Forget What You Know About Fentanyl
With fentanyl deaths at a record high, Andy speaks with two experts about rethinking opioids, overdoses, and addiction. Ed Ternan, a father whose son died from fentanyl poisoning after buying a fake Percocet on Snapchat, explains how fake pills and social media are driving an increase in deaths among teenagers and young adults, while RAND researcher Bryce Pardo provides data and solutions.
Keep up with Andy on Twitter @ASlavitt.
Learn more about counterfeit prescription pills and Ed’s story at Song for Charlie here: https://www.songforcharlie.org/
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Check out these resources from today’s episode:
- Learn more about Song for Charlie, an organization that raises awareness about fake pills made of fentanyl created by Ed and his wife, Mary, after the death of their son in 2020: https://www.songforcharlie.org/
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Andy Slavitt, Ed Ternan, Bryce Pardo
Andy Slavitt 00:19
Welcome IN THE BUBBLE. This is Andy Slavitt. Welcome to our Friday conversation. My God, it’s July 8 Already, we have a really compelling show for you today. I’ve been excited about this, ever since I met one of our guests who I’ll introduce to you in a moment. Look, we’ve experienced 100,000, or more deaths from fentanyl opioid than the last year since 1989. So 23-24 years ago, we’ve lost about a million Americans, which is an enormous cost and enormous consequence. But if we experienced a million in the last 27 years and 100,000 in the last year, that means something’s changing, something’s getting worse, because that puts us on course, to lose more than a million people in the next 10 years. And even worse, we’re experiencing these losses among young people. And one of the things that I’ve learned over the last short period of time and apart from talking to one of our guests, it’s this is not the pandemic, or epidemic that it was 10 years ago, it’s not that epidemic wasn’t even five years ago, there’s a lot of misconceptions that are important to get right and understand. And look for those of us who we love. There’s valuable information that they need to know. And that’s one of the reasons I’m so delighted to do the show today. Look, I don’t know how much you know about fentanyl. I thought I understood it a little bit, but a lot of what I thought was wrong. And I don’t know how much you think your kids understand about fentanyl, if you’ve got kids who are in their teens or their 20s. But I will tell you that in a few ways that we’re gonna explore on the show. It’s not what we think if our information is even a few years old. We’re going to explore a few things including the difference between kind of the organic drugs that were the past the poppies, etc. versus what the implications of having kind of more chemical factory produced drugs are. We’ve explored the difference between what we talk about commonly as overdoses, but I think our guests are going to persuade us are not really always overdoses, but in fact, are more like poisonings, oftentimes, and we’re going to talk about when we talk about drugs bought on the street, where that street is today, that street is not in front of your house, that street is on your internet. That street is some of the social media apps people use. And this whole idea of this whole blend between recreational use, counterfeiting, and social media sites is pretty lethal blend. So let me tell you, who’s on the show and welcome you. First is Ed Ternan, who is the founder of Song for Charlie, Ed, along with his wife started this organization to raise awareness about fake pills. And these fake pills made of fentanyl. And I had a chance to meet a few weeks back, and he’s got his own story, which he’ll share with you, Ed, welcome to the show.
Thank you, Andy. Thanks for having me. Appreciate it.
And also joining Ed is Bryce Pardo Bryce is the Associate Director of Drug Policy Research Center at RAND. Welcome, Bryce.
Glad to be here. Thank you, Andy.
Okay, maybe Bryce, you can start us out. To explain what the data is showing us right now about this rise we’re seeing in deaths among adolescents, something’s clearly changed. And tell us a little bit about the fentanyl business model. Why and where is it produced? The cost? Why is it so successful? The distribution methods being used, the forms it takes, etc.
