Welcome to Stuff You Should Know, a production of iHeartRadio.
Hey, and welcome to the podcast. I'm Josh, and there's Chuck and Jerry's here too, and this is Stuff you Should Know, the Big Bummer Edition.
Yeah, not very joky, because we're talking about fentanyl.
And.
While a great pain killer, 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's 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 one hundred percent
processed natural opium. Heroin is a kind of a combo hybrid between synthetic and natural, and then fentanyl is just straight up like a like it just made up. It's an analog and it's way more potent than anything anyone had ever seen before when it came on the scene.
Yeah, like a hundred times more potent than morphine, fifty times more potent than heroin. Created by a gentleman named Paul Janson of the Jansen Company in Belgium, and it was originally developed as an intravenous anesthetic, like for surgery. And they started out with a synthetic opioid as the base called my paradine I guess, and that was developed in the nineteen thirties. And so they had this sort
of my paradiine as the base. They change it around a little, I'll alter the chemical structure a little bit, because what they wanted was something that had fewer negative side effects, something that was safer to use, 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. So 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 fetanyl 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 fast, 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 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've mentioned, but it was nineteen sixty was when it first came on the scene. Europe starting using it in sixty three. Came to the US in sixty eight and approved by the FDA only by combining it with a tranquilizing drug called draperidol, because they said, you know that combination makes it even a lower potential for abuse, so you have to use it
with that. But over time, that kind of waned, and those limitations were lifted little by little until we got to the mid nineteen eighties when they had, you know, cheaper generic versions available, and it was pretty commonly used in surgery, 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 great equipment, it's actually very safe. It's the fact that the stuff that you buy in 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 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, uritary retention, breathing issues, as we'll see later on. That's you know, 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. For all these reasons. It's a schedule two narcotic with a high potential for abuse.
Just a reminder marijuana's Schedule one.
Yeah, exactly. And most of what we're going to be talking about is sort of the illegal, illicitly produced market. But there are fentanyl users that do get like the real stuff from I'm not sure how they get it, whatever connection they have, and they'll just have to you know, it's not like 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.
Yes, and there's different kinds of 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 as car fetanyl, 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 ten thousand times more potent than morphine. You can get that on the street apparently, although I think it's fairly rare. And then sue feentanyl is five to ten times stronger than fentanyl. So if you like people aren't like it's car fetanyl or sue fentanyl, 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 pitbull, 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 in 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 fetanyl and cocaine mixed together, and or fetanyl 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 that'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 US that's been going on for you know, ten fifteen years. The first wave was in the nineties, 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 ninety nine
and twenty ten. And twenty ten 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 formulas, Like this stuff is way too readily abuse, 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 was on HBO. I want to say you saw it right now.
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 oxy contin. Yeah, 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 this is covered a little bit too towards the end.
When you take people's OxyContin away and they're hooked on OxyContin and 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.
Yeah, and that was the second wave, and fatal overdoses of heroin because of that largely quadruple between twenty two and twenty thirteen. The third wave is the one we're kind of mainly going to be talking about that started in about twenty thirteen and mainly centers around illegally illicitly produced fentanyl and all the various harmful ways that can find your way into your body, even sometimes even if you don't want to be taking fentanyl.
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.
Yeah.
So I think in nineteen ninety nine, so this is when people are starting to take opioid prescriptions, there were two opioid overdose deaths per one hundred thousand people in the United States. Yeah, that was nineteen ninety nine. Twenty thirteen, the second wave is going on, that was up to eight. By twenty twenty two, when the third wave is in full swing, it was twenty five people per one hundred thousand people in the United States that were dying of overdose deaths from fentanyl.
Yeah. In twenty twenty two, deaths from fentanyl alone were seventy six two hundred and twenty six people, or sixty nine percent of total overdose deaths and ninety percent of the opioid overdose deaths.
Yeah.
Apparently it was the problem.
For sure, And apparently I was like, well, what else is anybody oding on? And it seems that meth has created a new epidemic of overdose deaths that everybody's like, what the hell's going on?
Yeah, well, Fintanel 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 Fintanel seems to have done it. And twenty twenty two only opioid related deaths resulted in three point one million years of lost life because a lot of these users are young. And if you ode it twenty two, they calculate the average lifespan and do the subtraction and that's
your number. So that you know, 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. Yes, that'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 US, but the UK and Europe sorry, UK 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 fatanmol. Yeah.
