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Podcast Notes: Fentanyl: Actually As Dangerous As They Say
Podcast Overview Title: Stuff You Should Know Hosts: Josh and Chuck Episode Title: Fentanyl: Actually As Dangerous As They Say Description: The episode discusses the alarming rise of fentanyl-related overdoses in the U.S., its origins, and its impact on the opioid epidemic.
Key Concepts and Discussions
Introduction to Fentanyl
- Fentanyl, a synthetic opioid, has become the most deadly street drug in the U.S.
- Initially developed as a painkiller and intravenous anesthetic, it became accessible in the 1960s.
- Fentanyl is 100 times more potent than morphine and 50 times more potent than heroin.
Characteristics of Fentanyl
- Chemical Structure: Altered to increase fat solubility, allowing rapid crossing of the blood-brain barrier.
- Onset and Duration: Fast-acting with a short duration, leading to higher addiction rates as users may require more frequent doses.
The Opioid Epidemic Waves
- First Wave (1990s): Rise of prescription opioids like OxyContin leading to increased overdose deaths.
- Second Wave (2000s): Shift to heroin as prescriptions tightened, leading to a quadrupling of deaths.
- Third Wave (2013-present): Surge in fentanyl use and related overdoses, with 76,226 deaths attributed to fentanyl in 2022.
Statistics Highlighting the Crisis
- 90% of opioid overdose deaths in 2022 were due to fentanyl.
- Death rates from fentanyl have drastically increased, with 25 per 100,000 people dying from overdose in 2022.
Public Health Impact
- Fentanyl's prevalence has significantly reduced U.S. life expectancy, contributing to 3.1 million years of life lost in 2022.
- Overdose deaths correlate with socioeconomic factors; lower social capital is associated with higher death rates.
Myths and Misconceptions
- Touching Fentanyl: It's a myth that touching or inhaling fentanyl can lead to overdose; the nocebo effect plays a role in panic responses.
- Illegal Immigration: A common misconception links fentanyl smuggling to illegal immigration; most fentanyl is smuggled by U.S. citizens at legal entry points.
Harm Reduction Strategies
- Testing Strips: Allow users to detect the presence of fentanyl in drugs, though they do not indicate the quantity.
- Narcan (Naloxone): A life-saving medication that can reverse opioid overdoses, becoming more widely available.
- Supervised Consumption Sites: Provide a safer environment for drug use, reducing the likelihood of fatal overdoses.
Future Trends and Hope
- Reports suggest a potential 15-20% decrease in fentanyl deaths in upcoming years due to increased awareness, harm reduction methods, and shifts in user behavior.
- Younger generations may be less inclined to use drugs due to the dangers associated with fentanyl.
Conclusion The episode emphasizes the complexity of the fentanyl crisis, intertwining public health, socioeconomic factors, and the urgent need for harm reduction approaches. Education and access to resources like Narcan and testing strips are pivotal in addressing the epidemic.
Key Takeaways
- Fentanyl's extreme potency and rapid onset significantly increase overdose risk.
- Public health initiatives are recognizing the crisis as a health issue rather than solely a criminal one.
- The importance of harm reduction strategies is critical in preventing further overdose deaths.
- Understanding the myths surrounding fentanyl can help reduce stigma and improve response strategies.
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Transcript
Automatic transcript. May contain errors.0:00This is an iHeart Podcast. Guaranteed Human.
0:31on the iHeartRadio app or wherever you get your podcasts.
1:01P, aka Neuro Linguistic Programming. Is it a self-help miracle, a shady hypnosis scam, or both? Listen to Mind Games on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts, starting January 20th. Welcome to Stuff You Should Know, a production of iHeartRadio.
1:28Hey and welcome to the podcast. I'm Josh and there's Chuck and Jerry's here too. And this is Stuff You Should Know, the Big Bummer Edition. 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. 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.
2:10And 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 a kind of a combo hybrid between synthetic and natural. And then fentanyl is just straight up, like 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. Yeah, like 100 times more potent than morphine, 50 times more potent than heroin, created by a gentleman named Paul Janssen of the Janssen Company in Belgium.
2:55And it was originally developed as an intravenous anesthetic, like for surgery. and they started out with a synthetic opioid as the base called meparidine, I guess. And that was developed in the 1930s. And so they had this sort of meparidine 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, you know, initially worked great. It was had a very fast onset, had a very high therapeutic index, which is how they measure like the ratio between how effective a dose is and how how you could get to a toxic dose.
