'That Fentanyl – That's Death': A Story of Recovery in Baltimore

http://www.npr.org/sections/health-shots/2017/08/03/537683319/that-fentanyl-thats-death-a-story-of-recovery-in-baltimore

by Mz • 9 years ago

106 113 9 years ago

npr.org

coldcode• 9 years ago

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

bbarn• 9 years ago

No, it's a business problem. There's too much money tied up in the infrastructure that criminalizes it, too many people invested and making a lot of money on the status quo.

teej• 9 years ago

There's also a lot of money to be made in keeping addicts hooked. In South Florida, there's a huge issue where opioid addicts are put into "treatment centers" that use them to defraud insurance carriers. The victims don't get treatment but instead get the exact opposite - handlers who make money by feeding the addiction.

http://www.nbcnews.com/feature/megyn-kelly/florida-s-billion...

djsumdog• 9 years ago

The pharmaceutical industry is a major part of the problem. Keep in mind morphine and oxytocin were in response to the control of heroin.

Adderall is not so different than methamphetamine.

The well of do these drugs legally and can afford rehab. Many of the people I've know that struggled with opium addiction could not afford to join treatment programs, many of which cost $2k ~ $15k.

There is a lot of money being made in all sides of this game and it's disturbing.

bpodgursky• 9 years ago

This is a super simplistic view. This is not like pot. This is not a drug that you can eve use casually. There is no moral legal framework in which these drugs can be freely bought. After you are on these drugs, you are no longer able to make free choices.

I agree that users should be receiving treatment. But anyone selling or importing these drugs absolutely deserves to be punished harshly -- they are destroying millions of lives.

wildmusings5• 9 years ago

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.

askvictor• 9 years ago

There are other countries that have stupidly harsh penalties for drug dealing and use (e.g. Thailand, Indonesia, Philippines). Hasn't really done much there. Only works in Singapore because it's already a police state. So perhaps you can solve the drug problem with police if you're already in a police state, but that doesn't strike me as a sensible approach.

jfoutz• 9 years ago

the law is a piece of the puzzle. I think that would be a tough approach in u.s. culture as you present it. For one, all it takes to get someone executed is a dishonest officer. Also, planting drugs on someone or their property seems like an "easy" way to get rid of them without a conspirator.

I see how that can work in some cultures and countries. I just think that approach wouldn't be very effective in the US. Probably not effective in countries larger than a few thousand square miles even with strong cultural support.

stickfigure2• 9 years ago

Please tell me, how many marijuana dealers would you have been willing to execute in the 80s? How many brewers would you have been comfortable executing in the 20s? How many homosexuals in the 50s?

I for one am very happy not to be living in an all-powerful police state. What's obviously "moral and good" seems to be awfully fluid across history.

mnw21cam3• 9 years ago

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.

ozmbie• 9 years ago

I lived in Singapore as an expat back in 2012, and from my experience, getting drugs (either online or through friend contacts) was not that hard. The penalties stop most people but the stuff still exists.

Nursie3• 9 years ago

Singapore is an island city, and a police state.

pjc502• 9 years ago

penal code cannot solve drug problems is frankly bs

This has been tried in the West for decades and not worked so far.

letting a fentanyl dealer rot in prison for the rest of their lives

This already happens.

sting operations with cops posing as drug-seeking addicts to catch doctors handing them out like candy

This already happens as well, although you then have to draw a line between perfectly legal prescription and illegal dealing.

If you sell drugs, you get executed

This policy is currently collapsing the Philippines; 7,000 dead already: https://www.hrw.org/report/2017/03/02/license-kill/philippin...

"Even prior to announcing his candidacy for the May 2016 presidential election, Duterte was already very clear about his intention to eliminate crime by eliminating criminals: “If by chance that God will place me there, watch out because the 1,000 [people allegedly executed while Duterte was mayor of Davao City] will become 100,000. You will see the fish in Manila Bay getting fat. That is where I will dump you.”"

The massacre of 100,000 people would put Duerte well into the "crimes against humanity" league.

qazpot• 9 years ago

The safest place in the world to live is a Police State.

wavefunction• 9 years ago

Singapore is always held up as an example for larger countries but it's really just a small city that doesn't offer much in the way of example for actual countries. We've already tried police brutality in the war on drugs and all it has gotten us is pain and misery. And epidemic after epidemic of drug abuse over the years.

And we'd have to send your commandos into China as well as Mexico if we truly want to stop the opioid epidemic. That's where all this fentanyl and carfentanil is coming from.

jokr004• 9 years ago

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.

microwavecamera• 9 years ago

Im glad to hear you're doing better. Keep at it. I didn't get into opioids personally but grew up in and lived in that type of environment for years and had my own addiction issues. I've seen alot of good people get caught up in it. We need more programs for addiction and mental health. It's wrong that things are the way they are. No one should have to live like that. We need to find a better way.

stronglikedan• 9 years ago

I'm in the process of recovering from a serious addiction to furanyl-fentanyl.
This stuff is a nightmare like you can't possibly understand without being there yourself

From someone who hasn't been there themselves, but just lost my best friend to fentanyl, I hope you stick with recovery. She was actually in a very nice recovery program, but managed to sneak a cell phone in. Point is, it only takes one bad decision that I hope you don't make.

Pigo• 9 years ago

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

throwanem• 9 years ago

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• 9 years ago

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

JonDav• 9 years ago

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.

