Fentanyl: Actually As Dangerous As They Say | STUFF YOU SHOULD KNOW

Welcome to Stuff You Should Know, a. production of iHeart Radio. 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. jokey because we're talking about. fentinil. And uh while a 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 um taken place. So, it is on. the decline, at least deaths. Uh, and. we'll talk about possibly why that is. later on. But, yeah, we'll talk about. the origin of fentanyl. Uh, for those of.

you who don't know, it's a synthetic. opioid. Um, 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 a d 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, 50 times more potent than. heroin. Uh created by a gentleman named. Paul Jansen of the Jansen Company in. Belgium. And it was originally developed. as an intravenous anesthetic like for. surgery. And uh they started out with a. uh a synthetic opioid as the base called. uh mearadine maperadine I guess. And. that was developed in the 1930s. And so. they had this sort of uh meadine as the. base. They changed it around a little.

altered the chemical structure a little. bit because what they wanted um was. something that had fewer negative side. effects, something that was safer to. use. And they were able to do that with. with fentinil. I mean it 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 uh 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. Um, and one of the things I just want to say. that they messed around with molecularly. to make fentinel. Um, 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. bloodb 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 bloodb brain barrier more. quickly. So the duration of the high. that you get lasts a shorter time. So. that just that one little tweak fat. solubility made this this drug what it. is because faster onset makes it. addictive. Shorter duration means that. you need to do more. Yeah. And in I. don't think I've mentioned but it was. 1960 was when it first came on the. scene. uh Europe started using it in '. 63, came to the US in ' 68 and approved.

by the FDA uh only by combining it with. a tranquilizing drug called uh. Droparadol uh 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. mid1 1980s uh when they had you know. cheaper generic versions available and. it was pretty commonly used in in. surgery and like postsurgical recovery.

with like skin patches and lossenes and. stuff like that for pain management. Yeah, I think still today it's the most. common opioid used for anesthesia during. surgery. Um and it's that just sounds. like madness. when you're familiar with. fentanyl, the street version, but in the. hands of like a really well-trained um. anesthesiologist with hospital grade. equipment, it's it's actually very safe. It's the fact that the stuff that you.

buy on the street has a very uneven um. uh like dosages. It means that's why. it's just so deadly because you're not a. trained anesthesiologist. You're not. using hospital grade equipment. You're. shooting up something that some dude. sold you and it's just not it's just not. trustworthy and it can kill you because. it takes such a small amount to create a. toxic dose. Yeah. Uh it will produce um. relaxation feelings, pleasure, sleepiness. Uh you can also get.

nauseous, uh dizziness, confusion, vomiting, uritary retention, uh. breathing issues as we'll see later on. That's, you know, basically why you. usually OD uh is because of breathing. issues. And uh besides the overdose. risk, which is great, uh you could also. have a heart attack, heart failure, um. mood disorders, immune system problems. Uh for all these reasons, it's a. schedule two narcotic with a high. potential for abuse. Just a reminder, marijuana is schedule one. Yeah,

exactly. Um, and most of what we're. going to be talking about is sort of the. the illegal illicitly produced market. Um, but there are fentinil users that do. get like the real stuff from uh 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. Um and there's different kinds, different analoges of fentanyl um that. everybody just kind of puts under the. the umbrella of fentanyl when you're. talking about illicit fentanyl. But two. of them that stand out um that aren't. actually illicit, but they're used in. the drug market is uh carfettanyl, which.

is used, there's no use for it in. humans. They use it to sedate. rhinoceroses and elephants. And I think. it's something like 10,000 times more. potent than morphine. You can get that. on the street apparently, although I. think it's fairly rare. And then suentil. is five to 10 times stronger than. fentanyl. Um, so if you like people. aren't like it's carfentyl or. sufentanyl. You're talking about. fentanyl. Yeah, exactly. It doesn't. necessarily mean it's the same exact. chemical structure. Uh, it's just sort.

of a catchall like Pitbull. Sure. The 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 pit bulls. Um, well, speaking of 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. How? Yeah. So, apparently that's fentanyl and cocaine. uh mixed together and or fentanyl and. methamphetamine. Some sort of speed. That's a speed ball. 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. Uh well, speaking of waves, uh there have kind of. been three, and this is just sort of an. overview of the opioid addiction crisis. in the US that's been going on for, you. know, 10, 15 years. Uh the first wave.

