Cognitive Dissonance - Episode 472: Opioid Crisis Part 1

Episode Date: June 3, 2019

This two part episode dives into the opioid crisis. If you have any experience with this issue or have any personal stories you feel like sharing please leave in the comments below. 

This episode of Cognitive Dissonance is brought to you by our patrons. You fucking rock. Hey, this is Jason from Des Moines, Iowa. So I have to correct you guys on a few things you just said. First of all, Des Moines does get pretty crazy for Cinco de Mayo. You should come down here and check it out sometime. We actually have a pretty good Hispanic population here. But more relevant is your comments about Steve King and immigration. You have to remember, they come to places where there's jobs and agriculture is a main driver here. So the Hispanic population of rural Iowa is actually significant because there's jobs there, meat packing plants, working fields, and in general, agricultural, particularly hog production. So to say that there's no immigrants coming is, it's just not right. They come here quite a bit. The problem is, well, Steve King doesn't represent Des Moines,

and Steve King doesn't represent a very populated area. Absolutely, he's a racist. Absolutely, he's terrible. But what he's saying, it does actually impact his constituency, but not in the way that you think it does. He's still terrible, and we can still be critical of people like him that are terrible while still being true to the facts. So he's garbage, but come out here for Cinco de Mayo or any time, and I'll get you a Des Moines beer. Take it easy.

Hey, Glory Hole guys. Just wanted to comment on your discussion regarding the measles outbreaks. A lot of the measles outbreak stuff, it gets sensationalized in the news because of the dipshit anti-vaxxers who have pushed their absurd agenda. And it is a problem. It is something that needs to be addressed with better education. But just so that you at least hear the other side of the story, I work in a pharmacy in a city that has had a measles outbreak out of the East Coast. And it's actually really heartening to see we're going through tons and tons of measles vaccines. We're getting boxes of it almost weekly because we're going through it so fast. So, yeah, there's a lot of idiots out there who are pushing their stupid

anti-vax agenda. But there's even a lot more people who realize how stupid it is and who are taking precautions to make sure that if their inoculations aren't up to date, they're getting them up to date. So it gives you a little bit of a warm feeling in the heart to see that it's not all just Ginny McCarthy and Jim Carrey and Andrew Wakefield being dumbasses. Flurry hole, motherfuckers. Bye. Cecil, Tom, you know, we shouldn't be too harsh on the attorney general. After all, it was his great-grandfather, Bill Barr Baggins, who famously redacted himself from the terrible small and goaded him into the open so mountain Jews could reclaim their ancient home and treasures. He has a heavy legacy to bear. Glory hold.

Be advised that this show is not for children, the faint of heart, or the easily offended. The explicit tag is there for a reason. Recording live from Glory Hole Studios in Chicago, this is Cognitive Dissonance. Every episode we blast anyone who gets in our way. We bring critical thinking, skepticism, and irreverence to any topic that makes the news, makes it big, or makes us mad. It's skeptical, it's political, and there is no welcome mat.

This is episode 472 of Cognitive Dissonance, Cecil. We are going to be doing something special this week and next week. We have a plan to talk about the opioid crisis. And it's not just the opioid crisis. It's the pharmaceutical company Purdue Pharma that's owned by the Sackler family

that has been in the news as of late. Tom and I consumed a lot of media on this. Podcasts, books, and then we've also read several substantial, very long Atlantic stories. I'll tell you what,

if you want to, like, you know what, I love the, I subscribe to the paper copy of The Atlantic. I love The Atlantic. It's great. But man,

The Atlantic's like, I'm going to tell you a little something, but I'm also going to give you a tremendous amount of superfluous color and detail. Yeah. And I'm going to tell you a little something. But I'm also going to give you a tremendous amount of superfluous color and detail. Yeah. And I'm going to tell you about the quiet tree-lined street that Dr. Whatever-the-Fuck grew up on.

That's so funny! I was thinking the same thing! When he was a kid, he had a tricycle. It was red, and he sometimes pedaled it around from Main to Tree Street. And his favorite popsicle was cherry. And sometimes a little bit would drip on his chin and it would come.

And you're just like, oh my fucking God. What happened with this guy? When are you taking drugs? Oh, Jesus. That was amazing. I remember listening to that too. And I was just like, okay, what are we talking about? What are we talking about?

But it was a great article. There's a lot of things that we listened to this week talking about the opioid crisis. So to start the show off, I want to talk about the history of the opioid crisis. Wait, can I stop real quick? Yeah. All right.

So we should have an opioid game, right? Like a drinking game. But like every time you say Sackler, one of us takes a hydrocodone. Everyone. One of us crushes an us, one of us crushes an oxy and a dollar bill

and then snorts the fucking thing. That'd be the most, fuck, all right. Every time, every time somebody says Purdue Pharma,

you put another fentanyl patch on your arm. I gotta, let's start, let's start out the show with personal stories. Do you have any personal stories

of, of, of any kind of opioids at all? I do have personal stories. Somebody that I was close with once was definitely addicted to Oxy. And it's funny to experience that from the outside. like to experience that from the outside, the amount of like,

the amount of disassociation that it creates and the amount of like memory loss that that creates is absolutely fucked up. Like it's a really fucked up drug to take over any significant course of time. And my own personal experience, when I had meningitis and when I had it, I took a bunch of pain meds and I like have no memories from that time period. Like very, very few. And then, you know, recently I had, I had some back problems and when I went to have those,

you know, addressed and what have you, and I've had them for about six years before I got them fixed, man, it's hard not to get drugs. Yeah, it's hard not to get that particular drug especially, right? It was hard not to get some kind of an opiate. You would go, you'd be like, and I would say at the outset, I don't have any interest in opiates. I've got this issue. I'd like to look at some

ways to deal with it. And they'd be like, I mean, you should probably have. You should probably just do the opioids. And then when I had the surgery recently, they gave me like a month's supply of hydrocodone. I needed a day's worth. You don't need that much. You're not in that much fucking pain.

The expectation that you're just going to be like, I don't know, I have a headache, so I took fucking morphine. We take knockout drops for a stubbed toe. Yeah. Fucking morphine. Like we take knockout drops for a stubbed toe. Yeah. I had a close, close friend of mine almost OD on pain pills.

I think they were Norcos. And those are interesting because they're both an opioid and they're a Tylenol type acetaminophen, right? And so your liver can't produce or can't do a bunch with it. Like if you can OD on Tylenol, it's pretty easy actually to OD on Tylenol.

They had taken enough pills to be admitted to the hospital. And it was a scary moment for a lot of people, a lot of people that were very close to that person. So I've dealt with it in that sense. I will say that I must be very sensitive to it because every time I've taken any kind of opiates, they prescribe me those Norcos and I got really sick the first time I tried them. Did you? I got very sick and I just threw the bottle away. I was like, I can't take these. I'm going to get sick to my stomach and I won't live like that. I'll just be in pain. I'd rather be in pain

than to have this queasy feeling. And so I just got rid of them. But, but our, you know, I, it's funny because like you and I are just two guys, you know, and we have stories of it, right? We have stories of people who have had to encounter these drugs and we're just two normal guys. We, this, this epidemic so far, um, has taken over 400,000 lives. Uh, and it's not the first time in the United States that something like this has happened. Uh, morphine was introduced all, you know, in the civil war. We listened to a podcast. We recommend it. Everything that we're going to, by the way, everything that we talk about today

will be on the show notes. We would suggest that you go and listen to some of these podcasts that we listen to. There's a ThruLine podcast by NPR that is fascinating. It talks about morphine, heroin, and OxyContin and the parallels that are between those three drugs. And it talks about

the origin of morphine in this country being used during the Civil War. It was called, you know, the soldier's, what was it, the soldier's drug or something like that. It was something like that, right? And it was a huge problem right after the war. It was a huge problem. And it turns out they've done research to find that it was actually a lot of women were taking morphine instead of the men who, you know, you would think if it was called like the soldier's drug, you would think the men would be, but a lot of women were taking it. In the form of Laudanum. Yeah. In the form of Laudanum, it was like very heavily prescribed. Yeah.

It's crazy. Like there was a moment in history where we got to have some ignorance around it, right? Like a lot of drugs. Sure. It's crazy. Like, there was a moment in history where we got to have some ignorance around it, right? Yeah. Like a lot of drugs. Sure. A lot of things.

