The Roots of the Opioid Epidemic: A Conversation With Sam Quinones

Strong Towns President and Founder Chuck Marohn is an avid reader, and every year, at the end of the year, Chuck publishes a short list of his favorite books of the year. The 2017 year-end list included a book called Dreamland by LA-based journalist Sam Quinones, about the rise of the American opioid epidemic. Recently, Chuck spotted Sam on social media describing himself as a fan of Strong Towns, and thought, “Can this be the same guy?” It was, and so for this week’s Strong Towns Podcast, we bring you a conversation between Chuck Marohn and Sam Quinones about the opioid crisis, and how it might relate to changes in the way we live in our cities and towns. A common theme between Strong Towns’s advocacy and Quinones’s work is the danger of seductive, simplistic solutions to complex problems. For us at Strong Towns, the complex problem is that of building a place that will have long-term, resilient value and prosperity. And the overly simple, purported miracle cures are everywhere—depending on who you talk to, it might be a freeway or a phony manufactured downtown or a convention center or self-driving cars or any number of other things. Growth itself as the solution to a city’s growing pains is another such miracle cure that, in practice, actually compounds our problems. In Quinones’s area of research, the complex problem is chronic pain. And the seductive, simple solution is, “Just pop another pill.” The opioid epidemic started in an innocent way, with narcotic painkillers prescribed to patients—including Chuck’s father—who really did benefit from them. Quinones says narcotics can be part of a healthy, holistic approach to pain management. But that this approach has given way, in a trend that started accelerating in the 1990s, to a societal obsession with pills. Quinones runs through the fascinating history of how we got to where we are today—a society in which the crime rate is as low as it’s been in decades, but the overdose death rate is at a record high. The history runs from a 1990s revolution in pharmaceutical marketing (a new generation of drug reps “didn’t know what they were selling, but they all knew how to sell it”), to the rise of “pill mills” in the mid-2000s, to the proliferation of heroin throughout places that had never had a heroin problem, where pain pill addicts were easy marks for dealers. How is all this related to our development pattern, Chuck wonders. Or is it? Quinones says he does think it’s connected to the isolation brought on by the way we build our cities. Increasingly in modern America, you buy a big house, you drive everywhere, and you don’t know your neighbors. People could more easily be slipping into addiction and not have anyone checking up on them—or a neighbor or other community member to go to and say, “Hey, I’m in trouble here.” The opioid epidemic, more than any prior one, has been driven by shame. Even in Quinones’s research, few people were willing to open up to him about their own families’ experiences with addiction. And yet, there’s a bright side. Because it’s local institutions that have to deal with the fallout of the opioid crisis, local solutions are beginning to proliferate. Quinones says an inspiring number and variety of groups are involved on the ground in constructive responses to addiction: the PTA, the Chamber of Commerce, the Kiwanis Club, drug counselors, law enforcement, and many more. The response crosses political and ideological boundaries, and is actually bringing communities together in ways that may help us learn to solve other problems, too. “This epidemic is really one of the great forces for change in America today. It’s a catastrophe, it’s a lacerating torment for thousands and thousands of families, but it’s pushing us beyond those silos, beyond those walls that we’ve constructed, to begin to learn again how to work together. And it’s happening mostly at the local level.” Sam Quinones shares his contact information at the end of the podcast. His website is http://www.samquinones.com/ . He has had the chance, since writing Dreamland, to speak with people and communities impacted by addiction, including “towns where no author ever goes. It’s a beautiful thing,” says Quinones. “You meet a lot of truly wonderful people.”