was in the '9s, and that's when you got. prescription opioids uh from your your. doctor. uh those really rose. dramatically because they they do a. really good job. Uh but that's also, you. know, in lock step 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 um. readily abused. So, you got to do. something. Yeah. And this is really well portrayed. in the limited series Dopessick. I can't. remember if it was on HBO. I want to say. you saw it, right? I No, I didn't see. that. Oh, man. It is really good. But. it's about the Sackler family in Purdue. Pharma essentially purposely hooking. America on Oxycontton. Yeah. Um and it's. it's a really good series that just.

punches you in the gut, but it's really. well done. Um 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 Oxycontton away. and they're hooked on Oxycontton, 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 Oxycontton anymore. Yeah.

And that was the second wave and fatal. overdoses of uh heroin because of that. largely uh quadrupled between 2002 and. 2013. Uh 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 the. fentanyl opioid death wave or fentanyl. driven wave um that is that vastly. outstrips the death rate from the first. two waves. Yeah. So I think in. 1999, so this is when people are. starting to take opioid prescriptions, there were um two opioid overdose deaths. per 100,000 people in the United States. Yeah, that was 1999. 2013, the second.

wave is going on. Um 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 um were. 76,226 people uh or 69% of total. overdose deaths and 90% of the opioid.

overdose deaths. Yeah. Apparently, so it. was the problem for sure. And and. apparently I was like, well, what else. is anybody oding on? And I it seems that. meth has created a new epidemic of. overdose deaths that everybody's like, what the hell's going on? Yeah. Well, well, fentanel has hit such a high that. it's actually had a a real impact on US. life expectancy. Um, it takes a lot to change a number. like that. Uh, but fentanel seems to. have done it. in 2022 only um 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 you know calculate the average. lifespan and do the the subtraction and. that's your number. Uh so that you know. a lot of middle-aged uh white people. without a college degree are the. victims. Um, 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 in at war. essentially. Yeah. Um, and you know, we're talking a lot about the US, but. the UK and Europe, sorry, UK, um, tracks. fairly closely, although the numbers are. lower, um, that it seems to to be. following like a similar pattern, although I think in some countries, I. think Estonia is one of them, like they.

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. uh I think they declared this a. a public health emergency in 2017 and. what they're finding is and this has. been cooperated from other surveys and. you know metadata studies and stuff is. there aren't more overdose deaths. because more people are using it. Uh. it's it's not just like oh well more. people are doing it so more people are. dying. It it seems like it's because.

this stuff is more dangerous. is 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. the when fentanyl came on the scene, yeah, people stopped using it as much, but the their deaths just increased, which if you look at it from a um 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. Uh it also sort of goes. in lock step with the um income. disparity in the United States and the. decline in fortunes for a lot of people. in this country. Um overdosing is. basically what they call it is a a. disease of despair. Uh when people are. are um destitute and when they're down.

or depressed or having really hard times. um a lot of times drugs can be a. distraction or um if you are a casual. drug user it could get worse during that. time. Uh and they found in 2017 they. studied counties in the US uh 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 there. Thanks. So yeah, this is I mean like. this whole thing kind of rose in lock. step. O opioid overdose deaths rose in. lock step with just these financial. crisis that the US found itself in over. and over again since 2008. Um job loss, loss of manufacturing jobs, um just all. of the hardship that the United States. has gone through since then. Opioid. deaths kind of tracked with it,

especially at first. Um especially with. people basically more people turning to. that kind of thing um as a a disease of. despair. Um, which is just sad. It's. just nuts that that's that you can kind. of connect those two things. Yeah. Uh, should we take a break? Yeah. All right. We're going to take a break and we're. I'm going to talk about uh the rise of. fentanyl right after. [Music].

