Grieving Out Loud: A Mother Coping with Loss in the Opioid Epidemic

A Drug Historian on What America Keeps Getting Wrong About the Fentanyl Crisis

Season 8 Episode 256

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0:00 | 41:20

When President Trump signed an executive order classifying fentanyl as a weapon of mass destruction, some who have lost loved ones to the powerful synthetic opioid applauded the decision. But a drug historian argues The White House is making serious mistakes in its approach to the crisis.

In this episode of Grieving Out Loud, historian Dr. David Herzberg looks back at earlier substance crises in the United States and discusses what went wrong, what went right, and what lessons those experiences might hold today. He explores how history can inform today’s policies, the unintended consequences of past approaches, and why understanding the bigger picture is crucial for tackling the opioid epidemic. By examining decades of drug trends and responses, Herzberg offers a perspective that goes beyond politics, helping listeners think critically about how America can respond more effectively to fentanyl and other substance crises.

Explore David's website and books here

Dr. Herzberg says research shows that roughly 75% of people who use even the most addictive drugs like heroin and cocaine do not develop an addiction. This means addiction risk is shaped less by the drug itself and more by a person’s circumstances, environment, and biology. That is why prevention, early intervention, and access to treatment matter so much. 

1. National Institute on Drug Abuse (NIDA) / Addiction Center (sourced from national survey data): “Approximately 25% of people who use illicit drugs develop an addiction.” — AddictionCenter.com, sourced from national substance use data

2. Peer-reviewed academic literature: Schlag, A.K. (2020). “Percentages of problem drug use and their implications for policy making: A review of the literature.” International Journal of Drug Policy. Key finding: “The majority of drug use is episodic, transient and generally non-problematic.”

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With this historic executive order, I will sign today for formerly classifying fentanyl as a weapon of mass destruction. It has been one team, one mission to get 100% operational control of the southern border When President Trump signed an executive order, classifying fentanyl as a weapon of mass destruction. Some who've lost loved ones to the powerful synthetic opioid, applauded the move. But a drug historian spoke out saying he believes Trump is making a terrible mistake when it comes to the fentanyl crisis. When we cut off that supply. We won't just have a, uh, this huge magnet sucking in new suppliers who, if history is a guide, are gonna be even worse than the ones that we already have. In this episode of grieving out loud historian, Dr. David Herzberg takes a closer look at past substance crisis in the United States. What went wrong, what went right, and what lessons those experiences may offer today. From the moment of the American Revolution, the, the people in my field talk about those years after the revolution as the alcoholic republic. A huge upsurge in drinking that was so intense that it provoked this century long battle against demon rum that culminated in literally. The prohibition, uh, of alcohol nationwide. So how should the United States deal with its deadly opioid crisis? I hope you'll find this conversation as eye-opening as I did, Today's guest brings a perspective we don't hear nearly often enough in our conversations. David Herzberg is a drug historian, which means he studies how Americans have actually used drugs over time, and how our policies and markets have shaped the crisis that we keep finding ourselves in. Yes, uh, hi. Thanks for having me on. Well, I am. I am so grateful that you're here. I read your recent New York Times op-ed that Trump is wrong about Fentanyl in almost every way, and it really truly stopped me in my tracks at a moment when fentanyl has been just declared a weapon of mass destruction. And we're hearing more calls for military force. And I, I'd like to just dive into. The situation we find ourselves in today and what we can learn from the history of drug use in this nation. Yeah, it's a, it's a great question and, and calling, uh, calling Fentanyl a weapon of mass destruction. There's so much in that, obviously from a, from a pragmatic perspective. Fentanyl is a bad drug for consumers. It's very dangerous. It's very hard to package for safe use. So nobody's defending fentanyl as a product. It's, it's actually quite, um, catastrophic that it became the primary opioid for non-medical markets in the us. The question is whether declaring. A weapon of mass destruction or blowing up boats in the Caribbean or, uh, taking warlike stances to China, were there