We had a moment, we had a time in history where it was like, yeah, we gave it to babies. Yeah. Like, God, a baby's crying. Yeah, there was, I'm going to give the baby

some fucking... Teething stuff or whatever, yeah. I'm not saying that was a better world. I am saying that that was a better world. I'm saying that was a quieter world.

That's what I said, better. How's the baby? Sleepy all the time. You know what? It's the fucking 1800s. He doesn't need to know math. It's not, it's not just the baby thing, but heroin was introduced by Bayer and Bayer marketed heroin as a substitute, a non-addictive substitute for morphine. I mean, this was, and that was the early start of this sort of pharmaceutical marketing, but heroin was marketed by Bayer. We've never been good with opiates, right? So like, not good with morphine, not good with heroin. And then... I will say one other amusing story. So my dad's dad, my grandfather, was a pharmacist back 1,050 years ago.

And he was a compounding pharmacist. He made his own medicines and all that stuff. Yeah, yeah. And when he passed, my dad went and cleaned up all of his old shit. And the pharmacy had long since closed. And my dad found you know, went and like cleaned up all of his old shit and the pharmacy had long since closed. And my dad found this big thing of heroin that my grandfather had. And this is, this is my dad in a fucking nutshell. And I love this. So he's telling me this story. He's like,

there was this big jar and he like makes his hands like big jar hands, right? Like this big jar just marked heroin. And I was like, holy shit. I was like, what'd you do? They go, I just poured it down the sewer. A couple of rats just walking around in circles around that shit. That's my dad's solution

to everything. Oh gosh. Motorola, poured it down the sewer. He poured it down the sewer. Just went down the sewer. It's just like what he did. So he finds,

old timey. He found cocaine and he had heroin because they were just using a variety of medical processes. For old-timiness. I've got the old-timies. I would like a prescription

for cocaine. The interesting thing, I listened to a couple of other things, and one of the things I was listening to was talking about how these opioids interact with us. And opioids interact with us, right? And they interact with us and they give us a dopamine hit. And it's this dopamine that makes us feel like, wow, that's, you know, that feels good, right? That's a, that's a good feeling.

And an interesting comment from someone, and I want to say it was a radio lab that I had heard on addiction. And it was, uh, interesting comment was, the people who are more susceptible to those hits, before the invention of those things that they're getting the dopamine hits from, they are actually more suited for survival. They're better suited to seek those things out because the hits naturally come from companionship, physical love, emotional love. They come from finding good food that is high in calories. See, this makes sense why those things make you sick, right? make you sick. Right. But it's interesting to think that a human being is actually more suited to survival is also more suited to addiction. Yeah. Right. They're, they're more susceptible to that dopamine hit and then trying to recreate it. Right. That's why they'd be more says,

because if they found that, you know, jar that, that they figured out that the bees made honey, right? Like your fucking primitive ass brain figured out, holy shit, bees make honey. Then, you know, you would then seek that out again and again and again, because it would be this crazy dopamine hit that you would find. Same thing would come with, you know, the love you would have for a child so that you would want to rear more children so that you could, you know, procreate. Spread your seed. Yeah, exactly. So, so, so there's, they're more susceptible to it. And that, what a tragedy that is that, you know, they're being in a, in some ways we've made it easy to punish them. I was alluding to this before, like, like there was a time and a place where we didn't know some stuff, right? Like I was joking, like, oh, we gave it to babies. Like we didn't know like how dangerous these things are.

And we're well beyond that. And we'll talk a lot about this, this subject, but like, we're well beyond being able to plead ignorance. Yeah. Yeah. And it's, it's kind of astonishing because it's like, we have this breadth of knowledge about opiates, about their history. We conveniently forget the history, right? Even though the parallels are cyclical, and they'll probably be cyclical again in our lifetime. There'll be some other.

And we don't get to plead ignorance on this one. Like, the opioid crisis is a manufactured crisis. It's not an accidental crisis. I think that there was probably a time and a place where you could say like, yeah, you know, we didn't know how addictive that was. Sure. Oops. You know, we invented heroin as a

replacement for morphine. Turns out that was a bit of a dud. Yeah. I don't think in fucking the 2000s you get to plead that case anymore yeah you just don't and and like given how this all plays out um it's astonishing that we pretend that this is anything other than a purposeful creation a manufactured purposeful crisis and it feels like there's two crises here. There's the people who come to the doctor looking to stop pain, right? Looking to slow pain down. We're going to talk a little bit about pain

later, about it as a vital sign, also it as a useful tool, right? And they come to try to slow that pain down. They go to the doctor and they say, I want less pain. Right. And there's a movement that talks about, you know, how people shouldn't have to be forced to live in pain. So they, they get these drugs approved to be given to people. And we start giving them really pure, you know, oxy, oxycodone, which is, you know, it's, it's, it's a hundred percent pure covered by a tablet that's supposed to be a time-release tablet. That's what oxycontin is. Oxy is the oxycodone and contin is short for continuous, continuous dose of oxy. So they're getting this really powerful drug and then they start to need this drug because the withdrawals on this stuff,

the physical withdrawal from this stuff is a horror. If you don't wean yourself off of it, I've heard many stories about people coming, dropping off of it, not being able to get it. And the muscle spasms and the nausea and the worst flu you could possibly imagine, that's what it feels like in your body. It just feels like if you can't get this stuff, it feels awful for you. So they're stuck in this rut. So the prescription has sort of created them, right? But then there's another crisis in the sense that we're now flooding the streets with something that people are treating as a recreational drug. And then that recreational drug, since it's so pure and it's made by a pharmaceutical company,

it's so, it's such a good hit. It starts to lead people on to heroin because it's, and then it starts to lead people from heroin, you know, they get, they get spiked.

It will get, it's spiked with fentanyl. Yeah. And they just, they get killed because tiny, I mean, it was like a rice grain worth of fentanyl can kill you.

Yeah. So it's, you know, like an amazing tiny amount of fentanyl can just murder you So it's, you know, like an amazing tiny amount of fentanyl can just murder you. And so they're getting fentanyl and they're dying from it. So there's really two crises.

There's the one that's sort of in the doctor's office that spreads. And then there's the one that sort of starts on the street with recreational drugs. And it gets fed by this, this pharmaceutical company's making money both ways.

Well, right. You know, I think, I think that's the thing that, that we have to keep in mind is like, every pill doesn't, it does not matter. It doesn't matter if the pill ends up getting resold. The pill at some point was sold

from the pharmaceutical company to a distributor, distributor to a doctor who wrote a prescription, filled it a pharmacy. That's how they make it out into the world it all it only starts in one place it's not like there's some guy with a grow house of oxycontin in his fucking neighborhood it all starts from a supposedly legitimate place the

problem is the word supposedly yeah because there's a tremendous amount of illegitimacy that the system is rife with. And the amount, just the sheer fucking volume of opiate drugs that are just out floating around is fucking insane. It's absolutely insane. Like, I just had a curiosity. Do you have any at your house just like laying around from this thing or that thing?

No, I don't keep them. No. Like I do what I think a lot of people do. Like I, I have, I have had prescriptions for pain and then I don't take them and I don't take very many at all. But I'm, I'm, I always feel like weirdly reluctant to throw them away because like in my mind it's like, well, what if something happens? And the hilarious part of that is I also think, well, what if something happens? I shouldn't prescribe drugs to myself. Yeah, and you should just go to the doctor and see what they say. And get a new prescription if I need one, right? But I know that I do what a lot of other people do. Like you hoard.

Absolutely. People hoard these medications. And then these medications, because they're so free, like so easy to get, so crazy to get. I do that with- They're all over the place. I do that with, so the doctor will write me an Advil prescription.

It's the, what, ibuprofen, but it's at a 600 milligram. So it's like taken two Advil and it's cheaper than buying a big bottle of Advil. Because your insurance too. Because your insurance covers it. So I do have some of those left over from when I I've hurt myself and the doctor says, you need to take anti-inflammatories. You can either take Advil or I can write you a prescription. And then they do, they write me a generic prescription for 600 milligrams of ibuprofen and then I take it.

