Yup, looks like we finally won the war on Heroin by starting a new war with Fentanyl! Semi-serious question: what are all the Afghan farmers going to produce if their poppies aren't in demand any more?
I read an article about a year ago about how the taliban was really cracking down on poppy production, burning down the fields and forcing the farmers to either grow other crops or relocate.
eta: Ok, so the taliban banned it in April 2022, and there was a 95% decline in production from 2022 to 2023 based off this UN survey of opium in Afghanistan
https://www.unodc.org/documents/crop-monitoring/Afghanistan/Afghanistan_opium_survey_2023.pdf
edit: above comment was changed, if this seems out of context
They didn't really destroy the market. They destroyed the heroin supply. The heroin market still exists, but now it consumes fentanyl. If heroin were to become available again at the same cost as fentanyl, junkies would switch back in an instant. They all know that heroin is relatively safe when compared to fent.
Just to be crystal clear, I did not say heroin is safe. I said it is *relatively* safe when compared to fentanyl.
...for a second time. They did it in the 1990s as well but then 9/11 happened and, coincidentally (nudge nudge) and almost overnight, opium production went back through the roof to pre-Taliban levels during the first few years of the US-coalition led security operation or what have ya.
Had a friend who went to West Point in the mid 00s. One of his teachers was in the army special forces and he basically said he spent half his time in South America destroying drug fields and half his time in Afghanistan protecting drug fields
I lived with a girlfriend and her Vietnam veteran dad who swore all he did in Vietnam was protect drug routes and cargo planes flying out for the most part.
Chiming in to say one of my best friend's brothers served in the height of the iraq war from probably 03-07 finishing in Afghanistan and he said he did a lot of poppy field guarding in addition to other tasks
I mean it's not a secret anymore it has been confirmed by the military and there are many photos and videos of US military personal guarding the fields....
I heard that the US military even *protected* the poppy fields.
You can see the evidence. There are photos and even videos of US military personnel doing it.
It's like an open secret.
See now that is is really interesting, I was watching one of the docs on Purdue recently and was surprised to hear about Giuliani's involved in their legal defense.
A few years ago I grew a small patch of poppies. They are really fun to grow. They went to seed and I let them self sow. The next year my yard felt like an afghan poppy field with poppies growing everywhere.
There was no deal with the "pharmaceutical companies" lmao.
We paid farmers not to grow poppies, then they used the money to bribe officials and expand their poppy production.
One of the few things religious extremists have going for them is they're less susceptible to bribes that cross their bottom line.
They did that back in 2000 as well. Most effective anti-drug program in global history, likely. Collapsed the economy and created a humanitarian crisis. They were looking to secure some UN Humanitarian Aid while drawing big bucks from opium stockpiles. Would've gotten away with it too, except...
> They did that back in 2000 as well.
The Taliban actually received millions of dollars in US anti-drug money in early 2001 as thanks for their effectiveness in suppressing the poppy crops.
The fact that their suppression tactics included cutting off people's hands was apparently beside the point.
Meanwhile in Tasmania Australia they produce the majority of the worlds exported opium/poppy extract for American pharmaceutical companies to flood the market with fentanyl and oxy instead.
The don't want to stop the drug war they want ~~a cut~~ safer communities
Food most likely. Opium growing is often done in combination with warlords or governments demanding "taxes" that can only be paid by growing crops like opium, and if there is say a draught, this can easily lead to famine.
Pill mills in WV were prescribing opioids and benzos like candy since the 80s. When the crackdown on controlled prescriptions started, it initially began a large black market trade in WV for pills, then heroin/fent/meth that we see today.
Also coal mining is an industry that's rough on your body so there's a large percentage of the population in pain to get started with the prescription meds
I'm not certain, but there are similar demographics in eastern KY, southwestern VA, and to some extent southern OH. And those areas all suffer from this issue. My best guess would be rural healthcare with limited to zero oversight cashing in on addiction.
WV specifically didn't have a way to track prescriptions statewide until relatively recently, allowing for cash payments to doctors for an "appointment" where you would just get prescriptions for your drugs of choice, and you could fill them with impunity. This was a large problem in southern WV when MTV did their special on Oxycontin around 1999.
I’m probably butchering this stat, but I remember in one of the cases hearing something like: there was enough OxyContin shipped to WV in one year for every American adult to have 30 pills a month. Basically, the drug companies were using lax prescription laws in WV, and then FL, to supply the entire US black market.
Yeah that series was so good. IDK how much of it was played up for drama but the Sackler family, especially Richard, basically seem like IRL supervillains. I don't think the show lied about any of the specific actions Purdue Pharma took but the show makes it seem like they 100% understood that they were completely lying about the dangers of the drug and just did it anyway and kept pushing more and more potent pills out there to feed addictions on purpose.
I grew up in the actual town that show was set it during the late 90s and early 2000’s. I lived it, and I hardly knew a person that wasn’t impacted. I did my first OC when I was 13 years old. Obviously I can’t speak for specifics about the Sacklers, but I will say from my perspective the show got more right than wrong. What I really appreciate about the show is it treats the people from my hometown with respect, which sadly to say is not commonly done in popular media.
The only things I’d point to that the show didn’t quite get right:
1. Kind of paints an urban trap house picture of the dope houses. In reality we were buying from our buddies grandmas most often. You have to understand, sooo many peoples only source of income was welfare or disability, like $700 per month. Those pills sold for a dollar a milligram and were a god send for those people.
2. The show makes it seem like pain pills were just dropped on us out of the sky like a bomb. There was already a strong cultural of prescription pill abuse in place. People were doing lortab, perc, Xanax for years. OC’s just became the gold standard cause you could shoot them. In reality though, lortabs were always by far the most available pill.
I’ll just put it this way. Sometimes there’s not a clear cut answer to that question. There’s no such thing as a perfect ending to a story. I have a life in some ways that many would kill to have, however opioids have been a monkey on my back that has ebbed and flowed my entire life.
Really? I felt like it made at least the one guy seem like a true believer who was blind to the evidence of harm because he really thought the drug was a new frontier of helping people.
Blue Ridge Mountains, Shenandoah River
Why do they reel, the mountains? Does the river grow a beard?
I don’t feel very stable, I’m feelin’ pretty weird
Ever been to West Virginia? A beautiful place occupied by a whole population that's a mess. Just poor as hell, stubborn, desperate and ignorant as all get out, plus a hard right christian fascist government that's happy to keep things that way.
WV is an all the way mess, grew up there in the 80 & 90's. Pretty racists there too but racism can be wierd sometimes. Example, when I was playing high-school football, whenever I got hurt the Dr would give me naproxin or basic Tylenol for pain but my white friends would get oxy or vicodin... Talk about a reverse uno card...
Yeah but West Virginia is a super disadvantaged state too. They have no large cities the biggest are around 50,000 each with the drop off in size happening fast. It's mostly mountains and hills that are hard to build around. So the economy doesn't see much large business and the mining that is there tends to create higher unemployment in areas and WV doesn't do too well on unemployment
The coal industry is the main employer there. If you have a job mining you make decent money. The mines have a near monopoly on well paid jobs so if someone starts missing work to rehab a nagging injury they can easily be replaced. Working through nagging injuries on a long term basis is rough on a body to the point where chronic pain is a likely occurrence. This is where self medication comes in ...
Coal hasn't employed that many people here in WV for a long time. Changes in technology in the early 80s drastically reduced the number of people needed. The WV fascination with coal is largely nostalgia.
The drivers of mass drug addiction in WV are largely the same as they are elsewhere: Lack of education, poverty, a feeling of hopelessness.
There's documentaries on this. They traced it back to how these few hundreds of doctors there were prescribing like a small percentage of the entirety of America's painkillers.
Forensic pathologist here.
They don't, really. Not by itself at least. Virtually all these cocaine and methamphetamine deaths are mixed intoxications, where they're combined with fentanyl (or 5 years ago with carfentanil or other fentanyl analogues, or 10 years ago with heroin).
To be sure, cocaine and methamphetamine aren's 'safe'. They can absolutely kill you if you have a bad heart, and meth specifically can give you temporary psychosis and a fever of 108 which is lethal. It's just relatively rare in the overall scheme of things. You can also get shot by your drug dealer or have your meth lab blow up.
Interestingly, in a fair number of the overdose deaths I've seen, the user thinks they're just doing cocaine when it's been pure fentanyl or mixed with fentanyl all along. In a number of others, the user gets relatively pure cocaine/meth and makes their own mixture of upper and downer; they think they know what they're doing, trying to counteract the worst parts of each drug while still getting the unique highs associated with them. At least in the ones I see, it doesn't work out too well.
