And as soon as you get like a hundred patients per uh physician cap, that's when it really becomes this sort of like
hardcore commercial enterprise just because people are always trying to push the edge. I do think that that treatment
and and rehabilitation should be available to them even if they are pushing the boundaries. And this is the difference between heroin use and heroin
dependence/addiction. But there is a whole lot of action and historical building that goes into
creating the systems in which these drugs now exist. So what it allowed for was simply the acceptance of open air
drug use with no no remediation or uh or responsibilities whatsoever. We haven't
done anything when we've had over 100,000 overdose deaths per year. Very few people understand that these three
drugs.
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Welcome. I'm uh here and honored to be with Emily Duftton. Uh she's a PhD in urban studies perhaps. Uh she'll maybe
rectify that uh uh term, but she's a historian. She's the author of a few a
couple books on addiction. Uh most recently, Addiction, Inc. uh Inc. period um as in incorporated and it came out
University of Chicago I believe April of this year and it's an interesting read um she goes over the history of
methadone and um I suppose maintenance therapy um principally concentrated in
the 60s7s and beyond and um it has policy implications for today for uh
narcotic and drug treatment um I thank you so much for being on Emily u what
did I get wrong first of all and uh tell what [laughter] what what inspired you to to write this book?
Oh, well, thank you so much for having me. I'm really happy to be here. Um, my PhD is actually in American studies,
which is uh sort of a nebulous field of study. Uh, but for the most part, I focused on American history and cultural
uh cultural history specifically. Um, I was inspired to write this book because I grew up in Allentown, Pennsylvania,
which was very hard hit by the prescription opioid epidemic in the early 2000s. uh and a very good friend
of mine passed away. He committed suicide by hanging himself um from a
tree in the woods behind our old middle school after about 15 years of steady and escalating and increasingly chaotic
opioid use. He was only using pills. He never injected heroin. He never joined
in his roommate's use of meth, but he was very much a person who became extremely dependent on prescription
opioids. And when he passed away, I was very uh upset by his death because he
was a good buddy of mine and I really enjoyed his company. Uh and I was very confused by it because I thought he was
one of the most vivacious person uh people I'd ever met in my entire life. And to lose him when he was just 30
years old was very disturbing. But of course, it wasn't just him that we lost. There was actually a number of people
from my old high school whom we had lost to either um overdoses, opioid overdoses
or uh suicides for a number of years to the point where you would go to a
reunion and they were just getting smaller and smaller because our population was just being cut down. And I was really upset by this because it
was a small high school. We were all very close and I was losing all of these colleagues and friends of mine. And so I
had just published my first book which was about the history of cannabis activism for and against legalization
from the 1960s to today. And I was kind of fishing around for another topic to write about. And I realized my friend
Dana's death posed um kind of a research problem that I could start to maybe
potentially write a book proposal for. So I started asking a lot of the doctors and researchers and experts whom I had
come to know through my years of working in drug history um what they would have done if my friend Dana had presented for
treatment. And this was back in the long ago days of 2018. And every single one
of them unanimously said he should have been placed on medicationass assisted treatment which was the term for uh this
protocol at the time. I know it's moved on to mode or mood medications for
opioid use disorder, but uh I continue to use medication assisted treatment just because it was the term that was
used by the federal government, scientists, researchers, doctors, and patients at the time. And I still think it's actually like a really good sort of
all-encompassing treatment uh term. Um but they said he should have been placed on Matt, MAT, medication assisted
treatment. And I asked what that was. I mean, I was familiar with some of it, but I wasn't deeply familiar with it.
And they explained it was the use of one of three FDA approved drugs either methadone, nalrexone or bupinorphine uh
in con combination with various other services to allow a person to move away
from street or elicit or chaotic drug use into a form of recovery. And I was
like, well, you know, sounds great, right? I'm coming at it from I have no
medical background whatsoever. As I was saying to you before, the sight of blood makes me incredibly queasy. Um, but I
was intrigued by this. I was like, well, what are these three FDA approved drugs? Why aren't they so well supported by the
number of people I'm talking to? And of course, why didn't Dana get them or the
number of other people who had died from my high school? Why didn't they get them? And that launched me on an 8-year
process to dig up the history of these drugs, where they came from, who
developed them, and why. and of course why they are not necessarily uh a strong
or a sufficient enough response to our larger opioid epidemic today. And that's
kind of what brings us up to and you're right, my book was released in April, April 13th of this year from the
University of Chicago Press. So that's that's that brings you up to today [laughter] or six months ago at least when the book
came out. Congratulations. I assume you've done the book too and interviews and so forth. uh what what's the uh this is not
to just save myself time but what what's the question that challenges the most or you find most memorable what's the point
that you want to bring to bear on on the public um for their knowledge and and
where do you think their lacuna absence of of expression and knowledge on this topic is or are
I think the biggest lacuna is that we very few people understand that these
three drugs all three of them and including actually a fourth drug that was also developed under the umbrella of
medication assisted treatment but we no longer use it today. They were all developed as a very radical public
health program in the 1970s which over the past 50ome years has transformed
into extraordinarily privatized profitering uh sort of commercial um
expedition today. And that is not necessarily functional for actually treating the opioid epidemic in the
United States. And it's too bad that we lost this public health uh sort of commitment to it. And I think we blame
the wrong people and we don't fully understand the history. And that is sort of the I mean that's sort of the driving
the the the driving uh force behind what I what I wrote. Um and why I'm trying to
bring this history back into the public light. Yeah. You know the seven blind men and the elephant. You know that parable.
Mhm. Sure. Yeah. I mean I you and I come at this a little bit
differently. I'm not going to I'm going to kind of suppress my my natural urges um [laughter] for a little bit, but you
know, I um um you know, I'm aware of the MIAT aspects
and and the drugs that are in in use. Um I I'm not sure I agree with your
conclusion, but this is kind of would be at the end of this interview, but um while we're on this topic, um you you
the way I see it, the way I interpret your book is that um the kind of fall
from grace was taking this MAT, this kind of at the time was methodone
treatment. There were there were other things as well. was the LAM and and and Nrexen, but principally methadone for
decades until bupinorphine came about um 2000s. Um but you see kind of the uh the
fall from from grace as the privatization of methadone clinics. Is
that right? I have that right? And and and similar along those lines, just to extend the question slightly, I apologize. um it would be that you would
see the the model um being more uh state controlled and or federal controlled um
to take the profit motive out of the methodone clinics. And so my my ancillary question on top of whatever
you want to discuss about that would be how would that improve things? Well, I don't know if it necessarily
would at the point at this point, right? I think is it's a little bit too complicated but I mean other countries are completely sufficient at
providing a level of care whether it comes with MAT or not for opioid use disorder or any other form of substance
use disorder that doesn't necessarily exploit patients and treat them simply as customers in a system to be uh you
know to be sorted profited off of and I don't know if that necessarily needs to be federally controlled. The United
States is obviously a far larger country than places like Switzerland or Portugal that do have systems like this in place.
But I think on a state-by-state basis, you can make this stuff available in a non-commercial way. I spent a lot of
time in St. Louis, Missouri, uh at the u at the um clinics that are run through
ARCA, the assisted recovery centers of America through Percy Menses, who I know you know as well and you interviewed. Um
he works very closely with the state government. He works very closely with a lot of other partners to provide
resources to individuals who are seeking help. And he does not exploit these people. He doesn't make uh he doesn't
make these programs available in a way where like you're charging every single day when if someone walks in the door.
These are a wide variety of sources that include medication, but he mostly focuses on buprenorphine and nrexone,
which is of course an opioid antagonist, so you're not necessarily on maintenance for the rest of your life. He also
provides things like food, housing, job placement. Um, there's a wide variety of resources that are available to people
in St. Louis and beyond through ARCA that I think are a model that other states could follow. The nationalized
system that was founded in the US in 1971 is an extraordinary moment in
American history, but I don't know if it's necessarily something that we could recreate now. I think there was like this moment and there were a whole lot
of factors driving what Nixon was doing when he instituted this model, but I don't know if that's necessarily true
anymore. We don't have the same models. We haven't done anything when we've had over 100,000 overdose deaths per year.
Um, but I do think on the state level, especially with money that's coming through either the opioid settlement funds or through the state uh state uh
uh federal funds that go through the states, there's a lot of options and opportunities to make treatment
available to individuals outside of commercial entities that I think would be valuable to pursue.
Yeah. So, um there's a lot there to parse. Uh hopefully we'll come back to to any or all of it. Um you did mention
the settlement. So this is interesting to me. Um, I wrote an article on uh Purdue Pharma and I I'm not a you know,
as a as a physician um you know before I I I wound up treating people with buprenorphine in the 2000s but before
that I was uh um alive and well and and treating patients from the 1980s on and
I had my own place in River Massachusetts 1987 on it's like a primary care office walk and whatever
and so I had my regular codery of patients but I would have um kind of a little bit don't don't misinterpret this
anybody, but you know, if you have a bright light out there in the in the summer, they're moths. Now, you may not
want them, but they're attracted to the light. Now, there's a great great Norm Coleman joke about this. Uh, I recommend
people look it up. It's with Conan and Brian. It's one of the great jokes of all time. Anyway, um, and so having a a
clinic like that, a storefront clinic with walk-in aspects, uh, I attracted a lot of people looking for drugs. uh poly
we call they call it poly pharmacy but really it's also poly doctoring um because they have uh frankly the
opposite of lack of access they have complete access they have you know at the time it's called Medicaid cards then
became mass health cards Massachusetts but it's basically they have you know formal welfare benefits um and they have
cart blanch um to to see physicians and they would do that over and over again they would um kind of like um you know
on the merry ground they collect the rings if that's still a thing um or Pokemon, collect them all or whatever.
So they they would go from doctor to doctor and they would kind of stop at me and uh I actually heard later on that my
term in their group was Dr. No, the James Bond villain, right?
I kind of think of myself as Dr. No at all, but but they they just had Dr. No because I would say no because I had
this thing where I while they were, you know, signing in, whatever, you know, it was kind of like there were things about
them that kind of rang a bell for me. you know, they'd come from another town, they had pain that wouldn't be solved by
just low-level percoet. They needed, you know, uh, higher level oxycontton and so forth. Anyway, um, but I would call
smarteries and see that they had had prescriptions yesterday, for instance, for right 90 of X and 30 of Y the day before and
what and it was kind of before computers a lot of this stuff. I mean, not quite, but before the the integration so
anyway. Um but so that that's kind of a little of a background of stuff I do. But um you know
and these people were these people were seeking um or various other pain
addiction treatment. They would want Oxycontton or or something of that level. They wanted some higher dose um
you know prescription narcotic um and they liked Oxycontton but it was
Oxycontton anyway. So I'm I'm doing two things some from opioid painkiller but not like a not like a treatment drug. They're
looking for specifically like a painkiller. Yeah. Well, yeah. And mind you, I think a lot of them were selling to be honest with you. They they were collecting and
selling. So, they were scavenging. You know, I actually call it raccooning. It's my own term. I don't know if anybody else used it. Um, you know,
raccoons are are reasonable animals out in the wild, but, you know, in the urban environment, they're they're they're tipping over garbage cans and hunting
for what they can. This is kind of the raccooning aspect where you're collecting stuff. Um, anyway. Um, but so
so that's kind of my own interaction with continent in the day. Um, but more recently, you know, I I re I re because
Purdue paid out this huge settlement. Um, and I researched it and and and to be honest with you, I kind of feel like
Purdue was scapegoed. Um, Oh, yeah. A bit. They were and they're not paying as much as they
could. And there but there's lots of other people who are paying the money, too. Well, yeah, but but they went my only point there's a long roundabout. I
apologize, but I think, you know, like Willie Sutton, you know, why did you rob banks? Because that's where the money
is. uh they went after Purdue Frederick uh at the time or Purdue Pharma because they had been bestin-class. They were
making kind of the boutique version of these narcotic pills and and their pills frankly were not the ones people were
injecting and so forth. That didn't that wasn't really the basis of the injectable um crisis. You know, people
were smooshing their their other narcotics and snorting all kinds of stuff. Um and they actually made an
abuse deterrent formula. And I think they their actual component of the number of pills that people were
overdosing on was was minuscule. was never like never bounded beyond like 3 to 4% of the total. So I think there are
other characters but they were generic and they weren't making the profit margin anyway. So that that's a little
bit of a preface a little bit about me and so forth but I apologize about that. But in Diviar, which is a a um a I guess
a a submerger of Wreckit was wrecked Coleman originally. Then they made
Buponorphine um as a as a um an analesic pain medication like a narcotic and then
it became Wreckit Benkeeser. They they merged with like Swiss company or something like that. Dutch Yeah, it was a Dutch.
Dutch. Thank you. Sorry about that. Um but you know in a in a sense it's exactly almost the same paradigm or
parable of the Purdue aspect which is they did exactly what the government wanted. Purdue was asked to make an
abuse deterrent formula. They did they made the perfect one oxycontton one I call it. Then they actually a few years later made Oxycontton what I call
oxycontton 2 which was even better. It was better like dumb and dumber was it was better than the than the previous
better one which was better than all the other ones because you could not snort it and so forth. you couldn't abuse it and the actual hardcore drug addicts
didn't want that stuff. I but um but my my point is about the settlement part.
Um whether you I don't know it's really more kind of recent thing. Um but I it
feels feels to me like they went after um Wreckit Ben Kaiser um because they
were pushing this thing but they were asked to push it through the data 2000 act the drug addiction treatment act 2000 under Bill Clinton. So I don't know
if you want Well, they weren't asked to push it. They were they were simply allowed to. But that's you're entirely correct in
that there are very strong parallels in between record Bener that then turns into indivce
like the heat really starts coming down from the DOJ the department of justice uh investigation and Purdue. Those those
parallels are made explicitly clear in the 2020 um sentencing of of Sean
Thaxter who was then uh RBP's recorder pharmaceuticals RBP's um at/indivor's
CEO what um what RBP did with Suboxone which is their version of bupinorphine
that was uh explicitly allowed to through the data 2000 the drug abuse and treatment act of 2000 which was signed
into law by Clinton uh President Bill Clinton in um I believe it was October of 2000. It was the first time that
physicians were allowed to prescribe maintenance medications in American history in about you know 80 plus years
since the 1914 Harrison Narcotics Act cut down on that availability and of course since after the morphine clinics
that were somewhat widely available after World War I and then got shut down
in the 1920s. Once those closed, um, there was no, I mean, like, uh, David Herszburg, who is a a drug historian up
at the University of New York in Buffalo, he wrote a great book called White Market Drugs, and he found that there was a little bit of underground
opioid maintenance um, going on after the after the Harrison Narcotics Act and
after the morphine clinics across the country closed, were sort of forced to close in the 1920s. The last one finally
closed in 1923. But of course, this is very small. It's very low level and it's very very very underground. So this
stops for about 80 years until it's resuscitated and revitalized by the data
2000 act. And that act simply allowed physicians to prescribe controlled
substances in schedules 3, four or five for opioid maintenance from their
private um from their private offices. uh private uh private far uharmacies
were allowed to distribute these drugs. But it made no specific it it didn't name buprenorphine. It didn't name
Suboxone. It didn't name recordbenkeiser pharmaceuticals. It simply said those substances in three, four or five,
schedule 3, four or five were allowed to be prescribed for this purpose. The only drug that was in schedule 3 that could
[laughter] be prescribed for maintenance of course was buponorphine. Now recorder
actually made two formulas of the drug. One was a purebupinorphine formula called Subutex and they never really
focused very much on that. Now data 2000 says that it's you're allowed to prescribe it but that was very much
withheld and sort of uh quarantined to specific circumstances like women who
are pregnant um ERS things like that. It was never a big seller. It was never the focus of the company. Suboxone was very
much the focus of the company. And that's a different drug that is four parts buponorphine combined with one
part nlloxxone to uh avert misuse of the drug because if was someone was to now
remember back in the 90s and early 2000s the only formula available of this drug is a is a tablet and it has to go under
the tongue it has to be distributed sublingually because if you swallow buponorphine it's neutralized by the liver and it doesn't work. So there were
these sublingual tablets that uh reports actually across Europe in the 1980s when
people when it was available simply as an analesic people were crushing them and injecting them and using as a
recreational drug and that was very much not the point right but so what re what
Beniser do uh record Beniser pharmaceuticals was trying to do in the early 2000s was promote suboxone as the
first maintenance medication to be available from a private physician in 80 years with this abuse used deterrent
through the addition of that one part in a lock zone. And they were actually going for a very different consumer at
the time in the late '9s when all of the lobbying is going on to pass data 2000 and shortly after the drug is approved
by the FDA in October of 2002 and then once it comes on the market in 2003.