Sure. So a few things I guess it’ll be easier to answer the last part of that question first. So fentanyl is a synthetic opioid, it is an essential medication. It’s used every day in hospitals to as a general anesthetic. So any kind of invasive surgery, you’re going to need fentanyl to really knock you out so that they can do whatever it is they’re doing in surgery wise. But the reason we’re seeing a lot of fentanyl showing up in the illegal drug markets today is largely because of two factors. One is economic, it’s very easy to produce synthetic opioids you don’t need poppy, you don’t need time to harvest poppy. You don’t need to pay a lot of laborers to extract the opium gum, you can make a sizable amount of fentanyl in a short period of time just using the precursor chemicals and just to know how to make it. The other component is pharmacological. And so these two are related. The potency of fentanyl, as you’d mentioned is orders of magnitude greater than heroin. So that means that you don’t need a lot in order to kind of have the same effect in a market. So if you’re a trafficker moving one kilogram of fentanyl could substitute for anywhere between 20 to 50 kilograms of heroin. So it makes it easier for the stuff to get into the country. What we’re seeing In the last 5-6 years has been the emergence of synthetic opioids largely illegally manufactured fentanyl from Mexico prior to that from China direct mail. But a large, large part of it now is generally from Mexico, coming into the heroin markets in the United States, because again, a little bit of fentanyl could supplant or replace a lot more heroin. And then in more recent years, a small amount of fentanyl is being made, basically pressed into counterfeit tablets and being sold on the streets made to look like genuine pharmaceutical grade product. So it’s confusing users. It’s elevating risks, and some cases, we’re starting to see fentanyl showing up in cocaine. Some cases methamphetamine, it’s not quite clear why that’s happening, because these are not opioids. So it’s not dealers are kind of replacing one opioid with another, which is the case with heroin. It could be kind of cross contamination that’s happening here. Because again, small amount can have a very potent effect here. But what we’re seeing in many cases is that individuals are not aware that they’re coming into contact with fentanyl, as these markets are transitioning. In the last three years to three years, we’ve seen a very sharp rise in the numbers of youth overdose deaths. Right now, fentanyl is the number one preventable cause of death in the age cohort of 18 to 45. So this is more than firearms, more than motor vehicle fatalities, more than, you know, accidents, cancers, what have you and in the youth cohort, say 25 and under, you do hear a lot more recent reports of kids buying tablets online, using social media sites, and then taking what they think is a diverted medication. And when in fact may contain two or three milligrams of fentanyl, no active ingredient, and then they’re overdosing and dying. And so this is what’s kind of contributing to a large part of the rise in overdose deaths in the last five, six years in the United States.
Andy Slavitt 06:44
So what you’re describing is, you forget what the product is, for a second, a really compelling business model, much easier to produce much lower cost, you could sell a lot more of it. What manufacturer in the world would say that’s great, distribution methods, which allow it to be easily disguised and distributed. You touched a little bit on the deed of social media making it easy for people to find. And yet the net effect for people on the other end of that is that it sounds to me like they could be thinking they’re buying a prescription medication through the internet, and in fact that they don’t know at all what they’re getting. And that not knowing could be fatal.
Yeah, that’s pretty common for drug users in illegal markets. They don’t know what they’re buying. I mean, they’re takers, right? They don’t have any, there’s no transparency, these markets are not regulated. And so they’re buying what they think in some cases is better quality heroin, or a diverted pharmaceutical, when in fact, neither of those products are true. They contain fentanyl. And so they’re putting themselves at great risk and overdosing and die.
Okay, so as we define the problem, I want to introduce you Ed, and I’m wondering, you could tell your story to us. You started this organization with your wife, Mary, called Song for Charlie, named for your son, Charlie, who died in 2020. Do you mind and I know it’s always difficult, and you have to do it a lot. But do you mind just giving us a personal sense of your son Charlie telling us a little bit of his story?
Ed Ternan 08:16
Yeah, sure. Thanks, Andy. Mary, and I and Charlie’s two older siblings found ourselves thrown into this world after Charlie died, from a what he thought was a Percocet that turned out to be one of these counterfeit tablets made of fentanyl. The story is that it was very early COVID. And Charlie was one of those kids who came home in March for spring break. And of course, the college administration, you know, very quickly said don’t come back, right. And everybody, the country locked down. Charlie was home with us as a result for a couple of months with my wife, Mary and I. And so we had eyes on and Charlie’s acting completely normally, there was no change his behavior. I mean, everybody was a little weird in early COVID, because the world had turned upside down. But we saw no indication of any, you know, substance use problem or abuse. He wasn’t drinking himself to sleep every night. There was none of that going on. Now, Charlie, about in early May, about a month prior to graduation, he and his friends said, hey, forget with the administration says, we got a month left in our college careers before we go our own way. We’re going back to campus to be together. And so he went back up to northern California to spend the last month of school and while he was up there, on a random Thursday afternoon, he was waiting for a job interview on the telephone. So when his fraternity brothers came by his room and said, hey, we’re gonna go out and do whatever college seniors do, hit some golf balls, do some day drink and whatever they’re going to do on a spring afternoon, Charlie declined. He said, I got to stay here. I got this job interview. His words were I’m going to crush this video game. So when his friends left he asked another housemate does anybody have any Xanax? And we’ve come to learn that, you know, kind of taking these prescription pills to chill out and watch movies or play video games is much akin to how we might smoke a joint back in the 70s or 80s. It’s pretty normal. And the word was no, nobody’s got any, but I know a guy on Snapchat. So they arranged to meet a dealer that they met on Snapchat, and they bought some Xanax and a Percocet. Charlie said, my back has been killing me. I’m gonna get one of those perks while we’re at. About three o’clock in the afternoon, somebody walked by Charlie’s room and said hi to him. And he answered back, we know that he never made the five o’clock phone call for the job interview. So at some point between three o’clock and five o’clock in the afternoon, he put the Percocet that turned out to be Fenta pill in his mouth. And it probably killed him about 15 minutes from what the doctors tell us. His friends found him about eight o’clock that night, game controller in his hand. So at that point, Charlie became an example of this new category of victim that’s being created by this intersection of two forces, in general fentanyl and fakery is the way I think of it. The emergence of these potent synthetics like fentanyl, and the now common practice of skidding them to selling them to users and consumers without their knowledge or consent. And this new category victim are often not suffering from a substance use disorder. There are no warning signs that parents anyone can see. They’re either experimenting or self-medicating. It’s a one and done situation. It’s Russian roulette. And if you come up with the wrong bullet in that chamber, you know, one pill can kill is what we say.