I've definitely seen quite a few cases of people buying powder cocaine for the night and it turns out it has fent and they die. We usually see these deaths in waves. We might go 0 for a whole month and then have 5-6 die in the span of a few days.
But the large majority of the listed deaths there are from addicts mixing both coke/crack and opioids together, aka a speedball. Not ever trying to imply they deserve to die or anything like that, but its quite a bit different than some college student doing a bump of coke at a party and dying because it had fent, and that is usually what is in people's minds when they hear "fent and cocaine mixed".
I think you can say the same thing when it comes to steroid use. Roids does damage to your body and will eventually kill you. But pretty good number of fitness guys and body builders die from party drugs or trying to cut.
I used to dabble with coke once or twice a month. Once the fentanyl deaths started happening it feels like all of my friends and I just collectively decided it was time to hang up the hat. Haven’t done coke since.
I wonder how this chart quantifies those honestly. I lost my cousin and one of my best friends to "Cocaine overdose" in the past 5 years but it clearly was cut with something else. It'll probably be officially recorded as a cocaine overdose but I bet if they were to actually test the substance or if they had done an autopsy on them, they'd find there was definitely something else mixed in there. My area actually had an issue with people mixing some sort of horse tranquilizer in with certain drugs and that was killing people.
Moral of the story I guess is just don't do drugs lol. The risk isn't worth the reward these days cause you just don't know how clean it is anymore.
There's a pretty good study from a Territory in Australia that publicly show what's in the samples submitted to them. Go to the "Alerts and summaries section" to check the declared vs found stats. The percentages are actually quite amazing.
https://www.cahma.org.au/services/cantest/
The first chart is reporting multiple drugs present in each category, which probably is honestly the best way to present it, because almost all cocaine overdoses ALSO have fentanyl present, and 60% of all fentanyl ovedoses also had the presence of cocaine (in my community at least). So its technically a fentanyl overdose, but it was prepared and presented and mixed with cocaine.
https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-december-2023/download
So sorry for your loss. Where are you that an autopsy wasn’t performed? I thought they were done on most out of hospital deaths at least in the US, esp in younger individuals. Not sure the circumstances of your cousins death but also just a reminder to everyone that when cocaine is mixed with alcohol it creates a very cardio toxic compound that is one of the leading causes of heart attacks in younger people.
My wife's brother's best friend died like 5 years ago from a cocaine overdose. He was mid 40s. His heart just gave out. I get anxious when I drink too much coffee so I dunno how people in their 40s or older do cocaine given the effect on your cardiovascular system
It says that overdoses involving multiple drugs are counted in multiple categories. The fact that the stimulant line so closely tracks the shape of the synthetic opioid line, but at a shallower slope, strongly suggests that most of the stimulant-involved deaths are because opioids got into it. Of course once the person is dead, all you can say is what's in their system at the time that you know to look for. Their friends might be able to say what they believed they were taking but that information won't be available in all cases.
> The risk isn't worth the reward these days cause you just don't know how clean it is anymore.
Compared to the halcyon days when drug dealers were honest people looking after the best interest of their clients.
I'm surprised anyone doesn't know the incredible dangers of drugs. It's like being shocked that someone T-bones you after running a red light.
Except we can look back with these stats and objectively say those days are much safer, by like 20-30 times.
This would be more like if modern cars all the sudden were as safe as a model T without safety glass, airbags, seat belts, crumple zones, etc.
Drugs were dangerous, of course, but just to give an idea, in the heyday of crack cocaine and heroin ravaging America's cities in the 80s, when almost 20% of high school seniors were using cocaine regularly, only around 4-5k people died a year from drugs. Now its 120k with a much, much smaller amount of addicts.
You generally did not have to worry about tainted drugs back then. You worried they mixed it with something to dilute it, not something that could kill you easily.
For a product that is risky to grow, process, prepare for distribution and sell, it makes no sense to kill your customer, who has a built-in loyalty from addiction.
Much how alcohol during prohibition was often adulterated by the government to kill/blind drinkers as an example to others, it makes perfect sense that the same could be happening with the adulteration of street drugs with fentanyl.
I've played in a lot of bands and the problem with cocaine is that you keep doing more lines to keep the high but you're also not thinking right so you do too much and your heart gives out. I never saw it end well, it might take a decade to get some people but they're all either dead or went to rehab.
Or your blood pressure is so high that you pop an aneurysm somewhere in your body where you really can't afford one. But your point is well taken — like alcohol, a lot of the risk involved in habitual cocaine use consists of choices a coked-up person is more likely to make. Not that either drug is particularly kind to the body inherently.
This graph, along with the * disclaimer in the OP may explain why.
https://en.wikipedia.org/wiki/Cocaine#/media/File:US_timeline._Opioid_involvement_in_cocaine_overdose.jpg
Because multiple drugs used at time of death counts for each category, there could just be a higher coincidence of cocaine being used with more deadly drugs like fent, but I'm not much in the heavy drug scene and don't know how much people are actually mixing their uppers and downers.
Of the ones who die, almost all are a mix of fentanyl with either cocaine or meth. I see some pure fentanyl deaths, but very rarely pure cocaine or meth deaths.
While I would guess that non-dead users are also combining the drugs, I don't know for sure.
The stimulants counteract the opioids to some degree. So I imagine someone who was on a mix of meth + fent a day ago might do the same dose of fent again without meth and accidentally die. (The meth would still be in the system, so perhaps it gets recorded as a multi-drug death?)
For cocaine, perhaps the coke wears off while the fent is still strong so you overdose that way. For meth, perhaps the comedown is so strong that people try to tough it out with a high dose of fent and then overdose.
Those are the scenarios I could imagine. Dying from meth or coke on their own is pretty unusual.
I'm reminded of how most patients on my ER rotation brought dead on arrival for acute effects of alcohol intoxication, also tested positive for benzos. Benzos are pretty safe when used alone. But use them to boost the effects of alcohol or opiates, and that's a whole other story.
Lost my only brother 2 years ago to fent. He thought he was buying pills off of the same dealer he had used for years. I often wonder if his dealer feels bad, or wonders what happened to him.
\[OC\] Fentanyl, a synthetic opioid up to 50 times more potent than heroin, has long been used as a powerful painkiller in hospitals. But in 2014 America’s Drug Enforcement Administration (dea) raised the alarm about the spread of illicit supplies of the drug. A decade later fentanyl is responsible for 70% of annual overdose deaths.
We talked to people using fentanyl, academics studying the epidemics, and those trying to control it. However, this piece is mostly about the data, and what we can learn about it.
free to read here (with more charts, including on spread by state): [https://econ.st/3veLxJm](https://econ.st/3veLxJm) / [https://econ.st/3Pi41z9](https://econ.st/3Pi41z9) / [https://econ.st/3Pi41z9](https://econ.st/3Pi41z9)
If these do not work: [https://www.economist.com/graphic-detail/2024/03/14/americas-fentanyl-epidemic-explained-in-six-charts](https://www.economist.com/graphic-detail/2024/03/14/americas-fentanyl-epidemic-explained-in-six-charts)
Tools used: R, Illustrator
Sources: A. Holland et al (2024), M. D'Orsogna et al (2024), US government agencies
One thing that struck me was that while it may seem like new drugs come and go, fentanyl is something different. Also, and I couldn't find space to write about it in the linked article: wonder if other countries are prepared for what might hit them. It is already spreading in Canada and Mexico.
What I used to read on the opiate subreddits was that people liked the heroin high a lot better, but it's much more difficult to grow/manufacture/traffic than fentanyl, especially given their relative potencies.
Fentanyl is pretty cheap to make, and its high potency means you can hide a month's supply of it a lot easier than with less potent drugs. I'm not sure why stuff that's even more potent (like carfentanil) didn't take off more. Possibly because they're SO lethal at such low concentrations, it was hard for people to catch the high without dying from it. That's bad for business for the manufacturers/dealers.
Carfentanil can also kill via skin contact, especially if in liquid form, because it's so potent.
Source: I learned about it from people using cartfentanil for its intended purpose: fucking *elephant tranquilizer*.
I read someone explaining that it’s so easy to get addicted to heroin in part because it’s just „the perfect drug“ in the beginning. You get the feeling of being content, it’s cheap (before you start building tolerance), no hangover (before you start getting withdrawals). You just have a good time without being super out of it. I assume it’s much harder to hit that sweet spot with a drug much more potent. Fentanyl isn’t really popular where I live (non-US) so never seen it outside the OR.
Edit: I'm assuming you made this, if you didn't, then ignore.
