Fentanyl: Actually As Dangerous As They Say

Summary

Podcast Summary: "Fentanyl: Actually As Dangerous As They Say"

Introduction to the Epidemic Timestamp: [01:06] - [01:24]

In this somber episode of Stuff You Should Know, hosts Josh Clark and Chuck Bryant delve into the harrowing reality of fentanyl, labeling it "the most deadly street drug in the United States." They set the stage by acknowledging fentanyl's dual nature: a highly effective painkiller with devastating societal impacts.

Understanding Fentanyl: Origins and Potency Timestamp: [01:24] - [05:11]

Josh explains that fentanyl is a synthetic opioid, distinct from natural opiates like morphine and heroin. Chuck adds, “...it is way more potent than anything anyone had ever seen before when it came on the scene” ([02:34]). Developed in the 1960s by Paul Janssen, fentanyl was initially intended as an intravenous anesthetic with fewer side effects. Its molecular structure was altered to increase fat solubility, leading to a faster onset and shorter duration of its high—factors that significantly contribute to its addictive potential and overdose risk.

The Opioid Epidemic: Three Waves Timestamp: [08:54] - [11:19]

The hosts outline the opioid crisis in three waves:

1. First Wave (1990s): Surge in prescription opioid use, leading to increased overdose deaths.
2. Second Wave (2010): Transition from prescription opioids to heroin as regulations tightened, causing a quadruple rise in heroin overdose fatalities between 2002 and 2013.
3. Third Wave (2013 onward): Dominance of illicitly produced fentanyl, resulting in skyrocketing overdose deaths that outpace the first two waves combined.

Josh highlights, “in 2022, [fentanyl] was responsible for 69% of total overdose deaths” ([11:34]).

Impact on Society and Life Expectancy Timestamp: [13:08] - [13:39]

The discussion reveals that fentanyl has significantly affected US life expectancy, particularly among middle-aged white individuals without a college degree. This demographic now faces earlier mortality rates compared to their parents, a change not seen since times of national crisis like wars.

Factors Contributing to Fentanyl's Deadliness Timestamp: [20:45] - [28:50]

Several factors make fentanyl exceptionally dangerous:

• Potency: Up to 100 times more potent than morphine, making precise dosing critical.
• Rapid Onset: Leads to quick addiction and leaves little time to respond during an overdose.
• Varied Methods of Use: Transition from injecting to smoking or snorting increases overdose risks.
• Illicit Manufacturing: Easy and cost-effective to produce, often cut with fentanyl without user knowledge, leading to unintentional overdoses.

Chuck explains, “It's really easy to make. You don't require tons and tons of agricultural workers...” ([21:05]).

Smuggling and Production Networks Timestamp: [29:22] - [32:46]

Originally manufactured in China, fentanyl production shifted due to regulatory changes in 2019. Cartels in Mexico now play a pivotal role, using simple methods to produce fentanyl from precursor chemicals. Misconceptions about illegal immigration being the primary smuggler source are debunked; instead, fentanyl often enters the US through legal points of entry, predominantly smuggled by American citizens. Josh cites a Cato Institute study, noting “86.3% of convicted fentanyl smugglers are American citizens” ([30:04]).

Myths and Misconceptions Timestamp: [46:57] - [49:47]

Several myths surrounding fentanyl are addressed:

• Passive Overdose Risk: The DEA’s 2016 advisory claiming skin contact or inhalation can cause overdose is misleading. Actual risk from mere exposure is negligible.
• Link to Homelessness: Contrary to popular belief, the homeless crisis in the US is primarily driven by housing costs, not drug use.
• Environmental Stereotypes: Fentanyl is often unfairly associated with specific demographics or behaviors, exacerbating social stigmas.

Chuck emphasizes, “It's not like helping someone. Like shaking somebody on the ground or something can get it into your skin that way.” ([48:14]).

Public Health Response and Harm Reduction Timestamp: [34:12] - [43:41]

The hosts discuss evolving public health strategies focusing on harm reduction:

• Test Strips: Allow users to check for fentanyl presence in their drugs, reducing accidental overdoses.
• Safe Use Sites: Provide supervised environments where users can consume drugs safely with immediate assistance available.
• Naloxone (Narcan): Widely distributed as an overdose reversal agent, though accessibility and timely administration remain challenges.