3:45So if you've got a high number and a greater difference, then that's good. Right. And one of the things I just want to say that they messed around with molecularly to make fentanyl, they increased its fat solubility, which sounds like who cares? But that has two really important effects that make fentanyl what it is. One, it allows the drug to cross the blood-brain barrier faster, which means fentanyl has a much faster onset than heroin or morphine, right? It just hits you much faster. and then it crosses back through the blood-brain barrier more quickly. So the duration of the high that you get lasts a shorter time.
4:26So just that one little tweak, fat solubility, made this drug what it is because faster onset makes it addictive. Shorter duration means that you need to do more. Yeah, and then I don't think I mentioned, but it was 1960 was when it first came on the scene. And Europe started using it in 63, came to the U.S. 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, you know, cheaper generic versions available.
5:13And it was pretty commonly used in surgery and like post-surgical recovery with like skin patches and lozenges and stuff like that for pain management. 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. It means that's why it's just so deadly because you're not a trained anesthesiologist.
5:58You're not using hospital-grade equipment. You're shooting up something that some dude sold you. And it's just not trustworthy and it can kill you because it takes such a small amount to create a toxic dose. Yeah, it will produce relaxation feelings, pleasure, sleepiness. You can also get nauseous, dizziness, confusion, vomiting, uretary retention, breathing issues, as we'll see later on. That's basically why you usually OD. It's 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.
6:39For all these reasons, it's a Schedule II narcotic with a high potential for abuse. Just a reminder, marijuana is Schedule I. Yeah, exactly. And most of what we're going to be talking about is sort of the illegal, illicitly produced market. it. But there are fentanyl users that do get like the real stuff from, I'm not sure how they get it, whatever connection they have. And they'll just have to, you know, it's not like in a pill or a powder. So it'll be like a patch or something that they might freeze and hold in their mouth, or they might remove the gel and then eat it or inject it or something like that.
7:16But 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. 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.
7:54And I think it's something like 10 ,000 times more potent than morphine. You can get that on the street, apparently, although I think it's fairly rare. And then sous-fentanil is five to 10 times stronger than fentanyl. So if you like people aren't like, yeah, it's carfentanil or sous-fentanil, you're talking about fentanyl. Yeah, exactly. It doesn't necessarily mean it's the same exact chemical structure. It's just sort of a catch-all, like pit bull. Sure The singer? No, no, no Pitbull the dog breed Which isn't really a dog breed I didn't know that Yeah, there's all kinds of terriers That people just call pitbulls 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?
8:48Yeah. 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. 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 U.S. It'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.
9:29But that's also 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 got to change your formula. It's like this stuff is way too readily abused. So you got to do something. Yeah. And this is really well portrayed in the limited series Dope Sick. I can't remember if it's on HBO. I want to say you saw it, right? No, I didn't see that. Oh, man. It is really good. But it's about the Sackler family and Purdue Pharma essentially purposely hooking America on OxyContin.
10:14Yeah. And it's a really good series. that just punches you in the gut, but it's really well done. And it covers all that period. The problem was, and this is covered a little bit too toward the end, when you take people's OxyContin away and they're hooked on OxyContin, an opioid, they're going to, a lot of them are at least, turn to whatever opioids are available. And that meant that a lot of people who otherwise would have never tried heroin took up heroin because they couldn't get OxyContin anymore. Yeah, and that was the second wave and fatal overdoses of heroin because of that largely quadrupled between 2002 and 2013.
10:57uh 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 uh fentanyl and all the various harmful ways it can find your way uh into your body even sometimes even if you don't want to be taking fentanyl so yeah so um that third wave the fentanyl opioid death wave or fentanyl driven wave, that vastly outstrips the death rate from the first two waves. 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.
11:45That 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 100 ,000 people in the United States that were dying of overdose deaths from fentanyl. Yeah. In 2022, deaths from fentanyl alone were 76 ,226 people or 69 percent of total overdose deaths and 90 % of the opioid overdose deaths. Yeah. Apparently. So it was the problem. For sure. And apparently I was like, well, what else is anybody ODing on? It seems that meth has created a new epidemic of overdose deaths that everybody's like, what the hell's going on? Yeah.
12:32Well, fentanyl has hit such a high that it's actually had a real impact on U.S. life expectancy. It takes a lot to change a number like that. But fentanyl seems to have done it. In 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, you know, a lot of middle-aged 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.
