Synthetic opioids deadlier than fentanyl are showing up in overdose cases
theconversation.com
theconversation.com
My 90 year old family member is having their bathroom renovated. 5 shoebox-sized packages arrive at like 4am, labeled "Shower Door". My relative gets up very early, so they see the package come in. They look at the boxes, think a) Thats not a shower door, and b) I'm not installing shower doors, so my relative opens them.
Inside are nondescript bundles of powder. My relative has no clue what it is. They call the contractor, the contractor comes over, takes one look, and calls the cops. It turns out to be 10+ pounds of fentanyl.
So clearly someone working with the contractor has a scheme going, where they target elderly, unsavvy people in order to ship hundreds of thousands of dollars of fentanyl in the middle of the night. The subcontractor presumably slips in before the homeowner notices, most people aren't awake at 5am checking building material deliveries.
The carrier was just some general shipping company. Not a big name, but not shady either. They had no idea what was being carried.
We don't think its the main contractor, because he easily could have gotten away with it. He could have said "Oh this is grout mix" and my relative would have been perfectly happy. I guess its a possibility though.
Supposedly the cops are looking into it, so I guess we'll see what happens.
I'm not sure what the point of this comment is. Fentanyl is only dangerous if ingested; incidental contact is harmless.
That shipment was, in all likelihood, intended for eventual distribution to opiate users, who have a higher tolerance than the general population. Making a comparison of how that would affect a person who has no tolerance is misleading fearmongering, when there was no indication that any person in this story was going to accidentally ingest the substance.
Bullshit. Your hand touches something that had fentanyl powder on it, your finger goes up your nose or in your mouth (most people in the world do this), then what?? Oh, nothing?
>Making a comparison of how that would affect a person who has no tolerance is misleading fearmongering, when there was no indication that any person in this story was going to accidentally ingest the substance.
I guess let's just ignore the problem, OP was being silly, there's nothing wrong here?? Is that really your line of thinking? What if the elderly person decided to open up one of the powder packages to see what kind of powder was in it, like if it had a smell or something, maybe it's chalk, maybe it's salt - they don't know. In that case they very likely would be dead. Inhaling it if grandpa did cut open one of the packages would likely kill anyone that entered the room.
I've never seen anyone be so cavalier about 10 pounds of fentanyl before.
Fentanyl is deadly in microgram doses, for it makes people stop breezing. Russians weaponized fentanyl into a gas and used it to disable Chechen terrorists in the Moscow theater hostage crisis in 2002 [0]. It was so effective that besides the terrorists some hostages died before an antidote could be administered.
[0] https://en.wikipedia.org/wiki/Moscow_theater_hostage_crisis
This is somewhere between myth and outright fiction.
There is zero evidence that fentanyl or its derivatives were responsible for any deaths. The claim that fentanyl was responsible is based on a single study which claimed to find fentanyl on one sample of clothing and in the urine of two survivors ten years after the incident happened, something which has & far more plausible explanations.
Based on the death rates, it seems like no one really has a higher “tolerance”. Even fetanyl users can’t handle fetanyl…
Yeah, there are lots of bullshit stories avout fentanyl that are completely implausible given the actual effects of fentanyl, and the vast majority of them are direct deliberate police political propaganda, and most of the rest are paranoid misinterpretations of events from people (mostly themselves street cops) whose understanding of the universe is shaped by being immersed in deliberate police propaganda.
I’m all for calling a pig a pig. Let me know.
Are you saying that fetanyl is no more deadly than heroin?
(Also, if anything, the whole “illegal substance flying in a person’s face” thing comes from comedy movies… Is this what you’re saying is untrue?)
Edit: one example here https://wpdh.com/city-of-poughkeepsie-cop-collapses-after-fe...
Yes, there are lots of urban legends! That doesn't make them true, especially when they fly in the face of basic science and can be disproven with even a back of the envelope calculation.
Are you saying that fetanyl is no more deadly than heroin?
