May 6, 2025 • 49 mins
Around 2013 heroin users in the US and other countries suddenly started dying from overdose in previously-unseen numbers. The culprit turned out to be the incredibly potent drug fentanyl and it soon created a massive new wave in the opioid epidemic.
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Speaker 1 (00:01):
Welcome to Stuff You Should Know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and Jerry's here too, and this is Stuff you
Should Know, the Big Bummer Edition.
Speaker 1 (00:19):
Yeah, not very joky, because we're talking about fentanyl.
Speaker 2 (00:22):
And.
Speaker 1 (00:24):
While a great pain killer, a very effective painkiller, it
has sadly become the most deadly street drug in the
United States. And we're going to tell you how that happened.
Speaker 2 (00:34):
Yes, but there's slight silver lining. It is possible that
it is so deadly and so dangerous that it's actually
created a decline in its use. At the very least
a decline in deaths from it has taken place. So
it is on the decline at least deaths, and we'll
talk about possibly why that is later on. But yeah,
(00:57):
we'll talk about the origin of fentanyl. For those of
you who don't know, it's a synthetic opioid. First, there
was morphine, which is I think basically one hundred percent
processed natural opium. Heroin is a kind of a combo
hybrid between synthetic and natural, and then fentanyl is just
(01:18):
straight up like a like it just made up. It's
an analog and it's way more potent than anything anyone
had ever seen before when it came on the scene.
Speaker 1 (01:29):
Yeah, like a hundred times more potent than morphine, fifty
times more potent than heroin. Created by a gentleman named
Paul Janson of the Jansen Company in Belgium, and it
was originally developed as an intravenous anesthetic, like for surgery.
And they started out with a synthetic opioid as the
(01:49):
base called my paradine I guess, and that was developed
in the nineteen thirties. And so they had this sort
of my paradiine as the base. They change it around
a little, I'll alter the chemical structure a little bit,
because what they wanted was something that had fewer negative
side effects, something that was safer to use, and they
(02:11):
were able to do that with fentanyl. I mean it,
you know, initially worked great. It was had a very
fast onset, had a very high therapeutic index, which is
how they measure like the ratio between how effective a
dose is and how how you could get to a
toxic dose. So if you've got a high number and
a greater difference, then that's good.
Speaker 2 (02:33):
Right, And one of the things. I just want to
say that they messed around with molecularly to make fentanyl.
They increased its fat solubility, which sounds like who cares,
But that has two really important effects that make fetanyl
what it is. One, it allows the drug to cross
the blood brain barrier faster, which means fentanyl has a
(02:55):
much faster onset than heroin or morphine. Right, it just
hits you much fast, and then it crosses back through
the blood brain barrier more quickly, so the duration of
the high that you get lasts a shorter time. So
just that one little tweak fat solubility made this drug
what it is, because faster onset makes it addictive. Shorter
(03:19):
duration means that you need to do more.
Speaker 1 (03:22):
Yeah, And then I don't think I've mentioned, but it
was nineteen sixty was when it first came on the scene.
Europe starting using it in sixty three. Came to the
US in sixty eight and approved by the FDA only
by combining it with a tranquilizing drug called draperidol, because
they said, you know that combination makes it even a
(03:42):
lower potential for abuse, so you have to use it
with that. But over time, that kind of waned, and
those limitations were lifted little by little until we got
to the mid nineteen eighties when they had, you know,
cheaper generic versions available, and it was pretty commonly used
in surgery, like post surgical recovery with like skin patches
(04:03):
and lozenges and stuff like that for pain management.
Speaker 2 (04:05):
Yeah, I think still today it's the most common opioid
used for anesthesia during surgery. And that just sounds like
madness when you're familiar with fentanyl, the street version, but
in the hands of like a really well trained anesthesiologist
with hospital great equipment, it's actually very safe. It's the
(04:28):
fact that the stuff that you buy in the street
has a very uneven like dosages means that's why it's
just so deadly because you're not a trained anesthesiologist, you're
not using hospital grade equipment. You're shooting up something that
some dude sold you, and it's just it's just not
trustworthy and it can kill you because it takes such
(04:50):
a small amount to create a toxic dose.
Speaker 1 (04:53):
Yeah, it will produce relaxation, feelings, pleasure, sleepiness. You can
also get nauseous, dizziness, confusion, vomiting, uritary retention, breathing issues,
as we'll see later on. That's you know, basically why
you usually od, it's because of breathing issues, and besides
(05:14):
the overdose risk, which is great, you could also have
a heart attack, heart failure, mood disorders, immune system problems.
For all these reasons. It's a schedule two narcotic with
a high potential for abuse.
Speaker 2 (05:27):
Just a reminder marijuana's Schedule one.
Speaker 1 (05:31):
Yeah, exactly. And most of what we're going to be
talking about is sort of the illegal, illicitly produced market.
But there are fentanyl users that do get like the
real stuff from I'm not sure how they get it,
whatever connection they have, and they'll just have to you know,
it's not like in a pill or a powder, so
it'll be like a patch or something that they might
(05:53):
freeze and hold in their mouth, or they might remove
the gel and then eat it or inject it or
something like that. But usually what we're talking about, the
really dangerous stuff is the powders and the pills that
are being made illegally and either brought into this country
or being made in this country, but usually brought into
this country.
Speaker 2 (06:11):
Yes, and there's different kinds of different analogs of fentanyl
that everybody just kind of puts under the umbrella of
fentanyl when you're talking about illicit fentanyl. But two of
them that stand out that aren't actually illicit, but they're
used in the drug market as car fetanyl, which is
used there's no use for it in humans. They use
(06:34):
it to sedate rhinoceroses and elephants, and I think it's
something like ten thousand times more potent than morphine. You
can get that on the street apparently, although I think
it's fairly rare. And then sue feentanyl is five to
ten times stronger than fentanyl. So if you like people
aren't like it's car fetanyl or sue fentanyl, you're talking
(06:54):
about fentanyl.
Speaker 1 (06:56):
Yeah, exactly. It doesn't necessarily mean it's the same exact
chemical structure. It's just sort of a catch all like pitbull, sure,
the singer no no, no pitbull the dog breed, which
isn't really a dog breed.
Speaker 2 (07:10):
I didn't know that.
Speaker 1 (07:11):
Yeah, there's all kinds of terriers that people just call pitbulls.
Speaker 2 (07:17):
Well, speaking of umbrella terms in different names, I think
we should talk about some of the names. The DEA
says that this is called and the only one I
could corroborate is the last.
Speaker 1 (07:30):
One, Tango and cash.
Speaker 2 (07:32):
Yeah, so apparently that's fetanyl and cocaine mixed together, and
or fetanyl and methamphetamine some sort of speed that's a speedball,
And as we'll see, that's actually proving to be a
really big problem that's created like a new wave of
opioid deaths.
Speaker 1 (07:49):
Yeah. Well, speaking of waves, there have kind of been three,
and this is just sort of an overview of the
opioid addiction crisis in the US that's been going on
for you know, ten fifteen years. The first wave was
in the nineties, and that's when you got prescription opioids
from your doctor. Those really rose dramatically because they do
(08:11):
a really good job. But that's also you know, in
lockstep with fatal opioid overdoses. They doubled between ninety nine
and twenty ten. And twenty ten was when things started
to change for a second wave because the government was like,
you can't be writing all these prescriptions like this to
doctors and to manufacturers, like you got to change your formulas,
(08:32):
Like this stuff is way too readily abuse, So you
got to do something.
Speaker 2 (08:38):
Yeah, and this is really well portrayed in the limited
series Dope Sick. I can't remember if it was on HBO.
I want to say you saw it right now.
Speaker 1 (08:47):
I didn't see that.
Speaker 2 (08:48):
Oh man. It is really good, but it's about the
Sackler family and Purdue Pharma essentially purposely hooking America on
oxy contin. Yeah, and it's a really good series that
just punches you in the gut. But it's really well
done and it covers all that period. The problem was
this is covered a little bit too towards the end.
(09:09):
When you take people's OxyContin away and they're hooked on
OxyContin and opioid, they're going to a lot of them
are at least turned to whatever opioids are available, and
that meant that a lot of people who otherwise would
have never tried heroin took up heroin because they couldn't
get OxyContin anymore.
Speaker 1 (09:30):
Yeah, and that was the second wave, and fatal overdoses
of heroin because of that largely quadruple between twenty two
and twenty thirteen. The third wave is the one we're
kind of mainly going to be talking about that started
in about twenty thirteen and mainly centers around illegally illicitly
(09:50):
produced fentanyl and all the various harmful ways that can
find your way into your body, even sometimes even if
you don't want to be taking fentanyl.
Speaker 2 (10:00):
So yeah, So that third wave, the fentanyl opioid death
wave or fentanyl driven wave, that is that vastly outstrips
the death rate from the first two waves.
Speaker 1 (10:13):
Yeah.
Speaker 2 (10:14):
So I think in nineteen ninety nine, so this is
when people are starting to take opioid prescriptions, there were
two opioid overdose deaths per one hundred thousand people in
the United States. Yeah, that was nineteen ninety nine. Twenty thirteen,
the second wave is going on, that was up to eight.
(10:36):
By twenty twenty two, when the third wave is in
full swing, it was twenty five people per one hundred
thousand people in the United States that were dying of
overdose deaths from fentanyl.
Speaker 1 (10:48):
Yeah. In twenty twenty two, deaths from fentanyl alone were
seventy six two hundred and twenty six people, or sixty
nine percent of total overdose deaths and ninety percent of
the opioid overdose deaths.
Speaker 2 (11:01):
Yeah.
Speaker 1 (11:01):
Apparently it was the problem.
Speaker 2 (11:03):
For sure, And apparently I was like, well, what else
is anybody oding on? And it seems that meth has
created a new epidemic of overdose deaths that everybody's like,
what the hell's going on?
Speaker 1 (11:15):
Yeah, well, Fintanel has hit such a high that it's
actually had a real impact on US life expectancy. It
takes a lot to change a number like that, but
Fintanel seems to have done it. And twenty twenty two
only opioid related deaths resulted in three point one million
years of lost life because a lot of these users
(11:38):
are young. And if you ode it twenty two, they
calculate the average lifespan and do the subtraction and that's
your number. So that you know, a lot of middle
age white people without a college degree are the victims.
So much so, and this is startling. But from that class,
middle aged white people without a college degree, they are
(11:59):
dying earlier on average than their parents did. Yes, that's
not how it's supposed to work.
Speaker 2 (12:04):
That's just not how it has worked, unless the United
States is at war essentially. Yeah, and you know, we're
talking a lot about the US, but the UK and
Europe sorry, UK tracks fairly closely. Although the numbers are lower.
It seems to be following like a similar pattern. Although
(12:26):
I think in some countries. I think estonia is one
of them. Like you can't even get heroin anymore, everybody's
just doing fatanmol. Yeah.
