SIO456: Are You a Good Drug or a Bad Drug?

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:15 Thomas: Hello, and welcome to Serious Inquiries Only. This is episode 456. I'm your host, Thomas Smith, and I'm very excited for part two with Dr. Jenessa Seymour on addiction, focusing more on some solutions. But there's a lot of stuff. It's learn about why certain drugs are so unavailable, even though they are beneficial, and the nothing that we can do about that. No, also how Narcan works and why we should all probably just like have some mean, not have some like, as in like have a drink right now, but like we should all have some Available to us because it's really a miracle drug. Right. Well, after this very brief break, we'll be on for part two with Dr. Jenessa Seymour. Thanks so much for listening and supporting. According, avoid the ads at patreon .com slash serious pod. Welcome back, Jenessa. I'm excited for part two. How are you doing today?

0:01:04 Jenessa: Good. How about you?

0:01:06 Thomas: Okay. Managed to avoid all fentanyl so far since we last spoke.

0:01:13 Jenessa: It's not coming for you.

0:01:14 Thomas: I don't know. Is it? I'm not sure. It seems scary. But anyway, yeah, it was interesting to hear that breakdown of how addiction works. And now in part two, I think we're going to perhaps talk solutions more. What

0:01:28 Jenessa: Yeah, yeah. So basically, what I'm thinking is we can talk a bit about, what are we actually doing? What could we be doing? Drug scheduling is affecting that? And I see a tie in with how drug scheduling

0:01:47 Thomas: Oh, God, I'm sure you and I could do an hour on that.

0:01:51 Jenessa: For sure. And then just kind of tie it together. You know, how do we conceptualize, create a framework for thinking about addiction and addiction treatment?

0:02:01 Thomas: So if you got into the bottom, why you and I are just not allowed, we have to be treated like criminals for the rest of our lives. Wait, you're on these drugs too, right? Well, I'll just speak for me. I had to be traded like a criminal for the looked at the bottle and I thought I have enough for the trip that we took. And then I didn't actually count. And it turns out, oh, no, I didn't have enough because that's I don't know. That's just I don't know why I didn't do it. I think I didn't have time. Normally, I would actually count it out. But I was so we were so behind in getting ready and packing and all that. So then happens is there's just nothing the fuck I could possibly do because I'm a criminal since I need, you know. Vyvanse. It's the one that Stormy Decisus

0:02:44 Jenessa: Know.

0:02:44 Thomas: Told me can't even be like ground up and snorted and whatever. Like there's no, I don't even think you can really abuse that short of if you really like. Not suffering having as many symptoms of ADHD, but that's just someone trying to use it for its purpose. So like what? Anyway, that's so frustrating. I you can't get it ahead of time. You can't do anything like it's just every month is a stressful thing of like, OK, I can go exactly now when I have like one pill left.

0:03:13 Thomas: And guess what? They're like, well, you should. Check back because we don't have it. So you should check a bunch of places. Oh, okay. That would be great. If you let me start trying to fill it two or three days earlier, maybe I can make sure to get to a location that has it. And they're like, no, you can't do that. But what you can do is just fucking die. I don't know. You can't, there's nothing you can And so anyway, it's, that's the life of someone who uses this medication to function.

0:03:39 Jenessa: Yeah. No, it's so frustrating. The one that always kills me is like, you the doctor writes the prescription and I don't go fill it immediately because I have ADD and plan things. And then they're like, oh, it expired. You to get a new one. Like you didn't fill it fast enough. And it's like. I was dealing drugs, don't you think I would fill that thing the absolute second I got the script? What drug dealer is like, I got time, whatever. Know. It's very frustrating. Ongoing battle of just like not only the patient, but also like the doctors always feeling like they have to. To be so careful about what they're prescribing and when and checking this, that, and the other thing. And it's like, that the DEA doesn't think they are drug dealers.

0:04:31 Jenessa: And this is a proven medication. It's highly effective. And I've been taking the same dose for like eight years. Constant frustration. I know exactly what you mean. Like, yeah, I didn't count the pills before I left. I grabbed the bottle and ran out the door because I was running late because I have ADD and I'm late to everything.

0:04:52 Thomas: It really is one of those things where it's like. They design it. So the thing you're trying to treat makes it specifically impossible. There's not a lot of other stuff like that. It's not like, you know, cancer drugs. It can take those cancer drugs well, if you have cancer, though, it's going to mess up taking them. And we wouldn't really settle for that. I'd be like, well, that seems stupid. You need to make so the people who have the thing that they needed for can do it. But oh, well. Anyway, so how is that related to any of this?

0:05:20 Jenessa: So should we go there first? Yeah, let's talk about that. So I look at the definitions here with drug scheduling, basically, these are regulations that come out of the DEA and basically Congress. Don't fully understand the whole process, but like they authorize the DEA to do this and then the DEA is going to set this up more specifically. But going to sound very medical and very much like, oh, this is based on science and doctors, but this is not the case. And that will become clear very quickly. So the thing that sounds like it makes sense, we've got scheduling from one to five, one being the most restricted and five the least. Schedule one is written as no currently accepted medical use, high potential for abuse. So one listed in there is heroin. Totally makes sense.

