The Solution to the Opioid Crisis | Joe Rogan & Johann Hari

underlying psychological needs. Let's think about you refer to the opioid crisis for example because I think even a lot of really good people are profoundly misunderstanding what's happening with the the opioid crisis. Where is the opioid crisis happening right? I've been to a lot of the epicenters of it places like Monadnock in in New Hampshire. Why is why are things so disastrous there? Why is there much higher opioid addiction in West Virginia than on the Faculty of Harvard right? People in the Faculty of Harvard have much better access to opioids, right? Everyone there has good health insurance. They have much better access. What's going on? The the amazing economist Sir Angus Dayton and Anne Case did a massive study of this and they said that we need to understand the opioid deaths mainly as what they call deaths of despair, right? It's not a coincidence that the places where opioid addiction is highest are also the places where Suicide not with opioids is highest where antidepressant prescriptions are highest. It's a whole these things are clustering together for a reason, right? And you don't have to spend much time in those places to see people through no fault of their own have unlike the rats in that first cage, right? They have been deprived of the things that make life meaningful This doesn't mean chemical hooks don't play some role they do play a role but I've been to the places that have solved this and it wasn't by thinking primarily about that so just Talk about the reality of chemical hooks if that's right, I think it's very important to understand in relation to opioids So there's a very strong agreement among scientists that the most powerful chemical hook we know is nicotine, right? You smoke cigarettes like my mother smokes 70 cigarettes a day You smoke cigarettes the thing you feel a physical craving for when you stop which my mother would never do is Is nicotine right? That's the chemical hook And and so in the late 80s when nicotine patches were invented There's this huge wave of optimism among scientists could they're like, oh right? Cigarette smoking is an addiction to the chemical hook nicotine now we can give people all the chemical hook They're addicted to without any of this shitty cancer causing smoke people are gonna stop smoking, right? So nicotine patches are introduced and the US Surgeon General's report a couple of years later finds highly motivated people using nicotine patches 17% of them will stop smoking right now. It's important to say that is not nothing, right? That means if you meet the chemical hook for people who are addicted cigarettes 17% of them will stop entirely That's a big deal. Right that saved a huge number of people's lives But obviously 17% is not 100% that leaves 83% They've got to be explained by the other things and that's really the factors that I talk about in in lost connections So I mean, there's a whole range of them, but you know, if you are acutely lonely We are the loneliest society there's ever been right you are much more likely to be vulnerable to despair depression addiction If you are controlled and humiliated at work, which most people now are to some degree You're much more vulnerable to these things There's a whole range I go through nine of these these factors in the book But to me the most important thing in thinking about the opioid crisis And I'm I find it really frustrating that this is never discussed in the American debate is I've been to the place that Solves an opioid crisis that had a disastrous opioid crisis and ended it right and they did something That's very different to what Americans are being urged to do So I'm a Swiss citizen because my dad's from there so in a Switzerland well and by the time you get to the year 2000 Switzerland is having like an opioid nightmare, right? People can look up videos from the time but you know people like Swiss people are obsessed with order It's not coincidence. They invented clocks and all that shit, right? Like in their public parks people like injecting in the neck like nightmare scenes, right? That'd be bad anywhere But to Swiss people this is like the worst nightmare, right and they try all sorts of things They try the American way arresting people punishing people shaming people and it just keeps getting worse and worse And then one day they get this this Incredible woman called Ruth Dreyfus who I got to know later who becomes the Minister of Health and then the president the first ever female president of Switzerland She explains to people I Think the solution is to legalize heroin and she said I know that sounds really shocking because when you hear the word Legalization what you picture is anarchy and chaos. She said what we have now is Anarchy and chaos, right? We have unknown criminals selling unknown chemicals to unknown drug users all in the dark All filled with violence disease and chaos Legalization she explained is the way we restore order to this madness, right? so the way it works isn't I spent a lot of time in these places and Obviously, no, maybe there's some really hardcore libertarians But almost no one believes we should legalize her in the way alcohol or cannabis illegal, right? No one thinks there should be a heroin aisle in CVS. That's not the plan, right? What I did in Switzerland is if you had a heroin problem, you were assigned to a clinic I went spent a lot of time in the one in Geneva The former president Ruth Dreyfus lives opposite this clinic. I think that tells you something and Like across the street across the street. What what it what it it's the way it works is she should move Well, but if you see the clinic, I'll tell you why right? so the way it works is You have to go to the clinic at 7 o'clock in the morning