Factually! with Adam Conover - Why Fentanyl is Suddenly Everywhere with Dr. Nabarun Dasgupta

Episode Date: January 3, 2024

While the rise of fentanyl may seem like it emerged out of nowhere, it has a long and complicated history dating back hundred years. The pharmaceutical industry, the illegal drug trade, and government response all have roles in the ongoing epidemic of overdoses. This week, Adam speaks with Dr. Nabarun Dasgupta, an epidemiologist and street drug scientist at the UNC Injury Prevention Research Center, to explore why the opioid crisis is so frequently misunderstood and the multi-faceted approach required to mitigate the dangers of fentanyl.SUPPORT THE SHOW ON PATREON: https://www.patreon.com/adamconoverSEE ADAM ON TOUR: https://www.adamconover.net/tourdates/SUBSCRIBE to and RATE Factually! on:» Apple Podcasts: https://podcasts.apple.com/us/podcast/factually-with-adam-conover/id1463460577» Spotify: https://open.spotify.com/show/0fK8WJw4ffMc2NWydBlDyJAbout Headgum: Headgum is an LA & NY-based podcast network creating premium podcasts with the funniest, most engaging voices in comedy to achieve one goal: Making our audience and ourselves laugh. Listen to our shows at https://www.headgum.com.» SUBSCRIBE to Headgum: https://www.youtube.com/c/HeadGum?sub_confirmation=1» FOLLOW us on Twitter: http://twitter.com/headgum» FOLLOW us on Instagram: https://instagram.com/headgum/» FOLLOW us on TikTok: https://www.tiktok.com/@headgum» Advertise on Factually! via Gumball.fmSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Hello and welcome to Factually. I'm Adam Conover. Thank you so much for joining me on the show again. This week, we're talking about the opioid epidemic and drug use in America in general. Now, this is a really tough subject. A lot of people are dying of opioid use right now. People I know have died of overdoses. Probably people you know have as well. But it's also one of the most misunderstood subjects in America. And today we have an absolutely fascinating guest to tell you about it. I met our guest today, Nabdas Gupta, at the Time 100 Next Gala, where we were both being honored for being, I don't know, interesting people doing interesting things. It was a pretty neat event. It was a Tuesday night.

Everyone got pretty drunk and we had a lot of really interesting conversations. I love talking to strange and interesting people about the weird shit that they know at parties that I don't know. And I had the most fascinating conversation with NAP. See, I always wanted to know if fentanyl is this new drug sweeping the country,

it's sometimes used in medical context, but now it's causing overdoses all across the country. Why don't we just stop the pharmaceutical industry from making it? Because that's what I assumed was the source. And he told me, no, actually, fentanyl is not a new drug. It's a very, very old opioid. It's been around for almost 100 years,

and it's very easy to synthesize. But what happened is, since we cracked down on the other less potent opioids like pharmaceuticals and heroin, the market moved to fentanyl and the cartels started shipping fentanyl across the border in response to enforcement. That one story completely reframed the way I think about fentanyl and the opioid crisis in America. And at that moment, I realized, I gotta have this guy on the show.

So we have him on today. But before we get to our interview, I wanna remind you that if you wanna support this show, you can do so on Patreon. Head to patreon.com slash adamconover. Five bucks a month gets you every episode of the show, ad-free. We got a lot of other great community features as well.

And if you like stand-up comedy, please come see me. I am on tour this January. I'm going to Arlington, Virginia, New York, Portland, Maine, Philly, Boston, Chicago, Atlanta, Nashville. Head to adamconover.net for tickets and tour dates. And now let's get to this interview. I cannot think of a better person to help us break down and understand this weird Wild West period in American drug culture and drug use. Nabarun Dasgupta is an epidemiologist and street drug scientist at the UNC Injury Prevention Research Center. Please welcome Nab Dasgupta. Nab, thank you so much for being on

the show. My pleasure. It's awesome to be here. It was really fun meeting you at the Time 100 Next Gala. We had a wild night and I talked to you enough. I was like, I got to have this guy back on the podcast when we're both a little bit more sober to talk about drugs. Sounds like a perfect plan. What could go wrong? I mean, the cool thing about this event was that every single person at this event did something really cool. Just tell us a little bit about what it is that you do before we get into it. So I'm a street drug scientist. I spend all my time thinking about drugs at work and our lab. So do a lot of people, but you actually, you're not breaking the rules when you're doing it. You're supposed to be.

No, I was probably like one of those kids who talked too much about drugs when we were younger and I made it into a career. So I'm at the University of North Carolina in Chapel Hill, and our lab tests street drug samples from around the country. And I also started a nonprofit to get the overdose reversal medication out in bulk to community-based groups that are distributing it to people who use drugs. And this overdose reversal medication I know has been a really big deal. It's saved a ton of lives. When I used to do homelessness street engagement, you know, I, there was a period for a couple of years I was doing it and every weekend we were bringing that stuff out like crazy, just being like, please, uh, please take this, use it. If, if you know anybody who, who is having an overdose, I, cause literally in the time that I did it, I saw multiple people die, not in front

of me, but you'd show up the next week and they wouldn't be there. What happened to that guy? Oh yeah. You overdosed last week. Um, it's, it's really an incredibly dangerous time, uh, for street drugs out there. Uh, but you know, what, what is from your perspective on the ground, what is our normal narrative about that epidemic as it's often called get wrong? Yeah. So I think like at the outset, let's, let's like acknowledge that there's a lot of people who have lost family members to overdose and friends, and that this is like a deadly serious topic. Right. And there's still, you know, like something like one out of every four out of every 10 people in the U S knows someone who's died of an overdose right now. And it's, you know, like we have to

treat this topic with some respect. And at the same time, drugs have also kept people alive and have, you know, made their lives better. And so there are people who benefit from some of the street drugs, too. So I think it's important to kind of keep those both frames in mind. I think this is important as like, you know, as we think about what we what we currently believe about how we got here to this point where there's over 100,000 people a year dying. And I think the traditional narrative is something along the lines of a small group of prescription opioid pharmaceutical companies started making these pills, started marketing them very aggressively, and then ended up like sparking this problem. And then it kind of, you know, the market forces switched it from pills to heroin and from heroin to fentanyl and fentanyl to worse. And that's like kind of a

general broad strokes. But what's interesting though is like those events that we're talking about kind of happened like 20 years ago and so the idea that like pharmaceutical marketing can explain everything that has happened over the last two decades is not really plausible there's much more going on like those companies really did do something terrible and deserve the criticism and penalties that they have faced and probably, frankly, deserve more. But that can't be the whole story. No. And the more we like rely on this narrative that it was like this one thing that happened a long time ago that we have no control over, those kinds of mindsets are like, cause us to right now feel like we can't do anything about the problem.

