Fentanyl vaccine tested in rats | Hacker News Reader

Fentanyl vaccine tested in rats

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113 pointsca98am79373 comments

The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine? If we don't address that nothing is going to stop the drug abuse let alone the relapse and overdose. I'm not talking about "more 12 step" here but more of a Frommian psychoanalytic approach. You are broken because society is broken. You have the ability to change yourself and subsequently society. A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.

I guess I'm a bit torn on this. Even if we had an extremely fair and equitable society with growth I imagine there'd still be plenty of people who feel rejected or lonesome at times. Or just like the feeling that these drugs give them above normal drugs.

I drink alcohol a couple times a week and do edibles once a month. I'm sure some would argue I'm not fulfilled but I think the easier explanation is that a lot of times doing mind-altering drugs is...fun? And can be social.

That sounds like a healthy amount of drugs. For people with self control like that, I think it would be healthy to trip once or twice a year and use stimulants (cocaine) for a party once a year.

A heroin vacation to an opium den on occasion sounds wonderful.

I certainly have used drugs socially (LSD in clubs or concerts can be fun), but also use them cannabis alone frequently.

This is the crazy thing about this whole issue. Some people can use drugs that are extremely harmful responsibly. It's a once-in-a-while excursion away from ordinary life. There's nothing wrong with having a scary drug, like heroin, a few times a year...except that for some people it leads to their entire life unraveling.

This idea that we're all the same and because drugs are physically addictive (i.e., sustained use leads to withdrawal of use ceases) means everyone would become addicts if they tried it is a D.A.R.E. style falsehood. It's true for some, but seemingly not most.

Even drugs/activities that don't seem physically very addictive, like pot and gambling, seem to have their addicts. I question what proportion of addiction is chemical and what is something deeper going on.

It's a pity though. I don't think I'm prone to addiction, but for the sake of my fellow humans and a functioning society I reluctantly accept that these things shouldn't be widely accessible. I've become much more of a prohibitionist as I've gotten older.

I appreciate the selflessness and pragmatism. Many responsible users are much more dismissive of prohibition.

It seems selfless but not pragmatic. Prohibition doesn't seem to make the opiate problem smaller, it just makes it more dangerous for users, the public, and the people selling it.

I have known quite a few friends from earlier in my life who became serious addicts and ruined their lives or ended their lives by it. I would not describe a single one as having started using because they were mad at society, sad, or lonesome. It was always some strange kind of strange, arrogant fetishization of drug-life and crime-life. There is an almost "drug life is THE life, and everyone else is lame" attitude in many circles, and I got a little too close to comfort to falling into it at one point in my life.

This doesn't mean there aren't a hundred reasons people get trapped in drugs. But a very real one is just because many people come to believe it's cool and tough, and end up fetishizing it until it's too late to get out. And like I said, in my hometown, this was the predominant reason.

Were they bored, did they not have exciting career or family prospects, was it ennui? Low-grade emotions can lead to addictive behaviors, not only high intensity trauma. The decision to subscribe to a malignant anti-authority lifestyle still shows that something is wrong, if it becomes so attractive an alternative to forsake one's life for.

Reading HN, I get the strong suspicion many people didn’t grow up around drugs.

People don’t always think they are throwing away their lives. They think “this makes me cool” and “it’s no big deal” and “anyone who’s anyone does it”. Often there’s the confident assertion “this ruins other peoples lives but I’m too good/special for that”. And often they don’t even realize it’s a problem, even when they’ve hit rock bottom, even when they’ve ruined their families lives for their drug addiction.

I’m not claiming other, much sadder reasons don’t exist. Or that we shouldn’t do something to help people survive and recover, like this vaccine that could mean thousands of lives saved, thousands of fewer mothers crying at funerals.

But there is also a lot of personal responsibility involved, and we can’t make this claim, that I see so many people on HN try to make, that people who have ruined their life (and more importantly, often their families lives) thru their own choices have no responsibility. That it’s all fault of vague “society” and if we just ban together with <vague handwavy socialist/utopian/whatever vision>, that people will stop making bad decisions about their lives.

Society doesn’t have to be a big nebulous thing. It can just mean the immediate family, the community, the town, the local economic situation.

> The decision to subscribe to a malignant anti-authority lifestyle still shows that something is wrong, if it becomes so attractive an alternative to forsake one's life for.

"anyone using [opioids]...wants to die, just a little, i think"

“It is no measure of health to be well adjusted to a profoundly sick society.”

Also, this: https://www.dailymotion.com/video/x305n83

Probably because it feels good.

Sometimes the simple answers are the most likely. Even if you have a great life, it’s tempting to have such experiences.

Sure, a lot of people use it as an escape though. But I imagine my dumbass brother in law died because he was trying to have fun, not check out of life. Miss him.

> Probably because it feels good.

This is the dirty little secret of 1980’s-style approach to keeping people off drugs: they feel great.

The old (current?) approach suffers from intellectual dishonesty of ignoring the physical pleasure.

They’re adding Fentanyl to everything now. I have Burning Man-adjacent friends who take ecstasy once a year at festivals, and they’re terrified of getting a tainted dose.

This affects many more people than just those addicted to opiates.

Legalize everything and produce it pharmaceutically, and this problems pretty much disappears.

Yeah, and a whole host of other problems show up…

can you elaborate?

“ Illegal drugs increase crime, partly because some users turn to crime to pay for their habits and partly because some users are stimulated by certain drugs to act more violently. Legalization, however, will not affect addiction and its effects on the propensity to violence. Instead of legalizing drugs, better treatment, education, and research are needed to curb dependency on drugs and the adverse health and social effects of drug use.”[0]

[0] https://www.ojp.gov/ncjrs/virtual-library/abstracts/against-...

'illegal drugs' is a pretty broad brush, and treating opiods and psychedelics equivalently is silly. Surely treatment, education and research would all be far easier alongside decriminalization?

"Illegal drugs increase crime, partly because some users turn to crime to pay for their habits "

If all drugs would be illegal, then they would be mostly so cheap that this argument falls apart very quickly. Drugs are only expensive because they are illegal. Poppy and coca are not hard to grow and neither is hemp. And the chemical drugs are way more cheap to produce. So very high quality stuff would remain expensive, the same way a fine wine is expensive, but just to get drunk is cheap (even with taxes).

"and partly because some users are stimulated by certain drugs to act more violently."

And yes, that is true, but one of the most famous and widespread drug that makes people aggressive is already legal - alcohol.

"Legalization, however, will not affect addiction"

And this is up for debate, for some it will be easier to get help, because the stigma and criminalisation is gone, but yes, some might start it, because it becomes avaiable. And I did not look in the recent numbers, but back then when I did - in the netherlands for example, drug use decreased, after marijuhana was legalised. It is quite complex - some people are afraid of anything illegal, some are appealed by it, mainly teenagers who are in most danger of becoming addicts/developing brain damage.

"better treatment, education, and research are needed to curb dependency on drugs and the adverse health and social effects of drug use."

But this is true. And better, than jail people who simply need help.

- The black market is always cheaper.

- Even in a legal market how many people are always buying their own?

- If everything is legal then it's even easier for people to spike drinks and the like.

- Purdue Pharma marketing issue writ large.

- Patients pressuring their doctors to prescribe, or alternatively feeling pressured by their doctors to use a particular drug.

- If it's legal it's easier to purposefully or accidentally overdose (e.g. alcohol today). Especially if it's also cheaper.

Off the top of my head.

That bit about Purdue resonates with me. I'm not firmly against legalization of harder drugs, but that's a case where average people given legal access to pharmaceutical-grade medicine through proper legal venues has been absolutely catastrophic. If I were making a case against legalization, that would be my Exhibit A.

> - The black market is always cheaper.

anecdata: I'm in canada, which has legalized marijuana recently. The black market is cheaper, but all but the most die-hard stoners I know like to buy government weed, because the product is consistent and you know what you're getting.

> - Even in a legal market how many people are always buying their own?

Maybe I'm misunderstanding, but in a legal market even if I don't buy something directly at least I have vastly increased faith that i know what something is.

> - If everything is legal then it's even easier for people to spike drinks and the like.

Who knows, but I strongly doubt that there is a large pool of potential rapists at large who are currently stymied primarily due to the difficulty in acquiring GHB.

> - Purdue Pharma marketing issue writ large. > - Patients pressuring their doctors to prescribe, or alternatively feeling pressured by their doctors to use a particular drug.

There are definitely a bunch of social and policy questions that would need to be addressed when considering legalization, sure.

> - If it's legal it's easier to purposefully or accidentally overdose (e.g. alcohol today). Especially if it's also cheaper.

Almost certainly not, as the majority of overdoses are the consequence of people not knowing what they're taking, or not knowing how to take it.

Hell even in states where it's illegal people prefer to drive to a state where it is legal or get it shipped compared to "street weed." This isn't to say that the market has dried up or anything but it's clearly an inferior good in the economic sense. As soon as as an alternative of comparable price entered the market people immediately switched.

Die-hards make up the most volume for recreational substances. Alcoholics by far consume the majority of alcohol sales, for instance.

MDMA became dangerous after it was made illegal.

When it was legal, it was made by chemists in labs who cared.

The problem with legalizing drugs is ensuring the greedpigs don't take over the industry and actually dealing with the root causes of addiction.

A better way to frame the drug legalization issue is, "should pharmaceutical companies be allowed to profit from incredibly addictive drugs?"

Does that framing change your mind at all? Sure, small-time drug dealers are currently allowed to profit from it. Once they get big enough though, they're usually stopped by the DEA.

The idea of giving this enormous profit incentive to multi-million dollar corporations with huge advertising budgets is absolutely terrifying to me.

This is an inaccurate understanding of the drug economy. The drug cartels that supply the street dealers are multi billion dollar businesses rivaling the size of the big pharma corporations. And the DEA absolutely is not "usually stopping" them. They disrupt low and mid level arms of their operations with some regularity, but it does little to stem the rivers of money flowing towards the groups controlling the illicit drug trade at a high level.

Even if we presume that big pharma is a very corrupt industry and that allowing advertising of narcotics would increase drug use in some populations, bringing the production and distribution into a moderately well regulated market would likely cause a net reduction of usage and overall harm.

Didn't we kind of already try this out some with opiates? Didn't big pharma already push opiates and cause millions of people to become addicted and cause an untold number of deaths and didn't that contribute to the current situation that we are in now with opiate addiction?

I don't see how legalizing it completely where anyone who wants it without a prescription could possibly turn into anything but an absolute mess. How many millions of people will say "O, the government legalized it and I can buy it in a store, it must not be so bad, I might as well try it out", become addicted and have their lives ruined? People can't rationalize their way out of addiction of this stuff easily.

Not exactly, hence the rise of fentanyl. Prior to the rise of fentanyl, new addicts often went from prescription pills like oxycodone to heroin as their lives unraveled because prescription drugs are expensive and hard to get. Some enterprising drug dealers started enhancing their cut heroin with fentanyl which can be imported from China and is extremely dense compared to other opiates, which matters because smuggling is most of the cost. Downward pressure on the prices changed the ratio until you were left with pure fentanyl, so in effect prescription pills were not available enough and drug dealers were able to capture the market with more dangerous but cheaper product.

> bringing the production and distribution into a moderately well regulated market would likely cause a net reduction of usage and overall harm

I don't understand how adding a profit incentive somehow _reduces_ the usage. Because the government would force less consumption somehow?

If they were generic, not marketed (a la nicotine products), and used a system similar to the one used by pseudoephedrine, I think it could work.

I think there will be a really big systemic drive to stop this kind of system because if we’re doing this already for “vice” drugs, why not do it for all drugs even if they don’t get you high? This would remove tons of middlemen and give consumers a lot more control over how they get their medication.

>produce it pharmaceutically

They are... in Mexico... with expert training from China...

With no consequences for chemically altering their products... or getting people killed...

Doesn't sound too different from Big Pharma in the US, at least in certain drug categories...

The problem is not actually the production of the fentanyl itself, but the way it’s mixed in with “heroin” or pressed into pills (plus all the likely accidental contamination from using the same equipment to process fentanyl and stuff like cocaine). If the mixture is not done well, it creates hotspots that can easily cause an overdose due to a much higher density of fentanyl.

And also, this part is not necessarily done pharmaceutically, so there is no standardization of dosage or strength. Which can in part incentivize producers to progressively increase the ratio of fentanyl to <other> so theirs is “stronger”.

I think this highlights the importance of addressing the _why_ even more. Most people are terrified of accidental fentanyl exposure. Some people seek it out. Why is that?

> Some people seek it out.

who's seeking it out? The article doesn't mention it, and the parent poster explicitly say that people are NOT seeking it out.

People that are already addicted may seek out the lowest cost opiate.

Yup.

Heroin will barely make some feel well.

Fent burns the Mu-opioid receptors, once normalized, H will barely get you high.

and, of course, you literally must have it - especially, to sleep.

Why some people try it out is different than why people keep using it. Why people try it out can range from getting addicted after being prescribed something legal to wanting to escape life. Why people keep seeking it out/why they are addicted is hard to rationalize and understand and is like answering the question why do people like sex? You can't peer into your own mind, determine how its working and how you can manually change it. After addiction there usually needs to be some adverse event or events where people realize that the pain is greater than the pleasure, but there are still other people where even majorly adverse events don't change their rationale. Why people use fentanyl over other opiates is kind of simple. It is cheaper than everything else, there is a high supply of it, and it is stronger than everything else.

It’s important to some people’s culture and religion.

Test strips: https://dancesafe.org/

Or on amazon

They give these out in NYC, but make a point to say that the test strips won't catch everything. So still be really careful if you go this route.

Yea it’s like skiing in avalanche terrain. Forecast and observation don’t remove the risk

Yep. I've seen bowls of those available for free at various events. Even if I'm not going to partake of stuff that would need those, I'm happy to see them passed around freely.

Test strips are just as or almost as illegal as the drug themselves in many state. Except without the huge profit margins to incentivize dealers to carry them.

Why are they illegal?

"Paraphernalia."

