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This is Rainbow Fentanyl, designed to get kids hooked.

It's the latest outrage identified by the DEA as the fentanyl crisis continues to explode all across the United States and here in Washington State.

Fentanyl killed 71,000 Americans in 2021 with no sign of letting up.

Tonight, our annual discussion with UW researcher Caleb Banta Green, who says fentanyl is the worst he's seen.

And that is saying something.

Next on Northwest now I look back in the northwest now Program archives recently in advance of doing this program.

In 2014, we did our first program with our guest.

Caleb Plant agreed it was about the reemergence of a terrible problem with heroin.

We did programs every year about the opioid crisis, but it wasn't until the winter of 2018 that we made the first mention of fentanyl, and in the years since, it has exploded exponentially with overdose deaths just about doubling every year.

The blue line on this chart shows the explosive increase in fentanyl involved drug cases in King County alone, starting in about 2017, you can see that it just goes parabolic with 388 deaths in 2021 alone, and the rest of the opioids are climbing right along with it.

Seattle police confiscated 650,000 pills in 2021, ten times the amount they found in 2020.

In October of 2022, the DEA, the FBI and the Seattle police seized two RVs packed with £1,000 of meth and fentanyl, enough to kill 132,000 people and resulting in the indictment of 11 people who also coughed up 43 guns and $1,000,000 in cash, certainly implying the continued deep involvement of the Mexican cartels.

Statewide, about 2000 people died of overdose in 2021, a 66% increase compared to 2019.

And COVID only made it worse.

Responding to the results of the most recent study, longtime Northwest now guest Caleb Banta Green, who's the principal research scientist at UW, the Addiction Drug and Alcohol Institute, said fentanyl growth is, quote, the biggest, fastest shift we've ever seen and also the most lethal.

Caleb, thanks so much for coming in Northwest now.

You've been a reliable and a valued guest here on this program as we deal with a major public health crisis, not only here in western Washington, but across the country as well.

And you're a nationally respected and nationally known leader on researching this and helping us all come to an understanding about what's really happening out there.

I want to start, though, this time, and we'll get into harm prevention and a lot of those strategies.

But for the people yelling at their televisions, quite literally saying what about personal responsibility decriminalizing this?

Has it worked?

Look at the streets.

The evidence is of failure.

What is your answer to that?

And like I said, I know your treatment focused and I am, too, quite frankly, because the house is on fire.

But what is your answer?

When people start pounding the desk and asking about personal responsibility, how do we think about that?

So we need to take a big breath and try to open our minds and understand a little bit about what's actually going on from the outside.

Just looking at it, it looks like people making bad choices.

They made a bad choice to start using.

They should make a good choice and stop using.

But what you don't see under the hood of the brain, whether it's alcohol or whether it's opioids or whether it's prescription opiates or whether it's heroin, is that brain chemistry is changing after repeated use of these substances.

Brain chemistry changes, people's biological priorities change, and they no longer can just make a choice to stop or to eat well or to have relationships.

It's there.

The hooks are so deep.

Yes.

So the head of the National Institute on Drug Abuse talks about addiction, hijacks the brain's reward system.

So our natural reward system is oriented towards food, water, relationships, all of those things.

But a reward system is literally hijacked where the number one priority becomes that alcohol or those drugs.

And so if you think about it at that level, think about your own personal drive for sleep or food or love or water, how strong those things are, how much your entire life is oriented to that.

Now, imagine it's all been hijacked and it's all about drugs, and that's what you're preoccupied with and that you've moved past the stage of it being a choice to stop using.

And you would need one substantial supports to stop using.

And in that process of using, you've burned a lot of bridges.

And to recreate that life takes a lot of effort.

And that's why we're so focused on trying to help people get stabilized so they can rebuild their brain chemistry and rebuild their lives.

And it takes patience and it takes a lot of empathy.

And that's hard to do when you see people sort of acting out, living in chaos, creating chaos in their community to be empathetic and realize this is a human being whose brain is no longer working correctly.

And we need they need support and they need time.

Just as we're feeling a lack of empathy and and then, like, we're all we're all done.

Well done.

Yeah.

And a little light just went off in my head listening to you.

One of the problems is we are mad at these people.

I think that's fair to say.

Yes.

Yes.

So what I think is important, I'm not a psychologist, but what's important is the emotion that you're feeling that another person creates is very likely.

The emotion they are putting out.

They are feeling out of control and in chaos and in crisis.

And you're picking up that vibe, so to speak.

So there is when you're just feeling mad and bad and this is chaotic and out of control, they are also feeling that.

But they're feeling at 24 seven.

