I will never forget the thrilling 24-hour sprint to break the news that President Joe Biden was selecting Dr. Rahul Gupta to be his director of drug policy. Somehow, Will Godfrey (Filter's founder and editor) and I beat every legacy outlet to the punch. Not just breaking the news, but publishing a full accounting of Gupta's sketchy policy record in West Virginia, where he had shut down a syringe program under political pressure.

Filter held his feet to the fire. It didn’t matter that he was a Democrat in what was supposedly the most progressive administration. We didn’t pull punches based on partisanship. Filter routinely punched above its weight as a small, independent outlet. It changed the way other outlets cover drugs and it’s a massive loss to see it shutter.

It got me thinking: Filter going offline feels like the end of something. The end of something much bigger than one website, the end of something that I don’t quite know how to articulate, let alone mourn. But I’m going to try and do both here.

For well over a year, I’ve had the feeling that, as journalism steadily declines—its credibility in the gutter and its finances sinking deeper into the abyss—that drug journalism is being ground to dust.

When I first jumped on the beat, drug journalism was lively, interesting, and boundary pushing. I was excited to join a group of fearless people challenging conventional wisdom that had hardened into dogma. Piece by piece, writers and journalists took a hammer to assumptions that had fossilized into stale, tired, and cliche coverage. Powerful institutions were investigated. Old ideas were interrogated, like recovery being synonymous with total abstinence. Or that to be truly “sober” one had to go to meetings for the rest of their life and have a vaguely spiritual outlook on life. The notion that people still using drugs were beyond hope and could not be helped unless they hit rock bottom and experienced some tough love.

These old narratives took a beating. And there was an opening for new ideas and ways of thinking. As I got started, around 2014, here is what was being published:

• 2015: Gabrielle Glaser wrote a viral story into 12-Step dogma for The Atlantic. It was a cover story and it exploded on the scene and sparked days, maybe weeks, of commentary.

• 2015: Jason Cherkis, in The Huffington Post, investigated the systematic suppression and discrimination of methadone and buprenorphine as options for treatment in an industry dominated by abstinence.

• 2016: Maia Szalavitz took a major swing in her book Unbroken Brain. It was covered and reviewed everywhere and from there it was off to the races. The drug beat was injected with life.

• 2016: Even local news outlets invested massive resources into drug coverage. Cincinnati Enquirer published a riveting story called Seven Days of Heroin. Boston Globe was analyzing the language of addiction.

• 2017: Alec MacGillis in ProPublica investigated the shady ties between law enforcement and Alkermes, the manufacturer of Vivitrol, which resulted in a false and misleading marketing campaign against agonist treatment.

It is jarring to juxtapose how ambitious and curious and incisive this work is with what little gets published today.

Take a recent Atlantic story that parachutes into Seattle to zoologically gaze upon unhoused drug users. The thrust of the story argues that syringe programs and other harm reduction practices are responsible for creating a zombie apocalypse. Studied practices that prevent disease, infection, and death are framed as coddling “addicts” who actually need a heafty dose of tough love and probably long-term incapacitation. We have seen hundreds of these stories, of course, written about Portland, San Francisco, Los Angeles. Curiously, every West Coast city where it costs $2,000 per month to rent a closet to live in has this same odd pattern of destitute people using drugs on the street. Very curious indeed.

Writing these kinds of stories means you don't have to get to know, let alone talk to, someone who uses drugs on the street. Why would you interview a zombie? They are sub-human and non-sentient.

I’m not saying everything published right now is like this. What I am saying is that the room to challenge old ideas and think critically about drug use, criminal justice, public health and homelessness, is shrinking. The opportunity to take big swings is vanishing.

There was a time when a different article about Seattle would have been written. Maybe that piece would take aim at the failures of governance in a city beset by yawning inequality. Legacy coverage of drugs is backsliding toward old school dehumanization.

In the words of the internet today, there has been a vibe shift. And in the current mood there is little appetite for the type of stories that were commissioned left and right not long ago. But it’s also more than just a vibe shift and changing of tastes and mood.

I decided to try to quantify what I’ve been seeing. Namely, this suspicion that attention paid to the subject is on the wane. There used to be several writers and journalists constantly publishing stories on the beat, and now I can only count a few.

So I built a query in Media Cloud, a platform connected to large databases of news articles, to analyze attention over time. The chart below tracks the rise and fall of the drug beat from 2014 through 2026 (ending Aug. 31). The chart tracks a surge of interest around 2015, a high peak in 2017-2018, and then a sharp decline with a few spikes here and there (mostly regarding stories about settlement money and lawsuits).

As attention fades, 70,000 people are still dying of drug overdoses each year, the same number as when the crisis was declared a national emergency in 2017.

I see the chart showing a few things: After the pandemic, coverage fell off a cliff. Which makes sense. How many public health emergencies can there be? Turns out a lot and they’re all competing for attention. I also see a mass casualty event become ambient background noise. People dying preventable deaths is another grim fact of American life that we are supposed to learn to live with.

I hear phrases like “compassion fatigue” and burnout but I don’t think these pat phrases do enough to explain the decline. Surely it’s in the mix. Especially on an issue like this that gets framed as a neverending crisis. A crisis with no end is a story with no arc or shape. The opioid epidemic, after all this time, is more like an opioid endemic. High drug mortality becoming a constant presence.

But there is also a structural explanation. Journalism is in ruins. If you don’t work in media it’s hard to appreciate how bad things are.

Since 2005, the U.S. has lost close to 3,500 newspapers, leaving most American cities and towns with little or no local coverage. The days of Google being a driver of traffic is over. AI Overview—and LLMs in general—are throttling traffic. Employment in journalism has fallen by more than three-quarters in this same window. Advertising revenues are tanking, creating a vicious loop of newsroom closures and more job losses. The few surviving outlets increasingly churn out national wire stories rather than original reporting.

In this decay, journalism is losing its capacity to cover anything outside a shrinking set of national flashpoints concentrated in Silicon Valley, Washington, D.C., and New York. The everyday beats that outlets throw resources at increasingly look like this:

Here is what this AI CEO said today.

Here is what Trump said today (I’m sure it was really bad!).

Here is the newest crazy person to enter the political scene in D.C.

Here is the latest way the internet is making everybody insane

This is occasionally interrupted by news from one of several war zones or climate disasters flaring up around the world at any given moment.

The issue here isn’t just one of fatigue, burnout, or disinterest. The market for coverage on this subject — and a lot of others in public health and criminal justice — is dying on the vine.

Will told me it was a massive struggle for Filter to survive in this environment. It became harder and harder to raise enough money to pay staff and keep the lights on. Funders and donors all over are bailing on media.

It wasn’t always like this. In fact not long ago being a drug journalist for me was a full-time job that I could barely keep up with. There were too many stories and things to cover. And that’s the story I want to tell here: How the drug beat exploded, what happened to it, and what it would take to bring it back to life. Drug journalism needs a shot of Narcan. Fast.

And no, a few niche Substacks are no replacement for a robust news operation. I like writing newsletters because I just love to write but this is not the same thing as being part of a real news organization.

Part 1: The Beat Blew Up

First, I pretty much owe my entire writing and journalism career to the likes of Will Godfrey, Maia Szalavitz, Tracey Helton, and Maer Roshan (former EIC of The Fix) — all of whom pioneered drug coverage in the digital era as I was coming up. Tracey and Maia, especially, were always generous with me. They were basically the only writers dedicated to covering drugs and harm reduction as a political and social movement. By that I mean they actually talked to people who used drugs. They actually talked to people who broke laws to help those people. They talked to doctors, researchers, lawyers, organizers, street medics, and so many others who live and work and dedicated their lives to this field.

Back then, we never felt like we were competing against each other as writers and journalists because there were so few of us. There was a spirit of collaboration, passing along tips and sources, and happily sharing the right editor’s email.

The rest of this post is for paid subscribers.

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Light topics. Practically a beach read. Let’s dive in.

Up first is the methadone vs. buprenorphine comparison study, which I think is one of the most important things to analyze right now in the current treatment landscape. There’s pending state and federal action on methadone clinics, a system in need of serious reform.

In West Virginia, Solutions Oriented Addiction Response (SOAR) is suing to overturn the state’s 20 year old moratorium on new methadone clinics. Congress is also debating a rollback of loosened rules around methadone dosing and take-home doses, which many reformers oppose. Methadone is supported by mountains of evidence, but a lot of it is old. It’s important to look at outcomes in the current world of deadly synthetics.

1. JAMA Network Open: Methadone vs Buprenorphine-Naloxone in Opioid Overdose Survivors

This study is the largest cohort of people starting medication treatment for opioid addiction (MAT/OAT/MOUD—whatever you want to call it) after an opioid overdose. Crucially, it’s the largest study of its kind in the fentanyl era. And it includes the highest-risk group: people who overdosed, were revived with naloxone, and then started on medication.

The strongest predictor of a future overdose is an overdose in the past. So how this group is treated is an actual matter of life and death.

The study’s core findings:

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Before diving in, I want to spell out what I call the conventional “treatment gap” narrative, and what I think it misses or sidesteps.

In the world of drug policy and addiction there’s a lot of talk about a “broken treatment system.” You will hear how this broken system results in a “treatment gap.” All that really means is that a lot of people out there need help but don’t get it. In this narrative, I hear an oft cited stat: about 9 out of 10 people diagnosed with a substance use disorder (SUD) do not recieve treatment. The “treatment gap” story then speeds up from there and goes right toward “increasing access,” which is another pat phrase you hear everywhere. Access. Access. We need more access. Everyone says it.

In certain areas, like buprenorphine for opioid addiction, access has been greatly expanded, but it hasn’t resulted in more people walking into the clinic and getting the medication. Despite medications being the best treatment, more than 80% (~3.4 million people) with an opioid addiction got no medication treatment for it. While there’s all sorts of complications here, creating more access doesn’t automatically mean more people are accessing treatment.

Zooming out: Almost 38 million people with a diagnosed addiction did not get treatment for it in 2025. But it is mistaken to chalk up that staggering number as a problem of access. Maybe we wish this was an access problem. If it were, it would be much simpler solve.

So what is going on with tens of millions of people who supposedly need treatment but didn’t get any? Who are they? What’s their deal? What do we know and don’t know? And is this a problem unique to addiction?

Here’s what we know from NSDUH: This huge chunk of people are not getting treatment because they do not think they need it.

It bears repeating: They do not think they need it!

About 94% (~35 million) are in this camp. That’s a huge group of people who neither sought out treatment nor believed they should get it.

This presents a hard set of questions and problems. I tend to analyze things through a materialist lens, which means I think about the structure. And this way of thinking does create a tendency — or bias — toward focusing on structural barriers, like economics and cost. But the problem with addiction treatment presented in NSDUH is not really structural or material. Cost, insurance, stigma regarding life or job consequences — all of that matters, but they rank well below what appears to be a baseline psychological and motivational block.

Now, I happen to not think that we just need to shake almost 40 million people out of their denial. I don’t think garden variety denial is the main issue here. Yes, addiction and denial go hand-in-hand. But I don’t think people in this camp are all deluded about their lives and can’t see what’s going on. It’s possible this is not self-deception, but is an accurate self-assessment of their needs.

So I will attempt to analyze this as systemically as possible with what little information we have about why people don’t think they need help.

First, here is a breakdown by age of those who actually got treatment. The biggest group is young people (12 to 17) and the second biggest is adults (26+). I think this makes sense: Adolescents get caught using drugs by school counselors and parents who can compel treatment. Meanwhile, older adults have had more time to accumulate consequences (job loss, health scares, family pressure, insurance and financial stability) that eventually pushes them toward treatment.

Now, let’s look at who has the most need for treatment. It’s the same group that recieved the least of it. That pesky 18 to 25 group.

18–25 year olds sit in this weird time in life. They are not kids anymore but they’re not really adults. They've mostly aged out of strict parental oversight and school-based pressures. But they don’t have the infrastructure of adult life, like employer- insurance, a family depending on them, and severe consequences. This is also the group that is still experimenting and learning how to become an adult. Some in this group may frame heavy drug use as normal. It’s not perceived as an addiction in anyway even if it is meets some of the criteria. It could be a temporary phase of young adulthood rather than a problem that needs to be treated. There is still a lot of time and flexibility at this age for things to change.

People age out and phase out of addictive behaviors all the time without any treatment or help.

Still, It’s in this young impressionable time when addiction can really take hold. So it’s not OK to just write off this whole group as not needing help. But also, this younger adult group doesn’t come close to making up the whole 38 million who don’t think they need treatment.

I think, in part, what’s going on is that treatment has an image and perception problem.

People meet the criteria for a substance use disorder, and they are told that they need treatment, and when they imagine what that looks like, they think: Hell no! That’s not for me.

When most people picture "addiction treatment," they see the version in pop. They see what’s depicted in movies and on TV: checking into a facility somewhere, disappearing from school, work, friends, family, whatever it is, for 30, 60, or 90 days, sometimes longer. And then through this intensive treatment, interminable hours if group therapy and drug tests, constant processing of emotions, checking-in and being monitored and talking about yourself incessantly, somehow you re-emerge from all of this as a changed person. But you’re not cured! You are told that you will never be cured. So now you embark on a life of endless maintenance to remain totally 100% sober. Now you go to multiple AA or NA meetings every week and sobriety is your life,

That’s a hard sell. But it’s also unrealistic. It’s not remotely necessary for most people. But this is what most of us imagine. It’s an enormous ask. It’s a massive disruption. It means pressing pause on your entire life, only there is no pause button on life so eveything will keep moving along without you which feels even worse.

If that's the only mental model someone has for "getting help," it's not hard to see why more than 90% of adults with an addiction diagnosis conclude they don't need help. The imagined cost of "fixing" the problem — which again, I do not think they are fully in denial of — feels wildly disproportionate to how bad things actually feel day-to-day.

And we know that severity matters. Treatment receipt scales with severity, which is what we’d expect to see. Someone with a severe disorder is roughly 7x more likely to get treatment than someone with a mild one (28.9% vs. 4.1%). The important bit here is that the biggest group of people are not in the severe category. The biggest group have a more mild case with fewer symptoms. It’s more than double the moderate and severe groups combined. People with a mild case do not need this intensive care. But it’s what they think “help” means.

One irony in all of this is that inpatient rehab is actually on the wane. Outpatient counseling (4.4 million people), telehealth (3.6 million), and medications for opioid or alcohol addiction that you take at home while going about your normal life — all of these far outnumber inpatient stays (2.2 million).

But I don’t think most people understand this yet. The image of treatment is stuck in the past. The way it’s depicted in pop-culture is of little help. It’s almost always hyperbolic and ridiculous and feeds into this misperception that addiction is this bout of severe insanity that requires being institutionalized. So those with a more mild case probably have no idea that there are things they could do to improve their lot. But they hear the words “addiction” or “substance use disorder” and “treatment” and they, rightfully so, get bugged out.

Most “treatment” today doesn’t look like leaving your life behind at all. It looks more like a weekly or monthly appointment, picking up a script, and moving on. It looks like what I do: I see a therapist (who has no specialty even treating addiction) and we talk.

My wife likes to joke about my dreams. When I recount the content of them—at least what I remember—they are utterly banal. They almost always involve snowboarding or skateboarding in some way. Makes sense, I did that every day I could as a kid. In these dreams I’ll be on a snowboard trip and: whoops, I forgot to pack my boots! That’s the whole dream. Anxiety about packing for a vacation. Sometimes, something cool happens. I’ll be snowboarding in the trees and bopping around, then gravity goes out. I float and float and I can’t get back down.

The joke is that my dreams remind her of Tim Robinson’s 2025 comedy called Friendship. Tim Robinson plays Craig Waterman, a boring, middle-aged wet blanket. Craig is bumbling, oblivious, he can’t take a hint and he couldn’t read a room if his life depended on it. But, endearingly, he yearns for connection. He just wants a friend.

