The Mystery of the Vape Shop Kratom

27:25from Southeast Asia. He decided to try to figure out how popular this new-to-him drug was, and so he designed a survey. And how were you conducting the survey? How were you finding the users? So at the time, we had the American Quadrum Association, which still exists to this day. I think they have evolved over time from a relatively really user-driven and user advocacy group to a little bit of a lobbying arm as well. But at the time, I reached out to them and asked, hey, would you be willing to just send out an email to your members to distribute this survey? So I didn't ask them for input on how to design the survey, but just to distribute it.

28:07And the first survey, I capped it at 10 ,000 responses, thinking that maybe I get 500 if I'm lucky in like two weeks or so. And within two weeks, I got 10 ,000 responses and I had to end the survey. So I would never have expected such a huge response rate. So that was the first survey that was published on Kratom use in the United States. The survey showed that people were using Kratom to treat a comically vast range of American maladies. Anxiety, depression, ADHD, PTSD, chronic pain. And not just that, Kratom as a substitute for people trying to break their relationships to other drugs. To alcohol, to fentanyl, to heroin, to benzos like Xanax, stimulants like Adderall.

28:55Kratom was even being used by people who just wanted to wean themselves off antidepressants. Dr. Grunman's survey offered a peek at Kratom's quiet, behind-the-scenes role in America, a substance a lot of people self-medicate with because either they don't trust or can't access our traditional medical system. Acknowledging this is not the same as saying Kratom is an effective remedy. That's actually been the question Dr. Grunman's work has investigated for almost a decade. But with this first survey, he knew that, effective or not, safe or not, Kratom had become popular. And at almost the exact same time that Dr.

29:33Grunman was sending out his first survey, a U.S. government agency was squinting at Kratom. The Drug Enforcement Administration, the DEA, in America decides how much a potentially dangerous drug should be restricted. Whether you need a doctor's prescription to use it, like a prescription painkiller, or whether it's used by citizens is completely illegal. In 2016, when the DEA looked at Kratom, they wanted to know, How addictive is it? How dangerous is it to the user and to the people around the user? And does it have a legitimate medical use? What did those internal deliberations sound like? It's unclear.

30:11The DEA did not respond to search engine's request for comment. But we can guess at what the agency thought by what it did next. The drug is called Kratom, and it comes in powder and pill forms. On Friday, the DEA is expected to And the DEA plans to make it a Schedule I drug as soon as tomorrow. That puts it in the same category as drugs like heroin, LSD, marijuana, and ecstasy. Federal authorities called the supplement an imminent hazard to public safety. News Channel 5's Alyssa Hyman. All this hubbub, a surprise to Dr. Grunman, a researcher just trying to collect some survey data about a new substance he'd just learned of.

30:48I didn't know about it until after my survey. I think right around the time that my survey was published. And the FDA recommended to the DEA to place mitragynin and 7-hydroxymitragynin, which were known at the time to act on opioid receptors, to place them into Schedule 1, make them basically illegal, which would have prevented us as researchers, as academicians, to conduct research on it, which has been a challenge for cannabis research for a very, very long time because it is very difficult to get a DEA Schedule I license to begin with. So from that perspective, from the research perspective, we were concerned.

31:32Kratom researchers were concerned. Kratom users were incensed. We are Kratom! Kratom advocates have reacted with anger and fear to the federal ban on a natural analgesic product they say is safer than the painkillers legally prescribed by doctors. The pushback the government got here was pretty extraordinary. Kratom supporters are fighting to keep the plant-based substance from being banned last month. There's 130 ,000 people nationwide who have signed this petition to stop the Drug Enforcement Administration from banning Kratom. A petition saying broadly there are very few good options for opioid addicts, that this seemed to be helping some of them, and that they didn't want it taken away.

32:17What's up, y 'all? Trey Crowder. This time I want to talk to y 'all about something that's deeply personal to me. Pills. Yeah, pills are a big thing with us rednecks, and I ain't talking about heart pills or the ones that keep the sugar from taking you to meet Jesus early. I mean, we fucks with them too, but I'm talking about party pills. That hillbilly heroin. This video particularly struck me from this YouTuber Trey Crowder, a.k.a. the liberal redneck. He's speaking from his porch in a sleeveless shirt over a chorus of cicadas. At first, I thought the video was a parody. Crowder's a comedian.

