I Don't Know About That - The Opioid Epidemic

Episode Date: July 25, 2023

Dr. David Herzog gives the IDKAT crew the sobering truth about the opioid epidemic. Check out some of David's books: "White Market Drugs : Big Pharma and the Hidden History of Addiction in America" and "Whiteout : How Racial Capitalism Changed the Color of Opioids in America." Jim's new special "High & Dry" is now available on Netflix!

Boobs. Vaginas. If you insert your penis into one of them, what will make a baby? There's no way to find out, but maybe you will. And I don't know about that. It's not in the boob, you don't put it into the boob, in between the boobs. I think I should stipulate that and if you're listening with your kids welcome I always think about our experts

who probably send their episodes to friends and family and it's like just skip the first I have to figure out what videos or images I'm going to put

at the intro for that one just a bunch of censored I'll have to get creative no what you do is you put you put some cleavage and on the second one

you put a pussy cat like a cartoon cat. Yeah, yeah, yeah. All right. That'll work for you. All right, all right. Or a picture of an actual vagina. Yeah.

We'll be fine. How's Hawaii? I'm hanging loose, man. And then I go chill out, and I get some food at Duke's. Ooh, I love Duke's. Duke's. I love Duke love Duke's. Duke's. Duke's, man. I just,

this is, we're recording this in advance because you're going on vacation. I got no shows. Normally I go to Hawaii for, this is my just a vacation Hawaii. What I was going to say, the news came across

that you were replacing Pat Sajak. Seacrest? Yeah, Ryan Seacrest. I didn't hear the news, but I've heard that through the grapevine. It's official. Through the entertainment biz. That's cool. Yeah. That's Seacrest. I didn't hear the news, but I've heard through the grapevine. It's official. Through the entertainment biz.

That's cool. That's Seacrest. What's the next one? I didn't get a call. I didn't even get an inquiry from the good people at the wheel. Why do you think you would? I'm a game show host. Oh, yeah, I'm sorry.

And did you watch me on Celebrity Wheel of Fortune? It was a good one. I shined. I really did. I really did. I really did shine. Look at that. I'm going to get myself to check that I'm being funny. They were talking about it on the radio when I came here,

and they were saying Pat Sajak is out and Vanna White wants her money now because I guess she hasn't gotten a raise or something like that. And so she's making a lot of money. I don't know the whole story, but that literally happened right before I got out of the car. Vanna, when the robots take over, they're going to be like, what the...

This was the first job. You should have appreciated your job. This was the first job. Like, she used to spin the letters. Now she doesn't even spin them. She just goes up and lightly touches them. She does absolutely nothing. Here we go.

Pat Sajak was making $15 million a year. Vanna, $10 million. Oh, wow. Get the fuck out of here. You're doing fine. And it says she hasn't had a pay raise in 18 years. So that... Yeah, but she was being paid back.

But also, over the last 18 years, I bet the ratings have dropped and dropped and dropped and dropped as streamers and stuff have come in. So it's all comparative to how much the network's making. But $10 million a year to touch. She doesn't even talk, man. She doesn't talk. This says $3 million a year.

She doesn't promos. I don't get her if she's getting that. I know. Her net worth is $85 million. She doesn't need more money. If you were watching Wheel of Fortune and Vanna White wasn't there, it would take you many episodes to even realize it. But you'd be like, oh, wait, is Vanna White not there? You know who you want to be in this world?

You want to be Vanna White's best female friend who's the same dress size. If you do that, you never have to buy it. There's just a warehouse of her just like, what do you want? I want green. We have 4,000 green. What tinge of green? Dark. Shoulderless. Dark dark shoulderless green and then just like a dry cleaners that all coming along the hooks and it all raised down in

banner's warehouse thanks banner i'll bring it back and van will be like this smoke and a crack pipe i don't give a fuck she does crack now her net worth is 10 million higher than pat's ajax so i bet you pat's had some divorces though yeah and i think she's got some business i don't know what it is probably like skincare and stuff like that kind of stuff yeah pat pat's had some divorces pat pat was pat came up to me after the we did the seven world fortune last thing he said to me he's like yeah he goes i goes, I'm going to have to check you out. You're an interesting guy. Thanks, Pat.

Well, he didn't give you the call for this to replace. No, no, I didn't get the call. But I reckon me and Pat Sajak could be friends. Pat Sajak's one of those guys that people are like this, oh, he's right. We're not. Fuck off with your fucking people who are on the right are bad people and people on the left are good people or vice versa.

The left are a bunch of this. The right are a bunch of this. Man, he's an older bloke who plays a game show who was nice to me. I'll talk to that cunt all day. He seemed very friendly. Also, I've never heard any of him say like because he. He went to. He's been to like maybe like a Trump dinner

or something like that like nothing he never says anything he's probably a Republican yeah if he's not using his platform to spew conspiracy theory bullshit

then I don't care he doesn't seem to he doesn't seem to keep to himself yeah maybe that's why he's retiring and this one's a

so we can and this one's a common phrase. And it's fucking libertards. Lock her up. Common phrase you'd use every day. Let's go, Brandon. Build that wall.

I wrote all these today. During the writer's strike the Wheel of Fortune will now be written by Pat Sajak what's that phrase from the QAnon where we go

oh we go whatever oh I don't know I don't know that one I don't know it's too deep it's from the documentary and one of them's just

women question mark what's the deal we've never had question marks before I don't know. It's from the documentary. And one of them is just women question mark. What's the deal? We've never had question marks before. I've worked that in. My ex-wife's a bitch. Well, happy retirement, Pat. Maybe you'll see one of the beaches of... Hey, Pat, you got my support, mate.

You're a nice fella. I enjoyed your company when I saw you. No, we didn't talk about it, but you got a proclamation in Reno. Ah, the people at Reno keep going me. Oh, yeah. This is a couple weeks back. I said a joke. You know when you're on the spot.

So what happened was I go to Reno. My day was in September. It was like September 10th or something. It was like before 9-11. It was like September 9th. Yeah, September 9th or something, right? And now they've moved me to June whatever. And I invited the mayor.

The mayor, by the way, lovely lady. And I risked being cancelled. Not too hard on the eyes. Good. All right, not too hard on the eyes. Diplomatically approved. Good, good, good. I don't know.

You can't even bloody compliment him these days. Anyway, so. That's another rule of fortune answer. I just said nice tits. You can't even say something nice, they bloody go. Anyway, so another lady, it was another very nice lady, came from... She's a councilwoman.

The councilwoman. She came along to the show and they gave me a new certificate and she had a whole speech worked out and I've got it in my bag somewhere i'll bring it on but it reads it's still like jim jeffries is here he hasn't sold as many tickets that's not true i sold out reno yeah you're sold out i haven't they were like we're only coming here to help you fill some seats i haven't not sold out reno in years that the silver legacy they always make me feel very welcome there at the Silver Legacy so so I

they go oh we're here to they go and the mayor can't come because she's at the rodeo right that's what she said

the mayor's at the rodeo so me being funny and please if the mayor's listening I didn't you know when you say a joke and you're like fuck that up

but it's caught on tape for the people of Reno oh good I said I said what is she competing or is she being ridden on? Yeah, yeah. I don't think they posted that part. But yeah, yeah.

I think that's all right. And then they gave you an Applebee's gift card. And I don't remember this. Allegedly, we bagged on them having an Applebee's. I think it was the montage at the beginning. Like, Reno's got everything. Like, that thing. This, that, at Applebee's.

I think it was kind of like that. They gave me an Applebee's card yeah they wanted to do it on stage but i was like nah i don't think the audience wouldn't have known what was going on i didn't quite know myself did they put it on their thing i don't know reno instagram do they have an instagram account because they would have but also they keep on bringing up and your show got cancelled well all shows get cancelled only about one percent of tv programming gets to end on its own fucking volition where it's like oh we're calling it a day maybe maybe four percent of all tv gets to go yeah no that's that we're ending it yeah right most 90 of all tv never makes it on tv to put it in in context. How many unaired pilots do you have under your belt?