When I met you, the first time a couple of weeks ago, you use some different language that I’m not used to hearing when people talk about drugs. People commonly just talk about drug deaths as being overdoses. Which implies to me at least a lot of drug use. You don’t use that phrase. You talk about forgeries. You talk about poisonings. Can you explain why that length? Why you use that language?
Ed Ternan 12:22
Yeah, absolutely, and drug overdose are still occurring. And we still in an overdose crisis, but we now call it an overdose and poisoning crisis. And it’s really about agency isn’t it? So, I use this analogy, and very common, iconic American brand. If I go to the store, and I order a handle of Jack Daniels, and I take that bottle home, and I drink the entire bottle in one sitting and die as a result, I have overdosed on Jack Daniels. Now, the fault ultimately, for that death lies on me, there may be extenuating circumstances, I may have a substance problem, a mental health issue. You know, we shouldn’t be, I shouldn’t be seen in a negative light because of that. But I overdosed on my drug of choice. Now, if I go to the store, and I go to ask for a handle of Jack Daniels, I’m sold a bottle of brown liquid, and I take it home and I take the recommended dose, which is a one ounce shot, and I fall over dead as a result. That is not an overdose. That’s a poisoning. And that raises questions about where the blame or the fault lies with that death. And this has implications for the legal system and criminal prosecution and so forth. So people in my world whose children, many as young as 13 and 14, were deceived into taking what they thought was a safe, familiar pharmaceutical pill. They’re very adamant about making this distinction that their child was poisoned.
I think that language is really important, and it’s impacted me. As I hear this, I think about anybody who obtains a prescription medication via the street, which in this case is the internet in the case of your son was with Snapchat specifically. But anybody who obtains a prescription medication that is not coming directly from a pharmacy, they’re at risk of being poisoned. Am I hearing that right?
Ed Ternan 14:26
I don’t, I think it’s just that absolute. And that’s the message that we take in our awareness campaigns is, especially with young people, is you know, if the pill you’re about to take didn’t come out of a bottle with two names on it, yours and your doctors, you cannot put that in your mouth, because you just can’t trust the job drug supply today. And anyone all along the substance use continuum from first time experimenters to hardcore addicts is really at a higher level of risk than they’ve ever been.
The other term you educated me on that it’s important for kids to hear says term, a fake or phony. And you use it an example of, you know, a lot of us aspire to buy a Rolex watch. And you have a very interesting analogy, but talk to you about why that language is also important.
We decided early on after Charlie died that our mission would be to take this warning message directly to young people and cut out the middleman as much as possible. And the people we consulted with said you have to be really careful about how you talk to kids and they just don’t relate to the Don’t do drugs message. Don’t say no, just say no message. But they really don’t like to be scammed. And in this Internet Information Age, they’re on the alert for fraud, kind of greenwashing. You know, false promises. And so we really play up the idea that these pills are not what you want, just like there are no Rolexes on Time Square. There are no Xanax on Snapchat, none. And that’s not where you need to go to get your medicines.
Andy Slavitt 16:04
So Bryce help us with that. What percentage of the time when people are buying what they think is a prescription for something on a site like Snapchat? Are they actually buying something with fentanyl in it? Do you know the answer?
