(film reel clattering) - Welcome to Ethnic Media Services' weekly national news conference.

I'm Pilar Marrero, EMS associate editor and today's moderator.

[background music] Today's topic is the fentanyl and meth double menace, the impact of powerful synthetic drugs in the economy, the rise in homelessness and youth fatalities.

The massive availability and use of powerful synthetic drugs like fentanyl, the most powerful drug known to man, and new more potent versions of meth like P2P are causing a growing problem in the United States.

Both drugs are now available coast to coast like never before.

Overdose deaths rose during the COVID-19 epidemic.

And in 2021, more than 200,000 people died in the U.S. of drug overdoses.

About 71,000 of those deaths were related to synthetic opioids according to the CDC.

Children and teens who ingest fake prescription pills and tiny candies laced with fentanyl are becoming seriously ill or dying every week in America.

Meanwhile, P2P, a very easily produced type of meth is ravaging the streets of the United States and increasing addiction, severe mental health, and homelessness.

Our two guests have a front row seat to this crisis and will share it with us.

They are Sam Quinones journalist, storyteller, former LA Times reporter and author of four acclaimed books of narrative nonfiction.

His most recent book "The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth" was released in 2021.

And, we have with us John, an ER doctor from a major western city.

He has agreed to speak on condition of anonymity.

You can use his first name and just identify him as an ER doctor.

Thank you for joining us, John.

We understand this is a very sensitive information that you bring, and we thank you for sharing it with us.

We are interested in hearing from you what you are seeing as a doctor in the ER so our communities that we cover, all of us, can begin to understand the impact of these new, more damaging drugs that our colleague Sam Quinones has written so much about.

So, let's start with this.

Can you share a little bit of the timeline?

Have you seen a change in the type of drug abuse and overdoses that take people to the ER?

And, if so, can you describe what that change is and when did you start to see it happen?

- So, what we saw for the opiate side of things is there was a decrease in opiate use when I first came back.

And, I believe that was likely from, you know, states cracking down on unnecessary prescriptions.

You know, people-- they really started cracking down on oxycodone prescriptions.

I think there's a lot of education surrounding it.

But then, about 2019, 2020 we started seeing an increase in opiate use disorder.

And, you know, I won't-- I don't know why that is.

I'd suggest probably the pandemic had something to do with it.

But, what we started seeing is more and more opiate use.

And, it started out with heroin.

And then, we'd start seeing these accidental overdoses again where it was, you know, heroin-- they tried to do heroin, but they accidentally did fentanyl.

Now, what we're seeing now is exclusively people using fentanyl on purpose.

There's no-- people don't have either access to fentanyl- or, I'm sorry- access to heroin, or they're just-- they like fentanyl more.

I won't, you know, I think it's probably that they don't have access to heroin.

But, what we're seeing now is when someone comes in and you say, "Do you do, you know, do you do any illicit drugs?"

They will answer, "I do fentanyl", instead of, "I do heroin".

And, that is a change that I've seen in basically the last year.

That it's primarily fentanyl that we're seeing that people are actually just purposefully using now.

Now my city, you know, just like any other city, we've had these overdose deaths with pills that, you know, it looks like an OxyContin pill and kids take it and they overdose on that.

- Can you describe each drug and the effects, the effects on people?

- One of the problems with fentanyl is that since it's dosed in micrograms, right?

It's a hundred times, a hundred fold more powerful or potent if you give that milligram dose, right?

And, that's why people who were trying to use heroin would use-- they would, you know try to use the amount of heroin that they use.

If it was fentanyl, they'd immediately overdose.

Right?

Whereas like I give someone 50 micrograms of fentanyl when I'm dosing it for pain in the emergency department or in EMS, 50 to a hundred.

Now that would be about 0.1 milligrams, right?

Of, if I'm doing my math right, of morphine or heroin, right?

So, and there's different equivalencies here but what I'm saying is that the dosage is much smaller for fentanyl.

The other thing with fentanyl, like I mentioned before, is it's "quick on/quick off."

So, what we-- you know, people will you know, get fentanyl, they'll be high for a very short amount of time or their pain will be treated for a very short amount of time, and then they'll have pain again.

And, one of the reasons we use it in the emergency department or an EMS is because that property makes it hemodynamically stable.

And, otherwise, let's say you have a trauma patient who has low blood pressure because they're bleeding, fentanyl is a way to help treat that bleeding quickly- or, I'm sorry- treat their pain quickly without dropping their pressure or affecting their pressure.

And, it's "quick on/quick off" means that, for us, since we're using such lower doses it's harder to get into trouble with stacking the dose on top of each other.