any of these efforts to try to forcibly shut off the supply? Is that going to actually fix the problem? Is that going to get fentanyl, uh, out of the system? Is that gonna help the people that we're trying to protect? And history suggests that it really won't. Um, for a variety of reasons I can, I can get into, but the, but the predominant one is that right now there are very large numbers of people in the United States who are very strongly committed to continuing to buy and use Fentanyl, um, as they have a condition that we call addiction. Right. And if you shut off that supply. Without having a plan in place, without having prepared a very large plan for the very large number of people we're talking about, there's still gonna be people who wanna buy Fentanyl. And in our world, when people wanna buy something bad enough, someone is gonna find a way to sell it to them. I. Right, right. It's about supply and demand, and I, I talk about demand all the time on this podcast and how we need to lessen the demand. also understand, and there are so many parents who have advocated parents in my position, parents who've lost a child to fentanyl, a child who most of the time didn't know they were getting fentanyl, which was in my daughter's case, didn't know it. It, it seems like murder. I always liken it, TIFF. People were putting fentanyl, alcohol, illegal, illegal drug in bars, you know, we, we'd be taking swift action. And so I, I understand the desire to ask politicians to do something, to, to declare fentanyl, a weapon of mass destruction to a, to to think that we need revenge on these enemies who are. China and Mexico who are contributing to putting this supply into our illicit drug supply, the supply of Fentanyl. So I understand it, Mm-hmm. if it's not going to solve the problem, then it, it just gets really, the problem is so complicated. I think if we could get at the root of the problem and do you think the problem's complicated or, or am I Oh no. It, that? it definitely is. And, and I think it's really important to keep our eyes on the prize, which is less people dying. Like the prize. The prize isn't an emotionally satisfying victory over, uh, bad guys. The, the, the victory is fewer people who have a child die. And so, you know, one of the ways to think about this, that's that. Allows for complexity is, you know, I study US history and from the, uh, from the moment of the American Revolution, the, the people in my field talk about those years after the revolution as the alcoholic republic. A huge upsurge in drinking that was so intense that it provoked this century long battle against demon rum that culminated in literally. The prohibition, uh, of alcohol nationwide. And so when you look at the history of the United States, one of the things you see is people have always been using a lot of drugs. The question is, why has that sometimes produced a crisis, a public health crisis of people dying of, of lots of addiction? And sometimes it hasn't. So we, we tend to think. Um, you know, drugs are bad and if we can get rid of fentanyl, then people will stop using drugs and that's good. We have this kind of on off switch. We want a drug free world. America's never been drug free, but sometimes the drugs haven't been catastrophically dangerous. Um. And so the, the, what we wanna orient our approach to this is thinking not how do we stop what seems to be a pretty deep rooted human behavior, but how do we make sure that it's channeled in directions that aren't harmful or could even be beneficial? And we don't get that by, uh, focusing on one part of the problem. Look, nobody is gonna defend people who are selling a dangerous product in dangerous ways. Like there's, you know, the people who sell fentanyl, just like any, uh, business that sells a product that kills people and they're not doing what's necessary to stop that, they're morally culpable for that. Uh, the question is how do we get them to change their behavior, the way that we change the behavior of other businesses that, uh, make decisions that endanger the public health. How do we do that? We, we'd be talking about changing the behavior of cartels as well as the dealers within the United States who are, you know, 80 to 90% of the time, American citizens. Yeah, I mean, it, it's a, it's a complicated task, but it starts with acknowledging, uh, that by. Prohibiting all of these substances, we have made sure that the people who sell them are going to be criminals. It, it sounds like it's just circular reasoning, but it makes sense if you think about how markets work, right? There is a market for fentanyl in the United States, right? Making it a prohibited substance. Didn't eliminate that market. We set up a market. And it has its own incentives. And the incentives are those of prohibition. So what are the incentives of prohibition? What, what re what behavior is