Opioids In America

[0] Christian nationalists want to turn America into a theocracy, a government under biblical rule.

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[2] I'm Heath Drusin, and on the new season of Extremely American, I'll take you inside the movement.

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[7] Lee County, Virginia is located in the southwest corner of Appalachia, and at the turn of the 20th century, its economy was booming.

[8] The coal and rail industries were thriving, people were moving in, houses were being built, things were looking up.

[9] But by the turn of the 21st century, Lee County looked different.

[10] A lot of its buildings were abandoned.

[11] The coal mining industry was struggling, and many of its residents were hooked on opioids.

[12] One of those residents was Arnold Fane McCulley.

[13] This was a man in his 70s.

[14] He had been a full -time coal miner.

[15] For years, Arnold was the guy who got stuff done.

[16] I asked his daughter what she remembered growing up, and she said, my memory of him was he worked.

[17] Coal mining is not an easy job, and Arnold suffered a lot of injuries at work, so he was no stranger to doctors.

[18] He treated numerous times with immediate released opioids and had always been able to get off.

[19] Then, one day, he saw a new doctor who prescribed him a drug called OxyContin.

[20] And this drug turned him in to a non -functioning person.

[21] He loses his job, loses his family.

[22] He ends up dead under shady circumstances in his tree.

[23] His truck overturned and pill bottles sort of like loose around him.

[24] The thing is, in this county, Arnold's story wasn't that uncommon.

[25] Person after person walked into the doctor's office after being prescribed that drug.

[26] They'd be like, Doc, I lost my family, I lost my house, I lost my farm.

[27] With a strangely familiar story.

[28] I lost my family, I lost my family, I lost my house, I lost my farm.

[29] That drug is my God.

[30] The opioid epidemic is getting worse.

[31] More people are addicted to opioid painkillers than ever before.

[32] On average, 130 Americans die every day from an opioid overdose.

[33] The deadliest drug crisis in American history.

[34] And there are virtually no signs of it getting better.

[35] You're listening to ThruLine from NPR.

[36] Will we go back in time?

[37] To understand the present.

[38] Hey, I'm Randadad de Vattah.

[39] I'm Ramtinara -Blui.

[40] And on this episode, America's opioid epidemic.

[41] We hear a lot about opioids these days.

[42] The U .S. has been in the midst of an opioid crisis, and it's gotten worse in the past few years.

[43] About 400 ,000 people have died in the last two decades, making it the deadliest drug epidemic in American history.

[44] Entire communities, like Lee County, have been devastated by it.

[45] It feels like there's no end in sight.

[46] But how did we get into this mess?

[47] Where does this crisis actually begin, and how does it fit into America's longer history with opioids?

[48] After all, opioids aren't new.

[49] They've been around for thousands of years.

[50] Humans throughout history have turned to opium, which comes from the poppy plant, for things like pain relief.

[51] The ancient Greeks, Persians, Egyptians, Chinese, all used it.

[52] Wars have been fought over it, empires built, fortunes made.

[53] But America's opioid story is uniquely American.

[54] To understand today's opioid crisis, we need to understand today's opioid crisis, we need to to explore the complicated relationship we've had with opioids for over a century now.

[55] While opioids can be addictive and dangerous, they've also provided very real relief for a lot of people.

[56] So we're going to tell you the story of three game -changing opioids.

[57] Morphine, heroin, and oxy -kind.

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[63] Part one, Morphi.

[64] In the early 1800s, a German pharmacist named Friedrich Zertrner was hard at work, conducting experiments on the opium poppy plant.

[65] He was trying to figure out how to isolate its most valuable component, the alkaloid, the ingredient in the plant that gets you high.

[66] and, more importantly for his research, provides pain relief.

[67] It was something no one had been able to do before.

[68] For years, Sertraterner ran all sorts of tests in the lab, on stray dogs and even on himself.

[69] Eventually, he cracked the code and managed to extract the alkaloid from the poppy plant.

[70] He called it Morphy, after the Greek god of dreams, Morpheus.

[71] And for the next few years, Sertrner continued to study this new thing, And he started getting more and more nervous about how it might be used in the future.

[72] He says, we must be very careful with this drug.

[73] And he warns people that calamity isn't around the corner.

[74] This is Beth Macy.

[75] I'm a journalist and an author based in Rone of Virginia.

