S7 E1: 100 Seconds to Midnight: The Opioid Crisis

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I'm Jackie and I'm Jessica, and
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to the dark Side. We're really
nice people once you get past the true

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crime and scary science. Hello and
welcome to Cause of Death one hundred seconds

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to Midnight. I'm your host,
Jackie Morante. Today we start seeon than

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seven. This season is called Countdown
and it's going to be a rough one.

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Carol, one of my loyal listeners, requested a whole season of one

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hundred seconds to midnight episodes. So
this season is dedicated to the things that

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the human race has done and continues
to do to destroy itself. It's ninety

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seconds to midnight and people from every
age group, every socioeconomic background, every

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geographical corner of the world are being
sucked into the vortex of addiction. If

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you or someone you know is struggling
with addiction, please call the Substance Abuse

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Mental Health Services Administration Hotline at one
eight hundred six six' two four three

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five seven. Help is available,
and there is hope. Drug addiction is

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currently one of the top health crises, not only in the US but around

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the world. It affects everyone,
whether they are personally addicted or not.

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It affects our workplaces, our commutes, and our social lives through people that

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we barely know or don't know at
all. But more importantly, it affects

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the lives of our families, our
children, our parents, and sometimes it

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affects generations of families. Addiction spins
lives out of control, especially for the

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people suffering from it. They give
up everything for one more drink, one

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more pill, one more high.
Sometimes they give their lives to their addiction.

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People can get addicted to anything,
but in this episode, I'm going

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to focus on drug addiction as it
relates to the opioid crisis. It's an

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issue that's not well understood and certainly
not easy to overcome. Opioids bind to

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the body's opioid receptors. These are
found in the areas of the brain that

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control pain and emotions. After taking
opioids regularly, the brain adapts to the

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drug and sensitivity is diminished. Addiction
occurs when the person taking the drug fails

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to feel pleasure from anything else.
The drug is the only thing that makes

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them feel anything. As I mentioned, the opioid crisis is not confined only

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to the United States, but I'm
going to start this episode in the US.

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In twenty fifteen, fifty two thousand
Americans died of drug overdoses. Thirty

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thousand of those deaths could be contributed
to opioid drugs. Most of these addictions

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began with prescription medications that were intended
to relieve chronic pain. In up to

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fifty percent of cases, postoperative chronic
pain begins the journey to drug addiction.

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Several factors came together to create this
crisis. Drugs that were inappropriately or over

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prescribed, and the lack of knowledge
as it pertains to the potential adverse effects

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of long term drug thereaty therapy are
certainly contributors to the current crisis. But

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we also have to be honest about
addiction. We have to consider the addicts

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themselves. Opioid misuse, abuse,
and dependence are the elephants in the room.

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And while I don't intend to cast
blame upon anyone suffering from addiction,

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I believe that those who are suffering
from addiction need to be accountable for their

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own actions. Honestly, the first
step to solving any problem in your life

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is omitting that you have a problem
in the first place. I encourage anyone

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listening. If you have a problem
with addiction, please seek help. You

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can break through this. The opioid
crisis evolved in three phases, first beginning

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in the nineteen nineties and continuing through
twenty ten, when pharmaceutical companies began huge

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marketing campaigns for opioids and lax regulations
by the FDA allowed irresponsible and often unchecked

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distribution by prescription. Most of us
remember those days. If you went to

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your doctor with anything from a hangnail
to an accidental amputation, he prescribed vicodin

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with refills. From twenty ten to
twenty thirteen, the government read the FDA,

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decided that there was a problem,
and the second phase of the crisis

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came into play. The FDA cracked
down on physicians who were over prescribing opioids

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to patients. Some of those drugs
were reformulated to become less addictive, and

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heroin use became more widespread. We
are now in the third phase of the

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crisis. This phase is seeing movement
towards synthetic opioids like fentanyl and more recently,

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tranquilizers like xylazine. The continued tightening
of regulation on prescription opioids is on

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one side of the crisis, while
the other side is the attempt to mitigate

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the problem through the growth of heart
reduction and better policies surrounding access to addiction

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treatment. While treatment is becoming more
readily available, it's not available for everyone.

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Often, drug rehabilitation is costly,
and not everyone can check out of

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their job or their life for a
month or two so that they can receive

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treatment. The stigma that attics face
becomes a hurdle that is sometimes insurmountable.

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Judgment from others is a powerful thing, even when it comes from total strangers.

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Those who feel they can't fight the
monsters will be even less able to

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do so when they're being diminished or
dismissed. That stigma is probably the hardest

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thing to overcome for those who seek
treatment. It drives people into hiding rather

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than allowing them to feel as though
they have support. In twenty eighteen,

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the total cost associated with opioid misuse
and addiction was estimated to be upwards of

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five hundred billion dollars annually. Very
little of that was attributed to treatment and

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rehabilitation. The side effects of the
opioid crisis are expensive death, job loss,

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homelessness, long term illness, criminal
activity, and the clean up efforts

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and parks and other public places.
While it may be better to redirect more

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of the five hundred billion into rehabilitation
programs that allow patients to remain at work

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and with their families, bureaucracy gets
in the way. The third phase of

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the crisis is based in illegal drugs, where supply and demand are the drivers

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of the crisis. It's this phase
that threatens communities all over the globe.