rewarded under prohibition? Well, you want a super potent drug because then it's small and easy to smuggle. Uh, you want, uh, a short supply chain because that exposes it less to the possibility of policing. Um, a lot of times you wanna involve, uh, children in the circulation because they have less, uh, they'll, they'll get, um. Reduced sentences. The, the cost of doing business will be lower. All these things that we don't like it, uh, it in incentivizes the most ruthless behavior. And so, uh, the one thing it doesn't incentivize is consumer safety. Now in most products, uh, on the market, the consumer's wellbeing is an important factor in determining whether your product is a success. And this is true in drugs too, uh, in the pharmaceutical, uh, sector and what I call white markets. So these are legal drugs prescribed by physicians and sold by pharmacists. They, um, they have to be precisely what it says on the label. They have to be quality manufactured. Uh, there are all of these safeguards, and that's how they compete in that market by having the best product that, uh, produces the most wellbeing for the consumer. That's at least that's the goal. Uh, there are times when that doesn't happen, as we all tragically know, and, and we can talk about that too, but think about all of those incentives are absent in a prohibition market. It's just, it's illegal to sell, uh, to sell a product and say, I'm selling you cocaine, but it's actually fentanyl. Or to sell fentanyl that says it's one dose, but it's actually 30 doses.'cause it was mixed wrong. It's all illegal. And so, uh, the manufacturers, the people who sell, aren't incentivized to think about consumer safety as a primary concern. And obviously they should anyway. Uh, ethics and morality calls for. But you know, as we know from capitalism, people who are driven by greed, they often need our help being forced to pay attention to these things. Right, and I've seen personally how drug dealers are driven by greed. Mm-hmm. Are you suggesting then that, that we should end prohibition against all drugs and we, we've, we've seen countries try to do that, right? Or, or even, um, states try to end, you know, criminalization of heroin and things like that. Is, is, and people are really afraid of that. People are also really hesitant even when it comes to harm reduction. Two words we're not supposed to use anymore. And so we, we call it lifesaving tools, but even then there are people opposed to, Yeah. certainly probably the one they're most opposed to is things like safe needle exchanges, but also even we distribute naloxone and fentanyl testing strips. And quite frankly, I think there are people that don't value the human life of people suffering from substance use disorder. I'm sure you're right about that. And the struggle to, uh, the struggle against those kinds of attitudes was a long one. It was fought by people who use drugs in the people who love them. And uh, and I think that there's also, in addition to that kind of s stigma and judgment, there is also. A real concern in there, which is that when people say legalization sometimes, you know, they mean, or they're imagining a free market. And free markets are actually, as in my, you know, examination of the history, they have functioned just as badly as prohibition markets. Right? They're both, you mean. Huh? So, uh, when, when there's no restraint at all on selling an addictive product. There's a lot of money to be made and a lot of, um, practices that are totally. Uh, in opposition to consumer health come about, we can start this with, uh, right before the eve of prohibition of alcohol, it, in the early 20th century, there was a huge, um, monopolization in the alcohol industry. So there were a few major corporations, they called them the liquor trust or big beer, and they bought up all the saloons and there was all this competition. So saloons started to just pop up everywhere. Especially in cities, but all over the place, uh, more than the public could bear. They were competing with each other by going for younger and younger consumers, they would stay open at all hours. They, uh, threw away all restraints on how they sold alcohol. And this is an example of like, you, you, you don't have to be a kind of repressive drug warrior to say that's not great to flood a community like that. With a product so that it's so easy to get that it becomes more likely that someone is gonna end up having a bad relationship with that, with that drug. Um, that was bad and it was done because there was this free market in a providing a profitable, addictive substance. Same thing happened again in um. In the 1950s and 1960s with, uh, sleeping pills like barbiturates. Uh, this is a class of drugs that eventually gave way to, um, pills that people will more likely have heard of, like Valium and eventually Xanax, uh, and amphetamine in the, in