because Swiss people believe in doing things really fucking early It's constant disagreement between me and my dad you turn up you go in they give you your heroin there They give you medically pure heroin You can't take it out with you You've got to use it there partly because they don't want you to sell it on but mainly because they want to monitor You to make sure you know, you don't overdose You use it there and then you leave to go to your job because you're given loads of support to get housing work and Therapy to figure out why you can't bear to be present in your life, right? So it's really important. They give two things that's put to bear in mind these two things It's the opposite of what we're doing at the moment here Give them the safest possible version of the drug and give them massive amounts of help to deal with the reasons why they need that Drug now giving them the drug are they injecting it in them? Yeah, they know they the individual injects himself or herself So if you if you were the patient, I'm the nurse I give you the heroin and I give you a clean syringe and one of the things that really surprised me At first I found really weird is They will give you any dose of heroin that you want apart from one that would kill you and there is never Any pressure to cut back and yet I went there when it was 13 years after this had first started and there was almost nobody on the program From the start there were like three people who've been there the whole time almost everyone does cut back and stop over time And I remember saying to Rita mangy. Who's the chief psychiatrist there? Well Well, how can that be because we're told? The chemical hooks take you over you need more and more if you had an unlimited supply you would just carry on forever What how could how could how do you explain this? And she looked at me like I was done and she said Well, we help them and their lives get better and as your life gets better You don't want to be anesthetized so much Which once that's explained to you is so Obvious, right? But and it's worth just explaining the results of the Swiss program in the Fifteen years now in the fifteen years since this began According to the best scientific evidence be like professor Ambrose uchtenhagen have shown there had been zero deaths overdose deaths on legal heroin not one person There's been a massive fall in overdose deaths outside the legal program because people transfer in because why would you carry on using expensive shitty? Street drugs when you could be getting you know help and given the drug for free And what is fascinating about this is Swiss people are really conservative, right? My Swiss relatives make Donald Trump look like Oprah and yet Swiss people after this have been in practice for five years had a referendum on whether to get rid of it and 70% of Swiss people voted to keep heroin legal not because they're so compassionate to be honest That's not they're not they're really not it was because crime fell so much right? It's much cheaper to give some crime for I've got the statistics in the book. It's fear since I wrote it But there was I think something like a 50% fall in street street crime street prostitution literally ended right? There was no street prostitution after that turns out women you know don't want to be on the street being fucked by random strangers, but the buddy if they've got like an alternative who knew but the There was an enormous fallen crime across the board and police confirmed that everyone agrees with that in Switzerland and all the kind of anarchy In the streets just just stopped right but but the reason I think this is really relevant to the opioid crisis is What we're doing is the exact opposite right so they give them the safe version of the drug Give them help to figure out why practical support to change their environment to get out of the isolated cage and walk into a life That's more like rat Park. What do we do if your doctor in this country finds out that you are using say percocet or oxy Not because you've got back pain, but because you've got an addiction Your doctor by law has to cut you off right if they don't they can be busted as a dealer It's happened to lots of doctors and they have to cut you off So instead of giving you the drug we stop you getting the drug most people then are not most a very large number Then transfer to much more dangerous street drugs like heroin Secondly far from giving you help to turn your life around we give you a criminal record We shame you we stigmatize you we put barriers between you and reconnecting the opposite of addiction is connection But what do we do we put barriers between people and reconnecting? This is why that's one part of it, right? So there's the drug policy part of it Where we're doing exactly the opposite of the country that succeeded in ending its opioid epidemic But there's something I think there's even deeper than that which you really see in places like West Virginia Monadnock the kind of hearts of the the opioid crisis, which is we're also creating a society That is becoming harder and harder for people to be present in especially in those in those places There's an analogy. I keep thinking of in the in the 18th century in Britain loads of people were driven out of the countryside into these disgusting urban slums in like London and Manchester and and Something happened that that it's been well documented. There was something called the gin craze, right? We're basically shit loads of people just became alcoholics drank gin until they died, right? There's a famous painting from the time called gin Lane of a mother down in like a bottle of vodka while a baby like Falls out the window right and things like that really were happening You look at what people said at the time very