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To completely understand this crisis, we
have to look back into history. Addiction

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is a systemic problem. It didn't
start in the nineties, and it didn't

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start with pharmaceutical companies. It began
with poppies. The earliest reference to opium

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use came from Mesopotamia in southwest Asia
around thirty four hundred BC. The Sumerians

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referred to the poppy as Hugil,
the joy plant. The Sumerians introduced it

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to the Assyrians, and they passed
it along to the Egyptians. The demand

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across the Silk Road increased, and
many countries began to grow and process it.

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Increased availability through cultivation, spread across
the Mediterranean, through Asia, and

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finally to China. The Silk Road
was a series of interconnected trade routes that

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connected Europe and China. These trade
routes developed between the empires of Persia and

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Syria and the Indian kingdoms in the
east. By the late Middle Ages,

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the routes extended from Italy to the
west, to China in the east and

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Scandinavia in the north. Many things
were traded along the Silk Road, food,

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textiles, people, and opium.
The Opium Wars occurred in the mid

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nineteenth century. The first lasted from
eighteen thirty nine to eighteen forty two,

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and the second from eighteen fifty six
to eighteen sixty. These conflicts were rooted

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in the trade imbalance between China and
Britain and the detrimental impact of opium on

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Chinese society. Before the conflicts began, Britain through the East India Company was

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smuggling vast quantities of opium into China. This led to widespread addiction and social

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breakdown. The Chinese government recognizing the
destructive nature of the drug, attempted to

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crack down on its importation and use. The Chinese began to seize and destroy

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stockpiles of opium that were stored on
ships and in warehouses. In response,

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the British government launched military expeditions to
protect their economic interests and to force China

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to open its ports for trade.
The British had superior naval and military technology,

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and the Chinese military was no match
for them. China was defeated in

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the First Opium War, and this
resulted in the signing of the Treaty of

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Nanking in eighteen forty two. Under
this treaty, China was forced to seed

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territories, pay indemnities, grant extra
territorial rights to foreign nationals, and opens

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several ports for trade. The Second
Opium War was largely provoked by the Chinese

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government seizure of a British registered ship. This conflict ended with the Treaty of

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Tiansen in eighteen fifty eight. This
treaty forced China to legalize the opium trade

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and give even more power to foreign
nationals in China. These wars serve as

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a reminder of the destructive power imbalances
that can result when global trade meets imperialistic

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ambitions. The Opium Wars remain a
symbol of China's struggle for self determination and

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sovereignty in the face of foreign exploitation. As opium moved around the world legally

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and illegally, it spread addiction with
it. During the American Revolution, both

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the Continental and British armies used opium
to treat sick and wounded patients. Benjamin

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Franklin took opium to relieve the pain
from bladderstones after his final duel with Aaron

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Burr. Alexander Hamilton was prescribed opium
for the wounds he sustained. The Civil

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War was the catalyst for the opium
epidemic in the US, though ten million

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opium pills and over two point eight
million ounces of opium powders and tinctures were

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issued to treat the Union army.
Because of this, many soldiers on both

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sides came home addicted. Those that
didn't already have addiction would at some point

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go to a doctor who would prescribe
opium for pain or illness. After the

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hypodermic syringe was introduced to the US
in eighteen fifty, six, it became

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easier for doctors to dose patients and
so much easier for patients to become addicted.

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Morphine was derived from opium in Germany
in the eighteen seventies, and this

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created more addiction. In his book
Dark Paradise, David T. Cortwright wrote,

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quote, though it could cure little, it could relieve anything. Doctors

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and patients alike were tempted to overuse
end quote. According to a survey of

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drug stores taken in eighteen eighty eight, opiates made up fifteen percent of all

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prescriptions dispensed in Boston. Women were
particularly vulnerable to falling into the trap of

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addiction. Most doctors at the time
were male and would prescribe opium for female

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complaints, everything from menstrual crabs to
diseases of a nervous character to God forbid

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mourning sickness was treated with laudanum,
a tincture that combined alcohol and opium.

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The late eighteen hundred saw more than
sixty percent of women addicted to opium.

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In his book The Opium Habit and
Alcoholism, published in eighteen eighty one,

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doctor Frederick Heman Hubbard wrote, quote, Uterine and ovarian complication caused more ladies

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to fall into the opium habit than
all other diseases combined. End quote tinctures

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such as laudanum and other opiate concoctions
were sold over the counter. It was

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used for any ailment, including teething
in babies and coughs from colds in children.

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Then there was a the turnaround.
The eighteen seventies and eighties saw many

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medical journals with articles warning physicians about
the dangers of opium addiction and use,

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but doctors of the time were slow
in response. They weren't well trained,

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and they had precious few alternatives.
Wealthy patients would demand opiates. Competition from

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other physicians and pharmacies who were willing
to take their money and give them the

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drugs put pressure on those physicians who
were trying to steer away from prescribing them.

