My Conversation with Ben Westhoff

Truly an excellent episode, Ben is an author and journalist.  Here is the audio and transcript, covering most of all the opioid epidemic and rap music, but not only.

Here is one excerpt:

COWEN: But if so much fentanyl comes from China, and you can just send it through the mail, why doesn’t it spread automatically wherever it’s going to go? Is it some kind of recommender network? It wouldn’t seem that it’s a supply constraint. It’s more like someone told you about a restaurant they ate at last night.

WESTHOFF: It’s because the Mexican cartels are still really strongly in the trade. Even though it’s all made in China, much of it is trafficked through the cartels, who buy the precursors, the fentanyl ingredients, from China, make it the rest of the way. Then they send it through the border into the US.

You can get fentanyl in the mail from China, and many people do. It comes right to your door through the US Postal Service. But it takes a certain level of sophistication with the drug dealers to pull that off.

COWEN: It’s such a big life decision, and it’s shaped by this very small cost of getting a package from New Hampshire to Florida. What should we infer about human nature as a result of that? What’s your model of the human beings doing this stuff if those geographic differences really make the difference for whether or not you do this and destroy your life?

WESTHOFF: Well, everything is local, right? Not just politics. You’re influenced by the people around you and the relative costs. In St. Louis, it’s so incredibly cheap, like $5 to get some heroin, some fentanyl. I don’t know how it works in, say, New Hampshire, but I know in places like West Virginia, it’s still a primarily pill market. People don’t use powdered heroin, for example. For whatever reason, they prefer Oxycontin. So that has affected the market, too.

And:

COWEN: Did New Zealand do the right thing, legalizing so many synthetic drugs in 2013?

WESTHOFF: I absolutely think they did. It was an unprecedented thing. Now drugs like marijuana, cocaine, heroin, all the drugs you’ve heard of, are internationally banned. But what New Zealand did was it legalized these forms of synthetic marijuana. So synthetic marijuana has a really bad reputation. It goes by names like K2 and Spice, and it’s big in homeless populations. It’s causing huge problems in places like DC.

But if you make synthetic marijuana right, as this character in my book named Matt Bowden was doing in New Zealand, you can actually make it so it’s less toxic, so it’s somewhat safe. That’s what he did. They legalized these safer forms of it, and the overdose rate plummeted. Very shortly thereafter, however, they banned them again, and now deaths from synthetic marijuana in New Zealand have gone way up.

COWEN: And what about Portugal and Slovenia — their experiments in decriminalization? How have those gone?

WESTHOFF: By all accounts, they’ve been massive successes. Portugal had this huge problem with heroin, talking like one out of every 100 members of the population was touched by it, or something like that. And now those rates have gone way down.

In Slovenia, they have no fentanyl problem. They barely have an opioid problem. Their rates of AIDS and other diseases passed through needles have gone way down.

And on rap music:

COWEN: This question is maybe a little difficult to explain, but wherein lies the musical talent of hip-hop? If we look at Mozart, there’s melody, there’s harmony. If you listen to Stravinsky’s Rite of Spring, it’s something very specifically rhythmic, and the textures, and the organization of the blocks of sound. The poetry aside, what is it musically that accounts for the talent in rap music?

WESTHOFF: First of all, riding a beat, rapping, if you will, is extremely hard, and anyone who’s ever tried to do it will tell you. You have to have the right cadence. You have to have the right breath control, and it’s a talent. There’s also — this might sound trivial, but picking the right music to rap over.

So hip-hop, of course, is a genre that’s made up of other genres. In the beginning, it was disco records that people used. And then jazz, and then on and on. Rock records have been rapped over, even. But what song are you going to pick to use? And if someone has a good ear for a sound that goes with their style, that’s something you can’t teach.

And yes on overrated vs. underrated, you get Taylor Swift, Clint Eastwood, and Seinfeld, among others.  I highly recommend all of Ben’s books, but most of all his latest one Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic.

Comments

'For whatever reason, they prefer Oxycontin.'

Big business is good at branding. Not to mention getting people to write love letters to them.

They don't "prefer" Oxycontin. They go to it when it is available and when their drug of choice is not available. Oxy does a really poor job of reliving their "need". Usually what the drug users want is cocaine. But most hard drug users will take anything rather than nothing.

'They don't "prefer" Oxycontin.'

I'm curious how confident you can be of that. Or to put it a bit differently, why do some alcoholics continue to prefer beer over vodka, for example.

'Usually what the drug users want is cocaine.'

Um, you really don't know what you are talking about, do you? From July 2019 - 'Charles Glover doesn’t mince words when assessing Clarksburg, West Virginia, the town where he was raised and still lives today.

“It’s not Clarksburg anymore,” Glover says. “It’s Methburg.”

Methburg. As in methamphetamines, a drug that ravaged his community more than a decade ago and today is coming back just as strong. .... Data from the U.S. Centers for Disease Control and Prevention indicates that overdose deaths from methamphetamine climbed from 547 in 1999 to 10,333 in 2017. Far more people continue to die from opioid-related overdoses – 47,600 in 2017 – but as the street price of meth continues to drop, health care professionals in Appalachia and beyond are deeply concerned by the trend. Meth is linked to hepatitis C infection, stroke and, of particular concern to law enforcement, psychosis.