13:20That's not how it's supposed to work. That's just not how it has worked unless the United States is at war, essentially. Yeah. And, you know, we're talking a lot about the U.S., but the U.K. and Europe, sorry, U.K., tracks fairly closely, although the numbers are lower. It seems to be following like a similar pattern. Although I think in some countries, I think Estonia is one of them. Like you can't even get heroin anymore. Everybody's just doing fentanyl. 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.
14:00And 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. 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.
14:36But when fentanyl came on the scene, yeah, people stopped using it as much, but their deaths just increased. which if you look at it from just an outside perspective, like it's just because it's so potent and it was rolled out or introduced to the drug supply in a really horrific way, as we'll see. 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.
15:21A 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 U.S. 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. Yes. So social capital is basically the size of your local Kiwanis chapter. I knew you'd get a joke in there. So, yeah, this is I mean, like this whole thing kind of rose in lockstep. Opioid overdose deaths rose in lockstep with these financial crisis that the U.S.
16:02found 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 you can kind of connect those two things. Should we take a break? Yeah. All right, we're going to take a break, and we're going to talk about the rise of fentanyl right after this.
16:56New year, new goals, and in this economy, a better money plan is more necessary than ever. I am Matt. And I'm Joel. We are from the How to Money podcast, and every week we help you to spend smarter, save more, and make sense of what's going on out there. If you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, Kyle. Could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link.
17:30Thanks. Hey, just finished drawing up that quick one-page business plan for you. Here's the link. But there was no link. There was no business plan. It's not his fault. I hadn't programmed Kyle to be able to do that yet. My name is Evan Ratliff. I decided to create Kyle, my AI co-founder, after hearing a lot of stuff like this from OpenAI CEO Sam Altman. There's this betting pool for the first year that there's a one-person billion-dollar company, which would have been unimaginable without AI, and now will happen. I got to thinking, could I be that one person? I'd made AI agents before for my award-winning podcast, Shell Game.
18:05This season on Shell Game, I'm trying to build a real company with a real product run by fake people. Oh, hey, Evan. Good to have you join us. I found some really interesting data on adoption rates for AI agents in small to medium businesses. Listen to Shell Game on the iHeartRadio app or wherever you get your podcasts. lines and times with spencer graves on the iheart radio app is a podcast designed for hunters and fishermen to enjoy success i like the idea of like hey put me on a big deer you know hey there's a big deer out here he's doing this be looking for this deer but i also love doing it on my own i love going out there and saying running my cameras i love patterning the deer i like showing up at the right time, checking the wind, knowing what stand I need to be in, and then whenever it all comes together and it happens, that's the most satisfying thing ever.
18:58So when you do it on your own, it's like, I then can hang my hat. But if I had somebody say, hey, pull up on these dots and catch them right here, and you're going to win, and then when I go in, it's like, yeah, that's cool. I won the tournament. The ultimate goal is done. But it's like, dude, when you find them and you make them right, that's the puzzle. I love it. Listen to Lines and Tines with Spencer Graves on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
19:41So 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.
20:16And they're basically saying fentanyl is basically the same deal. 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.
20:55And 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 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.
21:43Yeah. It's not like, hey, we're making the drugs cheaper now, so we're just going to give you a break on this. There was one study that found between 2013 and 2021 the percentage of heroin that had fentanyl rose from less than 1 % to 40 % over, what is that, eight years. and of course that's going to lead to a huge number of overdoses because a you've got these batches that are coming out that the you know the potency is got a pretty dramatic range from one batch to another sometimes yeah and then people at you know for a long time i think you know the word is finally out now and we're going to talk about that a little bit later but uh people that were heroin users thought they were getting heroin and knew how much heroin to take safely 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.
22:39But 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.
23:13That'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. Yeah. And by the way, when I said safely do heroin, I hope I'm clear that doing heroin is never safe. I just meant heroin users would know how much they can take without overdosing. Right. Yeah. Okay. I just want to make sure people knew what I was talking about there. I think that was worth mentioning. Yeah. Okay. Good. So the other problems with fentanyl is that it has a really intense rush when it's first used.
23:54Apparently, it's more of a head rush than a body rush. So it can be a little more, you can be a little more active as a user than maybe doing heroin and just like passing out on your couch for hours and hours. It's also dangerous because the high is only an hour or two. So, you know, the heroin high lasts longer. So that short duration is going to, you know, have people using more frequently. And every time you use fentanyl, it's just another chance to overdose, basically. 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. Yeah, I mean, it can happen.
24:29Like a fentanyl overdose can happen in seconds, right? 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. Yeah, it certainly can be. Another thing that makes it more deadly is that people started changing how they used it.
