The Secret Mass Killer

How to prevent the next tragedy.

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On today’s explainer, Declan is joined by RAND Corporation senior researcher David Luckey. A retired Marine Corps officer, David is now devoted to getting congressional attention to the thing that killed tens of thousands of Americans last year: fentanyl. David explains the scope of the overdose epidemic, its force multipliers, and the ways to fight it.

Show Notes:

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  1. Stephen.Fenwick

    Declan, is the USA on a per capita basis greater users of illicit drugs discussed in your recent podcast? In the podcast there was a brief reference to USA citizens being use to taking over the counter or prescription pills and the impact this may have, is the USA a leader in consumption of these over the counter etc type of drugs that are highly advertised? Regards Stephen Fenwick

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    JonathanRRogers

    This was a frustrating listen. If the problem is that people are dying because they inadvertently ingest fentanyl thought to be other drugs, why not decriminalize and regulate those drugs? I don't worry that the ibuprofen pills in the grocery store contain something that could kill me. OTOH, it is good that there was discussion of harm reduction as well as supply reduction.

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    1. MathewA

      Exactly, we had the same problem with alcohol prohibition. People dying or going blind from drinking bad hooch.

      That doesn't happen with Coors or Miller

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  3. MathewA

    This is one of the most disappointing podcasts I've heard from The Dispatch ever. So one sided.

    Let's look at some facts...

    1. It's been over 50 years of the war on drugs, and anybody can get any drug they want at anytime, even in friggin prison. WTF makes anyone think that more of the same will get a different result.

    2. Since the crackdown on getting legal opioids from doctors opioid deaths have drastically increased. This is ALWAYS the result of prohibition. During alcohol prohibition there were a lot of deaths and people going blind from bad hooch.

    3. We've seen from countries like Portugal that decriminalization can greatly reduce OD deaths.


    Bottom line we need a drastic change in strategy. IMHO I would legalize, and regulate. People can't be helped if they are dead, and prohibition isn't stopping anyone from getting the drugs.

    For the small percentage of users that have addiction problems they should be treated medically not criminally.

    Oh and it turns out a lot of of the other substances that have been outlawed like LSD, mushrooms, MDMA have a lot of benefits for treating addiction, depression, PTSD etc.

    Side note, when I was young, I tried just about everything under the sun, then like the VAST majority of people, I got older, got married and moved on. Now I don't even drink.

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    1. Volfarrell

      Most people who use drugs recreationally don't get hooked. Most people don't have an inherited or developed predilection for addiction. To me, fortunately, opioids kill pain and make me constipated and that's about it. To a significant percentage of us, opioids give a sense of euphoria and well being they haven't ever had and feel desperate to get again. So your own maturation isn't a guide to what our neighbors may need.

      You've suggested opioid crackdowns caused the spike in overdoses. The spike was first; that crackdown was inspired by deaths that preceded it - otherwise no one would have cared about the busloads of buyers trekking to Florida pill mills. Once (for several shabby reasons) pharma and hospitals exposed millions to opioids - and here the spike began - and then later took it away, the spiral sped up.

      The answer here isn't hamfisted prohibition. But it also isn't simple legalization, dooming millions to a baleful existence of "safely" chasing the dragon with state-proffered clean needles. And there absolutely is an appropriate role for the state to seek to punish those who manufacture fentanyl precursors and the governments that sponsor them.

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      1. MathewA

        Yes but for the small percentage of people that do have a problem we should be treating those people medically not criminally.

        Moreover, we shouldn't be criminally prosecuting the vast majority of people that don't have a problem.

        Regarding chemical precursors as noted in the podcast they have many many legal uses. You can't block them


        Finally if you look at the opioid death graph, it didn't really take off till after the crack down

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        1. Volfarrell

          For context, I am not in recovery but through my work I have visited more than 100 treatment programs, attended group programs, national conferences and met people seeking to get their lives back on track. I've been a public speaker on opioids, opiates, and the biology of addiction.

          Mathew, you've said "Yes but for the small percentage of people that do have a problem we should be treating those people medically not criminally."
          Me: I agree. But it is a gigantic problem that we are so very bad at treatment, medical or otherwise. Despite the deaths of thousands, injury to millions, waste of billions, this problem does not inspire much interest from our institutions. Amateurs (and some con men) are filling the vacuum and no one is tracking how the money is spent or who is getting results. Think of a parent, desperate to get their kid into treatment, who has nothing more than competing marketing websites and vague insurance coverage guidelines to make an urgent choice for where to send their kid and many thousands of dollars. Right now someone within 10 miles of you is in anguish with no good guidance.

          You've said "Moreover, we shouldn't be criminally prosecuting the vast majority of people that don't have a problem." I broadly agree but think we should recognize the unintended consequences of a fully liberalized policy, particularly while we fail to treat.

          Mathew: "Regarding chemical precursors as noted in the podcast they have many many legal uses."
          Nope. Fentanyl has legal uses as both anesthetic and analgesic, as do many opiates. I had knee surgery in August and was given Fentanyl. But the precursors (the ingredients that low-tech labs can use to manufacture illicit opiates) which are created and imported outside of an established and legitimate process are lethal in intent and result, and their creators should be prosecuted as criminals.