0:06:21 Jenessa: So like, yes, technically, it does provide pain relief. We have other pain relievers that are more effective, less side effects, safer, less likely to be addictive. So in practice, no, no medical use. And know this because we use it for medical use for a while there. Totally makes sense to say like, yeah, last resort if it's the only thing in your bag, I guess. But like, no, we got other things, right? Also schedule one would be LSD, marijuana, ecstasy, peyote.

0:06:57 Thomas: Marijuana is schedule one?

0:06:59 Jenessa: Correct.

0:07:00 Thomas: I thought, oh man, that's so dumb that I already forgot that.

0:07:05 Jenessa: Yeah. Yeah. So those are some examples of Schedule 1. 2 would be high potential for abuse with potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. So includes things like Vicodin, cocaine, meth. Oxycontin, and until very recently, fentanyl and Adderall and Ritalin. A little weird. Cocaine is two, but marijuana is schedule one.

0:07:38 Thomas: That is crazy.

0:07:40 Jenessa: Fentanyl has recently been raised to schedule one, It was Schedule 2 for a while, but it's Schedule 1, like, temporarily. That's going to expire in December of either 2024 or 2025.

0:07:55 Jenessa: It makes me think it might have gotten into, like an appropriations bill because they can't pass anything anymore. I

0:08:02 Thomas: It doesn't make sense though because it's not really money related, but maybe. We'll have to get the legal breakdown there. Unless it's like as a result of the crisis, they're like, it's not really a Schedule 1, but because of how, yeah, who knows? Weird.

0:08:05 Jenessa: Know. Just everything gets. Yeah. Interstate commerce of death. I don't know.

0:08:20 Thomas: Well, it does affect interstate commerce, that's for sure.

0:08:22 Jenessa: Yeah. Yeah, it's it's getting pretty bad. So then you've got like schedule three moderate to low potential for physical and psychological dependence. Abuse potential is lower. That sure, sure. Yeah. You know, moderate to low potential. Okay. TylenOL with codein and ketamine. Okay. Um, schedule four, low potential for abuse, low risk of dependence. That's going to have like Xanax, Ambien. Um. Schedule five, low Potential for Abuse.

0:08:35 Thomas: That should be like marijuana, maybe. Schedule one, right?

0:08:57 Thomas: Schedule five, what is that, like Crunch Berries? It's Cap 'n Crunch Oops All Berries specifically. Like the Cap 'N Crunch normal is like, that's like schedule six or something. But like, just the berries does have some potential for abuse. Like I remember as a kid, we just snort that shit right up.

0:08:59 Jenessa: Yeah, kinda, kinda. So, um. Oh, god. Do they even still make that? I haven't seen that one in a while.

0:09:19 Thomas: Probably not. Just pure sugar for breakfast.

0:09:23 Jenessa: So schedule five is like Robitussin. Over the counter, but they like make you give your ID, I guess. Think you can see like the definition sounds like, oh, you know, schedule one, like never prescribe this, no value, high potential for abuse. And like schedule five health provider, if you hear your patient is abusing this, be careful. But like this can be over the counter. It has value. It sounds so reasonable, but then it's not medical professionals and science telling you which one goes where. It is the DEA. And this is criminal enforcement deciding what goes where and. Just doesn't line up. And of the problem is this is being used to define criminal statutes. So it's not a perfect one to one, but the higher up on the schedule, the more severe the criminal penalties.

0:10:16 Jenessa: So like is schedule two. Is why we have to go to CVS and get interrogated and get a month at a time and you can't get it through the mail and you have to fill it immediately. And

0:10:27 Thomas: And I, yeah, I somewhat get it, but I wish it was like. We get like a pre on it or something like you and I like this is what we needed forever. It's it's one thing. It was like a new prescription that trying to get it a bunch. I get it. Yeah, people do try to sell out or all the kids or something for who have rich kids who need to take a test. It isn't super cool, but like on the one that's specifically not. I have to pay more for it because people You took all the ones that aren't criminally expensive, so do you want to do the criminally -expensive one? I was like, if that's all I can get, so why can't I at least get a little bit of trust from that, you know?

0:11:05 Jenessa: Right. And is part of the problem is like, you if my behavior suddenly changed, if all of a sudden I am way higher prescription. Filling it like more often. I go to a different pharmacy, like maybe, but yeah, I've been filling the same dose for eight years and I am often late filling it.

0:11:26 Thomas: You You have a thriving drug -dealing business. It's been reliable. The fundamentals are good. In the drug - dealing business for the long haul, I think, is what conclusion there is.

0:11:39 Jenessa: Apparently this was my favorite from the drug scheduling laws. As you scroll through, you come to the definition of an addict. The term addict means any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so far addicted to the use of narcotic drugs as to have lost the power of self -control with reference to his addiction.

0:12:14 Thomas: Said narcotic. Does that not include alcohol, then? Can I not be an addict to alcohol?

0:12:21 Jenessa: I'd have to go back and look if they then define narcotic somewhere.

0:12:26 Thomas: Yeah, maybe that includes.

