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Fentanyl: Actually As Dangerous As They Say · Stuff You Should Know

• 0:01
  Speaker 1: Welcome to Stuff You Should Know, a production of iHeartRadio.
• 0:11
  Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's
• 0:14
  Speaker 2: Chuck and Jerry's here too, and this is Stuff you
• 0:16
  Speaker 2: Should Know, the Big Bummer Edition.
• 0:19
  Speaker 1: Yeah, not very joky, because we're talking about fentanyl.
• 0:22
  Speaker 2: And.
• 0:24
  Speaker 1: While a great pain killer, a very effective painkiller, it
• 0:28
  Speaker 1: has sadly become the most deadly street drug in the
• 0:30
  Speaker 1: United States. And we're going to tell you how that happened.
• 0:34
  Speaker 2: Yes, but there's slight silver lining. It is possible that
• 0:39
  Speaker 2: it is so deadly and so dangerous that it's actually
• 0:43
  Speaker 2: created a decline in its use. At the very least
• 0:46
  Speaker 2: a decline in deaths from it has taken place. So
• 0:51
  Speaker 2: it is on the decline at least deaths, and we'll
• 0:54
  Speaker 2: talk about possibly why that is later on. But yeah,
• 0:57
  Speaker 2: we'll talk about the origin of fentanyl. For those of
• 1:00
  Speaker 2: you who don't know, it's a synthetic opioid. First, there
• 1:05
  Speaker 2: was morphine, which is I think basically one hundred percent
• 1:07
  Speaker 2: processed natural opium. Heroin is a kind of a combo
• 1:13
  Speaker 2: hybrid between synthetic and natural, and then fentanyl is just
• 1:18
  Speaker 2: straight up like a like it just made up. It's
• 1:22
  Speaker 2: an analog and it's way more potent than anything anyone
• 1:26
  Speaker 2: had ever seen before when it came on the scene.
• 1:29
  Speaker 1: Yeah, like a hundred times more potent than morphine, fifty
• 1:32
  Speaker 1: times more potent than heroin. Created by a gentleman named
• 1:36
  Speaker 1: Paul Janson of the Jansen Company in Belgium, and it
• 1:39
  Speaker 1: was originally developed as an intravenous anesthetic, like for surgery.
• 1:44
  Speaker 1: And they started out with a synthetic opioid as the
• 1:49
  Speaker 1: base called my paradine I guess, and that was developed
• 1:55
  Speaker 1: in the nineteen thirties. And so they had this sort
• 1:57
  Speaker 1: of my paradiine as the base. They change it around
• 2:00
  Speaker 1: a little, I'll alter the chemical structure a little bit,
• 2:03
  Speaker 1: because what they wanted was something that had fewer negative
• 2:07
  Speaker 1: side effects, something that was safer to use, and they
• 2:11
  Speaker 1: were able to do that with fentanyl. I mean it,
• 2:14
  Speaker 1: you know, initially worked great. It was had a very
• 2:17
  Speaker 1: fast onset, had a very high therapeutic index, which is
• 2:21
  Speaker 1: how they measure like the ratio between how effective a
• 2:24
  Speaker 1: dose is and how how you could get to a
• 2:27
  Speaker 1: toxic dose. So if you've got a high number and
• 2:30
  Speaker 1: a greater difference, then that's good.
• 2:33
  Speaker 2: Right, And one of the things. I just want to
• 2:36
  Speaker 2: say that they messed around with molecularly to make fentanyl.
• 2:40
  Speaker 2: They increased its fat solubility, which sounds like who cares,
• 2:44
  Speaker 2: But that has two really important effects that make fetanyl
• 2:48
  Speaker 2: what it is. One, it allows the drug to cross
• 2:51
  Speaker 2: the blood brain barrier faster, which means fentanyl has a
• 2:55
  Speaker 2: much faster onset than heroin or morphine. Right, it just
• 2:59
  Speaker 2: hits you much fast, and then it crosses back through
• 3:03
  Speaker 2: the blood brain barrier more quickly, so the duration of
• 3:06
  Speaker 2: the high that you get lasts a shorter time. So
• 3:10
  Speaker 2: just that one little tweak fat solubility made this drug
• 3:14
  Speaker 2: what it is, because faster onset makes it addictive. Shorter
• 3:19
  Speaker 2: duration means that you need to do more.
• 3:22
  Speaker 1: Yeah, And then I don't think I've mentioned, but it
• 3:23
  Speaker 1: was nineteen sixty was when it first came on the scene.
• 3:27
  Speaker 1: Europe starting using it in sixty three. Came to the
• 3:30
  Speaker 1: US in sixty eight and approved by the FDA only
• 3:34
  Speaker 1: by combining it with a tranquilizing drug called draperidol, because
• 3:39
  Speaker 1: they said, you know that combination makes it even a
• 3:42
  Speaker 1: lower potential for abuse, so you have to use it
• 3:45
  Speaker 1: with that. But over time, that kind of waned, and
• 3:47
  Speaker 1: those limitations were lifted little by little until we got
• 3:50
  Speaker 1: to the mid nineteen eighties when they had, you know,
• 3:54
  Speaker 1: cheaper generic versions available, and it was pretty commonly used
• 3:58
  Speaker 1: in surgery, like post surgical recovery with like skin patches
• 4:03
  Speaker 1: and lozenges and stuff like that for pain management.
• 4:05
  Speaker 2: Yeah, I think still today it's the most common opioid
• 4:09
  Speaker 2: used for anesthesia during surgery. And that just sounds like
• 4:14
  Speaker 2: madness when you're familiar with fentanyl, the street version, but
• 4:19
  Speaker 2: in the hands of like a really well trained anesthesiologist
• 4:23
  Speaker 2: with hospital great equipment, it's actually very safe. It's the
• 4:28
  Speaker 2: fact that the stuff that you buy in the street
• 4:31
  Speaker 2: has a very uneven like dosages means that's why it's
• 4:37
  Speaker 2: just so deadly because you're not a trained anesthesiologist, you're
• 4:41
  Speaker 2: not using hospital grade equipment. You're shooting up something that
• 4:44
  Speaker 2: some dude sold you, and it's just it's just not
• 4:48
  Speaker 2: trustworthy and it can kill you because it takes such
• 4:50
  Speaker 2: a small amount to create a toxic dose.
• 4:53
  Speaker 1: Yeah, it will produce relaxation, feelings, pleasure, sleepiness. You can
• 4:59
  Speaker 1: also get nauseous, dizziness, confusion, vomiting, uritary retention, breathing issues,
• 5:06
  Speaker 1: as we'll see later on. That's you know, basically why
• 5:09
  Speaker 1: you usually od, it's because of breathing issues, and besides
• 5:14
  Speaker 1: the overdose risk, which is great, you could also have
• 5:17
  Speaker 1: a heart attack, heart failure, mood disorders, immune system problems.
• 5:23
  Speaker 1: For all these reasons. It's a schedule two narcotic with
• 5:26
  Speaker 1: a high potential for abuse.
• 5:27
  Speaker 2: Just a reminder marijuana's Schedule one.
• 5:31
  Speaker 1: Yeah, exactly. And most of what we're going to be
• 5:35
  Speaker 1: talking about is sort of the illegal, illicitly produced market.
• 5:40
  Speaker 1: But there are fentanyl users that do get like the
• 5:43
  Speaker 1: real stuff from I'm not sure how they get it,
• 5:46
  Speaker 1: whatever connection they have, and they'll just have to you know,
• 5:49
  Speaker 1: it's not like in a pill or a powder, so
• 5:51
  Speaker 1: it'll be like a patch or something that they might
• 5:53
  Speaker 1: freeze and hold in their mouth, or they might remove
• 5:56
  Speaker 1: the gel and then eat it or inject it or
• 5:58
  Speaker 1: something like that. But usually what we're talking about, the
• 6:02
  Speaker 1: really dangerous stuff is the powders and the pills that
• 6:05
  Speaker 1: are being made illegally and either brought into this country
• 6:08
  Speaker 1: or being made in this country, but usually brought into
• 6:11
  Speaker 1: this country.
• 6:11
  Speaker 2: Yes, and there's different kinds of different analogs of fentanyl
• 6:17
  Speaker 2: that everybody just kind of puts under the umbrella of
• 6:19
  Speaker 2: fentanyl when you're talking about illicit fentanyl. But two of
• 6:22
  Speaker 2: them that stand out that aren't actually illicit, but they're
• 6:26
  Speaker 2: used in the drug market as car fetanyl, which is
• 6:31
  Speaker 2: used there's no use for it in humans. They use
• 6:34
  Speaker 2: it to sedate rhinoceroses and elephants, and I think it's
• 6:39
  Speaker 2: something like ten thousand times more potent than morphine. You
• 6:42
  Speaker 2: can get that on the street apparently, although I think
• 6:45
  Speaker 2: it's fairly rare. And then sue feentanyl is five to
• 6:48
  Speaker 2: ten times stronger than fentanyl. So if you like people
• 6:52
  Speaker 2: aren't like it's car fetanyl or sue fentanyl, you're talking
• 6:54
  Speaker 2: about fentanyl.