Oh, scripts sold. Development deals, at least eight. Eight scripts sold. Unaired pilots, I've had pilots... I've had a pilot where they made an entire set worth millions of dollars at Universal Studios, taking up an entire warehouse of my living room, a high school, all that stuff.

And the roof. And that never got made yeah they didn't even they didn't even with that set go well fuck it let's make the pilot and see if it's any good they didn't even get that far yeah they just that's all in a trash heap somewhere millions of dollars just pissed that's really good like they shipped in tiles for like the floor or something. It was nice. I had kitchens. I had a set that was on that show that I believe I've never seen in a TV show. It was a kitchen that was being rebuilt.

So over the course of the season the kitchen would be a little bit more finished as you watch. So the set designers would have to come in and finish one corner and all that type of stuff. There were tarps and stuff. There was tarps and all that. You came through. It was that area from Dexter.

Yeah. Yeah, anyway, it was a good script. Never happened. I was looking to see if it was posted anywhere on City of Reno. I look at the mayor of Reno. Eh, the mayor of Reno's okay. Another row with the mayor of Reno. Why don't you get married?

Yeah, you know. That's as far as you've put it. I become the mayor's husband of Reno. I'm looking. I've told you that before. In my advanced age, I'm a catch, clearly. Keep myself in good shape. Yeah.

Yeah. You have a lot to offer. I'm just trying to find a woman that'll take care of me as I get older. Yeah. Hey, rich ladies. You want a short marriage where you get to keep the money at the end? Yeah, yeah. I'm not going to take any of it.

I'll be dead way before you. He just wants to use it for 10 years, 20 years. I'll cook dinner, massage your feet. And then you get to keep it all yourself. You get a travel partner that's fun. I'm funny.

Forrest is organized. He knows how to plan a trip. Yeah, I am very organized. So what trips have we got? Am I in Australia right now? No, you're in, I think you're just coming back from Hawaii. All right, well, I'll be coming to you, Australia. And you're about to leave Australia. This is like the 25th of July.

I'm coming over to Australia to romance the Australian people with a little TV show I like to call the 1% Club. This year, we're getting our own Vanna White, a woman that just walks around. She's in like a nice dress. Really? Yeah, yeah. Oh, really? I thought you were kidding.

No, no, real, real. I've asked for this. There's going to be like a model, a female in a dress, and then when someone gets knocked out, she has to point at them and go, stupid. All right, I thought you were being serious. I thought you were and go, stupid. I thought you were being serious. I thought you were kidding. Then I was on board.

You were being serious. Not kidding. I would love that part of the show. Vanna White wants a pay rise for a job that if it came out today, wouldn't exist. Yeah. They would like, people would be up in arms. And there's a pretty girl who just touches the letters. Uh-huh.

Even Bob Barker only made $10 million a season hosting Price is Right. Okay, so if you watch Deal or No Deal, the American one, like Meghan Markle was there. She was there opening briefcases. The one in Britain, they get great big red boxes like this, like a box that's like four times the size of a shoe box right

and it's all the you get called up with your box so there's the 40 boxes and you might be there for 40 days but every single one of those people

eventually will be called up and they're all supportive of each other like I want you to win Gavin I hope there's one P in here and then they tear it off.

They open it up. Quarter of a million dollars. I'm sorry, Gavin, but there's still a lot of money on the board. Keep going. Keep going. You've played a good game so far. A game of chance and luck that means nothing. You've played a good game.

You've got the bankers scared. Keep going. And then I came over to America and I was like, the Americans know what they're fucking doing. No talking. I like a pretty good, opens a briefcase like this. Or. Or they do the little peek.

Yeah, they do the little peek. That's years of improv right peak. Yeah, yeah. They do the little peak. Ah! That's years of improv right there. Grandlings train. All right. Well, for all of Jim's upcoming shows, go to jimjeffries.com. Visit our Instagram, IDCatPodcast. And we'll be a live show, August 29th at Flappers.

And go to my website, too, 4shot.net. I got shows coming up. I just don't remember where they are. I'm in Montana, and thenth at Flappers. And go to my website, too, 4shot.net. I got shows coming up. I just don't remember where they are. I'm in Montana, and then I'm in San Diego, and then Vegas, and then Florida. Boom. 4shot.net. Nice. All right, let's meet our guest.

Please welcome our guest, Dr. David Herzberg. Hello, doctor. Now it's time to play. Yes, no. Yes, no. Yes, no. Yes, no. Yes, no. Yes, no. Yeah.

Judging a book by its cover. Come on now. Okay. Okay, so Doctor. Dr. David Herzberg. Dr. David, I'll tell you what you look like. You look like a billionaire. You look like a CEO of some startup company that's like, here at blah, blah, blah,

we want to do da, da, da, da, da, da, da, da. You look like you got shit tons of money. But yeah, I mean, that is a compliment. You got a bit of the Steve Jobs about you, like you're going to tell me how the world's going to work. All right. you're a doctor you're a doctor of medicine yeah you can answer yes or no questions yes or no questions no uh my as my family says i'm the wrong kind of doctor oh voodoo all right so he's a voodoo doctor. Okay, you're a doctor of philosophy? Yes. Yep, that's me. Okay, okay, doctor of philosophy. Is it about philosophy? No.

We're going to be talking about something. I don't know if you've ever done these. You might have done these at some point, but not like, yeah. Twins? Never. Doctor of twins. Maybe... I've always thought it's nice to have two. Talking of twins. Maybe... I've always thought it's nice to have two different types of people.

Something that's going on in this country that is negative. Very popular TV show. Oh, we've lost Pat Sajak. Is that what's happening? The loss of Pat Sajak? Dr. Wheel of Fortune. Yeah. No, we're not talking about that. This is something that is an epidemic. Is it AIDS? No, but it is. Is it the theory of AIDS? Theory of AIDS?

Philosophy. Okay. This is something that you might have taken after a surgery or something, I'm not sure. Is it? Oh, painkillers. We're talking about the opiate crisis here in America. The opioid epidemic. That is correct. Dr. David Herzberg has a PhD in U.S. history from the University of Wisconsin-Madison and is now a professor of history at the University of Buffalo

and the State University System of New York, where he has worked for nearly 20 years. His research focuses on the history of psychoactive drugs as a business in the modern United States with a special focus on pharmaceuticals. He has written books such as White Market Drugs, Big Pharma, and The Hidden History of Addiction in America, and also White Out, How Racial Capitalism Changed the Color of Opioids in America. And David Herzberg is also the co-editor of the Social History of Alcohol and Drugs as part of the Journal of the Alcohol and Drug History Society.

Thanks for being here, Dr. Herzberg. Can you tell us just how you got into or tell us a little bit more about yourself and the opioid epidemic? Well, thanks for having me. And I guess I should just also add that because of one of the books being a history of pharmaceutical opioids, I was a paid expert witness for the plaintiffs in the U.S. opioid lawsuit. So, of course, I only speak for myself in this context. And, you know, I got into this topic. I started out being interested in psychiatric medicines.

I've always had an interest in drugs one way or another. psychiatric medicines. I've always had an interest in drugs one way or another. And when I was going to graduate school in the 1990s, it was in the big time of Prozac, boom era for Prozac, and everybody was talking about Prozac and what it meant. And I was just so interested in the idea that there was this huge apparatus to sell psychoactive medicine, psychoactive drugs. And I was curious about how that related to this huge apparatus to totally prohibit and stop use of psychoactive drugs. So I started researching that. And there was a lot of attention to the drug side of it and to the drug wars and all that. And so I paid attention to the other side, the pro-drug side, the history of the pro-drug

industries and all the stuff that's gone into trying to persuade us to take more of these psychoactive substances. Alright, well thanks for being here. I'm going to ask Jerry, uh, Jerry, I'm going to ask Jim a series of questions about the opioid

epidemic. Alright guys, let's wrap it up. At the end of these questions and his answers, you're going to grade him on his epidemic. All right, guys. Wrap it up. Opioid epidemic. At the end of these questions and his answers, you're going to grade him on his accuracy 0 through 10. Kelly's going to grade him on confidence. I'm going to grade him on et cetera. We'll add all those scores together. Jim, if you score 21 through 30, cannabinoid

epidemic. That's a pretty good one. Just weed, you know. 11 through 20, the hemorrhoid epidemic. It's not a good one. 0 through 10, asteroid epidemic, I believe, would be the worst. That's pretty bad. Yeah. What are opioids, Jim?