0:12:27 Jenessa: They have like, um, a definition of controlled substance. And they Um, have a definition

0:12:36 Thomas: Jeez, that sounds really philosophical. The definition of substrate and yeah.

0:12:45 Thomas: Qualia is defined in there somehow. It's weird.

0:12:47 Jenessa: I just love that, like, they've defined addict and they have this list and it's an or list. So if you endanger the public morals and none of those other things, like good enough. Yeah. Drugs have endangered the of other people.

0:13:02 Thomas: So a lot of this is from like the 50s and then the 80s or something.

0:13:07 Jenessa: Yeah. Like, compare to the DSM definition we talked about that's all about, like, your personal negative consequences and your struggles that you are experiencing. This is a criminal statute defining who an addict is, not a person with a substance use disorder, an addict. So Like... we have this hanging out, right? Like. Adderall's schedule two, fentanyl will become schedule two again soon if nobody gets it together. But marijuana's schedule one, and it's all over the place. And you're an addict if you endanger the public morals. And it's started happening right we had this opioid epidemic which is obviously a huge problem um DEA starts cracking down on all these companies those companies don't just make opioids they also make ADHD medications and always regulated it this way but they got even more strict have caps on how much of a medication you can make if it's a controlled substance.

0:14:19 Jenessa: And was a combination of one factory got shut down because they were implicated in the opioid epidemic where like, They kind of like they weren't bookkeeping properly. So it's arguable. Like, they contribute to opioids getting out there that weren't documented properly? I know enough about that situation to know their culpability.

0:14:42 Thomas: Long story short, shut they down.

0:14:45 Jenessa: Pretty much. And they were in the middle of this shortage, like begging the DEA, like, can we at least make this other medication? Then And there's other factories that are like making the medication and they're like, can we make more? No, too bad. So because this is a schedule two controlled substance and you are capped factory, they could make more. Their capacity to manufacture is way higher. And in the middle of a multi -year shortage where people are suffering without this medication. You can't make more because that's the law. And the that is so wild about this, people with ADHD are already prone to substance use disorder. The prevalence of substance use is higher than among other people without self -medicating hypotheses that like people who aren't diagnosed or are diagnosed but aren't getting medication could be self - medicating with other substances.

0:15:35 Thomas: That makes sense. But it's also the reward center of your brain. Like, if you're not getting that treated, it's have never really been an addict of anything that I really know of. But I kind of get it, like, would say I... have behaviors I think that I'm pretty certain are ADHD that feel addiction -esque. Like I'll get extremely into something for a while and then I'll realize like, oh, this has taken over my whole life.

0:16:17 Thomas: And then I'm like, quit. Not so much anymore because I have kids, so I don't have time. But back before kids, it was like... Oh, my brother said, hey, maybe you should play Pokemon Go to try to get some steps in. It was during the pandemic, I think, because it was like, oh, I'm not. And it was a good idea. I was like oh, yeah, that's a good way to get steps in because I need a game to do anything. Like I can't just walk. That's impossible. Who could ever just do that? Yeah. And so I started doing it. And then before I knew it, I could almost like wake up and I'm like. I'm an insane Pokemon Go addict. I've got like four fucking phones I'm using with it. I'm like getting, I've gotten every single Pokemon. And then one day I was like, oh, this is insane. And so I just stopped forever and I have never picked it up again. And I get it. Anyway, that's not super important to the story, but I actually do think that it makes sense to me that people with ADHD could abuse things if

0:16:39 Jenessa: Because that's boring. Yep. Yeah,

0:17:13 Thomas: They're not getting treated.

0:17:14 Jenessa: No, I feel you. I might be the only person on the planet who genuinely enjoyed getting all 900 Koroks in Breath of the Wild.

0:17:22 Thomas: Jesus. I Did also got all those and needed to 100 % it because that's what the game is there for. So I too did that.

0:17:30 Jenessa: There's so many things you can do. I 100 %ed the map. I revealed every little thing on there because there is a counter in the upper right corner.

0:17:37 Thomas: This is getting scary. Yeah, it gives you a number. And I had to get that number to 100 percent. And it was insane. And Breath of the Wild, we should start a class action lawsuit, even though it's my favorite game, because like the way that it gives it's like if of Wild or any game set up that same system where it's And to get that last percent, you have to kill a man. You and I would be like, all right, I guess I guess. I have to. Kill somebody like what? It's not at 100. It's at 96 .8. What am I? What am.

0:17:40 Jenessa: It does. Would be having

0:18:11 Thomas: I going to do?

0:18:12 Jenessa: A philosophical debate about the ethics of like how to just

0:18:14 Thomas: We wouldn't we'd just be getting our murdering on we'd be there'd be a specific target you know I assume nintendo has like got a hit list yeah yeah I mean I got the hundred and like so the way that that game had had you accomplished a hundred was absolutely fucking criminally negligent like the fact that you have to go to each like map place where the title will pop up and you got to get all the Koroks.

0:18:21 Jenessa: Wake up covered in blood. Yeah.

0:18:39 Thomas: And it had almost nothing to do with like stuff that you would think is a game like the quests or the, I don't know, like other stuff like that. It's like, no, we don't care about that. I care about maps and Korok seeds. You and I are the only two assholes in the world who did it. That's crazy. I had no idea we had that in common.