You're unfortunately criticizing like the entire way that I tell nonfiction stories, which is that why are things the way they are today? Well, because of one thing that happened 20 to a hundred years ago. And let me tell you about it. That's literally my entire fucking shtick now. So- Here's my version of that. Okay, great. Well, complicated for me. Tell me what is the

more interesting story or truer story? So like, I mean, so it's awesome. You said 100 years ago, because like the if you look back at the old public health journals and medical journals from like literally 110 years ago, you'll see people saying the same exact thing that there are doctors who are misprescribing opioids, that people are getting addicted, that they're overdosing. It's like literally the same words. And it's all like, you know, the marketing of the, of the snake oil and the irresponsible prescribing. So

all these drugs were, that was around when opioids were first marketed, right? Like heroin was originally a Bayer product. Am I right about that? It's like the exact same story of what we have today. Yep. Yeah. Heroin is a perfect example because there's been this kind of like arms race of making, of trying to find better molecules than the ones that we have because of the abuse problem, right? So like heroin was developed as like a less addictive – even though they didn't use the word addictive, but that was the concept – a less addictive form of morphine. So morphine came first. There were problems with it. So they made heroin, right?

But I think of heroin as being worse than, isn't morphine what they now give people who are trying to get off of heroin? Sometimes in some countries, yeah. But heroin's like fascinating because like a hundred years ago, the top causes of death, right? In the US were like respiratory illnesses,

cancer and diarrheal diseases from infections, right? So if you had a medicine that could stop cough alleviate pain and plug people up wouldn't that be a miracle drug right like so the fact the fact that you can't shit when you're on heroin was like a part of the point it wasn't a bad side effect it was hilarious like yeah yeah and a great advantage of this is that you won't be able to shit that's uh great wow so the same with like methamphetamine was created as a less abusable form of amphetamine so it's like you know it's like the pharmaceutical industry keeps doing this the street chemists why do they keep inventing

worse versions of the thing they already have thinking it's going to be better? That's like, it's horrible to do that. Yeah, no, I know that, you know, DDT was kind of bad. How about Agent Orange? Like, it's just getting worse every time. Right. I mean, it's like, it's a really good point. Like, what happens in the street drug market is really reflected in what happens in the consumer product space.

So if you think about, if the question is, why is there fentanyl? Why are we getting new things beyond fentanyl? You know what I just saw an ad for was a Doritos flavored liquor. Why the fuck would there be a Doritos flavored liquor, right? Right. And this is the same thing that's happening with the market. There is experimentation. There's people's tastes are changing.

There is new things that are coming that the market is demanding. So how does this complicate the story that we're normally told about Purdue and fentanyl and opioids in the last 20 years to know that it started 100 years ago? So it's, I mean, it's job security if you're in this field because you just know this is all going to repeat. But on a very practical level, we need to kind of move beyond those narratives, acknowledge that they happened,

and then really figure out what's happening on the ground today so that we can come out with solutions for today and not from two decades ago. Got it. So what is happening today? I mean, you read all of these horrible headlines about the fentanyl epidemic. Like I said, from my own limited volunteer work on the ground, I've seen it myself. I know I have friends who work in city government here in LA who describe how bad the problem is. How bad is it from your point of view? It's bad. I mean, the street drug supply right now is so crappy that it's like nothing we've seen in decades. And the biggest problem with the street drug supply is

that it changes so much it's the variability that is what leads to overdoses so if you have just like the the chemicals that are in there some are more potent than others if you're used to using a certain amount and then you then the supply changes on you and you don't realize it, you may shoot the same volume of dope, but it has twice as much punch and it makes you overdose, right? So that variability is actually a large part of what's killing people. I find it really fascinating that you describe the problem as being one of the supply being too variable, or there's a problem with the supply. Because I think a lot of people's framing would be,

there's too much drugs out there. There's too many people doing the drugs or et cetera, that there is a supply at all. But you're pointing out that like, hey, the supply chain is actually fucked up. It changes too often. It's a crappy supply. Like there's a lot of bad shit in it that maybe shouldn't be. And that sort of implies that your solution, your first solution might be, hey, we need a better, more consistent, less tainted or less cut street drug supply or something along those lines. Is that the case?

that the case? Yeah, I think in the immediate solutions, that has to be on the table. What's really fascinating is we have this broad narrative with these huge broad strokes, but when you actually look at places where there are spikes and overdoses, those spikes and overdoses on a local level happen and they go back down. And when you go and actually investigate what causes those spikes and overdose, you see the same story over and over again of a particular potent batch of powder dope or pills or whatever comes on, people aren't expecting it, the overdoses go up, and then either the supply gets taken away and kind of renormalized or people learn to adjust to it. taken away and kind of renormalized or people learn to adjust to it. And so it's, you know, it's the variability.

So the street drug variability is one half of it. The other half is people's tolerances to the drugs are also constantly changing. And so if you are used to taking like, I don't know, say, you know, one dose a day, and then, but you don't realize you're getting like a double or triple dose you're going to start like feeling sick if you don't get two or three doses and then you're going to up how much you're taking to compensate for that and go back and forth and it's that variability and tolerance that is really kind of fluctuates with the street level stuff. And so it's not just about controlling and safe supply, but it is also about, you know,

how much people are using and yeah, yeah, there is too much. There is too much drug use. Like this kind of, in a lot of ways, like people are, I mean,

if you're overdosing, that means you're taking too much, right? Like at a, at a very individual level. And as a society, we're using these medications and these substances to alleviate other kinds of pain that we're experiencing. And when you go back to that narrative of the prescription opioid epidemic, then you're looking at, you're talking about physical pain. And I,

I mean, I started doing this work because I was working at a cardboard box factory in Maine where I grew up. And, um, cool. Was it, I mean,

was it fun making the cardboard boxes? We can talk about that for one second. Was that a cool, cause I'm, cause I don't know. I guess so many cardboard boxes at my house and I'm like, somebody's got to make all these fucking boxes. Right.