But, on the street, since it's dosed in such a small amount it's very hard for people to use it in a way that is safe.

- So, but fentanyl is a drug that can easily kill you the way it's been used on the streets, right?

- Absolutely, absolutely.

- [Pilar] And, what's the different way with meth?

- So, meth?

To be honest, the dosing of meth?

I don't know because, you know, (chuckles) I don't deal with it.

We don't have a medical equivalent of methamphetamine.

I guess, you know, you have things like Adderall and stuff like that, but-?

The dose of meth, you know, I couldn't be-- I wouldn't be able to give you a good answer on that.

But, I will say what we are seeing, and this is probably from, like, 2018 on, is that we're seeing more and more and more psychosis with methamphetamine.

That it's not this-- the people that we're seeing in the ER are absolutely paranoid, displaying signs of severe paranoia, severe psychosis.

I'm very hesitant to use the term "schizophrenia," like severe schizophrenic symptoms, because schizophrenia is generally more, you know, the person who has organic schizophrenia, or I'm sorry, nonorganic schizophrenia- who, you know, just develops schizophrenia naturally- they're usually withdrawn, right?

They're withdrawn.

They have paranoia.

They have-- but they're typically not the methamphetamine-type psychosis which is a very outward expressive schizophrenia where, you know, they're screaming- I'm sorry, psychosis- where they're screaming, you know, things are crawling out of the walls; they're screaming at other people.

They're potentially violent to themselves or others.

And, that's what we see with methamphetamine.

You don't-- I mean, you can see that with severe decompensated normal mental illness, but not to the extent that we see with the methamphetamine.

And, not to the amount of people that we're seeing with this is far beyond what we ever see with just normal mental health issues.

- Sam, I want you to join the conversation.

I don't know if you want to ask a question or if you wanna just chime in and answer some of the same questions I posed to him or make a comment.

- I wanted to ask John.

John, when we were speaking you mentioned a very interesting thing that dealt with I thought was connected to this idea that meth users in particular would go to any lengths to avoid to not be separated from their drug.

And, I was wondering if you could explain the whole idea that you talked to me about that I thought was fascinating of "it's not the meth."

- The opiate users understand that there's a problem.

They understand that it's an addiction but they say, "Look, I get drug sick.

I feel terrible".

And, you know-- and so, they'll acknowledge it that for whatever reason, methamphetamine users have a very, very difficult time acknowledging that.

And, I think part of that is, is because they're in a state of psychosis, right?

They're seeing spiders come outta the walls.

They're seeing you know, things that, you know, are terrifying to them.

And, they come to us and we say, "Look, I think it's probably the methamphetamine "that's causing this, 'cause you were normal before you started using this".

But, they cannot-- they can't acknowledge that for whatever reason.

- How are these drugs spreading now?

You have talked about the fact that supply is creating the demand.

So, clearly it's massive amounts that are getting here to the U.S. Are they being produced only in Mexico?

Are they produced here, as well?

And, how are they being sold?

Because what we are seeing, and somebody was asking in the chat is that traffickers are using social media to reach kids.

- Well, you're talking about two forms of traffickers.

All these drugs are made in Mexico.

There's no-- there used to be before the supplies that came outta Mexico there used to be meth cooks, you know?

Small scale meth cooks in various parts of the country.

And, those have been run out of business by this very, very cheap, very potent stuff coming outta Mexico.

So, you really do not see any classic little meth labs like we used to see, say, 15 years ago.

Those things have gone.

These pills are being sold frequently on social media apps like Snapchat, primarily.

I went to a Snapchat protest in Santa Monica, California.

It would've been a year ago in June.

So, June of 2021, where families who had lost their kids who had bought pills on Snapchat were protesting.

And, they had big posters saying "Snapchat is complicit in my son's murder."

A lot of this took place during COVID 'cause the kids couldn't leave the house.

The only way they connected to the world was through their phones.

And now, people went on anonymously and selling drugs with kind of very colorful menus, looked like an ice cream truck menu, almost.

That's what I thought when I saw one of them.

And, these are people who are probably not much older than the people they're selling to.

In LA, there was very clearly an offer to deliver the pills to the kids' house?

You know, that kind of thing.

And so, you're seeing the social media app become kind of like the new street corner, in a sense.

- John, have you seen, have you treated young people or a kid who overdosed on fentanyl?

And, how does the effect differ on young people versus adults, and what should parents look out for?

- Yeah.

I mean, I've treated, you know, children who accidentally, you know, ingested an opiate or, you know, or an adolescent who uses intentionally.

You know, I think-- you know, and then methamphetamine?

The same thing.

You see-- I've never seen a true child, like, someone under 12 on methamphetamine, accidentally.

