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dr. jeffrey singer, a health policy studies senior fellow at the cato institute. dr. singer, thank you so much for being with us. why don't we start by having to talk about your background both as a practitioner and also as a health policy researcher. guest: i'm originally from new york as you can probably tell by my accent but i've been in arizona now for 45 years and i've been practicing and private practices as a general surgeon for about 40 years, and i'm also a senior fellow at the cato institute in the department of health policy. the cato institute is a nonprofit, nonpartisan libertarian think tank that develops public policy proposals based on the principles of individual liberty, government, free markets and peace. and i work in the health policy space there.

host: much of your research as folks can have fentanyl epidemic. where are we in this public health valve? -- battle? guest: if the research holds, we are not anywhere close to seeing things get significantly better. a study came out by the university of pittsburgh school of public health that was published in a 2018 where they look at data from the cdc going way back into the 1970's. what they demonstrated was looking at the data, at the overdose rate from nonmedical use of drugs has been on a steady, exponential increase trend since at least the late 1970's. the only thing changed is that at different points in time, different drugs are predominantly used as the principal cause of overdose deaths. for example in the early 2000's, the principal cause of overdoses

was diverted prescription pain pills that found their way onto the black market and the recreational users. then as policy establishment, political establishment wrongly blamed it on doctors overprescribing prescription pain pills and clamped down on prescribing, which prescribing was in 1992, the people using nonmedically migrated first to heroin and then fentanyl, and we will see what is next. but it has generally been on a steady increase now. it spiked during the covid pandemic along with alcohol use and other substance use. a lot of factors involved, including the border closure, opium which is processed to heroin, drug traffic organizations with that the fentanyl, and fentanyl is much

more potent and potentially deadly than heroin. so that also contributed. and now that the pandemic has passed, you're starting to see an ebb in the overdose death rate and a return to heroin to the drug supply which may also be contribute in. and we've also seen a lot of states and even federal policies start to accept harm reduction strategies which have helped also reduce deaths, but we are still just under 100,000 a year, which is amazingly high, and if we continue our restriction is doubling down, then i would predict it is going to continue either at the same level or a higher level. host: you mentioned some of the causes and not causes for the crisis. remind air viewers exactly fentanyl is and what we know

about how it impacts the human body. guest: first of all, just a little bit of nomenclature. there are opioids and there are opiates. opiates are derived directly, naturally from the opium plants. codeine and morphine are opiates. opioids are opiates that have been chemically modified to get a certain desired result. so for example, oxycodone or hydrocodone, vicodin. these are opioids. they use the original, natural substrate of morphine and they make the additional molecules, they add additional molecules to get the desired result. and those are called semi synthetic opioids because they still have some of the natural part. and then there are completely synthetic opioids that don't require the plan at all, fentanyl was one of them. fentanyl has been around since the 1970's.

we use it every day, it is a very important drug. it rapidly reduces pain and wears off quickly. we use it in anesthesia. if anyone has had a general anesthetic or even a procedure where they had sedation, they likely received fentanyl. we give it to patients recovering and recovery rooms in intensive care and postop and we even have fentanyl skin patches with brand names that we've been giving to patients for decades where you put a patch on your skin and over about 72 hours, a small dosage slowly gets absorbed, and that usually reduces the requirement for oral pain pills because you've got that sort of in the background supplementing any pain pills. it is a very useful drug. there are also fentanyl analogs which are modifications of fentanyl, slightly different, and there are a few of them that we use in the medical field,

mostly anesthesia. now, just like methamphetamine, which by the way is a legally prescribed drug known to treat adhd and a brand name of the original, we still prescribe it occasionally even though adderall is more popular, but like that, fentanyl can be made in a lab, in an underground lab and then sold on the black market. that's why it is important to distinguish between fentanyl and illicit fentanyl. host: and our guest for the next 35 minutes or so is dr. jeffrey singer, a health policy studies senior fellow at the cato institute. joining us for a discussion on the fentanyl crisis in the u.s. if you have a question or comment for him you can start calling in now. the lines are regional for this. if you are eastern or central time zone, (202) 748-8000.

if you are in the mountain or pacific, (202) 748-8001. there is also a line if you have been impacted by the fentanyl crisis. you can call (202) 748-8002. dr. singer, you mentioned that it can be made, the illicit version to be made chemically. once it is made, how does it get into the u.s., legal or illegal crossings, and which borders are we looking at? guest: first of all, it is very easy to synthesize, and once it is made according to the data from the government, roughly 90% is smuggled in by legal u.s. citizens or residents. mostly in cars and trucks through illegal border crossings, not through illegal entry points.

and it doesn't just come in through the southern border crossings, it comes into the airports, through the mail. it occasionally comes into the northern border crossings. it is so powerful, and that is why it has gotten popular from the drug trafficking organizations, a very small amount can be hidden very easily. most dogs at border crossings are not able to smell fentanyl so it is easy to smuggle through. and a lot of peak think that the illegal migration across illegal border crossing areas is related to this, but that is actually a mistake. like i said, the government's own data show that most victims legally. think about it. if you were in the drug trafficking business, it makes much more sense especially considering the billions of dollars for sales on the black market, it makes much more sense to pay a handsome sum to some

u.s. citizen who will then drive it through the border and deliberate as directed to someone on the other side and will not be suspected at all by law enforcement then it is to trust somebody who is trying to maybe migrate up to the united states through central or south america or elsewhere and put some of it in their backpack and tell them when you get across to the other side, make sure you handed over to somebody. it just makes no sense. it makes much better business sense to spend that money on hiring people to do it. the precursors to make fentanyl originally were mostly coming from labs in china, but as pressure is placed on the chinese government to put pressure on these labs, they are now coming from a lot of other places. so we are seeing them made in india. they are coming from india, from myanmar, parts of southeast asia. and just recently we learned