And it was like this specialized factory where it's like, you know how in the grocery store you see apples on those like purple wavy cushions or, and then it was like so long ago that it was like, you made those. I made those. Cool. I love finding some interesting detail that was entirely off the topic of the podcast please go on but i would go in and i was you know it's this line job temp i was a temp worker and i would go in and there was like like these three dudes who would go into them into the bathroom right

before break i mean right before the shift started and you knew that you weren't allowed to go in there at that time because they'd be going in taking an Oxycontin crushing it up and cutting it up into three and taking turns snorting it so we knew that was their time we couldn't go in there and in talking with them about it um it was like they had been working these line jobs for decades and had literally mangled limbs right from machine work and they had like they were in terrible pain most of the time and of course this is a shitty job that didn't have health insurance and pt and any of that right so they were using it to provide for you know to get through the day provide for their families at the same time during smoke breaks um they would

also talk about hey can i get an extra oxy i'm going out on the boat this weekend and you know want to feel a little bit extra good right so it was this like even within the same individual you hear both sides of it with the same molecule a boat doesn't seem like the best place to do oxy i just want to say that's like you should have your wits about you you know you might need to you might uh when you're on the open seas uh look i guess people in international waters people get a little crazy um but i i've also heard you know we did a segment on adam ruins everything years ago about the opioid epidemic and a lot of it was the was that sort of narrative that has now become very standard about, you know, Purdue Pharmaceutical and, you know, opioids, etc.

But I did hear from some people who said, hey, you know, one of the things you didn't cover is that a lot of people have real, real pain that these drugs are sort of the only treatment for. And because of the crackdown that you're talking about, I can no longer get those drugs. And now I live with chronic pain with no way to alleviate it. That's a real, and there's a great piece at Harper's a number of years ago called, I think the pain refugees. It was very difficult to read, but it was an article about a bunch of people who had a, they had one of these doctors who was arrested or lost his license or whatever for giving out drugs too freely. But a lot of his patients actually were in desperate need of these drugs and had no place to get them.

And now suddenly they're living with the most excruciating back pain. So I'm really glad that you brought it to, hey, pain is real and people have it and these drugs do treat it. That's right. And we do, in our team at UNC, we do studies with pain patients who have been cut off from their medications and seeing what happens.

And the rates of suicide among people who had previously had their chronic pain stably managed and then got cut off by doctors for whatever reason, like those rates of suicide are real and they're high and they're heartbreaking. Like those rates of suicide are real and they're high and they're heartbreaking. And we hear, I mean, I think that's also, you know, it's like they, a lot of times chronic pain patients get treated as like collateral damage to this like bigger societal problem of overdose, but people's identities change. And if you're going to cut off access to people, you're kind of forcing them into street purchasing. I mean, the other, so we just published a study from Kentucky, using data from Kentucky. And what we found was like the date of the, from the last prescription dispensed for an opioid to the time when people overdosed and like the small portion of people that that

happened to was about two to three years. portion of people that that happened to was about two to three years. So a lot of times people are like looking to the street for two to three years to manage pain after being cut off from a prescription opioid. And as bad as those prescription opioids, you know, even if we say, yes, those caused a huge problem, at the very least, they were regulated by the government. And so you knew what was in them every time. I mean, it sounds like the argument that you're making about the supply and, you know, the variability and the unknowability of the supply, if you're an average drug user, seems like a huge argument for legalization. Right. Because, well, when when it's legalized, it will at least be regulated as, you know, weed is here in California. Well, we could talk about the problems with weed regulation, right? There's plenty of problems with it. But I know that I go to my local dispensary,

I know what's in it, right? I have enough confidence in this particular spot, right? Because of what the legal regime is in California. And there is not that for opioids. In fact, we've gone in the other direction because of what, you know, the normal narrative about it. But if it were legalized, we would have less people dying, perhaps. What's your thought on that? Yeah, that's, I mean, I think that's the right direction. But I think there's a lot of nuance into how that actually happens. Of course. Right?

So in Canada, for example, they tried to get people who had failed on other forms of drug treatment onto a drug called hydromorphone or Dilaudid as a replacement for heroin or fentanyl. And pharmacologically, molecularly, it seemed like a really good switch it's about the same potency as heroin um is hydromorphone but what like the number of pills that people had to take every day to get to the same level of the street dope was such a high pill burden that people dropped out of that program even though they could get it for free. Right. So it's like, we,

they're just like, ah, I got to swallow a whole bottle every day. I'm not doing this. I'm going to Johnny on the corner. He gives it to me straight. Yeah. So it's like,

yeah, I mean, legalization sounds good in theory and there's like, but, but just like, there's going to be just like with the street drug market, there's going to be commercial interests, right.

Just like with the street drug market, there's going to be commercial interests, right? That are going to be in there and manipulating that market and manipulating that conversation too. That's the – as there was with prescription opioids, right? Which we have a problem with. We have gigantic corporations manipulating the market and hurting people for profit. That happened. Gigantic corporations manipulating the market and hurting people for profit. That happened. But now we've overcorrected and now people are driven to street drugs where we also have people manipulating people for profit. But they're doing it by adulterating, by, you know, the supply changing too quickly.

This is now this is a very tricky problem. Well, look, I want to ask you more specifically about fentanyl, but we got to take a really quick break. But we'll be right back with more. Nab das good stuff. OK, we're back with Nab. I want to talk more specifically about fentanyl because and when we're talking about the drug supply, the thing that everybody knows is fentanyl is in everything. Fentanyl is in everything. There was a case recently in the last couple of years here in L.A. where I believe a kid in public school or might have been a private school, a kid in primary school died because, you know, they took what they thought was a Xanax or some other sort of normal drug from a friend's parents bottle.

And it turned out there was fentanyl in it. This kid died. And so suddenly people are going, oh, my God, do I have like tell my kids about fentanyl now when they're in high school? I was also talking to a friend, uh, before a party, he was just having a birthday party. He was like, I got to go test my drugs for fentanyl before the party so that we've got to make sure they're safe. I was like, that's kind of wild to me that at just a average party that I would go to, people would be concerned about that. I was like, maybe those, maybe I won't do any drugs at your party, even though you've tested them. You know, this stuff is like really reaching the public, right? So we have this perception that fentanyl is like sweeping the

country and it's infecting all these parts of life that we don't normally think of drugs like this as touching. Why is that? And where did it come from? That's a great question. So let me start with where is it. So we recently published a study looking at how much fentanyl is in coke and meth across the country. So we looked at like 25 states from samples that we had tested in my own lab. And what we found was that there was like grossly different levels of fentanyl in coke uh across the country so it was lower in the pacific northwest lower on the west coast than it was on the east coast where in places like new york um and along kind of like the big cities on the east you're talking are you putting out like a where to do coke guide like where's the same where not to do i't don't you know don't do coke anywhere if we're on youtube here

i'm trying to be uh trying to be safe for the kids uh yeah it's it's dangerous it is it is and but like in the pacific north but it's also important to point out places where there are low contamination because not because it's like an advertising you know for their tourism but it's more like the folks on the ground who are doing the prevention messaging shouldn't be wasting their time trying to prevent something that isn't really happening there there's like plenty of other shit like plenty of just fundamental problems with fentanyl and potency that really like in the pac Northwest, like when we were doing that study, our colleagues in the Pacific Northwest were like, we really aren't seeing it

here. It's like 3% of the Coke samples and meth samples in Washington State had fentanyl in it. Whereas in New York, it was like, in New England, it was like 20%. Wow. So those kinds of nuances matter. So you're doing like drug market weather. You're like the fentanyl is sweeping through the Northeast. Everybody be careful. Get your test kits.

