“In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain. But man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.”

This was extremely informative, and I should have read it sooner. More info and developments have come out about the opioid epidemic since this book was published in 2015, but this book itself won’t ever really be dated, because what he did here was to investigate its origins. No matter what happens down the road, this will always be how it started. (I’ve heard that Empire of Pain is a good follow up, but I don’t know if I have the emotional fortitude to tackle it anytime soon.)

Quinones tracks how various circumstances and choices collided in both the medical world and the drug world to make the perfect Venn diagram of how to make lots of people addicted to and die from opioid overdoses. It’s a lot to get into, obviously, because there’s a whole book about it, so I’m not even going to try. But Quinones lays it out very clearly, with lots of short chapters for easy digestion. He covers the medical thinking behind using opioids to treat pain, the emergence of predatory pain clinics, how a single out of context letter to a medical journal (not even a study) changed how doctors prescribed these drugs for years after, and how essentially a small town in Mexico spread the sale of black tar heroin throughout the United States, even to Hawaii. It’s medical nonfiction, true crime, and human interest all in one, an d it’s a really nice piece of investigative journalism. It’s also extremely disheartening.

Highly recommended if you are looking for a good place to learn about this topic.

Read Harder Challenge 2021: Read a work of investigative nonfiction by an author of color.