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Wendy Zuckerman

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Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

1019.86

That is, if you don't want to kill someone, why are we using these drugs in hospitals? And, well, these drugs are sometimes given to patients before surgery and it helps doctors to intubate them, you know, put the tube down their throats. It can stop you from gagging. Or if you wake up during, let's say, surgery, it would keep you from moving around so a scalpel doesn't slip. Mm-hmm.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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But because these drugs paralyze the muscles that allow you to breathe, if you're using them in a medical setting, you have to give someone a breathing tube or a respirator. So you're giving them oxygen artificially.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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What would it be like to die like that?

Serial Killers

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If some of his victims weren't unconscious, they would have felt it.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah, that's right. Because Ian, we talked about it and he said it would be almost like drowning because you're not anesthetized necessarily. So these drugs don't conk you out or, you know, put you to sleep. So you just can't breathe. And you can't even like move or scream. Oh my gosh, I can't imagine. Awful, awful.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Now, it is worth saying that in Efren's confession, according to the cops, he said that he would only do this... to patients who are unconscious.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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All 40 of them? Yeah, I don't know how we can know that for sure, exactly. So the cops hold Efren Saldivar on suspicion of murder. But even though he'd given this detailed confession, admitted to killing dozens of people, in the U.S. that's not enough to go on because of this rule that's called corpus delecti. Yeah, so tell us about it. Body of the crime, tell us what it is.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah, and in this case, all they have is a confession. They don't have any physical evidence because these patients really just could have died because they were sick. Yeah, okay. So John, the cops hold him for a couple of days while they're doing some detective work, but in 48 hours, what's he going to come up with? And so they have to let him go.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And when he gets out, Efren goes on national television and says that he lied about the confession. And Sarah, our journalist, told us that Efren basically says... I didn't do it.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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He sort of gave this idea that he was really depressed and basically suicidal and thought that if... He confessed to these killings, then maybe he would be given the death penalty, and then that would be his way out. Okay.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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I guess so. I guess so. He also said at the time that he was taking Valium and other sedatives and barely remembered what he said to the cops. And even a hospital spokesman around that time said, quote, "'We don't know if anything happened.'" End quote. Mm-hmm.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah, but meanwhile, the medical board responsible for respiratory therapists suspends Efren's license to practice, so he's no longer working at the hospital. And the cops, cops like John... They're not totally buying that his confession was a lie because it was just so specific, the drugs he used, you know, exactly how he did it. It felt like a weird thing to just say.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So the cops stay on the case and actually create a task force to find out what is going on here. And they start going through every patient that died under Efren's watch. And they're looking for suspicious cases. And this is a huge task. It meant wading through more than 1,000 complicated medical records.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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But they talk to the doctors and they learn fast. And they're looking for patients who weren't given Pavalon or succinylcholine legitimately at the time of their death, so they didn't need it for surgery.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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They start looking for patients as well who, at the time of their death, had this particular pattern in their breathing and heart rate moments before they died that might suggest they were given Pavalon or succinylcholine.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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They're also on the hunt for situations like salbius sartreans and the other patients we talked about at the start of the show where they're doing better and then suddenly they die for no clear reason. Like nosedive, yeah. And so after months of trawling through these records, they come up with 20 people whose deaths at the hospital were highly suspicious.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yes. Yes. I think that's one of the reasons I love science too. It's a way to understand the world. Yeah. If science is your side piece, I guess, your true love is really mysteries.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And so now the plan is to exhume the bodies from a cemetery and search for the drugs that Efren had said he used to kill the patients.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Ashley, that is the question. Because the cops start asking around and they realize that we do not have a good test to find these drugs in this situation. Oh, no. Basically, you can't pull out some easy-peasy test off our forensic science shelf that would detect what's expected to be pretty low levels of pavillard or succinylcholine in a decomposing human body.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So bottom line, even if they exhumed those bodies from those graveyards, There's no reliable test to find these drugs inside them. They've got nothing. So now what? The story can't end here, obviously. Obviously. They get a tip that there is this place that just might be able to help them. It's a lab that some call the lab of last resort. What a name. It's where we're at in this story, right?

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah, true. This lab is called the Lawrence Livermore National Laboratory. It's this huge, sprawling facility in California that was created in the early days of the Cold War and does some truly bonkers stuff. So they design nuclear warheads. They have one of the world's most powerful lasers. And they also have this forensic science centre that can trace tiny amounts of chemicals. Why?

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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That I've heard you say that you are obsessed with solving mysteries. Obsessed. What is it about a mystery that just grabs you and you cannot let go?

