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Did Politicians Cause the Fentanyl Crisis?
65 Plays1 year ago
We sat down with Jacob Rich, a PhD student at Case Western Reserve University School of Medicine and a policy analyst at Reason Foundation, to discuss the causes and solutions to America's Fentanyl Crisis.
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Transcript
Introduction and Guest Welcome
00:00:00
Speaker
Welcome everybody to the most recent episode of the Project Liberal podcast. I am your host Joshua Echol joined as usual by our co-host Jonathan Casey. Good afternoon, sir. Thanks for making time.
00:00:16
Speaker
We are thankfully and excitedly being joined again by the first guest who ever joined our show, Jacob Rich. Jacob is a PhD student at the Case Western Reserve University School of Medicine. He's also a policy analyst at Reason, at the Reason Foundation.
00:00:34
Speaker
and our resident expert on everything related to what, and he's epidemiologist, and he's a resident expert related to anything, prohibition, drug policy, et cetera. Jacob, thank you for taking time to join us again. Thanks for having me again. It's a pleasure. For those who don't know, our last episode with Jacob, we talked about RFK's vaccine claims. We looked into
00:00:55
Speaker
Kind of a lot of the claims with autism surrounding vaccines and we kind of dug into a lot of things there. We're going to look a little bit different, but for those who are interested in that, I found that episode very interesting. I learned a lot during that episode. I think that the medical field has a different way of looking at things than most normal people do, especially when it comes to investigating new medicines, bringing new medicines to market, particularly vaccines to market. So for those who are interested, absolutely check out that last episode.
00:01:27
Speaker
Absolutely, Jacob, I appreciate you making time to join us. I was going to say, I don't know if you have anything you want to add about yourself or any context that you want to share for our audience, but you're welcome to before we jump into the meat of the conversation today. No, I think you guys did quite a good job. Yeah,
Recap of Jacob's Last Appearance
00:01:42
Speaker
drug policy analyst at Reason Foundation. And I also direct a lot of the health care research. And I'm over here studying epidemiology in Cleveland at the Case Western Reserve University School of Medicine.
00:01:56
Speaker
been looking at these topics for about, uh, almost a decade now. And, you know, it's very interesting to me. So very excited for the conversation. Awesome. Okay. So let's frame everything then for the sake of the audience. The goal today is not to talk about vaccines again. While
Drug Prohibition & Opioid Crisis
00:02:10
Speaker
there's plenty of vaccine misinformation out there, um, we are not going to spend a full hour tackling that today. We wanted to talk about something that was, that is also in the news, uh, specifically related to drug prohibition, drug decriminalization.
00:02:24
Speaker
and the fentanyl and opioid crisis that the United States has been grappling with for
00:02:29
Speaker
damn near a decade now. And so that's the overall topic of the conversation. I think we were hoping to start a little bit to talk a bit about fentanyl and the opioid crisis. One of the reasons why we wanted to bring it up was because it is something that's talked about in the context of the presidential election. I always hear from right-wing pundits that there's all this fentanyl coming over the border from China, and it's a huge crisis killing many people. And I do think that there's a lot of credibility to that narrative and doing some reading.
00:02:57
Speaker
Think fentanyl is becoming one of the leading causes of death now for young people in the United States And it is a it is a real problem that needs to be addressed. So the goal I think from our perspective was to frame it talk about the facts try to make sure we're all kind of operating on the same framework of truth here and Then talk about what what caused the crisis? What are real policies to fix it and kind of how we get out of it? So if it's okay with you Jacob, I was actually just gonna start off with a very basic question like What is fentanyl? it's like
00:03:26
Speaker
What even is it? And what is this drug that everyone keeps talking about? Sure. No, that is a great question. So when we discuss drugs, there's various types and forms of narcotics that have all sorts of different types of euphoric effects. And one class of narcotics is opioids.
00:03:45
Speaker
Now opioids are one of the few narcotics that's in schedule two, meaning that they're not completely illegal because the government has determined that they actually have medical purposes. And almost everyone has had some sort of exposure to an opioid, whether you've had your wisdom teeth removed,
00:04:04
Speaker
or whether you've had a major surgery, you were probably given an opioid in order to reduce your pain while you were conscious. And if you went under, you were certainly given an opioid to make sure that the experience while you were unconscious wasn't too painful as well. So fentanyl is a, it's a newer, it's not that new, but its use in the illicit market and as a recreational substance is quite new.
00:04:31
Speaker
That's because most opioids that have been used recreationally like heroin or opium are actually derived from the opium poppy, something that you must grow, harvest, and then manufacture into a substance that is consumable. But with fentanyl,
00:04:49
Speaker
Everything about fentanyl is artificial and you don't need any sort of farms or large geographically large forms of capital in order to produce it. So instead you just find the chemicals, you create a lab, and if you have somewhat of a chemist who's generally good at what he does, you can basically produce a drug with a very small footprint that's very difficult to locate.
00:05:19
Speaker
So fentanyl differs from a lot of other opioids that are traditionally consumed, though, because it's so potent. It is anywhere from 30 to 100 times more potent than heroin, which makes it very easy to conceal for trafficking purposes. But if you're consuming the drug, a little bit of a mis-measurement can lead to death. Versus with heroin,
Fentanyl's Impact
00:05:44
Speaker
if you mis-measure it, you might just get a little bit more high relative to overdosing.
