The Dispatch Podcast - The Secret Mass Killer

Episode Date: November 10, 2022

On today’s explainer, Declan is joined by RAND Corporation senior researcher David Luckey. A retired Marine Corps officer, David is now devoted to getting congressional attention to the thing that killed tens of thousands of Americans last year: fentanyl. David explains the scope of the overdose epidemic, its force multipliers, and the ways to fight it. Show Notes: -The Morning Dispatch on the Fentanyl Crisis Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to the Dispatch podcast. This is Declan Garvey, editor of the morning dispatch, and we've got a heavier topic today. We're going to talk about the opioid crisis. Nearly 110,000 Americans died of drug overdoses last year, up 15% from the year before. And about two-thirds of those deaths were attributed to synthetic opioids, mainly fentanyl. Fentanyl has been around for decades and has many legitimate uses. Cancer patients, for example, are often prescribed patches to manage their pain. But something has shifted in the past decade with illicit fentanyl use skyrocketing and bringing overdose deaths with it. Our guest today has a better grasp on the size and scope of this issue than just about anyone. David Lucky is a retired Marine Corps officer and senior researcher at the Rand Corporation and spent most of last year working for the congressionally created commission on combating synthetic opioid trafficking and writing their final report, which was released earlier this year. David, thanks so much for joining us.

I want to start by running through some numbers that I have written down here. So 107,622. That's the number of drug overdose deaths in the United States last year, according to the CDC. And that was up 15% from 2020. 71,238, that's how many of those deaths were attributed to synthetic opioids. And then 50, that's how many times more powerful fentanyl, one of those synthetic opioids, can be than heroin. These synthetic opioids were invented decades ago and obviously have plenty of legitimate uses, cancer treatments, things like that, pain management. But they've really only become this big of a problem, particularly relative to heroin.

and other drugs over the past decade or so. So kind of, in your view, what's changed? What's driven that stark rise that we've seen? Fetnell and the other fentanyl analogs, the other illegally produced synthetic opioids, as you mentioned, fentanyl's been around for legal uses for decades. What we're seeing now is a 100-year displacement that took place when heroin displace,

morphine about 100 years ago, we're seeing now fentanyl displacing heroin. So this is one of those one in a hundred year events. And the reasons are multi-fold. The ease of production, the low cost of production, the incredibly more powerful substance. So it takes far less of it to get a similar type experience for the end user. The multi-substance, the polysubstance issue of mixing, fentany with other illegal substances, the counterfeit tableting. All of these and more are the reasons for this novel transformation that fentanyl is having in our illegal drug marketplace. You mentioned some of the changes in terms of ease of manufacturing and other reasons why this is growing. Are there demand side pressures as well? Is this something that in your research

you found users prefer it over heroin? Is it a different kind of high? Or is its growth primarily because of the ease of production and transportation? Yeah, that's a great question. I think both there is both some group of users who might prefer it. And I would also suspect some group of users who don't prefer it over heroin. One aspect, again, that's critical here, is the polysubstance use and mixing fentanyl with heroin, mixing fentanyl with methamphetamines, mixing fentanyl with cocaine.

We've even seen fentanyl sprinkled on marijuana. And so this is another critical element. It's not just the strength of fentanyl over heroin, 25 to 50 times. more powerful than morphine, but also the ease of mixing fentanyl with other illegal drugs. Right. And could you talk a little bit more about that 50 times more powerful figure? What does that actually mean in practice? How does that, you know, in terms of dosages and the likelihood of overdosing, why is it that fentanyl is so much more powerful than heroin? Yeah, the chemical synthesis, pure fentanyl, it's produced in a chemical synthesis as opposed to heroin that's produced from a natural substance, grown poppies, and then produced into heroin.

And the chemical synthesis allows for the greater strength of the aspect that fentanyl has on the receptors in the brain. We're also seeing other synthetic, illegal synthetic opioids such as carfetanil, one example, which is 100 times stronger than fentanyl, which is already 25 to 50 times stronger than morphine. You talked about how, you know, one of the biggest issues with this drug and one of the most tragic aspects of this drug is that, you know, it comes in many different forms as a powder, as pills. Many people who overdose on it don't even know they were taking it. Since we've written about this, I've heard from several dispatch members who've been touched by this personally. You know, the Wall Street Journal recently reported on three young people in New York City who died after buying cocaine laced with fentanyl. Similar things have happened with heroin, Xanax, Adderall, Oxycontin, all these other drugs.