And so I do have some of those, although I was warned off of those recently. Somebody told me, one of my doctors said, you shouldn't be taking that stuff. You should always try to take the lowest dosage of all medications and to try to stop the pain at the lowest levels possible. You shouldn't just try to drown it out. Lowest effective dose. You should always go with the lowest effective dose. So if it doesn't, if you take like a 200 milligram, you should be like, okay, well, I could still feel that, you know, you up it to three or whatever it is, but you shouldn't be doing the, what I do, which be like, okay, well, I could still feel that, you know, you up it to three or whatever it is,

but you shouldn't be doing the, what I do, which is like, well, let me take two of those fucking things. Don't worry about it. And that's the wrong attitude to have with medications. That's so funny. Cause that's like, I was just reading not that long

about lowest effective dose. I'm like, that makes sense. I've never done it. I've never done that either. I've never done it. I'm always like, yeah, I take two Tylenol when I have a headache. Why would I do anything other than maximum strength? What's the most I can take? Yep. This hurts now. I want it done that. I've never done that either. I've never done it. I'm always like, yeah, I take two Tylenol when I have a headache. Why would I do anything other than maximum strength?

What's the most I can take? Yep. This hurts now. I want it to stop. Give me the most stopping power possible. I want to talk about how these people marketed this drug. So the drug we're talking about, like we said, OxyContin.

It's Oxycodone covered in a time release coating. Oxy, the reason why we're going to spend, I think, a lot of time on oxy is because the company, Purdue Pharma, had some really aggressive ways in which they were trying to market this drug. So the Food and Drug Administration approved OxyContin in late 1995.

I'm quoting directly from one of the articles that we read. The agency permitted Purdue Pharma to make a unique claim for it, that its long-acting formula was, quote, believed to reduce its appeal to drug abusers compared with shorter-acting painkillers like Percocet and Vicodin. So it was marketed to them as a way to say, well, it's going to take a long time, so it's not as useful. But what happened was almost immediately, people were like, yeah, well, I'll just break the fucking coating off of it and then snort it and I'll get a huge dopamine hit from it. So they never used that. Well, and it's, it, it, one, one thing that's really clear from reading all these articles is Purdue Pharma time and time and time again, got away with making claims like, oh, this is good for this. You can take, it is, it is believed to be less addictive because of this

theory. Yeah. Not because of any set of facts. They, they don't, they didn't have any study to back this up. They didn't have, they had nothing. They have nothing. They continuously just said shit. They just said shit out loud. And for whatever reason, they were believed. And they were able to do that with respect to using OxyContin as something that would be less likely to be abused. as something that would be less likely to be abused.

They were able to do that in saying like, well, you can escalate the dosage and it would be safe to escalate the dosage to just fucking unbelievable levels that you could take it for as long as you needed because if you were in pain, you couldn't become addicted to it. That was a claim that they made too. They made a lot of claims about this drug,

none of which were backed by science, none of which had rep by science, none of which had reputable studies that lived behind them. They just said it, man. And it was the FDA piece that really was the selling point, right? So they got the FDA to say it's believed that because it's time-released, it's not as appealing to drug abusers. That piece was a selling point to all the doctors out there. They use that as a rallying cry. They also quoted, you had said earlier, they had quoted a study that was done by like one, it was like a study of one person. It's not even a study, you can't use that word.

But it was like the risk of addiction from narcotic painkillers was less than 1% and that the dosages could be increased without limit until the pain was overcome. So less than 1% of a chance, but it was not, that's not the actual numbers. Like that's not the numbers. They just use those numbers and then they found people

who would be the mouthpiece of those numbers and they hired them. Well, nobody fact checks this shit. I don't understand that. Like, let's be really clear. Like this is something I didn't know until we really dug into this. Nobody's fact checking it. The pharmaceutical companies are the gateway for the information about their own drug. They're patented drugs. So they create the drug, they test the drug, they market the drug. Then they have a team of people that go out and sell these drugs on commission.

Yeah. And they just straight make shit up and there's nobody checking them. There's nobody checking that work. Once it's FDA approved, it seems to me like they get the FDA approval to push it into the marketplace

and then it seems like they can say whatever the fuck they want to say because there doesn't seem to be any watchdog on this. And even though we know that they did this, it's not like the drugs are being pulled off the market. It's not like we have all this evidence and it's not like anything is happening as a result. The other thing that they were doing too,

the commissions they were getting were based on how much of the drug they sold. It wasn't that they were, you know, commissioned based on the subscription rate, right? Like, or the prescription rate. They weren't based on that. They were based on how many milligrams they were selling. So that's really problematic because now they're coming in and they're saying, you need to go to a higher dose, you need to go to a higher dose. And that opens up that avenue for doctors to believe that company that, oh, it's not going to hurt my patient. If they need more, I'm going to give them more. And then it just escalates and escalates

and escalates. Think about how fucked up that is that like, see, so it's entirely fucked. That the company that stands to gain from selling you the product, and that product is going to go in your body and it's going to have a serious impact on your health and it's meant to they have salespeople on commission.

Yeah. It shouldn't even be a thing. Right. You should not have drug companies with reps on the street with a fucking you know bag full of samples of fucking opiates knocking on doors like fucking door-to-door bible salesman fucking cuckoo hey hey hey you know what if you prescribe 50 milligrams i get a commission. If you give your patient a higher dosage of fucking drugs, what am I going to say to make that happen? I've been in sales. You're going to say whatever you think.

You're going to skirt every fucking line. If you're not a liar, you'll get close. How do they get time with my doctor? That's what I want to know because I sure as fuck can't. You know what I mean? He comes running in the room like it's a race for crying out loud.

How do you get 30 minutes with this fucking guy? I can't get three. Well, we should talk about that. I know, like, because,

you know, what they do is they get time, they get a little bit of time with the doctors, right? But they get a lot of time with the office staff. Yeah.

And doctors are busy, you know, especially soul practitioners. They feed the office staff. They feed And doctors are busy, you know, especially soul practitioners. They feed the office staff. They feed them. They give them little gifts. They give them pens and giveaways. And, you know, bring them lunch.

And, you know, they're attractive. And they've got samples. And maybe we took a sample. I don't know. And they... They don't have samples of this. They have coupons. It's different.

It's different. They can't give this... At least from what I read, they can't give this stuff away. But they can give you a coupon for a full 30 day supply. But I know that they used to do samples because that Atlantic article about that doctor that got hooked.

Yeah. Yeah. He got hooked on samples. And that's a kind of an opiate. It is. But I'm saying Oxy. Yeah, they specifically didn't have samples. What they had,

at least from what I read, they had these prescription, 30 day prescriptions. So they would give the doctor a booklet I read, they had these prescription, 30-day prescriptions. So they would give the doctor a booklet of these. They'll be like, here's a free 30-day prescription to get people on. First one's free, kids. But what they would-

It's literally that model. I mean, it really is. But what's hilarious is one doctor, I read about one doctor who was, he would give, people would come in. He was one of those sham doctors that would give away like, like opium prescriptions.

Yeah, he's a pill mill. They would come into his office. Tom, it's amazing. And he would, he would give them, he'd be like, I'll give you this, but I have this side job

where I sell long distance service. What? And they would sign up for long distance service. Isn't that amazing? I couldn't believe it. What? Right?

He's a doctor, and he's got a side gig, and the side gig is a commissioned side gig selling long distance service, and he would trade it away for OxyContin subscriptions. He's got two side gigs. The first is drug dealer. Yeah, no kidding, right? He's a two side gigs. The first is drug dealing. Yeah, no kidding, right? Yeah. He's a doctor who's got a side gig as a drug dealer

who's got a side gig as a... Oh, God. I couldn't believe it. Does he sell fucking whole life insurance too? What the fuck? I couldn't believe it when I heard that. It's the dumbest shit I've ever heard. I want to talk to one of the guys

that they bring up constantly. He was a spokesperson for Purdue Pharma. His name's Haddix, Dr. Haddix. Oh my God. He said when he was talking to doctors about people getting hooked on the drug, he would say that there is a thing called pseudo addiction. And it's when the body would go through withdrawal,

when they would, you know, and all that stuff, like when the body would go through withdrawal, when they would get, you know, they would want more, they'd need more to, to get their fix, et cetera. He's like, that's pseudo addiction. It's not real addiction. And that was the one that was based off the one cancer patient. That's what the, the, that's not a study. It's whatever. It's a, I'm telling you an anecdote at that point. It's basically an anecdote of a cancer patient. Right. And so he used that. Now, he was a spokesperson for Purdue Pharma. And so he's the one who is talking to large groups of people.