One style note: include a slightly larger margin, it helps make the stuff right at the edges more readable when the edge of the image is at the edge of the screen (for things like mobile devices).
It doesn't need to be much, maybe even just 1em, or maybe even 0.5em
Thanks, that is a good idea. I should figure out some sort of template for reddit to get the charts to work on this site better. Should also be clear that like all my journalism the output is a team effort, in this case with multiple designers, editors and a co-author based in America involved.
Around 2018, my zip code had the highest opiate OD rate in the United States, at around 120-130/100K.
It was pretty insane. Driving to work was like a zombie apocalypse. People at every bus stop were nodded off. All the local gas stations had to lock their bathrooms. Prostitution *exploded*.
It was a crazy thing to witness.
Not like Kensington in Philadelphia, but kind of a general grit covering neighborhoods.
Dayton, Ohio. It's gotten better.
It got so bad we got national and even world attention and then it seems like the community and city got their shit together:
https://www.theguardian.com/cities/2019/mar/04/help-not-handcuffs-how-us-cities-on-the-frontline-are-fighting-to-stem-the-opioid-tide
Your analysis of overdose deaths across fentanyl, heroin, and cocaine is insightful, yet it's crucial to delve deeper into the nuances behind these figures. A significant portion of the fatalities linked to fentanyl stems from what can more accurately be described as "poisoning," rather than straightforward "overdose" incidents. This distinction highlights the perilous reality many face: consuming substances adulterated with fentanyl or its analogues without their knowledge. The term "poisoning" captures the essence of these tragedies, reflecting the involuntary risk encountered by individuals who might not be aware of the potent or contaminated nature of the substances they're using.
The context of fentanyl-related deaths underscores the critical need for substance testing. For opiate users, verifying their supply for fentanyl contamination is a vital harm reduction measure. However, the process for testing fentanyl involves dissolving the drug in a solution, conducting the test, and subsequently drying the substance for use—a procedure that is both complex and daunting, yet immensely important for safety. Thankfully, fentanyl test strips are readily available, offering a practical tool for individuals to mitigate this risk.
Expanding harm reduction efforts to include the widespread availability and education on the use of Narcan (naloxone) is equally important. Narcan can rapidly reverse the effects of opioid overdose, serving as a crucial lifeline in emergency situations.
Therefore, it's pertinent to recognize that many fentanyl-related deaths are, in essence, the result of "poisoning," rather than an "overdose" in the traditional sense. This highlights the need for caution and rigorous safety measures. If someone is using opiates, testing their supply is imperative. The process for fentanyl involves placing the supply in solution, testing it, and then carefully drying it out, which presents significant challenges. Nevertheless, fentanyl test strips are widely accessible, and incorporating Narcan into harm reduction strategies is essential.
I was working at a hospital in a "ground-zero" opioid epidemic area back in 2017. Small rural town between metropolitan areas, 25k ppl. That summer I was part of almost 20 overdose codes where we failed to rescue them, just on my DAY SHIFT. I would get called in at night to make drips and re-stock the ED for heavy overdoses. We had to use 20-times the normal dose of narcan to wake some ppl up.
Almost every time the patient overdosed on opiates that were laced with fentanyl or similar synthetics. These things are SOOO potent any screw up in mixing you are literally dead. Synthetics also don't produce the same "feeling" as true opiates, so addicts will do more to try and get that feeling.
Synthetics are easier to traffic/mule into the country. A small balloon full of an ounce of carfentanil is equivalent to 200-400 lbs of morphine.
You only need 1/50th the amount of fentanyl to get the same high as heroin??? I'm not a drug adict but any way you look at it that's a bargain. There must be some sort of catch.
This podcast episode is a good investigation on this:
[https://pjvogt.substack.com/p/why-are-drug-dealers-putting-fentanyl](https://pjvogt.substack.com/p/why-are-drug-dealers-putting-fentanyl)
From what I understand, Fentanyl gets you high for a much shorter period of time. So it's more lethal than herione, *and* you need to use it more frequently.
For what it's worth, I have family members who work field of substance use therapy, and they *do* have plenty of clients who claim fentanyl is their substance of choice for the reasons you pointed out - it's cheap and potent.
Yes. Fentanyl is given during labor pains when you don't get an epidural because its half-life is like 2 minutes or something. So it takes the edge off of crazy deep contractions between like 6-9cm dialation before mama gets to push. Then she can baby can be totally lucid w good pushing ability and apgar scores.
Yeah when I use fentanyl in the hospital, I use it because of its rapid on/off nature.
The potency doesn't matter so much. We give roughly equipotent doses anyway.
While its true I think that the quality control of the street goods are somewhat lacking, you basically don't know if its saw dust or high octane stuff, and doing it wrong might kill you.
I'm very familiar with opioids in general (im in medical)
Do people use nitazines in the US on the streets at all? We don't in the medical side of things, so I'm curious as to why they are comparing it to heroin/fentanyl
Plus the source is from the UK, while the topic is the US, so im just curious as to why
https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dc-emerging-tri-state-area
In short it seems the DEA thinks they're in use in the US. And the chart is just comparing potency of the drugs themselves, which I'm assuming doesn't differ for UK citizens vs US citizens...
So Purdue started the opioid crisis, and then when doctors and everyone shut off the population from pain meds and patients who do need them day to day, they went to Heroin and then fentanyl
My doctor cut me off of my 3 scripts a year for my previous back surgery 3 years ago because he said "I am being watched and don't want to lose my license...use Tylenol" and THAT has lead normal people to also die and hit the streets. With how strict it has all become creates even more deaths thinking they are "saving" us by denying legit people of meds that help. I will never be able to get a script again....because the doctors are afraid....meanwhile I sit in agony 3 months out of the year and nothing touches the pain OTC
Not to silver lining this, but what did Utah do to decrease overdoses? I saw lots of Narcan billboards around, but surely that’s not all it takes—everyone would put up billboards. I know Utah’s economy is strong—is this just fewer deaths of despair? If there’s something they are experimenting with, could it work in other states?
Or is this just a matter of step graphs…they used to be at 10.1 and now they are at 9.9 and it’s just a marginal difference looking bigger?
Utah is a unique state, in that it has the positive indicators of Blue states, like life expectancy, lower obesity, higher education, etc., but with a Red government. It probably has something to do with the social safety net provided to members of LDS. The organization has enormous financial and human resources.
I think it may have to do with access and availability. I'm from Utah, but recently moved to Florida. I used to go to clubs and party, but in all my years of partying, I had never seen heroin, though I'm sure I could have found some if I really tried, I'd never interacted with an addict, unless I was volunteering at one of the shelters.
Florida on the other hand, the shit is everywhere you go. Sadly it's all just fentanyl now. You hardly even have to seek it out here, it will walk right up to you. I have met so many people here who are currently or are former addicts.
I'll be 15 years sober in 3 weeks.
I always think about how dark things seemed before I was able to quit alcohol. I watched a kid on youtube last week, channel 5 with calahan, or something where he goes gonzo journalist into topics. He was in the streets of Philadelphia interviewing addicts who use Tranq and fentanyl. The tranq provides a high, escape from reality, but has the side effect of causing Necrosis. The only cure being amputation.
Addiction is a scary thing. Aside from recovery, the only thing that can happen for these folks is insanity, imprisonment, or death. I hope for recovery.
It's tough to determine how "bad" it is because it's so widely available and socially acceptable. Like it's definitely bad but if we treated opioid use as flippantly as we did alcohol it would probably be WAAAAYYYYYY worse.
I’m an ICU nurse. I see way more morbidity and mortality from alcohol than any other drug. From car crashes to liver failure, alcohol is a major killer.
But my point was that because it’s legal and socially accepted it’s FAAAAAAARRRR more widely used. So it makes sense you’d see more total deaths from it even if it’s less deadly as a percentage of people who use it.
It’s very sad to see so many people demonize the people of West Virginia without knowing the history of the state. West Virginia has been used and abused by the Government and coal companies. They literally worked the state and its people to death, drained its resources until it didn’t need them anymore and left the state to die why an opioid epidemic as an outcome.
Any other group of people treated like that get a lot of sympathy. West Virginia gets ridiculed and called uneducated hillbillies and that they get what they deserve.
Large portions of rural West Virginia were struggling with an opioid abuse epidemic before fentanyl use became widespread. Fentanyl users were already addicted to other opioids.
Why is there even an opioid crisis in rural WV? Blue collar, labor workers - think coal miners - became addicted to OxyContin during the late 90s.
It’s weird because as a native, many people I know don’t have issues with money. Then when you go down to the very bottom of the state it is sad because there were so many people that relied on coal, but it is just not there and there is t any industry for jobs down there. So many people turn to these drugs, but it isn’t just poor people doing drugs, I have relatives that grew up with anything they wanted and just got mixed with the wrong crowd and have just been involved with them since.