Well, here's the deal though, is researchers have looked at these numbers. I think they declared this a public health emergency in twenty seventeen, and what they're finding is, and this has been coroberated 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. But when fentanyl came on the scene, yeah, people stopped using it as much, but their deaths just increased, which if you look at it from just an outside perspective, like it's just because it's so potent and it was rolled out or introduced to the drug supply in a really horrific way, as we'll see.
Yeah, for sure. It also sort of goes in lockstep with the income disparity in the United States and the client 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 twenty seventeen they study counties in the US and found that those with the lowest social capital, meaning networks that can help people, you know, with financial security and achieving goals, they had the highest rate of overdose.
Yes, so social capital is basically the size of your local Kowanas chapter.
I knew you'd get a joke in theres.
So yeah, this is I mean, like this whole thing kind of rose and lockstep. Opioid overdose sets rose and lockstep with these financial crisis that the US found itself in over and over again since two thousand and eight.
Job loss, aws of manufacturing jobs just all of the hardship that the United States has gone through since then, opioid debts 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.
Should we take a break? Yeah, all right, we're gonna take a break, and we're gonna talk about the rise of fentanyl right after this. It's stuffish. 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 nineteen eighty six 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 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 and our bathtubs and moonshine out in the woods, and the rise of crack in the nineteen eighties the same thing, and 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. 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 twenty twenty that basically wanted to find out why was fentanyl introduced. Was it users who are like, Hey, heroin's great,
but we need something way deadlier? Was it dealers who are 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.
Yeah, it's not like, hey, this, we're making the drugs cheaper now, so we're just going to give you a break this. There was one study that found between twenty thirteen and twenty twenty one, the percentage of heroin that had fentanyl rows from less than one percent to forty percent over what is that eight years? And of course it's going to lead to a huge number of overdoses because a you've got these batches that are coming out that the you know, the potency has got a pretty
dramatic range from one batch to another sometimes. Yeah, 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.
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 a 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 some prize. The fact that it was duplicitous is just awful because it's like, hey, good luck getting acclimated
to this there. It's gonna 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, it 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.
Yeah, and by the way, when I said safely do heroin, I'm hope unclear than that there's doing heroin is never safe. I just met heroin users would know how much they can take without overdosing, right, yeah, okay, I just wanted to make sure people do what I was.
I think that was worth mentioning.
Yeah, okay, good. So the other you know, problems with ventanyl is that it has a really intense rush when it's first used. Apparently it's more of a head rush than a body rush, so it can be a little more you can be a little more active as a user than maybe doing heroin and just like passing out
on your couch for hours and hours. It's also dangerous because the high is only an hour or two, so uh, you know, heroin high lasts longer, so that short duration is gonna you know, have people using more frequently, and every time you use ventyl 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 like 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 frau through on my buddy's mouth. I better call nine one one because there's good Samaritan laws in my state. It's like, oh my buddy just injected fentanyl and now they're dead. I mean, it's it's not that fast necessarily, but compared to heroin, it is. And yeah, I think it's measured in like seconds.
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 forty two percent over just a two year period between twenty and twenty twenty two, and they generally started smoking it that jumped to seventy nine 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 gonna stick a needle in my arm. That just seems like such a 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 gonna 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. 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.
Yeah, And you know, we're talking about smoking it and snorting it and like powder and a bad 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 CAS's pills. I think by late twenty twenty one, more than a quarter of the fentanyl seized was in pill form, And a lot of these pills are they
look like something else. You hear stories on the news about a kid that did not want to take fentanyl, that thought they were taking something else and it ended up being either laced with fentanyl or largely fentanyl, and they overdose without even knowing they took it.
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 M thirty's, So it would be very easy for something to be like, oh cool, here's an OxyContin. Fentanyl users know what they're doing. But if you didn't, we're in a fentanyl user and you just wanted an oxy contin. 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.
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 ventyl. 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 heroine, and all of a sudden you're snorting fentanyl without knowing it and you're on the floor.
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 speedball in 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 black Americans up into it more than the other previous waves have.
