Tonight, I want to talk about the opioid epidemic.
Okay, I get it. All right, look...
Last week we did Fortnite.
So our pattern is fun, depressing, fun.
So, if we get through this, next week,
I'm going to do the whole episode while jumping on a trampoline, okay?
Now, it is no secret that America is in the midst
of one of the most devastating drug epidemics in its history.
For the last two decades, the opioid epidemic has been getting worse and worse.
In 2017 alone, over 47,000 people died from opioids.
But at last...
there might be reason for hope.
A newly-released government database reveals the scope of the opioid crisis.
For the first time since 1990, deaths from overdoses declined last year.
“The CDC credits the drop to fewer deaths
from heroin and prescription painkillers.”
It looks like some of our responses to the opioid crisis might be working.
Isn't it so weird to hear genuinely good news?
It's like...
when you see your favorite celebrity trending on Twitter,
and you're like, “Oh, my God, please don't tell me he just got #MeToo-ed.
Oh, he just died. Thank God.
I can still watch his movies.”
You haven't felt that?
I know it's dark, but look, compared to 2017,
2018 overdose deaths were down almost 5%.
Experts say,
the drop comes from investments in treatment and public awareness.
Though there's something else that should get credit, too.
“Narcan also known as naloxone,
the generic name for the drug, is an opiate blocker
that can literally revive an overdose victim.”
“Jennifer Plumb, an emergency room pediatrician,
says naloxone is a miracle drug.”
Understand this stuff is really good at what it does.
It has one job.
You can just save a life with it.
I mean, how amazing is that?
Does it really bring people back from death?
It really does.
Wait, so you're telling me I could bring back Al Pacino?
And the lady's like, “Leslie, Al Pacino's not dead.
He's in a movie right now.
Naloxone's incredible.”
Naloxone is a godsend, though, and it's very big business.
Last year, the naloxone spray market was $178 million,
and by 2026, it's expected to hit nearly a billion.
The only other market that's growing that fast
is Casey Affleck insurance.
So that's the good news.
Prescription opioid deaths are down.
However, that graph isn't telling the whole story.
After soaring overdoses from prescription pain meds, then heroin,
now it's a synthetic opioid, fentanyl, on a rapid rise.
Over half the deaths from overdoses that we're seeing right now in America
are caused by the synthetic opioid fentanyl.
Fentanyl is often called the third wave of the opioid crisis.
The first wave was when doctors
were over prescribing painkillers like OxyContin.
The second wave happened when addicted patients
then turned to heroin.
And the third wave is fentanyl.
And because of fentanyl,
overdose deaths have exploded.
Now, when I first saw this graph, I couldn't believe what I was looking at.
It looks like the income of everyone in Destiny's Child.
Right, like, you have Michelle...
you have Kelly and then you're like, “Oh, shit! It's Beyoncé!”
That moment, right here,
this part, right here,
that is Lemonade. That is when she stopped talking to everybody else.
Fentanyl is 50 times stronger than heroin.
This photo is terrifying.
Now, not just because it looks like Honest Abe's about to get high,
but because this much fentanyl can kill an elephant,
and that's not just some big-ass novelty penny.
That's just a regular why-do-we-still-have-these penny.
In the last five years,
fentanyl and its analogs have killed an estimated 95,000 people.
That is nearly two-thirds of all opioid deaths.
And this thing, it does not discriminate.
Young...
old, rich, poor, famous.
Prince.
Tom Petty and Mac Miller all had fentanyl in their systems when they died.
So chances are you know somebody affected by fentanyl.
I personally know multiple people
who have lost their lives to fentanyl.
And the saddest part is they didn't even know they were taking it.
And I know for sure, they weren't trying to die.
But somehow fentanyl got them.
So I've been paying attention to how we talk about the opioid crisis,
and the problem is...
a lot of times we lump all the opiods together like they're the same.
But they are not.
Fentanyl is a completely different animal than oxy or heroin and the truth is...
there is no beating the opioid crisis until we figure out how to beat fentanyl.
