- I'm making you politician
and ruler of the United States where anything you say goes,
what is your new policy? - All drugs are legal, but they will be regulated by the FDA. - That is Ryan Marino. And based on his statement, you might think he has no idea what harm drugs can bring to society. Turns out, Ryan actually is a drug expert, but probably not the
kind you're thinking of. Allow me to introduce
you to Dr. Ryan Marino, emergency room toxicologist. This is a unique specialty of medicine that makes him an expert on something we see in TV,
movies and the news all the time, drug overdoses. Dr. Marino knows all about
drugs and what they do, but perhaps more importantly,
he knows what they don't do. Exhibit A, you've
probably seen news stories that sound a bit like this. - [Reporter] Dramatic body cam video capturing the moment Corporal Scott Crane of the San Diego County
Sheriff's Department is promising his trainee,
Deputy David Faiivae, he's not going to let him die after Faiivae was exposed to fentanyl while processing drugs at the scene of an arrest in early July. - So what's happening in those videos? Like I've even seen them
with the police officers that are like, "oh my
God, she's overdosing." They give her Narcan, she wakes back up. Like I think you even know
what I'm talking about. - Yeah. - Like what's happening there? - Something is happening. And I believe those are real symptoms. I can say that they're
not a fentanyl overdose, they're not an opioid overdose. They are in, I think every
situation I can think of, and I've seen I mean all of
these videos at this point, it's always the opposite. And so someone will
like have fear, anxiety, they'll be like rapidly breathing, all of these things that fentanyl
would do the opposite of. I mean, we use it in
medicine, end of life. It takes away your anxiety, your fear. We use it for people who
have like some lung problem, that kind of thing where they feel like they're
drowning or whatever. You can give fentanyl and it makes you feel
like you can breathe okay even if you're not. So my best guess, and this
is purely speculation, I don't want to try to
like diagnose anyone who I haven't been involved with here, is that this is either some
sort of like panic anxiety or the nocebo effect,
which is just like the- - Opposite. - Yeah, the like evil twin
for the placebo effect. And so if you believe so strongly enough, you've been conditioned, you've been told that being
near this white powder you're gonna overdose. And a lot of times in these situations, like there was one, maybe
it's been a year or two now, the San Diego sheriff
released this PSA video where they showed one of their deputies was like bagging up drugs in a car. And someone, the other
deputy with him was like, "careful, that's fentanyl, like you could just overdose
from being near it," and then he goes down. So it feels very conditioned
a lot of the time. But in that situation, if you
are having a nocebo reaction, the treatment would be a placebo. And so you give someone Narcan and they think it's treated them, even though they're like
breathing very fast, they're not having a true overdose that's why they think
that the Narcan works. And then people will say, "well,
I felt better after Narcan. So it has to have been
a fentanyl overdose." And yeah, the rubber just never hits
the road on these stories. But it's so pervasive that everyone's heard
one of those stories. It's used in law enforcement trainings. I mean, the DEA put out
guidance years ago about this. There was a website hosted by the CDC that said this for a while until it was taken down,
I think just last summer. But all the like scientific
data says that's impossible. Like literally, the
physical laws of earth, chemistry and physics here
say that it's impossible. And fentanyl has been
around since the '60s. It's been in street drugs
in the United States since at least the '70s. Congress actually had
a hearing in the '80s about whether it was gonna
be a risk to first responders encountering like fentanyl,
alpha-Methylfentanyl. If anyone's familiar
with like "China White," was the fentanyl analog. And they decided it was not possible. So it's kind of weird this has come back and it's like such a thing, but the fact that it wasn't
a thing until like 2017 and it only happens it seems
like in law enforcement. I mean, there's just a
lot of red flags here. Even if people don't
believe what I'm saying about like the science and stuff, it's just none of it adds up. - Ryan's entire mission is to provide proper
education and understanding around drug use. And despite what that might sound like, no, he doesn't want everyone
to start doing drugs, but he doesn't wanna ban drugs either. In fact, Dr. Ryan would love
to see all drugs legalized, with a catch. - I do think that the government should be out of kind of
like medicines and drugs. - Do you believe
prescriptions should go away and it should be all over the counter? - Well, I'm glad you asked that because I think they should be legal, but they need to be regulated. And so like alcohol's the classic example, prescriptions as well. Like when you get a prescription, you know you're not
gonna get fentanyl in it, you're not gonna get
xylazine in it, whatever. Your Adderall isn't going to kill you. And so alcohol, I mean we had alcohol prohibition. And people will argue that
maybe there were some benefits from reduced kind of drinking, but people were literally
