Heroin Overdose Epidemic - what is your perspective?

[Nephrology]

One of our latest OD death was from a mixture of fentanyl and heroin...but product was mostly fentanyl...not heroin. Whoever mixed that shit must've lost track. I just read that fentanyl is upwards of 80 times more potent that morphine.

Just about. 0.2 mg of fentanyl delivered intravenously is though to be equivalent to 10mg of IV morphine; so, 50x the fentanyl dose.

[Dr_Thanatos]

One of our latest OD death was from a mixture of fentanyl and heroin...but product was mostly fentanyl...not heroin. Whoever mixed that shit must've lost track. I just read that fentanyl is upwards of 80 times more potent that morphine.

They didn't lose track, it's on purpose. OD deaths are skyrocketing because the profit margin on fentanyl is so much better than heroin, that the heroin is being replaced. If you've seen one, expect more. Once it hits your area, there will be more deaths.

PM me for more details.

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[Totem Polar]

As an aside, I had to look up one of the diseases listed here.

The purpura usually begins suddenly, 7-10 days after the onset of the precipitating infection, with the development of progressively enlarging, well-demarcated purplish areas of hemorrhagic cutaneous necrosis with deranged coagulation factors. Lesions begin as erythematous macules that progress within hours to sharply defined areas of purpura.

Clearly, not good. Glad I had breakfast before hitting the images researching this.

[RoyGBiv]

Seven overdose deaths in one day reported in Cleveland area

"Hospitals in the Cincinnati area have seen more than a dozen overdoses a day since the powerful drug used to sedate elephants was found in the area's heroin supply about two months ago.

In one six-day span last month, there were 174 overdoses reported in Cincinnati and Hamilton County."

[Nephrology]

Seven overdose deaths in one day reported in Cleveland area

"Hospitals in the Cincinnati area have seen more than a dozen overdoses a day since the powerful drug used to sedate elephants was found in the area's heroin supply about two months ago.

In one six-day span last month, there were 174 overdoses reported in Cincinnati and Hamilton County."

Probably fentanyl or carfentanyl again...

[45dotACP]

As an aside, I had to look up one of the diseases listed here.

The purpura usually begins suddenly, 7-10 days after the onset of the precipitating infection, with the development of progressively enlarging, well-demarcated purplish areas of hemorrhagic cutaneous necrosis with deranged coagulation factors. Lesions begin as erythematous macules that progress within hours to sharply defined areas of purpura.

Clearly, not good. Glad I had breakfast before hitting the images researching this.

Heh, my appetite lives in a different place. I like wound care and think I may be moving towards wound care nursing professionally....

My purpura patient showered clots and coded right at change of shift, got intubated, put on pressors, on tube feeds Her druggie family can't make the choice to extubate and withdraw curative care. Get twelve drug addicts in a room and demand they reach consensus makes herding cats look easy.

[Dr_Thanatos]

Probably fentanyl or carfentanyl again...

Anytime they use "Elephant Tranquilizer", it's carfentanil.

http://www.pressherald.com/2016/09/1...fentanyl-raid/

This was likely carfentnanil. Y'all be careful with this shit.

[1911nerd]

Article in today's WSJ that is apropos: http://www.wsj.com/articles/for-smal...ome-1475074699.

[voodoo_man]

Just got a double OD in my area. A couple.

[peterb]

As I have posted elsewhere here, I have literally decades of experience with opiods, especially Oxycontin - not by choice. I have been extremely blessed to be able to stay controlled and functional for these many years, having been told I am very unusual because my dosages haven't changed in 4+ years. I'm not a Dr., but feel I'm eminently qualified to say the following. With all due respect, okie john, prescribing Oxycontin, a time-release med, for post-op pain is way out of line and is one of the main causes of folks getting hooked. Unfortunately, it happens all the time as Drs., even now, continue to write for Oxycontin, for situations just like your fiance - out of sheer ignorance. Oxycontin is a drug I am VERY familiar with and should ONLY be used in chronic (think never-ending here) pain control situations. The proper med for cases such as yours would be Vicodin, a short-acting med for short term pain control, or something in that same category.

Having recently started dealing with osteoarthritis pain, I'm more sympathetic to how some folks get started down the prescription painkiller road to heroin. They aren't looking for a high -- they just want to stop the hurting so they can get a good night's sleep and get through the day. On my bad days I can easily see how that could happen.

"Dreamland" was good read. It's sobering how one piece of data on the hospital use of opioids was repeatedly misused as "proof" that they were safe to prescribe for long-term use.