• 6:56
  Speaker 1: Yeah, exactly. It doesn't necessarily mean it's the same exact
• 6:59
  Speaker 1: chemical structure. It's just sort of a catch all like pitbull, sure,
• 7:05
  Speaker 1: the singer no no, no pitbull the dog breed, which
• 7:09
  Speaker 1: isn't really a dog breed.
• 7:10
  Speaker 2: I didn't know that.
• 7:11
  Speaker 1: Yeah, there's all kinds of terriers that people just call pitbulls.
• 7:17
  Speaker 2: Well, speaking of umbrella terms in different names, I think
• 7:21
  Speaker 2: we should talk about some of the names. The DEA
• 7:25
  Speaker 2: says that this is called and the only one I
• 7:28
  Speaker 2: could corroborate is the last.
• 7:30
  Speaker 1: One, Tango and cash.
• 7:32
  Speaker 2: Yeah, so apparently that's fetanyl and cocaine mixed together, and
• 7:37
  Speaker 2: or fetanyl and methamphetamine some sort of speed that's a speedball,
• 7:41
  Speaker 2: And as we'll see, that's actually proving to be a
• 7:43
  Speaker 2: really big problem that's created like a new wave of
• 7:47
  Speaker 2: opioid deaths.
• 7:49
  Speaker 1: Yeah. Well, speaking of waves, there have kind of been three,
• 7:52
  Speaker 1: and this is just sort of an overview of the
• 7:54
  Speaker 1: opioid addiction crisis in the US that's been going on
• 7:57
  Speaker 1: for you know, ten fifteen years. The first wave was
• 8:02
  Speaker 1: in the nineties, and that's when you got prescription opioids
• 8:07
  Speaker 1: from your doctor. Those really rose dramatically because they do
• 8:11
  Speaker 1: a really good job. But that's also you know, in
• 8:14
  Speaker 1: lockstep with fatal opioid overdoses. They doubled between ninety nine
• 8:18
  Speaker 1: and twenty ten. And twenty ten was when things started
• 8:22
  Speaker 1: to change for a second wave because the government was like,
• 8:25
  Speaker 1: you can't be writing all these prescriptions like this to
• 8:28
  Speaker 1: doctors and to manufacturers, like you got to change your formulas,
• 8:32
  Speaker 1: Like this stuff is way too readily abuse, So you
• 8:36
  Speaker 1: got to do something.
• 8:38
  Speaker 2: Yeah, and this is really well portrayed in the limited
• 8:42
  Speaker 2: series Dope Sick. I can't remember if it was on HBO.
• 8:45
  Speaker 2: I want to say you saw it right now.
• 8:47
  Speaker 1: I didn't see that.
• 8:48
  Speaker 2: Oh man. It is really good, but it's about the
• 8:50
  Speaker 2: Sackler family and Purdue Pharma essentially purposely hooking America on
• 8:56
  Speaker 2: oxy contin. Yeah, and it's a really good series that
• 9:00
  Speaker 2: just punches you in the gut. But it's really well
• 9:02
  Speaker 2: done and it covers all that period. The problem was
• 9:07
  Speaker 2: this is covered a little bit too towards the end.
• 9:09
  Speaker 2: When you take people's OxyContin away and they're hooked on
• 9:14
  Speaker 2: OxyContin and opioid, they're going to a lot of them
• 9:17
  Speaker 2: are at least turned to whatever opioids are available, and
• 9:21
  Speaker 2: that meant that a lot of people who otherwise would
• 9:24
  Speaker 2: have never tried heroin took up heroin because they couldn't
• 9:28
  Speaker 2: get OxyContin anymore.
• 9:30
  Speaker 1: Yeah, and that was the second wave, and fatal overdoses
• 9:33
  Speaker 1: of heroin because of that largely quadruple between twenty two
• 9:39
  Speaker 1: and twenty thirteen. The third wave is the one we're
• 9:42
  Speaker 1: kind of mainly going to be talking about that started
• 9:44
  Speaker 1: in about twenty thirteen and mainly centers around illegally illicitly
• 9:50
  Speaker 1: produced fentanyl and all the various harmful ways that can
• 9:55
  Speaker 1: find your way into your body, even sometimes even if
• 9:58
  Speaker 1: you don't want to be taking fentanyl.
• 10:00
  Speaker 2: So yeah, So that third wave, the fentanyl opioid death
• 10:05
  Speaker 2: wave or fentanyl driven wave, that is that vastly outstrips
• 10:11
  Speaker 2: the death rate from the first two waves.
• 10:13
  Speaker 1: Yeah.
• 10:14
  Speaker 2: So I think in nineteen ninety nine, so this is
• 10:18
  Speaker 2: when people are starting to take opioid prescriptions, there were
• 10:23
  Speaker 2: two opioid overdose deaths per one hundred thousand people in
• 10:27
  Speaker 2: the United States. Yeah, that was nineteen ninety nine. Twenty thirteen,
• 10:31
  Speaker 2: the second wave is going on, that was up to eight.
• 10:36
  Speaker 2: By twenty twenty two, when the third wave is in
• 10:38
  Speaker 2: full swing, it was twenty five people per one hundred
• 10:42
  Speaker 2: thousand people in the United States that were dying of
• 10:46
  Speaker 2: overdose deaths from fentanyl.
• 10:48
  Speaker 1: Yeah. In twenty twenty two, deaths from fentanyl alone were
• 10:51
  Speaker 1: seventy six two hundred and twenty six people, or sixty
• 10:55
  Speaker 1: nine percent of total overdose deaths and ninety percent of
• 10:59
  Speaker 1: the opioid overdose deaths.
• 11:01
  Speaker 2: Yeah.
• 11:01
  Speaker 1: Apparently it was the problem.
• 11:03
  Speaker 2: For sure, And apparently I was like, well, what else
• 11:06
  Speaker 2: is anybody oding on? And it seems that meth has
• 11:10
  Speaker 2: created a new epidemic of overdose deaths that everybody's like,
• 11:13
  Speaker 2: what the hell's going on?
• 11:15
  Speaker 1: Yeah, well, Fintanel has hit such a high that it's
• 11:18
  Speaker 1: actually had a real impact on US life expectancy. It
• 11:24
  Speaker 1: takes a lot to change a number like that, but
• 11:27
  Speaker 1: Fintanel seems to have done it. And twenty twenty two
• 11:30
  Speaker 1: only opioid related deaths resulted in three point one million
• 11:35
  Speaker 1: years of lost life because a lot of these users
• 11:38
  Speaker 1: are young. And if you ode it twenty two, they
• 11:41
  Speaker 1: calculate the average lifespan and do the subtraction and that's
• 11:44
  Speaker 1: your number. So that you know, a lot of middle
• 11:47
  Speaker 1: age white people without a college degree are the victims.
• 11:53
  Speaker 1: So much so, and this is startling. But from that class,
• 11:56
  Speaker 1: middle aged white people without a college degree, they are
• 11:59
  Speaker 1: dying earlier on average than their parents did. Yes, that's
• 12:03
  Speaker 1: not how it's supposed to work.
• 12:04
  Speaker 2: That's just not how it has worked, unless the United
• 12:07
  Speaker 2: States is at war essentially. Yeah, and you know, we're
• 12:12
  Speaker 2: talking a lot about the US, but the UK and
• 12:14
  Speaker 2: Europe sorry, UK tracks fairly closely. Although the numbers are lower.
• 12:22
  Speaker 2: It seems to be following like a similar pattern. Although
• 12:26
  Speaker 2: I think in some countries. I think estonia is one
• 12:29
  Speaker 2: of them. Like you can't even get heroin anymore, everybody's
• 12:32
  Speaker 2: just doing fatanmol. Yeah.
• 12:34
  Speaker 1: Well, here's the deal though, is researchers have looked at
• 12:37
  Speaker 1: these numbers. I think they declared this a public health
• 12:41
  Speaker 1: emergency in twenty seventeen, and what they're finding is, and
• 12:45
  Speaker 1: this has been coroberated from other surveys and you know,
• 12:48
  Speaker 1: metadata studies and stuff, is there aren't more overdose deaths
• 12:52
  Speaker 1: because more people are using it. It's not just like, oh,
• 12:56
  Speaker 1: well more people are doing it, so more people are dying.