Opioids, heroin, basically, they're, what's the best way to say? Hillbilly smack. Opioids, yeah,

they're painkillers. Names? Same as like, we all, if you're lucky enough in this world, most people die a drug addict. Most people die on opioids at the end for pain relief. Name three commonly prescribed opioids. Oxycontin. Fentanyl.

And... fentanyl and what's another one what's the what's the one that you get right before you die what's that one what's that one they give you as a painkiller when you get the heroin morphine what is the difference between prescription opioids and illegal opioids?

A bit of paper and one doesn't come in a yellow bottle with a white lid. Yeah. Okay. But the prescription is given out by a doctor. It's something that you would think. And then like heroin is an opioid made from, so if we go opioid poppies is where it all comes from, right? And so heroin is a non-prescription opioid,

but I believe that morphine is very close to heroin. Describe opioid withdrawal. Oh, it's meant to be terrible. You're meant to be vomiting and sweating and twitching. People who've witnessed someone getting off heroin or off the opioids on a mass scale, they say it looks like death. I've never seen it myself. Where did heroin come from originally and how did it become the most common quote-unquote street opioid?

come from originally and how did it become the most common quote-unquote street opioid i would say that heroin something chasing the dragon and all that type of stuff i'm going to say it's from china but most of the heroin the opium right now comes from so so the opium so the opening trail i think it's china where there's heroin yeah But most of the heroin now, the poppies come from Afghanistan. When did the U.S. first start the war on drugs and how effective has it been? The war on drugs was started in the 1980s by Ronald Reagan, but it was sort of hinted at before then. And then you started like talking. Well, I guess, no, you'd even go back further.

You'd go Nixon had the war on drugs and he elvis come and visit him and elvis upset but the actual uh just say no campaign was nancy reagan and where they actually upped the people going into prison for these stupid amounts of time um because what's the difference when going to prison for five years and going for 20 years you know you're either going to take the drug or you're fucking not. Well, okay. But it hasn't been effective. I'll take five years. No, but it hasn't been effective.

It doesn't stop people is what I'm saying. The extra 20 years doesn't stop. Of course you don't want to do the 20 years. The 20 years is ridiculous. I'm just saying when you're taking it, go, oh, no, you'll only go away for five years. I'll take it. Oh, you're going to go for 20 years.

Oh, I won't take it. No, you're going go away for five years. I'll take it. Oh, you're going to go for 20 years. Oh, I won't take it. No, you're going to take it or not. What 1938 tragedy caused the U.S. to require that pharmaceuticals be safe to use according to the instructions on the label? 1938 tragedy. 1938 tragedy. Say it again. Yeah. I'm going to say Pearl Harbor.

Yeah, that one's pretty bad. That required the U.S. to require pharmaceuticals to be safe, according to instructions on the label. Sure. I don't know. I don't think Pearl Harbor was then. Pearl Harbor was around then. I don't know.

I think it was later, but I'm not going to guess right. 1941, is it? I think so. Okay, so I'll take back the answer. It's not Pearl Harbor. Yeah. What tragedy? The'll take back the answer. It's not Pearl Harbor. Yeah. What tragedy? The death of rock and roll.

Wow. And then it got... What role did pharmaceutical companies and pharmaceutical opioids play in starting the crisis? Say that again? What, if any, did roll, did pharmaceutical companies and pharmaceutical opioids play in starting the crisis? Like, did pharmaceutical companies and their opioids create this crisis that we have now?

I believe they did. When you've got medicine, because you've got medicine for profit, right? So in other countries where you've got universal medication, right so in other countries where you got universal medication these we don't seem to have this same opioid um prescription pill problem that you have here in america because people weren't going in and asking for things you were given what the doctor gave you you know i i see adverts for prescription medicine on american tv all the time it's the most jarring thing when you first get to america that every tourist goes through where they're like,

what the fuck? Why are we watching this type of thing? So I believe because of medication for profit. Also, the rest of the world, this is just from me traveling, thinks that America

with their drug addiction, with their prescription pills are a bunch of pussies. We all make jokes about it and stuff like that. The rest of the world is like gutter drugs and fucking things made by bikies and labs and heroin and all that stuff and when you guys are like oh i got my oxys and all that type of stuff we're like all right ladies calm

down where are you having these discussions the rest of the world in the world okay so so i'm a stand-up i'm a stand-up comedy comic who has worked in Britain, Australia, America I've sat in dressing rooms Americans have this reputation with prescription pills I like when you separate yourself from America you can think what you want about me

but I am worldly I am what other factors contributed to the opioid crisis then? What other factors to the opioid crisis? We talked about pharmaceutical companies and you said that they're definitely responsible. We don't quite wire. Boredom. Boredom, yeah.

Yeah, boredom will get into it. Living in a shit town. The shit of the town, the bigger the opium problem. And I know I'm joking about about this but that is boredom so like you know if you can make put a couple more six flags around the country you probably you can probably that's all it takes the cure as president no little six flags at every time look you and me have driven through some towns where you're like, I get it. I get it. And to what you were speaking about before,

in Europe, for whatever reason, there's always a theme park in the middle of every town. Especially in the Norwegian countries. Why is there a roller coaster in the middle of this town? There always is. Stop the opium. Has the US ever had a prescription drug addiction crisis before? And if so, what was it And if so, what was it?

Well, okay. If so, what was it? That means the answer is yes. No, I didn't. I just did it in the end. I don't know what the answer is. Yeah, the answer is yes. Okay.

I'd say that's a good deductive reason. Yeah, yeah. The answer is yes. And what was it before? Prescription medicine. That's gone crazy there was a cholesterol medicine epidemic yeah lamidomide

aside from opiates what are some potentially addictive prescription drugs commonly sold today Xanax is an addictive thing Valium's got an addictive chemical in it but Xanax is definitely what they call habit-forming. That's the nice way of not

saying addictive. Habit-forming. Habit-forming. I would say that there is several antidepressants, like your Prozac and your Klonoprim and stuff like that. Are those addictive? I don't know. I've never taken them. I believe that there is something in them where you

have to up your dose and it takes a lot to get off them. Got it. You know, if you've been on them for years. But it could just be the addictive, I'm addicted to feeling better and not being depressed. You know, that could be the thing. I believe that's one of them.

I believe, I think that's it. Name one risk factor for opioid addiction. You don't have to name one, but you can name several if you want. Dying. Dying. That's a good one. What's the most common opioid sold illegally on the streets today? Why?

What, prescription opioid or just heroin? I don't know. I'm going to say heroin. Okay. And then I'm going to probably heroin. Okay. And then, I'm going to hopefully pronounce this right. What is naloxone?

Naloxone. Naloxone. Is that naloxone? That's the stuff you put to keep your hair growing. Oh. Yeah, we just do that in there. Trick question.

What is harm reduction? It's where you give someone, you give them the oxysys but you take away their bats and then all their sharp implements so they can't hurt themselves okay a couple couple more questions there what is medication assisted treatment or mat for short mat medication assisted treatment um that would be where you have uh your opioids administrated by a professional, like if you are getting morphine towards the end of your life where someone actually comes in and administrates it

rather than you doing it at home. What is the difference between methadone and suboxone? Methadone, there's one. There's one. That's one we should have put in. Methadone. That would be one of the three. Okay, so methadone is what you go on to get off heroin.