00:05:48
Speaker
So fentanyl is a new drug on the scene. It's been the major source of drug related deaths for about the last eight years now. And it has basically completely replaced heroin as the recreational opioid of choice of traffickers and consequently people who consume the drugs.
00:06:08
Speaker
Okay, and so I can assume that because of the reason that it can be so easily mismeasured and misdosed, like you know, a small amount of dose can completely result in death, is that one of the reasons why we're seeing so many young people die or die from it because of that nature? Are there other things at play that are causing it to be such a deadly substance?
00:06:31
Speaker
Yeah, that's exactly correct, what you just described, but it's both on the trafficker and the user. So either one of them, mismeasuring, can lead to death. And when traffickers are selling drugs, sometimes they give it to you in
00:06:48
Speaker
like multiple small baggies. And you might be told that a baggie is equal to one dose. But if the trafficker mismeasures that and you don't test it before you consume it or do any sort of test to figure out what the potency is, which are very hard to do on your own without a lab, that might lead to death. So a small amount of error by multiple parties in the entire drug using and trafficking system can lead to death. And one of the largest things leading to death isn't so much the
00:07:18
Speaker
this measurement but it's actually the contamination. So lots of drugs are stored in the same place in trafficking purposes and sometimes the fentanyl supply will contaminate the cocaine supply and lots of people who buy cocaine who have no intention of consuming opioids might overdose on fentanyl because there just happens to be fentanyl in their cocaine that they did not know about.
00:07:43
Speaker
Is it common for fentanyl to be added to other drugs to increase the potency? Or is that just an urban myth that I've heard? I have heard that fentanyl is added with other drugs to increase its potency. Is that true?
00:08:00
Speaker
Is that, is that more of an act? Sounds like what you're saying is it's more of an accidental, uh, it's accidental mixing of the drugs as opposed to an intentional, yeah, we're putting fentanyl in it to increase cocaine's ability to get someone high. Yeah. So it would typically be in an accident. Okay. I'm not going to say it's a zero amount of purpose. I'm sure everyone tries everything at some point, right? You know,
00:08:26
Speaker
I'm sure some traffickers have done that, but in general, you don't even want to get your consumer too high. There usually is a target effect that the consumer is looking for, and contaminating the drug supply will cause something different. So if you want to get high on cocaine, that's a stimulant. There's a very specific purpose for doing that, and consuming an opioid would probably interfere with that. So I don't really see
00:08:54
Speaker
it to be purposeful in terms of like methamphetamine consumption, cocaine consumption, and when you're dealing with people who are even using opioids, if you make the opioids too strong, you might kill your consumer. So I don't really see much of an incentive to purposefully put fentanyl into things, but using it as a substitute for the drugs that it could actually replace, that's happening all the time. So they might tell you that you're getting heroin,
00:09:20
Speaker
when you're actually getting fentanyl, but that's because those two drugs are relatively similar. And the traffic will
Roots of the Opioid Crisis
00:09:26
Speaker
likely reduce the amount of fentanyl in there to make sure that it's similar to a heroin dosage. Gotcha. Okay. So one of the questions that I wanted to ask you then Jacob is, and you know, this is something that I think you and the people at Reason talk a lot about is even in the drug market, you know, it is a market, right? There are market factors at play.
00:09:47
Speaker
That's also relevant to trafficking. Whenever I talk to people on the right, there are these drug dealers that are bringing these drugs that they want to kill people and they want to kill young people. It's almost like they have this malicious intent. They're serving a function of the market. There's no real market value for you to kill your consumer.
00:10:07
Speaker
Fennel is a real problem, but I am curious because it obviously something that we're hearing a lot about recently How it ties back to the opioid crisis because this is something that's been going on for a long time And it seems to me these two things are somehow connected and I'm curious as whether you could kind of connect those two strings for me like where does the opioid crisis play a role in this and You know like how do those things interact?
00:10:30
Speaker
So before we have a discussion about the opioid crisis, we should probably describe and define what the opioid crisis is because there's a lot of speculation and a lot of description in the news about what's happening with drug use and opioids in the country, but a lot of it's wrong. What's really happening is that we have an unprecedented number and rate of death from drugs, mostly opioids, and every single year it tends to go up.
00:10:56
Speaker
But in terms of addiction and drug use, those numbers have been relatively stable for the last two to three decades. And I only say two to three decades because that's about as far as the data go back. So maybe it's been stable for even longer than that.
00:11:13
Speaker
And if you look at what happens starting in 2015, in 2015, we actually saw a reduction in opioid use. Yet around 2015, we saw near exponential increases in opioid overdose.
00:11:29
Speaker
So it's not even clear that the number of drug users has much to do with the death. What I think the opioid crisis is, is a relatively stable number of drug users increasingly using drugs that are more dangerous as the pharmaceutical supply for recreational use goes down.
00:11:49
Speaker
We are at about the lowest rate of opioid prescribing from pharmacies in the last 20 years. It hasn't been since the 90s that we've had this low rate of opioid prescribing, yet we have unprecedented death. And if you look at the relationship at the state level of the prescribing versus the number of deaths, they move in the opposite direction.
00:12:10
Speaker
prescribing goes down and then deaths go up. And the percentage of those deaths caused by fentanyl and black market for varieties goes up. So it seems like there's a very clear relationship between the distribution of relatively safe pharmaceutical grade opioids into the market and the number of people who die from illicit drugs, from illicitly produced drugs sourced from the black market.