IN my state it is a felony have a reagent that say tests for THC whereas ownership of the THC itself is legal.

That's idiotic. I put it right up their with "let's reduce pregnancy by making it hard for teens to get condoms so that they don't have sex".

That's very confusing to me. Criminal drug dealers of course want to lower their costs and maximize repeat business, even if that hurts their customers. But people consume different drugs for different reasons, and I don't see the economic benefit in giving them something orthogonal or opposite to what they're actually looking for, when it would be cheaper and safer to just dilute with some inactive filler material.

A likely explanation is that China is using the cartels to wage a 21st century opium war. (The obvious link to China being that China produces most of the chemical precursors to fentanyl, and until recently produced most of the fentanyl itself.) The average American drug user isn’t the customer; he, or rather his eventual death or disability, is the product.

More parsimonious explanation is that the PRC bureaucracy isn't going to waste resources cracking down on precursor producers for legal medicine ingredients when it doesn't cause domestic issues, or issues in the majority of countries, including other eight nation alliance members that have exploited China far more than the US. Like why wage 21st century opium war against only 1/8 of historic grudges. The primary incentive to assist the US med system driven opiate crisis prior during periods of better relations was because it was politically worthwhile to waste PRC resources to cooperate on US war on drugs. If PRC really wants to be nefarious, she would engineer less lethal drugs that keep victims alive longer to drain more American resources. And she would move back to actual drug production instead of maintaining olive branch precursor production. In so much as working with cartels on state level, IMO PRC benefits more from intelligence / influence of triad + cartel relations as they try to make headway into the Americas. The actual killing Americans is incidental because Americans will reliably find other ways to OD.

the cartel, albeit advanced, are basically a village idiot on the ground for the PRC. this all makes sense.

Fentanyl deaths are rising in many Western countries, not just the US. Plus, the US is the primary geopolitical rival to China and hence the most relevant target. It's not worth the effort for China to exact revenge against, for instance, Austria and/or Hungary because neither of those countries are relevant to China now.

It's accidental, the deadly doses are so low that just not separating them perfectly when weighing or packing might contaminate the other.

It’s not always added intentionally. I think a huge number of those deaths are complete accidents

The two chemicals are made in the same superlabs in Mexico, with the LD-50 (lethal dose in half of average users) of one being 4 magnitudes (1,000) the other.

While I agree with you, at the same time, I can't help but think having someone take a pill or shot weekly/monthly/etc is whole lot simpler and easier than fixing the homeless problem, the cost of medical care, and training up (and paying) hundreds of thousands of new mental health professionals, among the dozens and dozens of different reasons people turn to drugs like this to 'escape'.

Do we have a clear picture for where we want this to go in the future? Though not exactly the same, does this start to walk the path towards a "soma" equivalent?

Humans were not evolved to resist these kinds of poisons. Nothing like this exists in nature. It’s an extremely potent chemical.

It's not that nothing like this exists in nature, it's that evolutionarily speaking nothing like this existed in the areas human first evolved. Or if they did, we either evolved to resist them, thus no longer see them as toxic, or we're still in an arms race with the life that produces them (which means they would be much less toxic than fentanyl, but still toxic).

Plants (and fungi, and animals) evolved to create noxious chemicals that keep animals from eating them, keep animals from breeding, or outright kill the animals. The Golden Poison frog's toxin is about 40 times more lethal than fentanyl.

The golden poison frog looks pretty scary to me. The yellow color. The big eyes. I would not try to eat it. But a white powder or pill that is equally lethal doesn’t ring any evolutionary alarm bells.

Could you please link to or expand about plants producing toxins that specifically keep animals from breeding? It's news to me, and a web search has failed me. Is that long-term pest control, or something else?

The term you want to search for is "phytoestrogens".

From wikipedia: "It has been hypothesized that plants use a phytoestrogen as part of their natural defence against the overpopulation of herbivore animals by controlling female fertility.[3][4]"

Though wikipedia also says: "These compounds in plants are an important part of their defense system, mainly against fungi.[19]"

So it could be that plants are principally targeting fungi for the most part, and just serendipitously targeting animals as well.

I'd say the opposite, nature creates all kinds of powerful attractants and poisons. There are plenty of things that will kill you at the micrograms dose. There are plenty of natural things that are horribly physically addictive.

I think you assume folks want to check out of life because they think fentanyl is a better choice, when instead fentanyl makes folks check out of life. Have you ever spoken with an addict who wants to get clean? It's bleak, they're basically enslaved by the substance. Having a vaccine to break the cycle is a huge boon.

I'm homeless and living in the Tenderloin in San Francisco.

People here want you to

- Be in a gang (or a prostitute, thief, ex-con and so forth) - Be on drugs (or in rehab for drugs) - Have a mental illness (so you can go to therapy) - Be disabled - Find religion

There isn't a position for "I ran out of money and my family wouldn't support me, and at some point finding web development work became too hard as the technology became more complicated." People want you to "get better." I don't do drugs, I don't smoke, I don't drink, I don't steal or assault anyone.

I just don't have any money.

But people here are morons. They need to have a reason for why someone is poor other than "I'm a person of average intelligence that doesn't know how to find a paying job in this society." I don't want to be psychoanalyzed, be put into rehab, go to church or join any number of the lonely people who have to have a support group because society is awful. I don't have problems other than being poor - if you managed to buy into the crypto ponzi scheme at the right time then no one is asking you to "find god" or "get better".

People are social animals. If you put them in a position where those are the options (jail, crime, drugs, psychoanalysis, religion, disability) they'll take the least unpalatable. There's a whole lot of people who walk around here with canes they don't need because otherwise the San Francisco General Assistance office won't spring for them to have housing. Also known as an apartment with a bed and a door that locks.

If I make more than 1500 dollars I lose my health insurance through Medi-cal.

And I'm no defender of a lot of these people. The bastards that set up tents on the sidewalk and smoke meth are just awful. But on the other hand, I have absolutely no idea how to get a job. None. I've done construction before and all I ended up with was bad memories and scarred hands. I could work "security" by putting on a t-shirt and standing outside a soup kitchen, but that's just bullshit make work the charities give out so the poor can buy shoes and feel special about themselves. Real security jobs outside of bars are a good way to get killed. And that's about it. I'm staying at a homeless shelter and have the clothes on my back so how am I supposed to get a job?

There's your why.

So let me give you a when. When, not if, your industry is automated or the code becomes too complicated for you to understand anymore you'd better have enough savings or a social network so you don't become homeless. Or you'll have to crawl into one of the buckets that allows society to make sense of you.

And today I'm sitting in the San Francisco library looking to make a contribution to a software project for free and I just don't know that I care anymore. And if you tell me it'll get better, then I have to ask if you're about to be laid off or not and what your plans are.

Thank you for sharing. I'm sorry.

You've explained this much more clearly than I've seen done before. Maybe because I hear my voice in yours.

Skip the web dev and be a writer. Surely other HNers can hire patientplatypus for this?

If you check the comment history it is unlikely that anyone here wants to listen to what this person has to say, let alone provide them with work. I have skimmed through a few of the comments and IMO there is nothing in there that warrents the downvotes / dead comments, which appear to not even get replies (tut tut HN, breaking your own "rules" again)

I do wish this person well however, I hope luck smiles down on them soon.

This comment will go the way of the dodo soon enough .!.. :-)

I’m not sure why it’s getting praised. The guy hijacked a thread discussing drug addiction so he could get on a personal soapbox and drone on about his own problems while trying to diminish others.

It was in response to this comment:

"The real issue here that people don't seem to want to face is the WHY."

They provided an answer to "why?". I think thats fair. Maybe I am wrong. I checked further on the comment history, it appears to me someone has it out for this person, as the other topics are not soapboxing at all, and most or dead without comments.

Care to discuss further?

Upon second reading, I misinterpreted GP and I don’t think they had any bad intent. So apologies to them for that.

As for the shadowbanning I’m not sure either. It’s not particularly new and like you kinda mentioned they don’t really say anything egregious, at least that I saw. Some accounts seems to be shadow banned at creations and the user doesn’t seem super active, but I’m not sure how all that works under the hood. I guess it’s even possible the GP comment was already dead, and was later vouched.

It seems relevant to me in a discussion of a vaccine to prevent people inadvertently getting addicted to drugs and having their lives spiral out of control for someone to bring up what it's like when you're not addicted to drugs and have your life spiral out of control.

GP mentioned that it's expected he'd be addicted to drugs because then the system would be able to categorize and address his needs better.

It's not a 1:1 match for the article topic, but I come to HN for the comments, especially ones that engage my curiosity, like GP's did.

I've been homeless and I think part of that is just for someone with no problems it doesn't make sense to be inner-urban homeless in these crim-ridden areas. I assume those people are all fucked up for one reason and therefore as a sane person I don't want to be around them.

I had a very strict rule when I was homeless. Stay away from other homeless people. Camp on the edge of town. Ride the bus into rural areas.

How did I get a job with just the clothes on my back? I hitch-hiked to north dakota in the oil fields where a man is a man and they don't give a fuck what you look like. They hired me to do day labor, and once you have enough money for a van or a short stay airbnb it only gets easier from there.

Get the fuck out of tenderloin, and san francisco at all costs. Hitch-hike if you must. If you want guaranteed housing you can also look into doing seasonal harvesting work for fisheries in alaska. They'll pay your flight from seattle and then cover your food/shelter while you're working.

Yeah, this right here.

Fishery: paid for transportation to the job, free housing and food on the job, and at the end of it you have a couple grand that hasn’t been blown on anything — free to do whatever you want with.

Tough work. You’re on a boat for 1-2 months. You work 12ish hours a day. If your body is able (or you can make it able), it’s good.

Next up is getting housing and cleaning yourself up for greener pastures. Oil fields is one. Lineman/tower climber is another.

Easy six figures. After a year of doing nothing but work, figure out what you want to do from there.

The work will distract you from your problems, and the change in environment will reset your mindset.

Lots of well-paid trades work in Washington for people that don’t have anything to lose.

I can't guarantee that I can help you find a new job or master skills but I'm willing to try. My email is kodah@pull.dev.

I'm sorry for your situation, but you also have to realize, things are partly your fault. You mention you could be a bouncer at a bar, but you would have to go to the gym to develop enough muscle. And possibly start using chemicals to alter your bone density and muscle mass. In your situation, I'd say you have to go "all in" on something, whatever it is. If you just half ass it and complain that the world is against you, you will not go anywhere. That's just how it is.

`And possibly start using chemicals to alter your bone density and muscle mass.` Just when you think you've seen some depraved/inhumane takes you see someone suggest that actually this homeless person deserves to be where they are because they're not risking enough of their health by taking hgh/ped to get a meager paycheck as a bouncer at a bar where they could very well get stabbed or shot providing security for a bunch of tech workers that hate their guts.

` If you just half ass it and complain that the world is against you, you will not go anywhere` This man is homeless what are you talking about?

I think you presume that human behavior must seem to have a cognitive reason for the "why", when it's entirely possible that the "why" is simply physiological/neurological. In the case of intense opiates, which have a profound effect on human neurology, it would be bizarre to not consider that in the "why".

I think this undermines the issue a bit. A lot of people get addicted to these substances completely by accident and aren't initially seeking to "check out of life." But once you are hooked, it can be a devastatingly difficult road to get off. For sure there are plenty of people who go out looking for escapes and I do agree it is something that needs to be addressed.

> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine

People start using drugs for different reasons. It's not correct to say that everyone starts abusing drugs as a form of pure escapism. A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

> You are broken because society is broken.

Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

I don't think these are mutually exclusive. Society wide problems cause a huge fraction of the population to experience severe emotional trauma, and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that. If you can understand this process, you can take ownership of it, and have a path to beating the addiction itself.

Ultimately, there is a lot of disagreement about what addiction is and how it really works, but I think this emotional trauma aspect is a key part of explaining why one person can use a drug recreationally or for medical purposes without addiction, and another can't. It explains a lot of weird observations that just didn't make sense with the classical chemical/neutrotransmitter model of addiction.

These links I think help explain this better than I can:

How Childhood Trauma Leads to Addiction - Gabor Maté https://www.youtube.com/watch?v=BVg2bfqblGI

Comic explaining the Rat Park research on addiction https://www.stuartmcmillen.com/comic/rat-park/

These ideas have explained why I personally have never been able to fight addictions through willpower alone, but have been able to eliminate addiction with other techniques that seem unrelated- therapy, meditation, exercise, hobbies, friends, ending bad relationships, etc. It seems that while chemical/physical addiction is a thing, emotionally and mentally healthy people don't experience opioids as a positive thing, such that the effect of the drug itself actually discourages it's use, and even motivates the experience of withdrawal.

Attempts to replicate the Rat Park experiment have failed: https://en.wikipedia.org/wiki/Rat_Park#Criticisms

It gets cited in a lot of pop-science and podcasts, but it's not actually the groundbreaking, universally-accepted study that people think it is.

Likewise Gabor Mate is more of a podcast, pop-science guy, not a real researcher. Take his podcast and YouTube content with a grain of salt.

I don't think psychology has advanced to the point where we can test ideas like this in a peer reviewed study on humans, yet as a personal experience- I have found that it is self evident once I looked deeper into my own feelings and actions. I feel those links do a good job of explaining the idea.

This reminds me, for example of the debate over Carl Jung. Some people say he set the field of psychology back with his scientifically untestable theories. Yet, I think it's obvious there is something to what he was saying, and it's likely he wasn't onto nonsense, but rather he was way ahead of his time.

>Society wide problems cause a huge fraction of the population to experience severe emotional trauma and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that.

So then why weren't addiction problems more widespread historically, like say 1900-1960? Life tended to have a lot more of what are generally considered traumatic experiences back then.

Weren't they? Perhaps they were just using different drugs, e.g. alcohol. You can't use a drug to escape negative feelings if you don't have access to it.

And perhaps nobody cared enough to log it, especially in the lower classes

You just shrugged off opium dens, or moonshining, or whatever substances could be had. The demon liquor and marijuana and heroin were all well known.

