1 00:00:00,080 --> 00:00:07,240 Speaker 1: M Hi. I'm Ethan Natalman and this is Psychoactive, a 2 00:00:07,320 --> 00:00:11,520 Speaker 1: production of I Heart Radio and Protozoa Pictures. Psychoactive is 3 00:00:11,560 --> 00:00:14,720 Speaker 1: the show where we talk about all things drugs. But 4 00:00:14,840 --> 00:00:18,760 Speaker 1: any views expressed here do not represent those of iHeart Media, 5 00:00:18,920 --> 00:00:23,680 Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, as an 6 00:00:23,680 --> 00:00:26,840 Speaker 1: inveterate contrarian, I can tell you they may not even 7 00:00:26,920 --> 00:00:31,120 Speaker 1: represent my own. And nothing contained in this show should 8 00:00:31,120 --> 00:00:34,040 Speaker 1: be used as medical advice or encouragement to use any 9 00:00:34,080 --> 00:00:43,760 Speaker 1: type of drug. You know. On this show, we talk 10 00:00:43,920 --> 00:00:47,200 Speaker 1: about the wonders of drugs, and we can also talk 11 00:00:47,400 --> 00:00:51,040 Speaker 1: about the horrors of drugs, because so much of this 12 00:00:51,200 --> 00:00:53,600 Speaker 1: is about the nature of our relationship with drugs, both 13 00:00:53,600 --> 00:00:58,240 Speaker 1: as an individual um and as communities and societies. Today, 14 00:00:58,440 --> 00:01:02,720 Speaker 1: we're gonna talk about one of the most devastating aspects 15 00:01:02,880 --> 00:01:07,480 Speaker 1: of drug use, which is the overdose epidemic, the overdose crisis, 16 00:01:07,520 --> 00:01:12,080 Speaker 1: the number of people dying from overdose. A few weeks ago, 17 00:01:12,760 --> 00:01:15,600 Speaker 1: the US Center for Disease Control came out with its 18 00:01:15,680 --> 00:01:19,640 Speaker 1: latest report, and it said that last year in over 19 00:01:19,800 --> 00:01:25,360 Speaker 1: ninety three thousand Americans died of an overdose. That was 20 00:01:25,400 --> 00:01:29,000 Speaker 1: an increase of almost thirty percent from the previous year. 21 00:01:29,640 --> 00:01:33,800 Speaker 1: This is a national problem where the overdoses went up 22 00:01:33,800 --> 00:01:37,360 Speaker 1: in forty eight of the fifty states in the United States. 23 00:01:37,920 --> 00:01:41,840 Speaker 1: If you think about how much is being lost if 24 00:01:41,880 --> 00:01:46,080 Speaker 1: we compare it to COVID, those nine three thousand deaths 25 00:01:46,160 --> 00:01:48,960 Speaker 1: were about a quarter of the three and seventy five 26 00:01:49,000 --> 00:01:52,720 Speaker 1: thousand people who died from COVID. But if you look 27 00:01:52,760 --> 00:01:55,840 Speaker 1: at the number of years of life lost, because so 28 00:01:55,920 --> 00:01:58,680 Speaker 1: many people who die from COVID are oftentimes quite elderly, 29 00:01:59,040 --> 00:02:02,000 Speaker 1: where so many people to die of overdose are whole 30 00:02:02,040 --> 00:02:05,320 Speaker 1: spectrum of ages from their teens into their fifties or sixties. 31 00:02:05,920 --> 00:02:09,560 Speaker 1: When you look at it from that perspective, COVID resulted 32 00:02:09,560 --> 00:02:11,920 Speaker 1: in five and a half million years of life lost, 33 00:02:12,200 --> 00:02:14,720 Speaker 1: but with overdoses it was three and a half million 34 00:02:14,800 --> 00:02:18,320 Speaker 1: years of life lost. I mean that's like six So 35 00:02:18,400 --> 00:02:21,880 Speaker 1: it's really a truly devastating problem. Now, in the New 36 00:02:21,960 --> 00:02:27,560 Speaker 1: York Times, the headline was a quote from an expert, 37 00:02:28,000 --> 00:02:33,680 Speaker 1: and it quotes said, it's huge, it's historic, it's unheard 38 00:02:33,680 --> 00:02:36,320 Speaker 1: of and on precedented. In a complete shame. You don't 39 00:02:36,320 --> 00:02:37,760 Speaker 1: see that in New York Times very often. That a 40 00:02:37,800 --> 00:02:39,760 Speaker 1: quote lands up being the headline of a major article. 41 00:02:40,240 --> 00:02:43,000 Speaker 1: The author of that quote is our guest today, and 42 00:02:43,040 --> 00:02:49,680 Speaker 1: that's Dan Chickerni, who's talking to me from Truckee, California, 43 00:02:50,000 --> 00:02:53,920 Speaker 1: out near Taho. Dan is um one of the world's 44 00:02:54,000 --> 00:02:56,600 Speaker 1: leading experts in this issue. He's a New Yorker who's 45 00:02:56,600 --> 00:03:00,280 Speaker 1: been in California for many decades now. He's a professor 46 00:03:00,440 --> 00:03:03,560 Speaker 1: and a doctor, a professor of Family and Community medicine 47 00:03:03,560 --> 00:03:07,359 Speaker 1: at the University of California, San Francisco. He's been studying 48 00:03:07,440 --> 00:03:10,080 Speaker 1: drug issues as it relates first to HIV A S 49 00:03:10,200 --> 00:03:13,639 Speaker 1: and now as it relates to overdose. He has one 50 00:03:13,639 --> 00:03:16,400 Speaker 1: of the biggest and most substantial grants from the federal 51 00:03:16,440 --> 00:03:20,720 Speaker 1: government to study this issue about heroin, marcus, invential markets 52 00:03:20,760 --> 00:03:23,360 Speaker 1: and all this sort of thing. I've known Dan for 53 00:03:23,400 --> 00:03:25,200 Speaker 1: a little bit for about twenty years, but I heard 54 00:03:25,240 --> 00:03:27,480 Speaker 1: him give a talk at International harmyshi and Comference a 55 00:03:27,480 --> 00:03:29,359 Speaker 1: few years ago, which is the best talk I ever 56 00:03:29,400 --> 00:03:32,040 Speaker 1: heard given on this subject. So he really is my 57 00:03:32,160 --> 00:03:34,520 Speaker 1: go to guy to talk about this. So Dan, thank 58 00:03:34,560 --> 00:03:37,560 Speaker 1: you so much for joining me today. I really appreciate 59 00:03:37,600 --> 00:03:40,520 Speaker 1: your taking the time and your expertise that it's a 60 00:03:40,520 --> 00:03:43,200 Speaker 1: pleasure to be here, and thank you for the kind introduction. 61 00:03:43,240 --> 00:03:46,480 Speaker 1: But your introduction to this crisis was excellent, so thank 62 00:03:46,520 --> 00:03:48,480 Speaker 1: you for that. Well, look, let me just start off 63 00:03:48,520 --> 00:03:51,640 Speaker 1: with a broad question, which is, what the hell is 64 00:03:51,680 --> 00:03:54,600 Speaker 1: going on here? I mean, it just keeps going up 65 00:03:54,600 --> 00:03:58,720 Speaker 1: and up. It's a devastating problem. We'll get into nitty gritty, 66 00:03:58,760 --> 00:04:01,560 Speaker 1: but what's your kind of bird's eye view of what's 67 00:04:01,600 --> 00:04:04,040 Speaker 1: going on in America? It is, well, as I told 68 00:04:04,040 --> 00:04:06,760 Speaker 1: the New York Times, this is a historic crisis. This 69 00:04:06,880 --> 00:04:10,320 Speaker 1: is a crisis that's unprecedented. Um, if you look back 70 00:04:10,880 --> 00:04:15,520 Speaker 1: almost forty years at mortality data due to illicit drugs, 71 00:04:15,920 --> 00:04:20,280 Speaker 1: we see a log rhythmic upward trend. That's a trend 72 00:04:20,320 --> 00:04:26,360 Speaker 1: that you would have to deliberately try to make that outrageous. 73 00:04:26,560 --> 00:04:30,240 Speaker 1: So why is it that we have exponentially increasing drug 74 00:04:30,320 --> 00:04:34,279 Speaker 1: overdose trend or log rhythmically increasing drug overdose trend for 75 00:04:34,320 --> 00:04:38,320 Speaker 1: the past thirty eight years? And the reason is that, um, 76 00:04:38,360 --> 00:04:42,240 Speaker 1: the drugs are getting more powerful, more potent, more available. 77 00:04:42,800 --> 00:04:46,680 Speaker 1: Despite our best efforts, they have become more deadly. Well, 78 00:04:46,720 --> 00:04:50,200 Speaker 1: you know, the standard history that's typically out there now 79 00:04:50,320 --> 00:04:53,400 Speaker 1: right is that these overdose who started growing in substantial 80 00:04:53,520 --> 00:04:56,640 Speaker 1: numbers back around the beginning of the century, so twenty 81 00:04:57,000 --> 00:05:00,120 Speaker 1: years ago. And I remember even the late nineties. I 82 00:05:00,160 --> 00:05:02,039 Speaker 1: was aware of this issue when I was running what 83 00:05:02,120 --> 00:05:04,719 Speaker 1: was then the Lindismith Center then Drug Policy Alliance, and 84 00:05:04,720 --> 00:05:07,120 Speaker 1: we organized the first international conference I'm Preventing over those 85 00:05:07,120 --> 00:05:10,000 Speaker 1: fatalities in January two thousand and We did it in 86 00:05:10,080 --> 00:05:13,320 Speaker 1: Seattle because that part of the Northwest was already seeing 87 00:05:13,400 --> 00:05:15,760 Speaker 1: kind of the early years of this stuff. But the 88 00:05:15,839 --> 00:05:19,640 Speaker 1: standard history that's happened since then is Phase one. The 89 00:05:19,720 --> 00:05:24,279 Speaker 1: first decade is about prescription opioids, oxy content, per Due 90 00:05:24,279 --> 00:05:27,120 Speaker 1: Farm and all the other manufacturers and distributors sort of 91 00:05:27,120 --> 00:05:30,320 Speaker 1: putting this stuff out overly aggressively. You know, you know 92 00:05:30,360 --> 00:05:32,120 Speaker 1: it's supposed to be be for serious pain. In the 93 00:05:32,200 --> 00:05:35,679 Speaker 1: marketing for chronic pain, it's getting diverted. Black markets cracked 94 00:05:35,680 --> 00:05:38,760 Speaker 1: out on that, and then you see the emergence of heroin. 95 00:05:38,960 --> 00:05:42,599 Speaker 1: People turning to heroin and heroin markets emerging. And then 96 00:05:42,880 --> 00:05:45,000 Speaker 1: I don't know if the crackdown on that was that effective, 97 00:05:45,080 --> 00:05:50,159 Speaker 1: but then Fentinel, the very powerful synthetic opioid, enters the market, 98 00:05:50,520 --> 00:05:54,359 Speaker 1: and then Phase four in some respects um is COVID, 99 00:05:54,760 --> 00:05:57,400 Speaker 1: which sort of kicks things up a whole another level. 