          Mathew: "Finally if you look at the opioid death graph, it didn't really take off till after the crack down"
          You've said that opiate control is killing, with the suggestion that legalization will save. That's bumper sticker policy that doesn't quite fit. And your phrase "didn't really take off" is doing a lot of work here. Pill mill crackdowns (and blunt oversight of MD prescribing) were responding to deaths and social breakdown. The spike preceded Fentanyl- from old fashioned heroin we were losing more people annually than were killed in the entire Vietnam War.

          Look, I'm a small-gov't guy and I am not saying we would be saved by more DEA agents. But we also owe neighbors more than a simple shrug a bag of clean needles.Expand full comment

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          1. MathewA

            I agree that we shouldn't just legalize shrug and move on. Hopefully we can devote some of the resources that we are currently wasting on locking people up for treatment instead. Also, I've seen some pretty promising treatment for using mushrooms, etc for treating addiction. I think that should be expanded. I'm hopeful that we can model much of this from the success that Portugal has had.

            One note, while I think the costs of prohibition are WAY higher than the benefits. I'm still fine with rules against public intoxication, loitering, homelessness etc. The choice shouldn't just be WoD, or downtown Portland or SF. Our public spaces still need to be safe. Just like I'm all for laws against intoxicated driving.

            Finally my experience with this is on the other side. I did my share of partying when younger, tried just about everything once, then again to make sure. Then like most people I grew up, went back to school, got married etc. Now I don't even drink.

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      2. Rcroxton

        You're exactly right. Most people don't have a problem even if they use drugs. I will say though, that from a governmental standpoint the problem with that fact is the word "most." When we're talking about 300 million people in America, a small percentage that are going to have problems can be a few million people. Of course that problem with using that as an excuse is that we have legal alcohol which causes massive problems (ask a nurse sometime why hospitals keep alcohol in the pharmacy) and we continue to allow it.

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    Hoopman.Ed

    Cursory googling found that AP fact checks fent. OD is NOT, in fact, the leading cause of death for ages 18-45 in the States.
    I'm trying to find the secret red phone for my Spatchfact signal, but no luck.
    I'm speculating that maybe it has to do with how things are counted.
    I don't want to suggest that this isn't a serious matter, but that stat was loud.

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      Dave T

      Links?

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    2. Rcroxton

      I can't find anything that refutes the claim. 2021 had over 60k fentanyl deaths in that age group. Car accidents, at second, isn't even close.

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      JonathanRRogers

      What is the leading cause of death for people 18-45 in the US?

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  5. Payette

    This was an excellent discussion. Thank you, Declan. A bit more on harm reduction would be helpful, especially some of the state and local barriers to this. Please consider bringing this gentleman back to update us on the problem or progress.

    Simple decriminalization of these substances is not the easy answer some would like. Look at the mess that Oregon has made in decriminalizing many illegal drugs: more drug use and users from out of state, increased homeless populations, increased violence.

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    1. MathewA

      decriminalization doesn't mean you need to accept large amounts of homeless people, or out in public drug use or intoxication.

      I think it's very reasonable to discriminate between people using drugs in their own home, or in a safe facility, and people using in the streets.

      Also, decriminalization isn't enough if you don't provide a safe legal alternative.

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  6. Volfarrell

    Thank you for bringing attention to a complicated but urgent issue.

    We need to take a hard look at how poorly we understand and treat addiction. Because of taboos and insufficient give-a-damn, we tend to toss heaps of money without expecting results in treatment. As a result, bogus programs are overpaid and promising efforts are neglected.

    We are terrible, terrible, at treating addiction. Most treatment programs have no objective measure for evaluating the condition and needs of patients at admission, no means for evaluating them at discharge, and they don't know how people do once they leave. Programs that are physician-led get the same reimbursement as programs that promote the healing power of crystals and swimming with dolphins. Time in treatment - one of the surest correlations to good outcomes - is driven by arbitrary insurance policies rather than the clinical needs of the person seeking recovery. From the little bit we do know, we see that relapse is extremely common.

    We need, from The Dispatch or whomever, a close look at the state of treatment and how it is funded by lip-service-because-I-have-to stupidity, how it is pillaged by vendors who see cash for the taking, and how, all too often, it is operated by well meaning people who are just guessing at what to do without measuring, tracking, counting, or in any way asking whether they are succeeding.

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  7. KateBird

    This was very informative...thank you for helping to bring it light. It is such an overwhelming, depressing and frightening problem. I am so grateful there are people like David Luckey who are so dedicated to exploring and tackling this issue. His statistics were staggering.

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  8. Dennis.Trask.Z

    Pax is a well researched demonstrated to be effective prevention method. https://www.paxis.org/school-based-programming/

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  9. Ianpaulleong

    What was going on with Squirrel Sarah in that first ad?

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      JonathanRRogers

      I think it was Sarah, but I couldn't be sure. I listen to most podcasts, including this one at 1.25x. In any case this should call attention to how annoying the ads are in general. I'm happy to pay for a Dispatch subscription. I don't think it's unreasonable to expect ad-free podcasts when paying, as many Patreon and Substack-supported podcasts do.

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      Gzexpat

      It was Sarah on election night. "I have to read this ad? Ok, here goes!"
      Ha ha

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      OJFL

      It was jarring to hear. Waiting for the normal ad and then Sarah was running somewhere.

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  10. David Beck

    Excellent podcast. The first ad at 21:55 played at four or five times speed - the second ad was at normal speed. I’m listening in Overcast on an iPhone SE 2nd generation running iOS 16.1.

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      OJFL

      Happened on Spotify as well, also iPhone IOS 16.1 .

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