He's given these talks. He's writing in journals and things like that about this particular thing. And doctors are, you know, they're hearing it and they're saying, oh, well, you know, that makes sense. Okay, well, I'll just follow that particular bit of. Well, they're the same fucking guys that said that you can't get addicted to it if you're in pain. Yeah, that's what that is. If you're in pain, you can't become addicted to pain medication. But then what they would also say is that physical dependence is a feature of all opiates.

Well, I'm sorry, but if physical dependence is a feature of an opiate, how is that not addiction? I'm physically dependent. That's not an addiction. They pushed at that, though. There were several things that I saw and read where they said they would fight that tooth and nail and say, no, physical need of this pill, physical need from this is

not addiction. And I was like, I don't get it. I don't understand it. But they were able to convince a lot of people of this. And you know, like the thing is, is I'm just a dumb asshole, right? I don't know anything from anything. All I know is what a lot of people have reported. So I don't know anything, but it sounds fishy to me. It sounds like it doesn't make a lot of sense to me, but maybe they were more convincing when it came to the doctors. I want to also say too, that they also, the pharmaceutical companies created the American Pain Society, or at least partially funded the American Pain Society. And they were the people who pushed for pain as the fifth vital sign.

So let's talk about this. So this is something that like, I know that I began noticing and feeling weird about. I remember feeling weird about. You go to the doctor now and they take your vitals. This is four vitals that they always used to take.

Now they take a fifth vital. It doesn't matter what you go to the doctor for. They're supposed to ask you to rate your pain on this chart, like one through 10, and it's got fucking unhappy faces. I have never done this. You've never? Every time.

I've never done it. Only thing I... So my doctor, I come in, and what's the four vitals? It's blood pressure. Temperature. Temperature. Heart rate and oxygen.

Oh, I was going to say weight. Oh, it's the oxygen sensor they put on your finger. Oh, I didn't realize. I had no idea. So all I know is for sure that they're putting a thermometer in my mouth, they're taking my blood pressure, and they're counting on my pulse. So I know for sure those are three things, right? But I'll tell you this.

They've asked me, my doctor, the hospital that I go to, they always ask about if I'm sad. So mine is based on depression, right? So the vital sign that they're looking for, I think, every time I ask is what my happiness level is. Do I feel depressed? It's not happiness. They're looking for sadness. They don't give a fuck if I'm happy. They care if I'm sad, right? Neutral or above. Neutral or above is cool. But they're like, have you had suicidal thoughts? Are you very sad? They ask you that a lot? They ask me every time. That's what they ask me. I've never once been asked, what's your pain level

today? Never a single time is that asked. And so when I'm reading all these articles and I'm hearing pain, I'm like, that's never happened to me. Now it might be that my hospital hasn't adopted that. And I've been going to the same hospital for 20 years. So it might be that my hospital hasn't adopted it, but I have never heard that said to me. Not once. Unless I come in and say, I'm hurt. I'm in pain.

Then they ask me, then they gauge it. Yeah, that makes sense. Yeah, I get asked all the time. I get asked all the time. And I will say, one of the things that I think is fucked is like, of course the company that sells the cure, quote unquote, for pain is pushing to get pain measured more. Sure.

Because when you ask people, what's your pain level? Like, people respond with a number, right? Like, they're just like, like oh i guess i should have pain like two three yeah you know when you're given when you're asked a question that is a list of options you tend to pick an option you you very infrequently would say oh no no none none at all yeah none and i will say like i actually had an appointment yesterday with my surgeon a follow-up appointment for my back surgery and they asked asked me, what's your pain? And I was like, I don't have any pain.

I'm great, you know. And she was, the nurse kind of looked at me like, weird, like. And I was like, isn't that what we're here for? Like, isn't that, that's the goal, right? That's why we did this whole thing. Yeah, shouldn't you be high-fiving me right now? Yeah. My guess is that people feel compelled to answer, you know, one or two.

Yeah. You know, fair to middling, you know, that kind of thing to answer, you know, one or two. Yeah. You know, fair to Midland, you know, that kind of thing. Sure, sure. You know, and as you do that, it's just going to push more and more people reporting pain. Yeah. Ask and you'll get an answer. Purdue Pharma also partnered with another company

and they used this system. And it was, I'm going to read directly from an article. In its approach to sales, Macy shows, Purdue was scientific. Using information purchased from a data mining firm, the company determined which physicians were prescribing the most of their competitors' painkillers and dispatched sales reps to their practices.

The more likely a doctor was to prescribe, the more often the reps darkened his door. The reps were highly motivated. Their bonuses were pegged with the milligrams of OxyContin that a doctor prescribed. So I found out also that their company had a share in this sort of market research company that just collected the data

on what doctors were prescribing so that they could focus and target better these doctors that were prescribing painkillers and so they could go out and sell their painkiller, a much more potent painkiller, to us. Yeah, and that means that the care that you're getting as a patient, let's just be very clear, the care that you're getting as a patient, let's just be very

clear. The care that you're getting as a patient is not evidence-based at that point, right? Because if a doctor is being swayed by a sales rep rather than by a study, rather than by the evidence, if the reason I'm switching from painkiller A to painkiller B is because that rep keeps coming in and buying my office lunch and my staff really likes that person and I just want to do something nice because the rule of reciprocity, that means that we're not talking about an evidence-based medical system. It means that you as a patient are getting care that's based on the high-pressure sales tactics of a fucking door-to to door Amway salesman that has fucking heroin in his pocket. That's a true thing. That's just a fucking true thing now. That's fucking crazy to think about.

And the doctors that like the doctors that are prescribing all of these medications, like you better believe they're getting something out of it. Like they're getting asked to go and like speak at this conference. Oh, you know what? You and your patients have such great success, you know, managing this kind of pain in your practice. Why don't you come speak at this conference for us? Oh, it happens to be in Bermuda. That's a thing. These all expense paid junkets where it's like, we'd love for you to be in on this association or this pain society or whatever and be a speaker. Oh, that's cool. Yeah. You want to do that? That's fine. Let's do that. Doctors and these people who are working for, I don't want to paint them as all people who are

like pushers trying to get you hooked, right? Because I think that there is something to be said about their intentions, right? When we don't know what their intentions are, you can only guess based on evidence that you have. So I can't tell you what they were thinking. But a lot of these people seem to be thinking that they're doing a good by taking people's pain away. There was one podcast we listened to, the New Yorker Radio Hour podcast we listened to. There's a sales rep, an old sales rep, who's

telling the people who he's talking to, the interviewer, that he thought he was doing something good. He didn't think he was doing something wrong. He wasn't out there trying to hurt people. He wasn't trying to make it so people would have more oxy. What he wanted was them to not have pain.

And so I don't want to paint everybody as like, oh my gosh, they're trying to push all this stuff, but they are trying to sell something. That's a true statement. Yeah, so let me kind of scale it back a little bit in the sense that I don't know that I would say that the individual sales rep is problematic. I would say that my view is that creating an incentive system from the top that says, hey, I'm going to incentivize you on the dosage and I'm going

to incentivize you. We're talking about a system, whether it's ethical or unethical, at the very best, the most generous thing you could say is it's not evidence-based. That's the most generous thing that you can say is that if I am a doctor and I'm prescribing a certain medication because of the tactics of a salesperson

and I'm switching from one prescription to another because the sales guy is more, you know, persuasive. That has nothing to do with like, well, it's more efficacious, right? Because that would be the most easy sales. My drug's more efficacious. Look at this study. Oh, that's more efficacious. Cool. I'm going to use that one. And that's it. You don't ever have to come here again. Every time somebody needs it, I'll just prescribe it. Why would you ever come back and talk to me again? Sure. Well, the reason they want to come back and talk to you again is because they want to stay on your fucking radar like any salesperson. It's just

part of the game. Sure. Incentivizing from the top these kinds of tactics at the most generous thing you can say about that is that it creates a situation where patients are getting care that is not evidence-based.

And like, that's hugely problematic. Other problematic things were some of the things that they knew, right? So that they found out about this drug and then they didn't disclose it, right?