100 00:05:58,000 --> 00:06:01,680 Speaker 1: So is that from your perspective, the basic frame for 101 00:06:01,800 --> 00:06:04,200 Speaker 1: looking at this historically as twenty years or how would 102 00:06:04,240 --> 00:06:07,600 Speaker 1: you nuance that to help our listeners understand this. Yeah, 103 00:06:07,640 --> 00:06:09,800 Speaker 1: So I coined the term a triple wave of epidemic, 104 00:06:09,839 --> 00:06:13,360 Speaker 1: and so there's three ways of mortality due to the 105 00:06:13,480 --> 00:06:18,120 Speaker 1: latest opioid related phenomenon. So first wave is opioid pills. 106 00:06:18,480 --> 00:06:22,680 Speaker 1: We wouldn't have been concerned about excessive prescribing practices or 107 00:06:22,720 --> 00:06:29,760 Speaker 1: excessive supply and the detailing, the manufacturing, the distributing of excessive, 108 00:06:30,120 --> 00:06:33,919 Speaker 1: huge numbers of opioid pills if it wasn't for the 109 00:06:33,960 --> 00:06:37,359 Speaker 1: fact that we saw a mortality curve increase along with 110 00:06:37,480 --> 00:06:39,919 Speaker 1: that supply. And we can talk about what the drivers 111 00:06:39,920 --> 00:06:43,160 Speaker 1: of that first wave were, but um, I will stand 112 00:06:43,200 --> 00:06:47,680 Speaker 1: by the statement that as we started to curtail that supplies, 113 00:06:47,760 --> 00:06:51,080 Speaker 1: we said, oh wow, opioid pill overdoses are going up, 114 00:06:51,160 --> 00:06:54,440 Speaker 1: deaths are going up. There's a problem. As we started 115 00:06:54,480 --> 00:06:58,080 Speaker 1: to curtail that and as we started apply downward pressure 116 00:06:58,120 --> 00:07:01,880 Speaker 1: on that supply, whether it's telling doctors to curb their 117 00:07:01,920 --> 00:07:05,640 Speaker 1: prescribing practices, whether it was through lawsuits that curtailed the 118 00:07:05,680 --> 00:07:08,800 Speaker 1: manufacturers and distributors that you know, they're still going on now. 119 00:07:09,080 --> 00:07:12,600 Speaker 1: As we saw that supply get constrained, we started seeing 120 00:07:12,720 --> 00:07:16,160 Speaker 1: heroin being picked up, and we started seeing an overdose 121 00:07:16,240 --> 00:07:19,520 Speaker 1: curve due to heroin UM. That would have been an 122 00:07:19,520 --> 00:07:22,960 Speaker 1: epidemic in and of itself if it wasn't for the 123 00:07:23,000 --> 00:07:28,480 Speaker 1: fact that in hot and synthetic opioids, including fentyyl and 124 00:07:28,880 --> 00:07:34,480 Speaker 1: hundreds of fentyel analogs UH started flooding the American streets 125 00:07:34,760 --> 00:07:37,920 Speaker 1: and people who were using heroin maybe depending on heroin, 126 00:07:38,320 --> 00:07:44,240 Speaker 1: started experiencing a fentyyl adulterated heroin and that increased the 127 00:07:44,280 --> 00:07:47,600 Speaker 1: mortality risk tremendously. So that's we've three of the crisis, 128 00:07:48,360 --> 00:07:51,480 Speaker 1: and that is still going on now. That started the 129 00:07:51,520 --> 00:07:55,240 Speaker 1: East coast, it's now hit the West coast as UM 130 00:07:55,360 --> 00:08:00,120 Speaker 1: and the mortality of old drugs overall is being driven 131 00:08:00,000 --> 00:08:04,680 Speaker 1: a synthetic opioids, including fentanyl and the analogs. So, Dan, 132 00:08:05,160 --> 00:08:07,800 Speaker 1: you look at the latest report and it's to some 133 00:08:07,880 --> 00:08:13,560 Speaker 1: extent fentinyl fentinyl fentinyl. What is fentinyl and why is 134 00:08:13,600 --> 00:08:16,360 Speaker 1: it playing such a massive role in killing people? So 135 00:08:16,520 --> 00:08:19,880 Speaker 1: fentanyl is a synthetic opioid. In order to understand that, 136 00:08:19,920 --> 00:08:22,840 Speaker 1: we need to know that opioids come in three forms. 137 00:08:23,000 --> 00:08:26,600 Speaker 1: Is natural opioids that come straight out of opium, which 138 00:08:26,640 --> 00:08:29,240 Speaker 1: is the extract from the poppy plant, that would include 139 00:08:29,280 --> 00:08:32,640 Speaker 1: morphine and coding. Then we have the semisynthetics, where you 140 00:08:33,120 --> 00:08:36,000 Speaker 1: change one part of morphine or one part of coding 141 00:08:36,040 --> 00:08:41,080 Speaker 1: to produce a medicine like hydrocodum um. And then you 142 00:08:41,120 --> 00:08:44,040 Speaker 1: have synthetics, which are fully they have nothing to do 143 00:08:44,080 --> 00:08:46,080 Speaker 1: with poppy plant, they have nothing to do with opium, 144 00:08:46,360 --> 00:08:49,920 Speaker 1: and they are manufactured in the lab Methodone is an 145 00:08:49,920 --> 00:08:53,400 Speaker 1: example of a synthetic opioid, as is fentyl and the 146 00:08:53,720 --> 00:09:00,240 Speaker 1: six D plus fentinyl analogs. So fentinyls is potent synthetic opioid. 147 00:09:00,559 --> 00:09:04,240 Speaker 1: It is forty times as strong as heroin by weight. 148 00:09:04,559 --> 00:09:07,760 Speaker 1: It's a hundred times as strong as morphine by weight. 149 00:09:08,280 --> 00:09:10,640 Speaker 1: It comes in a variety of chemical cousins, we call 150 00:09:10,720 --> 00:09:13,960 Speaker 1: them analogs, some of which are a couple of times 151 00:09:14,000 --> 00:09:17,440 Speaker 1: more potent than heroin, some of which reach almost a 152 00:09:17,559 --> 00:09:20,520 Speaker 1: thousand times as strong as heroin. That would be car 153 00:09:20,559 --> 00:09:24,240 Speaker 1: fentanyl and and the other n I l fentanyls. And 154 00:09:24,280 --> 00:09:26,559 Speaker 1: so when we saw that you jump in Ohio or 155 00:09:26,600 --> 00:09:29,480 Speaker 1: people dropping like flies, that was because car fentinel all 156 00:09:29,480 --> 00:09:31,160 Speaker 1: of a sudden hit the streets in a way that 157 00:09:31,200 --> 00:09:33,320 Speaker 1: people didn't know how to deal with it. Right, car 158 00:09:33,360 --> 00:09:36,360 Speaker 1: Fentanyl should not be in the human drugs supply. It 159 00:09:36,520 --> 00:09:40,960 Speaker 1: is meant as a large animal think elephant uh and 160 00:09:41,160 --> 00:09:45,320 Speaker 1: analgesic uh. So instead of injecting an elephant with a 161 00:09:45,400 --> 00:09:48,319 Speaker 1: gallon or two of opioid to help them with their 162 00:09:48,360 --> 00:09:52,000 Speaker 1: broken leg, you inject them with a normal size uh syringe, 163 00:09:52,320 --> 00:09:55,840 Speaker 1: but with a very potent chemical to help them deal 164 00:09:55,880 --> 00:09:59,600 Speaker 1: with pain or surgical procedure something like that. So, I mean, Dan, 165 00:09:59,720 --> 00:10:04,600 Speaker 1: when ask why this dramatic jump jump in the last 166 00:10:04,679 --> 00:10:08,839 Speaker 1: year and over those fatalities as creating headlines, I mean, 167 00:10:08,920 --> 00:10:12,840 Speaker 1: apart from COVID, is this about people just not knowing 168 00:10:12,880 --> 00:10:15,000 Speaker 1: the potency of what they're getting, or not knowing that 169 00:10:15,160 --> 00:10:18,000 Speaker 1: drugs they're getting, or is about all sorts of things 170 00:10:18,000 --> 00:10:20,480 Speaker 1: getting mixed into the supply? I mean, what do we 171 00:10:20,520 --> 00:10:24,400 Speaker 1: know about why this dramatic jump? So we have to 172 00:10:24,480 --> 00:10:27,000 Speaker 1: understand it is a twenty year historic phenomenon, right, and 173 00:10:27,200 --> 00:10:32,280 Speaker 1: talking about deaths, those deaths are higher than UM the 174 00:10:32,360 --> 00:10:36,200 Speaker 1: number of deaths at the height of the crisis. UM. 175 00:10:36,480 --> 00:10:40,320 Speaker 1: It's surpassed the number of motor vehicle accidents as as 176 00:10:40,400 --> 00:10:45,560 Speaker 1: the number one cause of unintentional accidental injury. And we 177 00:10:45,600 --> 00:10:47,920 Speaker 1: need to understand that it's a the reason I use 178 00:10:48,000 --> 00:10:51,120 Speaker 1: the metaphor of a triple wave, that each wave has 179 00:10:51,160 --> 00:10:53,720 Speaker 1: a certain energy behind it. We had the first wave 180 00:10:53,760 --> 00:10:56,880 Speaker 1: of opioid pills. It increased on the size of the 181 00:10:56,920 --> 00:11:00,640 Speaker 1: population that uses opioids. Some of those folks got cut 182 00:11:00,679 --> 00:11:03,600 Speaker 1: off from their supply and moved on to heroin, and 183 00:11:03,600 --> 00:11:05,880 Speaker 1: we saw it. Even though it is a fraction of 184 00:11:05,880 --> 00:11:08,840 Speaker 1: the original size of the population, that population was huge. 185 00:11:09,720 --> 00:11:12,640 Speaker 1: And now we have a historic number of people who 186 00:11:12,640 --> 00:11:15,200 Speaker 1: are using heroine. Some estimates make it as high as 187 00:11:15,360 --> 00:11:18,000 Speaker 1: three million active heroin users in the United States. We've 188 00:11:18,080 --> 00:11:20,920 Speaker 1: never had anywhere close to that number. You usually the 189 00:11:21,400 --> 00:11:23,840 Speaker 1: number of the past was half a million or three 190 00:11:23,920 --> 00:11:27,000 Speaker 1: quarters of a million heroin users. So the population of 191 00:11:27,000 --> 00:11:31,240 Speaker 1: heroin users has gone up multiple fold. That alone would 192 00:11:31,240 --> 00:11:33,560 Speaker 1: have been historic crisis in and of itself. A historic 193 00:11:33,600 --> 00:11:38,240 Speaker 1: crisis of heroin use and heroin consequences now comes along 194 00:11:39,000 --> 00:11:43,440 Speaker 1: a potent opioid meant to replace heroin, meant to come 195 00:11:43,440 --> 00:11:46,400 Speaker 1: from an industrial supply as opposed to an agricultural supply 196 00:11:46,920 --> 00:11:50,760 Speaker 1: that's forty times as potent as heroin by weight. Right, 197 00:11:51,000 --> 00:11:54,640 Speaker 1: and the fens we overfocus sometimes on this idea of potents. 