Speaker 1 (12:34):
Well, here's the deal though, is researchers have looked at
these numbers. I think they declared this a public health
emergency in twenty seventeen, and what they're finding is, and
this has been coroberated from other surveys and you know,
metadata studies and stuff, is there aren't more overdose deaths
because more people are using it. It's not just like, oh,
(12:56):
well more people are doing it, so more people are dying.
It seems like it's because this stuff is more dangerous,
it's getting in places that it shouldn't get because usage
has actually declined some over the past like eight years, right.
Speaker 2 (13:09):
Yeah. I think the first two waves were driven by
larger numbers increases in people using prescription opioids and then heroin,
so that accounted for it. But when fentanyl came on
the scene, yeah, people stopped using it as much, but
their deaths just increased, which if you look at it
from just an outside perspective, like it's just because it's
(13:31):
so potent and it was rolled out or introduced to
the drug supply in a really horrific way, as we'll see.
Speaker 1 (13:41):
Yeah, for sure. It also sort of goes in lockstep
with the income disparity in the United States and the
client in fortunes for a lot of people in this country.
Overdosing is basically what they call it is a disease
of despair. When people are destitute and when they're down
(14:02):
or depressed or having really hard times. A lot of
times drugs can be a distraction or if you are
a casual drug user, it could get worse during that time.
And they found in twenty seventeen they study counties in
the US and found that those with the lowest social capital,
meaning networks that can help people, you know, with financial
(14:23):
security and achieving goals, they had the highest rate of overdose.
Speaker 2 (14:27):
Yes, so social capital is basically the size of your
local Kowanas chapter.
Speaker 1 (14:34):
I knew you'd get a joke in theres.
Speaker 2 (14:36):
So yeah, this is I mean, like this whole thing
kind of rose and lockstep. Opioid overdose sets rose and
lockstep with these financial crisis that the US found itself
in over and over again since two thousand and eight.
Job loss, aws of manufacturing jobs just all of the
hardship that the United States has gone through since then,
(14:58):
opioid debts kind of tracked with it, especially at first,
especially with people basically more people turning to that kind
of thing as a disease of despair, which is just sad.
It's just nuts that that's that you can kind of
connect those two things.
Speaker 1 (15:17):
Should we take a break? Yeah, all right, we're gonna
take a break, and we're gonna talk about the rise
of fentanyl right after this. It's stuffish. So one reason
(15:56):
we've seen a surge in overdoses for something like this
is something called the iron law prohibition that was coined
in nineteen eighty six by an economist named Richard Cowan,
and it's basically saying that, hey, if you ban something
that people like doing, something's going to come along, and
it's probably going to be a stronger version. The reason
they call it the law prohibition is because that's what
(16:17):
happened when people were like, all right, you're going to
take our beer, We're going to start making gin and
our bathtubs and moonshine out in the woods, and the
rise of crack in the nineteen eighties the same thing,
and they're basically saying fentanyl is basically the same deal.
Speaker 2 (16:31):
Yeah, and not only more potent, but the fact that
it's more potent means that less of it can generate
just as much cash, which also means it's easier to
smuggle too. And like you said, fentanyl tracks exactly the
same way. It's really easy to make. I mean apparently
you just basically, if you have the precursor chemicals, you're
(16:52):
just making a stew in a pot that you're stirring,
You dry it out, and there you got a bunch
of fentanyl. So it's easy to make. You don't require
tons and tons of agricultural workers and tons and tons
of acreage to grow poppies that you process into heroin.
And because the potency is so much more, there is
(17:12):
a huge cost benefit. Apparently it just accrues to the dealers.
Though there was a study in the journal Addiction from
twenty twenty that basically wanted to find out why was
fentanyl introduced. Was it users who are like, Hey, heroin's great,
but we need something way deadlier? Was it dealers who
(17:33):
are like, hey, heroin's great, but this stuff I can
cut heroin with and like, I'll make a lot more
money or was it a combination of the two. They
didn't say definitively, but they made a pretty good case
that it does seem to have been the dealers looking
to cut costs because those costs or those savings weren't
passed on to users.
Speaker 1 (17:56):
Yeah, it's not like, hey, this, we're making the drugs
cheaper now, so we're just going to give you a
break this. There was one study that found between twenty
thirteen and twenty twenty one, the percentage of heroin that
had fentanyl rows from less than one percent to forty
percent over what is that eight years? And of course
(18:17):
it's going to lead to a huge number of overdoses
because a you've got these batches that are coming out
that the you know, the potency has got a pretty
dramatic range from one batch to another sometimes. Yeah, and
then people you know, for a long time, I think,
you know, the word is finally out now and we're
going to talk about that a little bit later. But
people that were heroin users thought they were getting heroin
(18:38):
and knew how much heroin to take safely.
Speaker 2 (18:41):
Yeah, And one reason why is because these dealers were saying,
if I sell you heroin mixed with fentanyl, I have
to use less heroin because it's going to be just
a potent or more potent. But I can charge you
heroin prices even though I'm paying way less for the
fentanyl that I'm using here. And yeah, people were caught
by some prize. The fact that it was duplicitous is
(19:03):
just awful because it's like, hey, good luck getting acclimated
to this there. It's gonna be a rough transition. But
if you look at it from a business standpoint, the
rollout of fentanyl into the American and European drug supplies,
it had terrible marketing, like it had zero marketing. It
was just all of a sudden there people started dying
and it took the authorities investigating what the heck was
(19:23):
going on for people to figure out that it was fentanyl.
That's how it was introduced. It was just so reckless.
I mean, I'm talking about heroin dealers being even more
reckless than they normally are. That's what happened with fentanyl
being introduced. It just suddenly popped up. No one said
anything about it first.
Speaker 1 (19:42):
Yeah, and by the way, when I said safely do heroin,
I'm hope unclear than that there's doing heroin is never safe.
I just met heroin users would know how much they
can take without overdosing, right, yeah, okay, I just wanted
to make sure people do what I was.
Speaker 2 (19:58):
I think that was worth mentioning.
Speaker 1 (19:59):
Yeah, okay, good. So the other you know, problems with
ventanyl is that it has a really intense rush when
it's first used. Apparently it's more of a head rush
than a body rush, so it can be a little
more you can be a little more active as a
user than maybe doing heroin and just like passing out
on your couch for hours and hours. It's also dangerous
(20:20):
because the high is only an hour or two, so uh,
you know, heroin high lasts longer, so that short duration
is gonna you know, have people using more frequently, and
every time you use ventyl it's just another chance to overdose. Basically.
Speaker 2 (20:33):
Yes, it's a great point. Yeah, and that has to
do with that fat solubility. Again, I said it before
and I'll say it again.
Speaker 1 (20:40):
Yeah, I mean it can happen like a fentanyl overdose
can happen in seconds, right.
Speaker 2 (20:45):
Yes, because the onset is so quick, which makes it
that's another reason that it's so deadly too, is you
don't have time to be like, oh man, there's frau
through on my buddy's mouth. I better call nine one
one because there's good Samaritan laws in my state. It's like,
oh my buddy just injected fentanyl and now they're dead.
I mean, it's it's not that fast necessarily, but compared
to heroin, it is. And yeah, I think it's measured
(21:07):
in like seconds.
Speaker 1 (21:09):
Yeah, it certainly can be. Another thing that makes it
more deadly is that people started changing how they used it.
Among people who died from illegal fentanyl overdoses, the portion
who injected dropped forty two percent over just a two
year period between twenty and twenty twenty two, and they
generally started smoking it that jumped to seventy nine percent.
(21:31):
I believe people also can snort the powder, but just
the fact that people aren't injecting it as much kind
of you know, if you connect the dots, somebody might
dive into using it a little quicker, if they're like, hey,
just snort this thing instead of hey, shoot up this thing.
Speaker 2 (21:49):
Yeah, because that's a big barrier for a lot of
people who are like I like drugs, but I'm not
gonna stick a needle in my arm. That just seems
like such a a horrible road to go down that
it will give people second thoughts. But smoking something geez,
I like marijuana, I like smoking crack, I might as
well try smoking fentanyl. It's just much less of a
(22:10):
barrier to overcome.
Speaker 1 (22:12):
Yeah, And if you're smoking it or snorting it, it
doesn't stay in your body as long as if you
shoot it, so again, just another case of it wears
off quicker and you're gonna want to use it again,
and that's just another overdose opportunity.
Speaker 2 (22:25):
Yes, yeah, I mean it's crazy if you think about it,
because most other drugs that you smoke you could conceivably
overdose on. But fentanyl, even though you're smoking it and
not injecting it, there's still a really good chance that
you could overdose and die from just smoking it. That's
kind of mind boggling, but it's accurate.
Speaker 1 (22:44):
Yeah, And you know, we're talking about smoking it and
snorting it and like powder and a bad kind of stuff.
But the real danger now, and the real problem all
of it is, of course, but the real, real scary
thing is the fact that these are generally sold and
the us CAS's pills. I think by late twenty twenty one,
(23:05):
more than a quarter of the fentanyl seized was in
pill form, And a lot of these pills are they
look like something else. You hear stories on the news
about a kid that did not want to take fentanyl,
that thought they were taking something else and it ended
up being either laced with fentanyl or largely fentanyl, and
(23:26):
they overdose without even knowing they took it.
Speaker 2 (23:28):
Yeah, and it's kind of hard to wrap your head around,
like why would somebody send you that? Like how evil
could you be? But apparently fentanyl pills are very frequently
created to look like old OxyContin what are called M thirty's,
So it would be very easy for something to be like,
oh cool, here's an OxyContin. Fentanyl users know what they're doing.
(23:52):
But if you didn't, we're in a fentanyl user and
you just wanted an oxy contin. That's how you could
die of an overdose fairly quickly. And those are, like
you said, those are the stories that you hear on
the news. I don't think it's a very frequent thing,
but when it does happen, it's just horrific.
Speaker 1 (24:08):
Yeah, for sure. Or if you say you want to
use some cocaine. You're like, Hey, that's my thing. Do
it every now and then on a Saturday night, I'm
going to get some of that stuff. For the same reasons,
Heroin is cut with ventyl. Cocaine can be as well,
So that's not even the same kind of high. You're
looking for cocaine. You may never in your life have
(24:29):
taken anything like morphine or heroine, and all of a
sudden you're snorting fentanyl without knowing it and you're on
the floor.
Speaker 2 (24:36):
Yeah, just a reminder, speedballs are what killed not just
John Belushi, but Chris Farley as well. And apparently this
is that fourth wave that we were talking about of
speedball in fentanyl, with cocaine or with meth. And it's
not just where dealers are cutting it and not telling
their buyers, like buyers are seeking this out. And apparently
(24:59):
this fourth wave has kind of caught black Americans up
into it more than the other previous waves have.