So tonight,
let's actually focus on fentanyl and look at where it's coming from
and why we haven't been able to stop it.
The first thing you need to know is that the story of fentanyl has two parts.
There's the legal side of fentanyl, which involves pharmaceutical companies
and the illegal side of fentanyl, which goes by a lot of different names.
What's on the street is a chemistry creation
also known as “Apache,” “China Girl” or "TNT.”
“‘Friend,’ ‘Jackpot,’ ‘TNT,’ and ‘Tango & Cash.’”
“Dance Fever,” it's called. “Goodfella,” “Jackpot,” “Murder Eight.”
Why does it sound like Vin Diesel came up with all of those titles?
He's just like, “‘Murder eight,’
‘China girl,’ ‘Cookie Dust,’ ‘Tricep Fire.’”
Good job, Vin. Way to stay focused.
No matter what it's called,
illegal fentanyl usually isn't sold on its own.
It's often laced into heroin, which can have devastating consequences.
“Huntington, once a thriving industrial hub,
had been crippled by years of job loss, rising crime
and 1,600 overdoses the previous year.
The calls started coming in at 3:21 on a warm August afternoon.
In just four hours, 26 people had overdosed
on a batch of fentanyl-laced heroin.”
This is one of the most tragic parts about fentanyl.
It kills a lot of people who don't even know they're taking it.
And that's because the heroin coming up from Mexico these days
is being laced with fentanyl, which is really dangerous.
Remember a pinch of this can kill an elephant.
So the margin here is just razor-thin for any error.
So you might be wondering...
why on earth would cartels risk killing their own customers?
It's because they can afford to.
It is the same business model as Jack in the Box.
Come on! Two tacos for 99 cents.
That is not a deal.
That is rat poop roulette, okay?
No one's talking about this.
Fentanyl-laced heroin is ridiculously profitable, okay?
It is 20 times more profitable than regular heroin.
Here's how you do it, okay?
You start with some pure heroin, that's the “H,” okay?
And then you cut it with whatever shit you have, which is the...
you guys get it, right? “S,” okay.
So you got all this really diluted heroin,
and if you sprinkle in a few thousand bucks of fentanyl,
you can make $1.5 million worth of product.
It's like selling bottled water at the airport.
You ever notice how you just magically walk into LaGuardia
and you're like, “All right, I guess Dasani is $17 now?”
That's the fentanyl effect.
Here's what's weird, though.
Most fentanyl doesn't originally come from Mexico, which is kind of surprising.
Doesn't it sound like a drug lord's dream?
Like, you would think El Chapo would have invented it.
But what you don't know is, he was really bad at o-chem.
And it turns out even Mexican cartels need a connect.
“Javier says he sources the precursor chemicals
to make fentanyl from China.”
“While doing our interview, Javier is called by one of his men.
They take us to another location where we wait.”
And in the meantime, he just left his half a kilo of heroin right here.
So it's just us and half a kilo of heroin.
Okay, that news crew is for sure about to do heroin.
Like, look at the way she's looking at it.
“Like I'm just not gonna do anything?
Let's do some heroin, let's have some fun.”
Also, isn't that the trick you use when you want to see your crush again?
You're like, “Hey, it's Javier, you know, the guy with all that gauze on his face.
Did I leave a half a kilo of heroin at your place?
Do you want to just grab dinner? Let me know.”
Like everything else in America, most fentanyl is made in China.
Even though China has regulations to stop illegal fentanyl,
the government rarely enforces them.
It's like taking Costco samples.
Like, in theory, there are rules.
But in reality, you can do whatever you want.
You know how you go in, and they're just like, “Sir, please take one sample.”
And you're like, “I need twelve for my entire family.”
And they're like, “Sir, how big is your family?”
And you're like, “Why can't you just be like Trader Joe's and not ask questions?
Let me do this.”
Dude, sometimes I'll just run for it.
I'm like, “Fuck it. You just have a vest. You can't stop me.
Let me live.
I've been a proud card carrying member since 1988.”
I know that's not possible.
Now, the point is...
that is why there is so much Chinese fentanyl around
and getting it is super easy,
even if you're not a drug king-pin.
“Law enforcement says it's just a click away on the internet.”
They can order it from China.
“My producers and I decided to put that to the test.”
I am interested in getting fentanyl
sent to us, submit.
“And then, just a few minutes later...”
Whoa! The email already came through.
“We ship to U.S.A. We only accept Bitcoin as payment method.
Warm regards.” Wow!
“Warm regards?”
Damn, I feel like those drug dealers care about me.
They're like, “Hey, here's enough fentanyl to wipe out Milwaukee.
Warm regards, Xiaofan.”
I'm like, “Thank you, Xiaofan.”
Americans are buying illegal Chinese fentanyl on the dark web
and then having it shipped to them through the U.S. postal system.
And now you know why millennials get so excited every time they get mail.
They're like, “Oh, my God! It's Fentanyl Friday!”
Now look, humans have been trying to get opium into our bodies for a long time.
We love this stuff, and why wouldn't we? Look at opium poppies.
It is a beautiful flower with drugs in it that eases pain and gets you really high.
That's why we have found every possible way to ingest it.
We drank poppy tea back in the day.
We smoked opium.
We injected morphine. We shot heroin,
and if you haven't watched Euphoria on HBO, now you're all caught up.
But in the mid-20th century,
something big happened.
Scientists figured out how to make opioids synthetically
without needing any of those poppies.
This was a game-changer.
Not just for opioid users,
but for the companies who could profit from selling it.
Which brings us to the legal side of fentanyl.
Before anyone ever really sold fentanyl on the black market,
there were two important uses for it, okay?
It was given to people for surgeries,
and it was prescribed to a very specific group of people.
Late stage cancer patients with pain so bad...
other opioids no longer worked.
Those were the only people it was supposed to go to,
but instead...
A new study finds as many as half
of patients prescribed fentanyl painkillers
should never have received them.
“The Journal of the American Medical Association found
thousands of people were prescribed fentanyl for far less serious conditions.”
“Doctors prescribe these powerful drugs
for groin pain, oral pain, and more.”
Can you imagine going to the doctor like, “Yo, my crotch hurts.”
And then he's like,
“Okay, here's the strongest drug known to mankind.”
You're like, “It's just an itch, but...
fuck it, I guess.”
By the way, real quick. Who's in their graphics department?
What the fuck is this?
They're like, “We don't have a visual. Someone open up Microsoft Word
and type in ‘groin pain’ and ‘oral pain.’
Make sure you grab it!”
Like, what the fuck, man?
Now, here's the question.
Besides these shitty graphics, how did so many people
get prescribed a supercharged medication they should have never had?
Well, it has to do with the drug's origin story.
Fentanyl was first synthesized in 1960 by a scientist named Paul Janssen,
and at the time, it was the most powerful opioid ever created,
but in 1981, Janssen's patent on fentanyl expired,
and the drug became a generic free-for-all,
and the other pharma companies went gangbusters.
They started making fentanyl patches, sprays, and lollipops,
which made for some very strange instructional videos.
“Place the Actiq unit into your mouth
between your cheek and gum
and actively suck on the medicine.
Plan to finish the Actiq unit completely in fifteen minutes.
If you finish Actiq too quickly,
you will swallow more of the medicine and get less relief.”
Why is that lollipop so small?
They're in pain, man. At least put some bubblegum on the inside.
Now, unlike with oxy, the FDA knew how dangerous fentanyl was.
So they tried to regulate it.
In 2011, the FDA created something called The TIRF-REMS program,
a strict set of rules to make sure doctors prescribed fentanyl
only to that small group of cancer patients.
There was just one problem.
Instead of the FDA running TIRF-REMS,
they did something really stupid.
They out-sourced it to the pharmaceutical companies,
and then pharmaceutical companies hired a company called McKesson,
one of the world's largest drug distributors to run it.
