BOB GARFIELD:  And so, the opioid crisis rages on.

  [CLIPS]:

PRESIDENT TRUMP:  We want to help those who have become so badly addicted. Drug abuse has become a crippling problem throughout the United States. Today, we’re bringing together leaders from inside our government and outside of our government and courageous people who have been affected and really affected by this terrible affliction.

BOB GARFIELD:  Despite repeated promises to end the crisis, Trump has acted without urgency. His March budget proposal claimed to add $500 million for drug treatment but, actually, that just put a new name on funds already set aside by the 21st Century Cures Act signed by President Obama in December.

And the Republicans’ health care bill, which Trump fervently supported, would have devastated addicts by allowing states to drop that part of Medicaid that covers drug treatment. To date, Trump’s signature drug policy is to double down on mass incarceration and to build a wall.

  [CLIP]:

PRESIDENT TRUMP:  We will construct a great wall at the border, dismantle the criminal cartel and liberate our communities from the epidemic of gang violence and drugs pouring into our nation.

  [CROWD CHEERS/END CLIP]

BOB GARFIELD:  The State Department estimates that Mexico produces 90 percent of the US heroin supply and is second, behind China, in production of illicit fentanyl. But trying to cut off supply has a long history of futility.

Journalist Sam Quinones has spent decades speaking with addicts, undocumented immigrants, drug traffickers and law enforcement, first in Mexico, as a crime and immigration reporter, and then in the US, for his book, Dreamland: The True Tale of America’s Opiate Epidemic. Sam, welcome to OTM.

SAM QUINONES:  Thanks very much for having me on.

BOB GARFIELD:  I want to talk to you about supply and demand. I think there's a consensus in law enforcement that the problem is that there is a lot of demand on this side of the border and plenty of cash to pay for all kinds of drugs, including heroin. Donald Trump seems to believe it's a supply side problem that the drugs are pouring over the border and if we could just stop them coming through, we could make a lot of strides.

SAM QUINONES:  I used to believe, when I lived in Mexico, that demand somehow was the thing that ignited these problems. I don't believe that anymore. The supply is here in our own country. It comes from doctors and it comes from pharmaceutical companies; a lot of that seeps out into the black market. That's the supply that we first need to address.

BOB GARFIELD:  In your book, Dreamland, you focused on Portsmouth, Ohio, which is as good a poster child for American postindustrial decline that you can imagine. Tell me about it.

SAM QUINONES:  Right, it was a glorious town at one point. It had one steel mill, it had shoe factories. It had 50,000 people and a very bustling Main Street. And it had at the center of it this glorious swimming pool. It was about the size of a football field that was the center of life. It’s where people saw each other and communed. And that town lost its steel mill, lost its factories. Half the population left and, in ’93, the pool, known as Dreamland, was dug up and is now a big parking lot in a strip mall.

It became the pill mill capital of America, really. It was where the pill mill was invented. And there was about a dozen pill mills operating at the height of all this in Portsmouth, Ohio. Pill mills were essentially pain management clinics. Really, what they were is an opportunity for a doctor to just prescribe endless amounts of pills for cash. Virtually an entire generation or more of people between, say, 15 and 40, 45 years old, got addicted, until the State of Ohio passed laws regulating pain clinics, and then all those pain clinics could be shut down. And, again, you get back to supply. That area begins to recover once the supply is dealt with.

It is absolutely true that people are switching to heroin because it is so cheap. It flows across the market in large amounts and comes from very close by, the country of Mexico. The question of whether or not building a wall would, therefore, stop that is quite unlikely.

BOB GARFIELD:  Quite unlikely? If a wall is impermeable, why won't it keep the drugs out, as well as undocumented workers?

SAM QUINONES:  Heroin is the easiest drug to smuggle. In fact, it owes its existence almost entirely to the underworld, and it comes through today, right now, through areas where there already are walls. Tijuana has two walls. Juarez has the Rio Grande and a wall. South Texas has a wall and the Rio Grande. It just comes in on people's person, in cars, in trucks. People do not run across the desert with large packs of heroin on their back. That occasionally happens but it does not account for the enormous supply we now have.

BOB GARFIELD:  You believe that the wall is not only unproductive as a barrier, it's politically exactly the wrong thing to do with the Mexican government because we need the Mexican government to get busy.

SAM QUINONES:  We really need them to get their act together. The problem with a wall is that it has this effect of pushing all the wrong buttons in Mexico that go back to 200 years, really, and taking of land from Mexico by the United States. Actually, in the last 10 years or so, even more, we've seen a whole lot of new cooperation. And all these major capos are now in our federal prisons, and Chapo Guzman is just the latest one.