They're not going for a prescription opioid user at that point. They're actually going for the rising number of
middle class and teenage heroin users because in the '9s there was a massive amount of very pure and relatively
inexpensive heroin being trafficked to the United States from places like the Middle East and Asia. Uh and that has
brought a new level of heroin use to places like the middle class that here24
had not been very interested in the drug. They were always turned off by injecting. They didn't want to use the needle. But as soon as it was pure
enough to snort, heroin started rising. And you see this in the 90s with like the heroin chic um uh fashion
phenomenon. You see it through the deaths of uh people like Kurt Cobain and the use of heroin use of people like
Perry Ferrell and all these other musicians. So data 2000 passed as a sort
of I guess you could say public health response to rising rates of heroin use
among the middle class and teenagers. people who either were not allowed to go to a methodone clinic because methadone
clinics aren't really allowed to treat treat people under the age of 18 or people who would refuse to go to a
methodone clinic like a middle-ass person who's not going to stand outside of a methodone clinic at 5:00 a.m. every
single day. Uh so it was not necessarily created to become a commercial bestseller. It was not necessarily
created to only support, you know, suboxone and buponorphine and things like that. But data 2000 opened the door
for this drug to enter into the marketplace and it really kind of takes off as a blockbuster phenomenon. Gosh,
almost a decade later, once is starting to be targeted toward that uh that prescription opioid use uh user and also
once you have a mass influx of the former salespeople from Purdue who used to be selling Oxycontton, they all get
laid off in the early in like the mid 2000s because Purdue is coming under fire from a numerous amount of lawsuits.
And once they shed all of their sales force, RVP sucks them all up and starts
to have them to sell um Suboxone instead to this rising number of of prescription
opioid users instead. And that's where it becomes a really a commercial commercial enterprise especially once
you lift the patient cap. So remember also in data 2000 uh doctors were
limited to 30 patients a piece. So it was a very limited patient population that that is raised to 100 patients a
piece in 2006 because of the escalated uh escalating prescription opioid crisis. And as soon as you get like 100
patients per uh physician cap, that's when it really becomes this sort of like
hardcore commercial enterprise. But it did not begin that way. really did start
as a I mean the guy who started it Charles O'Keefe who is the president of record banker pharmaceuticals here in
the US I've talked to him multiple times he's not this hardcore driving capitalist who is out there to exploit
all these individuals he really did believe in the drug he believed in the power of buponorphine he believed it had
the power to bring I mean if you have a million heroin users in the United States in the in the year 2000 and
that's what you know it's like a million to 1.5 million those are what federal estimates suggested And there's only
800,000 attending or not even that actually like less than that attending methadone
clinics. You have h far fewer far fewer right like 80,000 or something
sorry take away a zero like 80,000 you have a whole lot of people who are out of treatment who need assistance and
what he envisioned buponorphine being as something to kind of assist this large
you know majority of people who are are cannot access um cannot access addiction
treatment or don't want to um so he came to it with like a with a different viewpoint but it became something very
different Yeah. Um, you know, as far as the the blind men and the elephant, you
know, I kind of see this a little bit differently, and I don't want to be confrontational here, but, you know, you did bring up a few interesting points.
Uh, first of all, about the marketplace aspect. Um, you know, price of heroin going down brought more heroin users.
Um, and and and while we're doing little parables, I don't know if you know the song Little Old Lady Who Swallowed the
Fly. Do you know that song? Oh, yes. I have I have I have small children, so I hear it fairly often. I
[laughter] I love that song. I thought it was a book. I I remembered it as a book, but there's not really a book.
Apparently, more of a song. There is a book. Uh she swallows a fly. Uh it disturbs her, so she wants a cure. So,
she swallows a frog to eat the fly. Of course, eating a frog is not that great hopping around in her belly. And so, she
has to swallow a cat to to eat the frog. And then she has to swallow a dog to eat the cat. And every time her belly gets
getting bigger. It's a so hilarity ensues, right? It's a great song and it's great for kids and so what um but
you know the marketplace I mean you you bring up kind of I mean the essence of your book Addiction Inc. uh is that
there's an incorporation aspect as a like a privatization and a profit motive and you use the word exploit a couple times. Um I I I think there is
exploitation there of a sort um but I think it's it's um more of an annealing
with the private and public um marketplace. I think the public paradigm change uh created a private marketplace
and I also think the public institution and and um distribution of of an
ancillary narcotic whether it's methadone or bupinorphine and so forth and you say not distribute you know either pre-rean or post reagan one form
or another there's there's you know essentially free narcotic poured into the system form of methanone um it's not
there's no outside marketplace not being sold on the streets not really um you know treat you know a standard kind of
treatment something else. Um, but you know, if you are in that system, you're disabled or you're on Medicaid in one
form or another, you're going to get medic, you know, methadone and whatnot paid for. And so there's a whole institution there, whether it's, you
know, the strictly public health kind of version under Nixon, etc., or more of the privatized version of SAM under
Reagan, whatnot. There's kind of an ongoing expansion of methadone, which did not like. So the the point I make
is, you know, I don't think it necessarily, you know, made the pre-urs wild heroin dealers of the 70s become
travel agents, um, accountants, um, PhDs in in, um, economics. I I don't think it
changed them. I think they just went to other markets and I think they they expanded the marketplace. So, let's say,
for instance, you're the heroin guy and you have a whole bunch of heroin on your shelf in your in your safe and under
your under floor planks like Breaking Bad or whatever. you got a whole trove of this stuff. Um, and then they come
along with methanone. They're going to take away your best customers, say, and they're going to put them they're going to give them free narcotic in a clinic.
You know, what do you do with that stuff? It's all of a sudden you're not you're not going to donate it, you know, sell and donate it to Mother Teresa. You
know, you're going to find places to sell it, you know, so you can sell more because that's your business model. And
so, you know, what happened, you know, in the institution of methadone is that the um the numbers expanded widely. you
know, the the the the opioid epidemic we had, you know, in the 90s and whatnot,
certainly bad like the three waves of the opioid epidemic, you know, um Oxycontton, um uh rise lowering heroin
prices and then fentinel so forth. But but what's ignored is the fact that there really wasn't much of a heroin
market at all, you know, in what David Courtright calls the classic era of narcotic control and right and it came
about, I think, with the institution of methanol. Anyway, so I apologize for the diet drug, but um what do you think
about whether kind of the secondary marketplace that's stimulated that makes the dealers again not become travel
agents and lawyers and whatnot, but stay drug dealers and just find different marketplace and so forth. What do you
think about the that that kind of idea of the kind of the market expansion? Well, I think there's a lot of
historical support for it. You know, I mean, I think you can see the exact same analogy with the cocaine market turning
into crack, right? Cocaine in the early 1980s was extraordinarily expensive, prohibitively expensive, right? It was
more expensive than a gold. Um, but when you combine that cocaine with a very cheap filler like sodium bicarbonate and
some water and you turn it into crack and all of a sudden you make it widely available on the street for$5 or $10,
that expands the user base and of course it also expands the problem it's it's causing. Um, I mean this is this is
going to happen no matter what. This is something that Percy talks about a lot, right? If you expand the amount of opioids available, the opioid pres the
opioid problem is going to is going to increase. I don't have any argument against that, but I do think that there
were a lot of people at least in the late 90s and early 2000s who were
interested in addressing rising heroin use because even though it was small, it was still rising and like there there
there were issues with heroin in the 90s, right? It was it was becoming an issue. I I totally agree. Yes. Right.
But there there weren't problems in the 50s and there weren't really problems in the 60s. Oh god, no. But but of course you had
World War II destroying global trafficking networks. Well, there were no problems in the 30s. There was no problem in the 30s. There
was no problem. Yeah, that's true. There was no problem in the 20. You know, the the classic era goes from the
20s with prohibition. Um up until up until really the 70s um the 60s,
whatever. And and you know, you you covered Vincent Dolan, Marie Niswander,
however you pronounce it. Nice one. Nice wander. Think about like you're taking a nice wander through the water. It's nice
and Mary Mary Gene Crick I think it is um Creek. Yeah. Uh and that the interesting triumvirate
at Rockefeller University. Um they they came up with this methodone idea but but it wasn't instituted to treat drug
addiction. Um it was instituted to reduce crime. Um
well that's it's both. I mean it it it is both,
right? And I don't like sometimes I feel like people really glom on to this idea that oh it was just to reduce crime but
of course like it was but reducing drug addiction and crime simultaneously. I
don't think that they ex each other out and you I like if you go back to kind of like you put yourself in that moment of
like the the mid1 1960s into the late 1960s when crime was escalating like out of control. I mean like cities are
burning. It's not a bad idea necessarily to want to reduce crime. Now, the
connection between drug use and crime is axiomatic at the time and today. And as
I wrote about in my book, treatment doesn't necessarily bring down crime.
But I don't think that using like politicians and for the most part
doctors like they're not going to do a lot of things without something to justify their involvement. and
politicians particularly really want to have like very concrete um
concrete objectives that they can achieve and bringing down crime is a huge one. That's what literally got Nixon into the field in 1971 was the
1972 election was coming down and he sure did have to bring down crime which sure was rising in the late 1960s and
early 1970s. Uh so there was a a use of
drug addiction to bring down these levels but it was not the sole cause. There were a lot of like Dole and Nice
Wonder I found in my research and talking to Dole's son and talking to people who are connected with them. They
were very they were good people right they were benevolent people they like they cared
actually like Nice Wonder especially who had a Freudian psychoanalysis clinic for 10 years in East Harlem. She was working
with these people not because she just wanted to bring down crime because she was some kind of like Rudy Giuliani like let's let's get this taken care of but
because she actually cared about these individuals and bringing down their crime was simply part of it. Yeah. You know caring is is wonderful.
Um there are a lot of caring individuals but uh I I like to look at effects. I I'm kind of a Giuliani Fran fan. I grew
up in New York City and you know my teenage years were in the 70s. I got mugged a couple times in subways and
Yeah. You know it. You know the crime. Well, but Giuliani, you know, didn't have a magic wand, but he changed my New
York. You know, my New York was was one that's a lot more like today. You know, it's more like the 201s and 2020s and so
forth. Um, there was, you know, was the flowering graffiti. Um, we didn't have
homeless on the streets, I have to say, to the same extent we have now. We didn't have those scaffoldings around the buildings. Uh, a few differences. And immigration
was different. It wasn't, there were some, but it wasn't like massive. So what but but you know Giuliani made New
York a jewel. It was it was a people were avoiding New York City. There was all this flight from the city urban
flight in general. You know Detroit was kind of the paradigm for this. You know people just left the city. They were and
and Giuliani rejuvenated and it wasn't that hard. You know you can argue about his methods. I don't think they were that draconian. It's not like um you
know like El Salvador had huge crime just a couple years ago and and um Kelly
you know stopped crime. I mean, you know, it sometimes you have to break a few eggs or whatever, you know, and I'm I I I put this out as a separate issue,
but you know, I'm not a Mauist by any stretch of the imagination, but um um
you know, I kind of hate Mao. Um and I hate everything he stood for. I hate these uh you know, what do they call
them? Those struggle sessions and whatnot. I I hate the cultural revolution. I hate all kinds of things about Mao. Anyway, um but Mao adopted
came into a country in 1947 that was riddled with opium and there was a huge
heroin addiction problem and opium and all that kind of stuff and um you know he was a less nice guy than Giuliani and
he started hanging uh opium dealers and heroin dealers and so forth and and he didn't hang that many. I think they were
in the handful of hangings. Um I'm not sure what the the you know like a murder of crows. um you know I'm not sure what
a you know how many hang hangs hangings he did but but basically the the whole opium problem disappeared you know this
there's this thing where there's a permissiveness um you know so you know there's a lot of that Vincent Dole
espoused the disease model he actually called it a metabolic disease opiate yes use now he did this with zero data and
zero formulation never described what the metabolic problem was aside from the fact that people were using opiates fine
um but well but they didn't know about the opioid receptors at the time I he's writing He's writing about the metabolic
disease in the mid 1960s and he was basing that off of his study and he was I mean he was someone who researched
obesity in the human body prior to this point. He was simply I think translating his previous research current research
on I I I I disagree with formulation. I mean we we you know we have food receptors but you know we don't have
disease by eating food. You know it's like you know you you can put a disease model on almost anything that we do. I mean I I you know I like playing sports
and I like getting a runner's high. doesn't mean I have a disease per se doing that anything, you know. Anyway,
so there's like I'm kind of veering away from a question here and I apologize,
but um you know I I suppose the question would be since we're on Vincent Dole and and
Nicewander um nice wander. I'm sorry. Um yep, nice wander through the woods.
Yeah. Um you I guess we we done with crime. I mean, Jerome Jaffy like said in
Senate hearings that that this was a a a program to reduce crime. Um, you know,
crime wound up growing anyway. And I guess we're talking about Giuliani and draconian aspects and so forth and and
kind of the ethos of the of the and spirit of the time. You know, there there's kind of this kind of movement
one way or another about liberalizing rules around narcotic usage. Um, maybe we could talk about some of the
experiments that have been happening. I I know you're familiar with Switzerland. Um, I think Zurich had a needle park and
uh probably uh one in uh Lisba in Portugal and so forth. Um
you know, Portugu Portland, not Portugal, but Portland, I think legalized heroin a few years ago. They
undid that. Maybe we could talk about kind of the ethos and spirit of you know, where we st sit on this field. I
mean, it seems like there's a few different pendula that are swinging back and forth. Sometimes they hit each other.
For sure. For sure. Well, yeah. How do you want to approach the subject? I mean, [gasps] Oregon is Oregon was such
a disaster. [laughter] Like Oregon, Oregon's experiment with decriminalization was such a mess. Um,
and I think that actually speaks really well even to something we were talking about earlier, which is a versus a a
national even versus like a state-based response. Oregon was I was talking to a
buddy of mine at the ACLU. I think it was like 47th or 49th out of the country
out of 50 states to uh for for treatment availability. And what they did in I
believe it was 2020 or 2021 when they decriminalized the possession, personal possession of of all intoxicating
substances was to allow people to take either a $100 fine or like call a number
and then go be placed into treatment rather than being incarcerated or
punished for for their drug possession and use. In theory, we've seen it happen
in other places, and it's a very kind and wonderful idea, but you cannot put the cart that far ahead of the horse.