I mean, the data on that are really, really difficult to come by what we can say for sure. So looking at this taking a step, I guess I’m looking at how we got into this mess. And as you know, we over prescribed with medications. And then for 10,15, 20 years, we realized we’ve overdone it, we started to put constraints on accessing these medications, but that that kind of behavioral mindset of taking medications has sunk in. And then it starting in about 2015-2016, we started to see the emergence of fake counterfeits showing up in these markets. Fentanyl first started arriving and powdered heroin in most of the eastern half of the United States, New England Appalachia at first, but really in about 2015-2016 We started to see it showing up in these fakes counterfeits. In some cases, it was showing up in Xanax bars or tablets, pressed Xanax bars, which is extremely worrisome. Because if you’re a non-opioid user and trying to find some diverted benzodiazepines like Xanax, you could you could very well put yourself at high risk of overdose because you’re not you don’t have a tolerance for an opioid. So but we don’t quite know what the what the share is what we do know kind of looking at the trajectory of this, we put constraints on accessing medication such that there’s less diverted medication out today than there ever has been the last 15 years or so. The numbers of prescriptions have fallen. I think we’re now at rates closer to the early the early parts of the century. So we’re down in terms of the supply of diverted medications. DEA now says something around 70% of the tablets that they encounter in their seizure series are Mexican source illegally manufactured.
You said 70%?
That’s what the DEA says in their seizure dataset. I mean, of course, these are not representative samples because this is just what law enforcement is coming across. Yeah, but there’s also some diverted medications or sorry, the domestic fake manufacturing is happening here with regard to counterfeit tattling. So there are individuals up until 2019, it was very easy to find fentanyl on a vendor online selling from China that could ship you a sizable amount, maybe a kilogram at a time. And there are cases of individuals importing illegally, fentanyl here to the United States and then pressing it into their tablets in say, their basement or their garage and then distributing those on the dark net or in kind of local markets using the mail order system. But we don’t quite know what the share is. What we do know is that numbers of fentanyl showing up in markets and state markets is increasing and it’s increasingly changing in certain ways. We’re seeing a lot more fake tablets showing up out west to the point where we just don’t see a lot of powder, fentanyl showing up in some of these markets, especially mixed with heroin, predominantly fake counterfeit tablets.
Andy Slavitt 18:45
When come back. We’re going to talk about the role that social media plays in all this. Let’s take a quick break. So Ed, the pill that Charlie thought was Percocet when he bought on Snapchat and it seems like more drug sales now are happening over social media apps. 2021 investigation by NBC News found that Snapchat was linked to the sale of fentanyl pills killed teenagers in over a dozen states that they know of. So can you give us a sense, you know, all of us who have kids, I’ve got a kid at college, I’ve got a 24 year old and you know, all them have challenges and weak moments. And so I sit here and think, okay, how available is this? Can you tell us a little bit about how the internet sites like Snapchat work and how they’re used in a way that people use to obtain these counterfeit drugs?
Ed Ternan 20:05
Yeah, sure. It really is where this generation of young people do all their transactions, their social transactions, their interactions, it’s where they get their news. It’s where they meet their friends. And it’s where they find their drugs. You know, drug dealers will always use the current state of the art for distribution. So what happens is, the dealers make themselves very easy to find, they’re essentially marketers. And they will move across different platforms, and conduct different parts of their business on different apps. So for instance, on Snapchat, your posts disappear after a certain amount of time. So a lot of dealers will advertise their wares on an Instagram profile, because they leave their menu and they leave their goods up so people can see what they’ve got and know who they are, right? And then they’ll make contact on Instagram and say, let’s move over to Snapchat to arrange a meet up using the geolocation mapping technology. So snapshot often serves as like the last mile, where the actual meet of the dealer and the buyer takes place. This is increasingly happening on emerging platforms like wicker, Telegram, and Discord. And so these dealers are very savvy, they’re marketers, they’re advertisers, they want to be easily found. And another element of it is, if you remember, back to day, Andy, if you wanted to get drugs, you had to physically go somewhere, and make a transaction and exchange cash. Our kids today have grown up with this sense of trust in the internet and social media, that if someone I see, I come across online, is advertising drugs, and they’re somehow connected to a mutual friend of mine, well, they must be okay. And the idea of buying drugs from someone you’ve never met. And this is the first transaction interaction you’ve ever had with this person is actually pretty common. Parents need to understand that mindset and understand how these social media apps work.