Oh really, yeah, all right, Well, I guess we can
talk a little bit about where it comes from. A lot of it that smuggled into the US was originally made in China, but in twenty nineteen China said you cannot produce her sell fitting all anymore, and some people stop doing it, but a lot of manufacturers continued doing so, sometimes through Legit means that you 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 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.
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, so they just I guess we're interviewing some random ventanyl cook in Mexico. It was like three twenty 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.
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 twenty twenty two that found that forty percent of Americans believed that most ventanyl entering the country was being smuggled by illegal immigrants, basically,
and that's 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 a vehicle driven by US citizens.
Yeah, most often American women. And I think the Cato Institute did a study where they found eighty six point three percent 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 feentanyl. I'm making a pretty good assumption that you've never done fetanyl 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 because of the presence of fentanyl. I think that holds and I think this supports that thesis. In Cineloa, the Cineloa Cartel has a ban on selling
fentanyl in Sineloa punishable by death. So if you're a drug dealer in Cineloa and the Cineloa 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.
Yeah, for sure. Should we take another break? All right, We'll be back and talk about punishment and harm reduction right after this. It's stuff.
So one of the things that's a little different about the fentanyl epidemic is that it hasn't tracked closely or identically to pass drug epidemics, where like the crack epidemic or the cocaine epidemic, especially of like the nineties, where or the eighties or nineties, 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 of 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 ventanyl.
Well, let's say this. I don't remember anything growing up in the eighties 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, and now we're focusing. We're trying to focus on harm what's called harm reduction techniques, basically trying to keep people from dying. A bunch of different things have been tried, and a
lot of it has been fairly effective. As we're seeing like the numbers going down in overdoses, but distributing test strips. So if you buy a pill, or if you buy cocaine or something, and you have a test strip, you can test to see if that drug has ventanyl 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. 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.
Yeah. And I think that the test strips have helped a lot of people, if not save 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 one hundred 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 sized dose.
But if you're like I don't do fentanyl, those test trips are going to get 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 deal learn get your money back because it had fentanyl in it. Although who knows with kids these days.
Yeah, I mean that these newer generations may demand return restitution. So another thing that they can do is, you know, they're safe places where people can go use the drugs while people watch out for you. The drug users themselves seem to have wizened up a little bit because of all the news and probably seeing their friends die very sadly. But they may take, you know, dip their toe in the water a little bit at first and take a
smaller dose. Or they may if they're with a group that's using stagger the doses so people can be standing by with that narcan in case one of their friends passes out.
I wonder if, like you, they draw straws to see what order everybody does drugs in, Like, how do they how do they determine who's going to go last?
Any medium monuments? Okay, the age old the traditionally exactly, But I did mention Narcan and that is the brand name for naloxone or nelaxone, and that can redse reverse an overdose. And like, 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 Cross Street neighbors a nurse. She called nine one one. 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 do. 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.
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? Oh okay, 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. 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.
Yeah, and I didn't look this up, But can't you just buy a narcan?
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, 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 notes. 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 chests kind of hard, because it's a very uncomfortable thing to have done to you, and it can snap you out of a opioid stupor even that. But if they don't respond, then it's you need to call nine to one to one and or administered in the lockxown.
Yeah, I mean in the brain stem, there are a couple of regions, the medulla and the ponds, and they control the depth and rate of breathing. But both of those have a lot of opioid receptors. So if you do fentanyl and they attach to those receptors, which they will, they can change the behaviors of the cells such that they just stop working and you just literally just stop breathing, like it's that simple.
Yeah, And it's even worse than that, actually, because there's also opio 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 or repressed, and this thing that detects rises in CO two in your body that gets repressed as well.
Right, Yeah, So basically, if you want to take that deep breath, if you've since like you're in trouble, I'm like, oh man, I got to get a big breath of air here. You just do that normally, But little small increases in CO two are sensed, and thekarated body it's a little small cluster of sales in the neck. They're going to spur that increase in breathing to remove that
excess CEOs two. 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.
Yeah, So breathing, I think you said early on that typically is where fatal overdoses. 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 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 pukey?
Did I say a bunch of different ways?
You said, like three, you like spit it up or vomit it up or choke ers yeack it up.
I was like, we get it blow chunks it up.