But, people didn't care about the poor. Whether or not they do now, they do collect data about them. We don't necessarily have great understanding about prevalence of who used them how often, so we shouldn't pretend there was a significant difference unless there's a reason to. Nostalgia or rose-colored glasses or pretences of a better time aren't valid reasons to break from expectation.

There's absolutely some truth to that though. People do not fall into addiction at the same rate in all societies.

That's tricky though, as access to the drugs varies by society also.

I feel like your first paragraph and your second one contradict each other.

They start for various reasons, like your example of "seeking recreation" and having a certain person nearby.

They don't stop because they cannot stop due to a physical addiction. I do not think personal responsibility is the right topic for that once it has gotten to that point. They've entered a state of physical dependence in which the reason they started is kind of irrelevant, and it's very difficult to quit, through no fault of their own.

> They don't stop because they cannot stop due to a physical addiction.

What you wrote here is actually the issue I was trying to communicate: The notion that addicts are helpless and that the drug and/or society has already determined their outcome is the problem. This sets up a defeatist attitude where people feel like they shouldn't even try to overcome addiction because their contribution to the equation is 0%.

Different addiction programs handle this in a different way. AA/NA famously have the "submitting to a higher power" concept that is very divisive, but appears to work for many people. Other programs basically teach the user that they do have some control over their life, and that they need to start exercising little bits of control to move in the right direction (even if they can't choose to end their addiction tomorrow).

What doesn't work is telling people "it's not your fault" or trying to comfort people by blaming their problems on purely exterior sources. Addiction treatment specialists refer to this as "rescuing behavior" and will go out of their way to discourage it from support groups and in friends and family.

This is the problem with addiction explanations that try to shift the blame to society: They give the user an excuse to continue believing that they are 100% victim with no control over navigating their way out of their situation.

Thinking it’s not my fault worked for me. Your argument is a conservative argument.

Addiction treatment specialists are basically witch doctors

Why don't addicts get large doses of intravenous NAD+ by default? That would alleviate 90% of their addiction inside brain as they are typically brutally NAD+ depleted and on the hunt for anything that raises NAD+/FAD+ in the brain.

Conflating a holistic approach that acknowledges the material effect of the context around a person with the assertion that those things existing nullifies the contribution of said person's agency is one of the very stupidest contributions of individualism to society. Things can materially make abuse more likely. Actions can be taken _by society_ that will make any particular _individual_ abuse less likely, whatever the specifics in each individual situation. It is still largely effort by an abuser and their closest contacts that will make _specific, individual_ abuse less likely in the future. None of these analyses contradict.

There's a division between mitigation, where empowering people to get rid of their addiction, and root cause, around changing society to stop pushing people into addiction.

Not looking more broadly means youll never fix problems like doctors over prescribing pain killers, especially without explaining their risks

It's two separate conversations, for different purposes

> What doesn't work is telling people "it's not your fault"

> trying to comfort people by blaming their problems on purely exterior sources

These are not the same thing.

The former is literal truth. The latter hints at intention, blame, denial.

It's not their fault, but they can get through it. You can hold these two simultaneously.

Why is it not someone’s fault when they get addicted after choosing to do a known-addictive substance? “Not their fault” certainly doesn’t describe all addicts.

They don’t need to be faultless to deserve compassion.

The more life experience I have the more I conclude that assessing the existence and extent of someone's fault is a pointless exercise. People tend to exhaust enormous amounts of pointless energy stuck in that place.

Your last sentence drives it home. They deserve compassion. Who cares about subjective assessment of fault once you reach that conclusion?

Largely agreed.

To your last point, people who believe having an internal locus of control is useful for preventing (not necessarily treating) addiction.

Many people get addicted to drugs after being prescribed them following surgery or injury. I know someone this happened to exactly. They gave him a bunch of opiates for pain management and he took them as directed and wound up an addict. I think a lot fewer people "choose" to get addicted to medicine in this way than either you or the GP are implying.

And now big pharma will "cure" them of the disease they pushed.

Also how is it a vaccine?

When I was a teenager I was prescribed tramadol after a surgery.

I was in considerable pain so I took it as directed. It was hell a strong stuff and I basically slept 18 hours a day.

A week later I was still in pain, but less. I reduced my dosage below the prescription to only take a dose before bed to make it easier to stay asleep.

Well, did I notice the effects of dependence. It was subtle but throughout the day I'd have intrusive thoughts along the lines of "I haven't had a painkiller yet, I should have one"

If I'd taken the prescribed dose till completion I'd hate to think what my brain would have done.

That scared me enough at the right age that I've never taken illicit drugs. And any time I'm prescribed painkillers Ive ignored the dosage and take just enough to manage.

Tell them to take NAD+ boosters like NR or NMN, or even the good old vitamin B3 in large quantities (1g/day). Addiction is often a sign of NAD+/FAD+ depletion in the brain.

You keep posting this over and over again with no source. If addiction to opiates was as simple as taking vitamin B3 and solved easily with the information in an internet comment there would be multiple studies and I suspect all over the news.

Maybe if you looked it up ("NAD therapy"), you'd have found it, like this one:

https://www.webmd.com/mental-health/addiction/nad-therapy-ad...

https://pubmed.ncbi.nlm.nih.gov/31917996/

https://www.mdpi.com/2076-3921/9/5/425

"The late John P. Cleary, MD, explained that we are likely to experience strong cravings for substances like alcohol when our NAD+ receptor sites are empty. That’s because alcohol drives the formation of the chemical compound acetaldehyde, which then interacts with dopamine to yield morphine-like compounds that temporarily quell cravings and withdrawal symptoms. When the NAD+ receptor sites become unoccupied again, however, the withdrawal symptoms and alcohol cravings come rushing in, driving us back to the bottle."

While these points are valid, it's also a highly individualistic perspective. Social bodies have complexities and dynamics of their own. The obsessive pursuit of financial and political resources could also be seen as a kind of addiction, optimizing for one thing to an unhealthy degree while refusing to contemplate the negative consequences. There are certainly big payoffs to be had this way, but foreclosure of other possibilities can eventually lead to a dead end. A more harmonious, proportionate approach may not be as dramatic or impressive, but endure better.

Society encouraging people to take ownership of their actions and consequences is also part of how that would take place.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them

This is true for drugs in general, but not many people are stupid enough to take opiods recreationally.

> but not many people are stupid enough to take opiods recreationally.

Recreational opioid use is extremely common. People seek out opioids for their recreational value, including drug-naive users.

Perhaps we should start being honest about which recreational drugs present the greatest dangers of addiction and harm.

At least when I was in school, we were still teaching kids that pot was just as bad as opioids. You can't expect kids to find out that you're lying about the dangers of pot, while expecting them to take the warning about opioids seriously.

I know the UK did research a decade ago to rank which drugs were the most harmful for the drug user and for how the drug user treated those around them.

https://www.bbc.com/news/uk-11660210

>abusing drugs as a form of pure escapism

>start because they're simply seeking recreation

These are the same thing. Happy people don't seek to drown every waking moment in constantly escalating recreation, they got things to lose and when they are out having fun and an opportunity comes around to do drugs they are surrounded by friends and loved ones who care for them enough to not let them ruin their life for lolz.

You shouldn’t dismiss people’s opinions because they’re addicts… I agree with this hypothetical addict that you think should be ignored.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

Let's be clear here: someone's stated reason for using opiates might be recreation, but nobody starts shooting heroin for recreation without some pre-existing reason for self-destruction. It's not a secret that opiates are dangerous. People with normal self-preservation instincts find other ways to recreate.

> > You are broken because society is broken.

What this boils down to is that the addict has to understand, "Society isn't going to help you, so you have to help yourself." That's important for addicts to understand because it is, unfortunately, true. But if we lived in a society which actually gave enough of a shit about its citizens to help them when they have problems, the importance of understanding that society won't help them would obviously take a smaller role.

I want to be absolutely clear here: there is not effective help for the causes of addiction. For example, a common cause of addiction is homelessness. Contrary to HN opinion, the solution to homelessness is simple. The solution to homelessness is homes. Not shelters--don't embarrass yourself with the "I don't know what the word 'home' means" argument. The fact is, 1% of the US military budget would build a home for everyone in the US. It's not difficult: the reason it hasn't happened is that there are a lot of people opposed to it. Instead, we build shelters where nobody has any privacy or feels safe or can have a pet or storage for their belongings (that's just like a home, right!?), and only in places where they don't inconvenience anyone society cares about, and then blame the homeless for being hard to help when they choose not to pretend that our half-assed solution does anything to solve their problems.

> Variations of this concept are frequently used by drug addicts to justify continued behavior.

Think about it as a policy maker. You have a choice whom to blame - an individual or their environment.

If you blame the individual there is nothing you can do - we can’t change other people.

If you blame the environment now there’s something you can do. You can try to reduce supply by making it illegal (only works to a point) or you can try to reduce demand by increasing overall quality of life - housing, healthcare, and generally a way to escape the clutches of the rat race that is life in America for so many.

>Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

Control of what? That's the point of drug abuse - what is there to be controlling? We are gears in someone else's system, purpose is rarely possible in modern society. Address why this is.

>Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

I feel like the use of this argument should depend on the scope of the person who is speaking.

Law-makers and society-enablers should consider things in the far-scope of "society's fault", whereas this consideration is less useful on a personal scale other than for the purposes of blame-redirection.

I think quite a lot of people ended up addicted to opioids against their will, by starting with being over prescribed highly addictive pain medication which then ended up making them addicted to opioids, and then later on ended up trying to feed that habit from the streets once the easy access to pain meds dried up.

https://www.doj.nh.gov/news/2022/20220303-settlement-purdue-...

Personally I've been avoiding oxycontin like the plague for that reason. I had two surgeries where the doctors wanted to give me oxy to manage the pain afterwards and I refused to take them. It turned out in both cases the pain was manageable with less addictive options, so I'm not clear why they reached straight for prescribing opioids in the first place.

You're not wrong, but addiction is not a certain outcome. Most people who use a substance that can lead to addiction don't become addicted. The question is why can two people, for example, abuse alcohol for a period of their youth, but both don't become addicts?

We need to look at this holistically. Overprescribing is a problem, but we shouldn't be needlessly afraid of these substances. Personally I've been prescribed these medications, I took some and when it stopped hurting I stopped taking them and the bottle sat in my medical cabinet in case I injured myself later. Eventually it expired and I threw it away. It wasn't an issue of will power or anything like that. I just didn't feel the compulsion. I'm the same way with alcohol and other drugs. I enjoy it when appropriate, but I feel no compulsion whatsoever. I, in fact, prefer mental clarity.

But I have people in my life who develop very strong compulsions and become addicted to anything that distracts them from their psychological torments. Reducing access helps, but reducing other circumstances in their life that they may feel the need to numb has to be part of the solution.

> but addiction is not a certain outcome

Not certain but chances are very high with the new class of opioids.

Yep I've seen similar in various countries with a parent. They were prescribed large doses of some opioid pain killers and despite them being aware of the risk of addiction and thus being very careful about dosing (often skipping doses if the pain was tolerable and asking doctors to minimize the dose), in the end they still had a difficult time coming off them. They didn't end up trying to feed that habit from elsewhere, but it was still a lesson in how quickly a dependency can be formed.

I think skipping doses might actually increase the likelihood of addiction.

One of the things I recall that made oxycontin so problematic was Purdue's insistence to prescribe it as a 12-hour dose. There was an article I recall reading on the topic:

https://www.latimes.com/projects/oxycontin-part1/

> Experts said that when there are gaps in the effect of a narcotic like OxyContin, patients can suffer body aches, nausea, anxiety and other symptoms of withdrawal. When the agony is relieved by the next dose, it creates a cycle of pain and euphoria that fosters addiction, they said.

> Peter Przekop, a neuroscientist and physician who oversees the treatment of painkiller addicts at the Betty Ford Center in Rancho Mirage, said that repeated episodes of withdrawal from OxyContin “absolutely” raise the risk that patients will abuse the medication

To me skipping doses is likely to create those repeated episodes of withdrawal which even when minor can end up screwing with the brain's addiction centers. This is why I'd rather take other options that maybe only work for 5-6 hours instead of 12, but don't build this vicious cycle of addiction like oxy does.

Huh, I wasn't aware of that. Will keep it in mind in the future, although hopefully I don't end up needing to do so.

Medication management is a clusterfuck, same with ADHD meds.

Someone people just like to get high; painkillers to H to F seems far fetched but when you are chasing that original euphoria, its a much shorter timeframe than most expect.

Usually the "society" issue is framed as some sort of welfare crisis. I have a more-than-one-hand-full of friends and acquaintances from earlier in life who ruined or ended their life with drugs. And so I don't know anything statistically, but I have seen what caused the people near me to fall into it, and it wasn't some welfare crisis.

The number 1 reason I experienced is because some social circles fetishized it. It was a very cool, tough, and a superior lifestyle. Anyone who didn't do drugs was a loser, drugs were for winners.

When there is a strong cultural-current of this attitude, it can draw people in and ruin their lives by the time they realize it's all wrong.

I've seen some of this as well, though through my own anecdotal experience people in my life I've seen struggle with drugs do or did so because:

1. Ongoing health issues they can't afford to resolve. Chronic pain. Mental health issues. Sleep disorders.

2. Inability to cope with high levels of stress due to financial insecurity, bad relationships, or loneliness.

I think the cultural attitudes you describe may have some relation to other problems. Most people I've encountered seek escapism when their life experience is poor and they're unable to change their circumstances or unaware of ways to change their circumstances.

I think my point is that it can be both. There is a lot we can do to help in the cases you point out. But I just don’t think the problem is entirely solvable, or even mostly solvable, without changing a destructive sub-culture, which we can’t do in any way I can think of.

At least we are working on things like this vaccine to save lives. That’s something.

> The real issue here that people don't seem to want to face is the WHY.

Drugs get you high. Ants get drunk, goats chase psychedelic lichen, and dolphins pass around puffer fish like a dutchie.

> Why do so many people want to check out of life completely by abusing medicine

The short term benefits always outweigh the short term costs, but we're moving to a point in history where even it even seemingly outweighs the long term costs. There's no real disincentive anymore.

