Synthetic opioids deadlier than fentanyl are showing up in overdose cases

https://theconversation.com/nitazenes-synthetic-opioids-more-deadly-than-fentanyl-are-starting-to-turn-up-in-overdose-cases-212589

by elorant • 3 years ago

47 87 3 years ago

theconversation.com

peyton• 3 years ago

I’m not a public health expert but I don’t see how the status quo is preferable to letting anybody buy codeine at CVS. I’m seeing a lot of suffering in my neighborhood and a lot of money going towards it that could be better spent on other problems.

Euphorbium• 3 years ago

You will have to rip easy drug money from the cold dead cop hands.

Loughla• 3 years ago

Can you buy codeine over the counter? Where I live, any painkiller/opioid is exclusively by prescription.

diag• 3 years ago

Have you been to Canada? It's not hard to walk in a pharmacy and get it.

NikkiA• 3 years ago

Not pure codeine, but co-codamol (codeine/paracetamol mix) is OTC in about half of europe, and the UK.

ccooffee• 3 years ago

According to "Codeine" from the Canadian government[0]:

Certain lower-dose codeine products (8 mg or less per pill, 20 mg or less per 30 mL of liquid medication) can be purchased directly from a pharmacist without a prescription to temporarily treat mild or moderate pain, or as a cough suppressant.

[0] https://www.canada.ca/en/health-canada/services/substance-us...

standardUser3• 3 years ago

I wouldn't mind having access to codeine because it is a very effective painkiller compared to OTC stuff in the US. I also don't mind not having access because I find the addictive potential of opioids personally threatening.

None of that matters to heroin users or users of more powerful prescription opioids because codeine will not give them the high they want. A better model would be something along the lines of marijuana dispensaries or state-run liquor stores, where legal sales can be made but with added levels of difficulty/obscurity. That kind of rigid legalization scheme probably wouldn't kill the black market, but it would absolutely save lives. Many people who are dead today would still be alive if they could have simply purchased a safe version of the drug they were going to do either way.

aodonnell2536• 3 years ago

It’s my understanding that a similar compound known as dihydrocodeine (DHC) is sold OTC in some European countries, and is abused in a similar manner to how dextromethorphan (DXM) is abused in the US.

glimshe2• 3 years ago

Have you heard of https://en.wikipedia.org/wiki/Metamizole ?

Widely used outside the US, but illegal to prescribe here. But you can own it here as long as you are not prescribing it. It's not as potent as an opioid, but it's a step up from the OTC stuff. I often buy it when traveling abroad (a bottle costs less than a dollar in Latin America) and my family has used it for years as millions of people abroad. There are concerns with safety, but according to plenty of foreign research, these risks are comparable to other, widely used medicine, and are based on outdated results.

This medicine is so cheap it wouldn't be profitable to do new trials in the US, thus we will likely not see this sold here anytime soon.

Anyway, this is not medical advice!

evil-olive• 3 years ago

utterly predictable outcome:

The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases.

https://en.wikipedia.org/wiki/Iron_law_of_prohibition

standardUser3• 3 years ago

A more unusual trend I've noticed is that the price of illicit drugs has generally decreased over the past few decades. If you adjust for inflation, most drugs are now cheaper despite countless fortunes (of our money) wasted on trying to stop their production and sale.

pixl97• 3 years ago

Drugs have almost always been cheap in production costs. It was the risk that drove up retail costs. Heh, and better enforcement actually pulls more manufactures into the market, because while the risk increases, the potential profits tend to increase even more.

jstarfish• 3 years ago

A more unusual trend I've noticed is that the price of illicit drugs has generally decreased over the past few decades. If you adjust for inflation, most drugs are now cheaper despite countless fortunes (of our money) wasted on trying to stop their production and sale.

I assume this is because everything is being diluted with cheap fentanyl.

guardiangod• 3 years ago

Yes, that's why the drug utopia known as Canada has eliminated fentanyl death.

gwbas1c10• 3 years ago

It just makes me wonder what is the correct way to legislate opioids?