198 00:11:54,679 --> 00:11:58,559 Speaker 1: But it also comes in adulterating heroin. It's not being 199 00:11:58,600 --> 00:12:02,720 Speaker 1: sold as is. It comes in as a contaminant, comes 200 00:12:02,760 --> 00:12:05,920 Speaker 1: in as a poison, comes in as an adulterant of 201 00:12:05,960 --> 00:12:08,760 Speaker 1: the heroin supply in the East Coast. Users don't know 202 00:12:08,800 --> 00:12:12,680 Speaker 1: what hit them, and they start complaining the heroine is different, 203 00:12:12,679 --> 00:12:15,520 Speaker 1: it doesn't feel right, it's too strong. When was the 204 00:12:15,600 --> 00:12:18,360 Speaker 1: last time you heard a heroin user say, oh, the 205 00:12:18,440 --> 00:12:21,720 Speaker 1: ships too strong. So it came in as a tsunami. 206 00:12:21,800 --> 00:12:23,920 Speaker 1: So you have this triple wave of the third wave 207 00:12:23,960 --> 00:12:27,520 Speaker 1: of which is a tsunami that's bowling people over because 208 00:12:27,800 --> 00:12:31,480 Speaker 1: they're using it unbeknownst to them. They think they're using heroin, 209 00:12:31,480 --> 00:12:33,440 Speaker 1: but they're getting something else. And then to add to 210 00:12:33,520 --> 00:12:38,000 Speaker 1: that that fentel comes in all these different analogs chemical cousins, 211 00:12:38,040 --> 00:12:41,760 Speaker 1: if you will. That undulation and potent, say also asks 212 00:12:41,880 --> 00:12:46,840 Speaker 1: adds hugely to the risk because what causes overdose, amount 213 00:12:46,880 --> 00:12:49,640 Speaker 1: of opioid over your tolerance, and so you're messing with 214 00:12:49,679 --> 00:12:53,440 Speaker 1: people's tolerance by undulating the supply. So it's all those 215 00:12:53,480 --> 00:12:56,720 Speaker 1: forces that have led to three maybe even more than 216 00:12:57,240 --> 00:13:02,920 Speaker 1: because that's an under account death last year. Add on COVID, 217 00:13:03,120 --> 00:13:05,920 Speaker 1: add on the fact that our interventions have not been 218 00:13:06,440 --> 00:13:10,240 Speaker 1: powerful enough, potent enough to meet this historic foe, and 219 00:13:10,280 --> 00:13:12,920 Speaker 1: then we have a historic crisis. You know, I came 220 00:13:12,920 --> 00:13:14,720 Speaker 1: across I mean, let's just dig in a little further. 221 00:13:15,040 --> 00:13:17,640 Speaker 1: I came across the report recently, I think, put out 222 00:13:17,679 --> 00:13:21,480 Speaker 1: by the Rand Corporation, which has a drug policy analysis unit, 223 00:13:21,960 --> 00:13:25,800 Speaker 1: and there in their analysis they found that, you know, paradoxically, 224 00:13:26,400 --> 00:13:30,000 Speaker 1: when the pharmaceutical companies, under pressure from the government everybody else, 225 00:13:30,040 --> 00:13:33,480 Speaker 1: started to crack down and reformulate oxy content so it 226 00:13:33,520 --> 00:13:35,840 Speaker 1: was harder to kind of crush the pill and inject it, 227 00:13:36,120 --> 00:13:40,880 Speaker 1: the result was actually an increase in overdose fatalities. Yeah, 228 00:13:40,880 --> 00:13:44,600 Speaker 1: that's that's quite unfortunate. And I've actually produced a graphic 229 00:13:44,760 --> 00:13:48,680 Speaker 1: just using Google that as Google search terms for oxy 230 00:13:48,800 --> 00:13:51,760 Speaker 1: cotton went down, and they went down because they got 231 00:13:51,800 --> 00:13:56,040 Speaker 1: re formulated from the original crushable formula, which we called 232 00:13:56,280 --> 00:13:59,040 Speaker 1: CS to the op formula, which was non qrushable. You 233 00:13:59,080 --> 00:14:02,000 Speaker 1: see Google search is for heroin go up. It's just 234 00:14:02,080 --> 00:14:04,440 Speaker 1: beyond ironic. And so what we call this in drug 235 00:14:04,480 --> 00:14:08,679 Speaker 1: policy we call this the humble term of the balloon effect. Right, 236 00:14:08,679 --> 00:14:11,720 Speaker 1: And we try to squeeze supply on one end of 237 00:14:11,760 --> 00:14:15,120 Speaker 1: the balloon, it bubbles out in another part of the balloon. 238 00:14:15,400 --> 00:14:17,720 Speaker 1: And the important part of the balloon metaphor that I 239 00:14:17,800 --> 00:14:20,040 Speaker 1: like to remind people is not that the fact that 240 00:14:20,040 --> 00:14:22,560 Speaker 1: the other end of the balloon has gotten bigger. It's 241 00:14:22,600 --> 00:14:28,280 Speaker 1: gotten bigger, usually in an unpredictable direction. Think about when 242 00:14:28,280 --> 00:14:30,640 Speaker 1: you squeeze a balloon, you don't know where the rubbers 243 00:14:30,640 --> 00:14:32,320 Speaker 1: weakest on the other part of the balloon. It not 244 00:14:32,360 --> 00:14:35,120 Speaker 1: only bubbles out overall, but it might bubble out in 245 00:14:35,160 --> 00:14:38,200 Speaker 1: a funny direction. And that's exactly what we're seeing here. 246 00:14:38,200 --> 00:14:42,880 Speaker 1: We're seeing paradoxical effects of the war on drugs. So, now, Ethan, 247 00:14:42,920 --> 00:14:44,920 Speaker 1: you and I could really get into this, because this 248 00:14:44,960 --> 00:14:49,080 Speaker 1: starts to really explain why fentonel even came about in 249 00:14:49,120 --> 00:14:53,040 Speaker 1: the first place. Right, What is it about interdiction? What 250 00:14:53,160 --> 00:14:57,400 Speaker 1: is it about supply reduction that produces a thirty year 251 00:14:57,760 --> 00:15:03,960 Speaker 1: exponentially increasing curve in illicit drug mortality. Yeah, I remember 252 00:15:04,200 --> 00:15:07,120 Speaker 1: there was a moment with fentonel. I think there was 253 00:15:07,200 --> 00:15:10,360 Speaker 1: some lab in Mexico maybe fifteen twenty years ago that 254 00:15:10,480 --> 00:15:12,800 Speaker 1: was started supplying fentanyl and started to come into the 255 00:15:12,920 --> 00:15:15,240 Speaker 1: US or some overdose associated with it, and then in 256 00:15:15,560 --> 00:15:18,760 Speaker 1: a rare case of law enforcement being successful, the US 257 00:15:18,800 --> 00:15:21,400 Speaker 1: and Mexican authorities shut it down and the federal went away. 258 00:15:21,760 --> 00:15:25,520 Speaker 1: But now federals coming in from China, China directly, China 259 00:15:25,600 --> 00:15:28,880 Speaker 1: via Mexico, China via Canada. It's coming in small packages. 260 00:15:29,160 --> 00:15:32,000 Speaker 1: I mean, there essentially is no supply side solution to 261 00:15:32,040 --> 00:15:34,440 Speaker 1: this at this point. Right. A subtitle of one of 262 00:15:34,480 --> 00:15:36,840 Speaker 1: my papers UM a few years ago was the end 263 00:15:36,880 --> 00:15:41,000 Speaker 1: of introdiction. I think fentonyl proves that point. There's a 264 00:15:41,040 --> 00:15:43,200 Speaker 1: lot of us who have been kind of cynical about 265 00:15:43,240 --> 00:15:46,520 Speaker 1: supply side interventions and and whether there worth the money 266 00:15:46,600 --> 00:15:49,800 Speaker 1: or whether they're actually effective at all, um, and the 267 00:15:49,840 --> 00:15:52,360 Speaker 1: evidence is going against them. Do you think about it. 268 00:15:52,760 --> 00:15:55,560 Speaker 1: One of the main goals of introdiction is to stop 269 00:15:55,600 --> 00:15:59,680 Speaker 1: the flow of drugs sufficiently so that the price at 270 00:15:59,680 --> 00:16:03,200 Speaker 1: the end market user, the retail user, goes up. Well, 271 00:16:03,280 --> 00:16:06,920 Speaker 1: let's look at the data. Heroin for the last twenty 272 00:16:07,000 --> 00:16:11,400 Speaker 1: or so years has never been cheaper at the retail level. 273 00:16:11,600 --> 00:16:14,400 Speaker 1: So what does that say about interdiction Using their metric 274 00:16:14,840 --> 00:16:18,440 Speaker 1: of trying to curtail supply so that the price goes 275 00:16:18,520 --> 00:16:21,720 Speaker 1: up and purity goes down, they have failed. Because heroin, 276 00:16:21,720 --> 00:16:23,720 Speaker 1: if we if we use a standardized measure, which is 277 00:16:23,800 --> 00:16:27,960 Speaker 1: price per milligram pure keeps bouncing along at rock bottom 278 00:16:28,000 --> 00:16:31,040 Speaker 1: prices for the last decade or so. Now at the 279 00:16:31,080 --> 00:16:34,640 Speaker 1: same time, because of interdiction, there's been a honing effect, right, 280 00:16:34,640 --> 00:16:38,240 Speaker 1: And the honing effect is that there's exclusive markets of 281 00:16:38,320 --> 00:16:43,080 Speaker 1: heroin worldwide. So in North America, we have producers in 282 00:16:43,760 --> 00:16:48,000 Speaker 1: Colombia and in Mexico, and both of those bring heroin 283 00:16:48,280 --> 00:16:50,520 Speaker 1: only to the United States. That's what I mean by honing. 284 00:16:50,520 --> 00:16:54,440 Speaker 1: They're kind of exclusive supplier to wholesale to retail markets. 285 00:16:54,600 --> 00:16:56,440 Speaker 1: We used to have four suppliers in the United States. 286 00:16:56,480 --> 00:16:59,600 Speaker 1: We used to have Southeast Asia, Southwest Asia, and Colombia 287 00:16:59,640 --> 00:17:02,320 Speaker 1: and x Go. Now we only have two suppliers. And 288 00:17:02,360 --> 00:17:05,560 Speaker 1: guess what, the Colombian market just dried up. So now 289 00:17:05,600 --> 00:17:07,600 Speaker 1: the only way we get heroin in the United States 290 00:17:08,040 --> 00:17:12,840 Speaker 1: is from Mexican suppliers, Mexican CTOs, colinal trafficking organizations. So 291 00:17:13,200 --> 00:17:15,560 Speaker 1: the end game that the interdiction folks are hoping for 292 00:17:15,640 --> 00:17:17,320 Speaker 1: is that, well, now we just have one chest piece 293 00:17:17,440 --> 00:17:20,239 Speaker 1: and knock off the board. Left unfortunately made an end 294 00:17:20,280 --> 00:17:22,159 Speaker 1: run around that, and what is the end run. The 295 00:17:22,240 --> 00:17:26,560 Speaker 1: end run was fentinel adulterated heroin importing from a whole 296 00:17:26,600 --> 00:17:29,399 Speaker 1: new player. When you think of illicit drug producers in 297 00:17:29,400 --> 00:17:33,639 Speaker 1: the world, right, you just ask the general waties. They'll say, oh, Afghanistan, Pakistan, 298 00:17:33,760 --> 00:17:36,359 Speaker 1: there's like Colombia. They might say Mexico. No one's gonna 299 00:17:36,359 --> 00:17:39,800 Speaker 1: come up with China. Well, China is a balloon effect. 