Fentanyl giving Meth a run for it's money. China largest global supplier.

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steross

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#2
We know that fentanyl is exceptionally dangerous. The question is: How do we fight its distribution?

A critical step is finding supply routes, with the ultimate goal of stopping the illegal movement of fentanyl into the U.S. from overseas.



Hahahaha. Um, no. We have been finding cocaine supply routes for many decades at a cost of billions and it has done nada to stop the cocaine supply. Somehow, despite failing at cocaine, we think we can stop a more potent and far easier to ship powder by finding supply routes? Ya, right.

The supply will forever be available. The only possible answer is to work on the demand side.
 

RxCowboy

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#3
The only possible answer is to work on the demand side.
QFT. We have to treat chemical dependency like the disease it is.

There are a couple of problems with fentanyl on the streets. The first is that drugs in that class really have no ceiling on respiratory depression, and that is how it kills people. So, people develop tolerance to the high, but not to the respiratory depression. The second is that "fentanyl" isn't all fentanyl. Minor modifications in the chemical structure can alter the potency by orders of magnitude. Sufentanil and carfentanil are both much more potent than base fentanyl and therefore much more deadly.
 

llcoolw

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#4
QFT. We have to treat chemical dependency like the disease it is.

There are a couple of problems with fentanyl on the streets. The first is that drugs in that class really have no ceiling on respiratory depression, and that is how it kills people. So, people develop tolerance to the high, but not to the respiratory depression. The second is that "fentanyl" isn't all fentanyl. Minor modifications in the chemical structure can alter the potency by orders of magnitude. Sufentanil and carfentanil are both much more potent than base fentanyl and therefore much more deadly.
When I had my last bout of spinal chord burn, I had to go to the ER. Pain management couldn't help this one. They gave me two large syringes of fentanyl and one of morphine. Absolutely zip. Nada. Didn't cut the pain by 1%. They said "that's it, that's all we got". And they sent me home. For 9 days the only position I wasn't suicidal was laying over a small ottoman like a squirrel resting on a branch. Finally my pain doc came over to the house with a personalized cocktail of who knows what. Got me up on my feet and to the hospital for immediate surgery. Saved my freaking life. Point is, it's amazing how ineffective these potent drugs are in the face extraordinary pain.
 

NotOnTV

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#5
When I had my last bout of spinal chord burn, I had to go to the ER. Pain management couldn't help this one. They gave me two large syringes of fentanyl and one of morphine. Absolutely zip. Nada. Didn't cut the pain by 1%. They said "that's it, that's all we got". And they sent me home. For 9 days the only position I wasn't suicidal was laying over a small ottoman like a squirrel resting on a branch. Finally my pain doc came over to the house with a personalized cocktail of who knows what. Got me up on my feet and to the hospital for immediate surgery. Saved my freaking life. Point is, it's amazing how ineffective these potent drugs are in the face extraordinary pain.
I am very sorry you had to experience this.
 

llcoolw

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#6
I am very sorry you had to experience this.
Much appreciated. Costs of getting older I reckon. Just pointing out that I wasn't denied access or even questioned if I was faking. Very professional and helpful people. Just scary that there are pains out there that can't be helped without a scalpel. We hear stories about how one grain of the stuff can kill and I had a couple of ounces of it.
 
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#7
When I had my last bout of spinal chord burn, I had to go to the ER. Pain management couldn't help this one. They gave me two large syringes of fentanyl and one of morphine. Absolutely zip. Nada. Didn't cut the pain by 1%. They said "that's it, that's all we got". And they sent me home. For 9 days the only position I wasn't suicidal was laying over a small ottoman like a squirrel resting on a branch. Finally my pain doc came over to the house with a personalized cocktail of who knows what. Got me up on my feet and to the hospital for immediate surgery. Saved my freaking life. Point is, it's amazing how ineffective these potent drugs are in the face extraordinary pain.
I completely agree. I went to docs and they wanted to give me Opiates. I passed, I finally ended up in the ER and they gave me a shot of morphine, and ran some tests. I got a another shot when I left, they only lasted a hour. I eventually ended up in a dispensary in Colorado. I got some indica gummies and a CBD stick called 315 extreme salve. The salve has no THC and can be purchased online. Its amazing, the gummies help me too. I take one 10 mg before I sleep. No surgery for me , my MRI showed (2) bulging and (1) torn disc. After being so anti pot, I have a opened mind for it as a pain / sleep item.
 
Nov 6, 2010
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#8
QFT. We have to treat chemical dependency like the disease it is.

There are a couple of problems with fentanyl on the streets. The first is that drugs in that class really have no ceiling on respiratory depression, and that is how it kills people. So, people develop tolerance to the high, but not to the respiratory depression. The second is that "fentanyl" isn't all fentanyl. Minor modifications in the chemical structure can alter the potency by orders of magnitude. Sufentanil and carfentanil are both much more potent than base fentanyl and therefore much more deadly.
Isn't that what STEROSS was saying?
 