• 12:59
  Speaker 1: It seems like it's because this stuff is more dangerous,
• 13:02
  Speaker 1: it's getting in places that it shouldn't get because usage
• 13:05
  Speaker 1: has actually declined some over the past like eight years, right.
• 13:09
  Speaker 2: Yeah. I think the first two waves were driven by
• 13:12
  Speaker 2: larger numbers increases in people using prescription opioids and then heroin,
• 13:18
  Speaker 2: so that accounted for it. But when fentanyl came on
• 13:21
  Speaker 2: the scene, yeah, people stopped using it as much, but
• 13:24
  Speaker 2: their deaths just increased, which if you look at it
• 13:27
  Speaker 2: from just an outside perspective, like it's just because it's
• 13:31
  Speaker 2: so potent and it was rolled out or introduced to
• 13:35
  Speaker 2: the drug supply in a really horrific way, as we'll see.
• 13:41
  Speaker 1: Yeah, for sure. It also sort of goes in lockstep
• 13:44
  Speaker 1: with the income disparity in the United States and the
• 13:49
  Speaker 1: client in fortunes for a lot of people in this country.
• 13:52
  Speaker 1: Overdosing is basically what they call it is a disease
• 13:55
  Speaker 1: of despair. When people are destitute and when they're down
• 14:02
  Speaker 1: or depressed or having really hard times. A lot of
• 14:05
  Speaker 1: times drugs can be a distraction or if you are
• 14:10
  Speaker 1: a casual drug user, it could get worse during that time.
• 14:13
  Speaker 1: And they found in twenty seventeen they study counties in
• 14:15
  Speaker 1: the US and found that those with the lowest social capital,
• 14:20
  Speaker 1: meaning networks that can help people, you know, with financial
• 14:23
  Speaker 1: security and achieving goals, they had the highest rate of overdose.
• 14:27
  Speaker 2: Yes, so social capital is basically the size of your
• 14:30
  Speaker 2: local Kowanas chapter.
• 14:34
  Speaker 1: I knew you'd get a joke in theres.
• 14:36
  Speaker 2: So yeah, this is I mean, like this whole thing
• 14:39
  Speaker 2: kind of rose and lockstep. Opioid overdose sets rose and
• 14:42
  Speaker 2: lockstep with these financial crisis that the US found itself
• 14:46
  Speaker 2: in over and over again since two thousand and eight.
• 14:50
  Speaker 2: Job loss, aws of manufacturing jobs just all of the
• 14:54
  Speaker 2: hardship that the United States has gone through since then,
• 14:58
  Speaker 2: opioid debts kind of tracked with it, especially at first,
• 15:01
  Speaker 2: especially with people basically more people turning to that kind
• 15:05
  Speaker 2: of thing as a disease of despair, which is just sad.
• 15:10
  Speaker 2: It's just nuts that that's that you can kind of
• 15:13
  Speaker 2: connect those two things.
• 15:17
  Speaker 1: Should we take a break? Yeah, all right, we're gonna
• 15:19
  Speaker 1: take a break, and we're gonna talk about the rise
• 15:22
  Speaker 1: of fentanyl right after this. It's stuffish. So one reason
• 15:56
  Speaker 1: we've seen a surge in overdoses for something like this
• 15:59
  Speaker 1: is something called the iron law prohibition that was coined
• 16:02
  Speaker 1: in nineteen eighty six by an economist named Richard Cowan,
• 16:05
  Speaker 1: and it's basically saying that, hey, if you ban something
• 16:09
  Speaker 1: that people like doing, something's going to come along, and
• 16:12
  Speaker 1: it's probably going to be a stronger version. The reason
• 16:15
  Speaker 1: they call it the law prohibition is because that's what
• 16:17
  Speaker 1: happened when people were like, all right, you're going to
• 16:19
  Speaker 1: take our beer, We're going to start making gin and
• 16:20
  Speaker 1: our bathtubs and moonshine out in the woods, and the
• 16:26
  Speaker 1: rise of crack in the nineteen eighties the same thing,
• 16:28
  Speaker 1: and they're basically saying fentanyl is basically the same deal.
• 16:31
  Speaker 2: Yeah, and not only more potent, but the fact that
• 16:34
  Speaker 2: it's more potent means that less of it can generate
• 16:39
  Speaker 2: just as much cash, which also means it's easier to
• 16:41
  Speaker 2: smuggle too. And like you said, fentanyl tracks exactly the
• 16:45
  Speaker 2: same way. It's really easy to make. I mean apparently
• 16:49
  Speaker 2: you just basically, if you have the precursor chemicals, you're
• 16:52
  Speaker 2: just making a stew in a pot that you're stirring,
• 16:55
  Speaker 2: You dry it out, and there you got a bunch
• 16:56
  Speaker 2: of fentanyl. So it's easy to make. You don't require
• 17:01
  Speaker 2: tons and tons of agricultural workers and tons and tons
• 17:04
  Speaker 2: of acreage to grow poppies that you process into heroin.
• 17:08
  Speaker 2: And because the potency is so much more, there is
• 17:12
  Speaker 2: a huge cost benefit. Apparently it just accrues to the dealers.
• 17:19
  Speaker 2: Though there was a study in the journal Addiction from
• 17:22
  Speaker 2: twenty twenty that basically wanted to find out why was
• 17:26
  Speaker 2: fentanyl introduced. Was it users who are like, Hey, heroin's great,
• 17:30
  Speaker 2: but we need something way deadlier? Was it dealers who
• 17:33
  Speaker 2: are like, hey, heroin's great, but this stuff I can
• 17:36
  Speaker 2: cut heroin with and like, I'll make a lot more
• 17:40
  Speaker 2: money or was it a combination of the two. They
• 17:43
  Speaker 2: didn't say definitively, but they made a pretty good case
• 17:46
  Speaker 2: that it does seem to have been the dealers looking
• 17:50
  Speaker 2: to cut costs because those costs or those savings weren't
• 17:53
  Speaker 2: passed on to users.
• 17:56
  Speaker 1: Yeah, it's not like, hey, this, we're making the drugs
• 17:58
  Speaker 1: cheaper now, so we're just going to give you a
• 17:59
  Speaker 1: break this. There was one study that found between twenty
• 18:03
  Speaker 1: thirteen and twenty twenty one, the percentage of heroin that
• 18:07
  Speaker 1: had fentanyl rows from less than one percent to forty
• 18:11
  Speaker 1: percent over what is that eight years? And of course
• 18:17
  Speaker 1: it's going to lead to a huge number of overdoses
• 18:19
  Speaker 1: because a you've got these batches that are coming out
• 18:23
  Speaker 1: that the you know, the potency has got a pretty
• 18:25
  Speaker 1: dramatic range from one batch to another sometimes. Yeah, and
• 18:29
  Speaker 1: then people you know, for a long time, I think,
• 18:31
  Speaker 1: you know, the word is finally out now and we're
• 18:33
  Speaker 1: going to talk about that a little bit later. But
• 18:36
  Speaker 1: people that were heroin users thought they were getting heroin
• 18:38
  Speaker 1: and knew how much heroin to take safely.
• 18:41
  Speaker 2: Yeah, And one reason why is because these dealers were saying,
• 18:44
  Speaker 2: if I sell you heroin mixed with fentanyl, I have
• 18:49
  Speaker 2: to use less heroin because it's going to be just
• 18:51
  Speaker 2: a potent or more potent. But I can charge you
• 18:53
  Speaker 2: heroin prices even though I'm paying way less for the
• 18:56
  Speaker 2: fentanyl that I'm using here. And yeah, people were caught
• 18:59
  Speaker 2: by some prize. The fact that it was duplicitous is
• 19:03
  Speaker 2: just awful because it's like, hey, good luck getting acclimated
• 19:06
  Speaker 2: to this there. It's gonna be a rough transition. But
• 19:09
  Speaker 2: if you look at it from a business standpoint, the
• 19:11
  Speaker 2: rollout of fentanyl into the American and European drug supplies,
• 19:15
  Speaker 2: it had terrible marketing, like it had zero marketing. It
• 19:18
  Speaker 2: was just all of a sudden there people started dying
• 19:21
  Speaker 2: and it took the authorities investigating what the heck was
• 19:23
  Speaker 2: going on for people to figure out that it was fentanyl.
• 19:26
  Speaker 2: That's how it was introduced. It was just so reckless.