0:18:37 Jenessa: Yeah, no, no. But other game rewards you like that. Skyrim, you see a big mountain, you climb up it and you're just like, well, I'm here. That game, there was always a Korok. There was always something. You got up there and you were like, yes, I got it. Was so rewarding.

0:19:10 Thomas: And then Tears of the Kingdom, they OK, we weren't able to kill Jenessa and Thomas with Breath of the Wild. We weren't to ruin their lives. Let's make a game. And again, I'm not I haven't even I'm the asshole that I have to finish everything before I finish the quest. I don't have to 100 % everything, but I have get all the stuff that would make you powerful or get whatever. So that then it's inevitably the hugest letdown when I go to Ganon and then I hit him once and he's dead or whatever it is.

0:19:36 Thomas: So but I have to do that. So I don't know your 100 % counter. Your percentage counter doesn't pop up, I think, until you do that, so I don' t know where I am, but there's too much fucking shit. Yeah, that's how it is for Breath of the Wild. It doesn't show you it until.

0:19:47 Jenessa: I didn't even notice.

0:19:49 Thomas: Yeah. Yeah you probably wouldn't necessarily notice because I don't think your mindset is there until you like beat and then you're like, Oh, what else do I do? Kept wanting to check like, oh, where am I? I can't see it yet. So for all I know, I'll finish it and I'll say I'm 11 % done. How did us two ADHD weirdos get on this topic? Okay.

0:20:07 Jenessa: Focused. Right.

0:20:08 Thomas: So abusing drugs like Breath of the Wild and Pokemon.

0:20:11 Jenessa: Addictive personalities. Yeah. Yeah, so here's the thing, is the rates of addiction in ADHD, I was looking at various metrics, and it's like, some the metrics are like 15 % of people with ADHD have substance use disorders. It's through the roof.

0:20:29 Thomas: That's what's the baseline rate?

0:20:32 Jenessa: I think like three, 5%. It's bad.

0:20:34 Thomas: Yeah. Okay. That makes sense to me.

0:20:37 Jenessa: It's anywhere from like two to three times higher in most estimates.

0:20:41 Thomas: Sounds like it could be even more. That's crazy.

0:20:44 Jenessa: It's really bad. Now, here's the thing. Until recently, a lot of people didn't get diagnosed. And even if you got diagnosed, there was all this hesitation about treatment, specifically medication treatment, right?

0:20:59 Thomas: Hesitant like two whatever years ago I started this. I thought it

0:21:03 Jenessa: And especially like kids like you'll hear that like oh it's like basically meth okay no it isn't like so

0:21:12 Thomas: Was basically meth, but meth is just good. That is how I have been talking about it. I better change the way I have

0:21:19 Jenessa: Mean insofar as they're both stimulants but I mean like so is caffeine right like the thing is like you always got to remember chemically like slight changes in chemical composition make huge differences in the effects of something so like The between people who are consistently taking a reasonable dose of Adderall and somebody taking methamphetamine, you know, have not lost my teeth and disassembled a car in my front lawn and had to go to rehab. You know what I mean? Like, I'm doing all right.

0:21:53 Thomas: Okay, but the disassembling the car thing does sound sort of relatable.

0:22:00 Jenessa: Satisfying, possibly.

0:22:01 Thomas: No, yeah, like, you just see, okay, If my dosage were a little higher, like yeah, okay. I've done things that are like that. Oh my God. Poor, I don't know if Lydia will end up hearing this one because we're massively overworked. She probably will, but I'm sure she could identify some of the behavior of like, if I have to clean something, I is all the time. Never know where I'll end up. I couldn't, oh, I need to do the dishes. And then I've taken the refrigerator apart. Like, it's like, it is not. Unreasonable for that to happen. Like, I'll just be like, something else will be dirty or something. Oh, that needs to be replaced while I'm at it. And then I'll get into doing that and then I can't stop. So, wow. When you put it that way, okay. So it's not not meth, I guess, but it's diet meth.

0:22:46 Jenessa: Of risk factors for addiction, your physical health, your mental health, meth can eventually lead to meth -induced psychosis, which is basically schizophrenia. That's not happening with your Adderall. Yes.

0:23:05 Thomas: Right. And it's like, like you said, it's, like, anything different in intensity. And also, like. Just. I don't know if this is what it is exactly. But, like the dosage of the effective ingredient. I mean, with anything. Like, you could take a few ibuprofen. That's great. You take 20. Obviously, it is horrible. So, Jokes aside. So stimulant. But nowhere near the kind of danger that actual meth would present.

0:23:16 Jenessa: Of course. No. Right, right. Yeah, Don't don't... take more Adderall than your doctor recommended, for sure. It will not be good for you. Same as taking too much Tylenol is not good for but no, you are not going to get Adderal -induced That's not going happen.

0:23:41 Thomas: I've got just my regular psychosis. It's fine.

0:23:43 Jenessa: Exactly. So here's the thing, though. We started finding when people actually looked into this concern of like, oh, but it's addictive. When you compare people with ADD who do not take medication and people who do, we are significantly less likely to get a substance use disorder.

