Heroin Overdose Epidemic - what is your perspective?

[Nephrology]

kid overdosing after making tea from a fentanyl patch or some such shit.

... wow. What a goddamn idiot. Those patches can contain up to 16.8 mg of fentanyl, and are designed to release the drug over 24-168 hour intervals. For reference, 25micrograms (i.e. 0.025 milligrams) is a good starting dose for someone who is relatively opiate naive and in serious pain.

This article popped up in my AMA newswire today. US Opiate Deaths at an All Time High.

[Larry Sellers]

We're doing it daily here in a city of 60 or so thousand. Reportedly we as a department have used narcan roughly 200 times since its inception in February. The caveat to that is we don't get called to every OD in the city. We've also seen an uptick in the 911 EMS runs for "parties passed out on the side of the road in a car" and by the time we arrive they are pulling away. It's here, and we went to a run yesterday where a person had an opioid addiction secondary to a TBI and motorcycle wreck, he went to another state for a 9500$ procedure to have a "rapid detox" where they put you under and supposedly you end your addiction. We were at the house for an ems run due to the fact that he had taken too many valium and Percocet....


As others have said, it's here and it is not going anywhere anytime soon

[11B10]

This city's overdose rate is 13X the national average. It's hard to describe how prevalent it's become. I've lost friends to it, my sister is an addict, and more classmates and neighbors than I can count have died. This time last year five people I went to school with died in three weeks. My school had less than 400 students and is in probably the best neighborhood in the area. It seems like that by this point most of the stereotypical "junkies" have killed themselves off and now people you'd never assume would become users are dropping like flies.

The problems starts with the economy. This area(Huntington, WV) has been hit hard over the last couple decades or more and a large number of people are struggling. Instead of everyone working a decent job, staying busy, and spending their time with other people doing the same, there are way too many people unemployed or underemployed. Over time that causes the moral of a population to drop, and people with low moral and too much free time tend to start doing stupid shit. Throw in a drug pipeline with Detroit and a local university that brings thousands of young people into a small town, and you've got a recipe for disaster.

Everyone I know who has ever made it to heroin started with pills. Some get hooked on pills after being prescribed, some are self-medicating, some start socially when they are younger. Pills are like Skittles around here. When I used to go out on the weekends the bars were full of pills. People couldn't find a joint's worth of weed sometimes, but the pill supply was never dry. Eventually they either want a better high or the money runs out and heroin is cheaper. If they are fiending hard enough they break down and try dope. Once they start on heroin it's all they want.

Then the clinics started opening up. They should all be burnt to the ground. Someone can get hooked on pain pills after being overprescribed, and in effort to get off of them they go to a clinic. The clinic makes too much money to care about weening people down, and instead they do shit like run an addict through indefinite "programs" (I've known people who have been going to a clinic for ten years.) The clinics only introduce these addicts to even more addicts. They also put more drugs on the street. There are a lot of people who aren't really addicts who go to the clinic to get a suboxone script so they can resale them. There are also addicts who go to the clinic and get their script, keep half for themselves, and sell the other half to pay for next month's script. Suboxone being sold on the street means that addicts who are in a spell of trying to get clean don't go get real help. They buy suboxone to help with withdrawals. They manage this for a few days or weeks and then fall back to heroin, and these are the people most likely to overdose. There are also people straight up hooked on suboxone, regardless of the drug supposedly being non-habit forming. They go through their script in short order and are then buying more wherever they can find it. These people live and act just like any other addict.

The problem isn't going to get better until doctors get their act together and quit handing out pills like Halloween candy, the clinics get shut down, and suboxone is banned. Judges need to quit giving lenient sentences to addicts who commit crimes to support their habits. And even though I've lost a bunch of friends to overdoses, I'd like to see Narcan go away as well. It makes addicts way too comfortable. They all have a distorted view of reality as it is, and now they tell themselves they can always just get some Narcan if they OD. And in this area some good jobs would do wonders for the long term situation.

First and foremost - your stories break my heart. You are living in a nightmare world. I used to live in one until I got into a pain management program. Before you say it, I know many of these programs are crap, abused by many for personal profit and highs. I am not in one of those. Because of many reasons, some inherited, including a major car accident many years ago which left me with a legacy of problems - I have intractable pain. After decades of trialing one alternative after another, I have found - for me - MY pain only responds to the prescription meds which are causing many to become addicted. You have no idea how this makes me feel. On one hand, they enable me to have a full life, doing much more than most other 68 year old retirees - playing with my granddaughter, going to Gold's 3/week - lifting weights with my son, training with my firearms, riding bikes, working on cars, etc. - you know, living my life. Praise God that I have not succumbed to the horror stories you tell! On the other hand, I anguish over what these same meds are doing to so many. No answers, just one man's story.

[MSparks909]

I don't really have much to add besides that it's taking over Eastern NC pretty hard too. Seems as though a person I know a week is OD'ing on my Facebook newsfeed. I'll echo what others have said here, mainly that once pills got harder to find there was a massive uptick in heroin use. Really sad to see. Lost another HS friend (I'm mid-20s) this past weekend and another overdosed yesterday.

[Dr_Thanatos]

... wow. What a goddamn idiot. Those patches can contain up to 16.8 mg of fentanyl, and are designed to release the drug over 24-168 hour intervals. For reference, 25micrograms (i.e. 0.025 milligrams) is a good starting dose for someone who is relatively opiate naive and in serious pain.

This article popped up in my AMA newswire today. US Opiate Deaths at an All Time High.

Fentanyl Tea and other methods of abusing prescription fentanyl has been around for a long time. We routinely would have cases of people with "morphine" (fentanyl) patches in their mouth or stomach. The new wave is not diverted prescription fentanyl, it is illictly manufactured fentanyl and it is bad stuff.