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At the end of the nineteenth century, through several scientific discoveries, the

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tide turned again away from opium use. Acceptance of the germ theory of disease,

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vaccines, X rays, and the
introduction of different pain relievers such as

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aspirin began to change both doctors and
patients thinking on opiates. Better sanitation meant

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fewer patients turning to opiates for their
constipating and pain relieving effects because less people

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were getting dysentery. Medical journals of
the time announced to physicians, quote doctors

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who resort too quickly to the needle
are lazy, They're incompetent, they're poorly

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trained. There behind the times end
quote. Between eighteen ninety five and nineteen

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fifteen, many states prohibited the sale
of opiates without a valid prescription. No

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more OTC morphine, And just as
that epidemic was ending, a new epidemic

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started. Between the eighteen seventies and
the nineteen tens, opium dens started propping

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up. Chinese immigrants had brought opium
with them and were setting up shop,

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usually in Chinese laundries. A quote
from an opium smoker in eighteen eighty three,

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recorded in Dark Paradise said quote,
it's a poor town nowadays that has

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not a Chinese laundry, and nearly
every one of these has its layoutte.

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This was referring to the accessories that
are needed to smoke opium. During the

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nineteen tens, heroin was introduced to
the US, an underworld crime was running

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the market. Opium was still legal
at the time, but there was always

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a new element selling it, and
the face of addiction had changed. Now

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teenagers were openly snorting heroin on street
corners to feed their habits. They formed

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gangs and committed crimes like burglary and
per snatching. Often muggings would turn violent,

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whether the victims surrendered their valuables or
not. As the federal government started

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looking toward acquiring territories in the Pacific, particularly the Philippines, they began to

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consider banning opium use. The opium
trade in the Philippines was of grave concern

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to the US government, thus spurrying
President Theodore Roosevelt to call for an International

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Opium Commission to meet in Shanghai.
He was urged to call the meeting by

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American missionaries who were stationed in that
region. This led to a ban on

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opium in the US. After all, the government couldn't ban opium in a

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territory without doing something about rampant abuse
at home. Secretary of State Iliu Root

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submitted a draft bill to Congress that
prohibited the import of opium prepared for smoking.

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The punishment for this crime was up
to two years in prison. The

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bill was skewed though smoking opium was
mostly associated with Chinese nationals, gamblers,

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and sex workers who were severely marginalized
across the US, and these people became

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the targets of the bill. Even
though there were plenty of affluent white people

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using opium, they just weren't hanging
out in opium dens. This lat passed

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on February of nineteen oh nine,
but all it did was limit the supply

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and drive prices up. One addict
who was interviewed for a study at that

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time was quoted in Carolyn gene Acker's
book Creating the American Junkie Addiction Research in

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the classic era of narcotic control,
quote, the price of a can of

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hop jumped from four dollars to fifty
dollars end quote that pushed addicts to seek

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out more potent opiates. Morphine and
heroin became the flavor of the day.

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By nineteen fourteen, many doctors were
again prescribing opium, but this time with

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better intention. They were using it
as a way to help the addicted.

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They found that with long term maintenance, an addict could maintain a purposeful life,

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and sometimes they could be weaned off
the drugs altogether. The Harrison Narcotic

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Act of nineteen four team killed that
idea. What began as a regulation of

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medical opium became an almost total prohibition. The aim was to stop doctors who

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were helping addicts maintain, but by
nineteen nineteen several clinics had opened up across

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the nation to address the problem in
a more hospital like atmosphere. After all,

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doctors weren't allowed to treat addicts in
their offices, but if the attics

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were patients in a hospital, well, and some of these clinics produced excellent

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results. Many patients were returning to
productive lives while receiving treatment, and several

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had kicked the addiction altogether. These
were the precursors to the rehab clinics that

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are open today. The government wasn't
happy with that, though. The Treasury

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Department's Narcotic Division had forced these clinics
to close one by one, and by

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nineteen twenty one they were all gone. During World War II, drug use

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had become rampant among the military men. Some turned to drugs to escape the

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horrors that they were experiencing. Others
used them to become fiercer on the battlefield.

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Many soldiers were thrust into battles that
could last days without rest. Drugs

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were given to them not only to
help them cope with the stress, but

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to improve their performance. The government
was developing these drugs for that purpose.

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Amphetamines were specifically designed to keep soldiers
awake and alert. They were called go

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pills. Methamphetamines were also created during
World War II. While used to keep

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soldiers awake, they soon found their
way into the civilian population and many became

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addicted. During World War II,
the greatest impact of drug use was felt

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in Japan. The Japanese government gave
their soldiers meth to give them an edge

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over their enemies, but it became
almost a patriotic duty for factory workers to

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take it. Companies would distribute it
to workers so they could work longer hours

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and produce more goods. After the
war, people continued to take meth,

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many became addicted. A massive stockpile
flooded back into the market after the war,

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and meth began to fuel the black
market, and because it was so

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easy to get and it was cheap, teenagers became addicted to the drug.