But in the Pacific Northwest, you guys can rest easy. I mean, it's really fascinating that we have to look at it on that level because most people don't even understand that there could be differences in that way. Yeah, absolutely. And it's not like, oh, you know, like go use it without any, you know, without any concern. have you don't even understand that there could be differences in that way yeah absolutely and it's not like oh you know like go use it without any you know without any concerns it's like you have exceptions happening people buy stuff online people you know get on planes with drugs all the time and drugs move around the country so you know the trends change um but there are like in the pacific northwest for example we see particular

kinds of benzodiazepines or benzos which are like um in the family of valium or alprazolam or xanax um the ones that we're seeing in the pacific northwest are more potent um than the ones we would see in other parts of the country and sometimes we'll get calls from physicians at hospitals in North Carolina being like, this patient shows this really weird kind of withdrawal. We don't know what it is. It's not showing up on any of our medical blood tests. And we test the actual drugs and find out, yeah, this is this weird combination of new molecules, often these potent benzos. And when they asked the patient, where did you get it from? It was like, oh yeah, I bought it online from a supplier in the Pacific Northwest.

So these things are, you know, they move and we kind of have to be aware of it. So where does fentanyl come from and why is it finding its way into Coke, which is, by the way, a drug that you would take for a completely different type of experience than you would an opioid so it's right it's an odd thing to combine to be yeah so like coke is an upper and meth is an upper um and when you hear if you hear people talking about sleepy coke then that is usually like a sign like there's something bad get away don't hang out with the people hey man you want some sleepy coke this does the opposite of what normal you should not do not do that right creepy it's bad you know and it's like but those are but it's important to know kind of like like people aren't testing people don't have labs everywhere right testing what

they're putting in their bodies and so we need like cues to understand um kind of how people actually talk about it in a way yeah and our whole point is to try to help people make better decisions about what they put in their bodies it isn't about like it's we celebrate any positive change that the individual defines for themselves. And if that means going from using 10 times a day to three times a day, that's great. I would rather have that than 10 times a day problematic use continuing in perpetuity. And then when they get to three and they are ready to go down to two or one, great. We're happy to help you get to that point.

And here's some strategies to get you even lower. And if you want to get off, here's other resources that can help you do that. That's a wonderful treatment model to meet people where they're at. But I still got to know, where's all this fentanyl coming from? And why is it in our Coke? Sorry, in the world's Coke. It's not my Coke. I don't have any Coke.

The fentanyl is largely being manufactured in Mexico by two specific cartels. And the precursors, like the raw ingredient, is mostly coming from China and it's being processed in Mexico. mostly coming from China and it's being processed in Mexico. Now, one of those cartels recently, like in the last couple of months has said they're going to stop shipping fentanyl to the U S. Oh, okay.

And why we don't really understand, but, um, it was a press conference. Like, uh, did they, did they expect applause?

Like what's going on? Yeah, actually. Really? Yeah. It was like like they did a press uh interview in the wall street journal it was timed during the by like president biden's visit to mexico what it was coincident with like other policy announcements that the mexican government was making yeah so it was like a pr moment and wow and it shows how by the big and powerful and impervious these cartels are or how how normalized they are as sort of part of the power structure uh for that to be the case that's right and we've i mean that was like two months

ago or three months ago and in like some of the southwest border areas where you see a lot of kind of early stage stuff coming over from the Southern border, we're already hearing about less fentanyl, more old school heroin. So I don't know. It might be a fluke. But where does it come from? law prohibition, which is that the more you crack down on a drug, the more likely it's going to get to become more potent, more concentrated. Because when you're transporting, you assume that there's going to be a certain percentage loss from interdiction, right? A certain portion of your product is going to get captured by cops. And so when you do the economic modeling, the way to get over that kind of

interdiction is to put more in a more condensed way so you can have a higher margin on what gets across. So that's kind of the origins of fentanyl. Fentanyl, as you told me the first time we met, is not a new drug. It's's an old drug but it's far more potent and concentrated than heroin and so we cracked down on opioids well they needed a more potent replacement this is the most potent thing available and that's why it starts over and that's an economic reason it's not because that's what was fascinating, fascinated me about fentanyl, because the users I've talked to on the streets don't like it. They're like, ah, it's too concentrated. Give me the old stuff.

Where do I get my normal heroin? But they can't. Why can't they? Because the way we have cracked down on opioids has created an economic incentive for the cartels and the other various people running it to start to switch to that drug for economic reasons. That's right. Fascinating. Same way, like during alcohol prohibition in the U.S., right? You think about speakeasies, speakeasies weren't serving beer, right? Like they weren't like serving IPAs and craft booze. I mean, craft beer, they were serving alcohol. I mean, spirits like hard liquor, because that's high proof.

And, you know, it's the same pattern. It just happens over and over and over again in American society. And even before that, right, when we were thinking about these supply chains for these products, like heroin and fentanyl are different in one fundamental way, in that heroin grows out of poppies in the ground whereas fentanyl is synthesized completely in a lab and so right so that's like a very different kind of supply chain that and it's kind of like one of these consequences of globalization as a broader trend over the last couple of decades, that you can move large amounts of raw material to produce in different countries and ship back to other countries. And it's the same thing.

So what this is making me realize, you know, when people talk about the drug epidemic on the street, even just, you know, people here in LA are concerned about, or whatever city it might be, are concerned about the number of fentanyl overdoses, about that making life in our city worse. What can we do about it? We always talk about drug treatment programs, getting people off the streets, all stuff that's well and good and important. But what you're making me realize is

the reason for the fentanyl epidemic, it's a supply chain issue. It's like starting at the top. It's the macro economic incentives that are causing this to happen. And so something needs to change on that level, on like the federal government level or what's happening in Mexico on a national level or something. So it needs to be that big of a change because otherwise you're just sort of, you know, trying to trying to fuss around the edges.

