Fentanyl, a stealth killer
statnews.com
statnews.com
Also, look up sufentanil, and once you feel you're ready, carfentanil..
Also, yes, yes, fentanyl is made because of its potency and therefore cheapness, but a napkin-back calculation shows: 17 $ / g codeine * 100 g codeine / 70 g morphine in a conversion tek * 3 g morphine / 2 g heroin = ~$37 g/heroin, if you were a pretty good chemist, and could legally source precursors (pyridine HCL, acetic anhydride..), which is probably a lot better than the stepped on shit you would get for even 60 bucks a gram (although you can get 60 dollar grams on AlphaBay iirc). That's near a dollar a dose for an opiate-naive user and a day's worth for the 60-year old junkie down the street.
Also, the high/euphoria from fentanyl is much shorter lasting (hence its appropriate use in surgery) - I could see this encouraging heroin users to use more under the idea that they've simply increased their tolerance..
Also, Prince died with traces of U-47700 in his system.
someone addicted to a certain amount of heroin per day who stops using (money, access, etc) will come back to heroin with a much lower tolerance than before.
if they are sold fentanyl unknowingly, using a familiar amount can be a death sentence. if they are sold heroin cut with fentanyl, it could result in death as well.
these aren't entirely new concepts, nor are they explicitly attributable to fentanyl. addicts across the country are keeling over every day from traditional overdoses, fentanyl's presence means everyone using heroin intravenously, even the 60 year old junkie, needs to have a test shot first.
in my experience, fentanyl is good for withdrawal only. it is a cold, unfriendly high that leaves the user irritable.
it's nothing like the warm embrace of morphine.
So I did. And now my browser history is filled with random message boards of people discussing their tripping experiences with various chemicals.
Also learned that most people consider Carfentanil crazy dangerous. And his bigger brother Ohmefentanyl is straight up poison.
I have yet to come across a Wildnil experience report though, lol
Aside from that and a bit of gateway drug BS towards the beginning, this is a solid and somewhat moving, if long, account of the standard Heroin story, and is more or less the same as the ones I hear from fellow recovering addicts all the time.
Key features, so you can avoid the longread:
* Insurance refusing to pay for treatment
* Parents being forced to get their kids arrested to protect them (and the plan failing)
* Relapse, relapse, and more relapse despite full knowledge of the consequences and a strong desire not to relapse.
* Terror of being dope sick
* Doing stuff you don't want to do to avoid being dope sick
* Death
The police do not even try to find dealers of drug deaths, unless the victim is a celebrity.
Furthermore, every heroin dealer knows that each of their clients is likely to go into a downward spiral and become a liability. Thus, they treat their clients as expendable.
https://www.washingtonpost.com/national/her-fiance-gave-her-...
Thus, many of these people are not ruthless sociopaths, and recognize on some level that what they're doing is wrong. Through a great deal of rationalization, they are often able to convince themselves that it's morally OK.
These people would prefer not to have to bring murder into line with their already quite dissonant mental schema.
This is my experience talking to current and former dealers, mostly as part of my work with recovering addicts - I've had dealers help me track down relapsed sponsees, for instance, with very little convincing.
Huh? That's the exact drug that killed the person in the story. It's made quite clear:
Lucas County chief toxicologist Robert Forney and his staff meticulously screened DJ’s blood for drugs. Forney’s team didn’t find any heroin.
What they did discover was a lethal dose of fentanyl.
Blaming it on fentanyl is a red herring. The real issue is mislabeling. If people sold heroin instead of codeine or Tylenol, we'd see the same problem.
I can see a couple of reasons for this.
First, there seems to be a prevailing view here is that the war on drugs is an abject failure.
Furthermore, I believe addiction gets attention here as a fascinating scientific puzzle, whose questions and answers are deeply involved with philosophical issues such as free will and the nature of desire.
This is probably why the article made it as far up as it did on HN.
She was fine after this incident, but my sister happened to mention the story to an acquaintance of my mother's from church. Upon learning that there was a box of unused Fentanyl patches in my mother's house, she suddenly became her best friend and volunteered to begin taking her to doctor's appointments. She would take her to doctor's appointments, then while my mother was there, would go back to my mother's house to "clean up" - do dishes, vacuum etc. This wasn't a mere act of charity; she also "cleaned up" not only the patches, but a significant percentage of my mom's other opioid pain medications.
At first my mother thought she was going crazy when pills began going missing. She finally told me about it, and while I was inclined to believe that she was simply starting to lose her mental acuity, I bought her a lockbox for her pills. It was only after this woman (an upper middle class mother of three young children) brought tools with her during a visit and actually destroyed the electronic lock on the box that I realized that her trusted "friend" from church was stealing her pain medications. When my mother told one of the leaders of her church what happened, the woman denied it, and three weeks later moved her entire family several states away.