this. It's stuff you should know. [Music]. [Music]. So, one reason uh we've seen a surge in. overdoses uh 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 um that people like doing, something's going to come along and it's. probably going to be a stronger version. Uh 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 jin in our. bathtubs and moonshine out in the in the. woods." Uh and the rise of crack in the. 1980s, uh the same thing. And they're. basically saying fentinel 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 can um. generate just as much cash, which also. means it's easier to smuggle, too. And. like you said, fentanyl tracks exactly. the same way. Um 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. Um 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 um because the. potency is so much more there is a huge. um cost benefit. Apparently it just. occurs 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." Um, was it dealers who were. like, "Hey, heroin's great, but this. stuff I can cut heroin with, and um like. I'll make a lot more money." Uh, 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 on this. Uh there was one study. that found between 2013 and 2021, the um. the percentage of heroin that had. fentinyl rose from less than 1% to 40%. Yeah. Over what is that eight years? Uh. 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 um mixed with fentanyl, I have to use less heroin because it's. going to be just as potent or more. potent, but I can charge you heroin. prices even though I'm paying way less. for the fentanyl that I'm using here. Um. and yeah, people were caught by.

surprise. The fact that it was. duplicitus is just awful because it's. like, hey, good luck getting acclimated. to this. There's it's going to be a. rough transition. But if you look at it. from a business standpoint, the roll out. 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, uh I hope. I'm clear that there's 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. I think that was. worth mentioning. Yeah. Okay. Good. Uh.

so the other, you know, problems with. fentinel is that it has uh a really. intense rush when it's first used. apparently is more of a head rush than a. body rush. So, it can be a little more. uh 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. Um 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 going. to you know have people using more. frequently and every time you use.

fentinel it's just another chance to. overdose basically. Yes, it's a great. point. Um, 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. froth around my buddy's mouth. I 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 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. Um, another thing that. makes it more deadly is that people. started changing how they used it among. people who died from illegal fentinel. overdoses. The portion who injected uh. dropped 42% over just a two-year period. uh between 2020 and. 2022. And uh they generally started. smoking it. That jumped to 79%. Mhm. Uh.

I believe um people also can snort the. powder, but just the fact that people. aren't injecting it as much kind of uh. you know, if you connect the dots, um. 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. Cuz that's a. big barrier for a lot of people um who. are like, "I like drugs, but I'm not. going to stick a needle in my arm. That. just seems like such a a horrible road.

to go down that it'll give people second. thoughts. But smoking something. Geez, I. like marijuana. I like smoking crack. I. might as well try smoking fentanyl. It's. just much less of a barrier to overcome. 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 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 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 US seizes pills.

Uh I think by late 2021 more than a. quarter of the fentanyl seized was in. pill form and a lot of these pills are. they look like something else. Um, you. hear stories on the news about a a kid. that did not want to take fentinyl that. thought they were taking something else. and it ended up being um either laced. with fentinyl or largely fentinyl 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 um fentanyl. pills are very frequently um created to. look like old oxycontton what are called. M30s. Um so it would be very easy for somebody. to be like oh cool here's here's an. Oxycontton. Fentanyl users know what. they're doing. But if you didn't weren't. a fentanyl user and you just wanted an. Oxycontton 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. Um or if you let's say. you want to use some cocaine, you're. like, "Hey, that's my thing. Do it every. now and then on a Saturday night. I'm. going to get some of that stuff." Uh for. the same reasons heroin is cut with. fentinel, cocaine can be as well. So, that's not even the same kind of high. You're 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. Yeah. Just a reminder, speedballs. are what killed not just John Belalushi. but Chris Farley as well. Um and. apparently this this is that fourth wave. that we were talking about of um. speedballing fentanyl with cocaine or. with meth. Um, and it's not just where. dealers are cutting it and not telling. their their um 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. uh a lot of it that's smuggled into into. the US was originally made in China. But. in 2019, China said you cannot produce. or sell fentanyl anymore. Uh and some. people stopped doing it, but a lot of. manufacturers continued doing so. Uh.

sometimes through legit means that, you. know, made it very easy to ship. Uh but. then they also turn to the black market. to ship directly to customers in the US. and Europe or um hey let's let's ship. the stuff over to Mexico and these. cartels and they can just kind of put it. together there and work as the. distributor for us. Yeah. So the cartels. are getting these precursors. They're. turning around and distributing the. precursors to cooks who I read like a. Univision um story on some just they.