But, obviously with adolescents, adolescents you see it.

I'd say with opiate use disorder, I would, you know, suggest for any parents, the biggest thing is if- especially if you had an adolescent in the house- if there are any narcotics in the house, if mom or dad is on a pain medication chronically or gets a pain medication because they broke their arm, that needs to be locked away.

The other thing I'd suggest is that if your child ever, you know, breaks his bone or anything like that, that if they are prescribed an opiate question the doctor as to why they think that's necessary.

And also, keep that locked away and only dose it as prescribed.

As for the illicit, you know, the illicit use.

You know, you know?

I don't know.

I guess try to monitor your kids' social media, if you can.

Unfortunately, that's not something I can really-- I can't really speak of 'cause I, you know, I just see kind of the end result.

And, typically it's, you know, the parents are usually beside themselves and questioning, you know, why this happened and that there was no, you know-- they didn't see anything coming.

I'm sure an officer, you know, would have a better-- and/or someone in EMS who's actually on the truck would have a better idea of the situations that caused that.

But, unfortunately, I don't have anything to really add there.

- What do we know, what do you know about treatments and whether or not there can be recovery from-- you know, even-- well?

If you don't die, 'cause apparently everyone dies from fentanyl eventually.

- Sure.

- What are the potential treatments for either drug or both drugs?

- Sure.

So, the way we treat any opiate use disorder is typically the things you've heard of which is methadone, right?

Methadone is a common treatment for this.

But, that has been rapidly replaced by another drug called buprenorphine.

And, buprenorphine is a drug that is a partial agonist of that "mu receptor."

It works very well because, one, if you try to use a another opiate, it blocks it.

So, if you try to use fentanyl when you're on buprenorphine, it won't be as effective.

It won't get you high.

Okay?

And, it will also stave off those symptoms of withdrawal.

I'm gonna give a long-winded answer, so just bear with me for a minute.

So, in the ER we can treat, you know, opiate addiction, right?

If someone comes in after an opiate overdose, we have a very effective program-- I mean "effective".

Maybe, you know?

10% of the people, but still, it's-- we're helping people, right?

They come in, each one of us has a special "X waiver" which allows us to prescribe buprenorphine.

We then get these people into a bridge program where they're-- have a warm handoff to a treatment center.

And then, they can do outpatient treatment with buprenorphine moving forward.

The buprenorphine?

There's another name for it-- is suboxone...is the trade name.

The methamphetamine is considerably more difficult.

There's no treatment for methamphetamine addiction other than "stop using", right?

And so, what I was telling Sam before is it's actually very, very frustrating.

Because, you feel absolutely impotent in the ability to effect change in these people because all you have is a finger wag, right?

It's, like, "stop doing meth."

That's basically it.

The other thing, you know, that also makes it much more difficult because they have psychosis with this.

And, the psychosis is long standing.

The methamphetamine psychosis is not-- it does not go away when the high of the drug goes away.

It takes weeks to months to even years to go away.

And so, it's really, really difficult to effect change in the methamphetamine user.

And, there's no necessarily treatment or anecdote for methamphetamine.

- In some places, people are attempt, you know, different, you know, school districts and measures around, you know, and big cities are trying different things.

You know, treatment.

For example, you know, when you talked about the homeless situation.

You know, the homeless, you have been writing about this and people when they talk about homelessness they only talk about housing.

They, you know, housing, housing, housing!

But, you've told us that a lot of the homeless problem comes from distrust from especially meth.

So, are cities-- is anyone doing anything that could be remotely effective in terms of policy?

- I think what's happened is for a long time, as you say, the narrative around homelessness was it had only to do with a lack of affordable housing.

And, I think there is-- a lack of affordable housing has something to do with the homeless issue that we're seeing now and across America.

But, I cannot say that I would say that it's only to do with that.

Yet, that is really the narrative of people who are pushing that idea that there is no other idea.

There's no other cause of homelessness.

I believe that a drug addiction-- first of all, there's many reasons why people get addicted, get homeless, right?

They lose their homes.

It could be aging out of foster care.

It could be domestic violence, sexual abuse, leaving prison without any family backup on the streets.

Surgery, eviction, on and on, loss of a job.

All of that kind of stuff is part of how people lose their home.

And, I think drug addiction, particularly to these two drugs is a major part of it.

And, affordable housing is certainly part of that story.

But, the problem is this: once you are homeless, these drugs are in such vast supply that you use these drugs once they're on the street.

They're very easy to find on the street and they're very easy to use and everyone is using 'em.

Once you begin to use those drugs, you develop all kinds of other problems that make it very, very difficult for you to get off the street and into a house.