Josh notes, “Test strips have helped a lot of people if not saved their lives” ([38:24]).

Treatment and Rehabilitation Challenges Timestamp: [45:05] - [47:27]

Medication-Assisted Treatment (MAT) is highlighted as the gold standard, utilizing methadone or buprenorphine (Suboxone) to manage addiction. However, access is limited—only about 25% of those needing MAT receive it, according to a 2022 CDC study. Stigma within the medical community and logistical barriers, such as requiring daily clinic visits for methadone, hinder widespread adoption.

Chuck remarks, “A lot of people are like, hey, go to drug rehab and just quit doing all this stuff” ([45:23]).

Current Trends and Signs of Decline Timestamp: [50:19] - [56:50]

Fentanyl overdose deaths peaked in 2022 with an estimated 108,000 fatalities. Fortunately, indicators show a potential decline:

• Reduced Supply: Enhanced international cooperation between the US and Mexico has led to a 20% drop in fentanyl crossings in 2024.
• Increased Awareness: Education and harm reduction measures have made users more cautious.
• Fewer Active Users: The high mortality rate has naturally reduced the number of individuals using fentanyl.

Chuck observes, “drug users have gotten a little bit smarter” ([51:55]).

Conclusion and Final Thoughts Timestamp: [56:50]

Josh and Chuck reiterate the critical dangers of fentanyl, urging those addicted to seek help and advising against initiating use. They underscore the complexity of the epidemic, balancing the legitimate medical uses of fentanyl with the catastrophic consequences of its illicit abuse.

Josh concludes, “if you haven't tried it yet, probably you shouldn't start” ([54:25]).

Listener Engagement and Social Commentary Timestamp: [56:03] - [56:50]

The episode wraps up with listener feedback on the representation of Black individuals in disaster and horror movies, highlighting ongoing cultural discussions about media representation and its societal implications.

Notable Quotes

• Chuck Bryant: “It is way more potent than anything anyone had ever seen before...” ([02:34])
• Josh Clark: “in 2022, [fentanyl] was responsible for 69% of total overdose deaths” ([11:34])
• Chuck Bryant: “It's really easy to make. You don't require tons and tons of agricultural workers...” ([21:05])
• Josh Clark: “Test strips have helped a lot of people if not saved their lives” ([38:24])
• Chuck Bryant: “A lot of people are like, hey, go to drug rehab and just quit doing all this stuff” ([45:23])

Conclusion

This episode of Stuff You Should Know provides a comprehensive and nuanced exploration of fentanyl, examining its origin, unprecedented potency, role in the opioid epidemic, societal impacts, and the multifaceted approaches required to mitigate its deadly effects. Through detailed statistics, myth-busting, and discussions on public health strategies, Josh and Chuck offer listeners a deep understanding of why fentanyl is as dangerous as its reputation suggests and the ongoing efforts to combat this crisis.

Transcript

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[Chuck Bryant]

Welcome to Stuff youf Should Know, a production of iHeartRadio.

[Josh Clark]

Hey, and welcome to the podcast. I'm Josh and there's Chuck and Jerry's here too. And this is Stuff youf Should Know, the big bummer edition.

[Chuck Bryant]

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.

[Josh 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 100% processed natural opium. Heroin is kind of a combo hybrid between synthetic and natural. And then fentanyl is just straight up, 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.

[Chuck Bryant]

Yeah, like a hundred times more potent than morphine, 50 times more potent than heroin created by A gentleman named Paul Janssen of the Janssen 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 meperidine, I guess, and that was developed in the 1930s. And so they had this sort of meperidine as the base. They changed it around a little, altered the chemical structure a little bit, because what they wanted was something that had fewer negative side effects, something that was safer to use. And they were able to do that with fentanyl. I mean, it initially worked great. It had a very fast onset, had a very high therapeutic index, which is how they measure 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.

[Josh Clark]

Right. And one of the things I just want to say that they messed around with molecularly to make fentanyl, they increase 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 from 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 just that one little tweak, fat solubility made this, this drug what it is. Because faster onset makes it addictive. Shorter duration means that you need to do more.

[Chuck Bryant]

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 Droperidol, 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 cheaper generic versions available. And it was pretty commonly used in surgery and post surgical recovery with skin patches and lozenges and stuff like that for pain management.