Wait, does my wife think I’m a Craig? ….

There is a scene in Friendship where Craig licks the hallucinogenic poison excreted from a frog. He’s in search of something profound. He is looking for answers. The trip induced by poison will reveal some deep truth about his own nature. The lights go dim. A slow synthy song starts to play. Craig’s eyes are open wide in the dark room. The anticipation of a psychedelic journey builds, and then the scene cuts to Craig at Subway.

The totality of his entire Toad Trip centers around ordering a Subway sandwich: Black Forest ham on Italian herb and cheese bread, toasted. Craig then wakes up from this trip before he gets his sandwich.

Welcome back, Craig. Did you get the answer you were looking for?

“No, I ordered a sandwich! At Subway! That frog ripped me off.”

I saw a clip floating around on Twitter and it washed up on my screen the way a boat might bump into a giant pile of plastic garbage in the ocean. The clip had millions of views and it was Andrew Huberman recounting the time he took a combined dose of MDMA and magic mushrooms. The kids at Lollapalooza call this candy flipping, or is it hippie flipping? I forget which, but they probably did it during Charli xcx’s set last weekend.

But Huberman is a Serious Man. Tripping on psychedelics for him is not a fun time. In fact, for him, it’s work. It’s doing the work. He talked about how hard the trip was. How regenerating it was. How he “rewired” his brain. How you need clinical support and a guide to really get the full experience. All the guru speak sprinkled with neuro babble was flying, and it reminded me of the Toad Trip scene, which I think is a bit of comedic genius.

The Tim Robinson bit pokes fun at the way psychedelics have become cliche and thoroughly commodified. A transcendental spiritual experience is something you can buy now. There’s a cottage industry of guides and gurus and clinics advertised as a way to go beyond the doldrums and ordinary unhappiness of middle-aged American life.

Go deeper. Be more intentional. Live more fully. Who doesn’t want that? Psychedelics are peddled as a shortcut to a more meaningful way of life. But what happens when you lick the frog or sip the ayahuasca and all you do for a 12-hour trip is order a Subway sandwich?

Huberman began his whole guru spiel—on a podcast, of course—with all the necessary caveats. “No one should try this without clinical support,” he said. “Many people should not take these compounds at all.” But he sure can!

Then he goes: “BUT, Whoa!” and launches into the neuro science babble about “one session re-wiring” his brain and how this was “the hardest work I’ve ever done.” He talks about, after his trip, having the best workouts, the best work week, “etcetera.” He uses words like empathogen so you know he is being scientific.

Huberman says taking mushrooms alone (meaning without MDMA) was “a very dark and harrowing experience” — he said he vomited and it was a really “gnarly” trip. “It was terrifying to be on psilocybin.”

And to that I say: Well, if you are stuck staring at yourself, thinking about yourself, and you don’t like what you see, then yeah, mushrooms are not going to be a fun time. I think of the Sartre saying: “If you are lonely when you are alone, you are in bad company.”

But taking MDMA with mushrooms was an experience Huberman really seemed to love! But it’s also the hardest work he’s ever done.

What was so hard for Huberman? Well, it was “the work,” of course. How during the trip, or after the trip, he was ready to get to work. What that work is, or was exactly, he has no idea. But there surely is a lot of work to do.

He didn’t want to be vague about the work, so he tried to explain it:

“I spent a fair amount of time thinking about the harder things that had happened in my childhood and my life. Some of which were self-inflicted. Some of which were not self-inflicted. And, I’d come to peace about those through the work… With those two compounds in me, I felt: I could do this. That session took me through a brutally hard voyage of thinking about all the things that didn’t happen.”

Well that clears it up!

Who is Andrew Huberman? And what does his popularity and shtick say about us?

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If you talk to the quants and the wonks, they will tell you that these data are not the end all be all on the drug situation in America. Far from it. For starters, there are vast undercounts and excluded populations. The sampling structurally excludes many heavy using and high risk populations, like the unhoused and also people in jails and prisons. On top of that, this is all self-report. There are many reasons why people would lie or minimize their drug use when the government asks about it. There is also lag, which means the newest compounds emerging in our rapidly evolving and synthetic markets are not going to be picked up.

Basically, what you need to know is that the absolute numbers are probably closer to the floor, not the ceiling. And the methodology is consistent, which is valuable for tacking trends overtime. So with all that throat clearing out of the way, this is the data we’ve got and it is worth taking a close look.

1. Daily drug use, by the numbers

1. Marijuana — 7.4% (~21.5 million people). Weed is now the single largest daily-use substance in the country, full stop. Marijuana overtook daily use of cigarettes for the first time ever, which is a massive change. Cigarettes have been America’s default thing that people use every day for well over a century.

2. Daily cigarette smoking — 6.9%. Cigarette use continues to fall.

3. Nicotine vaping — 6.0%. To be sure, nicotine is still the largest category of substance use. When you combine cigarettes, vaping, cigars, smokeless tobacco, Snus, all of it, then it eclipses marijuana. But nicotine vaping is moving fast. It didn’t even exist as a tracked category before 2022, and now it’s grown from 4.5% to 6.0% in just three years. If trends continue it could surpass alcohol soon.

4. Alcohol — 5.9%. Daily/near-daily drinking has fallen steadily, from 8.0% in 2021 down to 5.9% in 2025. This is a real, sustained decline. Alcohol use spiked during the pandemic and it’s good to see it dropping.

5. Cocaine, heroin, hallucinogens, and prescription opioids, stimulants, tranquilizers, sedatives — these are all essentially 0.1% or less re: daily use. The figures are so small NSDUH can barely measure it with any precision.

Weed just became more common than cigarettes and alcohol and that’s wild

Weed overtaking cigarettes and alcohol is the single biggest shift in the whole report. What we’re witness is the change in habits, tastes, and use patterns more than a decade into the state-level legalization project. (In a little bit: I’ll give you a pet theory on why alcohol (and maybe cigs) are seeing such a sustained decline). It’s worth digging a little deeper into these numbers.

The percentage who used weed in the past month among people 12 and older increased to 15.1% in 2025 (43.8M people) from 13.2% in 2021 (about 37M people). But when you break the age down further, you can see who’s really driving the increase. It’s not in young people. In fact, among the 12 to 17 and the 18 to 25 categories we are seeing sustained declines. The central argument deployed by opponents of legalization was that state-level legalization would create a generation of young marijuana consumers. They were wrong. It just has not happened.

So where is the increase coming from? Adults. The growth in marijuana comes almost entirely from adults 26 and older, whose past-month use rose to almost 15% from 12.3%.

Also notable: More than a third (37%) of current marijuana users say they vaped it in the past month. Vaping is more common among the 18-to-25-year-olds; 45 percent say they vaped it. Like with nicotine, vaping weed has become a more mainstream mode of consumption, especially among the younger users.

3. Illicit drug use is only rising due to marijuana overall is up

Past-year illicit drug use rose from 22.2% to 24.0% of people 12+ (62.0 million → 69.8 million people). That sounds bad until you look at the figures and we already covered why: the report explicitly attributes the increase in illicit use almost entirely to marijuana. If you take out weed (which is not illicit in many states now) then you get another story entirely: illicit drug use either declining or holding steady.

• Prescription opioid misuse — it’s still dropping — from 3.0% to 2.0% of past-year users among young adults; this continues years of decline.

• Prescription stimulant, tranquilizer, and sedative misuse — all declined or held flat.

• Illegally made fentanyl (IMF) use: — I really cannot rely on the NSDUH figures here. They detect no significant change from 2021 to 2025, and find that fent use is holding at around 0.3% of people 12+ (roughly 768,000 people). The report flags that IMF estimates are almost certainly undercounts. Between the excluded populations and the fact that people still don’t know what they’re using sometimes it’s impossible to track from a self-report survey like this one.

• Hallucinogen use — one of the few things that ticked up — this is consistent with the broader psychedelics resurgence story that’s been building for a few years.

My theory: Drinking is down because of GLP-1s

I can’t prove this but the timeline of GLP-1 adoption lines up suspiciously well with the alcohol decline. It’s no secret: Basically everyone who takes GLP-1s say their desire for alcohol is substantially diminished, if not entirely gone. They just don’t want to drink. And if they were heavy drinkers, now they drink less than they used to.

GLP-1s are drinking alcohol’s milkshake.

I do have some figures to back up my theory. First, Gallup put awareness of GLP-1s at 91% in 2026. That means virtually the entire country now has a friend, coworker, or relative on one. And KFF polling found that about one in eight adults (12%) are currently taking a GLP-1 and that one in five have taken the drug before. That amounts to a range of 33 million to 49 million people. That’s a lot of people who are on a drug with this anti-craving side-effect. The use of GLP-1s basically doubled in 18 months.

Over that same stretch, NSDUH shows daily-or-near-daily alcohol use sliding from 8.0% in 2021 to 5.9% in 2025, with the steepest drop concentrated in the most recent years — right when GLP-1 uptake exploded.

We’ve got a huge number of people taking it. We have the widely known anti-craving side-effect. And the timeline. It all lines up.

I know, I know. GLP-1s cannot explain the whole decline. But I think it’s a factor. If step back, I know there are way more causes in play. Alcohol use has been declining since well before the GLP-1 bonanza. Gen-Z is like very sober for some reason. The COVID-era drinking spike is trending way down. You’ve got this whole wellness Instagram yoga-set that prefers green juice.

But I’m just saying, if the GLP-1 number keeps growing it wouldn’t take much for the “appetite-suppression-but-for-everything” effect to scale and start making a real dent in consumption patterns.

I will stop here for now. There is a whole other section on treatment access and the number of people actually getting help for addiction, which is always brutal and abysmal and depressing to cover. I didn’t want to do that on a Friday.

There is also an alarming section of the report about suicide. It seems as though older and middle-aged adults are trending worse on suicidal thoughts and behaviors, which is a data point that gets overshadowed by a lot of focus on the “youth mental health crisis.” I may have to do a more sober and depressing part 2 to this year’s survey.

Anyway, if you’ve made it all the way here, thank you for reading and supporting the newsletter. Hope out of all the slop and crap that gets emailed to you, that this is actually something you want to read. (If it’s not hitting the spot for you, then, please, give me some feedback!)

Be safe out there,

Zach

“I can’t follow my schedule and keep up — I think I have ADHD.”

“I have anxiety.”

“I’m depressed.”

“I’m traumatized.”

“I dissociate when….”

“I’m manic.”

“I’m addicted to… my phone, Instagram, strawberry matcha…”

If you are not saying this stuff yourself then your friends probably are — at least if you’re between ages 25-40 and live among Very Online people. And in the year 2026, who isn’t Very Online. I’d wager that complete strangers are lobbing their go-to DSM diagnoses at you in line at the grocery store when they space out—er, dissociate—for a moment.

I used to brush this off as just the way people talk today. And in many cases it’s fine. We understand hyperbole within context. We know the movie or the bad Zoom conference didn’t actually traumatize you. It’s therapy-speak and there’s a million TikToks posted each week about it.

I’ve noticed people are relying on clinical jargon more when life is actually hard. People aren’t using therapy-speak in the tounge-in-cheek, hyperoblic way. I probably notice this because, well, I’m a writer and pay close attention to words. Plus, my wife is a clinical psychologist. A lot of her friends and the people we hang out with are therapists. All of us are in therapy or couples therapy — probably both! So my antennae are obviousy extra attuned.

To be sure, this jargon isn’t coming from professional clinicians. At least, not from the good ones. Because I hear real therapists complain about the ways in which their clients show up to sessions using these big words, like dissociation, attachment, narcissist, trauma. Words that lift up, and I argue, obscure, entire worlds of meaning. What happens when we reach for therapy-speak too much is that we lose the ability to speak plainly about our inner world. And we actually miss the important, and harder to swallow, truth about what’s going on with us. When we rely on a diagnosis to explain a problem, we distance ourselves from what’s troubling us.

Arguably the most popular self-help group in America, Alcoholics Anonymous, implores attendees to self-diagnose and announce their condition before they speak. I saw the diagnosis-as-identity happening all the time in meetings. I think it actually makes sense to talk this way in a private self-help group. Plus, it’s a mouthful to say “My name’s so and so and I’m a person in recovery” or whatever, every time you want to pipe up. What’s happened, though, is that this self-diagnosing language, and wearing diagnosis as an identity, has escaped containment. It’s happening way, way outside the rooms of Alcoholics Anonymous.

I’ve been thinking about why this has spread and I think there’s something irresistible about finding the right words to externalize our murky interior world. Why else would so many of Freud’s quips and theories, after a century of floating out there, remain so sticky? Defense mechanisms, projection, reaction formation, repetition compulsion, repression, slips — these things are popular because we see it happen and it rings true.

Take a Freudian slip for the ages: Erika Kirk was giving a speech about how, in the afermath of her husbands assassination, there is a new generation of young conservatives ready to carry his torch.

Kirk said, “Despite the devastating loss of Charlie Kirk, my incredible husband... Caleb has persisted with the same grift.”

She meant to say “gift” or “grit,” who knows, but she caught herself saying “grift,” the thing Charlie’s critics so often accused him of. And realizing what she just did, she laughed it off: “It has been a long day!” This actually endeared me to her. Because we all have these moments where we accidentally betray or expose ourselves. I believe this happens because in moments when we’re feeling tired and overwhelmed, something real can slip through the censor managed by our carefully constructed defenses.

Noticing slips can fun and interesting and revealing. But that’s very different from trying on clinical identities like a new pair of jeans. I think when we do this we paper over what’s really going on.

Take a busy mom who says she can’t keep up with life because of her ADHD. It’s a lot easier to say that then: My husband is a workaholic. He neglects me. He’s never home. And I’m stuck doing all the work. Saying “I’m ADHD” is an easy out and it tees up a tangible solution that Americans love to reach for: a chemical. It’s a lot easier to ask a doctor for a stimulant than it is to confront your husband.

So a good therapist will try to dig beneath blaming the ADHD. What do you mean by ADHD? Tell me what that looks like? They won’t let the buzzwords fly around. Define attachment. Describe what you mean by dissociate.

An even better therapist will stop you at the level of grammar and syntax. Are you using a passive construction: everyday is just so stressful rather than saying: Ugh, I’ve got a lot going on and I’m super stressed. Are you using a diagnosis in a possessive register instead of a descriptive one? Saying, “I’m about to give a big talk at work and I feel anxious” is very different from saying, “I have anxiety.” There’s are subtle differences that can be hard to catch in the moment.

My therapist will constantly point out to me that I’m slipping into different perspectives. He’ll say: “You’re doing it again. You’re narrating your life as though it’s not you living it. You’re speaking as though you’re writing in the third-person.” He’ll ask: Where are you?

I used to get very annoyed at this. I’d deflect and say dude I’m a writer I can’t help it. I narrate. That’s what I do. But he was right. When talking about difficult stuff I’d use grammar and syntax to evade the feeling. I’d carefully distance myself from my own experience to spare me the pain.

I think this is what we are all doing when we throw around these big words. We can use language to conceal what’s really going on, not just to others but to ourselves. We can use language to blunt feelings from cutting too deep. Ultimately, language is all we have to try and know ourselves, and to make ourselves knowable to the world. You can use your words to create distance, or you can use your words to try and move closer to what’s true.

Hundreds of deaths. Billions of dollars. The kidnapping of a nation's head of state. If you take the President's word for it, the rationale for all this comes down to some combination of: cocaine, oil, or simply, because I can.

If the “for what” is slippery and evershifting, we can still at least, in some material ways, answer: What has this accomplished?

On this front, the President has lied again and again. At least 15 times, Trump has said the strikes on suspected "drug boats" reduced drug trafficking into the country by 97 or 98 percent. On Truth Social, Trump truthed: "98.2% of Drugs coming into the U.S. by Ocean or Sea have STOPPED!"