0:24:04 Thomas: Makes perfect sense to me.

0:24:06 Jenessa: Actually looked at, in people with ADD who have cocaine use disorder, if they then prescribed ADD medications, it helped with quitting cocaine. Is preventative.

0:24:21 Thomas: Can we please lighten up on us, everybody? Can you just let us get our fucking... I'm not asking for much. I'm just asking to be able to try to fill my prescription. Five days in advance because I need that breathing room in case you don't fucking have it. But no, it has to be on the day and I have to be like police escorted to the fucking thing. Anyway, I didn't even know this is what we were going to talk about. But yes, I fully believe it. When I first got on, uh, diet meth, meth zero, um, which it has, you know, it when I first got on it I remember feeling like I don't really feel like I need or want to drink as much, you know and like I we still enjoy our wine but it's I really think the about like reward centers or whatever. The reason I can't just do as many things normally as normal people is because my brain is like, that's nothing. I don't care about that. Like it doesn't, it My brain doesn't give me the good stuff for doing normal things. And so like chasing those substances, cause they do give you the good makes complete

0:25:26 Thomas: Sense to me. And then when you have, we have this medication that helps with that. It's like, I don't really, you know, it doesn't make it go away, but like,

0:25:35 Jenessa: Yeah, absolutely. That completely lines up with the science that we see this. Pretty much across the board, you know, there will always be one off instances of I'm sure there are people, especially if you look at somebody who is going to go above the recommended dose. I mean, yeah, if you crush it up and snort it, it's addictive.

0:25:56 Jenessa: But like your recommended dose, taking it monitored by a doctor. Is preventative. This is life -saving. And if we have a shortage and we have people who are desperate because they can't focus, they're going to lose their job, it's harming their personal relationships, and they go out on the street looking for something, what is going to happen?

0:26:20 Thomas: We're going to get fucking fentanyl laced crap, you know, and die. Awesome. Super cool.

0:26:25 Jenessa: So the drug scheduling is making addiction worse for people with ADD. Anyway, way all over the place, but it's shocking, right? So yeah, we've got this scheduling thing that is making ADD more difficult and possibly making, literally making addiction worse when it is supposedly going to make this better. Other side of things, coming back to like, okay, fentanyl, what are we going to do about this? What are we a little digging since we last talked, and were right that DARE fell out of favor until 2017 when

0:26:32 Thomas: Wow, that say. Oh, come

0:27:05 Jenessa: It made a comeback as a proposed solution to the opioid epidemic. I guess all those kids who got prescribed opioids for their back pain, like, needed

0:27:16 Thomas: On. Yeah, they didn't just dare to not do that.

0:27:21 Jenessa: Uh, yeah, Jeff Sessions, then Attorney General, spoke at their annual meeting in 2017, and I

0:27:26 Thomas: For fuck's sake. Keep in mind, too, I mean, I'm sure this is obvious, but it is in these companies financial interest to have a storyline that this is about personal failings rather than, you systemically them making money off the death and suffering of Americans. You know, sure, there's a lot of money that could go into efforts like that based on maybe pharmaceutical companies that wanted to be less about them and more about our personal failings being the reason why they ruined our lives.

0:27:34 Jenessa: Course. I mean, D.A.R.E. is not a government agency, to be clear. Like, this is a program.

0:27:58 Thomas: It's just a it's a yeah, but it's the thing that can get money from, you with police and with with cities and with whatever. Yeah.

0:28:07 Jenessa: Yeah, so as of 2024, the quote on their site, there are more than 2,000 law enforcement agencies delivering the D.A.R.E. program to 1.2 million K-12 students annually in more than 5,000 communities throughout the United States.

0:28:22 Thomas: Come on.

0:28:23 Jenessa: Yeah, it's not dead.

0:28:25 Thomas: That ought to do it. Good job.

0:28:28 Jenessa: So we got that, which is obviously not going to do a whole hell of a lot of good. Got the throw people in jail method, which is not really helping. Um, got the panic method. Um, part is, super um, fun. If you go to the DEA website, um. To this day, you will find little pictures of like, you to a penny or the tip of a pencil. Like this is the amount of fentanyl it'll take to kill the average American.

0:28:59 Thomas: Sure. I mean, but like that's kind of valid, right? Like it is very dangerous, isn't it?

0:29:04 Jenessa: So critical context there would be if injected. Problem is, in the same presentations of, look at this tiny little amount that can kill you, they will then say, and also it can be absorbed through the skin.

0:29:19 Thomas: Oh yeah. Okay. I will say I've talked about this on something. Oh, it was on OA. It was way back when. So I don't want to like do too much on this, but it and I had watched a completely reputable fucking documentary. On a real thing. It wasn't like Infra Wars is whatever, both like a totally reputable. I don't remember what it was now. Totally reputable source that I would otherwise trust had the stuff about the police. Yeah. In the room. And he just touched the thing and he passed out and then whatever. And I took that. I had no reason to doubt this claim. I didn't know shit about fentanyl. This was way back, obviously, you probably 20. Yeah, 17 ish. So that time period, 18, maybe in. I just had repeated that on OA, like, oh yeah, and it's that dangerous, you know?