So it's synthetic heroin that you take at a lower thing. It takes away the cravings and it makes coming off the drug a lot better. I believe you probably down your amount of methadone until eventually you're off it, like a nicotine patch. So between methadone and suboxone. Suboxone. Suboxone or suboxone suboxone suboxone or suboxone how do i say that suboxone is uh methadone for girls okay what is the good what is the good samaritan law like how does that apply to the opioid epidemic um the good

samaritan law i believe that's probably like if you come in and you say i'm a heroin addict or something like that then you don't get charged or anything. You get given help. Okay. Rather than just because I think previously people couldn't even admit to doing it because of the drug laws. Okay. Last question.

How can individuals dispose of unused prescription opioids properly? Down at the police station or the fire station. Okay. Dr. David Herzberg, how did Jim do on his knowledge of the opioid epidemic? Zero through ten, ten's the best. Just the whole thing.

Yeah. One score for the whole thing. Wow. You know, I'm going to go with six, six and a half. Six and a half.

Not bad. How do you do on confidence, Kelly? I think it was middle of the road. It was a five. I've never known a lot about this topic. This is not something, as I I think it was middle of the road. It was a five. I've never known a lot about this topic. This is not something... As I said, it's like an American thing that I...

By the time I got here, I'll be... By the time I got to America, I had already had a... I'd taken a lot of cocaine and ecstasy and, you know, and then someone, when I first came here, I was doing a gig and they were like, do you want an oxy? Like that. I was like, sure.

And I just threw one in my mouth and i was because i was like fucking americans and their prescription drugs like this the doctors give this to people i'll be fine i was like i couldn't that's the only gig i couldn't get through yeah i was like a fucking zombie i was like was it enjoyable no that's what xanax does to me, too. I can't imagine that people party with. Some of my friends are like, oh, I took a Xanny, and I'm drinking. And I'm like, it just makes me want to go to sleep immediately. Xanax is just to calm down and go to bed. Yeah.

So that's 11.5 total. I'm going to give you 0.5, et cetera. So you're in the hemorrhoid epidemic, which you are very knowledgeable about. All right. Dr. Herzberg, let's see here. What are opioids? Jim said heroin, basically, painkillers. Can you describe them to us?

Yeah. I mean, that's more or less right. It's a class of drugs that share certain common characteristics. So they do fight pain. They can be sedating. They also can produce physical dependence and addiction. So there's a whole bunch of them. Heroin is one, and the other ones you named are others.

And they're used for acute pain, like if you are in a car crash, you have surgery, they're used to help deal with that immediate pain. You know, they were used a lot for chronic pain, long-term pain. They were used a lot for chronic pain, long-term pain in the early 21st century. And then, like you said, they're used for end-of-life pain, particularly cancer pain. Yeah.

Because this is the thing. Whenever someone says something like fentanyl, oh, fentanyl's bad. Well, I think when it's misused. If you use it properly on a cancer patient you said your mother used my mom had fentanyl patches there were patches that were like slow release of both of them but by the time she had a blood cancer if people don't know and it's like a lot of her bones had fractured or continued to fracture and so she had a lot of pain all over

her body and by the time she passed away she was doing an amount that was difficult to get because it was difficult to get drugs for her because people that abuse these drugs when you go to these pharmacies they would like they they they're very you know they're not going to just get them out to you and if they were out i'd be like well do you know what other cvs around here has it we can't tell you legally that because of this the opioid epidemic that people that would be violently trying to get them or whatever. And so it was really, it really sucks. I'd always be like, well, this sucks for cancer patients that actually are using this in a quote-unquote responsible way,

you know, whatever, you know, to manage pain and stuff like that because people are abusing the drugs and stuff. So, yeah. Yeah, it's not the only time that the effort to try to stop these drugs ends up being worse in a lot of cases than the drugs themselves. It can be bad. Yeah, yeah, because if she ran out, then she's going through this opioid withdrawal stuff, which we can ask, so what is opioid withdrawal?

I'll go back to the other ones. But Jim says vomiting, sweating, twitching looks like death. Yeah, I mean, that's what it looks like. It can manifest in a bunch of different ways. There's a lot of sweating. And it's not just physical symptoms like that. It's like psychologically horrifying. It's like super depressing and you're miserable.

And it's because when the body gets accustomed to having the opioids in the system all the time, the body makes its own version of opioids and endogenous opioids. But once it gets in the habit of having these external opioids, it gets out of the practice of making its own. And so when you take the external ones away, there's this period of readjustment where your whole system was relying on those. And so these and so these, these substances that are crucial for, to feel okay. And for the functioning of your body are suddenly not around and you have to go through this withdrawal period until your system readjusts. Name three commonly prescribed opioids. Jim says, Oxycontin, fentanyl and morphine. Yeah. Yeah. He pulled that one out at the end with morphine,

probably one of the most common ones prescribed. Another one is codeine. It's prescribed a lot. That one is a relatively mild opioid. Often it's in, you know, if you get like Tylenol with codeine, if you get a Tylenol with a number like Tylenol 3 or whatever, sometimes that'll have codeine in it. And sometimes there's cough syrups have codeine too. Yeah, I've had codeine, Tylenol.

I didn't know codeine was an opioid. I didn't either. It's not a big dose. Well, the ones that you get. It's like a tenth as powerful as morphine. Yeah, you want to snort some codeine? Like, what? Get out of here. I don't know.

Yeah, I remember I watched, you said Hillbilly Smack or Hillbilly Heron or whatever you call it. I remember, did you ever watch that thing, The Whites of West Virginia? No. It was like, it was an HBO documentary. Is that the Charlottesville Rally? No.

It was an HBO documentary and the family was called The Whites. That was their last name. And they were like snorting stuff off the back. They were snorting Oxycontin.

I guess there was. I don't remember. All right. I don't know why I brought that up. What is the difference between prescription opioids and illegal opioids? Jim says a bit of paper. Like OxyContin, I guess there was. I don't remember. All right. I don't know why I brought that up. What is the difference between prescription opioids and illegal opioids? Jim says a bit of paper. One comes in a little yellow bottle with a white lid.

Yeah, I mean, that's the right spirit. They're the same stuff. But the most important difference between them, well, I guess there's two most important differences. They both come with the fact that one is legal and one is illegal. And so the legal one is like you have FDA inspectors at your factory. You have to keep track of everything. And there's all these essentially consumer protection regulations. So the people who use those are going to have the best chance of using them safely.

The illicit opioids are the same substances, if you're lucky, because FDA inspectors aren't going to the processing plant in the forest or whatever where they're making it. And so you don't know what's in them. And the people selling them are busy trying to avoid the law and not trying to think about consumer well-being or anything like that. So they end up being really different things. They can literally be different in the sense that if you buy morphine from one of the pharmaceutical companies, it's actually morphine. And when you buy the illicit and you think they say it's morphine,

it may or may not be. And so one ends up being a lot more dangerous than the other. I've never – this sounds terrible. I've never had morphine or anything like that. But I'm looking forward to the day that I get it. I've had it. Just to give it a spin. To start my arm.

It does sound awesome. Is that terrible? I've got bad news for you, man. It's going to feel exactly like the Oxy that you took because it's the same. Yeah, but I won't be doing stand-up on it. I assume I'll be in hospital. I didn't dislike the feel of the Oxycontin.

I just didn't want to be on stage. I had a morphine drip, as they called it, when I broke this arm and had the plate and the pin put in after the surgery. And I was alone in a hospital. My friends were going to a theme park. And also my girlfriend. And they all just left and went to Ohio to go to that roller, the Cedar Point. Well, yeah, there's a theme park around. Yeah, I'm'm in the hospital no opioids by myself and i had a button and they said

if you're feeling pain you can press this but i know it was regulated to stop at a certain point so i couldn't overdose the morphine but i was like in and out of consciousness like and it would seem like i'd fall asleep for an hour and wake up but it was like literally a minute and then i'd wake up and then and then i'd fall asleep and i was like man time's going so slow and then I would like listen to music and it didn't sound right I'm like I've listened to this album a million times it sounds weird I kept calling my family and like my mom said I would be like hey yeah I'm in here and then

I'd like just hang up the phone and I'd call back 10 minutes later and they're like stop calling us yeah it wasn't fun yeah it's not fun it was not fun for the other people either. Oh, you didn't enjoy it? It felt good.