Speaker 1 (25:07):
Oh really, yeah, all right, Well, I guess we can
talk a little bit about where it comes from. A
lot of it that smuggled into the US was originally
made in China, but in twenty nineteen China said you
cannot produce her sell fitting all anymore, and some people
stop doing it, but a lot of manufacturers continued doing so,
(25:29):
sometimes through Legit means that you made it very easy
to ship, but then they also turned to the black
market to ship directly to customers in the US and Europe,
or hey, let's ship the stuff over to Mexico and
these cartels and they can just kind of put it
together there and work as the distributor for US.
Speaker 2 (25:50):
Yeah. So the cartels are getting these precursors, they're turning
around and distributing the precursors to cooks who I read
like a Univision story, so they just I guess we're
interviewing some random ventanyl cook in Mexico. It was like
three twenty year olds who were just standing out in
the woods under a black tarp with a pot on
(26:11):
top of a fire, just stirring it like it was
really easy to make. And then that stuff goes back
to the cartels to smuggle across the border and sell.
Speaker 1 (26:22):
Yeah. Another myth we can kind of bust here as
far as where it comes from, is that in recent years,
there have been politicians that have tried to link the
influx of fentanyl in the United States to illegal immigration,
And there was a poll in twenty twenty two that
found that forty percent of Americans believed that most ventanyl
(26:43):
entering the country was being smuggled by illegal immigrants, basically,
and that's that's not true. The truth is is that
most of this drug comes through legal points of entry,
and when it does, it is smuggled in in a
vehicle driven by US citizens.
Speaker 2 (27:01):
Yeah, most often American women. And I think the Cato
Institute did a study where they found eighty six point
three percent of convicted fentanyl smugglers are American citizens, So
that seems to be totally untrue.
Speaker 1 (27:16):
Yeah, but apparently.
Speaker 2 (27:17):
This is a I think this is a measure of
how how bad fentanyl is, because I mean, Chuck, we're
pretty fentanyl naive. I've never done feentanyl. I'm making a
pretty good assumption that you've never done fetanyl and kept
it a secret from me. So it's entirely possible that
within this whole thing, we've passed along some myth or
exaggeration without being aware of it. Yeah, and for that,
(27:41):
I'm sorry. The thing is, it seems that the overall
theme that fentanyl is incredibly deadly and on a level
unlike any other drug that's ever hit the US market,
so much so that it's like, just don't do drugs.
It's too dangerous because because of the presence of fentanyl.
(28:02):
I think that holds and I think this supports that thesis.
In Cineloa, the Cineloa Cartel has a ban on selling
fentanyl in Sineloa punishable by death. So if you're a
drug dealer in Cineloa and the Cineloa Cartel catches you
selling fentanyl in their state in Mexico where they're supplying
(28:25):
the rest of the world with fentanyl, they'll kill you.
I think that says just about everything you need to
know about fentanyl.
Speaker 1 (28:32):
Yeah, for sure. Should we take another break? All right,
We'll be back and talk about punishment and harm reduction
right after this. It's stuff.
Speaker 2 (29:12):
So one of the things that's a little different about
the fentanyl epidemic is that it hasn't tracked closely or
identically to pass drug epidemics, where like the crack epidemic
or the cocaine epidemic, especially of like the nineties, where
or the eighties or nineties, where if you were caught
(29:32):
with it, especially if you're black, you're going to prison
for possibly the rest of your life. This time around,
it's been a little more there's been a little more
understanding that this is as much a public health crisis,
probably more of public health crisis than a crisis to
be addressed by law enforcement. And one of the more
(29:54):
cynical reasons why that's probable is because it's largely been
viewed publicly as a white issue, that it's mostly white
people who are overdosing and dying from ventanyl.
Speaker 1 (30:06):
Well, let's say this. I don't remember anything growing up
in the eighties that said, let's help these people addicted
to crack.
Speaker 2 (30:16):
No, you were just morally reprehensible and your kid was
probably screwed up.
Speaker 1 (30:21):
Throw away the key is what you got. So yeah,
I don't think that's cynical. I think that's absolutely the truth.
So thankfully they're taking a little bit different approach. We've
gotten a little bit smarter about this stuff, and now
we're focusing. We're trying to focus on harm what's called
harm reduction techniques, basically trying to keep people from dying.
(30:41):
A bunch of different things have been tried, and a
lot of it has been fairly effective. As we're seeing
like the numbers going down in overdoses, but distributing test strips.
So if you buy a pill, or if you buy
cocaine or something, and you have a test strip, you
can test to see if that drug has ventanyl before
you use it, or maybe your dealer even offers that service.
Speaker 2 (31:02):
That's really something.
Speaker 1 (31:04):
Yeah, I mean, if you want to be a and
again I say reputable drug dealer with sort of scare quotes,
but I would imagine that's a good thing to do,
is say, hey, this stuff is pure. I got a
test strip here, and you can test it to make
sure that you can be a repeat customer and not
dead on the sidewalk.
Speaker 2 (31:20):
Yeah. And I think that the test strips have helped
a lot of people, if not save their lives. The
problem with them that I've seen is that all they
do is show that there is fentanyl present. It doesn't
say whether it's a fentanyl analog like car fentanyl that's
one hundred times stronger than fentanyl. It doesn't say how
much fentanyl is in there, so is it just a
(31:41):
little bit or is it like a kill you sized dose.
But if you're like I don't do fentanyl, those test
trips are going to get quite a bit, like I
just want cocaine. Stop putting fentanyl in my cocaine. Those
test strips are going to help you, and they're going
to tick you off because I mean, I don't think
you can take cocaine back to the deal learn get
your money back because it had fentanyl in it. Although
(32:03):
who knows with kids these days.
Speaker 1 (32:06):
Yeah, I mean that these newer generations may demand return restitution.
So another thing that they can do is, you know,
they're safe places where people can go use the drugs
while people watch out for you. The drug users themselves
seem to have wizened up a little bit because of
all the news and probably seeing their friends die very sadly.
(32:29):
But they may take, you know, dip their toe in
the water a little bit at first and take a
smaller dose. Or they may if they're with a group
that's using stagger the doses so people can be standing
by with that narcan in case one of their friends
passes out.
Speaker 2 (32:43):
I wonder if, like you, they draw straws to see
what order everybody does drugs in, Like, how do they
how do they determine who's going to go last?
Speaker 1 (32:53):
Any medium monuments? Okay, the age old the traditionally exactly,
But I did mention Narcan and that is the brand
name for naloxone or nelaxone, and that can redse reverse
an overdose. And like, I have only one anecdotal example.
I don't know if it always works this way, but
(33:15):
one day quite a few years ago, a car just
kind of pulled around the corner and parked across the street,
and this dude got out of the car and his
girlfriend was like passed out, and it was clear that
it was a drug thing. Luckily, my Cross Street neighbors
a nurse. She called nine one one. Immediately they showed
up with narcan and dude they injected that, and this
(33:37):
girl was walking around and like saying, can I get
Can we leave now? Like minutes later?
Speaker 2 (33:43):
Wow, yeah, I mean it just reverses an overdose, right.
Speaker 1 (33:48):
Yeah, but I do. I mean, I don't know what
happens after that. All I saw was this snapshot where
she was like, I want to get out of here,
and I don't know what the law the laws are
as far as that kind of stuff goes. But the
ambulance I don't think is allowed to call the cops
on you. If I'm not mistaken. I think they're just like, Okay,
I guess you can go.
Speaker 2 (34:07):
Yeah. I don't know the law in Georgia or anywhere really, but.
Speaker 1 (34:10):
Yeah, those laws are called something what is it, good
Samaritan laws? Oh okay, yeah, I guess that's it.
Speaker 2 (34:16):
So you would be protected, but that wouldn't matter. It's
more like, if you're shooting up with your friend and
your friend overdoses and you have a bunch of heroin
or fentanyl on you, you can't be prosecuted for having that.
I mean, I'm sure to an extent because you just
because you called for help to help your friend and
the cops ended up showing up to you.
Speaker 1 (34:37):
Yeah, and I didn't look this up, But can't you
just buy a narcan?
Speaker 2 (34:40):
Yeah, it's getting much more widely available. Okay, Yeah, but
let's talk a little bit about overdoses because there's some
One of the telltale signs I think it's not just
with fentanyl, with heroin as well, or opioids in general,
is it can produce fluid in the lungs, so that
a telltale sign of an overdose is froth around the
(35:01):
mouth or in the notes. Once that happens, you need
to act pretty quickly, and one of the things that
they say to do first is rub your knuckles on
their chests kind of hard, because it's a very uncomfortable
thing to have done to you, and it can snap
you out of a opioid stupor even that. But if
(35:23):
they don't respond, then it's you need to call nine
to one to one and or administered in the lockxown.
Speaker 1 (35:30):
Yeah, I mean in the brain stem, there are a
couple of regions, the medulla and the ponds, and they
control the depth and rate of breathing. But both of
those have a lot of opioid receptors. So if you
do fentanyl and they attach to those receptors, which they will,
they can change the behaviors of the cells such that
they just stop working and you just literally just stop breathing,
(35:51):
like it's that simple.
Speaker 2 (35:52):
Yeah, And it's even worse than that, actually, because there's
also opio receptors in the parts of your brain that
control voluntary breathing. So like when you're like I need
to catch my breath and you take a deep breath,
or if you're meditating, when you purposefully breathe, that is
repressed as well, so you have involuntary breathing and voluntary
breathing or repressed, and this thing that detects rises in
(36:15):
CO two in your body that gets repressed as well.
Speaker 1 (36:18):
Right, Yeah, So basically, if you want to take that
deep breath, if you've since like you're in trouble, I'm like,
oh man, I got to get a big breath of
air here. You just do that normally, But little small
increases in CO two are sensed, and thekarated body it's
a little small cluster of sales in the neck. They're
(36:39):
going to spur that increase in breathing to remove that
excess CEOs two. But if that's not working and that
emergency sort of fail safe is switched off, then again
you can't even get that big breath to save yourself.
Speaker 2 (36:52):
Yeah, So breathing, I think you said early on that
typically is where fatal overdoses. It's just you just stop breathing,
stop being able to breathe. But there's other ways you
could die. I think you mentioned heart attack earlier too.
Another famous one with opioids is your gag reflex is suppressed.
So if you're basically knotted off and you throw up,
(37:15):
say you've been drinking as well, you're not going to
choke that stuff out or spit it out or throw
it up out of your mouth. It can just stay
in your mouth and it can go down your lungs
and you aspirate and or choke on your own vomit.
That's another way you can die from an overdose as well.
Speaker 1 (37:32):
I was waiting to see if you were going to
come up with like a fourth way to say pukey?
Speaker 2 (37:37):
Did I say a bunch of different ways?
Speaker 1 (37:39):
You said, like three, you like spit it up or
vomit it up or choke ers yeack it up.