32:47But he quickly moves into this argument for Kratom. At one point, he holds up a little green mason jar of Kratom tea. It's a mild stimulant. It hits some of the same parts of your brain that opiates do. And so a lot of addicts have been using it to keep off of the hard shit, which does not sit well with the lizards at the farm companies. And so their lapdogs at the DEA have announced that as of September 30th, Kratom will be banned in the U.S. This all-natural herb with hundreds of years of harmless human consumption behind it will be placed on the Schedule 1 alongside drugs like heroin and ecstasy.

33:16Sound familiar, you're weed people? I don't have to tell you that there are a lot of trade crowders in America, people whose families have been ravaged by opioid addiction. Enough of them demanded the government back off here that the DEA actually flinched. 51 federal lawmakers oppose a plan by the DEA to ban a drug that relieves pain and helps wean addicts off of opioids. The DEA is now backpedaling, seemingly second-guessing its widely criticized decision to ban something many say could help curb the nation's opioid abuse epidemic. 51 U.S. representatives, 22 of them Republicans, banded together and wrote a letter saying the DEA should do more research before scheduling this drug.

33:59They cited work by scientists, including one of Dr. Grunemann's colleagues. And surprisingly, their argument really mirrored the liberal rednecks. They did not call the people who worked at pharma companies lizards, but they said the government should not hastily ban a drug that might help in any way with our massive overdose crisis. Because while Kratom is an opioid, or if you prefer, exhibits opioid-like effects, overdoses from the drug are pretty rare. From 2011 to 2017, 13 users died. 11 of them had other drugs in their system. During that same time, over 200 ,000 users of other opioids died.

34:37The Kratom ban was to take effect in September 2016. Instead, that October, the DEA posted this very unusual letter into the Federal Register. It was titled, quote,

34:56Those are the two predominant psychoactive ingredients in Kratom, both opioids. This letter is government speak for my bad. As a person who studies drugs, how unusual is this for the DEA to back off of a decision like this? Yeah, I have not been involved with other drugs before that were at risk of being placed into Schedule 1. But it doesn't happen very often that the DEA does not move forward with placing a drug into Schedule 1. So this was certainly very surprising for a lot of people at the time. After 2016, when the DEA backed off, regulation of Kratom was left to the FDA, the Food and Drug Administration.

35:37We asked the FDA if Kratom was legal now to sell in the United States. A spokesperson for that agency told Search Engine that Kratom is not approved for any medical use, it is an unsafe food additive, and it is not appropriate in dietary supplements. Which is a very funny way of saying, yes, it is legal to sell in the United States. As long as you follow a few rules. In some states, the ingredients in your Kratom product have to match the ingredients advertised, and technically, you're not supposed to make medical claims, a rule as respected in vape shops as horn-honking laws are in New York City.

36:12The world these policies have created is one in which our listener Chris would walk into a store and see Kratom sold in various forms and under various brand names. K-Shots, MIT45 Super K, Ohm's Advanced Kratom Alkaloids. Occasionally, the packaging is sedate, like painkillers you'd get at Rite Aid. But usually, it's designed to look like illicit drugs, like Trucker Speed, or at least one brand I saw packaged like a large bag of heroin, with just the word train wreck written on it in marker font. The FDA pointed out to us that kratom is locally restricted or regulated in many states, which is totally true.

36:50But federally, there are no rules about how much kratom a person can buy, how old that person has to be, or rules placing limits on how strong kratom can be if it is going to be sold. It's funny. It's like for a moment, the federal government treated kratom as if it were too dangerous to tolerate, and then it treated it as something that it mostly just didn't want to think about. For someone like Chris, standing in the vape shop aisle, he could buy kratom, he could use it. But in a fundamental way, he would not know what he was taking. And the questions the government had said it wanted to answer, was the drug lethal?

37:26Was it addictive? Could it be useful? Those remained, for most people, open questions. I'm curious, like, as a substance, how addictive is kratom? What should I compare it to? Yeah. So that's a good question because only in recent years have a few NIDA studies, National Institute on Drug Abuse Studies under Kirsten Smith, who was a postdoc at NIDA and now is a faculty member at Johns Hopkins University, kind of elucidated to some degree what the symptoms of a potential Kratom use disorder are. And when we look at the criteria for what constitutes dependence, tolerance, withdrawal, and some other behaviors, we really see Kratom at the lower end of meeting these criteria.