getting poisoned. Alcohol had methanol in it, it had all these weird substances. Ginger Jake, was like a famous one in the toxicology literature. - What's that? - It was this like alcohol substitute to get past the weight. The government would weigh things to see if there was alcohol in it. And so people would drink
this like ginger flavoring thinking it had alcohol in it and they ended up with like spinal disease and like chronic paralysis,
issues with mobility. And so it was called like Jake leg and people had issues with walking. But yeah, so alcohol's legal. And not that alcohol is safe or everyone should be
out drinking alcohol, but you go to a bar,
like you're supervised. Someone will cut you off, if you get too rowdy they can like maybe
help you get into a car. It's illegal for you to
drive while you're drunk. Those kind of things. That's where the government
should step in, I think. Like if someone wants
to go home after work and smoke marijuana or shoot heroin. I mean, why do I care about that? As long as like they're
not harming anyone else, they're not harming themselves. - Well, they are harming themselves. If you're shooting heroin. - Well, I mean, people use heroin without having problems from it. - You think there's a way to use heroin not for pain but for pleasure and that would not be a problem for them? - Yeah. This is like very subjective data. - Okay. - But depending where you look, I mean the majority of people and up to like almost
most people who use heroin don't end up with like addiction, don't end up with complications from it. And it's not just like trying heroin- - Why is that?
- People can use like every day even. And I know plenty of people from working with them and stuff. - And how is that different than someone taking Percocet,
let's say long term? - It's not. - But yet we say Percocet can be so addicting and problematic. I mean, compared to other things, opioids definitely have
higher rates of addiction than like a lot of other medicines and even like mind-altering substances. So I don't think everyone should just be prescribed Percocet, but if someone like wants to go out and... People are gonna access
opioids if they want them. So I'd rather have someone be able to like go use
heroin in a safe space than buy like fentanyl cut with gabapentin and diphenhydramine and- - It's a very risky experiment though. - But I mean, before
we ended up with this, like we weren't having a
hundred thousand people die every year. - Sure. At that time though, it
wasn't yet where the... I forgot. Who was it? Was it Purdue, was telling doctors, "oh, this isn't addictive at all. Just prescribe it. Everyone's gonna love you. Your Press Ganey scores are gonna improve 'cause your patients are gonna say you treated their pain better." So like there's- - Yeah, so industry
definitely is a problem. But I mean the US government, like people have used heroin for... It was discovered in like
the late 1800s, I think. And it was a prescription medicine and it is still a prescription
in most of the world. It's just been banned in
the United States since 1924 but the US government destroyed
like the world opium supply, which they made heroin
from in the early 2000s. And so that was like
Afghanistan, northern Mexico, and that's where fentanyl came from because they didn't do
anything about the demand, they only got rid of the supply. And so when people were using heroin, like our rates of heroin
use haven't really changed. And still people call it heroin,
they sell it on the street. Everyone says heroin, there's no heroin anymore,
it's just fentanyl. - Wow. - If you can even get fentanyl now. But it was like 6,000 people a year would die from overdoses. And I mean that's something that if these people could go
in like a supervised center or I mean even if they just
had like a buddy with them, if they had Narcan, which the nasal Narcan wasn't
available till like 2016, those could have all been treated. But now people get fentanyl, people get whatever weird stuff and like a hundred thousand are dying. - Yeah. And also I think it depends which group of people we're talking about. When I say group of people, I
mean demographics, location. If you're living amongst
the poorest in our country, you likely have higher rates of trauma, that's statistically already been shown. And then if you're becoming
one of those people who will occasionally use heroin to come home after a long day, how long until the combination of almost like a drug
interaction, if you will, the trauma being a drug and
then the heroin being a drug till it becomes out of control? - Yeah. - And I feel like that becomes problem- - I mean, for opioids and these kind of things
where you get dependence and you need higher and higher doses and you get withdrawal symptoms and people are more likely to start using like more of the drug
and more often as well. And one important thing, I mean when it comes to
like opioid addiction, most people who have like
quote-unquote "addiction," who are using all the time are actually using just because the
withdrawal is so miserable. So like they wake up in the morning and they're having like diarrhea, they're throwing up, their nose
is running, they're crying. I mean you can't go to
work, you can't do anything. So it's not that people like want to use, that they're even able
to get high anymore. And so I mean, I think that's
an important distinction. But yeah, at the end of the day, like I personally am