[Josh Clark]

Yeah, I think still today it's the most common opioid used for anesthesia during surgery. And that just sounds like madness when you're familiar with fentanyl, the street version, but in the hands of like a really well trained anesthesiologist with Hospital grade equipment. It's actually very safe. It's the fact that the stuff that you buy on the street has a very uneven, like dosages means that's why it's just so deadly. Because you're not a trained anesthesiologist, you're not using hospital grade equipment, you're shooting up something that some dude sold you and it's just not. It's just not trustworthy. And it can kill you because it takes such a small amount to create a toxic dose.

[Chuck Bryant]

Yeah. It will produce relaxation feelings, pleasure, sleepiness. You can also get nauseous, dizziness, confusion, vomiting, ureter retention, breathing issues, as we'll see later on. That's 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 2 narcotic with a high potential for abuse.

[Josh Clark]

Just a reminder, marijuana's schedule one.

[Chuck Bryant]

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 the real stuff from. I'm not sure how they get it. Whatever connection they have. And they'll just have to. It's not like in a 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.

[Josh 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 rhinoceroses 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 sue, fentanyl is five to 10 times stronger than fentanyl. So if you like, people aren't like, it's carfentanil or sufentanil. You're talking about fentanyl.

[Chuck Bryant]

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

[Josh Clark]

Sure. The singer.

[Chuck Bryant]

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

[Josh Clark]

I didn't know that.

[Chuck Bryant]

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

[Josh 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, Tango and Cash. Yeah. So apparently that's fentanyl and cocaine mixed together and. Or fentanyl and methamphetamine. Some sort of speed. That's a speedball. And as we'll see, that's actually proving to be a really big problem. It's created like a new wave of opioid deaths.

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

No, I didn't see that.

[Josh Clark]

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

[Chuck Bryant]

Yeah.

[Josh Clark]

And it's. 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 turned to whatever opioids are available. And that meant that a lot of people who otherwise would have never tried heroin took up Heroin because they couldn't get oxycontin anymore.

[Chuck Bryant]

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 sometimes even if you don't want to be taking fentanyl.

[Josh Clark]

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

[Chuck Bryant]

Yeah.

[Josh Clark]

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

[Chuck Bryant]

Yeah.

[Josh Clark]

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

[Chuck Bryant]

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

[Josh Clark]

Yeah, apparently so.

[Chuck Bryant]

It was the problem for sure.

[Josh Clark]

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

[Chuck Bryant]

Yeah. While fentanyl has hit such a high that it's actually had a real impact on US life expectancy. It takes a lot to change a number like that. But fentanyl seems to have done it. And 2022 only 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 calculate the average lifespan and do the subtraction and that's your number. So that a lot of middle age white people without a college degree are the victims. So much so, and this is startling, but from that class, middle aged white people without a college degree, they are dying earlier on average than their parents did.

[Josh Clark]

Yes.

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

Yeah.

[Josh 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 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.

[Chuck Bryant]

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.

[Josh 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 well.

[Chuck Bryant]

Yeah, 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.

[Josh Clark]

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

[Chuck Bryant]

I knew you'd get a joke in there.

[Josh Clark]

So, yeah, this is. I mean, like, this whole thing kind of rose in lockstep. Opioid overdose deaths rose in lockstep with just these financial crisis 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.

[Chuck Bryant]

Yeah. Should we take a break?

[Josh Clark]

Yeah.

[Chuck Bryant]

All right. We're going to take a break and we're going to talk about the rise of fentanyl right after this.

[Josh Clark]

It's stuff you should know.

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[Chuck Bryant]

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, same thing. And they're basically saying fentanyl is basically the same deal.

[Josh 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. 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.

[Chuck Bryant]

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, that the percentage of heroin that had fentanyl rose from less than 1% to 40% over, what is that, eight years? And of course, that's gonna 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.

[Josh Clark]

Yeah.

[Chuck Bryant]

And then people, you know, for a long time, I think, you know, the word is finally out now, and we're going to talk about that a little bit later. But people that were heroin users thought they were getting heroin and knew how much heroin to take safely.

[Josh 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. 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 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.

[Chuck Bryant]

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

[Josh Clark]

Right? Yeah.

[Chuck Bryant]

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

[Josh Clark]

I think that was worth mentioning. Yeah.