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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What are they doing at this lab? So they use it to find chemical weapons, evidence of chemical weapons in an environment. Oh. And also alleged murderers. And here's how John describes this slab.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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After the break, we'll get inside that high security village, the lab of last resort. Let's do it. It's coming up. Welcome back. Today on the show, I'm here with Ashley Flowers, host of Crime Junkie, and we are cracking the case of Efren Saldivar, a healthcare worker who's suspected of killing dozens of patients. Wide open. Let's do it.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So we're now heading to the Forensic Science Center at Lawrence Livermore National Laboratory in California. The lab of last resort. And it's now up to some serious nerds to try to detect the tiny amounts of drugs in bodies that have been buried for years. Mm-hmm. Armando Alcaraz is an analytical chemist who works at Lawrence Livermore, and he was on the team who had to now create this test.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And when he heard about what he had to do, he was like, Oh my God, where are we going to find this stuff?

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So here's what they have to do. Let me describe the needle and the haystack. So needle is the drugs. The haystack are the loads of other chemicals that would be in these decomposing bodies. Armando told us that some of the patients were smokers. So... Tobacco would have been contaminating the tissue. So would any embalming fluid used in the burying process.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Dirty water would have been seeping into the coffins by now, leaching in all of these chemicals from the soil surrounding it. And it meant that if you were to look in liquid in their bladder.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Exactly. So they get to work and they quickly realize that one of the drugs that Efren had said he used to kill patients, succinylcholine, that is basically a lost cause. It's just too hard to identify it in a human body after all this time.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So they zoom in and try to create a test to identify Pavalon. And because they don't want to be doing this work in human bodies, they start working with something that's pretty close to a human body. Pig pigs. Do it. Yes. Yes. So Armando and his colleague get pig livers and they add a tiny bit of Pavalon.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Well, today we have a real mystery for you and it's got a whole bunch of science in it. So should we jump in?

Serial Killers

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Mm-hmm. Things are about to get a little bit grosser. So because they would take this pig liver Pavillon milkshake... And in some cases, let it sit and decay for months, making it more like what these bodies that have been decaying would be like. At this point, Armando and particularly his boss, Brian Andreessen, are up to their elbows in decomposing pig livers.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Word on the street is that the lab did smell kind of gross. What did it smell like?

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So decomposing bodies, whether it's pigs or humans or whatever, they emit these chemicals. And the two that he talked about, cadaverine and putrescine, they give off that particular smell of death, that smell that you described. And here's how Armando described it.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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It's two days after Christmas in 1996 and a woman named Salby Esatrian is rushed to Glendale Adventist Medical Center in California. She's 75 years old and is having trouble breathing. One hospital worker told the LA Times about her. He said, she's a sweet old lady. She got treatment at the hospital. And on December 30th, she's breathing on her own. Things are looking pretty good for her.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So while covered with this smell of death... They take the, we're going to go back to the decaying pig milkshakes that have been spiked with Pavalon. And they pass them through this particular contraption that's called a solid phase extraction polymer. It looks a bit like a plastic syringe and it has a kind of filter in it or what's called a cartridge.

Serial Killers

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And inside it, they're basically trying to separate Pavalon from all the other crap that is in these tissue samples. But what you have to know is that there's different cartridges out there that are used to isolate different chemicals. I had never thought about how one would isolate chemicals from a human body. Mm-mm.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And so basically they're pushing all tiny bits of samples through these little syringes. And what the game is to find the exact right cartridge that's going to trap Pavalon. But leave out everything else or as much as possible of everything else. And so Armando's colleague has been working on finding the right cartridge. Armando's focusing on another piece of this puzzle. It's really tough.

Serial Killers

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Just passing this milkshake through these filters could take days depending on how decayed the tissue is or how much mucus is in it. May turns into June. They're pulling 16-hour days. It's just late night after late night.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Hi, I'm Wendy Zuckerman, the host of Science Versus. And on Science Versus, we tell these bonkers science stories that matter to you and me. Whether it's a story about how much protein you need to eat every day, what is happening in your brain as you dream, And stories about serial killers. To find us, just search for Science Versus, that's Science VS, on whatever podcast app you're using.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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They're not finding what they need. It's depressing. Nothing is working.

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But then one day, Brian is testing this cartridge that was designed to detect the residue of chemical weapons. And from across the room, Armando hears his colleague saying something.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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They found the magic cartridge. So Armando would now extract all the chemicals in the cartridge and then using a bunch of tools like mass spectrometry. Oh, my God. This is why we call it mass specs because there's so many R's in that word. Using tools like mass spectrometry, which separates chemicals based on their weight, and then try to identify Pavalon in that sample.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And here Armando catches a break because it turns out that Pavalon creates this really unique signature that, which meant, yes, they can identify this drug. And so now it's time to see if what works in pig livers works in human bodies. So in the spring of 1999, the cops start driving out to the graveyards and bodies start getting exhumed. And John said even for him...

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This pulling out bodies from the ground, this was rough.

