Fentanyl: Actually As Dangerous As They Say

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. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 1:03Speaker 00

  Welcome to Stuff You Should Know, a production of iHeart Radio.

• 1:14Josh Clark?

  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.

• 1:21Speaker 02

  Yeah, not very jokey because we're talking about fentanyl. And while a great painkiller, 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.

• 1:36Josh Clark?

  Yes, but there is a 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, 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 a hundred percent processed natural opium. Heroin is a kind of a combo hybrid between synthetic and natural. And then fentanyl is just straight up.

• 2:22Josh Clark?

  Like a dur- 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.

• 2:31Speaker 03

  Yeah, like a hundred times more potent than morphine, 50 times more potent than heroin. Created by a gentleman named Paul Jansen 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 base called Meparadine, Meparadine, I guess. And that was developed in the 1930s. And so they had this sort of Meparadine as the base. They changed it around a little, 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.

• 3:11Speaker 03

  And they were able to do that with, 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.

• 3:35Josh Clark?

  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 fentanyl what it is. One, it allows the drug to cross the blood brain barrier faster, which means fentanyl has a much faster onset than heroin or morphine, right? It just hits you much faster. 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 the, just that one little tweak, fat solubility, made this, this drug what it is.

• 4:17Josh Clark?

  Because faster onset makes it addictive, shorter duration means that you need to do more.

• 4:24Speaker 03

  Yeah, and then I don't think I've mentioned, but it was 1960 was when it first came on the scene. Europe started using it in 63, came to the US in 68 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 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 1980s when they had, you know, cheaper generic versions available. And it was pretty commonly used in surgery and like post-surgical recovery with like skin patches and lozenges and stuff like that for pain management.

• 5:07Josh Clark?

  Yeah, I think still today, it's the most common opioid used for anesthesia during surgery. And it's, 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-grade equipment, it's, it's actually very safe. It's the fact that the stuff that you buy on the street has a very uneven, like dosages. It 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 not, it's

• 5:49Josh Clark?

  just not trustworthy and it can kill you because it takes such a small amount to create a toxic dose.

• 5:55Speaker 03

  Yeah, it will produce relaxation feelings, pleasure, sleepiness. You can also get nauseous, dizziness, confusion, vomiting, urinary retention, breathing issues, as we'll see later on, that's, you know, basically why you usually OD is because of breathing issues. And besides 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.

• 6:29Josh Clark?

  Just a reminder, marijuana is schedule one.

• 6:33Speaker 03

  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 an pill or a powder. So it'll be like a patch or something that they might 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.

• 7:13Josh Clark?

  Yes. And there's different kinds, 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 is carfentanil, which is used, there's no use for it in humans. They use it to sedate rhinoceruses and elephants. And I think it's something like 10,000 times more potent than morphine. You can get that on the street, apparently, although I think it's fairly rare. And then sufentanil is five to 10 times stronger than fentanyl. So if you like, people aren't like, get carfentanil or sufentanil, you're talking about fentanyl.

• 7:57Speaker 03

  Yeah, exactly. It doesn't necessarily mean it's the same exact chemical structure. It's just sort of a catch-all, like Pitbull.

• 8:05Josh Clark?

  Sure. The singer?

• 8:08Speaker 03

  No, no, no. Pitbull, the dog breed, which isn't really a dog breed.

• 8:12Josh Clark?

  I didn't know that.

• 8:13Speaker 03

  Yeah, there's all kinds of terriers that people just call Pitbulls.

• 8:17Josh Clark?

  Well, speaking of umbrella terms and 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 one.

• 8:32Speaker 03

  Tango and cash?

• 8:34Josh Clark?

  Yeah. So apparently that's fentanyl and cocaine mixed together and/or fentanyl and methamphetamine, some sort of speed. This is speedball. And as we'll see, that's actually proving to be a really big problem. It's created like a new wave of opioid deaths.

