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Comment by bilekas | Hacker News Reader

I'm no expert, but I've always thought that adding much more risk to the lives of your customers unnecessarily is not good for business.

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In this market, a better high for less money will attract lots of customers, even if it is less healthy than the alternative.

So, if you’re in the business of selling the somewhat healthier product, and one supplier starts to supply the otherwise superior product, that’s not good for business, either. You will lose customers.

Now, do you accept that, saying “I won’t sell that”, do you fight to outlaw the product (will be hard given at you’re not selling healthy products, either), do you fight the suppliers of the new product (a gang war) or do you add the product to your inventory?

There often isn’t a clear choice; each option has its pros and cons.

"less healthy" is a bit of an understatement; they're not selling cigarettes that will kill you in the long term (or even the medium or short term). Fentanyl will kill you the first time you're exposed to it.

Increasing the potency of some drug with fentanyl is an interesting choice, because by the time the user *knows* how strong it is, there's some likelihood they're already dead.

> Fentanyl will kill you the first time you're exposed to it.

Its lethal dose is a lot smaller than that of heroin, but it isn’t guaranteed to kill. If it were, why is it used so much in medicine?

https://en.wikipedia.org/wiki/Fentanyl: “Fentanyl is a highly potent synthetic opioid of the piperidine family, used primarily as pain medication

[…]

In 2015, 1,600 kilograms (3,500 pounds) were used in healthcare globally.

It is on the World Health Organization's List of Essential Medicines.”

is it used in general anesthesia?

for kids?

I don't know about kids, but yes it is used in general anesthesia.

Thanks. That is alarming. I wonder what the long-term side effects would be even for one time, which my kid underwent. She is not the same anymore. She used to be so joyous.

You are aware that "pharmaceutical" vs "poison" is a matter of doses and control, right?

That a dose not too different from adult posology of paracetamol can be lethal?

Maybe you did not know that "heroin" was developed at Bayer (the informal name came out of the trials after the reports from the testers)...

Pharmacology is the discipline that deals with drugs.

Mine was an honest question because I was concerned about my kid. She recently udnerwent a 30-min GA, even so, her behaviour has considerably changed. Her personality as well. So, I am not sure why it was being downvoted, and the snark in your comment is also undeserved.

> because I was concerned about

Everytime you deal with nominal professionals you should be concerned, because their professional ability is not granted. People who deal with bodies deal with an immensely complex and subtle mechanism: they do not know it as well as needed, and their regard is easily not too different from that of Robert Liston in their evaluation of compromises - your due diligence does realistically involve verifying that values are aligned (otherwise they may decide that they can sacrifice something that for you is critically vital).

> I am not sure why it was being downvoted

Neither do I - I did not. (I did take the implied into account.)

> snark

Good: since we are here, can you kindly explain what "snark" is, because I find the term in the guidelines, I have no idea how to interpret it, I asked it a few times and I got downvoted for the question?

Thanks.

Sometimes, text gives off a different vibe than intended. for instance:

"Pharmacology is the discipline that deals with drugs" is a very obvious statement that anyone with a primary grade education should know. So, if an obvious statement is stated, it constitutes a snark, <as if the other person is too stupid to realize that>. But given your new comment, it appears you didn't mean that.

(You were probably downvoted because supposing that a specific drug could have been a cause of damage, when potential causes of damage abound, may not sound sensible.)

I think you now understood that with «Pharmacology is the discipline that deals with drugs» what was meant is "If we interpret your questions as "could they have administered anything toxic", the answer would be "what they do is administering substances relevant to toxicity"".

I would approach the situation (just "my two cents") by trying to redirect towards health by maximizing healthy conditions. They do not sell "health pills" - but when one has had to take them, try to counterbalance that "compromise" with healthier lifestyle.

yes. They used it for a heart surgery on a new born that I know.

Thanks. I asked because I didn't know, and my kid had undergone a surgery. The downvote was undeserved-- but maybe it also tells us something.

Yes, you require analgesics for general anesthesia, it’s not optional.