00:12:36
Speaker
Why are prescriptions going down so far? If there's a correlation of legal drugs being prescribed going down and then illegal drug use going up, why are prescriptions falling? Why aren't people being prescribed as many opioids? Well, in 1996, OxyContin was
00:13:03
Speaker
was marketed and introduced to the public by Purdue Pharma. And then shortly after that time, the New York Times and other outlets started reporting on people dying from the drug. And in the early 2000s, around 2003, the Bush administration passed a law called the Harold Rogers Prescription Drug Monitoring Program.
00:13:25
Speaker
And this program allowed states to apply for funding to the DOJ in order to establish their own prescription drug monitoring programs. And what these programs do is they provide access to law enforcement of
00:13:44
Speaker
a doctor in patient drug histories. So sometimes the state level police have access to these records, but all the time the DEA has access to these records. So what's happening is that states put these programs into place, they start monitoring doctors and patients.
00:14:04
Speaker
And then law enforcement starts harassing and threatening the doctors who they deem to be overprescribing, and that's when prescribing goes down. And when doctors realize that they have to report their prescribing to the DEA, they start self-regulating, even if the DEA doesn't threaten them, because they know if they are flagged as an overprescriber or even an above average prescriber, they might have to talk to law enforcement, and that's very scary.
00:14:31
Speaker
Okay, so I assume that that became a much bigger problem after the opioid crisis became a very loud and public health crisis, right? I mean, like...
00:14:39
Speaker
I mean, when I think about the early 2000s, I think there was kind of a golden era where there was all this prescription of opioids. It was like a wonder drug that was given out like candy. Now that may not be true, but that's like the narrative I think people have in their minds. Yeah. Did like, was there a moment in time where the DEA and the CDC made a major change in their policy or started going after doctors more, which like made them even more.
00:15:09
Speaker
decided to self-regulate more, or has this just been kind of something that's been going on for a while? Well, it's really state-specific. So the moment that the programs go into effect at the state level is when the DEA would get more involved. So one of the earliest states to actually implement these policies, actually a state that did it before the funding was even derived was Kentucky. And Kentucky was one of the first states to experience an opioid crisis.
00:15:38
Speaker
Yeah, it's actually very interesting that the opioid crisis at the state level tends to begin when these programs are put into effect. Now, the funding for the programs was kind of motivated by national level data that showed that more prescribing led to more drug overdose deaths from opioids. And I think there's something to be said about that. I think we do need to concede that
00:16:04
Speaker
the increase in distribution of pharmaceutical grade opioids did lead to an increase in opioid related overdoses. But those opioid related overdoses between the years of about 2000 and 2010 were incredibly gradual.
00:16:22
Speaker
And while that was happening, the total illicit drug use rate, all types of illicit drug use together that are not marijuana, that remains stable. And as opioid use was increasing during that time,
00:16:38
Speaker
the use of other drugs like cocaine and methamphetamine was actually dropping. So you kind of had this relatively stable drug using population kind of shifting to the drugs that were more available. And it is easier to overdose on opioids relative to cocaine and methamphetamine. So you did see minor increases in drug related overdoses because of that.
00:17:03
Speaker
But once the government started getting involved and started trying to interfere with drug use and becoming much more draconian, you saw much more black market drug use in general. And that's when the overdoses really start to go up. OK, I want to talk. Yeah, I'm curious if I could if I could just for the sake of my own understanding and for the sake of the audience, because I feel like you are saying something I want to say back to you to make sure I understand it.
00:17:28
Speaker
The narrative that people hear in their minds when they think about, at least the most people that I talk to when they think about the opioid crisis, it's evil pharmaceutical companies coming in and addicting their patients to this drug, and there may be some credibility to that narrative. And then the cause is the fact that they then
00:17:50
Speaker
are now so addicted, they can't get the drug and when their prescription expires, then they go on heroin or whatever. What I'm hearing from you is that it's not nearly as cut and dry as that. It's not necessarily to say that there's an over prescription, which you might say there is. I'm curious as to how you'd respond to that, but it's also the major cause of the crisis is less about the prescription at the beginning of opioids and more about how like lawmakers pressured medical providers to
00:18:18
Speaker
cut off prescriptions when they maybe shouldn't have been cutting off, forcing consumers to go to illicit substances to get their high. I mean, can you elaborate a little bit on that or maybe correct me where I might've been wrong or mischaracterizing kind of the perspective? No, I think you're touching on where I should elaborate. Just to be clear, almost no addiction is started in a medical setting. When a doctor prescribes opioids to a patient,
00:18:46
Speaker
it is incredibly rare that that patient will develop an opioid use disorder. And even if they do develop an opioid use disorder, it's not even clear that it was because of the doctor prescribing to them. If you look at various studies that look at whether an opioid use disorder is developed after exposure to drugs, it happens to be well below 1%, somewhere around 0.6% at the highest.
00:19:15
Speaker
And this isn't even like necessarily caused by the exposure. It's just the fact that the exposure happened. And that's the percentage that happened to be addicted after the exposure. So we don't even know what the causal element is. It's like 0.6% is like the highest
00:19:30
Speaker
possible cause. So it's very low. So a doctor prescribing opioids understanding that the probability of addiction is going to be less than 1%, that's really not on dumb doctors exposing drugs or exposing patients to drugs and causing them to get addicted.