25:02Among people who died from illegal fentanyl overdoses, the portion who injected dropped 42 percent over just a two year period between 2020 and 2022. And they generally started smoking it. That jumped at 79 percent. 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. Yeah, because that's a big barrier for a lot of people who are like, I like drugs, but I'm not going to stick a needle in my arm.
25:45That just seems like such a horrible road to go down that it will give people second thoughts. But smoking something, geez, I like marijuana. I like smoking crack. I might as well try smoking fentanyl. It's just much less of a barrier to overcome. Yeah, and if you're smoking it or snorting it, it doesn't stay in your body as long as if you shoot it. So, again, just another case of it wears off quicker and you're going to want to use it again. And that's just another overdose opportunity. Yes. Yeah. I mean, it's crazy if you think about it, because most other drugs that you smoke, you could conceivably overdose on.
26:20But 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. it yeah and you know we're talking about smoking it and snorting it and uh like powder in a bag kind of stuff but the real um 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 u.s 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 or they look like something else.
26:59You 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. 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 weren't a fentanyl user and you just wanted an OxyContin, that's how you could die of an overdose fairly quickly.
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27:46And 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. Yeah, for sure. Or if you say you want to use some cocaine, you're like, hey, that's my thing. Do it every now and then on a Saturday night. I'm going to get some of that stuff for the same reasons. Heroin is cut with fentanyl. Cocaine can be as well. So that's not even the same kind of high. You're looking for cocaine. you may never in your life have taken anything like morphine or heroin. And all of a sudden you're snorting fentanyl without knowing it and you're on the floor.
28:23Yeah. Just a reminder, speedballs are what killed not just John Belushi, but Chris Farley as well. And apparently this is that fourth wave that we were talking about of speedball and fentanyl with cocaine or with meth. And it's not just where dealers are cutting it and not telling their buyers. like buyers are seeking this out and apparently this fourth wave has kind of caught um black americans up into it more than the other previous waves have oh really yeah all right well uh i guess we can talk a little bit about where it comes from a lot of it that smuggled into the u.s 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, you know, made it very easy to ship.
29:21But then they also turned to the black market to ship directly to customers in the U.S. and Europe. Or, hey, let's ship the stuff over to Mexico in these cartels and they can just kind of put it together there and work as the distributor for us. 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. 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.
30:02And then that stuff goes back to the cartels to smuggle across the border and sell. Yeah. Another, you know, myth we can kind of bust here as far as where it comes from is that in 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 percent of Americans believe that most fentanyl entering the country was being smuggled by illegal immigrants, basically. And that's not true. The truth is, is that most of this drug comes through legal points of entry. And when it does, it is smuggled in in vehicles driven by U.S.
30:48citizens. Yeah, most often American women. And I think the Cato Institute did a study where they found 86.3 percent of convicted fentanyl smugglers are American citizens. So that seems to be totally untrue. Yeah. But apparently, I think this is a measure of 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. And for that, I'm sorry.
31:30The 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 U.S. 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. Because 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.
32:15I think that says just about everything you need to know about fentanyl. Yeah, for sure. Should we take another break? All right. We'll be back and talk about punishment and harm reduction right after this.
32:42New year, new goals. And in this economy, a better money plan is more necessary than ever. I am Matt. And I'm Joel. We are from the How to Money podcast, and every week we help you to spend smarter, save more, and make sense of what's going on out there. If you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, Kyle. Could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link.
33:16Thanks. Hey, just finished drawing up that quick one-page business plan for you. Here's the link. But there was no link. There was no business plan. It's not his fault. I hadn't programmed Kyle to be able to do that yet. My name is Evan Ratliff. I decided to create Kyle, my AI co-founder, after hearing a lot of stuff like this from OpenAI CEO Sam Altman. There's this betting pool for the first year that there's a one-person billion-dollar company, which would have been unimaginable without AI, and now will happen. I got to thinking, could I be that one person? I'd made AI agents before for my award-winning podcast, Shell Game.
33:51This season on Shell Game, I'm trying to build a real company with a real product run by fake people. Oh, hey, Evan. Good to have you join us. I found some really interesting data on adoption rates for AI agents in small to medium businesses. Listen to Shell Game on the iHeartRadio app or wherever you get your podcasts. lines and times with spencer graves on the iheart radio app is a podcast designed for hunters and fishermen to enjoy success i like the idea of like hey put me on the big deer you know hey there's a big deer out here he's doing this be looking for this deer but i also love doing it on my own i love going out there and saying running my cameras i love patterning the deer i I like showing up at the right time, checking the wind, knowing what stand I need to be in.