You mentioned marijuana. Why is it that dealers or producers would want to mix their drugs with a substance that's so much more likely to kill their buyers? What's in it for them? I would suggest that the dealers are very smart business people, and the dealers, both at the wholesale and retail level, are not out to kill their buyers. I suggest that's a horrible offshoot of the business they're in. Mixing takes place, I would suggest, because some users find the, the, the, high preferable. And by mixing fentanyl with other non-opiate substances, now you're increasing

the number of folks buying and potentially being addicted. We've talked a little bit about the demand side of this issue and kind of how big of a problem that is in terms of preventing these overdose deaths. To move a little bit to the supply side, you know, obviously because it's so much more potent. You need so much less of it. One of the statistics that you cited in your recent report that we can get to is it takes three to five metric tons of fentanyl to satisfy U.S. demand for an entire year. That's compared to 47 metric tons for heroin and 145 metric tons for cocaine. It's also, you know, easier to make something in a lab and obscure that than it is to, you know, have these massive poppy fields and then eventually get it across the border. So, you know,

are there other aspects to the supply side, the production of this, the importation of this, that make this more difficult to stop and to keep it from entering the country? Yeah, that's a great question. Absolutely. The precursor chemicals that are used to produce fentanyl in many cases are legal substances with legal purposes. Many of them are regulated, but they are legal substances. And being that the chemical synthesis is so simple. Now what we're seeing is not only precursor chemicals being used to produce fentanyl, but pre-pre-cursor chemicals being used to produce the precursor chemicals that then go to produce the end product. And these pre-pre-cursor chemicals are even more plentiful and, you know,

less regulated. Can you tell me a little bit about this commission that you were a part of got put together how you ended up on the commission and kind of what that that process was like. The commission was established by Congress and signed into law by the president in December of 2019. It was signed. It was drafted into the 2020 National Defense Authorization Act. It was a bipartisan, bicameral joint legislative executive branch commission. And what that means is that there were U.S. senators from both parties, U.S. representatives from both parties. members of the executive branch of the federal government to include the departments of state, Homeland Security, Defense, and Treasury, and then some independent agencies like

the Drug Enforcement Administration, the Office of National Drug Control Policy, and the Office of the Director of National Intelligence. And then four private citizens who were selected by the Speaker of the House, the minority leader of the House, and the majority and minority leaders of the Senate for their expertise, for example, one of whom was a former a DEA administrator. Another was a former member of ONDCP, the Office of National Drug Control Policy. One was a current director of a high-intensity drug trafficking area. So these were experts in the field. And so the reason for that bipartisan bicameral and joint legislative executive branch forming of the commission was to get the greatest amount of buy-in, the greatest amount of

support and the greatest amount of ability to implement action items that were developed by the commission. The commission's goal was to develop consensus on a strategy to reduce the illegal flow of and overdose deaths from synthetic opioids and RAND's Homeland Security and Operational Analysis Center supported the commission from June of 2021 to February of 2022. We conducted the research and analysis and drafted the report on behalf of the commission. The commission itself, you know, on behalf of the commission, you know, we interviewed U.S. government and other subject matter experts, more than 60 of them. We supported presentations to the commission more than 40 presentations with multiple folks in each presentation. And then there were various

site visits that the commission and some of our researchers took to places like the International Mail Facility at the JFK International Airport. The U.S. Embassy and Mexican government personnel in Mexico City did a port of entry at the port of entry in El Paso, Texas, reviewing Customs and Border Protection Border operations. And then a couple trips in California, one to the Air and Marine Operations Center in Riverside, California and one to a high-to-high-intensity drug trafficking area and law enforcement coordination center in San Diego.

And the research that we did was reviewing data, chemical synthesis and supply literature, a government, non-governmental reports and documents, U.S. regulatory policies and international law and some intelligence documents. and then we did quantitative secondary data analysis on overdose deaths and illegal drug seizures. I can imagine, you know, spending that much time sifting through that data, hearing these anecdotes. One, it's heartbreaking. And two, you get a full grasp of the scope of this problem that I think very few people in the country have. You know, every single one of these is hard for me to read.