Andy Slavitt 22:20
So, Bryce, two questions for you. One is how common do we think some sort of internet social media site is in the distribution of fentanyl? You know, what are we talking about here in terms of his it’s a big portion of the problem is 1000s is 10s of 1000s. A day, what do we what do we know? And then help us think about how should we begin to think about what sort of culpability and accountability the social media sites ought to have for the role that they’re playing in the process.
It’s a good question. So the in terms of the retail level distribution, social media sites do play a role. I think there’s some differentiation in terms of the populations of those that use these drugs. The hardcore kind of heavy chronic users hand to mouth, they’re probably not on Snapchat, those are generally older folks who have had, you know, drug use careers for years, if not decades. But for younger populations, it seems like this is a potential vector of accessing drugs that are counterfeit. In terms of social media, we look the social media websites for our own analysis for the congressional committee, the Commission looking at synthetic opioid trafficking. We weren’t really invested into retail level transactions. But we were looking at this for wholesale and producers. And even on social media platforms, you can find precursor companies or companies that sell precursors that are not controlled that are only these precursors have only one purpose, which is to manufacture synthetic opioids like fentanyl, and they’re openly selling these on websites like Pinterest, Twitter, Facebook, so it’s quite easy for a Mexican drug trafficking organization to find a vendor on these retail, social media platforms that could then import a sizable amount of precursors to be used to manufacture synthetic opioids for trafficking later. In terms of culpability. We tried to kind of look at this in one way, which was, you know, social media platforms should do a better job when it comes to policing what is on these spaces. I mean, we’re finding out they have contributed harmful to our democracy in terms of misinformation, in terms of, you know, the lying about the outcome of the election in terms of White nationalism. So there’s a role for them to clean up these acts. I mean, there’s already a, there is a kind of a model to use when it comes to a child pornography or violence. Then again, though, the question is whether or not they’re going to do this and to do the self-policing that’s required. So at some point, Congress probably needs to get involved here to actually increase regulations, or at least try to encourage them to do a better job.
Andy Slavitt 24:58
Should we be thinking at a minimum otherwise, in terms of these social media sites being a part of a transaction that results in 10s of 1000s of deaths a year, is that is that the right way? Is that kind of how you think about it?
I mean, it’s very hard to claim to put the kind of the cause of anything in one specific area.
Sure, I say play a role, not purposely not saying in this complex web of things, I’m just saying, how often should we be thinking that this happens?
Well, in the information era, it’s important that they, they, as actors have part of this increasing information kind of network or environment that we live in, they need to do a better job of policing this space so that bad actors don’t get involved in or the same time, or that kind of innocent people aren’t being exposed to things that are counterfeit, or are potentially harmful. I mean, I use Amazon regularly to buy things. And I don’t want to come across things that are counterfeit, for obvious reasons, as a consumer. So the lacking of consumer protections in this space is problematic. And I think some of these, you know, some of these social media companies, they don’t really care to do anything about it. This was not their intention. They weren’t set up as retail spaces. But just given how humans interact. That’s just what’s going to happen.
Andy Slavitt 26:12
Well, as Ed said, you know, this is how people interact with each other these days. But the consumer protection thing is an interesting way to think about it. Ed, how do you think about that question of culpability in the role here?
right? It’s an important issue. And we have kind of zigged where the others zag, we work very closely with all the social media companies, all the major platforms, we have working arrangements with all of the majors. We first went to Snapchat in early 2021, we got their attention, and started to have a conversation. And you know, there’s two ways to get an organization to change their behavior, right? One is to compel or coerce them. And the other is to convince them, I believe we were able to convince the executives at Snapchat, that they had a problem that was unique and different. I don’t believe they understood the scope and scale of the counterfeiting and the deception that was going on by these bad actors on their platform. And when that light bulb went on for them, they engaged at a very high level very actively, they introduced us to the other platforms. I had a conversation last week with a high level executive at Google YouTube, who we also work actively with. And his comment to me was, I have not seen a higher level of energy around any other issue. within our organizations, or the other companies that we’re talking to, then I have around this fentanyl and fake pill issue. It is really an easy problem to identify with. Now, are they doing enough? People always say they’re not doing enough. But all of the platforms are helping us on the awareness side? And many of them are, there’s kind of conversations going on behind the scenes in terms of sharing technology. And I agree with your earlier comment, Andy, about thinking about this as a business problem. That’s the philosophy that I like to bring to this. When there’s a problem like this, it tends these days to be very politicized very quickly. We look for places to blame. Point the fingers. I think we ought to look at this new problem. This intersection of fentanyl and fakery, as a business challenge. Our adversaries after all our business people, they’re in it for the money. So let’s break this down to its component parts, reverse, engineer it and find new and innovative solutions.