Oregon did not have the infrastructure in place to actually create organizations where all of these people
could be funneled into. If it's not the prisons, which obviously do exist, they can't go to treatment facilities that
aren't there. So what it allowed for was simply the acceptance of open air drug
use with no no remediation or uh or responsibilities whatsoever. And very
quickly the entire state was like this is awful. It's really really bad. Now of course it was combined with a pandemic
with um housing crisis with the rise of fentinel. I mean it was it was a perfect storm for a whole lot of things to go
wrong but Oregon was not in a place to actually allow this to occur. And of course they're they they kind of had to
eat their words. And um most of drug possession was recriminalized in I believe 2024. But that's not like you
can't go about it in this way. And there's also like a very different cultural construct in Oregon versus
Portugal, you know. Well, I know it's always it's always the the phrase about communism has never been done right. You know, there
everything every time it fails because it's never been done right. I I think that there's, you know, a little bit of
excuse making about it. Um I I I am not a harm reduction kind of guy. I I like the words. I like reducing harm. I spent
my whole life trying to reduce harm in an individual basis. Not just for myself, but my patients. I want to reduce the harm they might have from
some future illness or the harm they might have x y and z. But the concept as a public health maneuver, harm reduction
has um whatever benefits it might have collectively, it it takes away incentives for for growth individually.
Um what's what's an example? Well, you know, the one is like say condoms in the middle school. um
there the idea is well we don't want teen pregnancy we don't want um I don't know teen veneerial disease whatever we
don't want this we don't want that so we will put condoms in the middle school and and you know if you ran a Catholic
school and I I think this is instructive actually because cath religion kind of falls into the addiction realm in a
sense I mean the the the drug addiction rate amongst Mormons practicing Mormons is effectively zero um and and the same
you know they're they're genetic conjuners you know in the Midwest in mountain states or whatever, you know, have a much higher uh drug rate as well
as alcohol and whatnot. So, you know, religion is kind of not quite it is it is a church that specifically
does not allow for it. It's like very similar to the Seventh Day Adventist church which is like huge around here no alcohol, no caffeine, no meat. I mean,
if you have a religious imposition that says you are not allowed to do these things, that's a pretty strong motivator. I Well, I understand that. But that
that's to the point of what we need to fix this. You know, a lot of these things are kind of replacement drugs.
So, they're getting to the harm reduction model and again condoms in the middle school. You know, there's there's a Bob Newhart um episode. Uh the late
great Bob New Hart. Uh company comes in for his office. She had a problem XY andZ. And he's like going to give her advice. It's like he's only going to
need $5 going to be three minutes. She's like, "How can that be?" He's like, "His advice, cut to the chase." He's like,
"Don't do that. Stop that." You know, this hurts. Then don't do it. Yeah. Yeah. But but it's like what we've done
said in in because the we have nice people you know Marie literally named nice wander um you know people have with
with kind of um softness in their heart and the grace of of wanting to help people doesn't mean they always do and
it doesn't mean that that their ideas can translate into policy and and and people are funny things you know they
sometimes go counter to the way that that the help would be there you know so
that if we give some if you again if you have free condoms in middle school. You know, the message to the middle
schoolers is, "Oh, we haven't been having sex. We should there's condoms. They're expecting us to have sex." You
know, you know, every time they've improved the helmets on snowboarders and
every time they put on better braces and and you know, better this and make things the sport safer, the snowboarders
jump from higher heights. You know what we see now? We have a you know, people bicycling down mountains, whatever. You
a lot of the times that we think we are reducing harm. What people actually want is the thrill and they they they go up
to the edge of where the thrill is. If you draw the line here, you have kids, you know, you draw the line here, they
they want to go there. And if you if the line were there, they want to go the thereer, you know, wherever it happens
to be, they want to touch up against that because that is the essence of our discovery process. You know, as babies,
we put everything in our mouth. We feel the world through our tongue and whatnot. And over time we have to experience the world a lot. I'm not I'm
not recommending you know kind of freef fall for people. But I'll just put this out as a kind of question and you know
over the same duration. Have we seen an alcohol epidemic? You know alcohol is freely available at a liquor store you
know bartenders and wherever um and even amongst teenagers and so forth they can
all find and get it. You know people alcohol is dangerous you know in excess and whatnot. to be a deadly and frankly
alcohol withdrawal is more deadly than narcotic withdrawal but we don't have a government apparatus. Have we seen the
same kind of expansion in alcoholism andor you know an opioid excuse me an alcohol epidemic when it's not something
that the government has you know had some kind of cure for you know by by virtue of of of you know kindness and so
forth. Well I mean alcohol deaths are about 178,000 per year. cigarette deaths are
about 480,000 per year and we're just now below 100,000 opioid over or drug
overdests per uh drug overdose deaths per year. So it's I mean it it's kind of
like this is an issue I have with the people who are are very gung-ho just for
legalization. You know, it's like well if we just legalize all drugs then you certainly have them under control and
and regulations and things like that. And I don't necessarily believe with that believe that. Excuse me. Um, I'm
sure you're familiar with the the iron law of prohibition, uh, which was, um,
Dick Cohen wrote about that in the 1986, uh, National Review article. And then he
actually went on to become the executive director of Normal, the National Organization for the Reform of Marijuana
Laws. He was like the only sort of like uh, conservative Republican uh, executive director in the organization's
history. But he argued, and a lot of people kind of glom on to this, that uh when a drug becomes prohibited, it
becomes more powerful because it's easier to traffic a very small amount of fentinyl that can get 40,000 people high
as opposed to a very large amount of morphine or opium, which is bulky and, you know, like it's very hard to hide in
in, you know, like your clothes or your suitcases or whatever. And that's true, but there is just as much an iron law of
legalization. And I think we're seeing that specifically in the realm of cannabis legalization. And we saw this
in the realm of oxycodone legalization. The only reason we went from a 20 to a 40 to an 80 mgram tab of oxycontent was
because Purdue Pharma was allowed to legally market these things. And the only way we've gotten to like 25 to 30%
THC cannabis flour and 99% THC dabs is because of the legalization of the
cannabis. these things are very very powerful because there's a whole lot of economic initiative behind that to make
them powerful because people are always looking to push the edge. I think that's I think that's entirely true but I don't
think that necessarily takes away the need for certain forms of of treatment or rehabilitation necessarily just
because people are always trying to push the edge. I do think that that treatment of and and rehabilitation should be available to them even if they are
pushing the boundaries. And the thing is like you're always going to have a lot of organizations and entrepreneurs who
are seeking to profit off of and I hate to use the word again but exploit those individuals who are looking to push the
boundaries. And 99% dab is not for like the like the user who's just like I want to relive my college days and smoke a
joint. Those are for that, you know, it's like the 8020 rule, right? like um 80% of the sales of most intoxicants go
to 20% of the most like sort of uh the highest the highest level users. And so I'm interested in in what you would then
say if you know how how does one respond to uh a situation like this because I
mean I think we've learned from the past couple of decades in the United States you can't necessarily just arrest
your way out of this problem even in dealers and things like that. You don't arrest you don't arrest everybody. So uh have you been you
choose to arrest then. Okay. Have you been to Japan? No, I was in South Korea in August
though. That was fun. Well, does South Korea have maintenance narcotics?
Gosh, what a great question. I don't know. But they um certainly alcohol is widely available. Cigarettes are widely
available, but I think they have pretty harsh drug laws. I would say in Well,
just to stay on topic, Addiction, Inc. is pretty much on the concept of opiates. Am I right? Hope you
Yes. Fair enough. So, um, [clears throat] for my book, um, which I hope you will
look at because I'd love to get your thoughts on it and maybe, uh, yes, you sent it to me. I started I I I
was just dipping in before our conversation, so I'll go back and maybe you can get revenge on me. Um,
you know, I I apologize if I, you know, give you, you know, kind of got you questions, but um, but I think you're
good and and you're smart. Um, you can handle these things. Anyway, [laughter] um but uh you know for my book I was I
was actually looking at Russia um which you know had we we had our kind of
heroin moment from the Vietnam War um and it kind of got into our experience. I mean obviously heroin is predates this
and you you bring up the interesting aspect of morphine clinics and you know morphine was there to treat opium and
then heroin was there to treat morphine. Get back to my little lady swallow the fly. and um and methadone was there to
treat heroin and in a sense buprenorphine is there to treat methadone. So you have is that five? I'm
not good at numbers. Actually I think that is five. Um you know things in succession whatnot. Um but you know
Russia had Afghanistan um their Afghanistan war uh I believe in the 70s
and um they had a lot of you know there's a lot of dope in in Afghanistan. There's poppy fields and and um um
heroin readily accessible. Um and they came up with a lot of addiction. So they had the same kind of ancillary problem.
We had the, you know, the golden triangle. We had uh we we had troops in various times, Laos, Cambodia, and
Vietnam. And uh there was, you know, not a lot to do there when you're off duty and and whatnot. People plus people were
literally in pain here and there. And so they were doing heroin. And the the the image and actually the interesting um
image from your book, I'm not going to show it here, but uh you have a Bill Sanders um
the editorial cartoon. Yeah. Milwaukee Journal Sentinel in 1971. Uh he illustrated I have my book here. I can show it.
[laughter] Fair enough. It's on uh if I can find it. Let's see what page is it on. It is on page 43. Um
thank you. And uh so the idea is that uh you know we are going to be mainlining into the
country. There's a needle and kind of these vicious devilish kind of uh fingernail
monstrous hand. Yeah. Yeah. Is going to Vietnam. This is got this is we're going to uh you know
there's the HL Mein said at one point uh dem theory of democracy is that people vote for what they want and they good
need and they deserve to get it good and hard. I think the concept here is we got we got into the Vietnam War
the Bard of Baltimore. I do love HL. Oh, it's great. And and so I think here
um Mr. What is his name again? Um Bill Sanders. Bill Sanders. I think he has a little
bit of um shenanoid towards the United States and we got into Vietnam. Well, here you're going to get this piece of
Vietnam, you know, heroin injected into your body politic and bodies general so forth. Um, I don't think this actually
happened. And I think a lot of the Oh, no, it didn't. Lot lot [laughter] the fright was there. I think I think Nixon a little bit got
hoodwinkedked into the methodone concept because of the presumed numbers coming
back from Vietnam. This was over and over. as a drum beat in the New York Times at the, you know, Erstwell, the
Times, the Urswell Times or the Times, um, that this is going to some this is a ticking time bomb and and whatnot. Um,
that that we're going to have all this massive influx of heroin addicts. And the fact of the matter is it it didn't happen. You know, there were heroin.
It did happen for a variety of reasons. And one of the biggest reasons that it happened was because Jerome Jaffy, the
head of the Special Action Office for Drug Abuse Prevention, or Seodap, just rolls off the tongue, um, instituted
urine testing in in Vietnam. And you would not be allowed to leave the war zone if you tested positive for opiates.
So, a whole lot of people stopped using heroin while they were still in Vietnam. And this was the biggest transformation
in the field because if you think about it, prior to about 1970, 1971, the general medical consensus was that
opioid addiction was a lifelong problem. You were never going to get off of it. This monkey was going to be on your back
for the rest of your life. But what happened was as soon as he instituted urine testing in Vietnam with a brand
new technology, the free radical essay technique or frat testing, which was allow which was this big bulky machine
like you know the way like computers were in the 1960s, right? was a huge machine. But they brought two of them to Vietnam. One was in um Saigon, one was
in um Long Bin, like the two main places that that service members were exiting the country. And a thousand service
members are exiting every single day, right? There's about 300 service members who are there in like the peak of the war in 1970, 1971. And all of a sudden,
you have to piss into a bottle and it's got to go through this little thing and it's going to show if you've used
opioids in the past 72 hours. And if you have, you are not allowed to leave a war
zone. There you go. And that's bad, right? People don't want to don't want to stay in Vietnam. So So
what what they were able to do, what many of these soldiers were able to, and this is the difference between heroin
use and heroin dependence/addiction. And Jaffy always knew this. He always knew that there was a difference. And
he's like, if you can get the people who are simply using periodically to just simply stop once they come back to the
United States, they're in a completely new environment. They're back home. They're with their family. They're with their friends. they probably will not
continue heroin use. The people who do have an issue, the people who are addicted or dependent, who do test
positive, yeah, they have to stay in detox in Vietnam, but when they come back to the US, there is services for them. And that's the biggest thing.
There was no I mean, this is what comes from um gosh, why am I blanking? Washington University at St. Louis. Her
name Lee Robbins. Oh, the woman. Thank you. Lee Robbins. She was this the report that she wrote after she followed 900 and some veterans
returning from the US after this urine test and all this when she realized that heroin addiction or opioid addiction at
large is not this lifelong chain that you have to wear around your neck and that was huge and but but no one had
proven that before and it took an example like Vietnam to actually give people so the thing that that puzzles me is we
have all these kind of dispositive evidence that this is not something you have to do forever but it But but if you
read the press and if you recreate the New York Times of the times um in New York the times of the times yes
well the uh [laughter] the times of the New York Times in New York um at the time of uh I can keep just I'll be here
all day anyway um you will find exactly the opposite that this ticking time bomb
uh image is is but that's the media firestorm. I mean that that well this has not been helpful you know
I think I think this became a perfect storm. I'm not a conspiracy guy, but I am a conspiracy of interests guy. Uh,
which is to say, the example I till I come up with a better one, the one I always use is I it's a hot day. I've got
an ice cream cone and uh maybe it's soft serve and I'm walking down the street enjoying it and I'm like looking at something and all of a sudden hot it
melts. It falls to the ground. Okay, the raccoons getting back to the raccoons or the flies, the insects, the ants. Um, I
don't know. The little old lady's going to eat all of those, by the way. She's just coming for them. Exactly. all those animals, um, pigeons,
whatever, they have no idea this going to happen. They're they're not conspiracy theorists about ice cream
falling in this spot. It happens. And they once the ice cream's there, there's a whole apparatus and engineering going
on. Who's going to get it the fastest? So, some pigeon's going to like try to whisk off at the whole thing. If it's a candy bar or whatever, and the answer,
if it's if it's liquid, they're going to be in the cracks that anyway, there's a whole operation to deal with the fact that I dropped the ice cream cone. So
nobody had the pre-ordained notion. There was no conspiracy about this happening. I didn't think I was what I
was going to do. It just happened. But once something happens, once there's an attractive nuisance um or moral hazard,
I guess you'd call it um there then then something happens beyond that. And so I think the the the
inst the conspiracy of interest where a few different things happening confluently um in in our world, you
know, Vietnam and this kind of concept that we had to get it good and hard for having violated, you know, whatever that
the the Vietnam, you know, sovereignity, whatever we did, we had to be punished and and this whole drum beat about the
the heroin thing is going to come bite us in the butt and the crime's going up and all this kind of thing. We need to
have methanone maintenance because Vincent Dole had come up with this idea and Howard Sweet and nice you know Maria
is and all kind of stuff. I think this was a bad idea applied and a wrong solution to a problem and I I you know
you bring up Marie uh nice wanders work in Harlem. This guy Robert Beard are you familiar with him.
