
'That Fentanyl – That's Death': A Story of Recovery in Baltimore - Mz
http://www.npr.org/sections/health-shots/2017/08/03/537683319/that-fentanyl-thats-death-a-story-of-recovery-in-baltimore
======
JonDav
A man walked into a meeting with a fent sucker in his mouth treating it like a
toothpick and I had to hold back my alarm so that everyone else did not ask
why I knew exactly what it was. At that time no one outside of post-op, end of
life cancer, or major pain management were really aware of this stuff. But to
see a guy just stroll in on fentanyl like it was nothing at all was a
watershed moment.

Now an addict does not need to steal from a ped surgery floor. You can buy
fentanyl straight from China in a properly wrapped packet. Dosage is the
problem, mixing dry is not easy, hence the street deaths.

I carried narcan back in the day because some of my friends were heroin users.
But I never came across a fent addict, now I can only imagine how much of this
stuff is floating out there.

Average people have no idea what this stuff feels like, what the pull is like.
In reality you never get away from it; it is always there in the back of your
mind but you have to tell yourself that it will destroy you.

sorry for the disjoint mess but I am being hit with the thoughts of those I
knew who were lost to black.

Apparently fent is the new black.

~~~
zappo2938
I had interventional radiology brain surgery three times. I got a decent
medical dose of fentanyl. I was strapped onto a surgery table awake because I
had to hold my breath every time they put tools into my brain. I could see the
x-ray image of the tools going into my brain in the corner of my eye on the
screen above the table. With fentanyl the world was right as rain, however, I
didn't feel any desire to have it again after. The feeling wasn't happy, sad,
high, speedy, or low. It was just everything was ok.

~~~
sillysaurus3
This is the most unsettling HN comment ever. Thank you for sharing it.

~~~
zappo2938
The most unsettling moment of the whole situation is when I first had the
operation and the doctor handing me the consent form says that the procedure
itself kills 1 in 400 people. I said those odds are shitty thinking about the
one time I had 4 aces in Texas Hold'em and lost to a royal flush and all the
other times I had a bad beat. The doctor said for someone off the street those
are bad odds but my odds of surviving without the procedure are probably much
worse. I didn't have any family there with me. My friends had no idea that I
was in that situation. I was a chef for a long time and said what I would say
to the cooks before a busy night. We are all human, we all make mistakes, I
just ask you do your personal best. I survived. The feeling I had on fentanyl
under those conditions was the same the night I was in the hot baths at Esalon
looking at the expansive milky way while the waves crashed on the rocks below.
Awe and wonder and it's all ok.

~~~
emmelaich
Great comments but

> 4 aces in Texas Hold'em and lost to a royal flush

is not possible. Maybe four nines? Or a (non-royal) straight flush.

~~~
zappo2938
Maybe it is one of those things where I should take Bill Murray's advice and I
can't tell anyone because nobody is going to believe me. It is possible at 1
in 165 million odds. [http://imgur.com/a/Kb9Oa](http://imgur.com/a/Kb9Oa)

~~~
emmelaich
Ah yeah oops my bad.

------
jokr004
I'm in the process of recovering from a serious addiction to furanyl-fentanyl.
I don't really care to get too into it, I really can't explain the pain that
stuff has caused me. I've been through a lot in life, but I've never been
through anything so traumatic.. This stuff is a nightmare like you can't
possibly understand without being there yourself, I hope none of you ever find
yourself in that position.. I've been in a methadone program for the past 6
months now. We really need to put money into treatment, the program that I'm
in literally saved my life. I'm lucky enough to have insurance that actually
covers most of the cost, but most people in my situation don't have that
luxury.

~~~
Pigo
I was actually addicted to methadone, only used heroin a couple times in my
life. I used it because I could work and get stuff done for days on end while
being high. I knew people who died because they forgot you can't drink alcohol
when you're on it, but I was delusional enough to think I was better when I
was on it.

It ended for me when I got old enough to notice the kids at these places I was
going to by my drugs, just to do my dirt and leave. The last straw was when I
stumbled into a bedroom while trying to find a bathroom at a dealers house. I
walked into a room with 6 or 7 kids under 10 years old wearing big bubble
coats and gloves, all huddled together in the middle of the room trying to
stay warm. It was winter, and it hadn't dawned on me that the house had no
heat. I've never been able to forget how I'd been contributed to their
situation, my actions rippled out to affect many people beyond myself. Relying
on drugs started to feel like a very selfish, narcissistic way of life

------
martinald
Fentanyl is nothing compared to carfentanil - some 100x stronger, which is
10,000x stronger than morphine, gram for gram.

So much so that first responders are suffering serious overdose from inhaling
bags of it accidently.

More crazy was the fact it's for sale on the darknet markets for as little as
$150/gram. Worldwide legal use is about 50g a year.

This is what prohibition does - inctentivizes strength per unit mass. It's
much easier to import 1g of carfentanil than 10kg of heroin. And I think it
will just get worse and worse.

