In the 1950s and ’60s, Clarksburg, West Virginia, was a bustling city of nearly thirty thousand, a patchwork of French, Belgian, Italian, Austrian, and German neighborhoods with their own shops, schools, and churches clustered around the glassworks that buoyed the city’s economy. Clarksburg’s proximity to abundant natural gas, coal, and silica deposits made it a natural location for glass manufacturing, and European artisans had flocked to the city known as “Little Chicago” seeking better working conditions and the possibility of unionization and political representation. But by the middle of the 1980s, things were different. Clarksburg couldn’t keep up with competition from China and Mexico; its last glass plant shut down in 1987. Neighborhoods emptied, shops shuttered, and the bustling streets became desolate as the population fled elsewhere, falling more than a third by 1990.

As Clarksburg watched residents leave, it saw something else arrive: pain pills, in increasingly large volume. In 1995, OxyContin began flooding into deindustrialized cities such as Clarksburg, following a revolution in pain management that dispensed with “common knowledge” on the addictive qualities of opioids. Purdue Pharma pitched the drug to doctors as a panacea for the kinds of aches and pains regularly experienced by former factory workers. Addiction spread like wildfire, and pharmaceutical companies poured on the pills like gasoline. Heroin soon followed, then the even more destructive fentanyl and methamphetamine. Cities filled with drugs and addicts; the morgues, with bodies.

Clarksburg was just one of hundreds of American towns to be radically transformed by the one-two punch of deindustrialization and opioid addiction. Sam Quinones, in his excellent new book The Least of Us, shows how the economic and narcotic devastation of America’s heartland – in cities such as Akron, Ohio; Elizabethton, Tennessee; and Muncie, Indiana – connected to other changes occurring at the end of the twentieth century: political turmoil in Mexico and China; the shift of the global drug trade away from poppy and cannabis fields toward laboratories both lawful and clandestine; sugar-filled industrial fast food. It is less a book about meth and fentanyl than an epic about how America transformed from a culture of ingenuity and prosperity to one of passivity and consumption, a withered tree on whose branches the dark fruit of catastrophic drug addiction slowly ripened until it fell.

Quinones is our Virgil through the opioid Inferno, and he tells his story with abundant care and compassion. But he doesn’t mince words: addiction is “a brainwashed slavery that deprives the user of free will and turns him toward self-harm in the search for dope”; decriminalization without stemming supply condemns addicts to death; the problem was exacerbated by people acting with the best of intentions. It’s an urgent and gripping account. We can hope it will be heeded by those with the power to do something.