similar to what they're saying now They said look at this evil drug gin Look what it's fucking done to us. If only we could get rid of this evil drug gin this problem would go away, right? We know now when we look back at the gin craze It can have been gin that caused it because anyone in Britain who's over the age of 18 can go and buy gin, right? And while we still have some alcoholics to be sure we don't have mass epidemics of alcoholism We don't have babies falling out of windows what changed? Wasn't the amount of availability it wasn't the availability of the drug the drug is more available now than it was then What changed was the amount of pain and distress in the society, right? We don't have a side with more as profoundly disorientated. I mean it's going up because we're creating more disorientation So we if you create a society where people's basic psychological needs are not met right where they have shrinking number of friends and social connections Where they're taught that life is about money and buying shit and displaying it on Instagram Excuse me Where they spend most of their time at jobs they find unfulfilling controlling and humiliating You're gonna create growing pools of people who can't and you by the way, make it constantly insecure financially insecure half of all Americans Have through no pot their own have been able to set aside five hundred dollars for if an emergency comes along She creates pervasive insecurity in the society. You're gonna create very large numbers of people Who are gonna want to fill a need to anesthetize themselves now? That's not a good solution. Obviously, I don't think heroin opioids. These are not good solutions to these problems But but it's not a crazy solution either. There's a line I think of all the time. I don't quote it very often because People can really react against this insight. I think it's actually important You know Marianne faithful the great like 60s British singer. She went out with Mick Jagger annoyingly. That's why people remember She's much better than Mick Jagger and in her memoir. She had a heroin addiction in the 60s. She was homeless for a while She has this very challenging line that I think about a lot. I'm gonna phrase it slightly wrong, but She said um heroin saved my life because if it wasn't for heroin, I would have killed myself at that point Right now Marianne faithful is not saying heroin was a good solution to her homelessness But we've got to understand this drug use is happening because it performs a function All right. One of the most important things I learned for both my books for chasing scream and lost connection is that these Forms of despair depression anxiety addiction. They are meaningful signals, right? They are telling us something the fact that they have been rising year after year after year But we're now at the point where average white male life expectancy has fallen in this country for the first time in the entire peacetime history of the United States that is a signal that is telling us something and that's because of drug addiction and Overwhelming because of drug addiction and suicide. It's risen to that point. There are other factors going on like obesity but that the main drivers are and overdose and suicide and That is telling us something and what we've been doing up to now is we've been insulting that signal We've either been saying depressed people addicted people are just weak or we've been saying it's just a problem in their brain There are real things going on in their brains, of course Or we've been saying, you know, it's just craziness and but in fact, it is largely a response to the way we're living of course, there are other things going on as well and we can talk about them and Once you understand that you realize there's got to be a deeper response and I went to places that I've done that not just Switzerland Switzerland what is the overall population? Five and a half million. So it's a small country fairly small country Yeah, how much money do they have to spend to keep this program going? And what is the time constraints in terms of like how long is a person who's got an addiction problem allowed to stay there and and Receive treatment. There's no time constraint You can stay on for your entire life if you want to in practice that doesn't happen very they stay in the facility No, no, they live in apartments. Okay, they just visit they just go every day or whenever they want to I mean, I think you can go twice a day and it's free. It's free doesn't cost anything I mean some people once they have jobs then pay health insurance and the health insurance pays for it But if you don't have money then they pay for it. And and one thing that was fascinating is they found it wasn't and Joanne set Did good research on or sites good research on this for she did research the Open Society Foundation. It's actually cheaper than The police constantly harassing people putting them in prison putting them on trial Those are really expensive things to do heroin is unbelievably cheap if you buy it legally, right? I would think did the amount of money they would save just in street crime being radically reduced Exactly. It makes it makes the life of the person with addiction better It makes the life of ordinary of other citizens who were not addicted better and it saves money Right, which is why Swiss people are very pragmatic. They're not, you know, the most compassionate people, but they are very pragmatic people That's why it was so popular system. Let's think about another place that adopted really different drug policies, right? Because I think it's something we can learn from there as well. So Portugal Around the time Switzerland's having its horrific heroin crisis. Portugal is having a fucking nightmare, right? By the year 2001 