Or are you just saying that the “wind blows substance in face” is only a thing seen in movies?
Hacker News is the last place I would expect people to blindly accept police press releases at face value, particularly when they fly in the face of basic science.
Your first link shows a guy administering Narcan to a man who's standing up, fully conscious, with his eyes open. Even if you've never seen an overdose in your life, that should set off some alarm bells.
These stories are evergreen and predictable. They make for good viral clickbait content, despite the fact that they never hold up. Every time, the story is the same: they run a test afterwards, and 90% of the time it turns out that there's no fentanyl in their system. The other 10% of the time, it turns out that the cop saw an opportunity to take a hit off the drugs they just seized (oftentimes non-opiate), and that resulted in an overdose.
For future reference, a good hint that these stories aren't portraying what they claim to be is that they almost never show people with symptoms consistent with fentanyl overdose (and typically with symptoms consistent of a panic attack).
The image of the police has become rather ideological of late, e.g. the "defund the police" movement and a counter pro-police movement. Both movements are tied in to other ideological positions, and I've seen quite a lot of HN posts on positions that are associated with pro-police stances (e.g. on climate change, COVID vaccines, etc).
So it doesn't surprise me to see HN readers accepting police press releases at face value. HN may have a reputation for a libertarian ethos, but libertarianism often supports law enforcement. It would be nice if that would get more skepticism when the press releases are such transparent propaganda, but as I said, we're all prone to swallowing propaganda that feels right.
If it's being sent through ordinary delivery means, such as a post office, do they ordinarily deliver at 4 AM?
If it's being sent through some drug-dealer courier system, is it necessary to go through the charade of dropping it off at a customer's house?
You're proposing escalating the drug war to literally unprecedented levels (treating drug users[0] as actual agents of war), in response to a completely nonsense fear (the idea that a "battery-powered fan" would be a viable route of administration).
The idea that fentanyl is toxic to the touch or aerosolized is pure police propaganda, contradicted resoundingly not only by all medical experts, but also by common sense (fentanyl is routinely handled in much larger quantities by nurses every day). The same applies to these other drugs - they're dangerous if ingested, but you're not going to be accidentally ingesting them, unless you're ingesting drugs obtained from pharmaceutical sources.
[0] No matter how you try to frame this as something that would only be leveraged against "traffickers", drug users will inevitably be the primary targets of any such law.
Nurses handle prediluted solutions (at the level of 50mcg/ml). That is still very strong but not the same as unknown quantities of unknown potency being secretly shipped around and mixed up by untrained dealers.
Currently, all the time, people mix up drugs with synthetics that they know can kill and sell it to unsuspecting people, who then die by the dozens. Some states already treat this as poisoning and manslaughter. Is this really that different from the scenario I’m describing?
There are literally orders of magnitude of difference between fentanyl administered as a nasal spray and fentanyl being used as a weapon. They're not remotely comparable.
> And there is also the Russian theater incident.
I don't know why people keep bringing this up. There is zero evidence that fentanyl or its derivatives were responsible for any deaths. The claim that fentanyl was responsible is based on a single study which claimed to find fentanyl on one sample of clothing and in the urine of two survivors, something which has a lot more plausible explanations.
> Certain lower-dose codeine products (8 mg or less per pill, 20 mg or less per 30 mL of liquid medication) can be purchased directly from a pharmacist without a prescription to temporarily treat mild or moderate pain, or as a cough suppressant.
[0] https://www.canada.ca/en/health-canada/services/substance-us...
None of that matters to heroin users or users of more powerful prescription opioids because codeine will not give them the high they want. A better model would be something along the lines of marijuana dispensaries or state-run liquor stores, where legal sales can be made but with added levels of difficulty/obscurity. That kind of rigid legalization scheme probably wouldn't kill the black market, but it would absolutely save lives. Many people who are dead today would still be alive if they could have simply purchased a safe version of the drug they were going to do either way.