34:39And then whenever it all comes together and it happens, that's the most satisfying thing ever. So when you do it on your own, it's like I then can hang my hat. But if I had somebody say, hey, pull up on these dots and catch them right here and you're going to win. And then when I go in, it's like, yeah, that's cool. I won the tournament. The ultimate goal is done. But it's like, dude, when you find them and you make them right, that's the puzzle. I love it. Listen to Lines and Tines with Spencer Graves on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
35:29so 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 as much a public health crisis, probably more a public health crisis than a crisis to be addressed by law enforcement.
36:09And 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. 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. No, you were just morally reprehensible and your kid was probably screwed up. 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.
36:51And now we're focusing, we're trying to focus on harm, what's called harm reduction techniques, basically trying to keep people from dying. A bunch of different things have been tried and a lot of it has been fairly effective as we're seeing, like the numbers going down in overdoses. But distributing test strips. So if you buy a pill or if you buy cocaine or something and you have a test strip, you can test to see if that drug has fentanyl before you use it. Or maybe your dealer even offers that service. That's really something. 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.
37:33I 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. 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.
38:07Like, 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. Yeah. I mean, these newer generations may demand return policy. 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.
38:47But 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. 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? Eeny, meeny, miny, moe. Okay, there you go. The age old. The traditional way. Exactly. But I did mention Narcan, and that is the brand name for Nalaxone, and that can reverse an overdose. And I have only one anecdotal example.
39:30I 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 cross street neighbor is a nurse. She called 911 immediately. They showed up with Narcan and dude, they injected that. And this girl was walking around and like saying, can I get, can we leave now? Like minutes later. Wow. Yeah. I mean, it just reverses an overdose, right? Yeah, but I mean, I don't know what happens after that.
40:09All I saw was this snapshot where she was like, I want to get out of here. And I don't know what 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, OK, I guess you can go. Yeah, I don't know the law in Georgia or anywhere, really. But yeah. Those laws are called something. What is it? Good Samaritan laws. OK, yeah, I guess that's it. 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.
40:44I 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. Yeah. And I didn't look this up, but can't you just buy Narcan? Yeah. It's getting much more widely available. OK. 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.
41:24And 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 an opioid stupor, even that. But if they don't respond, then you need to call 911 and or administer naloxone. Yeah. I mean, in the brainstem, 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.
42:09Like it's that simple. 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? Yeah. So basically, if you want to take that deep breath, if you sense like you're in trouble, like, oh, man, I got to get a big breath of air here.
42:47You just do that normally. But little small increases in CO2 are sensed in the carotid body. It's a little small cluster of sails in the neck. They're going to spur that increase in breathing to remove that excess CO2. But if that's not working and that emergency sort of failsafe is switched off, then again, you can't even get that big breath to save yourself. Yeah. So breathing, I think you said early on that that typically is where fatal overdose is derived from. 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.
43:24Another famous one with opioids is your gag reflex is suppressed. So if you're basically nodded 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 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. I was waiting to see if you were going to come up with like a fourth way to say puking. Did I say a bunch of different ways? You said like three. You like spit it up or vomit it up or choke it.
44:00Yak it up. I was like, we get it. Blow chunks it up. 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? Buprenorphine. 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've got to wait in line a lot of times. You've got to do it there. The other one, I believe, is given in the form, or I guess the brand name, Suboxone.
44:40and 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. 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, 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.
45:23So 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. Yeah. 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. Yeah. That's no way to kick. No. And the problem with it too is not just like, 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.
46:09And 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. Yeah. 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 can overdose you. Apparently, that came from a 2016 USDA advisory to claim that was possible. But this is sort of annoying because it's not, you know, generally absorbed through the skin.
46:54They have those transdermal patches, but it's not like helping someone or 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. 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.
47:37And it's, they're like, I just had, I just OD'd on fentanyl just from touching a little bit of it. That's the best explanation. It makes sense. The point is, is like you like interacting with somebody who's OD'd on fentanyl isn't going to give you a fentanyl higher overdose.
48:23Yeah, for sure. 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. I'm not saying they don't count, but it's the cost of housing. Yeah. It's crazy. Look at all the morality we associate with drugs. Like it's brought in by illegal immigrants. It's drug users accidentally create overdoses and first responders and paramedics trying to help them. It's the reason for homelessness. Like it's all there's all moral judgments associated with all of those things.