Yeah, it was difficult and yet critically. important research with the goal of preventing deaths from this poison. In fact, two of the commissioners were personally affected by family members from this problem. The levels of removal that folks have is, I would suggest, largely misunderstood. It's only a couple levels of removal. Either you know someone, you know someone who is directly affected or you know someone who knows someone else who was directly affected. Fetnell and other illegal synthetic opioids. It's the largest killer of Americans aged 18 to 45. I need to repeat that. It's the largest killer of Americans aged 18 to 45. Numbers higher than COVID, gun violence, traffic accidents,

disease, anything else, fentanyl is the number one killer of basically the future of this country. And if we don't pull on three main levers, you mentioned a couple of them, supply reduction, demand reduction, and harm reduction. If we don't do everything we can in each of these three areas, the numbers, as we've seen, are continuing to go up. I would suggest there is no single solution to this problem. They're only better and worse ways of attempting to resolve it. And we need to make every effort in all these areas that we've discussed already in many,

many more to attempt to start reducing this number of these tragic deaths. I want to talk about those three buckets that you mentioned, the demand reduction, supply reduction, and harm reduction. The report that you guys put out has five or so key suggestions or solutions, starting with harm reduction. What is it that the United States could be doing and federal policymakers could be doing that they're not currently? Yeah, great question. First of all, let me discuss the commission's five pillars under which they bucketed the action items. The five pillars the commission put out are policy coordination and implementation, supply reduction, demand reduction in

public health, internal cooperation and research and monitoring. And the action items are bucketed underneath those five pillars from the commission's report. I tend to simplify those into three areas of reduction, supply, demand, and harm reduction. Basically, supply reduction are things like enhanced interdiction efforts at U.S. mail and express consignment facilities and bolstering the capabilities and capacity of domestic law enforcement to investigate distribution, engaging private sector stakeholders to enhance control over chemicals, targeting the distribution of synthetic opioids and the precursors advertised online. It was incredible in our research.

We did open web and dark web surfing, and not only can you find synthetic opioids and the precursors in the dark web, but we found these same substances being advertised on the open web. Also, efforts to disrupt illicit financing requires. fire intensification as well. On the supply side, the report and most of what I've read seems to point to obviously the cartels in Mexico as having an enormous role in smuggling this and then the ingredients coming from Asia, primarily China. Is there a aspect of domestic production of this domestic manufacturing of these drugs or is it primarily imported? And if so, how is that

treated differently or how would that have a different solution? Yeah, fortunately, we haven't seen a large domestic production of this. The cost of production is so inexpensive that the cartels are producing it, you know, in Mexico and distributing it through the current illegal drug supply chain networks primarily, but not exclusively across the southwest border. Once entering the United States, then through, again, the normal drug distribution network. within the United States. And that's one of the challenging aspects to this that, in addition to all the other drugs that, you know, we're attempting to prevent, there are all the other, you know, illicit

aspects of the supply chain, things like counterfeit goods and the like entering this country. And so that's one reason that makes this issue so challenging is. you know, entering, bringing the substance into the country, and then once it enters the country, moving freely throughout the country is a difficult supply chain to disrupt. The report makes mention of the importance of collaborating with these other countries that play a huge role in the supply chain here, China, India, Mexico. What, if any of that collaboration, have you seen already happening, are these guys?

governments amenable to working with the United States on reducing the effects of these drugs or are they kind of willing to look the other way and facing kind of issues cracking down at home? Yeah, one aspect, and you already touched on this, Declan, which is a very good point. When we saw the resurgence of fentanyl in 2014-2015, that fentanyl, that fentanyl, was entering the country, extremely pure fentanyl was being directly mailed from production facilities in China to the United States through international mail, U.S. Postal Service, and express consignment carriers. In working with China, the United States got China to schedule

fentanyl, and that basically reduced the production in Mexico extensively to the point where now the majority, almost exclusive fentanyl production is coming across the border from Mexico, and as you mentioned, the production is done using precursor chemicals primarily still produced in China, other countries as well, but primarily China. And so the next step here is now working with the Chinese government to reduce the production and distribution of these precursor chemicals to the cartels in Mexico, primarily the Sinaloa and new generation cartels in Mexico, through things such as know-your-customers laws. Again, these precursor chemicals are legal chemicals. China, like many other nations, has a large chemical production. production effort, and they're producing these precursor chemicals largely for legal purposes. Then there are some of these chemicals, though, that are being diverted or, you know, sold directly

from these chemical production facilities in China to the cartels in Mexico. By disrupting that flow, that's one element that we can work on with the Chinese. Additionally, the United States government working with the Mexican government, tremendously important coordination, collaboration efforts are required with the Mexican government. This has been ongoing for years. The drug war in the United States started in the early 70s, 1972, 73. and the production of illegal drugs, production and distribution in Mexico and through Mexico has been taking place for decades. So that element of our interaction with Mexico is not new. What's new, though, is the fact the spike in overdose deaths caused by fentanyl.