• 8:50Speaker 03

  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, 10, 15 years. The first wave was in the 90s and that's when you got prescription opioids from your doctor. Those really rose dramatically because they do a really good job. But that's also, you know, in lockstep with fatal opioid overdoses. They doubled between 99 and 2010. And 2010 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 gotta change your formula.

• 9:34Speaker 03

  It's like this stuff is way too readily abused, so you gotta do something.

• 9:40Josh Clark?

  Yeah, and this is really well portrayed in the limited series Dopesick. Can't remember if it's on HBO, I want to say. You saw it, right?

• 9:49Speaker 03

  No, I didn't see that.

• 9:50Josh Clark?

  Oh, man, it is really good. But it's about the Sackler family in Purdue Pharma essentially purposely hooking America on OxyContin.

• 9:59Speaker 03

  Yeah.

• 9:59Josh Clark?

  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, and this is covered a little bit too toward the end. When you take people's OxyContin away and they're hooked on OxyContin, an opioid, they're going to, a lot of them are at least, turn 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.

• 10:32Speaker 03

  Yeah, and that was the second wave and fatal overdoses of heroin because of that largely quadrupled between 2002 and 2013. The third wave is the one we're kind of mainly going to be talking about that started in about 2013 and mainly centers around illegally, illicitly produced fentanyl and all the various harmful ways it can find your way into your body, even sometimes even if you don't want to be taking fentanyl.

• 11:02Josh Clark?

  So yeah, so um, the third wave, the fentanyl opioid death wave or fentanyl driven wave, that is, that vastly outstrips the death rate from the first two waves.

• 11:15Speaker 03

  Yeah.

• 11:16Josh Clark?

  So I think in 1999, so this is when people are starting to take opioid prescriptions. There were um, two opioid overdose deaths per 100,000 people in the United States.

• 11:30Speaker 03

  Yeah.

• 11:31Josh Clark?

  That was 1999. 2013, the second wave is going on, um, that was up to eight. By 2022, when the third wave is in full swing, it was 25 people per 100,000 people in the United States that were dying of overdose deaths from fentanyl.

• 11:50Speaker 03

  Yeah, in 2022, deaths from fentanyl alone um, were 76,226 people, uh, or 69% of total overdose deaths and 90% of the opioid overdose deaths.

• 12:03Josh Clark?

  Yeah, apparently.

• 12:04Speaker 03

  It was the problem.

• 12:05Josh Clark?

  For sure. And apparently I was like, well, what else is anybody ODing on? And like, it seems that meth has created a new epidemic of overdose deaths that everybody's like, what the hell's going on?

• 12:17Speaker 03

  Yeah, but while fentanyl has hit such a high that it's actually had a, a real impact on US life expectancy, um, it takes a lot to change a number like that, uh, but fentanyl seems to have done it. And 2022 only, um, opioid related deaths resulted in 3.1 million years of lost life because a lot of these users are young and if you OD at 22, they, you know, calculate the average lifespan and do the subtraction and that's your number. Uh, so that, you know, a lot of middle-aged, uh, white people without a college degree are the victims, um, so much so, and this is startling, but from that class, middle-aged white people without a college degree, they are dying earlier

• 13:02Speaker 03

  on average than their parents did.

• 13:04Josh Clark?

  Yes.

• 13:05Speaker 03

  That's not how it's supposed to work.

• 13:06Josh Clark?

  That's just not how it has worked unless the United States is in, at war essentially.

• 13:11Speaker 03

  Yeah.

• 13:13Josh Clark?

  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, that it seems to be following like a similar pattern, although I think in some countries, I think Estonia is one of them, like you can't even get heroin anymore. Everybody's just doing fentanyl.

• 13:36Speaker 03

  Yeah, well, here's the deal, though, is researchers have looked at these numbers. I think they declared this a public health emergency in 2017. And what they're finding is, and this has been corroborated 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, 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?

• 14:11Josh Clark?

  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 so potent. And it was rolled out or introduced to the drug supply in a really horrific way, as we'll see.