The reason synthetic opioids like fentanyl are used is because they actually have less side effects. Opioids can cause a histamine response, digestive issues and constipation. Newer synthetic and hybrid opioids cause that less, so they’re preferred in hospital settings.

There’s essentially no long term risk with the small doses required during surgery. The main risk is, of course, acute respiratory depression, which kills you. This is how opioid overdoses happen. This doesn’t happen under GA because the dose is tightly controlled, and your airway is supported anyway; you’re intubated.

Thank you very much for your kind response-- unlike the midwits who took issue with my question.

Midwits who downvote: show how my original/first-comment question was downvotable???

There's always a continuity there ("the dose makes the poison"), there's no known substance that will reliably kill you if you're exposed to a single molecule of it.

The issue with potency is that the more potent a substance, the more precise equipment and quality control you need to stay on the safe side. With fentanyl, healthcare and pharmaceutical industry can handle the precision and QC demands (which includes guarantees and maintaining public trust). Criminal enterprises cannot.

prions perhaps?

Even with prions, there evidence that the body (and probably more so with some people than others) has some level of ability to resist, slow, or sometimes prevent a prion infection.

See these:

- The influence of PRNP polymorphisms on human prion disease susceptibility: an update [1]

- A naturally occurring variant of the human prion protein completely prevents prion disease | Nature [2]

[1] https://pubmed.ncbi.nlm.nih.gov/26022925/

[2] https://www.nature.com/articles/nature14510?utm_source=chatg...

Carfentanil has got to be closer to that. It is said to be up to 100x more powerful than fentanyl.

Micrograms (yes still many molecules) could be lethal

1.53 × 10¹⁵ molecules per 1mcg. Which is 15 orders of magnitude larger than a single molecule. If 2mg of fentanyl is considered potentially lethal that would place carfentanyl at 20mcg, though I’ve heard conflicting reports on potency with some placing it at 10x not 100x. So roughly 16-17 orders of magnitudes.

I don’t take fentanyl but I regularly take signaling peptides where the doses are typically in the mcg range and still rather potent - though with signaling peptides the response curve typically flattens out so bigger doses don’t necessarily mean stronger effects - they can be saturated. Depends on what you’re signaling though.

I had correctly predicted my hypersensitivity to semaglutide (ozempic) so started using it for treating autoimmune issues at a dose of 25mcg and I still ended up with temporary gastroparesis.

> Fentanyl will kill you the first time you're exposed to it.

Fentanyl may in some cases kill you the first time you're exposed to it.

The way you state it, there are zero fentanyl addicts in the world today.

>>>>Fentanyl will kill you the first time you're exposed to it.

This is why DARE failed. You can't blatantly lie about everything just because you want what's best for people. At some point people find out you're a liar and don't believe a thing you say.

I guess if you’re the mafia you just murder the competitors. Can’t have stronger regulation than that!

Fentanyl is not a better high. It's decidedly less euphoric than traditional opioids. It's just dirt cheap, ridiculously potent so it's easier to traffic, and doesn't have any agricultural footprint. The market pressure for fent is completely on the supply side.

Fentanyl isn’t a better high is just (much) cheaper to ship/transport given its potency

There were rumors that that the "Chapitos" in Sinaloa purportedly banned the production and sale of fentanyl in their territories.

There were signs warning of this and if I remember correctly, they murdered two major fentanyl cooks, put their bodies on the side of a road, along with a warning sign and two huge piles of the drug around the bodies.

Drugs are a lot more geopolitical than people realize. Who brings drugs in and why drugs are coming into your country are important questions that nations have to ask.

CIA, Oliver North and Reagan would like a word.

The Fort Bragg Cartel and LASD would like a word

And: shaking the scene in a way that will attract too much attention, including crackdowns, is very bad for business.

Almost like it's not really about "business" at all and something more is going on for all the parties involved

Yes, internal destabilizing of the oppossition is a tried and well working oractice of inter empire warfare..

Soon after John Stewart Mill we assessed that markets are not perfect.

Accelerations in the different directions of bounded incentives create as-if Brownian motions, - not the stability towards optimality of a perfect organic model.

