This is the last Season 4 episode where Marge speaks because she has no lines in the following episode.
The Devil costume Homer wears when he visits Marge in prison is very similar to the outfit "evil Homer" wore in Homer's imaginary sequence in "Whacking Day".
This episode has assumed to predict the COVID-19 outbreak of 2020, although it can be doubted. Episode writer Bill Oakley criticized Internet trolls for using the episode for "nefarious purposes", including creating memes replacing "Osaka flu" with "coronavirus." Oakley stated his reference for the "Osaka" plot device was the 1968 flu pandemic which began in British Hong Kong, stating it was "just supposed to be a quick joke about how the flu got here." When speaking on "predictions" from The Simpsons in general, Oakley continued "It's mainly just coincidence because the episodes are so old that history repeats itself.
Comparisons to the episode experienced a resurgence in May 2020, following advisories by Washington state regarding Asian giant hornets in the region, citing a scene where an angry crowd tips over a truck they believed contained a "placebo" for Osaka flu, and accidentally unleashing a swarm of killer bees from a crate in the process.
Again in late May/early June 2020, the episode garnered more comparisons, as during the course of the episode, Police Chief Wiggum tries to control a protest using excessive force.
It's widely regarded that this episode is a summary of 2020.
Marge was convicted of a misdemeanor. She would have served her sentence in County or City Jail, she would not have been housed in a prison (state and federal institutions) alongside convicted murderers and other felons.
When the Japanese factory workers talk and then laugh, their lips are out of sync, but then returns to normal when one of them coughs. This may be a joke referencing bad English dubbing of Japanese movies and TV shows.
When Apu investigates why Marge triggered the alarm, the "GR" in "GREEN" on the label of one of the Squishee containers changes to an unknown symbol. When Apu explains the price of the aspirin and when he realizes that Marge did not pay for the bourbon, it changes back.
Also, the liquid inside the container is yellow.
The title of the episode is a possible reference to American rock band Alice in Chains.
Flanders blames his kids getting sick on God punishing him for watching Married...With Children. Married...with Children was, like The Simpsons, a FOX sitcom about a down-and-out, dysfunctional suburban family. Unlike The Simpsons, Married...With Children was a live-action show, had stronger sexual jokes, a more cynical take on modern life, premiered the same day FOX premiered as a channel (in 1987), and finished after a ten-year run. The joke in which Peg compares the lifeless and limp plants to Al's bedroom performance were the kind of jokes that were heard on the show.
Tattoo Annie has a tattoo on her back with Alfred E. Neuman on it. The tattoo references MAD magazine fold-ins and the phrase "What Kind Of Slime Would I Marry?" folded in reads: "What, me worry?", which is Alfred E. Neuman's trademark phrase.
Lisa says, "It seems like I've been wearing this same red dress forever!" This is a nod to the fact that Lisa is wearing the same red dress in almost every episode.
When the foreign workers are loading the Juice Loosener, the silent cut is quite likely an audio gag in reference to voice translations often being longer or shorter than the foreign speech it replaced.
Their oddly-placed laughter is also a gag about the prevalence of misplaced laughter in older English-dubbed Japanese media.
Maude watching Marge through a crack in the wall hidden by a picture is a reference to Alfred Hitchcock's movie "Psycho".
The Jimmy Carter statue's plaque has the words "Malaise Forever" (later modified to "Marge Forever" alongside the statue), a reference to Jimmy Carter's infamous Malaise Speech.