Yeah, they're exhausted, brains exhausted, their bodies exhausted.

They're in pure survival mode and think about what you would do in your life and you're in pure survival mode, probably different than what you do every day.

I've watched a lot of documentaries on this, on the various streaming channels and and PBS has done some great things on that as well.

And we always hear the sound bites from the people who are defiant and turning away treatment.

No, man, this is my life.

This is what I want to do.

I love it.

But if you watch, those are kind of the things you see more in kind of the popular media.

A quick tweet, but if you watch some of these documentaries and listen to the people, they are, they are miserable, they are suffering.

They want out.

They realize they are destroying themselves but cannot stop.

That's got to be awful.

It is awful.

And there's really two sides to what you just said in that exact moment of crisis or being unhoused or having lost all your relationships.

That drug is making you feel better than it is making you feel worse.

It's helping you cope with a really bad situation.

But when people give a moment to pause and reflect and so much of what our research is really focused is when you ask a person, Would you like to stop or reduce your use, over 80% of people say yes.

Ironically, though, we have an 80% treatment gap.

Most people are not currently able to access care for a lot of reasons.

We can get into if you want.

Yeah, I do.

Well, let's let's let's do let's dive right into it.

We've seen I think we've come to the conclusion with the war on drugs, we can't arrest our way out of this.

It's not a felony murder anymore in Washington State, but it's still a huge problem.

Yeah.

So what isn't happening?

Where are we?

Where are the troops not showing up on the beach front here?

Yeah.

So, you know, substance use disorder is a diagnosable medical condition, right?

Is a healthcare condition which we can treat.

We also need to recognize it's an emotional and a spiritual issue as well.

So we need to recognize this is complex.

People are complex and addictions role in people's lives is complex.

And so we're increasingly trying to take a health care focus, which I appreciate.

But the health care system, I don't know about you, but it's extremely difficult for me to navigate.

Yeah, it's not easy.

You're buried in paper.

Well, you have to have an address.

You have to write.

I mean, capable people struggle coping.

And so it's a typical process.

Let's say I have opiate addiction and I want to stop using and I want to use an effective treatment medication that I know a doctor can prescribe.

I get on the phone, I call them.

They say, Great, we'd love to see.

Why don't you come in next week and meet with a counselor?

You meet with a counselor.

They say, Great.

Come back next week, meet with a nurse.

They're going to do a medical assessment.

Great.

You come back a week later, they say Great.

Come back next week and to meet with the prescriber and then we'll actually prescribe the medication to you.

And then you need to go to the pharmacy and pick it up.

Yeah, you don't have that right for stages.

You don't have a right.

Yeah.

You're trying to survive in your life.

So what we're really saying is that both the health care system, please come along, the longstanding historical addiction treatment system, please come along as well.

Although recognize that that system, neither system is meeting the need.

So what we've been doing for six years now is really turning things inside out.

That's delivering care out in the community where people are, where they already go, where they already have, trusting relationships, where they've already shown I want to be here and then add in care there.

So we call it low barrier care, community based care health hubs for people use drugs, all these different names.

But the point is deliver care out in a community where people are on a drop in basis, not as scheduled basis, and be able to get them started on life saving treatment that day and make it easy for them to come back and keep coming back and keep coming back.

And it's really that model of care that we've been researching and showing really good uptake significantly reduces illicit drug use and we're getting the folks we sort of want the most, the folks who are in the most chaos, who are struggling the most.

And that also is where as a state, we're really turning in terms of policy responses, both with our opioid settlement recommendations as well as recommendations to the legislature about what care should look like.

We need to develop a new large scale of care out in the community where people are.

I'm just completely throwing away my notes here because we're having a good conversation that doesn't need these.

All right, now, I'm going to hit you with this.

You go to the community, you're out in the community delivering services where they're needed and you want I want to keep them from having to go out and drug seek.

Yeah, I want to hijack that so I can have their attention where they're not out worried about getting their next fix.

Should we be providing that fix.

As crazy as that sounds, yeah.

Should we be providing that fix so we can get them settled down, focused and deliver treatment?

So what you're saying, or should we be providing them a safer form of their drug?

Yeah, Yeah.

So with opioids we have those, and that's buprenorphine and methadone.

Those are 24 to 24 hour to 28 day acting medications.

And it take a person.

So this is heroin, heroin use for six times a day.

But that's a kind of a chaotic rollercoaster.

Oh, boy.

That now 12 to 24 times a day.

So these treatment medications just get you in a steady state.

You're not high, you're not in withdrawal.

You just feel normal.

So the short answer is yes.

And the reason, as I mentioned, the brain chemistry, those brain chemistry changes are very long lasting and they may well be permanent.