What’s happening now on our own domestic politics threatens to corrode all of that and send Mexico back to its default position of just doing nothing.

BOB GARFIELD:  We've heard that incarceration is not the solution but you believe it's also not NOT the solution. What role does law enforcement play?

SAM QUINONES:  Oh, an extraordinarily important role. We have this idea that we cannot arrest our way out of it, therefore, we need to expand the amount of treatment we offer. The problem with that idea is that getting out of treatment now is a lot like Russian roulette. You get out and, unlike with other substances, say nicotine - you know, I took nine times to quit but at no time did I die. Part of addiction recovery is relapse. You’ve got to expect it. But with these drugs, that's frequently what happens. People go into treatment. They get back out onto the street. They do well for a while and then they relapse and frequently use something similar to what they were using before, and they die.

We cannot treat our way out of this, either, so long as the supply remains as potent and as prevalent. And that is a law enforcement task, pretty clearly, it seems to me.

BOB GARFIELD:  When you talk about aggressive policing, in the last 30 years that’s resulted in the warehousing of drug offenders in a vastly expanding prison archipelago. The stop- and-frisk techniques that resulted in large numbers of drug arrests were clearly a mechanism of racial profiling, snaring a whole bunch of low-level offenders. What does your notion of aggressive policing look like?

SAM QUINONES:  I’m not sure I’d agree with your assessment of what went on. I lived in a community that was overwhelmed by crack cocaine and it created ripples of public violence that nobody could ignore. And most of those neighborhoods were Latino or black, and it was those people who were demanding something be done, and they didn't really care too much about drug treatment, I can tell you, at the time. The way you’re describing it loses a lot of the nuance of those people, like myself, who lived through that era.

BOB GARFIELD:  I understand why President Clinton, when he helped usher in Three Strikes You’re Out and mandatory minimum sentences, and so forth, that he had a coalition, including the residents of these drug-afflicted neighborhoods, but the consequence has been the incarceration of people for mostly nonviolent crimes. How would this be different? [LAUGHS]

SAM QUINONES:  The answer is, I'm not sure, it may not be. It may be that we will arrest a lot of people and a lot of those folks will end up being addicts who probably needed more treatment. People want to say, well, let’s just only arrest the dealers. Well, heroin, particularly, painkillers, as well, make dealers out of every addict. I’ve known guys who were very badly strung out who became mules for Mexican drug traffickers, taking pounds of heroin across state lines. Are those addicts or are they dealers facilitating the larger transportation of drugs? From a vantage point of up close, it is not easy to figure out exactly who is what and, therefore, what you should do.

It’s clear to me that many addicts do not need long prison terms. What they do need is very intense treatment. It’s a blunt instrument we’re dealing with. Probably the better idea is to say, what can we do in the future to avoid believing in silly ideas like opiate painkillers will not addict most people when prescribed in great amounts? And opening that Pandora's Box is what got us here.

BOB GARFIELD:  You have disagreed with almost everything [LAUGHS] that we've heard through the entire course of this hour but there is one place where you do become part of the consensus, and that is your notion that in the end the root cause of so much drug abuse, it’s economic privatization, hopelessness, despair.

SAM QUINONES:  To my way of thinking, at the root of all this is a deep isolation in American society that we have built into modern life through social media. Even though we’re connected, we’re not connected in any human way.

The opposite of isolation is community. We have done an enormous amount of destroying community in our country over the last 35 years, in Rust Belt areas that have lost all their jobs, in swanky upscale suburbs where the subdivision pattern is to build large houses where no one ever has to walk outside and no one knows each other. It explains why you can have Portsmouth, Ohio and Charlotte, North Carolina, not that far from each other, both have the same problem, when one is very poor and one has a beautiful skyline with two sports teams and, you know, and I don’t know how many country clubs in that town. Heroin is what you get when you destroy Dreamland.

BOB GARFIELD:  Sam, many thanks.

  [MUSIC UP & UNDER]

SAM QUINONES:  My pleasure, glad to be with you.

BOB GARFIELD:  Sam Quinones is the author of Dreamland: The True Tale of America’s Opiate Epidemic.

That's it for this week’s show, for which the heavy lifting was done by Micah Loewenger, with help from Paige Cowett. Our technical director is Jennifer Munson. Our engineer this week was Sam Bair. Additional thanks to Andy Lanset of the WNYC Archives.

BROOKE GLADSTONE:  On the Media is a production of WNYC Studios. I’m Brooke Gladstone.

BOB GARFIELD:  And I’m Bob Garfield.

  [FUNDING CREDITS]