• 19:29
  Speaker 2: I mean, I'm talking about heroin dealers being even more
• 19:33
  Speaker 2: reckless than they normally are. That's what happened with fentanyl
• 19:37
  Speaker 2: being introduced. It just suddenly popped up. No one said
• 19:40
  Speaker 2: anything about it first.
• 19:42
  Speaker 1: Yeah, and by the way, when I said safely do heroin,
• 19:46
  Speaker 1: I'm hope unclear than that there's doing heroin is never safe.
• 19:50
  Speaker 1: I just met heroin users would know how much they
• 19:53
  Speaker 1: can take without overdosing, right, yeah, okay, I just wanted
• 19:57
  Speaker 1: to make sure people do what I was.
• 19:58
  Speaker 2: I think that was worth mentioning.
• 19:59
  Speaker 1: Yeah, okay, good. So the other you know, problems with
• 20:03
  Speaker 1: ventanyl is that it has a really intense rush when
• 20:06
  Speaker 1: it's first used. Apparently it's more of a head rush
• 20:08
  Speaker 1: than a body rush, so it can be a little
• 20:11
  Speaker 1: more you can be a little more active as a
• 20:14
  Speaker 1: user than maybe doing heroin and just like passing out
• 20:17
  Speaker 1: on your couch for hours and hours. It's also dangerous
• 20:20
  Speaker 1: because the high is only an hour or two, so uh,
• 20:23
  Speaker 1: you know, heroin high lasts longer, so that short duration
• 20:27
  Speaker 1: is gonna you know, have people using more frequently, and
• 20:30
  Speaker 1: every time you use ventyl it's just another chance to overdose. Basically.
• 20:33
  Speaker 2: Yes, it's a great point. Yeah, and that has to
• 20:36
  Speaker 2: do with that fat solubility. Again, I said it before
• 20:39
  Speaker 2: and I'll say it again.
• 20:40
  Speaker 1: Yeah, I mean it can happen like a fentanyl overdose
• 20:43
  Speaker 1: can happen in seconds, right.
• 20:45
  Speaker 2: Yes, because the onset is so quick, which makes it
• 20:48
  Speaker 2: that's another reason that it's so deadly too, is you
• 20:51
  Speaker 2: don't have time to be like, oh man, there's frau
• 20:53
  Speaker 2: through on my buddy's mouth. I better call nine one
• 20:55
  Speaker 2: one because there's good Samaritan laws in my state. It's like,
• 20:58
  Speaker 2: oh my buddy just injected fentanyl and now they're dead.
• 21:01
  Speaker 2: I mean, it's it's not that fast necessarily, but compared
• 21:04
  Speaker 2: to heroin, it is. And yeah, I think it's measured
• 21:07
  Speaker 2: in like seconds.
• 21:09
  Speaker 1: Yeah, it certainly can be. Another thing that makes it
• 21:12
  Speaker 1: more deadly is that people started changing how they used it.
• 21:15
  Speaker 1: Among people who died from illegal fentanyl overdoses, the portion
• 21:19
  Speaker 1: who injected dropped forty two percent over just a two
• 21:23
  Speaker 1: year period between twenty and twenty twenty two, and they
• 21:27
  Speaker 1: generally started smoking it that jumped to seventy nine percent.
• 21:31
  Speaker 1: I believe people also can snort the powder, but just
• 21:36
  Speaker 1: the fact that people aren't injecting it as much kind
• 21:39
  Speaker 1: of you know, if you connect the dots, somebody might
• 21:43
  Speaker 1: dive into using it a little quicker, if they're like, hey,
• 21:46
  Speaker 1: just snort this thing instead of hey, shoot up this thing.
• 21:49
  Speaker 2: Yeah, because that's a big barrier for a lot of
• 21:52
  Speaker 2: people who are like I like drugs, but I'm not
• 21:56
  Speaker 2: gonna stick a needle in my arm. That just seems
• 21:58
  Speaker 2: like such a a horrible road to go down that
• 22:01
  Speaker 2: it will give people second thoughts. But smoking something geez,
• 22:05
  Speaker 2: I like marijuana, I like smoking crack, I might as
• 22:08
  Speaker 2: well try smoking fentanyl. It's just much less of a
• 22:10
  Speaker 2: barrier to overcome.
• 22:12
  Speaker 1: Yeah, And if you're smoking it or snorting it, it
• 22:14
  Speaker 1: doesn't stay in your body as long as if you
• 22:16
  Speaker 1: shoot it, so again, just another case of it wears
• 22:19
  Speaker 1: off quicker and you're gonna want to use it again,
• 22:22
  Speaker 1: and that's just another overdose opportunity.
• 22:25
  Speaker 2: Yes, yeah, I mean it's crazy if you think about it,
• 22:28
  Speaker 2: because most other drugs that you smoke you could conceivably
• 22:31
  Speaker 2: overdose on. But fentanyl, even though you're smoking it and
• 22:35
  Speaker 2: not injecting it, there's still a really good chance that
• 22:38
  Speaker 2: you could overdose and die from just smoking it. That's
• 22:41
  Speaker 2: kind of mind boggling, but it's accurate.
• 22:44
  Speaker 1: Yeah, And you know, we're talking about smoking it and
• 22:46
  Speaker 1: snorting it and like powder and a bad kind of stuff.
• 22:50
  Speaker 1: But the real danger now, and the real problem all
• 22:54
  Speaker 1: of it is, of course, but the real, real scary
• 22:56
  Speaker 1: thing is the fact that these are generally sold and
• 23:01
  Speaker 1: the us CAS's pills. I think by late twenty twenty one,
• 23:05
  Speaker 1: more than a quarter of the fentanyl seized was in
• 23:07
  Speaker 1: pill form, And a lot of these pills are they
• 23:10
  Speaker 1: look like something else. You hear stories on the news
• 23:14
  Speaker 1: about a kid that did not want to take fentanyl,
• 23:19
  Speaker 1: that thought they were taking something else and it ended
• 23:22
  Speaker 1: up being either laced with fentanyl or largely fentanyl, and
• 23:26
  Speaker 1: they overdose without even knowing they took it.
• 23:28
  Speaker 2: Yeah, and it's kind of hard to wrap your head around,
• 23:30
  Speaker 2: like why would somebody send you that? Like how evil
• 23:33
  Speaker 2: could you be? But apparently fentanyl pills are very frequently
• 23:40
  Speaker 2: created to look like old OxyContin what are called M thirty's,
• 23:45
  Speaker 2: So it would be very easy for something to be like,
• 23:47
  Speaker 2: oh cool, here's an OxyContin. Fentanyl users know what they're doing.
• 23:52
  Speaker 2: But if you didn't, we're in a fentanyl user and
• 23:54
  Speaker 2: you just wanted an oxy contin. That's how you could
• 23:57
  Speaker 2: die of an overdose fairly quickly. And those are, like
• 24:00
  Speaker 2: you said, those are the stories that you hear on
• 24:01
  Speaker 2: the news. I don't think it's a very frequent thing,
• 24:03
  Speaker 2: but when it does happen, it's just horrific.
• 24:08
  Speaker 1: Yeah, for sure. Or if you say you want to
• 24:11
  Speaker 1: use some cocaine. You're like, Hey, that's my thing. Do
• 24:13
  Speaker 1: it every now and then on a Saturday night, I'm
• 24:15
  Speaker 1: going to get some of that stuff. For the same reasons,
• 24:19
  Speaker 1: Heroin is cut with ventyl. Cocaine can be as well,
• 24:22
  Speaker 1: So that's not even the same kind of high. You're
• 24:26
  Speaker 1: looking for cocaine. You may never in your life have
• 24:29
  Speaker 1: taken anything like morphine or heroine, and all of a
• 24:32
  Speaker 1: sudden you're snorting fentanyl without knowing it and you're on
• 24:35
  Speaker 1: the floor.
• 24:36
  Speaker 2: Yeah, just a reminder, speedballs are what killed not just
• 24:39
  Speaker 2: John Belushi, but Chris Farley as well. And apparently this
• 24:43
  Speaker 2: is that fourth wave that we were talking about of
• 24:47
  Speaker 2: speedball in fentanyl, with cocaine or with meth. And it's
• 24:52
  Speaker 2: not just where dealers are cutting it and not telling
• 24:55
  Speaker 2: their buyers, like buyers are seeking this out. And apparently
• 24:59
  Speaker 2: this fourth wave has kind of caught black Americans up
• 25:04
  Speaker 2: into it more than the other previous waves have.