You really can't make this stuff up. Addicts come in all shapes and sizes and will do anything to quench their addiction.
The fact a "normal" person would rob an older woman for an essential medicine should reflect more on the society than the patient.
On top of that, do you know why she was on the medication in the first place? Would you have the same attitude if she was taking SSRIs for depression, couldn't afford them (or wasn't allowed to have them!), and stole them instead?
Again, would you have the same attitude if her options for depression were "steal SSRIs from a pharma company" or "buy from someone that gets unlabeled, unmonitored shit from China, resold by whoever?"
If gas was 50x more expensive, we'd probably see some desperate behaviour for a while.
Maybe your experience will differ. Keep your eyes out for pinned pupils when next dealing with lawyers, doctors, engineers, executives, etc.
You also almost certainly know someone addicted to opiates and have no idea.
There's only a small percentage of drug users who lack the ability to regulate enough to prevent a complete destruction of their lives, but those people will generally destroy their lives with anything, be it opiates or beanie baby mania. The rest of humanity can mostly hold their shit together, and you'll have no idea.
Alcohol is chemically addictive, sold over the counter, and is currently the fourth leading cause of preventable death in the U.S.
The legal aspects cause all of this. They raise prices, make supply hard, encourage fraud, discourage help, increase the terrible social stigma.
There are millions of legal users that are doing fine - hundreds of millions of prescriptions!
On top of this, it's an affront to the concept of individual freedom to deny medicine to patients just because you don't like them or have labelled them an addict. The current system encourages for-profit gatekeepers.
In this thread there's a lot of blaming of a chemical. There's a lot of blaming people getting caught by laws. Jaywalking is more dangerous to third parties than these drugs, yet we would not accept this kind of attitude toward jaywalkers.
People conflate the situation of drug use with the actual effects of substance. Even in this thread there's people bemoaning that junkies will do anything. While failing to acknowledge it's purely an artificial constraint that creates this situation in the first place.
Antibiotics are far more dangerous. It provides a serious threat to everyone, even those that don't engage. Where are the task forces raiding and jailing people for that? I can personally go purchase a 4th line antibiotic in about 20 minutes, but I can't get strong pain relievers?
The war on drugs, including (perhaps most importantly) the social attitudes, keeps countries in poverty and disarray. Look at Latin America, and how much money and blood, crime and fear is caused by this idiocy. Yet much of the population still views "dealers" and "drug traffickers" as inherently vile. In some countries, they have basically no drug user issues, yet they pay this ridiculous price.
I find it abhorrent to have for-profit gatekeepers deciding what people cannot do with their own bodies (or possessions for that matter). It's far worse than say, DRM or Apple-style device lockdown.
Edit: Perhaps I'm also excitable. I'd probably get annoyed if commenters kept repeating that "function" was a fine length for the lambda keyword/syntax, while simultaneously saying lambdas are too verbose.
That opiates when used in proper doses are extremely safe from a physical point of view is an indisputable fact.
Even then: I've had IV morphine at the hospital after getting my knee run through. I was high as hell. I've had hydrocodone given to me after hurting my back. Totally high, blissed out. Seems to be the common complaint: "I got pain pills, but they made me loopy!"
It's like when people say meth (or Adderall or Ritalin) works differently on people with ADHD. No it doesn't, they're just coming from a different baseline. It'll help anyone think better.
There might be some long-term problems with opiate use. Like reduced testosterone. Maybe reduced immunity (hard to tell, since so many chronic pain patients have severe illness). Prolonged constipation can certainly cause issues, too.
I don't see why you think that taking one hit of heroin each day would be any harder than drinking a glass of wine a day. Perhaps the heroin is more enjoyable, but given such small consumption it won't inherently be any more addicting than alcohol.
The point isn't that legalizing a drug makes it completely harmless to everyone in society, it's that legalizing may mitigate _some_ harms that are caused by the specific circumstance of being illegal. The obvious example is something like marijuana, where we had to manufacture scary bullshit to get people to go along with its illegal status (and all the harm illegalizing it caused). But even your example here works against your argument: as dangerous as alcohol is, we tried making it illegal (Prohibition) and then went back because it simply did not work.
Yes and honestly nobody cares because it's big business and is societally acceptable.
I had a chronic back problem, for which I was prescribed a whole bunch of painkillers. After Vioxx and Celebrex were pulled, that was the only real option for any kind of relief.