In other words...
The purpose of the TIRF-REMS program is to make sure that these drugs stay only
with those that it's indicated for.
McKesson had no interest in shutting people down
from getting this drug because they supply the drug.
That is the textbook definition of a conflict of interest.
Imagine if Eminem was like, “Too many kids are calling their mom a ‘bitch.’
You know who can handle it? Slim Shady.” You're like...
“Em, that's you.”
On top of that, the exam the doctors had to pass was ridiculously easy.
“Doctors who want to prescribe drugs in this program
need to complete an eleven-question quiz,
but it's an open book test with the answers easily found
in this nine-page handout.”
It's an open book test?
And it's multiple choice.
How is it that easy to get something this dangerous?
Just for comparison, and this is true,
you need to take an eight-hour course to sell churros in Times Square.
You know those guys who sell peanuts?
They failed churro school.
So the government's attempt to regulate prescription fentanyl
was a massive failure, but we can't forget
a huge part of the blame also falls on fentanyl makers themselves.
They've been aggressively pumping fentanyl for years,
and it's a tactic that they took directly from Purdue's OxyContin playbook.
Purdue convinced everyone that oxy wasn't that addictive,
which is insane.
It's like if Juul told people,
“Hey, it's just water vapor in a thumb drive, kids.”
Meanwhile, every fourteen-year-old that you know has nicotine shakes
like it's fucking 1920.
Look, there's a lot of corporate blame to go around
for prescriptions fentanyl abuse,
but I want to focus on a few key companies.
The first you might have heard about.
Either because they've been in the news or because they make SpongeBob Band-Aids.
Johnson & Johnson will be the defendant today
when an opioid-related lawsuit goes to trial.
Oklahoma's attorney general is suing Johnson & Johnson.
The AG says the company deceptively marketed the drugs
by overstating the benefits of opioids and downplaying the risks of addiction.
I know that's jarring.
It's like hearing Pantene makes atom bombs.
You'd be like, “Wait.
The secret ingredient is uranium?”
J&J made a fentanyl patch called Duragesic,
and Oklahoma prosecutors say that the company marketed it
as a much safer drug than it actually was,
contributing to the 6,100 opioid deaths in that state alone.
But J&J is just the start.
When it comes to over the top marketing for fentanyl,
no one went harder than a company called Cephalon.
They sell fentanyl in a number of forms, including that skimpy lollipop
that I was talking about earlier...
and pills.
They are really obsessed with pills.
This is an actual Cephalon sales meeting from 2006.
“Introducing Fentora,
the first and only buccal tablet that utilizes effervescence
to improve the rate and extent of fentanyl absorption.
A change is here.
Fentora, relief at effervescent speed.”
It is a beautiful day.
If you're gonna force something on people they didn't ask for,
it makes sense to use U2.
Also, why are they introducing that giant pill like it's Criss Angel?
They're like, “Fentora, it's a mind freak!”
And then Criss Angel pops out.
Oh, by the way...
remember those lollipops?
Thanks to Cephalon's aggressive sales force,
doctors prescribed them to a lot of people who didn't have cancer.
In 2006, only 1% of the lollipop prescriptions were written by oncologists.
1%. Imagine if finding out only 1% of drivers licenses
were given out by the DMV.
Actually, that would explain a lot. Okay.
Cephalon knew this was wrong.
That's why when they settled a nearly $450 million federal lawsuit,
they plead guilty to pushing fentanyl on people who didn't need it.
But other fentanyl makers just went with good old-fashioned corruption,
like Insys.
Five top drug company executives have been found guilty
in a bribery case involving the opioid fentanyl.
The multi-billionaire founder of Insys Therapeutics
and four other top execs convicted of racketeering.
Prosecutors say their scheme involved bribes, kickbacks,
even lap dances for physicians who prescribed large amounts
of the company's fentanyl spray to patients who did not need it.
They were getting lap dances?
I don't want to die because some horny doctor wants to make it rain.