Just like when you have diabetes, the functioning of your pancreas is changed.

Right.

In terms of insulin production, the same thing with brain and your endorphin system.

So people are going to need to be on treatment medications often for a long time.

And that's good because when you're on medications, you're in recovery.

It's not there off of opioids necessarily, but you're out of the chaos.

What I care about is being out of the disorder, out of the chaos.

I don't care whether you're on medications or not.

I care that you're out of chaos.

Now, I want to be clear.

That's that is a first step.

But if that person's still unhoused, still has untreated mental health conditions, still doesn't have the employment services they need, they still need help.

But that is such a big first step.

They might be open to that though, and receiving that help there would be receptive if their immediate problem with this terrible thing, with the shock syndrome is solved.

That's right.

To some to some extent.

The challenge I want to say is that that's on the opioid side, on a stimulant side, on the methamphetamine side, it's tricky because we don't have very good treatment medications.

I don't want you bringing up more problems.

Okay.

Well, I'm just letting you know the same approach of working with people.

Well, what I will say that's kind of foundational is this idea of of engagement.

Yeah.

That people want to connect with other people.

I don't go to the snobby coffee shop.

I also don't go to a place where I have to pick up my coffee on, you know, 6 a.m. on Thursdays, I go to a place where I can go wherever I want and people treat me well.

And we need the same thing around engagement.

Whatever the substances, whether it's alcohol, whether it's opioids, whether it's stimulant drugs, that engagement first approach sometimes called harm reduction.

Yeah.

And the reason is, is everybody wants everybody is struggling with serious addiction.

They want to reduce harm every day.

Some people want to stop using.

Some people want treatment, some people want health care, but they all want somebody to connect with and they all want to reduce the harm and chaos in their lives.

So why don't we make that universal and then layer in those other things as also being a bit you know why?

Because it's enabling.

You're enabling life.

We're enabling life, right?

So I get that people say that we're we're enabling the challenges and there's very good research on this around recovery.

Recovery for alcohol and marijuana.

People can really return to sort of stability within about a year.

There's very good research out of Harvard by Dr. John Kelly, but with stimulants and opioids, it's 2 to 3 years.

So what we're trying to say is that's a couple of years that we need to bridge that gap.

We're trying to keep them alive and engage during that period of time.

And that means staying connected to them because when they're disconnected to care, they're off on their own and they're really struggling and there's a high chance of overdose and death.

Your annual survey that you do every, every other fall came out a while ago, and your reaction to it really, really caught my attention.

He said Fentanyl is the worst, fastest, baddest thing I've ever seen.

I said, If Caleb said that, saying something.

Yeah, because you know, you've seen it all.

Your next survey comes up in fall of 2023.

Based on what the trends are, what is your gut telling you about what you're going to find?

I mean, I don't it seems like you and I have had this conversation now for a long time.

Yeah.

And it keeps getting worse.

Yeah.

So a couple of things.

That survey historically been done at syringe services programs, but syringe services programs, the last two years, the number of clients coming in and the number of syringes distributed have plummeted because people are switching to smoke, they're smoking fentanyl and they're smoking methamphetamine.

So one my survey has to gets expanded out to other sites in the communities so we can really get everybody who's using these substances.

And we have very good data showing the majority of people dying are smoking these substances, no longer injecting them.

So there's that.

The other thing I know we will find is that there's almost no heroin anymore.

And so what's happening?

It's meth, right?

It's meth and fentanyl that are being combined.

Well, there's there's fentanyl.

There's methamphetamine.

And some people are combining, but there's sort of two things going on.

What we're seeing with fentanyl is because a lot of it is in these fake pills.

Yes.

Even if people know it's fentanyl, there's somehow this aura of safety because it's in a pill format.

And that that barrier to entry is so low that adolescents and young adults are using it.

So we're seeing a huge young group of folks coming in.

They're buying it on Snapchat, they're banging on Snapchat, the act.

So it looks safe.

It's easy to get.

And guess what?

It's an extremely fast and extremely short high that that is highly addictive and and highly lethal.

It's both of those things.

So we're seeing a large group of young adults coming in and we see folks who are using heroin and or prescription opiates before that illicitly.

They're coming in and both of those groups are now using.

And what we're seeing is that the death rate is very similar for people under 30 and over 30.

That's always been very different.

Heroin over 30, under 30, prescription opiates over 30 under 30.

But for fentanyl, they're very similar.

So what I expect we're going to keep seeing is is an increasing young group and more and more folks smoking these substances.

There are things that we can do about that, right, in terms of really giving those harm reduction services, but also improving access to these treatment medications in new ways.