300 00:17:40,040 --> 00:17:43,160 Speaker 1: It's an invention in supply. So what we have now, 301 00:17:43,400 --> 00:17:46,520 Speaker 1: we have a whole new supply of powerful opiate. It's 302 00:17:46,600 --> 00:17:49,919 Speaker 1: immune to interdiction effects. There's no crops brain, there's no 303 00:17:50,160 --> 00:17:53,720 Speaker 1: large shipment that could be busted. It comes in smaller packages. 304 00:17:53,760 --> 00:17:55,560 Speaker 1: When I spoke to Congress a couple of years ago, 305 00:17:55,920 --> 00:18:00,200 Speaker 1: between my representatives and myself, there's a space between those 306 00:18:00,200 --> 00:18:03,840 Speaker 1: two desks, and I said, all the fentanyl that came 307 00:18:03,840 --> 00:18:09,480 Speaker 1: in could fit into twelve industrial oil barrels that could 308 00:18:09,480 --> 00:18:12,080 Speaker 1: all be seen right in front of us. Now, how 309 00:18:12,119 --> 00:18:16,120 Speaker 1: do you stop that flow across the Pacific Ocean from 310 00:18:16,160 --> 00:18:18,679 Speaker 1: a friendly training partners like China? The not on our 311 00:18:18,800 --> 00:18:21,440 Speaker 1: enemy list can go and invade them and and bring 312 00:18:21,480 --> 00:18:24,720 Speaker 1: military advisors there to stop the flow. So that is 313 00:18:24,760 --> 00:18:27,440 Speaker 1: what I call the end of interdiction. We've played the endgame, 314 00:18:27,600 --> 00:18:31,080 Speaker 1: and what we got was a super powerful and dangerous 315 00:18:31,440 --> 00:18:34,160 Speaker 1: drug on the American streets. Yeah, although you know, even 316 00:18:34,160 --> 00:18:36,800 Speaker 1: with heroin. I remember, I think was Senator moynihan who 317 00:18:36,880 --> 00:18:38,480 Speaker 1: kind of got smart about this at some point. He 318 00:18:38,560 --> 00:18:41,480 Speaker 1: pointed out, like all the cocaine being consumed in America 319 00:18:41,560 --> 00:18:43,880 Speaker 1: back twenty years ago could be in like a half 320 00:18:43,960 --> 00:18:46,359 Speaker 1: dozen or something shipping containers. I mean that there was 321 00:18:46,440 --> 00:18:49,160 Speaker 1: essentially no way to stop this. And people are realized 322 00:18:49,400 --> 00:18:52,000 Speaker 1: Mexico has been the source of at least a third 323 00:18:52,200 --> 00:18:55,440 Speaker 1: of the heroin consumed the United States for like seventy 324 00:18:55,600 --> 00:18:58,960 Speaker 1: eighty years. So which you say there is at Fentinel 325 00:18:59,280 --> 00:19:02,520 Speaker 1: just kind of pointed out the absurdity of the interdiction. 326 00:19:02,560 --> 00:19:07,160 Speaker 1: The supply side control strategy was always apparent, even though 327 00:19:07,160 --> 00:19:09,960 Speaker 1: the idiots and the Pentagon and law enforcement kept insisting 328 00:19:09,960 --> 00:19:13,160 Speaker 1: on it. Fedital just kind of made it the absurdity 329 00:19:13,480 --> 00:19:16,720 Speaker 1: totally clear. I mean, how many FedEx packages can you 330 00:19:16,800 --> 00:19:19,640 Speaker 1: stop coming in from, whether it's China directly or China 331 00:19:19,680 --> 00:19:25,280 Speaker 1: the in Mexico or what have you. We'll be talking 332 00:19:25,320 --> 00:19:41,639 Speaker 1: more after we hear this ad. Let me ask you 333 00:19:41,720 --> 00:19:44,119 Speaker 1: this question. And I know there's no really reliable to 334 00:19:44,160 --> 00:19:46,439 Speaker 1: answer this question. It's a it's an impossible question, but 335 00:19:46,480 --> 00:19:50,040 Speaker 1: I'll throw it at you, okay, which is imagine if 336 00:19:50,440 --> 00:19:54,240 Speaker 1: Produe Pharma, with its oxycontent and its competitors, that Johnson 337 00:19:54,240 --> 00:19:57,720 Speaker 1: and Johnson's and all the other firms had never started 338 00:19:58,000 --> 00:20:01,760 Speaker 1: over supplying opie it's pharmaceutical opioids twenty years ago, in 339 00:20:01,800 --> 00:20:06,080 Speaker 1: late nineties, early two thousand's right? Do you think we 340 00:20:06,119 --> 00:20:09,360 Speaker 1: still would have had this opioid epidemic? Wouldn't have happened anyway. 341 00:20:09,640 --> 00:20:12,920 Speaker 1: There's two ways to look at it. So the opioid crisis, 342 00:20:12,960 --> 00:20:15,440 Speaker 1: this trip away, a phenomena of pills, the heroin defense 343 00:20:15,480 --> 00:20:21,200 Speaker 1: and al that would not have happened. So supply does 344 00:20:21,359 --> 00:20:25,199 Speaker 1: lead to overuse. So I'm as a supply side thinker, 345 00:20:25,440 --> 00:20:27,120 Speaker 1: I can with two halves of my brains say on 346 00:20:27,119 --> 00:20:31,800 Speaker 1: one half says supply matters, right, supply actually does lead. 347 00:20:31,800 --> 00:20:34,720 Speaker 1: It's just pure economics. You bring in a cheaper good 348 00:20:35,200 --> 00:20:37,120 Speaker 1: and people are going to use it, right, And in fact, 349 00:20:37,320 --> 00:20:41,600 Speaker 1: that's one of the reasons why heroin and methomphetamine are 350 00:20:41,680 --> 00:20:44,639 Speaker 1: so cheap right now, is because we have free trade 351 00:20:44,640 --> 00:20:48,119 Speaker 1: agreements across the American borders NAFTA and KAFTA that not 352 00:20:48,160 --> 00:20:51,400 Speaker 1: only bring down the price of illicit goods, but they 353 00:20:51,440 --> 00:20:54,120 Speaker 1: also bring them the price of illicit goods. But it's 354 00:20:54,160 --> 00:20:57,600 Speaker 1: contrastraining supply that has been problematic. We have not been 355 00:20:57,600 --> 00:20:59,280 Speaker 1: able to do it. But let me get back to 356 00:20:59,359 --> 00:21:03,000 Speaker 1: your question, right, and that is if opioid pill supply 357 00:21:03,200 --> 00:21:05,800 Speaker 1: stayed at sort of normal levels. Now normal levels are 358 00:21:05,800 --> 00:21:08,040 Speaker 1: still high for American compared to other countries, but let's 359 00:21:08,040 --> 00:21:10,720 Speaker 1: just push that aside for a second, would we still 360 00:21:10,800 --> 00:21:17,399 Speaker 1: have had some kind of drug overuse problematic use cycle. 361 00:21:17,760 --> 00:21:20,240 Speaker 1: The answer is probably yes, right, and the reason is 362 00:21:20,400 --> 00:21:23,959 Speaker 1: because we have myasthmic drivers in America. So what does 363 00:21:24,000 --> 00:21:27,600 Speaker 1: my asthma? My asthma means that there's a syndrome of 364 00:21:27,720 --> 00:21:31,680 Speaker 1: issues that caused suffering and that leads to something that 365 00:21:31,720 --> 00:21:35,440 Speaker 1: public health is concerned with, you know, whether it's poverty 366 00:21:35,600 --> 00:21:41,280 Speaker 1: or social and economic inequities, disparities and access to health 367 00:21:41,320 --> 00:21:46,280 Speaker 1: care or in health care utilization. Right, America has these 368 00:21:46,320 --> 00:21:49,840 Speaker 1: false zones in which problematic drug use. Now we're not 369 00:21:49,880 --> 00:21:52,960 Speaker 1: talking about recreational drug use here, we're talking about problematic 370 00:21:53,000 --> 00:21:57,200 Speaker 1: drug use falls into the cracks off. And so what 371 00:21:57,280 --> 00:21:59,159 Speaker 1: issues do we have in America that that might be 372 00:21:59,200 --> 00:22:02,720 Speaker 1: creating these law scale cracks that might be fomenting problematic 373 00:22:02,760 --> 00:22:06,160 Speaker 1: drug use. Um, we could spend another hour on. Let's 374 00:22:06,200 --> 00:22:08,520 Speaker 1: just look at one issue in particular, and that is 375 00:22:08,560 --> 00:22:12,560 Speaker 1: the disenfranchisement of working class Americans. The whole idea of 376 00:22:12,760 --> 00:22:15,280 Speaker 1: you jobs going overseas, the whole idea of loss of 377 00:22:15,320 --> 00:22:18,639 Speaker 1: hope between a generation of a parents generation and the 378 00:22:18,720 --> 00:22:22,399 Speaker 1: kids generation. Um. And there have been some good economic 379 00:22:22,440 --> 00:22:27,440 Speaker 1: work showing that economic disenfranchisement of particularly you know, Midwest, 380 00:22:27,600 --> 00:22:29,480 Speaker 1: we think about sort of the this might be a 381 00:22:29,520 --> 00:22:32,159 Speaker 1: derogatory term, but for lack of a better term than 382 00:22:32,359 --> 00:22:35,560 Speaker 1: the so called rust belt where industry left left some 383 00:22:35,640 --> 00:22:41,360 Speaker 1: decaying disenfranchise communities. Well, guess where pills and heroin and 384 00:22:41,480 --> 00:22:44,119 Speaker 1: fencinel fell into. And I can say that if you 385 00:22:44,119 --> 00:22:46,439 Speaker 1: took the pills in, heroin and fentral away, that some 386 00:22:46,680 --> 00:22:50,760 Speaker 1: other miasma condition wouldn't have fallen in to those cracks. 