I actually don't know the name contemporaneous. [clears throat] I have a Substack. I'll send it to you. I hadn't been either. I I found him
researching for my book and uh it said Harlem doctor blah blah blah you know
comes out against um you know the methadone clinics because he thinks it's
going to bring more crime people are already addicted to stuff why add more you know narcotic into the mix all kind
of stuff and I just assumed I don't know I assumed he was a local Harlem doctor but he wasn't he was an upper east side
uh fill in the blank I think a diabetist he was endocrine guy and he was doing insulin and stuff and on his own. The
guy's like a bleeping saint. I mean, he spent his nights going up to Harlem and
with crime and all kind of stuff, driving the subway, whatever. Or maybe he drove his car, I don't know. But he he wound up in in East Harlem every
night of the week and sometimes the weekends as well dealing with narcotic addicts and he he tried to get them
unaddicted but he had group meetings and no drugs and he you know
he might have I don't if he had anything palative or whatever but he his whole thing was to get them off drugs and he was just
flumxed flabbergasted um etc etc that this was going to happen. he was, you
know, yelling stop and and uh so I have a little piece on him does kind of a a
payon to his his great work and totally ignored. Um but I don't think he was wrong. You
know what happened was the the the rate the of heroin usage was highest in New
York City amongst the whole country and New York City was the highest in Harlem Bedford the black neighborhoods not
because they're black because they were poor they were they were had the highest rate when when it was like Italian and so forth because of the poorest area the
poorest area in New York had the highest rate of heroin in the whole country because it's a port city um and that's
that's where the stuff would land so the places where there were heroin problems through that era of classic control were
Chicago uh New York LA in Fort Worth because on the you know the Texas border etc. And that's where the heroin was
happening in so far as it was happening for those that duration and and the the rate was highest in the black population
and over you know over the succeeding 20 years um the rate in Harlem was no
longer higher than the rest of the country. So that sounds great but that's not because the Harlem rate went down. It's
because everybody else went up to Harlem's rate. basically we Harlem was up here and all the tide everybody else
wound up at Harlem's rate of narcotic usage and heroin use and so forth. So, you know,
I kind of feel like that the, you know, we can we could talk about answers and solutions. Uh, but I feel as if this
hasn't been it. You know, as if kind of the the harm reduction approach and that that you know, certainly, you know, we
we know people who die from from opiates and that's tragic. Um I just don't know if we've applied the right answer to it
given that say getting to Japan and and or Russia. Um that Japan does not didn't
have an opioid epidemic. They didn't for the whole duration of our you know whatever you want to consider the 90s
and zeros and whatnot. Uh they didn't have it you know and Russia didn't either. You know they Russia's got loads of problems. Don't get me wrong. I I
wouldn't trade places with being in Russia. I might if I were Japanese to you know trade in Japan. I don't want to
learn the language but if I whatever but but you know there are places that are there experiments being run right now
they're called other countries that don't do this and frankly amongst our states we have other states that don't
do it you know Wyoming does not do it um it's small place it's hard to you know get much data from that but Mary Jane
Creek you know in one of these memorials to methadone and and self- congratulatory you know she she feels
that that what we need is is universal mandatory maximum access to methadone um
but of course that's not What the that was not the only thing that Seodap was promoting at the time when they were really in power from 1973 or 1971 to
1973. It all kind of fell apart in 1974 with everything else that fell apart in the Nixon administration with Watergate.
But that this was not what necessarily Seab's emphasis was. It's by far the most controversial. It's by the it's the
part that got them the most flak. It's the part that turned Jerry Jaffy into like a a sort of you know hated person
in Washington. But methadone clinics that they were funding at the time were only about onethird of the clinics that
they were funding otherwise. They were funding a lot of other programs, a lot of abstinence-based programs, detox
programs, counseling, therapeutic communities, halfway houses, all of this other stuff. We hang this albatross
around Seodap and Jerry Jaffy's neck saying, "Oh, you're Mr. Methadone and you're pushing this on the country and
blah blah blah." But that's not what he was doing. He was um he was a big proponent of what he called multimodal
treatment options. It was what the person wanted and could help them the most and that was simply to be made
available to them at the time. Now remember, methadone is still very very new. In the 1970s, in 1970, I found a
report that only 9,000 patients were on methodone maintenance in the United States and Canada combined. In 1971,
that does increase because of SEOP support for methadone clinics. And that increases to about over uh there's over
72,000 people in federally funded addiction treatment care by the end of 1973. But only a third of those patients
are me are methadone patients. It's not this overwhelming this is our only response and we've got to cut down crime
and blah blah blah. He was funding a number of programs. And there was so much controversy about methadone. People
hated it, especially in the black community because you're like I mean you're coming at the end of all of those racial uprisings, right? people who are
saying like you after the assassination of Martin Luther King and all this other stuff, they're like, "We want better
jobs. We want better housing. We want better schools. We don't want to live in these slums. Like, why don't you take care of these problems?" And when what
they get are simply like therapeutic communities and methadone clinics, they're furious. They're like, "This is
not the response that we were looking for." And methadone has been controversial from that point on. But,
um, Jaffy very much dislikes that he is only remembered for his participation in
the methadone clinic system. And that was why the first six times I talked to him on the phone when I was embarking on
this project, he would he he he was like, "You're just here to tell me how awful methodone is and blah blah blah."
He would make me cry. Like it was just awful. And finally, I won over his um his I I finally won his his trust when I
was like, "No, I've read all of your papers at the Library of Congress. I do not think you're just Mr. Methadone. I think you actually instituted a program
that was much more responsive to the wide variety of needs of a wide variety of people who use drugs." And then he
finally started talking to me and he was giving me a lot of his papers that he did not donate to the Library of Congress that he kept in his basement.
And that's how I found out a whole lot about the other stuff. But it is not um
the Nixon administration wanted to get reelected in 1972. And in 1971, you have
a perfect storm of three things, which is rising rates of heroin use in the United States, rising rates of crime in
the United States. and the media freak out about addicted soldiers coming back
from from Vietnam, the GI junkie phenomenon, which of course did not materialize. But the Nixon
administration simply had to respond. So they do bring in Jaffy out of nowhere. He's he did not realize he was going to
be the nation's first drugs. He just kept getting invited to Washington and then all of a sudden he's put out in front of Congress and the and the press
and he's like, "Okay, we have a new drugar and you're in charge of $155 million, twothirds of the federal drug
budget. You better open as many clinics as possible." the the biggest number you possibly can and you better bring down
crime. I mean, he had a huge job in front of him and to his credit, he actually did it. Crime did decrease in
1972. It was a blip, went back up in the in the later 1970s, but he got it done
by supporting as many options for treatment as possible, not just methadone. And um he was a big big big
supporter of Lamb, Lalpha acetylmethad. He was a big supporter of Nalrexone. He was a supporter of all forms of
addiction treatment that would get people to the point where they were no longer living lives of desperation.
Right? And that's that I think is probably the most important thing I want people to take away from my book and from this conversation. Like it wasn't
necessarily just trying to get Americans on maintenance and keep them on it forever. There was actually a really
fullthroated support for a wide variety of treatment options. Um, and we've forgotten those and we've turned pretty
much all of those actually into like money-making exploitative opportunities today. And that's that's bad in my
opinion. That's where I come down on it. Yeah. No, I think you and I can agree on certain aspects of this. I I'm sure it's
not my only I I don't I'm not saying I'm the inventor of this term, but I use the term methadone industrial complex. And
um I agree. I think there is an MIC. [laughter] Yeah. And I I wonder and worry whether
there's also a suboxone industrial complex in a sense as well. There is. There very much was. And it
was actively created by Wreckit Benkezer Pharmaceuticals under the direction of Sean Ther I I don't know that precisely.
So with methadone, you know, there's no there's no pharma company, you know, there is one. There's Malenrot makes the
stuff, but it's all behind the scenes. It's all like the Wizard of Oz, you know, somebody behind the green curtain, all that kind of stuff. Nobody sees
methadone. There's not commercial. There's no methadone commercial during the Super Bowl and you [clears throat]
know I don't I don't even know if there's a brand of methadone. There used to be Dolphin or whatever but you know methadone is not there's no pharma push
for methadone. There's no public push for methadone and yet methadone has expanded year by year by year and decade
by decade. Um it may have been tempered a little bit by suboxone as an alternative mo you know modality you
know which dstigmatized methadone and got rid of the methadone clinic you know kind of stink whatever nobody want wants
to hang out there etc. Um but it's not the methodone industrial complex I think
has much more to do with physicians and institutions that own those clinics and
so they have a business model which is very interesting. I have an article I hope to get out in the [clears throat] city journal or someplace called the
Starbucks of narcotics and [clears throat] it basically narcotics. This the puditive title is
star the Starbucks of narcotics that Starbucks narcotics I mean I think good pun here
I really like that and so uh you know Starbucks in my theory would
would love not only to be able to dispense coffee but to get $50 every day for for for you know having you drink it
especially in front of them or whatever drink your coffee and down it and we're going to get I don't know 45 bucks from the federal government or state or
whatever for doing it. So, we're going to get a fee. Now, caffeine is addictive and people you could argue that oh,
there's no reason. I mean, I I don't want to give a good idea to Starbucks, but um you know, they they would love
it. You know, cigarette manufacturers would love to say, you know, we have this addictive product and you know, we're going to make sure we we dose
people the right whatever. So, but but on the other hand, methadone does and I think it has much more to do with
addiction and public health and you know if you look up uh you know the goo Google book uh engram you know the
frequency of term usage addiction um we think of addictionologists and I'm sure they have their conventions every year
but uh I I was surprised to see that you know it only came into being I think in the 1980s and it just grew as a term
that's not like diabetist you know somebody like this do Dr. Robert Beard literally was a diabetes doctor and
diabetes as a term has been around forever but if you follow kind of the medicalization addiction um addictionology um these are relatively
recent conception not addiction per se but kind of the treatment around it is is a new formulation and and getting to
the little lady in the fly I think the more things we do for this sometimes it we're not necessarily making the problem better and and I think we have to kind
of detox uh from a lot of the you know a lot of the uh ideas that we just think
are there. You know, if you ask a fish what's water, you know, he might not have any idea because he's like swimming
in it all the time. He doesn't understand water being poured or water turning to ice cubes or whatever, you
know. Yeah, that's just his world is water. And so I think we are in a world where we think this is what we do. We have
where, you know, methadone opioid, excuse me, um medications for opioid use
disorder. You know, we've created this stuff. the these are things that align with the addictionology,
you know, college fund, you know, if you're an addictionologist, you want to get your kid through college, you know, this this has been very very good for
the concept. All of a sudden, again, bartenders would love this, you know, if they could not only pour the drink, but
get paid 40 bucks for having seen you, you know, and bill it to some third party that you're not aware of and and
taxpayers not aware of. This is I think the real blackbox warning that should be out there that the methodone is a black
box. It's it's right in plain sight but and and and and I I would put a slash with buprenorphine suboxone that these
things are out there and there's been a huge expansion of it and it's been on the taxpayer dollar for the most part
and um and they've been growing and their their method is essentially you
know like thyroid replacement like you know they use their analogy themselves all the time it's like di like insulin
for a diabetic. I do not think this is the case at all. You know, if you haul up uh, you know, in an Istanbul prison
like that, Midnight Express, you know, some two guys with needles and one of them is a junkie with heroin, one of
them is an insulin um diabetic and you take away their needles because they're both bad people, whatever something, you
know, the the diabetic dies in two weeks. That's it. And the the heroin guy is like feeling awesome in in four
weeks, not two weeks. And so you know this this concept where we are treating this but we don't treat addict you know
sex addiction we don't have you know we don't have replacement um you know therapy for Tiger Woods you know to get
see hookers we don't have gambling replacement you know where you go to Las Vegas only twice a week you know we
don't do that for any of the other addictions I think you know people are addictable clearly um to various things
um but I I think we have this idea that we are helping people by helping them
and sometimes they they are only helped when they you know craft their own exit
and it's a it's a it's a difficult thing. Well, I think you should talk to Sally Satell. She's a doctor here in DC. She
actually works in a methodone clinic and her book is coming out. I have the galley. Um uh not a disease.
Oh, there you go. Rethinking addiction in the heart of America's opio overdose crisis. She went
to uh she spent a year in Ohio, Iron, Ohio, I believe. And uh this book's
coming out and I think she would be someone who you could talk to specifically about that kind of stuff because she I think is very much a
proponent of that idea as well. Well, sort sort of I mean we've exchanged emails and without without
revealing any private s I've been in contact with her for like more than a decade. Um
and Sally's great. Yeah. I've never met her and I will asked to be on the show and u at first she said yes but that you know my ideas
about methadone are not hers and so she works for a methadone place. I don't know. You know, I'd love to hear what her concept in that book is. Maybe you
could report back uh to me or whatever. I don't want to get you to tell. I'll give you a full report, but but I think there's there's, you
know, an interesting aspect like I I've actually interviewed I don't know if you know Theodore Dal Rimple. Do you? Um his
he's writes for City Journalist. His name is Anthony Daniels. Uh he he eventually dropped the um the pen name a
few years ago. It's a great pen name though. Oh my god. Yeah. He I he told me how and why he picked it. There's another story.
You got to watch the show. Um, but brilliant man. I I he totally, you know,
you know, he's kind of my idol. Um, and he wrote a book in UK called Junk Medicine.
And here it's called Romancing Opiates, which is a less less good title, but if you want to find the book and uh
he covers a lot of things that I saw in real life, you know, IRL as the kids say. Anyway, um I want to give you the
last last words and I've taken a lot of your time and I apologize. Um, but I very much Oh, this is fun. This is a joy. Thank
you for having me. This is great. Um, and uh um I like I could come up
with a a last question. Um, but but why should people find and read your book
and and again, you did kind of some of the take-home messages, whatnot. Um, where do you think the best place for us
to go with addiction treatment would go would be? Well, I hope people read my book. It
would be great if you did. My publisher would be thrilled. But I think we we
treat substances like methadone and buprenorphine and nrexone as sort of these fixed ideas that they just sort of
arrived in our life and in our community and in our society and that's just how they've always been and that's just how
it is. But there is a whole lot of action and historical building that goes into creating the systems in which these
drugs now exist. And my book exposes and explains exactly where those systems
came from. And I think it's kind of interesting the fact that Richard Nixon in 19 on June 17th, 1971 created this
federal office, executive level federal office to oversee addiction treatment in the United States and it spiraled into
something now 56 years later which is radically different. Is it better? Is it worse? I mean, I think that's up to the
individual to say, but I do hope that if people are interested in understanding how we got to this point that they read
my book and they figure it out. I've been um really having a lot of fun talking to uh medical schools. I've been
talking to federal offices. I've been doing some consulting for people who are interested in understanding the mistakes
and the successes that we've had in the past and how that can influence the future of addiction treatment. Now,
going forward, I mean, I am not a licensed medical practitioner. I don't
know what's going to help, but I know a lot of people who have really benefited from that. I know a lot of people who are on it for a while and they've
tapered off and they're living great lives. And I know a lot of people who are dead and I don't know them anymore because they're dead. But I do think
that I I I I'm just on the side of the individual who's struggling, who needs
help. And I'm a big fan of offering them a suite of options with sustainable and
supportive people to allow that person to achieve whatever sustainable and
supportive sense of sobriety and remission and recovery looks like. I am not here to grind an axe. I really just
don't want my friends to die anymore. That's my That's my platform. It's a
hill I'll die on to not see my friends die. That's it. Well, that's awesome. I'm I'm the one always grinding axes. I keep I keep a
whole bunch you can't see them, but I keep a whole bunch sharp behind me. [laughter] You're a wood chopper. I get it. My wife
here. My wife thinks grievance is my chew toy. And actually, it's not quite true. Um I
I kind of enjoy the day most days, but there are things that I think uh need to be called out here and there and so
that's somehow fallen to me and I'm I'm currently now an old um so um at the
latter part of my career I kind of you know say what I need to say. Um anyway, thank you so much Emily. I it's been a
pleasure. I hope I can have you on again um and uh discuss any slashall of these
ideas and topics and it's been a complete pleasure and joy. It's been such a pleasure. Thank you so much for having me. I really enjoyed it.