the fifties as well. There were some market restrictions, but nowhere near enough and literally billions of these pills were sold 'cause they, uh, could earn so much money. So the, the similarity, the ironic and tragic similarity between the free market and prohibition markets is that they're both ruled by the profit incentive and there isn't any force there to require the companies cartels, whatever you wanna call 'em, they're businesses, all of them, legal and illegal from doing what it took to pad their bottom lines even at the expense of, um, the public health. Right. Even at the expense of human life and barbiturates, that was another overdose crisis that we don't really talk about in this country. A Absolutely. And it wasn't like a, um, acute old fashioned drug crisis, uh, in any way, shape or form in that, in a white market drugs, I. Graft this out and it's definitely was not as bad as the crisis that we are still going through today. But it was, it was not a joke. It was quite significant. It was unlike anything the country had seen before, or the country had seen since, uh, until we got to the 21st century opioid crisis. And it came again from being allowed to flood communities with a potentially addictive drug so that it was just too easy to get. Just like Oxycontin, I mean, really. yes. Are you ready to protect the next generation from the dangers of substance use? Emily's Hope has created a comprehensive K through 12 substance use prevention curriculum designed to educate, empower, and equip students with the tools they need to make healthy choices are age appropriate lessons, starting kindergarten and build through high school using science, real stories and interactive learning to help kids understand their bodies, brains, and risk of drug use. We're already reaching thousands of students across multiple states, and we're just getting started. Visit emily's hope edu.org to learn more and share our curriculum with your school administrators and counselors. At Emily's Hope, we believe prevention begins with education. Let's work together to keep our kids safe. so if, if complete prohibition isn't the answer and a completely free market isn't the answer. What have we done in this country that's been right? I mean, what, what, what is the in-between for that and what does that look like when it comes to and other illegal drugs like cocaine and, and other things pouring into this country? Yeah, that's the $60,000 question right there. And luckily, right. well, luckily it's not me. I don't have the answer, but we have done things that have worked, but. Before people get too excited, I have to be really clear. What does it mean to work? Okay, I'm gonna give an analogy here, uh, to the highway system. We have done so many things to make highways safer. We have airbags in the car, we have antilock brakes, we have rumble strips on the side of the highway. We have places where people can pull over and take a nap if they're getting sleepy. All of these things. And this is a success, but does that mean that no one ever dies in the highway? It's, it's a human world. It's an imperfect world, obviously. I, I think there are things we can, there are ways that we can improve, but we, we can't set our sights on something unachievable. Like, uh, nobody will ever die in a car again. What we want is to do better than we're doing and to do the best that we can. And so we've done things that worked, but you wouldn't necessarily know that they worked if you're. If you're, um, thinking if anyone ever dies of a drug, then that didn't work. Of course, by that measure, prohibition has failed beyond imagining for 150 years. so. I, I guess the first step in talking about what works is really to calibrate expectations. What we can do is better people. We have antibiotics. People still buy die of infections. We're, it's an imperfect human world and, and, um, and there's gonna be some degree of tragedies no matter what we do in any domain of our lives. But if we have honestly done our best. the sting to our collective conscience, uh, will be eased by knowing that we've done what we can do. And so in the case of drugs, what we can do is use the tools that we have developed to manage capitalism, the tools we have developed to incentivize people who wanna make profits. We incentivize them, uh, to behave in a way that we want, we say, okay. You wanna sell gizmos to, uh, you know, to Americans. Well, gizmos have certain risks and so therefore we're gonna say, you gotta manufacture it like this. You gotta let us test these kinds of products. We've got to, uh, have clear instructions for how to use the gizmos safely, whatever you want. Uh, all of the, all of the things that you as authorities, as the government believe need to happen. Uh, for this product to circulate in a way that's gonna benefit people, gonna bring people to benefit of this