijuana 20 years ago. That person is about to kill himself. And that’s, again, why I think we need to really rethink a lot of this stuff and come up with some new ideas.

Jeff: And when we talk about things like safe injection sites in the context of what you’re talking about, there’s a certain absurdity to it, it seems.

Sam: Well, I have not studied them enough to give them my reporter’s, not opinion, but data on what I’ve found. I will say this, one of the problems with fentanyl that calls into question the effectiveness of those sites, is that fentanyl is, first of all, it’s great anesthetic, used in operating rooms for 60,70 years, very, very effectively a wonderful, wonderful surgical drug. One of the reasons it’s so good is because it takes you in and out of anesthesia very quickly, and so you boom, you’re in, then you’re out, and so you’re not doped up for hours, like with morphine.

But that’s the problem of fentanyl when it comes to the street, because now on the street, as a user, you’re having to use over and over again all day long to keep the withdrawal symptoms away. Unlike heroin, which, if you’re using twice, three times a day, now suddenly, you have to use six, seven, eight times a day. What that means is that you have to live near the safe injection site as you develop your tolerance for fentanyl. You are going in there over and over and over again.

The other problem that I think those sites have, and again, I’m not necessarily saying that we shouldn’t try them. I’m just saying that it seems to me that fentanyl, again, requires us to rethink some of these ideas. And one of the other things, I think, is to suggest that because we have revived someone with naloxone, the antidote to opioid overdose while we’re in a site or because we have allowed them to use without dying from fentanyl, but that means we’ve saved their lives. And that is not the case. You have revived them. You are saving their life temporarily.

On the other hand, the longer those people continue to use fentanyl, there’s a saying on the street, too, that there’s no such thing as a long-term fentanyl addict. They’re all going to die. So the crucial issue is how can we use those sites to not just allow them to continue to use, but to find ways of … with some fairly rapidly getting them into treatment somewhere and treatment where they probably can’t leave because very quickly, as soon as they’re in treatment, the cravings are so intense that frequently people bolt and leave. Now, there are ways of preventing that, but I think that these are a couple of the ideas that make safe injection sites something that we have to, again, do some careful thinking about.

Jeff: And one of the things that you talk about in The Atlantic piece, and we’re starting to see it a little bit in San Francisco, and it’s been tried in some other cities that you talk about, is using law enforcement, using our jails as part of the process. Talk about that.

Sam: Well, first of all, let me say this, that law enforcement should always be a part of this solution. We got away from that largely because we thought, well, the drug war didn’t work, and so therefore, law enforcement has no role to play when it comes to drug addiction, drug treatment, et cetera, et cetera, all that. And my response to that is that seems crazy, because the reason we had trouble with the drug war and law enforces is not because we use law enforcers, it’s because we only use law enforcement. I believe that an appropriate response to addiction, particularly the way it’s ravaging our communities now, is an entire community response.

That there is no part of the community that says, “Well, we should be sidelined.” And certainly, without a doubt, not law enforcement. They have a crucial role in many ways. But one of the things that I think fentanyl and meth and these potent supplies, unrelenting supplies we’re seeing now, makes a requirement of is that we use the time in jail better. In fact, jail is showing in other parts of the country, not so much in California, I would say, or the West Coast, but we’re still getting over this aversion of the law enforcement, which I think we would very quickly be healthy to do in this issue.

But in other parts of the country, in the Midwest, where they’ve been active a lot longer with regard to the opiate epidemic, you’re seeing experiments with using jail as a place of recovery. So what happens then is that people get into jail, arrested. You have to use arrest. Yes, absolutely, you have to use arrest. While they’re there, they detox. That means they get a break from the drug. They get the drug out of their system. And what happens sometimes slowly, sometimes a little bit more quickly, but it takes some time, and it’s no doubt, is that people begin to think more clearly. So the readiness for treatment can more easily be developed when you’re away from the dope for a while.

