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.
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.
They probably are, and in part because of reassuring BS such as at the top of this thread. Just because something seems safe from a completely rational perspective or that of someone highly educated doesn't mean real people in less privileged circumstances won't suffer from it. Theory and practice are only the same in theory.
Incredible. I would be terrified to have an infusion of Wildnil unless I was actually in a medical setting, preferably with a crash cart and reversal drugs right on hand. I understand desperation though, and if people will cook their own desomorphine, I guess they will do ANYTHING.
Well, the simple RP/HI process that turns ephedrine into meth works to turn codeine into desomorphine, and it's not really as if IV desomorphine will rot your limbs off.. but all sorts of things left in the cooked up sludge (sometimes basified using CIGARETTE ASH.. omg..) def will..
I have yet to come across a Wildnil experience report though, lol
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
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.
What's interesting about dealers (at least the very low level ones that addicts typically buy directly from) is that they're often selling dope to support their own habits or to get ahead in a world they see as being stacked against them.
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.
While it isn't yet the law everywhere in the US, it's not just celebrities whose dealers get charged with murder for supplying drugs that kill via overdose.[1]
Couldn't agree more with the characterization of this article as sensationalist. Also, why post this to a forum such as Hacker News? If I wanted to read "news" of this nature, I'd go to Fox or Yahoo!
When the article is less sensationalist, HN often expresses an interest in stories about drug addiction.
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.
It's not a secret nor hidden. It's well known and something people want to avoid. Users don't intentionally take a dose dozens of times higher than helpful.
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.
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.
My sister is a heroine addict. Addiction does do crazy things and destroys lives.
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.
Its fates like this, which scream for a pragmatic approach. If you cant cure somebody, at least give him a dignified way to exist on. Enough to avoid the with drawl symptoms and a way to work.
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.
And that's not legitimate? Withdrawal is probably one of the worst physical experiences someone can go through.
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?
I don't know all of the details as to how she became addicted to them, but it certainly wasn't a financial issue. Her husband owned a chain of auto body shops and was by all accounts worth at least a few million dollars.
So the predicate "wasn't allowed" is even more accurate. She was prohibited, legally, to get properly labelled medication.
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?"
Forgive me if this is wrong, but are you really arguing for the over-the-counter sale of chemically addicting drugs, premised on the actions of junkies? Won't that just create more junkies?
Alcohol is chemically addictive, sold over the counter, and is currently the fourth leading cause of preventable death in the U.S.
> Alcohol is chemically addictive, sold over the counter, and is currently the fourth leading cause of preventable death in the U.S.
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.
Opiates are not anywhere nearly as harmful as alcohol. Apart from overdosing, there's very little side effect, generally. (Some people don't tolerate them well.) The health issues that junkies have is usually due to poor hygiene - many places don't even let them buy needles!
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.
This is probably the biggest lie that I ever heard in my life.
Go on and take your opiates if makes you happy, but don't try to deny reality.
Alcohol is assumed every day by billions people in the world and it has absolutely no harmful effects if taken moderately. Actually there are several studies about the healthy effect of one glass of wine a day.
A junkie instead cannot take his sh.t with moderation and will suffer plenty of ill effects.
You're completely off base here. Many times more people die of alcohol than heroin and prescription analogs put together. Also, there are tons of people who use opiates responsibly and in moderation--I'm one of them. Finally, lose the anger, it's a symptom of alcoholism ;)
No one ever died for drinking a glass of wine a day. Heroin users can't use it moderately by definition. Enjoy your addiction, but don't try to lie to the world saying that opiates are innocuous just to feel better with your conscience. ;)
>Heroin users can't use it moderately by definition.
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.
Opiates are consumed every day by tens of millions of people in the world and they have absolutely no harmful effects if taken according to prescription.
That opiates when used in proper doses are extremely safe from a physical point of view is an indisputable fact.
There's basically no difference. Chronic pain users will end up on ever higher doses and get rx's with amounts that'll make junkies jealous. Severe pain might make them even more tolerant to the drug.
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.
The benefits of alcohol drinking are very hard to separate from other factors that also differ between drinkers and non drinkers. There may be benefits but the data is hardly conclusive.
I know a fair amount of people that have used, some that died. I've been robbed by a relative so he could sell my shit to buy drugs. Yet I strongly believe that people should be able to make their own decisions, that personal freedoms are worth the price of people deciding to use whatever medicine they want.
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.
Legalization would avoid the shitty stuff part of junkies, for the most part. Or at least mitigate it to a huge extent, since costs would go down. Oxycodone, for instance, goes for about 30-100x on the street than at a grocery store.
If gas was 50x more expensive, we'd probably see some desperate behaviour for a while.
You know a few functional alcoholics right now, and you likely don't even know it.
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.
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.
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.
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.
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.
Addiction is way less harmful if it's legal. Clean needles, consistent dosages, better healthcare, no stealing/theft/lying/etc. If it's legal it's just a physical dependence. Other physical dependencies we have include: food, water, and air and we manage those OK.
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.)
I'm generally in favor of some form of legalization, but I feel like this conversation has a tendency to become very hand-wavy and legalization can be overly evangelized as a panacea for systemic problems related to addiction.
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.
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.
> 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.
I'm very sorry for your loss. My sister is a heroine addict. She now has a serious heart condition, and a pacemaker. Not even 30 years old yet. We really don't think she'll make it much longer as well. We don't know what to do.
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.)
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.
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.
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?"
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.
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.
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.
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.
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.
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.
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).