just I guess we're interviewing some. random fentinel cook in Mexico. It was. like three 20 year olds who were just. standing out in the woods under a black. tarp with a pot on top of a fire just. stirring it. Like it was really easy to. make. And then that stuff goes back to. the cartels to smuggle across the border. and sell. Yeah. Uh 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 uh politicians that have.

uh tried to link the the influx of. fentanel in the United States to illegal. immigration. And there was a poll in. 2022 that found that 40% of Americans. believe that most fentanyl entering the. country was being smuggled by uh illegal. immigrants basically. Um and that's. that's not true. Uh the truth is is that. um most of this drug comes through legal. points of entry and when it does it is. smuggled in in vehicles driven by US.

citizens. Yeah. mo most often American. women and I think the KO Institute did a. study where they found. 86.3% of convicted fentanyl smugglers. are American citizens. So that seems to. be totally untrue. Yeah. But apparently. this is a I think this is a measure of. how how bad fentanyl is because I mean. Chuck, we're pretty fentanyl naive. I've. never done fentanyl. I'm making a pretty. good assumption that you've never done. fentanyl and kept it a secret from me.

Um, 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. Uh, 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. Um, so much so that it's like. just don't do drugs. it's too dangerous. because of the presence of fentanyl. Um,

I think that holds and I think this. supports that thesis. In Sinaloa, the. Sinaloa cartel uh has a ban on selling. fentanyl in Sinnoloa, punishable by. death. So if you're a drug dealer in. Sinaloa and the Sinaloa cartel catches. you selling fentanyl in their state in. Mexico where they're supplying the rest. of the world with fentanyl, they'll kill. you. I think that says just about.

everything you need to know about. fentanyl. Yeah, for sure. Uh should we. take another break? Mhm. All right, we'll be back and talk about uh. punishment and harm reduction right. after this. [Music]. It's stuff you should know. [Music].

[Music]. So, one of the things that's a little. different about the fentanyl epidemic is. that it doesn't it hasn't tracked. closely or identically to past drug. epidemics where like the crack epidemic. or um the cocaine epidemic, especially. of like the 90s where or the 80s or 90s.

where if you were caught with it, especially if you were black, you're. going to prison for possibly the rest of. your life. this time around it's been a. little more um there's been a little. more understanding that this is a as. much a public health crisis probably. more a public health crisis than a. crisis to be addressed by law. enforcement. Um and one of the more. cynical reasons why that's probable is. because it's largely been viewed. publicly as a 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, that 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. Um, so thankfully. they're taking a little bit different.

approach. We've gotten a little bit. smarter about this stuff. Uh, and now. we're focusing um or trying to focus on. harm what's called harm reduction. techniques. Basically trying to keep. people from dying. Um, a bunch of. different things have been tried and a. lot of it has been fairly effective as. as we're seeing like the numbers going. down in overdoses. But um distributing. test strips. So uh 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 uh before you. use it. Or maybe your dealer even offers.

that service. That's really something. Yeah. I mean, if if you want to be a uh. and again, I say reputable drug dealer. with sort of scare quotes, but um I. would imagine that's a good thing to do. is say, "Hey, this stuff is 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 that 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 carfentinyl 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 sized dose but if you're like I. don't do fentanyl. Those test strips are. going to help quite a bit. Like I just. want cocaine. Stop putting fentanyl in. my cocaine. Uh 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 that these newer. generations may demand. uh return prostitution. So uh another thing that they can do is. um you know there are safe places where. people can go use the drugs while people. watch out for you. Um the drug users. themselves seem to have wisened up a. little bit uh because of all the the. news and probably seeing their friends. die very sadly. But um 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 uh 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? Eeny meeny miny. mo. Okay, there you go. The age-old the. traditional way. Exactly. Uh but I did. mention Narcan and that is the brand.

name for uh Nlloxxone or Nlloxxone and. that can red uh reverse an overdose and. like I have only one anecdotal example. I don't know if it always works this. way, but uh 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. Um. luckily my my uh cross street neighbor's.

a nurse. She called 911 immediately. They showed up with Narcan and dude, they injected that and this girl was uh. 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. I mean, I don't know what happens after. that. All I saw was this snapshot where. she was like, "I'm 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 the ambulance I don't.

think is allowed to call the cops on. you. Uh, if I'm not mistaken, I think they're. just like, "Okay, I guess you can go.". Yeah, I 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 to an extent. Um.