And, the psychosis John was talking about is certainly at the top of that list.

It would seem to me.

But, it seems to me a strange thing that we have, clearly on our streets, this behavior that is not normal, that is very psychotic and scary, and scary both for the person as well as for people watching it and all that kind of stuff.

And, still people will say, "no, the reason we have homeless people is because of affordable housing," and that's it.

There's like a shutdown to the discussion.

And, people-- I have even had people, treatment center directors; twice, in fact.

It was striking.

When I was asking them about this and about methamphetamine, they were explaining this whole psychosis idea that John was talking about, too.

They would lower their voices, lower their voices as if not to be heard around the office because there is this kind of stigma about, or you know, there's almost an inquisition looking for heresy about this issue.

And so, you can't talk about other issues that might be creating or exacerbating homelessness other than affordable housing.

I think as journalists, we all need-- all of you need to push back against that idea.

That is an outrageous idea, an outrageous diminishing of our ability to write what we see and what we have reporting that supports.

And, anything you can do to kind of broaden the discussion of why people are actually homeless and all the reasons that why they may get homeless and why they may be mired in homelessness once they're out there on the street, would be only healthy.

And so, keep that in mind that, that is not-- that is a dogma that is very strenuously felt when you start talking to homeless advocates, in particular.

- Do you know anything about the demographics of the users?

Does it affect one group more than the other?

- Oh, I would say that now, you know what?

Let me put it this way.

When I wrote "Dreamland", which was about the widespread over-prescribing of pain pills, that was almost entirely a white issue.

I did not see or really encounter anybody who wasn't white.

I mean, it was like no Blacks, Latinos, Asians.

There was Native Americans were involved to some degree.

So...but that was a long time ago.

With the supplies that we've seen now, I am stunned to see-- again, these drugs change everything.

And, one of the things that you are seeing is widespread use of methamphetamine among populations that never, ever, ever used methamphetamine before particularly African-Americans.

I can tell you 35 years as a crime reporter, until three, four years ago, I never saw a Black person ever know, ever buy, sell, use, or even know much about methamphetamine.

It was cocaine was the drug of choice.

And now, the drug is so vast.

You go down skid row, largely Black due to crack for many, many, many years.

And now, it's all Black people on methamphetamine which surprises pretty much everybody who's down there.

And so, you're seeing it widespread and you're also seeing because it's marketed as these-- and fentanyl is marketed in this pill form, you are also seeing it hit kids with really very little experience, if any at all, in the drug world.

And, that is really another dramatic thing.

That's the parents of those kids that are at outside Snapchat.

That's what-- their kids had never displayed-- most of them said "I never knew my kid "to ever be a drug addict but he was, you know, depressed or anxious."

So, buys a thing on the web and pretty soon, it's got-- and he buys it and it's got fentanyl in it.

And it's not what he thinks it is, and he dies.

And so, that is kind of how things are changing, as well.

- Those online sales, how does that work?

I mean, you order something, it comes in the mail?

- It's hard.

I mean, yes, there's been prosecutions of people who have sold online.

Craigslist is where a lot of this started.

I wrote a story about this a few years ago but then very quickly during COVID, particularly, it transitioned to some of the other social media apps like Snapchat, and so on.

There's been a lot of pressure put on Snapchat in particular because it seems to be the main one.

Again, you know, there's a lot of-- Snapchat says it's doing what it can do.

Parent groups, some parent groups say, "Okay".

Other parent groups say, "No, there's no way you're doing enough".

I mean, it gets into that kind of back-and-forth on that.

But, you know, it gets to the whole idea of whether these social media apps are platforms or editorial.

You know, have an editorial function.

And, they want to say that they're platforms and they can't govern what's going on, on their sites.

Anyway, that's kind of where we stand on this.

It's still something I think you can report on.

It's very important to reach out to the parents in your neighborhoods or in your towns or states or whatever and do these kinds of stories, because I still don't think people quite get what's goin' on.

- John, Sam?

Thank you so much for bringing us your knowledge on this.

This is something we really wanted to do.

I don't know.

Sandy?

You should say some words before we close.

- So often, we have great speakers.

They're experts, but there's a sense of distance with the subject.

You brought us right up close.

I definitely just want to thank you both for sharing you, John, as an ER on the front line, and you, Sam, as a journalist devoted to this topic sharing with fellow journalists [background music] what you're seeing, what you're really encouraging us to spend more time covering as this new drug era that we're now in is just all around!

I see evidence and signs of it here and there but no concerted sort of focus that this is happening now at the scale that it's happening.

So, this has been very, very illuminating.

Thank you.

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