America's ten-year-old fentanyl epidemic is still getting worse | Hacker News Reader

America's ten-year-old fentanyl epidemic is still getting worse

economist.com

47 pointspama34 comments

And the fentanyl epidemic is just a symptom, the underlying cause is something else. And of course it's much easier to talk about the chemical structure of molecules or about evil cartels than to face the real social problems that make people get addicted.

Yes and no. I know maybe a half dozen people first or 2nd hand who have OD'd on the stuff. All were happy people with accidental deaths from tainted Mdma or miss calibrated doses.

Fentanyl in MDMA, an easily synthesised empathogen stimulant - i.e. the complete opposite of an opioid high?

Are dealers just sprinkling it like fairy dust over everything?

What on earth is going on over there?

It's like MSG, sprinkle a bit on to induce addiction.

nope. Accidental or FUD.

Man. Very sorry for your loss.

The molecule really is uniquely more epidemic-causing than previously available molecules. So it is part of the underlying cause, along with social problems.

Yeah, I'd say its a symptom just like mass shootings and plunging birthrates are. I'd say the problem is the atomicity and spiritual poverty of modern American society, compounded by growing economic inequality as we debase our currency. Life sucks more now because we're lonely, tech addicted and getting poorer.

Link fix: https://www.economist.com/briefing/2024/02/29/americas-ten-y...

And... https://archive.is/2024.02.29-152604/https://www.economist.c...

Thanks. I don’t seem to have the ability to change the link — maybe the curator can fix it.

It kills 75k people per year, it would be 1m in over a decade. How does it compare to other drugs in history? Opium, etc.

An even better question is how it overlaps with those other drugs. Does 75k fentanyl deaths mean we've seen 75k fewer heroin deaths because they all switched to the new drug? Or are these things layered.

I came across a news item in Canada saying Heroin is basically impossible to find now. The lower quality but much cheaper product has replaced it. Clayton Christensen's theory of disruption in action.

There’s a graph in this very article that answers that question. Heroin deaths have declined significantly as fentanyl has displaced heroin on the market, but fentanyl deaths are far higher than heroin deaths ever were, because it’s far easier to OD on.

One thing I can’t understand about this is why purveyors of drugs would want to lace them with, effectively, a poison. The numbers must work out such that not enough of their customers die for it to make a measurable impact on profits.

You're making a lot of assumptions. Like the fact that they could do quality control if they wanted to. Or that they have a steady supply of product. Or that everyone's incentives are aligned. Or that people give a damn about the long term business. Or that users don't also make mistakes. Etc.

everything is a poison depending on the dose...whatever they put there, it is there for its psychoeffects...the dose is a secondary issue, or more likely: the quality control of the dose is a secondary issue

It's not precisely poison, it's an opioid 100x stronger than morphine that can be had for $.001 a dose coming in giant barrels from China marked SUGAR or MSG or whatever the hell. If I am a dealer, it's extremely tempting to try these waters. Unfortunately, most dealers weren't exactly in AP Chem, so they won't have any theoretical legs when it comes to figuring out how to measure 10-50mcg. The fatalities are strictly from crappy street chemistry, as it does not take much at all to make a "good product" a deadly one.

And of course the other temptation is to add it to everything, because man, opioids really are like Pringles. And once they're daily users, it's incredible torture for them to stop. I think the best description of opioid withdrawal . . ok, do you know the fingers on chalkboard sound? The way that feels, sort of a whole-body thing? Imagine that sensation, coming from somewhere inside you, basically all the time.

Another thing: the stories about cops dying from fentanyl fumes, or handling the stuff, or punching junkies, or getting licked or whatever - they're crap. They're all crap. Seriously. There's never been a toxicologically proven incidence of it ever passing the skin, ever, and it's too heavy to aerosolize without deliberately weaponizing the stuff. You might note that users have to punch the spike through their skin. It's just cop stories. If you know cops, you know they love their stories.

The upper limit of molecular weight for a substance to be absorbed transdermally is considered to be 500-600 g/mol. Fentanyl has a molecular weight of 336 g/mol, which is plenty low enough to pass through the skin. It also happens to be commonly administered medically through transdermal patches.