Serial Killers

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But then three and a half hours later, Salby was dead. That same day, Eleonora Schlegel goes into Glendale Adventist. She has some chronic illnesses, a nasty case of pneumonia. On New Year's Eve, her son Larry, he said in a documentary that she was sitting upright and breathing as best as she could. They apparently have this toast and say next year will be better. Oh, no.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So the caskets get opened, bodies removed, tissue samples are taken out and then sent to the lab of last resort. Finally, after all this time, Armando and his colleagues start testing their very first patient. And... You know, at this point, if they find Pavalon in these bodies, it really does mean, you know, there was no reason for Pavalon to be in their system unless Efren had put it in there.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And then they test the fourth patient.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah. They test another body. They don't find it. But then they get another hit and another hit. And they tell the cops, you know, these, Pavalon, we are finding it. And John remembers how he felt.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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Yeah, so they picked out the 20 patients that were most suspicious because they couldn't exhume a thousand bodies. So these are the suspicious cases.

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I think we don't know. They could have been killed with succinylcholine. Instead, or it could have been that the pavillon wasn't at too low levels to detect, or it could be that maybe the rest of the patients actually weren't killed by Ephraim. We don't know. That's the thing. When you don't find the chemical, you just don't know what the answer is.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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But finding the chemical showed that at least with six patients. There was this drug in there. Wow. Because that's how many patients, that's how many bodies that they found Pavalon in the end. It was six, including Jose Alfaro, who fought in World War II, Salvia Satrian, and Eleonora Schlegel, who toasted to the New Year with her son. Mm-hmm.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And still after this test, the cops actually aren't ready to arrest Efren just yet because this was happening just a few years after the OJ Simpson trial. And that case kind of fell on its face because the cops messed up and mishandled evidence.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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So Armando and his colleagues not only test the bodies for Pavalon, but then all kinds of stuff around the bodies because there was this suggestion that maybe Pavalon would be in the soil or would have been in the crypt water or the embalming fluid and then made its way into the bodies. And so they test that stuff. Everything's looking fine.

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You know, when Ian Musgrave, who was our pharmacologist, read details about their work, he He said, and I have never heard an academic describe a paper like this, but he said it was like seeing an experienced figure skater. Every move is smooth and beautiful. I love that. This one can appreciate the art. Yeah. Yes.

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But on January 2nd, Larry sees a message on his answering machine and it's from the hospital. His mum had died.

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And so in January 2001, this is three years after Efren's first confession, the cops arrest him on his way to work at a construction site. John brings him in for questioning. He tells Efren all the evidence that they have, that Pavalon was found in six bodies.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And as John remembers it, Efren confesses to killing the patients and at first he won't say how many he killed and instead he tells John what it takes to kill patients using Pavalon. And he says with just one vial, you can kill a lot of people.

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Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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What? Yeah. Oh, my gosh. Your mouth fell agape when you heard these numbers. Tell me what you're thinking.

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No, he didn't remember the patients. I mean, he even said that he like lost count at 60 patients.

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So as for the question of why he did it, John actually got, when I asked him, the cop, you know, what do people get wrong when they report this story? And he got quite passionate and he just said, you know, this case has been reported as an angel of death case that Ephraim was trying to reduce their suffering. Mm-mm.

Serial Killers

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But for this case, I mean, John says that they were specifically looking for victims who were getting better. You know, like you said, who were toasting New Year's, who wanted to live. And in that confession room, Efren told John that there was a completely different reason for doing what he did.

Serial Killers

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Yeah. Yeah. Oh, my gosh. Similar situation happens again. Jose Alfaro Sr. He was a father. He'd fought in World War II. He arrives at Glendale with severe pneumonia and two days later is found dead. And at the time, these deaths are sad, of course, but they don't raise any eyebrows because these patients, they were sick, had chronic illnesses. You know, it's a hospital. People die.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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What? Yeah. He told the police that, quote, it was not something that gave me joy. And then he said, quote, only when I was only at my wits end on the staffing, I'd look at the board, who we got to get rid of. What? So callous. We talked to Sarah, our science journalist, about the victims.

Serial Killers

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Efren was sentenced to six consecutive life terms without the possibility of parole for the murder counts and 15 years to life for the attempted murder of Jean Coyle, who was the woman who survived. And there is this extra weird twist to this story, Ashley, because if Efren had gone to trial instead of taking a plea deal, he might have been faced with the death penalty.

Serial Killers

Holiday Break: How a Nuclear Lab Helped Catch a Serial Killer

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And at that time, if he got the death penalty, do you want to guess? They would have used the same drug. Yes. One of the drugs that they would have used to kill him was Pavalon. Wow. So, Ashley, that's the case of how some nerds used some smooth and beautiful moves to catch a killer.

Serial Killers

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Yeah, exactly. Thank you so much for joining the show, Ashley. Thank you for having me. If you want to know more about this case, then go check out our transcript. So in the show notes for this episode, there's a link to our transcript and it's fully cited.