38:15So what people primarily report is tolerance, meaning they increase their dose of Kratom over time. And if they stop taking it, they get withdrawal symptoms. In general, these withdrawal symptoms are relatively mild for most people, maybe comparable to heavy caffeine use when you stop using it. So Dr. Grunman's research suggests that withdrawal from Kratom looks like headaches, anxiety, and occasional GI distress, which basically sounds like my Monday, or like what Chris was experiencing before he started taking that other drug, TNF-D. Of course, when anybody, me, you, the federal government, is evaluating the riskiness of a drug like Kratom, they're not just asking how addictive is it, they're also asking how easily can this thing kill you?

39:05Yeah, so it's interesting that we have this discussion today because just the other day, Yesterday, literally, I was giving a presentation at the North American Congress on Clinical Toxicology on Kratom, together with a few other folks. And we are not yet sure how somebody can get to very high concentrations in their blood of mitragynin that would cause or would contribute to a fatality. In other words, Dr. Grunman says it's unclear how someone would take enough kratom to die from it. Nearly every compound has something called LD50, lethal dose 50, the dose at which half of the lab rats died after taking the substance.

39:54Alcohol has an LD50, so does salt, so does water. The LD50 for mitragynine, the star alkaloid of kratom, is high enough that people should not be able to get that much into their blood by taking kratom any of the ways we know that they take kratom. And yet, there have been dozens of deaths in which the only substance found in the person's blood was high levels of mitragynine. So, this is kind of a mystery. One theory for what might be happening here is that in an unregulated gray market, kratom manufacturers are incentivized to make stronger and stronger formulations of the drug because there will be customers who want a stronger effect, and there's no rule stopping them.

40:35So it's possible that the people who are dying of kratom overdoses are taking kratom capsules somehow formulated to give them a way higher potency opioid high than the norm. What's interesting here, and quite sad, is that kratom leaf has been used internationally for hundreds of years, but it appears that it's only when the drug reached America that we discovered how to make it, in some instances, lethal. With this evolution of the Kratom market where we see extracts, concentrates, isolates emerging, that might be a driving force behind these lethal outcomes, which we have not seen in Southeast Asia with just chewing on the leaf or making that tea.

41:18So it's clear there is a strong suspicion that these high potency extracts and isolates are driving the lethality. It's funny. I mean, it's sort of, to me, what it reminds me of a little bit is the current gray market cannabis system we're in, where people both, like, broadly speaking, socially, we've agreed that cannabis has social upsides and that its criminalization has real social downsides. But because it's a bit of a patchwork, people who are buying cannabis products can't entirely be sure that they, I mean, at least in the state in which I live, like they don't necessarily know that they are buying what is being advertised.

42:01And there's this market incentive for higher and higher and higher concentrations, which can be a really different drug experience. Yeah, I actually think that what is happening now in the Kraton market is exactly mirroring what is happening with cannabis, right? When we look a decade ago, we had THC concentrations that ranged from like maybe 5 to 12%, maybe 15 % in high quality cannabis products. And now we have concentrates or edibles that contain 40 % THC. So very different ballgame, very different amount that you can get into your body from sometimes ingesting much smaller amounts.

42:49So let's return to our listener, Chris. Here is part of what I think went wrong for him. The first time in your life you try a drug, whether it's your first cup of coffee or your first sip of wine, you probably have a conversation with somebody about what to expect and what the risks are. Chris did not have as full a conversation about Kratom as he might have wished he'd had before he dove in. But if he'd had that conversation, what we now know he might have learned is that Kratom is an opioid, but it's not particularly lethal. It can give you withdrawal symptoms you won't enjoy, but nothing like what you'd get from a prescription painkiller.

43:25And something to watch out for is that it comes from the gray market, which means the drug itself might be adulterated, or it might be getting more potent month by month. So all of these risky calculations could be changing. Of course, Chris really got in trouble not with Kratom, but with another drug he mistakenly thought was a kind of Kratom, T-neptine. And the story of T-neptine, what it is, how it got here, and how much fault lies with the country of France, those answers surprised me. Mon Dieu! We will continue our story after a short break.

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47:25Welcome back to the show. So what does the internet have to say about TNeptine, the drug that Chris had found after Kratom, which had caused him his real problems? The vibe on Reddit in the TNeptine community is much darker than it is in the Kratom subreddit. I saw someone asking the question many people have wondered after consuming some exciting new substance. Quote, How many days in a row can I take this before I get addicted? The top voted reply, Quote, I did research before I tried it, thinking I'd be able to control what many others couldn't. Nope. I was fully addicted after a couple of weeks.

