
Fentanyl, a stealth killer - etendue
https://www.statnews.com/feature/opioid-crisis/dope-sick/
======
pizza
Just because fentanyl has a shit therapeutic index doesn't mean it has a high
body count (it gets used just fine even in tandem with other depressants in
clinical circumstances...) - I would say the problem is more in the hands of
the tough-on-crime lawmakers who seem to lack, at least in my neck of the
woods, remorse.

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.

~~~
oxide
Also, consider the tried and true method of overdosing: taking your usual dose
after a break in use.

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.

~~~
rhizome
As I read somewhere years if not decades ago, "opiates are only a problem when
you can't get them or they're too strong."

------
onetwotree
The mention of Fentanyl here is pure clickbait. Fentanyl is pretty well known
amongst opiate addicts (and has been for a while). Everyone knows it's
dangerous, including dealers, who like to avoid killing their customers and
catching murder charges, believe it or not.

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

~~~
hristov
Hate to break it to you but your dealer does not give a fuck about your
health. It is extremely difficult for the police to find the dealer of a dead
person, and then very difficult to prove the elements needed for a murder
charge.

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.

~~~
brainfire
I don't know where you're from, but my personal experience in my area
(Maryland, USA) is that everything in your post is incorrect.

~~~
dopamean
I'm from New York and now living in Austin, TX. I'll add that from my
experience I agree that what he said was incorrect.

~~~
opiatethrowaway
I can also concur. My dealer cares more about me than anyone except my mom.

------
downandout
Opiate addiction is a serious problem that affects people from all walks of
life. My mother has had rheumatoid arthritis for decades. She was prescribed
Fentanyl patches for the pain at one point, but the strength was too high. One
day she wound up passing out in her kitchen after applying a patch. After that
she stuck the patches in a drawer, intending for them to never to be used
again.

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.

~~~
MichaelGG
If someone was suffering from pain and couldn't even buy Ibuprofen due to an
oppressive government and shitty societal view, one might not be surprised if
they steal to get life-changing medicine.

The fact a "normal" person would rob an older woman for an essential medicine
should reflect more on the society than the patient.

~~~
vonklaus
That doesn't make any sense. Having seen a fair amount of shit, I go back and
forth. Should heroin be legal? It would certainly lower the price, but it
would definitely create more addicts. This isn't a headache, that is theft.

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.

~~~
adrusi
_I can certainly intellectually understand why society has banned this._

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.

~~~
vonklaus
I understand this more than most. The solution that fits best with my
experience and ideology is probably a combination of a few things. Just to
caveat, this is a thought experiment and while a lot has been done, there is
so much friction it is absurd.

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.

------
gallonofmilk
I just want to say that that I lost one of my close friends Thom Simmons last
April due to Fentanyl overdose. He was a young, voracious autodidact prodigy
that was always way ahead of the curve especially with technology. I met him
through the #django irc channel about 7 or 8 years ago when I was starting out
with python and django and we developed a friendship that lasted until he
overdosed on fentanyl and died in a motel room alone last year. I had
reconnected with him in his final weeks as he struggled to get clean and
desperately wanted out of his situation but he felt trapped, afraid, alone,
and hopeless. He broke down crying to me over the phone a few days before he
died, after I helped pay for a night in his motel room because he had run out
of money. I didn't realize the full gravity of the situation or know that he
had already relapsed at that point and he was dangerously close to the end. I
believe that Thom knew it was his last week on Earth and he was saying goodbye
to me. He told me what a special friendship we had and how much that meant to
him, how he hadn't met many people in his life that he could trust. We laughed
a lot about the many memories of late nights programming, scheming on grand
ideas for the next major social platform we wanted to build. He showed me
Reddit when no one knew what it was, he showed me hackerne.ws before it was
known, he helped me set up a trixbox server and program asterisk with voip
connections, we built a custom PLC software for a startup and worked on other
various projects. We also shared the disease of addiction and unfortunately he
couldn't get the help he needed to stay clean and sober. Upon his death all he
got was a short blurb in a rural Texas local newspaper, not a word about the
amazing person, friend, genius he was. I later found out that 15+ people died
of fentanyl overdose in his town that weekend, all of them addicts that lost
the battle.