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So there's links to Armando's amazing work that looks like a figure skater and also links to some amazing reporting that was done by staff at the LA Times who we used to help make this episode. Also, Sarah Skoll's book is called Countdown, The Blinding Future of Nuclear Weapons. And this story didn't make the cut. So it's called Countdown, The Blinding Future of Nuclear Weapons.

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This episode was produced by Katie Foster-Keys and Joel Werner, with help from me, Wendy Zuckerman, along with Meryl Horn, Rose Rimler and Michelle Dang. We're edited by Blythe Terrell. Mix and sound design by Sam Baer. Fact-checking by Diane Kelly. Music written by So Wiley, Bobby Lord and Bumi Hidaka.

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A special thanks to Roland Campos, Steve Wampler, Audrey Williams, the Audiochuck team, Jasmine Kingston, Connor Sampson, Stupid Old Studios, and Penny Greenhalgh. Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts.

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And if you are listening on Spotify, follow us and tap the bell icon so you'll get notifications when new episodes come out. Also, if you do like the show, we would love it if you would give us a five-star review because it really helps new listeners find the show. I'm Wendy Zuckerman. Back to you next time. That was one of our episodes from Science Versus.

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To find more stories from us, just search for Science Versus. That's Science VS. We'll catch you soon.

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Really close within days of each other. Okay. Okay. A few months later, though, rumors have been circulating that the deaths of patients like these didn't happen just because they were sick and elderly, but that these people were killed on purpose by someone who works at the hospital. The rumor is that someone is injecting something into their IV.

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Ashley, tell me what your face is doing right now.

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Okay. What on earth happened here and how the hell a lab that develops nuclear bombs got involved? Naturally.

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And so today, I'm telling you the story of how a lab that designs nuclear weapons helped catch a serial killer. Hi, I'm Wendy Zuckerman, and you're listening to Science Versus. Today on the show, how a lab that designs nuclear weapons helped catch a serial killer. And if you're going to do true crime, you better bring in the true crime queen, host of Crime Junkie, Ashley Flowers.

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Welcome back. We've just found out that patients at a hospital in California are dying under perhaps suspicious circumstances. Ashley Flowers, host of Crime Junkie, is here with us. Hey, Ashley.

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So it's now 1997. Whispers are going around that one guy might be killing these patients, and his name is Efren Saldivar. So we talked about him with science journalist Sarah Scholes, who wrote a book about nuclear weapons and stumbled across this case. So Sarah told us that back in Vertigo Hills High School, Efren was a bit of an oddball.

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In the senior Will's section of his high school yearbook at Vertigo Hills, he wrote, I, Efren, of great mind and hunk body, hereby will three quarters of Vertigo's female population my enduring love and passion. The right to preserve me in their hearts and souls for the rest of their lives and other times. Eternally yours and mine, Efren.

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You know, it was the 80s. He was pretty nutty. A hunk. would not be... If I was making a film, a high school film, he would not be cast in the hunk category. It would more be in sort of the dweeby, oddball category. I love it. Okay. So Efren makes it through senior year, but ultimately drops out of high school.

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So he's working at a grocery store, and one day... His friend came in wearing a medical uniform.

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Yeah. Is he talking about scrubs? He liked the scrubs. Which might sound like a weird reason to go into the healthcare profession. But, you know, you're 18. Cute fit. It's as good as any reason. I like cute fit. I like it. It's pajamas.

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I think the person who came in also had a stethoscope, so that might be kind of cool as well.

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So Efren enrolls in a respiratory therapy program, and respiratory therapists help patients who have trouble breathing. So they give patients drugs, oxygen, and manage ventilators, stuff like that. Okay. And so when Efren is just 19 years old, in 1989, he gets a job at Glendale Adventist Medical Center. I see where this is going.

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This is the place where the patients at the start of the episode died. So at Glendale Adventist, part of Efren's job was to take care of really sick elderly patients. And Efren is put on the graveyard shift. So he starts moonlighting and working at other jobs too during the day, other hospitals. So Efren is working all these jobs. He's a bit overwhelmed.

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And at one point, he starts gaining some notoriety at the hospital. So here's Sarah, our journalist again.

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Magic feels like a really weird word to describe it. And this is where, from reporting about this hospital at the time, it seemed like the healthcare workers, particularly the respiratory therapists, had this really, you could call it a dark sense of humor. It

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And then sort of other things start happening that make it harder to pass off as a joke. So here's Sarah.

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A co-worker also says he sees an empty syringe and a bunch of drugs in Efren's locker, drugs like morphine and this medication called succinylcholine, which is going to become important later. Okay. And so in April of 1997, a co-worker ends up reporting Efren to a supervisor saying, But the supervisor doesn't know about the drugs in the locker, so they really don't have that much to go on.

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It's just kind of rumor in a place where there's a lot of rumors and jokes going around. But still, they look into the hospital records to see if Efren's patients are dying more often than other patients.