And as soon as you get like a hundred patients per uh physician cap, that's when it really becomes this sort of like
hardcore commercial enterprise just because people are always trying to push the edge. I do think that that treatment
and and rehabilitation should be available to them even if they are pushing the boundaries. And this is the difference between heroin use and heroin
dependence/addiction. But there is a whole lot of action and historical building that goes into
creating the systems in which these drugs now exist. So what it allowed for was simply the acceptance of open air
drug use with no no remediation or uh or responsibilities whatsoever. We haven't
done anything when we've had over 100,000 overdose deaths per year. Very few people understand that these three
drugs.
[music]
[music]
[music]
Welcome. I'm uh here and honored to be with Emily Duftton. Uh she's a PhD in urban studies perhaps. Uh she'll maybe
rectify that uh uh term, but she's a historian. She's the author of a few a
couple books on addiction. Uh most recently, Addiction, Inc. uh Inc. period um as in incorporated and it came out
University of Chicago I believe April of this year and it's an interesting read um she goes over the history of
methadone and um I suppose maintenance therapy um principally concentrated in
the 60s7s and beyond and um it has policy implications for today for uh
narcotic and drug treatment um I thank you so much for being on Emily u what
did I get wrong first of all and uh tell what [laughter] what what inspired you to to write this book?
Oh, well, thank you so much for having me. I'm really happy to be here. Um, my PhD is actually in American studies,
which is uh sort of a nebulous field of study. Uh, but for the most part, I focused on American history and cultural
uh cultural history specifically. Um, I was inspired to write this book because I grew up in Allentown, Pennsylvania,
which was very hard hit by the prescription opioid epidemic in the early 2000s. uh and a very good friend
of mine passed away. He committed suicide by hanging himself um from a
tree in the woods behind our old middle school after about 15 years of steady and escalating and increasingly chaotic
opioid use. He was only using pills. He never injected heroin. He never joined
in his roommate's use of meth, but he was very much a person who became extremely dependent on prescription
opioids. And when he passed away, I was very uh upset by his death because he
was a good buddy of mine and I really enjoyed his company. Uh and I was very confused by it because I thought he was
one of the most vivacious person uh people I'd ever met in my entire life. And to lose him when he was just 30
years old was very disturbing. But of course, it wasn't just him that we lost. There was actually a number of people
from my old high school whom we had lost to either um overdoses, opioid overdoses
or uh suicides for a number of years to the point where you would go to a
reunion and they were just getting smaller and smaller because our population was just being cut down. And I was really upset by this because it
was a small high school. We were all very close and I was losing all of these colleagues and friends of mine. And so I
had just published my first book which was about the history of cannabis activism for and against legalization
from the 1960s to today. And I was kind of fishing around for another topic to write about. And I realized my friend
Dana's death posed um kind of a research problem that I could start to maybe
potentially write a book proposal for. So I started asking a lot of the doctors and researchers and experts whom I had
come to know through my years of working in drug history um what they would have done if my friend Dana had presented for
treatment. And this was back in the long ago days of 2018. And every single one
of them unanimously said he should have been placed on medicationass assisted treatment which was the term for uh this
protocol at the time. I know it's moved on to mode or mood medications for
opioid use disorder, but uh I continue to use medication assisted treatment just because it was the term that was
used by the federal government, scientists, researchers, doctors, and patients at the time. And I still think it's actually like a really good sort of
all-encompassing treatment uh term. Um but they said he should have been placed on Matt, MAT, medication assisted
treatment. And I asked what that was. I mean, I was familiar with some of it, but I wasn't deeply familiar with it.
And they explained it was the use of one of three FDA approved drugs either methadone, nalrexone or bupinorphine uh
in con combination with various other services to allow a person to move away
from street or elicit or chaotic drug use into a form of recovery. And I was
like, well, you know, sounds great, right? I'm coming at it from I have no
medical background whatsoever. As I was saying to you before, the sight of blood makes me incredibly queasy. Um, but I
was intrigued by this. I was like, well, what are these three FDA approved drugs? Why aren't they so well supported by the
number of people I'm talking to? And of course, why didn't Dana get them or the
number of other people who had died from my high school? Why didn't they get them? And that launched me on an 8-year
process to dig up the history of these drugs, where they came from, who
developed them, and why. and of course why they are not necessarily uh a strong
or a sufficient enough response to our larger opioid epidemic today. And that's
kind of what brings us up to and you're right, my book was released in April, April 13th of this year from the
University of Chicago Press. So that's that's that brings you up to today [laughter] or six months ago at least when the book
came out. Congratulations. I assume you've done the book too and interviews and so forth. uh what what's the uh this is not
to just save myself time but what what's the question that challenges the most or you find most memorable what's the point
that you want to bring to bear on on the public um for their knowledge and and
where do you think their lacuna absence of of expression and knowledge on this topic is or are
I think the biggest lacuna is that we very few people understand that these
three drugs all three of them and including actually a fourth drug that was also developed under the umbrella of
medication assisted treatment but we no longer use it today. They were all developed as a very radical public
health program in the 1970s which over the past 50ome years has transformed
into extraordinarily privatized profitering uh sort of commercial um
expedition today. And that is not necessarily functional for actually treating the opioid epidemic in the
United States. And it's too bad that we lost this public health uh sort of commitment to it. And I think we blame
the wrong people and we don't fully understand the history. And that is sort of the I mean that's sort of the driving
the the the driving uh force behind what I what I wrote. Um and why I'm trying to
bring this history back into the public light. Yeah. You know the seven blind men and the elephant. You know that parable.
Mhm. Sure. Yeah. I mean I you and I come at this a little bit
differently. I'm not going to I'm going to kind of suppress my my natural urges um [laughter] for a little bit, but you
know, I um um you know, I'm aware of the MIAT aspects
and and the drugs that are in in use. Um I I'm not sure I agree with your
conclusion, but this is kind of would be at the end of this interview, but um while we're on this topic, um you you
the way I see it, the way I interpret your book is that um the kind of fall
from grace was taking this MAT, this kind of at the time was methodone
treatment. There were there were other things as well. was the LAM and and and Nrexen, but principally methadone for
decades until bupinorphine came about um 2000s. Um but you see kind of the uh the
fall from from grace as the privatization of methadone clinics. Is
that right? I have that right? And and and similar along those lines, just to extend the question slightly, I apologize. um it would be that you would
see the the model um being more uh state controlled and or federal controlled um
to take the profit motive out of the methodone clinics. And so my my ancillary question on top of whatever
you want to discuss about that would be how would that improve things? Well, I don't know if it necessarily
would at the point at this point, right? I think is it's a little bit too complicated but I mean other countries are completely sufficient at
providing a level of care whether it comes with MAT or not for opioid use disorder or any other form of substance
use disorder that doesn't necessarily exploit patients and treat them simply as customers in a system to be uh you
know to be sorted profited off of and I don't know if that necessarily needs to be federally controlled. The United
States is obviously a far larger country than places like Switzerland or Portugal that do have systems like this in place.
But I think on a state-by-state basis, you can make this stuff available in a non-commercial way. I spent a lot of
time in St. Louis, Missouri, uh at the u at the um clinics that are run through
ARCA, the assisted recovery centers of America through Percy Menses, who I know you know as well and you interviewed. Um
he works very closely with the state government. He works very closely with a lot of other partners to provide
resources to individuals who are seeking help. And he does not exploit these people. He doesn't make uh he doesn't
make these programs available in a way where like you're charging every single day when if someone walks in the door.
These are a wide variety of sources that include medication, but he mostly focuses on buprenorphine and nrexone,
which is of course an opioid antagonist, so you're not necessarily on maintenance for the rest of your life. He also
provides things like food, housing, job placement. Um, there's a wide variety of resources that are available to people
in St. Louis and beyond through ARCA that I think are a model that other states could follow. The nationalized
system that was founded in the US in 1971 is an extraordinary moment in
American history, but I don't know if it's necessarily something that we could recreate now. I think there was like this moment and there were a whole lot
of factors driving what Nixon was doing when he instituted this model, but I don't know if that's necessarily true
anymore. We don't have the same models. We haven't done anything when we've had over 100,000 overdose deaths per year.
Um, but I do think on the state level, especially with money that's coming through either the opioid settlement funds or through the state uh state uh
uh federal funds that go through the states, there's a lot of options and opportunities to make treatment
available to individuals outside of commercial entities that I think would be valuable to pursue.
Yeah. So, um there's a lot there to parse. Uh hopefully we'll come back to to any or all of it. Um you did mention
the settlement. So this is interesting to me. Um, I wrote an article on uh Purdue Pharma and I I'm not a you know,
as a as a physician um you know before I I I wound up treating people with buprenorphine in the 2000s but before
that I was uh um alive and well and and treating patients from the 1980s on and
I had my own place in River Massachusetts 1987 on it's like a primary care office walk and whatever
and so I had my regular codery of patients but I would have um kind of a little bit don't don't misinterpret this
anybody, but you know, if you have a bright light out there in the in the summer, they're moths. Now, you may not
want them, but they're attracted to the light. Now, there's a great great Norm Coleman joke about this. Uh, I recommend
people look it up. It's with Conan and Brian. It's one of the great jokes of all time. Anyway, um, and so having a a
clinic like that, a storefront clinic with walk-in aspects, uh, I attracted a lot of people looking for drugs. uh poly
we call they call it poly pharmacy but really it's also poly doctoring um because they have uh frankly the
opposite of lack of access they have complete access they have you know at the time it's called Medicaid cards then
became mass health cards Massachusetts but it's basically they have you know formal welfare benefits um and they have
cart blanch um to to see physicians and they would do that over and over again they would um kind of like um you know
on the merry ground they collect the rings if that's still a thing um or Pokemon, collect them all or whatever.
So they they would go from doctor to doctor and they would kind of stop at me and uh I actually heard later on that my
term in their group was Dr. No, the James Bond villain, right?
I kind of think of myself as Dr. No at all, but but they they just had Dr. No because I would say no because I had
this thing where I while they were, you know, signing in, whatever, you know, it was kind of like there were things about
them that kind of rang a bell for me. you know, they'd come from another town, they had pain that wouldn't be solved by
just low-level percoet. They needed, you know, uh, higher level oxycontton and so forth. Anyway, um, but I would call
smarteries and see that they had had prescriptions yesterday, for instance, for right 90 of X and 30 of Y the day before and
what and it was kind of before computers a lot of this stuff. I mean, not quite, but before the the integration so
anyway. Um but so that that's kind of a little of a background of stuff I do. But um you know
and these people were these people were seeking um or various other pain
addiction treatment. They would want Oxycontton or or something of that level. They wanted some higher dose um
you know prescription narcotic um and they liked Oxycontton but it was
Oxycontton anyway. So I'm I'm doing two things some from opioid painkiller but not like a not like a treatment drug. They're
looking for specifically like a painkiller. Yeah. Well, yeah. And mind you, I think a lot of them were selling to be honest with you. They they were collecting and
selling. So, they were scavenging. You know, I actually call it raccooning. It's my own term. I don't know if anybody else used it. Um, you know,
raccoons are are reasonable animals out in the wild, but, you know, in the urban environment, they're they're they're tipping over garbage cans and hunting
for what they can. This is kind of the raccooning aspect where you're collecting stuff. Um, anyway. Um, but so
so that's kind of my own interaction with continent in the day. Um, but more recently, you know, I I re I re because
Purdue paid out this huge settlement. Um, and I researched it and and and to be honest with you, I kind of feel like
Purdue was scapegoed. Um, Oh, yeah. A bit. They were and they're not paying as much as they
could. And there but there's lots of other people who are paying the money, too. Well, yeah, but but they went my only point there's a long roundabout. I
apologize, but I think, you know, like Willie Sutton, you know, why did you rob banks? Because that's where the money
is. uh they went after Purdue Frederick uh at the time or Purdue Pharma because they had been bestin-class. They were
making kind of the boutique version of these narcotic pills and and their pills frankly were not the ones people were
injecting and so forth. That didn't that wasn't really the basis of the injectable um crisis. You know, people
were smooshing their their other narcotics and snorting all kinds of stuff. Um and they actually made an
abuse deterrent formula. And I think they their actual component of the number of pills that people were
overdosing on was was minuscule. was never like never bounded beyond like 3 to 4% of the total. So I think there are
other characters but they were generic and they weren't making the profit margin anyway. So that that's a little
bit of a preface a little bit about me and so forth but I apologize about that. But in Diviar, which is a a um a I guess
a a submerger of Wreckit was wrecked Coleman originally. Then they made
Buponorphine um as a as a um an analesic pain medication like a narcotic and then
it became Wreckit Benkeeser. They they merged with like Swiss company or something like that. Dutch Yeah, it was a Dutch.
Dutch. Thank you. Sorry about that. Um but you know in a in a sense it's exactly almost the same paradigm or
parable of the Purdue aspect which is they did exactly what the government wanted. Purdue was asked to make an
abuse deterrent formula. They did they made the perfect one oxycontton one I call it. Then they actually a few years later made Oxycontton what I call
oxycontton 2 which was even better. It was better like dumb and dumber was it was better than the than the previous
better one which was better than all the other ones because you could not snort it and so forth. you couldn't abuse it and the actual hardcore drug addicts
didn't want that stuff. I but um but my my point is about the settlement part.
Um whether you I don't know it's really more kind of recent thing. Um but I it
feels feels to me like they went after um Wreckit Ben Kaiser um because they
were pushing this thing but they were asked to push it through the data 2000 act the drug addiction treatment act 2000 under Bill Clinton. So I don't know
if you want Well, they weren't asked to push it. They were they were simply allowed to. But that's you're entirely correct in
that there are very strong parallels in between record Bener that then turns into indivce
like the heat really starts coming down from the DOJ the department of justice uh investigation and Purdue. Those those
parallels are made explicitly clear in the 2020 um sentencing of of Sean
Thaxter who was then uh RBP's recorder pharmaceuticals RBP's um at/indivor's
CEO what um what RBP did with Suboxone which is their version of bupinorphine
that was uh explicitly allowed to through the data 2000 the drug abuse and treatment act of 2000 which was signed
into law by Clinton uh President Bill Clinton in um I believe it was October of 2000. It was the first time that
physicians were allowed to prescribe maintenance medications in American history in about you know 80 plus years
since the 1914 Harrison Narcotics Act cut down on that availability and of course since after the morphine clinics
that were somewhat widely available after World War I and then got shut down
in the 1920s. Once those closed, um, there was no, I mean, like, uh, David Herszburg, who is a a drug historian up
at the University of New York in Buffalo, he wrote a great book called White Market Drugs, and he found that there was a little bit of underground
opioid maintenance um, going on after the after the Harrison Narcotics Act and
after the morphine clinics across the country closed, were sort of forced to close in the 1920s. The last one finally
closed in 1923. But of course, this is very small. It's very low level and it's very very very underground. So this
stops for about 80 years until it's resuscitated and revitalized by the data
2000 act. And that act simply allowed physicians to prescribe controlled
substances in schedules 3, four or five for opioid maintenance from their
private um from their private offices. uh private uh private far uharmacies
were allowed to distribute these drugs. But it made no specific it it didn't name buprenorphine. It didn't name
Suboxone. It didn't name recordbenkeiser pharmaceuticals. It simply said those substances in three, four or five,
schedule 3, four or five were allowed to be prescribed for this purpose. The only drug that was in schedule 3 that could
[laughter] be prescribed for maintenance of course was buponorphine. Now recorder
actually made two formulas of the drug. One was a purebupinorphine formula called Subutex and they never really
focused very much on that. Now data 2000 says that it's you're allowed to prescribe it but that was very much
withheld and sort of uh quarantined to specific circumstances like women who
are pregnant um ERS things like that. It was never a big seller. It was never the focus of the company. Suboxone was very
much the focus of the company. And that's a different drug that is four parts buponorphine combined with one
part nlloxxone to uh avert misuse of the drug because if was someone was to now
remember back in the 90s and early 2000s the only formula available of this drug is a is a tablet and it has to go under
the tongue it has to be distributed sublingually because if you swallow buponorphine it's neutralized by the liver and it doesn't work. So there were
these sublingual tablets that uh reports actually across Europe in the 1980s when
people when it was available simply as an analesic people were crushing them and injecting them and using as a
recreational drug and that was very much not the point right but so what re what
Beniser do uh record Beniser pharmaceuticals was trying to do in the early 2000s was promote suboxone as the
first maintenance medication to be available from a private physician in 80 years with this abuse used deterrent
through the addition of that one part in a lock zone. And they were actually going for a very different consumer at
the time in the late '9s when all of the lobbying is going on to pass data 2000 and shortly after the drug is approved
by the FDA in October of 2002 and then once it comes on the market in 2003.
