'That Fentanyl – That's Death': A Story of Recovery in Baltimore
npr.org
npr.org
Now an addict does not need to steal from a ped surgery floor. You can buy fentanyl straight from China in a properly wrapped packet. Dosage is the problem, mixing dry is not easy, hence the street deaths.
I carried narcan back in the day because some of my friends were heroin users. But I never came across a fent addict, now I can only imagine how much of this stuff is floating out there.
Average people have no idea what this stuff feels like, what the pull is like. In reality you never get away from it; it is always there in the back of your mind but you have to tell yourself that it will destroy you.
sorry for the disjoint mess but I am being hit with the thoughts of those I knew who were lost to black.
Apparently fent is the new black.
At least here in upstate New York, there aren't really 'fent addicts'. There are opioid addicts in general, but even the hardcore users are generally seeking heroin, not fentanyl.
People are _really_ scared of fentanyl...
One was a nurse, and the other a janitor. (They took the used patches out of the garbage.).
(That said, we should legalize at least bupenorpine, the generic version. Addicts would have an alternative to street drugs, and doctors who just charge too much. Plus--drug education should be taught early in school. And tell the truth. Like for nine months, the drugs will work. Then you will spend years just trying to feel the way you did before you took opiates:; if you're lucky.)
When talking about drugs, 'generic' refers to a nonpatented version of the same substance; buprenorphine isn't the same substance as fentanyl.
Buprenorphine and fentanyl are _very_ different drugs.
Like many other medications, there is a reason this requires a prescription.
It has a half-life of a few days, people die from overdoses like any other opioid and sometimes they make the mistake of having a drink (or a few) while it is in their system, which could kill them as well.
Overdoses of buprenorphine require exorbitant amounts of Naloxone to keep a patient breathing because of its half-life.
Nalaxone has a half-life of an hour or two in a healthy adult. Right now, a single metered and prepared dose of Nalaxone is roughly $4,500. [1]
> doctors who just charge too much
I agree. Suboxone is a racket, doctors need special licensing to prescribe it and they know they can charge desperate, dying people enormous amounts of money to treat them.
[1] https://www.scientificamerican.com/article/massive-price-hik...
> 4 aces in Texas Hold'em and lost to a royal flush
is not possible. Maybe four nines? Or a (non-royal) straight flush.
The oral version is purportedly amazing, it is basically an off switch for pain, exactly the sort of thing you'll want if some day you get shot or stabbed, or fall over onto a hard surface and break something.
Sometimes the brain is not well equipped to handle exceptional scenarios which none of our ancestors would have survived anyway. For those scenarios, there's Fentanyl.
> How is this unsettling?
What are the economics or pharmacology that make fent apparently widely used in US medicine?
Let me say that I am not qualified to answer that directly, but I can point to some things that I am led to believe.
> French EMT-equivalents use it for severe out-of-hospital cases while opioid derivates are used for diagnosed, chronic needs.
First of all, I don't think EMTs are regularly administering fentanyl at the scene. I could be wrong about that.
Ketamine can keep producing (a very wide range of) primary and side effects for a good 24 hours after it's administered, whereas with Fentanyl you get a lot more control since it comes on and wears off rather quickly. I know people who have used Ketamine recreationally, and the types of intense hallucinations they report seem like they would be pretty incompatible with restraints or some forms of surgery.
Other than that, I think the U.S. seems to have deployed it more quickly because the patients and their insurers are not as cost sensitive as in single payer systems. Common forms of Ketamine are not new to anyone, whereas the most common fentanyl products are from the '90s or later. People say Americans pay a lot for health care, and this is true, but they also get most of the cool new toys, drugs, and procedures first; and so take the first-mover advantages with the first-mover disadvantages.
That said, I don't think the (local) medical uses of fentanyl are particularly important to the abuse problem. I live in Canada, and I don't think we use fentanyl medically as much, but there's a lot of it on the street. It seems to be mostly coming from independent producers rather than theft or fraud against the pharmaceutical companies that package it for use in the U.S. and Canada.
You are, it's more and more being advised for EMS use over morphine.