Shockingly, this is not true.

The Washington Post got its hands on a report by the DEA analyzing the impact of the operation. Analysts can look at traffic in the Caribbean, wholesale and street prices of cocaine, and potency and price-adjusted purity levels. Lo and behold, the President's own agency found that the airstrikes failed to have a measurable effect on almost every available metric.

Blowing up boats allegedly filled with cocaine is, quite literally, a drop in the ocean.

The DEA analysts found that the airstrikes:

“…Failed to affect the supply or price of cocaine in the United States and had led traffickers to diversify beyond go-fast boats and to avoid international waters, opting instead for larger boats and hemming close to coastlines, where U.S. forces are less likely to open fire. In a closed-door briefing last month, Pentagon officials told lawmakers the strikes in international waters off South and Central America had not reduced its purity.”

Let's go through these metrics one by one, starting with purity.

Purity

A drug’s purity level is a strong market signal. In a prohibition market, which by its very nature attempts to evade detection, purity functions as an indirect economic and logistical indicator. It can tell us about supply versus demand pressure, whether enforcement is having an effect, and the overall consistency of the market.

Low purity tends to mean suppliers are trying to stretch a tight inventory. When purity rises, it signals that supply is abundant and there’s no need to dilute the product. High purity can also mean dealers are competing on quality to win over customers, a sign of a competitive market.

Cocaine purity in the U.S. is historically high right now, averaging upward of 80 percent in regional and domestic seizures. The Washington Post reports that Pentagon officials told members of the Senate Armed Services Committee that confiscated cocaine still showed high purity despite the airstrikes.

Price

Price is a more complicated measure of the market. Price alone, especially at the street level, doesn’t provide a strong signal, since one bag sold for the same dollar amount could contain wildly different purity and potency levels. Price becomes a more useful signal once it’s adjusted for purity, and there can be a strong relationship between the two.

When the airstrikes first started, cocaine prices briefly rose. That makes sense; the market was feeling new pressure. But prices quickly stabilized and have since reverted to pre-airstrike levels. Falling prices signal that a market is becoming more efficient, whether through better production techniques, more competition among suppliers, more efficient trafficking routes, or greater scale in distribution.

According to the DEA report, “Smugglers have adapted to the intensified pressure. Price and availability have not been noticeably affected.”

Now let’s look at availability and prevalence.

Availability / Use Prevalence

This one’s a doozy, especially for Trump officials trying to argue their policy is working: TL;DR, there’s a mountain of cocaine out there and millions upon millions of people using it.

Global cocaine production — mostly in Peru, Bolivia, and Colombia — has reached an all-time high, according to the UN Office on Drugs and Crime’s 2026 World Drug Report. From 2014 to 2024, global cocaine production grew more than fourfold, to 4,100 tons. That’s a truly vast supply. I tried to find objects that weigh roughly 4,100 tons to give you a visual reference, and the closest match I found was a crane weighing between 3.8 and 4.1 million kilos — about 8.5 to 9.1 million pounds, or roughly 4,100 tons.

This is the supply feeding the U.S. market, which remains the largest cocaine market in the world. Across North America, more than 6.5 million people — about 2 percent of the population aged 15–64 — used cocaine in 2024, the most recent year with available data. Demand for cocaine remains high, and that probably isn't going to change anytime soon.

Traffickers Adapt to New Reality

Purity, price, availability, and prevalence: on all fronts, the cocaine business is still very much booming. This is exactly what we’d expect, because blowing up small boats in the ocean is emphatically not going to meaningfully impact the global supply of cocaine.

Think about it for two seconds. Cocaine is a massive logistics business run by clever, savvy organizations whose job is to move product from A to B. If one route for moving product is no longer viable, they’ll find a different one — which is exactly what they did, according to the DEA.

This isn’t rocket science. Here’s what some traffickers in Colombia started doing to evade strikes:

“In one example, traffickers on Colombia’s La Guajira peninsula pay officials to disclose the locations of U.S. ships, then launch their vessels ‘once U.S. military assets have departed the area.’”

This is the same thing that always happens when pressure is exerted on drug markets: the organizations change their tactics, adapt to the new reality, and plow ahead.

Some organizations have simply abandoned fast boats in favor of submersibles, which are harder to detect. Others are hiding product in commercial shipping vessels, historically how very large shipments enter the U.S. Others still have switched to air routes.

The map below shows the traditional trafficking routes along with some new ones that emerged in reaction to the strikes.

There has always been a “drug war.” It’s hard to metabolize just how drastically things have escalated. I can’t get over the fact that hundreds of people have died over this. It’s for nothing. This muscle-flexing, global killing machine is not going to reduce the drug supply. It’s not going to help anybody struggling on the street. It’s not going to do anything but create a lot of anger and resentment toward America. I can’t help but imagine, years from now, what kind of blowback this creates.

More than 200 people are dead, for literally nothing. Some measure of accountability and justice is due for those conducting these extrajudicial killings in international waters. Alas, as taxpayers, this is happening in our name whether we like it or not.

First, be sure to read my first piece out in Playboy.com, on the ways people are using harm reduction, enabled by technology and science, to survive the chaos of the synthetic supply.

If you are really cool you’ll seek out the Summer print issue of the magazine, which contains an entire package on drugs. There is a super interesting piece on the underground popularity of a synthetic stimulant, described as a mix between cocaine and MDMA, by Michelle Lhooq. And there’s a story for the stoners, asking what it means that cannabis use, among certain demographics, has overataken alcohol.

The drug package isn’t contained to these pieces. On the cover is Cara Delevingne, an English model, musician, and actor who got sober in 2022. On podcasts and news shows, Delevingne has described a harrowing scene, where her girlfriend found her overdosing and her life was saved after medics revived her with naloxone. A chaotic life and a near fatal overdose spurred Delevingne’s recovery. If someone ever says sober isn’t sexy, bop them on the head with this beautiful magazine.

Despite what you may have heard: magazine writing isn’t dead. In our world of voluminous digital slop, I believe the style of magazine writing is needed — and wanted — more than ever. The art of the magazine is still alive and kicking. Playboy is taking risks and going for it. I highly recommend supporting them.

Plus: I think it’s really cool that a legacy brand like Playboy is jumping into the deep end of addiction and recovery, while bringing in a harm reduction perpesctive.

Because I'm a masochistic weirdo, I did read through some of the 250+ comments on Playboy's Instagram post of my story. Some were critical of the very idea of the drug package. Like, why is Playboy — of all places — covering this stuff? Do people need to be reminded that sex, drugs, and rock and roll has been Playboy's beat for half a century?

I was also happy to see that the magazine’s editor-in-chief, Phillip Picardi, responded to some of these meanies by raising the magazine’s history on this subject: “Playboy has been covering harm reductive approaches to drugs and alcohol since the 1970s.”

Hello! Hunter Thompson was a frequent Playboy contributor.

Anyways — I’m very happy to see the magazine is not shying away from its history. And not to toot my own horn, but I got to interview Nabarun Dasgupta, Morgan Godvin, and Stephen Murray for a print issue of Playboy magazine.

I can’t emphasize enough that this is not the norm for media. In most newspapers and magazines, you do not hear from people like this. And they don’t hire me to write on this subject. But it is what I love doing.

We are all encased in our own echo chambers. The algorithm traps us in a digital Skinner Box, dispensing little food pellets — the articles, food, music, and the infinite stream it wants us to scroll. What I get to do writing for print is break out of the digital prison, and expose new ideas to new people who would never discover that there’s scientists out there investigating a mass drug contamination that’s killing people.

I’m happy to say the Overton window is wide open. The needle is moving. And despite massive reactionary energy bent on containing harm reduction, I think it’s fair to say, judging by the 9 million people following Playboy on instagram, that harm reduction has and will continue to break containment.

I hope that you read and enjoy the hard work that goes into writing about this subject for an audience who may not know anything about it.

I’ll end with my favorite comment I saw on the Playboy instagram under my story:

Speaking of harm reduction breaking containment. This article in Politico by Amanda Friedman caught my eye.

Politico, 7/18: Red states reject Trump’s shift on overdose prevention

Trump’s public health policy vis-a-vis drugs is led by the very strange HHS Sec. RFK Jr. who has been taking a chainsaw to federal funding for harm-reduction (like syringe programs and drug checking). The rhetoric he uses is standard issue anti-harm reduction: Rather than help people get into recovery, these practices “facilitate” and “enable” dangerous drug use and create dangerous hubs of open air drug use. It’s not that different from the backlash, or frontlash?, to the conditions in San Francisco’s infamous Tenderloin neighborhood.

What’s suprising, though, is the way Republican states are moving in the opposite direction and funding these programs themselves because they know they are crucial.

• Florida: Gov. Ron DeSantis signed a law legalizing xylazine test strips.

• Kentucky: The Republican AG directed $34 million from opioid settlement funds to over 100 addiction organizations, including harm-reduction groups.

• Indiana: GOP lawmakers renewed funding for a syringe program through 2031.

• Ohio: Gov. Mike DeWine issued an EO expanding access to fentanyl/xylazine test strips.

• West Virginia: The GOP-led House rejected a proposal to eliminate the state’s syringe program for the second year running.

The GOP is genuinely split on this issue. And the fact that some harm reduction strategies are winning despite the rhetoric against them shows that, at the end of the day, there is a pragmatism to the politics of harm reduction that can (and does) win the day.

Nature Medicine, 7/21: A new additive in the opioid supply is causing disastrous complications

This piece has quite a bit of overlap with my Playboy piece. It's a commentary by Dr. Cara Borelli, an addiction medicine and emergency medicine physician at Yale School of Medicine. Dr. Borelli describes the rapid emergence of medetomidine in her practice in New Haven.

Medetomidine is a veterinary sedative that's similar but different from xylazine, and it's one of the newer adulterants in the U.S.'s fent supply. While xylazine caused those awful skin wounds, medetomidine doesn't, which could be why suppliers decided to start using it.

Dex/medetomidine amplifies and, crucially, extends the sedation caused by fent, which is notoriously short-lasting. And it does so without the skin wounds. But nothing is ever that easy.

This new additive is causing an absolute nightmare of a withdrawal syndrome. Dr. Borelli says some withdrawals are so bad that people are being put on life support to survive it. Dr. Borelli is sounding the alarm:

“To give an idea of how dangerous this is, in New York City, 18 deaths had medetomidine listed as a contributing cause in 2024, and this escalated to a preliminary count of 124 deaths in 2025.”

And these are not necessarily deaths from overdoses, but from withdrawal.

A good rule of thumb is that whatever effect a drug causes, the withdrawal will cause its exact opposite. The warm numbness caused by opioids will turn into a painful cold sweat where every drop of sweat on your body feels like a needle stabbing you. Medetomidine is no different. It causes drowsiness, decreased heart rate, and low blood pressure. The withdrawal will send your heart rate into the stratosphere, along with your blood pressure, and induce shaking, sweating, and agitation. This can be so severe that it causes heart failure.

Now, throw an opioid withdrawal on top of all this and it sounds like one of the worst things a human being can experience on planet Earth. People vomit so profusely that they can’t tolerate oral medications, so they need IV drips. It’s just a disaster.

Most of Dr. Borelli's patients have heard of xylazine (or tranq), but she says many of them are surprised to hear about medetomidine. Many have no idea they're using it. Hence why the story I wrote for Playboy is relevant. I focus heavily on Nabarun Dasgupta's Opioid Data Lab, which is using high-tech machines to analyze truckloads of drug samples from across the country. Last I checked, Dr. Nab's lab has found 1,368 unique samples with (dex)medetomidine in 21 states.

That shows this is not a one-off fluke additive. It's popping up in batches all over, which means suppliers high in the supply chain are deciding to use it. You can see in 2026 how dex/med starts to overtake xylazine.

The prevalence illustrates the thesis of my Playboy piece, which is: "Enterprising chemists are stitching together a Frankenstein's monster of new synthetic compounds, and no one can keep up—not lawmakers, not regulators, and not the users most at risk."

Dr. Borelli argues we need new policies to keep up:

“From a policy perspective, we need to fund drug checking for people to test their supply so that they can avoid samples with this additive. On April 24th, 2026, the Substance Abuse and Mental Health Services Administration (SAMHSA) sent out a letter that prohibits funds from going towards testing strips for drugs, specifically citing medetomidine as one of the prohibited items for funding. We also need to get the word out with ongoing public education on all fronts, including healthcare workers, public health officials, and patients. With these steps, we can tackle this and other new additives and contaminants in the opioid supply.”

I’m glad doctors like Cara Borelli are taking this seriously.

The authors of a commentary article in the Substance Use & Addiction Journal argue that the US ought to pilot “safer supply” programs to prevent overdoses much further upstream than the current slate of harm reduction interventions.

Let’s start by answering the basic question: wtf is a “safe supply” and can potent drugs ever be safe — or safer?

A safer supply means access to regulated, pharmaceutical-grade psychoactive substances to reduce (and hopefully eliminate) people’s reliance on the toxic, contaminated, and unpredictable illicit market. Part of the idea here is that while drugs (like opioids) do pose individual and public harms, the consequences of unregulated use are quite dire and those can be controlled for by bringing people (and their substances into regulated, controlled environments.

If you were to take a close look at overdose deaths over the past decade, the vast majority involve illegal drugs, procured on the street, consumed with little to no clinical guidance or understanding of the effects. A safer supply is about bringing people into a regulated environment with access to a level of quality control that the street can never promise.

It may sound like pie in the sky to give people with addiction issues high quality drugs, but these programs do exist (and have existed for a long time) around the world. The authors draw on international experience, from Switzerland to Canada and the United Kingdom. Each country has its own form of safer supply.

Switzerland

In 1994, Switzerland decided to dispense heroin to entrenched, long-term users in a clinical setting. The decision was born out of political pragmatism rather than a soft spot for drug users or some wild progressivism ideology.

Throughout the late 1980s and early 1990s, Zürich's Platzspitz Park—nicknamed "Needle Park"—had become one of Europe's largest open-air drug scenes. Across the street from this beautiful park was one of Zürich’s nicest hotels. And everyday, thousands of people gathered in the park to buy and inject heroin.

Overdoses, HIV, public injecting, and discarded syringes all surged and rose to impossible to ignore levels. The Swiss authorities repeatedly tried shutting the park down, only to watch the market pop-up again or relocate blocks away. Eventually, the Swiss concluded that they couldn't police their way out of this problem.

Do not be mistaken: Swiss politics are no bastion of left-wing progressivism. To be sure, the Swiss do hold strong civil libertarian beliefs (ahem, privacy for banks). But the Swiss adopted the dispensing model because their politics are pragmatic. They wanted to solve a problem. Despite whatever program of punishment and incapacitation they concocted, there was still drug use. It was visible on the street and led to public discomfort, with people seeing so much suffering out in the open (sound familiar?).

The Swiss adopted goals of public health and public order, which became tied to a new approach: Dispense pharmaceutical-grade heroin to the right population, in the right setting, with the proper controls and gaurdrails put in place.

The result was undeniable: Switzerland cut drug overdose deaths. HIV and hepatitis C declined. Public disorder and crime also went down as people no longer needed to engage in street life to procure their substances.

Today, Switzerland’s heroin-assisted treatment (HAT) program is surprisingly unremarkable. That is probably its greatest success.

Since being piloted in 1994, HAT has become a permanent part of the Swiss healthcare system. It was formally written into law in 2011. Around 1,600–1,700 people receive pharmaceutical heroin through roughly two dozen specialized outpatient clinics across the country, representing about 8% of people receiving opioid substitution treatment.

It’s considered a treatment of last resort for those who have tried other options and haven’t found stability. Once viewed as the world’s most radical policy intervention has become a routine, tightly regulated part of the country’s addiction treatment system.

