Chris Werb Posted October 28, 2018 Posted October 28, 2018 I watched Melania Trump speaking passionately about the "opioid crisis" in the States the other day. I knew there was a problem over there (we obviously have our own Class A drug problems) but I was unaware just how rapidly and seriously the problem had developed since the advent of Fentanyl. What actions can realistically be taken to reverse this alarming trend?
Rick Posted October 28, 2018 Posted October 28, 2018 I watched Melania Trump speaking passionately about the "opioid crisis" in the States the other day. I knew there was a problem over there (we obviously have our own Class A drug problems) but I was unaware just how rapidly and seriously the problem had developed since the advent of Fentanyl. What actions can realistically be taken to reverse this alarming trend?This is a personal responsibility decision. Make an obvious better choice and one will not have a drug problem.
Paul G. Posted October 28, 2018 Posted October 28, 2018 I watched Melania Trump speaking passionately about the "opioid crisis" in the States the other day. I knew there was a problem over there (we obviously have our own Class A drug problems) but I was unaware just how rapidly and seriously the problem had developed since the advent of Fentanyl. What actions can realistically be taken to reverse this alarming trend?This is a personal responsibility decision. Make an obvious better choice and one will not have a drug problem.🙄
Paul G. Posted October 28, 2018 Posted October 28, 2018 Chris its complicated. Many of these cases start with legitimate use of opioid pain meds. Contributing factors are doctors over reliance on simple solutions to patient pain avoidance. Another is the influence of big Pharma companies on the medical industry. A third is the weakness of the behavioral health field in regards health insurance coverage. The Fentanyl hazard is just the symptom of a greater problem.
Paul G. Posted October 28, 2018 Posted October 28, 2018 Here is a synopsis of the problem by the NIH. In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.3,4 Opioid overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.1 That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive) What do we know about the opioid crisis? Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.Between 8 and 12 percent develop an opioid use disorder.An estimated 4 to 6 percent who misuse prescription opioids transition to heroin. About 80 percent of people who use heroin first misused prescription opioids.Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.Opioid overdoses in large cities increase by 54 percent in 16 states.
Detonable Posted October 28, 2018 Posted October 28, 2018 Is heroin that available? Or perhaps the opioids were prescribed dishonestly to people who mainly wanted to get high? I think in West Virginia theres some of that.
Daan Posted October 28, 2018 Posted October 28, 2018 When the impact of the oxycodon epidemic became visible, the medical field curtailed its prescriptions and the addicts searched for alternative opioids such as heroine and (Chinese) fentanyl.
Ssnake Posted October 28, 2018 Posted October 28, 2018 (edited) Heroin is laughably easy to manufacture, so yes, you can offer it at really low prices. Fentanyl is a "fantastic additive" to heroin in that minute additions of Fentanyl enhance the effect so much that you can stretch the drug much, much more before selling it, which leverages the profit margin proportionally.The problem is of course that Fentanyl is orders of magnitude stronger than Heroin (I think the lethal dose is about a thousandth (ten thousandth?)), so that minute errors in the dosage will kill the users. Also, I heard that Fentanyl seems to creep into the production of official drugs as well ((well, counterfeit products sold through official channels) which may have killed Prince), at which point you can no longer shrug it off as bad choices made by individuals. Edited October 28, 2018 by Ssnake
Ivanhoe Posted October 28, 2018 Posted October 28, 2018 Chris its complicated. Many of these cases start with legitimate use of opioid pain meds. Contributing factors are doctors over reliance on simple solutions to patient pain avoidance. Another is the influence of big Pharma companies on the medical industry. A third is the weakness of the behavioral health field in regards health insurance coverage. What I hear from friends and acquaintances that go to the regional VA for dealing with chronic issues (mostly back/neck issues), the VA docs there have a two-step treatment process; 1) prescribe a giant bottle of ibuprofen.2) when patient keeps returning, prescribe Vicodin. It definitely gives the impression that the VA will go to any length to avoid surgery for as long as possible.
Dawes Posted October 28, 2018 Posted October 28, 2018 In the US, many of us never think of the UK (and Europe in general) as having any sort of drug problem. It doesn't make the news over here to any real degree.
shep854 Posted October 28, 2018 Posted October 28, 2018 Also, making pain levels a vital sign like pulse and blood pressure encouraged the overemphasis of pain relief with prescription drugs.