Obviously, we need some legislation, otherwise we'll revert to the world of patent medicines. (Basically, cure-all patent medicines had opioids in them, and people didn't realize what they were taking.)

Also, obviously, we shouldn't criminalize addiction to opioids.

Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?

akira25012• 3 years ago

It just makes me wonder what is the correct way to legislate opioids?

Is legislation the primary problem with these addicts? Or are there other social factors involved? If so, then perhaps the legislation itself is the least important part of the puzzle.

Also, obviously, we shouldn't criminalize addiction to opioids.

We don't.. it's just possession and sales that are criminalized.

can legally maintain an addiction

What social interest is there in promoting that?

a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?

There's a real fantasy on Hacker News about what the debonair lifestyles of heroin addicts actually are and zero apparent understanding of the long term consequences of the same.

stingrae3• 3 years ago

I don't think it is possible to allow people to legally continue the addiction because of growing tolerances to the drugs that require people to find stronger and stronger drugs or dosages.

Watching first hand how opioids impact people in SF. I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.

chimeracoder12• 3 years ago

Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?

You are describing maintenance programs. While methadone has been the maintenance drug of choice for programs in the US due to legal barriers, it turns out that heroin maintenance programs are even more effective than maintenance programs based on substitution.

With a maintenance program, members come to the site to receive a legally-obtained, pharmaceutical-quality[0] supply of the drug. Depending on the program, they may either use it on-site (e.g. supervised injection) or bring it home. Crucially, the drug is provided free of charge, so members don't have to worry about how to come up with the money to pay for it.

It turns out that these programs reduce crime rates among the members, because most crime that they are committing was in pursuit of the money for their basic needs[1]. Without having to worry about obtaining their drug, or the safety issues associated with the illegal drug market, many are able to find stable jobs, return to stable housing, and lead otherwise normal lives.

This isn't new science - one of the first studied attempts was in the 1990s[2], and there have been many more papers published since, documenting the extraordinary benefits. The science behind it is rock-solid. The challenge, as always, is a political one.

[0] Zero adulterants, no contaminants - just like the supply of morphine or fentanyl that is used in hospitals for inpatient treatment.

[1] Yes, for someone addicted to opiates, the drug is a basic need: involuntary withdrawal is extremely dangerous even under medically supervised conditions, let alone in the conditions most people are forced to experience it.

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28595/

hackeraccount• 3 years ago

Putting addicts in jail because they're addicts is dumb but standing quietly to the side while a person spends their life addicted to opioids is cruel.

I used to be sympathetic with that Bill Holiday song "Ain't nobody's business if I do." I'm doubtful about that now but I don't think anyone will stand for a half measure when there's a full measure available - and the last full measure is throwing someone in jail to protect them but that's dumb.

zactato• 3 years ago

Is that what's happening here? Has law enforcement become more intense over the last 15 years? I feel like its become less intense but the drugs have still become more potent.

steego• 3 years ago

The phenomenon doesn’t require for enforcement to become increasingly intense.

Enforcement just needs to be consistently intense enough to create an incentive for traffickers to opt for less bulky alternatives over bulkier alternatives.

WoahNoun• 3 years ago

Law enforcement is a broad term. 15 years ago oxycodone pills were everywhere. With the crackdown on "pill mill" doctors/pharmacies and prescription monitoring, it's almost impossible to find those pills and the alternative is the fentanyl currently flooding the market.

cameldrv• 3 years ago

I don't know if enforcement has all that much to do with it. I think it's just the iron law of capitalism + addictive substances. More powerful, more addictive, cheaper products win in the market. Everything is like this. Packaged food has better engineered flavor so you eat more. Legal weed is labelled with its (high) THC content. Even the ABV on beer has been going up a lot in the past couple of decades.