Clarksburg stands testament to a worsening crisis. Glover says he began seeing the return of meth, after peaking in the ’90s, about three years ago, “and then it just started escalating. .... “When a new drug comes to town, we’re probably the first ones that are going to see it,” he says. What they’re seeing most prevalently today is meth.

“Probably for every 20 drug screens that are positive, two would be opioids and 18 would be meth,” Hamrick says. “You may have both in there, which is kind of mind blowing. But the majority – probably at least 80 percent of every positive or more – is going to be meth.”'https://www.wvpublic.org/post/after-years-struggling-opioids-wva-town-facing-not-so-new-epidemic-meth

It would not be completely unfair to say that West Virginia is far too down market to have ever had many cocaine consumers.

You confuse what is available to what the drug users want. Meth is a terrible scourge and creates terrible suffering. But it is easy to make, cheap to make and creates huge profits; ditto for fentanyl. But they don't create the much better euphoria that cocaine does. Cocaine can be used to improve sex drive and pleasure and it can be controlled I,e, the amount can be controlled to lessen or prevent any harmful side effects.

OneGuy is a cokehead

Never did any drugs, not even pot. Never smoked. I did drink a little but haven't in many years. I am a chocoholic though if that floats your boat.

'Never did any drugs, not even pot.'

So, you really don't know what you are talking about.

It's called education. You should try it sometime. I have never jumped off the Empire State building either but I can tell you what the result will be.

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>Then they send it through the border into the US.

Gee. Maybe some kind of enforcement of the southern border would be a good idea. I'm surprised no one has ever proposed such a thing.

>By all accounts, they’ve been massive successes.

Really, now. ALL accounts of drug legalization have been MASSIVE successes. How about that!

Ty, maybe you should consider interviewing someone who has ever ventured outside his own house?

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By all reports, authors, journalists and liars, e.g., Ben don't get it right. It's purely opinion and speculation. To be fair, same is true of intellectuals with their shallow self-righteousness. l

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Rapping isn't hard.

Rap is a symptom of the moral decline of Western civilization. When I moved into the US I became horrified that are all listening to it, even among people with a good education.

Of course, it is not a problem if only a small fraction of the population listens to rap but when everybody is setting their brain on vegetative mode it starts to sound like a rather serious problem.

I think rap's rise is linked to the nichification of rock. Back in the 1970s-1980s good rock was mainstream. After Nirvana killed rock in the early 90s, popular music died and now good pop music is either underground or old. Rap is just the smell of the putrefied corpse of pop music, who died due to Nirvana's stab.

Eventually, I think that everybody in the US will be listening to Chinese music.

Rock was dead well before Nirvana. Witness late 80s hairbands and the promotion and airplay they got.

I agree entirely -- after the type of music that is terrible has been age adjusted.

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My thanks to Tyler for asking that rap question, even though the answer "It's hard", is far from satisfactory. The degree of difficulty in doing something doesn't correlate with how entertaining or satisfying it is. Perhaps the question should have been, "What do you find entertaining about rap? Why should I listen to an angry man shouting?"

Talent has meaning in the sense that it is something that not everybody can do. It has nothing to do with how "entertaining" the performance is. Often entertainment doesn't require any talent.

There is a lot of talent in rap. In the statistical sense that since there are hundreds of thousands of people who do rapping then there will be a lot of people at the tail of the talent distribution. To my ears, they all suck similarly though.

I hate rap. I am still amazed how modern 1950s-60s John Coltrane sounds. I wonder if maybe Kind of Blue was the peak of western music.

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"Why should I listen to an angry man shouting?"

Quite right: you can get that free in church. Or in church-substitutes.

Old white men don't 'get' rap. Shocking news.

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sure they do.

by the way you are old too

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That's what AM radio is for.

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I am surprised that an author of a book about fentanyl would list only the US and Canada as problem areas. Estonia has long had a very strong fentanyl problem which is now growing to include Latvia and Sweden. Estonia led most of the US fentanyl issues by around a decade.

Of course the data there is not so fun for the narrative being pushed, where needle distribution and harm reduction managed to do very little to decrease the death rate while preliminary data showed that the large interdiction efforts in 2017 had large payouts in 2018. Likewise lessening criminal sanctions in 2002 appeared to do jack all for improving health, decreasing drug enforcement costs, or diminishing the violence of the black market.

Again I come back to culture. Estonia is home to a large minority of Russophones who are economically and politically dispossessed. They likewise had historic ties to heavy industry. Once they started on the opioid track it became culturally acceptable and once the same happened for fentanyl, demand for heroin is basically dead.

I would submit that the cartels are not creating facts on the ground by where they push heroin and fentanyl, rather the places hardest hit were originally the dispossessed parts of New England and Appalachia. These are areas that have lost the community underpinnings that provided jobs, purpose and unity, but have been essentially written off by the political parties as not worth investing (particularly as these were all historic Democratic bastions that the modern party has ignored for almost 20 years). It seems like such places develop tolerance for drug use and settle into the the high mortality/high addiction equilibrium of opioids rather than the less deadly options.