[76] Her latest book is called Dope Sick.

[77] So several decades after morphine is discovered, Sir Turner's fears are realized.

[78] Calamity strikes an ocean away in the United States.

[79] The Civil War begins.

[80] It's an incredibly bloody war, the deadliest in American history.

[81] And most of those deaths actually happened off the battlefield.

[82] From things like disease and infection.

[83] But there was this great new way of controlling pain.

[84] That new drug, morphine.

[85] And the U .S. imported a lot of it.

[86] Many soldiers became hooked and stayed hooked after the war ended.

[87] There's a saying or a cliche that Morphiom, The morphine addiction in the late 19th century was the Army disease or the soldier's disease.

[88] This is drug historian David Courthright, and he says that nickname hides a significant detail.

[89] Which is other evidence suggests very strongly that the majority of addicts were women.

[90] So court right says, while a lot of soldiers did return from the front addicted to morphine, it appears that as a century went on, women began to make up the majority of morphine addicts in the U .S. Why was morphine prescribed in the 19th century?

[91] It's prescribed for pain of all kinds, which women tended to be diagnosed with to a much greater degree than men.

[92] This is Nancy Campbell.

[93] She's a historian of drugs and drug addiction.

[94] Men were expected to bear pain more stoically.

[95] They were not expected to seek out doctors for every ache and pain.

[96] There were also supposed racial differences in the ability to tolerate pain.

[97] So if you were a white woman who could afford prescription drugs, and you went to the doctor for, say, a cough or menstrual cramps, you were way more likely to leave with a prescription for morphine than anyone else.

[98] One doctor, Frederick Heeman Hubbard, wrote in 1881, uterine and ovarian complications caused more ladies to fall into the opium habit than all other diseases combined.

[99] So morphine was the catch -all drug that doctors and pharmacists used for pretty much everything, and they prescribed it to women like Mrs. Matilda Webster.

[100] Mother of nine children who suffered from neuralgia.

[101] Neurogia is a condition where nerve pain causes a stabbing burning sensation, usually in the head or face.

[102] She sent one night one of her nine children to Boyd's, which was her usual South Brooklyn drugstore, and the child reported to the druggist that her mother was in great pain, bodily pain, and was asking for something to help her go to sleep.

[103] The druggist, who was pretty familiar with Mrs. Webster, packaged up a couple of doses of morphine consisting of one grain each, and Mrs. Webster, instead of doing what the druggist thought she would do, which is taking a little at a time until her pain was controlled, took everything.

[104] the whole supply, and she went into a coma, lingered in a comatose state, and expired 24 hours later.

[105] She had overdosed on morphine, and the druggist who gave her the morphine was put on trial, which Campbell says was unusual because overdoses normally were reported as deaths by natural causes, but Matilda's husband wasn't willing to let go, and eventually was given $5 ,000 in her.

[106] you know, 1868, 1868.

[107] So not long after the Civil War ended, people were already starting to suspect that morphine was potentially dangerous.

[108] Like, warning, warning, this drug is not safe.

[109] As the 19th century went on, on top of the thousands of veterans who'd become addicted during the war, thousands more people, many women, became addicted.

[110] Still, doctors kept prescribing morphine throughout the 1800s.

[111] despite the warnings, mostly because there just weren't many good alternatives.

[112] I mean, aspirin wasn't even marketed until 1890.

[113] By the early 20th century, tens of thousands of Americans were addicted to narcotics like morphine.

[114] People were dying of overdoses, which sounds pretty familiar.

[115] Yeah, a lot like the crisis were in today.

[116] People would go to the doctor's office, get a prescription for morphine, become addicted, maybe even die.

[117] And communities, who were mostly white, were left devastated.

[118] Remember, morphine was disproportionately prescribed to white women at the time.

[119] And just like now, it probably had a lot of people asking, Oh, my Lord, what have we unleashed on this country?

[120] One doctor wrote in 1884, Prompt action is then demanded lest our land should become stupefied by the direful effects of narcotics and thus disease physically, mentally, and morally, the love of liberty swallowed up by the love of opium, while the masses of our people would become fit subjects for a despot.

[121] But undoing this crisis would not be easy.

[122] Right, like how do you take so many addicted people and make them unhooked?

[123] Well, in the early 1900s, one pharmaceutical company came up with a new drug to try to do just that.