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Yeah. So they didn't find anything unusual here. They let it go. Efren keeps working. And it's not until almost a year later, in February 1998, that the hospital receives another tip.

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The guy on the phone ends up being a pretty dodgy guy with a criminal record and seems to be implying that if he gets an extra $50,000, he'll give more information. Wow. He's basically extorting the hospital.

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Welcome to Science Versus. Hello. I'm so excited to be here. So something that a lot of people might not know about you is that you graduated from biomedical science. That was your degree. It was. And we are twinsies.

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And so this time, the hospital calls in the Glendale Police Department. And by the way, we did reach out to the hospital to ask them about parts of this story.

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Yes, all questions should be directed at Glendale Police Department. So enter Detective Sergeant John McKillop from the Glendale Police Department. He is put onto this case and John and his team start poking around and John told us that he is actually not buying this idea that Efren is a killer.

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How are you feeling at this point, Ash? What's your spidey senses telling you?

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Yeah, that's John's memory of it as well.

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Yeah. So but still, to sort everything out on March 11th, 1998, John's partner, Detective William Curry, calls Efren into the station just to ask him some questions. But John actually had something else to do that day.

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So I went to my hockey game. You were so sure that like, this is silly.

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I love it. Right. No need. I've got hockey. You take care of this. But it turns out this was not silly. When the cops start questioning Efren, he confesses to killing dozens of patients.

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Yeah. Over, like, what span of time? It's pretty vague at this point. The cops just found it very strange, particularly given this attitude of, I'm going to go play hockey, sure, bring him in. They want him to do a polygraph. The way that the cops remember it is just all of a sudden he starts talking and they were in the room going, Someone get a pen. Write this down. Exactly, exactly.

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So not only did he say that he killed patients, but he also told the cops how he did it. Like sometimes he would kill them with these drugs. He said he either used a drug called Pavalon or one called succinylcholine.

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Does he say why? At the time, he said that he did it to ease the suffering of these patients. Wow.

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Yes. It doesn't really make sense. He sort of fashions himself as a little bit of an angel of death type character in that room that he didn't like seeing the patients suffering, says things like that. Okay. So we wanted to know a little bit more about what these drugs do in the body and why they're used by healthcare workers.

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So we talked about this with Dr. Ian Musgrave, and he's a molecular pharmacologist at the University of Adelaide in Australia. He told us that pavilon and succinylcholine, they interfere with how a particular neurotransmitter works in our body, and ultimately they can paralyze your muscles.

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And so studies find that quite a lot of people who use meth, we're talking maybe one in three, one in two, will get meth-associated psychosis. But this is an experience they'll have while they're high. Those thoughts should go away pretty soon after meth is out of their system. So Tina, she only saw shadow people while she was taking meth.

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And Theo only got paranoid like that when he was using heavily. It is worth pointing out, though, that there are some unlucky folks who still get psychotic episodes even after they've stopped using meth. And they can actually end up with a diagnosis of schizophrenia. What's frustrating is that we don't know the chance that this will happen to you.

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Researchers told me that it's rare, but your risk goes up the more meth that you use. Now, if you are worried about getting schizophrenia, some research suggests that cannabis might be even riskier than meth. So where does this leave us? Will meth break your brain? Well, while you're using it, it can give you psychosis and make you go a little bonkers.

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But for a lot of users, if they can stay off meth, then their brain should actually get better. But that is if you stop using meth. So what's the chance that if you start, you can stop? That is, how addictive is meth really? That's after the break. Plus, a short pit stop at Meth Mouth. Meth is bad. It's going to rot your teeth out of your head. Coming up...

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Today's Ask Me Anything is brought to you by Amazon. Whether it's delivering medication to your door with Amazon Pharmacy or 24-7 virtual care with Amazon One Medical. Thanks to Amazon, healthcare just got less painful. So we are here with our little segment of Ask Me Anything with senior producer Rose Rimla. Hi, Wendy. And you've come to me with some questions from our lovely, lovely listeners.

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Well, thank you. Um, no, I have not done any casting for my voice. And in fact, early in my career, I was told that my voice is too low for radio.

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I think it was explicitly told to me not feminine enough. And I was in fact given tips to speak, I'll do it now, higher up here. in my voice up here and that that would be better for my career if I would speak like this.

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These days, I think about the microplastics episode the most. Really? Yeah. Rose, this was your episode because it really has changed what I do day to day. It's annoying to not put plastics in the dishwasher.

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Thanks, Rose. Thanks, Wendy. Today's Ask Me Anything was brought to you by Amazon. Thanks to Amazon, healthcare just got less painful. Welcome back. Today on the show, methamphetamine. Next up, meth mouth. There's this idea that meth is so bad for your teeth that it'll make them fall out and your gums will turn black.

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And for one of our listeners, we'll call them Fallon, they said that after smoking meth for just a couple of years, a few of their back teeth were pretty messed up.