The part that Misanthropist alluded to, is that the death investigation systems across the country are already underfunded and overloaded. Adding this to them is crushing many agencies. A large number have stopped doing autopsies on overdoses, because they can't keep up. Plus the good old days of being able to easily tell what drug someone took is mostly gone. The toxicology testing is more complicated, which adds to the cost and turnaround time. Our small office has already had two "Presumed Drug Overdose" deaths, because we couldn't identify the drug used.

This is going to get worse before it gets better.

[11B10]

Fentanyl Tea and other methods of abusing prescription fentanyl has been around for a long time. We routinely would have cases of people with "morphine" (fentanyl) patches in their mouth or stomach. The new wave is not diverted prescription fentanyl, it is illictly manufactured fentanyl and it is bad stuff.

The part that Misanthropist alluded to, is that the death investigation systems across the country are already underfunded and overloaded. Adding this to them is crushing many agencies. A large number have stopped doing autopsies on overdoses, because they can't keep up. Plus the good old days of being able to easily tell what drug someone took is mostly gone. The toxicology testing is more complicated, which adds to the cost and turnaround time. Our small office has already had two "Presumed Drug Overdose" deaths, because we couldn't identify the drug used.

This is going to get worse before it gets better.

May God have mercy!

[scjbash]

That probably explains why it seemed to take a long time for my friend's body to be released from autopsy this week. Thanks for the insight.

[45dotACP]

... wow. What a goddamn idiot. Those patches can contain up to 16.8 mg of fentanyl, and are designed to release the drug over 24-168 hour intervals. For reference, 25micrograms (i.e. 0.025 milligrams) is a good starting dose for someone who is relatively opiate naive and in serious pain.

This article popped up in my AMA newswire today. US Opiate Deaths at an All Time High.

It's only gonna get worse. Chicago's first Carfentanil OD just popped up. Near as I've been told, it's been making the rounds in Europe and Canada....and now it's here.

It's been linked to a 200 OD streak over a period of two fucking weeks in Cincinnati.

It's the worst of the real bad synthetics...its no shit 10,000 times more powerful than morphine. Some say it was what the russians pumped into the moscow theater crisis in 02 and killed 125 hostages because they underestimated how much Narcan they'd need. I wouldn't know for sure, but paramedics are now being advised to wear masks if they come into contact with OD's...because a dose the size of a snowflake can throw them into respiratory arrest.

[Nephrology]

First and foremost - your stories break my heart. You are living in a nightmare world. I used to live in one until I got into a pain management program. Before you say it, I know many of these programs are crap, abused by many for personal profit and highs. I am not in one of those. Because of many reasons, some inherited, including a major car accident many years ago which left me with a legacy of problems - I have intractable pain. After decades of trialing one alternative after another, I have found - for me - MY pain only responds to the prescription meds which are causing many to become addicted. You have no idea how this makes me feel. On one hand, they enable me to have a full life, doing much more than most other 68 year old retirees - playing with my granddaughter, going to Gold's 3/week - lifting weights with my son, training with my firearms, riding bikes, working on cars, etc. - you know, living my life. Praise God that I have not succumbed to the horror stories you tell! On the other hand, I anguish over what these same meds are doing to so many. No answers, just one man's story.

You shouldn't feel guilt or regret that the medication you take is causing suffering for others. Heroin, morphine, fentanyl, oxyocodone - they are simply chemical substances that have pharmacologic effects on the human body. Just like guns, they have no moral agency of their own, and just like guns, they can be tools for both good and evil.

I do have one question for you (and hopefully this too personal or too much of a derail) - are you prescribed any non-opiod pain medications, or have your doctors ever mentioned this as an alternative to you? I ask because currently in medical school we are taught that chronic non-cancer pain is typically best treated with non-opioid drugs, for all the reasons contained in this thread. There are lots of options for non-opioid control of chronic pain, depending on the type of pain you're experiencing. If you haven't tried those yet, they could be worth looking into. Just a thought.

We're doing it daily here in a city of 60 or so thousand. Reportedly we as a department have used narcan roughly 200 times since its inception in February. The caveat to that is we don't get called to every OD in the city. We've also seen an uptick in the 911 EMS runs for "parties passed out on the side of the road in a car" and by the time we arrive they are pulling away. It's here, and we went to a run yesterday where a person had an opioid addiction secondary to a TBI and motorcycle wreck, he went to another state for a 9500$ procedure to have a "rapid detox" where they put you under and supposedly you end your addiction. We were at the house for an ems run due to the fact that he had taken too many valium and Percocet....


As others have said, it's here and it is not going anywhere anytime soon

Sadly, no matter how you detox or how successful it is, the psychological addiction to a substance like heroin can long outlast the physical dependency...

[11B10]

Nephrology - I know when I read your posts, I'm going to be, first - educated, but also entertained. Thank you for taking the time to read my story and make logical and sensible suggestions. I will not get into all the protocols, of all types, that I've taken advantage of over the past 41 years. When I see that fact in print, I think: "That can't be right - 41 years!?" I won't get into them, mainly because I can't remember them! Seriously, I understand why you make the suggestions you do, but try to put yourself in my place for a bit. I'm 68+ years old and have been on the same meds AT THE SAME DOSAGE, for nearly 5 years. To answer your question: yes, I've taken many NON-opioid meds, some worse than others - none gave me what my current (almost 5 years, remember?) dosage does. Could my life be better? A definite MAYbe. Here's my question for you: Why should I submit to an unknown when I'm perfectly happy where I am? So I can say: "I don't take those awful opioids anymore?" I have full panel blood tests done every quarter - have for over 20 years. I know you can understand why. Again, thanks so very much for doing what you do and "listening" to me in a sincere attempt to help.

Much appreciated.