Those drugs give me a headache, and I didn't take them... But if I did, I would have taken hundreds of the things for a couple of years.
Clearly, there is a difference between opportunistically taking a few pills and working your way into someones life to rob them repeatedly. This reflects on the person and while I don't know if I made up my mind, I can certainly intellectually understand why society has banned this.
I agree, heroin is nasty stuff. But, we cannot eradicate it. In a free and liberal society, it's a farce that it's even a choice. It's a choice between denial and acceptance of reality. Accept it, lean in, fix things in a way that goes with the grain of human nature, not against it. (E.g. it's human nature to assume harm won't befall them so they are not dissuaded from a harmful thing. So, reduce the harm as much as you can.)
Firstly, what does legalization mean? Legal to prescribe? Legal to purchase over the counter after a certain age? Full, unrestricted legality? In weaker forms of these I think there's a case to be made that a black market doesn't disappear, but perhaps changes its business model. There's still benefits to be gained, in terms of more safety to addicts from impurities, but it seems difficult to claim that you can really control an addicts dosage when a black market can arise to meet their wants for higher dosages.
I don't think we should criminalize addiction directly, but I think that's really only part of the picture.
Part of the troubles of being an addict stem from stigmatization. We need to evolve from seeing addicts as degenerates and liars and instead as people suffering. We need a social climate that encourages addicts to seek help without social or criminal penalties. We need more addiction treatment programs, and we need treatment programs that don't impose their own judgements about getting clean through substitute drugs. We probably need to have lesser penalties for crimes that may be related to addiction (i.e. petty theft to pay for an addiction) or else we're simply criminalizing the addict in another way.
Didn't Portugal legalize heroin and realize that this was completely false?
But don't you see that opiates only make people do these horrible things because they're banned!? Opiates don't turn people into devastatingly manipulative thieves, they turn them into people who will do anything to get opiates. If you changed two things, junkies would be no more likely to engage in destructive behaviors like theft than alcholic or smokers. Those two things are making opiates cheap and easy to get (regulate them like cigarettes, say), and eliminating the employment stigma. Opiates aren't great for productivity, but they are much less of an impairment than alcohol, and alcoholics are almost always functional unless they also suffer mental health issues. Opiates slow down thoughts and movements somewhat, and they make you feel really good, but they don't make you stupid or rash like alcohol.
That's not to say that there wouldn't be problems with opiates. You'd probably have as many people on opiates on the road as we currently have drunk drivers (again, they probably wouldn't be as bad, because while opiates slow reaction times and reduce alertness, they don't make the user think they can do things they can't). And junkies would probably still squander their potential to an extent, and mothers of brilliant children who take up opiates instead of going to college might be devastated. But I think most of the new addicts that would be created by legalization would be people who would otherwise become alcoholics, people just looking for an escape, and society prefering clean opiates over alcohol would do wonders for public health.
I would like to see heroin decriminalized with specific designated zones (cities/towns) which fully supply and allow heroin use. If you are caught with heroin outside of a zone you must pay a fine. If you can't pay you are offered rehab or transportation to the administration zone.
Zones provide free narcotics and needles, ect and have adjacent treatment and medical facilities. This experiment has been run and was somewhat successful.
The thought process in my above statement is that broke heroin users can not interact with society. If a user wants to simply do heroin, there can be a designated development/town that allows it. If a user is outside of the zone, they must have the money to pay a fine (stay well) or they need to go to rehab or a place that allows drugs.
That way, normal people can interact and many users can function in society. If they can not they will be supplied with drugs outside of society until they regain financial independence or make the decision to enter treatment.
However, since this is impossible, I do not expect a legit solution to ever be implemented and thus am not sure where I land. So I would support efforts that compromise in a similar way to my above solution, but really not worth thinking much about as the gov (in US) has not even legally recognized recreational marijuana.
She went from being a beautiful model living abroad, to a lying junkie. She is constantly trying to hustle money from people. No job, no car, no money, and nothing going on. She now has a serious heart condition and a pacemaker. Not even 30 years old yet.
I had to get that out because every time I hear about fentanyl it reminds me of Thom and I hope that our society finds solutions to help addicts overcome the extremely dark and twisted pull of drugs and addiction so that other amazing people like Thom don't meet the same fate.
I'll never forget his memory and the amazing person he was, and that the very fact that I met him and we became friends was because of the same technology he was so fond of.
(http://www.legacy.com/obituaries/pearland/obituary.aspx?pid=...)
And a government that prioritizes moralizing over helping.