48:02I ended my addiction at 6 to 10 bottles of TD Red a day. I spent$20 ,000. This is Reddit, of course. Anyone can say anything. They often do. But you do notice here, Many more vivid warnings than celebrations. Many addicted users cautioning new people from following them down the path. Okay, TNFT, gas station heroin. Let's talk about it. And it's similar over on TikTok. This shit right here is sold in gas stations. Can you believe that? What they're doing is they're selling it in gas stations and head shops under the name Tia Red or Zaza. A lot of times it's labeled as Zaza in the gas station. And people are becoming addicted to them.

48:45Zaza at the gas station. Do not start taking this stuff. If you do, you will regret it. We're going to return to Dr. Oliver Grunman with more questions. But for TNP, I wanted to start by speaking to a different kind of chemist, someone whose work I've been following for a long time. My name's Hamilton Morris. I'm a chemist. I have a podcast that's about chemistry and pharmacology on Patreon. I made a documentary series about psychoactive drugs called Hamilton's Pharmacopia for many years, which you can watch for free on my Vimeo channel or a lot of other places. And I'm generally very interested in the chemistry and pharmacology of psychoactive drugs.

49:32Dear listeners, I present to you Hamilton Morris. I've never spoken to him before, but I have listened to his hypnotically dry voice for maybe hundreds of hours. I've heard him use it to soberly and methodically describe what it's like to consume the venom of a psychedelic toad, to participate in an iboga ceremony, to observe a bunch of meth heads stumble through a meth cook in a kitchen while wearing, for some reason, fireman's helmets. He's seen a lot. T-Neptine was obscure to me, but I had a suspicion it'd be old hat to Hamilton Morris. What is T-Neptine? What is its chemical composition? Where does it come from?

50:09What is it? Yeah, so T-neptine is an unusual substance. It's not chemically related to any of the botanical opioids or to fentanyl. It's kind of its own chemical structural class. It's a tricyclic that is closer to a lot of antidepressants. And that is actually the area where it was developed. There's a French pharmaceutical company called Servier that was exploring these tricyclic antidepressant-type structures. And this pharmaceutical company, Servier, had a bad reputation already. They were the major supplier of fenfluramine in Europe, which is a very cardiotoxic and potentially neurotoxic diet drug.

50:55So, first of all, T-neptine is not a naturally occurring substance like kratom is. It was synthesized by a company called Servier. Servier's bad reputation partly comes from their role in France as a major supplier of fenfluramine, half of the drug fen-fen, the famously lethal diet drug. Servier, the company, was also convicted for deception and manslaughter in French court over a different diet drug, which killed approximately 2 ,000 people. Tieneptine's path to its current life as American gas station heroin, it starts with Servier. In the 1970s, Servier synthesized T-neptine and sold it as an antidepressant called Stablon.

51:34The drug made people feel euphoric in opioid-like ways. But for decades, the company insisted it was not an opioid. Into this swirling morass of uncertainty stepped Hamilton Morris. So the first time I tried T-neptine was probably around the first time that I tried metragenin, probably around 2009. and I had to order a box of pharmaceutical Stablon tablets from France. And I had a kind of similar... I just have to say, you're a mailman.

52:07These are both to this day legal and certainly legal then. No one had ever even heard of this stuff really outside of, you know, people were really interested in this at that point. And it was a widely used antidepressant. And crucially, at that time, nobody knew that it was an opioid. So I took it and I thought, wow, this stuff makes you feel pretty good. This is interesting. I get it. This is a great antidepressant, I wonder. And so I followed TN-Eptine with interest after trying it. And what I noticed was an increasing number of reports of people abusing it, using massive, massive quantities, taking hundreds of these 12.5 milligram tablets.

52:47And there were some posts on various forums and Reddit with people saying these things like, I used to use heroin, and I swear that this stuff feels just like heroin to me. My pupils are pinpoints. I get this euphoric nodding effect. I really wonder if this stuff is an opioid. To be clear, some users suspected that this French drug was an opioid because they had taken opioids before. But no one in the general public, or scientists, knew the actual mechanism this drug was using to have its effect. If Servier knew, they weren't telling people. And so people were taking a drug that may have been an opioid, but the official story for how it was working on its users was different.