I think a case can be made that Martin vs. Boise had the most to do with this. That ruling was meant to push cities into creating the necessary facilities and number of beds to correctly address their homelessness problem; instead, it seems that many cities have used it as a way to entirely ignore the issue.

Instead of building the facilities, they're just throwing up their hands and allowing the kind of "public camping" that quickly turns into public open-air drug markets. Unsurprisingly, the population and markets grew.

> A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.

The twelve steps are about quite a bit more than "just" that. They're also targeted towards a person that is at a specific stage of addiction _and_ willingness to address it. It's not general purpose and you can't force people into it, particularly when their drug of choice is so easily available and socially acceptable.

You have to reduce the inflow of drugs. You have to stop drug markets from forming. You have to convince addicts to seek treatment.

On the last point, I think the most effective strategy would be confiscation. If you are caught with drugs for personal use, they should be taken and destroyed, and you should be given information and transportation to a treatment center if you desire. Otherwise, you should be free to go. If the state doesn't interject itself at some level then I don't think you stand a chance.

>You have to reduce the inflow of drugs.

And this is how we get fentanyl. Why import 2 tons of drugs when you can import 2 ounces with the same power.

Attempting to reduce the inflow has just created a violent black market and a dangerous police state.

There is so much reductive thinking in this thread, it is painful. Fentanyl has been on the market since the 1960. The deaths started spiking in 2014. Did we step up enforcement majorly in 2014? Or did something else start this rise?

Why import anything if you could produce it domestically? Is it possible that basic enforcement has obvious impact? If we allowed labs to produce it domestically, do you think we would see more, or less? What mechanism drives that outcome? What if this is already starting to happen?

The creation of the DEA has had a negative value outcome with respect to the amount of drugs in our society, I'll grant you, but I have a feeling that's due to it being setup as a paramilitary organization as opposed to a knowledge and tactical care based organization focused on the ground level issues surrounding actual users and user/dealers.

> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine?

I don't do powders, opioids, etc but I do have some friends within tech and the festival scene that do. My observation is that most people that die from fentanyl don't know they're taking it. They think they're doing cocaine, ketamine, heroin, or some other substance. Fentanyl presence is usually a case of cross contamination when the particular substance is being cut at each hierarchial level of the drug food chain. That's not to say that there isn't some small subset of dealers who don't purposefully drop in some fentanyl, but largely that'd be a stupid decision. The users life expectancy shrinks and their risks skyrocket when they come in contact with fentanyl, this is known.

If you want to stop the deaths, then you have to allow drug distribution that comes from clean rooms. At present, everyone should be using test kits, but fentanyl in particular is hard to test for because a single grain hiding in a mound can get and overdose a user.

If you want people to stop using drugs, well, I have less to say. The history of humanity is using intoxicants whether it be for recreation, psychological well-being, or medical necessity. We've only recently in the history of humanity gone on moral crusades to villainize it.

Chemically addictive substances are a little more challenging. Things like heroin, cocaine, and methamphetamine aren't drugs you can benefit from, but people still do them. Largely, it's because they got hooked on pain killers or some other "numbing" medication. Better availability to harm reduction resources, therapy, social safety nets, etc would improve metrics across the board in the chemically addictive substances category.

My fentanyl experiences have entirely been as part of surgery: it's part of the balanced triad of anaesthesia and I "recently" injured myself quite badly, resulting in three operations. After one of these, I spent about 36 hours on a fentanyl infusion and more than a month on oral morphine of various doses with my leg in an orthopaedic brace while I was bed-bound. I should point out that the alternative was a lot of screaming: visceral pain of the variety I cannot describe – I had a panicked, "help me" expression on my face and just felt utterly, utterly desperate. I was in a lot of pain and medically the drugs were appropriate, given the injuries I sustained.

I totally get why some people become addicted to drugs. Diazepam made me both in less pain and care less that I was in it. The opiates produced this warm, fuzzy haze of vivid dreams and imaginations and made a difficult time bearable. Fentanyl made me feel less than human but not able to suffer, and it was a necessity at the time.

Of all of them though, diazepam was the most dangerous. It just felt – well, nice. I didn't care that things were bad. I needed it medically to stop neurogenic muscle spasms and it made me both able to sleep well and feel OK about life in a way that is really hard to put into words. I have some in a bag, prescribed for me, in case I need it. Part of me – a small part of me, but a part nonetheless – wants to use it, a lot, when I don't need it. There's a little voice that just says "this makes you feel like you've been tucked up into bed nicely". I really can't explain it, but I know that voice is a temptation and a gateway to something that I don't want to have – but at the same time, I know that that drug both saves me from agony and helps me medically if I need it. I'm really not sure how I feel about that. I haven't had any in months, but the psychological aspect remains.

I can only imagine what "real" drug addicts go through. It must be incredibly hard, and individual's range of experiences will be very broad indeed.

Once you actually don't need it anymore, throw it far away and do not look back. Benzos and opiates ruin lives because of that little voice. That voice will be strong enough one day that if you have those close by you will take a few, because why not?

That voice is the voice of addiction. Once it starts it never fully goes away. It just gets less frequent.

My mother spent 6 weeks sedated with Fentanyl, on top of Alzheimer's. After a few days I realized she would survive. But she was in a hellish state for over a year, hallucinating and constructing parallel realities.

Ironically, she worked on the UK medical trial for Fentanyl when it was first introduced for surgery.

Fentanyl is strong but short acting opiate mostly used during surgeries. I am curious why it was used for such a long duration as 6 weeks.

Because it is there.

A good metaphor for addiction is speeding. You're driving down and empty highway, you want to get where you're going faster. You're not going to actively look down at your speedometer. You know you're probably breaking the prescribed limit a bit, but who cares. The when you finally are faced with looking at the speedometer, say when you get to windy section or a speed trap, you look down and you're going 25mph over the limit and you have no idea how you ended up going so fast, but by that time, you're brakes are squealing or worse.

> Why do so many people want to check out of life completely by abusing medicine?

This isn’t how it works.

Few people, if any, want to “check out.” What happens is that people are exposed to opiods via one of two channels (they are prescribed painkillers, or they party with someone who has acquired them) and they quickly get hooked because these drugs are cripplingly addictive.

So the only “why” questions we have to ask are:

1) Why do people take opiods the first time

2) Why do people continue

The answer to 1 is either because their doctor said so, or because they like to party and have no foresight. The answer to 2 is because if they stop, they experience the worst sickness imaginable.

Society is not broken and we don’t need weird conspiratorial explanations for any of this.

>Society is not broken and we don’t need weird conspiratorial explanations for any of this.

Life expectancy plummeting through deaths of despair, juxtaposed with widespread addiction (as much to drugs without physical dependence as opiates).

I think it's

> 1) Why do people take opiods the first time

that the GP is getting at. While doctors over-prescribing opiates is definitely a thing (esp. in the US), I'm not convinced that many people get hooked on opiates due to partying. I think it's more commonly:

"Used as an escape from a life that is unmanagable for some reason"

That's not conspirational. There's good evidence to show that life circumstances have a big effect on both initially becoming addicted and success when attempting recovery. The answer to this might look like a better welfare state or similar.

I think it'd be more likely that someone discovers opioids mask their pain while using them for legitimate purposes. After that is when gaming the doctor, street buys, and finally substitutions take place.

There are plenty of other fairly common reasons that don't involve simple escapism, with young people it's just as likely to be simple peer pressure or experimentation. It also doesn't help that it's common to treat drug highs as some sort of enlightening experience that needs to be experienced to understand.

Except that its nonsense. People know what opiates are. If you keep taking them and dont stop, you get physical withdrawal. That wont happen over night and its not "the worst sickness imaginable". And unless you did something even more stupid like switching to methadone it will be over in a few days.

It is quite simple, at some point, you decided to continue taking them despite knowing this to be problematic.

I would also like to add, that i have met very few addicts who blame the drug. Its most of the time relatives who like the story of their loved one getting tricked.

If it was only the fear of withdrawal, the opioid crisis would be solved next week. Literally. But the unfortunate problem is that people relapse. Because what ever made them take opioids every day didnt get fixed with a withdrawal. And if your life still sucks, its very easy to go back.

"investigating systems in their totality rather than focusing on isolated interactions within them" is not inherently conspiratorial. It's far weirder to suggest that "more people want to party for no particular reason" or "more doctors prescribe pain meds for no particular reason" than it is to suggest reasons that might contribute (say, "more people are suffering from chronic pain than before as the disparity between productivity and wage has widened" or "pharmaceutical companies are naturally incentivized to sell as much of their product as possible and those incentives may occasionally drive morally dubious decisions").

You make a good point regarding incentive structures in pharma - but this is nothing like what OP was saying. OP is asking for a “Frommian psychoanalytic approach,” whatever that is.

Your point about chronic pain increase is totally implausible. Automation of manual labor should result in less chronic pain, not more. The problem here is overprescription, and it’s my fault that my comment didn’t make that clear.

As regards:

> It's far weirder to suggest that "more people want to party for no particular reason"

I never said that. The number of people who want to party and have no foresight has remained constant. But access to opiods (and their normalization) has skyrocketed, due to aforeforementioned over-prescription.

Sorry, I missed this reply when you made it 11 days ago. Happy to respond:

Automation of manual labor _should_ result in a _lot_ of benefits to workers. But here's the thing: Automation is, largely, capital. And under capitalism, ownership of capital is private. That means that the benefits from automation are largely under control over the owners of it. And that ownership is for the purpose of making a profit. It is more profitable to automate as much as possible while simultaneously working the workers who are left as hard as possible, while paying the minimum amount to successfully do so.

This leads to a situation like we have in the U.S., where productivity has massively skyrocketed while median real wage has actually _decreased_ since the 70s. That median real wage means workers who can pay for less for a given hour for work, which means workers who need to work more _somewhere_ in order to support their conditions of work (pay for a place to live, pay for food, etc). Working more hours means getting less rest, which means less recovery, which means ::drumroll:: more chronic pain. The stats bear this out, and it's trivial to corroborate: The lowest-wage earners work more hours for less pay than they did fifty years ago, while percentage of take-home that goes to mortgage/rent has increased. This is a recipe for misery, and the most unbelievable thing about it is that it's not patently obvious to everyone. "Over-prescription" exists in those conditions: Pharma both has the incentive to sell more than is necessary, and no incentive to cure the actual _cause_ that bring people to seek a remedy for pain in the first place. "Partying", in this analysis, is not just a thing people "like to do" that they are now suddenly doing with more-abundant pain meds--it is a thing people are doing _with pain meds_ because those meds are _the thing that makes the general pain of being alive easier to deal with_, a thing large-scale abuse of substances (notably, alcohol) has been doing for thousands of years, where increased consumption has correlated strongly with increased human misery.

The party to addiction pathway is very regional, only affluent or hard-working teens can transverse that.

It's not that simple: https://www.wcvb.com/article/ex-cop-describes-descent-from-h...

Whoa, you’re so out of touch with reality. Yikes.

> Why do so many people want to check out of life completely by abusing medicine?

Painkillers can provide relief for emotional pain as well as physical pain.

Even something like Tylenol can help people going through painful breakups.

Unfortunately opioids are addictive and users build up tolerance, which is bad for people with chronic pain of any variety.

There’s also the medical systems unwillingness to help certain people and medicate; then people end up on the street getting more dangerous drugs in an uncontrolled fashion.

Do you think at any point in the last 100 years if drugs were readily available uptake would be low?

Do you really think that Michael Jackson and Prince wanted to "check out"?

My assessment is that if even people at that level of wealth and success can get addicted to opioids and die, pretty much anyone can.

Addiction, whether alcohol, drugs, cigarettes, etc., is something that is a genuine medical issue needing treatment. Thankfully, the medical community seems to be shaking off the social stigma about addiction and treating it properly now, but progress has been very slow.

> I'm not talking about "more 12 step" here but more of a Frommian psychoanalytic approach.

Do you have any evidence that that works better than (say) buprenorphine or naloxone, which target the underlying neurological problem?

>The real issue here that people don't seem to want to face is the WHY.

I doubt that it's always a "choice". But it wouldn't surprise if there was many main causes.

Something else I wonder is how have we managed to convince generations that smoking is not only horrible to your health and frowned upon but alcohol is acceptable?

Fixing society doesn't increase revenue. The opposite, actually.

For example: The more people are depressive, the more pills can be sold. If people kill themselves due to depression, that's too bad, but they didn't buy any pills to begin with.

Diabetes is great, because people depend on insulin. A never-ending money maker! Fat people are great! They eat more, thus spend more! Some of them get their fat surgically sucked out of their bodies, which also pays! When they get more and more sick, they need more and more medicine, which pays even more!

The transhumanism movement is awesome, because transitioned people require pills! Every day!

Sadness? There's a pill for that!

Drug addicts? Lets invent a vaccine for that!

Fantastic!

Society isn't getting fixed, because nobody actually has any interest in that. Those in power/money certainly don't give a fuck and rather want more money, while the actual people are mostly too stupid to figure out that the whole system needs changing.

Instead they whine, complain and protest and go voting, without realizing that it does basically nothing. Yes, voting actually does nothing. We didn't get to this point because voting helps anything. We got here, because voting doesn't matter.

Decades of evidence lay in front of everyone out there to see, yet for some reason every couple years people actually believe their button-pressing/their X-making actually gives them power over what's going to happen!

There's no vote allowing you to change who pays all the money to the politicians, law makers and judges. There's no vote that allows you to change the underlying corruption that's going on. There's no vote that enables you to decide what actually happens with your money.

You're fucking hilarious. You're not wrong per se, but also hilarious.

"Society needs fixing!!!111" well then get together with enough people and fucking fix it.

Politicians won't do it for you.

Better get your guns ready, btw, because it's definitely not going to happen peacefully.

I would ask a different 'why', which is 'why is fentanyl so easily accessible?'. We know where it's made, how it gets into the US, a long list of reasons for why people start taking it. But why hasn't the supply of fentanyl to the US been restricted?

