Sam Quinones is Wrong, Again

Like, what, dude?

I probably shouldn’t do this anymore. Maybe it’s in poor taste. But whatever.

Sam Quinones is making the rounds and is once again very wrong. He just published in The Washington Post, went on C-SPAN, and then wrote something for Bari Weiss’s revanchist news outlet dedicated to people in their 60s who can’t stop reading about children getting top surgery. It’s like every six months or so Quinones decides to waters the grass.

Every time I dig into what this guy says, I find such a staggeringly distorted picture that it necessitates a forensic critique. Here’s a guy who regularly gets invited to meet with politicians and policymakers and he’s font of errors, taking kernels of truths and blowing them up into farce.

In The Washington Post, Quinones wrote about the economic principle known as “supply-induced demand.” It’s the idea that the availability of a paritcular resource or good—the thing just being there—can drive consumer demand for it. A classic example is the construction of new lanes of highway. Meant to ease congestion, the new lanes attract more drivers, creating more traffic. The supply (new highway lanes) created more demand (more drivers on the highway), compounding the problem of congestion.

Quinones in a cabinet meeting with Denver’s public health & safetey cabinet

Quinones is actually not wrong about this. Fentanyl is indeed a real world case study of supply inducing demand. It’s not like heroin users one day called up a customer service representative at the drug factory and asked for fentanyl to be added in the next shipment of heroin. The suppliers just did it. And consumers, with little choice in the matter and heavy addictions to boot, were stuck with fentanyl even if they didn’t want it. Those who were already addicted to opioids were forced to make the transition.

Quinones is right about fentanyl being a thorny supply problem. But his interpretation of what that means is characteristically heavy-handed and his conclusions are thinly supported. I know his claims are ridiculous because they are almost always sourced to unnamed law enforcement officials who, for some reason, he believes wholecloth without ever bothering to check their work. Meanwhile, he ignores a whole body of research contradicting what his police friends tell him.

At stake here is: What does it mean that fentanyl created demand? How did it create demand? And that being the case, what’s to be done about it? What does this change? Fentanyl created demand—so what?

It’s actually not a new or novel concept, especially in the world of drugs, medicine, and health care. Nobody who felt depressed thought they should try ketamine untill an infusion clinic opened up in their neighborhood. Then they got curious. A bunch of people tried ketamine and it probably do all that much. Boring story.

Fentanyl Mixed Weed?

Here is how Quinones claims that fentanyl created demand (emphasis mine):

“The unrelenting supply the cartels create means fentanyl is now everywhere. It is mixed into counterfeit pills smuggled into the United States by the tens of millions. It is laced into many other drugs, such as meth, marijuana and cocaine. That’s why Black people are now dying at a higher rate of opioid overdose than White people — and usually not for any initial demand for it. Many Black drug users die from what they believe is cocaine but is actually cocaine laced with fentanyl.”

Like, what, dude? This is a doozy. There’s a lot in there that I’m going to dig into in the next many paragraphs. If you read me regularly you know that fentanyl pops up in other substances. I just went on at length about this in my “Tainted Drugs” piece. What’s baffling here is the claim that fentanyl being mixed into weed(???) is the reason why black overdose mortality is so high.

Tainted Drugs

Let’s tackle fentanyl mixed weed first. This is a rumor that just won’t die. An urban legend. I’m actually a bit sad that this got through fact checkers at The Washington Post. The link in the sentence ostensibly supporting that claim is to a CDC fact sheet about fentanyl that makes zero mention of black mortality or fentanyl being mixed into weed.

Fentanyl laced weed has been endlessly debunked. So where does the claim come from? Who keeps on believing that weed is laced with fent? Police do. Politicians do. People who want to believe it keep on believing it. It’s confirmation bias. It sails right through their tunnel vision. Of course fent is in weed! Because there’s a plot by nefarious drug dealers to dose everybody with fentanyl and turn everybody into a zombie.

Everytime law enforcement officials claim marijuana is being mixed with fentanyl, there’s never any proof. Lab tests come up negative. If fentanyl was really being mixed into weed at any scale, surely there would be dozens of samples by now to prove it.

The physics and chemistry also do not make any sense. Mixing fentanyl into flower and lighting it on fire won’t do anything because fentanyl is destroyed by direct flame. That’s why fentanyl users who “smoke” use tinfoil. To be sure, they’re not actually “smoking” it. A little glob of fentanyl is placed on the top side of the foil. A lighter is placed beneath the foil as a form of indrect heat, which produces streams of vapor that are inhaled. What about vape pens? The subject of a recent local news package? Vape pens on the market do not get hot enough to vape fentanyl. In order to vape fentanyl, the pen would have to heat to temperature in excess of 900 degrees, which would destroy whatever other substances were suspended in liquid form in the pen.