So one of the things that we've got to recognize is that Purdue Pharma is not a publicly traded company. So some of the checks and balances that might be involved in other companies, right, where, you know, people can see your profits, people see, you know, other sort of inner workings when you have

a board that's, you know, a profit. Yeah, this doesn't happen in a company that's privately owned. And so they had some protections when it comes to this stuff. Now, some of this stuff has come out because of whistleblowers and other people that have released memos and whatnot, and they're finding things out about Purdue Pharma now. And they're starting to prosecute some of these people because they found wrongdoing, things that they knew and they were still trying to push this drug.

Specifically, company executives knew three years prior to testimony and they covered up their knowledge. So three years before they knew about stuff and this stuff has come out, that there's been memos that have come out. One of the things that they knew for sure was that the time release portion of it was useless, right? So I don't know how they didn't know this, right? I don't know how that this did, this got past them. I, I can't imagine that they didn't know this at the outset, but they at least do it several years in advance that before it really started hitting was that this time release is a portion of the outside of the pill. And when you crush the pill, that time release portion is no, it doesn't do anything. Now you can

snort it or you can melt it down and shoot it or whatever you got to do. Or you can even just put it in your mouth then probably. And you'd be okay because it's going to release it all at the same time. And so, you know, that time release coating that was on that pill didn't do what they thought it was

going to do. You've gotten to the center of the 20-pup real fast. Yeah, it was one, two, three, and you got in there. It seems like, and the circumstantial evidence leads to me to believe that they were just okay with the, because they tried, they hid this for a while. They hid this idea that this coating did nothing. It makes, it leads me to believe that they just wanted to sell the pill, man. And I appreciate, I want to say, I appreciate your abundance of caution. I will throw that to the wind.

Because for my end, we know some shit called Purdue Pharma knew. They knew that these drugs were creating addiction problems. They knew when they, well, you know when you make up a lie. They knew, these drugs were creating addiction problems. They knew when they, well, you know, when you make up a lie, they, they knew they said shit that they knew demonstrably was untrue. And they continued to defend it years after they knew these things were untrue. It like, they don't have credibility.

The benefit of the doubt, like, because I know for a certain fact that they are willing to make up facts to persuade people to use their drugs. That's not a question. That's a true thing we know is, we know that they're willing to suppress knowledge about the danger of this drug until they get caught, sometimes for years. There's one part where the Sackler family, the guy, Mr. Sackler wrote in an email, we have to hammer on abusers in every way possible. They are the culprits and the problem. They are reckless criminals. And so he wanted to push the blame on people that were abusing it. Right. Because if it becomes a problem of just a bunch of people using it recreationally as a

street drug, then he doesn't have to deal with the first problem that you laid out, which is that it is dangerous for patients to take. It is over-prescribed. It's grossly over-prescribed. The way that it's prescribed, we know leads to addiction. It's not something we have to speculate about. We know that it leads to tremendous addiction. And we know that taking it, not only is just addictive, but it's dangerous. Like people overdose and they fucking die on this shit. Like the amount of deaths in the hospital, there was a study about the number of deaths in hospital related to opiates. And like in a relatively short period of time, went from like 0.7% to like 3.6%.

Yeah. It fucking quintupled. Yeah. And it was a relatively short, I forget the time, so it was a relatively short period of time. Like we know it's dangerous and they told everybody it's not dangerous.

It's not like they, they didn't even like say, oh, and we're just not going to comment on the danger of it. They marketed it as less dangerous. So I think it's entirely fair for you to be like, yeah, all the evidence leads to me thinking like,

if you didn't know better, you fucking should have. You fucking should have figured it out, yeah. And that's the most generous thing you can say. You fucking should have. I heard that it was that opioids now are the leading cause of death for people under 50.

That's fucking insane. Isn't that crazy? That one of the books I read started out with the fact that something like a large city, we're talking about 75,000 people a year, die. A whole large, just imagine a whole large city just gone. And that's a pretty sizable town. You know, there's several large cities that you could say that city

would just be wiped off the map. And so that's in one year that we've lost thousands, tens of hundreds of thousands of lives to this. And like, it's, you know, I want to talk a little bit about, we talk about this when we talk about the measles or we talk about other things, or if you only count fatalities as the cost, you miss a lot of what happens.

Right. Right. Oh yeah. Yeah. Yeah. That's a great way to huge cost in terms of lives, but like in terms of the damage that this shit does, it's way bigger than that. You know, there's, there was a guardian article, you know, where people were saying they were describing like their spouses as missing pieces, their children as being, you know, sullen and disinterested in the world. They're talking about, there's a story in the Atlantic about a doctor who, I mean, he became addicted to opiates. He lost his practice. He lost everything. He was delivering fucking pizzas at the end of that article. Yeah. And working in a shelter. Like that guy lost everything. He was delivering fucking pizzas at the end of that article and working in a shelter. Like that guy lost everything. He wouldn't count as one of those

statistics. None of those people. He didn't die. So if we only look at the cost in terms of deaths, we aren't seeing the total impact. It fucks people up and it ruins people's lives that don't die from it. There's a guy, I was watching a documentary. There's a PBS documentary. It might've been a Nova or a Frontline or something. And this guy, this poor guy, he gets his leg cut off in the mine. He's working in a coal mine.

Jesus! He gets his leg cut off, but he goes back to work because he doesn't want to lose his job. And so he's got a prosthetic because he lost the lower part of his calf down, it looks like. So he has to go back to work because disability won't support his family. So he has to go back to work. He goes back in. And as he goes back in, he's got to start taking these pain pills to get by through the day.

And then one day he doesn't have his pain pills and he's racked, absolutely racked in pain, can't get out of bed. At a certain point, he was saying that he had run up his credit card bills up $30,000 just buying pain pills. His wife leaves him. You know what I mean? Like it's-

And he wouldn't count as one of those statistics. It's the worst country song you've ever heard in your entire life. But this guy, this poor guy loses his leg and then he's just trying to work. And just to get by throughout the day, he's got to take these opioids because we don't take care of people that are

disabled, I guess, in this country. We're a bunch of fucking monsters in this country. Well, okay, to be fair, he's probably just one of those lazy welfare slobs. Unreal. Oh, look at me. I lost my leg and now I don't want to go to work. I'm just going to sit here and pop pills all day. Oh, what are you going to do? Lay around and fucking eat my government cheese, you lazy and now I don't want to go to work. I'm just going to sit here and pop pills all day. Oh, lay around,

fucking eat my government cheese. You lazy fuck. Couldn't believe it. And that's like just one story. Like there's so many. Rub some coal in it. This is one story, man.

There's a whole bunch of these stories and there's a whole bunch of stories of people who, you know, had opiates, use the opiates, you know, lost a lot of their life. Their life changed very drastically because of this. This is not a, it's not, you're right. It's, if you just look at deaths, you're not paying attention to the whole picture.

And the deaths are awful enough. Yeah. The deaths, yeah. Right. That's the other thing. It's like, it's not like the measles. Like you look at the deaths and be like, oh, it's not that many. It's like, this is a lot. It's a whole lot. Yeah, yeah. You look at like something like 9-11, right? And we're all, oh my God, we got to do something. 3,000 people, 75,000 people.

Yeah, 400,000 since it started, right? You're just like, oh my gosh, the amount of people that are dying. And it's ballooned and sort of worked its way up. You know, one of the things that they did when they... We talk about the way they're culpable, what they did to cover it up. They picked up references to abuse of opioid products on the internet. So they would troll these places on the internet to find where people were talking about their product.

to find where people were talking about their product. They knew that people were talking about how great their product was to get high on, to use as a recreational drug, which is illegal, right? It's not that I'm, and I don't want people to think that I'm against using something recreationally. Like, I don't think that there's anything wrong

personally with, I think you should pay attention, especially if you're using a very powerful opioid, opiate like Oxycontin. That's a, I would be very careful with that as a recreational drug. Yeah. Right. Um, it's, it's highly addictive. It's, um, it's, you know, it's been proven to be highly addictive over and over and over

again. It's super dangerous. Yeah. And it's, and it's, it's one of those, it was one of those drugs I certainly wouldn't take if it was offered to me, but I, you going to poo-poo what somebody wants to do with their own time. You do what you got to do. I'm not a guy who's anti-drug. I'm not a guy who's anti-altered state. You do what you got to do. But they should be following rules, right? They're selling a product that they're saying, this is for people in pain. This is for people who are looking for a way to slow that pain down,

to not deal with that pain. There should be something there that makes them stop and say, oh my gosh, because if you know it's being used like this, if you know it's being talked about on the internet like this, well in advance of any major, major, major problems with people becoming addicted to it, ethically, it's your duty to do something about it. Well, at some point, there is no way for them to bury their head in the sand and claim that they didn't have knowledge, that they were producing and selling vastly more of these fucking drugs than could possibly have any therapeutic benefit. Which means that the only conclusion is that outside of therapeutic benefit, we know that these drugs are somehow making their way into a secondary market. There's no way. But the quantity of pills, when you look at the number of these pills that are being sold and produced and sold, it defies imagination.