Oh God. So as far as treatment goes, it kind of goes and locks up with what they do for heroin. It's called medication assisted treatment or MATT. That's kind of the gold standard. We're talking about either methadone or how do you say that, bupa norphine. 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 subox Owne, and I think you can you can get that prescribed. But a lot of people are like, hey, you know, go to drug rehab and just quit doing all this stuff because you're still on another drug. If you're going to a methadone clinic every day, 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. Yeah, which is pretty rich considering the 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 twenty twenty two that the CDC conducted where they said that of the three point seven percent of all adults in the United States who need medication assisted treatment, I think only about twenty five percent of that three point seven percent, we're 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 that's no.
Way to kick 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 twenty twenty. But your tolerance has dropped, and so your likelihoo of an overdose is through the roof compared to what it was before you kicked heroin the hard way or fatanyl.
The hard way. 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 trades amounts can overdose you. Apparently that came from a twenty sixteen US DEA advisory to claim that was possible. But this is sort of annoying because it's not you know, 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.
Right, But there's cases of like first responders in paramedics suffering from exposure two very small amounts of fentanyl and people are like, what the heck's going on. The best explanation is that it's it's what's called the 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 odd on fentanyl, just from touching a
little bit of it. Yeah, that's the best explanation. It makes sense. The point is is like, you like, interacting with somebody who's odd on fentanyl. Isn't going to give you a fentanyl high or overdose?
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 in the streets, it's all because of fentanyl. They're out they're they're homeless now they're in your neighborhoods. And this is because of this epidemic. I'm sure that has happened where people you know, can't pay their rent and on the street because of an addiction like that. Sometimes people turn to drugs after the
fact if they are in house. 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.
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, 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. Yeah,
and you're associated 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, it was okay by the FDA, and that you know, wealthy pharmaceutical families in this country's got rich off of Yeah.
Well, let's just say again, fentanyl is perfectly safe in like a medical setting in the hands of the trained professional. It's just outside of that when when cartels become involved and it's it becomes a huge problem. But I said, at the outset, there is a silver lining or at least some hope because they're the use is well. First
of all, opioid deaths are declining. I think they peaked in twenty twenty two with one hundred and eight thousand opioid overdose deaths in the United States, and the numbers aren't in for twenty twenty four, but they think the estimate is that it's going to be anywhere between a fifteen to twenty percent drop in overdose deaths from fentanyl. And they say, okay, well, Chuck, why why are these fentanyl deaths finally subsiding? What's the deal?
Yeah, I mean there could be. It's 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 MATT 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.
Yeah, there was. Yeah, you were saying that, like younger generations might have been scared away from it.
Yeah, that's another reason.
Yeah, apparently I thought you said that. So apparently gen Z is unlikely or less likely to use drugs. I think like sixty seven of twelfth graders said that they abstained from drugs, meaning that they hadn't taken any drugs in the last thirty days. And I was like, I wonder what that is compared to gen X back and when we were in high school.
Oh my god, And I.
Was like, this is this is gonna be crazy. It is crazy, but it's the opposite way you would think the I think I can't remember what US agency conducts this every year, but in nineteen ninety three, high school seniors said that eighty one point seven percent said that they had abstained from drugs in the last thirty days. So gen Z is on way more drugs than gen X was, which is very surprising to me.
Or gen X is a generation of liars.
That's entirely possible too, are you Narkman.
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.
I wonder if it really is there is it's just a lot more prevalence of drug use because it's so easy to get it on the internet, and it used to be hard back when we were in high school for people maybe 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. That US of 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 twenty twenty four. Last year, the Mountain of Fitnel crossing that border dropped by about twenty percent.
So 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 in your 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.
Yeah, i'd say not even probably, let's say definitely do.
Okay, Well, since Chuck corrected me from probably to definitely, as was foretold in two thousand and eight, he is just god listener.
Now, all right, there's another two part around 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 black people will rarely lead or survive to the end of those movies, as well as other genre movies like horror or romcom 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 socio economics 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.
Awesome, thanks Kevin and Serena. That reminds me of a point online to make that I didn't have a chance to in Earthquake. Richard Rowntree aka Shaft, he was in that. He made it to the end, and he was also one of the heroes helping save Jenna Vie. M my saying your name correctly.
I don't know, but I know that Richard Rowntree 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 Rowntree. 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 of the Stuff podcast at iHeartRadio dot com.
Stuff You Should Know is a production of iHeartRadio. For more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows,