The United States is in the midst of one of the worst drug epidemics it has ever faced, with nearly 80,000 Americans dying every year from fentanyl poisoning.
If you're going to have Jonathan Haidt on the podcast, please consider also reaching out to someone like Mike Masnick, who can speak to the ways Haidt distorts social media research and misunderstands tech policy. In line with the Bulwark's interest in truth-telling, I think it would be really valuable to platform someone who could make a forceful case in favor of things like Section 230 that draw passionate but often poorly conceived opposition. (Other people who might be worth contacting: on the social media research side, Candice Odgers or Andy Przybylski; on the tech policy side, Alice Marwick, Corbin Barthold or Kate Tummarello.)
Brilliant show. So educational. I'm glad I listened. Now I know more and will share this knowledge. 200 deaths a day is a staggering number of lives lost!
The topic's important, but I'd prefer The Bulwark steer clear of podcasts hosted by current candidates for office (or current office holders for that matter).
We already have a full-time podcaster and part-time Senator in Ted Cruz. We don't need more of his species.
I work in the field of injury epidemiology, and my institute does a lot of research on both drug abuse and poisoning. While I found this episode constructive overall, the repeated effort to distinguish between "overdose" and "drug poisoning" was semantic nonsense. The two terms are synonyms. The data do not distinguish between them because there is no distinction to be made.
But, if you grant the attempted definition, "The poisoning is someone does it to you," then the claim that the data do not distinguish between them falls apart. In the coding of death certificates, the underlying cause of death for a poisoning must be an external cause of injury, which always tells you the intent of the injury event - i.e., whether it is an accident, suicide, homicide, undetermined-intent, or a result of law enforcement or war. Similarly, in medical data, the ICD-10-CM codes used to code poisoning include both the substance and the intent in the same code, making it impossible to code one without the other. (The code for accidental poisoning by fentanyl is T40.411A. For assault by fentanyl, T40.413A.)
Bherwani faults the system for not providing real-time data, but that's not a realistic demand. Even under optimal conditions with adequate funding, it takes time for data to be coded and made available to users. In the age of HIPAA and privacy concerns, data providers are legally required to focus on keeping data out of the wrong hands and preventing misuse of data. Furthermore, data providers tend to be proprietary about their data. That means they are usually obsessed with quality control, but also that they want to maintain control over what even the most trusted data users can do with their data. And special interests (e.g., hospitals) restrict what you can do with their data (e.g., I am prohibited from investigating the relative safety of competing hospitals - this is something that the medical industry colludes to prevent anyone from knowing).
Doesn't anyone think it's essential to explore why so many Americans are choosing to use non pharmaceutical drugs to get high? While it's important to stem the flow of fentanyl into our country, it's seems we are not realizing that something is radically wrong that so many are choosing to play Russian drug roulette. Understanding the why of drug usage is imperative as well educating our children that using street drugs may result in death and uncontrollable dependency.
The father whose son died from fentanyl laced cocaine didn't seem to question his use of cocaine, but rather that it's being adulterated with fentanyl was the issue. Unfortunately, once the human brain is exposed to these drugs, it usually creates an insatiable desire for more. Whether it's peer pressure, curiosity, depression, ignorance, or stupidity that motivates an individual to take the first drug induced trip, disaster inevitably ensues. It may not be death, but it often destroys the quality of life of the individual and irretrievably restructures the brain. Finding ways to discourage that first trip must be found and encouraging research to help those already addicted find a path to sobriety. Ultimately, decreasing the demand for fentanyl will decrease its flow into our country.
The current trend towards legalization of recreational marijuana will feed this conveyor belt of addiction. Today's weed, bred for maximum THC, is many times stronger than the stuff my peers smoked in the 1970s and 1980s. It is not aimed at casual users, but at hardcore daily users - the very kind of user who is likely to experiment with harder drugs.
The Justice Department just arrested 68 non-immigrants with 97 pounds of fentanyl. How far would 97 pounds of fentanyl go? For instance would it be sufficient for the city of Houston for a week? How much of this stuff is in circulation at any one time?