• 25:07
  Speaker 1: Oh really, yeah, all right, Well, I guess we can
• 25:12
  Speaker 1: talk a little bit about where it comes from. A
• 25:15
  Speaker 1: lot of it that smuggled into the US was originally
• 25:18
  Speaker 1: made in China, but in twenty nineteen China said you
• 25:21
  Speaker 1: cannot produce her sell fitting all anymore, and some people
• 25:25
  Speaker 1: stop doing it, but a lot of manufacturers continued doing so,
• 25:29
  Speaker 1: sometimes through Legit means that you made it very easy
• 25:33
  Speaker 1: to ship, but then they also turned to the black
• 25:36
  Speaker 1: market to ship directly to customers in the US and Europe,
• 25:39
  Speaker 1: or hey, let's ship the stuff over to Mexico and
• 25:44
  Speaker 1: these cartels and they can just kind of put it
• 25:46
  Speaker 1: together there and work as the distributor for US.
• 25:50
  Speaker 2: Yeah. So the cartels are getting these precursors, they're turning
• 25:52
  Speaker 2: around and distributing the precursors to cooks who I read
• 25:57
  Speaker 2: like a Univision story, so they just I guess we're
• 26:02
  Speaker 2: interviewing some random ventanyl cook in Mexico. It was like
• 26:05
  Speaker 2: three twenty year olds who were just standing out in
• 26:08
  Speaker 2: the woods under a black tarp with a pot on
• 26:11
  Speaker 2: top of a fire, just stirring it like it was
• 26:13
  Speaker 2: really easy to make. And then that stuff goes back
• 26:17
  Speaker 2: to the cartels to smuggle across the border and sell.
• 26:22
  Speaker 1: Yeah. Another myth we can kind of bust here as
• 26:25
  Speaker 1: far as where it comes from, is that in recent years,
• 26:29
  Speaker 1: there have been politicians that have tried to link the
• 26:33
  Speaker 1: influx of fentanyl in the United States to illegal immigration,
• 26:37
  Speaker 1: And there was a poll in twenty twenty two that
• 26:39
  Speaker 1: found that forty percent of Americans believed that most ventanyl
• 26:43
  Speaker 1: entering the country was being smuggled by illegal immigrants, basically,
• 26:49
  Speaker 1: and that's that's not true. The truth is is that
• 26:53
  Speaker 1: most of this drug comes through legal points of entry,
• 26:56
  Speaker 1: and when it does, it is smuggled in in a
• 26:59
  Speaker 1: vehicle driven by US citizens.
• 27:01
  Speaker 2: Yeah, most often American women. And I think the Cato
• 27:05
  Speaker 2: Institute did a study where they found eighty six point
• 27:08
  Speaker 2: three percent of convicted fentanyl smugglers are American citizens, So
• 27:13
  Speaker 2: that seems to be totally untrue.
• 27:16
  Speaker 1: Yeah, but apparently.
• 27:17
  Speaker 2: This is a I think this is a measure of
• 27:19
  Speaker 2: how how bad fentanyl is, because I mean, Chuck, we're
• 27:24
  Speaker 2: pretty fentanyl naive. I've never done feentanyl. I'm making a
• 27:27
  Speaker 2: pretty good assumption that you've never done fetanyl and kept
• 27:29
  Speaker 2: it a secret from me. So it's entirely possible that
• 27:34
  Speaker 2: within this whole thing, we've passed along some myth or
• 27:37
  Speaker 2: exaggeration without being aware of it. Yeah, and for that,
• 27:41
  Speaker 2: I'm sorry. The thing is, it seems that the overall
• 27:46
  Speaker 2: theme that fentanyl is incredibly deadly and on a level
• 27:51
  Speaker 2: unlike any other drug that's ever hit the US market,
• 27:55
  Speaker 2: so much so that it's like, just don't do drugs.
• 27:58
  Speaker 2: It's too dangerous because because of the presence of fentanyl.
• 28:02
  Speaker 2: I think that holds and I think this supports that thesis.
• 28:08
  Speaker 2: In Cineloa, the Cineloa Cartel has a ban on selling
• 28:13
  Speaker 2: fentanyl in Sineloa punishable by death. So if you're a
• 28:17
  Speaker 2: drug dealer in Cineloa and the Cineloa Cartel catches you
• 28:20
  Speaker 2: selling fentanyl in their state in Mexico where they're supplying
• 28:25
  Speaker 2: the rest of the world with fentanyl, they'll kill you.
• 28:28
  Speaker 2: I think that says just about everything you need to
• 28:30
  Speaker 2: know about fentanyl.
• 28:32
  Speaker 1: Yeah, for sure. Should we take another break? All right,
• 28:35
  Speaker 1: We'll be back and talk about punishment and harm reduction
• 28:38
  Speaker 1: right after this. It's stuff.
• 29:12
  Speaker 2: So one of the things that's a little different about
• 29:14
  Speaker 2: the fentanyl epidemic is that it hasn't tracked closely or
• 29:19
  Speaker 2: identically to pass drug epidemics, where like the crack epidemic
• 29:24
  Speaker 2: or the cocaine epidemic, especially of like the nineties, where
• 29:30
  Speaker 2: or the eighties or nineties, where if you were caught
• 29:32
  Speaker 2: with it, especially if you're black, you're going to prison
• 29:35
  Speaker 2: for possibly the rest of your life. This time around,
• 29:39
  Speaker 2: it's been a little more there's been a little more
• 29:43
  Speaker 2: understanding that this is as much a public health crisis,
• 29:46
  Speaker 2: probably more of public health crisis than a crisis to
• 29:49
  Speaker 2: be addressed by law enforcement. And one of the more
• 29:54
  Speaker 2: cynical reasons why that's probable is because it's largely been
• 29:58
  Speaker 2: viewed publicly as a white issue, that it's mostly white
• 30:02
  Speaker 2: people who are overdosing and dying from ventanyl.
• 30:06
  Speaker 1: Well, let's say this. I don't remember anything growing up
• 30:10
  Speaker 1: in the eighties that said, let's help these people addicted
• 30:15
  Speaker 1: to crack.
• 30:16
  Speaker 2: No, you were just morally reprehensible and your kid was
• 30:19
  Speaker 2: probably screwed up.
• 30:21
  Speaker 1: Throw away the key is what you got. So yeah,
• 30:24
  Speaker 1: I don't think that's cynical. I think that's absolutely the truth.
• 30:27
  Speaker 1: So thankfully they're taking a little bit different approach. We've
• 30:30
  Speaker 1: gotten a little bit smarter about this stuff, and now
• 30:34
  Speaker 1: we're focusing. We're trying to focus on harm what's called
• 30:37
  Speaker 1: harm reduction techniques, basically trying to keep people from dying.
• 30:41
  Speaker 1: A bunch of different things have been tried, and a
• 30:43
  Speaker 1: lot of it has been fairly effective. As we're seeing
• 30:46
  Speaker 1: like the numbers going down in overdoses, but distributing test strips.
• 30:51
  Speaker 1: So if you buy a pill, or if you buy
• 30:53
  Speaker 1: cocaine or something, and you have a test strip, you
• 30:55
  Speaker 1: can test to see if that drug has ventanyl before
• 30:59
  Speaker 1: you use it, or maybe your dealer even offers that service.
• 31:02
  Speaker 2: That's really something.
• 31:04
  Speaker 1: Yeah, I mean, if you want to be a and
• 31:07
  Speaker 1: again I say reputable drug dealer with sort of scare quotes,
• 31:11
  Speaker 1: but I would imagine that's a good thing to do,
• 31:13
  Speaker 1: is say, hey, this stuff is pure. I got a
• 31:15
  Speaker 1: test strip here, and you can test it to make
• 31:17
  Speaker 1: sure that you can be a repeat customer and not
• 31:19
  Speaker 1: dead on the sidewalk.
• 31:20
  Speaker 2: Yeah. And I think that the test strips have helped
• 31:23
  Speaker 2: a lot of people, if not save their lives. The
• 31:26
  Speaker 2: problem with them that I've seen is that all they
• 31:29
  Speaker 2: do is show that there is fentanyl present. It doesn't
• 31:32
  Speaker 2: say whether it's a fentanyl analog like car fentanyl that's
• 31:35
  Speaker 2: one hundred times stronger than fentanyl. It doesn't say how
• 31:39
  Speaker 2: much fentanyl is in there, so is it just a
• 31:41
  Speaker 2: little bit or is it like a kill you sized dose.
• 31:44
  Speaker 2: But if you're like I don't do fentanyl, those test
• 31:47
  Speaker 2: trips are going to get quite a bit, like I
• 31:49
  Speaker 2: just want cocaine. Stop putting fentanyl in my cocaine. Those
• 31:53
  Speaker 2: test strips are going to help you, and they're going
• 31:55
  Speaker 2: to tick you off because I mean, I don't think
• 31:57
  Speaker 2: you can take cocaine back to the deal learn get
• 32:00
  Speaker 2: your money back because it had fentanyl in it. Although
• 32:03
  Speaker 2: who knows with kids these days.