very pro-legalization. I don't think that everyone
should go out and try heroin, that heroin is safe, anything like that, but just the alternative
seems so much worse. And if we were able to take
our like drug war budget and put that towards housing,
childcare, food providing, yeah all of those things, I mean I think... And then even just educating people, like giving them Narcan, whatever, the amount of difference that could make rather than just like paying
for this drug police army and keeping prisons full, doesn't really help anybody, obviously, as we've seen like the US
I mean is doing the worst any nation in the history
of the world has ever done in terms of drugs. - And in our prison system as well- - Yeah. - With the huge numbers. For decades now, the US has
been embroiled in debate on whether or not we
should legalize marijuana. While to the naked eye it would seem marijuana doesn't
pose as strong health risk as alcohol, which is legal. Whether or not that's actually true is a little bit more murky. That's because according to the United States
Drug Enforcement Agency, marijuana is a Schedule 1 substance under the Controlled Substances Act. Meaning it has no currently
accepted medical use in treatment in the US. And there's a heck of a burden when it comes to organizations being legally allowed to study the drug. As long as this classification remains in place on the federal level, it creates a whole world of problems for physicians like myself trying to understand what health impacts this
drug can actually have on the human body. - The laws are just so
convoluted when it gets into this because I mean, at the federal level, marijuana is Schedule 1, it's illegal, it's literally on paper said
to have no medical benefit, there's no safe use whatsoever. But then state by state, I mean you can have it medical, you can have it recreational. And then there's the farm
bill from a few years ago where they made these
analogs of THC legal now. - The hemp farming thing, right? - Yeah. - Yeah. - And even like regular
THC which is Delta-9 THC is like the actual one that gives you the psychoactive effects from the cannabis plant is now legal up to a certain percentage. And so if you get like a 40-ounce drink, I mean that could have a
thousand milligrams of THC in it and be legal even though- - It's a huge amount, but that's because the concentration- - Yeah. It's way more than anyone
should ever be doing. - Wow. But see that's the scary part of it all. And initially, I remember I was invited
to speak on television about CBD being added to general products. And my big concern with it was you have it in FDA
controlled substances as a treatment for things. And when it comes to an
FDA approved substance, I mean, you know this better than I do, that dosing is a huge requirement of deciding whether or not
something is indicated or not or approved or not. And yet CBD being added
into sodas, burgers. Like I remember going to a diner and they're like, here's a CBD burger. And as a person in the world, you could be like pregnant and consuming huge amounts
of CBD throughout your day that add up and no one has any idea because it's just like an additive now. - Yeah. - That's scary. - And I mean, it gets into
kind of like wellness too, they put it in everything. It's in like soaps, shampoos,
that's been a problem. The military has much stricter guidelines on kind of like drug use and testing. And people have like tested
positive for cannabinoids because they were using,
allegedly, like soaps or shampoos that had CBD. - Oh wow. - So I mean, yeah, just getting into kind of
like the legal aspects, it's so convoluted and
we let a pregnant person can take as much CBD as they want. And who even knows if what you
buy or get is actually CBD? - Yeah. - And they've done testing and I think like close
to half of the products either didn't have CBD, and a bunch of them had actually like THC, which is the illegal one. So yeah, I don't think anyone benefits from the way we do this. And it also inhibits like
studying the effects too. - Well, yeah. When you keep it Schedule 1 that prevents institutions
that receive federal funding from studying it, right? - Yeah. You have to get like special permission from the federal government. - Yeah. I mean, clearly something needs to change, but I think politicians are
worried about their reputation or how they're labeled when
they start advocating for that. Which is silly, but kind of the PR
focused social media world that we live in these days. - Yeah. - I'm curious your take, and this may be a loaded question, do you think CBD works for
the widely purported uses that the supplement industry claims? - That is a loaded question, but not really. (both laugh) There's no evidence that
it works for anything other than those like very
rare seizure conditions. And that's at a very high dose, nothing you could ever
get from like your bodega, your gas station, whatever,
where people are... Even Whole Foods, I don't know where people
necessarily get CBD, but there's no evidence that
it does anything, I think. People will tell me all the time that rubbing CBD oil really
helps their arthritis. And I think if that works, that's great. That's better than being in pain or having to like turn to other things. But yeah, the evidence isn't there. - So when you see a professional athlete come out with a balm for their knees or a pill for their post