They're not going for a prescription opioid user at that point. They're actually going for the rising number of
middle class and teenage heroin users because in the '9s there was a massive amount of very pure and relatively
inexpensive heroin being trafficked to the United States from places like the Middle East and Asia. Uh and that has
brought a new level of heroin use to places like the middle class that here24
had not been very interested in the drug. They were always turned off by injecting. They didn't want to use the needle. But as soon as it was pure
enough to snort, heroin started rising. And you see this in the 90s with like the heroin chic um uh fashion
phenomenon. You see it through the deaths of uh people like Kurt Cobain and the use of heroin use of people like
Perry Ferrell and all these other musicians. So data 2000 passed as a sort
of I guess you could say public health response to rising rates of heroin use
among the middle class and teenagers. people who either were not allowed to go to a methodone clinic because methadone
clinics aren't really allowed to treat treat people under the age of 18 or people who would refuse to go to a
methodone clinic like a middle-ass person who's not going to stand outside of a methodone clinic at 5:00 a.m. every
single day. Uh so it was not necessarily created to become a commercial bestseller. It was not necessarily
created to only support, you know, suboxone and buponorphine and things like that. But data 2000 opened the door
for this drug to enter into the marketplace and it really kind of takes off as a blockbuster phenomenon. Gosh,
almost a decade later, once is starting to be targeted toward that uh that prescription opioid use uh user and also
once you have a mass influx of the former salespeople from Purdue who used to be selling Oxycontton, they all get
laid off in the early in like the mid 2000s because Purdue is coming under fire from a numerous amount of lawsuits.
And once they shed all of their sales force, RVP sucks them all up and starts
to have them to sell um Suboxone instead to this rising number of of prescription
opioid users instead. And that's where it becomes a really a commercial commercial enterprise especially once
you lift the patient cap. So remember also in data 2000 uh doctors were
limited to 30 patients a piece. So it was a very limited patient population that that is raised to 100 patients a
piece in 2006 because of the escalated uh escalating prescription opioid crisis. And as soon as you get like 100
patients per uh physician cap, that's when it really becomes this sort of like
hardcore commercial enterprise. But it did not begin that way. really did start
as a I mean the guy who started it Charles O'Keefe who is the president of record banker pharmaceuticals here in
the US I've talked to him multiple times he's not this hardcore driving capitalist who is out there to exploit
all these individuals he really did believe in the drug he believed in the power of buponorphine he believed it had
the power to bring I mean if you have a million heroin users in the United States in the in the year 2000 and
that's what you know it's like a million to 1.5 million those are what federal estimates suggested And there's only
800,000 attending or not even that actually like less than that attending methadone
clinics. You have h far fewer far fewer right like 80,000 or something
sorry take away a zero like 80,000 you have a whole lot of people who are out of treatment who need assistance and
what he envisioned buponorphine being as something to kind of assist this large
you know majority of people who are are cannot access um cannot access addiction
treatment or don't want to um so he came to it with like a with a different viewpoint but it became something very
different Yeah. Um, you know, as far as the the blind men and the elephant, you
know, I kind of see this a little bit differently, and I don't want to be confrontational here, but, you know, you did bring up a few interesting points.
Uh, first of all, about the marketplace aspect. Um, you know, price of heroin going down brought more heroin users.
Um, and and and while we're doing little parables, I don't know if you know the song Little Old Lady Who Swallowed the
Fly. Do you know that song? Oh, yes. I have I have I have small children, so I hear it fairly often. I
[laughter] I love that song. I thought it was a book. I I remembered it as a book, but there's not really a book.
Apparently, more of a song. There is a book. Uh she swallows a fly. Uh it disturbs her, so she wants a cure. So,
she swallows a frog to eat the fly. Of course, eating a frog is not that great hopping around in her belly. And so, she
has to swallow a cat to to eat the frog. And then she has to swallow a dog to eat the cat. And every time her belly gets
getting bigger. It's a so hilarity ensues, right? It's a great song and it's great for kids and so what um but
you know the marketplace I mean you you bring up kind of I mean the essence of your book Addiction Inc. uh is that
there's an incorporation aspect as a like a privatization and a profit motive and you use the word exploit a couple times. Um I I I think there is
exploitation there of a sort um but I think it's it's um more of an annealing
with the private and public um marketplace. I think the public paradigm change uh created a private marketplace
and I also think the public institution and and um distribution of of an
ancillary narcotic whether it's methadone or bupinorphine and so forth and you say not distribute you know either pre-rean or post reagan one form
or another there's there's you know essentially free narcotic poured into the system form of methanone um it's not
there's no outside marketplace not being sold on the streets not really um you know treat you know a standard kind of
treatment something else. Um, but you know, if you are in that system, you're disabled or you're on Medicaid in one
form or another, you're going to get medic, you know, methadone and whatnot paid for. And so there's a whole institution there, whether it's, you
know, the strictly public health kind of version under Nixon, etc., or more of the privatized version of SAM under
Reagan, whatnot. There's kind of an ongoing expansion of methadone, which did not like. So the the point I make
is, you know, I don't think it necessarily, you know, made the pre-urs wild heroin dealers of the 70s become
travel agents, um, accountants, um, PhDs in in, um, economics. I I don't think it
changed them. I think they just went to other markets and I think they they expanded the marketplace. So, let's say,
for instance, you're the heroin guy and you have a whole bunch of heroin on your shelf in your in your safe and under
your under floor planks like Breaking Bad or whatever. you got a whole trove of this stuff. Um, and then they come
along with methanone. They're going to take away your best customers, say, and they're going to put them they're going to give them free narcotic in a clinic.
You know, what do you do with that stuff? It's all of a sudden you're not you're not going to donate it, you know, sell and donate it to Mother Teresa. You
know, you're going to find places to sell it, you know, so you can sell more because that's your business model. And
so, you know, what happened, you know, in the institution of methadone is that the um the numbers expanded widely. you
know, the the the the opioid epidemic we had, you know, in the 90s and whatnot,
certainly bad like the three waves of the opioid epidemic, you know, um Oxycontton, um uh rise lowering heroin
prices and then fentinel so forth. But but what's ignored is the fact that there really wasn't much of a heroin
market at all, you know, in what David Courtright calls the classic era of narcotic control and right and it came
about, I think, with the institution of methanol. Anyway, so I apologize for the diet drug, but um what do you think
about whether kind of the secondary marketplace that's stimulated that makes the dealers again not become travel
agents and lawyers and whatnot, but stay drug dealers and just find different marketplace and so forth. What do you
think about the that that kind of idea of the kind of the market expansion? Well, I think there's a lot of
historical support for it. You know, I mean, I think you can see the exact same analogy with the cocaine market turning
into crack, right? Cocaine in the early 1980s was extraordinarily expensive, prohibitively expensive, right? It was
more expensive than a gold. Um, but when you combine that cocaine with a very cheap filler like sodium bicarbonate and
some water and you turn it into crack and all of a sudden you make it widely available on the street for$5 or $10,
that expands the user base and of course it also expands the problem it's it's causing. Um, I mean this is this is
going to happen no matter what. This is something that Percy talks about a lot, right? If you expand the amount of opioids available, the opioid pres the
opioid problem is going to is going to increase. I don't have any argument against that, but I do think that there
were a lot of people at least in the late 90s and early 2000s who were
interested in addressing rising heroin use because even though it was small, it was still rising and like there there
there were issues with heroin in the 90s, right? It was it was becoming an issue. I I totally agree. Yes. Right.
But there there weren't problems in the 50s and there weren't really problems in the 60s. Oh god, no. But but of course you had
World War II destroying global trafficking networks. Well, there were no problems in the 30s. There was no problem in the 30s. There
was no problem. Yeah, that's true. There was no problem in the 20. You know, the the classic era goes from the
20s with prohibition. Um up until up until really the 70s um the 60s,
whatever. And and you know, you you covered Vincent Dolan, Marie Niswander,
however you pronounce it. Nice one. Nice wander. Think about like you're taking a nice wander through the water. It's nice
and Mary Mary Gene Crick I think it is um Creek. Yeah. Uh and that the interesting triumvirate
at Rockefeller University. Um they they came up with this methodone idea but but it wasn't instituted to treat drug
addiction. Um it was instituted to reduce crime. Um
well that's it's both. I mean it it it is both,
right? And I don't like sometimes I feel like people really glom on to this idea that oh it was just to reduce crime but
of course like it was but reducing drug addiction and crime simultaneously. I
don't think that they ex each other out and you I like if you go back to kind of like you put yourself in that moment of
like the the mid1 1960s into the late 1960s when crime was escalating like out of control. I mean like cities are
burning. It's not a bad idea necessarily to want to reduce crime. Now, the
connection between drug use and crime is axiomatic at the time and today. And as
I wrote about in my book, treatment doesn't necessarily bring down crime.
But I don't think that using like politicians and for the most part
doctors like they're not going to do a lot of things without something to justify their involvement. and
politicians particularly really want to have like very concrete um
concrete objectives that they can achieve and bringing down crime is a huge one. That's what literally got Nixon into the field in 1971 was the
1972 election was coming down and he sure did have to bring down crime which sure was rising in the late 1960s and
early 1970s. Uh so there was a a use of
drug addiction to bring down these levels but it was not the sole cause. There were a lot of like Dole and Nice
Wonder I found in my research and talking to Dole's son and talking to people who are connected with them. They
were very they were good people right they were benevolent people they like they cared
actually like Nice Wonder especially who had a Freudian psychoanalysis clinic for 10 years in East Harlem. She was working
with these people not because she just wanted to bring down crime because she was some kind of like Rudy Giuliani like let's let's get this taken care of but
because she actually cared about these individuals and bringing down their crime was simply part of it. Yeah. You know caring is is wonderful.
Um there are a lot of caring individuals but uh I I like to look at effects. I I'm kind of a Giuliani Fran fan. I grew
up in New York City and you know my teenage years were in the 70s. I got mugged a couple times in subways and
Yeah. You know it. You know the crime. Well, but Giuliani, you know, didn't have a magic wand, but he changed my New
York. You know, my New York was was one that's a lot more like today. You know, it's more like the 201s and 2020s and so
forth. Um, there was, you know, was the flowering graffiti. Um, we didn't have
homeless on the streets, I have to say, to the same extent we have now. We didn't have those scaffoldings around the buildings. Uh, a few differences. And immigration
was different. It wasn't, there were some, but it wasn't like massive. So what but but you know Giuliani made New
York a jewel. It was it was a people were avoiding New York City. There was all this flight from the city urban
flight in general. You know Detroit was kind of the paradigm for this. You know people just left the city. They were and
and Giuliani rejuvenated and it wasn't that hard. You know you can argue about his methods. I don't think they were that draconian. It's not like um you
know like El Salvador had huge crime just a couple years ago and and um Kelly
you know stopped crime. I mean, you know, it sometimes you have to break a few eggs or whatever, you know, and I'm I I I put this out as a separate issue,
but you know, I'm not a Mauist by any stretch of the imagination, but um um
you know, I kind of hate Mao. Um and I hate everything he stood for. I hate these uh you know, what do they call
them? Those struggle sessions and whatnot. I I hate the cultural revolution. I hate all kinds of things about Mao. Anyway, um but Mao adopted
came into a country in 1947 that was riddled with opium and there was a huge
heroin addiction problem and opium and all that kind of stuff and um you know he was a less nice guy than Giuliani and
he started hanging uh opium dealers and heroin dealers and so forth and and he didn't hang that many. I think they were
in the handful of hangings. Um I'm not sure what the the you know like a murder of crows. um you know I'm not sure what
a you know how many hang hangs hangings he did but but basically the the whole opium problem disappeared you know this
there's this thing where there's a permissiveness um you know so you know there's a lot of that Vincent Dole
espoused the disease model he actually called it a metabolic disease opiate yes use now he did this with zero data and
zero formulation never described what the metabolic problem was aside from the fact that people were using opiates fine
um but well but they didn't know about the opioid receptors at the time I he's writing He's writing about the metabolic
disease in the mid 1960s and he was basing that off of his study and he was I mean he was someone who researched
obesity in the human body prior to this point. He was simply I think translating his previous research current research
on I I I I disagree with formulation. I mean we we you know we have food receptors but you know we don't have
disease by eating food. You know it's like you know you you can put a disease model on almost anything that we do. I mean I I you know I like playing sports
and I like getting a runner's high. doesn't mean I have a disease per se doing that anything, you know. Anyway,
so there's like I'm kind of veering away from a question here and I apologize,
but um you know I I suppose the question would be since we're on Vincent Dole and and
Nicewander um nice wander. I'm sorry. Um yep, nice wander through the woods.
Yeah. Um you I guess we we done with crime. I mean, Jerome Jaffy like said in
Senate hearings that that this was a a a program to reduce crime. Um, you know,
crime wound up growing anyway. And I guess we're talking about Giuliani and draconian aspects and so forth and and
kind of the ethos of the of the and spirit of the time. You know, there there's kind of this kind of movement
one way or another about liberalizing rules around narcotic usage. Um, maybe we could talk about some of the
experiments that have been happening. I I know you're familiar with Switzerland. Um, I think Zurich had a needle park and
uh probably uh one in uh Lisba in Portugal and so forth. Um
you know, Portugu Portland, not Portugal, but Portland, I think legalized heroin a few years ago. They
undid that. Maybe we could talk about kind of the ethos and spirit of you know, where we st sit on this field. I
mean, it seems like there's a few different pendula that are swinging back and forth. Sometimes they hit each other.
For sure. For sure. Well, yeah. How do you want to approach the subject? I mean, [gasps] Oregon is Oregon was such
a disaster. [laughter] Like Oregon, Oregon's experiment with decriminalization was such a mess. Um,
and I think that actually speaks really well even to something we were talking about earlier, which is a versus a a
national even versus like a state-based response. Oregon was I was talking to a
buddy of mine at the ACLU. I think it was like 47th or 49th out of the country
out of 50 states to uh for for treatment availability. And what they did in I
believe it was 2020 or 2021 when they decriminalized the possession, personal possession of of all intoxicating
substances was to allow people to take either a $100 fine or like call a number
and then go be placed into treatment rather than being incarcerated or
punished for for their drug possession and use. In theory, we've seen it happen
in other places, and it's a very kind and wonderful idea, but you cannot put the cart that far ahead of the horse.