49:06Yeah. And you associate it with the drug. And anybody who doesn't do that drug and loves first responders, doesn't like illegal immigrants and doesn't like homeless people is going to hate that drug from that point on. Yeah, the drug that was okayed by the FDA and that, you know, wealthy pharmaceutical families in this country got rich off of. Yeah, well, let's just say, again, fentanyl is perfectly safe in like a medical setting in the hands of a trained professional. It's just outside of that. When cartels become involved, then it becomes a huge problem. But I said at the outset, there is a silver lining or at least some hope because the use is, well, first of all, opioid deaths are declining.
49:46I 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 percent drop in overdose deaths from fentanyl. And they say, OK, well, Chuck, why? Why are these fentanyl deaths finally subsiding? What's the deal? 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.
50:32one 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 yeah there was yeah you were saying that like younger generations might have been scared away from it Yeah, that's another reason. 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.
51:19And I was like, I wonder what that is compared to Gen X back when we were in high school. Oh, my God. And I was like, this is going to 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. Or Gen X is the generation of liars. That's entirely possible, too. Are you a narc, man? 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.
52:03I wonder if it really is. There is it's just a lot more prevalence of drug use because it's so easy to get it on the Internet. And it used to be hard back when we were in high school for people who did drugs in high school. Well, I mean, there's definitely improved international cooperation between the United States and other countries just to reduce the supply. The U.S. 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 percent.
52:45So that's pretty good. Yeah. I mean, that's pretty significant. What else? I got nothing else. 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 whatever help you can find to get off of it. And if you haven't tried it yet, probably you shouldn't start. Yeah, I'd say not even probably. I'd say definitely don't. Okay. Well, since Chuck corrected me from probably to definitely, as was foretold in 2008, he has just triggered listener mail.
53:22All right, this is another two-parter on disaster movies, because we heard from two African-American listeners, because I specifically asked, like, how mad are you about the fact that black people get killed in movies 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 an avid movie watcher, the new thing is the black person often dies in sacrifice of something or someone else.
53:59So 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 of 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.
54:34But 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. Awesome. Thanks, Kevin and Serena. That reminds me of a point I wanted to make that I didn't have a chance to. In Earthquake, Richard Roundtree, a.k.a.
55:10Shaft. He was in that. He made it to the end. And he was also one of the heroes helping save Genevieve Bujol. Am I saying your name correctly? I don't know, but I know that Richard Roundtree is almost always the hero. 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. Yeah. Nice work. Nice work, Richard Roundtree. And if you want to be like Kevin and Serena and want to share your thoughts with us, we love that kind of thing. you can send us an email to stuffpodcasts at iheartradio.com. Stuff You Should Know is a production of iHeart Radio.
55:50For more podcasts from iHeart Radio, visit the iHeart Radio app. Apple Podcasts are wherever you listen to your favorite shows.
56:03Hi, Kyle. Could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link. Thanks. Hey, just finished drawing up that quick one-page business plan for you. Here's the link. But there was no link. There was no business plan. I hadn't programmed Kyle to be able to do that yet. I'm Evan Ratliff here with a story of entrepreneurship in the AI age. Listen as I attempt to build a real startup run by fake people. Check out the second season of my podcast, Shell Game, on the iHeartRadio app or wherever you get your podcasts. What if mind control is real?
56:36If you could control the behavior of anybody around you, what kind of life would you have? Can you hypnotically persuade someone to buy a car? When you look at your car, you're going to become overwhelmed with such good feelings. Can you hypnotize someone into sleeping with you? I gave her some suggestions to be sexually aroused. Can you get someone to join your cult? NLP was used on me to access my subconscious. Mind Games, a new podcast exploring NLP, a.k.a. neurolinguistic programming. Is it a self-help miracle, a shady hypnosis scam, or both? Listen to Mind Games on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
57:13Starting January 20th. And the winner of the iHeart Podcast Award is... You can decide who takes home the 2026 iHeart Podcast Awards Podcast of the Year by voting at iHeartPodcastAwards.com now through February 22nd. See all the nominees and place your vote at iHeartPodcastAwards.com. Audible is a proud sponsor of the Audible Audio Pioneer Award. Explore the best selection of audiobooks, podcasts, and originals all in one easy app, Audible. There's more to imagine when you listen. Sign up for a free trial at audible.com. This is an iHeart Podcast. Guaranteed human.
From the publisher
Around 2013 heroin users in the US and other countries suddenly started dying from overdose in previously-unseen numbers. The culprit turned out to be the incredibly potent drug fentanyl and it soon created a massive new wave in the opioid epidemic.
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