00:19:49
Speaker
what the prescribing and the increase in prescribing did was within a community of drug users who were already established drug users, increased the amount of opioid use among them. And the reason why I can confidently say that opioid distribution has very little effect on addiction is because addiction rates to opioids and all illicit substances in general, again, have been stable for decades.
00:20:18
Speaker
how does the prescribing of opioids increase addiction when we saw major increases in prescribing, yet stable rates of addiction? That's a
Government Interventions
00:20:30
Speaker
very powerful and interesting way to look at things that I don't think I've ever thought about before. So it's almost like we're framing it by saying the rise of fentanyl was a direct consequence of government intervention in the market to reduce the supply of opioids, safe opioids,
00:20:46
Speaker
Which has then caused people to seek your destructive substances. It's very interesting Yeah, that's a very interesting way to look at it So has the crisis evolved in recent years and John I want to let you try me with some questions, too I mean has have we seen major change? Yeah, don't worry So it's gonna say have we seen an evolution of this crisis at all in recent years I mean seems like fentanyl is the thing that people are talking about now it seems like that's the substance of choice for some of these users and
00:21:13
Speaker
But how has this changed over the last 10 or 20 years? Do you have any commentary on just that in general? Sure. So the use of fentanyl among recreational drug users has gone up. But I don't know if that's necessarily because it's the drug of choice. It's the drug of availability. Opioids are the drug of choice. And fentanyl just happens to be what's available. I see. In 2018, one of the first articles I wrote for Reason was called Congress Needs an Opioid Intervention.
00:21:43
Speaker
And it was an article on the Support for Patients Act that was passed under President Trump and had massive bipartisan support. And what this program was going to do was basically increase funding for surveillance, try to crack down maybe at the border,
00:22:00
Speaker
invest in machines that could possibly find opioids as they're coming in through ports of entry, and give law enforcement more resources to enforce laws. And what I wrote in 2018 was that this is precisely what made the crisis deadly in the first place. If these laws go into effect, we are only going to see an increase in opioid overdoses.
00:22:26
Speaker
And unfortunately, what's happened since 2018 is that opioid overdoses have almost doubled. So the latest development in policy surrounding drug use is that the government has just doubled down on what it was doing before, has put more funding into what it was doing before. And it's no surprise that everything has gotten much worse.
00:22:46
Speaker
Well, it's like Milton Friedman. I think Milton Friedman, I'm going to paraphrase him quite badly here, but it's the best way for a government program to get more funding is to fail. Right?
Historic Prohibition vs. Current Policies
00:22:55
Speaker
Because the more it fails, the more it can say we need, we need more money to actually do what you want us to do. Right? That's the thing. No, the point I was going to make earlier was.
00:23:03
Speaker
We've seen, we've seen these type of interventions, government interventions of prohibition, especially, um, change the marketplace and actually make things far more dangerous than they were before. For example, in the prohibition of alcohol, it's what you had is beer sales almost did almost die off. The real problem was is you had liquor sales skyrocketed to replace it because liquor is far more, uh, dense, far more, uh, you know, you talked about fentanyl being far more potent.
00:23:29
Speaker
liquor sales went up because liquor is far more potent than regular beer was, right? So you have this, you know, and not to mention it was far more dangerous for people to start drinking it. The government even poisoned several supplies of it, if I remember correctly. Quite horrific stuff, but it sounds like we're doing the same thing
00:23:49
Speaker
all over again where government saying no we need to we need to stop all of these things we need to stop you know these these other opioids and it's forcing the market to go to a more potent more dangerous substance whereas if less dangerous substances were legal the
00:24:06
Speaker
market would probably go, okay, I will choose the safer option because I can get the same stimulus from that that I can from a more dangerous substance. Have we seen any changes in states that have done drug legalization? Have we seen any changes in the rates of fentanyl use and overdoses? Have we seen any correlation between the two?
00:24:31
Speaker
I know that, I'm assuming that states really haven't legalized the similar opioids to fentanyl, like heroin or things along those lines. So we probably won't, unless we legalize those, we probably won't see much of a correlation, but is there any correlation yet? Yeah, so the only correlation that we could possibly see would be in one direction because states have not increased access to any sort of steroids.
00:24:58
Speaker
I mean, that's I see what you're saying. Is there any is there any state or even country, Jacob, that is that has a policy here that you feel like is worth exploring? I mean, I think we could go into and I do want to pick your brain on this. Like we could talk about theoretical policy solutions that could, you know, fix some of these things or at how many cases it's mostly the government getting the hell out of the problem. But I'm curious, is there any model of any country or any state that you say that are showing promise?
00:25:28
Speaker
in fighting the crisis? Yeah. The Netherlands used to have a heroin crisis. And they are one of the few countries throughout the world that have somewhat moved towards legalizing heroin. Now, exactly how they do it might not be the most efficient. But despite that, they've seen major success. And basically, what they have done is that they have located the people within their country who use heroin
00:25:58
Speaker
And then they just provide it for free. And daily, people who use drugs can go and they can consume them, and they're clean. And the drug overdose rate basically fell to zero. Some things that aren't so ideal about that program, though, is that a lot of the people who are using drugs feel like they've been abandoned because
00:26:23
Speaker
It's like a stable rate of drug users. So they're not really provided much incentive to get off the drugs because they're free. And when you make something free, it at least would lead to stable use. But one thing that's very important about providing drugs, whether they're free or at a market price, is that it replaces the black market. And there's no black market in the Netherlands now to offer these drugs to children.