Speaker 2 (37:44):
I was like, we get it blow chunks it up.
Speaker 1 (37:47):
Oh God. So as far as treatment goes, it kind
of goes and locks up with what they do for heroin.
It's called medication assisted treatment or MATT. That's kind of
the gold standard. We're talking about either methadone or how
do you say that, bupa norphine. If you get methadone,
it's going to be done at a clinic. It's not
(38:09):
like they just hand that out at the pharmacy, which
means you have to go to that clinic. You got
to wait in line a lot of times. You got
to do it there. The other one, I believe is
given in the form or I guess the brand name
subox Owne, and I think you can you can get
that prescribed. But a lot of people are like, hey,
(38:29):
you know, go to drug rehab and just quit doing
all this stuff because you're still on another drug. If
you're going to a methadone clinic every day, right.
Speaker 2 (38:38):
A lot of people don't have access to the kind
of doctor that's going to prescribe that for them. There's
a lot, like even among medical professionals still believe it
or not, there's still a lot of stigma associated with
being an opioid addict. Yeah, which is pretty rich considering
the American physicians, a significant chunk of them got America
(39:01):
hooked on opioids in the first place. But that's neither
here nor there right now. So I think there was
a study from twenty twenty two that the CDC conducted
where they said that of the three point seven percent
of all adults in the United States who need medication
assisted treatment, I think only about twenty five percent of
(39:22):
that three point seven percent, we're able to get it.
Speaker 1 (39:26):
Yeah.
Speaker 2 (39:26):
One of the other ways that you can get off
of it is to go to prison where they are
just like, good luck drying out.
Speaker 1 (39:34):
Yeah, that's that's no.
Speaker 2 (39:36):
Way to kick no. And the problem with it, too
is not just like that's I can't imagine going through that.
But if you get out of prison or say you're
able to get heroin or something or fentanyl in prison
after you've kicked it, your tolerance has dropped. And we
talked about this in our Heroin episode in twenty twenty.
But your tolerance has dropped, and so your likelihoo of
(40:00):
an overdose is through the roof compared to what it
was before you kicked heroin the hard way or fatanyl.
Speaker 1 (40:05):
The hard way. Yeah, so we busted the myth about
illegal immigrants smuggling this into the country. Earlier, there was
another myth apparently police departments kind of spread this one
that touching fentanyl at all or inhaling just trades amounts
can overdose you. Apparently that came from a twenty sixteen
(40:28):
US DEA advisory to claim that was possible. But this
is sort of annoying because it's not you know, generally
absorbed through the skin. They have those transdermal patches, but
it's not like helping someone like shaking somebody on the
ground or something can get it into your skin that way,
or inhaling enough to overdose you. Is like, there's no
(40:50):
way you would accidentally inhale enough to overdose.
Speaker 2 (40:53):
Right, But there's cases of like first responders in paramedics
suffering from exposure two very small amounts of fentanyl and
people are like, what the heck's going on. The best
explanation is that it's it's what's called the culture bound syndrome,
this expectation that it can happen. It leads to a
(41:14):
nocebo effect where the person essentially freaks themselves out into
a panic attack, and it's it's they're like, I just
had I just odd on fentanyl, just from touching a
little bit of it. Yeah, that's the best explanation. It
makes sense. The point is is like, you like, interacting
with somebody who's odd on fentanyl. Isn't going to give
(41:35):
you a fentanyl high or overdose?
Speaker 1 (41:38):
Yeah, for sure. Another myth, I guess the final myth
that we can bust is if you hear somebody saying, like,
you know, all these unhoused people in the streets, it's
all because of fentanyl. They're out they're they're homeless now
they're in your neighborhoods. And this is because of this epidemic.
I'm sure that has happened where people you know, can't
(41:59):
pay their rent and on the street because of an
addiction like that. Sometimes people turn to drugs after the
fact if they are in house. But if you look
at it on a macro level, the data shows that
the reason America has an unhoused crisis like we do
now is mainly because of the cost of housing. It's
not drug use, it's not mental illness, it's not unemployment,
(42:22):
even all those things are a factor, not saying they
don't count, but it's the cost of housing.
Speaker 2 (42:27):
Yeah, it's crazy. Look at all the morality we associate
with drugs, Like it's brought in by illegal immigrants, drug
users accidentally create overdoses, and first responders and paramedics trying
to help them. It's the reason for homelessness, Like it's all.
There's all moral judgments associated with all of those things. Yeah,
(42:48):
and you're associated with the drug. And anybody who doesn't
do that drug and loves first responders, doesn't like illegal immigrants,
and doesn't like homeless people, is going to hate that drug.
From that point on.
Speaker 1 (42:59):
Yeah, the drug, it was okay by the FDA, and
that you know, wealthy pharmaceutical families in this country's got
rich off of Yeah.
Speaker 2 (43:06):
Well, let's just say again, fentanyl is perfectly safe in
like a medical setting in the hands of the trained professional.
It's just outside of that when when cartels become involved
and it's it becomes a huge problem. But I said,
at the outset, there is a silver lining or at
least some hope because they're the use is well. First
(43:27):
of all, opioid deaths are declining. I think they peaked
in twenty twenty two with one hundred and eight thousand
opioid overdose deaths in the United States, and the numbers
aren't in for twenty twenty four, but they think the
estimate is that it's going to be anywhere between a
fifteen to twenty percent drop in overdose deaths from fentanyl.
(43:49):
And they say, okay, well, Chuck, why why are these
fentanyl deaths finally subsiding? What's the deal?
Speaker 1 (43:56):
Yeah, I mean there could be. It's it's probably most
of these things combined. When you look at it on
a bird's eye perspective. A lot of people say, the
testing strips have made a big deal, that narcan has
made a big difference, that MATT treatment has made a
big difference. One reason is because drug users have gotten
(44:17):
a little bit smarter. Like I mentioned earlier, some people
are trying to avoid it altogether. Some people are, like
I said, dipping their toe in the pond or making
sure their friends don't overdose. One of the saddest possible
factors is that so many people have died off there
just aren't as many active users anymore for that reason.
Speaker 2 (44:35):
Yeah, there was. Yeah, you were saying that, like younger
generations might have been scared away from it.
Speaker 1 (44:43):
Yeah, that's another reason.
Speaker 2 (44:44):
Yeah, apparently I thought you said that. So apparently gen
Z is unlikely or less likely to use drugs. I
think like sixty seven of twelfth graders said that they
abstained from drugs, meaning that they hadn't taken any drugs
in the last thirty days. And I was like, I
wonder what that is compared to gen X back and
when we were in high school.
Speaker 1 (45:06):
Oh my god, And I.
Speaker 2 (45:07):
Was like, this is this is gonna be crazy. It
is crazy, but it's the opposite way you would think
the I think I can't remember what US agency conducts
this every year, but in nineteen ninety three, high school
seniors said that eighty one point seven percent said that
they had abstained from drugs in the last thirty days.
So gen Z is on way more drugs than gen
(45:29):
X was, which is very surprising to me.
Speaker 1 (45:32):
Or gen X is a generation of liars.
Speaker 2 (45:35):
That's entirely possible too, are you Narkman.
Speaker 1 (45:39):
Yeah, I don't know. I mean, I was a good
boy growing up, but I certainly I feel like all
my friends were doing all the drugs.
Speaker 2 (45:45):
I wonder if it really is there is it's just
a lot more prevalence of drug use because it's so
easy to get it on the internet, and it used
to be hard back when we were in high school
for people maybe drugs in high school.
Speaker 1 (45:59):
Well, I mean, there's definitely improved international cooperation between the
United States and other countries just to reduce the supply.
That US of Mexico has gotten together, and they've been
working together for a while now trying to intercept those
drug shipments and trying to you know, mess up the
cartel and what their activities, what the cartel is doing.
(46:21):
I think in twenty twenty four. Last year, the Mountain
of Fitnel crossing that border dropped by about twenty percent.
So that's pretty good.
Speaker 2 (46:29):
Yeah, I mean that's pretty significant.
Speaker 1 (46:31):
What else I got? Nothing else?
Speaker 2 (46:34):
Well, I guess we should probably say before we end
the episode, Chuck, if you do fentanyl in your addicted
to fentanyl, please seek as whatever help you can find
to get off of it. And if you haven't tried
it yet, probably you shouldn't start.
Speaker 1 (46:50):
Yeah, i'd say not even probably, let's say definitely do.
Speaker 2 (46:53):
Okay, Well, since Chuck corrected me from probably to definitely,
as was foretold in two thousand and eight, he is
just god listener.
Speaker 1 (47:00):
Now, all right, there's another two part around disaster movies,
because we heard from two African American listeners, because I
specifically asked, like, how mad are you about the fact
that black people get killed in movies and horror movies
and disaster movies routinely and that's just such a well
(47:21):
known trope, And we heard from a couple of faithful listeners. Hey, guys,
you asked if it's still a thing amongst black people
about being the first to die in scary movies. Yes,
it is still a running joke, of course, but there's
more to it now I found. I'm finding as an
African American and avid movie watcher, the new thing is
the black person often dies in sacrifice of something or
someone else. So yes, we still may go first in
(47:43):
the film, but often for a noble cause. I guess
that makes it more palatable. Lol. That is from Serena
and then this is from Kevin. First of all, I'm
a casual fan of this subgenre, enjoy the exciting thrills
that come with it. For years, it's become common knowledge
black people will rarely lead or survive to the end
of those movies, as well as other genre movies like
(48:05):
horror or romcom in mainstream Hollywood. It doesn't make me mad, though, guys,
because at the end of the day, I just want
the escapism of the movie. I don't want to think
about the socio economics behind everything. But I understand that
Hollywood has catered to a white audience since the beginning,
as they figure that this is a safe bet financially
and minorities are expendable. My movie watching friends pretty much
(48:27):
know who will survive and who will hook up, and
we just want to enjoy the show. But I am
glad to live in a time where we are having
more representation behind the scenes to pull more strings in
our favor. Keep up the good work and that is
again Kevin and then Serena.
Speaker 2 (48:42):
Awesome, thanks Kevin and Serena. That reminds me of a
point online to make that I didn't have a chance
to in Earthquake. Richard Rowntree aka Shaft, he was in that.
He made it to the end, and he was also
one of the heroes helping save Jenna Vie. M my
saying your name correctly.
Speaker 1 (49:03):
I don't know, but I know that Richard Rowntree is
almost always the hero. Yeah.
Speaker 2 (49:07):
So yeah, he was like a motorcycle stuntman, so he
was sadly an exception, but he definitely did make it
to the end.
Speaker 1 (49:14):
Which was great. Yeah. Nice work, Nice.
Speaker 2 (49:17):
Work, Richard Rowntree. And if you want to be like
Kevin and Serena and want to share your thoughts with us,
we love that kind of thing. You can send us
an email of the Stuff podcast at iHeartRadio dot com.