Feb 6, 2007
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#9
When I had my last bout of spinal chord burn, I had to go to the ER. Pain management couldn't help this one. They gave me two large syringes of fentanyl and one of morphine. Absolutely zip. Nada. Didn't cut the pain by 1%. They said "that's it, that's all we got". And they sent me home. For 9 days the only position I wasn't suicidal was laying over a small ottoman like a squirrel resting on a branch. Finally my pain doc came over to the house with a personalized cocktail of who knows what. Got me up on my feet and to the hospital for immediate surgery. Saved my freaking life. Point is, it's amazing how ineffective these potent drugs are in the face extraordinary pain.
Have endured three spinal surgeries myself. Prior to the third one, they had me on Oxycontin for about a month and I honestly could not tell any difference between it and a Tylenol 3. My experience with livestock (and my personal experiences as well) and sedatives has led me to believe that different individuals, be they bovine or human, my have different tolerances to pain medication (metabolize if differently?). I have seen standard doses of a given sedative knock a 1200 lb. steer on their ass and have almost no effect on another of very similar weight. Strong opioids given me for kidney stones often have little effect, while others say that the very mildest sedatives render them incoherent and nonfunctional.
I would be interested to hear @RxCowboy and @steross comment on individual differences in regards to tolerance or metabolism of pain medications.
 

steross

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#10
Have endured three spinal surgeries myself. Prior to the third one, they had me on Oxycontin for about a month and I honestly could not tell any difference between it and a Tylenol 3. My experience with livestock (and my personal experiences as well) and sedatives has led me to believe that different individuals, be they bovine or human, my have different tolerances to pain medication (metabolize if differently?). I have seen standard doses of a given sedative knock a 1200 lb. steer on their ass and have almost no effect on another of very similar weight. Strong opioids given me for kidney stones often have little effect, while others say that the very mildest sedatives render them incoherent and nonfunctional.
I would be interested to hear @RxCowboy and @steross comment on individual differences in regards to tolerance or metabolism of pain medications.
As humans, we usually want a quick and straightforward reason for why things are but this is one that is not probably that way. Likely primarily has to do with variation in liver metabolism, some kidney. Then variation in the genetic expression of receptors, mix in a bit of suggestibility for some, other medical conditions and probably some other stuff and you have a pretty wide variation.
 

RxCowboy

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#12
Have endured three spinal surgeries myself. Prior to the third one, they had me on Oxycontin for about a month and I honestly could not tell any difference between it and a Tylenol 3. My experience with livestock (and my personal experiences as well) and sedatives has led me to believe that different individuals, be they bovine or human, my have different tolerances to pain medication (metabolize if differently?). I have seen standard doses of a given sedative knock a 1200 lb. steer on their ass and have almost no effect on another of very similar weight. Strong opioids given me for kidney stones often have little effect, while others say that the very mildest sedatives render them incoherent and nonfunctional.
I would be interested to hear @RxCowboy and @steross comment on individual differences in regards to tolerance or metabolism of pain medications.
The biggest difference between oxycodone (OxyContin) and codeine (Tylenol #3) is oxycodone is better absorbed and causes less stomach upset. If you use equivalent doses you get equivalent analgesia, but significantly more GI problems with codeine. Also, OxyContin is sustained release. If OxyContin was the only thing they had you on, they were using it wrong.
 

llcoolw

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#13
The biggest difference between oxycodone (OxyContin) and codeine (Tylenol #3) is oxycodone is better absorbed and causes less stomach upset. If you use equivalent doses you get equivalent analgesia, but significantly more GI problems with codeine. Also, OxyContin is sustained release. If OxyContin was the only thing they had you on, they were using it wrong.
I'm encountering numerous professionals who should know better. Can't tell if it's the medias fault or all the crisis talk. People keep getting OxyContin for immediate pain issues. I.e. Broken leg or recent surgery. According to my pain specialist, it's only for chronic pain. Oxycodone is for immediate pain. I still say the former is a miracle drug. It's amazing how it can give relief for a herniated disk but a sore throat or paper cut comes through untouched.
 
Jul 20, 2018
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#14
I'm encountering numerous professionals who should know better. Can't tell if it's the medias fault or all the crisis talk. People keep getting OxyContin for immediate pain issues. I.e. Broken leg or recent surgery. According to my pain specialist, it's only for chronic pain. Oxycodone is for immediate pain. I still say the former is a miracle drug. It's amazing how it can give relief for a herniated disk but a sore throat or paper cut comes through untouched.
I recently had shoulder surgery and was prescribed percocet, hydrocodone, and oxycodone at various times through post surgery and rehab. I was very careful to take them only as prescribed. I did notice that they were mixed with acetaminophen to keep someone from taking too much. It was interesting. Everytime I went for a follow up, the nurse asked me if I needed more medicine. Fortunately, I developed no dependency to them.
 