387 00:22:51,200 --> 00:22:53,800 Speaker 1: And so I'm a balanced thinker. I think them both 388 00:22:53,800 --> 00:22:56,280 Speaker 1: supply side, but I also think in terms of demand side, 389 00:22:56,600 --> 00:22:59,160 Speaker 1: and if interdiction is an endgame, right, if we if 390 00:22:59,160 --> 00:23:03,360 Speaker 1: we've run a ground with our forty year war on drugs, 391 00:23:03,800 --> 00:23:06,320 Speaker 1: we need to pay attention to the demand side. We 392 00:23:06,359 --> 00:23:09,000 Speaker 1: need to pay attention to those false zones, to the 393 00:23:09,080 --> 00:23:12,679 Speaker 1: cracks in society. Need to make America more resilient, not 394 00:23:12,760 --> 00:23:15,440 Speaker 1: necessarily to drug use in general. We've we focus our 395 00:23:15,440 --> 00:23:18,359 Speaker 1: resiliency on that don't use drugs, don't use marijuana. Right, 396 00:23:18,640 --> 00:23:22,920 Speaker 1: What if we just focus on resiliency to problematic drug use, 397 00:23:23,000 --> 00:23:26,239 Speaker 1: to drug use that's used to solve, to soothe, for 398 00:23:26,280 --> 00:23:29,480 Speaker 1: people to self medicate with. Right, Let's bring it back 399 00:23:29,480 --> 00:23:31,600 Speaker 1: to a robust medical system. Let's bring it back to 400 00:23:31,600 --> 00:23:34,560 Speaker 1: a robust public health system. Let's work on fixing those 401 00:23:34,560 --> 00:23:38,560 Speaker 1: cracks in society and making any more just and equitable society. 402 00:23:38,840 --> 00:23:40,879 Speaker 1: M we know. I think also if you look at 403 00:23:40,880 --> 00:23:43,359 Speaker 1: the recent data of who's dying now, we so much 404 00:23:43,400 --> 00:23:46,959 Speaker 1: associate this with the kind of white middle lower middle class, 405 00:23:46,960 --> 00:23:50,360 Speaker 1: declining income group in these kind of Midwestern states. At 406 00:23:50,359 --> 00:23:52,800 Speaker 1: the same time, it's worth pointing out to other things, 407 00:23:52,960 --> 00:23:54,280 Speaker 1: you know, I mean I live on the upper west 408 00:23:54,280 --> 00:23:56,439 Speaker 1: side of New York and about a block for me, 409 00:23:56,480 --> 00:23:59,720 Speaker 1: on the very expensive apartments that lines the west side 410 00:23:59,760 --> 00:24:02,280 Speaker 1: of sand Hill Park, Central Park West, there is a 411 00:24:02,320 --> 00:24:06,920 Speaker 1: building there probably average department caused five, ten, fifteen million dollars, right, 412 00:24:07,200 --> 00:24:10,920 Speaker 1: very wealthy families. I know of at least four families 413 00:24:11,000 --> 00:24:14,040 Speaker 1: in that building who have lost a son to an 414 00:24:14,040 --> 00:24:16,840 Speaker 1: opioid overdose. So you can see it can hit the 415 00:24:16,920 --> 00:24:20,000 Speaker 1: kind of upper income folks as well in a way. 416 00:24:20,359 --> 00:24:22,119 Speaker 1: But at the same time, if you look at the 417 00:24:22,200 --> 00:24:24,640 Speaker 1: data that's coming out in the last year, I mean, 418 00:24:24,720 --> 00:24:27,320 Speaker 1: overdose has always been a problem among poor black and 419 00:24:27,400 --> 00:24:29,960 Speaker 1: Hispanic people in the cities and elsewhere. Remember New Mexico 420 00:24:30,040 --> 00:24:31,240 Speaker 1: used to have a big problem, but it's also in 421 00:24:31,280 --> 00:24:33,680 Speaker 1: the cities. But when you look at the data last year, 422 00:24:33,800 --> 00:24:37,119 Speaker 1: you see the most dramatic increases in over those fatalities 423 00:24:37,119 --> 00:24:40,600 Speaker 1: are happening among blacks and Hispanics. Just explain what's going 424 00:24:40,680 --> 00:24:45,000 Speaker 1: on there. Yeah, So let's start with the earlier phase 425 00:24:45,040 --> 00:24:48,080 Speaker 1: of the crisis, right, So, when it was pills, you know, 426 00:24:48,119 --> 00:24:52,800 Speaker 1: wave one of the Triple Waves that showed inequities in 427 00:24:52,920 --> 00:24:55,640 Speaker 1: access to medication. So so the fact that it hit 428 00:24:56,080 --> 00:24:59,920 Speaker 1: middle class, upper middle class, white more than it hit 429 00:25:00,200 --> 00:25:02,800 Speaker 1: brown and black folks in America shows that they had 430 00:25:02,840 --> 00:25:06,639 Speaker 1: greater access to pain medication. And that's is well substatiated 431 00:25:06,640 --> 00:25:09,919 Speaker 1: in the literature. There's that there's disparities in access to 432 00:25:09,960 --> 00:25:13,399 Speaker 1: pain medication as it moves towards and and and the 433 00:25:13,440 --> 00:25:16,320 Speaker 1: pain has been so widespread ethan, I mean, this is 434 00:25:16,560 --> 00:25:20,399 Speaker 1: this is why I use language like crisis. You know, 435 00:25:20,400 --> 00:25:22,359 Speaker 1: I'm not just calling this an epidemic, which you know, 436 00:25:22,400 --> 00:25:24,600 Speaker 1: the epidemiologist and me would say, hey, let's just call 437 00:25:24,600 --> 00:25:26,879 Speaker 1: it an epidemic, which is a rising curve of something, 438 00:25:26,960 --> 00:25:29,359 Speaker 1: in this case, a rising curve of death. But I 439 00:25:29,440 --> 00:25:32,439 Speaker 1: call it a crisis because we're out of control and 440 00:25:32,520 --> 00:25:35,919 Speaker 1: because we don't fully understand what tools we need to 441 00:25:35,960 --> 00:25:39,080 Speaker 1: apply to this. Right, we lack deep understanding and we 442 00:25:39,200 --> 00:25:43,240 Speaker 1: lack a strong sense of intervention. But let's talk about 443 00:25:43,280 --> 00:25:45,600 Speaker 1: the disparities that are happening now. Right, So, as we 444 00:25:45,680 --> 00:25:48,480 Speaker 1: moved towards Heroin, as we moved into the we we've 445 00:25:48,600 --> 00:25:52,080 Speaker 1: three the fentinel crisis we are seeing in the inner 446 00:25:52,080 --> 00:25:56,840 Speaker 1: city more rapidly increasing rates of death among black and 447 00:25:56,880 --> 00:26:00,760 Speaker 1: brown populations. What's going on there? Based on my ethnographic 448 00:26:00,760 --> 00:26:02,840 Speaker 1: work where I spend time in the inner cities, I've 449 00:26:02,840 --> 00:26:05,880 Speaker 1: been extensively to Baltimore. I've been to Chicago a few times. 450 00:26:05,920 --> 00:26:07,119 Speaker 1: I spent a lot of time, of course at my 451 00:26:07,160 --> 00:26:09,600 Speaker 1: hometown of San Francisco. I've been to New York a 452 00:26:09,640 --> 00:26:12,480 Speaker 1: few times. What's happening there is there was some resistance 453 00:26:12,720 --> 00:26:15,600 Speaker 1: to fencyl Right, if you're African American and you lived 454 00:26:15,600 --> 00:26:19,240 Speaker 1: in Baltimore, you knew how to get good heroin that 455 00:26:19,400 --> 00:26:23,480 Speaker 1: wasn't adulterated with fentanyl for a couple of years, and 456 00:26:23,520 --> 00:26:27,120 Speaker 1: then the gauntlet fully got dropped and you couldn't find 457 00:26:27,160 --> 00:26:31,080 Speaker 1: anything but defenconyl laced heroin. And so the African American 458 00:26:31,200 --> 00:26:33,880 Speaker 1: death rates going up now because they're u accustomed to it. 459 00:26:34,200 --> 00:26:36,320 Speaker 1: They didn't like it for a while. They have no 460 00:26:36,440 --> 00:26:40,040 Speaker 1: resilience to it. Um Now shift over to San Francisco. 461 00:26:40,160 --> 00:26:44,520 Speaker 1: San Francisco has just recently begun seeing fencyyl. It's being 462 00:26:44,560 --> 00:26:47,560 Speaker 1: sold as is. And I can't fully explain this ethan, 463 00:26:47,920 --> 00:26:53,080 Speaker 1: but our African American opioid related mortality rate is skyrocketing. 464 00:26:53,359 --> 00:26:55,800 Speaker 1: It's much worse than it is for whites. I don't 465 00:26:55,880 --> 00:26:58,359 Speaker 1: understand it. I don't understand in a in a free 466 00:26:58,720 --> 00:27:02,800 Speaker 1: flowing fentyyl market, why African Americans might be choosing the fenyel. 467 00:27:03,119 --> 00:27:05,359 Speaker 1: This all needs to be explored. COVID simply got in 468 00:27:05,359 --> 00:27:07,360 Speaker 1: the way. We weren't able to do research last year. 469 00:27:07,680 --> 00:27:09,520 Speaker 1: But this is what we need to do in San Francisco. 470 00:27:09,600 --> 00:27:11,639 Speaker 1: We need to find out why it is that the 471 00:27:11,680 --> 00:27:14,119 Speaker 1: opioid death rate among African Americans is so high in 472 00:27:14,119 --> 00:27:17,280 Speaker 1: San Francisco. Yeah, so, I mean, Dan we typically think 473 00:27:17,320 --> 00:27:20,280 Speaker 1: about the United States is one great, big national market, 474 00:27:20,600 --> 00:27:24,159 Speaker 1: but there are clearly substantial regional variations in terms of 475 00:27:24,240 --> 00:27:26,760 Speaker 1: overdose and even drugs. I mean, so, is the US 476 00:27:26,800 --> 00:27:29,399 Speaker 1: not really a national market? Is what California gets different 477 00:27:29,400 --> 00:27:31,800 Speaker 1: than what Louisiana gets, different than what Maine gets, different 478 00:27:31,800 --> 00:27:37,920 Speaker 1: from what Ohio gets. So the overdose due to fentonel 479 00:27:37,920 --> 00:27:41,520 Speaker 1: and other synthetic opioids went up far more dramatically in 480 00:27:41,560 --> 00:27:45,760 Speaker 1: the Midwest, Northeast, down to mid Atlantic, over to Appalachia 481 00:27:46,119 --> 00:27:48,800 Speaker 1: regions um far ahead of the rest of the country. 482 00:27:48,840 --> 00:27:51,680 Speaker 1: So they were of that area got hit in fourteen 483 00:27:51,720 --> 00:27:54,520 Speaker 1: so that's your our first indication that supply is different 484 00:27:54,520 --> 00:27:56,960 Speaker 1: than the supply of fentyyl. And this is again fentyel 485 00:27:56,960 --> 00:28:01,800 Speaker 1: adulterating heroin was different. And if you say the northeast 486 00:28:01,880 --> 00:28:04,919 Speaker 1: quadrant of the United States, then it's spilled over to 487 00:28:04,960 --> 00:28:07,520 Speaker 1: the south. And now it's spilling over to the west. 488 00:28:07,560 --> 00:28:11,240 Speaker 1: And why is it different, Well, where is it coming from? Well, 489 00:28:11,240 --> 00:28:14,000 Speaker 1: defending is coming from China, but it's being put into 490 00:28:14,000 --> 00:28:18,240 Speaker 1: the heroines through the Mexican criminal trafficking organizations. Right. Those 491 00:28:18,560 --> 00:28:22,640 Speaker 1: criminal trafficking organizations have been multiple, right, And the reason 492 00:28:22,680 --> 00:28:25,160 Speaker 1: why they're multiple is because some of the bigger ones 493 00:28:25,800 --> 00:28:30,239 Speaker 1: have been successfully toppled and that leads to fragmentation of them. 494 00:28:30,320 --> 00:28:33,320 Speaker 1: So now there's a bunch of little carteltos or or 495 00:28:33,960 --> 00:28:36,800 Speaker 1: smaller c t o s and they've just divided up America. 