Speaker 1 (49:30):
Stuff You Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows,
Welcome to Stuff You Should Know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and Jerry's here too, and this is Stuff you
Should Know, the Big Bummer Edition.
Speaker 1 (00:19):
Yeah, not very joky, because we're talking about fentanyl.
Speaker 2 (00:22):
And.
Speaker 1 (00:24):
While a great pain killer, a very effective painkiller, it
has sadly become the most deadly street drug in the
United States. And we're going to tell you how that happened.
Speaker 2 (00:34):
Yes, but there's slight silver lining. It is possible that
it is so deadly and so dangerous that it's actually
created a decline in its use. At the very least
a decline in deaths from it has taken place. So
it is on the decline at least deaths, and we'll
talk about possibly why that is later on. But yeah,
(00:57):
we'll talk about the origin of fentanyl. For those of
you who don't know, it's a synthetic opioid. First, there
was morphine, which is I think basically one hundred percent
processed natural opium. Heroin is a kind of a combo
hybrid between synthetic and natural, and then fentanyl is just
(01:18):
straight up like a like it just made up. It's
an analog and it's way more potent than anything anyone
had ever seen before when it came on the scene.
Speaker 1 (01:29):
Yeah, like a hundred times more potent than morphine, fifty
times more potent than heroin. Created by a gentleman named
Paul Janson of the Jansen Company in Belgium, and it
was originally developed as an intravenous anesthetic, like for surgery.
And they started out with a synthetic opioid as the
(01:49):
base called my paradine I guess, and that was developed
in the nineteen thirties. And so they had this sort
of my paradiine as the base. They change it around
a little, I'll alter the chemical structure a little bit,
because what they wanted was something that had fewer negative
side effects, something that was safer to use, and they
(02:11):
were able to do that with fentanyl. I mean it,
you know, initially worked great. It was had a very
fast onset, had a very high therapeutic index, which is
how they measure like the ratio between how effective a
dose is and how how you could get to a
toxic dose. So if you've got a high number and
a greater difference, then that's good.
Speaker 2 (02:33):
Right, And one of the things. I just want to
say that they messed around with molecularly to make fentanyl.
They increased its fat solubility, which sounds like who cares,
But that has two really important effects that make fetanyl
what it is. One, it allows the drug to cross
the blood brain barrier faster, which means fentanyl has a
(02:55):
much faster onset than heroin or morphine. Right, it just
hits you much fast, and then it crosses back through
the blood brain barrier more quickly, so the duration of
the high that you get lasts a shorter time. So
just that one little tweak fat solubility made this drug
what it is, because faster onset makes it addictive. Shorter
(03:19):
duration means that you need to do more.
Speaker 1 (03:22):
Yeah, And then I don't think I've mentioned, but it
was nineteen sixty was when it first came on the scene.
Europe starting using it in sixty three. Came to the
US in sixty eight and approved by the FDA only
by combining it with a tranquilizing drug called draperidol, because
they said, you know that combination makes it even a
(03:42):
lower potential for abuse, so you have to use it
with that. But over time, that kind of waned, and
those limitations were lifted little by little until we got
to the mid nineteen eighties when they had, you know,
cheaper generic versions available, and it was pretty commonly used
in surgery, like post surgical recovery with like skin patches
(04:03):
and lozenges and stuff like that for pain management.
Speaker 2 (04:05):
Yeah, I think still today it's the most common opioid
used for anesthesia during surgery. And that just sounds like
madness when you're familiar with fentanyl, the street version, but
in the hands of like a really well trained anesthesiologist
with hospital great equipment, it's actually very safe. It's the
(04:28):
fact that the stuff that you buy in the street
has a very uneven like dosages means that's why it's
just so deadly because you're not a trained anesthesiologist, you're
not using hospital grade equipment. You're shooting up something that
some dude sold you, and it's just it's just not
trustworthy and it can kill you because it takes such
(04:50):
a small amount to create a toxic dose.
Speaker 1 (04:53):
Yeah, it will produce relaxation, feelings, pleasure, sleepiness. You can
also get nauseous, dizziness, confusion, vomiting, uritary retention, breathing issues,
as we'll see later on. That's you know, basically why
you usually od, it's because of breathing issues, and besides
(05:14):
the overdose risk, which is great, you could also have
a heart attack, heart failure, mood disorders, immune system problems.
For all these reasons. It's a schedule two narcotic with
a high potential for abuse.
Speaker 2 (05:27):
Just a reminder marijuana's Schedule one.
Speaker 1 (05:31):
Yeah, exactly. And most of what we're going to be
talking about is sort of the illegal, illicitly produced market.
But there are fentanyl users that do get like the
real stuff from I'm not sure how they get it,
whatever connection they have, and they'll just have to you know,
it's not like in a pill or a powder, so
it'll be like a patch or something that they might
(05:53):
freeze and hold in their mouth, or they might remove
the gel and then eat it or inject it or
something like that. But usually what we're talking about, the
really dangerous stuff is the powders and the pills that
are being made illegally and either brought into this country
or being made in this country, but usually brought into
this country.
Speaker 2 (06:11):
Yes, and there's different kinds of different analogs of fentanyl
that everybody just kind of puts under the umbrella of
fentanyl when you're talking about illicit fentanyl. But two of
them that stand out that aren't actually illicit, but they're
used in the drug market as car fetanyl, which is
used there's no use for it in humans. They use
(06:34):
it to sedate rhinoceroses and elephants, and I think it's
something like ten thousand times more potent than morphine. You
can get that on the street apparently, although I think
it's fairly rare. And then sue feentanyl is five to
ten times stronger than fentanyl. So if you like people
aren't like it's car fetanyl or sue fentanyl, you're talking
(06:54):
about fentanyl.
Speaker 1 (06:56):
Yeah, exactly. It doesn't necessarily mean it's the same exact
chemical structure. It's just sort of a catch all like pitbull, sure,
the singer no no, no pitbull the dog breed, which
isn't really a dog breed.
Speaker 2 (07:10):
I didn't know that.
Speaker 1 (07:11):
Yeah, there's all kinds of terriers that people just call pitbulls.
Speaker 2 (07:17):
Well, speaking of umbrella terms in different names, I think
we should talk about some of the names. The DEA
says that this is called and the only one I
could corroborate is the last.
Speaker 1 (07:30):
One, Tango and cash.
Speaker 2 (07:32):
Yeah, so apparently that's fetanyl and cocaine mixed together, and
or fetanyl and methamphetamine some sort of speed that's a speedball,
And as we'll see, that's actually proving to be a
really big problem that's created like a new wave of
opioid deaths.
Speaker 1 (07:49):
Yeah. Well, speaking of waves, there have kind of been three,
and this is just sort of an overview of the
opioid addiction crisis in the US that's been going on
for you know, ten fifteen years. The first wave was
in the nineties, and that's when you got prescription opioids
from your doctor. Those really rose dramatically because they do
(08:11):
a really good job. But that's also you know, in
lockstep with fatal opioid overdoses. They doubled between ninety nine
and twenty ten. And twenty ten was when things started
to change for a second wave because the government was like,
you can't be writing all these prescriptions like this to
doctors and to manufacturers, like you got to change your formulas,
(08:32):
Like this stuff is way too readily abuse, So you
got to do something.
Speaker 2 (08:38):
Yeah, and this is really well portrayed in the limited
series Dope Sick. I can't remember if it was on HBO.
I want to say you saw it right now.
Speaker 1 (08:47):
I didn't see that.
Speaker 2 (08:48):
Oh man. It is really good, but it's about the
Sackler family and Purdue Pharma essentially purposely hooking America on
oxy contin. Yeah, and it's a really good series that
just punches you in the gut. But it's really well
done and it covers all that period. The problem was
this is covered a little bit too towards the end.
(09:09):
When you take people's OxyContin away and they're hooked on
OxyContin and opioid, they're going to a lot of them
are at least turned to whatever opioids are available, and
that meant that a lot of people who otherwise would
have never tried heroin took up heroin because they couldn't
get OxyContin anymore.
Speaker 1 (09:30):
Yeah, and that was the second wave, and fatal overdoses
of heroin because of that largely quadruple between twenty two
and twenty thirteen. The third wave is the one we're
kind of mainly going to be talking about that started
in about twenty thirteen and mainly centers around illegally illicitly
(09:50):
produced fentanyl and all the various harmful ways that can
find your way into your body, even sometimes even if
you don't want to be taking fentanyl.
Speaker 2 (10:00):
So yeah, So that third wave, the fentanyl opioid death
wave or fentanyl driven wave, that is that vastly outstrips
the death rate from the first two waves.
Speaker 1 (10:13):
Yeah.
Speaker 2 (10:14):
So I think in nineteen ninety nine, so this is
when people are starting to take opioid prescriptions, there were
two opioid overdose deaths per one hundred thousand people in
the United States. Yeah, that was nineteen ninety nine. Twenty thirteen,
the second wave is going on, that was up to eight.
(10:36):
By twenty twenty two, when the third wave is in
full swing, it was twenty five people per one hundred
thousand people in the United States that were dying of
overdose deaths from fentanyl.
Speaker 1 (10:48):
Yeah. In twenty twenty two, deaths from fentanyl alone were
seventy six two hundred and twenty six people, or sixty
nine percent of total overdose deaths and ninety percent of
the opioid overdose deaths.
Speaker 2 (11:01):
Yeah.
Speaker 1 (11:01):
Apparently it was the problem.
Speaker 2 (11:03):
For sure, And apparently I was like, well, what else
is anybody oding on? And it seems that meth has
created a new epidemic of overdose deaths that everybody's like,
what the hell's going on?
Speaker 1 (11:15):
Yeah, well, Fintanel has hit such a high that it's
actually had a real impact on US life expectancy. It
takes a lot to change a number like that, but
Fintanel seems to have done it. And twenty twenty two
only opioid related deaths resulted in three point one million
years of lost life because a lot of these users
(11:38):
are young. And if you ode it twenty two, they
calculate the average lifespan and do the subtraction and that's
your number. So that you know, a lot of middle
age white people without a college degree are the victims.
So much so, and this is startling. But from that class,
middle aged white people without a college degree, they are
(11:59):
dying earlier on average than their parents did. Yes, that's
not how it's supposed to work.
Speaker 2 (12:04):
That's just not how it has worked, unless the United
States is at war essentially. Yeah, and you know, we're
talking a lot about the US, but the UK and
Europe sorry, UK tracks fairly closely. Although the numbers are lower.
It seems to be following like a similar pattern. Although
(12:26):
I think in some countries. I think estonia is one
of them. Like you can't even get heroin anymore, everybody's
just doing fatanmol. Yeah.