Widely used outside the US, but illegal to prescribe here. But you can own it here as long as you are not prescribing it. It's not as potent as an opioid, but it's a step up from the OTC stuff. I often buy it when traveling abroad (a bottle costs less than a dollar in Latin America) and my family has used it for years as millions of people abroad. There are concerns with safety, but according to plenty of foreign research, these risks are comparable to other, widely used medicine, and are based on outdated results.
This medicine is so cheap it wouldn't be profitable to do new trials in the US, thus we will likely not see this sold here anytime soon.
Anyway, this is not medical advice!
> The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases.
I assume this is because everything is being diluted with cheap fentanyl.
But for drugs I do know and sometimes purchase, dollar prices have barely budged while the value of the dollar has declined (compared to the 90's). It's still $60-$120 for a gram of cocaine. It's still $3-$5 for a hit of acid. It's still $20-$30 for an eighth of shrooms. Ecstasy pills sometimes go for $30 now, but you can still find them for $20 just like in the 90's.
This is a myth. Nobody is cutting non-opiate drugs (like cocaine) with fentanyl. Fentanyl overdoses from non-opiate drugs are the result of accidental contamination, not intentional adulteration.
Drugs like cocaine are cut with other substances intentionally, but not fentanyl.
Obviously, we need some legislation, otherwise we'll revert to the world of patent medicines. (Basically, cure-all patent medicines had opioids in them, and people didn't realize what they were taking.)
Also, obviously, we shouldn't criminalize addiction to opioids.
Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?
Is legislation the primary problem with these addicts? Or are there other social factors involved? If so, then perhaps the legislation itself is the least important part of the puzzle.
> Also, obviously, we shouldn't criminalize addiction to opioids.
We don't.. it's just possession and sales that are criminalized.
> can legally maintain an addiction
What social interest is there in promoting that?
> a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?
There's a real fantasy on Hacker News about what the debonair lifestyles of heroin addicts actually are and zero apparent understanding of the long term consequences of the same.
> What social interest is there in promoting that?
Because the whole reason why we have the opioid crisis is because consuming any opioid without a medical reason is illegal.
IE, if you have an injury, and are prescribed opioids, and then accidentally get addicted, your only legal option is to go through withdrawal.
If you or I found ourselves in that situation, we'd probably go through withdrawal. Other people won't, and choose to violate drug laws in order to maintain their addiction.
Edit: I just want to point out that plenty of people willingly do stupid things: They get addicted to cigarettes, become alcoholics, drive too fast, write mean comments on the internet... We don't force them to quit their vices. The same should apply to opioids too.
> If you or I found ourselves in that situation, we'd probably go through withdrawal.
I wouldn't be so quick to make that assumption if I were you. Most people who become opiate addicts involuntarily would have assumed they would never resort to illegal opiate use.
That's a crucial piece of the puzzle: opiate users aren't a different class of person than you or any of the other users on this site. They're not cut from a different cloth. In all likelihood, most people on this site would respond the same way if put in the same situation. The only difference is that most are lucky enough that they haven't been put in that situation.
I could hardly function on the opioids (Lortab?) that I was prescribed after major surgery. I was relieved when my surgeon told me to stop taking them. Likewise, and I really hate the other opioids (Percoset?) I've been prescribed for minor dental surgery.
One person I know really enjoyed them and ended up dying from the addiction.
Clearly my head and body react differently than other people. I assume that akira2501 would be ultra-careful if he was in my situation.
Threw away the rest of the capsules. If my physiology reacts in such a way, it means I was beginning to develop a physical addiction to it. To Kratom, of all things.
It kind of opened my eyes to how quickly it can happen to people as well as how the desire to feel better and reduce suffering can easily lead us to ruin if we aren't careful and attentive.
Fair enough, but I am simply unwilling to call "just letting them be addicted" a _solution_ of any sort whatsoever. I'm entirely disappointed with this level of social response. You can be saddened by the apparent hopelessness of their situation, but beckoning further destruction and squalor for lack of willingness to truly care about the problem genuinely upsets me.