A lot. Hunt's Point in the Bronx, NY., is one of the worst offenders. It comes in there & is transported to all these local apartments rented for processing it. A few grains of that shit will kill you. I have been researching this topic since Prince oded from a fentanyl laced oxycotin pill in April of 2016.
We need a crusade against all recreational drugs which seem to lead to fentanyl. Who does not know someone who has not been touched by a fentanyl death? Thank you for this podcast. I learned from it and am inspired by it.
I don't think the fentanyl crisis has suffered (in attention) due to being "blurred with the larger opioid crisis" as Avlon suggests. Fentanyl (a synthetic opioid) is just the current, continuing result of the opioid crisis put into play by the pharmaceutical industry, aided by our own FDA and medical systems 20+ years ago. Legal pharmaceutical opioids can still lead to addiction. The guest was very well informed and articulate and had some great ideas.
I almost passed on reading this today and that would have been a huge mistake. First I want to thank Kamal Bherwani for working so hard on this issue and my heart felt sorrow for him losing his son. The most poignant thing I took away from his message is Fentanyl is a poison. True enough all opioids can be poisonous but this is several magnitudes more serious. Intentional poisoning of an already deadly addiction. The fact that Congress seems to want to deal with almost every aspect of our lives we have a deafening silence on real plans for this since the sources of precursors and the ability of the distributors from outside and within that it isn't as if Congress doesn't have something to aim for. This podcast was excellent but so very limited in distribution that it needs a voice where it counts and that is on the US House floor or the Senate. We have to hear from the insipid rants from the MTGs so let's replace that with voices working on real issues.
> The fact that Congress seems to want to deal with almost every aspect of our lives we have a deafening silence on real plans for this since the sources of precursors and the ability of the distributors from outside and within that it isn't as if Congress doesn't have something to aim for.
The Biden-Harris “Detect and Defeat” Counter-Fentanyl legislative proposal would give border officials the tools they need to more effectively track and target the millions of small-dollar shipments that cross our borders – closing a loophole that drug traffickers exploit.
The legislative proposal would help DHS, and particularly CBP, effectively go after the abuse of “de minimis” shipments, some 4 million low-value shipments every day that are currently subject to less rigorous reporting requirements than higher value shipments. CBP would be granted the authority to demand additional documentation and other information about de minimis packages and would impose a corresponding penalty on violators. The change would enable customs officials to more effectively analyze risk, identify patterns of concern, and take action against those who try to abuse our system. The legislation would also add a user fee for de minimis packages to help pay for the staff and equipment needed to better identify, and seize, illicit fentanyl being shipped in small packages into our country.
It would establish a registry of pill presses and tableting machines so that our law enforcement officials can keep track of these machines and take action against their illegitimate use.
Beyond serializing and tracking pill presses, industry partners would be empowered to identify and report suspicious behavior. The legislative proposal also includes reinstating subpoena authority to investigate suspicious packages.
It would permanently regulate fentanyl-related substances as “Schedule I” drugs – subjecting the distribution and possession of these drugs to heightened penalties– and would also increase penalties on those who unlawfully manufacture and distribute precursor chemicals and associated machinery.
Too many Americans don't pay attention to what Congress actually does. Performative garbage is generally the style many prefer anymore, which is a turn off to so many of us. CSpan and CNBC have always been things I watched when I could to check in on Congress. Not very exciting, but if you wanted to know what Senators and Representatives were doing...
I think it was GW's chief of staff who said that it used to be that people didn't really know what happened on a daily basis in congress. The business of running the country is rather boring, really, or it should be. It was business like and procedural. It slowly pivoted – is it all Trump's fault? – to loud performative acting and divisive rhetoric where clicks and being in front of a camera become the goal of many politicians, and the press eats it up.