I'm a paramedic in New York. We carry both fentanyl and ketamine.
Fentanyl is my preferred choice for analgesia (over morphine). It acts faster, is more effective for acute pain, and has fewer side effects.
Ketamine is used for sedation, not analgesia. It's also rarely my first choice (Versed is generally my go-to for sedation, as benzos are much safer in a prehospital setting).
Also, your claim about how the high cost of the US healthcare system is worth it because the "cool new toys, drugs, and procedures" is a common myth... Fentanyl, for instance, was developed by a Belgian company.
This is incredibly misleading. Most pharmaceutical and medical research companies make the bulk of their revenue from the US market, either directly or indirectly, regardless of where they are based.
The US market is the primary funding source for medical research, even for drugs which are developed by foreign companies.
Where the drugs are developed, where the funding comes from, and where they are first made available are three completely separate questions.
Still, lot of heroin addicts around where I live. Most you wouldn't even recognize as addicts, but they're there.
Sounds similar to codeine (medical use, moderate to high dose). It has no particular strong feeling in and of itself, but if I'm doing something I already enjoy it makes things feel a notch better (vs. if I'm bored/annoyed etc. it's hardly noticeable other than being in less pain).
Talking about OTFC lollipops? You can get those in the mail from China? I'm guessing these are disjoint cases.
> Dosage is the problem, mixing dry is not easy, hence the street deaths.
I feel like the bad rap it gets is mostly about dosage, ultimately it is the market at work despite the law, producing ever more potent and compact (concealable) fixes as customers demand. If caffeine were a controlled substance, people would buy it more often in the (hazardously potent) powdered form. When booze was prohibited, it was regularly distributed in 180/190 proof.
The demand is the part you can improve, the supply is the part you think you can solve.
> This stuff is a nightmare like you can't possibly understand without being there yourself
From someone who hasn't been there themselves, but just lost my best friend to fentanyl, I hope you stick with recovery. She was actually in a very nice recovery program, but managed to sneak a cell phone in. Point is, it only takes one bad decision that I hope you don't make.
It ended for me when I got old enough to notice the kids at these places I was going to by my drugs, just to do my dirt and leave. The last straw was when I stumbled into a bedroom while trying to find a bathroom at a dealers house. I walked into a room with 6 or 7 kids under 10 years old wearing big bubble coats and gloves, all huddled together in the middle of the room trying to stay warm. It was winter, and it hadn't dawned on me that the house had no heat. I've never been able to forget how I'd been contributed to their situation, my actions rippled out to affect many people beyond myself. Relying on drugs started to feel like a very selfish, narcissistic way of life
So much so that first responders are suffering serious overdose from inhaling bags of it accidently.
More crazy was the fact it's for sale on the darknet markets for as little as $150/gram. Worldwide legal use is about 50g a year.
This is what prohibition does - inctentivizes strength per unit mass. It's much easier to import 1g of carfentanil than 10kg of heroin. And I think it will just get worse and worse.
Consider the mixing requirements of carfentanil: one insufficiently ground grain of the chemical is lethal. And the people making the end-product are amateurs.
One kilo from China was confiscated in Canada. Certainly a bit hyperbolic, but "According to the Canada Border Services Agency, the shipment contained 50 million lethal doses of the drug, more than enough carfentanil to wipe out the entire population of the country[...]". Divide that by ten and it's still terrifying. Dump a small bag over NYC Times Square or Mumbai and you'd create mass casualties.
This isn't some crazy, Bethesda-managed super-bug or insecticide. It's a bog standard, synthetic opioid.
The idea of humans actually trying to get high on the stuff is insane and terrifying.
I imagine most aren't (knowingly) trying to get high on it. It'll be cut with binders and passed off as a lower potency opiate.
Genuinely quite scary that it's out there as a drug of abuse.
Still, the ease with which I just found vendors offering bulk fentanyl analogues for not a lot of money (<$10K/KG) is alarming. I knew sites offering so-called 'research chemicals' (mostly barely tested analogues of existing drugs AFAIK) were a thing, but I hadn't expected something as potent as fentanyl to be (seemingly) so readily available.