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And I should say that not all meth PSAs went for the scare the hell out of you approach.

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And a study of more than 500 heavy meth users found that just under a third of them had six or more missing teeth, which is quite a bit higher than the general population. Meth users also have higher rates of holes in their teeth and gum disease. And this all makes sense based on everything we've heard about meth, right?

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And then just tell us how many times you've tried meth. So I asked Kate, does meth eat away at your gums and teeth?

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There's this idea that the smoke from smoking meth is acidic and eats away at your teeth, which is why you lose them. But a study of 300 folks who were dependent on meth found that IV users were actually way more likely to be missing teeth than those who smoked meth. which the researchers said belies the common notions about the corrosive effects of meth. So what is going on here?

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Well, Kate told me that meth can make you grind your teeth and also some people get a really dry mouth from using meth, which could be bad because saliva helps protect your teeth from tooth decay.

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But Kate, as well as some other researchers, have suggested that there could be a much simpler explanation for what's happening here, which is that when you get high a lot, you just might not take good care of your teeth. And research has found that chronic meth users tend to drink a lot of sugary drinks and sometimes aren't so great at dental care.

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Looking at the research, it just doesn't seem like meth is uniquely bad for your teeth. Like a study of almost 60 drug users found that the teeth of heroin users was just as bad as the teeth of meth users. And researchers found that when meth users do brush their teeth, they're less likely to have crappy teeth.

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Quite a few of the folks that I spoke to who had used meth were actually so paranoid about getting so-called meth mouth that they made sure that they took care of their teeth. Like Tina. First of all, I still have all my teeth.

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And so were you brushing your teeth? Is that why you think you were fine?

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A little more alliteration than science. But as I was researching about meth and its effects on the body, I realized that there are some other less well-known things that I really wanted people to know about. And one of them is the toll that meth can take on your heart. Meth can increase inflammation in your blood vessels, increasing your risk of getting a serious heart disease.

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And in fact, in the U.S., more and more people are dying from meth overdoses. It's actually the second most common kind of drug to die from after opioids. People who die with meth in their system aren't just dying from heart attacks, but also things like suicide and car accidents. Okay, our next question. Is meth the most addictive drug in the world?

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But even this busy bee, who's frantically cleaning her house with a toothbrush, ends up in bad shape. And if all that wasn't bad enough, watching the news, it seems like we're in a meth epidemic with this super addictive drug only getting more powerful. This month, the New York Times wrote that meth is more dangerous than ever.

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You know, remember those ads from the start of the show? Oh, not that one. The other ones that were like, I went to a party, I tried it once, and now my life is ruined. Well, is that true? Is that how addictive meth really is? And, you know, because meth has those powerful effects on our brain, it does make sense that it would be super, super addictive.

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And so I talked to our Breaking Bad fan and neuroscientist Martin Paulus about this. Can you just try meth once and walk away?

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This huge survey on the drug use of millions of folks in the US found that in 2023, over 16 million people said that they had used meth at least once in their lifetime. And around 11% of those were classified as having a meth use disorder. So based on that metric, roughly 1 in 10 people who tried meth are currently classified as having a meth addiction or meth use disorder.

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And when you compare meth to other drugs, it actually doesn't stand out. So based on that huge survey, slightly more people who'd ever used pot ended up with a pot use disorder. More people who had tried alcohol ended up with an alcohol use disorder. Another study from the 90s found basically the same thing.

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I mean, in that study, they included tobacco, and you were three times more likely to become dependent on tobacco versus stimulants like meth. And I don't know if you're surprised about this. I definitely was when I first read about it. But the researchers I spoke to were not.

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Because they told me, well, yeah, you know, the reason that you get addicted to a substance, it's driven by the chemicals in the drug, but also a whole bunch of other things, like what your friends are doing, what you have easy access to, what society says is kind of acceptable.

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So I think based on the research, meth does not deserve its reputation as this drug that's going to get everyone hooked. But there is something about meth's reputation that's right.

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Mutton means that the speed that you can go from feeling in control of your drug use to being addicted to meth can be pretty fast. There was this one survey of almost 300 meth-dependent users, and it found that on average, the time it took them to go from trying it once to then having a meth use disorder was around three months.

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which is quite a bit faster, according to other research, than for alcohol, cocaine or cannabis. So while the majority of people who try meth will actually never get addicted to it.

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And this is where that stereotype or even the people that you see using meth in the news, this is where it really comes from. It's the minority of users who fall far. And for most of the people that I spoke to about their meth use, the ones that you're hearing from, Their meth use, it actually did get pretty bad.

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So that listener from the start of the show who at first felt really twinkly, like she was from Twilight when she started using meth, she ended up getting arrested twice. Others lost jobs, got kicked out of their home, found themselves in really dangerous situations. Theo, who started using meth in his late teens, remembers when his addiction had well and truly set in.