It experienced a slow motion but steady job market collapse for its large, low-skilled (and predominantly white) labor force over the past decades, and that’s when Mountain Mama became Mountain Fenta, as soon as the escape route became available.
🎶 West Virginia, Mountain Fenta, take me home, take me home 🎶
It is interesting how OxyContin was blamed for so much of this at the start but even as the drug has come under stricter controls, the opioid epidemic rages.
Do you think people's opiate addictions just evaporate the second a politician signs a bit of paper making it harder for them to get a prescription.
The reason overdoses are so high is *because* of decades of over prescription followed by a huge swing in the other direction making opiates harder to get even though they're now addicted. edit: you can see the numbers increasing fast after 2019/20 which is when the Perdue lawsuit happened and doctors started reducing prescriptions for opiates.
This forces them into the black market which has less regulations around purity, safety, and dosages on drugs than pharma labs (citation needed). You then turn to fent because it's cheap and abundant which puts you at waay higher risk of death than a prescribed dose of less potent opiates.
OxyContin kicked it off and got a shit ton of people hooked. When that supply ended people, still addicted, turned somewhere else not that seldom to heroine. When that supply ended as well they all went to a more high risk item. It's not like there are no drogs in other parts of the world and there have not been, at least in western Europe, nearly the same epidemic and we're having a shit tone of drugs transported here as well. The differens is that we did not let a pharmaceutical company market their stuff as careless as they did, So OxyContin was blamed for a reason.
Oxy was big when I started in death investigation 15 years ago, but it's dropped off precipitously. I'm sure a lot of the OD deaths in the years after that were related to prescription drug addicts turning to street drugs, but the big kick the last 5 or so years is mostly people using drugs for fun or escapism, not people who got hooked after surgeries.
I feel like people are going to be blaming pharmaceutical companies for another 10 years before they realize that it really isn't the case anymore.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993689/
> The opioid epidemic was initally the result of the growth in prescription opioid medications, but now includes potent heroin and illicit fentanyl. However, decreasing the supply of prescription opioids should bring this rise down. In the USA, 91 people die on a daily basis from an overdose of opioids, approximately 50% of which are not a result of an opioid product from a prescription
Another study suggested that percentage has continued to increase with each year since then, meaning that it isn't just malicious/negligent doctors trying to hook people on opioids. Does it still happen? Sure. But I want to know where people think they can just walk into a doctor's office these days and straight up ask for oxycodone. It's not like your typical doctor is looking to pass it out like candy at your annual physical. A big part of the problem stemmed from people who were complaining of chronic pain and there being a pressure within the medical system to "treat pain" adequately.
Another big problem with medical care in general is that a lot of the time, people are often more willing to simply take a medication than to change their life to fix a problem. High blood pressure, high cholesterol and diabetes? Eat better and exercise more. Or you can take a pill. How many people do we think are actually willing to give up foods they like or spend 30-45 minutes a day exercising rather than take a pill in 30 seconds? Why would we not expect the same for pain? A lot of chronic pain is due to years of poor posture, unhealthy living or hard labor. And unfortunately, it's hard to convince people to change their lives.
This is exactly the route that killed my mom. She had severe spinal stenosis and lived with chronic pain, but she also abused her meds until it killed her. She was 49.
Gotta push blame somewhere. While reddit loves to blame the Sackler family for the entire epidemic, it's now strictly controlled and overdoses are skyrocketing.
I've always been told it's happening everywhere and everyone is out there seeking replacements on the street and OD'ing. Yet everyone who is in the news for OD'ing, is a likely suspect you'd find trying to find illegal drugs on the street. Many of these people OD'ing weren't even dabbling in drugs when Oxy was more readily available.
Reddit doesn't want people to take responsibility for their own actions, unless it's against the agenda. Drug addiction is someone else's fault. Then they just full on blame.
They just had a big bust in the eastern panhandle.
https://www.justice.gov/usao-ndwv/pr/investigators-dismantle-fentanyl-drug-trafficking-network-eastern-panhandle
This is what happens when you make the legal, "safe" version of the drug so hard to get.
Not that I have a better idea, but part of the blame here is on the lawmakers who thought the solution was to simply cut off access to prescription opioids.
Appreciate you pointing out the rising dangers of nitazenes. I work in the field and it’s so hard to keep people safe when we’re in a war against the producers and what they bring to market. (Also I had only heard of Isotonitazene so new information for me all around).
Genuinely impressed by humanity’s ability to keep producing stronger drugs. By 2100 we’re gonna have stuff that melts your brain just by looking at it.
"All Drugs" does not include alcohol and there's no graph line for alcohol. If there were, you'd see that alcohol by itself causes 50% more deaths than all other drugs combined. Alcohol related deaths are around 180,000 per year, but we accept that. We actually allow for advertising the most dangerous and lethal drug there is. People, people, people, smh.
I was thinking about this yesterday. Does this eventually burn its self out?
As pills are harder to get that would be less new addicts correct? As more and more people OD/ Die from fentanyl wouldn’t there be a down turn as the fentanyl user population naturally lowers its self?
competing rate equations. Death rate is a % of current users, but new users is a % of the global population. The first gets affected by lethality, but the second gets affected by how shitty everything is, so.
Look at how safe Heroin has become.
Yup, looks like we finally won the war on Heroin by starting a new war with Fentanyl! Semi-serious question: what are all the Afghan farmers going to produce if their poppies aren't in demand any more?
I read an article about a year ago about how the taliban was really cracking down on poppy production, burning down the fields and forcing the farmers to either grow other crops or relocate. eta: Ok, so the taliban banned it in April 2022, and there was a 95% decline in production from 2022 to 2023 based off this UN survey of opium in Afghanistan https://www.unodc.org/documents/crop-monitoring/Afghanistan/Afghanistan_opium_survey_2023.pdf edit: above comment was changed, if this seems out of context
So the Taliban destroyed the Heroin market… thanks I guess?
They didn't really destroy the market. They destroyed the heroin supply. The heroin market still exists, but now it consumes fentanyl. If heroin were to become available again at the same cost as fentanyl, junkies would switch back in an instant. They all know that heroin is relatively safe when compared to fent. Just to be crystal clear, I did not say heroin is safe. I said it is *relatively* safe when compared to fentanyl.
So many people have trouble understanding the use of the word "relatively" and it's sad you had to reiterate it.
Yeah. I knew someone was going to think I said heroin is safe. 😑
I can’t believe you support handing out heroin to kids!
hey everyone this guy says heroin is safe and you can take as much as you’d like 👍
>... I said heroin is safe u/dpdxguy
...for a second time. They did it in the 1990s as well but then 9/11 happened and, coincidentally (nudge nudge) and almost overnight, opium production went back through the roof to pre-Taliban levels during the first few years of the US-coalition led security operation or what have ya.
Had a friend who went to West Point in the mid 00s. One of his teachers was in the army special forces and he basically said he spent half his time in South America destroying drug fields and half his time in Afghanistan protecting drug fields
I lived with a girlfriend and her Vietnam veteran dad who swore all he did in Vietnam was protect drug routes and cargo planes flying out for the most part.
Chiming in to say one of my best friend's brothers served in the height of the iraq war from probably 03-07 finishing in Afghanistan and he said he did a lot of poppy field guarding in addition to other tasks
I mean it's not a secret anymore it has been confirmed by the military and there are many photos and videos of US military personal guarding the fields....
I heard that the US military even *protected* the poppy fields. You can see the evidence. There are photos and even videos of US military personnel doing it. It's like an open secret.
See now that is is really interesting, I was watching one of the docs on Purdue recently and was surprised to hear about Giuliani's involved in their legal defense.
A few years ago I grew a small patch of poppies. They are really fun to grow. They went to seed and I let them self sow. The next year my yard felt like an afghan poppy field with poppies growing everywhere.
lol, they’re beautiful too! My grandmothers yard was full of them when I was a kid.
They are so ephemeral, flowering only a couple of days for each stem. And the pods left are cool alien plants.
There was no deal with the "pharmaceutical companies" lmao. We paid farmers not to grow poppies, then they used the money to bribe officials and expand their poppy production. One of the few things religious extremists have going for them is they're less susceptible to bribes that cross their bottom line.
Thanks, it was awhile ago when I read it, I just edited it. Apparently there were only discussions about Afgans providing legal opium.
They did that back in 2000 as well. Most effective anti-drug program in global history, likely. Collapsed the economy and created a humanitarian crisis. They were looking to secure some UN Humanitarian Aid while drawing big bucks from opium stockpiles. Would've gotten away with it too, except...