Given how many lives this destroys, how many people it takes out of the potential workforce, how many social problems this causes (crime, homelessness, exasperated mental health issues) - why isn't there the political will to change this?

I answered this at length in a forum some months back and sadly can't find the text (for now).

The abridged version is: there too much money to be made.

Fentanyl has gone from direct primary import (which was blocked) to banning of exporting precursor drugs from bulk suppliers in China (to slow down | stop Mexican drug labs from mixing them to make Fentanyl) to where things are today ...

relatively mobile "popup" drug lab networks that start with bulk pre precursor drugs to make the precursor drugs that are funneled to final product labs.

It's a hell of a whack a mole game across Mexico, the USofA and Canada with a process that's tough to break, the initial drugs used are too useful for too many things to ban outright and the production aspect is broken down into many replaceable parts.

( I had references to most of those stages in the original comment, apologies for not having them to hand ).

Appreciated, the context is useful.

It's provocative in rats, but there's lessons from similar attempts that need to be considered. Cocaine-specific vaccines have been in development for years, and they haven't been successful. The biggest problem is that you need people to maintain an enormous concentration of antibodies against the drug so that even minute quantities are captured within seconds of entering the blood stream. Even if you can achieve an initial therapeutic levels, you need to constantly boost the vaccine to maintain high antibody titer. All of these attempts have targeted people with cocaine use disorder and are able to focus on shots every few weeks to months. We're nowhere close to developing something that would work as a routine preventative vaccination.

We do have a once a month injection of naltrexone that can block all opioids, which can be effective in the right person. A targeted approach to fentanyl alone would probably work in people who don't have an opioid use disorder (and therefore wouldn't be as prone to substitution with an alternative opioid). This is an interesting step, but our understanding of immunology is far too limited to make this realistic in the near term.

Someone in my family died from fentanyl at 26. I knew him since he was a little kid. We don't know if they were aware of the presence of that substance, but they certainly were in a higher risk situation. They had a decent life and a loving, if imperfect, family. They just happened to fall into a rougher crowd in middle school and, despite more than a decade of support and help and money, never really broke out of it.

One of my last conversations with this individual: they were excited to go to some convention in Minneapolis that was all about mushrooms and psychedelics. What struck me was how excited they were, how into that community they were. I couldn't relate. I thought to myself, isn't there anything in your life more exciting than this? Rewind 12 years, and I also have a memory of his fascination with tagging buildings on YouTube. The art of it aside, I was so struck by his ignorance to the fact that you're damaging someone else's personal property without their consent.

To deepen the mystery: I grew up in an unstable household, suffered emotional abuse and physical abuse on one occasion. I remember sleeping at a friend's house for a week and begging them not to call the police. When I look at this deceased person's life, whatever grievances they had, it really pales in comparison to my experience. And yet I never touched drugs. It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.

Whatever your personal views, it is objectively true that a vaccine would prevent some people from dying, so it's likely a good on balance.

I'm sorry for those impacted by this.

I appreciate you sharing your experience, but keep in mind two things:

1. It's unclear what your family member was going through. Your own experience is much more salient to you, but battles are more and more invisible to external viewers, so it makes sense that you would characterize your experience as more difficult. It can be true that you had a horrible experience, and so did this person. There's a reason the "walk to school uphill both ways" meme exists.

2. Your sample size here is very small. Even if it is true that your experience was worse (we can't know for sure), your actions in that circumstance shouldn't be generalized to people-in-general, and the same applies for your family member.

> It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.

I'd encourage you to challenge whether predestination / loss of control is the qualifier for compassion. How can we know, for certain, why people make the choices they do? If you were predestined or not, we don't currently have a way to know.

Would people deserve compassion if everything they go through is a direct and pure result of their choices and nothing else?

> they were excited to go to some convention in Minneapolis that was all about mushrooms and psychedelics. What struck me was how excited they were, how into that community they were. I couldn't relate. I thought to myself, isn't there anything in your life more exciting than this?

Are you always this judgmental of others’ interests? Do you have these feelings towards someone excited about e.g. a new video game or a programming conference?

Actually, no. Had he been drawn to a programming conference, I wouldn’t have been able to draw a line between the dangers he’d been near and those interests. But when you see someone in a situation, and see them drawn to the wrong things for the wrong reasons, yes of course it triggers at least concern. I wish a lot I had been wrong.

I don't think it's fair to conflate mushrooms and psychedelics with Fentanyl.

On the one hand, you're absolutely correct.

On the other hand, there is some overlap in classification here: experience-altering substances.

OP's intuition is, "this person's entire mental interest pool is consumed by some form of escapism."

There's some fallacy in this equating, but the heuristic isn't way off.

Also a note of caution... You could easily fall prey to confirmation bias on this one. Their interest in shrooms or psychedelics isn't necessarily a straight line to fentanyl. Plenty of people have one without the other.

I have a lot of interest in psychedelics (haven't tried it myself). How would you know if my interest is "for the wrong reasons"? And, what level of judgment clarity is required to know if the reasons are wrong, right, or neither?

> "a vaccinated person would still be able to be treated for pain relief with other opioids [such as morphine]"

Good to hear, but at its worst, my pain was only relieved by fentanyl (administered by a professional in a hospital). Noticeably better than Dilaudid (hydromorphone).

Is morphine a reliable replacement for fentanyl? Fentanyl is used quite often in palliative care because it lacks the side effects of morphine, is this correct?

Does this prevent death or just the perceived effects of the drug? This could be very dangerous for users who relapse. There is a known pattern of users who get off opioids then relapse and die because their bodies can no longer tolerate the doses that they were used to taking before they quit. This could have a similar effect where users take the drug, don't feel it, and then increase their dose to lethal levels hoping that they can get high again or believing that the drugs they purchased are diluted or ineffective.

Can you elaborate on your point of confusion? The mechanism of action was explained in the article.

That's strange that they describe the selling point as being that you can't get high anymore. If it's really attacking and neutralizing the chemical per se, and if it's truly neutralized in every way, that would mean it would stop overdoses. That seems like a much bigger selling point.

Exactly. Hard to treat someone who is dead

If the vaccine only suppresses opioid euphoria, users would continue dosing assuming they needed a higher dose to feel the effects leading to overdose and have possible respiratory failure.

My point of confusion is still my initial question. It was actually the description of the mechanism, as given, that had me questioning it's effects on the overall toxicity/danger of ingesting the drug.

"Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys. Thus, the individual will not feel the euphoric effects and can ‘get back on the wagon’ to sobriety,” said the study’s lead author Colin Haile"

They clarify that this causes a user to not feel the positive effects of the drug, but I would assume that if the drug was also able to prevent overall mortality, they would be excited enough to mention it.

That helps clarify a lot, thank you.

To answer your question: yes, it does stop mortality. The general cause of death from opioid overdose is respiratory suppression when the brainstem is too “sedated” to continue sending signals to the rest of the body to breathe, so by stopping the fentanyl from entering the brain, this vaccine also blocks mortality.

Hard to do this justice without writing a full essay, but this vaccine need not be seen as an antabuse-like “restriction” on drug users. E.g. for the stereotypical* case of a user who unknowingly gets heroin cut with fentanyl, this would protect them from the fentanyl without blocking the euphoric effects of the heroin. Its most promising utility is in preventing users of other drugs from unintentional exposure to fentanyl via contaminated supply.

*(Yes, I know most street dope is Fentanyl-based these days.)

E: And to elaborate on why they might be putting emphasis on the fact it blocks the effects of fentanyl in their explanation, it might help prevent “unintended” addiction to fentanyl when users are unknowingly consuming it in conjunction with other drugs.

The abstract of the underlying research paper: https://www.mdpi.com/1999-4923/14/11/2290/htm contains the quote "Vaccination prevented decreases on physiological measures (oxygen saturation, heart rate) and reduction in overall activity following FEN administration in male rats." These physiological measures are the precursors to overdose, which occurs when low oxygen saturation becomes hypoxia and becomes fatal.

To summarize, yes, this vaccine prevents overdose, as well as the other drug effects.

This is kind of strange. Is it really fentanyl-specific, or does it effect all opioids? Problems either way; if just fentanyl, then, duh, that's not the only way to get high. If all opioids... So it makes opioids no longer available for pain relief... forever? ("vaccine"?). (Major surgery and recovery without opioids is no walk in the park, it's PTSD-inducing excruciating pain).

It claims to block the ability to get high -- does it also block overdose potential? Or is this just going to lead to lots of people OD'ing as they try to take enough to get high?

One way or another, it seems likely to lead to even greater harm as addicted people look for something else that does work.

Honestly seems like a bad idea overall, based on wrong and unuseful ideas about the nature of addiction.

This is an incredible opportunity to save lives. You need to familiarize yourself with accidental opioid overdose deaths. Most people who die from a fentanyl overdose were not intending to ingest fentanyl. Fentanyl is often used to boost the strength of more expensive opioids sold on the street. Fentanyl is very cheap to produce compared to heroin or whatever is the flavor of the month pressed pill. People die because the recreational dose for an opioid like heroin isn't many orders of magnitude away from the LD50

I see what you mean, but:

"Once feared, illicit fentanyl is now a drug of choice for many opioid users: People with opioid-use disorder are increasingly seeking out illicit fentanyl, often smoking it."

https://www.nbcnews.com/health/health-news/feared-illicit-fe...

(I really do know that everything you read in popular media about drug use in general, and opioid use specifically, cannot necesssarily be trusted. But my understanding from several sources is that this is so. The fact that fentanyl is cheaper for the effect is a reason a user might choose it too, or it may simply be what is available, or affordable)

Whether users are intentionally seeking and/or aware of getting fentanyl or not, I am saying that the consequences of making someone's dose not have the effect they are looking for can often be that they take more (getting more of all of the substances that were in the dose, known or unknown), or that they switch to an alternate supply/substance. Either of which can have very dangerous outcomes.

I won't tell you what you need to familiarize yourself with, or assume I know what you are or are not familiar with.

> “The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.

Not really clear if it prevents ODing but the article says:

> Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys.

> Major surgery and recovery without opioids is no walk in the park, it's PTSD-inducing excruciating pain

I had rather major surgery. Once I was sent home, the opioids just weren't worth it. (I was surprised.) Ibuprofen actually worked a lot better.

Granted, I don't think I'd want to undergo surgery without opioids during the first few days of recovery.

>This is kind of strange. Is it really fentanyl-specific, or does it effect all opioids?

This is answered in the article.

>“The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.

>Problems either way; if just fentanyl, then, duh, that's not the only way to get high.

Yes, but fentanyl is considerably more dangerous than most of those other methods. Mis-judging your poorly-cut heroin dose by a milligram at least doesn't kill you. That's part of the point of targeting fentanyl itself with a vaccine - it would be accepted by the drug-taking public, because most of them don't want to be taking fentanyl in the first place: there are other ways to get high.

Does the vaccine make fentanyl less dangerous then, does it keep you from OD'ing on it?

Oh boy, the pharmaceutical companies can sell a new product to help solve the mess that one of their previous products created.

An opioid that's more potent, more addictive, and more deadly than heroin should never have gone to market in the first place. It speaks of enormous corruption and a complete lack of ethics when regulators didn't see an issue with fentanyl and let it move forward.

The "but people are in pain" argument doesn't hold up very well when heroin is safer and has less potential for abuse but they already made illegal in the US.

>sell a new product to help solve the mess that one of their previous products created

That's gotta describe like 75% of US healthcare budget, right?

Red Dye #40, BPA, preservatives, emulsifiers, PFAS -> ADHD, Anxiety, Depression -> Adderall, Xanax, Prozac

Sugar, seed oils, preservatives, endocrine-disrupting chemicals in food, water & air -> Obesity, hypertension, diabetes -> Lipitor, Insulin

Alcohol, smoked/grilled meat, tobacco, microplastics, pesticide residues, air pollution from cars & factories -> cancer

I don’t think there’s a reputable link between red dye #40, BPA, preservatives, emulsifiers(?!) and ADHD, anxiety, and depression.

Further, are you claiming meat, tobacco, and alcohol are products of the US pharmaceutical industry?

Literally everything on this list is supported by publicly available, peer-reviewed papers that could be found by 30 seconds of googling, but people downvote instead of being curious and learning something.

Here's a layman-friendly article that covers several papers on red dye #40: https://www.verywellhealth.com/red-dye-40-adhd-5220957

Here's a page from Columbia university on BPA: https://www.publichealth.columbia.edu/research/columbia-cent... with quote "Researchers have linked BPA to developmental and health problems in children, including learning and behavior conditions like Attention Deficit Hyperactive Disorder (ADHD), anxiety and depression"

You're getting downvoted for making a strong causal claim without initially citing any sources, and the citations in this comment don't even support your claim. From your first link:

>It’s important to note that artificial food colors do not cause ADHD.8 One study found that removing artificial food colors from the diet had a statistically significant effect on ADHD symptoms, however. The authors noted that the improvements were modest but still statistically significant.9

its not only that, the vaccine will create issues for people when they want to have a surgery so it CREATES NEW ISSUES

While fentanyl is amazingly effective in a controlled environment like an operating room, it's not the only option at their disposal. I suppose if this vaccine took off and you got it, it'd be good to keep an electronic medical ID on you.

It's the option they tend to select for a reason, though.

> An opioid that's more potent, more addictive, and more deadly than heroin should never have gone to market in the first place.

This is a little misplaced. Fentanyl is a medically useful drug. Fentanyl had years of use as an anesthetic agent (and still does - it is an essential ICU medication) before the idea of marketing it for other purposes occurred.

And without defending the pharma industry and their role one bit. The vast majority of fentanyl these days is not from big pharma, and it's arguable what relative role fentanyl played vs all the other drugs

Specifically, the demand for illegitimate fentanyl today was mostly driven due to addictions from other medications that were NOT fentanyl - such as oxy, hydrocodone and even the "safe" tramadol.

Having said that, it's going to be a hard sell that all opioids should be banned. There is some middle ground between reserving for palliative and acute critical illness and having PCPs prescribe for simple back pain.