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Pervetin was the first mass produced meth
amphetamine. It became widely available to the

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German army in nineteen thirty eight.
Temler, the drugs manufacturer, saw great

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potential for the drug. In wartime. Soldiers who took it could stay awake

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for days and march continuously without rest. Hitler was determined to win the war

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despite being poorly armed. Pervetin was
his ace in the hole. It's rumored

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that the Blitzkrieg was fueled by pervetin. Oxycodone was derived by German researchers in

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nineteen sixteen from opium derived theben Hitler
would often mix heroin and cocaine, then

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when he couldn't sleep as doctors would
give him oxycodone. His doctors administered the

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drugs intravenously on a schedule. He
received his morning dose of vitamins, then

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in the afternoon he received a dose
of heroin and cocaine, and in the

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evening he got oxycodone. He was
high all the time. American and British

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forces also supplied their troops with meth. After the war, many soldiers came

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home with addiction issues. The surplus
of the drugs that were given to them

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overseas was funneled back into the black
market. An addiction became widespread among former

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military and civilians during the Vietnam War, drug use was widespread. When the

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war began, marijuana was readily available
in Vietnam, and it was the drug

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of choice for many soldiers fighting there. But when the Vietnamese government started to

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crack down on marijuana use, soldiers
turned to heroin to ease the pain of

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the war and help them cope.
Soon, these same soldiers became addicted to

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opium and morphine. These men came
home addicted to drugs, and the backlash

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from anti war protests and the terrible
way they were treated when they returned home

254
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only fueled the fire. Vietnam was
the first conflict that saw soldiers come home

255
00:24:36.839 --> 00:24:41.279
to malice rather than welcomes, and
when they returned they had a hard time

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returning to their communities. This gave
rise to more and more drug abuse.

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There were rehabilitation centers run by the
VIA, but the VIA is often slow

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and many times these men didn't get
the treatment that they needed or deserved to

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help them recover. Going with the
history of opioid use, but I just

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wanted to give you a short background
on it so that you could understand two

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things. The first one being that
opioid use is not new. The world

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has been dosing people since the beginning
of time. This is important to remember

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because we all need to realize that
addiction is systemic. The second reason is

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that I wanted you to understand that
addiction is not a simple problem. Like

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so many things I talk about.
It's complicated and there are no easy solutions.

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The pharmaceutical companies did not intend to
create the most prolific health crisis worldwide.

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Their intention was to find drugs that
could relieve chronic pain. But the

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road to hell was paved with good
intentions. The demand for pain relievers spurred

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Purdue Pharmaceuticals to take the genie off
the shelf and rub the lamp. A

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generic form of oxycodone hydrochloride was approved
for use by the FDA in nineteen ninety

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five and patented a year later.
Soon, Perdue began marketing the drug heavily

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to doctors who saw it as a
miracle drug for people with chronic pain.

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This marketing campaign used data that told
Perdue where they could find doctors who would

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be receptive to prescribing OxyContin to patients. Sales representatives would seek out doctors who

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prescribed opioids regularly, and they were
the main targets for the campaign in the

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beginning, but soon most doctors were
over prescribing opioids, and not just OxyContin

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either. Oxycodone, hydrocodone, and
codeine were also flying off the shelves.

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Soon patients began asking for opioids,
then they started demanding them. Doctors were

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doling them out to anyone with even
the smallest alements. Any awi and you

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could get a thirty day supply with
refills just in case. Sales grew from

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eight million dollars in nineteen ninety six
to almost one point one billion dollars in

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00:27:12.960 --> 00:27:18.839
two thousand and By two thousand and
four, oxyconton had become the most abused

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00:27:19.000 --> 00:27:26.319
drug in the US. In nineteen
ninety eight, Perdue distributed fifteen thousand copies

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of a video that sung the praises
of oxyconton to physicians. This video was

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never submitted to the FDA for review. Perdue later said that this was an

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00:27:37.559 --> 00:27:41.920
oversight on their part, but to
be fair, the FDA never asked about

287
00:27:41.920 --> 00:27:45.480
it either. In two thousand and
one, they submitted a different version of

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00:27:45.519 --> 00:27:51.000
the video to the FDA, but
the FDA didn't review the video until a

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00:27:51.039 --> 00:27:56.960
year later, and that was only
after the General Accounting Office asked about it.

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They wanted to know the content of
the VI. After review, the

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00:28:03.240 --> 00:28:07.359
FDA concluded that the video stated that
the risks were minimal and the reward was

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great. At least according to Purdue. Labeling on the drug was a bit

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00:28:12.559 --> 00:28:18.519
shady too. In nineteen ninety six, the FDA approved the drugs since the

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label said that aatrogenic addiction was very
rare if it was taken as prescribed for

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00:28:25.519 --> 00:28:32.039
pain management. In two thousand and
one, the labeling changed. That label

296
00:28:32.200 --> 00:28:36.720
was modified to read that data was
not available for getting a true read on

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00:28:36.839 --> 00:28:42.279
the incidents of addiction in patience.
Long story short, the FDA dropped the

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00:28:42.319 --> 00:28:48.799
ball when it came to Oxyconton.
There was no formal audit of Purdue or

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00:28:48.160 --> 00:28:55.319
Oxyconton. After the FDA picked the
ball back up and started cracking down on

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bogus prescriptions, those who had become
addicted and those newcomers seeking the high or

301
00:29:00.839 --> 00:29:08.720
getting it on the streets, and
they still are many see doctors at pain

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00:29:08.880 --> 00:29:15.599
clinics, but most of these doctors
are not legit. They may be unlicensed,

303
00:29:15.759 --> 00:29:19.119
or they may be just unethical.
They may be just guys pushing illegal

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00:29:19.200 --> 00:29:25.640
oxy that they were getting from other
unethical employees of the same pharmaceutical company.