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. Okay. Um Yeah. But. let's talk a little bit about overdoses. because um 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. um fluid in the lungs. So that a. telltale sign of an overdose is um froth.

around the mouth or in the nose. Once. that happens, you need to act pretty. quickly. Um, and one of the things that. they say to do first is rub your. knuckles on their their chest kind of. hard because it's a very uncomfortable. thing to have done to you and it can. snap you out of a um opioid stuper. Um, even that but if they don't respond then. it's it's you're you need to call 911. andor administer nlloxxone.

Yeah. I mean it in in the brain stem. there are a couple of regions the. medulla and the pawns and they control. the depth and rate of breathing but both. of those have a lot of opioid receptors. So if you do fentinel 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. 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. repressed and this thing that detects. rises in CO2 in your body that gets. repressed as well, right? Uh yeah. So basically, if you if you. want to take that deep breath, if you. sensed like you're in trouble and like, oh man, I got to get a big breath of air. here, you just do that normally. But uh.

little um small increases in CO2 or. sensed and the corateed 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 CO2. But if if that's not working. and that emergency um sort of fail safe. is switched off, then again you you. can't even get that big breath to save. yourself. Yeah. So breathing I think you. said early on that that typically um is. where where fatal overdoses derive from.

is 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, um. you're not going to choke that stuff out. or spit it out or like throw it up out. of your mouth. It can just stay in your. mouth and it can go down your lungs and. you aspirate and or choke on your own. vomit. That's another way you can die.

from an overdose as well. I was waiting. to see if you were going to come up with. like a fourth way to say puking. How. what did I say? A bunch of different. ways. You said like three. you like spit. it up or or vomit it up or choke or yak. it up. I was like, we get it. Blow. chunks it up. Oh god. Uh so as far as. treatment goes, it kind of goes and. locks up with what they do for heroin. It's called medicationass assisted. treatment or Matt. That's kind of the. gold standard. Um we're talking about. either methadone or uh how do you say.

that? Buprenorphine. Buprenorphine. Uh 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. Uh. the other one I believe um is given in. the form or I guess the brand name uh. Suboxone. Uh, and I think you can um you. can get that prescribed, but a lot of. people are like, "Hey, you know, uh, go.

to drug rehab and 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 a an. opio opioid addict. Yeah. Um 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. Um, so I think there. was a study from 2022 uh that the CDC. conducted where they said that of the. 3.7% of all adults in the United States. who need medicationass assisted. treatment, um, 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 There's no way to. kick. No. And the problem with it too is. not just like that's I I can't imagine. going through that, but if you get out. of prison or say you're able to get. heroin or something or fentanyl in. prison after you've kicked it, your. tolerance has dropped. And we talked. about this in our heroin episode in. 2020, but your tolerance has dropped. And so your your likelihood of an.

overdose is through the roof compared to. what it was before you kicked heroin the. hard way or fentanyl the hard way. Yeah. Uh so we busted the the myth about. illegal immigrants smuggling this into. the country earlier. Uh there was. another myth uh apparently police. departments kind of spread this one that. touching fentinyl at all or inhaling. just trace amounts can can overdose you. Uh, apparently that came from a 2016. USDA advisory that claimed that was.

possible. But, um, this is sort of. annoying because it's not, you know, uh, 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. Uh, or inhaling enough to overdose. you is uh, like you 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 what the heck's going on? The best. explanation is that it's it's what's. called a c culturebound syndrome. This. expectation that it can happen. Um, it. leads to a noibo effect where the person. essentially freaks themsself out into a. panic attack and it's it's they're like, I just had I just ODed 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 ODed on. fentanyl isn't going to give you a. fentanyl higher overdose. Yeah, for sure. Uh, another myth, I. guess the final myth that we can bust. is, uh, if you hear, um, somebody saying. like, you know, all these unhoused. people on the streets, it's all because. of fentanyl. They're out, they're. they're homeless now. They're in your. neighborhoods and this because of this. ep uh, epidemic. Um, I'm sure that has. happened uh, where people, you know, uh, can't pay their rent and they're on the.