[124] And it would transform the landscape of drugs and drug addiction in the U .S. In the process, they unleashed an even scarier monster.

[125] Our next drug, heroin.

[126] On the TED Radio Hour, MIT psychologist Sherry Turkle, her latest research into the intimate relationships people are having with chatbots.

[127] Technologies that say, I care about you, I love you, I'm here for you, take care of me. The pros and cons of artificial intimacy.

[128] That's on the TED Radio Hour from NPR.

[129] Would you please say one, two, three, four?

[130] Yeah.

[131] One, two, three, four.

[132] Testing one, two, three, four.

[133] Part two, heroin.

[134] Umpara, where were you born?

[135] Where did I sit?

[136] Huh?

[137] San Juan.

[138] San Juan, Puerto Rico.

[139] When were you born?

[140] May 8th, 1914, Old Harlem Hospital, 137 Street on Lenox Avenue in Harlem.

[141] These are the voices of former heroin addicts who became hooked in the 1920s and 30s.

[142] David Courtright talked to them in the 1980s.

[143] One night I walked in the bathroom and I saw this girl sitting on the tub with this rubber band around a needle and scared me to death as I'd never seen nothing like that and she said oh this is something try this In 1921 I started using heroin I said I'll never use another needle And I actually admit it.

[144] Did you know that it was heroin?

[145] Saviak had a heroina.

[146] Everybody was sick and puking and it's not all the laying on old curb.

[147] It only takes a few days of continuous using it to pick up a habit.

[148] And once you start with that, you can't stop.

[149] We know now that heroin is more potent, more likely to cause addiction than morphine.

[150] But when it first appeared, heroin was seen as a safe alternative.

[151] to morphine, the hero to end the morphine crisis.

[152] That initial perception of heroin as a safe alternative was no coincidence.

[153] In the late 1890s, the pharmaceutical company Baer began marketing heroin as a non -addictive wonder drug.

[154] They published ads claiming that heroin would relieve your cough, even marketing it to children.

[155] Heroin for kids.

[156] Imagine that.

[157] And this whole marketing campaign was uncharted territory at the time.

[158] The idea that pharmaceutical companies could be big business in the way that, say, toys or textiles are.

[159] Originally, pharmaceutical manufacturers were called ethical pharmaceutical houses.

[160] Again, Nancy Campbell.

[161] And they did not market direct to consumers.

[162] Bear did market direct to consumers.

[163] But even so, even so, by the early 1900s, people are beginning to write articles for medical journals.

[164] journals with titles like, and I quote, the heroin habit, another curse, in which they point out that, yeah, you can get addicted to this stuff too.

[165] In 1906, the American Medical Association included heroin in its annual publication with this disclaimer.

[166] The habit is readily formed and leads to the most deplorable results.

[167] Despite that warning, heroin was readily available as an over -the -counter drug.

[168] And politicians became more and more suspicious of its supposed non -addictiveness.

[169] In 1914, a new law called the Harrison Act was passed.

[170] It put attacks on morphine and heroin and forced doctors to register drugs with the government to prevent doctors from over -prescribing them.

[171] See, even though there was growing awareness about the dangers of opioids, some doctors were still prescribing morphine.

[172] And the government didn't want to leave room for a repeat of the morphine epidemic, with either morphine or any new opioid that came along.

[173] So they decided to step in.

[174] The idea is to create a kind of closed system in which everything is transparent and the narcotics are going only for legitimate medical purposes.

[175] That act was important because it criminalized something that formerly was not thought to be a crime.

[176] Up until then, opioid addiction was seen as a medical problem, not a criminal one.

[177] The result of this new law was fewer and fewer doctors prescribing morphine and almost no doctors prescribing heroin.

[178] Problem solved, right?

[179] Well, yes and no. On the one hand, morphine use dramatically decreased, but on the other hand, this law had unintended consequences.

[180] It began to move both morphine and heroin, really, into the fringes of the underworld.

[181] After all, if people couldn't get what they needed from a doctor, they were probably going to look for it somewhere else.

[182] The moment they were prescribed, and that prescription ran out, they were soon experiencing that feeling of dope sickness.

[183] Again, Beth Macy.

[184] That excruciating withdrawal.

[185] That's like the worst flu times 100.

[186] And then they're going to the black market for heroin or for pills.