product and protect them to the extent that we can from the risks. And we're really good at that. Uh, I gave the examples of cars. Do you think automobile manufacturers wanna put expensive airbags in the cars? No. It, it raises the price of cars. Uh. Health insurance programs, they, people wanna sell super cheap health insurance plans that don't cover things and regulations don't allow it because it's, uh, would be, uh, a problem for consumers who spend the money on and then it's not there when they need it. All of these products have these kinds of, uh, differential incentives bid in that we, that we attract the sellers by saying, you can make money, you can make an honest profit. But you're gonna have to make an honest product. And then when it comes to. Illegal drugs. We just, we just throw it all away. And we have evidence that it can work not only in white markets. So the same drugs are sold in white markets are sold by, uh, physicians and pharmacists. And don't tell me that pharmaceutical companies aren't run, uh, for profit. Don't tell me that doctors don't wanna earn money. Don't tell me that pharmacists don't wanna earn money. That whole system, it's a commercial system. This is America. It's capitalists. They're all, you know, they may have other motives too. But they're all after profits. So it can, it can work. And then you see, um. You know, some more unexpected examples, and then I'll just give this one and then, and then stop for, for follow up. But in the, in the 1980s when we were both in high school, we were talking about earlier, um, we are aware there was a public health crisis related to a form of cocaine prepared for smoking called crack cocaine. And the data on this are pretty fascinating, uh, that it, it seems, from what we can tell that. the rate of white people who smoked crack cocaine was actually higher than the rate of black people who smoked cocaine. Not a huge surprise because, um, it takes money to use drugs and so you find that people with money tend to use more drugs, but. The, um, the rate of addiction to crack, the rate of intense, uh, continual use was higher in black communities. And the, the best explanation that we can come up for with this is that, uh, the literal markets where crack cocaine was sold were physically located in the neighborhoods. Uh, where the black communities were living in cities so that public authorities kind of quarantined residentially, segregated the housing, and then quarantined the vice trades into the same neighborhood. So living in the middle of a crack market made it more likely, not that you would use crack, but that you would become addicted to crack because you were in a situation where crack was really easily available. So when I think of, look at that situation, one of the things I think is, huh. A little piece of friction simply having to drive to an unfamiliar neighborhood to buy a drug that had an impact on, uh, not necessarily who, who tried crack, but who became addicted to crack and who experienced those harmful consequences. So little things like that that, uh, that we could introduce into markets to steer people, uh, away from. Harmful drugs and harmful relationships to drugs and towards, okay, let's say that there's a human impulse to alter your mental state. Steer that impulse in a safer direction so that it's not gonna hurt you or anybody. Right. That's one of the things we are trying to do at Emily's Hope with our substance use prevention curriculum is to give kids, other things that they can think about and do, and to protect their bodies and their brains and knowledge rather than the war on drugs. We know that didn't work. We know just say, no, didn't work, or we wouldn't be where we are today. And to me, this, um, war on Fentanyl is not going to change these intrinsic things about people that lead them to addiction. Yeah. So there's two different drug markets. And, and one drug market is for people with an addiction. And, and this is a really specialized market. And let's say, you know, that, that I start from a position of caring about people who use fentanyl 'cause they're people and they use fentanyl. Uh, and let's say that one of the things I think is man fentanyl is, is a bad product. Um, and you know, so I understand the impulse. I would, I wish, I wish we hadn't. You know, as, as crazy as it sounds, it was better when those markets were selling heroin. Heroin's a better product. But, you know, there are all these people who are committed to fentanyl. Do I have to be a kind of a, uh, a free marketeer and say, well, the consumers just always get what they want. Not necessarily it's possible to say, okay, we're gonna try to shut off this, this fentanyl spigot, but first we're not. That's, that's step three. Step one is we need to talk to the people who are intensely using Fentanyl now, and, uh, prepare a plan for how, what are, what