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Theo knew the day he had to quit. He was in his room. He could hear his sister on the phone with his mom, who lives in Mexico. He's got a really good relationship with them both, loves them a lot. And Theo could hear them talking about him and how bad he was doing.

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But something here doesn't quite add up. Because, as scientists kept telling me, meth is an FDA-approved drug. Did you know this? In the US, it's used to treat ADHD, and it can be given to people six years and older. Children, we're giving meth to children. So today on the show, is meth really this horrendously bad drug where one hit will get you so addicted it'll ruin your life?

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Yeah. So what did you do next?

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And once you are addicted like this, it can be hard to quit. The stats are a little all over the place depending on stuff like how long the studies follow people for. But as an example, there was this one US study of more than 300 meth users who went to an LA treatment center and they found that around 40% stayed off meth for the first year. Five years later, only 13% were abstinent.

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Another survey, slightly better results, 25% were abstinent. So one in four, five years later. Theo ended up going to AA and Narcotics Anonymous meetings. He's relapsed a few times, which according to one study, happens to about half of those who try NA. But he told me that it's never gotten as bad as it was that first time. And he's doing much better now. Theo has gone back to college.

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He's almost finished a math degree.

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For Tina, when her boyfriend at the time got a job overseas, she saw it as this opportunity to stop using. And actually, when Tina told her mom, I'm leaving, they had this big fight.

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She's been off meth for almost 10 years. And in fact, a few of our listeners that you heard from stopped using by basically walking away. Researchers like Dr. Krista Seyfried at the University of New South Wales in Sydney are now looking into new ways to help folks with meth dependence. And some are pretty surprising.

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Like there's therapy, CBT for meth, where you teach people coping strategies around cravings.

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How do you surf the urge? What's one tip?

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There's also these pretty cool programs out there that will give people a bit of money when they can show that they haven't been using meth. And that has been found to help. And researchers are also looking into medications that we could use here. Like, you know how we use methadone to help people with opioid addiction or nicotine patches for nicotine addiction?

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Well, one of the things that Krista is currently researching is ADHD medication. Not meth, but a drug called Lisdex amphetamine. And their early research is showing that it really could help some people use less meth. As we were wrapping up, I asked Krista, do you think that meth has earned its reputation as one of the scariest drugs out there?

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What exactly does meth do to our brain and our body? When it comes to meth, there's a lot of... Oh, meth.

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Do you know current working title for this episode is Meth, the Most Misunderstood Drug?

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Is it the most misunderstood drug? Well, I had thought that meth was this uniquely hyper addictive drug that was terrible for your brain and even rotted your teeth.

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It's in the naughty pile, but it's just a drug. You know, it can be fun, but also, particularly if you take a lot of it, it can have some pretty nasty consequences. You want to be careful here. I don't know if I'd try it. Probably not.

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And then there's science. Science vs. Meth is coming up just after the break. Welcome back. Today on the show, meth. So right off the bat here, there's this idea that the new meth on the street is like meth on steroids. It's sometimes called super meth and headlines are screaming that it's a monster. It's actually not a new drug. Meth is still meth.

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This episode was produced by me, Wendy Zuckerman, with help from Meryl Horne, Rose Rimler, Michelle Dang and Aketi Foster-Keys. We're edited by Blythe Terrell. Fact-checking by Erica Akiko Howard. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka, So Wiley, Emma Munger and Peter Leonard.

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Thanks to all of the researchers that I spoke to for this episode, including Dr. Heather Barkholz, Professor Nadine Ezzard, Dr. Nicole Lee, Dr. Samantha Brooks, Dr. Steph Kershaw, Professor Stephen Shoptor, Dr. Susan Calcaterra, Professor Harriet DeWitt, and Professor Edith London. A special thanks to the Zuckerman family and Joseph Lavelle Wilson. Science Versus is a Spotify Studios original.

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You can listen to us for free on Spotify or wherever you get your podcasts. And wherever you are listening, if you like the show, we'd love if you gave us a five-star review because it helps other people find the show, hear more about science, which is great. If you are listening on Spotify, though, you can follow us and tap the bell icon so you get notifications when new episodes come out.

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I'm Wendy Zuckerman. Back to you next time.

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But for a while now, it's been produced in a different way. And a big thing is that it's cut with less crap. An analysis of meth samples in the US done by the Drug Enforcement Administration found that in the late 90s, the purity of meth that you'd buy on the street was about 20%. Fast forward more than 20 years. On average, it's almost 97% pure. That is Walter White-level pure.

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So now let's find out what meth, just meth, is doing to our brain. And I really wanted to understand just what it felt like to take meth. So I reached out to our listeners who had tried it and had these awesome conversations about the highs and the lows of using meth. So here's how they described what meth can feel like.