> heroin is safer

It is a smidge more complex. Fentanyl has some pharmacologic properties that make it safer for controlled use in sick patients. Heroin has similar metabolite related side effects as morphine.

I would suggest becoming actually educated before developing strong opinions.

The drug is extremely useful and saves lives in a clinical setting; chances are it will save your life or someone you know and love. It's literally used _every hour_ around the clock in ERs.

Nearly all problematic Fentanyl in the US is illegally imported and created by third parties overseas. It is not manufactured by those big bad US Pharma companies.

Yup, people don't realize but whereas a brick of heroin is a lot, a brick of fentanyl can supply a decent sized city. Because small amounts are so valuable, it's super easy to smuggle, and for a long time the Chinese would produce and sell it at rock bottom prices (I'm guessing that was state sponsored as a finger to the west for opium and the opium wars, which they're still very sore about)

> I'm guessing that was state sponsored as a finger to the west

I've heard this only from people with no experience dealing with the Chinese chemical industry.

I don't think people fully realise how hands off the state typically was in the last couple of decades - you could get Chinese contract labs or chemical suppliers to make and ship you almost anything, and they would even mislabel it to get it through customs.

There were dozens of labs that were churning out batches of whatever the latest "research chemical" "not for human consumption" was, for the western consumer market.

No state sponsor needed - the business was extremely lucrative for all involved, and the materials absolutely dirt cheap to produce.

There was a solid 10 or so years where simply picking out a new analogue and having it manufactured to order was a de-facto licence to print money due to how long it took for a novel substance to be banned.

I've had dealings with Chinese chemical producers. You don't open a business or sell things to foreign countries in China without the CCP's knowledge and some small degree of consent. Considering the risks and the degree of monitoring I doubt Chinese chemical producers would try to pull a fast one on the party. The party also almost certainly provided capital for a lot of these businesses.

Yes, most of the fentanyl that's abused comes from illegal sources. However, like cocaine, methamphetamine and heroin, I put some of the responsibility on the people who created it and promoted its use in the first place.

It's naive to think we could make "super heroin" and it would stay restricted to safe, controlled medical environments. I'm not convinced the good it does in certain cases outweighs the enormous harm it's also responsible for.

I don't think academic pharmacologists should try to avoid discovering drugs that have potential for abuse. They should be following medical efficacy - and it seems like generally they are.

Nobody was 'contracted to invent super heroin', they modified molecules with medical efficacy and tested to see which ones were also effective. Drug discovery is a much less deliberate process than you are making it sound.

> I put some of the responsibility on the people who created it and promoted it's use in the first place.

While there was a little bit of questionable marketing around some forms of fentanyl it was mostly around for the ride - the real blockbuster drugs leading to the medical establishment opioid crisis were hydrocodone, oxycodone and tramadol. Making fentanyl a scapegoat is misplaced.

The opioid epidemic did not need a "super heroin".

> It's naive to think we could make "super heroin" and it would stay restricted to safe, controlled medical environments

It's naive to think organized crime cartels would not have figured it out anyway.

I'm not making fentanyl a scapegoat, just look at the US drug overdose statistics, especially the huge jump around 2020. Fentanyl is eclipsing every other opioid, synthetic or otherwise. It alone is responsible for what is quickly becoming the deadliest drug epidemic of all time.

There's good reason for my harsh criticism, and I don't think most people truly realize how bad the situation is.

> There's good reason for my harsh criticism, and I don't think most people truly realize how bad the situation is.

No. I'm saying, as someone that understands the nuances better than you that, focusing on the fentanyl statistic is misleading.

> It alone is responsible for what is quickly becoming the deadliest drug epidemic of all time.

No it is not "alone" responsible. All the other stuff: oxy, hydro, tramadol, heroin, morphine is more responsible for the current mess. People didn't routinely end up with opioid addictions due to fentanyl as much as all these other medications (and illicit heroin, not all addictions are the doing of big pharma)

The fact that they are now seeking out illegal suppliers and that invariably these end up being fentanyl based due to the convenience for that organized criminal enterprise is why fentanyl shows up so much.

It's not the root cause though. And the forces that make it appealing in the illegal market would be present regardless of its legal status as a prescription medication.

> "super heroin"

The whole problem with fentanyl is that it sucks, the high isn't very good, which makes it extremely dangerous if you think that it might be a good idea to try to take more. It's the opposite of super heroin. It's a garbage substitute for the actual fun stuff.

Yeah in its pure form it's a very strong opioid by weight, but that's of minimal relevance in practice.

I’m aware of it being used for epidurals, but honest question - how does this particular painkiller save someone’s life instead of another, less potent painkiller at a higher dosage?

A memory that un-repressed itself about a year ago was being a teenager and hearing my mom wailing, "I can't do it anymore. I'm done." in the later stages of her cancer treatment. Apparently shortly after that they had a fairly significant intervention with the physicians and she got fentanyl patches. I got about another year with her.

I completely agree that there's a ton of recklessness in the history of opioid prescription. It's been a horrible plague on society that will have generations of lasting impact. But there's uses for it. I dunno, maybe heroin patches could have become a thing?

If I fall off a ladder and break my leg, I want the good stuff. I’ve found old bottles of expired Vicodin and such around that I was prescribed but never finished. I have zero interest in recreationally using opiates. I also have zero interest in bravely tolerating agonizing pain if I don’t have to.

It's easy to say this when you already know that you, personally, can resist the temptation of abusing drugs like Vicodin.

Personally, I refuse all pain killers except OTC and local anesthetics like novocaine. I rather risk biting through my tongue than getting addicted to that shit.

I get that, but that doesn't mean there's no room for powerful painkillers for the situations that call for them. If someone dying from cancer wants to be stoned out of their minds to avoid the pain, I'm all for letting them. You and I don't want that because our current circumstances don't call for it. Someday, they might. If that day comes, I wouldn't want to live in a world without access to strong analgesics.

I think that the palliative care of a cancer patient is slightly different than a broken leg. Only one of these lead to the opioid crises.

I don't know about that. The immediate post-trauma care of something like a broken leg would reasonably involve strong narcotics. You're not going to be sent home with a batch of it, but may get some on your way to surgery.

> You're not going to be sent home with a batch of it,

You might, that's the issue. Maybe doctors are more hesitant to prescribe such pills now, but for instance they tried to prescribe Vicodin (iirc) to me after I had my wisdom teeth removed (which required general anesthesia to my chagrin.) I refused and took the max recommended dose of over the counter acetaminophen for a few days instead. I was in pain but it was tolerable, the pills they tried to push on me were totally unnecessary.

That sort of post-op pain is only temporary, but a pill addiction could last the rest of your short life.

I'm not sure why you're bringing this up. I'm not advocating for everyone to get Vicodin if they stub their toe. My point is that narcotics, even the strongly addictive ones, have their place in short term or terminal pain management. It would be unconscionable to make them unavailable to everyone.

Some people huff nitrous oxide. That sucks and I wish they didn't do it. I'd still opt in for general anesthesia if I were having surgery done. In my opinions, having those things as options vastly outweigh the cons of their abuse potential.

> It speaks of enormous corruption and a complete lack of ethics when regulators didn't see an issue with fentanyl and let it move forward.

Do you think there would be a meaningful difference in the volume of illicit fentanyl if it was never approved by the FDA?

If the manufacturers and regulators were more concerned with human lives than making money, they would have quietly buried the research. It may have entered the illegal market eventually, but there wouldn't be factories producing large quantities of the drug like there are now.

They should have known that an opioid 50 times more potent, deadlier, and more addictive than heroin would be responsible for the worst drug epidemic the world has ever seen.

I think we fundamentally disagree here. There might be some 20:20 hindsight way to completely avoid the opioid crisis (especially with the behavior of Purdue Pharma), but from my perspective if Fentanyl (or other potent synthetic opioid) reaches illicit manufacturing it almost always becomes a dominate force in the black market. The cost, strength, and ease of smuggling are big perks. Regulators have little impact on what black market drug labs produce.

Eh. I'm an an antique Schedule II drug. The literature notes that people with my condition don't seem to end up addicted to said drug (or its pals). Probably because we're just glad to take the edge off the pain. It's already rather potent, as painkillers go, as it previously was given to women in labor.

However, as my condition becomes more severe, a time will come when I will have to "graduate" to something stronger. The end of that choo-choo train looks like fentanyl or something very much like it, assuming I don't just up and die first. I'm glad that there is something there.

A friend of mine, his mother died of the same thing many years ago, when it was poorly understood and largely untreated. She was kept in a distant corner of the house so that the screams were less bothersome. Raving in pain, she would curse his name for not helping her to die. That's what it looks like at the end when there's not enough painkillers.

So I guess if you get your way, can I bunk at your place?

I joke, but only a little. You don't have a lot of skin in this particular game. Consequences are far away, third-order at best. I dunno, maybe listening to someone howling away might bring it home, maybe not.

To someone like me, it looks like someone who won't really be affected at all just trying to yank one of the few solutions I have left away, and for no good reason at all.

Flash reactions:

* You could identify fentanyl passed off as heroin, cocaine, etc because they don't work as well.

* "Damn this cocaine is weak. Maybe I need to take more" - I could imagine this leading to more fentanyl overdoses.

* Something like this happened in neuromancer.

> Something like this happened in neuromancer.

Right, and Case bought betaphenethylamine instead of speed which was way harsher. That's exactly what is going to happen, some more potent drug that escapes the vaccine is going to get more popular. It's a bandaid solution that ignores the root cause (drug prohibition)

Wait, what? Selling fentanyl as candy in every street corner shop is going to fix this?

There is a broad gulf between selling something like candy and criminalizing its possession. You need to be of-age to buy beer. Sudafed is sold OTC but with strict limits. You need a prescription to get many pharmaceuticals.

The reason for the strict limits on pseudoephedrine is because of its use in the manufacture of (prohibited) methamphetamine, so that's a poor example. Prescription drugs are also a bad example because fentanyl (and most other opioids) are already available with a prescription in most of the world.

Alcohol and nicotine are the only real middle ground in the US (maybe cannabis, but that's in a paradoxical legal status right now). Neither really seems to be in a "solved" state. Though I concede that at least alcohol and nicotine seem to be in a better state than fentanyl.

I really don't undertand this binary thinking regarding drugs. It seems like there's at least a third option in there somewhere between "ban it all and everything related and lock people up for decades if they touch the stuff" and "put it in a Pez dispenser and give every elementary school student a 12 tab slider with lunch every day."

We don't do that with alcohol or weed, I don't see why that's the first (and often only) option that comes to people's minds when suggesting some form of legalization.

Well, even as a legalization sympathetic person, I can _sorta_ see the argument when you look at how marijuana legislation has gone. Dispensaries all over the damn place and the endless variety of products and general "mainstreaming" of weed use... I'm not opposed in principle but as sympathetic as I am I can't help wondering if some of it has gone a little far.

That said though, I totally agree that "legalize all drugs" doesn't have to imply that we would do the same super fun dispensary thing that we do for weed for something like fentanyl, or even something more benign like mushrooms. I imagine legal fentanyl would be more like a freely available prescription or similar, where you can be dispensed a certain amount under reasonable conditions as opposed to just walking into the fentanyl dispensary and picking your favorite strain in a colorful container.

I wonder if there is a correlation between an accessibility of cannabis and alcohol-related incidents. Cannabis is much safer than alcohol. Would my friends and I have drank as much as we did when I was younger if cannabis was cheap and accessible?

Methadone is accessible for people dealing with opioid addiction, but that doesn’t provide a high so it doesn’t actually solve the problem of addicts choosing to continue opioid use.

Keeping fentanyl illegal evidentially can’t stop the problem of it ending up in street drugs causing overdoses. I concur a prescription for fentanyl patches would likely be the best approach.

Prescription of some kind, maybe in a similar but less permissive vein as medical marijuana, seems right to me too.

I'm pretty much in favor of letting people decide what goes into their bodies but I can't see a lot of benefits to freely available fentanyl. But I would definitely like to see an approach that decriminalizes addiction. It's a really tough nut to crack though. Not sure what the best approach is.

One of the purported benefits of legalization is that you eliminate some of the black market incentives for distribution. Prescriptions still leave room for a black market so I'm not sure they solve much... I'd be interested to hear arguments for any approach that could make the problem better.

> freely available fentanyl

I posted up-thread and want to clarify. Fentanyl and other strong synthetic opiates are mostly the product of heroin or opium being illegal. Decriminalized heroin would mean that opiate addicts would not have to resort to sketchy drugs to get high.

I don’t think it would. Fentanyl is on the streets because it is cheaper, stronger, and easier to smuggle than heroin is. Decriminalized heroin wouldn’t stop dealers from cutting their supply with fentanyl which is the main cause of opioid overdoses afaik. Regulated, controlled, and accessible fentanyl would mean addicts can safely get high.

I think the middle ground is, "medically supervised with informed consent" like we do with every other prescription medication. You wanna drop acid, take molly, pop an addy, or k-hole yourself, have a blast. Get a doctor to sign off that you know how it works, how to take it safely, what to do in an emergency or overdose situation, and that you don't have any complications with your health or other prescriptions.

It would at least be a safer and more honest policy about what the current state of recreational drug use is like in the US.

Yeah. Since alcohol became legal nobody has died from it.

You left off the /s ?

Opioid overdoses are typically due how opioids effect the brain, so this would prevent fentanyl from contributing to and overdose.

Opioid overdoses are typically due to overestimation of one's tolerance or underestimation of the strength of the drug being taken, and what you are responding to is a way that a weakened fentanyl effect could lead to that.

You could still OD, but it would not be a fentanyl OD, because the fentanyl in the drug would not be able to interact with the brain. If you took this vaccine, it seems like you would be just as likely to OD from heroin as you would from fentanyl+heroin.

Yeah that did cross my mind. I wonder if it really blocks it at the same level that you're talking about.

That is part of the goal of the vaccines, but I don't think there is enough trial data to know yet.

actually have a friend who nearly died from snorting fentanyl passed off as cocaine. fortunately an ambulance got there in time and saved him with narcan. his doctor friend also snorted coke with him, was carrying narcan in her purse and managed to Pulp Fiction herself on the way down.

fentanyl is scary stuff.