You had a lot of emotional pain because everybody ditched you. Time went so slow. It was like because of the in and out of consciousness. You weren't getting sleep. You know, there are some studies that if mice are given the choice of when to use a drug like morphine or even cocaine they'll get addicted to it but if you decide when to give it to them without them having any choice and you just suddenly surprise them and give it to them that they actually hate it and they don't end up um choosing to do it when they when they have the chance because they hate it like a lot of people who have that kind of experience have such negative associations with it that that they're

kind of uh that they don't that they don't enjoy the feeling even afterwards, even like the next time. Isn't there a thing that I may have heard it on this podcast. We'd like, so there's all the people who used heroin in Vietnam. And then when they came back, they didn't need it because they weren't at war anymore. So that addiction has more to do with your actual life than just the chemical reaction, or is that a load of bullshit? No, it's not bullshit at all.

There were a lot of different factors. For one thing, the soldiers in Vietnam had access to really pure heroin, like it could be 98% pure, and then they were facing this really traumatic situation every day. And then they went back home and authorities were petrified like all these young men trained to kill and the addicted drugs were going to come back and it was going to be awful but then um number one the heroin in the u.s was like three percent pure so it was you know for them it was practically nothing number two all the um all the uh triggers

that made them the thing that situations in which they usually used drugs weren't there, not just the traumatic ones, but like, you know, people who smoke cigarettes and like to have it with coffee and the coffee is not there. They may not have the urge to smoke a cigarette. So they're in a totally new situation. The people they used drugs with weren't around, et cetera. And then, of course, hopefully their lives were not as traumatic as being on the front lines of a war. So, yeah, addiction, I mean, that wasn't one of the questions, but addiction is just a word that we use to describe a really intense habit that's hurting the person who has the habit. Because I don't know, a lot of people have a really strong habit of drinking coffee in the morning and they're going to be really upset if they don't do that um and there are a whole bunch of other habits that we have to drugs and other things but it only is addiction if it's if it's harmful to you um for a lot of different reasons

this is a controversial not that controversial but so i i i'm i'm an alcoholic i've given up drinking i've given up smoking i've i've uh um but with the giving up drinking. I've given up smoking. But with the giving up drinking, and it's been a couple of years now, at patches in these last two years, it's been some of the most depressed times in my life. Also, it's been more positive than it has been negative because people drink to self-medicate. I haven't had any medication, so I've just had to deal with my shit. And that's

been really hard i'm not saying if you're addicted stick with it it sounds like it well i mean like a lot of it wasn't helping right like it was a lot of the emotional shit it was worse i was good i was just masking emotional problems that i had i wasn't actually solving the problems and now I'm working through them with the better help and therapy. But I have had some of my more acute depression since giving up booze because I haven't been able to just mask it all the time. So I don't know that plays into anything that we're talking about. No, it totally does. I mean, addiction would thrive in a situation where you were depressed or your life was tumultuous or you were in an abusive household

or something like that. Any way to escape your life. The childhood mistakes I've made in adult life, the things that I've had to go through, loss and all that stuff, all the hits, you know what I mean? But I definitely used to get blackout drunk and now and then just go to bed and go to sleep and wake up with a hangover now i lay in bed like this well we'll talk about that the question coming up you said boredom was like well we'll

talk about that yeah yeah i'm telling you that's one of the things um where sorry bruce now i was just going to say that like one of the um you know, this is pretty idiosyncratic, but one of the, one of the, you know, drug talks I give to my own kids is drugs are like really important and you're going to need them. So try really hard not to fuck them up because, you know, sometimes if you, if you fuck up with them, then you have to, you know, not use them again. And humans are, you know, a drug-using animal, and we always have been. And so it's a good thing to be careful with.

It's like my nicotine. I just want it when I really need it. How old are your kids, by the way? Do you say fuck up to them? They're like eight. They're three. They're four. Don't fuck up.

Oldest one is 26 and the youngest one is 15. All right. Where did heroin come from originally and how to become the most common street opioid? Jim said from China, now Afghanistan. What's going on there? Well, it initially came from Bayer Pharmaceuticals. Back in 1898, they were tinkering around with the morphine molecule, and they found diacetylmorphine, which is heroin. They marketed it with the name Heroin. Back then, it had a capital H because it's a brand name. It was mainly as a cough suppressant,

but it was heroin for its heroic qualities. They hoped it was going to not be addictive. It was named after female heroes no it was named that ending is uh is like a a chemist name that uh that the uh that plant derived drugs a lot of them at that time ended in ended in im so they went with hero and then they called it hero in it didn't have an e at the end wow i don't know okay and then they called it Hero N. It didn't have an E at the end. Wow. I didn't know that. Okay.

And then how did it become a common street opioid? Yeah. So it was a new drug at the turn of the century, right at a time when everyone was figuring it out. Like, oh, my God, this morphine that we've been using left and right, that's addictive. And so they imposed these new limits on the opioids that they knew were addictive. So morphine and smoking opium, which is a big thing amongst the Chinese immigrants at the time that they brought in from the practice from China, where it had been kind of encouraged at gunpoint by Britain. And so people who already used opioids, and there were tons because there were very few restrictions on the sales at that time, they were looking for a

drug that wasn't, number one, that wasn't as stigmatized at that time, it wasn't as illegal. And number two, one that was better for smuggling. Because smoking opium is like gummy and stinky, and it's bulky. But heroin is this powder, super easy to smuggle. It was kind of new, so it didn't have a bad name yet. And so it really quickly took over those illicit markets. We're talking in the 1910s and the 1920s. This is where the terms like dope fiend and junkie came from to describe this one generation of people who mostly started using morphine or smoking opium when

it was legal then the hammer fell and then they switched to this one that was easy to smuggle and when when did it start becoming an injectable drug because you know i i assume that i've probably taken a bit of heroin in an ecstasy tablet or something like that you know what i mean but i've never done an injectable drug in my life. So you said it was smoking. When was the first bloke to pull out a spoon? Yeah, well, the hypodermic needle was, hypodermic syringe, sorry, was invented in mid-19th century, and doctors started to carry them around a lot in the late 19th century after the Civil War.

And so heroin was one of the drugs that could be injected or you could use it, especially for coughs, you could use it in oral solutions. And so right from the start, it was available for injection. Just like at the late 20th century, in the late 19th century, there was a huge opioid addiction crisis that was primarily because of sales of morphine from doctors and pharmacists, and that was mostly through injection. When did the U.S. first start the war on drugs and how effective was it? Jim said it was Nixon and up the amount of people going to prison for super amounts of time so it wasn't effective yeah that that's um it's pretty good if you're going to talk about the war on drugs as a phrase itself as a formal phrase because that was nixon's lingo calling it the war on drugs but the war on drugs was launched way earlier because some historians think the very well the first war on a drug in the U.S. was the war against demon rum, against alcohol, started in the 1820s. The first war against a narcotic was actually launched by the Chinese government in the 19th century.