00:26:54
Speaker
A lot of times what happens when you make something illegal is that the illicit market comes in, starts providing it to adults, but the illicit market's actually much more likely to sell to children than the regulated market.
00:27:09
Speaker
And one remarkable thing we've seen with marijuana is that when marijuana is legalized in a state, the rates of child marijuana use either stabilize or go down. And that's because it's much harder for a child to get marijuana from a regulated business
00:27:27
Speaker
That is in the light of day and has to follow regulations Versus some shady guy who's selling weed and willing to sell to anyone, right? The other theory I've heard on that too. Is that well if you see your parents or grandparents smoking marijuana, it's not cool anymore So why do it? Yeah, I think there is something to be said about that in the Netherlands as well because these people who use drugs in the Netherlands are kind of you know in the public and people know who they are and
00:27:53
Speaker
and children don't really grow up wanting to be them or to become them. So if you don't really have an illicit market offering income to young people who would be willing to work the streets to sell drugs, and you also don't have the marketing of children,
00:28:14
Speaker
Yeah, you basically replace all of the nefarious things that can lead to childhood exposure to drugs, which is usually what leads to drug addiction in the long run. Do we see the
International Drug Policies
00:28:26
Speaker
same effects around
00:28:30
Speaker
drug use facilities, like I think Canada has enabled some, I know some, it's very spotty in the States about whether they allow them- Needle exchanges, right? Needle exchanges or places where you can go to have your drugs tested or you can go to have medical professionals around when you use your drugs. I forget what they're exactly what they're called, but I haven't seen any data showing that those reduce overdoses and what's the general effect.
00:28:55
Speaker
They generally don't reduce overdoses because you don't use the drugs on the spot and the drugs that you use are still sourced from the illicit market. Now what they do tend to do is reduce blood-borne disease.
00:29:11
Speaker
and a lot of blood-borne disease is spread by the sharing of dirty needles. So when these programs go into effect, people at least have cleaner supplies to use their drugs and various harms that are caused by dirty needles go away. But in terms of reductions and overdoses, we really haven't seen that much. Canada has been flirting with providing, what was it called? Hydromorphone, which is very similar to heroin,
00:29:39
Speaker
to people who use drugs. But they've seen an increase in overdoses since they've done that. And I don't know how careful they've been about implementing that policy. And the policy is relatively new. So noted that what the effects of that are kind of still to be determined. I couldn't imagine the nuclear level meltdown that would happen in the United States if some mainstream politician recommended that we should provide
00:30:05
Speaker
I mean, again, it seems like there's definitely shortcomings to those policies, but there are some that do reduce harm. I think this is a good pivot, though, to kind of the next segment of the conversation, which is around prohibition and decriminalization broadly. So you touched on the Netherlands, which...
00:30:26
Speaker
has taken some non-traditional approaches to reduce harm. What about just general effects of decriminalization on drug use overall? I know one of the things that I remember hearing about, and I just feel like I haven't heard about in years, is Portugal. Portugal did this whole full-scale decriminalization effort for drugs. Do you have any doubt on what happened there after we've looked back a couple years after they've made this policy change? What were the impacts?
00:30:54
Speaker
Yeah. So I don't know if I could really describe what Portugal did as decriminalization per se, because they didn't really allow people to use drugs. What they did was is that they removed incarceration from drug use and then they would give people who they found using drugs an ultimatum in order to go into therapy.
00:31:20
Speaker
So it was basically locating drug users and coercing them into therapy instead of locking them up. And I think that's a much better approach. It's better. It's objectively a much better approach, but describing that is decriminalization. I don't think it's really accurate because there is still a component of coercion and you can get in trouble if you decide that you don't want to stop using drugs.
00:31:46
Speaker
Okay. Do you know, did that, did that policy change have any sort of impacts at all? Do you, uh, you know, whether that was, did it have any positive impact, uh, overall? You know, maybe not the ideal policy, but.
00:32:04
Speaker
It's, Portugal is kind of hard to wrap my head around because the data of Portugal are kind of sparse. So it's not exactly clear what happened afterwards. What we know for sure what happened is that there was an immediate decrease in heroin related deaths and drug overdose related deaths.
00:32:23
Speaker
And the New York Times reported that there was a substantial drop in heroin use. So when I look at those data, I think it's not so much that Portugal made the drug using environment safer versus it just coerced a whole bunch of people into not using drugs anymore.
00:32:44
Speaker
But I'm not even sure whether those New York Times figures on the 75% reduction in heroin use are even real, because some new figures came out about drug use among adults in Portugal, and it showed that drug use has gone up among adults. So what is actually happening there? I'm not sure.
00:33:04
Speaker
It seems like, at minimum, there was a reduction in death. And since the the United States' major problem is death, replicating what Portugal did probably isn't the dumbest thing to do. Got it.
Impact on Pain Patients
00:33:17
Speaker
OK, so there have been experience in the United States, too. Right. Like we in 20 was at 2015, 2016, there were a lot of states that effectively full blown legalized cannabis, for example. And I know Oregon decriminalized with Celia Seidman, I believe a couple of years ago. It's not heroin or decriminalized everything.