And that's really there's so much misunderstanding.

I've been listening to interviews, reading qualitative work with folks who are dependent on fat.

And I was listening to an interview on the way down here.

There's still a lot of misunderstanding from folks about what opiate use disorder is and what are those effective treatments.

And so we need we need to do a better job of educating people, but we also need people being willing to listen.

Yeah.

And understand what actually works.

I don't want to get too far into the weeds for people who don't follow this, but proof that our frame is actually showing to be a little bit blunted by fentanyl, which is it's like having COVID in the vaccine that working this tool seems to be blunted a little bit by this awful drug.

Is that something to worry about or do you think more in the pipeline?

How do you analyze that?

So there's a medication called buprenorphine, and it is what we call a partial opiate.

I know that sounds inside baseball, but it really matters.

So heroin and fentanyl are pure opiates.

The more you use, the more effect you get.

Buprenorphine is a partial opioid, so there's kind of a sealing effect, and it can be a little harder for folks to get started on buprenorphine.

And the dose may not be high enough, but we are seeing success with higher dose and also long acting injectable form of morphine so it can work.

It's a technique issue.

It's about the medication.

It is a technique issue.

I think that's a fair thing to say and we need to make much better use of the medication.

Methadone, which is a full opioid and is highly, highly effective.

It's kind of trapped within these large buildings and a lot of regulations, but it is a very effective medication.

At the interview I was listening today, this guy had just said, you know, the only time I've not used fentanyl in the last couple of years is when I was on methadone.

Right.

So I hope it really does work and a step down, maybe do some methadone for a while, step down to buprenorphine for free, you know, maybe.

Or we've got folks who've been on methadone for 20 or 30 years.

Yeah.

You know, they're businesspeople, they're politicians.

So it's still better than getting poisoned by an unknown dosage from a pill from Mexico that you're having to steal to go get.

Yeah.

Still better implies there's something bad about it.

And I wouldn't say there's nothing bad about it.

You know, I have a friend who has been on buprenorphine, the lowest dose for ten years now, and I said, Are you thinking of going off of it?

She's like, Why would I?

I've had and raise two kids and grown my career and I feel normal.

Why would I put that in jeopardy?

I'm getting no negative side effects.

Why wouldn't I just stay on?

It's just like an antidepressant and anti-hypertensive diabetes medication.

It's the same thing.

We're talking about long term chronic medical condition.

Yeah, and that's a good point.

I'm glad you called me out on that.

I think.

I think you're welcome.

Yeah.

The the Chinese apparently have been blunted.

When I read what the DEA says that they've it's let's face it, it's not totally controlled, but they've been able to address that a little bit.

Now it's the Mexican cartels.

There was a couple of RV's busted recently with $1,000,000 of cash in them, a cache of weapons.

That tells you the cartels are involved.

Yeah.

Does your research look at that at all?

And and when it comes to making things like candy colored fentanyl, it appears there's an active effort out there to recruit users.

It's not a by product.

Oh, I ran out of my actually prescription, so I found this other thing that.

No, it's a it's a there's an active effort to undermine, I would say, society to some degree.

Bye bye profiteers.

How do we address that?

And I know you're a researcher on the medical side, but I also know that you when you look at this problem, you're forced to contemplate that as well.

What is your contemplation of that?

The drug cartels are for profit businesses that have all of the money and none of the rules.

And we have the United States government, which has all the rules and very little money.

So that is an asymmetry.

And the trajectory of that has been very clear for the last 50 years, and it hasn't really budged.

And so my point being in all of that is that I think we're never going to be able to fully blunt supply.

We never have.

We've been trying for 50 years to what effect?

So drugs, drugs get more prevalent and cheaper.

So we need to understand why people use drugs, try to help prevent that.

We know so much of that has to do with trauma, mental health issues, all of these other issues.

We need to really try to work with young adults.

This is a very important piece.

I think around fentanyl in particular.

I spoke with many, many parents whose adolescents have died from fentanyl almost to a person.

Those adolescents had mental health issues, sleep issues, pain issues.

They weren't party animals.

Okay?

They're using those drugs for the same reasons that adults use a lot of medications and alcohol.

I was going to say it's the reason they mix a gin and tonic at night.

It's the same thing.

It's the same.

And so we need to recognize that when, you know, start early messaging right around health and wellness and, you know, I want to be so we want to start that early messaging around health and wellness and people really trying to develop their own toolkit.

Like when I'm feeling stressed, I have three things I'm going to try out.

And the first three things, none of them are in a bottle, whether it's a medication bottle or an alcohol bottle.

So really trying to build that up.

