How fentanyl and meth exploded nationwide and led to more mental illness, homelessness, and deaths

Written by Amy Ta, produced by Michell Eloy

For the first time ever, more than 100,000 Americans died from a drug overdose in just one year, according to preliminary numbers released by the CDC this week. Most deaths were from fentanyl, a synthetic opioid that can be 100 times more potent than morphine. Just a few milligrams of it can be lethal. For decades, fentanyl was only used in hospitals, but now you can find it anywhere. 

Meth is also available cheaply, and it’s stronger now than ever, causing people to hallucinate. This meth, made from common chemicals that are easy to access, is a big reason why so many people are living on the streets in LA, according to journalist and author Sam Quinones.

His new book is called “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.” His previous book on the opioid epidemic, “Dreamland,” won the National Book Critics Circle Award for nonfiction. 

Quinones tells Press Play that this book is about how the “underworld,” particularly the Mexican trafficking world, became the lead driver of pain pills and pushed America’s epidemic of drug addiction into the “synthetic era,” meaning the drugs are now made entirely with chemicals in laboratories (and no longer require plants like cocoa in cocaine or poppies in heroin). They’re also more potent and dangerous than anything that’s been on the streets before. 

Fentanyl: from a chemist’s lab to the streets 

Quinones explains that a Mexican-born and San Diego-raised underground chemist named Ricardo Valdez-Torres was one of the first people to introduce Mexican drug traffickers to fentanyl. Known as “El Cerebro” (“The Brain”), Valdez-Torres got caught by law enforcement in the 1990s, went to prison for a decade, and was deported back to Mexico, where he was approached around 2004 by the Sinaloa drug cartel. They wanted him to make ephedrine, a chemical that goes into methamphetamine, but he had other plans.

“He really thought he was above that and wanted to make fentanyl, and he did so unbeknownst to them at first. And then once he had fentanyl going, he explained to them the ‘beauty of fentanyl is that it was very cheap to make, very easy to make, and extraordinarily potent, and therefore enormously profitable,’” says Quinones. 

Then his fentanyl went from a small lab in the town of Toluca, outside of Mexico City, to the U.S., where it began killing people, first in Chicago, then Detroit, St. Louis, Philadelphia, and other places. Then authorities busted the lab in Toluca and deaths dropped. 

Quinones emphasizes that the Sinaloa drug cartel had no idea what fentanyl was until Valdez-Torres told them. Only then did they understand the colossal profit potential. 

“The Mexican drug world begins to understand how to make fentanyl, and that's what's happening now. They buy ingredients, precursors to fentanyl, from the Chinese, but it's almost entirely made in Mexico now.”

Why would dealers want to sell a substance so powerful that it could kill their customer base?

Quinones says one reason is traffickers learned that fentanyl could be used like salt in food — a sprinkling of it would boost a drug’s potency. And dealers liked mixing fentanyl with cocaine and meth because it could lead buyers to become opioid addicts who’d need to buy every day to keep withdrawal sickness away, rather than just using drugs recreationally.  

He adds, “The deadliness of the drug is actually an attraction. Once people are addicted to fentanyl, people do not view a death or an overdose as a warning. [It’s viewed as] an advertisement — ‘that's really potent dope, I got to go get that. I'm not going to die. That guy died. I'm not gonna die.’ That is very, very common. And dealers know that. … From a perspective on the street, if you can get people addicted and buying more every day, that's a big plus.”

He notes that fentanyl is extremely effective when used medically. “I had a heart attack four years ago, and in the surgery, they put a stent in my artery. They gave me fentanyl. It’s a magnificent drug when used medically. The problem is when it gets into the hands of people who have no medical training, whose only motive is profit … it's creating catastrophe as we're seeing now across America.”

Fentanyl is used as pain medication and for anesthesia — but it’s also sold illegally on the black market and often mixed with heroin, cocaine, or other drugs. Photo by Shutterstock. 

It’s easy to become a kingpin 

Quinones says supplies are so vast that anybody can sell fentanyl, but many of them aren’t savvy enough to be in this business, don’t know what they’re doing, and make mistakes. 

For example, a young Orange County man named Wyatt Pasek started making counterfeit pills laced with fentanyl. 

“He's producing … 100,000 pills a week and selling them, making $25,000 a day. … He becomes narcotized by the money. He puts up on Instagram all these pictures of himself with Maseratis, with AK-47s and bathtubs full of cash. … Cash everywhere, all just spilling out of his clothes. ... Pretty soon you're going to get the attention of law enforcement and they arrest him. And when I met him, he was 23.”

Quinones says fentanyl spread so widely throughout the U.S. because it absorbed people who saw it as a way to make money. 

Black Americans and overdose deaths

Before fentanyl was mixed with other drugs, the opioid epidemic mostly affected white people, not African Americans and Latinos. Now fentanyl-laced cocaine is the root of many overdose deaths of African Americans, Quinones says. 

“In the African American drug-using community, cocaine is the drug. … Well, African American dealers figured out … that they could add fentanyl to the mix. And soon their customers would be addicted to fentanyl. The problem is that when they add it to the mix frequently, the folks who are buying it, not knowing what's in it, thinking they're buying cocaine, have no tolerance whatsoever to it. And so … since about 2015, you've seen a big increase in overdose deaths to opioids on the part of African Americans.”

Sam Quinones’ new book is “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.” Photo credit: Bloomsbury. 