workout inflammation, how do you feel? - I don't feel great about it because at the end of the day when people are selling
you those products, like they have to have
something behind it, otherwise they're just
kind of scamming you. - I mean, they'll say it works for me. - Yeah. - I mean, we've seen it
with Gwyneth Paltrow. We have our little coffee
cup that you brought, thank you for my housewarming present, "coffee is a friend, not an enema." But we see that with Goop-esque
companies all the time. And I don't know, I find it hard being a doctor
fighting back against that because you and I really want to be
evidence-based physicians, but in order to be an
evidence-based physician and say those products don't work, we need to prove they don't work. Saying that there's no
evidence that they work is the honest thing,
which is what you said, but it's not powerful enough
to dissuade people from using. - Yeah, for sure. And so, I mean that's why I support, like I don't wanna medicalize cannabis, I don't wanna medicalize all these. Like if people wanna try
something, go for it. They should be informed on like what the actual evidence supports, what the harms are. And so if CBD like really helps someone who has had, I don't know,
PTSD, insomnia, arthritis, whatever these conditions are that we don't have any
other better treatments for, I'm all for that. It's not gonna really harm you as long as you know that like
you might not be getting CBD, it might not actually do anything, you might be getting
something totally unrelated. You might fail a drug test because it actually has THC in it. But yeah, at the end of the day, I don't want to yuck anyone's yum. - I don't either. But what about when those people have it, take the substance, say it works, and now encourage others to do so? And we're living in an age where even YouTube is promoting... How do they describe it? Like first person stories of illness. Like they'll highlight individuals who are living with diabetes in order to help people feel connected. And it's for a good reason. - Yeah. - But then what happens when
one of those individuals, like I have diabetes and
I take miracle potion Y and it helps my blood sugar. Does that then cross the line? - So that's really tough because I think a lot of times those like first person accounts of my illness, what worked for me, can actually lead to
like meaningful research or meaningful breakthroughs on the topic. But a lot of times too, it is someone who either is just kind of
promoting something unfounded or wants to profit or it doesn't end up
actually having any benefit at the end of the day. So I mean, I think medicine as a whole doesn't do a good job of kind of like listening to people who are living with the illness. And we do fixate on like
the evidence-based portion and living with... Especially like chronic
diseases and stuff. Those people have a lot of
experience that is meaningful. It's just really hard to kind of tow the line of
what's useful, what helps, and what is predatory or unhelpful. - Yeah, because- - So I don't have a good answer. - No. It's an almost impossible
question to answer. And the reason I ask it is
because I even have friends and let's say one of their girlfriends is like, I love this miracle thing. I electrolyte my water. Not electrolyte, ionize my water to change the pH. And I'm like, that's beautiful that you're
doing that for yourself. Like if that makes you happy, please. But then when we're sitting at a dinner and now there's people who are
sick or having some symptoms and she's like, you gotta
do this to your water. And I just want to be like, no. Like that's not what's
going on with this person. And I don't know how to do it without coming off like a dick. - Yeah, it's a really hard line. I mean like I interact
with a lot of people who have like chronic pain, especially, and all the evidence says
that like long-term opioids do not have benefits for chronic pain. - Yeah. - But people will tell you like they can't function in their life without being on like their
chronic Oxycontin or whatever. And so it is really hard
because like on one hand, can you tell someone
that their own experience with their life and their own
illness is wrong or not true? But people will then like push it. Like not everyone is genuine. So I don't know, it's super nuanced. - Yeah. - I don't have an answer. It's always on like a case by case basis. But yeah, when someone's
like, "oh, you're sick? Here, take this like
herbal portion I made you," I think that that kind of crosses a line. - Yeah. And that happens a lot with people that are
susceptible to getting tricked because they've had such a bad experience with their healthcare system. And you mentioned people
with chronic disease. I think they get treated not just the worst by
our healthcare system, but they get taken advantage of by the pharma companies the most. - Yeah. - Because pharma, they're smart, they're business people. That's what they are. They're capitalistic. So they say, okay, what illness do people have pretty bad
symptoms but don't die so we have them as customers? And they look at people
with autoimmune conditions, with chronic diseases and they're like, "let's develop a drug
that fixes those people but they have to take it forever." - Yeah. - It's like the best business model ever. It's almost like getting someone hooked on an addictive substance without having the addictive substance or negative ramifications of doing so. One of Dr. Marino's specific complaints regarding the federal