• 32:06
  Speaker 1: Yeah, I mean that these newer generations may demand return restitution.
• 32:12
  Speaker 1: So another thing that they can do is, you know,
• 32:16
  Speaker 1: they're safe places where people can go use the drugs
• 32:19
  Speaker 1: while people watch out for you. The drug users themselves
• 32:22
  Speaker 1: seem to have wizened up a little bit because of
• 32:25
  Speaker 1: all the news and probably seeing their friends die very sadly.
• 32:29
  Speaker 1: But they may take, you know, dip their toe in
• 32:32
  Speaker 1: the water a little bit at first and take a
• 32:33
  Speaker 1: smaller dose. Or they may if they're with a group
• 32:36
  Speaker 1: that's using stagger the doses so people can be standing
• 32:39
  Speaker 1: by with that narcan in case one of their friends
• 32:42
  Speaker 1: passes out.
• 32:43
  Speaker 2: I wonder if, like you, they draw straws to see
• 32:45
  Speaker 2: what order everybody does drugs in, Like, how do they
• 32:49
  Speaker 2: how do they determine who's going to go last?
• 32:53
  Speaker 1: Any medium monuments? Okay, the age old the traditionally exactly,
• 32:58
  Speaker 1: But I did mention Narcan and that is the brand
• 33:01
  Speaker 1: name for naloxone or nelaxone, and that can redse reverse
• 33:08
  Speaker 1: an overdose. And like, I have only one anecdotal example.
• 33:12
  Speaker 1: I don't know if it always works this way, but
• 33:15
  Speaker 1: one day quite a few years ago, a car just
• 33:18
  Speaker 1: kind of pulled around the corner and parked across the street,
• 33:21
  Speaker 1: and this dude got out of the car and his
• 33:25
  Speaker 1: girlfriend was like passed out, and it was clear that
• 33:27
  Speaker 1: it was a drug thing. Luckily, my Cross Street neighbors
• 33:31
  Speaker 1: a nurse. She called nine one one. Immediately they showed
• 33:34
  Speaker 1: up with narcan and dude they injected that, and this
• 33:37
  Speaker 1: girl was walking around and like saying, can I get
• 33:41
  Speaker 1: Can we leave now? Like minutes later?
• 33:43
  Speaker 2: Wow, yeah, I mean it just reverses an overdose, right.
• 33:48
  Speaker 1: Yeah, but I do. I mean, I don't know what
• 33:50
  Speaker 1: happens after that. All I saw was this snapshot where
• 33:53
  Speaker 1: she was like, I want to get out of here,
• 33:55
  Speaker 1: and I don't know what the law the laws are
• 33:57
  Speaker 1: as far as that kind of stuff goes. But the
• 34:00
  Speaker 1: ambulance I don't think is allowed to call the cops
• 34:02
  Speaker 1: on you. If I'm not mistaken. I think they're just like, Okay,
• 34:06
  Speaker 1: I guess you can go.
• 34:07
  Speaker 2: Yeah. I don't know the law in Georgia or anywhere really, but.
• 34:10
  Speaker 1: Yeah, those laws are called something what is it, good
• 34:13
  Speaker 1: Samaritan laws? Oh okay, yeah, I guess that's it.
• 34:16
  Speaker 2: So you would be protected, but that wouldn't matter. It's
• 34:18
  Speaker 2: more like, if you're shooting up with your friend and
• 34:20
  Speaker 2: your friend overdoses and you have a bunch of heroin
• 34:22
  Speaker 2: or fentanyl on you, you can't be prosecuted for having that.
• 34:27
  Speaker 2: I mean, I'm sure to an extent because you just
• 34:31
  Speaker 2: because you called for help to help your friend and
• 34:34
  Speaker 2: the cops ended up showing up to you.
• 34:37
  Speaker 1: Yeah, and I didn't look this up, But can't you
• 34:39
  Speaker 1: just buy a narcan?
• 34:40
  Speaker 2: Yeah, it's getting much more widely available. Okay, Yeah, but
• 34:45
  Speaker 2: let's talk a little bit about overdoses because there's some
• 34:49
  Speaker 2: One of the telltale signs I think it's not just
• 34:51
  Speaker 2: with fentanyl, with heroin as well, or opioids in general,
• 34:54
  Speaker 2: is it can produce fluid in the lungs, so that
• 34:57
  Speaker 2: a telltale sign of an overdose is froth around the
• 35:01
  Speaker 2: mouth or in the notes. Once that happens, you need
• 35:04
  Speaker 2: to act pretty quickly, and one of the things that
• 35:08
  Speaker 2: they say to do first is rub your knuckles on
• 35:11
  Speaker 2: their chests kind of hard, because it's a very uncomfortable
• 35:15
  Speaker 2: thing to have done to you, and it can snap
• 35:18
  Speaker 2: you out of a opioid stupor even that. But if
• 35:23
  Speaker 2: they don't respond, then it's you need to call nine
• 35:26
  Speaker 2: to one to one and or administered in the lockxown.
• 35:30
  Speaker 1: Yeah, I mean in the brain stem, there are a
• 35:32
  Speaker 1: couple of regions, the medulla and the ponds, and they
• 35:34
  Speaker 1: control the depth and rate of breathing. But both of
• 35:37
  Speaker 1: those have a lot of opioid receptors. So if you
• 35:42
  Speaker 1: do fentanyl and they attach to those receptors, which they will,
• 35:45
  Speaker 1: they can change the behaviors of the cells such that
• 35:48
  Speaker 1: they just stop working and you just literally just stop breathing,
• 35:51
  Speaker 1: like it's that simple.
• 35:52
  Speaker 2: Yeah, And it's even worse than that, actually, because there's
• 35:55
  Speaker 2: also opio receptors in the parts of your brain that
• 35:57
  Speaker 2: control voluntary breathing. So like when you're like I need
• 36:00
  Speaker 2: to catch my breath and you take a deep breath,
• 36:02
  Speaker 2: or if you're meditating, when you purposefully breathe, that is
• 36:06
  Speaker 2: repressed as well, so you have involuntary breathing and voluntary
• 36:10
  Speaker 2: breathing or repressed, and this thing that detects rises in
• 36:15
  Speaker 2: CO two in your body that gets repressed as well.
• 36:18
  Speaker 1: Right, Yeah, So basically, if you want to take that
• 36:25
  Speaker 1: deep breath, if you've since like you're in trouble, I'm like,
• 36:27
  Speaker 1: oh man, I got to get a big breath of
• 36:28
  Speaker 1: air here. You just do that normally, But little small
• 36:33
  Speaker 1: increases in CO two are sensed, and thekarated body it's
• 36:37
  Speaker 1: a little small cluster of sales in the neck. They're
• 36:39
  Speaker 1: going to spur that increase in breathing to remove that
• 36:42
  Speaker 1: excess CEOs two. But if that's not working and that
• 36:45
  Speaker 1: emergency sort of fail safe is switched off, then again
• 36:49
  Speaker 1: you can't even get that big breath to save yourself.
• 36:52
  Speaker 2: Yeah, So breathing, I think you said early on that
• 36:55
  Speaker 2: typically is where fatal overdoses. It's just you just stop breathing,
• 37:02
  Speaker 2: stop being able to breathe. But there's other ways you
• 37:04
  Speaker 2: could die. I think you mentioned heart attack earlier too.
• 37:07
  Speaker 2: Another famous one with opioids is your gag reflex is suppressed.
• 37:11
  Speaker 2: So if you're basically knotted off and you throw up,
• 37:15
  Speaker 2: say you've been drinking as well, you're not going to
• 37:19
  Speaker 2: choke that stuff out or spit it out or throw
• 37:22
  Speaker 2: it up out of your mouth. It can just stay
• 37:24
  Speaker 2: in your mouth and it can go down your lungs
• 37:26
  Speaker 2: and you aspirate and or choke on your own vomit.
• 37:29
  Speaker 2: That's another way you can die from an overdose as well.
• 37:32
  Speaker 1: I was waiting to see if you were going to
• 37:34
  Speaker 1: come up with like a fourth way to say pukey?
• 37:37
  Speaker 2: Did I say a bunch of different ways?
• 37:39
  Speaker 1: You said, like three, you like spit it up or
• 37:41
  Speaker 1: vomit it up or choke ers yeack it up.
• 37:44
  Speaker 2: I was like, we get it blow chunks it up.