Meth in America: It all started with two brothers 

Luis and Jesus Amezcua were undocumented immigrants working at a car repair shop when a local resident asked them to import ephedrine into San Diego. Soon, the two brothers helped turn the city into the meth capital of America, Quinones recalls. 

“Ephedrine is an antihistamine, you find it in Sudafed pills. … It was legal and very easy to come by. And so they could make a lot of it. And they began to do that, and soon everybody else began to follow. And after a while, you began to see a meth industry taking shape, first along the border, and a lot of times into the California Central Valley, and first Temecula, Riverside, then up into Bakersfield. … After a while, as law enforcement got wise to it and began cracking down and regulating ephedrine, all of that business moved south into Mexico.”

He notes that with a few chemical tweaks to ephedrine, people easily made methamphetamines, but in time, the Mexican government began to restrict ephedrine imports. Understanding that ephedrine wasn’t going to be available much anymore, people in the Mexican meth industry switched to a different way of making the drug. 

A new kind of meth: P2P

The ephedrine method was replaced by the P2P (phenyl-2-propanone) method — messy, smelly, and involves a lot of chemicals that are common, cheap, and highly toxic, Quinones explains.

He says two big shipping ports on the Pacific coast of Mexico — in Colima and Michoacán — began to see a huge flow of chemicals used to make meth. 

“There was this explosion of this beginning about 2013-14. … It is beginning to really invade Los Angeles in quantities that boggle the mind. Then by 2016-17, it's in the Midwest. Then by 2018-19, it’s on the East Coast and up into New England, which never had any meth at all. … Meth that used to go for $14,000-15,000 a pound, now it’s going for $3000-2000 in some areas. And so you see this saturation, which is where we are now.” 

Meth made via the P2P method uses lots of toxic chemicals, but the process costs little money. Photo by Shutterstock. 

P2P meth’s link with mental illness and homelessness 

Quinones says when people started using P2P meth, it led to a spike in scary symptoms of schizophrenia, paranoia, and hallucinations. So as meth spread across America, so did mental illness and homelessness. 

“Folks on this meth cannot really be around other people. They can't live, they can't follow rules. They’re really almost incapable of holding conversations sometimes. They fill the ERs and the mental health clinics. … As this meth gained momentum and the spread of these supplies took place, you've seen homelessness and mental illness spread all across the country, not just in LA or Las Vegas or Seattle or Portland where we're used to it, but in rural areas too, West Virginia, rural Indiana, eastern Tennessee.” 

A bike is seen as a Los Angeles Sheriff’s Department deputy walks by a row of homeless encampments at the VA in Brentwood, September 16, 2021. Photo by Zaydee Sanchez for KCRW. 

This could explain why so many homeless encampments have popped up across LA, with people who appear to be mentally ill and who have all sorts of belongings, particularly bicycles. 

Quinones says P2P meth breeds hoarding and a fascination with bikes. “When you're up on meth, you can take them apart and put them together endlessly. That's part of the symptoms. But also because when you don't have a car… you're riding around and looking for more stuff.” 

He explains that tents fit this kind of meth perfectly. “This is a meth that really brings you into your brain, and you really don't have much connection with anybody else. Well, what better place to isolate from your world than a tent? And so in these tents, people are living in their own little universe.” 

Tents can also be sites for prostitution and pimping. “Meth is a wonderful drug for controlling women. I spoke with a transgender woman who came down to LA. … She's pimped out by several pimps and they give her meth. That's also the time when they began to mix it with fentanyl. Fentanyl seemed to balance some of those psychotic symptoms. And so you could work a woman, you could control her with a meth addiction, and if you added fentanyl to it, she would be not screaming at demons, which would make her difficult to get any work. You would find that balance between control and insanity,” Quinones says. 

What happens when people stop using meth?

Quinones says withdrawal from meth isn’t like opioid withdrawal, which includes symptoms such as shaking, nausea, vomiting and diarrhea. Instead, he says people sleep for days, which is what you see when people go to jail. Also, people have a difficult time staying in treatment, which requires a human connection.

“But if you have a person who's screaming about cheetahs and it takes weeks of detox before that person actually comes to some normal sobriety, that's a very difficult thing to do. That's what a lot of counselors have told me — it's almost impossible to talk to these folks in there for treatment. … Frequently what they end up doing is running back to those encampments,” he says.  

Quinones adds that the country needs to shift the national conversation about homelessness away from the high cost of housing and toward the meth problem. “I've found in Los Angeles … nobody wants to understand or recognize the enormous, the pivotal role that this methamphetamine — coming up from Mexico — now is playing in our homeless problem. To me, what we first need to do is redirect the conversation to say we have a very, very serious meth problem, and that we need to really, really address that.” 

Should the U.S. return to criminalizing misdemeanor drug use/possession? 

Quinones says possibly — but it needs to happen along with a rethinking of the jail system. “Jail is a disaster in this country. There's almost nothing that creates worse problems of mental illness, criminality, and addiction than jail. You don’t do anything. You watch ‘Judge Judy.’ You barter. There are predatory moments, then tedium. And there's no way of taking people who are in addiction and beginning to help them recover.” 

He notes that across the country, sheriffs are starting to set up recovery pods in jails — a community of people working toward sobriety. This needs to be a part of every county’s criminal justice system, he adds. 

“Then what you can do is begin to arrest people for minor drug things, not to send them to prison. … It's to get them off the street because if you do not, they will die. There's fentanyl on the street. ... And then pairing that in turn with a drug court system that allows you to come out into sober housing.”



  • Sam Quinones - journalist and author of “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth” - @samquinones7