analyte1232• 3 years ago

If the deadly compounds are not approved for medical usage anywhere in the world, they should simply be treated as chemical weapons. Even if you want to quibble about the intent of the dealers, something this lethal could be easily weaponized to kill hundreds with nothing more than a battery powered fan.

flenserboy• 3 years ago

It feels much more like an act of war than a ratcheting up by drug purveyors.

local_crmdgeon• 3 years ago

It's retribution for the humiliation and destruction of the Opium Wars.

dendrite9• 3 years ago

Some time ago I heard a journalist comment about the synthetic opioid issue being something akin to the Opium wars but without many of is realizing what is going on. Every so often I see news that makes me think he may have been onto something, I wish I could remember who/where it was.

https://en.wikipedia.org/wiki/Opium_Wars

buildbot• 3 years ago

Russians literally did this during the Moscow Theater Crisis - they aerosolized Carfentanyl and Remifentanil into the vent system!

https://en.wikipedia.org/wiki/Moscow_theater_hostage_crisis

chimeracoder12• 3 years ago

If the deadly compounds are not approved for medical usage anywhere in the world, they should simply be treated as chemical weapons. Even if you want to quibble about the intent of the dealers, something this lethal could be easily weaponized to kill hundreds with nothing more than a battery powered fan.

You're proposing escalating the drug war to literally unprecedented levels (treating drug users[0] as actual agents of war), in response to a completely nonsense fear (the idea that a "battery-powered fan" would be a viable route of administration).

The idea that fentanyl is toxic to the touch or aerosolized is pure police propaganda, contradicted resoundingly not only by all medical experts, but also by common sense (fentanyl is routinely handled in much larger quantities by nurses every day). The same applies to these other drugs - they're dangerous if ingested, but you're not going to be accidentally ingesting them, unless you're ingesting drugs obtained from pharmaceutical sources.

[0] No matter how you try to frame this as something that would only be leveraged against "traffickers", drug users will inevitably be the primary targets of any such law.

analyte1232• 3 years ago

Aerosolized fentanyl is literally produced for administration as a painkiller [1]. And there is also the Russian theater incident.

Nurses handle prediluted solutions (at the level of 50mcg/ml). That is still very strong but not the same as unknown quantities of unknown potency being secretly shipped around and mixed up by untrained dealers.

Currently, all the time, people mix up drugs with synthetics that they know can kill and sell it to unsuspecting people, who then die by the dozens. Some states already treat this as poisoning and manslaughter. Is this really that different from the scenario I’m describing?

[1] https://medlineplus.gov/druginfo/meds/a612015.html

koromak2• 3 years ago

Only slightly related anecdote, happened just last week:

My 90 year old family member is having their bathroom renovated. 5 shoebox-sized packages arrive at like 4am, labeled "Shower Door". My relative gets up very early, so they see the package come in. They look at the boxes, think a) Thats not a shower door, and b) I'm not installing shower doors, so my relative opens them.

Inside are nondescript bundles of powder. My relative has no clue what it is. They call the contractor, the contractor comes over, takes one look, and calls the cops. It turns out to be 10+ pounds of fentanyl.

So clearly someone working with the contractor has a scheme going, where they target elderly, unsavvy people in order to ship hundreds of thousands of dollars of fentanyl in the middle of the night. The subcontractor presumably slips in before the homeowner notices, most people aren't awake at 5am checking building material deliveries.

The carrier was just some general shipping company. Not a big name, but not shady either. They had no idea what was being carried.

We don't think its the main contractor, because he easily could have gotten away with it. He could have said "Oh this is grout mix" and my relative would have been perfectly happy. I guess its a possibility though.

Supposedly the cops are looking into it, so I guess we'll see what happens.

windsurfer• 3 years ago

10 pounds of fentanyl is enough to lethally overdose about 2 million people.

chimeracoder12• 3 years ago

10 pounds of fentanyl is enough to lethally overdose about 2 million people.

I'm not sure what the point of this comment is. Fentanyl is only dangerous if ingested; incidental contact is harmless.