You're not actually making a difference. Does that seem correct? That does. And I think that's like, yeah yeah i think a top that's like the top down approach right and we've been trying to do that for decades too right there's been all sorts of you know da and mexican government attempts to take down the cartels and to stop how much is crossing the border at this like if we if we. So drugs are kind of this free market in a lot of ways. And if we believe in these market forces, then the part that we've kind of left out of the equation all along is that the role that the consumers have in trying to push back against some of these problems. And I think we're at this stage where if we look back

at the historical antecedents and kind of the pro forma way that policy has tried to address the problem, it has clearly failed, right? Our current approach sucks. Like if 100,000 people a year are dying, it's not working. So a more kind of bringing the consumers back into the picture, I think, is a really fascinating, newer idea that brings agency to individuals. And, you know, how do we get them to push back against their suppliers and say, like, I don't want fentanyl. I don't want this. Right. Wait, this is this is sort, I want to pull apart this idea a little bit because at first it sounds insane to me because you're talking about sort of consumer

activism in the same way where it's like, hey, don't buy plastic packaged products. Buy something made of cardboard instead, which I kind of think of as being a facile and pathetic form of activism generally. Are you proposing that drug users do the same thing? Hey, Mr. Drug Supplier, you know what? You're not, is that ethically sourced heroin or are you serving me some fentanyl made in a lab? Uh-uh, I think I'm gonna go to the farmer's market and get some of the good heroin.

Is that, you must be talking about something more serious than my very silly caricature I just said. Yeah, that caricature is pretty close i mean but the point here isn't like that we're trying to just say like condone the drug use and say like oh yeah you should get whatever you want and have like all your choices like that's not that's not kind of the direction for this it's like right now the solutions that we've been trying to do for decades haven't worked. We need more allies and more groundswell, grassroots ways to address the problem. If you go around the country and talk to communities that have been severely devastated by overdose, you feel this pervading sense of hopelessness that they can't do anything about it and this goes back to the same kind of narrative about like if we only think of this as a top-down problem of like

policy and international we're gonna feel stuck there's not enough that we can do and some of these forces are so big that we feel really small um like in rural towns in Appalachia, like trying to get the Sinaloa cartel to stop shipping fentanyl, like it's just not something that's in their intervention policy toolkit, right? And so kind of working with people on the ground who use drugs to understand what they're putting in their bodies, why they're doing it, and getting at kind of the primary reasons why they're using drugs in the first place is super important. Finding out like kind of what their options are for non-judgmental treatment when they're ready for treatment, like those are things that we can do. And for people who are not ready to go down that pathway of getting sober, we need things to

keep them alive so that they are alive and can recover. And so, yeah. It seems like what you're talking about a little bit is taking this kind of drug use out of the shadows, that people who use these drugs are so often marginalized, made invisible, and to the extent that they are using them, you know, or that we are aware of people using them, sort of treat it as, oh, that's your own fault. Wow. Oh, horrible. You know, just what a shameful thing. What a thing you wouldn't want to talk about. You know, obviously people are, you know, that sort of uses criminalized widely.

But if instead we had a little bit of normalization in the way of saying, hey, we've got millions of Americans using these drugs for all sorts of reasons and they deserve safety and to not have an adulterated drug supply. And they could say that a little bit more openly and the rest of us could speak up for them as well. Maybe that's, is that sort of what you're talking about? saying like, hey, we've got fucking drug users in this country. A great step would be if they weren't having adulterated drugs or if the drug supply was better. And and just sort of saying that loudly in a is that sort of what you're talking about?

Yeah. And I think like, you know, there's there's if you look at the modeling of the trajectory of the overdose problem, there's these great modelers out of Harvard who show like under the most optimistic scenarios where we like dump tons of resources into this. We're still looking at like eight to 10 years before it gets back down to, you know, levels that we saw before 2000, the calendar year 2000. And so we're going to have- It's a lot of people dying. It's a lot of people dying. And there's a lot, you know, there's kind of the next stage of kind of going beyond just like criminalization of individuals is like, okay, addiction is a brain disease. This is, you know, adverse childhood experiences.

So maybe you had experienced some sort of sexual trauma as a child and you're using drugs to stay alive. Those narratives are kind of the next level of compassion that is quite popular in the science arena. But those also tend to kind of put the agency away from the individual and the current time and pin it back to these things that happened a decade ago or things that are beyond our control. And so one of the kind of counter arguments to this general approach is that we should be re-stigmatizing drug use and re-stigmatizing drugs. that we should be re-stigmatizing drug use and re-stigmatizing drugs. And I think this is a kind of a natural reaction for folks who don't understand what it's like on the ground. And I think the missing part of that equation is compassion, right? It's like, we're not going to just try to like substitute one drug for another and say, okay, just keep doing what

you're doing. It's going to be like, cool, all right, let's get you stabilized so you're not in withdrawal. And hey, how about getting you a driver's license? How about let's get you signed up for a work program or let's get you, you know, let's like find you a better place to live or let's get you out of that abusive situation. And there's a lot more care that goes on to address the upstream causes of that drug use that kind of gets put to the shadows when we only focus on the molecules or like clean syringes and the reversal agent, right? It's not just molecules. It's like a whole holistic, compassionate approach that helps people in a more fundamental way than just saying, like, take this other drug and this is better for you. And I love the focus on the agency, that any sort of mental model that is taking agency

away from the person is maybe one to be avoided. And any that supports their agency, supports them making choices, supports them as the active movers in their lives is going to be more valuable. I'm curious if you think that, look, the examples I used at the beginning of this about, you know, the kid who died at the school in L.A. and, you know, my friend's birthday party, right? What do those two examples have in common?

Those are like nice white people, right? Like that fentanyl has reached sort of suburban middle-class America to the extent that parents are going, oh my God, I have talked to my, like again, white suburban parents are saying, oh my God, I have to talk to my kids about fentanyl. What the fuck is going on? It has become so widespread

that there are very few parts of American society that are insulated from it. I'm curious if you think that that could cause any, you know, thought in our attitude towards these drugs that that maybe could help us build some compassion since it is touching so many parts of America now. Yeah, you're absolutely right. I mean, we can't have a serious drug, serious conversation about drugs in America without talking about race and privilege. And that is just a fundamental reality that drug laws get enforced disproportionately against minority communities. substances can end up in white people's bodies is kind of a, it has been like a societal learning process over the last like decade and a half. And by the way, I sort of glided over the fact that there's a pattern in American life where a social problem is only taken seriously once it affects affluent white people. And so I sort of presented that as like, Hey, maybe things will

get better now that that's happening. It's still an ugly social problem that we only take things seriously at that point. That's right. But that point has been reached in the case of this issue. It has. And I think there's – I mean, I do a lot of work in Appalachia and kind of rural parts of the South. And those problems appear – the problems with overdose appeared there 15, 20 years ago. And so it's not just a matter of race. There's also like huge class differences.