496 00:28:37,119 --> 00:28:39,479 Speaker 1: You know, Sinala has been sort of the big one. Uh, 497 00:28:39,520 --> 00:28:42,400 Speaker 1: it's still kind of fairly large and monolithic. But Sinelo 498 00:28:42,520 --> 00:28:44,520 Speaker 1: has been split up by the arrest and next tradition 499 00:28:44,680 --> 00:28:47,320 Speaker 1: of its leader was held in Chicago jail right now, 500 00:28:47,760 --> 00:28:51,239 Speaker 1: and um, the so lower cartel has become fragmented and 501 00:28:51,280 --> 00:28:55,120 Speaker 1: more creative and and splitting up the country and and 502 00:28:55,160 --> 00:28:58,520 Speaker 1: again my research has been curtailed. I'm not getting much 503 00:28:58,520 --> 00:29:00,160 Speaker 1: from the D A, from O, N, D C, be 504 00:29:00,320 --> 00:29:02,760 Speaker 1: from from height I mean, uh, to tell me, you 505 00:29:02,800 --> 00:29:05,400 Speaker 1: know why it is that fentinel's hitting the western half 506 00:29:05,440 --> 00:29:09,080 Speaker 1: the United States. But my suspicion is that it's less 507 00:29:09,320 --> 00:29:12,520 Speaker 1: cartel based. This seems to be more fentel being sold 508 00:29:12,560 --> 00:29:16,680 Speaker 1: as is um. I'm not sure that it's cartel based. 509 00:29:16,680 --> 00:29:19,640 Speaker 1: It might be entrepreneurial based. It might be local people 510 00:29:19,680 --> 00:29:22,600 Speaker 1: buying it directly from China and selling it. I I 511 00:29:22,680 --> 00:29:25,520 Speaker 1: really don't know. But there's a lot more mystery. And 512 00:29:25,600 --> 00:29:28,520 Speaker 1: so here we are five years into a fenil epidemic, 513 00:29:28,800 --> 00:29:31,400 Speaker 1: and there's still mystery. There's still things that need to 514 00:29:31,440 --> 00:29:34,080 Speaker 1: be explored. There's still things that we should have and 515 00:29:34,120 --> 00:29:36,680 Speaker 1: could have been on top of. But for some reason, 516 00:29:36,720 --> 00:29:41,080 Speaker 1: we lack sufficient curiosity, we lack sufficient understanding of drug 517 00:29:41,120 --> 00:29:44,120 Speaker 1: flows to really make a public health impact. And this 518 00:29:44,160 --> 00:29:45,560 Speaker 1: is one of the things that I'm pushing. Since I 519 00:29:45,600 --> 00:29:48,840 Speaker 1: am a supplied side thinker, I've been pushing anyone will 520 00:29:48,880 --> 00:29:51,560 Speaker 1: listen to me, D O J HIDA, D A C 521 00:29:51,760 --> 00:29:55,360 Speaker 1: d C to say, listen, this is a poisoning crisis. 522 00:29:55,520 --> 00:30:01,280 Speaker 1: Fentinel represents an unfeseen and historic foe. In order to 523 00:30:01,320 --> 00:30:04,440 Speaker 1: understand it better, we need to understand the supply of it. 524 00:30:04,800 --> 00:30:07,680 Speaker 1: So let's start sharing data. We could use it for 525 00:30:07,760 --> 00:30:11,640 Speaker 1: public health. It's called an epidemiology. We'd call it surveillance, right. 526 00:30:11,720 --> 00:30:14,280 Speaker 1: Don't you want to know where the poison comes from, 527 00:30:14,400 --> 00:30:17,360 Speaker 1: what products it's in, what its potency level is, what 528 00:30:17,400 --> 00:30:20,800 Speaker 1: its purity level is, And that's what information we lack 529 00:30:20,840 --> 00:30:23,440 Speaker 1: here on the West Coast. We're operating blindly in public health. 530 00:30:23,440 --> 00:30:25,640 Speaker 1: We're operating blindly in the e r S and we're 531 00:30:25,680 --> 00:30:28,680 Speaker 1: only counting the quote dead bodies as they lie, which 532 00:30:28,680 --> 00:30:32,479 Speaker 1: is a hundred and fifty years UM old process of 533 00:30:32,480 --> 00:30:35,239 Speaker 1: doing public health. We should use technology, We should use 534 00:30:35,320 --> 00:30:40,040 Speaker 1: modern surveillance, modern toxicology to understand supply better. By the way, 535 00:30:40,040 --> 00:30:42,040 Speaker 1: all those initials that Dan was reeling off O N 536 00:30:42,120 --> 00:30:45,240 Speaker 1: d CP refers to the Drugs RS Office Higher refers 537 00:30:45,280 --> 00:30:49,400 Speaker 1: to another federal drug enforcement collaboration. I think most people 538 00:30:49,480 --> 00:30:51,800 Speaker 1: know what d e A is, um but you left 539 00:30:51,800 --> 00:30:53,800 Speaker 1: out one of them, which is not a National student 540 00:30:53,840 --> 00:30:56,320 Speaker 1: on drug abuse, And uh, you know I one of 541 00:30:56,320 --> 00:30:59,320 Speaker 1: the people I talked to for Psychoactive. Is Nora Vocale 542 00:30:59,400 --> 00:31:01,280 Speaker 1: the head of it to National stud on Drug Abuse. 543 00:31:01,320 --> 00:31:03,640 Speaker 1: I think the interview with her will run after yours, 544 00:31:03,920 --> 00:31:06,160 Speaker 1: But I gave her a hard time about this. I mean, you, 545 00:31:06,240 --> 00:31:08,120 Speaker 1: thank god have one of the big grants to do 546 00:31:08,160 --> 00:31:10,920 Speaker 1: the ethnic, graphic and statistical and all the sort of 547 00:31:10,960 --> 00:31:13,240 Speaker 1: work that's necessary to dig into this. But there should 548 00:31:13,240 --> 00:31:15,760 Speaker 1: be a hundred people like you being funded, whereas there's 549 00:31:15,800 --> 00:31:17,800 Speaker 1: only five or ten. I believe you know. And I'm 550 00:31:17,840 --> 00:31:21,040 Speaker 1: asking the question like, who knows what retail drug sellers 551 00:31:21,120 --> 00:31:23,480 Speaker 1: know about what they're selling? How much do retail drug 552 00:31:23,480 --> 00:31:27,040 Speaker 1: sellers actually know about whether there's ventil in their drug, 553 00:31:27,080 --> 00:31:29,120 Speaker 1: what it's being cut with, or what about the people 554 00:31:29,160 --> 00:31:31,080 Speaker 1: one level up from them? What do we know about 555 00:31:31,080 --> 00:31:33,600 Speaker 1: where stuff is being mixed and where stuff is being cut? 556 00:31:33,760 --> 00:31:36,640 Speaker 1: And these are not impossible questions to answer. One could 557 00:31:36,640 --> 00:31:39,240 Speaker 1: be interviewing people who are behind bars for drugs selling 558 00:31:39,240 --> 00:31:41,680 Speaker 1: and offering them confidentiality and some money in order to 559 00:31:41,680 --> 00:31:44,200 Speaker 1: tell you what's going on. One could have that type 560 00:31:44,200 --> 00:31:51,280 Speaker 1: of research, but it's not happening. We'll be talking more 561 00:31:51,440 --> 00:32:08,720 Speaker 1: after we hear this ad. Until fentanyl came around, the 562 00:32:08,840 --> 00:32:12,000 Speaker 1: large majority of people who quote unquote overdosed. It wasn't 563 00:32:12,000 --> 00:32:14,240 Speaker 1: because they just took too much actual content or too 564 00:32:14,280 --> 00:32:16,840 Speaker 1: much heroin. You typically have to mix it with alcohol 565 00:32:17,200 --> 00:32:21,040 Speaker 1: or benzos or their tranquilizers. Fentanyl changes the game. But 566 00:32:21,160 --> 00:32:24,120 Speaker 1: before Fentonel, there was almost no effort on behalf of 567 00:32:24,280 --> 00:32:28,160 Speaker 1: either federal or state authorities to educate consumers of these 568 00:32:28,200 --> 00:32:31,200 Speaker 1: illicit drugs, don't mix drugs or if you do, know 569 00:32:31,320 --> 00:32:34,520 Speaker 1: the consequences. So, I mean there's an element of gross 570 00:32:34,640 --> 00:32:38,040 Speaker 1: policy failure and gross public education failure on the part 571 00:32:38,040 --> 00:32:39,920 Speaker 1: of the government when it comes to these sorts of things. 572 00:32:40,000 --> 00:32:42,240 Speaker 1: I actually call it a blind spot, right, and that 573 00:32:42,360 --> 00:32:45,400 Speaker 1: is we seem to like the tools that we have, 574 00:32:45,760 --> 00:32:48,320 Speaker 1: which is, if somebody winds up in the emergency room, 575 00:32:48,320 --> 00:32:51,800 Speaker 1: where somebody winds up in the morgue, we understand what 576 00:32:52,360 --> 00:32:55,520 Speaker 1: that body died from, right, We understand the chemistry of 577 00:32:55,600 --> 00:33:00,360 Speaker 1: that body. But that is a profound misunderstanding of what 578 00:33:00,520 --> 00:33:03,720 Speaker 1: you do in poisoning crises. Right, That's only one way 579 00:33:03,720 --> 00:33:05,280 Speaker 1: of looking at it. The other way of looking at 580 00:33:05,320 --> 00:33:08,800 Speaker 1: it is what is the person doing? So you bring 581 00:33:08,840 --> 00:33:11,520 Speaker 1: up the whole conundrum of poly drug use, of mixing 582 00:33:11,560 --> 00:33:14,920 Speaker 1: different drugs. That's poorly understood. As you pointed out, it's 583 00:33:14,960 --> 00:33:17,360 Speaker 1: one of the blind spots. But the other blind spot 584 00:33:17,400 --> 00:33:20,200 Speaker 1: is what's going on in terms of the wholesale and 585 00:33:20,240 --> 00:33:24,320 Speaker 1: retail supply of drugs. We could ascertain that through UH interviews, 586 00:33:24,480 --> 00:33:27,760 Speaker 1: We could ascertain that through acquiring some of those drugs, 587 00:33:27,880 --> 00:33:31,480 Speaker 1: or for example, any urban setting. Right now, there are thousands, 588 00:33:31,480 --> 00:33:35,160 Speaker 1: if not tens of thousands of CIS drug samples that 589 00:33:35,280 --> 00:33:39,120 Speaker 1: were obtained through criminal justice proceedings, you know, small busts 590 00:33:39,240 --> 00:33:42,040 Speaker 1: that are being held as evidence against that person that 591 00:33:42,040 --> 00:33:44,560 Speaker 1: could be analyzed right now. I could go to the 592 00:33:44,600 --> 00:33:48,400 Speaker 1: Baltimore Crime Lab and say, can you analyze a hundred 593 00:33:48,440 --> 00:33:51,719 Speaker 1: specimens from last week and tell me what's in them? 594 00:33:51,800 --> 00:33:55,080 Speaker 1: What mixtures? Is the fencinyl contaminating the method? And fetamine 595 00:33:55,120 --> 00:33:57,719 Speaker 1: is that in the cocaine of which different types of 596 00:33:57,720 --> 00:34:00,440 Speaker 1: fen anmals were present last week? Right I could have 597 00:34:00,480 --> 00:34:04,520 Speaker 1: a great understanding mapped out across all of Baltimore with 598 00:34:04,640 --> 00:34:07,760 Speaker 1: a couple hundred drug samples tested last week of the 599 00:34:07,760 --> 00:34:09,719 Speaker 1: Baltimore crime Lab. I could do that in San Francisco. 