
A community on the front lines of the opioid epidemic - iamjeff
https://www.statnews.com/2016/08/22/heroin-huntington-west-virginia-overdoses/
======
alasdair_
My daughter died from a fentanyl overdose a couple of months ago.

Like many of the people on this site, I am a software engineer working for a
top-tier tech firm in SF. Money isn't a serious problem in our lives.

Total time from "maybe our daughter is doing drugs?" to death was less than
three months. We sent her to rehab in that time because she was abusing
cocaine and asked to go. I am not some ignorant parent - I've tried plenty of
things and k ow the signs well.

Please, if you have kids, tell them about fentanyl. It is SO much more potent
than heroin and can kill on the first dose. She went to a party, someone
offered her some "coke", she snorted some and she died soon after. Turns out
the coke was fentanyl or at least had some in it.

The autopsy of my daughter showed that there were no injection marks. She had
a career and in no way fit the stereotype of an addict. One day she existed,
the next she did not.

I am neither pro nor ani drug. I don't care about that. All i care about is
telling people the story of my daughter. Fentanyl is so much more potent than
heroin and it is sweeping the entire nation. If you have kids, please tell
them tbat it exists and that people are selling it right now claiming its
something different.

~~~
TheSpiceIsLife
I watched a friend start to lose consciousness and start to lose colour from
extremely shallow breathing after taking more Heroin that he should have.

Fortunately I knew what to do. We kept him breathing till the ambulance
arrived and got him breathing and back to a reasonable level of consciousness
again using nasally administered Naloxone (Narcan) solution.

As far as I'm aware Fentanyl overdose can be treated the same way: Give
breathes until an ambulance arrives.

What saddens me most about these stories is that _no one present_ had the
knowledge necessary to keep someone alive long enough for help to arrive.

Never use along, never dose at the same time as your buddy / buddies. Make
sure your buddy / buddies know what to do. If in doubt half the dose.

~~~
darpa_escapee
> Fortunately I knew what to do. We kept him breathing till the ambulance
> arrived and got him breathing and back to a reasonable level of
> consciousness again using nasally administered Naloxone (Narcan) solution.

That's amazing, you're quite literally a hero.

> As far as I'm aware Fentanyl overdose can be treated the same way: Give
> breathes until an ambulance arrives.

I believe some of the fentanyl analogues going around are more potent than
fentanyl itself. Fentanyl overdoses can require multiple doses of Narcan.
Fentanyl analogues may require much more than that if it works at all.

> Never use along, never dose at the same time as your buddy / buddies. Make
> sure your buddy / buddies know what to do. If in doubt half the dose.

Half the dose can be too much. Titrate upwards as if you were just sold pure
fentanyl powder by a dealer who doesn't know any better, because that's a
thing that happens.

------
touchofevil
It seems like the real problem causing the overdoses is that fentanyl and
carfentinal are getting mixed into the heroin. At the minimum, the US should
provide a program where heroin addicts can get heroin from government clinics,
which is what they offer in the Netherlands[1] where addicts can get heroin
three times a day and apparently rarely overdose presumably because the heroin
is pure. But at this point, I'd rather see most drugs legalized and the tax
money poured into addiction recovery programs, government clinics for
supervised drug use, and drug use prevention.

[1] [https://news.vice.com/article/only-in-the-netherlands-do-
add...](https://news.vice.com/article/only-in-the-netherlands-do-addicts-
complain-about-free-government-heroin)

~~~
mirimir
If morphine was legal, probably about ~10-20% of the population would be
addicts. In 1900, 2-5% were morphine addicts.[0] And advertising was pretty
lame back then.

0)
[http://www.druglibrary.org/olsen/dpf/whitebread02.html](http://www.druglibrary.org/olsen/dpf/whitebread02.html)

~~~
touchofevil
I'm not sure where you are getting your estimate that 10-20% of the population
would be addicted to morphine if most drugs were legalized in the USA today.
If you look at the stats on Portugal, you'll see that drug use and drug
related deaths have declined since the country legalized all drugs[1].

Also, morphine was only invented around 1818 and its addictive properties were
not understood until much later[2]. For example, "...initially morphine was
also marketed as a non-addictive cure for addiction to both alcohol and
opium..." That was happening in 1853, nearly 40 years after the invention of
morphine.

In the article you linked to, the author states that many of the morphine
addicts of the 1900s were people in rural communities who were sold "elixirs"
by traveling "doctors" and these potions were often 50% morphine. Which causes
the author to state: "...if you look at drug addiction in 1900, what's the
number one way in which it is different than drug addiction today? Answer:
Almost all addiction at the turn of the century was accidental."