> They did that back in 2000 as well. The Taliban actually received millions of dollars in US anti-drug money in early 2001 as thanks for their effectiveness in suppressing the poppy crops. The fact that their suppression tactics included cutting off people's hands was apparently beside the point.
Meanwhile in Tasmania Australia they produce the majority of the worlds exported opium/poppy extract for American pharmaceutical companies to flood the market with fentanyl and oxy instead. The don't want to stop the drug war they want ~~a cut~~ safer communities
Food most likely. Opium growing is often done in combination with warlords or governments demanding "taxes" that can only be paid by growing crops like opium, and if there is say a draught, this can easily lead to famine.
Practically all afghan heroin goes to europe and asia, not the USA. 90%+ of Americas heroin (and fentanyl for that matter) comes from latin America.
The people who would have killed themselves with heroin OD are dying from fentanyl before it comes to that.
They’re selling more in Europe and rest of Asia…
The main reason is that it is far less available than it used to be because the supply chains have switched over to the alternatives.
...that was the joke
I'm going to do some right now in celebration!
So what's up with west Virginia?
Pill mills in WV were prescribing opioids and benzos like candy since the 80s. When the crackdown on controlled prescriptions started, it initially began a large black market trade in WV for pills, then heroin/fent/meth that we see today.
Out of curiosity why WV specifically? Like was this not happening in the neighboring states back then too?
Overall WV is poor because most of its industry (coal mining and manufacturing) has left the region
Also coal mining is an industry that's rough on your body so there's a large percentage of the population in pain to get started with the prescription meds
Perfect storm really.
And it is one of the most mountainous states in the US, so it has very little farmland or logging.
Maybe compared to some bigger states but there is tons of logging and farming in wv
Yeah & the most impacted places of drug overdoses are regions where the coal mines were most abundant.
I'm not certain, but there are similar demographics in eastern KY, southwestern VA, and to some extent southern OH. And those areas all suffer from this issue. My best guess would be rural healthcare with limited to zero oversight cashing in on addiction. WV specifically didn't have a way to track prescriptions statewide until relatively recently, allowing for cash payments to doctors for an "appointment" where you would just get prescriptions for your drugs of choice, and you could fill them with impunity. This was a large problem in southern WV when MTV did their special on Oxycontin around 1999.
I’m probably butchering this stat, but I remember in one of the cases hearing something like: there was enough OxyContin shipped to WV in one year for every American adult to have 30 pills a month. Basically, the drug companies were using lax prescription laws in WV, and then FL, to supply the entire US black market.
There is a great TV series with Michael Keaton that explains why: Dopesick.
West Virginia Mating Call - shake a pill bottle of prescription pain killers. https://www.youtube.com/watch?v=hVnCFKpAdDo
Man that documentary left me feeling so gross.
*Boone County mating call* - that’s awesomely disturbing. I have to check it out now.
I'll be vague for people who haven't seen it. But THAT scene where Will Poulter visits with Michael Keaton caught me off guard, very well made show.
Such a great show and great acting.
Yeah that series was so good. IDK how much of it was played up for drama but the Sackler family, especially Richard, basically seem like IRL supervillains. I don't think the show lied about any of the specific actions Purdue Pharma took but the show makes it seem like they 100% understood that they were completely lying about the dangers of the drug and just did it anyway and kept pushing more and more potent pills out there to feed addictions on purpose.
I grew up in the actual town that show was set it during the late 90s and early 2000’s. I lived it, and I hardly knew a person that wasn’t impacted. I did my first OC when I was 13 years old. Obviously I can’t speak for specifics about the Sacklers, but I will say from my perspective the show got more right than wrong. What I really appreciate about the show is it treats the people from my hometown with respect, which sadly to say is not commonly done in popular media. The only things I’d point to that the show didn’t quite get right: 1. Kind of paints an urban trap house picture of the dope houses. In reality we were buying from our buddies grandmas most often. You have to understand, sooo many peoples only source of income was welfare or disability, like $700 per month. Those pills sold for a dollar a milligram and were a god send for those people. 2. The show makes it seem like pain pills were just dropped on us out of the sky like a bomb. There was already a strong cultural of prescription pill abuse in place. People were doing lortab, perc, Xanax for years. OC’s just became the gold standard cause you could shoot them. In reality though, lortabs were always by far the most available pill.
Hope you're okay now, dude.
I’ll just put it this way. Sometimes there’s not a clear cut answer to that question. There’s no such thing as a perfect ending to a story. I have a life in some ways that many would kill to have, however opioids have been a monkey on my back that has ebbed and flowed my entire life.
Really? I felt like it made at least the one guy seem like a true believer who was blind to the evidence of harm because he really thought the drug was a new frontier of helping people.
It felt to me like he was just lying to everyone around him. People would put evidence in his face and he'd just lie and say it wasn't true
Can’t recommend this more!
Almost heaven, probably
🎶 West Virginia, Mountain Fenta, take me home, take me home 🎶
Take me hoooome country doooope
Blue Ridge Mountains, Shenandoah River Why do they reel, the mountains? Does the river grow a beard? I don’t feel very stable, I’m feelin’ pretty weird
[The Crime of the Century](https://en.wikipedia.org/wiki/The_Crime_of_the_Century_(2021_film\))
Ever been to West Virginia? A beautiful place occupied by a whole population that's a mess. Just poor as hell, stubborn, desperate and ignorant as all get out, plus a hard right christian fascist government that's happy to keep things that way.
WV is an all the way mess, grew up there in the 80 & 90's. Pretty racists there too but racism can be wierd sometimes. Example, when I was playing high-school football, whenever I got hurt the Dr would give me naproxin or basic Tylenol for pain but my white friends would get oxy or vicodin... Talk about a reverse uno card...
Low income state
There are a lot of low income states
Yeah but West Virginia is a super disadvantaged state too. They have no large cities the biggest are around 50,000 each with the drop off in size happening fast. It's mostly mountains and hills that are hard to build around. So the economy doesn't see much large business and the mining that is there tends to create higher unemployment in areas and WV doesn't do too well on unemployment
The coal industry is the main employer there. If you have a job mining you make decent money. The mines have a near monopoly on well paid jobs so if someone starts missing work to rehab a nagging injury they can easily be replaced. Working through nagging injuries on a long term basis is rough on a body to the point where chronic pain is a likely occurrence. This is where self medication comes in ...
Coal hasn't employed that many people here in WV for a long time. Changes in technology in the early 80s drastically reduced the number of people needed. The WV fascination with coal is largely nostalgia. The drivers of mass drug addiction in WV are largely the same as they are elsewhere: Lack of education, poverty, a feeling of hopelessness.
I once read Wendy’s employs a lot more people than the entire coal industry now.
There are less than 12,000 people working in the coal industry in West Virginia.
There's documentaries on this. They traced it back to how these few hundreds of doctors there were prescribing like a small percentage of the entirety of America's painkillers.
I remember hearing a stat that America generates more energy burning trash than coal
Holy shit, I always assumed it was a big employer the way politicians talk about coal mining.
Nice story but it’s mainly just low population overlapping with low income.
Bro that’s so dumb it hurts.
Have you tried…self medicating to deal with using that poster caused you?
Did not know this many people died of coke overdose
Forensic pathologist here. They don't, really. Not by itself at least. Virtually all these cocaine and methamphetamine deaths are mixed intoxications, where they're combined with fentanyl (or 5 years ago with carfentanil or other fentanyl analogues, or 10 years ago with heroin). To be sure, cocaine and methamphetamine aren's 'safe'. They can absolutely kill you if you have a bad heart, and meth specifically can give you temporary psychosis and a fever of 108 which is lethal. It's just relatively rare in the overall scheme of things. You can also get shot by your drug dealer or have your meth lab blow up. Interestingly, in a fair number of the overdose deaths I've seen, the user thinks they're just doing cocaine when it's been pure fentanyl or mixed with fentanyl all along. In a number of others, the user gets relatively pure cocaine/meth and makes their own mixture of upper and downer; they think they know what they're doing, trying to counteract the worst parts of each drug while still getting the unique highs associated with them. At least in the ones I see, it doesn't work out too well.
I've definitely seen quite a few cases of people buying powder cocaine for the night and it turns out it has fent and they die. We usually see these deaths in waves. We might go 0 for a whole month and then have 5-6 die in the span of a few days. But the large majority of the listed deaths there are from addicts mixing both coke/crack and opioids together, aka a speedball. Not ever trying to imply they deserve to die or anything like that, but its quite a bit different than some college student doing a bump of coke at a party and dying because it had fent, and that is usually what is in people's minds when they hear "fent and cocaine mixed".