And like one of the counties I worked in was Wilkes County and kind of the Appalachian foothills in Northwestern North Carolina. And they, when we started, they had the third highest drug overdose death rate in the country. Wow. And we were able to bring that down like 70% and keep it down through this community-wide intervention. But one of the questions at that time was like, why Wilkes? Why would this one county have such a big problem? And Wilkes County is also the birthplace of NASCAR.

Do you know why that would be related? Why? No. No, i don't so people people huffing gas i don't know what is it so if you have like so if you have like a regular car that's stripped down looks like a normal car and can go really fast right then that's like where moonshine of Of course. Right. Yes. You, you can,

you can smuggle. I knew about this. I knew this about the history of NASCAR, that it was like, uh, smuggling related, uh, during the prohibition era. Right.

That's right. Yep. So this County was like the birthplace of NASCAR, NASCAR, because it had particularly strong moonshining as a historical antecedent. When I first started working up there and, you know, kind of talking about drug use in a more compassionate way from a public health standpoint,

I was presenting at this community meeting and this like the oldest person in the room, this white, old white dude with a bow tie comes up and he's like, son, what's your name again? And I told him, and he's like, that's not a Wilkes name now, is it? And I said, yes, sir, it's not. And he's like, I'm going to tell you something. We don't need people from the outside coming in and telling us what to do because we already know that we can't lock up our sons for providing for their families. We've been doing it for generations.

So give us the tools, teach us how to do it and let us take care of this problem wow well and it goes to show how this kind of drug use of any kind is you know an ancient human thing right that like moonshine i mean we call it moonshining humans have been fermenting shit into alcohol since for thousands of years is one of the oldest forms of agriculture or whatever. Right. It's like up there with the birth of agriculture. And so, of course, a bunch of people in Appalachia are just, yeah, we can make our own booze. What do you what are you going to fucking do? Just like I got a garden in the back and I got a bathtub full of gin.

Like, what are you going to stop me doing? And, you know, opioids are fundamentally kind of the same thing. I mean, the human desire to get fucked up is part of humanity. It's universal. It is. It is. And it's like, I mean, the historical part is so fascinating because if you, okay, this is going to seem like it's from out of left field. But like the reason why the European powers were looking for a better route to the Indies was because of spices, right?

That's the narrative we know. But they weren't looking for spices because the food in Europe was crappy at the time. It was more because spices were the pharmaceuticals of the medieval age. were the pharmaceuticals of the medieval age. So cinnamon that we just have on cinnamon, like cinnamon raisin bread, whatever, that cinnamon was considered to be a life-saving drug that could bring people back from the dead because it was believed to be harvested

from the nest of the phoenix, like the mythical bird that bursts into flame and comes back to life and like black i heard that's where coke comes from actually it's from the nest of the phoenix i'm sorry please go on like uh black pepper just like regular table pepper uh was the medieval viagra and you could like pay your taxes in viagra in London back in medieval times. And cloves and nutmeg and all these spices had very specific medicinal properties. And if you look back at the illuminated manuscripts from that era,

you see exactly the same rhetoric of these being devil drugs. And some of them have these like psychoactive properties like you know they can make you horny or whatever right and the rhetoric hasn't changed it's almost verbatim the same and like in one of dante's like circles of hell and the inferno is someone who uh is put there because they they figured out how to use cloves. And that was like what damned them to hell. And they created a market that made cloves expensive and da-da-da-da. It's amazing how fundamental that is.

And by the way, you can look at – there's so many other stories from the colonial period, opium and even tea as a, you know, as a source of caffeine. It really drugs have made the world go round for as long as humanity has been around. Incredible. We have to take another quick break. We'll be right back with more. So I want to ask you at the same time that we've seen skyrocketing rates of overdoses and sort of a panic in this country around fentanyl and opioids there's also been in my experience

just anecdotally over the last five years an unprecedented like liberalization of our attitudes towards all other types of drugs and And by our, I mean, again, like affluent, mainstream, largely white America. Weed legalization is obviously exploding all over the country. I would have to say, in my opinion, that's largely a good thing with a lot of problems, but a lot of us go, oh my God, long time coming.

But at the same time, I've started to notice a lot of other drugs exploding in popularity. Psychedelics, there's been a lot of coverage of them over the last five years. Michael Pollan wrote a book, an entire book about how great psychedelics were. And now they're doing research and them being used as treatment for depression. I've covered that stuff on the show. What has surprised me though, is how much, how the, how the legal drug market has changed or the semi-legal drug market has changed. So I was just at a friend's party a couple of weeks ago and he says, Hey, we got some drugs at the party. I thought he was going

to give me, you know, like a, what's a party in LA. I thought he was going to hand me a weed gummy. He pulls out a bag of gummies packaged with a logo and like a cool photo on it and everything, bag of gummies that had psilocybin and MDMA in them. And he was like, it's a little micro dose. A couple of us, you know, makes you feel a little glowy, whatever. I had not even been aware that this was a product that you could buy. Like this looked like something that would be sold at a weed dispensary in L.A. sold at a weed dispensary in LA. And I've seen just over the last couple of years,

just if you want to get mushrooms, right? It go from, hey, I know a guy to, hey, my friend makes chocolates to, hey, there's a website you fill out a form and then they'll call you and make sure you're legit and send you chocolates too. Here's a website you just put in your credit card information and they will send you psilocybin, you know, mushroom chocolate just direct from Colorado. Right. It's like gone very, very quickly. And, um, uh, I find that kind of interesting and weird because it, I mean, psilocybin is not legal