0:30:05 Thomas: And then listeners corrected me and I was like, are you fucking kidding me that the police are, it's still in our, in society, like we give police so much, even like among the left, like we give so much more credibility than they apps deserve at all. And so anyway, long not as though you can just touch some fentanyl and then you, you in a coma for life, like police fucking claimed, right?

0:30:04 Jenessa: Mm hmm? Basically, I mean, there are in a hospital setting when it is prescribed for pain relief. There are transdermal patches, but it's like suspended in a particular formulation and it's under a patch against your skin. And the we are having is people get pulled over and a cop sees it and... Really, what's happening here, I do think they're having a very real experience. What that thing is called is a psychogenic illness or what we might have called in the past hysteria. Like this person is having a panic attack.

0:31:04 Jenessa: And if somebody told me this tiny amount can kill you and it also separately a minute later, it can get through your skin. I would be panicking too, right?

0:31:14 Thomas: Yeah. If you thought you, like, touched something that was deadly.

0:31:17 Jenessa: So the problem is, like, the reason we know that's not really what's going on is if you see in these videos, it's just not consistent with an opioid overdose. Opioid overdose, you'd have slower breathing, loss of consciousness, the symptoms of a depressant drug. And you'll often see the person is hyperventilating with their eyes open. It's just not consistent. A panic attack is a very real serious thing that sucks. You're not going to die. You don't need Narcan. Real problem is we are seeing. EMTs expressing apprehension about administering aid to ODing patients because they're like, what if I get fentanyl on me?

0:31:56 Thomas: That's not good, yeah Yeah.

0:31:57 Jenessa: Yeah, this is going to kill people. We don't address that, like, you can safely help someone who is ODing on fentanyl. Like, don't touch needles. I don't know. Like don't like face, rub your face in it. But like, it's you're not going to pull someone over and accidentally like breathe it in and start ODing. You're going to be okay. Please help people. So that are helping prescriptions for Narcan. It's now over the counter. Hooray. Drug name, the generic is naloxone. This one is super cool. We talked about how heroin binds the opioid receptor and it has this high binding affinity, fentanyl even more so. It's an agonist. It makes the opioid go nuts, which is like hooray pain relief, but also at high enough doses suppresses your breathing and your heart rate. And that's where the OD comes from. Narcan is going to do, even higher binding affinity. And it's an antagonist. So it blocks it and the receptor can't do anything. It kicks that drug out. It basically gives you time to metabolize the heroin or the fentanyl. It And prevents the high, but it also prevents the overdose. And just let your kidney and livers do their work.

0:33:19 Jenessa: Really a fantastic solution. Sometimes if somebody has enough of the drug in their system, they might need a second dose of Narcan. For the most part, yeah, I mean, it is. Truly miraculous the way that this can prevent an overdose. You can get this over the counter. You can get training in how to use it, but really it's a nasal spray. Over the for a reason. It is very easy to use, safe to use.

0:33:45 Thomas: Is it, is there any danger if let's say you there is a police officer having a panic attack and they do, is any danger? If you aren't overdosing to using it.

0:33:54 Jenessa: Is what's so amazing. No, it does not hurt you to have it.

0:33:56 Thomas: That's crazy. What a wonder drug, right?

0:33:59 Jenessa: No known like, oh, you're going to OD on Narcan. Is why they recommend if you think what you're seeing is an overdose, just give it.

0:34:08 Thomas: Yeah. Sounds like it.

0:34:10 Jenessa: If the drug isn't an opioid, it won't work to prevent the overdose, but it's not going to hurt them. Just give to somebody if you're not sure you could save their life.

0:34:20 Thomas: Yeah. I've seen people say like, we all should just have this like in case, I mean, depending on where you are. Yeah, if you live in a city, even especially because like people are ODing on the street a lot. Wow,

0:34:30 Jenessa: And that's pretty much what it looks like is there's just, appear to be any harm in when in doubt, give it.

0:34:37 Thomas: That is fascinating. And good. Yeah.

0:34:48 Jenessa: Seeing these myths flying around about Lazarus parties, that people are giving themselves OD levels of heroin and then doing Narcan, not a thing. Seems to be just more coming out of police departments, like scaring people away from Narcan.

0:35:04 Thomas: And also, honestly, there's a certain amount in our society, I know this is going to be the case, if not explicitly, where I think... will be people who don't like this whole Narcan thing because then these bad people aren't suffering the consequences of their choices. So there's going to be all this like that. That kind of myth that you're talking about there fits perfectly into kind the years what I've learned, how reactionaries deal with everything, which is like form this mythology that's going just provide a very life -saving thing, you know, that is pretty much unambiguously good. Oh, but what if these people are doing this party? It's like, well, what if they were? You know, I don't fucking care. What that matter to me? And maybe they'll, like, if they're making those, if that's real, if their doing that kind of thing, well shit, sounds like they're doing something dangerous and that could be bad for them, but, what does that mean for me? Why would I care, why would I take away something from somebody who needs it because of that?

0:36:02 Jenessa: There's no logic to this. I think you're entirely right. It's just like, how do we make this out to be a bad thing that's saving people's lives? For while there, before it was over the counter, it was given with a needle. There was this myth that like, oh, actually, they get a hold of this kit and they use the needle for heroin, not Narcan. Right, great. So they got a clean needle. I don't know what you want from me.