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=...](http://www.legacy.com/obituaries/pearland/obituary.aspx?pid=174779466))

~~~
frandroid
Your friend and the others who died that weekend didn't "lose the battle".
They were poisoned, murdered by an unscrupulous and/or clueless dealer.

~~~
aianus
> They were poisoned, murdered by an unscrupulous and/or clueless dealer.

And a government that prioritizes moralizing over helping.

~~~
knowaveragejoe
Did that form in a vacuum? Society promoted that behavior and it translated
into government.

------
filoeleven
I've read a fair amount online about ibogaine, derived from iboga root, as a
treatment for addiction, and opiate addiction in particular. It doesn't seem
to be very well-known, but everything I've read makes it seem like a miracle
cure. It is a schedule 1 psychedelic in the US, but there are apparently
clinics/retreats in Mexico and Canada where it is used to treat addiction.

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.)

------
jessaustin
Found by a coworker within two minutes of passing out, but no one called an
ambulance for thirty minutes. We ought to care more about the people around
us.

~~~
MichaelGG
Having been in non-drug, legal, harm situations, there's a huge pressure not
to involve authorities. Embarrassment and hassle, costs (perhaps not in
Canada) are bad enough. Legal and social repercussions due to officially
having a problem on your record can really damage. (Applies to people seeking
mental health help, too!) Add in potential to be arrested and it's not hard to
see why someone might delay or even let someone die.

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.

~~~
jessaustin
You're right, of course. The coworker was probably quite young, and the
outcomes you describe loomed larger for her than the actual outcome. This sort
of thing really ought to be addressed in high school, but unfortunately all we
get is, "drugs're bad, mmm-kay?"

~~~
MichaelGG
If the coworker had drugs on them, the potential outcomes might actually _be_
far worse than the actual outcome here. They'll feel like shit. But you know,
in a few years, the emotional pain will have subsided quite a bit. And it
wasn't really their fault, directly, totally - it'll get rationalized.

Whereas a drug arrest, a criminal history, that could take much more work and
time to get over.

~~~
jessaustin
Well sure one definitely doesn't call 911 while possessing illegal substances,
but it just takes a minute to walk out to one's car/the dumpster/some other
place the cops ain't going to search because one called an ambulance for an
unconscious coworker. Who would complain, the manager who wasn't present?
Actually this train of thought would be pretty ethically indefensible.

------
trhway
people who get addicted should be treated similarly to the mentally
impaired/disabled persons. Once addicted, a range of specific brain functions
are impaired, and thus it is a medical issue. A lot of other medical issues
are result of personal irresponsibility too. That doesn't stop us from
treating those issues medically (though it seems it took some time, even as
recently as the end of the 20th century, to accept HIV as a medical disease to
be treated instead of a "God's punishment for perversion"). Yet when it comes
to addiction, the patients are treated as criminals instead.

------
Floegipoky
It's 2016, and the media is still pushing the same classic tropes, marijuana
as a gateway drug, etc. Yet other than a quick characterization of DJ being a
risk-taker, this article fails to even consider the most important question-
why did he start using? What was the _cause_ of his addiction?

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.

------
alasdair_
My daughter died of a fentanyl overdose one month ago. She was 21.

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.

~~~
davidhariri
That's tragic. I'm so sorry for your loss.

------
bdavisx
There would be far, far fewer deaths from overdose if all drugs were legal.
There may be more addicts if they were legal, I don't know - but there would
be a lot fewer deaths.

~~~
ergothus
I'm not against legalization, but have you done the research to back this up?
We have plenty of alcohol-related deaths (both indirect (traffic, etc), and
direct (alcohol poisoning).

~~~
Archio
We do have tons of alcohol deaths. But the idea here is that no one dies from
alcohol today because their alcohol dealer slips in unknown amounts of toxic
potentiators to cut costs (which is effectively what is happening with heroin
et al. today).

~~~
FireBeyond
That's not "strictly" overdose, but contamination. The original point still
stands, re alcohol overdose.

------
milesf
Sad that the message of this piece will likely be discounted and discredited.
It amazes me the blasé attitudes towards drugs in the tech world. Hearing even
high-profile tech leaders extoll the 'virtues' of getting high while ignoring
the huge toll it takes on individuals and their families seems selfish to me.