Speaker 1 (12:34):
Well, here's the deal though, is researchers have looked at
these numbers. I think they declared this a public health
emergency in twenty seventeen, and what they're finding is, and
this has been coroberated from other surveys and you know,
metadata studies and stuff, is there aren't more overdose deaths
because more people are using it. It's not just like, oh,
(12:56):
well more people are doing it, so more people are dying.
It seems like it's because this stuff is more dangerous,
it's getting in places that it shouldn't get because usage
has actually declined some over the past like eight years, right.
Speaker 2 (13:09):
Yeah. I think the first two waves were driven by
larger numbers increases in people using prescription opioids and then heroin,
so that accounted for it. But when fentanyl came on
the scene, yeah, people stopped using it as much, but
their deaths just increased, which if you look at it
from just an outside perspective, like it's just because it's
(13:31):
so potent and it was rolled out or introduced to
the drug supply in a really horrific way, as we'll see.
Speaker 1 (13:41):
Yeah, for sure. It also sort of goes in lockstep
with the income disparity in the United States and the
client in fortunes for a lot of people in this country.
Overdosing is basically what they call it is a disease
of despair. When people are destitute and when they're down
(14:02):
or depressed or having really hard times. A lot of
times drugs can be a distraction or if you are
a casual drug user, it could get worse during that time.
And they found in twenty seventeen they study counties in
the US and found that those with the lowest social capital,
meaning networks that can help people, you know, with financial
(14:23):
security and achieving goals, they had the highest rate of overdose.
Speaker 2 (14:27):
Yes, so social capital is basically the size of your
local Kowanas chapter.
Speaker 1 (14:34):
I knew you'd get a joke in theres.
Speaker 2 (14:36):
So yeah, this is I mean, like this whole thing
kind of rose and lockstep. Opioid overdose sets rose and
lockstep with these financial crisis that the US found itself
in over and over again since two thousand and eight.
Job loss, aws of manufacturing jobs just all of the
hardship that the United States has gone through since then,
(14:58):
opioid debts kind of tracked with it, especially at first,
especially with people basically more people turning to that kind
of thing as a disease of despair, which is just sad.
It's just nuts that that's that you can kind of
connect those two things.
Speaker 1 (15:17):
Should we take a break? Yeah, all right, we're gonna
take a break, and we're gonna talk about the rise
of fentanyl right after this. It's stuffish. So one reason
(15:56):
we've seen a surge in overdoses for something like this
is something called the iron law prohibition that was coined
in nineteen eighty six by an economist named Richard Cowan,
and it's basically saying that, hey, if you ban something
that people like doing, something's going to come along, and
it's probably going to be a stronger version. The reason
they call it the law prohibition is because that's what
(16:17):
happened when people were like, all right, you're going to
take our beer, We're going to start making gin and
our bathtubs and moonshine out in the woods, and the
rise of crack in the nineteen eighties the same thing,
and they're basically saying fentanyl is basically the same deal.
Speaker 2 (16:31):
Yeah, and not only more potent, but the fact that
it's more potent means that less of it can generate
just as much cash, which also means it's easier to
smuggle too. And like you said, fentanyl tracks exactly the
same way. It's really easy to make. I mean apparently
you just basically, if you have the precursor chemicals, you're
(16:52):
just making a stew in a pot that you're stirring,
You dry it out, and there you got a bunch
of fentanyl. So it's easy to make. You don't require
tons and tons of agricultural workers and tons and tons
of acreage to grow poppies that you process into heroin.
And because the potency is so much more, there is
(17:12):
a huge cost benefit. Apparently it just accrues to the dealers.
Though there was a study in the journal Addiction from
twenty twenty that basically wanted to find out why was
fentanyl introduced. Was it users who are like, Hey, heroin's great,
but we need something way deadlier? Was it dealers who
(17:33):
are like, hey, heroin's great, but this stuff I can
cut heroin with and like, I'll make a lot more
money or was it a combination of the two. They
didn't say definitively, but they made a pretty good case
that it does seem to have been the dealers looking
to cut costs because those costs or those savings weren't
passed on to users.
Speaker 1 (17:56):
Yeah, it's not like, hey, this, we're making the drugs
cheaper now, so we're just going to give you a
break this. There was one study that found between twenty
thirteen and twenty twenty one, the percentage of heroin that
had fentanyl rows from less than one percent to forty
percent over what is that eight years? And of course
(18:17):
it's going to lead to a huge number of overdoses
because a you've got these batches that are coming out
that the you know, the potency has got a pretty
dramatic range from one batch to another sometimes. Yeah, and
then people you know, for a long time, I think,
you know, the word is finally out now and we're
going to talk about that a little bit later. But
people that were heroin users thought they were getting heroin
(18:38):
and knew how much heroin to take safely.
Speaker 2 (18:41):
Yeah, And one reason why is because these dealers were saying,
if I sell you heroin mixed with fentanyl, I have
to use less heroin because it's going to be just
a potent or more potent. But I can charge you
heroin prices even though I'm paying way less for the
fentanyl that I'm using here. And yeah, people were caught
by some prize. The fact that it was duplicitous is
(19:03):
just awful because it's like, hey, good luck getting acclimated
to this there. It's gonna be a rough transition. But
if you look at it from a business standpoint, the
rollout of fentanyl into the American and European drug supplies,
it had terrible marketing, like it had zero marketing. It
was just all of a sudden there people started dying
and it took the authorities investigating what the heck was
(19:23):
going on for people to figure out that it was fentanyl.
That's how it was introduced. It was just so reckless.
I mean, I'm talking about heroin dealers being even more
reckless than they normally are. That's what happened with fentanyl
being introduced. It just suddenly popped up. No one said
anything about it first.
Speaker 1 (19:42):
Yeah, and by the way, when I said safely do heroin,
I'm hope unclear than that there's doing heroin is never safe.
I just met heroin users would know how much they
can take without overdosing, right, yeah, okay, I just wanted
to make sure people do what I was.
Speaker 2 (19:58):
I think that was worth mentioning.
Speaker 1 (19:59):
Yeah, okay, good. So the other you know, problems with
ventanyl is that it has a really intense rush when
it's first used. Apparently it's more of a head rush
than a body rush, so it can be a little
more you can be a little more active as a
user than maybe doing heroin and just like passing out
on your couch for hours and hours. It's also dangerous
(20:20):
because the high is only an hour or two, so uh,
you know, heroin high lasts longer, so that short duration
is gonna you know, have people using more frequently, and
every time you use ventyl it's just another chance to overdose. Basically.
Speaker 2 (20:33):
Yes, it's a great point. Yeah, and that has to
do with that fat solubility. Again, I said it before
and I'll say it again.
Speaker 1 (20:40):
Yeah, I mean it can happen like a fentanyl overdose
can happen in seconds, right.
Speaker 2 (20:45):
Yes, because the onset is so quick, which makes it
that's another reason that it's so deadly too, is you
don't have time to be like, oh man, there's frau
through on my buddy's mouth. I better call nine one
one because there's good Samaritan laws in my state. It's like,
oh my buddy just injected fentanyl and now they're dead.
I mean, it's it's not that fast necessarily, but compared
to heroin, it is. And yeah, I think it's measured
(21:07):
in like seconds.
Speaker 1 (21:09):
Yeah, it certainly can be. Another thing that makes it
more deadly is that people started changing how they used it.
Among people who died from illegal fentanyl overdoses, the portion
who injected dropped forty two percent over just a two
year period between twenty and twenty twenty two, and they
generally started smoking it that jumped to seventy nine percent.
(21:31):
I believe people also can snort the powder, but just
the fact that people aren't injecting it as much kind
of you know, if you connect the dots, somebody might
dive into using it a little quicker, if they're like, hey,
just snort this thing instead of hey, shoot up this thing.
Speaker 2 (21:49):
Yeah, because that's a big barrier for a lot of
people who are like I like drugs, but I'm not
gonna stick a needle in my arm. That just seems
like such a a horrible road to go down that
it will give people second thoughts. But smoking something geez,
I like marijuana, I like smoking crack, I might as
well try smoking fentanyl. It's just much less of a
(22:10):
barrier to overcome.
Speaker 1 (22:12):
Yeah, And if you're smoking it or snorting it, it
doesn't stay in your body as long as if you
shoot it, so again, just another case of it wears
off quicker and you're gonna want to use it again,
and that's just another overdose opportunity.
Speaker 2 (22:25):
Yes, yeah, I mean it's crazy if you think about it,
because most other drugs that you smoke you could conceivably
overdose on. But fentanyl, even though you're smoking it and
not injecting it, there's still a really good chance that
you could overdose and die from just smoking it. That's
kind of mind boggling, but it's accurate.
Speaker 1 (22:44):
Yeah, And you know, we're talking about smoking it and
snorting it and like powder and a bad kind of stuff.
But the real danger now, and the real problem all
of it is, of course, but the real, real scary
thing is the fact that these are generally sold and
the us CAS's pills. I think by late twenty twenty one,
(23:05):
more than a quarter of the fentanyl seized was in
pill form, And a lot of these pills are they
look like something else. You hear stories on the news
about a kid that did not want to take fentanyl,
that thought they were taking something else and it ended
up being either laced with fentanyl or largely fentanyl, and
(23:26):
they overdose without even knowing they took it.
Speaker 2 (23:28):
Yeah, and it's kind of hard to wrap your head around,
like why would somebody send you that? Like how evil
could you be? But apparently fentanyl pills are very frequently
created to look like old OxyContin what are called M thirty's,
So it would be very easy for something to be like,
oh cool, here's an OxyContin. Fentanyl users know what they're doing.
(23:52):
But if you didn't, we're in a fentanyl user and
you just wanted an oxy contin. That's how you could
die of an overdose fairly quickly. And those are, like
you said, those are the stories that you hear on
the news. I don't think it's a very frequent thing,
but when it does happen, it's just horrific.
Speaker 1 (24:08):
Yeah, for sure. Or if you say you want to
use some cocaine. You're like, Hey, that's my thing. Do
it every now and then on a Saturday night, I'm
going to get some of that stuff. For the same reasons,
Heroin is cut with ventyl. Cocaine can be as well,
So that's not even the same kind of high. You're
looking for cocaine. You may never in your life have
(24:29):
taken anything like morphine or heroine, and all of a
sudden you're snorting fentanyl without knowing it and you're on
the floor.
Speaker 2 (24:36):
Yeah, just a reminder, speedballs are what killed not just
John Belushi, but Chris Farley as well. And apparently this
is that fourth wave that we were talking about of
speedball in fentanyl, with cocaine or with meth. And it's
not just where dealers are cutting it and not telling
their buyers, like buyers are seeking this out. And apparently
(24:59):
this fourth wave has kind of caught black Americans up
into it more than the other previous waves have.