My point: we used to trust what our congressmen and women were doing, we trusted they were debating and working together on solutions that were best for this country. The current congressional culture, however, particularly on one side, has no interest in legislating or governing for the entire country and we're allowing them to get away with this. It will take the public getting more educated, knowledgeable and expecting things to get done in congress before our congress will get back to actually doing their jobs.
Basically, elect people of good character and competence, and then we shouldn't have to pay all that much attention. It is part of that division of labor thing which makes the modern world so efficient. But today we can't even agree on what comprises good character and fitness for elective office.
1. I hope that the Bulwark turns more and more toward positive, prescriptive content from a centrist/bipartisan but most of all pragmatic, outcomes-first standpoint. Make this pod permanent or re-focus the others somewhat. We have to turn from surviving in the darkest times to succeeding in better ones - together. Thank you JVL & crew for seeing this necessity!
2. Avlon is running as a D in an Obama-Trump NY district. Which seems relevant to mention to this audience, especially because these early topics & guests (fentanyl, Haidt) and Avlon's tone (more on that in a moment) are coded really hard right. Liberal viewers' trust in the B is still fragile (or is it just me?)...might wanna tread carefully.....
3. I understand that we're talking about, and to, people who have suffered profound personal tragedy. But, to me, John's tone was almost comically pitched into melodrama. I would recommend a more clinical rather than emotive inflection for the majority of the air time. Drippy-insistent GRAVITAS! reeks of Fox News or charity informercials or...something...manipulative and slimier than an honest policy discussion.
But overall - this sort of content is super important, and thanks for doing it. I will look forward to each one!
Liberal here who would not say that my trust in the B is not fragile. But do agree that the tone was pitched into melodrama, not 'natural', seemed a little performative, but I assume that is because he is professionally a political commentator and so that's his public style of speaking.
The loss of a child is not drama. It is trauma. People would want to know why Kamal is doing this work. His story is important and might save lives. I believe humanity should be interjected in politics and policy and story telling is the way to wake up people.
Absolutely, I agree. I have no quibble with the choice of guest or how the father related his story. The father's tone was much more measured than the host's, which is who I was talking about. Of course people will have different reactions, just my own 0.02
This podcast was in important and timely addition to the information & response needed to combat the scourge of opioid deaths ravaging our country for the last decades and made an even more critical issue by the introduction of fentanyl & fentanyl derivatives in the last few years. The guest, a father who lost his newly college- minted son to fentanyl poisoning (cocaine laced with fentanyl) outlined a very cogent argument for a multi-pronged response to this crisis.
What utterly freaked me out was the comparison of the number of fentanyl deaths EVERY DAY to a plane-load of passengers on a typical flight: 200 people EVERY DAY dying of this scourge; the question being would we, as a country, really allow a plane full of passengers to die on a daily basis without making it a federal & state & local governmental priority to find and fix the cause(s) of these daily deaths? And yet, this is what we are allowing to happen. Fentanyl deaths are the leading cause of death in the 14-18 year old age group and opioids are the leading cause of death in all Americans under the age of 45. Why are we, as a society, not doing more? The stigma associated with drug use….still, in 2024. The understanding that drug use is a mental health disease and that harm reduction methodologies are critical to keeping people alive long enough to heal is a no- brainer. It doesn’t matter if you are a Republican or a Democrat… opioids are going to kill your child or your spouse or your parent no matter what political party they embrace. This is a truly national crisis I which we all must be invested.
If you're going to have Jonathan Haidt on the podcast, please consider also reaching out to someone like Mike Masnick, who can speak to the ways Haidt distorts social media research and misunderstands tech policy. In line with the Bulwark's interest in truth-telling, I think it would be really valuable to platform someone who could make a forceful case in favor of things like Section 230 that draw passionate but often poorly conceived opposition. (Other people who might be worth contacting: on the social media research side, Candice Odgers or Andy Przybylski; on the tech policy side, Alice Marwick, Corbin Barthold or Kate Tummarello.)
Amazing podcast. Incredible information. Very worth your time.
Brilliant show. So educational. I'm glad I listened. Now I know more and will share this knowledge. 200 deaths a day is a staggering number of lives lost!