~~~
MichaelGG
The issue here was not caused by the actual substance. It was caused to due to
terrible social and legal attitudes that encourage mislabeled medicines to be
sold.

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.

~~~
sremani
As much as I want to agree with you, the story of the two dudes losing their
jobs and constantly being broke says otherwise. I know there are lot of
functioning addicts, and I have seen them in life. But the two guys in the
article are anything but functioning. Their education suffered, their job
prospects suffered.

~~~
MichaelGG
The issue of being broke is directly related to having to buy off a black
market. Opiates are stupidly cheap - for a naive user, they are cheaper than
Tylenol.

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?

~~~
mindslight
To be fair, users that are sanctioned under the current legal regime are
forced to keep up appearances, which likely includes holding down a job. If
they do run into financial issues, their legal supply likely gets cut off when
the prescriber sees them deteriorate. At which point they're no longer legally
sanctioned.

(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.)

------
jalami
In the US you can't do research about a product then go out and buy quality
product from a quality provider. That's really where I see a lot of the
problems with all of this.

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.

------
loverofcode
Fentanyl is coming from China and other places. The main problem is the users
not knowing what they are getting and dose exchanges, not the opioid itself.
The DEA and people using addicts to make money instead of treating as a
healthcare problem is what is causing this.

------
baus
I talked to a friend of mine today who has a serious opiate addiction. It is
heartbreaking. He is on the verge of losing what he has left to lose, but I
don't know if there is anything to do. He refuses to seek treatment. I think
his options are running out.

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.

~~~
tigershark
Why is he so unhappy? Reading this thread it would seem that opiates are
innocuous, a glass of wine is more dangerous apparently. Seriously, I can't
understand how people can say such things actively encouraging people to take
opioids because they have "less side effects than alcohol".

~~~
aianus
Nobody is telling people to go out and try opiates. We'd just rather people
who are already addicted be able to get a cheap, safe fix than /go broke/go to
jail/OD on sketchy drugs.

~~~
tigershark
There are people in this thread explicitly saying that getting high with
heroine once a day is not different than drinking a glass of wine a day. If
this is not an opiates eulogy then I don't know what is it. For me should be
even illegal to incentivise opiates usage so irresponsibly.

------
anonbanker
was recently given fentanyl when I had to have a dislocated arm re-located. I
passed out within 4 minutes, and woke up without a dislocation. I don't
understand why you'd want to take it recreationally (how much does your life
suck that you want to sleep constantly?), but I'm glad it exists to ease
suffering. Maybe some of these scare articles should look at the "Rat Park"
study, and figure out _why_ people are doing the drug in the first place?

------
RankingMember
This was a well-written story but I could've done without:

A. The "MARIJUANA, THAT DEVIL WEED, STARTED HIS DESCENT INTO HELL" routine.

and

B. The "truth" anti-drug ad campaign-style video overlays

~~~
gedy
Frankly, virtually everyone I've known who ended up in drug 'hell' did start
with pot; so while correlation does not equal causation, the belief or concern
it's a gateway drug really should not be mocked. Questioning, debating, fine -
but mocking people's concern, is frequently about friends and family who are
in trouble.

~~~
dragonwriter
> Frankly, virtually everyone I've known who ended up in drug 'hell' did start
> with pot

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".

~~~
gedy
Fair enough, but as I mentioned, I'm addressing your moralizing tone about it,
not your belief.

~~~
dragonwriter
> I'm addressing your moralizing tone about it, not your belief.

My response to your post was my first post in this thread, so I don't think
you are addressing _my_ anything.

~~~
gedy
Sure, confused you with OP

------
civilian
Chapter 2 is titled ‘Kissed by Jesus’, if that helps anyone avoid the
longread.

// 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.

~~~
tensor
There is nothing religious in this. The quote was describing the feelings when
they were on the drug.