If drugs were legalized, consumers would not be getting accidentally addicted
to morphine as they were in the 1900s, because they would be able to know for
certain what drugs they were buying and ingesting.

[1] [https://mic.com/articles/110344/14-years-after-portugal-
decr...](https://mic.com/articles/110344/14-years-after-portugal-
decriminalized-all-drugs-here-s-what-s-happening#.ldEGEaPU2) [2]
[http://www.todayifoundout.com/index.php/2014/09/invented-
mor...](http://www.todayifoundout.com/index.php/2014/09/invented-morphine/)

~~~
mirimir
10-20% is my estimate.

50% morphine is only about three times opium potency.

I'm talking legalized, not just decriminalized.

I doubt that there are any morphine sodas for sale in Portugal. With viral
Facebook promotion featuring tunes from Nirvana and Smashing Pumpkins.

~~~
touchofevil
I assume that the same rules that prevent cigarettes from being advertised
would also apply to legalized drugs.

~~~
mirimir
They don't apply very effectively to big pharma, do they?

~~~
touchofevil
Big pharma is allowed to run ads b/c they aren't advertising recreational
drugs which is different from cigarettes and the proposed recreational drugs
we are discussing.

~~~
TheSpiceIsLife
The idea that smoking cigarettes is a form of recreation seems comical to me.
But then, as a non-smoking Australian... Have you seen our cigarette
packaging?

~~~
mirimir
Hey, try it, you'll like it ;)

I smoked hand-rolled Sobranie Turkish/Virginia blend when I could afford it,
and whatever I could afford, otherwise. For about 20 years.

Nicotine isn't exactly recreational, but it does take the edge off that "too
much coffee" feeling. Especially if you've been working more than several
hours. And it does sharpen the mind, sort of orthogonal to caffeine. I've had
some profound insights after coffee and a cigarette.

On the other hand, there's the fact that quitting is very hard. Harder than
opiates. Harder than benzodiazepines. And the long-term health effects, of
course, are horrible.

------
wallace_f
Meanwhile yearly marijuana overdoses stay at a constant zero every year, while
enforcement of marijuana prohibition kills untold numbers of convincingly
innocent people.

~~~
drawkbox
Just recently Insys, the company that makes fentanyl[3] and gave 500k to help
defeat legalized marijuana on Arizona[1], got approval/classification
(Schedule II) for a synthetic THC/cannabinoid, Syndros, that does have the
potential for overdose[2]. So not only are they killing opioid addicted users,
now they are starting this. Somehow synthetic THC is Schedule II while
natural/real cannabis is Schedule I.

Fentanyl, synthetic opioid, was the cause of most of the ODs in the article,
synthetics are a worse problem than the natural versions.

 _But police suspect the heroin here was mixed with fentanyl, a synthetic
opioid that is many times more potent than heroin. A wave of fatal overdoses
signaled fentanyl’s arrival in Huntington in early 2015, and now some stashes
aren’t heroin laced with fentanyl, but “fentanyl laced with heroin,” said
Police Chief Joe Ciccarelli._

[1] [https://www.leafly.com/news/politics/fentanyl-maker-insys-
gi...](https://www.leafly.com/news/politics/fentanyl-maker-insys-
give-500k-defeat-legalization)

[2] [http://www.thecannabist.co/2017/03/23/synthetic-thc-drug-
ins...](http://www.thecannabist.co/2017/03/23/synthetic-thc-drug-insys-
therapeutics-dronabinol-syndros/76030/)

[3] [https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-
fa...](https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fatal-doses/)

~~~
c0nducktr
I seriously can't understand how someone could work for that company in clear
conscience.

~~~
noonespecial
Its easy. Just add bills and take away options until your conscience is the
least of your worries.

When you're choosing between falling another month behind on rent on the
apartment you were "so lucky" to get and getting a throbbing cavity filled at
the dentist, you might not think too much about it.

~~~
c0nducktr
There are a lot of people working there who aren't close to falling a month
behind on rent, and those people were who my comment was addressing.

There are a lot of business out there which make a lot of their money in some
very unethical ways, and people who choose to be part of that... I just don't
understand. I couldn't live with myself.