305
00:29:26.359 --> 00:29:33.480
Some abusers get it from friends or
relatives with legitimate prescriptions. Others are getting

306
00:29:33.519 --> 00:29:38.720
it from street dealers who have chemists
working in clandestine labs. These chemists are

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00:29:38.799 --> 00:29:44.440
using recipes that they got god knows
where, and they often don't follow those

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00:29:44.480 --> 00:29:48.359
recipes very well. When you add
all of this to the other drugs being

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00:29:48.400 --> 00:29:52.519
imported from all over the world that
are available on the streets, it's not

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00:29:52.559 --> 00:29:57.759
surprising that more and more people are
becoming addicted to drugs. The thing that

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00:29:57.880 --> 00:30:04.160
surprised me was that attics are getting
younger and they're living outside of urban areas.

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00:30:06.680 --> 00:30:11.839
The death rate from opioid overdose in
people eighteen to twenty five has risen

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00:30:11.000 --> 00:30:17.759
twenty five percent over the last ten
years. Seventy five percent of attics who

314
00:30:17.799 --> 00:30:22.240
sought treatment were from suburban or rural
areas. We're going to take a quick

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00:30:22.279 --> 00:30:26.920
break to hear from our sponsors,
then come back to see how other countries

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00:30:26.960 --> 00:30:33.160
are dealing with the opioid crisis.
While the opioid crisis is more prevalent in

317
00:30:33.200 --> 00:30:37.200
the US. Other countries are also
facing high rates of opioid abuse and addiction.

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00:30:38.480 --> 00:30:44.799
During the late nineteen nineties, Portugal
was experiencing an unprecedented addiction problem.

319
00:30:45.319 --> 00:30:48.400
Heroin had become so prevalent that out
of the ten million people who lived there,

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00:30:48.640 --> 00:30:56.480
everyone was either addicted to heroin or
knew someone who was. This epidemic

321
00:30:56.599 --> 00:31:02.079
stemmed from the end of the dictatorship
of the Second Republic. The Second Republic

322
00:31:02.240 --> 00:31:07.599
was an authoritarian regime that believed in
extreme conservative government. From nineteen thirty three

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00:31:07.680 --> 00:31:12.599
to nineteen seventy four, the Portuguese
people were essentially closed off from the rest

324
00:31:12.640 --> 00:31:18.559
of the world. They had no
social liberties. When that ended, they

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00:31:18.559 --> 00:31:23.839
were very naive about drugs. The
government that followed gave the Portuguese new freedom,

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00:31:25.319 --> 00:31:30.440
and the citizens began to indulge in
whatever came their way. Soldiers returning

327
00:31:30.440 --> 00:31:36.559
from African colonies brought home marijuana,
and the black market stepped in and brought

328
00:31:36.599 --> 00:31:41.480
heroin and cocaine. By the nineties, addiction had become a top priority when

329
00:31:41.480 --> 00:31:45.599
it came to public health. In
nineteen ninety eight, the government created a

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00:31:45.680 --> 00:31:52.039
task force to deal with the epidemic. They brought together doctors, judges and

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00:31:52.160 --> 00:31:56.799
mental and social health care workers.
This team came up with a plan.

332
00:31:56.960 --> 00:32:04.079
They decriminalized all drugs, and they
created new policies and programs to treat addicts

333
00:32:04.160 --> 00:32:07.920
and prepare them to re enter society. The laws changed in two thousand and

334
00:32:07.960 --> 00:32:12.920
one. After that, when someone
was caught with a small amount of any

335
00:32:13.000 --> 00:32:16.200
drug, they were put before a
panel that was made up of a psychologist,

336
00:32:16.559 --> 00:32:22.359
a social worker, and a legal
adviser. This panel would then create

337
00:32:22.440 --> 00:32:27.680
a treatment plan for the accused.
This person was able to refuse treatment or

338
00:32:27.720 --> 00:32:30.880
accept the panel's treatment plan. Either
way, they weren't going to go to

339
00:32:31.000 --> 00:32:36.680
jail. After all. Addiction is
an illness that needs to be treated,

340
00:32:36.839 --> 00:32:42.559
and prison doesn't cure anything. Without
the threat of prison hanging over their heads,

341
00:32:42.680 --> 00:32:46.640
more and more addicts began to seek
treatment. By two thousand and nine,

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00:32:46.799 --> 00:32:52.319
illegal drug use by teenagers had dropped, as had rates of HIV infections.