It's in the billions. It's a crazy, wild, insane amount. billions. It's a crazy, wild, insane amount. There's no reasonable person that could look at the sheer volume of these pills produced and say, well, yeah, I mean, like, it's probably true that like, you know, one out of 10 people needs a prescription for Oxycontin because that's, that's like what it would boil down to. It's like one out of 20, right? Like needs a fucking prescription for fucking Oxycontin at any given moment. That's insane. So you have to know, you can't pretend you don't know that you're producing a trillion pills or whatever the number is. Oh, but you know, we don't want anyone to abuse them.

Yeah. You don't give a fuck. What you want to do is sell a trillion pills. Yeah. I, uh, there's another part too. It says, uh, this is from another article. It says new civil suits from the attorneys general in New York, Vermont, and Washington State accused distributors. Now, this is something else we were talking about

before we started recording the distributors of brazenly devising systems to evade regulators. Yeah. They allege that the companies warned many pharmacies at risk of being reported

to the DEA helped others to increase and circumvent limits on how many opioids they were allowed to buy and often gave advance notice on the rare occasions they performed audits. That's now going not just for the Purdue Pharma, that's the distributors trying to again sell this drug

and warning people off, trying to tip them off when there's going to be some sort of reckoning. There were stories from that distributors article. There were stories of like these little like two lightstop towns in like West Virginia that were getting, you know, they had a population of like a couple thousand people and they were getting shipments of these fucking pills that exceeded their population. Like that exceed, like vastly, by tenfold. So like people, everybody in town would have to be getting

a hundred pills a month in one of these towns. And like, there's no way both the distributor and Purdue Pharma don't, you can't claim ignorance. You don't get to claim that when these numbers get this big because that's your bottom line. If you sell something, one thing you know

is how much of the thing you sell. Like, you know how much of the thing you made, how much of the thing you just sold. You don't get to pretend that you didn't. And you don't get to pretend that you shipped, you know, 40,000 fucking Oxycontin to a, you know, podunk West Virginia with a population of 3,000, when you're the one warning them, hey, that number's, you know, a little too high, that hits the red line. Why don't you scale it back to 38.5, right? That's like telling your buddy, hey man, deposit $9,900 in the bank. You don't have to fill out that $10,000 form, right? Yeah. When you know some shit is shady. Yeah. They know the shit is shady. They know this isn't going to people

that are just like, I got a backache. Yeah. You know that you're creating a crisis. You know it. And they continue to do it because the money is so big. The money is so big that one of those distributors is like the biggest pharmaceutical distributor that distributes

OxyContin is one of the top 15 highest grossing revenue companies in America. They got hit with like a $60 million fine and they just shrugged that shit off because they have revenues in the billions of dollars. It's a drop in the fucking bucket. They're like, it's a cost of doing business. Yeah. It's like the old EPA people when they would dump a bunch of stuff and instead of remediating all that garbage that they were sending into a river, if it costs us $70,000 to remediate it or $10,000 fine, I'm going to take the $10,000 fine and you deal with my garbage yourself. It's the Pinto equation.

Yep. Exactly. Yeah. It's the Pinto equation. Pinto equation from Fight Club. Yeah, right. One of the things I want to talk about is the Sacklers a little

because the Sacklers own Purdue Pharma. Purdue Pharma is the maker of OxyContin. The Sacklers, the older Sackler, Arthur Sackler was the one, he's passed away now, but he was the guy who basically, you know, they said he really revitalized some pharmaceutical marketing. He bought a marketing company early on and he used marketing tactics to sell these drugs. And his family became very wealthy off of this.

And one of the things that, one of the pushback pieces of this is that, you know, while they might have to pay some fines, and I think there was something to that effect. None of them have gone to jail, right? But there has been returning, not returning of their money, but certainly refusing of more money. The Guggenheim,

they were huge. These people are huge philanthropists. They give money to the arts all over. Medical schools. These people are huge philanthropists. They give money to the arts all over. Medical schools. And people are taking their names down and also just not accepting any more money from those families. A million dollar donation was turned down. Yeah.

And the commentary was like, how bad do you have to be that somebody doesn't want your million dollars? Yeah. You live and die on donations. You're like, no, man, that's dirt. Because that's the thing, it's dirty money. Yeah. It's dirty money.

And there's no way to, that's dirt. Because that's the thing. It's dirty money. It's dirty money. And like, there's no way to pretend it's not dirty money. There was even like an article that was talking about Arthur Sackler himself saying he didn't know, he didn't know. Yeah, because he got out of it. He got out of it early or whatever because he died early. No. And then they find information afterwards like, no,

he knew. Like he knew. The family knew. They were in bed with the whole thing. And they play this game where they pretend to be disassociated with the everyday, when in fact, they were micromanagers of the entire incentive program that pushed those drugs out into the market and had those guys, Amway, got drugs, knocking on fucking doors. I got to say, there's a really powerful piece, and I think it's in the Daily Podcast that's in our notes, in the show notes for this episode.

That, the Guggenheim protest that they did. Oh, yeah. They go into the Guggenheim. The Guggenheim, I guess they gave a bunch of money to the Guggenheim. They staged this timed protest where all these people are in the Guggenheim on a free night.

Yeah. And they're all up the staircase or whatever. And they did this thing where they start shouting, you know, about, you know, they're doing a chant. And as they're doing a chant, they release prescriptions with people's names on them that have died. So prescription pads.

Right. With people's names on them who've died. So prescription pads with people's names on them who've died from the opioid crisis and they release it in the Guggenheim. And I was like, that is an artistic, a very artistic, very well thought out protest. And I thought that was really something. But there's been a lot of pushback to this.

There's also been some people who have gone to jail. Well, they got in felony charges. I don't know that they've gone to jail. I want to read part of this. It says, in 2007, Purdue Pharma pleaded guilty to a felony charge of misbranding OxyContin while marketing the drug by misrepresenting, among other things, its risk of addiction and potential to be abused. Three executives, the company's chief executive, Michael Friedman, its top medical officer, Dr. Paul Goldenheim, and Mr. Udell, who died in 2003, each pleaded guilty to a misdemeanor misbranding charge that solely held them liable as Purdue Pharma's responsible executives and did not accuse them of any wrongdoing.

The company and the executives paid a combined $634 million in fines and the men were required to perform community service. So that's the damage that they received. Yeah, the company wrote a fucking check. Yep. A billion, billion dollar company. Yeah.

Wrote a check. Wrote a big check, but it's still a check. Yeah, but it's a check that doesn't, ultimately doesn't hurt them. They're still around. They're still in business, right? They didn't have to sell the furniture. Yeah, right. Yeah. Wrote a big check, but it's still a check. Yeah. But it's a check that doesn't, ultimately doesn't hurt them. They're still around. They're still in business. Right. They didn't have to,

they didn't have to sell the furniture. Yeah. Right. Yeah. Nobody went to jail. And like, that's the thing. It's like,

we're in the middle. Like I was, I, we read article after article, after article Cecil. And I'm like, and it's still the only game in town. Yeah.

It's still the only game in town. Like we, we have, we have this crisis going on and there doesn't seem to be effective enforcement whatsoever. There was an article that we read that like one of the enforcement officials,

a DEA enforcement official, was hooked on fentanyl lollipops. Do you remember reading that article? Yeah. He's like leaving the fucking wrappers for his fentanyl lollipops around the office. It's like, it's got tentacles everywhere. These drugs are so dangerous.

They're crazy, crazy, wildly dangerous. And we have a system that makes it, because, you know, partially it's because of the culture that the drug companies have created, to go back to a point before, where we have an anti-pain culture. And I don't point before where we have an anti-pain culture. And I don't know that we always had an anti-pain culture, but we have a culture. One of the articles that we were listening to was talking about how old guard nurses.