Canada

Canadians went a different route than the Swiss. They began exploring safer supply by conducting clinical trials. The two big ones were dubbed NAOMI (North American Opiate Medication Initiative) and SALOME (Study to Assess Longer-term Opioid Medication Effectiveness).

NAOMI tested injectable diacetylmorphine (pharmaceutical heroin) against oral methadone for people with treatment-refractory opioid use disorder and found higher treatment retention, along with reduced illicit opioid use and illegal activity, among the diacetylmorphine group.

SALOME followed up by testing injectable hydromorphone as an alternative, finding it worked about as well. It offered a more accessible and legally available option since hydromorphone is already an approved medication in Canada.

Canada provides the most extensive real-world testing of safer supply models. Since these studies, Canada has expanded beyond injectable opioids into a variety of safer supply approaches, including community-based and primary care prescribing, fentanyl patch programs, oral administration of Kadian (morphine), and even vending machines that dispense people’s prescriptions.

Canada also stands out for using participant-defined metrics that go beyond standard clinical outcomes (such as illicit substance use, overdose, and abstinence from other drugs) and include quality-of-life measures like stability and well-being.

Showing similar trends to the US, overdose deaths in Canada declined by 23 percent in 2025, following a 17 percent drop in 2024, marking the second consecutive year of decline. I find this interesting because I kept hearing arguments that Canada’s aggressive harm reduction policies would undermine overdose prevention. Not only is the sky not falling in Canada, but the overdose trends are moving in the right direction.

United Kingdom

The UK’s experience is far more limited than Canada’s and Switzerland’s. The key trial in the UK was called RIOTT (Randomized Injecting Opioid Treatment Trial, which, like already by the name, we are not off to a good start), which tested supervised injectable heroin against oral methadone, specifically among people for whom standard treatments had already failed.

The trial found that injectable heroin reduced illicit heroin use and other substance use more effectively than methadone in this treatment-resistant population.

Despite positive trial results, the UK has not scaled up the provision of pharmaceutical-grade opioids. Outside of research settings and a few small pilot programs, implementation has remained limited and highly selective, available to only a very narrow subset of people rather than becoming a broader public health response.

The UK case demonstrates that supervised opioid provision is clinically feasible, but it also serves as a cautionary example that you can’t expect strong trial evidence to automatically translate into broader implementation. Cost and funding were hot-button issues, and they stemmed from broader political and ideological resistance to the very idea of supplying users with pharmaceutical-grade drugs. The UK’s heroin-prescribing pioneers faced massive public opposition, and many of the prescription heroin clinics closed in the early 1990s.

Much like the US experience, the UK’s national drug strategy is committed to an abstinence-based framework, though harm reduction is emphasized more in some areas than others. And like the US, the focus is often on the supply side: securing the border, going after criminal organizations, tackling supply chains, etc.

This political dynamic goes back decades, and there doesn’t appear to be much public buy-in for safer supply programs in the UK right now.

The question of safer supply is not really whether it works or doesn’t work. There are clinical trials and real-world case studies showing that, yes, when the right population is granted access to a regulated, quality-controlled supply of their actual drug of choice, they do OK. They tend to do stabilize and their risk of overdose is significantly diminished. It also becomes possible for people who were deemed helpless to see great improvement in many facets of their life: employment, family, and other quality of life measures improve over time.

I see the decisions surrounding safer supply in the US as being more about the legal, practical, and logistical side of the equation. Though, of course, like in the UK, there would also be a massive political hurdle to clear but that feels like a seperate piece from this look at whether it’s effective and technically feasible. Both are yes.

On the practical need for it.

Currently, the US has only two FDA-approved opioids for treating opioid addiction: methadone and buprenorphine. If you look at almost any other condition, from anxiety to depression, there are dozens of different medications, both within and across different drug classes, that people can try or switch between if their meds aren’t working.

It’s kind of crazy to me that only two opioid agonist medications for opioid addiction exist. And of these two agonists, both are imperfect for their own reasons. We all know that methadone is a super effective treatment, but for a lot of people the clinic system is way too invasive, bureaucratic, punitive, and generally hard to navigate. As for buprenorphine, it is simply a bad match for some of those who are intensly dependent on fentanyl, nitazenes, and other weird synthetics. For some it can take a whole week of hospitalization to survive the transition. People have suffered horrorifically painful withdrawals trying to make the switch to buprenorphine (see: percipitated withdrawal). As a result, many are afraid to try again or try at all and feel stuck.

Yes, there is a third drug, naltrexone, but it is an antagonist that, from my work on this topic, very few people are interested in taking or staying on for very long. Plus, it’s even harder to transition from fentanyl to naltrexone than it is to buprenorphine. So that really just leaves methadone as a realistic option for a lot of people who need help.

Piloting a safer supply model in order to start diversifying options people is well worth it. It makes sense that some, who fit select criteria, should be able to try these other opioids if the current narrow slate of FDA-approved options aren’t working for them.

As the authors lay out, there are, technically, some plausible pathways and structures for beginning safer supply pilot programs. In the near term, they suggest that healthcare-based pilots, built on existing prescribing infrastructure, with the right legal protections and guardrails—and, crucially, the right leadership and buy-in—could work. Basically, it would work, functionally, like a methadone clinic, but for safer supply.

Table 1 in the article outlines several potential models. Here is a screengrab of the first.

On practical implementation, one especially important point the authors make is about what kind of setting and structure would work best for the people who would actually use these programs.

They write:

“Safer supply will be most effective when access is simple, respectful, and stigma-free; dosing is individualized; and programs avoid punitive discontinuation in response to missed visits, urine drug test results, or ongoing substance use. When monitoring tools such as urine drug screening are used, they should support safety, documentation of medication use, or clinical care rather than function as automatic grounds for dose reduction or discontinuation. Programs should also build in flexible route options, multiple access pathways, privacy protections, and data minimization (collecting only the minimum personal information necessary for safe care, program operations, and evaluation). Participant-centered safety supports, including education, secure storage options, co-dispensed naloxone, and optional observed dosing when preferred, should be embedded into program design.”

Importantly, the authors add, “safer” does not necessarily mean “safe.” They argue that “the goal is to reduce preventable harm by shifting quality control and access away from the unregulated drug market into a regulated system.”

On that front, as I’ve said, safer supply programs do work. The question of whether there is enough political will to let them work is something else entirely. I think by starting out small, and quietly piloting a few for the right population, this could get off the ground in… hopefully my lifetime.

I won’t spoil the whole movie but “Maddie’

s Secret” is very funny and has a lot of heart. Written, directed, and starring the comedian/actor John Early, he has a particular eye for spotting ridiculous and vapid cultural trends plaguing millennial taste. The way food “content” exploded on Instagram and devolved into pornographic ASMR slop. The looks, the sounds, the liberal use of smash cuts. Smash burgers. Mozzarella cheese pulls. Chili crisp on everything. The way people use that Instagram voice, a kind of rapid-fire droning.

“Maddie’s Secret” skewers the internet food fads forced down our throats, and throws them back up in our face.

That’s not all it does. Part of the movie takes place, daringly, in a hospital’s in-patient eating disorder wing. It’s very risky to make fun eating disorders and treatment and mental illness. I think John Early is one of the few people who could pull it off, who can say something real about the experience while making us laugh.

Having spent my own time in these types of clinical settings for addiction, I think Early nails the irony of it, the gallows humor and unlikely camaraderie that forms. Plus, the Mean Girl style cliques and all of the high school tendencies that get reproduced but in a pathological, highly distorted way, because we are not in high school, in fact we are being treated, ostensibly, for an illness that could kill us. Humor is a way to cope with the sad, helpless, desperate place we find ourselves in. At least, that’s how I coped and confronted the awful and quite dire state of my life.

Parts of “Maddie’s Secret” gave me flashbacks to my time in an in-patient detox wing of a behavioral health hospital outside Chicago. And then, after that, being inpatient in a youth-adolescent facility in the Twin Cities. The one thing all these places have in common is interminable hours of group therapy. And within “the group” there are silly rites and rituals and traditions that form, which then get socially transmitted. It’s amazing, the way us humans adapt and behave in group settings.

In Maddie’s Secret, you can only talk in the group if you are holding the talking stick, a sort of cheerleader baton with pompom fringes that gets thrown around the room at people. Maddie, at first, speaks very briefly, holding the stick for a quick second and throwing it. I instinctively understood her approach in the group. She said she was doing great and fine and the doctor points out that just two days ago she almost died in a hospital.

I understood Maddie because I’ve seen it before. The first rule of group therapy is to not stand out in the group. Never attract excess attention. One way people try (and fail) to do this is by being psychotically positive. Positive to the point of coming off as obviously fraudulent. They say they love the experience, they love the staff, they’re inspired by their peers, and they’re truly growing. They get it.

Other people hide in the group. They blend in by doing the absolute bare minimum. Only speak when spoken to. Do not share anything more than is expected. Whatever you do, do not attract the spotlight.

I didn’t do either of these. In my early twenties I was a ridiculous person. And aggressively contrarian, pedantic, and annoying. I did not hide what I thought. I did not go along to get along. I was the opposite of psychotically positive. I was deeply pessimistic, fronted as a nihilist, and when I disagreed with an idea or concept I vocalized it loud and clear. I was, in other words, a little shit.

There was a whiteboard with our names and a grid that we’d have to fill out each morning as group began. Using a combination of numbers scales and words we’d give our vibe check that day. Like what our craving level is, how many days sober we had, and there was also a spot for sharing our mood/feeling that day. That is where I’d really shine.

My counselor Dan berated me because I had put down, as my mood, “laissez faire,” which was typically used in the 18-19th century to describe a free-market, non-interventionist style of economics. In my mind I was saying: Look I’m just gonna let stuff happen I won’t fight the process I’m just gonna try to let it happen. And I thought this was a good thing and it was my way of saying I’ll stop interfering with the program. Well, that is not the reaction I got. I was berated because this bit — using big words, being willfully obscurant, putting down elaborate and cheeky moods/feelings on the white board — it had been building and building and Dan was sick of my shit.

Counselor Dan barked, “laissez faire!? Laissez faire!? What the hell, Zach? That is not a mood, that is not a feeling. You’re smart ass antics are getting in the way of the group…..” and he went on to yell at me for making fun of everything and de-railing the process.

And then to make amends, because this is part of the program, one would have to make a big apology to “the group” and say publicly how we’re being selfish and willful and how this behavior is a huge let down, that we’ll never get better on the “outside” if this is how we behave on the “inside.” That’s how life gets split. Like we’re severed. Our ability to live outside is judged by how we live inside.

I somehow got my life together despite the way I acted inside. And looking back, humor was a defense. It was my way of coping. And frankly, the whole setting of in-patient treatment is eminently make funn-able. Using smiley faces or frownie faces and numbers to share our moods and feelings on a whiteboard? C’mon! It’s goofy stuff. Especially given the gravity and stakes of our situation.

I think that I started to get better because I did not try to hide, and I did not try to feign positivity, and actually expressed my deep pessimism at the outcome of treatment and shared my skepticism of “the program” and argued that it probably wasn’t going to be the thing that helped me.

Maddie’s Secret nails another the dynamic of treatment: the relationship between patients and the staff. There is a kind of prisoner/prison guard mentality that gets created even though the front door is open and anyone can leave at anytime. There is always a Very Overzealous staff member who isn’t a counselor or doctor or clinician, they’re a glorified babysitter, and it’s their job to make sure we generally stick with the program and show up on time. This person takes their job extremely seriously and exerts tremendous authority. It’s kind of like that gung-ho, peppy camp counselor.

We called them “techs” and they were usually young, fresh out of college, looking to gain experience while they decide if they should get their masters in counseling. It’s a hard job to herd a bunch of semi/fully crazy young people who are keen on breaking rules and pushing boundaries. If you have button, it’s going to get pressed. Of course lots of silly stuff shenanigans and pranks ensue among us. We feel like we are prisoners even though it’s a ridiculously nice facility and we’re being looked after and cared for and people want us to get better and we fight them the whole way. It’s absurd.

But I will say that I genuinely liked some of the Techs. And that a special bond between “the group” and the staff does form. And I believe it is in this relationship where good things actually can happen. I won’t forget: I was about to “graduate” from an inpatient stint. There’s multiple groups and events related to someone who is leaving. One of the Techs said that they actually appreciated how I pushed back against things, that I challenged stuff, and vocalized my disagreements. He said he saw a lot of people come through the program who did not speak their mind and faked their way through it. So despite being difficult and annoying in lots of ways, the Tech said he was glad that I acted how I did and I think back to that moment sometimes, and I feel that he was right. My process was going to be my process and it was always going to be sort of adversarial and annoying. I’m sort of stubborn in my own way. I like ideas. I like to think about things a lot. I was always going to be a bit contrarian and poke holes in ideas and pick fights and disagree over values and principles.

Maddie’s Secret has a sweetness to it. And it reminded me of my own time in treatment. So if you have any treatment experience or not, I highly recommend watching it.

Enter Orange County’s Rehab Riviera, a stretch of coastline so saturated with treatment centers (more than 300 licensed facilities) that, according to a new study in the journal Substance Use & Misuse, simply showing up to The OC for treatment nearly doubles your odds of overdosing.

The study analyzed overdose patterns in Orange County and produced an eyepopping figure and I had to write it up: Out-of-state visitors to Orange County were 159% more likely to overdose than in other parts of California.

The researchers arrived at this staaggering stat by analyzing three years of emergency department records across California, comparing OD rates across CA to The OC rates, and calculating odds ratios for three seperate groups: Local OC residents, visitors from other CA counties, and visitors from out-of-state. It’s the latter group that had the highest overdose rate, which the authors say is consistent with prior reports that out-of-state visitors are the primary group being exploited by a predatory addiction treatment industry.

It bears repeating that there are more than 300 licensed facilities operating in Orange County. You might think that the abundance of treatment would create some sort of buffer against overdose morbidity and mortality. In most places where treatment is highly accessible, that is usually the case. But Orange County bucks that trend because the “treatment” that people access is, for lack of a better term, horeshit.

The glossy brochures for these places look more like wellness retreats or lux day spas than a clinical setting that treats a deadly condition. Equine therapy. Surf therapy. Sunset yoga. Chef-prepared meals. Ocean-view suites with turndown service. Acupuncture, sound baths…. the amentities and services go on and on. In a perverse way, these sketchy operations actually compete with each other over the kinds of perks (sorry not those kind of “percs,” well actually some do offer drugs) that they offer.

Nothing against wellness style treatment per se but if you don’t have real therapists and real clinicians who can manage complex, co-morbid mental illness while managing multiple medication regimes — then, sorry, you’re not really treating addiction. You’re selling the fantasy of rehab as a vacation while massively billing insurance companies without worrying too much if anyone actually gets better. And no one knows if these places do help anybody because they do not (publicly) track outcomes and never will unless the state forces them to (which I think should happen).

In a sad way, this rehab scam story is old news. A similiar predatory treatment economy proliferated in South Florida, which became a hub of “patient brokering,” kickback schemes, and fraudulent billing. Fun fact: I sort of started my journalism career muckraking and exposing “The Florida Shuffle” in the mid-2010s. One of my early bylines while I was still in J-School was an investigation into a massive treatment scam in Florida, and the dude at the center of it went to prison. I was tipped off to it because a young woman overdosed and died in on one of the “sober houses” tied to the network of scam facilities. I say all this because those are the stakes. People get hurt and worse when they’re being exploited by this industry. And we wouldn’t tolerate it happening in any other field of medicine or health care but, you know, “addicts” have coming whatever comes is the sad apathy that keeps this stuff going on.

But that’s not the only reason this nonsense is still happening. Despite efforts to integrate addiction treatment into mainstream health care, there remains a subsection of the industry that is a quasi-clinical unregulated zone that operates way outside the bounds of any kind of standardized medicine that we’re used to in America.

