Hacker News Reader

Comment by dash2 | Hacker News Reader

I see a lot of posters confidently saying that the solution is obvious and it's [insert their favourite social panacea here]. The level of confidence does not seem related to the amount of evidence presented.

Examples include: more equality; more opportunity; less democracy; reducing gun accidents; less stress; and less teenage parenthood.

Many of these problems have been around for a long time. For example, the US has long been unequal and long been a democracy. Teenage parenthood has actually been falling. The fentanyl epidemic is relatively recent. You cannot explain a change by a constant.

I would support more intellectual humility and attention to the evidence in thinking about this terrible problem.

View on HN

A simpler explanation is there's just a LOT more fentanyl on the streets now then there use to be. And then, it's very potent and easy for users to overdose. It's easy to make the jump from those two factors to a rapid increase in fentanyl addiction and deaths. If you remove one of those two factors then you reduce the increase in addiction and death. So either reduce the amount of fentanyl on the streets or reduce the risk of overdose. I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least.

Narcan only works if there's someone else who can administer it. And that someone else should be sober enough to do it.

I’m in the U.K. and how do you even get this? I’d happily keep it on me but there’s not much info

Edit: oh it’s illegal unless you’re in a very specific position that will likely not save anyone unless it’s very lucky thanks U.K. government. Dickheads.

There are lots of people who believe someone ODing on fentanyl deserves to die.

Yes that policy seems dumb. I'm all for everybody being able to buy it. I'm not at all for having to use public funds to pay for it. Let all the saints buy it over the counter with their own money to be the hero, and spare me the tax money.

A lot of people go the brink and come back and live happy lives.

It used to only work when there was someone to call a medic, and hope they arrived in time. Now, if there's someone to call a medic, then that person can just immediately administer the Narcan. Thus, the point about reducing deaths still stands.

An article that just went by on Twitter: https://www.nbcnews.com/news/us-news/california-police-union...

Unaccountable policing strikes again, this time by running organized crime importing fentanyl.

> I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least

My theory is that this is why there is so much more fentanyl. If you think of a street level hard drug dealer, other than law enforcement, his biggest problem is the churn of his customer base due to overdoses/prison/going clean. The logical consequence of preventing overdoses is that his customer base will have less churn, expand more over time, and be more profitable. The effect of that is that organized crime becomes a bigger business, with all that entails.

I’ve never heard that customers churning out is a problem for dealers. My understanding is that someone ODing is actually good marketing for their product quality and will bring in more customers.

That's old fashioned, from a time when it meant that the heroin wasn't cut with a bunch of inactive stuff.

Nowadays someone ODing means your stuff is cut with fent, which isn't good marketing.

When every dealers known for ODs it stops becoming a concern.

Customer retention rate must necessarily be an implicit property of any business, even drug dealing.

Different businesses are more or less sensitive to different variables

> The logical consequence of preventing overdoses is that his customer base will have less churn, expand more over time, and be more profitable.

street dealers aren't that sophisticated in my experience. If there's competition they just kill each other. They don't have to worry about demand because addiction handles it for them. All the actual street dealers i've encountered ( quite a few in my 20s ) were basically the equivalent of a vending machine.

edit: well i will admit one clever setup i saw in old East Dallas. A drug house started taking copper as payment for drugs because, at the time, copper scrap was very valuable. So like the dealer would take a bunch of copper pipe in trade for drugs. It made for a rash of ridiculous copper thefts, like breaking into and stealing all the wire out of the walls in apartment construction sites.

I'm not describing any sophistication on the part of the dealers; what I'm attempting to describe is more akin to the proliferation of a species in a given ecological niche if more food were introduced. If the drug users die less, the dealers have more customers and make more money, and everything else follows from there.

I overheard an interesting tinfoil-hat theory about these overdoses, particularly why they seem to come in waves. It goes something like this:

- The best customers are newly minted addicts. They still have jobs, personally property, and friends and family who trust them. They can spend massive amounts of money quickly.

- Over time, these customers lose access to money as they spiral into addiction. They lose their jobs, run out of things to sell, and run out of friends and family to steal from.

- Eventually, they end up breaking into cars, stealing from businesses, mugging people, and committing burglary.

- This increase in crime attracts the attention of the general public and law enforcement.

- Drug dealers, in order to refresh their customer base and start the cycle over, distribute a 'hot' batch of product that kills off many of their customers.

Not sure how sound this theory is, but I thought it was interesting.

Interesting theory, but the last step doesn't make a lot of sense to me. Wouldn't the dealers be happy to take the money, no matter how the users can get it, and just focus on finding new customers?

The idea is that deaths of drug addicts attract less heat than property crimes. Questionable for sure.

A lot of these overdoses are because they think they are taking genuine Xanax or Percocet

Many of the Hays County kids who overdosed thought they were taking Xanax or Percocet; instead, the pills turned out to be counterfeits laced with fentanyl. Fentanyl is easier and cheaper to manufacture than natural opioids. It’s also much stronger, and can be unevenly distributed in counterfeit pills, making dosing more difficult

> I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least.

Unfortunately, we're starting to face a new monster named Carfentanil, and that monster is Narcan resistant.

That said, the move to make it OTC will definitely reduce the deaths. At risk people, can now keep it readily available. In the cases where there is someone able to call a medic for their friend, and wait for a possibly too late Narcan application, that person will simply be able to administer it immediately.

According to Wiki, carfentanil is ≈10,000 times more powerful than morphine. We're now talking 10s of micrograms for LD50 in humans. Whilst not as a potent a killer as botulinum toxin (a few nanograms), we're dealing with a substance that's essentially unmanageable.

As Wiki mentions, carfentanil is powerful enough to be classed as a chemical weapon. It's time this message was widely broadcast.

Why is there demand for something that is more likely to kill the user? Is it cheaper to produce? Harder to test for? Does it give a stronger high?

Indications are that it's easier to synthesize than morphine. If so, one doesn't run the trafficking risk with local production. Seems also it's cheaper (pushers make more profit).

(If addicts know they're taking carfentanil and risks associated with it then it's indicative of how powerful a hold the drug has over them.)

Unfortunately nobody’s confused about the explanation. It’s finding a solution that’s the problem.

People are arguing that more equality, reducing gun accidents and less teenage parenthood will reduce the number of Fentanyl Overdoses?

Might as well ban the sale of Purple Shoes as well, who knows how many lives that could save...

Reply on news.ycombinator.com