600 00:34:09,760 --> 00:34:11,680 Speaker 1: I could do that in New York, actually do the Chicago. 601 00:34:11,960 --> 00:34:16,600 Speaker 1: I could understand supply from a poisoning point of view, 602 00:34:16,680 --> 00:34:19,960 Speaker 1: from a exposure point of view, right, And so now 603 00:34:20,000 --> 00:34:22,719 Speaker 1: we would have a more complete understanding. We would understand exposure, 604 00:34:22,960 --> 00:34:26,160 Speaker 1: we would understand use, and we would understand the end 605 00:34:26,200 --> 00:34:28,400 Speaker 1: result of use, you know, landing up in the hospital 606 00:34:28,520 --> 00:34:31,200 Speaker 1: to e er or the morgue. Right. But we only 607 00:34:31,239 --> 00:34:34,400 Speaker 1: have one of those three legs of our three legged stool. 608 00:34:34,560 --> 00:34:37,520 Speaker 1: So as you suggest that it's a failure to failure 609 00:34:37,560 --> 00:34:41,080 Speaker 1: research policy, it's a failure of public policy. Here's the 610 00:34:41,120 --> 00:34:43,719 Speaker 1: other big failure, other big blind spot, ethan, Can you 611 00:34:43,760 --> 00:34:47,040 Speaker 1: tell me how many active heroin injectors there are in 612 00:34:47,040 --> 00:34:49,560 Speaker 1: the United States right now? Yeah? One million, four d 613 00:34:49,719 --> 00:34:52,480 Speaker 1: sixty thousand, eight hundred and twelves. How many are there? 614 00:34:52,760 --> 00:34:54,440 Speaker 1: How many are there? We don't know, right, We have 615 00:34:54,520 --> 00:34:58,160 Speaker 1: no idea. The answer is unknown. Now, why is it 616 00:34:58,200 --> 00:35:02,560 Speaker 1: in a growing epidem where the severe consequences including death, 617 00:35:02,800 --> 00:35:05,400 Speaker 1: that we don't understand the size of the at risk population? 618 00:35:06,040 --> 00:35:09,120 Speaker 1: Basic epidemiology one oh one? What is the size of 619 00:35:09,160 --> 00:35:11,960 Speaker 1: the population at risk? We don't know that. And every 620 00:35:12,000 --> 00:35:13,680 Speaker 1: time I meet with the CDC, I mentioned this, and 621 00:35:13,719 --> 00:35:15,560 Speaker 1: I say, shame on you because you don't know the 622 00:35:15,560 --> 00:35:17,439 Speaker 1: answer to this question. Right, who should know the answer 623 00:35:17,440 --> 00:35:19,520 Speaker 1: to the question sentence for these controls and the answer 624 00:35:19,520 --> 00:35:21,840 Speaker 1: to that question, and they refuse to do it. You 625 00:35:21,920 --> 00:35:25,840 Speaker 1: fund five, six, a dozen researchers from around the country 626 00:35:26,000 --> 00:35:28,799 Speaker 1: to do capture recapture studies, we can have the answer, right, 627 00:35:29,040 --> 00:35:31,600 Speaker 1: but they refuse to fund those studies. Neither refuses to 628 00:35:31,600 --> 00:35:34,560 Speaker 1: fund those studies despite the fact that we're in an epidemic. 629 00:35:34,600 --> 00:35:38,680 Speaker 1: And what a crisis means, ethan, what a crisis means 630 00:35:38,760 --> 00:35:43,000 Speaker 1: is that we don't understand based on our current tool set. 631 00:35:43,480 --> 00:35:45,400 Speaker 1: So what you do then is you start getting creative. 632 00:35:45,480 --> 00:35:49,520 Speaker 1: What other tools have we ignored? What other interventions have 633 00:35:49,640 --> 00:35:52,920 Speaker 1: we ignored? Right? We need to be creative, We need 634 00:35:52,960 --> 00:35:55,920 Speaker 1: to be bold, We need new sources of funding, and 635 00:35:55,960 --> 00:35:58,480 Speaker 1: we need new understandings in order to handle this historic 636 00:35:58,560 --> 00:36:01,160 Speaker 1: crisis we do. The other thing, of course, we don't 637 00:36:01,200 --> 00:36:04,239 Speaker 1: know right now is the latest reports say show on 638 00:36:04,280 --> 00:36:07,520 Speaker 1: the one hand, that fentanyl is pervasively connected to the 639 00:36:07,560 --> 00:36:12,920 Speaker 1: overdose fatality epidemic, but they also show that stimulants cocaine, methamphetamine, 640 00:36:12,920 --> 00:36:14,880 Speaker 1: and other things like that are showing up more and 641 00:36:14,880 --> 00:36:16,920 Speaker 1: more and more, and it appears that some of these 642 00:36:16,960 --> 00:36:19,640 Speaker 1: overdoses involved just the use of stimulants like cocaine and 643 00:36:19,680 --> 00:36:23,160 Speaker 1: meth amphetami without fentanyl. Other cases they're mixing it with fentanyl. 644 00:36:23,280 --> 00:36:25,759 Speaker 1: But we don't know why they're mixing it, right, I mean, 645 00:36:25,800 --> 00:36:27,200 Speaker 1: you know, one of the theories has been it's like 646 00:36:27,200 --> 00:36:29,960 Speaker 1: the old heroin cocaine speedball that was popular back in 647 00:36:30,000 --> 00:36:32,520 Speaker 1: the eighties, where people like the mixture of the drugs. 648 00:36:32,560 --> 00:36:35,200 Speaker 1: Another is that the sellers don't even know what they're mixing. 649 00:36:35,200 --> 00:36:37,200 Speaker 1: It's just you know, a little bit of stuff getting 650 00:36:37,200 --> 00:36:39,719 Speaker 1: mixed accidentally or whatever. But what more can you tell 651 00:36:39,800 --> 00:36:42,440 Speaker 1: us about why this stimulant thing is showing up more 652 00:36:42,480 --> 00:36:44,879 Speaker 1: and more and more, both with and without fentanyl. Yeah, 653 00:36:44,880 --> 00:36:46,680 Speaker 1: this is a great question. It's such a great question 654 00:36:46,719 --> 00:36:49,360 Speaker 1: that I've spent most of COVID pondering it and written 655 00:36:49,360 --> 00:36:52,439 Speaker 1: two papers. My most recent papers discussed the fourth wave 656 00:36:52,600 --> 00:36:56,480 Speaker 1: of the opioid epidemic, which is the stimulant use and 657 00:36:56,640 --> 00:36:59,200 Speaker 1: polly substance use that includes the mixture of an opioid 658 00:36:59,200 --> 00:37:02,840 Speaker 1: and a stimulant. The goofball, which is historically what we 659 00:37:02,920 --> 00:37:08,800 Speaker 1: called methan fetamine and heroin mixed together, was historically unusual. 660 00:37:08,920 --> 00:37:10,759 Speaker 1: You had to be an expert to do it, you 661 00:37:10,760 --> 00:37:12,080 Speaker 1: had to know what you were doing. You had a 662 00:37:12,160 --> 00:37:15,160 Speaker 1: feather in the methanphetamine in just the right amounts, and 663 00:37:15,200 --> 00:37:17,200 Speaker 1: so you didn't see a lot of it. You had to. 664 00:37:17,280 --> 00:37:19,799 Speaker 1: There was only a few very fussy people who knew 665 00:37:19,800 --> 00:37:22,000 Speaker 1: how to mix them the right way, and that's because 666 00:37:22,000 --> 00:37:24,280 Speaker 1: the methan and fetamy would simply bowl over the heroine 667 00:37:24,600 --> 00:37:27,279 Speaker 1: and you've wasted your money on the heroine. Now, fentanyl 668 00:37:27,640 --> 00:37:31,040 Speaker 1: is a very powerful opoid, so now they're meeting manoamano 669 00:37:31,280 --> 00:37:34,160 Speaker 1: powerful synthetic stimulant like meth and fhetamine, which is coming 670 00:37:34,200 --> 00:37:40,279 Speaker 1: in historic levels of potency and purity potent percent pure. 671 00:37:40,360 --> 00:37:43,440 Speaker 1: We've never seen methan and fetamine like this before. You 672 00:37:43,520 --> 00:37:46,600 Speaker 1: got this powerful opioid and you get this powerful stimulant 673 00:37:46,600 --> 00:37:51,200 Speaker 1: that are coming together, and half of us stimulant deaths 674 00:37:51,239 --> 00:37:54,680 Speaker 1: are related to that combination. Now, where fentanyl is being 675 00:37:54,680 --> 00:37:57,000 Speaker 1: detected along with meth and fetamine in the bloodstream of 676 00:37:57,000 --> 00:37:59,759 Speaker 1: people who have died, it needs to be explained. We 677 00:37:59,800 --> 00:38:03,719 Speaker 1: have this vague notion in drug policy that uppers and 678 00:38:03,760 --> 00:38:06,239 Speaker 1: downers kind of undulate through history, that we have the 679 00:38:06,280 --> 00:38:09,480 Speaker 1: sort of upper wave and then the next generation chooses 680 00:38:09,520 --> 00:38:13,000 Speaker 1: downers like heroin, and the next generation uses uppers like crack. 