53:35it. The mechanism that was considered the explanation for its effect was that it was a serotonin reuptake enhancer, not inhibitor. Oh, not inhibitor. Enhancer. I even wrote an article for Playboy years ago that described all of this. Like, gee whiz, isn't it strange that two drugs with diametrically opposed mechanisms, one that enhances serotonin reuptake and one that inhibits serotonin reuptake are both antidepressants. The brain sure is weird, right? Right. So there was something about this that was paradoxical. And then more and more people kept taking higher and higher doses. The evidence that it seemed to exert some kind of opioid type effect was continuously accumulating.

54:23Then there was a medical case report of somebody that had overdosed on TNP tablets, and their overdose was reversed with naloxone, Narcan, the opioid blocking medication. A strong indicator that this is an opioid. Yeah, so this was a kind of like, isn't that odd that this serotonin reuptake enhancer is blocked by an opioid blocker? Huh. Yeah. Like, what's the deal with that? So it was pretty clear that there was something going on, but no one had firmly established it. Finally, in 2017, a student at Columbia University figured out how to solve this chemical mystery. Hamilton told me that the student sent a sample of t-neptine to UNC Chapel Hill, which has something called the psychoactive drug screening program.

55:12Chemists there can take a drug, expose it to cloned human or rodent central nervous system receptors and actually tell you when this drug is put in your body, here are the receptors that it acts on. Since we know that we define an opioid not by its chemical structure, but by whether or not it interacts with our opioid receptors, this would be the definitive test to prove if t-neptine was in fact an opioid. And the answer was kind of the obvious answer that everybody expected, which is that it was a full agonist at the mu opioid receptor. A full agonist at the mu opioid receptor. A full agonist is a substance that binds to a receptor and fully activates it.

55:53Other full agonists at the mu opioid receptor? Oxycontin. Heroin. This drug was not as potent as them, but it was an opioid by anybody's definition. Some untold number of people had been taking an opioid without ever knowing it. And we know how we feel about opioids in this country. They are highly addictive substances that often kill their users. But the strange thing about T-neptine, an opioid, is that while it does seem to be a quite addictive substance, it doesn't seem to be as lethal as other drugs in its class. For reasons that aren't fully understood, there are opioids that don't cause profound respiratory depression, relatively speaking.

56:36And for that reason, they don't tend to cause fatal overdoses because that's the mechanism through which opioids exert their effect in terms of killing people is respiratory arrest. arrest. Few Americans' lives would be improved by the addition of an addictive opioid, but the question you'd hope the federal government might look into is whether those Americans who are already addicted to a lethal opioid might benefit from a less lethal one. I asked Hamilton about this. TNeptine, relative to heroin, if somebody were recreationally deciding to, for instance, like stop using heroin, TNeptine might be a good option for that person because they'd be replacing something that gave them a high that they found that they wanted or needed with one that would be less likely to kill them in an overdose?

57:29That would be my guess. Yeah. I mean, I wouldn't want to make that claim. I wouldn't say, hey, if you're struggling with opioid dependence issues, transition onto TNeptine. That's not something that I'm saying. But conceivably, that would work. And that's also one of the things that Kratom is very popular for, is getting off of opioids. Because when it comes to our methodology for treating opioid addiction in the United States, pretty much the name of the game is simply replacement therapy. That's it. If you go to a doctor and you say, I have a problem using heroin, they'll give you methadone or they'll give you buprenorphine, both of which are opioids.

58:15And the idea is just here is a safe, regular supply of an opioid that you can take every day that is considered to have a slightly lower abuse potential. But that's pretty much it. To me, what's interesting, and tell me if this analogy feels facile to you, it's like one way you could understand T-neptine is that it's almost similar to nicotine vaping, where the idea with nicotine vaping was, okay, for people who are addicted to cigarettes, this can be an off-ramp from cigarettes. But what also happened is that there were a lot of people who didn't smoke cigarettes, and nicotine vaping was an on-ramp.

58:49Like, instead of getting them off a drug to something less dangerous, it got them onto a drug. Like, is it possible that T-neptine could work the same way? Oh, certainly. Yeah, I think that's very much a possibility. One really important distinction that I want to make is that I think there is a huge difference between giving someone an opioid that they recognize is an opioid and providing something deceptively where they don't know what they are consuming. That is unacceptable. And unfortunately, it is incentivized by the existing legal framework. So if you were to say, hey, this is an opioid and it has this or that risks associated with its use and you should use it in the following way, that would potentially make it impossible to sell.