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00:32:53.000 --> 00:32:58.720
More astoundingly, the number of people
who sought treatment for addiction more than

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00:32:58.880 --> 00:33:04.960
doubled. What was a plan based
on hope had far exceeded the expectations of

345
00:33:05.000 --> 00:33:10.880
the Task Force. Since then,
several other European countries have opened heroin clinics

346
00:33:10.960 --> 00:33:15.519
where the severely addicted can go to
get safely dosed in an effort to wean

347
00:33:15.599 --> 00:33:21.960
them off of the drug. Methadone
is also available, but many times the

348
00:33:22.200 --> 00:33:27.880
very severely addicted don't respond to it. In these countries, the conversation is

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00:33:27.960 --> 00:33:31.880
changing. Drug abuse is seen as
an illness, not a criminal activity,

350
00:33:32.200 --> 00:33:38.720
and the treatments are more available.
Drug wars rage in Central and South America

351
00:33:38.799 --> 00:33:44.559
to see who can take over the
American drug market. It's a competitive business

352
00:33:44.839 --> 00:33:52.480
and a very lucrative one sixteen million
people worldwide either have had or currently suffer

353
00:33:52.599 --> 00:34:00.000
from opioid addiction. Of those,
three million reside in the United States.

354
00:34:00.079 --> 00:34:02.880
Tells have a wide range of targets
to choose from when it comes to the

355
00:34:02.920 --> 00:34:09.559
manufacturing and distribution of opioids and the
manufacture of illicit drugs has seen more and

356
00:34:09.599 --> 00:34:15.639
more additions to the recipes. The
goal is to create a better high,

357
00:34:15.920 --> 00:34:20.960
cheaper During the last ten years,
fetanyl has been added to the menu.

358
00:34:22.159 --> 00:34:27.559
Fetanyl is an FDA approved drug that's
used for pain related to surgery. It's

359
00:34:27.639 --> 00:34:32.119
usually a part of the anesthetic given
during surgery. It's a synthetic drug that

360
00:34:32.159 --> 00:34:37.760
has appeared in street drugs, either
as an addition to other opioids or as

361
00:34:37.800 --> 00:34:42.440
a standalone drug. Vetanyl is cheaper
to make, and mixing and matching it

362
00:34:42.480 --> 00:34:49.360
with other opioids gives drug dealers the
opportunity for higher profits. It's important to

363
00:34:49.360 --> 00:34:52.840
remember that, no matter where you
stand on to criminalization or legalization, street

364
00:34:52.840 --> 00:34:59.440
dealers, illicit manufacturers, and cartels
don't care whether their customers experience a greater

365
00:34:59.639 --> 00:35:04.039
high. They're not going to show
up at an abuser's funeral and tell everyone

366
00:35:04.119 --> 00:35:07.880
what a great guy he was.
They're more like knockoff department stores, only

367
00:35:07.920 --> 00:35:13.519
interested in profit, and if one
attic dies from an overdose, there are

368
00:35:13.639 --> 00:35:17.360
three million more to take his place, so they will do whatever it takes

369
00:35:17.400 --> 00:35:25.480
to manufacture their wares as cheaply and
efficiently as they can. Fentanyl is fifty

370
00:35:25.599 --> 00:35:30.079
to two hundred times more potent than
morphine, and a little bit goes a

371
00:35:30.119 --> 00:35:36.719
long way when it comes to overdose. In the last ten years, it

372
00:35:36.800 --> 00:35:42.679
has contributed to a rise in overdose
deaths in the US, according to a

373
00:35:42.719 --> 00:35:47.280
DEA report published in January of twenty
twenty three. From April of two thousand

374
00:35:47.320 --> 00:35:53.280
and five to March of two thousand
and seven, the DEA surveillance system reported

375
00:35:53.559 --> 00:36:02.079
oneenty thirteen confirmed deaths from non pharmaceutical
fentanyl related use. Most of these deaths

376
00:36:02.320 --> 00:36:07.559
occurred in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey,

377
00:36:07.639 --> 00:36:15.480
and Pennsylvania. The DEA took immediate
action to control the contributing substances used to

378
00:36:15.519 --> 00:36:21.159
make illegal fentanyl. This resulted in
a decline in deaths, but that decline

379
00:36:21.199 --> 00:36:27.559
was small. Just because the US
is controlling the contributing substances to make fentanyl

380
00:36:27.679 --> 00:36:32.000
doesn't mean that other countries are,
and clandestine labs exist in other countries,

381
00:36:32.159 --> 00:36:38.719
including Mexico. In the last two
years, there have been record breaking seizures

382
00:36:38.760 --> 00:36:45.119
of fetanyl by law enforcement throughout the
US, especially along the border. San

383
00:36:45.159 --> 00:36:51.880
Diego has become an epicenter for the
trafficking of fentanyl. It's also coming across

384
00:36:52.000 --> 00:36:58.559
land into Arizona, New Mexico,
and Texas. Stories of children dying of

385
00:36:58.599 --> 00:37:04.360
fentanyl overdoses aren't uncommon in the border
states. Toddlers who find the drugs on

386
00:37:04.400 --> 00:37:08.360
a kitchen table and think it's candy, infants who are exposed by parents who

387
00:37:08.440 --> 00:37:15.239
are careless. These kids turn into
collateral damage in a world where no one

388
00:37:15.320 --> 00:37:22.320
is around to protect them. The
loxone can treat fetanyl overdose. Fetanyl is

389
00:37:22.360 --> 00:37:27.400
a synthetic opioid, but it still
works the same as other opioids. In

390
00:37:27.480 --> 00:37:34.039
some states, theloxone or narcan is
sold over the counter. Community based distribution