And again, these cartels are. are very astute business people, and they're producing drugs that Americans are taking, and they're changing the production and distribution mechanisms to take advantage of Americans' wants. Not long ago, I saw someone go through a sudden loss, and it was a stark reminder of how quickly life can change, and why protecting the people you love is so important. Knowing you can take steps to help protect your loved ones and give them that extra layer of security brings real peace of mind.

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My understanding is that that's not how fentanyl gets in the country. There was a big bust a couple weeks ago at, I think, L.A.X airport where these pills were hidden inside candy boxes and people were trying to fly into the country with them. It's because it's much smaller, it's much more potent, it's easier to smuggle. How does that affect, you know, border enforcement, the ability to kind of snuff this stuff out as it tries to enter the country? Yeah, another terrific question. because fentanyl is a powder, that makes it challenging in and of itself. Because fentanyl is being mixed with other drugs and other substances, that makes it extremely challenging.

Because of the potency and the small quantities involved, that adds to the challenge in this issue. So it's because of all these issues and more that create the novel challenge that we're seeing. let me talk a bit about the counterfeit tablets you know there is the vast majority of Americans you know want to have no part in intravenous drug use or or smoking or snorting drugs but America by nature is a is a accepting of taking pills you know Americans take prescription medication and and vitamins and minerals and the like and so taking a pill is not seen in the same light as these other forms of ingestion. And the cartels have capitalized on this effort, along with the transition away from

legal drugs such as oxicotin, Vicodin, and the like, that opened up another aspect of the market that the cartels have taken advantage of. And folks in the United States who would have no, you know, would never inject intravenously drugs into their system are taking counterfeit oxycotton, Vicodin, et cetera, tablets that are not oxycotton or Vicodin and others and, you know, they're 99.9% inert substance and, you know, one-tenth of one percent of active fentanyl. This is obviously a much bigger problem and, you know, one that we're not going to suss out in this conversation today, but many of these overdose deaths have, you know, in recent years, been labeled deaths of despair. There's a lot of societal factors pushing

people to these drugs. But the report talks about specific public health intervention. that would benefit or reduce the demand for not just, you know, fentanyl, but opioids and these drugs in general. So could you talk through a little bit of what you found there? This gets into somewhat of the demand reduction, but more into the harm reduction aspect of this. And, you know, there are naxillone strips and other things that will prevent deaths in this country, there are still challenges with that. Some folks don't see the benefit or value to those things. There are ways other drug treatment therapy at reducing opioid use disorder, substance use disorder in folks has proven extremely efficacious in cost. Removing someone's

dependence through those means has shown to save between a 25,000. and $105,000 per person for each person that is, you know, their dependence is removed. These other strategies which haven't gained strong favor in some parts of the country are really effective and thus far proven to be some of the only effective ways of doing this. And so, again, all three of these levers, supply reduction, demand reduction and harm reduction are needed. And I suggest we need to make inroads in all three of these areas if we're to get a handle on this, this challenging problem. The testing strips that you talked about there, those are illegal in some states around the country. They're treated as, quote, drug paraphernalia.

These are strips that you can put on your drugs and make sure they're not laced with fentanyl. It would show up there and you can avoid disaster that way. What are the arguments that you've seen that outlawing those is actually more beneficial than allowing them. And sure, you don't want to incentivize drug use, but if people are going to do it regardless of whether or not it's legal, it should be safe. How have you navigated that debate? Well, I think you just simply outline the problem.

There are some folks who would suggest that it does incentivize drug use. Therefore, the position is we don't want to incentivize drug use, so we don't want to provide the ways that folks can use drugs. And that's in some elements of the country, that's how it's perceived. I want to end this conversation kind of on a more interpersonal note. I'm sure that, you know, given what you've studied and what you've worked on in your own personal life, you get asked this all the time. But there's, you know, millions of parents out there who, you know, you mentioned most of these deaths are occurring in 18 to 45-year-olds.

It's the leading cause of death. among that age group, what do you, what's your message to parents if they want to talk to their kids about the dangers of fentanyl? What is the, you know, messages that work, what doesn't work, kind of how, how should we think about, you know, informing the public and especially these younger people that are, that are more at risk to, to this of the dangers that they're facing here? Yeah, that is a terrific question. Thank you for that. First of all, I would suggest that parents have the conversation. Don't take anything for granted.