Carfentanil seems to be a step far further.
I could not read past this without imagining a random corpse in Fallout 4 or Skyrim stretching its limbs out to infinity and dancing and twisting around in the sky like some crazy, drunk harvestman-fairy.
But this is undoubtedly referring to level-4 containment at the National Institutes of Health, which keeps samples of diseases that would potentially be useful for biological warfare.
Also, you say it lacks some of the side effects of morphine - do you have a source for that too? Morphine causes respiratory depression, histamine release, constipation, nausea, loss of libido, inability to orgasm; actually, any opioid that doesn't recruit beta-arrestin (such as mitragynine) will have much the same side effects.
That being said, it's my go-to tool for analgesia. It acts a lot faster than morphine, and wears off faster as well (which is a useful property in the event of an adverse reaction). Before we carried fentanyl, it would not be uncommon for some patient's pain to remain untouched by morphine. I've yet to have that happen with fentanyl.
Carrying fentanyl means the difference between "Let's get some pain medication in place before we manipulate your broken leg in order to splint it" vs "Morphine is gonna take 20 minutes to reach a meaningful therapeutic effect, and we don't have time for that, so just grit your teeth and we'll try to be quick".
Not sure where everyone here is from, but in Connecticut we've seen hundreds of people die from fentanyl overdoses in just the past few years.
In an overwhelming majority of the cases, they were sold what they thought was heroin.
Why should we keep forcing drug addicts to buy from dangerous and expensive dealers? Not only would legalizing heroin save millions of lives, it would bring in trillions of dollars in tax revenue
My girlfriend, who has lupus and constant pain, was recently denied pain medication because the doctor was concerned that continuing to write prescriptions for opiates would cost him his license. So my girlfriend has been in excruciating, 9/10 pain for the last month because doctors are too concerned about over-prescribing because every soccer mom is suddenly concerned that responsible adults in pain are suddenly going to turn into opiate crazed monsters.
As much as addicts need help, the feeling of the general population is that it's better for someone in pain to suffer than for someone to get a safe, known, pure quantity of opiates without having a good enough reason.
http://www.philly.com/philly/columnists/mike_newall/opioid-c...
http://www.nbcnews.com/feature/megyn-kelly/florida-s-billion...
I was looking for an apartment on Craigslist here not too long ago. More than half the rooms for rent I saw were "sober living" half way houses.
Adderall is not so different than methamphetamine.
The well of do these drugs legally and can afford rehab. Many of the people I've know that struggled with opium addiction could not afford to join treatment programs, many of which cost $2k ~ $15k.
There is a lot of money being made in all sides of this game and it's disturbing.
Other way around. Heroin was the response to morphine.
If you can get addicted to it, you can get rehab'd for it if you're willing.
Ftfy
I agree that users should be receiving treatment. But anyone selling or importing these drugs absolutely deserves to be punished harshly -- they are destroying millions of lives.
I don't buy it. I heard exactly this being said about cocaine, heroin, methamphetamine, ecstasy, and yes marijuana in the 80s. Reefer Madness was not a parody movie, and let's not forget that pot is still officially Schedule I in the US.
I'm not saying that all drugs require equal amounts of care - carfentanyl sounds more like a chemical weapon, and for that reason alone should be heavily regulated. But folks tend to overreact with panic every single time a new drug comes up, and I've watched this excuse ("no longer able to make free choices!") used to justify ratcheting up the drug war every time.
This particular claim doesn't pass the obvious sniff test - if fentanyl was so compulsive, heroin addicts would be seeking it out instead of trying to avoid it. Yeah, these powerful new drugs are killing people - and we should lay the blame square where it belongs, with the prohibition of milder alternatives.
What do you think the addiction rate of opioids is?
What is it for fentanyl?
So this oft-repeated mantra that the penal code cannot solve drug problems is frankly bs. I'm not suggesting that we should throw drug addicts in prison for a dozen years, but I'd have no problem letting a fentanyl dealer rot in prison for the rest of their lives. Maybe start sending commandos to kidnap cartel leaders from Mexico to bring them to the US to face charges, for trafficking drugs and for murder. Let's run sting operations with cops posing as drug-seeking addicts to catch doctors handing them out like candy.
