The fentanyl epidemic - what to do?

[SpankyMcFarland]

I'm surprised nobody has started a thread on this. Fentanyl is a synthetic opioid that is approximately 80 times more potent than morphine and therefore easier to smuggle into the country in small packages where it can be diluted with other substances.

https://en.m.wikipedia.org/wiki/Fentanyl

Obviously, this dilution process doesn't always go as planned with the dealers and the safety margins are small. Fentanyl overdose can lead to depression of the respiratory centre in the brain and death. An epidemic of such fatalities is now sweeping North America:

http://www.livescience.com/54595-prince-death-prescription-opioids-lethal.html

In Canada, the crisis is most acute in BC:

http://www.cbc.ca/news/canada/british-columbia/bc-police-say-fentanyl-a-game-changer-struggle-to-stop-ovderdoses-on-the-street-1.3762446

http://www.cbc.ca/news/canada/british-columbia/the-new-face-of-fentanyl-addiction-kati-s-story-1.3766697

I have no definite answers or particular expertise on what should be done. It seems to me we have to target the supply (particularly China via the Internet to dealers or even users here) as diligently as we can and come up with a co-ordinated national strategy as soon as possible. The antidote to fentanyl needs to be made as widely available as possible. We need to be able to map every incident of overdose or death across the country in real time, something we are a long way from achieving at the moment. As to harm reduction and legalization or decriminalization of less dangerous opioids, the debate goes on. BC certainly needs more beds to treat these people as the Premier admitted recently.

The medical profession in Canada has played a regrettable role in using opioids indiscriminately and inappropriately to treat non-cancer pain. We are belatedly recognizing that many people have become addicted to opioids through this route.

One thing looks certain - this disaster is moving across the country and will hit all provinces eventually.

Edited September 18, 2016 by SpankyMcFarland

[TimG]

Fentanyl gives drugs addicts a bigger high for a lower cost. The only way to deal with overdose deaths is to deal with addiction. Harm reduction in this case may only exacerbate the problem. A message of 'this crap will kill you' coupled with Darwinian selection could be a more effective means to get people into treatment.

Edited September 18, 2016 by TimG

[dialamah]

Fentanyl gives drugs addicts a bigger high for a lower cost. The only way to deal with overdose deaths is to deal with addiction. Harm reduction in this case may only exacerbate the problem. A message of 'this crap will kill you' coupled with Darwinian selection could be a more effective means to get people into treatment.

In BC this year from January to July, there were 433 drug overdoses, up from 249 in 2015 so I'm pretty sure addicts already have the message "This crap will kill you". "Darwinian selection' would not be your go-to solution if a family member of yours were an addict, but perhaps this comment wasn't intended to be taken seriously.

The only way to deal with overdose deaths is to deal with addiction.

I agree that dealing with addiction should be a priority, and that an effective means to get people into treatment would be to have affordable treatment places available. Short of getting on Intervention Canada, an average family isn't going to be able to afford 10's of thousands of dollars for treatment. Figuring out why people get addicted in the first place would probably be a step in the right direction.

[Scott Mayers]

Fentanyl gives drugs addicts a bigger high for a lower cost. The only way to deal with overdose deaths is to deal with addiction. Harm reduction in this case may only exacerbate the problem. A message of 'this crap will kill you' coupled with Darwinian selection could be a more effective means to get people into treatment.

I agree too to some degree. I think that the cheaper for more idea is actually better. It's the unpredictability of it that makes it troublesome. As to 'addiction', I think life itself IS an addiction and while it is good to try to postpone experiencing such things for as long as life without these are good, I don't even think addiction itself is necessarily a bad thing, including the potential of death that may arise. What matters though is to HOW people use them where it directly imposes potential harm on others. I'd like to see legality be done WITHOUT the haters using it to exploit the nature of it as they do with tobacco and alcohol. Controlled environments and good supports can help if legal.

I think the major concern is more to those who prefer to keep the poorer people sufficiently desperate enough and ONLY enhanced in ways that make them more productive at minimal cost. Who'd be the maids and butlers at $2/hr if they could escape to a relatively better life as an addict that makes them feel like Gods?

[TimG]

As to 'addiction', I think life itself IS an addiction.

I think you are minimizing the particular form of insanity we call drug/alcohol addition that leads it sufferers to destroy everything in their life just so they can get high. It is nasty and brutal disease that can be treated but only if the addict 'hits bottom' and becomes willing to accept help. This means public health efforts must walk a fine line between keeping addicts alive until they 'hit bottom' and actually prolonging the addiction by making the addictive lifestyle too comfortable.

[Scott Mayers]

I think you are minimizing the particular form of insanity we call drug/alcohol addition that leads it sufferers to destroy everything in their life just so they can get high. It is nasty and brutal disease that can be treated but only if the addict 'hits bottom' and becomes willing to accept help. This means public health efforts must walk a fine line between keeping addicts alive until they 'hit bottom' and actually prolonging the addiction by making the addictive lifestyle too comfortable.

I've seen lots of addicts in my life and thankfully my own is only tobacco and coffee. But they are extreme.