Yeah. Difference between the nurses. Old guard nurses would be like, yeah, I mean, sometimes shit just hurts. You know, you had a big surgery. Sometimes shit just hurts. Sometimes shit just hurts. You had a big surgery. Sometimes shit just hurts.

And the new guard nurses who have been taught a culture around pain that, oh my God, we can't have anybody in pain. Nobody should be in pain. We got to treat pain. Pain is a pain epidemic in America. There's a pain epidemic going on. The pain epidemic is a term and a movement which was funded by Purdue Pharma. Sure. and a movement which was funded by Purdue Pharma. Sure.

They created organizations to sell this idea, to sell this narrative that America is in the midst of a pain epidemic. Why? Because they sell pain pills. Then they were the ones that like wrote the book about, like literally wrote a book that they distributed for free as an educational guide as the American Pain Management Society. Oh, don't worry. We'll underwrite making this book and distributing this book on how to treat and manage pain. And then we'll make pain the fifth vital sign.

We'll create an entire culture around destroying pain about, we'll tell you that it's a problem. We'll tell you that it's a crisis. We'll tell you that you should have a zero tolerance for pain. Incidentally, we happen to sell fucking pain pills. We sell a thing that slows your brain from, and it really doesn't even replace the pain. It just makes it dissociative. But it's those practices, right? It's those practices when you see that their hands are in the creation of this idea that really makes it feel like there's a lot of circumstantial evidence that makes me believe that this company should be punished more. That's the main thing that I think I'm coming back to,

is that there needs to be more punishment for these people. One of the things that they're talking about, President Trump is talking about, he's talking about this opioid epidemic, but when he's talking about it, he's talking about death sentence for drug dealers. Did you hear this? Yeah. Death sentence for drug dealers.

That's not the problem. They're talking about punishing the doctors. They're talking about punishing, but there's never any mention of punishing these executives. Or the distributors. Or the distributors, right? There's some people that are,

and I always wondered this too, there's plenty of these, when there's a suit against a company, we're talking about, there's a lot of parallels in some of these articles to the cigarette industry, right? There's a lot of parallels because the cigarette industry was secretive.

They denied the fact that cigarettes were addictive. They were duplicitous. Even to Congress. And then they shredded a bunch of documents, et cetera. But they got those whistleblower that called them out, sent out some memos, really changed the face of how we dealt with the cigarette industry.

But after that happened, some states sued these companies, right? And so they sue these companies for damages. And that is starting to happen now in some of these states, right? We're seeing some of these attorneys general are bringing suits against them. But these are all, I think, fine suits, right? Because cigarette companies still exist, right? They don't have to sell the fucking furniture

like we said earlier. They still are around because they have an addictive product. That's the other thing that they have in common, right? Is that they have a market which once they have created

that market, the market self-perpetuates. And somebody's got to feed the machine now. Yeah. Right? And they literally have a patent on the problems, on the solution to the problem.

They have a literal, actual patent on it, Cecil. Yeah. Unlike cigarettes, right? Which like lots of people can make cigarettes. So like if R.J. Reynolds was lying, but fucking the other guys, I don't know, Robert Morris, whatever, wasn't, if they fine R.J. Reynolds out of business, somebody else

picks up the mantle, these people need to go to prison. And we're seeing the first spate of, amongst the distributors, we're seeing the first spate of criminal prosecutions, amongst the distributors, we're seeing the first spate of criminal prosecutions, not just civil suits, but criminal prosecutions because it goes beyond negligence. It's to the point of saying like, yeah, I put dollars in front of the truth and I lied, I expressly lied

and I hid this shit from regulation. And I think the only thing that changes this is criminal penalties. Human beings, actual people have to go to jail for a super long time at the very top so that they say like, okay, well, we got to make, we got to make the number of pills we push into the market make sense.

Yeah. Because it doesn't make sense that you could stem this tide from the top. You can't stem it from the bottom. The bottom is the guys on the street reselling. By the time you sell it on the street, how many hands has it had to go through? It has to have passed through, at the very least,

Purdue Pharma to a distributor, a distributor to a pharmacy, a pharmacy to a person, a person to a second person, right? So if I'm getting to recreational it's got to go five yeah it's five degrees

five degrees right well the place to solve it isn't at the bottom of that funnel yeah the place to solve it is at the top but there's no incentive

because all they have to do is write they write a little check and then next week they get a bigger check it doesn't matter what the fuck do I care it doesn't matter

right there's incentive in the sense that, you know, I could go to jail for this, that's a big deal. Right. When you watch your buddy that like is in the fucking

next shiny office over getting led away in handcuffs and he's- Thrown down on his fur carpet. Right. Get thrown fucking in handcuffs. And that fucker's going to die in jail now.

Yeah. Oh, okay. Well, you know what I'm going to do? I'm going to, we're going to start putting together some systems to make sure that I make exactly the number of pills that make sense.

And these people created political capital by contributing to political funds. I mean, they contribute to political funds. They were talking about in one company was fighting against, there was a congressional hearing on opioids, and one Democrat was railing against, not against the company,

but against the idea that this was happening, right? Well, then they showed later on, he got 10 times more of a contribution than anybody else, right? Because there's an incentive there. It's the same incentive. It's a very similar incentive to what we were talking about earlier

when you're talking about, you brought my staff lunch, you take me on a Bahamas tour or whatever. And then suddenly I feel that need to reciprocate. And I think the same thing here. It's this political group is just funneling money to them and being like,

hey, you need to be pushed back on this stuff because it's not a bad thing. And I will say, the politicians may think they're doing the right thing because they're getting this information, but these people have shown themselves to be bad information brokers, right? They give false information. They've been shown to

do it time and time and time again. Then they've been shown to do it to sell profit, to make profit, to sell pills. What blows my mind is like, for an individual, once you find out that somebody is willing to lie big for their own gain, if you found this out about a person you knew, you'd be like, that is an untrustworthy person. And then, at least in my mind, then you're like,

that is an untrustworthy person. And then, at least in my mind, then you're like, that is an untrustworthy person. Like, nothing they say means anything anymore. Like, all that goes into the bucket of you lied big for your own gain. I can't trust you anymore. You live in a different bucket.

Crazily, for these major corporations, it's like we know that they lied and then we let them promise to do better. It's like, like how many more times are they going to let him hit us? You know what I mean? Like this feels like, like,

I feel like I'm just like flinching all the time. Like, ah, like really? Like, well, this is like the solution. I'm like,

all right, I'll write you a check and I'll promise to do better. No you lost the benefit of the doubt you also never get it back. You never it's too important 400,000 people are dead you never get the benefit

of the doubt back now regulators live in your house. Yeah. You're the only one that makes it you have the literal patent on it. It's only you. You only got to go to one company to fix this.

So I was watching an interesting I think it company to fix this so I was watching an interesting I think it was a PBS special that I was watching on it and really moving piece on some of the victims of this one interesting thing that they're doing in Vancouver

that they've installed that they won't do here won't happen in the United States but they have it in Vancouver and I think they have it in Canada and different places. It took them a while to get it instituted, but they finally have it. And it's a place to go shoot up supervised.