I understand that part of the concern is these people acquiring a "record" that will make their life difficult in the future. A simple mechanism that expunges these charges entirely upon proof of sobriety is all that's needed to solve this.
Basically, the problems that arose from alcohol prohibition are the biggest proof that keeping a substance illegal leads to crime and squalor; not the substance itself.
(Assuming you're in the US or similarly governed countries:) The law isn't about forcing people to make the right decisions for themselves, it's about helping society function. IE, "freedom" only works when other people can do dumb things.
Clearly, our current situation (opioid consumption is illegal unless actively being used for pain management) isn't working; and doubling down on that situation isn't a solution either.
There's a clear difference between "you shouldn't do this" and "doing this is illegal." Having the maturity to understand the difference is why we ended alcohol prohibition, and also what's needed to contain (and hopefully end) the opioid epidemic.
Watching first hand how opioids impact people in SF. I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.
Getting police involved in trying to solve social problems has its own inevitable tragic consequences. This is not a problem you can arrest people out of.
This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand.
> I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.
Forced treatment is itself inhumane. It's a "solution" proposed only by people who have little idea of what it looks like in practice, of how substance abuse works, or of what successful treatment actually entails. In reality, "forced treatment" dramatically increases the death rates of people subjected to it.
If your problem is with people living "on the street", there are lots of simpler ways to address that problem than to subject them to a costly, expensive government response that will statistically end up killing them.
I think he is just saying even if you legalize it and allow addicts to get drugs easily, it’s not viable long term as the addicts will develop tolerance to the drugs and will need ever increasing doses.
Right, and that's not true, because that's not how addiction actually works.
Can tolerance result in withdrawal when dependence is present? Probably not? No one has mentioned it anyway. If so a person who has developed tolerance and dependence on a drug will just not feel any of the effects when they take it but will feel withdrawal effects when they stop.
Addiction is a different can of worms though. If addicts crave the effects of the drug and won’t be satisfied otherwise, then tolerance is a problem for them and they will require ever higher doses to stop the cravings.
This is exactly what I'm afraid of. Especially when it is very easy to overdose on fentanyl.
The main reason why overdoses occur is because street drug potency is unknown, and because street drug potency can be inconsistent within the same batch.
(IE, if my black market "heroin" is really powdered fentanyl mixed in a gel, if I don't mix it well the fentanyl will clump, and the clumps could kill someone.)
Just to be clear here, I'm speaking from a position of much more domain knowledge than "a quick reading of a few health websites".
> If addicts crave the effects of the drug and won’t be satisfied otherwise, then tolerance is a problem for them and they will require ever higher doses to stop the cravings.
This, along with the entire trichotomy you've presented, is incorrect. It may surprise you to know that this is a topic that has been quite extensively researched, and there are mountains of clinical data on the topic. Maintenance doses aren't "ever-increasing" - they're fixed.
Pardon me. It’s hard to tell since your original post was pretty low on content. “No you are wrong” isn’t very insightful.
> Maintenance doses aren't "ever-increasing" - they're fixed.
Does this work for addiction or just dependence? Can we see some of the “mountains of clinical data on the topic”?
Canada ran a safe injection site with (cough) free heroin of guaranteed quality and potency, and free access to addiction counseling.
Turns out most people (in the program) quit using eventually.
I personally don't remember the details, and if you want to do the research to confirm (or dispute) my facts, that's on you.
The bigger problem is that government anti-drug propaganda (like DARE in the US,) biases people to assume that legal access to drugs will increase addiction, when the facts generally disprove this assumption.
You are describing maintenance programs. While methadone has been the maintenance drug of choice for programs in the US due to legal barriers, it turns out that heroin maintenance programs are even more effective than maintenance programs based on substitution.