> Although it is legally prescribed for pain sufferers, such as those with cancer, almost all of the street-level fentanyl is illicitly produced in places such as China. A kilogram of fentanyl purchased from a lab in China for $3,000 to $5,000 can generate $1.5 million in revenue on the street, according to the DEA.
Reportedly, withdrawal symptoms immediately begin to subside when the trip hits and then disappear completely, never to return. Cravings don't return either. The success rate is incredible--one study I read about from ~2011 followed up with its participants, and 30/30 were still not using, and they and their partners reported a much higher quality of life. All from a single six-hour trip (though it seems like these places want people to hang out for a week or so afterward, too).
When I say "miracle cure" and "incredible" I mean them in the superlative sense, but these kinds of claims also make me suspicious because I'd expect to hear more noise about them if they worked as well as advertised. So consider this post both a plea to share more info if anyone has it, either for or against, as well as a jumping-off point for further research for anyone who is personally or knows someone who is suffering from an addiction. On the one hand, it sounds too good to be true, but on the other hand, psychedelics are so demonized that I could believe the word just hasn't gotten out yet. (After all, clinical LSD treatment showed a lot of promise in curing/greatly reducing alcohol addiction 50 years ago, among a host of other things, but you wouldn't know it unless you go looking yourself.)
It's easy to visualize the damage of being wrong - you just "ruined" someone's life just because they might be in mortal danger.
If there was a guarantee of no investigation, no publicity, no named record, this might not happen as much. Also, making easy, cheap access to naloxone might mean more users would carry around antidote.
Whereas a drug arrest, a criminal history, that could take much more work and time to get over.
Nobody wants to consider the consequences of a society that confines adolescent male hominids in a classroom during the height of puberty, then locks them in cages to keep them from bothering others when they become too much of a bother, or a family that attempts to account for every minute of their adult offspring's life. I can't speak to the female experience, but I still remember the existential ache of a teenaged male trying to make his place in the world. But there's a pill for that, right? Nobody wants to admit that fighting a War On Drugs without fundamentally reforming our toxic society is the same as fighting a War On Climate Change while still burning fossil fuels.
It was her first time taking it. I assume she thought it was cocaine or something similar and simply took far too much.
If you have children, please teach them about drugs. That means more than "just say no" it means being really, really clear with them that a huge danger is that they get given something that isn't what it is claimed. Sadly, this is especially true if they are young and female and perhaps a little naive.
I expect that my younger children will experiment with drugs even knowing what happened to their sister. I expect their friends will as well.
All I can do now is teach them how quickly their life can end and, perhaps, give them ready access to test kits in the same way that they will have ready access to condoms and std education when the time comes.
Please, if you have a child, talk to them today about fentanyl in particular - most of her friends has never heard of it before she died and had no idea how strong or cheap it was.
> Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.
>Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.
You could make the scores come out however you wanted based on the people you chose for the "1-day interactive workshop" and the criteria you used as the basis for the analysis. This isn't something you'd ever want to use as a basis for policy.
If alcohol was illegal the death toll might be even higher. People might shift to something with more bang for the buck and have an even shittier and shorter life than dying with 64 from liver failure.
I don't know any user of any substance that would say "well 1 unit is likely to get me off a bit, so I think I'll take 20 just to be sure".
Opioids can be used in VERY high doses as a person becomes more dependent. What is clear is that people are use to heroin and then take the higher dose without knowing and OD. This is the current trend. It is cheaper to get the Fent from Ch than the H from Afgan.
[1] http://content.time.com/time/specials/packages/article/0,288... [2] http://www.slate.com/articles/health_and_science/medical_exa...
Better data about drug policy and harm reduction can be found by looking at results from Portugal or other countries with permissive policies. None of them supports the claim that prohibition reduces use or harm caused.
2/3rds of all overdoses are opiate related.
The biggest impactor to preventing overdose death is the drug Naloxone which is an opioid blocker.
Putting naloxone in the hands of at risk drug users, and as standard kit for police officers/EMTS, is the most effective way to save lives.
oh, and 4. combining a stimulant with a larger/more euphoric dose of the CNS depressants so if the respiratory stimulating effects of the stimulant run out first, respiratory depression ensues
I didn't understand why people mixed in benzos, unless to curb withdrawals.
Some people take them to increase the nod. Others might have insomnia and don't want to take so much opiates to really sleep.
Edit: And there's obviously some information on this, somewhere because e.g. IV opiate+midazolam is quite a common thing. [In a 3rd world pharmacy, I was actually offered liquid midazolam as a sleep aid when I complained long-lasting benzos were too long-lasting and asked for a medium-duration sleep aid.]