are you gonna do? When we successfully make it so that it's really hard to bring Fentanyl in this country, we wanna make sure that we've connected you to a program where Suboxone is available, where methadone is available, and hey, maybe there might be people who aren't ready for that kind of step and we might need to have intermediate, uh, steps where they can, get access to injection, pharmaceutical, opioid, something so that when we cut off that supply. We won't just have a, uh, this huge magnet sucking in new suppliers who, if history is a guide, are gonna be even worse than the ones that we already have. So this one, We saw that happening with Oxycontin when Oxycontin was cut off. yes. came in. So you cut off Fentanyl. What's next? Nitazenes? I mean, it's Yeah. thing, Yeah. And, and you know, we, we are so used to blaming foreigners for the drug supply. Hey, you could make fentanyl in the United States. Amphetamine was made here. Yeah. are, And, and so if you cut off that supply chain without taking care of the people who are currently so, uh, committed to using fentanyl, you know, it's really throwing the dice, uh, in a, in a dangerous way that's gonna. Cause a lot of harm. Have you lost a loved one to overdose or fentanyl poisoning? I'd like to invite you to share their story on our new Emily's Hope memorial website called More Than Just a Number. They were our children, siblings, cousins, husbands, wives, aunts, uncles, and friends. So much more than just a number. You can submit a memorial today on more than just a number.org. We've seen cuts, uh, from this administration for treatment. And so that's, uh, terrifying to me because I've always said, well, yes, we, we need to have some accountability in law enforcement in this fight, but we need to have prevention and treatment as well. And we, we, we just look at one thing instead of all three legs of the stool, Yeah, over. absolutely. I mean, and cuts the exact opposite of what, what you need is you need a, a ramp up. You really just need to acknowledge that over the last 30 years, uh, due to policy mistakes. Many, many, many more people were exposed to the risk of addiction than was Histo has historically been the case. And we need to take decisive action to bring the chapter to a close by, by really doing right by these people who are being harmed. Really say, okay, we're not, we don't see you as the enemy. Uh, we, we need to. Reach out a hand so that when whatever our other drug policy is doing, if we're gonna say like, fentanyl is not a product that we want circulating freely through the country.'cause it's just a, a bad product. It's dangerous. Uh, and, and it's hard to, it's just hard to use safely. It's hard to have a stable life while, uh, while using Fentanyl. Uh, that, but that we don't want you to be harmed by this, um, by these policies. So we know that fentanyl is American problem and I know that you study the history of this country, not necessarily other countries, but fentanyl is not the kind of problem in other European countries that it is here in the United States. And I think we could learn from some of the things that they have been doing in Europe, um, for a long time when it comes to how they Yeah. substance use disorder. Yeah. I mean in, now Europe does have its own substance use disorder issues. Uh, they aren't generally with fentanyl, but one thing that you do find that's very common, uh, in Europe is a, Less free pharmaceutical market that the, that the market for medicinal drugs, which Fentanyl, you know, was until fairly recently, are much more strongly controlled by tradition and culture, by the, um, by the professional, classes that, uh, in, in medicine and pharmacy. And they're, they're on a, a tighter leash. So if you think about, um. What I was saying about the, the twin problems of the free market and and prohibition, there's a much stronger tradition in Europe of having tighter regulation on pharmaceuticals, and pharmaceuticals are often. The, the launchpad for, uh, American drug Crises. There's this, it's like a two stroke engine. First, you know, we, we overdo it in both directions. We overdo it by saying, oh, there's a new miracle drug. Everybody and their brothers should have it. We'll put, you know, 8 billion pills into a small West Virginia town. Um, and then in reaction we say, oh my God, this was a terrible mistake, and we totally slam the brakes and impose a kind of a prohibition. And then suddenly all these people who have. Become addicted to this drug, can't get it anymore. Let's just put it this way. You can make a lot more money in American pharmaceuticals than you can make selling pharmaceuticals in Europe, uh, because. We set up the system to enable that boom bust kind of rhythm. And when the boom is going, a lot of people are earning a lot of money. So that's one, one obstacle. Another one is that the United