Tracing America's 'opiate epidemic'

America's opiate problem starts with something as simple as a wisdom tooth. When you have your wisdom teeth extracted, you go home with a prescription. You pick up the meds at the pharmacy: a bottle of 60 Vicodin.

"You don't get 10 pills, you get 60," journalist Sam Quinones told MPR News host Kerri Miller. Quinones talked with dozens of dentists, doctors, law enforcement agents, addicts and grieving parents when researching his book "Dreamland: The True Tale of America's Opiate Epidemic."

A small minority of people prescribed opiates becomes addicted — but the flood of pills has contributed to the crisis.

"We have a huge new supply of opiate painkiller all across the country," Quinones said. The over-prescription of opiates like Vicodin or OxyContin means extra pills often end up sitting in medicine cabinets where teenagers can find them and start experimenting. They can end up on the black market, feeding the habit of other addicts. When pills aren't available, many turn to heroin.

The addiction can be deadly. Drug overdose-related deaths have been rising: In 2014, 47,055 people died from overdoses in the U.S. — the highest number on record.

"Dreamland" explores how opiate addiction has grown and spread. Quinones takes readers to a small town in Mexico that sends its sons north to deal heroin, and to cities like Portland, Salt Lake, Columbus, and Minneapolis that seem to have an unquenchable thirst for it. He traces how pharmaceutical companies and doctors ignored warning signs.

This epidemic is different, Quinones said, than the crack cocaine epidemic in the 1980s and early 1990s.

"I was a crime reporter during the crack years," he said. "Crack was accompanied by a massive, scary amount of public violence: Drive-by shootings, car jackings, the spread of gangs. ... The only response we had at the time was to build more prisons and strengthen laws and increase enforcement. ... We did not increase our treatment infrastructure measurably during that time."

"What has happened with opiates and heroin, we have seen a new way of approaching addiction." There's a new focus on treatment rather than punishment. This shift is due to the different demographics of opiate addiction, Quinones said.

"I think it's largely because most of the folks who are getting addicted are white kids. Their parents are connected in the community, they donate money, they're on the same church or football teams as the legislators in their area," he said. "They have their ear. It's very different."

For the full discussion with Sam Quinones on "Dreamland," use the audio player above.