59:46Hamilton is pointing to a pretty extraordinary contradiction here. A policy problem I don't know how you'd begin to fix. Obviously, consumers should know what drugs they're taking. They should know that Kratom is a partial opioid agonist, that T-neptine is a full one. Ideally, the government would regulate the concentration and purity of these opioids. And yet, if everyone widely understood these drugs were opioids, it's very hard to imagine that they wouldn't be outright prohibited or severely restricted. Our listener Chris had wanted to know if other people were struggling with these drugs, and if the government was going to do anything about it.

1:00:25Some people are struggling with these drugs. Others say they're being helped by them. There are people who are addicted to more dangerous opioids who appreciate a less lethal substitute. That's the problem I don't know how to fix. Dr. Grunman seemed to think that T-neptine will likely end up as a prescription-only drug in America, just like in France. But kratom is tricky.

1:00:52There are people who feel that kratom is a medicine for them. A medicine that today they can access without having to rely on a healthcare system that may have gotten them addicted to lethal opioids in the first place. Looking at this situation, it's hard not to wish that we had some other tool. Some way to get these complicated substances to the people they'd help. some option beyond prohibition, prescription, or vape store free-for-all. I asked Dr. Grunman if he had any bright ideas. If you had to guess, like, given the research we have right now, I feel like a reasonable thing to say is that the best way to distribute these drugs is not in unknown quantities from unknown manufacturer at gas stations.

1:01:38what would not thinking about the political realities of life in america but given how people use them and what we know about the risks and benefits what would be the best way for these drugs to be distributed based on the available information yeah so i like the way you phrase that because it wouldn't fit in the current regulatory scheme or how this would ever be realize. But if you look, for example, at some of the ephedrine, pseudoephedrine products that were kind of pulled from the market in regards to just being over the counter. So you could just buy them from a pharmacy without any questions being asked, because we know that pseudoephedrine, ephedrine and the like products are being used in the manufacture of methamphetamine.

1:02:24And instead, they're now behind the counter and you can get a certain amount without requiring a prescription, but you still need to present some form of identification that has been done in all U.S. states by now. So I think that Kratom and or Tianeptin would qualify for something like that because then you need to interact with a pharmacist or a pharmacy technician that can ask you, do you have any underlying health conditions? Do you have a prior substance use disorder to kind of provide a little bit of counseling and a little bit of information and actually utilizing the pharmacist. I realize I'm advertising for pharmacists here because I'm with the College of Pharmacy and not just being pill counters because to be honest, pharmacists are a lot more and they can provide a lot more and they remain the most accessible healthcare professionals out there.

1:03:19If you want to go to a doctor, you need to make an appointment. If you need some help with figuring out, is this medication safe to take or is this substance safe to take, you can go into a pharmacy and there will be a pharmacist. Is that how it works in Europe? So I grew up in Germany and I trained as a pharmacist there. And yes, we don't necessarily have over-the-counter, although some medications are now available like Tylenol or so that you can buy in small amounts, small packages in a grocery store. But most of even what is considered over - the counter here in the U.S., is behind the counter.

1:03:57So either a pharmacy technician or pharmacist needs to grab it at least and put it on the counter for you in order for you to purchase it. In addition to that, we have certain supplements that are considered supplements here, St. John's Word, Ginkgo, that you can actually get as a prescription from your doctor and it is paid by your insurance, by your health insurance. So we do have a different system where we value more the expertise of pharmacists beyond their ability to count pills.

1:04:38Sometimes you ask a question and you get actually a pretty good answer. Empowering pharmacists to do more than we currently ask of them does not seem like a bad solution. Even if, for now, it does seem like, at least in America, an unlikely one. Oliver, thank you so much. I feel like I understand this much better than I did before we started talking. Certainly, my pleasure. Dr. Oliver Grunman, clinical professor at the University of Florida College of Pharmacy and president of the American College of Clinical Pharmacology.

1:05:30Search Engine is a presentation of Odyssey and Jigsaw Productions. It was created by me, BJ Vogt, and Shruthi Pinnemananey, and is produced by Garrett Graham and Noah John. Fact-checking this week by Holly Patton. Theme, original composition, and mixing by Armin Bazarian. Our executive producers are Jenna Weiss-Berman and Leah Reese-Dennis. Thank you to the team at Jigsaw, Alex Gibney, Rich Pirello, and John Schmidt, and to the team at Odyssey, J.D. Crowley, Rob Mirandi, Craig Cox, Eric Donnelly, Kate Rose, Matt Casey, Maura Curran, Josephina Francis, Kurt Courtney, and Hilary Schoff. Our agent is Oren Rosenbaum at UTA.

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