[Chuck Bryant]

Okay, good. So the other 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 passing out on your couch for hours and hours. Um, 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 gonna, you know, have people using more frequently. And every time you use fentanyl, it's just another chance to overdose, basically.

[Josh 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.

[Chuck Bryant]

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

[Josh 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 not that fast necessarily, but compared to heroin, it is. And yeah, I think it's measured in like seconds.

[Chuck Bryant]

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 at 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.

[Josh Clark]

Yeah. Because that's a big barrier for a lot of people who are like, I like drugs, but I'm not gonna stick a needle in my arm. That just seems like such a 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.

[Chuck Bryant]

Yeah. And if you're smoking it or snorting it, it doesn't stay in your body as long as if you shoot it. So again, just another case of it wears off quicker and you're gonna wanna use it again. And that's just another overdose opportunity.

[Josh Clark]

Yes. Yeah. I mean, it's crazy if you think about it, because most other drugs that you smoke you could conceivably overdose on, but fentanyl, even though you're smoking it and not injecting it, there's still a really good chance that you could overdose and die from just smoking it. That's kind of mind boggling, but it's accurate.

[Chuck Bryant]

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 overdosed without even knowing they took it.

[Josh Clark]

And 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 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.

[Chuck Bryant]

Yeah, for sure. Or if you, let's 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 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.

[Josh Clark]

Yeah. Just a reminder, speedballs are what killed not just John Belushi, but Chris Farley as well. And apparently this is that fourth wave that we were talking about of speedballing fentanyl with cocaine or with meth. And it's not just where dealers are cutting it and not telling their. Their buyers. Like 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.

[Chuck Bryant]

Oh, really?

[Josh Clark]

Yeah.

[Chuck Bryant]

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 continued doing so, sometimes through legit means that made it very easy to ship. But then they also turned to the black market to ship directly to customers in the US And Europe or, hey, let's. 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.

[Josh 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.

[Chuck Bryant]

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 believed that most fentanyl entering the country was being smuggled by illegal immigrants, basically. And that's not true. The truth is that most of this drug comes through legal points of entry. And when it does, it is smuggled in in vehicles driven by U.S. citizens.

[Josh 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. Yeah, but apparently this is a. I think this is a measure of how. How bad fentanyl is. Because, I mean, Chuck, we're pretty. Fentanyl naive. I've never done fentanyl. I'm making a pretty good assumption that you've never done fentanyl and kept it a secret from me. So it's entirely possible that within this whole thing we've passed along some myth or exaggeration without being aware of it. Yeah, and for that, I'm sorry. The thing is, it seems that the overall theme that fentanyl is incredibly deadly and on a level unlike any other drug that's ever hit the US market. So much so that it's like, just don't do drugs. It's too dangerous. Because 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.

[Chuck Bryant]

Yeah, for sure. Should we take another break? All right, we'll be back and talk about punishment and harm reduction right after this.

[Josh Clark]

It's stuff you should know.

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[Josh 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 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 a, 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.

[Chuck Bryant]

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.

[Josh Clark]

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

[Chuck Bryant]

Throw away the key is what you got. So yeah, I don't think that's cynical. I think that's absolutely the truth. So thankfully they're taking a little bit different approach. We've gotten a little bit smarter about this stuff and now we're focusing or trying to focus on 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.

[Josh Clark]

That's really something.

[Chuck Bryant]

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.

[Josh 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. It doesn't say how much fentanyl is in there. So is it just a little bit or is it like a kill you size 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.

[Chuck Bryant]

Yeah. I mean, these newer generations may demand return restitution. 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 wisened 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.

[Josh Clark]

I wonder if, like, they draw straws to see what order everybody does drugs in. Like, how do they determine who's going to go last?

[Chuck Bryant]

Eeny, meeny, miny, mo.

[Josh Clark]

Okay, there you go.

[Chuck Bryant]

The age old, the traditional way.

[Josh Clark]

Exactly.

[Chuck Bryant]

But I did mention Narcan, and that is the brand name for naloxone or nalaxone. And that can reverse an overdose. And 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. Luckily, my. My cross street neighbor's 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.

[Josh Clark]

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

[Chuck Bryant]

Yeah, but, I mean, I don't know what happens after that. All I saw was this snapshot where she was like, I want to get out of here. And I don't know what the law. The laws are as far as that kind of stuff goes, but the ambulance, I don't think is allowed to call the cops on you, if I'm not mistaken. I think they're just like, okay, I guess you can go.