> * Something like this happened in neuromancer.

You just reminded me that I want to re-read it soon.

Legalized cocaine would be tested for fentanyl and other potential contaminants.

It's already legalized, requires prescription or license to administer.

Wait - do I not know what the word 'vaccine' means?

Opioid addiction is a malignant disease, what's wrong with the usage here?

We usually think of vaccines as medicines that train the immune system to attack unwelcome molecules / microbes.

Perhaps the parent was asking if this technique actually uses the immune system?

(From skimming the article, I think the answer is yes.)

In the 8th sentence it says the vaccine will "generate anti-fentanyl antibodies" with the goal of preventing mental illness.

The study's intro explains the use of the term: https://www.mdpi.com/1999-4923/14/11/2290/htm

> OUD [Opioid Use Disorder] is a chronic disorder that even with maintenance therapy has relapse rates approaching 90% largely due to poor medication compliance with current agents [17,18]. Immunotherapy using vaccines can reduce this compliance problem by requiring less frequent administration. Vaccine immunotherapy targets small molecule antigens such as opioid compounds consisting of the antigen (hapten) linked to an immunogenic carrier protein that stimulates the immune system to generate antibodies. An adjuvant is often added to the formulation to increase immunogenicity (antibody formation) against the hapten. After vaccination, when an opioid is consumed, antibodies bind to the target opioid in the periphery and prevent it from getting into the brain or affecting other organs. The kidneys subsequently eliminate bound drug from the body. Numerous pre-clinical studies targeting a broad range of opioids have demonstrated vaccine efficacy [16,19,20,21,22].

> Recent studies testing various formulations of anti-FEN vaccines show efficacy in attenuating the behavioral and lethal effects of FEN and its derivatives [23,24,25] including findings from our group [26]. Our vaccine formulation is composed of a FEN-like hapten containing a linker with a carboxyl moiety suitable for carbodiimide coupling chemistry to form amide bonds to lysine residues on the carrier protein CRM197, a genetically deactivated diphtheria toxin contained in several FDA-approved conjugate vaccines. We combined our conjugate (FEN-CRM) with an adjuvant derived from heat-labile enterotoxins from E. coli (LT) named dmLT or LT(R192G/L211A) that has been combined with other vaccines in several human clinical trials

I thought it seemed like a stretch to use that word, but from the article it sounds like the immune system literally attacks the fentanyl as if it's a pathogen.

I can imagine such a thing being a double-edged sword, in that it blocks the analgesic effects of the drug as well as the high. Doubly so if this one is a success and they make similar versions targeting other addictive painkillers.

I can imagine people taking the vaccine proactively (the normal way people think about vaccines, after all) from the perspective of, "I don't want to become an addict, I better take this!" and then later regretting their choice when their options are limited in terms of pain management.

However, if you limit the vaccine to people in recovery, then the harm reduction itself is blunted because the initial adverse event (addiction) has already happened, and this would only affect secondary harms (relapse).

I guess it's better to have more tools in the toolbox, at least, but I'm a bit concerned that these tools might be used injudiciously once they exist.

> and this would only affect secondary harms (relapse).

But this is a HUGE step. If you could drop the relapse rate, that would be a major accomplishment.

If we limit it to people who are using non-prescription drugs, without judgement, this will be the Game Changer they describe. First Heroin, but now cocaine, and even black market cannabis, are being tainted with fentanyl. For that set of people, stopping an accidental poisoning is much more important than potential complications with pain medication later.

This seems utterly insane to me as a solution compared to just making it possible (without facing extreme criminal penalties) to buy what you think you are buying. I haven't checked but I would guess that the number of fentanyl deaths for people who buy cannabis from legal businesses don't typically get product that is contaminated.

> even black market cannabis, are being tainted with fentanyl

I've heard claims like this for decades, it was and probably still is a frequent claim made by cops and teachers giving DARE presentations in American public schools. It doesn't make much sense and never did, why would weed dealers be giving people more drugs than they actually paid for?

It sounds like a cope excuse people come up with on the spot when they don't want to admit what drugs they were actually taking. Ask an alcoholic after a car accident how many drinks they had: "I only had one beer, I don't know how this could have happened!" Ask a fent-head after the OD what happened: "I don't know, I only smoked a little weed!" Yeah right.

inb4 "dealers do it to get people addicted"; it's weed, it sells itself.

This is a good time to remind people that https://twitter.com/justsaysinrats exists for a reason.

... and, indeed, the uh.edu article only tangentially indicates that the actual study (https://www.mdpi.com/1999-4923/14/11/2290/htm) has only been conducted in rats at this time.

Interesting, but since it's brain chemistry we should be wary of getting too excited about the likelihood that this chemical pathway works similarly enough in rats and humans to allow for the drug to be translated (many pathways do! But many don't, and the more complex the system the less likely it translates without deleterious side-effects).

Isn't the whole point of doing it in rats that it's way more similar to humans than say Drosophila flies?

Somewhat related: has the result from the Rat Park experiment been debunked or shown not to apply in humans? https://en.wikipedia.org/wiki/Rat_Park

The link you posted says that the original rat park researcher's own graduate student was unable to replicate the original experiment when he tried reducing the confounds. That seems like the most favorable possible situation for a replication to me. It also says that one confound was that morphine consumption wasn't measured in the same way between conditions in the original experiment. That seems pretty bad to me. Linked article also mentions that other researchers have had trouble replicating the results fully.

Rat park doesn't consistently apply to rats, so why should its results be considered particularly informative about humans?

Has someone done a much better study on rats since then? Significantly larger N, always taking measurements the same way across conditions, genetics carefully controlled or at least measured? I'm not an animal behavior researcher, so I'm sure there could be other things important to handle.

Rats are certainly more similar to humans that flies are, but that doesn't mean any particular study is informative about humans.

Just saying, since neither humans nor rodents typically live in cages, maybe rodent experiments would be more predictive of human behavior if they weren't forced into living in small cages.

looks around his cubicle

I must be in the control group. ;)

This article doesn't mention whether it prevents the cardiovascular depression that actually kills most people exposed to fentanyl. If the vaccine doesn't prevent that, it's useless. A vaccine that makes fentanyl less "fun" doesn't do anything for the people who ingest it thinking that it's something entirely different.

A vaccine doesn't work unless it helps the tiny fraction of fentenyl deaths who unintentnially take the drug? How about this: You're less likely to come in contact with the drug if there are fewer users getting high off it.

Is there some group of people who are taking fentanyl en masse intentionally?

I know a few people who have died after taking what they thought were bars or ecstasy and died because it was laced with fentanyl. I know 0 who go out of their way to find and take fentanyl.

Wildly anecdotal, this is like thirdhand info, so take with a bunch of salt. But I have heard before that heroin/opioid addicts have begun to deliberately seek fentanyl because it's cheaper and more potent.

It makes at least some sense given the common narrative of the pipeline from painkiller addiction to heroin (i.e. it's the same relationship - people who are addicted to painkillers may transition to heroin because it's cheaper and more powerful).

I've heard it's cheaper, but the half-life is so short that just to keep the withdrawal symptoms at bay, addicts need to dose more often than if they're using heroine, oxycodone, etc.

Right. My understanding is that it's very common to have fake oxycodone or heroine that's fentanyl or carfentanyl, and the short half-life of fentanyl and carfentanyl means that addicts will get withdrawl symptoms in just a few hours. My understanding is that heroine and oxycodone have long enough half-lives that many people can hold down jobs and generally be pretty functional by taking small doses before work (and maybe mid-shift, not sure). My understanding is that it's nearly impossible to do something similar with fentanyl/carfentanyl.

Though, I have little exposure to hard drug culture, and get most of my information from headlines.

Yes people take fentanyl intentionally.

The real heroin, the real opioid pills, and other forms of opioids have mostly dried up. Now we get fentanyl and fentanyl analogs, and other potent synthetic opioids that aren't well tracked. The reason is that it's extremely potent so it's easier to smuggle from China, Mexico, wherever it's being made.

So now you get "pressies" [homemade pressed pills] which is diluted fentanyl. Everyone knows it's fentanyl. Everyone knows you can't get real heroin in the US anymore. They know these fake pills aren't real. Even worse, when the fentanyl dries up they start cutting it with xylazine and other bullshit that narcan doesn't even work on.

Research areas such as Kensington and the blighted areas of Baltimore. There's videos on youtube showing just how many users are out on the streets. You can imagine how many more are still not down to that level yet. You can also look at the opioid and drug subreddits. It's all fent and everyone wishes they could get their impure crappy brown heroin back.

> The reason is that it's extremely potent so it's easier to smuggle from China, Mexico, wherever it's being made.

Which is also why this won't work. Even 100% of the population were vaccinated against fentanyl, the end result would just be even more deaths because dealers would switch to using carfentanyl.

Would this be solved by legalizing and regulating opiates?

You would think. But FDA is going opposite direction making legal opiates even harder to get by putting pressure on doctors.

Yeah. The way I understand it is that most users would prefer natural opiates but they're getting more and more expensive while synthetics are cheaper than ever. And, because the market is unregulated, even if you try to buy heroin you'll end up getting fentanyl mixed in anyway.

Yeah "heroin" can often be this weird brown product they mix in mexico. who knows what they add. whatever opiate like drug they have their hands on.

late stage cancer patients are often prescribed it

I would say most users now are taking the drug intentionally. I know of people who do seek out fent or fent laced drugs specifically. Its a lot cheaper to buy than heroin or any other opioid these days.

Let's go another way with this: You are extremely unlikely to ever come across a fentanyl user, even if you work for law enforcement, even if you're a LEO in a major metro.

10x people died of heart attacks than any opioid, not only fentenyl, over the past few years. Almost as many people died of cancer as heart attacks, and half as many people died of COVID as cancer.

Obviously, you can't equate research with other research; research and the drive to do research as a researcher is not a fungible item, but if we're spending tax payer money on it, why not a vaccine for foods that are low in fat, low in sodium, low in nutrition, and high in simple and processed carbs? That could save 700k+ lives a year in the US, more worldwide; and given that is also linked to cancer as the primary driver of it outside of smoking and drinking, another 600k+.

> Let's go another way with this: You are extremely unlikely to ever come across a fentanyl user, even if you work for law enforcement, even if you're a LEO in a major metro.

I'm gonna need a citation for that outrageous claim

> Obviously, you can't equate research with other research; research and the drive to do research as a researcher is not a fungible item, but if we're spending tax payer money on it, why not a vaccine for foods that are low in fat, low in sodium, low in nutrition, and high in simple and processed carbs? That could save 700k+ lives a year in the US, more worldwide; and given that is also linked to cancer as the primary driver of it outside of smoking and drinking, another 600k+.

Because that is nonsense. We don't have that technology.

> Because that is nonsense. We don’t have that technology.

https://www.theringer.com/2023/1/20/23562871/america-isnt-re...

That is nothing like a "vaccine for junk food"

> You are extremely unlikely to ever come across a fentanyl user, even if you work for law enforcement, even if you're a LEO in a major metro.

Since you're using ancedata, I'll use ancedata as well. I don't care to find the actual data.

Fentanyl is showing up in a huge amount of urinary drug screens right now. Unfortunately, much of this is the result of other drugs being cut with Fentanyl.

Fentanyl is the leading cause of death for those aged 18 to 45 in the US. Seems pretty important to me. We can also look at the things you suggested, it's not like there's an Obesity OR Fentanyl choice here.

> it's not like there's an Obesity OR Fentanyl choice here

Thats kind of my point. If they managed to make a working vaccine, good on them. It doesn't necessarily take away from efforts into other things, as two parents above me were casually implying.

> You are extremely unlikely to ever come across a fentanyl user,

... unless you walk around downtown in many major cities, where you will come across dozens in the space of a city block. People who work in downtown Vancouver often carry naloxone kits, not because they're ever going to use, but because they don't want to watch somebody die on the street. You don't even need to know how to use the naloxone -- if somebody is in distress and you say "hey I've got a naloxone kit" you're already a hero because everybody else knows how to use it.

> You are extremely unlikely to ever come across a fentanyl user, even if you work for law enforcement, even if you're a LEO in a major metro.

is this a joke?

Yeah but my understanding is that most of the overdosing are from people seeking something else. In some cases it’s akin to a contamination problem.

We are at the point in the fentanyl epidemic where most users are specifically seeking out fentanyl or fentanyl laced drugs.

Because fentanyl is way cheaper by itself. Why mix in more expensive drugs? The issue is China, full stop.

Exactly, fentanyl is now cheaper than most other drugs and opiods. So many opioid users have just switched to fentanyl. Why pay extra for heroin? The issue is also the cartel in mexico, fentanyl is produced there too.

https://www.nbcnews.com/health/health-news/feared-illicit-fe...

I agree. Blows my mind that I was downvoted so hard on my factual comment. But it is HN.

I suspect most people looking for cocaine or methamphetamine or mdma are not looking for fentanyl.

Maybe, but theres also a huge market for fentanyl specifically because its the cheapest opioid you can get your hands on.

https://www.nbcnews.com/health/health-news/feared-illicit-fe...

Citation needed.

Here you go! Plenty of similar articles out there if you search for this yourself. I’ve also seen people break up these pills and put into glass pipes to smoke at the train station.

https://www.nbcnews.com/health/health-news/feared-illicit-fe...

And how do you propose we get all the users vaccinated with the fentanyl jab? Another round of mass vaccinations? Make all the kids in school do it? Forced vaccinations for anyone in jail or rehab? Honestly, all of those seem like bad ideas.

If the government subscribed wholly to utilitarian ethics, it's arguable that it would be an ethical imperative to contaminate the fentanyl supply with vaccine.

I don't agree, and think it's immoral and unethical to subject citizens to such medical treatment without informed consent. However, under some ethical systems, the improvement in aggregate health makes in an ethical necessity.

The US government has actually done similar things before, such as poisoning bootlegged alcohol with methanol. It's good that you bring it up because at some point somebody in power will.

Drug treatment is a common alternative to jail time. Clean drug tests are often a condition of bail and parole.