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Hi, I'm Wendy Zuckerman, and you're listening to Science Versus. Today on the show, methamphetamine. More and more people in the US are trying it, and it's got this reputation as being one of the scariest and most addictive drugs out there. Is that true? I feel like basically every message that we get about meth is that it's this uniquely dangerous drug, almost in a category of its own.

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So how can meth make you feel this way? Turn on the happy in your head. I talked about this with Professor Martin Paulus, scientific director at the Laureate Institute for Brain Research. And he loves studying meth. He loves watching TV shows about meth.

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So Mun told me that meth releases a bunch of chemicals into our brain, like adrenaline and serotonin. But a biggie is dopamine, which is kind of like the feel-good chemical. And meth does this pretty cool stuff to get dopamine really working in your brain.

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Normally what happens when you do nice things that bump up your dopamine, not meth, but let's say you have a little sex, you eat a little chocolate, you get a little dopamine hit.

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What methamphetamine does... Is it floods parts of your brain with dopamine, but then... It stops that sucking up. And the fact that then it stops it getting sucked back, so the dopamine will hang around for longer as well?

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Studies in rats have found that meth increases dopamine in a part of their brain by more than 1,000%. Compare that to cocaine, which bumped up dopamine by a measly 350%. Meth also crosses the blood-brain barrier really quickly, so if you're snorting, injecting or smoking it, it means you can get high super fast. Plus, that high can last for hours, some eight times longer than coke.

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So that is part of the reason that meth can give you this incredible high, because it's flooding your brain with dopamine. Dopamine also helps you focus and pay attention to things, which is why a little bit of meth can work as a medication for ADHD. But feeling that huge happy in your head, it doesn't last forever, because like other drugs, your brain builds up a tolerance.

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Dopamine works by binding to all these little receptors on your brain cells. But as you keep using meth, your brain takes some of those receptors away. So here's Martin, our neuroscientist again.

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So that is why you might not keep twinkling as bright as a teen heartthrob when you keep using meth. But then our next question is, what are the risks here? Because people say that meth can break your brain in all kinds of ways. And one thing that a lot of our listeners were worried about who had used meth was how the drug had affected their memory.

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And it is true that when you're using a lot of meth or soon after you stop, it can screw with your cognition and memory. One paper said it was similar to what you might see in folks with alcohol use disorder. You can even see abnormalities popping up in brain scans of heavy meth users.

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Now, it's not that noticeable or bad for everyone, but one guy I spoke to who asked us to call him enough, he's used meth pretty much every day for the last four years. He told me that these days his memory is shot.

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But what a lot of the scary meth news articles out there don't tell you is that if you stop using meth, your brain can at least partly recover. Studies show that even after long-term heavy use, once users stay off meth for, let's say, six months, a year, their scores on cognitive tests improve, including their memory. Over time, some areas of the brain itself even start to look more normal.

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Martin told me that this is good news here.

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Like in this government PSA, you see a normal teenager whose life is ruined by it.

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In the longer term, there are some other things to worry about, though, like meth might put you at an increased risk of Parkinson's disease, which is a disease related to dopamine. But the big thing that you hear a lot about when it comes to meth is that it'll make you go basically psycho, where you start seeing things and hearing things.

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One of our listeners, she asked me to call her Tina, started off just taking meth with friends to go dancing on the weekend. She'd party all weekend on this big binge, and on her way home, sometimes she'd start to see things.

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For another listener, we'll call him Theo. After he was using meth for a couple of years, when he was high, he would get into this really creepy headspace.

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Collectively, all of these symptoms, hallucinating, getting paranoid, this is all called meth-associated psychosis. And researchers say that it can look indistinguishable from schizophrenia. And I called up Jennifer Scheer, a neuroscientist who did her PhD on this at the University of Cape Town in South Africa, to find out why it happens.

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And she told me something that most scientists studying meth don't. didn't tell me. I love meth.

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Jen used to go to these dance parties in South Africa, and she tried meth a handful of times.

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Anyway, we got to talking about why meth can cause psychosis. And she told me that some of what's going on here is probably from sleep deprivation. Meth can keep you up for days if you take enough of it, and that can make you go loopy in all kinds of ways. But something else is happening here too.

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So right now, you are probably not on meth, and your brain cells are communicating, sending signals to each other in this orchestrated dance that allows you to listen to this podcast and not to think about other stuff swirling around your brain. But because meth has these powerful effects on different chemicals in our brain... Jen says that it can scramble that dance.

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And that's the idea, right? That meth is so addictive that if you try it just once at a party, you won't be able to stop. And in the meantime, it'll destroy your life. We hear that meth will rot your gums, make your teeth fall out. I mean, ever heard of meth mouth? And even worse, apparently after using meth, your brain will never be the same again.

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For example, a really important thing that your brain does is that it inhibits or shushes certain signals. But meth stops some of that from happening. So all of a sudden, you're seeing things and thinking things that you wouldn't normally be.