• 14:43Speaker 03

  Yeah, for sure. It also sort of goes in lockstep with the income disparity in the United States and the decline 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 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 2017, they studied counties in the US, and found that those with the lowest social capital, meaning networks that can help people with financial security and achieving goals, they had the highest rate of overdose.

• 15:29Josh Clark?

  Yes. So social capital is basically the size of your local Kiwanis chapter.

• 15:36Speaker 03

  I knew you'd get a joke in there.

• 15:37Josh Clark?

  Thanks. So, yeah, this is, I mean, like, this whole thing kind of rose in lockstep. Opioid overdose deaths rose in lockstep with these financial crises that the US found itself in over and over again since 2008. Job loss, loss of manufacturing jobs, just all of the hardship that the United States has gone through since then, opioid deaths 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.

• 16:17Speaker 03

  Yeah.

• 16:19Speaker 03

  Should we take a break?

• 16:20Josh Clark?

  Yeah.

• 16:21Speaker 03

  All right, we're gonna take a break and we're gonna talk about the rise of fentanyl right after this.

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• 20:06Speaker 03

  So one reason we've seen a surge in overdoses for something like this is something called the iron law prohibition that was coined in 1986 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 of prohibition is because that's what happened when people were like, all right, you're going to take our beer, we're going to start making gin in our bathtubs and moonshine out in the woods. And the rise of crack in the 1980s, the same thing. And they're basically saying fentanyl is basically the same deal.

• 20:43Josh Clark?

  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 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 a huge cost benefit.

• 21:28Josh Clark?

  Apparently, it just accrues to the dealers, though. There was a study in the journal Addiction from 2020 that basically wanted to find out why was fentanyl introduced? Was it users who were like, hey, heroin's great, but we need something way deadlier? Was it dealers who were 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.

• 22:07Speaker 03

  Yeah, it's not like, hey, we're making the drugs cheaper now, so we're just going to give you a break on this. There was one study that found between 2013 and 2021, the percentage of heroin that had fentanyl rose from less than 1% to 40% over, what is that, eight years?

• 22:28Speaker 03

  And of course, that'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.

• 22:40Josh Clark?

  Yeah.

• 22:41Speaker 03

  And then people at, 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 and knew how much heroin to take safely.

• 22:53Josh Clark?

  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 as 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 surprise. The fact that it was duplicitous is just awful because it's like, hey, good luck getting acclimated to this. There's, it's going to 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 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 going on for people to figure

• 23:37Josh Clark?

  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.

• 23:54Speaker 03

  Yeah. And by the way, when I said safely do heroin, I hope I'm clear that there's, doing heroin is never safe. I just meant heroin users would know how much they can take without overdosing.

• 24:07Josh Clark?

  Right. Yeah.

• 24:08Speaker 03

  Okay. I just wanted to make sure people knew what I was talking about.

• 24:10Josh Clark?

  I think that was worth mentioning. Yeah.

• 24:12Speaker 03

  Okay, good. So the other, you know, problems with fentanyl 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 because the high is only an hour or two. So, you know, heroin high lasts longer. So that short duration is going to, you know, have people using more frequently. And every time you use fentanyl, it's just another chance to overdose, basically.

• 24:45Josh Clark?

  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.

• 24:52Speaker 03

  Yeah. I mean, it can happen, like a fentanyl overdose can happen in seconds, right?

• 24:57Josh Clark?

  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 froth around my buddy's mouth. I better call 911 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 in like seconds.

• 25:21Speaker 03

  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 42% over just a two-year period between 2020 and 2022. And they generally started smoking it. That jumped to 79%. 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.

• 26:02Josh Clark?

  Yeah, because that's a big barrier for a lot of people who are like, I like drugs, but I'm not going to stick a needle in my arm. That just seems like such a horrible road to go down that it'll 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 barrier to overcome.

• 26:24Speaker 03

  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 going to want to use it again, and that's just another overdose opportunity.

• 26:37Josh Clark?

  Yes, yeah, I mean, it, 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.