I am an American who has lived in Thailand for several years.
The US has a huge drug problem and SE Asia doesn't even come close. The local population does not abuse drugs at all. Nearly all of the drug trade caters to American/European tourists. Which is incidentally why the punishment is so harsh, they do not tolerate foreigners poisoning their society.
Enforcement works.
I feel like if crazy penalties like that were levied in America we would take it as a challenge. We have a long history of that.
If anything, stigmatizing a situation only drives it underground where it isn't talked about, and essentially flourishes in the darkness.
In this case, how would foreigners be responsible for "poisoning their society"?
To me this sounds a lot like what you here in the West concerning drugs... America claims its' foreign traders with "terrorist connections" who do drug sales (e.g. all the talk about Colombian drug cartels, or Mexican drug wars).
I see how that can work in some cultures and countries. I just think that approach wouldn't be very effective in the US. Probably not effective in countries larger than a few thousand square miles even with strong cultural support.
I for one am very happy not to be living in an all-powerful police state. What's obviously "moral and good" seems to be awfully fluid across history.
But I think enforcement can work if we're willing to do what must be done. People exporting and importing large quantities of hard drugs into the United States get no sympathy from me.
But now? Super powerful chemicals being continually adjusted. A zillion e-packets zipping around the world. Forget about full enforcement. That is no longer possible if we "just try hard enough". Unless maybe you want to stop the mail and bomb 35 countries into smithereens. And incarcerate even more people than the ridiculous number we already have. We can still "discourage" with occasional busts (and probably should for deadly drugs for now) but maybe it's time to sit down and rethink rather than continuing to playing wack-a-mole.
Make better drugs. Less harmful ones. That's the eventual answer I think.
It's clearly not working.
https://www.vox.com/policy-and-politics/2017/5/30/15591700/m...
The US incarcerates more people than any other country, and yet it still has much higher rates of crime, including violent crime, than Europe.
If imprisonment worked to reduce violent crime we'd expect Europe to have higher rates of violent crime than the US.
Your point about Singapore is taken though, you raise a strong point. I think the issue though is that there are two effective ways to deal with drugs:
1. Totalitarian-police-state-type of enforcement (lets call it the Singapore model) where even low level offenders are hit were severe sentences.
2. The end of prohibition. This destroys the current economic framework supporting the drug industry; this would severely reduce the violence associated with the illicit drug trade.
What doesn't work is this sort of middle-of-the-road approach that we currently have.
Obviously, these two are at exact opposite ends of one another. I think we should pick the one that is more fitting with our national character and purported values of life, liberty, and individualism (the 2nd option...)
Wow, yeah, let's just invade another country and commit an act of war to get what we want.
This is one of the reasons why a lot of the rest of the world hates Americans.
"International law" does not exist. In international affairs, there is only power. If the security of our people depends on resolving some situation in another country, then we must do it. Some worthless piece of paper with no realistic enforcement mechanism (i.e. not law) be damned.
This has been tried in the West for decades and not worked so far.
> letting a fentanyl dealer rot in prison for the rest of their lives
This already happens.
> sting operations with cops posing as drug-seeking addicts to catch doctors handing them out like candy
This already happens as well, although you then have to draw a line between perfectly legal prescription and illegal dealing.
> If you sell drugs, you get executed
This policy is currently collapsing the Philippines; 7,000 dead already: https://www.hrw.org/report/2017/03/02/license-kill/philippin...
"Even prior to announcing his candidacy for the May 2016 presidential election, Duterte was already very clear about his intention to eliminate crime by eliminating criminals: “If by chance that God will place me there, watch out because the 1,000 [people allegedly executed while Duterte was mayor of Davao City] will become 100,000. You will see the fish in Manila Bay getting fat. That is where I will dump you.”"
The massacre of 100,000 people would put Duerte well into the "crimes against humanity" league.
And this is ignoring state violence.
And we'd have to send your commandos into China as well as Mexico if we truly want to stop the opioid epidemic. That's where all this fentanyl and carfentanil is coming from.