I've seen advertising campaigns throughout the country, such as one pill can kill. This isn't a death that you can, these aren't deaths that can be surmounted. You know, oh, we got through it so we're okay. That might not be the case. one use, you know, is one too many, specifically for some of the reasons that we've discussed today, that if folks or young people in this country, kids in this country are using other

substances, they might have no intention of taking fentanyl. In fact, there's a large population of folks in this country who died. not knowing and not wanting to take fentanyl. And I would suggest that the youth population who's dying from this, I would suggest that's a very great percentage of those tragic deaths, whether they were intending to take some other illicit substance or not knowing at all what they were taking. And the great challenge with fentanyl is without tolerance,

takes even less than the tiny amount that it would take for someone with tolerance to be killed. And so for a young person of less weight, the amount of fentanyl that it takes is far less. Even for these experienced drug users who two milligrams of fentanyl might be one dose and three or four milligrams will kill you and that's the equivalent of, you know, of a few grains of salt, For someone without tolerance, it might be only one milligram or two milligrams of fentanyl that could kill. And that amount is like specks of dust, almost, you know, almost invisible to the naked eye. The quantity is so small because of the potency of this drug. And so first, have that conversation with your kids.

Don't take anything for granted. I mentioned the one pill can kill campaign. I've seen other advertising campaigns of, you know, be careful of all these drugs you're buying off the street because any of these drugs you're buying off the street could contain fentanyl and the amount of fentanyl that will kill you is so small that all these illicit substances bought off the street are dangerous. David, is there anything else that I didn't ask you about or that you think is important for people to know here. Yeah, a couple points, Declan. Thank you so much.

The first is that this, the addictive characteristics of fentanyl, of these illegal synthetic opioids, fentanyl and fentanyl analogs is so powerful that it really reduces our most basic human instinct of survival. And what do I mean by that? When folks who are opiate or opioid users hear about what are known as hot batches, having killed someone, they seek these hot batches out. That's how powerful the addictive characteristics of this poison are in reducing our most basic human instinct of survival. These hot batches are extra powerful batches because of the mixing of fentanyl in these polydrug substances is never uniform because the amount, the quantity of fentanyl necessary is so small that you never get a uniform, truly uniform batch.

And so some batches of this substance, when they make their way from the production, distribution, wholesale down to the retail and end user level, you get these batches. that have maybe a little more fentanyl than they intended and other batches that have a little less and the users of these substances the opiate and opioid users are seeking these batches out that have these higher percentages of fentanyl in them even though they perhaps knew that a similar portion of this batch has killed other people another point that I would like like to make is just on the number of deaths alone in this. You know, there are many things that kill Americans from disease, from car crashes, from gun violence, from war, from famine, from all these other elements. And when we think about the tragedy of war in this country, and it is tragic, the number of deaths from war and combat operations in this country. The number of deaths from overdose in the last couple decades surpassed the number of all Americans

killed in war and combat operations in the history of our nation. That's how many people have died from this. So if Americans are looking at reducing deaths, looking at fentanyl, along with the other overdose from the other illegal substances as well, but primarily what we're seeing now is fentanyl drastically driving up these numbers of deaths. And if we can get a better handle on these deaths, then I think, you know, we can really help Americans. And one way that I look at this, you know, on 9-11, when the two planes crashed into the world trade towers and three to four thousands Americans were killed on that tragic day.

You know, between one and 200 people are dying from this every day. And in a year, as you mentioned, Declan, over 70,000 in the last year. And if we can get even a modest handle on this problem, say 10%, and in my line of work, when looking at improving things based just on efficiencies, 10% is a number. number frequently used. 10% of 70,000 is 7,000 deaths. That's double the number who died on 9-11 every year. Yeah, those are, those are astounding figures. And, you know, it's, it really brings home the, the importance of the work that you're doing, the report that you guys commissioned, and I'm really glad that we were able to have you here today to talk about it. So,

thank you, David, again, for being here. Yeah, thank you so much. We were honored to support the commission and produce this work that with all hopes and intense will save American lives. Did you lock the front door? Close the garage door? Yep. Installed window sensors, smoke sensors, and HD cameras with night vision? No. And you set up credit card transaction alerts, a secure VPN for a private connection,

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