It is hard to get true data, when the only supposedly creditable source (CDC), mixes its data to include all prescription drugs including SSRI's and illicit fentanyl from china.
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.
The statistics are interesting, but they kind of miss the GGP's point. Decriminalization is not legalization. If you just decriminalize, drug users still have to buy their drugs from sketchy black-market suppliers. That's very dangerous compared to buying from a legal, regulated industry. For example, alcohol is predictable and pure today but in the prohibition era, when all suppliers were criminals, it wasn't [1][2].
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).
There was a nice article about how you survive addiction by growing it out. Addiction has also to do with the circumstance and the personality, not just with the drug itself.
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 mean look at this statement
"A study showed patients prescribed high dosages of
opioids long-term (>90 days) had 122 times the risk
of opioid use disorder compared to patients not
prescribed opioids"
from the cdc to drs here http://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a....
So people taking opioids have are at more risk of opioid use disorder than people who dont take them. -YA THINK. And finally look at how they garble the data here http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm they are finally getting to where they can see the drugs are from illegal sources and not dr regulated rxs.
This study comes up time and again but is really not founded very well. I couple of members of the Independent Scientific Committee on Drugs - whatever exactly that is - sat together and scored a selection of drugs on a selected set of criteria. That's it, there is really no data behind this study other than the opinions of those people. Those opinions might be correct but they may as well be biased or even totally wrong.
>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.
In the case of alcohol, there was a period of prohibition that did not decrease the death count nor reduce harm to individuals or the society.
Granted it was a long time ago.
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.
Many (if not like more than half, I forget the statistic..) of those overdose deaths result from combining a GABAergic like alcohol or especially benzodiazepines with an opioid.
I wonder why mixing cns depressants is so common? Is it because opioids are so expensive / hard to get, and benzos/alcohol easier to get and cheaper? Or is it simply a better feeling mixing them...
There's also no literature on the subject. So if you need benzos and opiates, there's zero guidance on what's safe. Just "we don't know, we don't measure, don't do it". In other words, abstinence.
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.]
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
and SSRI's, if someone takes herion, zoloft, and xanax and OD's from zoloft, it gets placed in the prescription and illegal category. Instead of quantifying the actual numbers and being precise. So even though zoloft killed them, it will go under opioids.
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.
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.
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.
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?
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.)
I don't remember ever hearing a 'high-profile tech leader' extoll the virtues of getting high on opiates. Yes, Steve Jobs talked about his experience with LSD in positive terms, but LSD is as similar to fentanyl as Advil is to Viagra or alcohol is to coffee. They really have nothing in common other than being labeled 'drugs', which at this point is a term just as empty of meaning as 'chemicals'.
FWIW Advil and other OTC painkillers (NSAIDs) cause almost as many deaths as opiates. If opiates were readily legally available in proper dosages and cheap prices, NSAIDs would almost certainly pass them in harm.
> FWIW Advil and other OTC painkillers (NSAIDs) cause almost as many deaths as opiates.
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]
I have never heard of any high-profile tech leaders defending the recreational use of opioids, nor is it a popular position on HN. What's often praised, however, is education (eg. not throwing all drugs into the same bag).
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.
Starting material, precursors, cost analysis, and a darknet market for sales. You can say they're not advocating or advising for anything, but they just did to anyone who could be interested, from start to completed product to where to sell it.
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.
There are recreational drugs, and then there are addictions. I don't think I've witnessed the blasé attitude towards highly addictive substances you have witnessed, except possibly with nicotine. Certainly not in person.
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.
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.
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.
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".
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.
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.
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?
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.
> 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".
The thing about marijuana is it doesn't do serious organ damage over time like alcohol, opiates or cigarettes will. I'd always take medical marijuana for chronic pain vs prescription opiates.
I'd not call this an over reaction. This part of the story, no matter how true, will be used to smear pot users in the future.
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"
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.
Drug addiction is a mental health disease. We don't tell depressed people that this is just natural selection at work, "just shake it out". We get people treated with the right medication. A huge amount of drug addicts suffer from untreated psychological trauma, particularly childhood trauma.
Disease assumes it's something out of your control. Nobody decides to get cancer or get depressed. Taking drugs, especially starting to, is 100% up to you.
People need to learn about the consequences of their actions, and take some responsibility, instead of blaming it on the seller. It's like blaming the knife manufacturers for the stabbing victims.
> Taking drugs, especially starting to, is 100% up to you.
It can also be a way of coping with/escaping problems/depression. This quote from the article hints at that:
“I felt more laid-back, carefree,” said Justin of that first experience with drugs, “just like everything was kind of pushed off to the side.”
Furthermore an addiction can easily develop from legitimate use of a substance, i.e. pain killers after an accident.
Btw, pure opiates have a very low toxicity, if you have a reliable source (say a doctor) you can take it for decades. And lots of respectable people are doing that and you'll never know - maybe even your banker or a local judge. Most problems are due to unreliable quality and mislabeled substances - both results of prohibition.
> take some responsibility, instead of blaming it on the seller
When unreliable quality and mislabeled substances are the problems, the seller is responsible - not necessarily the small dealer, but somewhere up the chains someone messed up big time (whether it's greed or ignorance does not really matter here).
Moreover, the effects of addiction, the way choices made in childhood or under duress can affect the brain well into adulthood, and the fact that unregulated drugs sold can be far more dangerous than believed (you know, what the article was about) make this a hardly tenable position. "The dangers are generally known" is only said about opiate addiction by someone who doesn't know much.
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.