They wanted to try to stop Britain from importing smoking opium from Britain's colony of India. smoking opium from Britain's colony of India. But in the US, it really starts in about 1914, which is when the Harrison Anti-Narcotic Act is passed. And that's when they, it's the first law, national law restricting the sale of a particular good. And heroin, cocaine, morphine, these became America's first prescription only drugs. They were still legal, but you had to have a prescription to possess them or to sell them. And they had to do crazy hijinks to make that even remotely constitutional, because at that time, the federal government didn't have those kind of powers. So it's kind of wild. They passed a tax on the sale of those drugs and said you had to register with the federal government to pay the tax, but only doctors and pharmacists and manufacturers could register. So if a regular

person had possession of these things, they wouldn't have paid the tax because they weren't registered to pay the tax. And the only exception to that rule was if you had a prescription from a doctor written in the good faith practice of medicine, then you were allowed to possess it without paying the tax. It was kind of a jury-rigged contraption, but it worked because they wanted it to work. So the war on drugs clearly hasn't worked out, right? We haven't stopped drugs or anything like that. What do you think is the plausible answer?

what do you think is the plausible answer for me the plausible answer is to decriminalize and robustly regulate you know we're pretty good at selling dangerous products and making them be i mean more or less acceptably safe and think about automobiles super dangerous in all kinds of ways. And first we put in seatbelts and rumble strips on the highways and airbags. And then now that, oh, they're destroying the planet too. So we're going to try to make them electric so they don't, you know, spot out those fumes. And we have all of these tools for making sure that people who sell stuff behave themselves and sell products in ways that people can use them less dangerously. I mean, people still die in car accidents, right? So it's a little bit crazy with

drugs. We just kind of shrug our shoulders and say, no, we're just not going to use any of these tied and tested methods that we've used for 100 years to incentivize good behavior and punish bad behavior. You know, we're just going to say it's illegal, let's say, to sell heroin. We're not going to say, well, it's say to sell heroin we're not going to say well it's illegal to sell heroin in a way that's dangerous we're going to try to encourage safer sales that's that's where i go on it yeah no i i agree we were just in portugal and portugal seems to have really done a good job but you will get fagging blokes out the front of a food court in the middle of the day. Everywhere. Cocaine. I don't think it was good quality.

Yeah, I don't think it was real cocaine. I've never seen that in an American city, never. That's true. This was everywhere. The guy wasn't worried about saying it to a cop or anything. It was just like, you might as well have a sign. Cocaine! Stop fruit standing. After your chicken.

What 1938 tragedy caused the U.S. to require that pharmaceuticals be safe to use according to the instructions on the label? I don't believe

it was the death of rock and roll, so maybe you can tell us. Weirdly enough, it was the death of rock and roll. Ah, what? Now, this was a cheap,

this was a cheap question. It's just an important little moment in history that nobody remembers, but there was a, at that time, you just had to not lie on the label. That was what the FDA's rules were. The Food and Drug Act said you had to tell the truth on the label. made batches of this, of one of the first antibacterial drugs, the sulfa drugs, and they used a solvent to make it into a medicine. I may be getting, I may be remembering the name wrong. I think it's ethylene glycol. It's an ingredient now in antifreeze. And it turns out that if you took this medicine, you died and you died a really painful death. And, you know, a few hundred people took this medicine and died this death, including some children. And they went hunting around for

the culprit. And then they found that, in fact, these bottles were accurately labeled. It said ethylene glycol right on the label, but nobody knew what ethylene glycol was. It's poison. Not any of the people taking it. We told you it was poison on the label. Is Massengill the same company that makes douches now? I doubt it. You're the one who came from the factory.

You tell me. No, I just remember there was a, when I was young, there was an ad for douches and it was Massengill Freshness. I remember, because when you were a kid, that was like an insult. You'd be like, you're a Massengill, I don't remember. Anyways, moving on. The was Massengill Freshness. I remember because when you were a kid, that was like an insult. I don't remember. Anyways, moving on. The ocean called her out of shrimp. Okay.

Alright. What role do pharmaceutical companies and pharmaceutical opioids play in starting the crisis? Jim said they did it to create medicine for profit and so forth. Yeah, this one's about half right. The big picture is totally correct that the opioid manufacturers and all the various companies

that profit from the sale and moving circulation of opioids, they helped create the crisis and they did it to boost sales and to make profit. But they didn't so much do it with over-the-counter advertising, like, sorry, direct-to-consumer advertising. They don't, for the most part, controlled substances

aren't advertised directly to the public. So how did they do it? Well, there's a long history of realizing like, wow, you know, with prescription only medicine, instead of having to advertise to 300 million consumers, you know, we just have like 300,000, just those people with MDs after their name. And we can really concentrate our firepower on them. And since the early 20th century, there's been this enormous enterprise of figuring out how do you persuade doctors to do stuff and investment tons of money into the kinds of things you sell them the sales people who come to their offices and with um and also uh something called selling sickness which is when you take a real problem that people have like a you know uh shyness or anxiety or sadness or whatever like a real thing that sucks and causes a lot of suffering.

And then you attach that suffering to a magical solution and a pill. And then you put a bunch of money into organizing the people who are suffering from that problem to demand that they get access to the solution. And so these companies, on the one hand, they did these kind of, they call them astroturf campaigns to sell sickness, to really make sure everyone understood that pain is abnormal and that you have a right to be free of pain. And then they also invested literally millions and millions, tens of millions of dollars into getting all of the specialty medical societies, the places, you know, like the American Geriatric Society, the American Academy of Pain Medicine, all of these different organizations, the Federation of State Medical Boards,

to change their opioid guidelines to encourage more opioid prescribing for more different kinds of pain. opioid guidelines to encourage more opioid prescribing for more different kinds of pain. And, you know, if you're a diligent doctor who is trying to do your best, these are the places that you look to to get the latest pronouncements on. Here's what the science says. Here's how to do right by your patients. And all those folks started to sing the same song, in part because the song they were singing had been written by the same people, which is these pharmaceutical companies. So you had a kind of a meeting in the middle of all the medical experts who were starting to, you know, evangelize this gospel of opioids. And then they were met with these patient advocacy groups who were insisting on right to access. And the thing is, it works because there is more than a grain of truth in there, right? We've already talked about how important opioids are for managing pain.

And so it's not like they were inventing it out of whole cloth. It was really difficult to pick apart, well, which things are really true? Which things do we not have evidence for yet? Which things do we need to study more? And all those questions, the answer is we need to spend a bunch of money to find out who had all the money. The pharmaceutical industry had all the money, and they weren't interested in finding out those questions. So those weren't the questions they were researching. Are there other reasons, too?

Like Jim said, boredom, if we put like six flags, you know, on every town? I would love to see a controlled study, you know, of, you know, take a country like America, nice country, put a six-pack in every town and see what happens. But yeah, there are other factors, too. And the two biggest headliners are the economy and racism. had, this was a period of time in which there were communities that were, that had been kind of semi-protected from this tendency of capitalism to just pick up its skirt and run to the place where it's easier to exploit the labor and get cheaper labor. And these were these predominantly white areas in the places that became famous for the opioid crisis, like in the Rust Belt and Appalachia and in New England.

And their economies shifted dramatically from places that had careers where you could have a family-sustaining career, maybe not even with a college degree, working in industry and things of this sort. And as those jobs started to flee down south, first to the southeast in the U.S., then to Mexico, then overseas, there was new kinds of not just poverty, but kind of that dread sense you get when your whole community is just getting a little worse over time. I live in Buffalo, and Buffalo has been on the upswing for a couple of decades. And there's just something in the air when you're living somewhere that's getting better. Feels good. And when and when you know that you're being abandoned

by your society in a certain way and things are just getting a little worse every year, that kind of that kind of hopelessness or feeling like there's nothing in the future has an effect that compounds the poverty. Because there were other people in the U.S. who were extremely poor, who were not having this crisis, particularly racial minorities in cities, and they had a different experience. And that brings in the racism issue. You might think opioids, we've known opioids were addictive for like 2,000 years.