RxCowboy

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#15
I'm encountering numerous professionals who should know better. Can't tell if it's the medias fault or all the crisis talk. People keep getting OxyContin for immediate pain issues. I.e. Broken leg or recent surgery. According to my pain specialist, it's only for chronic pain. Oxycodone is for immediate pain. I still say the former is a miracle drug. It's amazing how it can give relief for a herniated disk but a sore throat or paper cut comes through untouched.
I recently had shoulder surgery and was prescribed percocet, hydrocodone, and oxycodone at various times through post surgery and rehab. I was very careful to take them only as prescribed. I did notice that they were mixed with acetaminophen to keep someone from taking too much. It was interesting. Everytime I went for a follow up, the nurse asked me if I needed more medicine. Fortunately, I developed no dependency to them.
I worked in pain management for a couple of years early in my career at Baptist Medical Center in OKC. It was mainly inpatient stuff, but a lot of chronic pain, acute on chronic pain, acute pain... the entire spectrum. OxyContin is misused all the time, and that's one of the problems that we're having. The other problem that we're having is treating mild to moderate pain with opioids in the first place, such as osteoathritis. We were told in the early 90s "if we treat pain adequately it won't create dependence". Turns out that is untrue. It also appears that anything that acts at opioid receptors will produce dependence regardless of chemical structure.
 

llcoolw

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#16
I recently had shoulder surgery and was prescribed percocet, hydrocodone, and oxycodone at various times through post surgery and rehab. I was very careful to take them only as prescribed. I did notice that they were mixed with acetaminophen to keep someone from taking too much. It was interesting. Everytime I went for a follow up, the nurse asked me if I needed more medicine. Fortunately, I developed no dependency to them.
I don't remember too many people getting "hooked" during the 80's and 90's from hydrcodone. It was a standard script from dentists to discomfort from a sore throat. You took them as directed until the pain was gone and usually you had some left over and just saved until the next pain came up. It wasn't a big deal and it wasn't looked down on either. You shouldn't develop a dependency on them unless you were taking them for recreation. The reason the morphine and fentanyl didn't work on me wasn't because I had a high tolerance, it was because I was in exceptional pain. If I went and got those same doses today, it would probably knock me right out.
 

llcoolw

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#17
I worked in pain management for a couple of years early in my career at Baptist Medical Center in OKC. It was mainly inpatient stuff, but a lot of chronic pain, acute on chronic pain, acute pain... the entire spectrum. OxyContin is misused all the time, and that's one of the problems that we're having. The other problem that we're having is treating mild to moderate pain with opioids in the first place, such as osteoathritis. We were told in the early 90s "if we treat pain adequately it won't create dependence". Turns out that is untrue. It also appears that anything that acts at opioid receptors will produce dependence regardless of chemical structure.
Is there a relationship between Caucasians and opiate receptors? Is that why this seems like a white people only disease? Maybe asians too.
 
Nov 6, 2010
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#18
I recently had shoulder surgery and was prescribed percocet, hydrocodone, and oxycodone at various times through post surgery and rehab. I was very careful to take them only as prescribed. I did notice that they were mixed with acetaminophen to keep someone from taking too much. It was interesting. Everytime I went for a follow up, the nurse asked me if I needed more medicine. Fortunately, I developed no dependency to them.
I've noticed that people like yourself that have a fear or at least respect the possibility of addiction tend to not have the problem. I've heard your story from a lot of people who would even take less than prescribed and put up with a more pain in order to avoid that outcome and it seems to work for them. I'm sure there are other factors, but it seems being conscious of the possibility is a pretty good safeguard.
 

CTeamPoke

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#19
Is there a relationship between Caucasians and opiate receptors? Is that why this seems like a white people only disease? Maybe asians too.
No way. Heroin was a big killer in black communities in the 60s and 70s.

I think the opioid crisis we are currently facing... which is opioids in pill form... is heavily impacting white folks because of money, access to healthcare, and a propensity to work blue collar jobs in the places most harshly effected. They had a factory job, got hurt, were prescribed a pain pill, got hooked...

Humans are humans, man. I mean... I'm not a doctor or an expert, but I think neurology with this type of thing is going to peanut butter across race.
 
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#20
No way. Heroin was a big killer in black communities in the 60s and 70s.

I think the opioid crisis we are currently facing... which is opioids in pill form... is heavily impacting white folks because of money, access to healthcare, and a propensity to work blue collar jobs in the places most harshly effected. They had a factory job, got hurt, were prescribed a pain pill, got hooked...

Humans are humans, man. I mean... I'm not a doctor or an expert, but I think neurology with this type of thing is going to peanut butter across race.
This ^^^ & the fact that street prices for opioids are very high, which has in turn brought heroin back.

If you'd have told me 20 years ago that heroin would make this big of a comeback, I'd have told you you're crazy.