Andy Slavitt 28:45
So you mentioned that you zig while others have zagged. And you’ve taken a tact of say, let us try to compel them through logic, reasoning, business, etc, to get them to take action. And it sounds like you have it sounds like there probably are other parents that feel differently. You could argue that if a car company had a vehicle that of which 6000 people a year died, while they drove the vehicle, even if there was a part manufactured in Mexico, that was in the car, or for whatever reason, you know, there’d be a recall on the car. So first of all, is that faulty logic? Secondly, are there parents in who families who feel that way? And is that a legitimate point of view? Or do you see it as much more complicated than that?
Well, I guess I see it as more complicated than that. Mary and I looked at all our options. We looked at suing Snapchat and just can’t do it. There are people working to reform the internet. And they’ve been at that for 15 years. And those conversations are still going on. I think that these companies are being pulled in a lot of different directions. So when we got the social media companies to engage with us, we got them to give us lots of ad credits and to consult with us on how to reach their audiences. And in the last year alone, we have reached, you know, we’ve had 125 million impressions. across all of these platforms, we’ve reached 52 million unique viewers. And those are kids and parents of the right demographic, because we’re targeting these messages on Snapchat, tick tock and Facebook, to the age groups that we want to reach. You can’t do that, if your first meeting with them is with the attorneys. And your first ask of them is, I want your head on a pike and I want you out of business. I think there’s a push pull thing that goes on here, some public pressure is certainly good. And these, these companies all need to be pressured to do more. I use the analogy of working with the DEA, the DEA has one job. And that is to keep drugs out of America and keep Americans safe from illicit drugs. They’ve been around for 50 years, if you talk to them, and we have we just came back from a family summit that the DEA put on in Washington DC, with about 75 families who’ve been affected by this. When you talk to the DEA about how it’s going, they will say this is a tricky problem. It’s like Whack a Mole. Every time we catch one of these guys, another one pops up. They keep changing their tactics. We don’t have the budget nor the manpower, but we’re working as hard as we can. And their success rate self-reported is 10 15%. And the response to them typically is good job. How can we support you and get you some more resources? Now in a social media company, which has not just the job of keep protecting their young people, their users from drugs, but also from sexual exploitation, bullying, they’ve got special interest groups around unsafe driving, texting and driving dead naming, you know, nude photos, pornography. And they say, we’re doing as much as we can on this drug problem. But it’s really tough. It’s Whack a Mole. When we try one tactic, they move over here, right? We don’t have the resources, we don’t have the manpower, these guys are really tricky. The response is, you should have had this figured out by now, we want to drive you into court. I don’t follow that. That logic. What I’d like to see is the DEA and the social media companies get together and pull their resources.
Andy Slavitt 32:39
We got to hold everybody accountable. You’re saying the other thing I think I hear you saying is unless you’re saying okay, let’s take down all social media and then social media. They’re a fact of life. And it’s not like a car company where you could say just recall the vehicle, you got to effectively deal with these facts of life. Let’s do a break, let’s come back and talk about solutions and where we go from here.
Let’s talk about what were some of the solutions, space lies. One of the things I hear from people when asked my own kids about this is about these devices that they can purchase that are supposed to tell them whether or not the drugs that they have are indeed counterfeit. Do those work? Do you recommend those?
Well, if you’re asking me and the there’s really one product that dominates the consumer market for testing substances for fentanyl, these are called fentanyl test strips. And they’re designed to test liquids. They’re very effective as far as I know for detecting fentanyl in substances. It’s an interesting kind of very fluid situation where the harm reduction community has embraced these and I think they are they are saving lives all across the country. If you take a powder, whether it’s cocaine for instance, if young people are thinking about buying some cocaine on a weekend. It is really important; I think for them to also get some fentanyl test trips and to test that cocaine for fentanyl. It’s really highly effective at picking up trace amounts of fentanyl in diluted powders. It’s a little tricky with tablets because you have to destroy the entire tablet to test it and then ingested another way. You have to test a powder. You can’t just scrape a little bit off a pill and test that little sample and assume that the rest of the pill is free of fentanyl because once you press it into tablet form, the distribution of the fentanyl is a locked in place, it’s called the chocolate chip cookie effect. So you could have a clump of fentanyl in the part of the pill you didn’t sample. So for pills, it’s a little tricky but for testing heroin before you inject or a sample of your cocaine before you use it on the weekend, there are test kits out there, test strips out there that I think work, Bryce would you agree?