States is, uh, is a country that's kind of, uh, riven apart by a lot of social divides, divides of race and class and these kinds of things. And. A lot of times, most typically drug policy is seen through the prism of things that really don't have anything to do with drugs and addiction like race. So when heroin was a, um, a big public health crisis in major American cities in the sixties and seventies, this was considered to be a black problem, a Latino problem, and that. Um, and that colored authorities' responses, it made it hard for them to think pragmatically about it because they couldn't think through their own prejudices about the communities where those problems were happening. And in a weird way, the same things can happened in the, uh, in the 21st century opioid crisis. The, uh, prejudices and assumptions about. Rural white people also affected, uh, drug policy in some ways. The, the cultural traditions of kind of, um. Mythologizing, these areas helped lead to more support and, and empathic policies. But it also led to a, a, a kind of a dangerous, um, story of exceptionalism that like, unlike every other community that was flooded with addictive drugs like this one, this crisis was unique. When, if you look in over the last 150 years, pretty much every community that was just flooded within a, a potentially addictive drug, there was enough trauma there that, that caused a crisis. Um, you know, in 1950s, 1960s, uh, some of the wealthiest people in the history of humanity, the, the suburban, uh, middle class white American families, those were where, uh, Valium addiction was running out of control. So you didn't need a ton of trauma. You just need flooding of pills. And as humans, we bring enough trauma with us, right? Uh, sadly, life is tough. And also just the, and physiological propensity for addiction, especially with substances that most people couldn't avoid it, um, Yeah. powerful substances that are out there. Yeah. I mean, and, and this is a real, this is one of the things that I think can give us hope, and it's, and it's the kind of hope that I've been selling all along. So the kind of hope that we don't necessarily get jubilant about, but that I think we can see, uh, is real. About 75% or so of people who use even the most addictive drugs like heroin and cocaine, do not develop an addiction. Um, and that should give us a lot of hope because it means this is a number that we can try to improve on, right? That we, we don't, at least from a historian's point of view, haven't seen a time where absolutely no one used those drugs. And there have been times where the. It was much easier to control markets than, than it is today with all the internet and, and people moving around everywhere. So, we can try to, uh, figure out what that, what explains this, uh, the 75% versus the 25%, and then change the way that, drugs circulate so that fewer people who are gonna be in that 25% encounter the drug that's gonna. Lead them down the wrong path. And the people within addiction are a small part of the market for drugs in the United States. The overwhelming majority of people are not intensely committed to any particular drug they're gonna use what's, for the most part, what's most easily available. And so we should make real sure that, um, substances that are. Harmful and activities that are not harmful are the easiest ones to get to with it. I, I call it market friction. It should be real, real, real hard to get. Fentanyl should be less hard, although still hard to get. Right, right. And it made me think while you were speaking and you're talking about like availability and supply and how people get these drugs, it made me think about how while we're to. Declare fentanyl, a weapon of mass destruction, perhaps in order to bomb Venezuela more, or the boats more. We're not willing to hold social media companies accountable for the drugs that are traded to our children on their platforms. And this has been something Yeah. discussed quite extensively on this podcast with parents whose kids have been harmed, be, and I think a lot of that has to do. I mean, it comes down to politics. Right? So you talked about being divided by race and divided by class, but also divided by our politics. Yeah, that's a, that's a tricky one, isn't it? And, and the social platforms, it's kind of like a exponential because they themselves are designed to be addictive and they themselves, you know, seem to be producing a lot of real psychological, uh, trauma in, especially, uh, in young people. And then, uh. As a, as a place where these kind of unregulated markets can flourish, where people can make money without being, you know, it's, I love humans. I, I am a human. I, I love us, but, but we, uh, we've got some flaws. And one of them is that, we'll, that many of us. Are easily led astray by the lure of profit, and that without, without