And for most of the 20th century, there was one cardinal rule in pain management, which is you don't prescribe opioids for chronic pain. You might wonder, well, you can't. What do you subscribe it for? For acute pain, like right after surgery or end-of-life pain, things like that. And I'm not trying to say I'm not a doctor. after surgery or end of life pain, things like that. And I'm not trying to say I'm not a doctor. I, you know, there are still debates about the proper role of opioids and chronic pain. And I think there is a role there. It's not the role the pharmaceutical industry said it was, but it does exist. But I'm not the one to say it. But so the thing is, you might wonder, how did the pharmaceutical

industry convince people? And you can spend a lot of money to try to be like hey hitting yourself in the forehead with a hammer is awesome everyone should be doing it it's not going to work you can spend billions it's not going to work so how did they do it and one reason that they did it is they marketed these drugs in these white areas that had a lot of suffering you know physical and otherwise but that also because everyone in these areas involved in the opioid trade was white, there's kind of a tradition in the U.S. that's saying that addiction is a problem that happens to black people, brown people, and poor people, often overlapping categories in our society, you know. And so if you just market

your drugs to white people, well, you know, those are health-seeking people. There's a stereotype, a racial stereotype of white people. Like they just want to work again. They want to be good citizens or whatever. And so they're not really a risk of addiction. And if you look at their campaigns, where they put their advertising money, the kind of people that they put in their advertisements and all this stuff, it was really racially targeted to white people. And they were helped by the fact that in 1980, there was a huge addiction panic over what they called crack cocaine, which was a,

it's essentially just cocaine packaged for poor people, because you could buy it for just a few dollars, just one hit to smoke. And the markets for those were in central cities where a bunch of racial minorities were kind of segregated into. And so that kind of associated addiction really strongly with those racial minorities, kind of reinforcing this cultural tendency in U.S. history to imagine that, well, you know, white people are the people we sell drugs to because drugs will be good for them. And the black and brown people are the people that we need to punish for using drugs because that makes them into these scary things. And so between those two, those had a, I suppose, wait, sorry, there's one more factor, which was, of course,

the thing stopping the pharmaceutical companies from selling like this before was this robust federal government rules and red tape and bureaucracy, all the stuff that the Reagan era, you know, conservative counterrevolution hated. Bureaucracy, red tape. You've got to unleash the private sector to solve these kind of problems. And the pharmaceutical industry was one of the industries unleashed one of the private sector entities unleashed to solve the problem of chronic pain so that's the three things medicine inquisition three things so so medicine for profit then rollercoasters yeah has the u.s ever had a prescription drug addiction crisis before you mentioned there was a heroin there was an opiate.

Was that what it was? We had this before, or is it something else? Yeah, there was that one. And then in the 50s, 60s, and 70s, it was with uppers and downers. So sleeping pills, sedatives, amphetamine was a big one. What was the one that Elvis was on? Uppers. He was on both. He was on bar? Uppers. He was on both.

I think he was on barbiturates. He was on ones to wake him up and ones to put him to sleep. Yeah, yeah. So I think he was on barbiturates, which are the sedatives. They called them goofballs. Goofballs. Fistballs. And amphetamine.

Those were pet pills or stimulants. I like the drugs back then. Uppers, downers. Much easier. What does this one do it says what it does on the tip truth in advertising goofballs whiz balls uh aside from opiates what are some potentially addictive prescription drugs commonly sold today jim said xanax and xanax antidepressants xanax yeah xanax is a big one um antidepressants, Xanax. Yeah, Xanax is a big one. Antidepressants, not usually thought of as

addictive, mainly because two things. Number one, usually when people use them for long term, it's not hurting them. Usually, if they're using it long term, it's usually because they're glad about that. And then, and there isn't so much, you don't increase the dosage over time. Usually, there isn't a craving to do that. But the other big class that needs to be mentioned is amphetamine, which is, you know, opioids got famous for their sales shooting up in the 90s, early 2000s. Sleeping anti-anxiety drugs like Xanax shot up. And the other class is amphetamine, which is for ADHD.

Oh, right. I was... Hyperactivity disorder. That's through the roof. I was pumped full of Ritalin as a child. Yeah. Like pumped full of it. I was on about eight a day at the end.

Jeez. Eight? Yeah, eight of them. Holy shit. Eight 10 milligram tablets of Ritalin a day. My mother would wake me up with a tablet and just shove it in my mouth. And then i got off

it when i was a teenager because i was just like i don't think like like i was like i don't want to be on this fucking shit all the time you know and um i didn't at that stage i didn't believe in attention deficit disorder i thought it was all bullshit and now i believe that attention deficit disorder is a thing that's over prescribed, over diagnosed. And anyway, I don't take Ritalin anymore. Fun, fun story. I took tons of it, tons of it. And I still think my hands shake to this day. I reckon it's because of that.

Oh, yeah, maybe. I think it is because when I was in my teenage years, I wasn't, my hands have been shaking since I was a teenager. Yeah. Risk factor for opioid addiction, Jim said dying. I'm assuming that's one. Yeah, I thought that question went the other way, which is like, what is a factor that says

you're at risk of getting a different opioid? Oh, yeah, sure. But like, definitely, yeah, overdose is definitely... Age, race, situation, where you live. No theme parks. No theme parks. Yeah, how close are you to a theme park? What's the most common opioid sold illegally on the streets today?

Jim says heroin. You know, heroin is actually hard to find these days. And this is one of these really interesting stories. Remember I talked about how when the hammer fell down on smoking opium, people switched to heroin? Yeah. Well, when the hammer fell down on smoking opium, people switched to heroin? Yeah. Well, when the hammer fell down on like OxyContin and the prescription opioids in the early, you know, in the last couple of decades, there was all these people who had become addicted

to them, right? They were really intensely committed to continuing to use them. So when their doctor wouldn't prescribe anymore, they went somewhere else to try to use them. So when their doctor wouldn't prescribe anymore, they went somewhere else to try to buy them. And so this brought in a huge new group of consumers, many of them who, you know, had some money in their pockets, and it really reshaped illegal drug markets. There'd been people buying and using heroin for decades, sometimes the same people, like still around buying heroin since the 60s or 70s. And when this new influx came in, that invited new suppliers into the story, because there needed to be a higher volume of illegal opioids sold to meet the demand of all these new people

with addiction. And it tended to follow the prescription pills at first. And it tended to follow the prescription pills at first. And these new suppliers, you know, heroin, you have to grow fields of opium poppies, and you've got to harvest them, and then you've got to, like, use a knife to cut the little pod under the flower, and the goo goes out. It's a complicated, long process. But there are these other opioids that are a lot stronger. Fentanyl, for example, you don't need an opium poppy, you can just make it in a lab out of various chemicals. And then

it's like 50 to 100 times more potent than heroin. So you need one 50th or one 100th of the amount. one 50th or one 100th of the amount and so that makes it easier to smuggle too so these new suppliers came in and they started to provide fentanyl instead of heroin and that's when people started to die fentanyl seems to be seems to ruin drugs like like like cocaine and all type of stuff like it's very hard for me to tell my children, don't take drugs, because there's so much footage of me saying I've taken drugs. Right. And, but I don't want to be like one of these people who are like, back in my day, it didn't have fentanyl in it. It was pure. Yeah, it was pure.

But it seems like every generation gets a shittier fucking hand dealt to them of drugs. Is that right? Well, I mean, it is. And that's because of the drug war, right? I mean, you wouldn't, there were no people taking heroin who were like, Hey, wait, you know what I'd really like to have is a drug that, uh, has is much shorter acting and you have to mix it exactly right or you're going to die. That would be better than what I'm using now. It wasn't a demand side switch. It was a switch because it was better to smuggle.

It's so much smaller. And so, you know, that kind of moving to shittier drugs is because if you think about like how a market works, right, sellers get incentivized and they follow their incentives. And when the incentives are like consumer satisfaction and consumer well-being products get better and better like cars are better than they used to be because people like to drive more awesome cars but in illegal drug markets that's not the incentive at all it's to stay in business it's to not get arrested it's whatever and so the drugs get shittier because um the smuggling stuff when it comes to drugs like selects for shittier drugs because it's just more powerful. And the latest now is xylosine is this tranquilizer that makes the fentanyl last

longer but it also uh gets causes these horrifying flesh infections that can lead to gangrene and it makes people pass out and uh and when and because it's a tranquilizer like those are if you get a physical dependence on on sedatives like alcohol or barbiturates or Xanax or xylosine, the withdrawal is much, much, much more dangerous. You can die. You can have seizures. So it just makes, it's making everything even worse to solve a problem that only appeared in the first place because of the perverse incentive of the drug war. Like, it's bad. What is naloxone?