Yes, yeah, the research there has shown that some users do change their they modify their behaviors in terms of reducing overdose risk. So they’ll use more slowly not use the whole bag when they when they come to find out that fentanyl is there. But there are limitations as Edie pointed out with counterfeit tablets. Yeah, you do have to destroy the whole tablet because you have to test the whole thing. These are not homogeneous. In addition to that, if the market has shifted entirely defensive on everything contains fentanyl, these are presumptive, yes, no tests are like a pregnancy test. So does you really no good because everything contains fentanyl already. So if you’re a novice user, or a new initiate, or someone who is avoiding opioids, entire, like a cocaine user, these could work. But there are limitations for other sets of populations that do use drugs.
Andy Slavitt 36:02
Okay, so it sounds like potentially helpful in some situations, but by all means, not a silver bullet doesn’t solve the whole problem. So in your minds, because you you’ve, you’ve both done a tremendous amount of work on this. What are the most important things, but Bryce, why don’t you start?
Well, I think it depends on the population you want to focus on. So right now we do have a huge population of individuals, individuals with opioid use disorder that don’t have access to quality treatment like methadone and buprenorphine. So expanding access to those medications can help get them out of these markets so that they’re not being exposed to fentanyl, in counterfeit tablets or heroin. So that’s critical, trying to expand access to good quality treatment in some of these places is good. The administration is starting to work on some of those ideas. I know CMS is now starting to reimburse for methadone provision. So there are things that are being done there. But there’s again, limitations if federal government only do so much there are many state policies that have been put into place that limit, for example, expanding Medicaid, there are many states that still do not expand access to Medicaid, which is the number one provider for addiction therapy. In terms of other populations that are, that don’t have a UD, you’re going to need to think more differently. So these are kind of younger folks, people who are coming into contact with counterfeit tablets, those folks you know, again, offering the methadone, it’s not going to do anything for them. Because they don’t have an opioid use disorder, you’re going to think more in terms of changing, or framing the drug use problem differently such that you’re not shaming them. You’re de stigmatizing drug use, you know, use more carefully, don’t use alone use with Naloxone, don’t crush, it’s not your entire tablet, consider that it’s probably fake. So kind of the harm reduction messaging there can help other novel harm reduction methods or techniques could be useful. Their drug content testing, like we talked about fentanyl test strips could help for some of those individuals like their cocaine users. But you’re going to need to differentiate the responses here in many different ways. And it just keep in mind that there’s going to be limitations when it comes to facing some of these populations with kind of the traditional tools that we have, because fentanyl is really it’s really eliminating the availability and the efficacy of some of the traditional tools that we’ve used to deal with drugs. It’s just a different ballgame entirely.
Andy Slavitt 38:09
And Ed, how would you answer that? What do you think the most important steps are?
Right. And I agree with everything that Bryce said, the game has completely changed, the landscape has evolved, there’s been a seismic shift from say, when I was growing up, where it was described as kind of a journey where you were going to experiment with some drugs. At some point, if you’re not careful, you might get dependent and they may be addicted and down the line, maybe overdosed on your drug of choice, that was the danger. Now it’s more like a minefield, where your very first step into that world could be your last if you don’t know what’s going on. And I do like the idea of thinking this kind of moving away from the War on Drugs language that we’ve been using for 50 years, and thinking about this more like a business problem. So one of the projects I’m excited about at song for Charlie is, as a result of the national fit Awareness Day we put together this past May, we are putting together a panel of experts from all three of these stakeholder groups, supply reduction, demand reduction in harm reduction, and some social media and technology people. And we’re going to these people have committed to get in a room virtually, and have a series of meetings and begin at least to decide on what are the right questions to be asking. Because as Bryce said, the kind of broad brush solutions we’ve been used to don’t apply anymore, we really have to break the problem down in terms of the population you’re trying to serve, and then apply the right solutions to each of those groups. And one of the interesting things I’ve learned is that and sometimes I get emotional when I tell these stories, but you know, there are people who really, really care a lot about trying to keep people who use drugs safe. And those people come from all walks of life. So it’s cops who are it’s their job to arrest people, they care a lot. And they’re shocked and horrified at the overdoses that they’re seeing. And so are the EMTs. And it’s the people who live and work in the harm reduction sites, giving out, you know, buprenorphine, or safe needles and stuff like that. And it’s the drug prevention education, just say no people, and it’s the executives and social media companies. So if we can bring people from of good faith from all those different groups together around that one shared passion, and the one share kind of jaw dropping, you know, reaction that they’re getting to, this is crazy, the number of people dying, something’s got to be done. If we can rally around that. We’re gonna have, you know, I think we can come up with some new stuff. But we’ve got to stop talking at each other and start talking to each other.