So, fentanyl mixed into weed obviously cannot explain the sharp rise in black overdose mortality. That leaves cocaine and meth. There are indeed samples of meth and cocaine that contain fentanyl, but I can’t find anywhere that attributes that as the primary driver of black overdose mortality.

Here is where Quinones goes off the rails. He seems to be confusing many things. More overdose deaths does not automatically mean more demand. Because death does not create demand, for obvious reasons. People dying from taking fake pills, or from contaminated meth or coke contaminated—that is not demand for fentanyl. It’s demand for oxycodone, demand for meth, demand for coke.

So this idea that drugs contaminated with fentanyl is creating new demand for fentanyl just doesn’t make sense. Demand for fentanyl came from people already addicted to street opioids, who then were forced to transition to fentanyl because it displaced heroin. And now, years later, their tolerance has adapted to fentanyl and it’s what they prefer. That’s what fentanyl creating demand means. Quinones is completely misreading the population-level dynamics at work here.

Bryce Pardo, formerly of RAND and now a researcher for the United Nations Office on Drugs and Crime, told me that, actually, fentanyl is not creating a huge swath of new users. I interviewed him for The New Republic in 2021 and here’s what he said: “It’s not that fentanyl is attracting more users or creating new users. It’s just a very dangerous time to be a drug user and to be buying street drugs.”

That’s because, thanks to fentanyl, the average harm per dose is much greater than it ever has been before. And there’s way more doses of fentanyl out there. It’s pretty much infinite, which is a scary thought. So this puts those with addiction at great risk. Also casual, novice, recreational users are arguably at an even greater risk. And that’s actually sort of new here, and it’s important to recognize.

An asymmetry of information is often crucial for supply-induced demand to work. Suppliers know the pills are fake and they contain fentanyl. But for a while, consumers really thought they were buying oxycodone. Closing that information gap is a crucial way to make a dent in the problem. But Quinones doesn’t mention that in his piece. He thinks people addicted just need to dry out in jail.

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Quinones is getting another thing mixed up. Lately there is a trend in mortality data where people have multiple drugs in their system at their time of death. Much more common than ever post-mortem is the fentanyl and meth mixture. Perhaps he thinks this is all because of fentanyl is secretly mixed into meth. But when I ask experts about this, they say it’s much more plausible that people are intentionally mixing.

Indeed, that is what people say they are doing. The deliberate co-use of stimulants and opioids is a big trend right now.

Part of the reason is due to basic supply-induced demand principles: Despite all enforcement efforts, there are metric shit tons of cheap, high quality meth out there. There’s a lot of it and people are using it. There’s also some rational reasons why meth and fent is a popular combo. Daily, chronic users say that they prefer fentanyl mixed with cocaine (“speedballs”) or with meth (“goofballs”) as an adaptation to the displacement of heroin. Studies of this have found multiple reasons, such as using meth to try and counterbalance the potent analgesic effect of fentanyl:

“One of the possible explanations for the rise in methamphetamine usage, according to user experience, is that it served as an opioid substitute, offered a synergistic high, and balanced out the effects of opioids in order to regain ‘normalcy.’”

Unhoused people have also reported using meth to adapt to life on the street. They’re afraid to fall asleep at night. Quinones doesn’t cite this research, nor does he seem to listen to the actual users he’s talking about.

Black and Indigenous Mortality

An analysis from the CDC using data from 25 states found that fatal overdoses increased by 44 percent among Black people in 2020 compared to 2019, along with a sharp uptick among American Indian and Alaska Native people. The CDC attributed higher BIPOC mortality not to cocaine or meth being contaminated, but to structural health inequities, like “unequal access to substance use treatment and treatment biases.” Areas with the highest level of income inequality were found to have the highest rates of overdose deaths. From top to bottom, the study found racial minorities were the least likely to have had access to treatment for substance use.

Quinones doesn’t mention any of this as a reason why people of color have a higher level of mortality. I think this is the case because he seems constitutionally incapable of thinking in structural terms. Everything is about individuals to him. Perfect for his little anecdotes. Plus, when you ask a cop why more Black people are dying from fentanyl than White people, they aren’t going to say what the CDC epidemiologists say. They’re going to say something like: You know they smoke a lot of weed and crack, right? Welp, entanyl is mixed into that stuff.