They're not going to give you the drugs. They're not going to do anything like that. Oh yeah, I read about this. They'll give you clean needles. Yeah. They're standing on, ready to, they're going to give you

all the types of things you need to make sure that you can, you know, shoot it up safely. And then, you know, like all the antiseptic, all that stuff, it's all just there waiting for you to use. You have a little booth that you can use it in. You have someone there to talk to, right? So one of the things, one of the benefits of it is someone shooting up. Well, there's a human being across from you if you need to ask for help, right? We have bad ways of getting off these opiates. The only ways we know right now of how to get off these opiates,

most of the ways are the 12-step process or variations, which are really, really inefficient. 6% I think is what they say is the rate. That sounds bad for the other 94%. So there's a lot of relapses, it turns out. But you get a chance to talk to a human being. They have Narcan on site. So if somebody does have a bad dose and with some fentanyl in it, they can get this shot up. They said that the amount of people that died

from this has changed dramatically because they're not doing it on the street corner. They're not doing it behind a building. They're doing it with a clean needle. They're doing it under supervision. They're doing it in a place where they can make sure that somebody, if they're going into complications, is there for them. It's really changed the face in Vancouver specifically of how this is done there. And I really wish it was something that we instituted here. One thing that occurs to me is

one of the reasons we would never do that here is because in the States, we think that if you're a drug dealer, you deserve it. Yeah. And if bad shit happens to you because you, and we're so hypocritical about it

because if you ask people about their drug use at some point in their life, almost everyone's got a story, right? So we're just, we're all liars about that. Not, I mean, like culturally speaking, right? Not individually. Like culturally speaking, like I know that like, there'd be people who'd be like,

well, fucking they're vermin anyway. Let them execute themselves, right? Let them die. Like we don't look at it in the sense that like, that addiction is a problem we can address and we can reclaim people from addiction like we also don't look at addiction as a problem that can be if not eliminated managed in a way that people can still be productive sure because that's a true thing too like it's we look at it as this weird zero-sum game

where it is somehow immoral to get fucked up if it's heroin and it's totally fine if it's, you know, beer. You know, like we're weirdly moralistic about the ways and the preferences people have around getting fucked up. Yeah. And then, like, we have this idea that, like, if it goes bad for you it's your fault and you had it coming

and we also have this idea that like it's an all or nothing you do heroin you're a piece of shit you can't possibly go to work except for the people who do you know there's plenty of people that are addicted to what we would consider hard drugs or take hard drugs and go to work and have families

and I listened to an NPR story about a guy that overdosed and he was a regular guy. Like he got up in the morning and he got showered and he shot up some heroin and then he had a cup of coffee and he went to work and he worked a full-time job and he came home and his wife loved him, except for that he had this problem with heroin, you know, and then he eventually, he ended up overdosing. And it was super fucking sad. He's not some fucking, you know,

vagrant living on the street corner. The only picture we paint is a dishonest picture. Like, we paint, and it fucks us up. And we can't solve the problem because we refuse to recognize what the problem is and what it looks like and who the face of it is. And we don't have any good systems to deal with it. I was listening to a podcast, a Radiolab podcast, about is there a drug, some kind of drug out there?

You hear some of these people talk about some hallucinogens. If they take it, they can get off of a different drug. It breaks it, right? Breaks the cycle of the drug. And then there's a couple of these other drugs. There was a guy who wrote a book about how he was an alcoholic and he took this muscle relaxer and it just made him not want to have that ever again. And never have alcohol again, right? So he took this drug and it immediately broke him of that thing.

And then there's, you know, we're talking about the Narcan. We're talking about all this other stuff that counteracts these types of drugs. We treat them, there's, you know, I know that there's people who think that, you know, that might be a path to go, but the way in which we treat it is that,

you know, you gotta have a deity thing that they do at the 12-step thing. You gotta like, and you know, you got to have a deity thing that they do at the 12 step thing. You got to like, and you know, it's funny because again, in a couple of these things where they're showing people who have sort of recovered, you know, they're showing them on the, on the, on the couch and they're reading a Bible because that's what, you know, that's the thing that how, that's how, that's how recovery works in this country. That's how it works. We don't do anything else. I know that for a while, they were doing a methadone. I'm sure they still do it. And actually, to be honest,

one of those people in one of the things was actually hooked on the methadone because the methadone is a way to get them off of heroin. That's not as, I guess, a big a hit, but it still doesn't make them so that they have the cravings for heroin. But it still is a drug. It's still the same types of thing. It's still a drug. And this one woman, she wound up being in debt to the methadone clinic. She was in debt to them. It's not that we just provide someone methadone to get off of it.

I never thought about that. They have to pay for it. And she ran up a bunch of credit card guys. She couldn't pay for it. She couldn't pay to get the thing that she needed to get off of these drugs. So we treat these people. One, we treat addicts in this country in a way that is horrid, right? We treat them horribly. Like you said, all addicts are the bottom of the gutter when it comes to addicts. And I got to say, I am soured because I grew up around an addict. My father was an addict. And so I am soured towards addicts. I know I am. I try not to be, right? I try to think about people as, you know, individuals and, you know, it's a problem, but you need, you know, that you maybe want to address or whatever, but, you know, you don't want to, I don't want to immediately throw you out. But it's hard because, you know, when you grow up with an addict, you know what happens, you know what they'll do, you know what they'll do to get what they,

what they want. And so, um, so you, you know, it's hard not to be cautious around that. And you see constantly the people who let addicts into their lives. There's, there's a lot of stories, a lot of stories about the consequences of that. Um, so, you know, it's, it's a, but we never do anything collectively in this country to try to stem that tide and change that. Instead, what we're getting, what we're talking about in this country is like, we want to put people to death that deal drugs instead of saying, hey, maybe we should deal with the problem. If there's no users, then there won't be any drug problem.

Right. Well, maybe we should start with Purdue Pharma if we're going to start executing people. Start at the top and start at the bottom, right? Take care of the people at the bottom. Start at the top. Start taking those people and, like you said, putting them in jail. If you take away the top and the bottom, there's nothing left in the middle. The middle collapses pretty quickly, right?

The middle goes away. Like, there's nothing there in the middle. The middle goes away. Like there's nothing there for those people. You know, it's funny because like, to your point about the methadone, like we don't do a good job moving people from one harm to a lesser harm, right? We're not good about that. Well, the picture you paint of like the guy on the couch,

you know, with the Bible, it's like, oh, well, you know, he did it through faith and a force of will, right? And the problem is that the diametric opposite of that is that you're an addict because you have a lack of faith and no will, right? Yeah. So those stories have counterparts, right? Right, yeah.

So you have to tell both sides of that story. So it's a problematic story because it's dishonest. When what's more likely is like, look, let's switch people from smoking to vaping. Yeah, you're still addicted to something, but it's so much less harmful. Switch you from fucking heroin to methadone, and then from maybe methadone to the next thing. We should be pouring resources into finding out what technological and pharmacological solutions exist to maybe not even eradicate. If we can't eradicate, can we reduce? Yeah. Is there, are there, are there harm ameliorations, you know, procedures that we can undergo? Like how do we

take this from a 10? If you can't make it a zero, how do you make it a three? How do you make it a four? Because that's a lot better, right? Yeah, I was going to say a four. You know, like, I mean, you're going to expect it to happen. It's going to happen. But, you know, how do we reduce the harm in the best way that we can? So next week, it's our great hope

to have on Dr. Stephen Novella. Dr. Stephen Novella is the, one of the hosts of Skeptic's Guide to the Universe. He's also one of the authors of the Skeptic's Guide to the Universe, How to Know What's Really Real in a World Increasingly Full of Fake. We're anxious to have him on the show. We're both big fans, and so

we're looking forward to that. Next week, we're going to be talking about this topic with him, talking about pharmacies, talking about, we're going to be talking about big pharma. We're going to be talking about this topic with him, talking about pharmacies, talking about, we're talking about big pharma. We're going to be talking about Purdue pharma. We're going to be talking about OxyContin, pain drugs, pain management.

So you're going to want to listen to it. I think it's going to be a great follow-up to this episode. We also want to encourage everybody who's listening right now, if you have a story or if you want to talk about it, if you want to give us a critique or whatever, send us an email, dissonance.podcast at gmail.com. Um, we will also, uh, pay attention to the thread on Facebook. And, uh, if there's something on Twitter, we're going to ask Ian to, uh, to send it to us. I don't think Tom or I check Twitter anymore, but if there's something interesting or you want to say something to us,

Ian, um, we'll give it to us on Twitter. Or like I said, the best way, of course, is through email, email, voicemail, those types of things. If you're going to leave a voicemail, please make sure it's brief.

We can't play two, three, four minute voicemails. We just can't do it. But make sure your voicemail is under a minute long. But we'd love to hear from you. If you have opinions on this subject, if you think we got something subject, if you think we got

something wrong, if you think there's something else we should look into, please send it to us and please comment on this episode. So that is going to wrap it up for this week. Be sure to tune in next week with Dr. Steven Novella, but we're going to leave you like we always do with the Skeptic's Creed. Credulity is not a virtue. It's fortune cookie cutter, mommy issue, hypno-Babylon bullshit. Couched in scientician, double bubble, toil and trouble, pseudo-quasi-alternative, acupunctuating, pressurized, stereogram, pyramidal, free energy, healing, water, downward spiral, brain dead, pan, sales pitch, late late night info docutainment Leo Pisces cancer cures detox reflex foot massage death and towers tarot

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