I know several people who have died of overdoses, so I'm probably biased, but
I'm truly disgusted by what is going on.

~~~
exolymph
People rationalize their positions. Human morality / ethics is very flexible.

"It is difficult to get a man to understand something, when his salary depends
on his not understanding it." — Upton Sinclair

~~~
wallace_f
It's different for different people. Some people are dirtbags, some people are
saints, and everyone else is in-between.

------
gragas
So what can be done? I usually update my theory about the situation when I
read new articles, but now I'm really at a loss. I'd love to help these
people, but I can't see a fool-proof solution.

Some questions come to mind:

\- Is it the role of the government to keep people safe from themselves? If
so, how?

\- Would harsher drug laws make things better or worse?

\- How big of a role does purported economic opportunity have to do with drug
abuse? My theory used to be that structural unemployment was the root of this
epidemic; those born into the quickly receding middle class---those who relied
on low-knowledge/low-skill jobs for a modest living---are hit the hardest
since they did not anticipate such a shortage of low-skill jobs.

\- What does religion have to do with this?

\- What does culture have to do with this?

\- Are members of the military more or less affected by opiod drug abuse?

\- Does providing safe places to take drugs alleviate the problem, or does it
make it worse?

~~~
zkms
These overdoses are an an expected and predicted consequence of opioid
prohibition.

See, before opioid prohibition, deaths from opioid use were quite rare. You
ever heard a pothead drone on about "it's nearly impossible to overdose from
smoking marijuana"? The same thing applies to smoking opium. It's nearly
impossible to overdose on that. But prohibition (which optimises for
potency/volume, in order to reduce the risks of ending up in a concrete box)
has pushed us from opium smoking and oral laudanum to injectable heroin to
fentanyl and now (in the late 2010s) we're at fucking _carfentanil_ (which is
so potent it's been used as a chemical weapon).

This is the "iron law of prohibition" at work:
[https://en.wikipedia.org/wiki/Iron_law_of_prohibition](https://en.wikipedia.org/wiki/Iron_law_of_prohibition)

The current USian "opioid crisis" is another manifestation of opioid
prohibition pushing people from safer, cheaper, less disruptive and deadly
drugs to more deadlier ones. Two decades ago some USian opioid users could go
to pill mills and get prescriptions for pharmaceutical grade opioids but the
DEA kicked down doctor's doors a bunch and that ended up pushing people to the
illicit market. Maybe next time you see those scary increasing graphs of
opioid deaths vs time, give that a thought? Sum up all those deaths (compared
to the baseline, prior to the increased LEA focus on "pill mills) and ask
yourself: are all those needless deaths worth it?

The DEA cracking skulls over opioids and investigating doctors is literally
the only reason illicit fentanyl (and fent analogues) even is a thing. I am so
very doubtful that skull-cracking and door-kicking will miraculously work
after decades of it not working. The only way out of this hell is a total
unconditional surrender in this "war on drugs".

~~~
alsetmusic
> See, before opioid prohibition, deaths from opioid use were quite rare. You
> ever heard a pothead drone on about "it's nearly impossible to overdose from
> smoking marijuana"? The s

I'm not an expert. Can you please link to studies to verify this?

We're talking about overdosing and I don't think marijuana falls into that
category.

~~~
mirimir
It's really hard to OD on opium. Now purified morphine, sure. And it's the
same with coca leaves vs cocaine vs crack.

Can you imagine a THC analog that's 10^4 times more potent? Is overdose really
impossible? I suspect that we'll find out, in a few years :(

~~~
fragmede
Sadly, you're very right. "Spice", or "bath salts", as synthetic cannabinoids
have been called, with much higher potency than marijuana, have already hit
the recreational pharmacutical market with predicably negative consequences.

~~~
zkms
Yeah, "designer drugs" \-- the products someone trying to make a drug that
works on the same systems but is different enough in structure from anything
on a Controlled Substances list are bad news. The problem lies in the fact
that many drugs with long histories of human use (opium, marijuana) have _long
histories of human use_ , and so they've been tested extensively and are known
not to produce horrid adverse effects. Trying to replicate a compound that has
been tested for efficacy and safety over literal millenia (and not being
allowed to just change tiny things on the molecule) is not something that is
likely to give results close to the original.

Ironically, the obverse task -- trying to create a molecule that acts on
similar neurobiological targets as an illegal drug but _doesnt_ get people
high or look like a molecule from an illegal drug -- is similarly fraught. A
flagrant example is BIA 10-2474, an experimental drug meant to target the
endocannabinoid system in a roundabout way -- not by directly activating
receptors, but by inhibiting an enzyme that degrades endogenous chemicals that
activate endocannabinoid receptors -- which would have similar effects as
directly activating those receptors. A trial of it killed one person and
irreversibly neurologically damaged a few others.

We criminalise drugs at deep costs to research and medecine (I haven't even
gotten into the use of MDMA in psychotherapy or ketamine for depression), and
regardless on what side of the law they work on, it is a very difficult task
for chemists to try to imitate drugs that have been with humanity for millenia
when they aren't allowed to make molecules that look like blacklisted ones.

------
mirimir
So what would it cost to distribute safe heroin?

I mean, restricting availability of Oxycontin etc clearly hasn't worked.

Edit: My point is that the Drug War is immoral.