Andy Slavitt 40:57
That sounds really promising. Maybe we could close with the solutions, not at the policy level. But at a family level. You know, after talking to you, as I mentioned, I reached out to both of my sons 24 and 20. And I realized a couple of things. One is, it’s not a very comfortable conversation to have. I have not had the conversation with them. Hey, do you guys do this? You know, we think we do. We think we know our kids; my kids live all the way across the country. I think of them as good kids. But that actually makes it harder to broach the topic, because you have this perception. So it’s for one tough topic to broach. Number two, what do you say? What’s most important for them to know? You know, if you’ve if you have two minutes, and you go around, do a lot of speaking and if you go, if you have two minutes with a family, or a college kid or high school kid or someone, what’s most important for them to hear? And if someone’s going to do what I suspect a lot of people who listen to this are going to do which is after this episode, maybe decided to pick up the phone and call or video chat or whatever it is. We do these days, Snapchat, whatever it is, with a loved one who they think that was like, what script? I mean? How do you help people think that through?
Ed Ternan 42:17
Well, I think that Bryce will back me up and saying that, you know, it’s safe to say within it’s not exaggeration to say fentanyl is just everywhere in the drug supply. And it doesn’t matter what substance you’re going after. Whether you’re self-medicating or a weekend warrior, partying with an eight ball of cocaine, you have to be aware of the fact that fentanyl has infiltrated the drug supply in the US. So the conversation I think can come from a concern about your loved one safety. There’s no moralizing involved, this is don’t do drugs, drugs, you know, drugs are bad. This is not just saying no, we use the kind of gimmicky language if we say just say no, but we spell it know, it’s really important kids that you know what’s going on in the world of drugs, because it is not like it was five years ago. So you play on the fact that it’s a recent phenomenon. There’s, I just want you to know this because it’s new. If you haven’t heard about this, you need to know it. And please do some research, find out what’s going on and tell your friends. One of the things that we really believe in at Song for Charlie, and that people who are expert and communicated, you know, people told us is they care about their friends, young people care about their friends. So we make this an empowering message. And we say you didn’t create this problem. This is happening way beyond your control. But you do have the solution. And within your power, you can be careful about what’s going on, you can educate yourself, and you can make sure all your friends know that the drug supply today has been completely polluted by fentanyl, and you have to be super careful.
Well, we’re going to have a link if you go to the show notes for SongforCharlie.org, which is a great site, a great place of resource. And, you know, I think your awareness campaign. It’s already saving lives. It’s already taking off. And I think it’s important for those of us to think we understood this problem. Who could say, You know what, I don’t know, you know, the person I care about doesn’t have an addiction problem, so I don’t need to worry about them. That thinking is off the table, at least for me. And I think for people who are becoming aware and look, you and your wife and your kids have dedicated yourself to keeping families out of this situation. That takes a tremendous amount of generosity and graciousness and courtesy each you’ve also shown to everybody involved in this process. So I just want to tell you that I think there’s a lot of people listening to this, that will would want you to know how much admiration they have For you and your family. So I want to thank you for being in the bubble. Bryce. Thanks for your continued good work here in. And can only say Ed, when you said I hope that maybe they finally gone too far. And that it’s time to go back against them that the tides have turned. I hope that you’re right.
Amen. Thank you Andy
Okay, let me tell you what we have coming up. On Monday, we have a conversation about air travel with an airline CEO, that you all helped me put together, I crowd sourced a bunch of questions for Scott Kirby, the CEO of United Airlines. We’re going to be talking about what’s happened in that industry, what’s happening to people who are trying to fly, and how that relates, or in his opinion, doesn’t relate to the big bailout of the airline industry. That’s quite a choice conversation. It’s everything you’ve wanted to ask airline CEO and may not have had a chance to. On Wednesday, we have an episode on COVID again, BA5 is coming to the country. And we’re going to be talking with Bill Hanage. And particularly exploring what’s happening to our immunity because BA5 seems not to be paying attention to the immunity that people have established in many respects. So we’re going to try to figure that out. And then Friday is another great Friday conversation. This will be the launch of the 988 line. The National Suicide Hotline. Chris Murphy will be here the next week. And we’re going to review the bill that he shepherded through the first bipartisan gun legislation in a couple of decades. I’m gonna talk to Chris about that, how that happened, what that entails and what’s next. Alright, have a great weekend, everybody.
Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.