But the ones I've seen most troubled with addiction factors and to which I MOSTLY still find personal frustrations with often have to deal with accessibility to other options better than drugs. The insanity does occur but CAN be curbed by first teaching about drugs not as a mere socially vial things as they do in most educational forms but to HOW one can use them in ways with better responsibility. For some, the abuses that cause harm to others, are often of non-drug related mindsets of people prior to using drugs which when used improperly do lead to abuses.

I won't go further into this now as I'm having an ongoing related debate on sugar elsewhere. It seems that now some are trying to find some means to get government to intervene to impose taxation on those taking sugar. It's a con like the "Super Size Me" concerns that cleverly make our OPTIONS in supply a 'fault' for giving us actual advantages. I like, for instance when companies 'super size' products. But you can opt to NOT super size or dump out what you don't want. But why the hell DEMAND these companies to make them purposely more expensive? It's a con just like with the way governments use legalized products like tobacco or alcohol and their controversially associated problems as justifications to extort those who like things that are in both high demand and high supply (which normally should make prices go down, not up).

[SpankyMcFarland]

I think you are minimizing the particular form of insanity we call drug/alcohol addition that leads it sufferers to destroy everything in their life just so they can get high. It is nasty and brutal disease that can be treated but only if the addict 'hits bottom' and becomes willing to accept help. This means public health efforts must walk a fine line between keeping addicts alive until they 'hit bottom' and actually prolonging the addiction by making the addictive lifestyle too comfortable.

There's a fair bit of debate about that now. Some people talk of 'raising the bottom'.

http://drugabuse.com/library/hitting-rock-bottom-myth/

In the first place, it isn't just the individual who is at risk from his addiction. Through crime and disease, he endangers many others. Society has a vested interest in intervening as early as possible.

Another aspect is that with fentanyl the chance of accidental death is considerably enhanced. Occasional users end up dead.

A passive, Darwinian 19'th century approach would take many years to show any effect. Anyway, I hope we can do better than that.

Edited September 18, 2016 by SpankyMcFarland

[TimG]

There's a fair bit of debate about that now. Some people talk of 'raising the bottom'.

Your link makes the same point that I do: that sometimes letting the addict experience negative consequences is better for the addict but this must be done while giving the addict the choice to get immediate treatment.

In the first place, it isn't just the individual who is at risk from his addiction. Through crime and disease, he endangers many others. Society has a vested interest in intervening as early as possible.

Reducing disease transmission is the reason why I have come around to support safe injection sites and needle exchange programs. But this is a non-issue if the negative consequence is death.

Another aspect is that with fentanyl the chance of accidental death is considerably enhanced. Occasional users end up dead.

Public education on the risks is the best way to help with that but there is nothing that can be done if people still choose to take risks. These kinds of people are like the skiers that insist on going outside of the designated ski area. At some point people need to be held responsible for their own choices. That said, I believe that anyone who sticks needles in the arm to get high is a drug addict in need of treatment so your point is moot.

[SpankyMcFarland]

Your link makes the same point that I do: that sometimes letting the addict experience negative consequences is better for the addict but this must be done while giving the addict the choice to get immediate treatment. Reducing disease transmission is the reason why I have come around to support safe injection sites and needle exchange programs. But this is a non-issue if the negative consequence is death. Public education on the risks is the best way to help with thatThat said, I believe that anyone who sticks needles in the arm to get high is a drug addict in need of treatment so your point is moot.

Does it? The idea of a bottom is subjective. Some negative consequences does not sound like a traditional 12 Step bottom to me.

My point is quantitative - fentanyl is like driving without brakes. It greatly amplifies the hazard of taking drugs.

Edited September 18, 2016 by SpankyMcFarland

[TimG]

Does it? The idea of a bottom is subjective. Some negative consequences does not sound like a traditional 12 Step bottom to me.

When did I say the bottom was not subjective? All I said was there is a dynamic at play where harm reduction policies can prolong the harm and that it is difficult to know where to draw the line.

[SpankyMcFarland]

No easy solutions, that's for sure.

Here's some stuff on the Purdue/physician connection:

http://canadians.org/blog/who-behind-canadas-opioid-epidemic

And a (sort of) famous doctor (sort of) apologizes for his role:

http://www.theglobeandmail.com/opinion/i-was-part-of-big-pharmas-big-influence/article535295/

Some new guidelines for Canadian doctors:

http://nationalpaincentre.mcmaster.ca/opioid/cgop_b01_deciding_to_initiate_opioid_therapy.html

And a piece by David Juurlink:

https://www.thestar.com/opinion/commentary/2016/05/09/let-the-sun-shine-on-doctors-ties-to-pharma.html

Edited September 18, 2016 by SpankyMcFarland

[eyeball]

When did I say the bottom was not subjective? All I said was there is a dynamic at play where harm reduction policies can prolong the harm and that it is difficult to know where to draw the line.

Do you have a peer reviewed study that demonstrates the dynamic and how it plays out?

[TimG]

Do you have a peer reviewed study that demonstrates the dynamic and how it plays out?