In what other field of “medicine” do you fly someone to your center from Ohio and, unbeknownst to them, sign them up for a platinum insurance plan, put them up in an ocean-view suite, and start hardcore billing the insurance company; meanwhile the “patient” twiddles their thumb in aimless group therapy sessions between shuttles to 12-step meetings and thrice daily urine screens? If the “patient” relapses, even better! The rehab shuffle starts over again and the billing continues.

It’s raw capitalism at its finest. Human misery as revenue.

The saddest part is the people caught in the shuffle. Addiction is uniquely exploitable. People are in desperate need of help. They are often isolated from family and friends. Someone offers them a plane ticket to start over. Florida! California! It’s amazing I promise.The vulnerability of addicted people is the fuel that keeps the business running.

Eventually the Florida Shuffle attracted such an insane amount of heat. The scams and fraud were so brazen. A statewide task force with real teeth aggressively went after shady treatment centers. New laws were passed and it became a lot harder to scam people.

The DOJ and California state authorities are cracking down. Dozens of operations have been shutdown. Tons of people have been indicted for racking up fraud in the hundreds of millions. The fact that the predatory business model presists speaks to the broader structure of private, for-profit treatment that remains siloed off from any semblance of mainstream health care.

I lost count of the desperate moms and dads, brothers and sisters, that have DM’d me over the years asking how they can help their loved one get help. I always say, whatever you do, do not Google “rehab near me,” because that’s basically the front-door that will lead you directly into the net of these fraudsters.

So what do you do? Usually I tell people to look for a physician, preferably a family doc or someone board certified in addiction, someone who is not attached to any particular treatment brand or business, and ask for an evalutation. Then, go from there.

God speed.

To be clear: This is just my take on someone’s spot. I’m not a doctor. And I think someone in this situation should talk to a doctor knows their stuff, which, in this field, as you well know, isn’t easy to find.

I know this person is not alone and there are others trying to figure out how to reduce or stop using kratom. Before diving in I want to post some resources on kratom.

There are online meetings and support: Kratom Quitters

Reddit: Quitting Kratom

The chemistry of kratom: https://pubs.acs.org/doi/10.1021/acs.jnatprod.0c00257

Kratom Kicker: I have been on/off kratom for the past 3 years. Before that, I was on/off oxy, H, fent — I’ve done every opioid, ever. And I basically stopped using more hardcore opioids thanks to kratom. It worked as a replacement/manitenance substitute for a while… until now I feel like I’m just kinda stuck and I want to try to stop. After switching back/forth from 7-OH (pills) to powder kratom I feel like I’m just on this merry go round and I want to get off.

I feel like I’m at a placewhere I am functionally and physically dependent on this stuff. I have tried some tapers but I feel withdrawal. Anxiety, sweats, bad sleep. It all just makes me feel like I want to crawl out of my skin. So I dose with kratom and feel relief. Maybe I’m doing too fast of a taper? Or I’m not measuring it out right. I just want to stop using this crap for good but don’t think I can do it on my own. Whenver I google kratom addiction and stopping I get ads for treatment and telehealth places like QuickMD and they all offer Suboxone.

I am thinking about going that route, not necessarily an online doc, but trying out bupe to finally kick kratom. But I’m not sure. What do you think?

Dear Kratom Kicker,

I will say up front that I am biased toward using medications like buprenorphine. If you read and subscribe to me you probably already know that. And going that route for kratom, to me, isn’t that complicated in an empirical or clinical sense. I know that using bupe for kratom isn’t, technically, “standard.” All this is sort of new.

There’s some research and case studies/series out there showing people can safely and effectively transition to bupe (off kratom) without major complications. There is a clinical trial happening now that is examining the use of bupe to treat kratom withdrawal. I think we’ll see that yes, bupe can and does help treat kratom withdrawal and dependence.

I think the complexity of switching to bupe lies much more in the realm of our social and cultural ideas about dependence than it does in the physiology. And that means it is pretty complicated to sort through.

I can already see eyes rolling: This guy got on kratom to get off prescription and street opioids! Kratom is an herbal supplement with “opioid-like” effects, so why go back to using some semi-synthetic and arguably much stronger opioid? First, let’s just call a spade a spade: kratom is not a normal opioid but it basically acts like one. Its active compound binds to mu-opioid receptors, which produces a mild stimulant boost and opioid-like relief, relaxation, and sedation. Crucially, when you stop, it produces withdrawal. So we don’t have to quibble about the opioid-like nature of kratom.

BUT isn’t starting bupe just going back to thing that brought you to seek out kratom in the first place? Isn’t this just trading deck chairs on the Titantic (if the Titantic was a life-long struggle with opioid use). Why use a replacement opioid like bupe for kratom, which was already a replacement opioid for other opioids! This argument goes on and on like that. Look, I get it. It can sound Kafkaesque to replace an opioid with an opioid to replace that opioid — where does it end?!

Fair. Totally fair. That’s why this is more about our ideas around dependence. Going the route of bupe is a deeply personal choice. It’s not one I cannot make for you.

But if I may, I will try to put myself in your shoes…

My question for myself would be: What am I hoping to achieve? What are the desires and values driving my goal?

If you have a long history of opioid use (which you say you do) and you’re trying to stop an annoying, frustrating, time intensive, problematic, chaotic type of drug use, and you’re okay with transitioning to something more steady, stable, predictable, and in a lot of ways, easier to deal with day-to-day, then buprenorphine does make sense.

You just have to know that this means you’ll be dependent on an opioid, maybe indefinitely. And that just doesn’t work for everyone.

Yes there’s hang-ups — especially in America — around dependence. We’re supposed to be free! Independent! Don’t you watch Dutton Ranch, or whatever the Taylor Sheridan shows are. The heroes in these stories have no masters. They bow to no one. They are self-sufficient and don’t need help. They don’t need to take a pill everyday to be a bad ass.

I hear this debate play out a lot in the context of GLP-1s, like Ozempic: What happens when you stop? Won’t you just gain all the weight back and return to exactly the place you were before the drug? So what good is it?

Well, it depends. Maybe your new behaviors and habits will really stick. Maybe while on the drug you’ve done a lot of work to ensure that your new behavior can outlast the drug. But maybe not and the gains will reverse when you stop taking it. But sorry, that’s how medicine works! If statins lower your cholesterol and then your cholesterol rises after you stop taking statins, well maybe you need to keep taking statins to live.

If you are living a full and healthy life what does it matter if you take statins or ozempic or bupe? We’re talking about treating serious chronic conditions.

So let’s go back to the goals and why we have them. I can say for myself that I think a lot about time. How I spend my time. What occupies my time. How am I being-in-time? Time is a finite resource and the older I get the more I think about what I want to do with it. If i could just write blogs and play with my son and go on dates with my wife every single day I would be very happy! But I have to do other crap that takes up a lot of time! We alll do.

So think about your time. Think about your routine. How much time is being eaten up drinking god awful kratom dirt? How much time goes to measuring doses, timing doses, thinking about when, where, and how to dose? How much time (and money, another thing that’s really important) goes into buying this stuff?

We have one life. And do you want to be spending all this time, exerting all this energy toward…. drinking kratom dirt?

Enter bupe. I think what it gives you back is your time. You dose once a day and you’re fine. Maybe you get the bupe shot and you dose once a month! Regardless, you don’t have to spend all this time thinking about your opioid dependence and how to feed it. It may sound counter-intuitive but being dependent on bupe means you are more free and more independent.

If you are hung up around dependence, and you jump to worrying, well, when I get off bupe how do I do it? And you don’t want to deal with any opioid in your life at all. I get it. If you’re contemplating how to stop kratom, and trying to figure it out on your own to no avail, then it’s probably time to seek out some professional help. Maybe if you work with a clinician who knows how to do harm reduction, who knows tapering and knows opioids really well, maybe you can do a slow kratom taper with help and treat your withdrawal symptoms with non-opioid medications (“comfort meds”). You may not need expensive rehab and inpatient and all that. It could be as simple simple doctor visits and working in some accountability mechanism.

But if you’re dependence is that severe and tapering on your own hasn’t worked, switching to something like bupe that is much easier to deal with could be the right move.

Good luck Kratom Kicker.

Whether your opioid dependent or not, I hope you find some stability and peace in your life.

I’ve seen quite a few lists this year — for some reason — about movies. That is, the most American movies about the best darn country in the whole world. What movie is quintiessentially American? About America? The usual suspects are on them, such as, There Will Be Blood, All The President’s Men, Casablanca, Nashville, Citizen Cane, etc. etc. All great movies. Very American, indeed. But I’m going to throw out my own personal movie recco for this 250th birthday: Paul Schrader’s The Card Counter.

The first thing I will say about this movie is that it is bleak as fuck. It’s about war. Or, rather, how people live in the aftershock of it. I will offer a detailed plot summary sans spoilers, and then a bit about why I think it’s very good, very American movie that’s worth a watch on 4th of July.

The Plot

William Tell (played by Oscar Isaac) is an ex-military interrogator who served time in Leavenworth — the infamous military prison — for his role in the Abu Ghraib prisoner abuse and torture scandal. Since his release, William has remade himself into a loner and low-stakes gambler, drifting between casinos in the middle of America. He plays Blackjack. And with his time in prison he learned to count cards. He bets just enough to win without drawing attention to himself. He drives a non-descript sedan and lives out of cheap motels off the freeway.

One of the casinos happens to be hosting some sort of private defense/security contractor convention, which is where William meets a young man named Cirk (Tye Sheridan). And that’s right, Kirk with a “C.” Cirk’s father was also a party to the Abu Ghraib torture scandal and he didn’t make it out — let’s say — as in tact as William, which is already a low bar.

William lives in his own self-contructed prison, and he punishes himself severely for his crime even after doing his time. Like the weight of debt that gamblers feel, William feels the weight of a moral debt that he cannot figure out how to release himself from. So he lives a highly regimented, intensely structured, boring and very lonely life. I have spent my own fare share around poker tables at casinos and an old guy, he was a regular, said to me that spending his days sitting around a poker table amounted to “a lot of wasted life.” More on this in a minute.

The plot moves as Cirk and William strike up a relationship, and William gets staked by a woman named La Linda (Tiffany Haddish) to play in poker tournaments. She believes in his ability and will pay his entry fee for the tournament, and she gets a cut of his winnings. These tournaments basically work like a USA road trip, only you drive to truly desperate no-frills casinos all over America.

Cirk (with a “C”) shares with William that he wants revenge on one of the higher-ups at Abu Ghraib who walked away from the whole scandal scot-free. His name is Major Cirillo (Willem Dafoe). He’s a former officer who trained and then abandoned the men who did the dirty work of torturing prisoners. Now, he works comfortably as a private security contractor selling some face-tracking technology that claims the ability to interpret emotions through micro-expressions and yada yada. Basically, selling interrogation junk technology.

William Tell, recognizing Cirk’s rage and bloodlust, befriends him. He tries to steer the young lad away from violence and revenge. So he takes the young man under his wing, on the open road. He hopes that he can send Cirk down a different path: go to college, get a job, move on from the ugly past.

But the weight of that past haunts both of them. Cirk hatches a plan to get his revenge. What does William do? Should he let Circk go for it? Should he intervene somehow? Can he save the kid from his revenge? Can William find a way to shed the moral debt weighing him down?

WATCH THE MOVIE!

A Very American Movie

Why? The psychological toll of our — as politicians call them now — “forever wars,” which have lasted my entire life, no matter which party or politician is in charge, combined with the scene, setting, and atmosphere of, The American Casino, makes The Card Counter a truly American movie capturing something pure and real and true about our contemporary American life.

War. Gambling. Elite impunity. People drifting. People free, but stuck in their own psychological prisons. The casino is a sort of prison.

These are not Las Vegas casinos. They have no cute themes. They’re not lavish or lux in anyway, whatsoever. These casinos are basically an Amazon warehouse for gambling addicts. They are wide and long, vast arrays of slot machines, arranged in a grid, with a few bars and TVs scattered on the edges. These are dark, dingy, local casinos in the heartland. The casinos where people sit in the zone all day on slot machines. Read Natasha Dow Schull for more on The Zone.

At its core, The Card Counter is a movie about the American war economy and the American gambling economy, the politics within these economies, and their toll on us.

I hope you enjoy it. Happy Birthday.

At the same time the agency was running that campaign, DEA agents were sitting back and watching as millions of fentanyl pills changed hands without making a single seizure, according to an investigation by Jim Mustian and Joshua Goodman at the Associated Press.

The justification offered by agency officials rests on “bigger fish” logic, the kind of thing you see dramatized in drug movies and TV shows all the time. Allowing drug deals to go down — aka letting the drugs “walk” — enabled investigators to trace supply chains, build larger cases, and ultimately take down major trafficking organizations. Or so they say.

A consequence of letting drugs walk to build big cases meant being okay with a high potential for “collateral damage" in the form of overdose deaths.

The passive approach could make sense for cocaine, heroin, or MDMA, the drugs the DEA has long dealt with. But the DEA argued publicly that fentanyl was an entirely different animal. Zero tolerance was the policy. People caught selling fentanyl would recieve ennhanced punishments because the drug is so deadly. DEA officers, who took that message seriously, had serious disagreements with agency policy that let massive shipments of fentanyl hit the streets.

Internal DEA records and interviews with current and former agents, including whistleblower David Howell, a 19-year agency veteran, revealed a profound institutional contradiction between its public messaging and private decision making.

“We poisoned our community to make cases,” Howell told the AP.

AP Reporter Jim Mustian: Our reporting highlighted the example of a 2023 fentanyl shipment that DEA agents monitored — but did not seize — at an Albuquerque mobile home park. Agents gathered such detailed intelligence that they wrote in their investigative report that 74,000 pills had been delivered. Howell told me that decision, which came as fatal overdoses hit their peak around the country, was akin to “providing one fentanyl pill to each person at a football stadium.”

The DEA is notoriously closed off to journalists. They operate behind a veil of secrecy. I can count on one hand the number of times they’ve responded to my requests for comment. This is, in part, what makes the AP’s investigation so important. It’s a rare glimpse into the disconnect between the DEA’s public message and its private dealings.

We, the public, are told to trust what the DEA does without actually knowing what they’re doing. In this case, the DEA exhibited a willingness to treat ordinary Americans as acceptable collateral in their pursuit of splashy, headline-making busts.

I love to hear behind the scenes stories of how journalists conduct investigations when the information they are after is shrouded in secrecy, redactions, and buried in the bowels of our government. Here Jim Mustian explains how he and his colleague found their whistleblower, thanks to sloppy redacting:

Goodman, my AP colleague, first spotted the whistleblower complaint accusing the DEA of allowing fentanyl to hit the streets of New Mexico. The report was sent to the White House in September but escaped media attention at the time.

As government records often go, it was heavily redacted to shield not only the whistleblower’s identity but the amount of fentanyl that was not seized.

There was a critical oversight in the government’s redactions. I noticed that the whistleblower’s name ended in an “l” — a single letter that, for some reason, was missed by the black marker.

I sent a flurry of messages on LinkedIn to DEA agents whose named ended in “l” and had worked in Albuquerque. One afternoon in March, I was at my desk when I received a response from an agent who connected me to the whistleblower, David Howell. A couple weeks later I flew to New Mexico and met with Howell.

Finding the whistleblower, and then getting more primary internal documents, revealed startling facts: Between 2023 and 2025, DEA agents in Albuquerque, New Mexico, repeatedly monitored fentanyl shipments and chose not to stop them. In one instance, agents deciphered coded cellphone calls and closely monitored a transaction at a local mobile home park, documenting in their own reports that 74,000 pills changed hands — and officers did nothing to stop the deal from going down.