Oregon did not have the infrastructure in place to actually create organizations where all of these people
could be funneled into. If it's not the prisons, which obviously do exist, they can't go to treatment facilities that
aren't there. So what it allowed for was simply the acceptance of open air drug
use with no no remediation or uh or responsibilities whatsoever. And very
quickly the entire state was like this is awful. It's really really bad. Now of course it was combined with a pandemic
with um housing crisis with the rise of fentinel. I mean it was it was a perfect storm for a whole lot of things to go
wrong but Oregon was not in a place to actually allow this to occur. And of course they're they they kind of had to
eat their words. And um most of drug possession was recriminalized in I believe 2024. But that's not like you
can't go about it in this way. And there's also like a very different cultural construct in Oregon versus
Portugal, you know. Well, I know it's always it's always the the phrase about communism has never been done right. You know, there
everything every time it fails because it's never been done right. I I think that there's, you know, a little bit of
excuse making about it. Um I I I am not a harm reduction kind of guy. I I like the words. I like reducing harm. I spent
my whole life trying to reduce harm in an individual basis. Not just for myself, but my patients. I want to reduce the harm they might have from
some future illness or the harm they might have x y and z. But the concept as a public health maneuver, harm reduction
has um whatever benefits it might have collectively, it it takes away incentives for for growth individually.
Um what's what's an example? Well, you know, the one is like say condoms in the middle school. um
there the idea is well we don't want teen pregnancy we don't want um I don't know teen veneerial disease whatever we
don't want this we don't want that so we will put condoms in the middle school and and you know if you ran a Catholic
school and I I think this is instructive actually because cath religion kind of falls into the addiction realm in a
sense I mean the the the drug addiction rate amongst Mormons practicing Mormons is effectively zero um and and the same
you know they're they're genetic conjuners you know in the Midwest in mountain states or whatever, you know, have a much higher uh drug rate as well
as alcohol and whatnot. So, you know, religion is kind of not quite it is it is a church that specifically
does not allow for it. It's like very similar to the Seventh Day Adventist church which is like huge around here no alcohol, no caffeine, no meat. I mean,
if you have a religious imposition that says you are not allowed to do these things, that's a pretty strong motivator. I Well, I understand that. But that
that's to the point of what we need to fix this. You know, a lot of these things are kind of replacement drugs.
So, they're getting to the harm reduction model and again condoms in the middle school. You know, there's there's a Bob Newhart um episode. Uh the late
great Bob New Hart. Uh company comes in for his office. She had a problem XY andZ. And he's like going to give her advice. It's like he's only going to
need $5 going to be three minutes. She's like, "How can that be?" He's like, "His advice, cut to the chase." He's like,
"Don't do that. Stop that." You know, this hurts. Then don't do it. Yeah. Yeah. But but it's like what we've done
said in in because the we have nice people you know Marie literally named nice wander um you know people have with
with kind of um softness in their heart and the grace of of wanting to help people doesn't mean they always do and
it doesn't mean that that their ideas can translate into policy and and and people are funny things you know they
sometimes go counter to the way that that the help would be there you know so
that if we give some if you again if you have free condoms in middle school. You know, the message to the middle
schoolers is, "Oh, we haven't been having sex. We should there's condoms. They're expecting us to have sex." You
know, you know, every time they've improved the helmets on snowboarders and
every time they put on better braces and and you know, better this and make things the sport safer, the snowboarders
jump from higher heights. You know what we see now? We have a you know, people bicycling down mountains, whatever. You
a lot of the times that we think we are reducing harm. What people actually want is the thrill and they they they go up
to the edge of where the thrill is. If you draw the line here, you have kids, you know, you draw the line here, they
they want to go there. And if you if the line were there, they want to go the thereer, you know, wherever it happens
to be, they want to touch up against that because that is the essence of our discovery process. You know, as babies,
we put everything in our mouth. We feel the world through our tongue and whatnot. And over time we have to experience the world a lot. I'm not I'm
not recommending you know kind of freef fall for people. But I'll just put this out as a kind of question and you know
over the same duration. Have we seen an alcohol epidemic? You know alcohol is freely available at a liquor store you
know bartenders and wherever um and even amongst teenagers and so forth they can
all find and get it. You know people alcohol is dangerous you know in excess and whatnot. to be a deadly and frankly
alcohol withdrawal is more deadly than narcotic withdrawal but we don't have a government apparatus. Have we seen the
same kind of expansion in alcoholism andor you know an opioid excuse me an alcohol epidemic when it's not something
that the government has you know had some kind of cure for you know by by virtue of of of you know kindness and so
forth. Well I mean alcohol deaths are about 178,000 per year. cigarette deaths are
about 480,000 per year and we're just now below 100,000 opioid over or drug
overdests per uh drug overdose deaths per year. So it's I mean it it's kind of
like this is an issue I have with the people who are are very gung-ho just for
legalization. You know, it's like well if we just legalize all drugs then you certainly have them under control and
and regulations and things like that. And I don't necessarily believe with that believe that. Excuse me. Um, I'm
sure you're familiar with the the iron law of prohibition, uh, which was, um,
Dick Cohen wrote about that in the 1986, uh, National Review article. And then he
actually went on to become the executive director of Normal, the National Organization for the Reform of Marijuana
Laws. He was like the only sort of like uh, conservative Republican uh, executive director in the organization's
history. But he argued, and a lot of people kind of glom on to this, that uh when a drug becomes prohibited, it
becomes more powerful because it's easier to traffic a very small amount of fentinyl that can get 40,000 people high
as opposed to a very large amount of morphine or opium, which is bulky and, you know, like it's very hard to hide in
in, you know, like your clothes or your suitcases or whatever. And that's true, but there is just as much an iron law of
legalization. And I think we're seeing that specifically in the realm of cannabis legalization. And we saw this
in the realm of oxycodone legalization. The only reason we went from a 20 to a 40 to an 80 mgram tab of oxycontent was
because Purdue Pharma was allowed to legally market these things. And the only way we've gotten to like 25 to 30%
THC cannabis flour and 99% THC dabs is because of the legalization of the
cannabis. these things are very very powerful because there's a whole lot of economic initiative behind that to make
them powerful because people are always looking to push the edge. I think that's I think that's entirely true but I don't
think that necessarily takes away the need for certain forms of of treatment or rehabilitation necessarily just
because people are always trying to push the edge. I do think that that treatment of and and rehabilitation should be available to them even if they are
pushing the boundaries. And the thing is like you're always going to have a lot of organizations and entrepreneurs who
are seeking to profit off of and I hate to use the word again but exploit those individuals who are looking to push the
boundaries. And 99% dab is not for like the like the user who's just like I want to relive my college days and smoke a
joint. Those are for that, you know, it's like the 8020 rule, right? like um 80% of the sales of most intoxicants go
to 20% of the most like sort of uh the highest the highest level users. And so I'm interested in in what you would then
say if you know how how does one respond to uh a situation like this because I
mean I think we've learned from the past couple of decades in the United States you can't necessarily just arrest
your way out of this problem even in dealers and things like that. You don't arrest you don't arrest everybody. So uh have you been you
choose to arrest then. Okay. Have you been to Japan? No, I was in South Korea in August
though. That was fun. Well, does South Korea have maintenance narcotics?
Gosh, what a great question. I don't know. But they um certainly alcohol is widely available. Cigarettes are widely
available, but I think they have pretty harsh drug laws. I would say in Well,
just to stay on topic, Addiction, Inc. is pretty much on the concept of opiates. Am I right? Hope you
Yes. Fair enough. So, um, [clears throat] for my book, um, which I hope you will
look at because I'd love to get your thoughts on it and maybe, uh, yes, you sent it to me. I started I I I
was just dipping in before our conversation, so I'll go back and maybe you can get revenge on me. Um,
you know, I I apologize if I, you know, give you, you know, kind of got you questions, but um, but I think you're
good and and you're smart. Um, you can handle these things. Anyway, [laughter] um but uh you know for my book I was I
was actually looking at Russia um which you know had we we had our kind of
heroin moment from the Vietnam War um and it kind of got into our experience. I mean obviously heroin is predates this
and you you bring up the interesting aspect of morphine clinics and you know morphine was there to treat opium and
then heroin was there to treat morphine. Get back to my little lady swallow the fly. and um and methadone was there to
treat heroin and in a sense buprenorphine is there to treat methadone. So you have is that five? I'm
not good at numbers. Actually I think that is five. Um you know things in succession whatnot. Um but you know
Russia had Afghanistan um their Afghanistan war uh I believe in the 70s
and um they had a lot of you know there's a lot of dope in in Afghanistan. There's poppy fields and and um um
heroin readily accessible. Um and they came up with a lot of addiction. So they had the same kind of ancillary problem.
We had the, you know, the golden triangle. We had uh we we had troops in various times, Laos, Cambodia, and
Vietnam. And uh there was, you know, not a lot to do there when you're off duty and and whatnot. People plus people were
literally in pain here and there. And so they were doing heroin. And the the the image and actually the interesting um
image from your book, I'm not going to show it here, but uh you have a Bill Sanders um
the editorial cartoon. Yeah. Milwaukee Journal Sentinel in 1971. Uh he illustrated I have my book here. I can show it.
[laughter] Fair enough. It's on uh if I can find it. Let's see what page is it on. It is on page 43. Um
thank you. And uh so the idea is that uh you know we are going to be mainlining into the
country. There's a needle and kind of these vicious devilish kind of uh fingernail
monstrous hand. Yeah. Yeah. Is going to Vietnam. This is got this is we're going to uh you know
there's the HL Mein said at one point uh dem theory of democracy is that people vote for what they want and they good
need and they deserve to get it good and hard. I think the concept here is we got we got into the Vietnam War
the Bard of Baltimore. I do love HL. Oh, it's great. And and so I think here
um Mr. What is his name again? Um Bill Sanders. Bill Sanders. I think he has a little
bit of um shenanoid towards the United States and we got into Vietnam. Well, here you're going to get this piece of
Vietnam, you know, heroin injected into your body politic and bodies general so forth. Um, I don't think this actually
happened. And I think a lot of the Oh, no, it didn't. Lot lot [laughter] the fright was there. I think I think Nixon a little bit got
hoodwinkedked into the methodone concept because of the presumed numbers coming
back from Vietnam. This was over and over. as a drum beat in the New York Times at the, you know, Erstwell, the
Times, the Urswell Times or the Times, um, that this is going to some this is a ticking time bomb and and whatnot. Um,
that that we're going to have all this massive influx of heroin addicts. And the fact of the matter is it it didn't happen. You know, there were heroin.
It did happen for a variety of reasons. And one of the biggest reasons that it happened was because Jerome Jaffy, the
head of the Special Action Office for Drug Abuse Prevention, or Seodap, just rolls off the tongue, um, instituted
urine testing in in Vietnam. And you would not be allowed to leave the war zone if you tested positive for opiates.
So, a whole lot of people stopped using heroin while they were still in Vietnam. And this was the biggest transformation
in the field because if you think about it, prior to about 1970, 1971, the general medical consensus was that
opioid addiction was a lifelong problem. You were never going to get off of it. This monkey was going to be on your back
for the rest of your life. But what happened was as soon as he instituted urine testing in Vietnam with a brand
new technology, the free radical essay technique or frat testing, which was allow which was this big bulky machine
like you know the way like computers were in the 1960s, right? was a huge machine. But they brought two of them to Vietnam. One was in um Saigon, one was
in um Long Bin, like the two main places that that service members were exiting the country. And a thousand service
members are exiting every single day, right? There's about 300 service members who are there in like the peak of the war in 1970, 1971. And all of a sudden,
you have to piss into a bottle and it's got to go through this little thing and it's going to show if you've used
opioids in the past 72 hours. And if you have, you are not allowed to leave a war
zone. There you go. And that's bad, right? People don't want to don't want to stay in Vietnam. So So
what what they were able to do, what many of these soldiers were able to, and this is the difference between heroin
use and heroin dependence/addiction. And Jaffy always knew this. He always knew that there was a difference. And
he's like, if you can get the people who are simply using periodically to just simply stop once they come back to the
United States, they're in a completely new environment. They're back home. They're with their family. They're with their friends. they probably will not
continue heroin use. The people who do have an issue, the people who are addicted or dependent, who do test
positive, yeah, they have to stay in detox in Vietnam, but when they come back to the US, there is services for them. And that's the biggest thing.
There was no I mean, this is what comes from um gosh, why am I blanking? Washington University at St. Louis. Her
name Lee Robbins. Oh, the woman. Thank you. Lee Robbins. She was this the report that she wrote after she followed 900 and some veterans
returning from the US after this urine test and all this when she realized that heroin addiction or opioid addiction at
large is not this lifelong chain that you have to wear around your neck and that was huge and but but no one had
proven that before and it took an example like Vietnam to actually give people so the thing that that puzzles me is we
have all these kind of dispositive evidence that this is not something you have to do forever but it But but if you
read the press and if you recreate the New York Times of the times um in New York the times of the times yes
well the uh [laughter] the times of the New York Times in New York um at the time of uh I can keep just I'll be here
all day anyway um you will find exactly the opposite that this ticking time bomb
uh image is is but that's the media firestorm. I mean that that well this has not been helpful you know
I think I think this became a perfect storm. I'm not a conspiracy guy, but I am a conspiracy of interests guy. Uh,
which is to say, the example I till I come up with a better one, the one I always use is I it's a hot day. I've got
an ice cream cone and uh maybe it's soft serve and I'm walking down the street enjoying it and I'm like looking at something and all of a sudden hot it
melts. It falls to the ground. Okay, the raccoons getting back to the raccoons or the flies, the insects, the ants. Um, I
don't know. The little old lady's going to eat all of those, by the way. She's just coming for them. Exactly. all those animals, um, pigeons,
whatever, they have no idea this going to happen. They're they're not conspiracy theorists about ice cream
falling in this spot. It happens. And they once the ice cream's there, there's a whole apparatus and engineering going
on. Who's going to get it the fastest? So, some pigeon's going to like try to whisk off at the whole thing. If it's a candy bar or whatever, and the answer,
if it's if it's liquid, they're going to be in the cracks that anyway, there's a whole operation to deal with the fact that I dropped the ice cream cone. So
nobody had the pre-ordained notion. There was no conspiracy about this happening. I didn't think I was what I
was going to do. It just happened. But once something happens, once there's an attractive nuisance um or moral hazard,
I guess you'd call it um there then then something happens beyond that. And so I think the the the
inst the conspiracy of interest where a few different things happening confluently um in in our world, you
know, Vietnam and this kind of concept that we had to get it good and hard for having violated, you know, whatever that
the the Vietnam, you know, sovereignity, whatever we did, we had to be punished and and this whole drum beat about the
the heroin thing is going to come bite us in the butt and the crime's going up and all this kind of thing. We need to
have methanone maintenance because Vincent Dole had come up with this idea and Howard Sweet and nice you know Maria
is and all kind of stuff. I think this was a bad idea applied and a wrong solution to a problem and I I you know
you bring up Marie uh nice wanders work in Harlem. This guy Robert Beard are you familiar with him.