Speaker 1 (25:07):
Oh really, yeah, all right, Well, I guess we can
talk a little bit about where it comes from. A
lot of it that smuggled into the US was originally
made in China, but in twenty nineteen China said you
cannot produce her sell fitting all anymore, and some people
stop doing it, but a lot of manufacturers continued doing so,
(25:29):
sometimes through Legit means that you made it very easy
to ship, but then they also turned to the black
market to ship directly to customers in the US and Europe,
or hey, let's ship the stuff over to Mexico and
these cartels and they can just kind of put it
together there and work as the distributor for US.
Speaker 2 (25:50):
Yeah. So the cartels are getting these precursors, they're turning
around and distributing the precursors to cooks who I read
like a Univision story, so they just I guess we're
interviewing some random ventanyl cook in Mexico. It was like
three twenty year olds who were just standing out in
the woods under a black tarp with a pot on
(26:11):
top of a fire, just stirring it like it was
really easy to make. And then that stuff goes back
to the cartels to smuggle across the border and sell.
Speaker 1 (26:22):
Yeah. Another myth we can kind of bust here as
far as where it comes from, is that in recent years,
there have been politicians that have tried to link the
influx of fentanyl in the United States to illegal immigration,
And there was a poll in twenty twenty two that
found that forty percent of Americans believed that most ventanyl
(26:43):
entering the country was being smuggled by illegal immigrants, basically,
and that's that's not true. The truth is is that
most of this drug comes through legal points of entry,
and when it does, it is smuggled in in a
vehicle driven by US citizens.
Speaker 2 (27:01):
Yeah, most often American women. And I think the Cato
Institute did a study where they found eighty six point
three percent of convicted fentanyl smugglers are American citizens, So
that seems to be totally untrue.
Speaker 1 (27:16):
Yeah, but apparently.
Speaker 2 (27:17):
This is a I think this is a measure of
how how bad fentanyl is, because I mean, Chuck, we're
pretty fentanyl naive. I've never done feentanyl. I'm making a
pretty good assumption that you've never done fetanyl and kept
it a secret from me. So it's entirely possible that
within this whole thing, we've passed along some myth or
exaggeration without being aware of it. Yeah, and for that,
(27:41):
I'm sorry. The thing is, it seems that the overall
theme that fentanyl is incredibly deadly and on a level
unlike any other drug that's ever hit the US market,
so much so that it's like, just don't do drugs.
It's too dangerous because because of the presence of fentanyl.
(28:02):
I think that holds and I think this supports that thesis.
In Cineloa, the Cineloa Cartel has a ban on selling
fentanyl in Sineloa punishable by death. So if you're a
drug dealer in Cineloa and the Cineloa Cartel catches you
selling fentanyl in their state in Mexico where they're supplying
(28:25):
the rest of the world with fentanyl, they'll kill you.
I think that says just about everything you need to
know about fentanyl.
Speaker 1 (28:32):
Yeah, for sure. Should we take another break? All right,
We'll be back and talk about punishment and harm reduction
right after this. It's stuff.
Speaker 2 (29:12):
So one of the things that's a little different about
the fentanyl epidemic is that it hasn't tracked closely or
identically to pass drug epidemics, where like the crack epidemic
or the cocaine epidemic, especially of like the nineties, where
or the eighties or nineties, where if you were caught
(29:32):
with it, especially if you're black, you're going to prison
for possibly the rest of your life. This time around,
it's been a little more there's been a little more
understanding that this is as much a public health crisis,
probably more of public health crisis than a crisis to
be addressed by law enforcement. And one of the more
(29:54):
cynical reasons why that's probable is because it's largely been
viewed publicly as a white issue, that it's mostly white
people who are overdosing and dying from ventanyl.
Speaker 1 (30:06):
Well, let's say this. I don't remember anything growing up
in the eighties that said, let's help these people addicted
to crack.
Speaker 2 (30:16):
No, you were just morally reprehensible and your kid was
probably screwed up.
Speaker 1 (30:21):
Throw away the key is what you got. So yeah,
I don't think that's cynical. I think that's absolutely the truth.
So thankfully they're taking a little bit different approach. We've
gotten a little bit smarter about this stuff, and now
we're focusing. We're trying to focus on harm what's called
harm reduction techniques, basically trying to keep people from dying.
(30:41):
A bunch of different things have been tried, and a
lot of it has been fairly effective. As we're seeing
like the numbers going down in overdoses, but distributing test strips.
So if you buy a pill, or if you buy
cocaine or something, and you have a test strip, you
can test to see if that drug has ventanyl before
you use it, or maybe your dealer even offers that service.
Speaker 2 (31:02):
That's really something.
Speaker 1 (31:04):
Yeah, I mean, if you want to be a and
again I say reputable drug dealer with sort of scare quotes,
but I would imagine that's a good thing to do,
is say, hey, this stuff is pure. I got a
test strip here, and you can test it to make
sure that you can be a repeat customer and not
dead on the sidewalk.
Speaker 2 (31:20):
Yeah. And I think that the test strips have helped
a lot of people, if not save their lives. The
problem with them that I've seen is that all they
do is show that there is fentanyl present. It doesn't
say whether it's a fentanyl analog like car fentanyl that's
one hundred times stronger than fentanyl. It doesn't say how
much fentanyl is in there, so is it just a
(31:41):
little bit or is it like a kill you sized dose.
But if you're like I don't do fentanyl, those test
trips are going to get quite a bit, like I
just want cocaine. Stop putting fentanyl in my cocaine. Those
test strips are going to help you, and they're going
to tick you off because I mean, I don't think
you can take cocaine back to the deal learn get
your money back because it had fentanyl in it. Although
(32:03):
who knows with kids these days.
Speaker 1 (32:06):
Yeah, I mean that these newer generations may demand return restitution.
So another thing that they can do is, you know,
they're safe places where people can go use the drugs
while people watch out for you. The drug users themselves
seem to have wizened up a little bit because of
all the news and probably seeing their friends die very sadly.
(32:29):
But they may take, you know, dip their toe in
the water a little bit at first and take a
smaller dose. Or they may if they're with a group
that's using stagger the doses so people can be standing
by with that narcan in case one of their friends
passes out.
Speaker 2 (32:43):
I wonder if, like you, they draw straws to see
what order everybody does drugs in, Like, how do they
how do they determine who's going to go last?
Speaker 1 (32:53):
Any medium monuments? Okay, the age old the traditionally exactly,
But I did mention Narcan and that is the brand
name for naloxone or nelaxone, and that can redse reverse
an overdose. And like, I have only one anecdotal example.
I don't know if it always works this way, but
(33:15):
one day quite a few years ago, a car just
kind of pulled around the corner and parked across the street,
and this dude got out of the car and his
girlfriend was like passed out, and it was clear that
it was a drug thing. Luckily, my Cross Street neighbors
a nurse. She called nine one one. Immediately they showed
up with narcan and dude they injected that, and this
(33:37):
girl was walking around and like saying, can I get
Can we leave now? Like minutes later?
Speaker 2 (33:43):
Wow, yeah, I mean it just reverses an overdose, right.
Speaker 1 (33:48):
Yeah, but I do. I mean, I don't know what
happens after that. All I saw was this snapshot where
she was like, I want to get out of here,
and I don't know what the law the laws are
as far as that kind of stuff goes. But the
ambulance I don't think is allowed to call the cops
on you. If I'm not mistaken. I think they're just like, Okay,
I guess you can go.
Speaker 2 (34:07):
Yeah. I don't know the law in Georgia or anywhere really, but.
Speaker 1 (34:10):
Yeah, those laws are called something what is it, good
Samaritan laws? Oh okay, yeah, I guess that's it.
Speaker 2 (34:16):
So you would be protected, but that wouldn't matter. It's
more like, if you're shooting up with your friend and
your friend overdoses and you have a bunch of heroin
or fentanyl on you, you can't be prosecuted for having that.
I mean, I'm sure to an extent because you just
because you called for help to help your friend and
the cops ended up showing up to you.
Speaker 1 (34:37):
Yeah, and I didn't look this up, But can't you
just buy a narcan?
Speaker 2 (34:40):
Yeah, it's getting much more widely available. Okay, Yeah, but
let's talk a little bit about overdoses because there's some
One of the telltale signs I think it's not just
with fentanyl, with heroin as well, or opioids in general,
is it can produce fluid in the lungs, so that
a telltale sign of an overdose is froth around the
(35:01):
mouth or in the notes. Once that happens, you need
to act pretty quickly, and one of the things that
they say to do first is rub your knuckles on
their chests kind of hard, because it's a very uncomfortable
thing to have done to you, and it can snap
you out of a opioid stupor even that. But if
(35:23):
they don't respond, then it's you need to call nine
to one to one and or administered in the lockxown.
Speaker 1 (35:30):
Yeah, I mean in the brain stem, there are a
couple of regions, the medulla and the ponds, and they
control the depth and rate of breathing. But both of
those have a lot of opioid receptors. So if you
do fentanyl and they attach to those receptors, which they will,
they can change the behaviors of the cells such that
they just stop working and you just literally just stop breathing,
(35:51):
like it's that simple.
Speaker 2 (35:52):
Yeah, And it's even worse than that, actually, because there's
also opio receptors in the parts of your brain that
control voluntary breathing. So like when you're like I need
to catch my breath and you take a deep breath,
or if you're meditating, when you purposefully breathe, that is
repressed as well, so you have involuntary breathing and voluntary
breathing or repressed, and this thing that detects rises in
(36:15):
CO two in your body that gets repressed as well.
Speaker 1 (36:18):
Right, Yeah, So basically, if you want to take that
deep breath, if you've since like you're in trouble, I'm like,
oh man, I got to get a big breath of
air here. You just do that normally, But little small
increases in CO two are sensed, and thekarated body it's
a little small cluster of sales in the neck. They're
(36:39):
going to spur that increase in breathing to remove that
excess CEOs two. But if that's not working and that
emergency sort of fail safe is switched off, then again
you can't even get that big breath to save yourself.
Speaker 2 (36:52):
Yeah, So breathing, I think you said early on that
typically is where fatal overdoses. It's just you just stop breathing,
stop being able to breathe. But there's other ways you
could die. I think you mentioned heart attack earlier too.
Another famous one with opioids is your gag reflex is suppressed.
So if you're basically knotted off and you throw up,
(37:15):
say you've been drinking as well, you're not going to
choke that stuff out or spit it out or throw
it up out of your mouth. It can just stay
in your mouth and it can go down your lungs
and you aspirate and or choke on your own vomit.
That's another way you can die from an overdose as well.
Speaker 1 (37:32):
I was waiting to see if you were going to
come up with like a fourth way to say pukey?
Speaker 2 (37:37):
Did I say a bunch of different ways?
Speaker 1 (37:39):
You said, like three, you like spit it up or
vomit it up or choke ers yeack it up.
Speaker 2 (37:44):
I was like, we get it blow chunks it up.