00:33:34
Speaker
Oh, Oregon did. Oh, they did. OK, that's something I should know. I didn't realize it. So do we have any doubt on the impacts in Oregon? Like I knew that they did decriminalization decriminalization of a handful of drugs. I didn't realize it was across the board. What was the impact there? Yeah. So the impact there was pretty similar to the rest of the country. More opioid overdoses.
00:33:55
Speaker
And so this is why I make the distinction between what Portugal did and decriminalization. I'm not sure if decriminalization really is a good idea. And the reason I say that is because it might be the worst of both worlds. You have a situation where people who produce deadly drugs don't have as much enforcement against them
00:34:24
Speaker
How should I put this? Yeah, if you make it harder to arrest people for supplying dangerous drugs, then there's gonna be more dangerous drugs. And getting rid of, decriminalizing the drugs reduces the cost to use drugs, so you could even see an increase in drug use, and then that could actually lead to an increase in violence as well. And we've seen that in Oregon. There's an increase in opioid overdoses,
00:34:52
Speaker
And there's also an increase in violence. Now, there's only been like a year or two of data. So determining whether those data points are related is going to be difficult. We're going to need Oregon to carry out this experiment a little longer before we know exactly what happened. But there's already a bunch of pressure on Oregon to reverse these laws.
00:35:19
Speaker
Yeah, there does seem to be, you know, it's one of those things that there's so many different things that intertwine with public policies along these lines, right? Because you have so many different variables going on, right? Whether you have a doctor. Well, let's actually change. Let's actually talk about this for a second. We talked about opioids.
00:35:34
Speaker
Do we see, you know, opioid addiction? What about somebody who just is in pain and their doctor isn't prescribing them pain medication? Is that something we see often? Is that, you know, is that part of what's driving this is people just trying to deal with their pain and their doctors saying, well, I don't want to get on that big government list of over prescribers. So I'm just going to cut you off here because while you're not, you don't send as much pain as this other guy who I'm going to give it to. So do we see, do we see that happening?
00:36:00
Speaker
Yeah, we definitely see that happening. So legitimate pain patients who have no legal access to opioids do sometimes turn to the illicit market to address their legitimate pain needs. And sometimes they overdose and die as well.
00:36:16
Speaker
I saw something really interesting when I was at a heroin conference, I think back in 2019. An attorney general from New Jersey showed this video, and it was documenting this person who was addicted to opioids. But this person who was addicted to opioids was on crutches.
00:36:32
Speaker
and he was crutching around homeless and he lost his leg in a motorcycle accident and he seemed he seemed to feel very bad about like wanting opioids but he's like sitting there and he's like yeah if I could get corrective surgery on my leg I probably wouldn't be in pain anymore
00:36:49
Speaker
and then I wouldn't need opioids. And I'm watching this video thinking, I think this guy just needs corrective surgery and is in legitimate pain. He doesn't even seem like he's like addicted. It's just like he literally has like an infected wound on his leg from a motorcycle accident and no one's helped him. And I think a lot of people who are legitimate pain patients are often confused for people who are addicted to talk. They are different.
Public Opinion & Policy Reform
00:37:19
Speaker
If you are in pain, the way that the opioids work on your opioid receptors is actually different than if you're addicted. So if you're in a lot of pain, the appropriate amount of opioids actually doesn't cause a euphoric experience for you, which is interesting.
00:37:39
Speaker
So lots of people who are taking opioids often for their pain needs don't actually have euphoric experiences because it like cancels out the pain and it just levels them off versus produces anything euphoric. They're not even high.
00:37:53
Speaker
The human brain is a wild thing and how it works with pain, pleasure, sensation, all of those things, it's pretty amazing. And I think that it's a subject that many people spend a lifetime trying to just grasp the basics of. And that's why trying to allow police officers to regulate
00:38:17
Speaker
Yeah, it blows my mind that the government is basically telling doctors, you can't do what you think is best for your patients. You have to meet some mythological standard of average prescription rates, whereas quite easily you can imagine a scenario where a doctor just has a lot of patients in pain.
00:38:39
Speaker
That is not something that you would find outside the norm. Of course, some doctors are going to have more patients who have pain issues. Or your doctor is a surgeon.
00:38:49
Speaker
Right. Right. And that's what happened at the beginning of these prescription drug monitoring programs. Doctors received notes from the DEA saying, you're an above average prescriber. And it's like, yeah, I'm a surgeon. I give everybody opioids because I cut them all open. Yeah. Yeah. They weren't able to make the distinctions. And wow, it's very wild that like the organization that's most in charge of regulating access to opioids only has police officer training, no medical training.
00:39:17
Speaker
That's absolutely crazy. Absolutely crazy. Okay. So it's interesting to me. I feel like I've learned a couple things. And I think if I'm speaking on behalf of many of the people in our audience, I think they're in the same boat. I think we've dispelled
Heroin Legalization Argument
00:39:31
Speaker
the narrative that the opioid crisis was caused by a bunch of greedy pharmaceutical companies. And I'm sure there might be greed at play, but I don't think that was the whole cause of this problem after really reflecting on the policy response.
00:39:44
Speaker
And we've also talked a bit about what I think a lot of people in our space think is a silver bullet policy proposal, which is decriminalization. I have not seen, I've not been aware of the fact that the response to decriminalization was an increase in drug use and violence.