• 37:47
  Speaker 1: Oh God. So as far as treatment goes, it kind
• 37:51
  Speaker 1: of goes and locks up with what they do for heroin.
• 37:53
  Speaker 1: It's called medication assisted treatment or MATT. That's kind of
• 37:56
  Speaker 1: the gold standard. We're talking about either methadone or how
• 38:01
  Speaker 1: do you say that, bupa norphine. If you get methadone,
• 38:07
  Speaker 1: it's going to be done at a clinic. It's not
• 38:09
  Speaker 1: like they just hand that out at the pharmacy, which
• 38:11
  Speaker 1: means you have to go to that clinic. You got
• 38:12
  Speaker 1: to wait in line a lot of times. You got
• 38:14
  Speaker 1: to do it there. The other one, I believe is
• 38:18
  Speaker 1: given in the form or I guess the brand name
• 38:20
  Speaker 1: subox Owne, and I think you can you can get
• 38:26
  Speaker 1: that prescribed. But a lot of people are like, hey,
• 38:29
  Speaker 1: you know, go to drug rehab and just quit doing
• 38:34
  Speaker 1: all this stuff because you're still on another drug. If
• 38:36
  Speaker 1: you're going to a methadone clinic every day, right.
• 38:38
  Speaker 2: A lot of people don't have access to the kind
• 38:41
  Speaker 2: of doctor that's going to prescribe that for them. There's
• 38:45
  Speaker 2: a lot, like even among medical professionals still believe it
• 38:48
  Speaker 2: or not, there's still a lot of stigma associated with
• 38:51
  Speaker 2: being an opioid addict. Yeah, which is pretty rich considering
• 38:57
  Speaker 2: the American physicians, a significant chunk of them got America
• 39:01
  Speaker 2: hooked on opioids in the first place. But that's neither
• 39:04
  Speaker 2: here nor there right now. So I think there was
• 39:07
  Speaker 2: a study from twenty twenty two that the CDC conducted
• 39:11
  Speaker 2: where they said that of the three point seven percent
• 39:14
  Speaker 2: of all adults in the United States who need medication
• 39:17
  Speaker 2: assisted treatment, I think only about twenty five percent of
• 39:22
  Speaker 2: that three point seven percent, we're able to get it.
• 39:26
  Speaker 1: Yeah.
• 39:26
  Speaker 2: One of the other ways that you can get off
• 39:28
  Speaker 2: of it is to go to prison where they are
• 39:30
  Speaker 2: just like, good luck drying out.
• 39:34
  Speaker 1: Yeah, that's that's no.
• 39:36
  Speaker 2: Way to kick no. And the problem with it, too
• 39:38
  Speaker 2: is not just like that's I can't imagine going through that.
• 39:42
  Speaker 2: But if you get out of prison or say you're
• 39:45
  Speaker 2: able to get heroin or something or fentanyl in prison
• 39:48
  Speaker 2: after you've kicked it, your tolerance has dropped. And we
• 39:51
  Speaker 2: talked about this in our Heroin episode in twenty twenty.
• 39:55
  Speaker 2: But your tolerance has dropped, and so your likelihoo of
• 40:00
  Speaker 2: an overdose is through the roof compared to what it
• 40:02
  Speaker 2: was before you kicked heroin the hard way or fatanyl.
• 40:05
  Speaker 1: The hard way. Yeah, so we busted the myth about
• 40:10
  Speaker 1: illegal immigrants smuggling this into the country. Earlier, there was
• 40:14
  Speaker 1: another myth apparently police departments kind of spread this one
• 40:19
  Speaker 1: that touching fentanyl at all or inhaling just trades amounts
• 40:23
  Speaker 1: can overdose you. Apparently that came from a twenty sixteen
• 40:28
  Speaker 1: US DEA advisory to claim that was possible. But this
• 40:33
  Speaker 1: is sort of annoying because it's not you know, generally
• 40:36
  Speaker 1: absorbed through the skin. They have those transdermal patches, but
• 40:38
  Speaker 1: it's not like helping someone like shaking somebody on the
• 40:42
  Speaker 1: ground or something can get it into your skin that way,
• 40:45
  Speaker 1: or inhaling enough to overdose you. Is like, there's no
• 40:50
  Speaker 1: way you would accidentally inhale enough to overdose.
• 40:53
  Speaker 2: Right, But there's cases of like first responders in paramedics
• 40:57
  Speaker 2: suffering from exposure two very small amounts of fentanyl and
• 41:03
  Speaker 2: people are like, what the heck's going on. The best
• 41:05
  Speaker 2: explanation is that it's it's what's called the culture bound syndrome,
• 41:10
  Speaker 2: this expectation that it can happen. It leads to a
• 41:14
  Speaker 2: nocebo effect where the person essentially freaks themselves out into
• 41:18
  Speaker 2: a panic attack, and it's it's they're like, I just
• 41:22
  Speaker 2: had I just odd on fentanyl, just from touching a
• 41:25
  Speaker 2: little bit of it. Yeah, that's the best explanation. It
• 41:29
  Speaker 2: makes sense. The point is is like, you like, interacting
• 41:32
  Speaker 2: with somebody who's odd on fentanyl. Isn't going to give
• 41:35
  Speaker 2: you a fentanyl high or overdose?
• 41:38
  Speaker 1: Yeah, for sure. Another myth, I guess the final myth
• 41:41
  Speaker 1: that we can bust is if you hear somebody saying, like,
• 41:45
  Speaker 1: you know, all these unhoused people in the streets, it's
• 41:47
  Speaker 1: all because of fentanyl. They're out they're they're homeless now
• 41:50
  Speaker 1: they're in your neighborhoods. And this is because of this epidemic.
• 41:55
  Speaker 1: I'm sure that has happened where people you know, can't
• 41:59
  Speaker 1: pay their rent and on the street because of an
• 42:01
  Speaker 1: addiction like that. Sometimes people turn to drugs after the
• 42:05
  Speaker 1: fact if they are in house. But if you look
• 42:08
  Speaker 1: at it on a macro level, the data shows that
• 42:11
  Speaker 1: the reason America has an unhoused crisis like we do
• 42:15
  Speaker 1: now is mainly because of the cost of housing. It's
• 42:18
  Speaker 1: not drug use, it's not mental illness, it's not unemployment,
• 42:22
  Speaker 1: even all those things are a factor, not saying they
• 42:25
  Speaker 1: don't count, but it's the cost of housing.
• 42:27
  Speaker 2: Yeah, it's crazy. Look at all the morality we associate
• 42:30
  Speaker 2: with drugs, Like it's brought in by illegal immigrants, drug
• 42:34
  Speaker 2: users accidentally create overdoses, and first responders and paramedics trying
• 42:40
  Speaker 2: to help them. It's the reason for homelessness, Like it's all.
• 42:45
  Speaker 2: There's all moral judgments associated with all of those things. Yeah,
• 42:48
  Speaker 2: and you're associated with the drug. And anybody who doesn't
• 42:51
  Speaker 2: do that drug and loves first responders, doesn't like illegal immigrants,
• 42:55
  Speaker 2: and doesn't like homeless people, is going to hate that drug.
• 42:57
  Speaker 2: From that point on.
• 42:59
  Speaker 1: Yeah, the drug, it was okay by the FDA, and
• 43:01
  Speaker 1: that you know, wealthy pharmaceutical families in this country's got
• 43:05
  Speaker 1: rich off of Yeah.
• 43:06
  Speaker 2: Well, let's just say again, fentanyl is perfectly safe in
• 43:09
  Speaker 2: like a medical setting in the hands of the trained professional.
• 43:12
  Speaker 2: It's just outside of that when when cartels become involved
• 43:17
  Speaker 2: and it's it becomes a huge problem. But I said,
• 43:20
  Speaker 2: at the outset, there is a silver lining or at
• 43:23
  Speaker 2: least some hope because they're the use is well. First
• 43:27
  Speaker 2: of all, opioid deaths are declining. I think they peaked
• 43:30
  Speaker 2: in twenty twenty two with one hundred and eight thousand
• 43:33
  Speaker 2: opioid overdose deaths in the United States, and the numbers
• 43:37
  Speaker 2: aren't in for twenty twenty four, but they think the
• 43:41
  Speaker 2: estimate is that it's going to be anywhere between a
• 43:43
  Speaker 2: fifteen to twenty percent drop in overdose deaths from fentanyl.
• 43:49
  Speaker 2: And they say, okay, well, Chuck, why why are these
• 43:52
  Speaker 2: fentanyl deaths finally subsiding? What's the deal?