A former DEA supervisor told the AP that agents allowed “millions” of pills to go unseized over the course of a multistate investigation. Howell’s whistleblower disclosures put the number for that case at at least 1.8 million pills. He described allowing the 74,000-pill delivery to go down like handing a fentanyl pill to every person in a football stadium.

And here is the massive contradiction: You cannot simultaneously warn the public that a single pill is a potential death sentence and then make a cold calculation that millions of pills hitting the street is an acceptable cost of doing business. The DEA is saying that millions of lives are worth the cost of making a big case.

This creates a bind for the DEA: Either the messaging is true — in which case the conduct of letting this many pills walk is indefensible — or, the messaging is drug war theater, alarming the public while the agency pursues its own institutional priorities behind closed doors, threatening the public’s health in the process.

My personal take is that the “One Pill Can Kill” slogan is more of the same old fear-based PSAs that have become the subject of mockery and never age well. I believe the impact of these fear-campaigns on public health is negligble.

That’s because a campaign based in fear will only arouse fear in someone who thinks they are vulnerable to the severe outcome being messaged. And this fear message lands like a lead balloon on teens because teens tend to believe they are invincible and they act like they are untouchable. That’s the developmental stage teens are at. It’s not untill much later in life that young people are capable of assessing risk, controlling their impulses, and thinking about future consequences.

As an aside: My own addiction history has always been interesting to me because the worst of my addiction wrapped up right around the age of 24, which is about the time men’s brains fully develop, and it’s when I could personally understand “the future” as something other than a boring abstract concept that adults pester me with.

There is more that’s wrong with the One Pill Can Kill campaign: Say a young person takes a fentanyl pill and doesn’t die, then they may conclude that the government is lying to them, just like they lied about drugs turning your brain into scrambled eggs and so on. It’s a credibility problem.

To be sure, fentanyl is very messy situation. There are awful cases of young people taking one single counterfeit fentanyl pill and dying. There was, and remains, real urgency around broadcasting information about counterfeit pills. But there are also tragic cases of young people taking fake pills, not dying, but becoming addicted. Then there are others who do try pills, decide they don’t like it, and stay away. Saying “One Pill Can Kill” means nothing to a large portion of young people experimenting with drugs, especially those who took a pill, became addicted, and lived.

This is why the public health community has largely moved away from fear-based campaigns. Sure, they might scare some off some, but those who are at risk need much more attention and help than a pithy slogan.

Back to the AP investigation….

In 2017, the DOJ adopted Fentanyl Protocols to handle the emerging synthetic takeover of the drug market. These protocols instructed agents to seize fentanyl “as soon as practicable,” stating that “protecting public safety is paramount” regardless of whether seizures complicate investigations.

That was probably the right call policy wise. But by 2024, as Howell’s whistleblower complaint was working through the system, the DOJ rewrote the rules to give agents more discretion on when to make a seizure.

For speaking up, and for disagreeing with retroactively changing the policy to suit the flawed practice of letting drugs walk, Howell was assigned to desk duty for over a year. His performance evaluations were docked. He was barred by prosecutors from testifying in federal court. Howell was punished for taking the agency’s public message to heart.

The DEA insists its conduct was lawful and that characterizations of it “knowingly permitting fentanyl to reach communities” are false. The DEA points to seizing big shipments as evidence that the “bigger fish” approach worked. Maybe the agency can defend the practice, but this investigation shows there is a vast gulf between the agency’s public message and its private decisions.

So, here’s some drug and addiction news that I have been following for the week. Hope you all have a safe and enjoyable long weekend.

As always, thank you for reading & subscribing. I’m pleased that the newsletter is growing a bit more and getting some attention. I will keep making these posts for free. Keep telling your friends!

5/19 Miami Local 10: Cheap cocaine floods the market (whoops!)

This local Miami story caught my eye. For the past few years I have been seeing report after report about a surge in cocaine production and subsequent cocaine use around the world.

After caffeine, marijuana, opioids, and amphetamines, cocaine is the most widely used drug. For some reason, the cocaine market has been booming, with global production reaching a new high in 2023, according to a United Nations report.

It raises a few questions and exposes some interesting wrinkles. First, there’s lots of talk about synthetics taking over the drug supply and replacing organic compounds. And yet, cocaine, which requires growing actual coca leaves, endures. Unlike with heroin, there has not been a synthetic takeover of cocaine markets. So, what does that say? Old fashioned agricultural drug production is still happening and the grim predictions about synthetic drugs may be off.

There’s yet more interesting things to glean. Is the surge in cocaine production racing to meet demand? Or is a market flooded with cheap product of purportedly decent quality creating new demand? Can we even tease the two sides of this equation apart?

The DEA’s shop in Miami (historically a cocaine hub) claims cocaine prices are the lowest seen in years, at roughly $10,000 per kilo. Prices normally drop when there is a surplus. Cheaper prices could certainly be creating new demand. Either way, the whole cocaine situation throws a wrench in the Trump & Hegseth narrative re: blowing up boats in the Carribbean and kidnapping Venezuela’s President Nicolas Maduro. They say they did all of this to stop drug trafficking. Drug trafficking did not only not stop, it’s accelerating.

DEA officials in Miami say traffickers quickly rebounded after the widely publicized airstrikes. That tells us that the air strikes did not have much of a deterrence effect. Miami DEA says the supply of cocaine is flowing from the same source countries, Colombia, Bolivia, and Peru. To be clear, Venezuela is more of a transit point and not a major source.

You probably can guess where I’m going with all of this:

Decades of drug policy research suggest that supply-side interdiction—seizing shipments, or in this case, bombing boats — may temporarily disrupt markets. But without meaningfully addressing demand and changing incentives for growers and producers in source countries, the market will endure. What the airstrikes amounted was military and national security theater. The Pentagon widely published videos of random boats being blown up for anti-drug propaganda, and to create a pretext for the raid on President Maduro in Caracas, who was brought to the United States to face charges of “narco-terrorism.”

What we see happen over and over again is that one kingpin gets taken down, like, say El Chapo, and then the freelancer effect kicks: several crews splinter-off and fill the void. When one trafficking route closes, a new one opens. And on and on.

The Miami DEA’s own data makes the point clear. Cocaine is cheaper and more available now than at any point in the last decade, with lower prices and high purity. And that’s even after high-profile airstrikes.

The Trump administration claims to be winning the drug war but the government’s own data undercuts the narrative.

5/21 NYT: Meta settled (another) social media addiction lawsuit

Meta agreed to settle a yet another social media addiction lawsuit amid a flood of more than 1,200 lawsuits brought by school districts across the country. This particular suit was brought by a Kentucky school district and the settlement headed off what would have been a bellwether trial accusing tech giants (Snap, TikTok, Google) of engineering addictive products that harmed children and therefore burdened schools.

The settlement terms were not disclosed, though the district had sought more than $60 million in damages. The deal comes on the heels of two major jury verdicts against Meta in March. One suit awarded $6 million to a young woman in Los Angeles who claimed social media worsened her mental health, and another awarded New Mexico $375 million for violating consumer protection laws.

These wins have emboldened plaintiffs using a legal strategy modeled on the 1990s Big Tobacco battles and the more recent opioid epidemic litigation. With trials against TikTok, Snap, and YouTube also queued up through 2027, the wave of litigation shows no sign of cresting.

5/21 CBS: Colorado approves ibogaine research

Colorado’s legislature has passed a first-in-the-nation bill creating a state-sanctioned ibogaine research pilot program. The measure would authorize up to five pilot research sites under the state’s Behavioral Health Administration, require FDA Investigational New Drug compliance and strict medical oversight, and mandate a benefit-sharing arrangement with the Indigenous communities from which the plant-derived psychoactive compound is sourced.

I have been covering ibogaine more and more since President Trump signed an executive order pushing ibogaine research, apparently at the behest of Joe Rogan. Ibogaine has long been used by people trying to kick opioid addiction. Those I’ve talked to claim it made their withdrawal and cravings, somehow, vanish. I’m curious whether that’s an acute effect or something that’s more durable.

Still, no randomized controlled trials yet exist and that the drug carries serious cardiac risks, which will surely complicate any research and require intense screening. Anyone with a personal or family history of cardiac events may not be a great candidate for ibogaine.

This Colorado bill is about creating the necessary infrastructure to do research and hopefully push a more empirical understanding of how and why ibogaine works, if it works. Funding remains the program’s biggest open question, with no state dollars currently allocated. The bill now awaits Governor Polis’s signature.

5/20 Filter Mag SAMHSA’s new guidance pushes methadone patients to taper

The “Dear Colleague” letters continue apace from the Trump administration. Helen Redmond, writing in Filter, dives into the latest SAMHSA letter from April, which, against all evidence, plays into pernicious ideas about dependence on opioid medications like methadone and buprenorphine.

Let me put this plainly, every addiction doctor I’ve ever interviewed on this subject has told me roughly the same version of this risk matrix: A person they’re treating was chaotically and dangerously using uber-potent opioids like fentanyl. This person almost died many times. Now, this person is stable on methadone or buprenorphine. Not just stable, they are thriving. And their risk of dying from an overdose, with these meds on board, is drastically reduced. We’re talking death rates cut in half or more. Thus, there is no reason for them to stop the medication, unless they really want to, in which case, that’s their perogative.

The evidence to support this is so vast it can reach the moon and back. And yet, here is how SAMHSA puts it:

“SAMHSA remains committed to expanding access to comprehensive, evidence-based treatment, including the use of medications. But we are equally committed to ensuring that medications are part of the pathway to long-term recovery and sobriety, self-sufficiency, and thriving, not as a default sentence to life-long medication use.”

It’s not subtle. SAMHSA is adopting the worst tendencies of ideologically militant abstinence only programs that aruge being on medicine is not real recovery. Who honestly cares if someone needs methadone or bupe for the rest of their life?

It’s top-shelf bullshit of the highest order for the government to double down on this absurd hair-splitting about who is in real recovery and who isn’t. Is the militant sober dude, who takes bootleg peptides, rips testosterone, chugs monster and cigs all day, BUT DOESN’T DIRNK ALCOHOL, is in real recovery? Come on, man.

It’s even more absurd to go off like this when uptake of these medications is pathetically low in the USA, where something like 75 percent of people who could actually benefit from being on methadone or buprenorphine simply aren’t on it. It’s not like we’re in France where you can buy bupe and a baguette on every corner. More people clearly need help making the switch to medication and they have enough of a hard time doing so and they don’t need to contend with the government telling them they’re in fake recovery.

Alright. Even though I can keep going on about this I’ll stop here. If you made it this far, congrats. And please, do me a favor, if you hear people out in the world talking about medications the way our own government does now, tell them to shut up, and tell them that no one cares about their ill informed opinion.

DFW puts it this way: “You get to consciously decide what has meaning and what doesn’t. You get to decide what to worship.” And he goes on in a beautiful paragraph that if you worship money, you will feel like you never have enough; if you worship beauty, you will always feel ugly; worship power, and you will live your life fearful and afraid of everyone around you.

So the point of being educated is not to learn what to think, but to learn how to think. “The alternative,” he said, “is unconsciousness, the default setting, the rat race, the constant gnawing sense of having had, and lost, some infinite thing.”

DFW’s message is exceptionally on-the-nose, as students yell and shout down their commencement speakers — the wealthy elite, the titans of industry, the tech overlords — telling today’s bright-eyed graduates to worship at the altar of Large Language Models, to love the machines they are told that, if all goes according to plan, will wipe out entry-level jobs.

It’s even more on the nose when you look at the impact of LLM use on human beings. Research suggests that using LLMs creates a cognitive debt, whereby independent reasoning and critical thinking slowly goes dormnant.

The more we offload our thinking and decision-making to LLMs, the more we use them to tell us what to eat for lunch, what to wear to work, how to build spreadsheets, write our emails, what to say to our loved ones and crushes, the more our own capacity to do all of these things erodes.

LLMs do not teach us what to think let alone how to think. They do something even worse than that: they do all of the thinking for us. LLMs lull us.

And college students—who just spent four years in this new world where a machine can write their Comp Lit essay on Don Quixote in two minutes—are told to like all of this. They are told to get with the program. They are told to adopt “AI” or be left behind. And these titans and moguls, mostly men born in the 1950s, are genuinely taken aback, left stunned and stammering in their utter failure to read the room and understand the world that they built.

Here is Gloria Caulfield, a wealthy real estate executive, who throws up her arms as students yell and boo her Hallmark card line about “AI” being the next industrial revolution.

Here is Scott Porchetta, the 63-year-old CEO of Big Machine Records, whose response to students booing his “AI” boosterism was: “You can hear me now or pay me later.”

Here's 71-year-old billionaire and former Google CEO Eric Schmidt being shouted down as he says it is no longer a question of if "AI" will dramatically reshape our lives and society. He says it's happening no matter what. The students do not like the sound of that.

It’s actually banner week for old wealthy people talking down at everyone else.

Here is Kevin O’Leary, another billionaire, a 71-year-old shark turned actor, who collects cars and watches for fun, who lives in a mansion in Miami — here he is scolding young people for spending $28 on lunch when they make just $70,000 a year (a Chipotle burrito with guac and a drink is over $20 right now).

What are young people so mad about?

They are entering the bleakest job market in recent history, rivaling the pandemic and the 2008 recession. And the graduation speakers, who are supposed to inspire the future generation, who are supposed to impart hard-earned wisdom, didn’t take into account that maybe they do not like hearing the message from “AI” executives. Maybe young people actually do not want jobs that entail babysitting “AI” agents.”

Just four years ago, a degree in computer science, engineering, or some adjacent quantitative financial field all but guaranteed graduates an entry-level job with a solid salary, competitive benefits and perks, equity and options. Developers, coders, engineers, and quants didn't even need to climb a ladder to the top. They just had to step aboard the golden elevator and glide their way to the penthouse of American society.

In four years, that world has disappeared. At a recent talk at Stanford, the billionaire Ken Griffin explained how tasks that once took months for a team of PhD-level workers could now be done in days by "AI" agents. Extraordinarily high-skilled jobs are being automated away, Griffin added.

That is, unless you are one of the select few who study machine learning and LLMs and work at one of the big companies. The rest of us — if you studied the humanities or, god forbid, tried to write for a living — good luck to you! We’re cooked.

Just as blue-collar workers suffered as factories shuttered and steel towns died, that same suffering is coming for white-collar workers (if it’s not already here).

DFW told students that the adult world they are entering into will be hard. That the gravitational force of the everyday rat race will be, at times, impossible to resist. That the inertia will force all of them to rely on their unconscious, hard-wired, selfish default settings. To figure out how to not behave this way will take up most of your life.

He ends his speech:

“It is unimaginably hard to do this, to stay conscious and alive in the adult world day in and day out. Which means yet another grand cliché turns out to be true: your education really IS the job of a lifetime. And it commences: now.

I wish you way more than luck.

We’re all going to need it.

The results caught my eye because after decades of searching and billions of dollars spent on cocaine treatment research—from vaccines to behavoiral therapy to esoteric compounds—nothing has ever really worked. There’s no FDA approved medications for cocaine use.

Enter this trial, where a single dose of psilocybin—combined with a brief therapy program—substantially reduced cocaine use in an important population that needs cocaine treatment: low-income, mostly black, and with long histories of drug use.

Here’s the results by the numbers:

• A single psilocybin dose left participants ~29 percentage points more likely to be cocaine-free on any given day, compared to placebo

• 180 days after treatment: 30% of the psilocybin group was completely abstaining from cocaine vs. none of the placebo group

• The reduced risk of relapse held stable across the entire 180-day follow-up — suggesting a durable rather than acute effect

• No serious adverse events occurred

There’s a lot of interesting background and context about this study, such as the recruitment phase, which spanned 9 years due to “budget constraints, sociopolitical considerations, and the COVID-19 pandemic.” Reading between the lines: studying a Schedule I substance, especially a species of mushroom that likes to grow in cow shit, is quite difficult.