[187] They want your sweet, innocent girls to take the bulls so they can be enticed into honky -tunks.

[188] Not long after that, in 1920, Funny, prohibition began, banning alcohol throughout the country.

[189] And during that time, organized crime, also called the syndicate, begins to grow.

[190] Underground networks of alcohol smugglers began popping up everywhere, importing alcohol from countries around the world.

[191] And those networks made it easy to smuggle in other things, too.

[192] So you begin to get markets for...

[193] illicit products, products like heroin.

[194] So heroin started to be seen as a drug of the underworld, a quote -unquote street drug.

[195] And in 1924, the government outlawed heroin altogether, making it completely illegal, even for medicinal use, pushing the heroin market even further underground.

[196] Fast forward to the 1940s.

[197] World War II is coming to an end.

[198] And a lot like the post -Civil War period, Opioids became a big issue in post -World War II America.

[199] Yes, every war has its drug, and what typically happens is after war's end, that drug becomes a domestic problem.

[200] We have not thought well about how the practice of war seems to require so much pharmaceutical support.

[201] During the war, the supply of opioids dried up.

[202] But after the war ended, opioids began flooding into the war.

[203] black market do elicit networks.

[204] You begin to see heroin traffic heat up.

[205] These black markets were mostly concentrated in big cities, where a lot of the drug routes pass through.

[206] So by this time, the average opioid addict looked different.

[207] The median age falls to age 20 or so is more frequently someone from a community of color, African Americans, Puerto Ricans in New York.

[208] So by the 1940s and 1950s, narcotic addiction, in the United States is mainly centered on big cities, and it's mainly a matter of drug traffickers smuggling the drug heroin into the country and distributing it through various illicit networks.

[209] U .S. customs officers and police are having another drive to round up dope smugglers, and here's some of the swag.

[210] Concealed in barrels of olive oil, they find millions of dollars worth of deadly heroin.

[211] Enough, they say, to kill six million people.

[212] So in 1951, Congress is concerned enough about the situation that they pass the first mandatory minimum sentences for drug use.

[213] Otherwise known as the Boggs Act.

[214] They cannot say these are innocent teenagers who are preyed upon by dealers.

[215] They have to sentence them to five, ten, ten, fifteen years, depending upon the quantity they possess at the time of the arrest.

[216] And keep in mind, these heroin markets were in majority black and brown neighborhoods in cities, so the Boggs Act disproportionately affected those communities.

[217] What we think about addicts depends very much on who is addicted.

[218] Again and again in the literature, you'll see this distinction being made between medical users or medical addicts and pleasure users or recreation.

[219] users, and they were generally considered to be more blameworthy.

[220] Morphine addicts were seen as medical users, heroin addicts as recreational users.

[221] But there's one sure thing.

[222] This is one game nobody beats.

[223] If you use narcotics before long, you'll have the habit.

[224] Another way to say this is that if the composition of the addict population hadn't changed, if we had this had the same pattern of most of the heart, mostly medical, mostly female, mostly morphine addicts that we'd had in 1870, then I don't think American drug policy would have taken the punitive turn that it did.

[225] In the 1950s, that punitive approach got even more intense.

[226] Hearings were held in 14 major cities across the country.

[227] Politicians declared war on heroin.

[228] And Congress decides to stiffen those.

[229] penalties, allow for deportation of foreign nationals, and the death penalty to dealers.

[230] It wasn't the drug problem in the United States.

[231] It was the heroin problem.

[232] Most of the known addicts are addicted to heroin.

[233] Here is heroin, this white powder.

[234] As far as the policymakers in Washington were concerned, and as far as the police in most American big cities were concerned, heroin was the drug to worry about in the fifth.

[235] 50s and the 60s and early 70s.

[236] Despite all these efforts, heroin remained on the streets, and drug users continued to be treated as criminals.

[237] America's public enemy number one in the United States is drug abuse.

[238] Until a new opioid appeared on the scene.

[239] Part 3, OxyContin.

[240] Okay, first question.

[241] Have you ever heard the name Sackler?

[242] It probably sounds familiar.

[243] because it pops up on buildings everywhere.

[244] On universities, hospital buildings, and medical facilities, and art museums the world over.

[245] Plus, it's been in the headlines a lot lately for multiple lawsuits.

