Hacker News Reader

Comment by 0xCAP | Hacker News Reader

Non US person here, so feel free to call me out on BS. IMHO people who do fentanyl already have pretty serious mental and/or existential issues going on, like who tf would play russian roulette like that? Sounds more like a societal problem than a mere drug distribution regulation problem to me.

View on HN

Presumably you start with other drugs and especially weaker opiates. E.g. painkillers in pill form might be relatively harmless (compared to Fentanyl of course) but are more expensive and harder to get especially after the crackdown on prescriptions.

Fentanyl OTH seems to have a great cost/“value” ratio so when you’re already addicted and can’t afford anything else you don’t really have much of a choice. At that point your description of Fentanyl users is probably accurate but there is a long road to get there for most.

Also let’s be fair, it’s not like some European countries don’t have serious problems with drug related deaths (even if on a much smaller scale overall). Scandinavian countries all especially bad in that regard (Sweden has the highest number of deaths per capita though Finland and Norway are not that far behind). They are just much better at sweeping these problems under the rug because it’s not as visible (no homeless people).

While it's true that we indeed do have a severe drug problem in Finland, it really hasn't been pushed under the rug. We have a working social services system and the addicts have a place they can get their legal drugs from.

Also the overdoses per 100k residents are around 5.8, while in the us it seems to be 27.8

> Sweden has the highest number of deaths per capita

In Europe? It looks like the US has almost 3X as many. The US' map of deaths looks dominated by economics, while the European one looks like it follows the latitude with seasonal depression.

> In Europe? It looks like the US has almost 3X as many.

Yeah, of course, US is on a completely different scale.

> while the European one looks like it follows the latitude with seasonal depression.

And/or drug policies. Sweden is significantly more prohibitionist than most countries in Europe. Generally discussion about drug use are also generally much less tolerated and the social stigma attached to it is bigger.

Sometimes (from what I've read, I'm also non-US) many people who end up on fentanyl were not even going through any mental or existential issues, at least not overtly, but rather were prescribed opiates such as oxycodone after being legitimately diagnosed with more-or-less severe and prolonged pain. When I say they were "legitimately" diagnosed, I mean that the patient didn't fake their ailment nor went to the doctor with the intent of getting opiates—at least not initially. Whether opiates were a reasonable approach to deal with the patient's pain is a whole'nother issue.

Over time, as the prescribed opiate painkiller loses effectiveness (as well as its pleasurable side-effects), patients may request a longer or a stronger prescription. Their doctor may or may not oblige. The patient may switch doctors to another who is more accommodating. Then the new prescription loses potency, and the cycle repeats. At some point the patient is not even taking the opiate primarily for their pain, whether they are aware of it or not, but rather for how it makes them feel. Eventually the patient cannot get a stronger prescription, or even prolong the one they had already, for whatever reason—be it financial, insurance, or doctor's refusal. That's when getting a tiny dose of fentanyl will "help". And now they're on fentanyl.

Obviously this does not happen in a vacuum. There are many societal, cultural and healthcare issues that make this scenario much more likely in the USA than in other developed countries: a combination of the healthcare system, workplace expectations, and the culture of pulling oneself up from ones own bootstraps.

Fent is mostly a street drug. While i guess those cases exist, the problem we are seeing now is mainly a flood of cheap fent on the street from people who have probably never been prescribed opioids before (or indeed, haven’t seen a doctor very much at all in their life). The older middle class people who were/are abusing opioids aren’t the same people on the street who never had much anyways.

From what I understand - people who got addicted to legal opiates now can't access them and fentanyl is somewhat accessible and gives same effect with lower dose. So it's not necessarily your stereotypical junkies that are using it, it's normal people who were given opiates to deal with pain and now got addicted.

So all those oxy prescriptions weren't a good idea then?

I don’t think you’ll find anyone to argue that they were.

You'll find some right in this thread

https://news.ycombinator.com/item?id=37544012

Lots of people think non-trivial pain warrants opiods. The problem becomes who decides what counts as non-trivial pain. There was a shift in early 2000's towards "believe the patient", which caused an explosion in prescriptions pretty quickly. After all "if 5% of people after xyz surgery demand them, maybe the other 95% are silently suffering", etc.

(just describing what is, not what ought to be)

Unfortunately, my understanding is that some companies found a _lot_ of people to argue exactly that - if anything, to create plenty of value for the shareholder.

And who are the shareholders at the end of the day? The same people taking the pills.

Edit: I’m talking about the elderly and their 401ks / pensions and retirement all invested in these types of companies.

Not at all. In fact, we're having a huge public reckoning right now.

It's now in pressed pills that look identical to prescription pills. Someone goes to take a 5mg hydrocodone and they end up overdosing on fentanyl. All of the safer drugs that existed in the past are now either cut with fentanyl or are just fentanyl, even things like cocaine, ketamine, ecstasy, etc.

Fentanyl is frequently laced into other drugs (without the buyer knowing) because it is cheaper to produce than e.g. heroin. Or it is used as the main ingredient in fake versions of “real” painkillers like Oxy.

But it’s so deadly at low levels that it’s very easy to end up with a lethal amount in a single dose through inconsistent manufacturing processes, unbeknownst to seller or buyer.

Everything related to the surge in opioid addiction is obviously a societal problem. But not the one you’re imagining.

As the article mentions, some people are unwittingly taking it because their other drug of choice is laced with it, and they become addicted this way.

it's very very rare that somebody would intentionally seek out fentanyl without a pre-existing opiate addiction, probably from over prescribed pain meds that turned into black market pain meds then heroin

Think of it like guns. In the east, children don't touch guns that easy as Americans. So you not going to hear about accidental gunshot in the east no matter how stupid or how genius you are as Asian. In America, that is a normal annual statistical happenings. Fentanyl is like that. There are many incidents paper money laced with fentanyl where you touch it, you get fentanyl overdose. You almost can argue it seems foreign agents are slowly decimating American people to soften the take over with immigrants.

> There are many incidents paper money laced with fentanyl where you touch it, you get fentanyl overdose.

This is a myth perpetuated by cops having panic attacks.

You can dip your hand in liquid fentanyl and be fine. https://pubmed.ncbi.nlm.nih.gov/35722948/

"This has never happened," said Dr. Ryan Marino, a toxicologist and emergency room physician who studies addiction at Case Western Reserve University. "There has never been an overdose through skin contact or accidentally inhaling fentanyl." https://www.npr.org/2023/05/16/1175726650/fentanyl-police-ov...

Reply on news.ycombinator.com