It read to me like the user just said that fentanyl isn't that much cheaper than making heroin, and showed his work. They aren't actually advocating or advising for anything.
Generally speaking, when a drug exists in prescription form, you don't see too many people rushing out to make it. (Methamphetamine's probably one of the few exceptions because it can relatively easily be (badly) made by "home chemists".) Instead, the focus becomes more on obtaining diverted prescription drugs via illicit channels ("doctor shopping", shady pharmacies, pharmacy theft, etc.). See: oxycodone, vicodin, etc.
Beyond that, most of these compounds are patented or have been at one point, and there's certainly plenty of patents on fentanyl. Patents pretty much contain much of the information you need to make the compound, easy enough to look this information up. This is not very "top secret" information. Actually the poster provided hardly the information needed to actually make the compound in comparison to what you can Google.
Finally, for those wishing to pursue this for some reason, said poster did not describe what to do when "the law" shows up at your door to inquire just what in the heck you are doing ordering acetic anhydride (it is, er, a U.S. DEA List II compound after all) or other watched chemicals. :) If someone's going to get into the illicit drug manufacturing business, they're going to need far more than a Hacker News post to do such.
Maybe, maybe not. The basis on which that claim has usually been made has been discredited, but there is a dearth of good data on which to make a claim either way. [0]
[0] http://www.practicalpainmanagement.com/treatments/pharmacolo...
If anything else in our society was mislabeled by a factor of 50, there'd be outrage over the vendor, regulators, etc. But with drugs, it's always "user error".
Opiates are extremely well tolerated, with basically no upper bound on use. They are incredibly cheap, black market aside. There's probably a fair amount of libertarian-leaning people here that see the harm as caused by things other than drugs.
The "toll" it takes on people is almost 100% caused by the legal status. Hence why millions of people in America alone enjoy prescribed opiate usage without dying or having their life spin out of control.
A lot of the problem almost certainly stems from this broke/steal/intervention/etc. cycle. Do legally sanctioned opiate users suffer from a high rate of financial and employment issues?
(FWIW I do agree with your general viewpoint. Not because I have much of an interest in drugs, but because if somebody purports to tell you how and how not you can affect your own body, that person is an enemy of your freedom. Freedom necessarily must include the option to harm yourself, otherwise you are actually just picking from preordained choices.)
Yes there's a failure of information somewhere and people that fall through the cracks should be able to find their way out again, but the root of the problem stems from publicly vilifying people and actions that should be legal. Regulating all drugs like cigarettes, for example, would make it so they wouldn't have to get grade E stuff from some alley, we'd stop imprisoning people that may just need help and we could have discussions in the open about abuse. Privately vilify all you want, but the government should be mute on people's preferences as long as they are capable of making decisions, there's mandatory information disclosure surrounding dangerous drugs and companies can't lie about what they're selling.
Heroine for better or worse is a product that people are willing to go far out of their way to purchase and that goes for nearly all drugs. I would never do it and I believe if you made it legal, most people not doing it today wouldn't pick it up. We really need to get the idea that legal === government endorsement out of our heads.
We do things because the pros of doing them outweigh the cons of not doing them. Information around drugs, proper, honest and often, deters dangerous adoption.
I've had my problems in life, specifically with mental illness and benzo addiction, but I'm thankful that I never went the opiate route.
A. The "MARIJUANA, THAT DEVIL WEED, STARTED HIS DESCENT INTO HELL" routine.
and
B. The "truth" anti-drug ad campaign-style video overlays
People will look at the original drug as the cause when in reality there are probably many more possible things that could be associated with the cause.
This sort of thing becomes played out after time. "It's not the person's fault! It's that they used this devil plant"
Funny, everyone I've known who ended up in drug "hell" started with either tobacco or alcohol. Which means just as much nothing as yours...
> so while correlation does not equal causation, the belief or concern it's a gateway drug really should not be mocked.
Anecdote ("virtually everyone I've known...") doesn't equal meaningful correlation in the general population, much less causation.
And "people who end up in drug hell are likely to have used X drug in the past" is the wrong correlation, anyway, to support "dangerous gateway drug" claims (even leaving aside the need to move from correlation to causation.) You really want "people who use X drug are likely to go on to end up in drug hell".
My response to your post was my first post in this thread, so I don't think you are addressing my anything.
// edit whoops yeah I'm wrong, my replier is correct. Nevertheless... Chapter 1 was stumbling into a long resume of the boy's high school experiences and I was getting bored, so when the title of chapter 2 was "Kissed by Jesus" I ended early. The first portion of the article is really good, but the long backstory and gateway-drug-ism in the article got old.