00:40:00
Speaker
I'm curious as to whether that's an aberration. Oh, overdoses. Sorry. Gotcha. Not necessarily drug use. OK, overdoses and violence. And I am curious as to watch those numbers play out over the long run. But it sounds to me like all roads are converging on a full scale. If we're talking about policy solutions, it's converging on a legalization effort. It's let the market function.
00:40:21
Speaker
Make sure it's done in a regulated way. Make sure the products are safe and marketed. Safe, legal, and rare. Yeah, safe, legal, and rare. I'm curious, Jacob, if you could talk about that a little bit more. I mean, to say publicly that we should legalize heroin is an incredibly controversial thing to say. Do you feel like that is a solution that should be attempted or looked at? I mean, to solve the opioid crisis? I think it's the only solution.
00:40:50
Speaker
That is the silver bullet to solving the crisis. You legalize heroin. You allow people who want to use heroin or just pain medications up to that level of potency to use them. You destroy the black market. You dissuade black markets from offering these drugs to children. And you remove all the violence and overdoses associated with drug use.
00:41:16
Speaker
you will get more drug use but you're trading drug use for fewer deaths and less and uh for fewer deaths yeah fewer deaths understood understood well so so in in in states where they legalize cannabis for example drug use like fewer overdoses and less murders that's what you're trading it for
00:41:41
Speaker
Got it, okay, good distinction. Well, and less people in prisons, less people incarcerated. I mean, you talk about a huge complex, an industrialized complex of our prison system of just churning people, pushing people right into our prison system. And then once you get incarcerated, your chance of being re-incarcerated in the future goes skyrocket, right? So you're putting kids into these prison systems and then they just get into this vicious cycle
00:42:09
Speaker
And that's they may never have even used drugs themselves, but just because they were a part taking of you know passing it from one person to the other They got caught up in this in the system you cut that you cut that completely out if you legalize it you end that
00:42:25
Speaker
Nobody's using kids to sell alcohol on the streets, right? Nobody's using kids to sell legal products on the streets. Well, some legal products, obviously. But they're not being put in jail for those other products. And I think that alone, you keep a lot of kids out of the system from the very get-go with legalization. Or even marijuana in the states that have legalized. Yeah.
00:42:51
Speaker
Yeah, that's a good distinction. One of the things that I think a lot of people perceive, and there's like a mental image that I don't know if it's the same for you guys that comes up. When somebody says legalized heroin, what I think about is I'm going into a gas station, and there's a pack of cigarettes and a pack of beer and a pack of heroin right next to it. I don't think that's effectively the way that this policy would play out. I feel like it would probably be a lot more regulated. I'm curious as to whether or not you could expand a little bit on that, Jacob, of like, have there been anyone that's done this right?
00:43:21
Speaker
When we talk about the Netherlands, for example, they're providing it. Has there been any countries in the entire world or states that have approached this or tried to look at this in any way? Or is this a completely novel new idea? Well, in terms of modern countries, it would be completely novel and completely new. But it's actually not novel in terms of the history of the United States.
00:43:46
Speaker
before Woodrow Wilson became president, all drugs were legal, and you could go to various stores and buy heroin and cocaine exactly as you just described. So the world where heroin and cocaine were literally at your convenience store did exist, and there really wasn't that big of an issue of drug use then. As you're saying, we need to make America great again. That's exactly what I'm saying.
00:44:12
Speaker
the 19th century again. There you go. At least in that one aspect, yes. There you go. That's a mag movement I can get behind. All right. Let me ask
Liberalism and Drug Policy
00:44:23
Speaker
another big picture question since we're getting close to the end of our time. I do think that if there's anything that's happening in the zeitgeist of public opinion and the Overton window is moving away from this idea, especially among our generation,
00:44:39
Speaker
We should treat drugs like a criminal issue. Drug users need to go to jail and drug dealers are these evil criminals.
00:44:47
Speaker
And there's a lot of people saying, hey, look, we need to look at this as a public health problem. Um, and we need to treat people with a lot more respect and give people the dignity they deserve. Um, I think markets play a role. I think people recognizing the role of markets is something that needs to be more part of the conversation because I don't think people fully understand that dynamic, but I'm curious as to whether you have any commentary for me on just that trend that's happening. Um, and you know, like how we can push this narrative forward are examples of.
00:45:15
Speaker
how that's helped people. Just a big picture conversation. Yeah, I think – I'm not exactly sure why this is, but I think people have generally – have just started to accept the non-aggression principle. If someone is breaking the law, but it has no harm on other parties, why are you harming them?
00:45:38
Speaker
And I think liberalism, as much as we like to say that the United States and other countries are becoming less liberal, it seems like liberalism actually is moving forward. We see various world leaders fight against it, but I think the world is probably more free than it has ever been before. And this is just a part of that entire movement. People recognize that adults should be allowed to make their own decisions. They should not be criminalized unless they are actively harming
00:46:07
Speaker
other people, and that's probably what the biggest motivation is. The movement to criminalize drugs is barely 100 years old. It's a very new idea in terms of government roles, and people have seen what this criminalization has done. It's been incredibly disastrous, and I think people are ready to get away from it.