• 26:57Speaker 03

  Yeah, and you know, we're talking about smoking it and snorting it and like powder in a bag 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 seizes pills. I think by late 2021, 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 they overdose without even knowing they took it.

• 27:40Josh Clark?

  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 M30s? So it would be very easy for somebody to be like, oh, cool, here's, here's an OxyContin. Fentanyl users know what they're doing, but if you didn't, weren't a fentanyl user and you just wanted an OxyContin, 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.

• 28:19Speaker 03

  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 fentanyl, cocaine can be as well. So that's not even the same kind of high. You're, you're looking for cocaine, you may never in your life have taken anything like morphine or heroin. And all of a sudden, you're snorting fentanyl without knowing it and you're on the floor.

• 28:48Josh Clark?

  Yeah. Just a reminder, speedballs are what killed not just John Belushi, but Chris Farley as well. And apparently, this, this is that fourth wave that we were talking about of speedball and fentanyl with cocaine or with meth. And it's not just where dealers are cutting it and not telling their, their buyers, the buyers are seeking this out. And apparently, this fourth wave has kind of caught black Americans up into it more than the other previous waves have.

• 29:19Speaker 03

  Oh, really?

• 29:20Josh Clark?

  Yeah.

• 29:22Speaker 03

  All right, well, I guess we can talk a little bit about where it comes from. A lot of it that's smuggled into the US was originally made in China. But in 2019, China said you cannot produce or sell fentanyl anymore. And some people stopped doing it, but a lot of manufacturers continue doing so. Sometimes through legit means that made it very easy to ship. But then they also turn 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.

• 30:02Josh Clark?

  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 on some, they just, I guess we're interviewing some random fentanyl cook in Mexico. It was like three 20-year-olds who were just standing out in the woods under a black tarp with a pot on 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.

• 30:34Speaker 03

  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 2022 that found that 40% of Americans believe that most fentanyl entering the country was being smuggled by illegal immigrants, basically. And 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 vehicles driven by US citizens.

• 31:14Josh Clark?

  Yeah, most often, American women. And I think the Cato Institute did a study where they found 86.3% of convicted fentanyl smugglers are American citizens. So that seems to be totally untrue.

• 31:28Speaker 03

  Yeah.

• 31:29Josh Clark?

  But apparently, this is, 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 fentanyl. I'm making a pretty good assumption that you've never done fentanyl and kept it a secret from me.

• 31:44Josh Clark?

  So it's entirely possible that within this whole thing, we've passed along some myth or exaggeration without being aware of it.

• 31:52Speaker 03

  Yeah.

• 31:53Josh Clark?

  And for that, 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.

• 32:08Josh Clark?

  So much so that it's like, just don't do drugs. It's too dangerous because of the presence of fentanyl. I think that holds and I think this supports that thesis. In Sinaloa, the Sinaloa cartel has a ban on selling fentanyl in Sinaloa punishable by death. So if you're a drug dealer in Sinaloa and the Sinaloa cartel catches you selling fentanyl in their state in Mexico, where they're supplying the rest of the world with fentanyl, they'll kill you. I think that says just about everything you need to know about fentanyl.

• 32:44Speaker 03

  Yeah, for sure. Should we take another break?

• 32:47Josh Clark?

  Mm hmm.

• 32:48Speaker 03

  All right, we'll be back and talk about punishment and harm reduction right after this.

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• 36:23Josh Clark?

  So one of the things that's a little different about the fentanyl epidemic is that it doesn't, it hasn't tracked closely or identically to

• 36:32Speaker 03

  Right.

• 36:32Josh Clark?

  past drug epidemics where like the crack epidemic or the cocaine epidemic, especially of like the 90s where, or the 80s or 90s where if you were caught 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 a public health crisis than a crisis to be addressed by law enforcement. And one of the more 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 fentanyl.

• 37:17Speaker 03

  Well, let's say this, I don't remember anything growing up in the 80s that said, "Let's help these people addicted to crack."

• 37:26Josh Clark?

  No, you were just morally reprehensible and your kid was probably screwed up.