That same CDC analysis found that the bulk of the mortality came from black men 65 and older, whose death rate was seven times that of white men in the same group. That’s a crucial finding, and says something about the composition of street opioid use in cities like D.C., Chicago, Baltimore, Philadelphia, and New York. For decades, these cities have had a high population of older Black men using heroin. Once fentanyl displaced that heroin, they were hit quite hard. Many were caught off guard and didn’t know they needed much smaller and more careful dosing.

Here’s an excellent Washington Post investigation into the local D.C. government neglecting to help its black residents:

“The city’s overdose victims are different from those in areas of the country more commonly associated with opioid abuse. Many are black men who have been addicted to heroin for decades. And unlike drug users elsewhere, they have often been left by their government without basic help.”

That Washington Post piece goes on to document a dearth of resources in Black communities for substance use, especially a lack of naloxone distribution. The city’s response to fentanyl in black neighborhoods was deemed totally “incompetent” and on par with a long history of neglect.

Instead, Quinones’s theory about the fentanyl supply creating demand hinges on contamination and adulteration of specifically non-opioid drugs. That then hinges on a plot by dealers to sneak fentanyl into other drugs in order to get them hooked for life. Maybe it’s a bit less salacious than that?

<3 Jail

This last section is about Quinones and his favorite policy pitch: jail. In The Washington Post he wrote:

“With users so outmatched by these drug supplies, we need to get them off the street and to a place where they can’t leave when the dope tells them they must. One welcome change is that jail is being rethought as a place of recovery — where, after an arrest, people with addiction can get blessed refuge while their brains heal.”

To say in the year of our lord 2024 that “jail” is a “blessed refuge” allowing brains to heal is… truly something. People still use drugs in jail, and jails do a crappy job at treating addiction. Last week, the Prison Policy Initiative published a disturbing report about the lack of adequate treatment and health care in jails. PPI found:

“People with serious health needs are warehoused with severely inadequate healthcare and limited treatment options. Instead, jails and prisons rely heavily on punishment, while the most effective and evidence-based forms of healthcare are often the least available.”

Quinones seems to think that jails across America actually function as a network of Utopian treatment facilities. Being in jail is like being sent to a secluded ranch in Malibu or a bucolic Hazelden facility near a big lake somewhere in Minnesota, where trained doctors and counselors are committed to healing.

What’s really going on is that lawyers at the Department of Justice are trying to figure out how to force jails to actually offer FDA approved medications to treat opioid use disorder (MAT). These laywers have argued that denying MAT violates the Americans with Disabilities Act. If jails are so keen on helping people with substance use disorders, as Quinones thinks, then why must they be sued by the federal government into actually providing it? If jail helps people so much, why are recently released prisoners roughly 129 times more likely to die of an opioid overdose than the rest of the population?

Jails are simply not a good place, in fact, maybe they’re the worst place, for somebody with a complex medical disorder and a multtiude of comorbidities who requires tons of medication and monitoring.

Perhaps that’s why the actual data on jails and addiction treatment paint a grim portrait. (Yes, the latest data we have is from 2019. Maybe it’s possible things are a little better).

Quinones clearly has some reference or image in his mind about jail being a great place to treat addiction, but it’s so off base from what’s actually happening.

He then implies that somewhere along the way America stopped arresting people for drug crimes. The latest figures on America’s incarcerated population vis-a-vis substance use and addiction from PPI clearly show that millions of people are arrested for drug crimes every year.

“Approximately three million people with substance use disorders are locked up in any given year: at least two million people with substance use disorders are arrested annually and about half a million people in state and federal prisons meet the criteria for such disorders at the time of their admission.”

America has the largest incarcerated population in the world. If this worked, wouldn’t it, well, have worked by now?

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If Quinones is so wrong, then why should we care about what he says? Why am I dedicating thousands of words on and my time on a Thursday night to this guy?

Quinones has become a kind of drug policy whisperer for politicians and policymakers. He gets invited to big cities and small towns by mayors who read his books and ask him what to do in high-level cabinet meetings. He gets invited to testify before Congress. He speaks all over the country on the topic. So, yeah, it’s important to actually scrutinize what he’s saying.

And not everything he says is so wrong. It’s just that he always lands on the same idea, no matter what the context is. Fentanyl and meth are so exceptionally strong, causing such a powerful addictions, that the only way to really help people is to send them to jail. And it's just sad. That no matter which drug epidemic America is in grappling with, whether it’s crack, meth, heroin, or now fentanyl, this is where American drug policy always ends up going.