[246] The Sacklers are one of the richest families in America, and for generations now, they've had a real sweet spot for philanthropy.

[247] And you may be wondering, where did all that money come from?

[248] The answer to that question gets at the thing that the Sacklers are facing lawsuits over.

[249] whether they bear some responsibility for the opioid epidemic.

[250] There's a kind of conversation I think we have in America where we realize that a lot of our great cultural and educational institutions were built on money that we would now think of as tainted money.

[251] This is Patrick Raddenkeef.

[252] He writes for the New Yorker, and Patrick spent months investigating the history of the Sacklers for a piece called The Family That Built an Empire of Pain.

[253] He says the story of how the Sacklers made their money is also the story of how the drug at the center of today's opioid crisis, OxyContin, came to be.

[254] It all begins in the 1950s with three brothers in Brooklyn.

[255] Arthur and Mortimer and Raymond Sackler.

[256] They're from an immigrant family.

[257] They grow up in the Great Depression.

[258] And all three of them?

[259] All three brothers train as doctors.

[260] The oldest brother, Arthur Sackler, is kind of the patriarch of the family.

[261] He's this gap -toothed, brilliant, brilliant guy who becomes a doctor.

[262] Specializes in psychiatry.

[263] Does a huge amount of path -breaking medical research in the 1950s.

[264] Arthur and his brothers authored more than a hundred studies on the biochemical roots of mental illness.

[265] In other words, they challenged a lot of Sigmund Freud's ideas.

[266] Despite his success in that field, Arthur Sackler began to get restless.

[267] After all, he was a natural -born entrepreneur.

[268] So...

[269] On the side.

[270] Arthur joined and later bought an ad agency that specialized in medical insurance.

[271] advertising.

[272] It's clean, it's simple, and it's tantalizingly incomplete.

[273] What's missing?

[274] I thought of it as almost a kind of Don Draper figure, where in the 1950s, you have this revolution in advertising in which all of these new persuasive techniques are being brought to bear to sell everything from Jim Sox to Ford convertibles.

[275] And Arthur Sackler has this revelation, which is, what if we applied some of the same?

[276] some of those bells and whistles to the way we sell drugs, the way we sell medicine.

[277] He's the father of modern pharmaceutical marketing.

[278] I don't mean to, you know, rain on a parade or anything, but I've been a little bit surprised to hear him credited as the inventor of this phenomenon, which seemed to me to be everywhere in the 1950s.

[279] This is David Herzberg.

[280] He's a professor of history at the University at Buffalo.

[281] There was this purposeful turn in the 1950s.

[282] to really institutionalize and expand consumer markets and all the various forms and guises from real estate to pharmaceuticals.

[283] Arthur Sackler may not have been the only one breaking into the medical advertising game at the time, but he was definitely one of the best because his approach was innovative.

[284] Back in the early 1900s, when Bear tried advertising heroin, their marketing campaigns were basic.

[285] If you look at any of these early 20th century ads that Bear puts out...

[286] Again, Nancy Campbell.

[287] It's not really made visual in the ways that we think of advertising as being visual.

[288] In other words, they were pretty boring.

[289] And what Arthur realized that the people at Bayer hadn't was that advertising a drug is an art of seduction.

[290] And it doesn't actually begin with the consumer, the patient.

[291] The first person you need to seduce is the doctor.

[292] Why?

[293] People trust doctors.

[294] And he trusted doctors.

[295] And so if you have an endorsement from a doctor, it's like putting Mickey Mantle on a box of weedies.

[296] So he started developing ad campaigns.

[297] Brilliant and very persuasive advertising campaigns.

[298] With doctors at the center of them.

[299] You want to sell a lot of a drug.

[300] You sell it to these doctors who will then prescribe it to their patients.

[301] Which sounds pretty similar to how morphine spread.

[302] Right.

[303] But in this case, the business model was much more deliberate.

[304] And this ended up becoming, I think, a really key act.

[305] of how we got to where we are with the opioid crisis, is that it's one thing to go out on a street corner and try and find some sketchy person who's going to sell you something in an alley.

[306] It's another thing altogether to go into your doctor's office and have your doctor write to a prescription.

[307] But doctors were skeptical of prescribing opioids.

[308] Physicians and patients have now learned their lesson.