And that’s what you see happening in a lot in these jails where people where they’re trying new things. And this is an experimental thing. It’s been only, I’d say, six, eight years old that the jails I’m aware of have been doing this. But once you do that, see, jail provides that essential thing. It’s a place where you can go to get away from the street, yet you cannot leave once the dope tells you that you absolutely must. You get over a couple of those humps. You get a brain clearing, a brain healing, a brain defogging. And then all of a sudden, people view their lives a little bit more differently, and they view the wreckage of what they’ve created of their lives. And then the growth and readiness for treatment.

And then a lot of these jails have been creating recovery pods, pods where people are all about their recovery. So you’re waking up in the morning, eight in the morning, you’re making your bed, you’re in classes most of the day, you are in a 12-Step meetings. There’s social workers signing you for Medicaid so you have health insurance. Once you leave, there’s actually a jail that spends a lot of time preparing people for what happens when they actually leave, which is a radical idea. Most jails have not, in my experience, done much thinking about that at all. There’s the pods that are governed by very strict rules of accountability. So there’s no drugs.

And many jails are drugs are fairly commonly. But in these pods, it’s not the case. They sign people up for medically assisted treatment, the medicine that can help people overcome the cravings that accompanies opioid overdose, particularly when we get out on the street. And then, very importantly, I think, in all of this, there is a continuum of care on the outside that has developed, certainly in the county that I read about in the piece, and I’ve written about in my book, The Least of Us, in Kentucky, where you have a whole array of services available on the outside once somebody leaves.

Again, the idea that a jail should be preparing some thinking about how to make it easier for that person to succeed once that person leaves jail is a radical idea for America. But the thing is that the drugs are now making this almost a requirement. I began following the jail in Kenton County about seven, eight years ago when it first opened, and I thought, “That’s a good idea. That’s great. I’ll continue to follow it, see how it goes.” Now with fentanyl and meth on the streets, I think it’s an essential idea because you need some place to go to get away from it, so you can break from it, so you can reset your life. And jail, we’ve never treated jail like this, but jails in the Midwest are actually showing that this is what can happen.

Jeff: One of the issues that we’re hearing already in San Francisco where there has been some effort to begin to arrest not only the dealers, but the addict themselves is the Civil Liberties issue.

Sam: I think there’s a valid concern when it comes to that. I would say, though, that, first of all, when it comes to people who are dealing fentanyl … when it comes to addict on the street, that’s one thing. But when it comes to people dealing fentanyl, and almost everybody’s dealing fentanyl, whether they know it or not, you say is, I think that is a no-brainer. You have to arrest those people. You have to make sure that they are not — this is a substance that is very much selling fentanyl, is very much akin to firing a gun into a crack. You know you’re going to hurt somebody when you do it. You know what you’re doing is going to hurt somebody.

You know there’s fentanyl in what you’re selling, and you’re most likely will kill somebody. And to me, that does not smack of a misdemeanor. It feels very much more serious than that. And that the problem is that once people understand that you’re not taking that seriously, and I think this is the case in some cities, maybe in San Francisco for a while, where you are finding people are saying, “Well, nothing’s going to happen to me.” Well, that breeds more people who believe, “Yes, I’ll go get in that business because nothing is going to happen to me.”

The other point, though, is that frequently people are selling to support their own habits. Those are exactly the people who are doing this extraordinarily risky behavior to support their own — those are exactly the kind of people that may benefit from being off the street and being in treatment and being a place where they can’t go. I mean, those people are going to die. So either way you look at it, the sale of fentanyl is, to me, hard to make the argument you should ever treat it as a minor thing.

Again, there’s no such thing anymore with fentanyl and meth on the street. I don’t believe there’s any such thing really as a minor drug charge, because it’s all going to damage people’s brains, perhaps irreparably, but certainly semi-permanently with methamphetamine nowadays. But then also with fentanyl, that’s going to kill them. And so it’s hard to make the argument that somehow we should be treating this as a minor thing. It’s not. Every sale of fentanyl is a major, I think, criminal event.

Jeff: And when you hear talk about decriminalization of all of this, talk about your reaction to that and why you think it is so misguided.

Sam: Well, I think decriminalization comes from a good place. It comes from this idea like, this is a libertarian idea. And there’s a certain amount of that I agree with. The problem is that when you decriminalize drugs that are this potent and this prevalent, again, as I say, it’s a new high tide of drugs, not a wave of drugs, a new high tide of these things, where they’re almost, in the case of methamphetamine, virtually free in many, many cases.