Or: what you write is rational, but people are easily not... The supply side should disappear from the market when irrational, but changes are slow..

Did we? Because while seemingly obvious nowadays it is not a settled matter in orthodox econ academia.

Yes. Everybody here should be or get acquainted with Herbert Simon - he is both "Logic Theory Machine" and "General Problem Solver" and "linked lists", and "bounded rationality" and "satisficing".

Herbert Simon - https://en.wikipedia.org/wiki/Herbert_A._Simon

People would benefit from learning some control theory too. A little tinkering with (even abstract) PID controllers can quickly disabuse one of the notion that feedback loops settle instantly.

If its cheap enough to be worth letting a few customers churn, then profits will be positive

https://freesound.org/people/PicassoCT/sounds/848731/

You just need to keep your customers alive long enough.

70% of food in the supermarket is ultra processed. But as long as people make it to 65 years old they are still good customers. That is still 50 years of sales.

> 70% of food in the supermarket is ultra processed.

Yes. And 70% of Earth atmosphere is nitrogen.

The two figures have about the same relevance to health.

When there are enough customers, individual customers do not matter.

Making it up with volume

Maybe the mafia saw the population curves and realized how precious each customer is now and will be in the future. Something tech companies would be wise to think about...

https://www.macrotrends.net/global-metrics/countries/ita/ita...

And the curve is the same across almost all the world. Italy is 1.3, you need 2.1 to even tread water and keep the population you have. Who buys the stocks and fentanyl when each year you have less and less buyers?

There's also the reality of some glimmer of patriotism and care for one's neighborhoods. If Italy nosedives into a fentanyl epidemic, that will both decrease the public image of the Families (which isn't completely negative throughout Italy), and decrease the quality of live where they live.

Sure, they're OK with some heroin addicts. I'm suggesting they drew a line in the sand.

Italians need to make more babies - or there's going to be a serious pizza baker shortage by 2030!

(It follows straight from the general population decrease.)

I think it’s what customers want though as it gets you higher and closer to that high they’re always chasing. That it can kill you is a marketing feature if anything.

The rest of the economics behind fentanyl are great for drug producers vs heroin though, so it probably doesn't matter?

When the risk is the benefit things get weird

Might want to look at the cigarette industry

Kills you very late, gives all the time to reap.

Curiously, this is still relevant to my comment nearby about "slow effect models" ( https://news.ycombinator.com/item?id=49842956 ).

They still traffic heroin though, which is not stellar for customer's life expectancy.

Tell this to junk food manufacturers...

Junk food dont have a chance to kill a person on first try or high chances to kill them withih a year or so.

I think you are right, but doesn't that mean the consequences of fentanyl do not weigh in on society as badly as junk food? Dead people do not cause extra costs for the rest of society

I can understand where is your cynical take comes from, but even from that perspective I would say you're wrong. Having people around who are burden to their families, friends and society is a "good" thing.

When you grow up in a society and see results of gambling, tabacco, alcohol and drug addictions around you that usually deter you from a getting into it. It does not deter everyone, but society actually sees the consequences.

Same with junk food and obesity - when you have people in your family struggle with weight, diabetis and tons of related health issues that's give you more healthy outlook on life.

This is why drugs that kill people fast are so dangerous - because you dont see addicts around you who sttugle to find meaning in life for years because heroine burned their brain. People just start to use and die, fast.

It's not even just about food or drugs. This is how Russia wage a war for 5 years with 400,000 people dead via mercenary army. Society dont see the scale of war because almost no one returns so people keep selling their life for $50,000 thinking its a good way to make money or get rid of debts.

I was going to make a joke about how it depends on how fast you eat it but you're absolutely right.

Tobacco is incredibly damaging but because it doesn't kill you right away we tolerate it.

There's probably a rather grim metric that defines time to death ratio for addictive substances somewhere in a government report.

Now we have the unions, we have the gambling - and they're the best things to have - but narcotics is the thing of the future. Now if we don't get a piece of that action, we risk everything we have. I mean, not now, but ten years from now.

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