The topic's important, but I'd prefer The Bulwark steer clear of podcasts hosted by current candidates for office (or current office holders for that matter).
We already have a full-time podcaster and part-time Senator in Ted Cruz. We don't need more of his species.
I work in the field of injury epidemiology, and my institute does a lot of research on both drug abuse and poisoning. While I found this episode constructive overall, the repeated effort to distinguish between "overdose" and "drug poisoning" was semantic nonsense. The two terms are synonyms. The data do not distinguish between them because there is no distinction to be made.
But, if you grant the attempted definition, "The poisoning is someone does it to you," then the claim that the data do not distinguish between them falls apart. In the coding of death certificates, the underlying cause of death for a poisoning must be an external cause of injury, which always tells you the intent of the injury event - i.e., whether it is an accident, suicide, homicide, undetermined-intent, or a result of law enforcement or war. Similarly, in medical data, the ICD-10-CM codes used to code poisoning include both the substance and the intent in the same code, making it impossible to code one without the other. (The code for accidental poisoning by fentanyl is T40.411A. For assault by fentanyl, T40.413A.)
Bherwani faults the system for not providing real-time data, but that's not a realistic demand. Even under optimal conditions with adequate funding, it takes time for data to be coded and made available to users. In the age of HIPAA and privacy concerns, data providers are legally required to focus on keeping data out of the wrong hands and preventing misuse of data. Furthermore, data providers tend to be proprietary about their data. That means they are usually obsessed with quality control, but also that they want to maintain control over what even the most trusted data users can do with their data. And special interests (e.g., hospitals) restrict what you can do with their data (e.g., I am prohibited from investigating the relative safety of competing hospitals - this is something that the medical industry colludes to prevent anyone from knowing).
Doesn't anyone think it's essential to explore why so many Americans are choosing to use non pharmaceutical drugs to get high? While it's important to stem the flow of fentanyl into our country, it's seems we are not realizing that something is radically wrong that so many are choosing to play Russian drug roulette. Understanding the why of drug usage is imperative as well educating our children that using street drugs may result in death and uncontrollable dependency.
The father whose son died from fentanyl laced cocaine didn't seem to question his use of cocaine, but rather that it's being adulterated with fentanyl was the issue. Unfortunately, once the human brain is exposed to these drugs, it usually creates an insatiable desire for more. Whether it's peer pressure, curiosity, depression, ignorance, or stupidity that motivates an individual to take the first drug induced trip, disaster inevitably ensues. It may not be death, but it often destroys the quality of life of the individual and irretrievably restructures the brain. Finding ways to discourage that first trip must be found and encouraging research to help those already addicted find a path to sobriety. Ultimately, decreasing the demand for fentanyl will decrease its flow into our country.
The current trend towards legalization of recreational marijuana will feed this conveyor belt of addiction. Today's weed, bred for maximum THC, is many times stronger than the stuff my peers smoked in the 1970s and 1980s. It is not aimed at casual users, but at hardcore daily users - the very kind of user who is likely to experiment with harder drugs.
Single largest fentanyl seizure in CBP history was just this past July at the Mexico border in Arizona. 4 million pills. A 20yr old US citizen. Probably a mule for the cartel. Some very interesting information about what the CBP is doing with respect to intelligence gathering in the Release. https://www.cbp.gov/newsroom/local-media-release/cbp-officers-arizona-seize-more-half-ton-fentanyl-largest-seizure#:~:text=With%20the%20assistance%20of%20a,fentanyl%20seizure%20in%20CBP%20history.
Good addition to the Bulwark line-up. Fingers crossed that for Avlon winning NY-01.
The Justice Department just arrested 68 non-immigrants with 97 pounds of fentanyl. How far would 97 pounds of fentanyl go? For instance would it be sufficient for the city of Houston for a week? How much of this stuff is in circulation at any one time?