I was listening to a video where I was saying, I don’t know what it costs anymore because it’s free. For me, I get it free, almost. It takes understanding of brain chemistry, it seems to me to understand why decriminalizing the sale of these drugs is a really, really bad idea. You need some kind of protection. People, they are too addictive, they are too overwhelming to our brain chemistry. And also, the more you allow it to be decriminalized in fact or in practice, again, the more supply. This is about supply creating demand. This is not about demand creating supply. Supply is what creates this, and then you get the demand that follows, and after that’s a cycle.

And so the idea that somehow we can treat our way out of it without dealing with the issue of supply is, first of all, an enormous, enormous task that I don’t believe we have either budget or political will for, number one. But also, those drugs will continue to create demand. And so we will be in this treadmill that we’ll never get off of. I think we really need to understand that we have to say, “Selling these drugs, these two in particular is simply beyond the pay.” We cannot have people doing that. And when we begin to do that, then all of a sudden, supply reduction is harm reduction. So you get fewer people out there with access to it, that is a good thing.

There are other things that must be done. This is not the only — I’m not trying to say this is the only thing we need to do. There’s a whole community response. As I said, we’ve gone through periods where we’ve only used one response to an immensely complex thing that originates in the brain chemistry of each individual. And trying one response to any of this is a problem. But that’s my point that we’ve got these other aspects of our community that we have sidelined because we think, “Oh, the drug war was bad.” Well, no, drug war, to the extent it didn’t work, not because we tried law enforcement, used law enforcement, but as I said, because we only tried law enforcement or used law enforcement. There are many tools that we need to use them all. And without a doubt, law enforcement is very near the top, in fact, but not alone.

Jeff: Why has it been so difficult, in your opinion, to make those that did argue for compassion and that make the compassion argument, why has it been so difficult to get them to understand how awful these drugs are, as you’ve been explaining?

Sam: I’m willing to be well-intentioned about this and understand that people have different perspectives and they come from different parts of life and they’ve seen certain things. And there’s a lot of reasons why you might look at the drug war and say, “Yes, that’s bad. So we should never go anywhere near that ever again.” I think in its worst forms, what you’re describing, there’s a lot of very well-intentioned people, very compassionate people. And I don’t mean to be not interested in sitting up here and passing judgment like this. On the other hand, there are people, I think, who do get a lot of their own self-worth from feeling that they are doing the noble thing, the compassionate thing.

And the ideas that are being tried now are ideas that were really formulated before fentanyl and meth took over in the potency and the prevalence with which we now find among the streets of America. So again, this is something I believe that we really need to rethink because the drugs have changed in ways that we did not imagine and we’ve never seen before. So it’s hard for me, too, I have to say, to look at us treating a tent encampment, rather a street community of drug users and say, that’s a compassionate idea that those folks be allowed to live on the street.

I believe the tent encampments now, it’s my hunch, let’s say, the tent encampments have become part of the problem because people refuse treatment in those tent encampments because they know they have a community where everybody knows their nickname, and they can get their dope pretty easily. And so why leave that? It’s a good feeling to be in part of that. But then, of course, the effect is to leave people in a situation of utter squalor, frequently women pimped out, a lot of violence, a lot of public health disaster for the community at large, not to mention a very inviting place for people to get involved in a wide range of criminal activity.

Jeff: The other question is whether or not we even have the jail capacity in some of our cities today to deal with this.

Sam: Well, here’s the thing. We may not. But the point is not to say, but because we don’t have that, let’s just not try anything. I think the idea is that once you begin to try new ways of doing things that other counties have actually shown work, that then you begin to nibble away at the problem, and the problem becomes more manageable as jail becomes a place of positive, productive progress. Then all of a sudden it takes away from some of the negativity, perhaps, that it was creating by simply being a place where people go to vegetate. Because truthfully, jails in America for about forever, really, I think, have been a symbol of the throw-away-the-key idea.