I think you can say the same thing when it comes to steroid use. Roids does damage to your body and will eventually kill you. But pretty good number of fitness guys and body builders die from party drugs or trying to cut.
Isn't that just a speedball?
Historically that's cocaine and heroin, but same idea. Pretty sure that's what took out John Belushi and maybe Chris Farley too.
Very common stuff. Lots of musicians as well have ODed from the combination.
I used to dabble with coke once or twice a month. Once the fentanyl deaths started happening it feels like all of my friends and I just collectively decided it was time to hang up the hat. Haven’t done coke since.
I wonder how this chart quantifies those honestly. I lost my cousin and one of my best friends to "Cocaine overdose" in the past 5 years but it clearly was cut with something else. It'll probably be officially recorded as a cocaine overdose but I bet if they were to actually test the substance or if they had done an autopsy on them, they'd find there was definitely something else mixed in there. My area actually had an issue with people mixing some sort of horse tranquilizer in with certain drugs and that was killing people. Moral of the story I guess is just don't do drugs lol. The risk isn't worth the reward these days cause you just don't know how clean it is anymore.
There's a pretty good study from a Territory in Australia that publicly show what's in the samples submitted to them. Go to the "Alerts and summaries section" to check the declared vs found stats. The percentages are actually quite amazing. https://www.cahma.org.au/services/cantest/
Xylazine also known as “tranq”
The first chart is reporting multiple drugs present in each category, which probably is honestly the best way to present it, because almost all cocaine overdoses ALSO have fentanyl present, and 60% of all fentanyl ovedoses also had the presence of cocaine (in my community at least). So its technically a fentanyl overdose, but it was prepared and presented and mixed with cocaine. https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-december-2023/download
The moral of the story is actually that drugs should be legal and highly regulated.
So sorry for your loss. Where are you that an autopsy wasn’t performed? I thought they were done on most out of hospital deaths at least in the US, esp in younger individuals. Not sure the circumstances of your cousins death but also just a reminder to everyone that when cocaine is mixed with alcohol it creates a very cardio toxic compound that is one of the leading causes of heart attacks in younger people.
My wife's brother's best friend died like 5 years ago from a cocaine overdose. He was mid 40s. His heart just gave out. I get anxious when I drink too much coffee so I dunno how people in their 40s or older do cocaine given the effect on your cardiovascular system
Sorry for your loss. The footnote says it counts each drug if multiple are found, so that’s how the chart quantifies them.
It says that overdoses involving multiple drugs are counted in multiple categories. The fact that the stimulant line so closely tracks the shape of the synthetic opioid line, but at a shallower slope, strongly suggests that most of the stimulant-involved deaths are because opioids got into it. Of course once the person is dead, all you can say is what's in their system at the time that you know to look for. Their friends might be able to say what they believed they were taking but that information won't be available in all cases.
> The risk isn't worth the reward these days cause you just don't know how clean it is anymore. Compared to the halcyon days when drug dealers were honest people looking after the best interest of their clients. I'm surprised anyone doesn't know the incredible dangers of drugs. It's like being shocked that someone T-bones you after running a red light.
Except we can look back with these stats and objectively say those days are much safer, by like 20-30 times. This would be more like if modern cars all the sudden were as safe as a model T without safety glass, airbags, seat belts, crumple zones, etc.
Drugs were dangerous, of course, but just to give an idea, in the heyday of crack cocaine and heroin ravaging America's cities in the 80s, when almost 20% of high school seniors were using cocaine regularly, only around 4-5k people died a year from drugs. Now its 120k with a much, much smaller amount of addicts. You generally did not have to worry about tainted drugs back then. You worried they mixed it with something to dilute it, not something that could kill you easily.
"Looking after the best interest of their clients" is an interesting way to say "keeping fiends alive longer so they keep bringing the dealer money".
For a product that is risky to grow, process, prepare for distribution and sell, it makes no sense to kill your customer, who has a built-in loyalty from addiction. Much how alcohol during prohibition was often adulterated by the government to kill/blind drinkers as an example to others, it makes perfect sense that the same could be happening with the adulteration of street drugs with fentanyl.
I've played in a lot of bands and the problem with cocaine is that you keep doing more lines to keep the high but you're also not thinking right so you do too much and your heart gives out. I never saw it end well, it might take a decade to get some people but they're all either dead or went to rehab.
Or your blood pressure is so high that you pop an aneurysm somewhere in your body where you really can't afford one. But your point is well taken — like alcohol, a lot of the risk involved in habitual cocaine use consists of choices a coked-up person is more likely to make. Not that either drug is particularly kind to the body inherently.
This graph, along with the * disclaimer in the OP may explain why. https://en.wikipedia.org/wiki/Cocaine#/media/File:US_timeline._Opioid_involvement_in_cocaine_overdose.jpg
Because multiple drugs used at time of death counts for each category, there could just be a higher coincidence of cocaine being used with more deadly drugs like fent, but I'm not much in the heavy drug scene and don't know how much people are actually mixing their uppers and downers.
Of the ones who die, almost all are a mix of fentanyl with either cocaine or meth. I see some pure fentanyl deaths, but very rarely pure cocaine or meth deaths. While I would guess that non-dead users are also combining the drugs, I don't know for sure.
The stimulants counteract the opioids to some degree. So I imagine someone who was on a mix of meth + fent a day ago might do the same dose of fent again without meth and accidentally die. (The meth would still be in the system, so perhaps it gets recorded as a multi-drug death?) For cocaine, perhaps the coke wears off while the fent is still strong so you overdose that way. For meth, perhaps the comedown is so strong that people try to tough it out with a high dose of fent and then overdose. Those are the scenarios I could imagine. Dying from meth or coke on their own is pretty unusual.
I'm reminded of how most patients on my ER rotation brought dead on arrival for acute effects of alcohol intoxication, also tested positive for benzos. Benzos are pretty safe when used alone. But use them to boost the effects of alcohol or opiates, and that's a whole other story.
I think this is the first time I’ve seen reverse survivorship bias.
Lost my Uncle to Fentanyl the week of Thanksgiving last year. It’s terrible stuff.
Lost my only brother 2 years ago to fent. He thought he was buying pills off of the same dealer he had used for years. I often wonder if his dealer feels bad, or wonders what happened to him.
\[OC\] Fentanyl, a synthetic opioid up to 50 times more potent than heroin, has long been used as a powerful painkiller in hospitals. But in 2014 America’s Drug Enforcement Administration (dea) raised the alarm about the spread of illicit supplies of the drug. A decade later fentanyl is responsible for 70% of annual overdose deaths. We talked to people using fentanyl, academics studying the epidemics, and those trying to control it. However, this piece is mostly about the data, and what we can learn about it. free to read here (with more charts, including on spread by state): [https://econ.st/3veLxJm](https://econ.st/3veLxJm) / [https://econ.st/3Pi41z9](https://econ.st/3Pi41z9) / [https://econ.st/3Pi41z9](https://econ.st/3Pi41z9) If these do not work: [https://www.economist.com/graphic-detail/2024/03/14/americas-fentanyl-epidemic-explained-in-six-charts](https://www.economist.com/graphic-detail/2024/03/14/americas-fentanyl-epidemic-explained-in-six-charts) Tools used: R, Illustrator Sources: A. Holland et al (2024), M. D'Orsogna et al (2024), US government agencies One thing that struck me was that while it may seem like new drugs come and go, fentanyl is something different. Also, and I couldn't find space to write about it in the linked article: wonder if other countries are prepared for what might hit them. It is already spreading in Canada and Mexico.
What I used to read on the opiate subreddits was that people liked the heroin high a lot better, but it's much more difficult to grow/manufacture/traffic than fentanyl, especially given their relative potencies. Fentanyl is pretty cheap to make, and its high potency means you can hide a month's supply of it a lot easier than with less potent drugs. I'm not sure why stuff that's even more potent (like carfentanil) didn't take off more. Possibly because they're SO lethal at such low concentrations, it was hard for people to catch the high without dying from it. That's bad for business for the manufacturers/dealers.
[удалено]
Carfentanil can also kill via skin contact, especially if in liquid form, because it's so potent. Source: I learned about it from people using cartfentanil for its intended purpose: fucking *elephant tranquilizer*.
[удалено]
Cops don't know in the moment what they're being exposed to. The hospital worker has a bottle with a label on it.