~~~
CoffeeDregs
Carfentanil is terrifying. Wound up in a Wikipedia hole looking that up.
10,000 times as potent as morphine. Only recently illegal in China.
Therapeutic dose of one _microgram_. May have been the way the Russians
subdued the Moscow Theater Attack
([https://en.wikipedia.org/wiki/Moscow_theater_hostage_crisis#...](https://en.wikipedia.org/wiki/Moscow_theater_hostage_crisis#Chemical_attack))
by just spraying it over the crowd. It seems that many people died of
asphyxiation when they passed out and flopped over. It's considered a chemical
weapon.

Consider the mixing requirements of carfentanil: one insufficiently ground
grain of the chemical is lethal. And the people making the end-product are
amateurs.

One kilo from China was confiscated in Canada. Certainly a bit hyperbolic, but
"According to the Canada Border Services Agency, the shipment contained 50
million lethal doses of the drug, more than enough carfentanil to wipe out the
entire population of the country[...]". Divide that by ten and it's still
terrifying. Dump a small bag over NYC Times Square or Mumbai and you'd create
mass casualties.

This isn't some crazy, Bethesda-managed super-bug or insecticide. It's a bog
standard, synthetic opioid.

~~~
QAPereo
I remember when I first learned of Carfentanil years ago under the name
Wildnil, very large game tranquilizer. What I remember most was the speech we
got about handling is and how little time we have if we were exposed, how much
reversal agent will be needed in the reversal agent was always to be had
whenever carfentanil was to be handled.

The idea of humans actually trying to get high on the stuff is insane and
terrifying.

~~~
stordoff
> The idea of humans actually trying to get high on the stuff is insane and
> terrifying.

I imagine most aren't (knowingly) trying to get high on it. It'll be cut with
binders and passed off as a lower potency opiate.

~~~
QAPereo
Oh those poor bastards, thats even worse.

------
dreamcompiler
Fentanyl is a wonderful, miraculous, lifesaving drug when used by doctors and
paramedics. In a hospital setting, it's a much better drug than morphine for
acute pain management in most cases. It's also -- no question -- really
freaking dangerous when abused. I worry about stories like this painting such
a one-sided picture that Fentanyl will be demonized out of existence.

~~~
loeg
Just curious -- what makes fentanyl better than morphine in a hospital
setting?

~~~
microcolonel
That I understand, The fentanyl lollipop has completely changed battlefield
pain relief, it's also been used for cancer patients. Morphine can take 15-20
minutes to kick in, and needs to be injected into muscle, whereas the fentanyl
citrate lollipops take considerably less time and can be administered and
removed abruptly by putting it in or taking it out of the mouth. It also lacks
some of the unpleasant side effects of morphine.

~~~
GordonS
Morphine can be administered IV too, in which case its effects will be felt
immediately. If taken orally, it generally takes around 40 minutes to be felt,
the same as for most opioids when taken orally. Do you have a source for
fentanyl lollipops acting faster than that?

