Welcome to the Dispatch podcast. This is Declan Garvey, editor of the morning dispatch, and we've got a heavier topic today.

We're going to talk about the opioid crisis.

Nearly 110,000 Americans died of drug overdoses last year, up 15% from the year before, and about two-thirds of those deaths were attributed to synthetic opioids, mainly fentanyl.

Fetanyl has been around for decades and has many legitimate uses. Cancer patients, for example, are often prescribed patches to manage their pain.

But something has shifted in the past decade with illicit fentanyl use skyrocketing and bringing overdose deaths with it.

Our guest today has a better grasp on the size and scope of this issue than just about anyone.

David Lucky is a retired Marine Corps officer and senior researcher at the RAND Corporation, and spent most of last year working for the Congressional Created Commission on Combating Synthetic Opioid Trafficking and writing their final report, which was released earlier this year.

David, thanks so much for joining us. I want to start by running through some numbers that I have written down here.

So 107,622. That's the number of drug overdose deaths in the United States last year, according to the CDC, and that was up 15% from 2020.

So 71,238. That's how many of those deaths were attributed to synthetic opioids, and then 50. That's how many times more powerful fentanyl, one of those synthetic opioids, can be than heroin. These synthetic opioids were invented decades ago, and obviously have plenty of legitimate uses, cancer treatments, things like that, pain management.

But they've really only become this big of a problem, particularly relative to heroin and other drugs over the past decade or so. So kind of in your view, what's changed? What's driven that stark rise that we've seen?

Betmil and the other fentanyl analogs, the other illegally produced synthetic opioids, as you mentioned, fentanyl has been around for legal uses for decades.

What we're seeing now is a 100-year displacement that took place when heroin displaced morphine about 100 years ago. We're seeing now fentanyl displacing heroin. So this is one of those one in a 100-year events, and the reasons are multi-fold.

The ease of production, the low cost of production, the incredibly more powerful substance. So it takes far less of it to get a similar type of experience for the end user.

The multi-substance, the polysubstance issue of mixing fentanyl with other illegal substances, the counterfeit tableting, all of these and more are the reasons for this novel transformation that fentanyl is having in our illegal drug marketplace.

You mentioned some of the changes in terms of ease of manufacturing and other reasons why this is growing. Are there demand side pressures as well? Is this something that in your research you found users preferred over heroin? Is it a different kind of high? Or is it's growth primarily because of the ease of production and transportation?

Yeah, that's a great question. I think both there is both some group of users who might prefer it. And I would also suspect some group of users who don't prefer it over heroin.

One aspect, again, that's critical here is the polysubstance use and mixing fentanyl with heroin, mixing fentanyl with methamphetamines, mixing fentanyl with cocaine. We've even seen fentanyl sprinkled on marijuana.

And so this is another critical element. It's not just the strength of fentanyl over heroin, 25 to 50 times more powerful than morphine, but also the ease of mixing fentanyl with other illegal drugs.

And could you talk a little bit more about that 50 times more powerful figure? What does that actually mean in practice? How does that in terms of dosages and the likelihood of overdosing? Why is it that fentanyl is so much more powerful than heroin?

The chemical synthesis pure fentanyl, it's produced in a chemical synthesis as opposed to heroin that's produced from a natural substance, grown poppies, and then produced into heroin.

And the chemical synthesis allows for the greater strength of the aspect that fentanyl has on the receptors in the brain. We're also seeing other synthetic illegal synthetic opioids such as carfetanol, one example, which is 100 times stronger than fentanyl, which is already 25 to 50 times stronger than morphine.

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