percent of the population was addicted to heroin, which is incredible, right and Every year they were like Switzerland They were trying the American way shame punishment stigma and things just kept getting worse and worse and worse And then one day the Prime Minister and the leader of the opposition got together and they're like, oh we can't go on like this What are we gonna what are we gonna do and they decided to do something really radical something? No one had done since the drug war began in this country 70 years before They said should we like ask some scientists what the best thing to do would be? So they set up a panel of scientists and doctors led by an amazing man I got to know in Portugal called dr. Hualgulao a totally extraordinary person and And he'd run the first of a drug treatment center in Portugal founded after the dictatorship and they said to them You guys just go away Look at all the evidence and figure out what the hell we can do. So they go away for two years They they learn about rat Park. They learn loads of things and they come back and they say, okay solution is we want to Decriminalize all drugs from cannabis to crack but and this is the crucial next step Take all the money we currently spend on fucking people up Arresting them shaming them imprisoning them and spend all that money instead on turning their lives around and interestingly It's not really what we think of as drug treatment here in the United States, right? So they do some residential rehab that has some value Main thing they did was a big program of job creation for people with addiction problems saying you used to be a mechanic They go to a garage and they say if you employ this guy for a year We'll pay half his wages again much cheaper than sending him to prison, right? They set up a big program of small loans So people with addiction problems could set up and run businesses the things they thought were important at the time people like this is crazy They're just gonna spend it all on drugs lunacy. Right? And by the time I went to Portugal It was again 13 years since this had begun and the results were in addiction was down by 50% Over and this is by figures of in the British Journal of Criminology the best scientific study of this and overdose deaths were massively down HIV was massively down Every single indicator on problems related to drug use had fallen like a cliff, right? It wasn't perfect They've still got problems, of course But there was that massive improvement and one of the reasons you know It works so well is that virtually no one in Portugal wants to go back. I went and interviewed a Great guy called qualfiguera who at the time of the decriminalization was the top drug cop in the whole country and He said what I'm sure loads of your listeners are thinking right at the time Which was like if we decriminalize all drugs, we're gonna have an explosion in drug use. We can have loads of kids using a nightmare We can't do this When I went to see him the audios on the chasing screen website. He said something like Everything I said would happen didn't happen and everything the other side said would happen did and he talked about how he felt really ashamed It's been so many years prior to the decriminalization screwing people's lives up when he could have been helping them turn their lives around Hmm, and and this is something that I saw all over the world right the places that have drug policies based on shame and stigma and the fantasy that you can get rid of drug use which you can never They have massive really terrible and rising problems the places that have policies based on okay Let's restore order to the market and let's give luck liberty to drug users and love and compassion and practical help For people with addiction problems have declining drug problems, right again, not perfect But it was such a significant improvement that support in Portugal I mean, they've got five main political parties. None of them want to go back right that tells you something, right? Yeah, no when they did this in Switzerland What was the primary cause for this drug addiction and how did they deal with that? so if they dealt with it in Portugal with these loans and and and Helping out businesses by paying for half the salary and all those things like that seemed like wonderful ideas What do they do in Switzerland to sort of mitigate? What are the issues whatever the issues were that were causing people to be drug addicts in the first place? So it's a combination they gave people lots of therapy So I remember one of the people I spent some time within that clinic had been terribly sexually abused and there's a lot of evidence that Giving survivors of sexual abuse safe places in which they can release their shame about that leads to a big fall in depression Addiction and other problems. It's a lot of evidence that that kind of abuses is It's a big driver of a lot of addiction for a lot of people though. Clearly not everyone Some of it was just there were people who Had never been given a chance in life or I had never had stable lives it was kind of a mixture of things and one of the things that's really good about the Swiss system is It wasn't saying in this kind of cookie-cutter way that often happens in drug treatment in the United States Well, there's plenty of good examples as well, you know, you don't arrive and they say this is your problem We're here to tell you your problem and how to solve your problem. It's very much guided by actually the person themselves, right? people who are in deep pain The core of it is you have to listen to them right if we think about this addiction depression in the way that I'm arguing that we should see them as signals that are telling us something Most important thing is to listen to the signal, right? I