• 43:56
  Speaker 1: Yeah, I mean there could be. It's it's probably most
• 43:59
  Speaker 1: of these things combined. When you look at it on
• 44:01
  Speaker 1: a bird's eye perspective. A lot of people say, the
• 44:06
  Speaker 1: testing strips have made a big deal, that narcan has
• 44:09
  Speaker 1: made a big difference, that MATT treatment has made a
• 44:12
  Speaker 1: big difference. One reason is because drug users have gotten
• 44:17
  Speaker 1: a little bit smarter. Like I mentioned earlier, some people
• 44:20
  Speaker 1: are trying to avoid it altogether. Some people are, like
• 44:23
  Speaker 1: I said, dipping their toe in the pond or making
• 44:25
  Speaker 1: sure their friends don't overdose. One of the saddest possible
• 44:29
  Speaker 1: factors is that so many people have died off there
• 44:32
  Speaker 1: just aren't as many active users anymore for that reason.
• 44:35
  Speaker 2: Yeah, there was. Yeah, you were saying that, like younger
• 44:39
  Speaker 2: generations might have been scared away from it.
• 44:43
  Speaker 1: Yeah, that's another reason.
• 44:44
  Speaker 2: Yeah, apparently I thought you said that. So apparently gen
• 44:47
  Speaker 2: Z is unlikely or less likely to use drugs. I
• 44:52
  Speaker 2: think like sixty seven of twelfth graders said that they
• 44:56
  Speaker 2: abstained from drugs, meaning that they hadn't taken any drugs
• 44:59
  Speaker 2: in the last thirty days. And I was like, I
• 45:02
  Speaker 2: wonder what that is compared to gen X back and
• 45:04
  Speaker 2: when we were in high school.
• 45:06
  Speaker 1: Oh my god, And I.
• 45:07
  Speaker 2: Was like, this is this is gonna be crazy. It
• 45:09
  Speaker 2: is crazy, but it's the opposite way you would think
• 45:12
  Speaker 2: the I think I can't remember what US agency conducts
• 45:16
  Speaker 2: this every year, but in nineteen ninety three, high school
• 45:20
  Speaker 2: seniors said that eighty one point seven percent said that
• 45:23
  Speaker 2: they had abstained from drugs in the last thirty days.
• 45:26
  Speaker 2: So gen Z is on way more drugs than gen
• 45:29
  Speaker 2: X was, which is very surprising to me.
• 45:32
  Speaker 1: Or gen X is a generation of liars.
• 45:35
  Speaker 2: That's entirely possible too, are you Narkman.
• 45:39
  Speaker 1: Yeah, I don't know. I mean, I was a good
• 45:41
  Speaker 1: boy growing up, but I certainly I feel like all
• 45:44
  Speaker 1: my friends were doing all the drugs.
• 45:45
  Speaker 2: I wonder if it really is there is it's just
• 45:49
  Speaker 2: a lot more prevalence of drug use because it's so
• 45:51
  Speaker 2: easy to get it on the internet, and it used
• 45:54
  Speaker 2: to be hard back when we were in high school
• 45:56
  Speaker 2: for people maybe drugs in high school.
• 45:59
  Speaker 1: Well, I mean, there's definitely improved international cooperation between the
• 46:04
  Speaker 1: United States and other countries just to reduce the supply.
• 46:07
  Speaker 1: That US of Mexico has gotten together, and they've been
• 46:10
  Speaker 1: working together for a while now trying to intercept those
• 46:13
  Speaker 1: drug shipments and trying to you know, mess up the
• 46:16
  Speaker 1: cartel and what their activities, what the cartel is doing.
• 46:21
  Speaker 1: I think in twenty twenty four. Last year, the Mountain
• 46:24
  Speaker 1: of Fitnel crossing that border dropped by about twenty percent.
• 46:27
  Speaker 1: So that's pretty good.
• 46:29
  Speaker 2: Yeah, I mean that's pretty significant.
• 46:31
  Speaker 1: What else I got? Nothing else?
• 46:34
  Speaker 2: Well, I guess we should probably say before we end
• 46:36
  Speaker 2: the episode, Chuck, if you do fentanyl in your addicted
• 46:41
  Speaker 2: to fentanyl, please seek as whatever help you can find
• 46:45
  Speaker 2: to get off of it. And if you haven't tried
• 46:47
  Speaker 2: it yet, probably you shouldn't start.
• 46:50
  Speaker 1: Yeah, i'd say not even probably, let's say definitely do.
• 46:53
  Speaker 2: Okay, Well, since Chuck corrected me from probably to definitely,
• 46:57
  Speaker 2: as was foretold in two thousand and eight, he is
• 46:59
  Speaker 2: just god listener.
• 47:00
  Speaker 1: Now, all right, there's another two part around disaster movies,
• 47:07
  Speaker 1: because we heard from two African American listeners, because I
• 47:10
  Speaker 1: specifically asked, like, how mad are you about the fact
• 47:15
  Speaker 1: that black people get killed in movies and horror movies
• 47:18
  Speaker 1: and disaster movies routinely and that's just such a well
• 47:21
  Speaker 1: known trope, And we heard from a couple of faithful listeners. Hey, guys,
• 47:26
  Speaker 1: you asked if it's still a thing amongst black people
• 47:28
  Speaker 1: about being the first to die in scary movies. Yes,
• 47:30
  Speaker 1: it is still a running joke, of course, but there's
• 47:33
  Speaker 1: more to it now I found. I'm finding as an
• 47:35
  Speaker 1: African American and avid movie watcher, the new thing is
• 47:38
  Speaker 1: the black person often dies in sacrifice of something or
• 47:41
  Speaker 1: someone else. So yes, we still may go first in
• 47:43
  Speaker 1: the film, but often for a noble cause. I guess
• 47:46
  Speaker 1: that makes it more palatable. Lol. That is from Serena
• 47:51
  Speaker 1: and then this is from Kevin. First of all, I'm
• 47:54
  Speaker 1: a casual fan of this subgenre, enjoy the exciting thrills
• 47:57
  Speaker 1: that come with it. For years, it's become common knowledge
• 48:00
  Speaker 1: black people will rarely lead or survive to the end
• 48:03
  Speaker 1: of those movies, as well as other genre movies like
• 48:05
  Speaker 1: horror or romcom in mainstream Hollywood. It doesn't make me mad, though, guys,
• 48:09
  Speaker 1: because at the end of the day, I just want
• 48:11
  Speaker 1: the escapism of the movie. I don't want to think
• 48:13
  Speaker 1: about the socio economics behind everything. But I understand that
• 48:18
  Speaker 1: Hollywood has catered to a white audience since the beginning,
• 48:21
  Speaker 1: as they figure that this is a safe bet financially
• 48:23
  Speaker 1: and minorities are expendable. My movie watching friends pretty much
• 48:27
  Speaker 1: know who will survive and who will hook up, and
• 48:30
  Speaker 1: we just want to enjoy the show. But I am
• 48:33
  Speaker 1: glad to live in a time where we are having
• 48:34
  Speaker 1: more representation behind the scenes to pull more strings in
• 48:38
  Speaker 1: our favor. Keep up the good work and that is
• 48:40
  Speaker 1: again Kevin and then Serena.
• 48:42
  Speaker 2: Awesome, thanks Kevin and Serena. That reminds me of a
• 48:46
  Speaker 2: point online to make that I didn't have a chance
• 48:48
  Speaker 2: to in Earthquake. Richard Rowntree aka Shaft, he was in that.
• 48:54
  Speaker 2: He made it to the end, and he was also
• 48:56
  Speaker 2: one of the heroes helping save Jenna Vie. M my
• 49:01
  Speaker 2: saying your name correctly.
• 49:03
  Speaker 1: I don't know, but I know that Richard Rowntree is
• 49:05
  Speaker 1: almost always the hero. Yeah.
• 49:07
  Speaker 2: So yeah, he was like a motorcycle stuntman, so he
• 49:10
  Speaker 2: was sadly an exception, but he definitely did make it
• 49:14
  Speaker 2: to the end.
• 49:14
  Speaker 1: Which was great. Yeah. Nice work, Nice.
• 49:17
  Speaker 2: Work, Richard Rowntree. And if you want to be like
• 49:19
  Speaker 2: Kevin and Serena and want to share your thoughts with us,
• 49:22
  Speaker 2: we love that kind of thing. You can send us
• 49:24
  Speaker 2: an email of the Stuff podcast at iHeartRadio dot com.
• 49:30
  Speaker 1: Stuff You Should Know is a production of iHeartRadio. For
• 49:33
  Speaker 1: more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
• 49:37
  Speaker 1: or wherever you listen to your favorite shows,