391
00:37:34.199 --> 00:37:38.239
groups give it out, as do
local public health groups. Often those groups

392
00:37:38.280 --> 00:37:43.599
will give it out free of charge. If you know someone who struggles with

393
00:37:43.639 --> 00:37:46.960
addiction, it might be good to
keep it on hand. Narcan has saved

394
00:37:47.239 --> 00:37:54.639
many lives. Xylazine is a relative
newcomer to the drug world. Xylazine is

395
00:37:54.719 --> 00:38:00.960
used as a tranquilizer for large animals. Generally, it's given just before a

396
00:38:00.000 --> 00:38:09.199
surgical procedure. Xylazine is currently being
procured illegally and added to fentanyl. Originally,

397
00:38:09.400 --> 00:38:14.840
xylazine was being added to fentanyl as
a way to make fentanyl cheaper.

398
00:38:15.719 --> 00:38:22.159
Xylazine added weight After adding fetanyl to
other opioids, many people became addicted to

399
00:38:22.199 --> 00:38:28.159
fentanyl and began using it instead of
mixing it with other drugs. This made

400
00:38:28.159 --> 00:38:34.559
the demand for fentanyl go up and
prices for it rose. Xylazine as an

401
00:38:34.559 --> 00:38:39.639
additive made fentanyl cheaper. Between twenty
twenty and twenty twenty one samples from eight

402
00:38:39.719 --> 00:38:45.920
syringe service programs were tested, and
xylazine was found mixed with fentanyl in eighty

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00:38:46.000 --> 00:38:52.280
percent of those samples. In Philadelphia, xylazine was found to be a factor

404
00:38:52.400 --> 00:38:59.960
in thirty one percent of overdose deaths. While xylazine is often mixed with OPIOIDSLI

405
00:39:00.000 --> 00:39:05.000
belongs to a different class of drug. It's a tranquilizer, so narcan won't

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00:39:05.039 --> 00:39:09.280
work for xylazine overdose. It may
reverse the effects of the opioid, but

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00:39:09.360 --> 00:39:15.360
it won't reverse the effects of xylazine. The long term consequences of xylazine are

408
00:39:15.440 --> 00:39:21.719
horrific. Users often pass out,
standing up, they wander around dazed,

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00:39:22.079 --> 00:39:25.679
they have seizures, and one of
the most terrible side effects is that they

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00:39:25.679 --> 00:39:31.760
develop sepsis and their flesh begins to
necrose. For many of these users,

411
00:39:31.880 --> 00:39:38.760
amputation is necessary. Users become addicted
to xylazine along with addictions to opioids,

412
00:39:39.039 --> 00:39:44.880
but xylazine addiction doesn't respond to any
of the drugs used to treat opioid addiction,

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00:39:45.760 --> 00:39:50.159
so now doctors are struggling to find
ways to treat this new addiction.

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00:39:51.079 --> 00:39:53.480
While the high from fatinyl lasts about
two or three hours, The high from

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00:39:53.599 --> 00:40:00.360
xylazine lasts up to five but when
the user comes down from the high mediately

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00:40:00.519 --> 00:40:07.320
need another hit. It's a revolving
door. Xylazine is not an illegal drug.

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00:40:07.800 --> 00:40:13.920
It is not produced in clandestine labs. People can use fake veterinary certificates

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00:40:14.119 --> 00:40:19.960
to order it online, and employees
at veterinary hospitals and clinics are also known

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00:40:20.039 --> 00:40:25.599
to sell it for under street value. This puts law enforcement in a quandary.

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00:40:27.159 --> 00:40:30.239
Since it's not an illegal drug,
there's very little that law enforcement can

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00:40:30.280 --> 00:40:36.480
do about the problem. Xylazine was
developed in nineteen sixty two as an animal

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00:40:36.519 --> 00:40:42.480
tranquilizer, but human trials were shut
down because the drug repressed respiratory function,

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00:40:42.800 --> 00:40:47.679
lowered heart rates to dangerous levels,
and caused skin ulcers at the injection sites.

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00:40:50.039 --> 00:40:54.440
In twenty twenty three, President Biden
declared xylazine use a public health crisis.

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00:40:55.400 --> 00:41:00.599
Of course, committees and task forces
were created and there working on some

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00:41:00.760 --> 00:41:07.840
solution. Meanwhile, in Philadelphia's Kensington
neighborhood, Sean Westfall, an outreach worker

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00:41:07.920 --> 00:41:13.440
with Prevention Point Philadelphia, told The
New York Times quote, it's too late

428
00:41:13.519 --> 00:41:17.960
for Philly. Philly's supply is saturated. If other places around the country have

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00:41:19.000 --> 00:41:22.199
a choice to avoid it. They
need to hear our story end quote,

430
00:41:22.639 --> 00:41:29.199
and Philadelphia's story is bleak. The
Kensington neighborhood is a known drug haven that

431
00:41:29.320 --> 00:41:34.119
is now filled with people passed out
in the streets amongst the trash and dirty

432
00:41:34.159 --> 00:41:39.760
needles. The only hope that Kensington
has is the outreach workers who tirelessly put