But psychedelic research is moving very fast. There’s a pharmaceutical gold rush underway to extract, isolate, and tweak these compounds in the hope of monetizing them. Sam Altman, the CEO of OpenAI, invested in a company that’s making MDMA and was recently green lit to goto trial. Peter Thiel is a major backer of Compass Pathways, which is developing a synthetic psilocybin for mental health treatment.

The researchers of this trial disclosed financial ties to Beckley Psytech, Reunion Neuroscience, Negev Labs, and a handful of psychedelic biotech startups. The data from this very study has already been licensed to Filament Health, a drug development company focused on psychedelics for stimulant use disorder, with the explicit goal of attaining FDA authorization.

I’m quite skeptical of even the best pharmaceutical researchers and engineers devising synthetic versions of drugs like psilocybin. I’m not sure they can do better than what nature has given us. Just look at all the bizzare brands of synthetic marijuana that seem to cause nightmarish highs. Or take “bath salts,” aka methylone, which started by making small changes to the atomic skeleton of MDMA (MDMA, to be sure, doesn’t grow on trees).

Maybe I’m just being silly. But regardless of where you fall on the synthetic vs organic debate, the race to bring psychedelics to market for the treatment of mental health and addiction issues is very much on.

Back to the trial…

The study, funded by the University of Alabama at Birmingham (UAB) and the Heffter Research Institute, enrolled 40 adults. They were predominantly black, low-income, and with cocaine habits spanning two decades.

The sample was very deliberate: the authors specifically called out that prior psychedelic trials have skewed toward wealthy, educated participants, the yoga mat psychedelic set. A review of 98 psychedelic trial articles found that 93% of participants were college educated and high-income. This raises questions about who and what these treatments are really for. Are clinical-psychedelics meant to help rich people go on a Spirit Quest? Or are we talking about treating serious substance use disorders and debilitating mental health issues? This study squarely deals with the latter.

So here is how it went down: After extensive screening and medical evaluations, qualified participants completed four to five weekly therapy sessions to prepare for “the treatment.” Before dosing, each participant needed a urine-screened verified week of cocaine abstinence. On dosing day, recipients either recieved a 25mg dose of psilocybin or placebo (diphenhydramine; Benadryl). The drug session itself was a single all-day experience with therapists present, and dose days were bookended by structured cognitive-behavioral therapy.

Limits

The trial was small — only 40 people — and the authors are cautious about how they interpret their findings, which they call “hypothesis-generating rather than confirmatory.” Blinding is also pretty much impossible: the psilocybin recipients correctly guessed what they’d taken. And if you were in the Benadryl group you were probably sorta bummed.

How it Works

One of the treatment participants was interviewed by Science:

Among the participants was Lorenzo, who had been using cocaine almost daily for decades. In that time, Lorenzo, who asked that his last name be withheld to protect his privacy, lost his house, saw his marriage fall apart, and spent a few days in jail for possessing the drug. “It becomes a priority in your life,” he says.

During his all-day dosing session, Lorenzo first saw frightening, dark imagery, including a looming, mountain-size demon. “It was like I was facing death and the devil,” he says. Eventually, light began to creep in, then rainbow colors. Fear was replaced by happiness and joy, but also sadness and regret. “In one part of the session, I was apologizing to God,” he says. “Like, ‘I’m sorry I let you down. If you give me another chance I’ll definitely straighten myself out.’”

It’s a little window into what psilocybin is actually doing for someone in this particular group. It’s a cliche to say that so and so has demons, or must confront their demons. Well, cliches are sorta true. And in this case, a man’s cocaine addiction manifested in hallucinations of a biblical battle between God versus Demons.

It makes me think that the trip is the point, that being in this state can scramble things enough to cause one to re-prioritize their life and choose to do things differently. Thus, psilocybin works because of the whole experience: the introspection, the dissolution of habitual thought patterns, the therapeutic relationship between drug and person, and person and clinician. And you can’t fully separate the molecule from the context.

Hence, the concept of “set and setting.” All of this stuff matters and even little details can make a big impact and on the whole experience. Which means there’s a lot of variables here. And if Silicon Valley biotech startups want to isolate the molecule, strip away the context, and offer people a pill, I think we’re going to be missing some crucial elements.

What will it look like if and when this goes to market? What these peole went through in this trial is very intensive and expensive. The screenings and evaluations, several appointments with clinical psychologists, procuring the drug itself, an all day trip-sit with therapists present. That’s not a very “market friendly” experience. Turning psychedelics into an insurance-billable, 20 minute appointment, where you get your dose and go home. Or you dose without the bookended therapy to prepare and help make it all make sense.

I don’t know how all of this will work if and when it ever gets to market. But these results will only propel the race for some company to try and own psilocybin.

I believe in taking care of myself, in a balanced diet, in a rigorous exercise routine. First thing every morning, I take a vitamin D gummy. Nearly two-thirds of Americans are vitamin-D deficient, which can make you feel lazy and dull.

The demands of my life require mental clarity.

After brushing my teeth using an electric toothbrush designed by an oral surgeon, I wear a Shark CryoGlow LED Face Mask for fifteen minutes. It was the most highly rated UV light-therapy mask in its category on Wirecutter and it costs $699. If my face looks a little puffy, I’ll turn on the mask’s chilled, under-eye panels while I do my Total Body Crunches. I can do a thousand TBCs now.

After I remove the mask, I gently wash my face using a sea kelp foaming cleanser. In the shower, I use a body scrub that contains cold-pressed rosehip and marula oil. My hair almost never looks oily and I don’t wash it very often because doing so strips my scalp of its essential natural oils.

Then, I wear a collagen intensive phyto-retinol renewal mask for seven minutes while I take a cold plunge in my newly installed Stealth Luxe Cold Plunge, which I maintain at the coldest temperature setting, 37 degrees fahrenheit.

I am always clean shaven. And I only use after-shave lotions without alcohol because alcohol dries out your face and makes you look older. Then I apply moisturizer, an anti-aging eye balm, followed by a final moisturizing protective lotion with 30 SPF. Too many Americans do not wear sunscreen and it could explain why 1 in 5 Americans develop skin cancer by age 70.

There is an idea of Patrick Bateman, some kind of abstraction, but there is no real me, only an entity, something illusory, and though I can hide my cold gaze and you can shake my hand and feel my flesh gripping you and maybe you can even sense our lifestyles are probably comparable: I simply am not there.

Starting with news.

Reuters 4/18: Ibogaine on the fast track

After listening to Joe Rogan, the Trump administration is attempting to “fast-track” ibogaine through regulatory structures via executive action. Ibogaine is a powerful psychedelic that people have long sought out for mental illness, addiction, and other quests for existential clarity.

Part of this trend involves people traveling abroad to ibogaine clinics. Lately, there’s a lot of interest and visibility in the subject. Last March, political reporter Robert Draper wrote a long personal narrative for The New York Times Magazine about his own ibogaine treatment at a clinic in Mexico, which he described as “reassuringly airy and modern.” Draper took ibogaine hoping to confront or reconcile, or to simply better understand, his feelings of loss, grief, and subsequent guilt that he has long felt over his “alcoholic college dropout” brother, who died in a motorcycle crash. The kind of thing one might want to explore in psychotherapy for weeks or months, maybe years, now confronted in what can only be described as an excruciating 12-hour (maybe longer) trip.

Across the so-called manosphere and constellations of podcasts, including Joe Rogan, psychedelics are a frequent topic of conversation. Live your best life, man. Be your best self. It fits squarely within the realm of what passes for acceptable medicine in the Make America Health Again movement. Going to therapy and taking anti-depressants? That’s for beta cucks. Tripping balls for 12 hours in Tijuana? That’s how real men confront their demons.

As a glimpse into how our government works these days, Dr. Oz, Joe Rogan, and RFK Jr. were at the White House for the signing of the executive order re: ibogaine. Fast-tracking ibogaine could mean that, sooner than later, people will no longer need to travel abroad to use ibogaine. The EO granted ibogaine “investigational new drug” clearance, which means the drug can now be shipped to investigators for research purposes, which enables human clinical trials for the first time in the U.S. The Trump administration allocated $50 million for federal research into ibogaine. Good luck with all that, I guess, is my generous response.

The Intercept 4/21: Two Americans killed in Mexico worked for the CIA

Nick Turse over at The Intercept published a curious scoop that caught my eye. Two Americans killed in Mexico were previously identified as “staff from the United States Embassy,” but sources told him that the two Americans were actually working for the CIA and participated in a raid on a drug lab.

The official story goes: The American personnel died in a car crash in the mountains of the Sierra de Chihuahua. Following news of the deaths, the State Department refused to elaborate, which is an odd stance to take given the story that two of its officials died. Then, Mexico’s President Claudia Sheinbaum said she had no idea of any work being done between the U.S. embassy and officials in the Chihuahua state.

Apparently, the two CIA operatives died in a crash following a drug raid, alongside two Mexican officials, including Román Oseguera Cervantes, the director of the Chihuahua State Investigation Agency.

Here is what Turse’s sources said:

“Two U.S. government officials who spoke to The Intercept on the condition of anonymity said the CIA has been running covert operations in Mexico, working alongside vetted Mexican state-level police forces and other government agencies. The sources said the Americans died after a raid on a synthetic drug lab.”

We typically do not hear about U.S. drug operations in Mexico, but that is changing under Trump’s drug policy, especially when these operations lead to deaths of Americans.

What’s been interesting to me as an observer and analyst of drug policy is that the Trump administration barely produces any domestic news on this front, but lots of news abroad. Airstrikes in the Caribbean. The raid on Venezuela capturing President Nicolás Maduro. Threats against Colombia. And now this apparent CIA operation in Mexico, which we probably only know about because operatives were killed.

There is a long history of overt and covert drug operations in Mexico and across Latin America. I’m reminded of the Toluca, Mexico fentanyl lab that was raided in 2006, recounted in this DOJ Sit Rep dated June 2006. It’s a reminder that the synthetic drug takeover has a long history with numerous precedents. The Toluca fentanyl lab was linked to a surge of deaths across the Midwest, like in Chicago and Detroit, in 2005.

Turse writes, “The Americans killed in the wreck in Mexico are some of the first known casualties since Trump ramped up military and CIA operations in and around Latin America last year.”

Between the boat strikes and this raid on a lab, I expect there’s a lot to learn and uncover about American drug war adventurism in our hemisphere under Trump.

CATO Institute 4/16: The Case Against Social Media Addiction

Writing in CATO’s blog, Jeffrey A. Singer and Adam Omary argue that social media use, however problematic and heavy, should not be labeled as a proper addiction.

They’re writing in the context of a recent landmark trial against Meta and Google, a slew of pending legislation to limit social media use, and a broad backlash against Big Tech, all of which adds up to, they say, our minds pretty much being made up: social media is addictive and it’s causing harm.

First, they argue that formal diagnostic and clinical terminology is being used rather loosely. Singer and Omary draw sharp distinctions between addiction, dependence, and habit. They say heavy social media use almost certainly falls into the “habit” category, that it’s not a compulsive behavior driven by deep neurological changes (i.e., reward circuit “hijacking”). Calling social media use addiction basically exaggerates the clinical seriousness of what most people experience, they say.

There are a few more threads in their argument beyond the neurological and clinical. With recent lawsuits being won against Meta and Google, financial incentives are lining up to reward “over-diagnosis.” A formal “social media addiction diagnosis” would unlock insurance reimbursement, which means creating a whole treatment industry (retreats, counseling programs, apps) and profits from expanding the definition of harms. They cite the massive surge in stimulant prescribing following ADHD, the expanded definition of autism, and so on.

Lastly, they’re skeptical of downstream consequences: Accepting the addiction framing invites more litigation, content regulation, mandatory age verification, and government intrusion into online “speech” and design.

I’ve been trying to genuinely think through this and figure out where I land. I tend to be in the camp that we shouldn’t liberally throw around words like “addiction” and “dependence.” I tend to dislike the overly formal diagnostic and clinical approaches to these very subjective aspects of mental and psychic life. I do not think the harms of cocaine addiction or opioid addiction are in the same ballpark as “social media addiction.”

I recently got in a back-and-forth with the journalist Taylor Lorenz, who covers the culture of the internet, social media, and tech. A neuroscience (EEG) study analyzing brain activity vis-à-vis short-form video consumption concluded it’s important to develop interventions to mitigate “short video addiction.” I, as we tend to do, glibly responded to this study that I knew was kind of silly. It’s taking an EEG of a few dozen people and drawing broad conclusions. And I’m just generally skeptical of neuroscience studies exactly like this kind. I don’t think they ever tell us much about the inner workings of our vastly complex mental life.

And Lorenz responded: “Please don’t fall for this ridiculous stuff.”

Which I do appreciate. I think EEG and fMRI studies can indeed be ridiculous. But what I was saying was that we do not need neuroscience to tell us that our phones and laptops and the internet turning into infinite feeds of short-form videos is bad. That turning everything into a slot machine is not good. And that as a person who works on the internet, I can see and feel the baseline awfulness of being online. How after even a five-minute dive into an infinite video feed, afterward I feel shallow and vapid and stupid and hollow. That seeing 20 recipe videos, new product demos by influencers droning on in that influencer voice, or a day-in-the-life of so-and-so, or a new piece of real estate I could never afford — all of it is just a waste of time and makes me feel like there is no there there.

And what I’m getting at here is that this is my taste and judgment kicking in. I am saying that this stuff is bad and stupid. That I dislike these video platforms trying to sell us ads and bullshit products all of the damn time.

Which finally gets me back to this article: I do not really think we need science and clinical diagnostic criteria and brain studies and yada yada to collectively argue that social media should be limited, that these companies are making a product that wastes our time, and that we should agree that this is not good for the world that we want to be building.

The Atlantic 4/20: What I Learned About Billionaires at Jeff Bezos’s Private Retreat

Noah Hawley wrote a staggering piece about the time he was invited to a “Campfire retreat” in Santa Barbara hosted by Jeff Bezos.

To understand the sharp wit and observation of the essay, you have to understand the broader work and mind of Noah Hawley, who I am a huge fan of. He is a TV writer, creating shows like Fargo, Legion, and the new Alien: Earth series. What I love about his work and his writing are the themes he can subtly work into the mainstream and put on millions of TV screens. Themes like cosmic horror, human insignificance, the absurd meaning-making apparatus that is the human mind, and our frailties, our hubris, our inability to understand our place in the world and cosmos, and all of the folly that stems from these facts.

The fact that Bezos, or his team of aides, invited a guy like Hawley — a writer who concerns himself with human morality — to a billionaire’s “ideas” retreat is hilarious in its own right. A writer like Hawley is unlikely to be wowed and wooed by the wealth and power displayed by a guy like Bezos. Instead, he’s more likely to see through the charade and question: what’s really going on here? Why is this billionaire, wearing t-shirts that are too tight, who laughs too loud, who stages his role as a “family man” (Bezos and his wife divorced a few weeks after this retreat), and who invites wealthy and powerful people to eat Wagyu and talk about ideas?

What Hawley sees on this trip is that a guy like Bezos has “clearly left the world of consequences behind.” In other words: “For the richest men on Earth, everything is free and nothing matters.”

Hawley writes:

“The closer I’ve gotten to the world of wealth, the more I understand that being truly rich doesn’t mean amassing enough money to afford superyachts, private jets, or a million acres of land. It means that everything becomes effectively free. Any asset can be acquired but nothing can ever be lost, because for soon-to-be trillionaires, no level of loss could significantly change their global standing or personal power. For them, the word failure has ceased to mean anything.”

And what does this do to a person? What does it mean to live in a frictionless world that never pushes back? The world simply exists for you to act upon it. Hawley makes an incisive point about prolonged exposure to this way of life: “The basic mechanism by which humans learn that other people are real goes dark.” It reminds me of that line from Succession: “No real person involved.” Nothing and no one can get in your way.