681 00:38:13,480 --> 00:38:17,360 Speaker 1: This vague notion of of undulation throughout the decades. Here 682 00:38:17,600 --> 00:38:20,799 Speaker 1: they're colliding together. So not only is stimulus coming at 683 00:38:20,840 --> 00:38:25,080 Speaker 1: the end of a twenty year opioid triple wave, but 684 00:38:25,160 --> 00:38:28,640 Speaker 1: it's coming in as a as a combined use, and 685 00:38:28,800 --> 00:38:32,160 Speaker 1: that needs to be explored. There's two forces that are 686 00:38:32,280 --> 00:38:37,719 Speaker 1: driving the latest numbers. One is the breaching of the 687 00:38:37,760 --> 00:38:40,279 Speaker 1: East West divide in terms of fentel. Fentinel has now 688 00:38:40,360 --> 00:38:45,359 Speaker 1: moved westward. And the second is the methophetamine epidemic. We've 689 00:38:45,400 --> 00:38:47,680 Speaker 1: always had an endemic problem in the United States in 690 00:38:47,719 --> 00:38:50,520 Speaker 1: the West coast. For the opposite phenomenous happening, and that 691 00:38:50,560 --> 00:38:52,759 Speaker 1: is meth and fetamine is now going all the way 692 00:38:52,800 --> 00:38:55,280 Speaker 1: to the northeast United States where it didn't hit before 693 00:38:55,560 --> 00:38:57,520 Speaker 1: and they're not used to it. The size of the 694 00:38:57,520 --> 00:39:00,160 Speaker 1: at risk population has increased for methan fhetamine on the 695 00:39:00,160 --> 00:39:02,799 Speaker 1: East coast and for fentinel on the West coast, and 696 00:39:02,840 --> 00:39:06,080 Speaker 1: that's raising the numbers as well. So the question about 697 00:39:06,120 --> 00:39:09,600 Speaker 1: what to do, I mean, obviously there's a bigger socioeconomic 698 00:39:09,680 --> 00:39:12,480 Speaker 1: factor here and about jobs, an opportunity and people having 699 00:39:12,520 --> 00:39:14,920 Speaker 1: a sense of hope. That is probably the most important 700 00:39:15,160 --> 00:39:18,719 Speaker 1: contextual answer to this problem of the opioid epidemic. But 701 00:39:18,760 --> 00:39:21,040 Speaker 1: then there's the specifics. We know that making the lock 702 00:39:21,120 --> 00:39:23,680 Speaker 1: zone more widely available the antidote has you know, saved 703 00:39:23,719 --> 00:39:26,120 Speaker 1: tens of thousands of lives, if not, if not hundreds 704 00:39:26,160 --> 00:39:28,480 Speaker 1: of thousands of lives. We know that more drug treatment 705 00:39:28,560 --> 00:39:31,720 Speaker 1: smart drug treatment. We know that more needle exchange programs 706 00:39:31,719 --> 00:39:34,160 Speaker 1: are hopefully allowing safe injection sites. So what are now 707 00:39:34,239 --> 00:39:37,480 Speaker 1: called over those prevention centers that those things could be beneficial. 708 00:39:37,520 --> 00:39:40,320 Speaker 1: We know that drug testing slips where people get fentel 709 00:39:40,360 --> 00:39:42,319 Speaker 1: and have it tested. But when you think, are there 710 00:39:42,320 --> 00:39:45,640 Speaker 1: other key things apart from the ones that I've reeled 711 00:39:45,680 --> 00:39:48,640 Speaker 1: off that you think are really important to have out there? Yeah, yeah, 712 00:39:48,680 --> 00:39:51,080 Speaker 1: that's a great list. You know, that's a historic opportunity. 713 00:39:51,080 --> 00:39:53,680 Speaker 1: And people ask me, am, I that's a mr an optimists, 714 00:39:53,680 --> 00:39:55,920 Speaker 1: and I'm I'm always an optimist because here we have 715 00:39:56,000 --> 00:39:59,160 Speaker 1: a historic crisis. But in crisis, there's opportunity, right, And 716 00:39:59,160 --> 00:40:01,360 Speaker 1: what's the opportunity there? The opportunity is to take a 717 00:40:01,360 --> 00:40:03,840 Speaker 1: deeper understanding of where we are as Americans, right to 718 00:40:03,960 --> 00:40:06,400 Speaker 1: look at those false zones in America, to look at 719 00:40:06,719 --> 00:40:09,399 Speaker 1: what we can do to lift cities up, to make 720 00:40:09,400 --> 00:40:12,359 Speaker 1: communities healthier. So I agree with what I would call 721 00:40:12,480 --> 00:40:15,920 Speaker 1: primary prevention and not just educating don't do drugs right, 722 00:40:16,160 --> 00:40:20,440 Speaker 1: but making communities more resilient, making them healthier, making them happier. 723 00:40:21,000 --> 00:40:24,160 Speaker 1: The other historic opportunity here is to move away from 724 00:40:24,280 --> 00:40:27,800 Speaker 1: what's been an unfortunately unbalanced drug policy where we focus 725 00:40:27,880 --> 00:40:30,719 Speaker 1: too much on supply, too much on catching the quote 726 00:40:30,760 --> 00:40:33,200 Speaker 1: bad guys end quote, or or stopping the flows of 727 00:40:33,280 --> 00:40:35,680 Speaker 1: drugs or locking people Upright, Remember, the war and drugs 728 00:40:35,719 --> 00:40:38,080 Speaker 1: has also been a warm black and brown people. It's 729 00:40:38,120 --> 00:40:41,359 Speaker 1: been heavy incarceration rates, right, we need to end that 730 00:40:41,440 --> 00:40:43,920 Speaker 1: has been an utter failure. It's broken families apart. It 731 00:40:44,000 --> 00:40:48,920 Speaker 1: isn't actually led to the disenfranchisement of communities. Um, to 732 00:40:49,000 --> 00:40:53,600 Speaker 1: change how we view drug use is the most important 733 00:40:53,600 --> 00:40:56,600 Speaker 1: opportunity here. Right, We're not gonna put the genie back 734 00:40:56,600 --> 00:40:59,640 Speaker 1: on the bottle. We're not going to stop recreational drug use. 735 00:41:00,120 --> 00:41:02,480 Speaker 1: It's a human phenomena that's been going on for thousands 736 00:41:02,480 --> 00:41:05,080 Speaker 1: of years. That's an American phenomena. People like to alter 737 00:41:05,120 --> 00:41:08,440 Speaker 1: their consciousness. But can we make it less risky, and 738 00:41:08,480 --> 00:41:11,200 Speaker 1: the answer is yes. And that's where harm reduction comes in. 739 00:41:11,560 --> 00:41:14,560 Speaker 1: That's where regulation and taxation comes in, and we have 740 00:41:14,680 --> 00:41:18,520 Speaker 1: to stop making it punitive to use, stop locking people 741 00:41:18,600 --> 00:41:21,759 Speaker 1: up for it. That's where diversion programs come in. That's 742 00:41:21,800 --> 00:41:25,759 Speaker 1: where creating an opportunity comes in. That's where I would 743 00:41:25,800 --> 00:41:27,920 Speaker 1: expand my list that I love harm reduction. We need 744 00:41:27,960 --> 00:41:29,640 Speaker 1: more in the locks than we need more needle exchange. 745 00:41:29,880 --> 00:41:32,879 Speaker 1: I love the idea of demand reduction, including treatment low 746 00:41:33,000 --> 00:41:36,239 Speaker 1: barrier treatment, including upreneurs the methodone. But I also think 747 00:41:36,239 --> 00:41:40,680 Speaker 1: we need to change the conversation about drugs and accept 748 00:41:40,760 --> 00:41:44,319 Speaker 1: that it's a normal human behavior that we can redirect 749 00:41:44,760 --> 00:41:48,759 Speaker 1: from problematic use to less problematic use. And that's our 750 00:41:48,760 --> 00:41:52,560 Speaker 1: cultural opportunity. Okay, well listen, Dan, you've been a spectacular guest. 751 00:41:52,680 --> 00:41:54,799 Speaker 1: I have learned a lot. I'm sure our listeners have 752 00:41:55,000 --> 00:41:57,640 Speaker 1: learned to use amounts. So thank you ever so much 753 00:41:57,680 --> 00:42:00,600 Speaker 1: for joining me today, and I welcome any comments from 754 00:42:00,600 --> 00:42:02,840 Speaker 1: our Psychoactive listeners, which I'll be happy to share with you. 755 00:42:03,120 --> 00:42:05,120 Speaker 1: Thanks so much, then, thanks for inviting me. It's been 756 00:42:05,120 --> 00:42:19,120 Speaker 1: a pleasure. Psychoactive is a production of I Heart Radio 757 00:42:19,320 --> 00:42:23,319 Speaker 1: and Protozoa Pictures. It's hosted by me Ethan Naedelman. It's 758 00:42:23,360 --> 00:42:27,759 Speaker 1: produced by Kacha Kumkova and Ben Cabrick. The executive producers 759 00:42:27,800 --> 00:42:32,120 Speaker 1: are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski 760 00:42:32,239 --> 00:42:35,920 Speaker 1: for Protozoa Pictures, Alex Williams and Matt Frederick for I 761 00:42:36,040 --> 00:42:39,920 Speaker 1: Heart Radio, and me Ethan Naedelman. Our music is by 762 00:42:39,920 --> 00:42:44,280 Speaker 1: Ari Belusian and Especial thanks to Avivit Brio, Sef Bianca 763 00:42:44,320 --> 00:42:48,279 Speaker 1: Grimshaw and Robert Beatty. If you'd like to share your 764 00:42:48,320 --> 00:42:51,920 Speaker 1: own stories, comments, or ideas, please leave us a message 765 00:42:52,040 --> 00:42:58,080 Speaker 1: at eight three three seven seven nine sixty. That's one 766 00:42:58,520 --> 00:43:03,880 Speaker 1: eight three three Psycho zero. You can also email us 767 00:43:04,000 --> 00:43:07,279 Speaker 1: as psychoactive at protozoa dot com or find me on 768 00:43:07,280 --> 00:43:10,439 Speaker 1: Twitter at Ethan Natalman. And if you couldn't keep track 769 00:43:10,440 --> 00:43:13,120 Speaker 1: of all this, find the information in the show notes. 770 00:43:15,719 --> 00:43:19,040 Speaker 1: Tune in next time for one of America's leading writers, 771 00:43:19,360 --> 00:43:22,200 Speaker 1: Michael Pollen, whose recent book This Is Your Mind on 772 00:43:22,320 --> 00:43:26,040 Speaker 1: Plans is breaking new ground. There are insights. I had 773 00:43:26,080 --> 00:43:29,680 Speaker 1: an influence of mushrooms years ago. They still have validity 774 00:43:29,680 --> 00:43:32,719 Speaker 1: in my life today. You had I think the same experience. 775 00:43:32,800 --> 00:43:35,080 Speaker 1: Oh yeah, I know I did. There are insights I 776 00:43:35,160 --> 00:43:37,440 Speaker 1: had and you could. You know. You can also call 777 00:43:37,520 --> 00:43:42,840 Speaker 1: them banal insights around love and connectedness, but they're real. Um. 778 00:43:43,200 --> 00:43:46,120 Speaker 1: But also, think of the people using psychedelics to quit 779 00:43:46,200 --> 00:43:49,480 Speaker 1: smoking and they come to the profound conclusion that smoking 780 00:43:49,560 --> 00:43:52,279 Speaker 1: is stupid and it's killing them. They knew that at 781 00:43:52,360 --> 00:43:56,000 Speaker 1: one level. But there is a sturdiness to the insight 782 00:43:56,320 --> 00:43:59,360 Speaker 1: on psychedelics. It's it's what James called the no edic quality, 783 00:43:59,440 --> 00:44:01,160 Speaker 1: right that this is not just an opinion, this is 784 00:44:01,160 --> 00:44:04,839 Speaker 1: a revealed truth. Subscribe to Cycoactive now see it, don't 785 00:44:04,840 --> 00:44:07,360 Speaker 1: miss it. M