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00:41:39.800 --> 00:41:45.320
together triage kits, hand out clean
needles and syringes, and walk the streets

434
00:41:45.360 --> 00:41:51.960
giving out Narcan to those living there. Outreach workers say shame is the biggest

435
00:41:52.000 --> 00:41:55.519
reason that drug abusers don't seek treatment. Shame and the judgment that comes from

436
00:41:55.559 --> 00:42:00.320
hospital healthcare workers who think that atticts
our own only showing up in the er

437
00:42:00.519 --> 00:42:07.599
to get more drugs. While I
don't condone the wholesale legalization of every drug

438
00:42:07.639 --> 00:42:15.519
available, I do condone decriminalization and
treatment. The US has begun to move

439
00:42:15.559 --> 00:42:20.199
in that direction, but it moves
slowly, and contrary to popular belief,

440
00:42:20.800 --> 00:42:29.199
not all people are created equal.
Drug treatment is not available to all marginalized

441
00:42:29.239 --> 00:42:37.800
communities, especially people of color,
and the impoverished are left behind. I've

442
00:42:37.800 --> 00:42:42.639
been thinking about this episode for over
a year now. I've been considering different

443
00:42:42.679 --> 00:42:45.039
ways to approach it, different ways
to think about it, and different ways

444
00:42:45.039 --> 00:42:50.400
to present it. I grew up
in a family of addicts, and while

445
00:42:50.400 --> 00:42:54.280
my childhood wasn't horrible, it was
hard to watch my parents suffer from alcoholism

446
00:42:54.320 --> 00:42:59.920
and addiction. My father died of
cirrhosis of the liver when I was seven,

447
00:43:00.400 --> 00:43:04.360
and my mother continued down her path
until she died at seventy of lung

448
00:43:04.400 --> 00:43:08.360
cancer. At that time, no
one talked about these issues. It was

449
00:43:08.440 --> 00:43:13.440
accepted they didn't have any problems.
They just like to have a good time.

450
00:43:14.679 --> 00:43:19.639
Now we see addiction differently. There
is more conversation about it, and

451
00:43:19.719 --> 00:43:25.320
there is help and hope. It's
ninety seconds to midnight, and the conversation

452
00:43:25.480 --> 00:43:30.039
is beginning to take shape about a
problem that is plagued mankind for centuries.

453
00:43:31.000 --> 00:43:36.400
It will be through awareness, compassion, and the hard work of those brave

454
00:43:36.519 --> 00:43:40.440
souls who want to overcome their addictions
and those who never give up on the

455
00:43:40.480 --> 00:43:47.199
people that they love that this crisis
can be overcome. Thank you so much

456
00:43:47.239 --> 00:43:52.239
for listening to Cause of Death.
One hundred seconds to midnight. I want

457
00:43:52.320 --> 00:43:54.360
to give the phone number again to
those who want to reach out for help.

458
00:43:55.119 --> 00:44:01.360
Please call the substance Abuse. Mental
Health Services administers stration hotline at one

459
00:44:01.679 --> 00:44:08.639
eight hundred six six' two four
three five seven. I have other resources,

460
00:44:08.679 --> 00:44:15.119
including international ones listed at the top
of the show notes. I have

461
00:44:15.199 --> 00:44:19.719
to apologize for the overly long hiatus. I had intended to only take a

462
00:44:19.760 --> 00:44:23.119
month off, but I had just
recovered from walking pneumonia in July, and

463
00:44:23.159 --> 00:44:28.800
then I came down with COVID in
August. My recovery was slow, to

464
00:44:28.840 --> 00:44:31.360
say the least, but now I'm
back at it and I'm excited for this

465
00:44:31.519 --> 00:44:37.119
season. I want to thank DJ
jem Jam and Murder and Mimosas for the

466
00:44:37.119 --> 00:44:44.800
great reviews. Thank you both so
much for listening. Countdown is going to

467
00:44:44.840 --> 00:44:47.480
be a rough season, but the
things that I talk about this season are

468
00:44:47.639 --> 00:44:52.960
important issues that we're all facing.
This season was suggested by one of my

469
00:44:53.079 --> 00:44:59.239
longtime listeners, Carol, who really
likes the one hundred seconds to Midnight episodes.

470
00:45:00.079 --> 00:45:04.639
Thank you Carol for the suggestion.
I hope that everyone who is listening

471
00:45:04.679 --> 00:45:08.360
will learn something from it, and
thanks to all of you who have listened

472
00:45:08.360 --> 00:45:12.840
to the show. It's come a
long way since the beginning, and my

473
00:45:12.920 --> 00:45:17.039
hope is that it continues to grow. The next episode will be a little

474
00:45:17.079 --> 00:45:22.400
lighter. It's my Halloween episode.
I'm not going to tell you what it's

475
00:45:22.440 --> 00:45:24.519
about. It's sort of a surprise, but you can take it with a

476
00:45:24.519 --> 00:45:29.320
grain of salt. It's not going
to be as serious as my normal episodes.

477
00:45:30.199 --> 00:45:32.760
Until then, remember that no matter
what I talk about, there is

478
00:45:32.840 --> 00:46:52.639
always hope that things will change.
Okay, okay, and