00:46:31
Speaker
How do we, how do we sell that message to some people? I know, for example, like my parents, Republican, diehard Republican, conservative. Growing up, they never touched alcohol. They drink wine now every once in a while. They're going down a slippery path. But beyond that, even my parents right now look at, look at marijuana and they're, they,
00:46:51
Speaker
realize that it shouldn't be illegal, that it's fine to legalize it. They're okay with that now. But these harder drugs, that is not a conversation that they're going to want to have. So how do we open up that conversation? How do we talk to them and say, you know, these are all the harms that making this, these are dangerous drugs, but it's even more dangerous when they're illegal. How do we have that conversation with people? How do we talk to people and say, there is a better way than what we're doing now?
00:47:21
Speaker
I think you tell them you can have either less drug use or fewer deaths, but you cannot have both. And you make the case to them that it really is a decision of your priorities. And if they're decent people, they should prioritize fewer people dying.
00:47:42
Speaker
Yeah, that I think that one of the the one thing I would might add to that is when you know, one of the reasons why I think we may want a legalization became Generally accepted and among most most Americans today. I think are very on board with Legalizing marijuana. I think part of it was is that
00:47:59
Speaker
You humanize marijuana users, right? Back in the day, it used to be marijuana users were these potheads, these lazy potheads who did nothing. But then you started getting stories about people who, like for example, I knew a friend of mine, she had cancer when she was 16 and they gave her THC because when she was gone chemotherapy, they gave her THC to help her eat, to give her an appetite to be able to eat.
00:48:23
Speaker
And then there's other cases of THC being used by parents of children who have seizures, or you have these stories of having legitimate medical uses, or helping somebody deal with pain, or helping a soldier with PTSD. We're seeing some studies around, not necessarily marijuana, but
00:48:49
Speaker
A few different opioids that help soldiers with PTSD, right? So we can humanize the people who have legitimate needs or who have
00:49:02
Speaker
you know different whatever whatever the reason is for doing drugs i think if we can humanize them we can show people that hey these are humans they're trying to deal with things we talk about pain patients not all pain is is necessarily physical right so i think a lot of drug use is other types of pain right either dealing with something from their past or i'm not saying that all drug users that's the reason but i'm saying that we can say listen people are just dealing with their demons it's okay to let them deal with it let's let's try to make them as safe as possible when they're dealing with these demons yeah
00:49:34
Speaker
Yeah, my one of my favorite writers of all time, Glenn O'Brien, he said that a country with good manners doesn't need any laws. And I think that's something there's like this big movement within academia, to say that stigma is bad, all stigma should be gotten rid of. But I think if you're thinking about this correctly,
00:50:00
Speaker
Stigma is preferable to laws. You need some sort of motivation to push people into making better decisions or just to be more sociable, just to be in public and to interact better. And just because something is legal does not mean it's your endorsement of it.
00:50:18
Speaker
I think
Conclusion and Contact Info
00:50:19
Speaker
that's one thing that actually helps try to convince older people. It's helped me convince my parents. I think I've sold them on this idea. They don't think drug use is right. They don't think heroin use is right. But that's okay. Not everything that is bad needs to be illegal.
00:50:37
Speaker
Yeah, it's legal to lie. You shouldn't lie. Yeah, it's you know, and if it's legal to use heroin, you probably shouldn't go to work high on heroin, right? Those those things don't change if the legal
00:50:50
Speaker
If the legality surrounding it changes no, and it's it's the same you can make the same. I mean, that's a truly liberal idea It's the same thing for free speech. It's like sure it's legal this to you know Say a Nazi slogan or hate speech is legal right that doesn't necessarily mean that we endorse it by any means but a situation where the government can control speech or behavior or criminalize those things which are inherently a
00:51:17
Speaker
Nonviolent actions is a far more destructive and dangerous reality than just letting those things play out in the you know, those peaceful behaviors play out and Yeah, it's a pretty powerful way. I think that's actually a good a good way to kind of close out the conversation I don't I don't know if you two have anything else that you feel like you want to throw at us or talk about but I think this has been a very enlightening conversation for me and Jacob I I've enjoyed you you coming back on The pleasure being here. Thanks for inviting me again
00:51:45
Speaker
Yeah, absolutely. I will, before we close out the show, let you plug anything you want to plug, Jacob. I don't know if you've got a sub-stack. I know you've got an X account. Is there anything, if somebody wants to learn more about your perspective, where should they go? Well, you can go to Reason.org, which is the Reason Foundation website. A lot of my work's there. And if you happen to be on X.com, you can find me at JacobJamesRich.
00:52:11
Speaker
Awesome. Perfect. I've got one question. It might be a little bit of a curveball, but I'll throw it at you. Go ahead. What does liberalism mean to you? Oh, man. Why would... I told you it was going to be a curveball. I'll throw you on the spot. And you can define it however you feel like it. You can just go with your gut on it. What does it mean to you? Liberalism, to me, is... It's like the... How would you put it?
00:52:40
Speaker
The antonym to socialism. It's anti-socialism. Anti-collectivism. I like it. Yeah.
00:52:48
Speaker
There we go. Good stuff. Beautiful. Jacob, thank you again for making time. Everyone go check out his work at Reason on X as well. Jacob James Rich. We will see you again, I'm sure, in six months. And hopefully by then, I'll have another 10 million views on our YouTube channel. But if you are interested, check us out at Project Liberal at Project Liberal on X. Same thing for you can find us on YouTube at Project Liberal. Hit that Subscribe button if you haven't already. That'd be very appreciated. We will see you guys very soon. Thanks again. Thank you.