I should re-phrase that, because like its aerosol military usage[1], yes, the right formulation passes skin tissue.

Transdermals take hours or days, and the formulation is geared specifically so that it's carried fluid-to-fluid via fats in the skin layers. Fentanyl wholesale is never anywhere near pure form, and it's locked in crystal structures of other substances. When it's added to other crap, the concentration goes down even more.

Should you roll around in giant piles of street grade fentanyl? No. Should you lick your fingers after arresting junkies? Ew, and also, no.

Do you get chain overdosed from helping someone to an ambulance or being in the same room as a herd of junkies? Hard nope, but also, check your wallet.

[1] Which sucks as "knockout gas", by the way. Real good at "killing the whole elementary school" though.

Try giving https://pjvogt.substack.com/p/why-are-drug-dealers-putting-f... a listen. There are many reasons, some more plausible than others, but most surprising to me is that there’s a heavy amount of demand for it.

It's like 90% cheaper than heroin and the high lasts longer. Everyone works towards their numbers, and that's especially important to keep in mind around such an agenda-driven topic.

the fentanyl high is apparently shorter, more rushy than heroin.

If anyone's interested in how this actually happens, where it comes from, how it works, or how to fix it, or with any other good-faith questions, feel free to comment.

Meanwhile, the War On Pain Relief is making huge progress on all fronts

https://www.goerie.com/story/opinion/voices/2023/01/05/cdc-o...

https://www.sfchronicle.com/health/article/pain-opioid-presc...

https://www.painnewsnetwork.org/stories/2024/1/11/nbsp-90-of...

https://www.nytimes.com/2023/01/03/opinion/chronic-pain-suic... https://archive.is/0efUy

https://www.wtae.com/article/investigation-chronic-pain-pati...

https://www.newsweek.com/2023/05/12/opioid-backlash-addictio...

https://www.wired.com/story/opioid-drug-addiction-algorithm-...

https://thehill.com/opinion/healthcare/583332-the-opioid-cra...

https://ashpublications.org/ashclinicalnews/news/4706/The-Ot...

https://washingtonmonthly.com/2021/06/15/the-opioid-crackdow...

https://www.unionleader.com/news/health/chronic-pain-patient...

https://www.forbes.com/sites/andrewpulrang/2021/03/17/people...

https://www.washingtonpost.com/graphics/2018/local/impact-of...

Like lp4vn wrote: why are people even going so often to pain meds? Why does someone in the us gets opioids for an headache while in europe he takes an aspirin or something else?

No one in the US is getting opioids for headaches. There are a lot of people in chronic pain in the US (car and motorcycle accidents, workplace accidents, genetic disorders, etc).

The car accident one is really noticeable - it shows up over and over again in stories I’ve read about the crisis where someone started on opioids after getting insufficient treatment for some kind of crash and needing to go back to work before they were pain free, possibly compounded by a doctor being afraid of the DEA investigating them if they gave too many prescriptions which weren’t unambiguously necessary. I think a lot of our discussions about car safety saw fatalities declining and conflated “doctors are keeping more people from dying” with “driving getting safer”.

We do not have a culture of preventative medicine and we have weak labor laws. You need opioids to work with a bad back, knee, etc and you'll be out on the street if you don't work.

This. Basically it's the price of not having proper social security against illness.

I live in the Netherlands and opioids are unheard-of except cancer patients etc.. A friend of mine broke his collar bone, which was bulging out a bit, in a cycling accident and got only ibuprofen while waiting for surgery for 2 weeks. He just rested home on sick leave. No one expects you to work like that. This and unemployment benefits cost like 25% premium on the gross salary paid by the employer. At the end if you have a long term sickness leave like more than 3 months you are paid 75% of your salay from the social security fund. Employers are also supported to get temporary replacements in this case. Overall much cheaper than managing opioid addiction.

Maybe if the US spent less on NATO it would have more money for social programs. Looks like the Netherlands spends 1.5% of GDP vs 3.5% for the US.

https://www.nato.int/nato_static_fl2014/assets/pdf/2023/7/pd...

Modern opium war.

How can I get rid of the paywall?

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