0:36:25 Thomas: Yeah. Nope, can't have that.

0:36:27 Jenessa: So basically, that's what we've got going on in the US is like one big positive is Narcan. Getting better, I think, about like rehab facilities as, you know, an alternative to jail, but it's kind of piecemeal the extent to which that's happening. Did want to talk about I found a really amazing example of probably the most extreme example of harm reduction I've ever seen. So if people aren't familiar, the idea of harm deduction is like, basically, opposed to like abstinence only or a punishment model, how do we just take a thing that we feel like is kind of inevitable, and reduce the harm? This was in Switzerland. The bill passed in 1994, and it has four major pillars. How are we going to deal with drug addiction? We've got harm reduction, treatment, prevention, and then repression, which would be law enforcement, but it's focused on high -level dealers. Accepting that low level users do sometimes engage in small time dealing. So like, dealing doesn't mean the occasional sale, it means like the person with a warehouse. So came across this because I was looking into, we talked about last time, like heroin, it's metabolized into morphine in the body for the most part. So I was like, I don't know, why aren't people just doing morphine then? I found this study that comes from Switzerland where they were. Blind giving some people heroin and some people morphine.

0:38:02 Jenessa: And I was like, how? Well, it turns out they have a thousand five hundred people in their heroin assisted treatment program. What they do, the requirement to join, you have to have had at least two years of opioid dependence. Tried and failed two other addiction treatments and at least 18 years old. And basically, if you qualify for that, like you can't seem to quit. They will give you heroin. You come to the facility and you get your dose in the morning. Drug overdose deaths dropped by 64 percent. HIV infection dropped 84 percent. Part's wild to me. Home theft dropped 98%. This they have prosecuted 75 % fewer opioid -related drug cases each year. Of the articles I was reading was like of the popular press reporting on this. And so of course they have like example people and like. The woman they talked about was like she's holding down a job she's going on vacation she's seeing her kids and she's doing heroin like of course they love to phrase it like that right and all I could think was like you know what at the end of the day as wild as this sounds like that is kids whose mom is alive like know how to get around that being a good thing so

0:39:25 Thomas: No, I know. It's sucks it's that we can't we're not allowed to have good things in this country, but it's nice that in another place they might be allowed to get nice things. That's that's good for them. I'm happy for them, but we have to be like, no, that mom deserves to die because she's a druggie. So and then that's like our entire country, except for you and I and like a couple of the listeners.

0:39:44 Jenessa: Much. Think I that there is so much moralizing that goes on that I think a lot of people just think that people deserve it and

0:39:51 Thomas: I 100 percent think that's what it is. Yeah did want to make a comment, though, as much as I'm anti police and all that, I do want to say I do think police action is necessary, especially among people who are like lacing things with fentanyl. You know, so I don't want it to be like I'm against policing addiction, but like there are a lot of bad people who Are just killing people to make money. And those people I do believe should be behind bars like Want to make clear that I'm not a hundred percent anti. There is a place. For criminal justice. And as much as I don't think it should be with just an addict who's struggling, but it really does seem like, mean, I this crisis is, it's costing a lot of lives. We went over that last episode and the people who are just lacing things with fentanyl for the purposes of making more money, essentially, like they definitely do deserve to be brought to justice. I can't believe people would do that. It's just like sickening to me.

0:40:43 Jenessa: It's truly out of control. And it is feel like a completely different story when we look at people who are dealing with an addiction and people who engaged in that small time dealing that is connected to addiction, as opposed to, yeah, somebody who is dealing a warehouse full of cocaine, except just kidding. Fentanyl and baby powder. Like, it's really a lot of people might be interested in checking out the Biden administration has a page that's like a policy statement on this that is like, on the one hand, like, you know, working on addiction treatment for individuals, but also like, why is fentanyL going to go back to schedule two when heroin and marijuana are schedule one?

0:41:30 Thomas: Yeah. I mean, there are definitely inherent stupidities with that. I think from what I understand, the reason it's schedule two is because it's in so many approved medications. So fentanyl as an ingredient is in a bunch of approved medications, and so if it was schedule one, you couldn't have that at all. And so that makes sense, but marijuana being scheduled one makes no fucking sense. So like, yeah.

0:41:49 Jenessa: Like, And there's also some talk of like, how do we deal with a lot of this is coming from imports. Like not necessarily manufactured in the US. So we need to be smart about how we approach that. Really complicated how to address it. But honestly, I mean, the most effective way to address is if you address addiction and people aren't using the drug, then they're not going to accidentally get fentanyl. Like, I don't know if they can get their legal prescription Adderall, then they're not going to go to the street to get fake Adderall.

0:42:22 Thomas: Yeah even, you know, cocaine or something because they can't they're addicted because. Yeah, totally.

0:42:27 Jenessa: They need something and their life is falling apart. So, I mean, it just seems especially cruel that we told people opioid medications were perfectly safe and then we found out it was addictive. So we cut them off and they start doing heroin. So he throw them in jail and then there's fentanyl in the heroin and that's killing them. And we're just.