~~~
gragas
I think

1\. We need more radical ideas like distributing heroin.

2\. I'm not by any means convinced that distributing heroin will actually
solve the problem. Clearly, nothing we've done so far has worked. Perhaps this
will work.

3\. There is _some_ good sentiment behind the drug war. Still, there are a lot
of evil pharmaceutical companies which have no good intentions.

4\. Pharma firms inherently gravitate towards evil because more money lies
there. Perhaps there are a few truly evil execs at these companies, but I
think the sith-like aura comes from the sum of many only slightly evil
actions. If we remove the money, we remove the problem. But how?

~~~
mirimir
The core problems here are profit-driven corporations and advertising. Without
those, there would be no need for anti-drug laws. Back in the day, only
corporations with public-interest charters were legal. And "get everyone
addicted to oxycodone" was never going to make it as a public-interest
charter. But those days are gone, so corporations are fighting with each other
about which drugs it's OK to addict people to, and which it's not.

------
gm-conspiracy
From August, 2016.

~~~
rhizome
...and "this city" is Huntington, W. Va.

------
goldenkey
The problem isn't opiates. It's larger doses than necessary combined with
synthetic drugs that are much more powerful than the natural poppy alkaloids.

Quick rundown: The poppy plant has two main alkaloids that make up the
majority of its analgesic activity: codeine and morphine. Codeine works
following being broken down by the liver into morphine. It's essentially the
same drug but requires larger doses due to the inefficient pathway.

I have had a chronic pain condition for many years now and take 30mg morphine
sulfate tablets twice daily. Instant release taken often works far better than
extended release drugs because the total dose is much less, which keeps
tolerance levels low, thereby lower dependence.

Oxycodone is 1.5 to 2x as strong as morphine. [1]

Oxymorphone is 7-8x times as strong as morphine. [1]

Fentanyl is 50-100x times as strong as morphine. [1]

Of course this is referring to gram for gram, and these substances do have
different molecular weights. But even so, the potency has much to do with
bonding length between the drug and the body's receptors. Bonding length is
correlated with bonding strength, also correlated with addictive qualities.

For low to moderate pain, Tramadol[2] is the best analgestic. For moderate to
severe pain, Tapentadol[3] (Nucynta) is by far, the most therapeutic and least
addictive. I used to take it until I lost my insurance. Unfortunately it costs
$1500 a bottle. It's a newer drug. The same company Depomed that created
Tramadol kept going and made a better and stronger version. Having tried
gabapentin, muscle relaxers, all kinds of stuff, pretty much everything out
there, I will say, Tapentadol is really an amazing drug. It's unfortunate its
so expensive and not covered by many insurances though.

So in summary, if a person has the insurance, the doctor should prescribe them
Tapentadol or Tramadol. As a last resort, prescribe Codeine and/or Morphine.
Not these crazy synthetics with ridiculous addiction profiles and bonding
strengths.

Hope this helps anyone who ever has a pain condition.

[1]
[https://en.wikipedia.org/wiki/Equianalgesic](https://en.wikipedia.org/wiki/Equianalgesic)

[2]
[https://en.wikipedia.org/wiki/Tramadol](https://en.wikipedia.org/wiki/Tramadol)

[3]
[https://en.wikipedia.org/wiki/Tapentadol](https://en.wikipedia.org/wiki/Tapentadol)

------
michaelhoney
Serious question: would it not be better to make opioid painkillers available
again, rather that have people substitute with heroin or worse?

------
addict_gt
I'm reluctantly commenting, throwaway account. I had spent an hour writing
this huge note, but don't think it was constructive. Check out the reddit
description of opiates and heroin, the youtube spoken word video will help
non-addicts understand the power of these drugs and the control they have over
your life and your brain chemistry and how easy it is to become dependent.