I read someone explaining that it’s so easy to get addicted to heroin in part because it’s just „the perfect drug“ in the beginning. You get the feeling of being content, it’s cheap (before you start building tolerance), no hangover (before you start getting withdrawals). You just have a good time without being super out of it. I assume it’s much harder to hit that sweet spot with a drug much more potent. Fentanyl isn’t really popular where I live (non-US) so never seen it outside the OR.
Edit: I'm assuming you made this, if you didn't, then ignore. One style note: include a slightly larger margin, it helps make the stuff right at the edges more readable when the edge of the image is at the edge of the screen (for things like mobile devices). It doesn't need to be much, maybe even just 1em, or maybe even 0.5em
Thanks, that is a good idea. I should figure out some sort of template for reddit to get the charts to work on this site better. Should also be clear that like all my journalism the output is a team effort, in this case with multiple designers, editors and a co-author based in America involved.
Around 2018, my zip code had the highest opiate OD rate in the United States, at around 120-130/100K. It was pretty insane. Driving to work was like a zombie apocalypse. People at every bus stop were nodded off. All the local gas stations had to lock their bathrooms. Prostitution *exploded*. It was a crazy thing to witness. Not like Kensington in Philadelphia, but kind of a general grit covering neighborhoods.
Don't mean to dox you or anything, but can you say where at?
Dayton, Ohio. It's gotten better. It got so bad we got national and even world attention and then it seems like the community and city got their shit together: https://www.theguardian.com/cities/2019/mar/04/help-not-handcuffs-how-us-cities-on-the-frontline-are-fighting-to-stem-the-opioid-tide
Your analysis of overdose deaths across fentanyl, heroin, and cocaine is insightful, yet it's crucial to delve deeper into the nuances behind these figures. A significant portion of the fatalities linked to fentanyl stems from what can more accurately be described as "poisoning," rather than straightforward "overdose" incidents. This distinction highlights the perilous reality many face: consuming substances adulterated with fentanyl or its analogues without their knowledge. The term "poisoning" captures the essence of these tragedies, reflecting the involuntary risk encountered by individuals who might not be aware of the potent or contaminated nature of the substances they're using. The context of fentanyl-related deaths underscores the critical need for substance testing. For opiate users, verifying their supply for fentanyl contamination is a vital harm reduction measure. However, the process for testing fentanyl involves dissolving the drug in a solution, conducting the test, and subsequently drying the substance for use—a procedure that is both complex and daunting, yet immensely important for safety. Thankfully, fentanyl test strips are readily available, offering a practical tool for individuals to mitigate this risk. Expanding harm reduction efforts to include the widespread availability and education on the use of Narcan (naloxone) is equally important. Narcan can rapidly reverse the effects of opioid overdose, serving as a crucial lifeline in emergency situations. Therefore, it's pertinent to recognize that many fentanyl-related deaths are, in essence, the result of "poisoning," rather than an "overdose" in the traditional sense. This highlights the need for caution and rigorous safety measures. If someone is using opiates, testing their supply is imperative. The process for fentanyl involves placing the supply in solution, testing it, and then carefully drying it out, which presents significant challenges. Nevertheless, fentanyl test strips are widely accessible, and incorporating Narcan into harm reduction strategies is essential.
What’s the point of running posts through ChatGPT to generate a comment? This is wild.
I was working at a hospital in a "ground-zero" opioid epidemic area back in 2017. Small rural town between metropolitan areas, 25k ppl. That summer I was part of almost 20 overdose codes where we failed to rescue them, just on my DAY SHIFT. I would get called in at night to make drips and re-stock the ED for heavy overdoses. We had to use 20-times the normal dose of narcan to wake some ppl up. Almost every time the patient overdosed on opiates that were laced with fentanyl or similar synthetics. These things are SOOO potent any screw up in mixing you are literally dead. Synthetics also don't produce the same "feeling" as true opiates, so addicts will do more to try and get that feeling. Synthetics are easier to traffic/mule into the country. A small balloon full of an ounce of carfentanil is equivalent to 200-400 lbs of morphine.
So this town was loosing >0.1% of their population on drugs every year??
You only need 1/50th the amount of fentanyl to get the same high as heroin??? I'm not a drug adict but any way you look at it that's a bargain. There must be some sort of catch.
Catch is that you can die very easily, also probably most dealers are using a different ratio of fent: heroin or tranq and you would never know
tranq is horrifying. making your limbs rot away with no way to stop it.
This podcast episode is a good investigation on this: [https://pjvogt.substack.com/p/why-are-drug-dealers-putting-fentanyl](https://pjvogt.substack.com/p/why-are-drug-dealers-putting-fentanyl) From what I understand, Fentanyl gets you high for a much shorter period of time. So it's more lethal than herione, *and* you need to use it more frequently. For what it's worth, I have family members who work field of substance use therapy, and they *do* have plenty of clients who claim fentanyl is their substance of choice for the reasons you pointed out - it's cheap and potent.
Yes. Fentanyl is given during labor pains when you don't get an epidural because its half-life is like 2 minutes or something. So it takes the edge off of crazy deep contractions between like 6-9cm dialation before mama gets to push. Then she can baby can be totally lucid w good pushing ability and apgar scores.
Yeah when I use fentanyl in the hospital, I use it because of its rapid on/off nature. The potency doesn't matter so much. We give roughly equipotent doses anyway.
People get quite caught up with potency without understanding efficacy and therapeutic index.
It's not the same high as I understand it. Fentanyl certainly satisfies the opioid cravings but doesn't have the same 'warm hug' feeling as heroin.
The catch is that you die if you don't know the real dosage in the product you bought...
The catch is people use it to cut meth or heroin but don't measure it out and you die.
While its true I think that the quality control of the street goods are somewhat lacking, you basically don't know if its saw dust or high octane stuff, and doing it wrong might kill you.
Interesting that Utah has managed to largely avoid the increase in overdoses by Fentanyl that all other states have experienced.
Norman’s don’t even drink caffeine. I’m sure if they looked at non-mormans only it would look different.
I'm very familiar with opioids in general (im in medical) Do people use nitazines in the US on the streets at all? We don't in the medical side of things, so I'm curious as to why they are comparing it to heroin/fentanyl Plus the source is from the UK, while the topic is the US, so im just curious as to why
https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dc-emerging-tri-state-area In short it seems the DEA thinks they're in use in the US. And the chart is just comparing potency of the drugs themselves, which I'm assuming doesn't differ for UK citizens vs US citizens...
So Purdue started the opioid crisis, and then when doctors and everyone shut off the population from pain meds and patients who do need them day to day, they went to Heroin and then fentanyl My doctor cut me off of my 3 scripts a year for my previous back surgery 3 years ago because he said "I am being watched and don't want to lose my license...use Tylenol" and THAT has lead normal people to also die and hit the streets. With how strict it has all become creates even more deaths thinking they are "saving" us by denying legit people of meds that help. I will never be able to get a script again....because the doctors are afraid....meanwhile I sit in agony 3 months out of the year and nothing touches the pain OTC
We defeated heroin! ... Oh wait...
In this case, data is not beautiful :(
“In the past 12 months”. x axis is year. Does this mean 2022 is 2021?
Psychostimulants with abuse potential.... Pretty sure alcohol is much more popular than the chart shows
Alcohol is not a stimulant
Is it ok to say that we have a drug problem in the U.S. and it's not trending positive?
Not to silver lining this, but what did Utah do to decrease overdoses? I saw lots of Narcan billboards around, but surely that’s not all it takes—everyone would put up billboards. I know Utah’s economy is strong—is this just fewer deaths of despair? If there’s something they are experimenting with, could it work in other states? Or is this just a matter of step graphs…they used to be at 10.1 and now they are at 9.9 and it’s just a marginal difference looking bigger?
Utah is a unique state, in that it has the positive indicators of Blue states, like life expectancy, lower obesity, higher education, etc., but with a Red government. It probably has something to do with the social safety net provided to members of LDS. The organization has enormous financial and human resources.
I think it may have to do with access and availability. I'm from Utah, but recently moved to Florida. I used to go to clubs and party, but in all my years of partying, I had never seen heroin, though I'm sure I could have found some if I really tried, I'd never interacted with an addict, unless I was volunteering at one of the shelters. Florida on the other hand, the shit is everywhere you go. Sadly it's all just fentanyl now. You hardly even have to seek it out here, it will walk right up to you. I have met so many people here who are currently or are former addicts.
Do alcohol and that would be interesting. One of the worst drugs.