And the difference between today’s centi-billionaires and the 20th-century robber barons — aside from the astronomical differences in wealth and subsequent inequality — is that the 20th-century titans of industry still engaged with the world around them. What’s going on with the billionaires today is that they are sealing themselves off from the masses. They move through a different world, one of private jets, private entrances, backdoors, and swift exits. They don’t wait in any lines. They don’t go through security. They don’t show their ID or passport.

They float through it all, frictionless.

Hawley:

“Today’s billionaires are clearly manipulating society to maximize their own profit, something else is also happening — a disassociation from the reality of cause and effect, from meaning and history. These men no longer feel the need to change the world in order to succeed, because their success is guaranteed, no matter what happens to the rest of us.”

For guys like Bezos, there are no more consequences.

This piece will be about why and how I quit the most addictive drug on the planet, along with a detailed chart at the very end: Zach’s Anti-Vaping Protocol, that shows you how to slowly titrate off of nicotine in a relatively painless way. The reason I put this together, the reason I want to share in detail my quitting experience, is because whenever I tell people that I quit vaping, I get a lot of questions. How I did it chief among them. And was it hard? Did the cravings suck? How painful was it? All the answers are here.

Plus, if my titration protocol helps anyone out there quit or reduce or even slightly modulate their nicotine intake in anyway, I’ll be happy. If you manage to read these 3,000 words and come away thinking I’m crazy for putting this much thought and detail and energy into quitting nicotine, that’s fine. Nicotine use consumed me for well over a decade and it took a lot to stop.

I know I’m not alone. Some 47 million U.S. adults use at least one tobacco or nicotine product. And that figure marks a significant decline. Meanwhile, sales of nicotine pouches (re: Zyn) are surging. Nicotine pouch sales jumped 250 percent between Jan. 2023 and Aug. 2025. It’s a fact that millions of people are dependent on nicotine, and I would wager that, given the market of vapes and Zyns, that many are on nicotine doses that are absurdly high and make them feel like shit. And I like to think most people out there will not be lifelong users. And that some people want to stop. And if I can stop, I believe others can too.

Before I get into the why and how of it, I want to start with what nicotine acutally does and why people around the world, across cultures and civilizations, enjoy the effects of this subtly stimulating chemical.

Alcohol is known as a social lubricant. For me, nicotine was an intellectual and cognitive WD-40, chemically greasing the rails that thoughts and ideas run on. Studies find that nicotine enhances short-term memory and speeds up information processing—very good things if you read and write and interview people for a living. Nicotine is also an appetite suppressant, which for me meant I often skipped lunch, and I could power through a work day with minimal interruption until I needed a late afternoon snack before a proper dinner.

The cumulative feeling of nicotine, in the right dose, at the right moment, is a sharp mental clarity. I could sit my ass in the chair and work productively in a state of calm alertness. I’d feel energetic without the jitters. My mind locked in on the task. Nicotine came to be my favorite mind altering chemical, surpassing even caffiene, my second favorite, now my first favorite and only chemical romance.

I think it’s important to lead out with how amazing nicotine can feel because we have to be clear-eyed about why it’s hard to stop, and why it’s hard to want to stop. Nicotine is super addictive and produces powerful cravings in its own right, but there is also human volition at work here. It’s cliche but I do believe that to stop one must want to stop. And it’s hard to want to stop because of all the benefits I felt. Thus, quitting nicotine required serious discipline on my end. I had to muster mountains of internal will to stop this habit. And it took me a long time to want to stop.

But nothing lasts forever. Returns diminish. Fortunes reverse. And so went the benefits of JUULing. The stimulating buzz that bloomed in my cortex faded. And when stacked against the totality of the whole vaping enterprise, the benefits of nicotine eventually paled.

The idea to quit vaping, in the early spring of 2024, first announced itself as a barely legible whisper. The whisper grew louder and louder until that summer I was nicotine free for the first time since 2013, during a period of time I was at a treatment facility in Minnesota for an opioid addiction. It was technically a program for “adolescents” and, in addition to only serving us half-caffienated coffee, one of the many nanny-ish indignities we endured, they did not let us smoke. When pressed on why we can’t smoke their response was always the same: we have data that show those who quit smoking have a better chance at also quitting their drug of choice. A treatment friend I made, who hailed from a coal mining town in West Virginia, and always wore a Pittsburgh Steelers jersey, snuck in a tin of wintergreen Skoal pouches and we all got in trouble for indulging. After 90 days I left that facility and bought a pack of cigarettes.

I had fits of stopping and starting ever since then. But this time things were different.

The notion to stop—in the immortal words of Ray Velcoro, Colin Farrell’s character in True Detective Season 2—”sucking the robots dick” first manifested in an inescapable feeling of annoyance. My dependence on nicotine finally made me feel inconvenienced in a way that, over time, grew intolerable. The logistics and daily calculus necessary to maintain my supply of JUUL pods became absurdly elaborate. And the whole ritual, the ridiculous amount of mental energy it occupied, felt embarrassing to engage in as an adult.

I had to buy my weekly stash of pods. At my worst, I vaped one pod per day, sometimes more, and with four pods coming in a pack, at roughly $20 per pack, that meant I had to buy two packs at a time to last a week. So that’s about a $40 per week habit. Nothing crippling, of course. I don’t drink so I’m still probably saving money given that one cocktail at a nice restaurant costs as much as a pack of pods and barely lasts 20 minutes.

The ritual around JUULing grew in complexity and became more and more convoluted after a series of major federal and local regulations restricted the sale of JUUL pods, specifically flavors. I started on “cool mint” but that flavor was banned alongside mango, fruit, cucumber, and crème. That left us stuck with tobacco or menthol. Right after I switched to menthol, then-Mayor of Chicago Lori Lightfoot banned menthol pods, too. Only tobacco remained, and that tasted as though you were inhaling dust off of cardboard.

On public health grounds I opposed these anti-vaping policies even though they did make the cost of vaping higher, thus raising my level of annoyance. And even though these rules were aimed at prevening the so-called “youth vaping epidemic,” they did, in part, help spur my quitting.

But I kept on going and kept on enduring this annoying ritual. Menthol pods were still, on the sly, available at certain stores. Instead of being prominently displayed by the cash register, menthol pods were now hidden in Chicago stores. I’d have to ask the cashier if they had them and if I wasn’t a regular the cashier would look me up and down with suspicion.

Due to the prohibitions the cost was rising, exceeding $20 per pack of four in some stores. The only place I found that sold menthol pods at a decent price was a convenience store underneath a Blue Line stop in Logan Square. To get the best deal I had to pay in cash and purchase more than two packs at a time, reducing the price to roughly $17 per pack. But this meant I had to stop at a bank and withdrawal cash. And every week or two I’d find these crumpled ATM receipts—withdrawals in increments of $40, $60, $80—taunting me. Little pieces of shitty paper to remind myself that I’m, quite literally, vaporizing money.

As a former opioid user, I could tolerate a lot of inconvenient and even self-destructive and financially ruinous rituals. But back then I was young and in my addicted adolescence I was not thinking about life and time and my health in the way I think about it now. Time is a precious commodity. Money is also a thing I need to care about. I want to be physically healthy and I want to feel good. I exercise. I’m active. My wife makes me smoothies all the time. So this vaping habit, my one vice, was the only mark of unhealthiness on my current record.

But it wasn’t any acute health scares that got me on the track to quit. The stupid USB stick I needed to take everywhere. The back up JUUL. The chargers. It felt childish and started to remind me of a baby who couldn’t get through the day without using a pacifier to soothe themselves and who would meltdown if they lost it for even a second.

Which brings me to another annoying thing that came with JUULing. The feeling I’d feel when misplacing my JUUL caused an all-consuming panic. My friend and fellow JUULer Justin coined the term “Jang-xiety” to describe this momentary freakout that would leave me groping around like an old man whose lost his glasses. I always thought I’d lost my JUUL, but the thin rectangluar object was really just on the floor, or between couch cushions, maybe I’m sitting on it or it’s in the interior pocket of the last jacket I wore.

By May 2024, as these annoyances mounted, quitting my JUUL habit and the ridiculous ritual it spawned had gained real momentum in mind. The whisper was louder now and I could audibly hear all these misgivings. And for the first time in a long time I felt something changing in my mind. Something that amounted to choice was inserted back into my conscious thoughts around nicotine. Windows of decision were opening.

Neuroscienitsts like to say that drugs hijack the brain, and that human volition and choice has little to do with addiction. But that was not my experience with nicotine, again, the most addictive drug out there. Stopping nicotine announced itself to me and I had the choice to stop and listen. Maybe these thoughts to quit had been buried in my unconscious and the whisper slowly passed through a censor and entered into my conscious awareness.

I could hear: I want this to end. I want to stop this. I don’t like it anymore. I’m tired and annoyed and this is embarassing. I don’t want to sleep with a JUUL under my pillow. I don’t want to vape in movie theaters or at restaurants or on the train. Stop.

I could hear these words. And I could feel the weight of their meaning bearing down on me.

Step 4: “a searching and fearless moral inventory”

Alongside the annoyance, the elaborate ritual, the idiotic quest to secure my stash of pods, there was one more thing going on in my life at this time that catalyzed my desire to quit.

I had just hit my mid-30s, and as I kind of always do around my birthday, I took a personal moral inventory. I am not a follower of the 12 Steps of Alcoholics Anonymous and I have not been for a long time. But there is one step, Step 4, that has always left a mark on me: to conduct searching and fearless moral inventory of oneself. There is a by-the-book formula for doing this moral inventory but essentially it boils down to a sober assessment of where you’re at and what you’re doing. Are you happy with the way you’re living? Are you hurting those you love? Is your side of the street clean?

My side of the street was littered with dead JUULs, empty pods, excess chargers, and little green caps.

Importantly, around this mid-30s birthday, is also about the time that my partner and I discussed having a baby in a serious way. We had been together for 10 years. We’d gotten married, not that we think marriage is a prerequisite for having a baby, but marriage for us was something we had procrastinated on for many years after my partner’s mom died in 2019.

Her death dramatically altered the trajectory of our lives. We were derailed by a sudden tragedy. And it took time and hard work to figure out how to live our lives in this new reality. Getting married became a symbolic event loaded with secret meanings for us. Getting married meant that we were deciding to go on living in this new reality, and build a life for ourselves despite this profound loss, an absence that stopped us cold in our tracks. After years of grief and stagnation and a lot of psychodynamic therapy, we felt like we were ready to trudge onward. And after getting married, having a child felt tangible and real and something we were nervous and excited and scared about.

We wanted to start the process as physically healthy as possible. Though we had a small sample size, almost everyone we know struggled to have kids in some form or fashion. I won’t get into the grim details but in our midst was a lot of IVF, ectopic pregnancies, miscarriages, and so on. We wanted to give ourselves the best chance at a good outcome.

Our odds were good. I gave up weed a long time ago. I dislike every single aspect of alcohol. My opioid use was in the rear view mirror, distant and appearing smaller and smaller everyday. JUULing was my only vice. The only part of my life, health wise, that stoodout as needing adjustment.

I did not want to be a dad pushing a stroller while pulling on a JUUL. The time was now.

Everything lined up. I finally wanted to stop. And I had the most powerful propellant I could probably imagine: Wanting to become a father.

Which brings us, finally, to Zach’s Anti-Vaping Protocol. At the end of this piece is a table that outlines, week-by-week, the titration plan I roughly followed. This is a guide that I reconstructed from my notes app, which is where I was tracking my nicotine intake day-by-day: dates, times, dose, and frequency.

To be sure, this is not something I followed perfectly. Some days I deviated for the better, taking in less nicotine than I expected, and some days I slipped and used more than I anticipated. But this is basically how I did it. A slow, steady, consistent reduction in nicotine intake until I felt like I could get to zero milligrams without feeling insane withdrawal.

All of the amazing feelings that nicotine produced would come back roaring in their exact inverse: headaches, paralyzing cravings, intense irritability, difficulty concentrating, fatigue, and a ravenous appetite.

The first step in my anti-vaping protocol was switching from JUUL to nicotine lozenges. I tried a few brands and came to like the mint flavored Nicorette lozenges, which are white and about the size of a TicTac.

I had tried gum before and I hated it. The patch wouldn’t really satisfy the oral fixation. Why not Zyn or some other snus style alternative? The whole point of finding a suitable nicotine replacement, for me, was the ability to tweak and titrate the dose a needed. Nicorette lozenges are an FDA-approved, over-the-counter medication, like Tylenol. It has clearly labeled doses. I know a 4mg lozenes has 4mgs of nicotine. And when I got low enough I could buy 2mg lozenges, and then I could start breaking those into halves and so on.

Whereas snus brands advertise 3mg, 6mg, etc. concentrations, you cannot break those into halves, and I don’t really think I could taper off a high Zyn dose without feeling these intense cravings and shitty withdrawals. I wanted as painless of a nicotine withdrawal as possible. Plus, I think Zyns pack quite the punch. I doubt I could get by on just one 3mg Zyn in a day. I know I’d use more and more and I’d be back on the carousel of switching from JUULs to Zyns and back again.

The reduction plan I landed on was pretty simple:

I started out buying 4mg lozenges. That first week I established my baseline daily dose, which is a crucial step, and from that baseline (about 20mg daily), I created a titration plan that, in retrospect, was quite ambitious. The whole thing is about 15-16 weeks, about 3.5 to 4 months. But like I mentioned, I was highly motivated. I can see a case for going much more gradually and aiming for a 6 month plan, tapering at 10% to 20% each week and then pausing at certain doses for longer to maintain stability before tapering again.

My initial advice though is: The first week of switching from the vape or Zyn or whatever to lozenges is just let it rip. Don’t even bother counting. Just take lozenges every 1-2 hour as needed to not vape. And then once you feel sufficiently dosed, calculate your baseline and set up your plan from there. It may sound and look like a slog, but trust me, you will start to notice changes.

Best nights of sleep in years….

Once I stopepd vaping and switched to a managable nicotine dose on the lozenges, I immediately noticed feeling a lot better day-to-day. While JUULing I felt a constant low-level thrum of anxiety and restlessness practically all the time. Sometimes my mind would feel like it was racing and I couldn’t slow it down. And my sleep suffered. If I went to bed at 10pm I wouldn’t fall asleep until well after 11pm, close to midnight. This changed very quickly once I stopped JUULing.

Because here’s the problem with vaping: I had no fucking clue how much nicotine I was actually consuming. And I only realized afterward that I was using way, way too much. Vapes, and I think Zyns, too, deliver huge amounts of highly concentrated nicotine. Way more than cigarettes. Yes, these are cleaner nicotine delivery mechanisms. But they pack way more of a punch than cigarettes. And I think there’s a lot of people out there, millions if we are to believe the data, who don’t realize how absurdly high their nicotine consumption is. They don’t know why they feel so nervous or on edge all the time or why their sleep sucks.

Once my nicotine dose was under control—I’d say at less than 20mg—I could fall asleep much faster and sleep better without disturbance. My wife used to always fall asleep before me. For the first time in our entire relationship I started to pass out before her. She was shocked by this development. And almost didn’t like it because she preferred to fall asleep before me. That free-floating anxiety that followed me around cleared away. I was free of the annoying ritual. I felt more calm. I slept better. Did I gain weight? Yeah. I started to eat like a more normal person. Which is fine.

All of this is to say: Had I not started to feel immense improvements in my day-to-day life fairly quickly, I probably would have reverted back to JUULing. If this didn’t result in material gains and tangible results I wouldn’t have been able to stick with it. But I did stick with it. And apart from a random Zyn here or a random cig there, like when I play some poker, I’m totally nicotine free and I’m a father to a boy who is now a year old.