Also, you say it lacks some of the side effects of morphine - do you have a
source for that too? Morphine causes respiratory depression, histamine
release, constipation, nausea, loss of libido, inability to orgasm; actually,
any opioid that doesn't recruit beta-arrestin (such as mitragynine) will have
much the same side effects.

~~~
JshWright
IV fentanyl is a lot faster than IV morphine (3-5 minutes vs 20 minutes for
peak analgesia).

------
cody8295
Legalizing heroin and regulating it like alcohol would save so many lives.

Not sure where everyone here is from, but in Connecticut we've seen hundreds
of people die from fentanyl overdoses in just the past few years.

In an overwhelming majority of the cases, they were sold what they thought was
heroin.

Why should we keep forcing drug addicts to buy from dangerous and expensive
dealers? Not only would legalizing heroin save millions of lives, it would
bring in trillions of dollars in tax revenue

~~~
cuckcuckspruce
Not only that, the response to the opiate epidemic has negative impacts on
people actually in pain.

My girlfriend, who has lupus and constant pain, was recently denied pain
medication because the doctor was concerned that continuing to write
prescriptions for opiates would cost him his license. So my girlfriend has
been in excruciating, 9/10 pain for the last month because doctors are too
concerned about over-prescribing because every soccer mom is suddenly
concerned that responsible adults in pain are suddenly going to turn into
opiate crazed monsters.

As much as addicts need help, the feeling of the general population is that
it's better for someone in pain to suffer than for someone to get a safe,
known, pure quantity of opiates without having a good enough reason.

------
peterwwillis
Librarians in Philadelphia have started keeping naloxone in their desks so
when the next addict OD's in the grass in front of the library they can bring
them back to life.

[http://www.philly.com/philly/columnists/mike_newall/opioid-c...](http://www.philly.com/philly/columnists/mike_newall/opioid-
crisis-Needle-Park-McPherson-narcan.html)

------
kazinator
_[Fentanyl] is on the World Health Organization 's List of Essential
Medicines, the most effective and safe medicines needed in a health system._

[https://en.wikipedia.org/wiki/Fentanyl](https://en.wikipedia.org/wiki/Fentanyl)

~~~
JshWright
I'm not sure the intent behind your quote, but that's very true. Used in a
clinical setting, fentanyl is generally the best choice for acute pain
management (post-op, traumatic injury, etc).

------
coldcode
Why do we continue to treat this as a criminal problem. It's a healthcare
problem.

~~~
marcoperaza
Treating it like a criminal problem works extremely well for Singapore. If you
sell drugs, you get executed. If you have any amount drugs, you almost
certainly go to prison. Police have extraordinary powers to investigate and
prosecute drug crimes, including compelling drug tests of suspected users. As
a result, there is effectively no drug use or trafficking in Singapore.

So this oft-repeated mantra that the penal code cannot solve drug problems is
frankly bs. I'm not suggesting that we should throw drug addicts in prison for
a dozen years, but I'd have no problem letting a fentanyl dealer rot in prison
for the rest of their lives. Maybe start sending commandos to kidnap cartel
leaders from Mexico to bring them to the US to face charges, for trafficking
drugs and for murder. Let's run sting operations with cops posing as drug-
seeking addicts to catch doctors handing them out like candy.

~~~
mnw21cam
> Maybe start sending commandos to kidnap cartel leaders from Mexico to bring
> them to the US to face charges, for trafficking drugs and for murder.

Wow, yeah, let's just invade another country and commit an act of war to get
what we want.

This is one of the reasons why a lot of the rest of the world hates Americans.

~~~
pjc50
Worse, what happens when your illegal commando raid fails?

~~~
mnw21cam
I'm sure there was a Clancy book about this. Maybe it even got made into a
film!

------
throwanem
Glad to know naloxone kits and the training to use them are available. The
first aid kit in my satchel will be a lot more useful once so augmented.

~~~
danbolt
Organizing a party and having one on hand gave me a lot more security in my
abilities as a host.

------
acjohnson55
I'm surprised it hasn't been said yet on this thread, but Fentanyl is what
killed the musician Prince
([https://en.wikipedia.org/wiki/Prince_(musician)#Illness_and_...](https://en.wikipedia.org/wiki/Prince_\(musician\)#Illness_and_death)).