remember saying I thought about a lot this weird experience I kept thinking about all the time. I was writing my book lost connections about depression And so I did quite like in late in the day that I realized why I kept thinking about it so much. I Was in Vietnam about Five years ago now maybe a little bit less. Um, and I did this really stupid thing I was I was in Hanoi and I was really tired. I was doing research for a different book that haven't finished yet and By the side of the road I saw this big red apple women selling it and I'm shit at haggling So I paid like five dollars for this Apple or something and I took it back to my hotel I was so tired. I lay on the bed and I start eating it and it was just gross, right? It was something really it's chemical taste. It was like how I imagined Food would taste after a nuclear war when I used to watch those films in the 80s, right? But I was so tired even though I knew it's wrong. I ate like half of it and threw it in the garbage and Next like four days. I was just like violently sick All right, like just in it like something from the exorcist So I'm lying there in front of CNN and occasionally projectile vomiting and it gets like bored But I'd had food poisoning before I basically lived on fried chicken in my 20s. So I was not new to this rodeo and after about four days I Said to huang my fixer and translator who was arranging I was there to interview survivors of the war Vietnam War for something I'm like look I'm only here for another three days or whatever it was I've got to go meet these people as this whole trip will have been a waste of time So he drives me like six or seven hours into the countryside And we get there and he's lined up these people for me to interview and I'm like, oh the god I feel so bad actually I'm sitting in this heart with this this woman who's an 86 year old woman who was the only person from her village that survived the Vietnam War so I'm talking to her And as she's speaking that The room starts to I've never had this feeling before I've had a feeling when you're drunk when you feel the rooms move it it Literally felt like the room was moving around me like like I didn't feel like I was disorientated and then while she's talking I just like explode all over her heart From both ads like fucking horror show right and so I say to huang Just just take me back to put me in the car Take me back to Hanoi, right and he's this old woman's like saying something to him and I'm just like lying there And he says she says you've got to go to the hospital. You're really sick and I'm like, no, no I just need to go back to the hotel and he said Yohan This is the only woman who survived the Vietnam War in this village. I'm gonna listen to her health advice over yours We're going to the hospital. So we go to this hospital where I'm pretty sure I was the only European it ever been treated They take me in and huang's like completely lying going like this is an important West O'Dow It will disgrace Vietnam if he dies there, right? and so I'm lying there and they like jibing me with everything and I'm like what's going on and They're asking me lots of questions and I felt the most nauseous I've ever felt right and I kept saying to them Give me something for the nausea through huang could they didn't speak in English and the doctor said to me You need your nausea. It will tell us what's wrong with you. All right, even lying there. I think it was kind of interesting I also remember thinking lying there and thinking they figured out was the Apple and I'm having they're having such a ridiculous thought I thought I'm about to die. I've been killed by an apple I'm like Eve or like Snow White or like Alan Turing and then I was like You're about to die and your last thought is that you're basically a pretentious cunt Right. I was like horrified by myself. Anyway, they gave me those treatment and a few days later when I leave I'm talking to the doctor and I Was discussing various things with him and I said to him what would have happened if I'd If I had gone back to Hanoi if he'd driven me back to Hanoi and he said oh Well, what happened is my kidneys have stopped working son kept any water in for four days So it was like I had been in the desert for four days and a doctor said oh you would have died on the journey when it made it and So I kept thinking about this experience which really didn't actually affect my like worldview or anything It's the closest I've ever had to a need-to-heath experience But all through research in my book about depression lost connections. I kept thinking about this thing, right? You need your nausea. It will tell us what's wrong with you and I realized All the time I had been depressed if I think about my relatives and people I love who'd had addiction problems. I Had seen that my depression their addiction as a bit like that nausea, right as like a kind of malfunction right saying that you should get rid of and actually What we need to do is hear it right because it will tell us what's wrong with us, right? It doesn't mean it's a good feeling It's awful right depression is worst thing I've ever felt Addiction is a terrible state to be and it's not saying just in some kind of you know way Oh, we need to put up with it It's that if we hear the signal we can begin to find solutions and all the places I went the places that have solved depression Crises that I went to for lost connections places that have solved addiction crises that I went that I went to for chasing the screen Are places that have said actually this means something right your pain makes sense? You feel these ways for reasons and we need to get down into these these deeper reasons Which is really not what we've done in the United States since the drug war began, you know a century ago