JshWright6• 9 years ago

I never came across a fent addict

At least here in upstate New York, there aren't really 'fent addicts'. There are opioid addicts in general, but even the hardcore users are generally seeking heroin, not fentanyl.

People are _really_ scared of fentanyl...

icantdrive55• 9 years ago

And they should be. Two employees at my local hospital died sitting on the can in the bathroom, with a fentanyl Patch lying on the ground.

One was a nurse, and the other a janitor. (They took the used patches out of the garbage.).

(That said, we should legalize at least bupenorpine, the generic version. Addicts would have an alternative to street drugs, and doctors who just charge too much. Plus--drug education should be taught early in school. And tell the truth. Like for nine months, the drugs will work. Then you will spend years just trying to feel the way you did before you took opiates:; if you're lucky.)

nefitty• 9 years ago

I'm scared I may have to advise close friends to start carrying Narcan. It doesn't really make sense how horrifying opiates are until they start ripping away people you've known for years...

zappo29383• 9 years ago

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• 9 years ago

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

acjohnson552• 9 years ago

That's familiar to me from vicodin

stordoff4• 9 years ago

The feeling wasn't happy, sad, high, speedy, or low. It was just everything was ok.

Sounds similar to codeine (medical use, moderate to high dose). It has no particular strong feeling in and of itself, but if I'm doing something I already enjoy it makes things feel a notch better (vs. if I'm bored/annoyed etc. it's hardly noticeable other than being in less pain).

MrFantastic2• 9 years ago

I don't think people can feel brain surgery.

taternuts• 9 years ago

For most people driven to addiction, having something that guarantees you will feel that "everything was ok" is exactly the draw, I think. It gets worse as you become more and more addicted and have more and more to hide from as you let other parts of your life you cared about continue to slide.

microcolonel5• 9 years ago

A man walked into a meeting with a fent sucker in his mouth...You can buy fentanyl straight from China in a properly wrapped packet.

Talking about OTFC lollipops? You can get those in the mail from China? I'm guessing these are disjoint cases.

Dosage is the problem, mixing dry is not easy, hence the street deaths.

I feel like the bad rap it gets is mostly about dosage, ultimately it is the market at work despite the law, producing ever more potent and compact (concealable) fixes as customers demand. If caffeine were a controlled substance, people would buy it more often in the (hazardously potent) powdered form. When booze was prohibited, it was regularly distributed in 180/190 proof.

The demand is the part you can improve, the supply is the part you think you can solve.

peterwwillis• 9 years ago

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...

martinald• 9 years ago

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• 9 years ago

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#...) 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.

QAPereo2• 9 years ago

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.

Nursie3• 9 years ago

Wow, I didn't realise that had hit the illegal drug trade. That's insane. Carfentanil has been used to knock out elephants, and it's always package alongside naloxone, just in case the vet accidentally gets themselves.

Genuinely quite scary that it's out there as a drug of abuse.

logfromblammo• 9 years ago

Bethesda-managed super-bug

I could not read past this without imagining a random corpse in Fallout 4 or Skyrim stretching its limbs out to infinity and dancing and twisting around in the sky like some crazy, drunk harvestman-fairy.

But this is undoubtedly referring to level-4 containment at the National Institutes of Health, which keeps samples of diseases that would potentially be useful for biological warfare.

whipoodle• 9 years ago

That is insane. Part of what's so awful about this is how these can just be mixed into other powder drugs and nobody is the wiser. Like, doing coke now just seems crazy to me, where in the past it didn't seem a big deal at all. But the lethal doses of these things are so tiny that it seems not worth the risk.

cylinder• 9 years ago

But what are our "thought leaders" talking about all day -- the dangers of AI. * rolleyes

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dreamcompiler• 9 years ago

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.

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loeg• 9 years ago

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

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stordoff4• 9 years ago

Searching "Fentanyl vs morphine for acute pain" will give plenty of studies comparing the two. At a quick glance through a few of them, it appears the main differences are faster onset, shorter duration, lower incidence of side-effects (primarily nausea), and less histamine release.

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microcolonel5• 9 years ago

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.

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zlynx• 9 years ago

It is super fast. A while ago when I went to the ER with a broken arm they gave me fentanyl as an injection. As I remember it, it took less than ten seconds to go from extreme pain to not caring.

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JshWright6• 9 years ago

Paramedic here... I agree wholeheartedly. I see both the best and worst of fentanyl. I have woken up plenty of folks who took a much bigger dose than they expected (because it was cut with more fentanyl than usual), and pronounced more than a couple people dead for the same reason...

That being said, it's my go-to tool for analgesia. It acts a lot faster than morphine, and wears off faster as well (which is a useful property in the event of an adverse reaction). Before we carried fentanyl, it would not be uncommon for some patient's pain to remain untouched by morphine. I've yet to have that happen with fentanyl.

Carrying fentanyl means the difference between "Let's get some pain medication in place before we manipulate your broken leg in order to splint it" vs "Morphine is gonna take 20 minutes to reach a meaningful therapeutic effect, and we don't have time for that, so just grit your teeth and we'll try to be quick".

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kazinator• 9 years ago

[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

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JshWright6• 9 years ago

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).

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cody8295• 9 years ago

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

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vesche• 9 years ago

Obligatory Ron Paul - https://www.youtube.com/watch?v=c4Eca-INIOw

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cuckcuckspruce• 9 years ago

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.

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acjohnson552• 9 years ago

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_...).

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'That Fentanyl – That's Death': A Story of Recovery in Baltimore

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