And then it is very important in adolescents to say, you know, hey, if a kid's talking to you about mental health or sleep or pain to take it seriously and at the same time, if they're an adolescent, say, I really want to make sure that you and your friends are not using these things and you can frame it about their friends so they don't get as defensive.

Having have teenagers recently, you know, just sort of say, I want to make you really sure that you're aware of this, that there are these fake pills out there.

Nobody, nobody.

The first time is they can, oh, I'm using fentanyl.

They think they're using a perk.

30.

Yeah, they think they're using an oxy because their friends are telling them that the person on Snapchat told them that and they're lying.

Yeah, there are no those on the street.

They don't exist.

It's all fentanyl.

And you don't know if it's half a milligram or five milligrams and it's so potent it instantly fatal.

Yeah.

Yeah.

I want to be on the air.

I only mentioned gin and tonics by coincidence.

Yeah, well, but I think it's important to say and you know, to that point, you know, I'm a little over the top, as you might imagine.

But for me it's being very explicit about why and how I drink, you know?

So if I say to my kids, like, you'll notice and I will walk, walk the walk, you'll notice that when I drink, I never have more than one drink in an hour.

Yeah, Yeah, that's purposeful.

Here's another thing.

I'm glad you brought up the parents and the kids piece.

One of the things that I noticed, too, and this is purely anecdotal for the media I consume and I do kind of as, you know, follow this to some degree.

A lot of I would say a certain percentage of the kids who die are outside standing kids, high achievers, the club president, star athletes, 4.0 plus students picked to go to college.

Is there an overachievement or are those kids more vulnerable or particularly vulnerable in a certain way because they're trying to put this signal out that everything's great, I don't have any problems.

What's your analysis of that niche, whatever size it is of the problem with you?

Yeah.

So I think it's a really important point that we do see these sort of, quote, high functioning, high achieving folks.

But what I think it really represents is that addiction and drug use hits everybody, including those folks.

You're going to hear less about the underachieving, less spectacular person.

But I think what it really is represents is nothing specific about them, but rather that addiction can have anybody.

That's really what that identifies to me, you know, are some of those folks, the sensitive geniuses?

I don't know, maybe.

But what I really see is just that it can hit anybody, just like it has in my life and maybe in your life.

It hits all sorts of folks all across the range of whether they're wealthy or whether they're poor or they're high achieving or low achieving their We all deal with stress and trauma and physical and emotional pain in different ways.

And some people, certain substances connect and click and other that people they don't.

But addiction isn't that it really can't hit anybody.

It has nothing to do with intelligence or wealth or the color of their skin.

It's just it's biological.

And I think your point is well taken, too, that those are kind of the holy cow stories that we tend to hear.

And remember that the all star kid who dies of that, you're thinking, why?

What What's this idea of an innocent victim?

Yes.

Which implies a guilty victim.

And I think that's really the challenge when it comes to drugs, is that, you know, with alcohol and now cannabis, it's sort of like, oh, yeah, that sort of innocent fun.

We all do that.

But somehow with illicit opioids, that's a pharmaceutical, like it starts getting gray over there and the methamphetamines bad, but the Adderall is okay, you know, why can't we just recognize that a lot of people take a lot of stuff for a lot of different reasons and how do we help them be healthier?

And some of those people have a disorder that that where the opioid is particularly crushing to their brain and addictive.

So, yes, and specifically in talk with a lot of young adults, they say the first time I took opioids is the first time I ever felt normal.

That's actually the scary reaction.

You want a person to feel nauseated and sleepy, But normal is bad.

Normal is bad because that means that you happen to have brain chemistry and or an emotional state or a history of trauma that it's addressing some underlying need.

And you don't want that.

Yeah, you want to have this idea about there are sort of healthier ways to deal with that discomfort.

Yeah it's this got that kind of Fitbit with your molecule.

That's right.

And yeah Caleb thanks so much for coming in Northwest now.

Great discussion.

You bet.

Thank you.

I know the temptation watching programs like this one is to yell at your television about personal responsibility and all the horrible decisions drug addicts make.

The bottom line, when you take a step back and consider individuals, you quickly realize that the dead and addicted are people's children, siblings and parents.

And that's why I will continue to talk about this problem.

As maddening as it can be, I hope this program got you thinking and talking to watch this program again or to share it with others.

Northwest now can be found on the web at KBTC dot org and be sure to follow us on Facebook and Twitter at Northwest.

Now a Streamable podcast of this program is available under the northwest now tab at KB Etsy dot org and on Apple podcasts by searching Northwest.

Now that's going to do it for this edition of Northwest now.

Until next time.

I'm Tom Watson.

Thanks for watching.