Sorry, I was trying to find the word. It doesn't make your hair grow, right? No, it doesn't make your hair grow. This is to reverse an overdose. It's kind of a miracle drug, actually. So, you know, your brain has little receptors, morphine receptors, opioid receptors in your brain. And when too many opioids go into them, one of the effects is to repress your breathing.

And so when people die of an overdose, they just stop breathing. But naloxone has got what they call a really strong affinity for those receptors. It'll just kick the opioids right out and snuggle in there instead. On the good side, this means that it immediately reverses that problem of breathing. On the bad side, it immediately reverses all the other effects of opioids too, meaning that if you're addicted to opioids, you're about to go into withdrawal unless they really got the amount just right. But if it's an accidental overdose, like you bought a Zanny at a party or whatever, and

it's full of fentanyl, then that naloxone is going to save your life. I have some. Do I have it right? Yeah, I've looked into ordering some. A friend of mine just a couple months ago died from an accidental overdose, and she was just found too late in the bathroom. And it's like all of her friends, it's like, if we would have been carrying this with us,

and like it's so demonized, the idea of even carrying one. And it's like, it's not for me, but if I'm with somebody that this is happening to, you might as well be prepared. Do you inject it? I think it's an injection, right? It used to be. Now the one that I have is just a little nasal squirter.

You just go. You don't need to be trained to use it. And the best thing about it is. If the person's overdosing, how do they breathe it in? You just squirt it. It's the liquid that goes in. Yeah. Do they need to?

No, when you squirt something. Yeah, everybody should have some. I think, you know. Yeah, we had it for my mom, too, like with cancer patients, people that are like having, that taking the painkillers. What is harm reduction? It's when you give them the oxys, but you take away a bit, oh, the bats and sharp implements. Okay. Like harm reduction is shifting the goal away from saying our goal is that people should use less drugs or use no drugs at all. And instead saying we want people to experience fewer of the harm that can happen to you when you use drugs. Like, I don't care if you get high. What I care about is if you die of an overdose.

I care about if you can't hold down a job. I care about, you know, if you get an infection or something like that. And so there's this whole science, it's kind of a renegade science or a guerrilla science, activist science that was that came up from the streets amongst people who used heroin, taking care of each other, learning about well, how do you how can you use this stuff safely? What do you you know, they were the ones who discovered the idea of bleaching needles in between injections to avoid HIV. And they're the ones who kind of forced a really reluctant and, you know, frankly, uncaring medical establishment to adopt naloxone. I mean, the attitudes that medical, that health care providers had towards people with addiction, you know, that it'll turn your stomach. it'll turn your stomach. And it took decades and years of these street harm reduction activists pushing these kind of, you know,

it is worth saving the life of someone with addiction. Like, that used to be a radical thing to say. Judge Judy said that all the heroin addicts should share needles and get HIV and die. That's Judge Judy. What? She said that? Something along that lines. Don't quote me exactly, but Judge Judy definitely said that heroin addicts should all get AIDS.

That was right there, Judy. Yikes. A lot of people, a lot more people than you'd think, said things like that. Harm reduction is awesome stuff. Those people are inspirations, man. They're amazing. What is medical assisted treatment, or Matt? Is that when opioids are administered by a professional? Sort of. So if you're addicted to opioids, you're really strongly motivated to keep using opioids and it's really hard to

stop. And so one way it's a, it's a harm reduction method. Like it's a way of saying, okay, we actually are just going to not tell you you have to stop using opioids. Instead, we're going to switch you from one that you have to inject into your body every three to four hours, which is dangerous for a lot of different reasons, and it's illegal. It's going to cause all kinds of problems in your life. Instead, here, have this opioid. You can drink it, a little, you know, berry-flavored juice, and it'll last 24 hours and it costs like three cents yeah and suddenly you know you don't have to stop using drugs to hold down your job and to take care of your kids and to do all this other stuff because it's legal it's inexpensive and and every

day at least the start you've got to go into the clinic where they provide it and so you're seeing people who in hopefully care about you. And if you want to then pursue other kinds of ways of recovery and getting better, they're right there to be like, oh, you feel like that today? Well, come on, let's talk about it. And what is the difference between methadone and suboxone, if I'm saying that right? Yeah, I mean, there's a pharmaceutical difference. They're both long acting opioids that are used for maintenance. The first one was methadone from the 1960s. Suboxone was discovered a while ago.

Buprenorphine is the chemical name. It has slightly less opioid strength in terms of providing euphoria and repressing breathing. So it's slightly safer. But main differences are regulatory differences. If you want methadone, you have to go to a methadone clinic, and they watch you drink your little cup of medicine, you have to take piss tests and all that stuff. It's very, it's sort of like a cross between a prison and a health clinic, because they're really like surveilling you. And Suboxone, your family doctor can prescribe.

And so big surprise, methadone is the primary way of treating addiction in black and brown and poor people. And Suboxone is overwhelmingly provided to middle class white people who get addicted. But so they get they get their privacy. They get their dignity, they get to take their bottles of medicine home and don't have to show up at a clinic every day. It means they can go on vacation, etc. Those are the main differences. And then how can individuals dispose of unused prescription opioids properly? I think Jim got this right. This is what I did down at a police station or fire station.

Well, my mom's. It depends on the community. Sometimes they have take-back centers and sometimes at a police station or fire station. Well, my mom's. Yeah, you can. It depends on the community. Sometimes they have take-back centers, and sometimes they have their own particular rules or places you can drop them off. It's also worth checking the rules. In some cases, you can flush them down the toilet,

but you definitely want to check first because if that's going to pollute your waterways, you want to do that. We did a thing about that on Jim Jefferies' show about these fish were getting addicted to cocaine. When my mother passed away, my mother had an oxycodone habit towards the end there for pain relief or whatever. And when she died, they found a whole lot of pills in the thing.

And then, you know, I got my responsible cop brother. Yeah. So they didn't exist anywhere i've looked around in drawers they're all gone um all right i got one other thing can i i'm sorry we there was it it's kind of uh it's kind of a significant one that what is the good samaritan law oh my god yeah mine i skipped that for two seconds that's that's important because if you come across someone who is overdosing, even if you were using drugs with them and you call 911, the Good Samaritan law says that you

are safe from legal jeopardy if you are trying to save somebody's life. And these are kind of at loggerheads with what they call drug-induced homicide laws, which are trying to charge, let's say you share some drugs with a friend and those drugs turn out to be laced with fentanyl and your friend dies in a lot of places they're charging you with murder um in that situation so there's the good samaritan laws that protect you and then there's the drug-induced homicide which would make you think twice about calling 9-1-1 if your friend overdosed and you're thinking why i could go away for life for that. Jeez. Fun.

All right. Now's the time for our show called Dinner Party Facts. We ask our expert to give us a fact, something obscure, interesting, they can use to impress people. Do you have something for us, Dr. Herzberg? I mean, we mentioned already that heroin started out as a Bayer product. Yeah.

That's pretty good. You should have saved it. I like that. I thought you were going to go, and I also made an easy bike oven. You're like, I already did it. Now, when you said it, when you said that, I was like, that should have been the dinner party back then.

I was thinking that too. Everybody go back and listen to Minute whatever that was. Thank you for being on the podcast, Doctor. Please, if you're interested in more about this, check out some of Dr. David Herzberg's books, White Market Drugs, Big Pharma and the Hidden History of Addiction in America and White Out, How Racial Capitalism Changed the Color of Opioids in America. Doctor, thank you so much for being on the podcast.

We appreciate it. We all learn a lot of things. If you ever had a party and someone comes up to you and goes, hey, this cocaine doesn't have fentanyl in it, go, well, I don't know about that and walk away. That's my message for the kids. Just say no. Good night, Australia.