CT96 Posted October 28, 2018 Posted October 28, 2018 Pain is not a true vital sign, as it is inherently subjective. It is important to track, but unlike BP, pulse, respiratory rate, or SpO2, there is no reference or anchor. I had a patient who was in extreme pain... right up until we started the IV. The needle was an order of magnitude more painful than the pain she was complaining of. Now, maybe the medic botched the IV, but I'd seen him make enough with no fuss on that shift alone... maybe it was something else. I don't know. And therein lies the problem with treating pain as a vital sign. Chronic pain is a real problem, and in truth there are no one-size-fits-all answers. Any treatment option comes with pluses and minuses. What matters most is involving the whole of the patient, care team, family, friends, etc. Chronic pain patients are often very, very draining to those same people.
Murph Posted October 28, 2018 Posted October 28, 2018 It is bad stuff. I, personally, have worked several deaths by accidental overdosing on Fentanyl by dopers who think they could use it like their regular opiate.
Chris Werb Posted October 28, 2018 Author Posted October 28, 2018 It is bad stuff. I, personally, have worked several deaths by accidental overdosing on Fentanyl by dopers who think they could use it like their regular opiate. Where is it coming from? The non prescribed stuff that is.
JWB Posted October 28, 2018 Posted October 28, 2018 China....and North Korea. Fentanyl isn't even close to the strongest. https://en.wikipedia.org/wiki/Equianalgesic
Murph Posted October 28, 2018 Posted October 28, 2018 China and Mexico for the stuff we get here. It is bad stuff. I, personally, have worked several deaths by accidental overdosing on Fentanyl by dopers who think they could use it like their regular opiate. Where is it coming from? The non prescribed stuff that is.
Panzermann Posted October 28, 2018 Posted October 28, 2018 It is bad stuff. I, personally, have worked several deaths by accidental overdosing on Fentanyl by dopers who think they could use it like their regular opiate. Where is it coming from? The non prescribed stuff that is. You can also make it Breaking Bad style in the US. Then drugs fall off trucks or get stolen. People with a prescription selling it on.
carrierlost Posted October 28, 2018 Posted October 28, 2018 Fentanyl and more recently the thousand times more potent carfentanyl has been a problem in Estonia for like 15 years and has pushed out the heroin from the market. Originally arrived here from Russia, nowadays probably China. Apparently carfentanyl is very hard to discover at the border as the amounts needed to cover the market are miniscule - a deadly dose is comparable to a sugar grain. About 100 addicts die in a year from (car)fentanyl OD. Most (75-80%) OD vicitims are male russian speakers.
Chris Werb Posted October 28, 2018 Author Posted October 28, 2018 China....and North Korea. Fentanyl isn't even close to the strongest. https://en.wikipedia.org/wiki/Equianalgesic That list is astonishing. The precision needed in creating a "safe" but effective dose of Carfentanil must be pretty extreme.
John_Ford Posted October 29, 2018 Posted October 29, 2018 China....and North Korea. Fentanyl isn't even close to the strongest. https://en.wikipedia.org/wiki/Equianalgesic That list is astonishing. The precision needed in creating a "safe" but effective dose of Carfentanil must be pretty extreme. Thumbnail sketch as I understand it. Fentanyl was the drug the Chinese were producing. DEA and US State started to crank in the screws when China was identified as the production source. Fentanyl is/was not illegal to produce in China. They were cranking it out by the ton. One of the avenues it came in through was... Canada. Shipping containers. State And DEA were finally able to get the Chinese Gov't to make Fentenyl illegal to produce. So we get Carfentanil, much more lethal and one step ahead of the Chinese Gov't who.. Who, of Course, just make Fentanyl illegal. So now the whole circus starts all over. The production companies just change the chemical make up and it drops off the Schedule of Controlled Substances. Rinse, Lather, Repeat.
Mistral Posted October 29, 2018 Posted October 29, 2018 China exporting opiates. Am I the only one who noticed the irony?
Colin Posted October 30, 2018 Posted October 30, 2018 It's payback for 1842 and 1860.I suspect very much so, revenge is a dish best served very cold.
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now