Just throw them there, and they vegetate for nine months, and then forget about it. And then they leave and they go off and they do their thing, and they come back six months later and go, you again. But once it stops being so much that, at least for some people, little by little by little, problems become more manageable. People come, which they found in some of these counties, is that people come out of the woodwork to be a volunteer because they see something as being part of a solution rather than right now, “Why should I do anything? Nothing’s working.” Well, maybe this might work. So maybe I’ll try doing this.

This is absolutely what’s happened in the counties that I’ve been to. And certainly the county in Kentucky that I’ve written so much about. You have people who are adding their energies and their talents that were not known. They were part of the society not doing any of that. But now they see that maybe jail is actually a good part of the solution. Let’s try that. That’s not a bad idea. So the little steps, it doesn’t matter if you have 10 beds in the jail that is trying this. It’s the little steps that add up that matter in the long run. Not trying it, but the real damaging thing would be to say, “Well, we can’t do anything. So even though we only have — why try with 10 beds? What’s the point of that?”

Well, the point of that is very, very important. You begin to do that, and little by little by little, people see that this can work. And, of course, this is an experiment. People are trying ideas, some things work, some things don’t work. It’s not that anyone has a monopoly on these new ideas. Everyone’s trying to figure it all out. The point is, though, the larger point that I was trying to make in that story is that we don’t get anywhere as long as we say certain things we’re not going to try because we think they didn’t work in the past.

In fact, they did work to some degree, but the problem was we used, as I said with law enforcement, we used only law enforcement, and you should never use only one thing when you’re dealing with issues developed in our very, very complex and very individualized, obviously, brain chemistry.

Jeff: And finally, Sam, how do you see this playing out? I mean, even to the extent that we do this experimentation and we have some success with it, we’re not having a whole lot of success on the interdiction front. There is, as you said at the very outset of this conversation, a supply that keeps growing and growing and growing. Where does this go?

Sam: Well, that is a problem. I guess I come down on the idea that we try things and we keep trying them and we don’t let a failure get us down. We don’t let that be a setback. And I see people across the country doing this, by the way. You can try or you can fail. You can try or you can give up. And I think there’s a lot of Americans out there that are not giving up. And I think in the long run, that’s how you win. It seems very daunting. I completely agree with you, but the worst would be to give up, you throw up your hands and say, “Oh, well, there’s no point to any of this.”

I think that’s what we did with our gun issue. “No, there’s nothing we can do about these assault weapons.” It’s, “Oh, my God, you can’t do anything. So we’re not going to try anything.” And I think that it’s the small steps that get us there. It’s childish and completely unrealistic to think that, well, we’ve got one solution or a few solutions, and they alone will solve the problem and everything else, we shouldn’t even try.

I just think that’s crazy, but that’s where we are in a lot of cities in America, frankly, where we’re saying, “Well, no, jail has no role, arrest has no role.” Even when people are selling a poison, that will absolutely kill most of the people who use it immediately or within very quickly, and in the long run, it’ll kill everybody who uses it. They, “Well, forget it. We should not. Nothing could be done. What can we do?” I think that’s a damaging idea.

And again, it gets back to the whole idea of this has got to be a community response and to say that something as fundamental and as absolutely powerful as law enforcement should not be used or should be sidelined, I just think that’s part of the problem and that’s crazy. That is a huge institution that absolutely has to be employed in many, many ways that we’re not using it now.

Jeff: Sam Quinones, his article currently appears in The Atlantic. His book is The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam, I thank you so very much for spending time with us here today on The WhoWhatWhy podcast.

Sam: I appreciate the interest, Jeff, thank you.

Jeff: Thank you. And thank you for listening and joining us here on the WhoWhatWhy podcast. I hope you join us next week for another Radio WhoWhatWhy podcast. I’m Jeff Schechtman. If you liked this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to


  • Jeff Schechtman

    Jeff Schechtman’s career spans movies, radio stations and podcasts. After spending twenty-five years in the motion picture industry as a producer and executive, he immersed himself in journalism, radio, and more recently the world of podcasts. To date he has conducted over ten-thousand interviews with authors, journalists, and thought leaders. Since March of 2015, he has conducted over 315 podcasts for

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