rules, uh, these, these kinds of market behaviors, they tend to not end well. And so carving out a space where people can do trading without any kind of, um, regulations that, that. At least incentivize, if not enforce good behavior that's gonna lead to trouble. whether it's regulating social media or substances, Hirschberg says there's no simple solution. While that may sound cliche, he says there's actually practical wisdom in recognizing that any meaningful response has to be multifaceted. There's one kind of problem where you. Vanquish the foe. You, you, you solve it. And then we move on to the next thing. There are other problems that are more like housework, like no matter how many times I conquer the dishwasher, there are more dirty dishes and, and there's a part of my brain that's like, okay, there's stuff that I just always gotta do and always gotta take care of. It's never gonna be perfect. I'm always gonna be handling some new, uh, thing that's arising. And if we think about. Drug policy more in the model of housework, frankly, that is, it will never end. We will never have a complete victory. We will figure things out. We will do things better and worse. We can clean up after big messes in in ways that are appropriate to those messes that. That's the mentality. Uh, and and I know so many people in this country, and I know you're part of an organization that's very involved with this, are doing this. Right. They are doing it day to day. They're not thinking, if we can just get rid of the leader of Venezuela, then somehow drug problems will go away. No, they're, they're doing that work on the. Uh, in the communities on the street harm reductionists, people in addiction treatment, these are, I call'em street policy makers. In a way, they're doing the things that we should collectively be doing as a society by caring about the people who are in danger, by working to protect them, to try to help them to have decent lives. And, and that should be our guide. That's our, that's our model. That's what, that's what it's all about. Yeah, I, I, I've learned a long time ago that I can't save everybody, you know, that I, the, with the work that we do, I can't save everybody, but if just one life has changed, if just one family doesn't have to go through what my family went through, I'm gonna keep doing this work. And so I think that, that, that's, that sort of the pragmatic long-term view of, of doing this kind of thing. And it, it isn't solved by any one single action or that a politician can do. Yeah. Although politicians can, can get behind and support and, and give the needed resources for the kind of daily, the daily work that we all need to be doing. and we know that there's a lot of opioid settlement money throughout this. Nation Yeah. that also sometimes fuels greed, and everybody wants a piece of that pie where I, I'd like to see it all go exactly where it's intended to Yeah. people well and healthy and save lives. Yeah. Amen to that. Uh, it's, that's, uh, that's another battle, isn't it? Herzberg has used his knowledge to write three books. You can find information about them by checking out the show notes on this podcast. And while you're there, we'd appreciate it if you take a moment to rate and review this episode and share it with your friends and family. Together we can raise awareness and make a difference. Herzberg's latest book is titled White Market Drugs, That's a history of. Addictive pharmaceuticals going all the way back to Bayer's, heroin and, uh, Quaalude and all this up to the present. It's a, it's a, it's a, it's a scholarly book, so don't hate me if you start to read it and, and it, uh, I'm a, I've got a license to bore as a historian. you are a college professor, That's right, that's what, that's my license to bore. Um, and, uh, my new research project is on the history of addiction among physicians and other healthcare workers in the United States. And I'm also doing an oral history of harm reduction in my area, which is Western New York, Buffalo. Uh, I'm working with a, a former PhD student of mine and we are interviewing the people who really. Uh, started these kinds of, um, like back when they were illegal, started doing things to try to save the lives of people, uh, who were addicted to heroin, uh, back in the back in the eighties and nineties. Oh, it sounds really interesting. So I look, I look forward to reading more from you in the future, and thank you so much for coming on the podcast. you for having me. and thank you for listening to this episode of Grieving Out Loud. Each week, tune in for a new conversation. You can also check out hundreds of past episodes anytime on our website, Emily's Hope Charity. You can find a link in the show notes. Thanks again for listening. Until next time, wishing you faith, hope, and courage. This podcast is produced by Casey Weinberg, king and Kaylee Fitz.