street because of an addiction like. that. Uh, sometimes people um, turn to. drugs after the fact if they are. unhoused. But uh if you look at it on a. macro level, the the data shows that the. reason uh America has a an unhoused. crisis like we do now is mainly because. of the cost of housing. It's not um 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 uh it's. brought in by illegal immigrants. drug. users um accidentally create overdoses. in first responders and paramedics. trying to help them. It's the reason for. homelessness. Like it's all there's all. moral judgments associated with all of. those things. Yeah. And you associate it. with a drug and anybody who doesn't do. that drug and loves first responders, doesn't like illegal immigrants and. doesn't like homeless people is going to. hate that drug from that point on. Yeah. the drug that was okayed by the FDA and.

that uh you know wealthy pharmaceutical. families in this country got rich off. of. Yeah. Let's just say again fentanyl. is perfectly safe in like a a medical. setting in the hands of a trained. professional. It's just outside of that. Um when when cartels become involved. then it's it becomes a huge problem. But. I said at the outset there is a silver. lining or at least some hope um because. there the usees well first of all opioid. deaths are declining. I think they. peaked in 2022 with 108,000 opioid.

overdose deaths in the United States. Um and the numbers aren't in for 2024, but they think um the estimate is that. it's going to be anywhere between a 15. to a 20% drop in overdose deaths um 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.

uh when you look at it on a um bird's. eye perspective uh a lot of people say. the testing strips have made a big deal. that Narcan has made a big difference uh. that Matt treatment has made a big. difference uh one reason is because uh. drug users have gotten a little bit. smarter like I mentioned earlier some. people are trying to avoid it altogether. uh 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. Um there was a Yeah, you. were saying that like younger. generations might have been scared away. from it. Uh yeah, that's another reason. Yeah. Apparent. So apparently Gen Z um. is unlikely or less likely to use drugs. Uh, I think like 67% of 12th graders. said that they abstained from drugs, meaning that they hadn't taken any drugs. in the last 30 days. And I was like, I.

wonder what that is compared to Gen X. back in when we were in high school. Oh. my god. And I was like, this is going to. this is going to be crazy. It is crazy, but it's the opposite way you would. think. the the I think I can't remember. what what US agency conducts this every. year, but in 1993. um 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 a.

generation of liars. That's entirely. possible, too. Are you a Narkc man? Yeah, I don't know. I mean, I was a good. boy growing up, but uh 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 who did drugs in high school. Well, I mean, there's definitely uh.

improved international cooperation. between the United States and other. countries uh just to reduce the supply. the uh US and Mexico has gotten together. and they've been working together um for. a while now trying to intercept those. drug shipments and trying to you know. mess up the cartel and what their. activities uh what the cartel is doing. Um I think in 2024 last year the amount. of fentanel crossing that border dropped. by about 20%. 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. uh end the episode, Chuck, if if you um. do fentanyl and you're addicted to. fentanyl, please seek as whatever help. you can find to 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 don't. Okay. Uh well, since Chuck corrected me. from probably to definitely, as was. foretold in 2008, he has just triggered.

listener mail. [Music]. All right, this is another two-parter on. disaster movies uh 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 uh we. heard from a couple of faithful. listeners. Uh hey guys um you asked if. it's still a thing among 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 uh 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 pal. palatable, lol. Uh that is from Serena. And then this is from Kevin. Uh first of. all, I'm a casual fan of this subgenre. Enjoy the exciting thrills that come uh. 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 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. socioeconomics behind everything, but I. understand uh 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. Uh 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 uh Kevin. and then Serena. Awesome. Thanks Kevin. and Serena. Um that reminds me of a a. point I wanted to make that I didn't. have a chance to. In Earthquake, Richard. Roundtree aka Shaft. He was in that. He. made it to the end and he was also one. of the heroes helping save um Genevie.

Bujold. 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. stunt man. Um, so he was sadly an. exception, but he 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 the Stuff. Podcast at. iheartradio.com. Stuff You Should Know.

is a production of iHeart Radio. For. more podcasts, iMheart Radio, visit the. iHeart Radio app, Apple Podcasts, or. wherever you listen to your favorite. shows. [Music].