• 37:31Speaker 03

  Throwaway 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. 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 fentanyl before you use it, or maybe your dealer even offers that service.

• 38:13Josh Clark?

  That's really something.

• 38:15Speaker 03

  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.

• 38:31Josh Clark?

  Yeah. And I think that the test strips have helped a lot of people, if not saved 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 100 times stronger than fentanyl.

• 38:48Speaker 03

  Right.

• 38:48Josh Clark?

  It doesn't say how much fentanyl is in there. So is it just a little bit or is it like a kilo sized dose? But if you're like, I don't do fentanyl, those test strips are going to help 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 dealer and get your money back because it had fentanyl in it. Although who knows with kids these days?

• 39:16Speaker 03

  Yeah. I mean, these newer generations may demand a return.

• 39:21Josh Clark?

  Restitution.

• 39:23Speaker 03

  So another thing that they can do is, you know, there are 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, 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.

• 39:53Josh Clark?

  I wonder if like 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?

• 40:03Speaker 03

  Any medium, any more.

• 40:04Josh Clark?

  Okay. There you go. The age old.

• 40:06Speaker 03

  The traditional way.

• 40:07Josh Clark?

  Exactly.

• 40:09Speaker 03

  But I did mention Narcan and that is the brand name for naloxone or nalaxone. And that can reverse, reverse an overdose and like.

• 40:21Speaker 03

  I have only one anecdotal example. I don't know if it always works this way, but 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.

• 40:40Speaker 03

  Luckily, my cross street neighbor is a nurse. She called 911 immediately. They showed up with Narcan and dude, they injected that and this girl was walking around and like saying, can I get, can we leave now? Like minutes later.

• 40:54Josh Clark?

  Wow. Yeah. I mean, it just reverses an overdose, right?

• 40:58Speaker 03

  Yeah, but I don't mean, I don't know what happens after that. All I saw was this snapshot where she was like, I'm 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, 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.

• 41:17Josh Clark?

  Yeah, I don't know the law in Georgia or anywhere really, but yeah.

• 41:22Speaker 03

  Those laws are called something, what is it?

• 41:24Josh Clark?

  Good Samaritan laws.

• 41:25Speaker 03

  Okay. Yeah, I guess that's it.

• 41:26Josh Clark?

  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, to an extent

• 41:41Josh Clark?

  because you, just because you called for help to help your friend and the cops ended up showing up to you.

• 41:47Speaker 03

  Yeah. And I didn't look this up, but can't you just buy Narcan?

• 41:51Josh Clark?

  Yeah, it's getting much more widely available.

• 41:54Speaker 03

  Okay.

• 41:55Josh Clark?

  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, but 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 mouth or in the nose. 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, their chest 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 they don't respond, then it's, it's your, you need to call 911 and/or administer naloxone.

• 42:40Speaker 03

  Yeah, I mean, in the brainstem, 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. Like, it's that simple.

• 43:03Josh Clark?

  Yeah, and it's even worse than that, actually, because there's also opioid 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 repressed, and this thing that detects, rises in CO2 in your body, that gets repressed as well, right?

• 43:31Speaker 03

  Uh, yeah, so basically, if you, if you want to take that deep breath, if you've, since like, you're in trouble, like, oh, man, I gotta get a big breath of air here, you just do that normally. But, uh, little, um, small increases in CO2 or synched, and the carotid body, it's a little small cluster of cells in the neck, they're gonna spur that increase in breathing to remove that excess CO2. But if, if that's not working, and that emergency, um, sort of failsafe is switched off, then, again, you, you can't even get that big breath to save yourself.

• 44:03Josh Clark?

  Yeah, so breathing, I think you said early on that, that typically, um, is where fatal overdoses derive from, is 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, say you've been drinking as well, um, you're not going to choke that stuff out, or spit it out, or like, 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.

• 44:43Speaker 03

  I was waiting to see if you were gonna come up with like, a fourth way to save puking.

• 44:47Josh Clark?

  How, what, did I say a bunch of different ways?

• 44:50Speaker 03

  You said like, three. You like, spit it up, or, or vomit it up, or choke, or...

• 44:53Josh Clark?

  Yak it up?

• 44:55Speaker 03

  I was like, we get it.

• 44:56Josh Clark?

  Blow chunks of it up?

• 44:58Speaker 03

  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 MAT. That's kind of the gold standard. We're talking about either methadone or how do you say that?

• 45:12Josh Clark?

  Buprenorphine.

• 45:14Speaker 03

  Buprenorphine. If you get methadone, it's going to be done in a clinic. It's not 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, Suboxone. And I think you can, you can get that prescribed. But a lot of people are like, hey, 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.

• 45:49Josh Clark?

  Right. 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.

• 46:05Speaker 03

  Yeah.

• 46:06Josh Clark?

  Which is pretty rich considering that American physicians, a significant chunk of them, got America hooked on opioids in the first place, but that's neither here nor there right now. So I think there was a study from 2022 that the CDC conducted where they said that of the 3.7% of all adults in the United States who need medication assisted treatment, I think only about 25% of that 3.7% were able to get it.

• 46:36Speaker 03

  Yeah.

• 46:37Josh Clark?

  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.

• 46:44Speaker 03

  Yeah, that's no way to, that's no way to kick.

• 46:47Josh Clark?

  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 2020. But your tolerance has dropped and so your, your likelihood of an overdose is through the roof compared to what it was before you kicked heroin the hard way or fentanyl the hard way.

• 47:17Speaker 03

  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 trace amounts can overdose you. Apparently, that came from a 2016 USDA advisory that claimed that was possible. But this is sort of annoying because it's not 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.

• 47:55Josh Clark?

  Mm-hmm.

• 47:56Speaker 03

  Or inhaling enough to overdose you is like, there's no way you would accidentally inhale enough to overdose.

• 48:04Josh Clark?

  Right, but there's cases of like first responders and paramedics suffering from exposure to very small amounts of fentanyl. And people are like, what the heck's going on? The best explanation is that it's what's called a culture-bound syndrome. This expectation that it can happen, it leads to a nocebo effect where the person essentially freaks themselves out into a panic attack. And it's, they're like, I just had, I just OD'd on fentanyl just from touching a little bit of it.

• 48:37Speaker 03

  Yeah.

• 48:38Josh Clark?

  That's the best explanation. It makes sense. The point is, is like interacting with somebody who's OD'd on fentanyl isn't going to give you a fentanyl higher overdose.

• 48:48Speaker 03

  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 on the streets, it's all because of fentanyl. They're out, they're homeless now, they're in your neighborhoods, and it's because of this epidemic. I'm sure that has happened, where people, you know, can't pay their rent and they're on the street because of an addiction like that. Sometimes people turn to drugs after the fact, if they are unhoused. 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 even.

• 49:33Speaker 03

  All those things are a factor, not saying they don't count, but it's the cost of housing.

• 49:37Josh Clark?

  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 in 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.

• 49:58Speaker 03

  Yeah.

• 49:59Josh Clark?

  And you associate it with a 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.

• 50:09Speaker 03

  Yeah, the drug that was okayed by the FDA and that, you know, wealthy pharmaceutical families in this country got rich off of.

• 50:16Josh Clark?

  Yeah, well, let's just say again, fentanyl is perfectly safe in like a medical setting in the hands of a trained professional. It's just outside of that. When cartels become involved, then it's, it becomes a huge problem. But I said at the outset, there is a silver lining or at least some hope because the uses, well, first of all, opioid deaths are declining. I think they peaked in 2022 with 108,000 opioid overdose deaths in the United States. And the numbers aren't in for 2024, but they think the estimate is that it's going to be anywhere between a 15 to a 20%

• 50:55Josh Clark?

  drop in overdose deaths from fentanyl. And they say, okay, well Chuck, why, why, why are these fentanyl deaths finally subsiding? What's the deal?

• 51:07Speaker 03

  Yeah, I mean, there could be, 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,

• 51:22Speaker 03

  that MAT treatment has made a big difference. One reason is because drug users have gotten 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.

• 51:45Josh Clark?

  Yeah. Um, there was, yeah, you were saying that like, uh, younger generations might have been scared away from it.

• 51:54Speaker 03

  Yeah, that's another reason.

• 51:55Josh Clark?

  Yeah, apparently, I thought you said that. So apparently Gen Z is unlikely or less likely to use drugs. I think like 67% of 12th graders said that they abstained from drugs, meaning that they hadn't taken any drugs in the last 30 days. And I was like, I wonder what that is compared to Gen X back in when we were in high school.

• 52:17Speaker 03

  Oh, my God.

• 52:17Josh Clark?

  And I was like, this is gonna, this is gonna be crazy. It is crazy, but it's the opposite way you would think. The, the, I think, I can't remember what, what US agency conducts this every year. But in 1993, um, high school seniors said that 81.7% said that they had abstained from drugs in the last 30 days. So Gen Z is on way more drugs than Gen X was, which is very surprising to me.

• 52:42Speaker 03

  Or Gen X is a generation of liars.

• 52:46Josh Clark?

  That's entirely possible too. Are you a narc man?

• 52:50Speaker 03

  Yeah, I don't know. I mean, I was a good boy growing up, but, uh, I certainly, I feel like all my friends were doing all the drugs.

• 52:56Josh Clark?

  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 who did drugs in high school.

• 53:09Speaker 03

  Well, I mean, there's definitely, uh, improved international cooperation between the United States and other countries. Uh, just to reduce the supply, the, uh, US and Mexico has gotten together and they've been working together, um, for a while now. Trying to intercept those drug shipments and trying to, you know, mess up the cartel and what their activities, uh, what the cartel is doing. Um, I think in 2024 last year, the amount of fentanyl crossing that border dropped by about 20%, so that's pretty good.

• 53:40Josh Clark?

  Yeah. I mean, that's pretty significant. What else?

• 53:43Speaker 03

  I got nothing else.

• 53:45Josh Clark?

  Well, I guess we should probably say before we, uh, end the episode, Chuck, if, if you, um, do fentanyl and you're addicted to fentanyl, please seek as, whatever help you can find to, to get off of it. And if you haven't tried it yet, probably you shouldn't start.

• 54:01Speaker 03

  Yeah, I'd say not even probably, let's say definitely not.

• 54:03Josh Clark?

  Okay. Uh, well, since Chuck corrected me from probably to definitely, as was foretold in 2008, he has just triggered listener mail.

• 54:15Speaker 03

  All right, this is another two-parter on 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, in horror movies, in disaster movies routinely? And that's just such a well-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 the film, but often for a noble cause. I guess that makes it more palatable? LOL?

• 55:00Speaker 03

  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 that black people will rarely lead or survive to the end of those movies, as well as other genre movies like horror or rom-com in mainstream Hollywood. Does it 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 socioeconomics 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 know who will survive and who will hook up. And we just want to enjoy the show.

• 55:43Speaker 03

  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.

• 55:53Josh Clark?

  Awesome. Thanks, Kevin and Serena. That reminds me of a point I wanted to make that I didn't have a chance to. In Earthquake, Richard Roundtree, aka Shaft, he was in that. He made it to the end. And he was also one of the heroes, helping save Genevieve Bujold. Am I saying her name correctly?

• 56:13Speaker 03

  I don't know. But I know that Richard Roundtree is almost always the hero.

• 56:17Josh Clark?

  Yeah. So, yeah, he was like a motorcycle stuntman. So, he was sadly an exception, but he definitely did make it to the end, which was great.

• 56:26Speaker 03

  Yeah. Nice work.

• 56:28Josh Clark?

  Nice work, Richard Roundtree. 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 to [email protected].

• 56:40Speaker 00

  Stuff You Should Know is a production of iHeartRadio. For more podcasts, iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 56:56Josh Clark?

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