in America, right? It is not, we've not had, uh, the process that we went through over like 20 years to get to where weed legalization is today. So it seems like there's sort of an exploding, you know, legit or gray market industry around all these other drugs just very recently. Have you so you're the perfect person to ask, is this really happening? Because it's literally just been my experience so far. Your experience is spot on. We see this a lot. And we call it psychedelic exceptionalism, where the psychedelics are kind of treated as plant medicines having kind of native, roots with indigenous communities. And sometimes they're like ayahuasca is sometimes called a sacrament. And there's a lot more mythology and process and cultural, I don't know, nuance surrounding them. But at a fundamental level, you're right, like the amount of psilocybin that's going into brains in the United States has probably increased 100 foldfold from like a decade ago, just guessing on numbers. And so, I think it's a combination of psilocybin, MDMA or ecstasy, it's DMT or ayahuasca, and ketamine. Those four in particular, I think, are having a moment. And it's like we sometimes see ketamine mixed into weed or into meth i mean

there's a lot of it's like you have kind of this like permissiveness in society around these and then that bleeds over into kind of the harder drug illicit markets that traditionally have existed and people you know it's just a very confusing mix but a lot of times people who are using one are also using the other and um there's crossover it's interesting because there are there are legitimate medicinal uses for almost all of these i mean i have friends who told me and i really believe them they're not fucking around that they cured their depression with psilocybin or that they treated really bad depression with ketamine. These are being used in clinical or quasi clinical settings, you know, for real.

But at the same time, it was it's just a little bit like, again, I'm looking at that packet of gummies. Right. I'm going like, wait, where did this actually come from, though? And like, why is this person? It's very interesting that there's some company that's packaging the shit. They're making a label. They're putting a little percentage of how much is it on the thing they process. They're processing it at some kind of factory. Right. And they must feel the feds aren't going to come for us. Right. Even though there are two federally scheduled drugs on this and it's not

weed, that seems kind of new that there must be something a little bit different about either our enforcement regime or that the belief in the market about whether or not they'll be enforced. Do you have any view about that? That's right. Yes. I think exactly what you said, like the belief of what you get in trouble for. So it's fascinating in drug crime psychology, the deterrent doesn't come from how long a drug sentence is, it comes from whether you're going to get caught in the first place or not. And so this kind of blooming of the market is probably exactly what you said like people thinking that they're not going to get caught um at the same time like they're trying to make a

buck right like drugs and money are intimately linked and that's what the market is demanding right now and that demand is coming from you know all sorts of kind of upstream sources and this is where it goes back to agency and autonomy again and again and again. Because if people like for your friends who use psilocybin to treat their depression, right, the traditional routes of going to a doctor, getting it covered by insurance, the pharmaceutical version of these products, like that whole process of getting help for depression is depression removes so much agency at every single step that it is not what people necessarily want.

People want new ways to deal with old problems. And if the regulated, legit, mainstream marketplace isn't nimble enough to deliver on that, the illicit marketplace is going to. Yeah. And it also seems like that's an extremely good point, first of all. It also seems like that is helping with a certain sort of normalization. Like here, at least from, again, this is like my friend group, the sort of people I'm around, right? But you've got on the one hand, legal weed that like has a certain sort of packaging and people are used to seeing served in a certain way. And they say, oh, that's safe, right?

Because it sold to me this way. Then there's the culture of, hey, I have a friend who's like a psilocybin, you know, treatment person and you can go to them and they'll, you know, it's not, you know, it costs a couple hundred bucks. You can't get it through your insurance, but it's really, really legit because they really did their research and all'll, you know, it's not, you know, they call it costs a couple hundred bucks. You can't get it through your insurance, but it's really, really legit because they really did their research and all that.

Right. And then you've got those two things sort of combining such that somebody gets a little packet of gummies that says 0.5% psilocybin on or whatever. And they say, ah, that's legit in both ways. And it just sort of, but it just kind of looks legit. Right. Like, like I was like, I don't actually understand the supply chain. The reason I didn't take a gummy from my friend, he, and I'm not saying it was unsafe what he was handing me, but I was like, I don't understand

the supply chain well enough, but I see how this looks super safe in all these, in both of those ways. Right. And serves to normalize it. I could see most people who I would hang out with in America being handed that and say, oh, that looks safe to me. Oh, yeah. I have friends who do that. It's no big deal. And that's a big difference from just 10 years ago that like so the drug what's interesting is it seems like the drug culture in a lot of America, not just the, you know, the folks using fentanyl on the corner, but again, affluent, middle-class America has really changed over the last couple of years in a fascinating way. Yeah, it has. And it's like these are all unregulated products.

And even when you go get melatonin to put your kids to sleep from a grocery store or pharmacy, even that is unregulated. Like the amount of melatonin in those gummies is also not something that is like standardized and quality controlled. It's just whatever the company wants to put in there because of like arcane FDA rules. But the same kind of, it's easy to, in our world today where we can 3D print anything, where we can make, you know, use Canva to make cool looking graphics, like it's easy to have the trappings of legitimacy.

And, you know, it doesn't change like the shittiness of the product that's going in that package. And we've seen cases of overdoses happening because people, it looked like regular weed, but it turned out to have weird opioids in it or weird other chemicals in it that were causing serious harms. And people bought it thinking that it just looked like a normal package of weed that they were used to getting. So this is kind of a really bad time to be doing drugs in America. It's kind of the bottom line.

And that's odd because I think for a lot of people, it feels like a great time to be doing drugs because so many drugs seem legal or quasi-legal and available, right? Where it's a lot of stuff again for, and I keep drawing this comparison between affluent folks and, you know, the stereotype of drug user on the street. I don't mean that one of those groups of people is better than the other.

I'm just drawing the distinction between like, you know, what we often think of as a mainstream society and how that changes overall attitudes. But it feels like that there's been a there's been a large normalization but that normalization comes with an assumption of safety that might not be there that's right i absolutely i absolutely agree i think the normalization is a double-edged sword right if it if it leads to less stigma and people having more agency people being able to decide what they put in their bodies like that's great less incarceration is great for

people with you know addictions and at the same time like we can't be duped into a false sense of security it's like again like drugs and money and go hand in hand and they always have and always will yeah and you know and that's why i brought up like even the example of the europeans you know powers trying to find new shipping routes right they weren't doing it because of flavor it was because of money and yeah drugs and money are going to go hand in hand and people are going to take advantage of any system that is not super tightly regulated and watched to make a quick buck and i think that's part of like the fundamental reason why fentanyl has changed i mean one of the questions i get a lot is like is you know why would uh why would someone want to be making a product that kills their customers right like it doesn't make

an economic sense to do that and it's kind of like with houses right like where you have all these people flipping houses and changing neighborhoods by by doing that the barrier to entry to getting into the dope game is now lower than it has been um for decades and so before there was a bit of pride and control that the organized crime organizations would have and exert to have somewhat quality products so that their reputation could build. Now, because it's so easy to get a kilo of fentanyl and flip it, you can even buy it on credit now, which is unheard of. Then like you don't have people who are in it for brand reputation.