Speaker 1 (37:47):
Oh God. So as far as treatment goes, it kind
of goes and locks up with what they do for heroin.
It's called medication assisted treatment or MATT. That's kind of
the gold standard. We're talking about either methadone or how
do you say that, bupa norphine. If you get methadone,
it's going to be done at a clinic. It's not
(38:09):
like they just hand that out at the pharmacy, which
means you have to go to that clinic. You got
to wait in line a lot of times. You got
to do it there. The other one, I believe is
given in the form or I guess the brand name
subox Owne, and I think you can you can get
that prescribed. But a lot of people are like, hey,
(38:29):
you know, go to drug rehab and just quit doing
all this stuff because you're still on another drug. If
you're going to a methadone clinic every day, right.
Speaker 2 (38:38):
A lot of people don't have access to the kind
of doctor that's going to prescribe that for them. There's
a lot, like even among medical professionals still believe it
or not, there's still a lot of stigma associated with
being an opioid addict. Yeah, which is pretty rich considering
the American physicians, a significant chunk of them got America
(39:01):
hooked on opioids in the first place. But that's neither
here nor there right now. So I think there was
a study from twenty twenty two that the CDC conducted
where they said that of the three point seven percent
of all adults in the United States who need medication
assisted treatment, I think only about twenty five percent of
(39:22):
that three point seven percent, we're able to get it.
Speaker 1 (39:26):
Yeah.
Speaker 2 (39:26):
One of the other ways that you can get off
of it is to go to prison where they are
just like, good luck drying out.
Speaker 1 (39:34):
Yeah, that's that's no.
Speaker 2 (39:36):
Way to kick no. And the problem with it, too
is not just like that's I can't imagine going through that.
But if you get out of prison or say you're
able to get heroin or something or fentanyl in prison
after you've kicked it, your tolerance has dropped. And we
talked about this in our Heroin episode in twenty twenty.
But your tolerance has dropped, and so your likelihoo of
(40:00):
an overdose is through the roof compared to what it
was before you kicked heroin the hard way or fatanyl.
Speaker 1 (40:05):
The hard way. Yeah, so we busted the myth about
illegal immigrants smuggling this into the country. Earlier, there was
another myth apparently police departments kind of spread this one
that touching fentanyl at all or inhaling just trades amounts
can overdose you. Apparently that came from a twenty sixteen
(40:28):
US DEA advisory to claim that was possible. But this
is sort of annoying because it's not you know, generally
absorbed through the skin. They have those transdermal patches, but
it's not like helping someone like shaking somebody on the
ground or something can get it into your skin that way,
or inhaling enough to overdose you. Is like, there's no
(40:50):
way you would accidentally inhale enough to overdose.
Speaker 2 (40:53):
Right, But there's cases of like first responders in paramedics
suffering from exposure two very small amounts of fentanyl and
people are like, what the heck's going on. The best
explanation is that it's it's what's called the culture bound syndrome,
this expectation that it can happen. It leads to a
(41:14):
nocebo effect where the person essentially freaks themselves out into
a panic attack, and it's it's they're like, I just
had I just odd on fentanyl, just from touching a
little bit of it. Yeah, that's the best explanation. It
makes sense. The point is is like, you like, interacting
with somebody who's odd on fentanyl. Isn't going to give
(41:35):
you a fentanyl high or overdose?
Speaker 1 (41:38):
Yeah, for sure. Another myth, I guess the final myth
that we can bust is if you hear somebody saying, like,
you know, all these unhoused people in the streets, it's
all because of fentanyl. They're out they're they're homeless now
they're in your neighborhoods. And this is because of this epidemic.
I'm sure that has happened where people you know, can't
(41:59):
pay their rent and on the street because of an
addiction like that. Sometimes people turn to drugs after the
fact if they are in house. But if you look
at it on a macro level, the data shows that
the reason America has an unhoused crisis like we do
now is mainly because of the cost of housing. It's
not drug use, it's not mental illness, it's not unemployment,
(42:22):
even all those things are a factor, not saying they
don't count, but it's the cost of housing.
Speaker 2 (42:27):
Yeah, it's crazy. Look at all the morality we associate
with drugs, Like it's brought in by illegal immigrants, drug
users accidentally create overdoses, and first responders and paramedics trying
to help them. It's the reason for homelessness, Like it's all.
There's all moral judgments associated with all of those things. Yeah,
(42:48):
and you're associated with the drug. And anybody who doesn't
do that drug and loves first responders, doesn't like illegal immigrants,
and doesn't like homeless people, is going to hate that drug.
From that point on.
Speaker 1 (42:59):
Yeah, the drug, it was okay by the FDA, and
that you know, wealthy pharmaceutical families in this country's got
rich off of Yeah.
Speaker 2 (43:06):
Well, let's just say again, fentanyl is perfectly safe in
like a medical setting in the hands of the trained professional.
It's just outside of that when when cartels become involved
and it's it becomes a huge problem. But I said,
at the outset, there is a silver lining or at
least some hope because they're the use is well. First
(43:27):
of all, opioid deaths are declining. I think they peaked
in twenty twenty two with one hundred and eight thousand
opioid overdose deaths in the United States, and the numbers
aren't in for twenty twenty four, but they think the
estimate is that it's going to be anywhere between a
fifteen to twenty percent drop in overdose deaths from fentanyl.
(43:49):
And they say, okay, well, Chuck, why why are these
fentanyl deaths finally subsiding? What's the deal?
Speaker 1 (43:56):
Yeah, I mean there could be. It's it's probably most
of these things combined. When you look at it on
a bird's eye perspective. A lot of people say, the
testing strips have made a big deal, that narcan has
made a big difference, that MATT treatment has made a
big difference. One reason is because drug users have gotten
(44:17):
a little bit smarter. Like I mentioned earlier, some people
are trying to avoid it altogether. Some people are, like
I said, dipping their toe in the pond or making
sure their friends don't overdose. One of the saddest possible
factors is that so many people have died off there
just aren't as many active users anymore for that reason.
Speaker 2 (44:35):
Yeah, there was. Yeah, you were saying that, like younger
generations might have been scared away from it.
Speaker 1 (44:43):
Yeah, that's another reason.
Speaker 2 (44:44):
Yeah, apparently I thought you said that. So apparently gen
Z is unlikely or less likely to use drugs. I
think like sixty seven of twelfth graders said that they
abstained from drugs, meaning that they hadn't taken any drugs
in the last thirty days. And I was like, I
wonder what that is compared to gen X back and
when we were in high school.
Speaker 1 (45:06):
Oh my god, And I.
Speaker 2 (45:07):
Was like, this is this is gonna be crazy. It
is crazy, but it's the opposite way you would think
the I think I can't remember what US agency conducts
this every year, but in nineteen ninety three, high school
seniors said that eighty one point seven percent said that
they had abstained from drugs in the last thirty days.
So gen Z is on way more drugs than gen
(45:29):
X was, which is very surprising to me.
Speaker 1 (45:32):
Or gen X is a generation of liars.
Speaker 2 (45:35):
That's entirely possible too, are you Narkman.
Speaker 1 (45:39):
Yeah, I don't know. I mean, I was a good
boy growing up, but I certainly I feel like all
my friends were doing all the drugs.
Speaker 2 (45:45):
I wonder if it really is there is it's just
a lot more prevalence of drug use because it's so
easy to get it on the internet, and it used
to be hard back when we were in high school
for people maybe drugs in high school.
Speaker 1 (45:59):
Well, I mean, there's definitely improved international cooperation between the
United States and other countries just to reduce the supply.
That US of Mexico has gotten together, and they've been
working together for a while now trying to intercept those
drug shipments and trying to you know, mess up the
cartel and what their activities, what the cartel is doing.
(46:21):
I think in twenty twenty four. Last year, the Mountain
of Fitnel crossing that border dropped by about twenty percent.
So that's pretty good.
Speaker 2 (46:29):
Yeah, I mean that's pretty significant.
Speaker 1 (46:31):
What else I got? Nothing else?
Speaker 2 (46:34):
Well, I guess we should probably say before we end
the episode, Chuck, if you do fentanyl in your addicted
to fentanyl, please seek as whatever help you can find
to get off of it. And if you haven't tried
it yet, probably you shouldn't start.
Speaker 1 (46:50):
Yeah, i'd say not even probably, let's say definitely do.
Speaker 2 (46:53):
Okay, Well, since Chuck corrected me from probably to definitely,
as was foretold in two thousand and eight, he is
just god listener.
Speaker 1 (47:00):
Now, all right, there's another two part around disaster movies,
because we heard from two African American listeners, because I
specifically asked, like, how mad are you about the fact
that black people get killed in movies and horror movies
and disaster movies routinely and that's just such a well
(47:21):
known trope, And we heard from a couple of faithful listeners. Hey, guys,
you asked if it's still a thing amongst black people
about being the first to die in scary movies. Yes,
it is still a running joke, of course, but there's
more to it now I found. I'm finding as an
African American and avid movie watcher, the new thing is
the black person often dies in sacrifice of something or
someone else. So yes, we still may go first in
(47:43):
the film, but often for a noble cause. I guess
that makes it more palatable. Lol. That is from Serena
and then this is from Kevin. First of all, I'm
a casual fan of this subgenre, enjoy the exciting thrills
that come with it. For years, it's become common knowledge
black people will rarely lead or survive to the end
of those movies, as well as other genre movies like
(48:05):
horror or romcom in mainstream Hollywood. It doesn't make me mad, though, guys,
because at the end of the day, I just want
the escapism of the movie. I don't want to think
about the socio economics behind everything. But I understand that
Hollywood has catered to a white audience since the beginning,
as they figure that this is a safe bet financially
and minorities are expendable. My movie watching friends pretty much
(48:27):
know who will survive and who will hook up, and
we just want to enjoy the show. But I am
glad to live in a time where we are having
more representation behind the scenes to pull more strings in
our favor. Keep up the good work and that is
again Kevin and then Serena.
Speaker 2 (48:42):
Awesome, thanks Kevin and Serena. That reminds me of a
point online to make that I didn't have a chance
to in Earthquake. Richard Rowntree aka Shaft, he was in that.
He made it to the end, and he was also
one of the heroes helping save Jenna Vie. M my
saying your name correctly.
Speaker 1 (49:03):
I don't know, but I know that Richard Rowntree is
almost always the hero. Yeah.
Speaker 2 (49:07):
So yeah, he was like a motorcycle stuntman, so he
was sadly an exception, but he definitely did make it
to the end.
Speaker 1 (49:14):
Which was great. Yeah. Nice work, Nice.
Speaker 2 (49:17):
Work, Richard Rowntree. And if you want to be like
Kevin and Serena and want to share your thoughts with us,
we love that kind of thing. You can send us
an email of the Stuff podcast at iHeartRadio dot com.
Speaker 1 (49:30):
Stuff You Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows,
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