The 21st Show

Best of: Sam Quinones on the origins of the opioid and fentanyl crisis

Sam Quinones is the author of

Sam Quinones is the author of "Dreamland" and "The Least of Us." Provided by author

All this week, we are focusing our program on the drug known as fentanyl. It’s an opioid — meaning it locks on to parts of the brain, dulls pain, and creates a feeling of euphoria. It’s kind of like heroin, but instead of being grown in the ground, it’s made in labs. It’s also orders of magnitude more potent than heroin — and thus even tiny amounts can lead to overdose and death.

If you or someone you know is suffering from a substance use disorder, call 1-833-2FINDHELP (1-833-234-6343), text "HELP" to 833234, or visit

We’re seeing well more than a hundred thousand Americans dying from overdose every year. In fact it’s the leading cause of death for people between the ages of 18 and 45.

  • Today’s show will be an overview of the fentanyl crisis.
  • On Tuesday, we’ll talk with people who’ve experienced addiction themselves, and now help others get treatment for this disease.
  • Wednesday will focus on the politics of fentanyl — including competing views on how best to prevent this incredible level of death.
  • Thursday will focus on different solutions people are trying — from what governments are doing with billions of dollars in opioid settlement money, to attempts to reach people one-by-one in hospital emergency departments.
  • Finally, on Friday, we’ll probe how best to talk to our young people about drugs — moving beyond the “just say no” campaigns many of us grew up with.

We begin with the writer and journalist Sam Quinones. He's been covering the opiod crisis for well more than a decade, and has written two books on the subject. First was “Dreamland: The True Tale of America’s Opiate Epidemic.” It won the National Book Critics Circle Award for 2015. He followed up in 2021 with “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.” It’s a kaleidoscopic book, moving among orderly Belgian pharmaceutical labs, a Mexican prison, and Chinese government conference rooms … all while remaining grounded in the deep pain of countless families across the United States.


Sam Quinones
The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth (2021)
Dreamland: The True Tale of America’s Opiate Epidemic (2015)

A version of this conversation originally aired on January 8, 2024.