[309] And so Arthur, along with other pharmaceutical companies at the time, turned to two different classes of drugs called barbiturates and benzodiazepines.

[310] Which were not opioids.

[311] and were, they're not derived from plants, so their manufacture and circulation was relatively controlled, they didn't seem like they posed a problem.

[312] And as a result, we've had a new acceptance of the idea that there is a pill for every ill and that taking pills can support productive everyday lives.

[313] And Arthur Sackler's marketing techniques played a big part in that shift.

[314] He develops his first real force.

[315] marketing drugs like Valium.

[316] Then he sort of brings along his brothers, Mortimer and Raymond.

[317] And they end up buying a small pharmaceutical company at the time.

[318] It was called Purdue Frederick.

[319] And the company starts developing a succession of drugs.

[320] During the 1950s and 60s, Arthur and his brothers began making so much money.

[321] We're talking millions and millions of dollars.

[322] They were a company that knew.

[323] how to market their products really well, which is the goal of any business.

[324] And a lot of people did benefit from these drugs.

[325] But their success and the growing pharmaceutical industry made some politicians suspicious.

[326] So Congress held a hearing about the pharmaceutical industry and called Arthur Sackler to testify.

[327] And he was a genius.

[328] I mean, he was a really brilliant guy.

[329] And he just, I've read the transcripts and he dances circles around these guys.

[330] In Keefe's New Yorker piece, he quotes from a congressional staffer's memo, quote, The Sackler Empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested, and secure favorable reports on the drug from the various hospitals with which they have connections.

[331] It's like they have drugs that they're developing and then medical journals that can run articles about the drugs, and then doctors who can go out and promote those.

[332] those drugs.

[333] So it becomes this extraordinarily sophisticated, self -serving system.

[334] Arthur and his brothers came out of the hearing unscathed.

[335] Their drugs kept selling, they kept making money, doctors and pharmaceutical companies became more and more intertwined, and that idea that there's a pill for every ill became the new status quo.

[336] But almost none of those pills were opioids.

[337] Remember, after morphine and heroin, doctors were resistant.

[338] to prescribing opioids in any form, because they turned out to be really addictive.

[339] Heroin was criminalized in 1924, and sales of morphine and other familiar opioids were restricted robustly.

[340] The pharmaceutical industry tried to introduce new blockbuster opioids every few years for the next 70 years.

[341] But these kinds of campaigns were never allowed to come to fruition.

[342] There was a very fierce counterattack against any idea that there could be such a thing as a non -indictive.

[343] But in the 1990s, that started to change.

[344] In fact, pain itself was redefined.

[345] Yeah, so early to mid -90s, physicians, pharmaceutical companies, pain groups funded by pharmaceutical companies.

[346] Again, Beth Macy, started pushing this notion that we had this epidemic of untreated pain.

[347] Pain became reclassified as a fifth vital sign, like blood pressure, heart.

[348] heart rate, temperature.

[349] You also began to get different ideas about the safety and applicability of opioids for people experiencing pain in the 1990s that comes out of a few, at first, marginal figures in the pain reform movement, but these marginal figures with shocking rapidity become dominant figures who are claiming that opioids are in fact terribly underused.

[350] that they are one of the best and first -line treatments for a much wider range of pain.

[351] And the reason that these quite radical reinterpretations of opioids go from the margins to the mainstream so rapidly is because of funding from people like the Sacklers who give them a megaphone for their voices.

[352] At the same time, Purdue Pharma was developing a new drug based on the opioid oxycodone.

[353] By this time, Arthur Sackler had passed away, and Richard Sackler, Arthur's nephew, was a leader in the company, now called Purdue Pharma.

[354] And in 1996, Purdue released OxyContin.

[355] To market OxyContin, Arthur Sackler's living relatives and Purdue Pharma took his approach to a whole new level.

[356] Starting with the FDA.

[357] There was a evil genius sophistication to...

[358] to the whole arsenal of tricks that were employed to persuade the FDA.

[359] When the FDA approved OxyContin in 1995, it approved a claim that OxyContin was safer than other similar drugs on the market, with this wording, quote, delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug, end quote.

[360] OxyContin's biggest selling point was that it had a time -release mechanism built into it.

[361] So if you took one pill, the drug would be slowly released over the course of 12 hours, offering you longer -lasting pain relief and supposedly...

[362] Supposedly.