And who would do such studies unless they had a vested interest in the outcome? The fact is there are no scientifically validated treatments for addictions. The treatments that do exist only work for some people and it is impossible to predict which treatments work for which people. That said, experience matters And people with experience helping addicts will tell you the same thing.

Here is a link that talks about how helping actually causes harm:

https://www.recoveryplace.com/blog/the-dangers-of-enabling-a-loved-one-addicted-to-drugs-or-alcohol/

Edited September 18, 2016 by TimG

[SpankyMcFarland]

Another class of drugs now causing havoc are the psychedelics. N-Bomb is becoming widely available, is highly potent and can be ordered online:

https://en.m.wikipedia.org/wiki/25I-NBOMe

http://www.cbc.ca/news/canada/newfoundland-labrador/n-bomb-fake-lsd-being-sold-in-n-l-prompts-rcmp-warning-1.3212467

https://www.inverse.com/article/8865-why-college-kids-are-overdosing-on-the-hallucinogen-25i-nbome-n-bombs

Some of these drugs have had their structures altered creating legal problems for prosecution.

One of the most alarming things about this drug is that it attracts young users in their teens.

Edited September 18, 2016 by SpankyMcFarland

[BC_chick]

"Darwinian selection' would not be your go-to solution if a family member of yours were an addict, but perhaps this comment wasn't intended to be taken seriously.

Well said.

[SpankyMcFarland]

Here's a physician who became addicted to fentanyl:

http://www.cbc.ca/news/canada/toronto/programs/metromorning/physician-barrie-addiction-fentanyl-recovery-1.3765601

Opioid addiction has always been an occupational hazard for physicians, esp. those with easy access like anesthesiologists.

[SpankyMcFarland]

Well said.

It's hard to imagine a more awful circumstance than having a child addicted to opioids or meth. The disruption, uncertainty, anger and guilt must be close to unbearable.

[TimG]

I'm pretty sure addicts already have the message "This crap will kill you".

And most don't internalize the message. It is said addicts are committing 'suicide on the installment plan' and many addicts caught up in their addiction may actually like the idea of dying.

What we need is enough extra space in publicly funded detox and treatment facilities that an addict can get a bed within a few days of expressing a willingness to clean up. The same day would be better. But even if the government did that many addicts would not be able to get through the detox and will be back on the street. There comes a point for some addicts where death by their drug of choice is simply a question of time. The hard truth is society and immediate family members may be much better off if it happened quickly instead of slowly.

[bush_cheney2004]

.... There comes a point for some addicts where death by their drug of choice is simply a question of time. The hard truth is society and immediate family members may be much better off if it happened quickly instead of slowly.

Agreed....let addicts have their charter right to kill themselves sooner rather than later.

[eyeball]

But even if the government did that many addicts would not be able to get through the detox and will be back on the street. There comes a point for some addicts where death by their drug of choice is simply a question of time.

Hence the need for harm reduction.

The hard truth is society and immediate family members may be much better off if it happened quickly instead of slowly.

The even harder truth is that attitudes like that would make society an even more judgmental uglier place leading to more people doing more drugs to escape it.

[BC_chick]

It's hard to imagine a more awful circumstance than having a child addicted to opioids or meth. The disruption, uncertainty, anger and guilt must be close to unbearable.

It is everything you think and worse. Unfortunately I'm not unfamiliar with addiction (not me but in my family) and every day I dread the idea of my daughter growing in an age of fentalyn. Young, beautiful talented teenager are dying from having tried this drug and becoming an addict.

When I was growing up my parents instilled the difference between hard drugs and soft drugs and I think it made a huge impact in my life. This is one of those 'never try' drugs but so many other drugs are tainted with it, I think the only way to avoid it is to avoid everything including pot.

I would like to see the BC government allocate a huge portion of our 2 billion surplus to come up with treatment facilities.

Given the deadly epidemic I would also like to see dealers face life in prison if convicted.

Edited September 19, 2016 by BC_chick

[Bryan]

One of my son's friends died of a fentanyl overdose. The stuff is insidious.

One of the biggest problems in terms of the stuff killing people is that most of the drugs on the street right now are either laced with fentanyl, or are just fentanyl instead of whatever they are being sold as. That's where it gets really scary.

[TimG]

I would like to see the BC government allocate a huge portion of our 2 billion surplus to come up with treatment facilities.

We need:

1) detox facilities that can provide help immediately (1 week or so)

2) in-patient treatment centers (30-60 days);

3) group recovery homes (3-12 months);

One of the issues is kids in suburbs have to go to the DTES to access detox.

I don't see this as helping the process.

[TimG]

One of the biggest problems in terms of the stuff killing people is that most of the drugs on the street right now are either laced with fentanyl, or are just fentanyl instead of whatever they are being sold as. That's where it gets really scary.

What's really scary is some addicts like the stuff laced with fentanyl because it provides a better high. The demand side of the equation could make it very difficult to get the stuff off the street. Edited September 19, 2016 by TimG

[eyeball]

I'm pretty sure the evolution of more dangerously potent drugs is the result of decades of trying to prohibit far far safer drugs like pot. That of course is the fault of conservatism.

We have to do something about getting conservatism off the street.