"Pain is the 5th vital sign" could not have addicted so many people; many of them were not even born then. What it did do was utterly destroy the cultural prohibitions on open drug use and acceptable addiction. Once the genie leaves the bottle, getting back a cultural taboo on addicting substances is hard to stop as shown by the places first and currently being hit by fentanyl.

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"Portugal had this huge problem with heroin, talking like one out of every 100 members of the population was touched by it, or something like that. And now those rates have gone way down."

As someone who was living (and occasionally doing drugs) in Portugal at the turn of the century when decriminalization was implemented, this 1 out of 100 statistic is beyond inane. I've tried to source it, senza fortuna: there are multiple references to it, but no primary source can be found.

Looking at comparable and verifiable data (SICAD numbers, sourced from news report because, for some reason, they seem quite reluctant in keeping data and reports older than a few years available), the number of drug consumption related deaths:

1999 - 369 deaths
2000 - 318 deaths
2001 - 280 deaths (decriminalization is from July 2001)
2002 - 156 deaths
2003 - 152 deaths
2004 - 156 deaths
2005 - 209 deaths
.
2014 - 220 deaths
2015 - 268 deaths
2016 - 208 deaths
2017 - 259 deaths

As for overdose deaths, the picture is at best mixed and confusing - it seems the dataset used in the early 2000s was for "suspected overdosed deaths" and later in 2009 they switched for "confirmed overdosed deaths". Looking at the 2018 EMCDDA Statistical
Bulletin, opiate poisoning deaths rose from 34 in 2002 (there are no numbers pre decriminalization for some reason) to 54 in 2015.

It's indisputable that HIV incidence has sharply decreased. But it was already decreasing pre-decriminalization and I suspect that expansive needle exchange programmes are the primary factor, not drug decriminalization.

Back to the1 out 100 heroin users data, I'd happily bet that when or if the source is traced, we'll find some estimate with shaky methodology - unrepresentative sample, self-selected, whatever. If that. often the references are in the form of "the heroin addiction touched/affected/impacted/etc", followed by an abundance of anecdotal colour. I wouldn't be surprised if the 1% of the population "touched" by heroin didn't refer to users, but also included relatives, victims of robberies by addicts, and so on.

The major success of the Portuguese drug decriminalization policy might very well be one essentially be about PR and good press, engineered by the mood affiliation of

It's incredibly weird how difficult it is to find a consistent dataset, let alone any sort of study addressing confounding factors, when the thing is routinely presented as a huge success.

[I had a bunch of links with sources, but it would seem they're getting the comment stuck in the filter, I'll try to post them on a different comment]

One or more URLs seem to get the comment block and I don't have to find which, but sources are sicad dot pt, emcdda and a few online articles from PT newspapers.

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COWEN: But let’s say I’m a lawyer; I earn 170K a year. I try a potent version of fentanyl once. It doesn’t kill me. What am I likely to do next? Stop, kill myself, something else? Move on to heroin?

WESTHOFF: You’d probably use it again, I hate to say. People describe it as that good.

COWEN: So the key decision is not using it at all?

WESTHOFF: That would be my recommendation, absolutely.

...


WESTHOFF: Legal — that’s a little tricky because I wouldn’t say it’s driven by the legal access because, for example, decriminalization has had a really positive effect. But I do think that the way we go about the war on drugs is feeding the problem, absolutely.

COWEN: So what does the world look like if we decriminalize opioids? What forces step in to make things better?

WESTHOFF: First of all, people are treated like they have a disease, so they’re not sent to prison or jail, and it doesn’t start the cycle of recidivism again. People are instead given these opioid blockers or these low-level opioids like methadone and Suboxone and can figure their lives out.

These two snippets only seem to reconcile if we assume that decriminalization will not result in any additional experimenting with fentanyl.

We have done the experiment and the data is in: we ended the prohibition of alcohol and alcoholism went away.

And everyone lived happily ever after.

QED

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Some people actually like their drugs and don't want to stop, and will eventually forsake crime in order to avoid the prospect of being put in a place where they can't access the alcohol and drugs that they like so much (unless they get thrown in before they have a chance to voluntarily stop). Some people don't mind spending regular brief periods in prison so threatening them with that is counter-productive. (As I previously recommended: Beggars & Thieves: Lives of Urban Street Criminals, by Mark Fleisher). Rehabilitation is based on a flawed model of what motivates the target population, what their real world options are, and what is likely to be effective in altering their preferences, decision-making processes, and deeply ingrained view of the world and how it works.
Personally, I favor not penalizing drug users if they haven't done anything other than use drugs. However, social approval and disapproval often works well in modifying human behavior and it's cheaper than police courts and prisons. (Depending on the source of the social approval/disapproval and the individual's susceptibility to it.)
Production and distribution is a different matter and can be regulated like other potentially hazardous materials.

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I enjoyed this one. Also: I just started Paul Tough's new book about university. If you can get him, I'd be interested to listen to it. It occurs to me that the conversation might be just as good if he interviewed you.

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