A lot. Hunt's Point in the Bronx, NY., is one of the worst offenders. It comes in there & is transported to all these local apartments rented for processing it. A few grains of that shit will kill you. I have been researching this topic since Prince oded from a fentanyl laced oxycotin pill in April of 2016.
I gather then that 97 lbs is drop in the bucket of the problem, not a major supply disruption?
A spectacular show.
We need a crusade against all recreational drugs which seem to lead to fentanyl. Who does not know someone who has not been touched by a fentanyl death? Thank you for this podcast. I learned from it and am inspired by it.
I don't think the fentanyl crisis has suffered (in attention) due to being "blurred with the larger opioid crisis" as Avlon suggests. Fentanyl (a synthetic opioid) is just the current, continuing result of the opioid crisis put into play by the pharmaceutical industry, aided by our own FDA and medical systems 20+ years ago. Legal pharmaceutical opioids can still lead to addiction. The guest was very well informed and articulate and had some great ideas.
I almost passed on reading this today and that would have been a huge mistake. First I want to thank Kamal Bherwani for working so hard on this issue and my heart felt sorrow for him losing his son. The most poignant thing I took away from his message is Fentanyl is a poison. True enough all opioids can be poisonous but this is several magnitudes more serious. Intentional poisoning of an already deadly addiction. The fact that Congress seems to want to deal with almost every aspect of our lives we have a deafening silence on real plans for this since the sources of precursors and the ability of the distributors from outside and within that it isn't as if Congress doesn't have something to aim for. This podcast was excellent but so very limited in distribution that it needs a voice where it counts and that is on the US House floor or the Senate. We have to hear from the insipid rants from the MTGs so let's replace that with voices working on real issues.
Kaaren, you, the Bulwark, we, the readers are the backbone and heart of HOPE…. At least for me…. Do not feel so lonely or alone…. Thanks
> The fact that Congress seems to want to deal with almost every aspect of our lives we have a deafening silence on real plans for this since the sources of precursors and the ability of the distributors from outside and within that it isn't as if Congress doesn't have something to aim for.
https://www.whitehouse.gov/briefing-room/statements-releases/2024/07/31/fact-sheet-biden-%E2%81%A0harris-administration-announces-new-actions-to-counter-the-scourge-of-fentanyl-and-other-synthetic-drugs/
Summary from elsewhere:
The Biden-Harris “Detect and Defeat” Counter-Fentanyl legislative proposal would give border officials the tools they need to more effectively track and target the millions of small-dollar shipments that cross our borders – closing a loophole that drug traffickers exploit.
The legislative proposal would help DHS, and particularly CBP, effectively go after the abuse of “de minimis” shipments, some 4 million low-value shipments every day that are currently subject to less rigorous reporting requirements than higher value shipments. CBP would be granted the authority to demand additional documentation and other information about de minimis packages and would impose a corresponding penalty on violators. The change would enable customs officials to more effectively analyze risk, identify patterns of concern, and take action against those who try to abuse our system. The legislation would also add a user fee for de minimis packages to help pay for the staff and equipment needed to better identify, and seize, illicit fentanyl being shipped in small packages into our country.
It would establish a registry of pill presses and tableting machines so that our law enforcement officials can keep track of these machines and take action against their illegitimate use.
Beyond serializing and tracking pill presses, industry partners would be empowered to identify and report suspicious behavior. The legislative proposal also includes reinstating subpoena authority to investigate suspicious packages.
It would permanently regulate fentanyl-related substances as “Schedule I” drugs – subjecting the distribution and possession of these drugs to heightened penalties– and would also increase penalties on those who unlawfully manufacture and distribute precursor chemicals and associated machinery.
Too many Americans don't pay attention to what Congress actually does. Performative garbage is generally the style many prefer anymore, which is a turn off to so many of us. CSpan and CNBC have always been things I watched when I could to check in on Congress. Not very exciting, but if you wanted to know what Senators and Representatives were doing...