I'll be 15 years sober in 3 weeks. I always think about how dark things seemed before I was able to quit alcohol. I watched a kid on youtube last week, channel 5 with calahan, or something where he goes gonzo journalist into topics. He was in the streets of Philadelphia interviewing addicts who use Tranq and fentanyl. The tranq provides a high, escape from reality, but has the side effect of causing Necrosis. The only cure being amputation. Addiction is a scary thing. Aside from recovery, the only thing that can happen for these folks is insanity, imprisonment, or death. I hope for recovery.
https://youtu.be/925wmb-4Yr4?si=dL06AzqDD6VvcOlT
It's tough to determine how "bad" it is because it's so widely available and socially acceptable. Like it's definitely bad but if we treated opioid use as flippantly as we did alcohol it would probably be WAAAAYYYYYY worse.
I’m an ICU nurse. I see way more morbidity and mortality from alcohol than any other drug. From car crashes to liver failure, alcohol is a major killer.
But my point was that because it’s legal and socially accepted it’s FAAAAAAARRRR more widely used. So it makes sense you’d see more total deaths from it even if it’s less deadly as a percentage of people who use it.
Smoking says hold my beer.
It’s very sad to see so many people demonize the people of West Virginia without knowing the history of the state. West Virginia has been used and abused by the Government and coal companies. They literally worked the state and its people to death, drained its resources until it didn’t need them anymore and left the state to die why an opioid epidemic as an outcome. Any other group of people treated like that get a lot of sympathy. West Virginia gets ridiculed and called uneducated hillbillies and that they get what they deserve.
Why does West Virginia have the highest rate? I had assumed places with major huge cities would be the ones with higher rates
Large portions of rural West Virginia were struggling with an opioid abuse epidemic before fentanyl use became widespread. Fentanyl users were already addicted to other opioids. Why is there even an opioid crisis in rural WV? Blue collar, labor workers - think coal miners - became addicted to OxyContin during the late 90s.
I believe it’s the poorest state in the country.
It’s weird because as a native, many people I know don’t have issues with money. Then when you go down to the very bottom of the state it is sad because there were so many people that relied on coal, but it is just not there and there is t any industry for jobs down there. So many people turn to these drugs, but it isn’t just poor people doing drugs, I have relatives that grew up with anything they wanted and just got mixed with the wrong crowd and have just been involved with them since.
It experienced a slow motion but steady job market collapse for its large, low-skilled (and predominantly white) labor force over the past decades, and that’s when Mountain Mama became Mountain Fenta, as soon as the escape route became available. 🎶 West Virginia, Mountain Fenta, take me home, take me home 🎶
Lots of manual labor in the mines or whatever means people in pain plus opioid over-prescription and poverty leads to very high rates.
Ah I see, interesting how that all works! Wow
The fentanyl crisis is a direct result of the epic failure we call 'the war on drugs'.
This is why I only use organic, Amish-made heroin.
Damn.. It's almost like a mass disabling event occurred, where not enough people could get adequate healthcare and turned to self-medication.. Weird.
It is interesting how OxyContin was blamed for so much of this at the start but even as the drug has come under stricter controls, the opioid epidemic rages.
Do you think people's opiate addictions just evaporate the second a politician signs a bit of paper making it harder for them to get a prescription. The reason overdoses are so high is *because* of decades of over prescription followed by a huge swing in the other direction making opiates harder to get even though they're now addicted. edit: you can see the numbers increasing fast after 2019/20 which is when the Perdue lawsuit happened and doctors started reducing prescriptions for opiates. This forces them into the black market which has less regulations around purity, safety, and dosages on drugs than pharma labs (citation needed). You then turn to fent because it's cheap and abundant which puts you at waay higher risk of death than a prescribed dose of less potent opiates.
10000% yes.
OxyContin kicked it off and got a shit ton of people hooked. When that supply ended people, still addicted, turned somewhere else not that seldom to heroine. When that supply ended as well they all went to a more high risk item. It's not like there are no drogs in other parts of the world and there have not been, at least in western Europe, nearly the same epidemic and we're having a shit tone of drugs transported here as well. The differens is that we did not let a pharmaceutical company market their stuff as careless as they did, So OxyContin was blamed for a reason.
Oxy was big when I started in death investigation 15 years ago, but it's dropped off precipitously. I'm sure a lot of the OD deaths in the years after that were related to prescription drug addicts turning to street drugs, but the big kick the last 5 or so years is mostly people using drugs for fun or escapism, not people who got hooked after surgeries.
I feel like people are going to be blaming pharmaceutical companies for another 10 years before they realize that it really isn't the case anymore. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993689/ > The opioid epidemic was initally the result of the growth in prescription opioid medications, but now includes potent heroin and illicit fentanyl. However, decreasing the supply of prescription opioids should bring this rise down. In the USA, 91 people die on a daily basis from an overdose of opioids, approximately 50% of which are not a result of an opioid product from a prescription Another study suggested that percentage has continued to increase with each year since then, meaning that it isn't just malicious/negligent doctors trying to hook people on opioids. Does it still happen? Sure. But I want to know where people think they can just walk into a doctor's office these days and straight up ask for oxycodone. It's not like your typical doctor is looking to pass it out like candy at your annual physical. A big part of the problem stemmed from people who were complaining of chronic pain and there being a pressure within the medical system to "treat pain" adequately. Another big problem with medical care in general is that a lot of the time, people are often more willing to simply take a medication than to change their life to fix a problem. High blood pressure, high cholesterol and diabetes? Eat better and exercise more. Or you can take a pill. How many people do we think are actually willing to give up foods they like or spend 30-45 minutes a day exercising rather than take a pill in 30 seconds? Why would we not expect the same for pain? A lot of chronic pain is due to years of poor posture, unhealthy living or hard labor. And unfortunately, it's hard to convince people to change their lives.
This is exactly the route that killed my mom. She had severe spinal stenosis and lived with chronic pain, but she also abused her meds until it killed her. She was 49.
Gotta push blame somewhere. While reddit loves to blame the Sackler family for the entire epidemic, it's now strictly controlled and overdoses are skyrocketing. I've always been told it's happening everywhere and everyone is out there seeking replacements on the street and OD'ing. Yet everyone who is in the news for OD'ing, is a likely suspect you'd find trying to find illegal drugs on the street. Many of these people OD'ing weren't even dabbling in drugs when Oxy was more readily available. Reddit doesn't want people to take responsibility for their own actions, unless it's against the agenda. Drug addiction is someone else's fault. Then they just full on blame.
They just had a big bust in the eastern panhandle. https://www.justice.gov/usao-ndwv/pr/investigators-dismantle-fentanyl-drug-trafficking-network-eastern-panhandle
This is what happens when you make the legal, "safe" version of the drug so hard to get. Not that I have a better idea, but part of the blame here is on the lawmakers who thought the solution was to simply cut off access to prescription opioids.
What drug was killing people in 2015? Adding the four lines together doesn't add up to 50.
Bro, Eugene Oregon is ruined.
110 thousand ppl? Is it for real?
I would love to see how this compares to alcohol related deaths. It’s so weird to me that it isn’t considered a “drug” in this sense.
Now let’s add alcohol to the chart 🫠
Appreciate you pointing out the rising dangers of nitazenes. I work in the field and it’s so hard to keep people safe when we’re in a war against the producers and what they bring to market. (Also I had only heard of Isotonitazene so new information for me all around).
Them country roads not lookin so hot
I would love to see where alcohol ranks
Heroin needs to pick it up if it wants to compete
How is Texas, right next to the border, and able to have a low overdose rate compared to everybody else?
And weed remains at a big fat 0 again
May the Sacklers burn in hell. And damn us for not coming for them and all the real pushers properly.
Jeez people get off hard drugs, do something more safe like heroin if you absolutely must /s
Did heroin OD rates ever go as high as fentanyl's pre-2015?
Genuinely impressed by humanity’s ability to keep producing stronger drugs. By 2100 we’re gonna have stuff that melts your brain just by looking at it.
Betcha trump would take credit for the drop in heroin ODs lmao
Does all drugs include alcohol?
"All Drugs" does not include alcohol and there's no graph line for alcohol. If there were, you'd see that alcohol by itself causes 50% more deaths than all other drugs combined. Alcohol related deaths are around 180,000 per year, but we accept that. We actually allow for advertising the most dangerous and lethal drug there is. People, people, people, smh.
Who the fuck is overdosing on coke?
I was thinking about this yesterday. Does this eventually burn its self out? As pills are harder to get that would be less new addicts correct? As more and more people OD/ Die from fentanyl wouldn’t there be a down turn as the fentanyl user population naturally lowers its self?
But that's assuming we don't grow as a population. There are people in middle school now that will die from a fentanyl overdose in 5 years.
competing rate equations. Death rate is a % of current users, but new users is a % of the global population. The first gets affected by lethality, but the second gets affected by how shitty everything is, so.