I am an addict. I have been all of my life, and will be until the day I die
(hopefully at an old age and happy).

I'm also business owner, young and I would say very successful compared to
others in my age group.

Ironically, I actually credit Oxy for getting sober from alcohol (coming on 3
years), and I've been sober from cocaine for probably around 3.5 years (don't
remember, very blurry).

However I'm currently dependent on opiate pills and I feel very lucky that I
can afford my addiction, at least for now.

I'm afraid to get sober. I'm afraid to tell the truth to the ones I love who
supported and congratulated me on getting sober from alcohol and cocaine.

Instead of telly a long story, I wanted to offer some ideas to this community,
from the perspective of an addict and entrepreneur, a few of these could even
be successful startups that save lives:

1) doctors need to stop prescribing. I am very open with my Doctor, it is
written on the front page of the screen that shows my health record:
previously cocaine dependent, alcoholic. Yet when I went in for a bad burn,
they prescribed Percocet. I went to the doctors seeking some numbing cream and
to ensure I didn't get an infection. But I got pills, and I'm an addict. I
KNEW 100% I would become addicted. It didn't happen over night of course, but
here I am. Replacement therapy is called liquid handcuffs for a reason:
methadone is dangerous and deadly, Sub withdrawal I hear is worse than
oxy/heroin withdrawal. I would love to see an experiment long term between
traditional replacement therapy, compared to actually supplying addicts with
pure drugs.

2) make a reliable and widely available and free test kit to detect Fent and
other deadly synthetic and powerful opiates.

3) make a cheap wearable fitbit like device. It will detect slowed/stopped
breathing and alert either authorities or maybe an app that has listed
contacts who are trained and have access to naloxone, like a rape or danger
alert sent to your designated contacts and if no response 911. It would have
to have little monetary value so it's not sold, but maybe could help save some
lives.

4) make an implant that can detect slow breathing/overdose and administer
naloxone during an overdose internally. Like a diabetes monitor/pump.

5) sue Purdue and change our countries addiction to prescription pain killers.
To me this is the big tobacco of our time. They spent millions and millions
advertising and buying doctors telling them this is a non-addictive 12 hour
pain reliever. Pain in the past was rarely medicated. Purdue changed this and
made billions. The truth is Percocet/Oxy usually lasts only 6-8 hours, maybe
10 if you're lucky. Each individual is unique. Purdue advertised 12 hours non-
addictive and that's how doctors prescribed. so when the pain comes back
before 12 hours or you start getting sick you take the next pill. And you use
your entire script before the next refill. They MUST have known this.
Profiting on addiction is shameful. Marketing a product to purposefully create
addicts to sell more pills is criminal an I hope that somebody can leak or a
prosecutor can make this case and bring some justice, and badly needed funding
to aid in recovery, research, and alternative replacement options.

~~~
unlmtd
Opium is the most beneficial plant known to man. Your solutions are wrong: If
opium isn't banned, everyone can grow poppies and enjoy natural opium latex.
Nobody would use fentanyl. It wouldn't even be produced. And, yes, it cures
alcohol addiction. Ethanol is a poison, morphine is a medicine.

~~~
addict_gt
I agree that open/free access to opiates is a solution and don't think I wrote
anything against opium? - I mentioned better replacement therapy ie the actual
drugs instead of methadone/subs.

I'm also not sure that Fent/synthetic opiates would go away if everyone could
grow opium. It depends on cost and scale. Fent is cheap as shit for how
powerful it is. I'm not sure mass cultivation (time + resources) would be
cheaper. IDK maybe I have no idea I have never grown poppies and don't know
the cost.

But I do know the price for 100 grams of fent and it's insanely cheap.

If opium/naturally derived opiates were available for cheaper/free from
governments than sure it would probably reduce dramatically the amount of fent
produced.

I'm not sure how I feel about your characterization of poison/medicine.

I don't want to argue about it either.

But I guess I'm genuinely curious as to where you're coming from with that
statement and your experience. Are you an opiate user? alcoholic/recovering
alcoholic or addict? mental health? everyone's experience is different so who
am I to judge or critique.

 _edit_ again don't want to argue, but I guess I would offer a simple question
about the 'most beneficial plant known to man'. How would you compare say,
antibiotics derived from plants to poppies in terms of benefit to man?

~~~
unlmtd
It's cheaper to drink pure ethanol than wine. You can hit me on matrix.

------
revmoo
Gonna get worse once they ban kratom. Brace yourselves.

