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Comment by kstrauser | Hacker News Reader

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.

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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.

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”.

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.

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".

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.

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