0:42:49 Thomas: Yikes. Think, yeah, the lesson for me, I guess, is if we can get more people to approach this as a problem that needs like compassionate solutions rather than something to punish people for. Like that really is the fundamental difference. Like, that changes your outlook. It'll maybe we can't 100 % agree on what the solution is, but if we can move more people to trying to solve it from a non -punitive perspective, from like a moralizing perspective, that will get a lot more people interested in solutions that might actually do something, seems to me.

0:43:22 Jenessa: Absolutely. And that all together, knowing what we know about the and the neuroscience of this, how this is affecting people, I be tough, right? Because if you look at somebody who is just like... ruining their life. They're engaged in this behavior. And from the outside, it just looks like, I mean, come on, what are you doing? Internally, for those of us who have not struggled with this, think about how, you These circuits are there to reward you for doing things that push you towards survival for pain relief purposes. Right. They have these built in homeostatic mechanisms, which is balancing. Things get boring. You seek novelty. So you shouldn't get too, too trapped in a cycle. They're not perfect. We've all had bad habits that we need to break or something. The short term, it's very rewarding. We cognitively know in the long term it's not helping me.

0:44:24 Thomas: And we know that our world is so different than the one in which most of our evolution kind of took place. So like, yeah, it's

0:44:31 Jenessa: Is where cognitive behavioral therapy can come in, where we make a strategy. What is like the alternative positive behavior I'm going to replace this with? And the first time you do it, it doesn't feel good. I am foregoing reward to do this other thing. Eventually, when I start to feel better. A mechanism that will teach your body, will classically condition yourself. Hey, I feel good. Let's make a reward pathway that rewards me for doing this alternative behavior. I felt bad before. Let's break the reward pathway for doing that behavior. It's not rewarding anymore to do this other thing. So it's hard. It is not easy to break habits, but you can do it that way. Sometimes you can do it on your own. Sometimes you go to therapy, you do cognitive behavioral therapy to get help doing that. If you can understand that, take that times a thousand for these exogenous drugs, because with that habit, that was your endogenous natural chemicals. Your brain was doing that because of dopamine. It was affecting your entire dopamine system. When we're talking about heroin, this is. Dopamine times a thousand, way stronger than you evolved to handle. This is hitting some dopamine receptors and not others. The balancing mechanism is out the window. This also hitting opioid receptors. So in addition to the reward, you're getting pain relief. Try to bring your normal, I'm going to break a habit strategy, you are bringing a knife to a gunfight with these drugs. There's no mechanism built in to just get past this. People need strong supports to get out the end of this. And that's why these diagnostic criteria emphasize so strongly that someone is persisting in the behavior despite negative consequences. We just have a system that says, well, we're going to treat this by adding negative consequences like jail, of course it doesn't work. They persist despite negative consequences. That's addiction.

0:46:40 Thomas: Because they're that bad of people. They want to be bad people. That's the thing. You don't understand. I wish I was joking. Like, it really is. That's how a lot of people think. Like they're just fundamentally bad people and bad people are going to do that and deserve punishment. And it's like it's so frustrating and sad.

0:46:57 Jenessa: Of know, and I think like a lot of people have experienced like if you've had friends or family members who went through this, like, they might have really been miserable and made your life miserable. And like, I don't want to make anybody feel like. That's, you you got to forgive someone for that, or you can't like feel bad about that. It's valid, of course, but like, just from the perspective of like, as a public health policy thinking across, you know nationwide, how we want to address this, it's just not working. Just punish people like the compassionate solution is what is working other places and in isolated places in the U.S. it's working. And all this was was a tolerance and withdrawal thing, if this was just a willpower thing, a week in jail would cure everybody because you'd be out the other end of the withdrawals and it'd be over. And So, you know, I don't have a great answer to the legal solutions. You know you and Matt have talked about.

0:47:54 Thomas: Maybe once you pass the bar.

0:47:56 Jenessa: Yeah. There we go.

0:47:57 Thomas: Hey, how's that going?

0:47:59 Jenessa: It's super fun to have ADD and try to study 12 separate subjects that seem.

0:48:04 Thomas: Well, she got assholes having you do podcast interviews. What the hell?

0:48:09 Jenessa: This is my break. This

0:48:13 Thomas: Hey, well, I hope the new bar exam with Heather segments are helping you because those are super fun and cool.

0:48:19 Jenessa: I love it. Oh, no, I've actually intentionally been, I wait to listen to the question at the end until the answer comes out so listen and I it before I hear your answer so I can make my answer. Been a really good study tool, actually. I'm enjoying it for sure. That's

0:48:36 Thomas: Awesome. Well, thank you so much. Been a really interesting deep dive, both parts here. So thank you so much for doing this. Any final thoughts that I didn't let you get to or.

0:48:47 Jenessa: The big stuff. Yeah, yeah.

0:48:49 Thomas: Excellent. Dr. Jenessa Seymour, thanks so much and good luck on your bar prep. Forward to speaking to you again.

0:49:12 Jenessa: Would be having a philosophical debate about the ethics of like how to just

0:49:15 Thomas: We wouldn't we'd just be getting our murdering on we'd