[Josh Clark]

Yeah. I don't know the law in Georgia.

[Chuck Bryant]

Or anywhere, really, but, yeah, those laws are called something. What is it?

[Josh Clark]

Good Samaritan laws.

[Chuck Bryant]

Oh, okay. Yeah, I guess that's it.

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

[Chuck Bryant]

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

[Josh Clark]

Yeah. It's getting much more widely available. Okay. Yeah. But let's talk a little bit about overdoses, because there's some. One of the telltale signs. I think it's not just with fentanyl, 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 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 you need to call 911 and. Or administer naloxone.

[Chuck Bryant]

Yeah. I mean, in the brain stem, there are a couple of regions, the medulla and the pons, 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.

[Josh 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?

[Chuck Bryant]

Yeah. So, basically, if you. If you want to take that deep breath, if you. Since, like, you're in trouble, like, oh, man, I got to get a big breath of air here. You just do that normally, but little small increases in CO2 are sensed. And the carotid body, it's a little small cluster of sails in the neck, they're gonna spur that increase in breathing to remove that excess CO2. But if that's not working and that emergency sort of fail safe is switched off. Then again, you can't even get that big breath to save yourself.

[Josh Clark]

Yeah. So breathing. I think you said early on that that typically is where fatal overdoses derive from. It's just you just stop breathing, stop being able to breathe. But there's other ways you could die. I think you mentioned heart attack earlier, too. Another famous one with opioids is your gag reflex is suppressed. So if you're basically knotted off and you throw up, say you've been drinking as well, 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.

[Chuck Bryant]

I was waiting to see if you were going to come up with a fourth way to say puking.

[Josh Clark]

Did I say a bunch of different ways?

[Chuck Bryant]

You said like three. You, like, spit it up or vomited up or choke or yak it up. I was like, we get it.

[Josh Clark]

Blow chunks it up.

[Chuck Bryant]

Oh, God. So as far as treatment goes, it kind of goes in lockstep 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?

[Josh Clark]

Buprenorphine.

[Chuck Bryant]

Buprenorphine. If you get methadone, it's going to be done at 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 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.

[Josh 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.

[Chuck Bryant]

Yeah.

[Josh 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.

[Chuck Bryant]

Yeah.

[Josh 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.

[Chuck Bryant]

Yeah. That's no way to. That's no way to kick.

[Josh 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.

[Chuck Bryant]

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 traits amounts can overdose you. Apparently that came from a 2016 USDEA 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. Or inhaling enough to overdose you is like, there's no way you would accidentally inhale enough to overdose.

[Josh 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, it's. They're like, I just had, I just OD'd on fentanyl just from touching a little bit of it. Yeah, that's the best explanation. It makes sense. The point is, like, you like, interacting with somebody who's OD'd on fentanyl isn't going to give you a fentanyl higher overdose.

[Chuck Bryant]

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

[Josh 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. 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.

[Chuck Bryant]

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

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

[Chuck Bryant]

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, 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.

[Josh Clark]

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

[Chuck Bryant]

Yeah, that's another reason.

[Josh 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.

[Chuck Bryant]

Oh, my God.

[Josh 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. I think. I can't remember what. U.S. agency conducts this every year, but in 1993 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.

[Chuck Bryant]

Or Gen X is a generation of liars.

[Josh Clark]

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

[Chuck Bryant]

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

[Josh Clark]

I wonder if it really 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.

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

I got nothing else.

[Josh Clark]

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

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

Alright, 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 and horror movies and 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. 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 those movies as well as other genre movies like horror or rom com in mainstream Hollywood. It doesn't make me mad though guys, because at the end of the day, I just want the escapism of the movie. I don't want to think about the 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. 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.

[Josh 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 Rountree, 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?

[Chuck Bryant]

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

[Josh 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.

[Chuck Bryant]

Yeah. Nice work.

[Josh 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. The Stuff podcastheartradio.com.

[Chuck Bryant]

Stuff youf Should Know is a production of iHeartradio. For more podcasts My Heart Radio, visit the iHeartradio app. Apple Podcasts are wherever you listen to your favorite shows.

[Josh Clark]

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