That shipment was, in all likelihood, intended for eventual distribution to opiate users, who have a higher tolerance than the general population. Making a comparison of how that would affect a person who has no tolerance is misleading fearmongering, when there was no indication that any person in this story was going to accidentally ingest the substance.

petsormeat• 3 years ago

My parents had a similar experience in their idyllic exurb, where affluent retirees can afford lengthy home renovation projects. A neighbor's multi-car garage had noticeable traffic to and fro, on a country road in a small town where everybody seems to know each other's vehicles. It turns out the contractor was dealing heroin from the garage. I think the scheme worked for as long as it did because, like your case, nobody suspected anything like that in such a location.

jfengel2• 3 years ago

I'm puzzled by the early-morning delivery.

If it's being sent through ordinary delivery means, such as a post office, do they ordinarily deliver at 4 AM?

If it's being sent through some drug-dealer courier system, is it necessary to go through the charade of dropping it off at a customer's house?

flerchin3• 3 years ago

I don't understand the mentality of people who partake in these things. Everyone has seen the zombies in the streets. Who looks at the human misery that is the direct consequence of opioid abuse and decides "It won't happen to me, I'll take two fentanyls please Mr Drug Dealer"?

glimshe2• 3 years ago

In a nutshell, addiction. If people could just easily walk away from it through moral reasoning, the problem wouldn't be happening at the scale it is. And the first contact with the drug is triggered by other things, like pain, peer pressure etc.

alecco• 3 years ago

IMHO working on this at an NGO, these are mostly people who hate themselves and have extreme depression. They will take anything, even poison. They usually are not looking for a high but complete detachment.

The solution is intervention but this is out of fashion thanks for campaigns against it. From Foucault to One Flew Over the Cuckoo's Nest. Their magic solution for the broken system was to destroy the system. Now he have all these "zombies" who are just slowly killing themselves, in front of us, and they are causing a lot crime and problems. The problem is snowballing and will end up in unspeakable solutions. It's sad.

650REDHAIR2• 3 years ago

Most people aren’t buying fentanyl. They’re buying something else that is laced or cut with fentanyl. Typically the end user is unaware.

flerchin3• 3 years ago

That just slightly changes the question to the drug dealer. People, seeing zombies in the streets, are still making purchases.

BobaFloutist• 3 years ago

Ignoring the recreational pipeline, opioid addiction usually comes from chronic pain.

You're a manual laborer. Your body gets slowly worn down by the job, and over time you get more and more dramatic joint and muscle pains but you don't have enough money to retire. At first NSAIDs are enough, but then you start slowing down again, and finally someone offers something that works better - but you still can't stop working, so you injure your body more and more while numbing the pain.

You're a sex worker. Violent sex (at times indistinguishable from sexual violence) has become a de facto cultural norm. Your clients are increasingly brutal, not even necessarily in seriously injuring you, just in their indifference to your comfort. In order to keep up with their appetites, and to keep a roof over your head, you resort to some chemical escapism - it feels good, and it makes it feel less bad when you're working. It also relaxes your body, so that the unbelievably incompetent sex can actually happen.

You're in a car accident, or get injured playing school sports, or are born in a body that just hurts all the time, for any or no reason. You're on a controlled, calculated, sustainable regimen of prescription opioids. Then you lose your health insurance, or your provider retires, or pharmacies stop being willing to fill your prescriptions because their role in the opioid crisis has shown them they have liability and they refuse to actually make judgment calls. You are in constant, excruciating pain, you're suffering from sudden, involuntary, unpredictable withdrawal, and there's no legal recourse.

Pain is the most fundamentally unpleasant experience there is. You might think you have a high pain tolerance, and you might even be right, but...have you ever had a headache that lasted a whole day, or just been sore from something for a solid 8 hours? If you have, you know how quickly you get worn thin, irritable, incapable of rationality. Imagine if you were in pain at all times.

Does this help you understand?

Synthetic opioids deadlier than fentanyl are showing up in overdose cases

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