This entire bribery scandal happened under their former CEO John Kapoor,
who looks like Al Franken in brown face.
Now, before he was a convicted felon,
John Kapoor made himself a shitload of money.
“A pharmaceutical entrepreneur.
Dr. John Kapoor.
That's him in the middle.
Forbes lists him as one of the wealthiest people in America.”
How does he look like he's twelve years old and 80 years old at the same time?
Dude, this is messed up.
He made all of those people filthy rich, and nobody would even give him a boost.
You know what pisses me off?
Even though he's gonna be in prison, you know his parents are still gonna be like,
“You know John's a pharmacist, right?”
This Punjabi Oompa Loompa became a billionaire
by pushing addictive drugs through bribery and corruption.
And some Insys employees were told to go even further.
I would say, “Hi, this is Patty. I'm calling from Dr. Smith's office.
I'm calling to request prior authorization for a medication called Subsys.”
They thought you were from the doctor's office.
Yes, because that's what I told them because that's what I was trained to tell them.
“To get a surefire approval, Patty said she'd sometimes just claim
the patient had cancer.”
You see a cancer patient, you were like, “Yes!”
That was exciting. This is a slam dunk. I can do this without any guilt.
Imagine how messed up your job has to be
if your response to hearing that someone has cancer is,
“Oh, this is a slam dunk.”
There was no line Insys wouldn't cross to sell more fentanyl.
“Sarah Fuller didn't have cancer.
She was plagued with chronic neck and back pain from two car accidents.
But her doctor Vivienne Matalon
actually brought an Insys sales rep to an appointment.
Fourteen months after she started taking Subsys,
Sarah was found dead on her bedroom floor.”
What killed your daughter?
Well, technically fentanyl.
But a drug company who couldn't care less about a human life.
That's heartbreaking...
and infuriating and there are a lot of stories like Sarah's,
which is why earlier this year, Insys settled a federal investigation
of their bribery scheme for $225 million,
which made Insys the first opioid company to go bankrupt.
Insys basically OD'd on its own shittiness, which sounds like justice,
until you hear what's happening right now.
These motherfuckers can't sell fentanyl anymore,
but they can sell the antidote for fentanyl, naloxone.
So, let me hit that home for a second.
Insys went bankrupt because of opioids,
and now they're trying to revive themselves with naloxone.
They're just gonna spray it right up their profit hole,
and they are the last people who should be doing this.
But our pals at Cephalon are somehow even worse.
Cephalon is now owned by Teva Pharmaceuticals,
and four months ago, Teva got FDA approval for its naloxone spray.
So do you understand what's happening here?
They're unleashing a plague and also selling the antidote.
That's actually the plot of Mission: Impossible 2,
and I know that because last night I spent nine hours watching it on TNT.
These companies help fuel the fentanyl crisis on both ends,
legal and illegal.
When they marketed legal fentanyl to patients who didn't need it,
a lot of people ended up getting hooked,
and that intensified the appetite for illegal fentanyl,
which is leveling so many communities across the country.
Now, at this point, we have seen this pattern.
A powerful new opioid is created,
the companies in charge push it recklessly,
people get addicted to it,
and once it's out there, it's out there.
The genie is out of the bottle.
We saw it with oxy,
we saw it with fentanyl,
and, guys, this is fucking crazy to say,
but we're about to see it again.
The FDA has approved a powerful and controversial new painkiller.
Dsuvia is an opioid taken in pill form, ten times stronger than fentanyl
and up to a thousand times stronger than morphine.
Projected annual sales of this drug-- $1.1 billion.
Wow, so people stand to make a lot of money off this.
Dsuvia is ten times stronger than fentanyl.
What could possibly go wrong?
Look, we know the problems this is gonna bring.
How do we make sure this drug only gets to the right people?
How do we make sure people don't get addicted to it?
And how do we make sure it doesn't start killing people
like the people I knew
who never even intended to take it in the first place?
Unless you can answer those questions,
guess what, pharmaceutical companies?
This crisis is on you.
Warm regards.