Didn't we already do it? Ban people from working if they don't take it, maybe take away any benefits too. Don't allow them to public places?

> Ban people from working if they don't take it, maybe take away any benefits too. Don't allow them to public places?

Over a one's own choice to not have a medical procedure?

Should we do the same to those whom have abortions?

Who gets to make a choice on what medical procedures a population should have? Why is it not the individuals decision?

This is a frighteningly totalitarian comment.

As someone who's not a drug addict or around people who use substances that might be tainted with it, I don't want this. If I'm in a car accident or a serious condition where I need immensely powerful pain-killers I sure as you know what want Fentanyl to work.

> you know what want Fentanyl to work [sic]

Your concerns are addressed in the article you're commenting on

Not really. There are people for whom Fentanyl is the only real choice for use _during_ surgery. I'm one of them, and I don't want doctors mucking about inside my chest without ample pain relief.

Interesting, can you explain why fentanyl is the only real choice, instead of alternatives, please?

Fentanyl (and the derivative the vaccine works on) have very short half-lives, which is ideal for _minimal_ dosing during surgery. Any drug that lengthens the QT interval, or fucks with the S wave will bring about catastrophic heart failure in people with conduction channel issues. The only time alternative anesthetics are given to me for example is to induce heart failure in order to test new leads.

I find the idea of a vaccine that makes therapeutic drugs fail to work quite scary personally.

Seems like there is a lot of unwarranted criticism of this, and I think it is from a misunderstanding of how it would be used. This is meant to be a treatment targeted to people who are addicted to opioids. It would prevent overdose deaths due to heroin and pills which have unexpectedly large amounts of fentanyl (e.g. due to mistakes made when the supplier cut the drug). If taken in combination with proposed heroin and oxy vaccines, it could prevent many opioids from being effective - that could be a tool someone uses to help stop themselves from relapsing in the future. Someone taking this would have to way the benefits against the risks of not being able to take fentanyl when needed (e.g. for surgery).

Pray you then never get cancer or other nasty shit that requires proper painkillers.

The article mentions that it’s specifically targeted at fentanyl and doesn’t interact with other opioids such as morphine

And fentanyl specifically exists because of the downsides of other opioids such as morphine.

Fentanyl is preferred for cancer patients and end-of-life patients for a reason. Morphine is difficult to administer efficaciously at those levels of suffering, and has some very undesirable side effects (so I've been told. IANA Anesthesiologist).

I was just about to create a new account anyway and my stephangaphy evidently is uncorrelatable, so may as well signoff with a likely-in-vain AMA:

Ask a daily Fentanyl user/addict anything?

Irony.

The kids trying to play it safest are the ones who end of dying.

A friends 5mg Percocet or 7.5 Vicodin Pills feel nice. Not really the first time, but the second? You're a little happier. a somehow pure, happy blissful moment. pure satisfaction. the world is exactly as it should be - youre at a party in high school! and youre doing the cool stuff!. things change slow, sometimes fast. depends on the money involved, and where and how the pills originate. but once they originate, they are analogous to a social endemic.

Pills feel nice, but they do eventually creep up, financially and tolerantly and socially, until you really need that one girls brother to be at KMart by 5:50 or your stomach will hurt Tuesday. All friendships are simply transactional, ledgers of who gave who what when, and, but "she owed me!"? But those people are dead now, because they were smart, and better. The were just doing medication. They weren't doing actual, yanno, _drug_ _drugs, like heroin or meth. Only dumbasses did that.

The dumbasses like myself - we did the math - the $dollar per / dopamine! we werent the dumb ones. Why buy 4x Perc30s for $60e each to barely feel a nod when a $5bump of H will do that and more....But we were the rest able to ride the dovetails of the last bit of domestic heroin import. Because of that, our tolerance and slow unremarkable experience and slow taper into being Fent intake saved the ultimate mortal moment, and prevented our inevitable unexpected encounter with the substance being our last mistake - yet.

Do I get high anymore? Only because I went without, and got relief. Sometimes my eyes feel droopy, or the two top most contexts in my stack of a RAM were just swapped, leading me uncontrollably to say something I was thinking about a moment ago.

Did I ever get high? Surely this year of continuous, continual odding had to be enjoyable.

I didn't do that math too accurately recently - felt too good for too long. Better refrain slightly tomorrow. Lest a lapse - and we can't have that, can we?

I used to follow Naltrexone trials: blocks opioids by having higher affinity in brain receptors), in principle it can work as a one month injection, but the results were also pretty poor. Even in well functioning medical professionals with opioid addiction, adherence was pretty poor. The hypothesis I remember was that the drug didn't have any tangible benefit, so it was hard to continue using it.

I am curious and have been researching this chemical and related structures recently.

I can't see this being a good or sustainable idea.

First it will probably just lead people to find other means of getting high. (if they want to).

Second it might well make drug cartels reformulate the drugs to try to "bypass" the "locks" the vaccine placed. and that might mean even more dangerous versions flooding the market.

This is an utterly horrible idea. People are so caught up in the fear mongering that they forget that fentanyl is used in pain management in end of life care.

Vaccinating yourself against the effects of pain meds is as stupid as it gets. And it gets really vicious once you start pushing this on people.

You wouldn't give this to the general population, only to addicts that couldn't get clean otherwise.

Those might need the end of life pain management one day. Its what makes it so vicious. They are in no position to think the horrible consequences through.

edit: Lets lot sugarcoat this. This is not a new idea. If you push this on somebody, you might as well torture them to death yourself. Its that bad of an idea and your motivation doesnt change the outcome.

There are a whole lot of worse fates then being an addict and being in excruciating pain because of a preventable lack of end of life pain meds is one of them. You can look around, large parts of the world are doomed to this because of a merciless crusade against pain meds by people who couldnt deal with their loved ones choosing a drug. And i will be damned if its because nobody wanted to hurt their feelings by explaining this to them.

>Those might need the end of life pain management one day

If you need end of life pain management, then it means you never fatally OD'd on fentanyl, which is the likely outcome of opiate addiction.

That is a caricature. You can invest in naloxon if you are worried about that. Or better yet, go the route of Switzerland and provide safer alternatives for life long addicts. It does absolute wonders for their quality of life.

The crux just is, that in this discussion, sober is the most important metric for a lot of people. Overlooking not just the end of life problems, but the simple truth that without drugs, a lot of those addicts would have killed themselves already. Drugs arent just a fly trap for the careless, they are a haven in the storm for the desperate. A shitty haven for sure, but in some situations less bad then the alternative. That distinction explains a lot of why all the warnings get ignored and all of the "education" on the topic finds only deaf ears.

Watch this therapy disable the painkilling potential of every opioid in the body, including natural opioids.

The article actually discusses this:

“The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.

What about twilight anesthesia? With my cardiac problem, I can't have general anesthetics, but I can have Fentanyl/Midazolam to sedate and numb up a bit. Saying "it's specific to fentanyl" doesn't help those for whom fentanyl is a life saving drug.

The reply above that the real issue is WHY Americans like fentanyl so much is on the money in my opinion.

Well the idea is not for everyone to get OUD vaccines. They would be targeted to people with OUD. If you did have OUD, this treatment would unfortunately probably not work for you due to your cardiac problem. However, depending on the severity of OUD and how effective this vaccine turns out to be, it might be worth forgoing the possibility of surgery.

Forgoing surgery in my case would be rather fatal.

One catch is that if you're undiagnosed with some problem like mine (Brugada Syndrome) you might get the vaccine before you know that's a bad idea. I have, in the past, been dependent on opioids thanks to my broken body, and yeah, getting off them has challenges. But I think the key is WHY some people like them so much. There's something a bit off when the aim is to take so much you vomit but don't die, which I'm given to believe is the "ideal" recreational dose.

Synthetic depression pill developed just wouldnt have that headline.

Aside:

Fentanyl is commonly used in the epidural during childbirth.

Severe allergies to other opiates occur in about 1/50 people.

Or just make fentanyl very hard to prescribe? We are getting dumber by the minute.

The drug war proved that making it harder to get things doesn’t help.

The problem is not fentanyl prescriptions, it's fentanyl being slipped into other drugs. I imagine for a drug user this could be a life saver.

nearly all the fentanyl on the street is illegally manufactured, not diverted from prescriptions.

fentanyl is ideal for smuggling because of how potent it is, and ideal for clandestine manufacture because it doesn't require opium as a starting material.

most fentanyl is manufactured in clandestine labs in mexico and distributed by drug gangs

Most fentanyl is manufactured in China, most illicit fentanyl is produced in Mexico. (nitpick)

i suspect illicit fentanyl greatly outweighs legitimate at this point

any reason but speculation? If so, please inform the DEA!

https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-...

fentanyl is a relatively exotic pharmaceutical and is not widely prescribed except in very serious or unusual circumstances. i have read a good deal about production shifting from china to mexico in the last few years with china shifting more toward precursors following a ccp crackdown, but what i've read today suggests that the bulk is still produced and finished in china for export, with india's chemical industry as a potential major new source. i found this collection enlightening: https://insightcrime.org/investigations/mexico-deadly-rise-f...

i have very strong certainty that illicit fentanyl production outweighs legitimate simply due to the fact that it is not widely prescribed while it is crowding out the entire hard drug market in the US, but illicit fent still appears to mostly be produced by china for now.

> most fentanyl is manufactured in clandestine labs in mexico

contradicts your later statement

> the bulk is still produced and finished in china for export

> illicit fent still appears to mostly be produced by china for now

yes, that is why i was writing that comment, to point out corrections to both of our previous comments, hence "what i've read today"

As I understand it, this would have significant negative impact on anesthesia.

Although fentanyl is used for anesthesia, especially for deep sedation, it is not the only option. From the article:

So they could still use other opioids for anesthesia.

https://www.reddit.com/r/science/comments/yvnr4n/comment/iwg...

"So I’m an anesthesiologist. This vaccine would wreak havoc with surgery. Fentanyl is the go-to opioid for surgery. If you can’t use fentanyl then sufentanil can be used instead. Both are desirable because they have durations of under an hour which allows for surgical analgesia but still waking the patient after the procedure. The abstract here says the vaccine blocks both fentanyl and sufentanil. They don’t mention alfentanyl or remifentanil which would be the remaining options. Morphine, hydromorphone, codeine etc are all inappropriate for short surgical cases as the sole opioid because their durations of action are closer to 4 hours."

Of course fentanyl is the preferred opioid for a reason. Using other options could increase surgical risks. But that seems pretty insignificant for anyone with OUD given how likely they are to die from overdose vs. other causes.

Proposal, people with "opioid use disorders" are more than likely suffering in some way that needs evaluation and treatment. Many of them were probably on something and then cut off suddenly from the supply of that something, leading them to seek illicit sources instead and leaving them in the position of both unregulated treatment, and being unable to get proper regulated treatment because they are labeled either addicts by people who know about their illicit use, or "drug seeking" by people who don't that they ask for access to their drug of choice and almost all sources of proper health will refuse to treat them without them first continuing to insist they stop their use entirely. Cutting them off suddenly again by simply making their drug of choice stop working does nothing at all to address the underlying reason why they think or do need the drug and treatment in the first place. Given that our medical system often gives you a drug and then kicks you out the door to deal with it and its effects on your own, this "vaccine" seems more likely to exacerbate the larger drug problem, even if the specific "opioid" problem is solved. More likely rather than getting someone off their drug habit, this will simply drive users its forced on into seeking out other drugs to get the same results, possibly at higher and even more unsafe dosages.

Drug use is a symptom, and until our medical community wises up to that fact, the fight against any "drug use disorder" is going to continue to be a losing fight.

Dear pharma, please (please, please!) make something to fight food addiction?

Wegovy?

Will it stop me getting high on food?

If so, it's a blessing.

I believe so. But do please recall that your consciousness supervenes on a maschine made of meat, and spent several billion years wiring itself to get a dopamine hit from, yes, nutrients.

It's called walking the gradient ;D There's no cure, alas, for being a neural network

the fashion industry tried and failed

Bulimia or similar? Treatment options already exist.

(Unless this is a joke about eating disorders)

This is good news, but the epidemic clearly has other major causes we're still not addressing. A pharmaceutical to combat an epidemic created by another blockbuster pharmaceutical seems very... dystopian.

I'm waiting for the vaccine booster V4 myself.

Nothing wrong with this being on the front page. Just posting this here as a question. Is the reason why this is on the front page because a good number of software engineers addicted? Maybe you don't have the numbers but you yourself who's reading this may be personally interested in a vaccine?

I think it’s more about interest in the system, threat and the mitigation. The technical nature of biochemistry attracts many to this forum. Biohackers if you will.

Additionally I think a lot of hacker types are just interested in drugs and drug policy. There are lots of back and forths on here about "legalize all drugs" and stuff like that. There's a lot of hacker-related threads running through drug topics - there's the whole "hacking your mind" / psychonaut angle, there's the sorta libertarian intersection with the law, there's the counter-culture ideas and historical interest.

Even as a kinda drug-interested guy though, I've always thought of opioids as strictly off limits recreationally, just too many downsides and they don't have the same "expand your mind" appeal as psychedelics or even weed. (Not really endorsing the idea of mind expansion, I think it's oversold, but it's part of the culture).

Hacker News is for any kind of intellectual curiosity. It’s right there in the community guidelines.

And who knows, maybe this bit of creative immune system hacking will inspire a security researcher.

Not me personally, but I distanced myself from some close college friends when I figured out they were using heroin. Both later cleaned up, one relapsed, and I bumped into the other at the funeral.

So, yeah, the opiate problem effects more than just users.

It would’ve saved my brother in law. That’s mostly why I’m interested.

Not necessarily addicts, but where fentanyl is poisoning the illegal street market, even those once a month cocaine or illegal ketamine or mdma users are at risk, not just oxycontin addicts. Even purchasers of Adderall have to be careful these days. And vaccines are just cool technology. Why wouldn't I take this thing that makes me immune to as certain type of poisoning. It may not be for iocaine power but I'll take that vaccine as soon as it comes out!

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