With a maintenance program, members come to the site to receive a legally-obtained, pharmaceutical-quality[0] supply of the drug. Depending on the program, they may either use it on-site (e.g. supervised injection) or bring it home. Crucially, the drug is provided free of charge, so members don't have to worry about how to come up with the money to pay for it.
It turns out that these programs reduce crime rates among the members, because most crime that they are committing was in pursuit of the money for their basic needs[1]. Without having to worry about obtaining their drug, or the safety issues associated with the illegal drug market, many are able to find stable jobs, return to stable housing, and lead otherwise normal lives.
This isn't new science - one of the first studied attempts was in the 1990s[2], and there have been many more papers published since, documenting the extraordinary benefits. The science behind it is rock-solid. The challenge, as always, is a political one.
[0] Zero adulterants, no contaminants - just like the supply of morphine or fentanyl that is used in hospitals for inpatient treatment.
[1] Yes, for someone addicted to opiates, the drug is a basic need: involuntary withdrawal is extremely dangerous even under medically supervised conditions, let alone in the conditions most people are forced to experience it.
I used to be sympathetic with that Bill Holiday song "Ain't nobody's business if I do." I'm doubtful about that now but I don't think anyone will stand for a half measure when there's a full measure available - and the last full measure is throwing someone in jail to protect them but that's dumb.
No, legal access to opioids to maintain an addiction also comes with addiction treatment options.
Enforcement just needs to be consistently intense enough to create an incentive for traffickers to opt for less bulky alternatives over bulkier alternatives.
The solution is intervention but this is out of fashion thanks for campaigns against it. From Foucault to One Flew Over the Cuckoo's Nest. Their magic solution for the broken system was to destroy the system. Now he have all these "zombies" who are just slowly killing themselves, in front of us, and they are causing a lot crime and problems. The problem is snowballing and will end up in unspeakable solutions. It's sad.
As someone who works on the forefront of this epidemic (EMS) I can say with near 100% certainty you know people who consume drugs.
I certainly haven't displayed any, you're right. I would say that "drug addicted people in the streets, unable to care for themselves" is more humanizing than "zombies", but otherwise is unwieldy.
> I can say with near 100% certainty you know people who consume drugs.
This may well be true, but they certainly are hiding it from me, hence my lack of comprehension of the issue. With over a hundred Americans dying of opioids everyday, it's clearly a widespread issue. I can understand that addicts have an enormous challenge to beat addiction, but I cannot understand how there seems to be more addicts everyday.
You're a manual laborer. Your body gets slowly worn down by the job, and over time you get more and more dramatic joint and muscle pains but you don't have enough money to retire. At first NSAIDs are enough, but then you start slowing down again, and finally someone offers something that works better - but you still can't stop working, so you injure your body more and more while numbing the pain.
You're a sex worker. Violent sex (at times indistinguishable from sexual violence) has become a de facto cultural norm. Your clients are increasingly brutal, not even necessarily in seriously injuring you, just in their indifference to your comfort. In order to keep up with their appetites, and to keep a roof over your head, you resort to some chemical escapism - it feels good, and it makes it feel less bad when you're working. It also relaxes your body, so that the unbelievably incompetent sex can actually happen.
You're in a car accident, or get injured playing school sports, or are born in a body that just hurts all the time, for any or no reason. You're on a controlled, calculated, sustainable regimen of prescription opioids. Then you lose your health insurance, or your provider retires, or pharmacies stop being willing to fill your prescriptions because their role in the opioid crisis has shown them they have liability and they refuse to actually make judgment calls. You are in constant, excruciating pain, you're suffering from sudden, involuntary, unpredictable withdrawal, and there's no legal recourse.
Pain is the most fundamentally unpleasant experience there is. You might think you have a high pain tolerance, and you might even be right, but...have you ever had a headache that lasted a whole day, or just been sore from something for a solid 8 hours? If you have, you know how quickly you get worn thin, irritable, incapable of rationality. Imagine if you were in pain at all times.
Does this help you understand?