Just 10 years ago, hardly anyone knew how to pronounce "naloxone."

When Sam Quinones turned in his manuscript for his book "Dreamland: The True Tale of America’s Opiate Epidemic," only three lawsuits had been lodged against drug companies for misuse of prescription drugs.

He believed no one would read the book because no one wanted to talk about this topic.

After the book was released in 2015, people came out of the shadows and into the light to share their stories, Quinones said. He began to receive invitations to speak to communities around the U.S.

“I’d like to say I saw the country. In fact, I did not. I saw airports, I saw Hampton Inns,” he said.

“But what I did see — which is even better for a reporter, healthier for a reporter — was I did not see America. I saw Americans," he said. "Judges, counselors, drug addicts, county administrators, cops, prosecutors and families of addicted loved ones."

His publisher soon wanted another book. While "Dreamland" focused on black tar heroin and addictive prescription medications, two other substances began to take center stage: methamphetamine and fentanyl.

“What could be worse than heroin?” Quinones asked. "I watched, in fact, the dawning of the synthetic era of drugs, which is what we are firmly in the middle of and may not leave any time soon."

A decorated journalist and critically acclaimed author, Quinones gave the keynote speech Thursday during Panhandle Health District's Substance Use Summit, held at the Red Lion Templin’s on the River in Post Falls.

Attended by many in health care and recovery services, the summit provided an overview of drugs in Idaho, information about screening, intervention, treatment, overdose fatalities, substance use disorder case studies and more.

At the center of the event were the words of Quinones, who delved into his experiences writing his most recent book on the subject, "The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth," for which he was nominated as a finalist for a National Book Critics Circle award for best nonfiction book of 2021.

"Everywhere I go now, the story is meth and fentanyl, or fentanyl and meth, almost always together," he said.

In his research for "The Least of Us," Quinones studied neuroscience and consumer marketing, as well as the concept of reduction of friction to use, which is used by fast food, social media and other corporations to make it as easy as possible for people to use their products. Even the McDonald's arches, unchanged for decades, are strategic in how they trigger consumers to use what the company makes, he explained.

Synthetic drug dealers and traffickers are following this corporate business model. Quinones said methamphetamine seems to be almost free in many communities, with never-ending supply everywhere.

"Fentanyl, they know our love affair with pills. It's profound," Quinones said. "It feels like a no-brainer, then, to make fentanyl into something that looks like we bought it from a doctor. This changes so much about what we know about drugs."

This means society must rethink its approach to the drug epidemic, as everything has changed. Quinones said synthetic substances have spelled the end of the recreational drug-use era.

He described taking prescribed fentanyl after he had a heart attack six years ago.

"I saw the beauty of fentanyl. A few minutes you were doped up, then, boom!, you're right out of it, unlike morphine at four hours later, you're nauseous or high," he said. "Fentanyl, none of that. It revolutionized surgery in America, fentanyl did. Fantastic drug. Really great drug. But it's that same property that made it such a revolutionary drug that makes it such a torment for the user, because it takes you in and out, in and out, all day long."

Heroin addicts, he said, will use the substance two or three times a day to keep withdrawalm symptoms at bay. With fentanyl, its exponentially higher. People will smoke dozens of the pills a day as their tolerance skyrockets.

Quinones said long-term fentanyl use does not exist, because users die in two years.

"You are never far away from the withdrawal beast," he said. "It makes a lot of sense if you are a trafficker to have this situation. Synthetics are all about what benefits traffickers."

Also easy to make is meth, which Quinones said began production with ephedrine in Mexico in the 1980s. An earlier form, P2P, was used by the Hell's Angels even earlier than that.

Meth use fosters hoarding and isolating behaviors. It burns away empathy and is accompanied by symptoms of terrifying schizophrenia, Quinones said — delusions, hallucinations, paranoia. He witnessed its effects on the streets, especially in tent encampments. After doing this research, Quinones said he has found meth to be a major driver of mental illness and homelessness.

"It's not a wave of meth," he said. "It's a new high tide."

Meth drives people mad, Quinones said.

Fentanyl kills them.

The COVID-19 pandemic arrived just as traffickers became most effective in covering the country with these substances.

"I think we understand what the epidemic and now the pandemic are trying to teach us: That we are only as strong as the most vulnerable, we are only as strong as the least of us," he said.

In spite of this darkness, hope does exist. Quinones spoke of a rural Ohio sheriff who hired a heroin addict to work at the jail as a custodian, then as a dispatcher. He shared a story of a Kentucky woman who used money left to her by her late husband to open a tattoo-removal shop to help people in her community clean up their lives.

"When we repair these torn connections, it seems to me then, the solutions present themselves a little more," he said.

It's daunting, Quinones said.

But with small steps, change can happen.

"Synthetic dope is scary. It's toxic and nasty," Quinones said. "A more powerful thing than that is what we have and what we believe is possible for us."