I actually don't know the name contemporaneous. [clears throat] I have a Substack. I'll send it to you. I hadn't been either. I I found him
researching for my book and uh it said Harlem doctor blah blah blah you know
comes out against um you know the methadone clinics because he thinks it's
going to bring more crime people are already addicted to stuff why add more you know narcotic into the mix all kind
of stuff and I just assumed I don't know I assumed he was a local Harlem doctor but he wasn't he was an upper east side
uh fill in the blank I think a diabetist he was endocrine guy and he was doing insulin and stuff and on his own. The
guy's like a bleeping saint. I mean, he spent his nights going up to Harlem and
with crime and all kind of stuff, driving the subway, whatever. Or maybe he drove his car, I don't know. But he he wound up in in East Harlem every
night of the week and sometimes the weekends as well dealing with narcotic addicts and he he tried to get them
unaddicted but he had group meetings and no drugs and he you know
he might have I don't if he had anything palative or whatever but he his whole thing was to get them off drugs and he was just
flumxed flabbergasted um etc etc that this was going to happen. he was, you
know, yelling stop and and uh so I have a little piece on him does kind of a a
payon to his his great work and totally ignored. Um but I don't think he was wrong. You
know what happened was the the the rate the of heroin usage was highest in New
York City amongst the whole country and New York City was the highest in Harlem Bedford the black neighborhoods not
because they're black because they were poor they were they were had the highest rate when when it was like Italian and so forth because of the poorest area the
poorest area in New York had the highest rate of heroin in the whole country because it's a port city um and that's
that's where the stuff would land so the places where there were heroin problems through that era of classic control were
Chicago uh New York LA in Fort Worth because on the you know the Texas border etc. And that's where the heroin was
happening in so far as it was happening for those that duration and and the the rate was highest in the black population
and over you know over the succeeding 20 years um the rate in Harlem was no
longer higher than the rest of the country. So that sounds great but that's not because the Harlem rate went down. It's
because everybody else went up to Harlem's rate. basically we Harlem was up here and all the tide everybody else
wound up at Harlem's rate of narcotic usage and heroin use and so forth. So, you know,
I kind of feel like that the, you know, we can we could talk about answers and solutions. Uh, but I feel as if this
hasn't been it. You know, as if kind of the the harm reduction approach and that that you know, certainly, you know, we
we know people who die from from opiates and that's tragic. Um I just don't know if we've applied the right answer to it
given that say getting to Japan and and or Russia. Um that Japan does not didn't
have an opioid epidemic. They didn't for the whole duration of our you know whatever you want to consider the 90s
and zeros and whatnot. Uh they didn't have it you know and Russia didn't either. You know they Russia's got loads of problems. Don't get me wrong. I I
wouldn't trade places with being in Russia. I might if I were Japanese to you know trade in Japan. I don't want to
learn the language but if I whatever but but you know there are places that are there experiments being run right now
they're called other countries that don't do this and frankly amongst our states we have other states that don't
do it you know Wyoming does not do it um it's small place it's hard to you know get much data from that but Mary Jane
Creek you know in one of these memorials to methadone and and self- congratulatory you know she she feels
that that what we need is is universal mandatory maximum access to methadone um
but of course that's not What the that was not the only thing that Seodap was promoting at the time when they were really in power from 1973 or 1971 to
1973. It all kind of fell apart in 1974 with everything else that fell apart in the Nixon administration with Watergate.
But that this was not what necessarily Seab's emphasis was. It's by far the most controversial. It's by the it's the
part that got them the most flak. It's the part that turned Jerry Jaffy into like a a sort of you know hated person
in Washington. But methadone clinics that they were funding at the time were only about onethird of the clinics that
they were funding otherwise. They were funding a lot of other programs, a lot of abstinence-based programs, detox
programs, counseling, therapeutic communities, halfway houses, all of this other stuff. We hang this albatross
around Seodap and Jerry Jaffy's neck saying, "Oh, you're Mr. Methadone and you're pushing this on the country and
blah blah blah." But that's not what he was doing. He was um he was a big proponent of what he called multimodal
treatment options. It was what the person wanted and could help them the most and that was simply to be made
available to them at the time. Now remember, methadone is still very very new. In the 1970s, in 1970, I found a
report that only 9,000 patients were on methodone maintenance in the United States and Canada combined. In 1971,
that does increase because of SEOP support for methadone clinics. And that increases to about over uh there's over
72,000 people in federally funded addiction treatment care by the end of 1973. But only a third of those patients
are me are methadone patients. It's not this overwhelming this is our only response and we've got to cut down crime
and blah blah blah. He was funding a number of programs. And there was so much controversy about methadone. People
hated it, especially in the black community because you're like I mean you're coming at the end of all of those racial uprisings, right? people who are
saying like you after the assassination of Martin Luther King and all this other stuff, they're like, "We want better
jobs. We want better housing. We want better schools. We don't want to live in these slums. Like, why don't you take care of these problems?" And when what
they get are simply like therapeutic communities and methadone clinics, they're furious. They're like, "This is
not the response that we were looking for." And methadone has been controversial from that point on. But,
um, Jaffy very much dislikes that he is only remembered for his participation in
the methadone clinic system. And that was why the first six times I talked to him on the phone when I was embarking on
this project, he would he he he was like, "You're just here to tell me how awful methodone is and blah blah blah."
He would make me cry. Like it was just awful. And finally, I won over his um his I I finally won his his trust when I
was like, "No, I've read all of your papers at the Library of Congress. I do not think you're just Mr. Methadone. I think you actually instituted a program
that was much more responsive to the wide variety of needs of a wide variety of people who use drugs." And then he
finally started talking to me and he was giving me a lot of his papers that he did not donate to the Library of Congress that he kept in his basement.
And that's how I found out a whole lot about the other stuff. But it is not um
the Nixon administration wanted to get reelected in 1972. And in 1971, you have
a perfect storm of three things, which is rising rates of heroin use in the United States, rising rates of crime in
the United States. and the media freak out about addicted soldiers coming back
from from Vietnam, the GI junkie phenomenon, which of course did not materialize. But the Nixon
administration simply had to respond. So they do bring in Jaffy out of nowhere. He's he did not realize he was going to
be the nation's first drugs. He just kept getting invited to Washington and then all of a sudden he's put out in front of Congress and the and the press
and he's like, "Okay, we have a new drugar and you're in charge of $155 million, twothirds of the federal drug
budget. You better open as many clinics as possible." the the biggest number you possibly can and you better bring down
crime. I mean, he had a huge job in front of him and to his credit, he actually did it. Crime did decrease in
1972. It was a blip, went back up in the in the later 1970s, but he got it done
by supporting as many options for treatment as possible, not just methadone. And um he was a big big big
supporter of Lamb, Lalpha acetylmethad. He was a big supporter of Nalrexone. He was a supporter of all forms of
addiction treatment that would get people to the point where they were no longer living lives of desperation.
Right? And that's that I think is probably the most important thing I want people to take away from my book and from this conversation. Like it wasn't
necessarily just trying to get Americans on maintenance and keep them on it forever. There was actually a really
fullthroated support for a wide variety of treatment options. Um, and we've forgotten those and we've turned pretty
much all of those actually into like money-making exploitative opportunities today. And that's that's bad in my
opinion. That's where I come down on it. Yeah. No, I think you and I can agree on certain aspects of this. I I'm sure it's
not my only I I don't I'm not saying I'm the inventor of this term, but I use the term methadone industrial complex. And
um I agree. I think there is an MIC. [laughter] Yeah. And I I wonder and worry whether
there's also a suboxone industrial complex in a sense as well. There is. There very much was. And it
was actively created by Wreckit Benkezer Pharmaceuticals under the direction of Sean Ther I I don't know that precisely.
So with methadone, you know, there's no there's no pharma company, you know, there is one. There's Malenrot makes the
stuff, but it's all behind the scenes. It's all like the Wizard of Oz, you know, somebody behind the green curtain, all that kind of stuff. Nobody sees
methadone. There's not commercial. There's no methadone commercial during the Super Bowl and you [clears throat]
know I don't I don't even know if there's a brand of methadone. There used to be Dolphin or whatever but you know methadone is not there's no pharma push
for methadone. There's no public push for methadone and yet methadone has expanded year by year by year and decade
by decade. Um it may have been tempered a little bit by suboxone as an alternative mo you know modality you
know which dstigmatized methadone and got rid of the methadone clinic you know kind of stink whatever nobody want wants
to hang out there etc. Um but it's not the methodone industrial complex I think
has much more to do with physicians and institutions that own those clinics and
so they have a business model which is very interesting. I have an article I hope to get out in the [clears throat] city journal or someplace called the
Starbucks of narcotics and [clears throat] it basically narcotics. This the puditive title is
star the Starbucks of narcotics that Starbucks narcotics I mean I think good pun here
I really like that and so uh you know Starbucks in my theory would
would love not only to be able to dispense coffee but to get $50 every day for for for you know having you drink it
especially in front of them or whatever drink your coffee and down it and we're going to get I don't know 45 bucks from the federal government or state or
whatever for doing it. So, we're going to get a fee. Now, caffeine is addictive and people you could argue that oh,
there's no reason. I mean, I I don't want to give a good idea to Starbucks, but um you know, they they would love
it. You know, cigarette manufacturers would love to say, you know, we have this addictive product and you know, we're going to make sure we we dose
people the right whatever. So, but but on the other hand, methadone does and I think it has much more to do with
addiction and public health and you know if you look up uh you know the goo Google book uh engram you know the
frequency of term usage addiction um we think of addictionologists and I'm sure they have their conventions every year
but uh I I was surprised to see that you know it only came into being I think in the 1980s and it just grew as a term
that's not like diabetist you know somebody like this do Dr. Robert Beard literally was a diabetes doctor and
diabetes as a term has been around forever but if you follow kind of the medicalization addiction um addictionology um these are relatively
recent conception not addiction per se but kind of the treatment around it is is a new formulation and and getting to
the little lady in the fly I think the more things we do for this sometimes it we're not necessarily making the problem better and and I think we have to kind
of detox uh from a lot of the you know a lot of the uh ideas that we just think
are there. You know, if you ask a fish what's water, you know, he might not have any idea because he's like swimming
in it all the time. He doesn't understand water being poured or water turning to ice cubes or whatever, you
know. Yeah, that's just his world is water. And so I think we are in a world where we think this is what we do. We have
where, you know, methadone opioid, excuse me, um medications for opioid use
disorder. You know, we've created this stuff. the these are things that align with the addictionology,
you know, college fund, you know, if you're an addictionologist, you want to get your kid through college, you know, this this has been very very good for
the concept. All of a sudden, again, bartenders would love this, you know, if they could not only pour the drink, but
get paid 40 bucks for having seen you, you know, and bill it to some third party that you're not aware of and and
taxpayers not aware of. This is I think the real blackbox warning that should be out there that the methodone is a black
box. It's it's right in plain sight but and and and and I I would put a slash with buprenorphine suboxone that these
things are out there and there's been a huge expansion of it and it's been on the taxpayer dollar for the most part
and um and they've been growing and their their method is essentially you
know like thyroid replacement like you know they use their analogy themselves all the time it's like di like insulin
for a diabetic. I do not think this is the case at all. You know, if you haul up uh, you know, in an Istanbul prison
like that, Midnight Express, you know, some two guys with needles and one of them is a junkie with heroin, one of
them is an insulin um diabetic and you take away their needles because they're both bad people, whatever something, you
know, the the diabetic dies in two weeks. That's it. And the the heroin guy is like feeling awesome in in four
weeks, not two weeks. And so you know this this concept where we are treating this but we don't treat addict you know
sex addiction we don't have you know we don't have replacement um you know therapy for Tiger Woods you know to get
see hookers we don't have gambling replacement you know where you go to Las Vegas only twice a week you know we
don't do that for any of the other addictions I think you know people are addictable clearly um to various things
um but I I think we have this idea that we are helping people by helping them
and sometimes they they are only helped when they you know craft their own exit
and it's a it's a it's a difficult thing. Well, I think you should talk to Sally Satell. She's a doctor here in DC. She
actually works in a methodone clinic and her book is coming out. I have the galley. Um uh not a disease.
Oh, there you go. Rethinking addiction in the heart of America's opio overdose crisis. She went
to uh she spent a year in Ohio, Iron, Ohio, I believe. And uh this book's
coming out and I think she would be someone who you could talk to specifically about that kind of stuff because she I think is very much a
proponent of that idea as well. Well, sort sort of I mean we've exchanged emails and without without
revealing any private s I've been in contact with her for like more than a decade. Um
and Sally's great. Yeah. I've never met her and I will asked to be on the show and u at first she said yes but that you know my ideas
about methadone are not hers and so she works for a methadone place. I don't know. You know, I'd love to hear what her concept in that book is. Maybe you
could report back uh to me or whatever. I don't want to get you to tell. I'll give you a full report, but but I think there's there's, you
know, an interesting aspect like I I've actually interviewed I don't know if you know Theodore Dal Rimple. Do you? Um his
he's writes for City Journalist. His name is Anthony Daniels. Uh he he eventually dropped the um the pen name a
few years ago. It's a great pen name though. Oh my god. Yeah. He I he told me how and why he picked it. There's another story.
You got to watch the show. Um, but brilliant man. I I he totally, you know,
you know, he's kind of my idol. Um, and he wrote a book in UK called Junk Medicine.
And here it's called Romancing Opiates, which is a less less good title, but if you want to find the book and uh
he covers a lot of things that I saw in real life, you know, IRL as the kids say. Anyway, um I want to give you the
last last words and I've taken a lot of your time and I apologize. Um, but I very much Oh, this is fun. This is a joy. Thank
you for having me. This is great. Um, and uh um I like I could come up
with a a last question. Um, but but why should people find and read your book
and and again, you did kind of some of the take-home messages, whatnot. Um, where do you think the best place for us
to go with addiction treatment would go would be? Well, I hope people read my book. It
would be great if you did. My publisher would be thrilled. But I think we we
treat substances like methadone and buprenorphine and nrexone as sort of these fixed ideas that they just sort of
arrived in our life and in our community and in our society and that's just how they've always been and that's just how
it is. But there is a whole lot of action and historical building that goes into creating the systems in which these
drugs now exist. And my book exposes and explains exactly where those systems
came from. And I think it's kind of interesting the fact that Richard Nixon in 19 on June 17th, 1971 created this
federal office, executive level federal office to oversee addiction treatment in the United States and it spiraled into
something now 56 years later which is radically different. Is it better? Is it worse? I mean, I think that's up to the
individual to say, but I do hope that if people are interested in understanding how we got to this point that they read
my book and they figure it out. I've been um really having a lot of fun talking to uh medical schools. I've been
talking to federal offices. I've been doing some consulting for people who are interested in understanding the mistakes
and the successes that we've had in the past and how that can influence the future of addiction treatment. Now,
going forward, I mean, I am not a licensed medical practitioner. I don't
know what's going to help, but I know a lot of people who have really benefited from that. I know a lot of people who are on it for a while and they've
tapered off and they're living great lives. And I know a lot of people who are dead and I don't know them anymore because they're dead. But I do think
that I I I I'm just on the side of the individual who's struggling, who needs
help. And I'm a big fan of offering them a suite of options with sustainable and
supportive people to allow that person to achieve whatever sustainable and
supportive sense of sobriety and remission and recovery looks like. I am not here to grind an axe. I really just
don't want my friends to die anymore. That's my That's my platform. It's a
hill I'll die on to not see my friends die. That's it. Well, that's awesome. I'm I'm the one always grinding axes. I keep I keep a
whole bunch you can't see them, but I keep a whole bunch sharp behind me. [laughter] You're a wood chopper. I get it. My wife
here. My wife thinks grievance is my chew toy. And actually, it's not quite true. Um I
I kind of enjoy the day most days, but there are things that I think uh need to be called out here and there and so
that's somehow fallen to me and I'm I'm currently now an old um so um at the
latter part of my career I kind of you know say what I need to say. Um anyway, thank you so much Emily. I it's been a
pleasure. I hope I can have you on again um and uh discuss any slashall of these
ideas and topics and it's been a complete pleasure and joy. It's been such a pleasure. Thank you so much for having me. I really enjoyed it.