I think it was GW's chief of staff who said that it used to be that people didn't really know what happened on a daily basis in congress. The business of running the country is rather boring, really, or it should be. It was business like and procedural. It slowly pivoted – is it all Trump's fault? – to loud performative acting and divisive rhetoric where clicks and being in front of a camera become the goal of many politicians, and the press eats it up.
My point: we used to trust what our congressmen and women were doing, we trusted they were debating and working together on solutions that were best for this country. The current congressional culture, however, particularly on one side, has no interest in legislating or governing for the entire country and we're allowing them to get away with this. It will take the public getting more educated, knowledgeable and expecting things to get done in congress before our congress will get back to actually doing their jobs.
Basically, elect people of good character and competence, and then we shouldn't have to pay all that much attention. It is part of that division of labor thing which makes the modern world so efficient. But today we can't even agree on what comprises good character and fitness for elective office.
First impressions:
1. I hope that the Bulwark turns more and more toward positive, prescriptive content from a centrist/bipartisan but most of all pragmatic, outcomes-first standpoint. Make this pod permanent or re-focus the others somewhat. We have to turn from surviving in the darkest times to succeeding in better ones - together. Thank you JVL & crew for seeing this necessity!
2. Avlon is running as a D in an Obama-Trump NY district. Which seems relevant to mention to this audience, especially because these early topics & guests (fentanyl, Haidt) and Avlon's tone (more on that in a moment) are coded really hard right. Liberal viewers' trust in the B is still fragile (or is it just me?)...might wanna tread carefully.....
3. I understand that we're talking about, and to, people who have suffered profound personal tragedy. But, to me, John's tone was almost comically pitched into melodrama. I would recommend a more clinical rather than emotive inflection for the majority of the air time. Drippy-insistent GRAVITAS! reeks of Fox News or charity informercials or...something...manipulative and slimier than an honest policy discussion.
But overall - this sort of content is super important, and thanks for doing it. I will look forward to each one!
(Edit: spelling of Avlon)
Liberal here who would not say that my trust in the B is not fragile. But do agree that the tone was pitched into melodrama, not 'natural', seemed a little performative, but I assume that is because he is professionally a political commentator and so that's his public style of speaking.
The loss of a child is not drama. It is trauma. People would want to know why Kamal is doing this work. His story is important and might save lives. I believe humanity should be interjected in politics and policy and story telling is the way to wake up people.
Absolutely, I agree. I have no quibble with the choice of guest or how the father related his story. The father's tone was much more measured than the host's, which is who I was talking about. Of course people will have different reactions, just my own 0.02
You have misspelled John's names multiple times in the promotion!
This podcast was in important and timely addition to the information & response needed to combat the scourge of opioid deaths ravaging our country for the last decades and made an even more critical issue by the introduction of fentanyl & fentanyl derivatives in the last few years. The guest, a father who lost his newly college- minted son to fentanyl poisoning (cocaine laced with fentanyl) outlined a very cogent argument for a multi-pronged response to this crisis.
What utterly freaked me out was the comparison of the number of fentanyl deaths EVERY DAY to a plane-load of passengers on a typical flight: 200 people EVERY DAY dying of this scourge; the question being would we, as a country, really allow a plane full of passengers to die on a daily basis without making it a federal & state & local governmental priority to find and fix the cause(s) of these daily deaths? And yet, this is what we are allowing to happen. Fentanyl deaths are the leading cause of death in the 14-18 year old age group and opioids are the leading cause of death in all Americans under the age of 45. Why are we, as a society, not doing more? The stigma associated with drug use….still, in 2024. The understanding that drug use is a mental health disease and that harm reduction methodologies are critical to keeping people alive long enough to heal is a no- brainer. It doesn’t matter if you are a Republican or a Democrat… opioids are going to kill your child or your spouse or your parent no matter what political party they embrace. This is a truly national crisis I which we all must be invested.
327 people are shot everyday of which 117 die. We seem quite numbed to that. Why would fentanyl be any different?
Why should we be numbed to either? Your question is a non-starter.
Well, very little has happened on gun safety.