regulation of prescription drugs is the drug enforcement agency, which he says doesn't have an actual
medical professional on staff. This has resulted in regulations
that just don't make sense leading to nationwide
shortages of a substance many college students know well, Adderall. - The DEA is our drug enforcement agency at the federal level. They have no one medical
on their staff, but they- - No one? - No one. - Like they don't have a medical director. - They're-
- How's that possible? - Prosecutors and law enforcement. - They have no medical people. Wow. - No. And so they set quotas on
all controlled substances for production from
pharmaceutical companies. Who can make them, how much they can make, they set it a year in advance. Like that's the reason we're in an Adderall shortage right now, is because the DEA didn't believe that the prescriptions were legitimate and this one company that
is allowed to make Adderall cannot get the precursor products because of supply chain issues. And the DEA will not allow
anyone else to make more or any new companies to make it. - Wow. And like who's guiding
those decisions for them? Like is it a team, is it collaborative or is it just like one person? - And it's very opaque. - Wow. So DEA's controlling limits without... It's almost like they're
trying to be predictive and you don't know why that's happening. Wow. - And so, yeah. I mean Adderall is a
good kind of topic here for like legalization and
these kind of legal issues, federal policy, that kind of thing. Like ADHD is a real thing. Adderall and other stimulants
for treatment of ADHD is honestly one of the
most evidence-based things in medicine. The data, I mean, is like super robust. Goes back many, many years. Has been repeated over and over. And in the pandemic, with the kind of waivers that were given for telehealth and prescribing, these companies sprung up that
maybe took advantage of it. People were able to get
like an app on their phone and basically like order Adderall, and that was a concern but
that was not a ton of people. Like diagnosis rates for things like ADHD, and it's not just ADHD
that Adderall is used for so I don't wanna like
make people think that, but diagnosis rates- - What else are they using it for? - For narcolepsy, for
end of life depression. It's like one of the best antidepressants. But over the past, I mean decades, like diagnosis rates have
gone up for things like ADHD because people have gotten
better at diagnosing them, we've realized you can treat it, like it makes a difference
in people's life. And I think for most people it still seems like it
is an invisible illness. You don't see that people have ADHD, but if you look at the data,
like people die years earlier, people get in way more car accidents, they have like bad things happen to them. And I mean, not only that, but
like people can't function. People can't like go to
school, do their jobs, that kind of thing, which
we should also care about. But the DEA felt that these
rising prescription rates were not legitimate. They thought they were
mostly like fake people ordering this through apps. So in 2021, they set their quota for 2022, which they did not take into account the rise in prescribing rates 'cause they didn't believe it. - But I mean, you can't judge... That's not their place to judge. - Exactly. - So even though maybe I don't even fully
disagree with them, but they can't judge that. It's from such a macro level. Wow. Because then you're screwing everybody, not just the people like- - And so now, I mean people
are without their meds, there's problems from that, but people are getting
put on different meds. And so other people who need
their like Ritalin, Vyvanse, whatever, all these things, those are now having big issues too. There's no end of the shortage in sight. And I mean someone literally at the DEA could snap their fingers
and end this today. It's been nine months now. And so I mean that's just like one example but that's a good example, I think, because it shows kind of
how broken the policy is. - Well, I feel like a lot of the problems that come from our government happen because of the
lack of collaboration. Like even when they're
making insurance policies for physicians, they never have a physician
in the room deciding this. It's like a legislator, a
lawyer, a finance person. No doctor. Or some like healthcare administrator. I'm like, but get a clinician in the room, like a person who spent
a day seeing patients. It's such a big difference- - And then they'll find
like a family member who has a sob story about like, Adderall
killed my mom or something. - Yes, and get press and yeah.
- Yeah. That gets all the attention. - That's very true. So after hearing a bit more
of Dr. Ryan's expertise on the subject of drugs
in the United States, let's listen to President
Marino's plan for America one more time. I'm making you politician and
ruler of the United States where anything you say goes, what is your new policy,
drug policy, obviously? - All drugs are legal, but they will be regulated by the FDA. - Let me know down below what you think of this bold proposal. I know it's a touchy subject. Speaking of drugs, you may have heard about the
new miracle weight loss drug, Ozempic. Click here to learn the truth about what Ozempic actually does. And as always, stay happy and healthy.