They're in it to make a quick buck and get on with whatever else they actually want to do with their lives. Right. So you just do it a little bit on the side, just like someone's like, oh yeah, we do have a little real estate side so we buy houses and flip them. I guess sometimes I just it a little bit on the side, just like someone's like, oh, yeah, we do have a little real estate side hustle. We buy houses and flip them. Sometimes I just buy a kilo and, you know, cut it, cut it and flip it, right? Chop it up a little bit and send it out to the corner boys and, you know, make myself a quick meal and then move on.

Yeah, that is what's happening. It seems like it's a Wild West time right now in both the sort of cartel side of the drug market and the sort of weird, you know, we put it in baggies and ship it out from Denver quasi legal market that I'm talking about with a lot of bad effects. And again, this to me, it seems like like an argument for mass legalization of these drugs. I didn't bring you on here to come up with a big policy prescription, but when people of all walks of life are dying, all drug users, no matter their background, deserve safety, right? And if we actually had regulation, a big part of the problem seems to be we don't know what's in the shit. So that seems to be an argument for simply making this stuff as legal as we can and then regulating it at least as well as we do

pharmaceuticals, which are not, there's a lot of bad things about the pharmaceutical industry, but at the very least, when I get my amphetamines from the psychiatrist and it says this many milligrams, I know that there's that many milligrams in it and that there's nothing else in it. I do at least have that confidence that it's not adulterated with some other substance or that there isn't radically more or less than I expected. Uh, so I mean, is that something that, is that where your mind goes as well? It does, but I'm also a pragmatist on this in that, like, you know, it's like if we switch to legalize all drugs today, there would also be huge collateral damage to society that we would not be tolerating, and that experiment would get shut down immediately. Like what? And with decriminalization in Oregon right now, where the people of Oregon voted to decriminalize, so get rid of the criminal penalties, but not legalize all drugs.

And so the consequences of that have taken, yes, there's been less arrests and kind of some of the negative societal consequences, especially around race, have been tempered. But the amount of drug use seems like there's been a blowback because it's not enough to stop the overdoses that are happening because, A, it hasn't been given enough time to work. been given enough time to work but also like decriminalization is not the same as a regulated legal market yeah where you still like even in places like portugal where they've done like nationwide decriminalization talking to our colleagues in labs there that test the street drugs they're saying that you know the drug supply is still as fucked up as always it's just people don't get arrested for it in the same way, but it doesn't make the drugs necessarily all that much safer. People who have been shooting heroin for like 20 years and fentanyl for 20 years and have tried like every kind of drug treatment known to man and are still kind of stuck and really want to get off of it. Working with those folks to see whether like heroin prescribing is an intervention that's been done in Canada and Europe. done in Canada and Europe. And that's like a really good starting place to like test out some of these ideas about what legalization should work could look like. And that's why I bring up

the Canadian example of when they tried to do that, they ended up like having to use this sub optimal form of a pharmaceutical medication that created this huge pill burden, people dropped out of that trial, even though they were getting free drugs from the government, right? They still, it wasn't in a way that actually helped them stop or curtail their use in a way that was meaningful to them. So legalization, great as a concept, but like having been in this field for 20 years, it's like we keep hearing about this conversation but like the but when it the people who are dealing with the practicalities of it are kind of faced with all these practical

issues that kind of make it a lot more complicated that makes sense like i can sit here and say hey looks like all the problems that we have are because this one class of drugs is illegal. That that's why we've got all these supply chain issues that are causing all these deaths. And if it was simply, you know, right next to pharmaceuticals in terms of government regulation, FDA and all that sort of thing, if we had that regulatory regime, we wouldn't have this problem. And it's all well and good for me to sit here and say, hey, legalize it, man. Right. But how do we get there from here is a much is a much more difficult question to answer. And I completely acknowledge that. Are there any other steps that you suggest that we take immediately in order to, at the very least, prevent deaths from all of this.

Yeah, I mean, the testing of the drugs has been a really fascinating kind of evolution over the last couple of years. I mean, again, having done this for 20 years and having lost a lot of friends to overdose and not seeing that much progress. And if anything, the shit's gotten worse, right? The overdoses have gotten worse. And so seeing that, one of the few game changers that I've noticed in my career has been the drug checking where people can get their drugs tested. And what we hear repeatedly is the word options. When people find out what's actually in their drug supply, people come back and ask for what are my options to get to not put this in my body. And that like, I have not seen any other public health intervention where like literally in front of my eyes, people would find out what's in their drugs, like their what they thought was fentanyl, but it had some very toxic adulterant in it and throw it away.

Do you see people throwing away drugs with other kinds of interventions? No. And even in some of the instances, we've heard of people taking back results from drug checking to suppliers and saying like, Hey, this, there's like some super potent unknown, you know, experimental opioid in this batch. This is killing people. Look, here's what it is. And they destroy those batches. Like, wow. Okay. This is, this is when you were telling me about consumers pushing back on suppliers. Now I'm seeing how this really works. That's incredible. It is. And it's been, it was not something we expected to happen, but it's like, I don't know. We hear those stories every week of people wanting to make better decisions about what

they put in their bodies. And I think we don't respect people. We have this kind of mental model that drugs will make you a zombie, will kind of hijack all your decision-making power. And yeah, when you're in the super deep throes of addiction, those things do happen. But that happens to a relatively small portion of maybe 10%, 15% of all people who use drugs. percent, 15 percent of all people who use drugs. And if you can get the people who have a little bit more physiological agency over what they put in their bodies to push back against the suppliers, you actually see legit changes in what's in the street.

That's incredible. I love the focus on agency. And you're making me feel very guilty for my glib farmer's market joke about 20 minutes ago. I apologize. That's amazing. And the fact that you respect the users of these drugs and their own agency to improve the situation is really inspiring to me. I love the work that you do. I couldn't thank you enough for being here, Nab. Where can people find out more about your work? And where can they find some more resources on this? Yeah, so our nonprofit that distributes naloxone in bulk, that's the antidote for reversing an overdose, is remedyallianceftp.org.

And then our drug testing service is through UNC, and that is streetsafe.supply. Amazing. Thank you so much for coming on, Nam. It's been incredible. It's been my pleasure. Thanks so much for this great conversation. Well, thank you once again to Nam for coming on the show.

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