Before writing his latest book "Dreamland: The True Tale of America's Opiate Epidemic," Sam Quinones spent a lot of time writing about a place he later found out had a lot to do with the problem: Mexico.
Quinones, the featured speaker for West Virginia University's David C. Hardesty Jr. Festival of Ideas this year, was a freelance writer there from 1994 until 2004, focusing on small-town life and immigration.
He came back to the United States in 2004 to work for the LA Times, where he was assigned to write about the success of Mexican drug traffickers in the United States.
"I really backed into this story," Quinones said of the opiate epidemic. "I do not start with the pills, I started with heroin. My question was why were the heroin traffickers doing such big business in America today from Mexico."
A former crime reporter, Quinones was baffled by the rise in heroin use, which he thought was passe. Yet figures from the Drug Enforcement Administration indicated more and more of it was seized at the border every year.
He found out about a "revolution" in pain management that the United States had gone through while he was in Mexico. The revolution was an attitude that the United States was a "country in pain," he said, and that the only way to fix that was prescription drugs.
"These pills just happen to contain synthetic drugs, mostly oxycodone and hydrocondone that are molecularly very similar - they're narcotic pain killers like heroin and morphine is," Quinones said.
Quinones said he wasn't surprised to hear of a small, working-class Mexican town where people grow up to be heroin traffickers in the United States.
In poor Mexican towns, he said, "your educational opportunities are very limited so what you end up doing is learning your job from everyone around you," he said. Other reporting had uncovered towns where everyone was a construction worker or a tortilla shop owner, he said. In Xalisco, Nayarit, it just so happened they were all heroin traffickers. And they were polite ones, at that. They focused on branding and customer service, printed business cards and delivered just as well as a pizza business would.
"They are the vanguard of a new kind of drug trafficking that relies a lot less on gun play, which they've seen doesn't work ... it just leads to a lot of police attention and uproar," Quinones said.
"If you're quiet about it, if you're branding if you're focusing on customer service and stuff like that it's a far more effective way of making a lot of money and that's what they all are. They're not about killing people, they want to make money."
The title "Dreamland" comes from a community pool by the same name in the southern Ohio town of Portsmouth, which was known for its pain clinics and high rates of addiction. The pool was the center of life and community in the town, until the jobs in the community began to diminish and eventually the pool closed. Quinones said he sees the pool as a metaphor for life in America when it lost its sense of community.
"We destroy community and what creeps in is this noxious virus we call addiction," he said.
Isolation is one of the major themes in the story of the epidemic, he said. Isolation in the way we treat pain medication, in the way that no one across medical fields talk to one another about the problem and even isolation from family members within our homes. To protect kids, we keep them at home, where they sit in their rooms by themselves, he said.
"Sadly that's where a huge number of kids basically hide their dope, use their dope, shoot up and die," he said.
When it comes to combating the opiate epidemic, Quinones said, there's not just one solution.
"There are a bunch of ways that towns should try," he said.
While physicians should be more nuanced and judicious with the way they prescribe pain medications, patients should also question the use of prescription drugs. It's easy to only blame the doctors, he said.
He also thinks the government should revamp jails and prisons so that they have full-fledged rehabilitation centers so that the time criminals spend behind bars is an investment, not a cost.
The three medical specialties that deal most with the epidemic - family practice/general practitioner, addiction specialists and pain management specialists should have a regular conference to exchange ideas, he said.
"The antidote to opiate addiction is not Naloxone, it is community," Quinones said. "It is people doing things in public, knowing each other. [It's] families doing things together."
West Virginia University's David C. Hardesty Jr. Festival of Ideas, which is free and open to the public, will be 7:30 p.m. Feb. 29, at the Clay Center for the Arts and Sciences.
The event is co-sponsored by the Charleston Gazette-Mail.
Reach Lori Kersey at Lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.