Let's Talk About The Opioid Problem

[Peruvian]

I have 5 seven year old girl’s sleeping over at my house tonight.


Is there anything stronger than fentanyl?

Cute. I've got 4 Gen Z ladies in my dining room.

[SumJongGuy]

So I would argue that millions of alcoholics and addicts go to the doctor/dentist all the time. If there functional and have a home and job.

A lot of the people in the rooms were pretty functional.. earning good money. I never lost a job. In fact, I went 10 years straight without calling in sick even once.. working retail management 48 hours a week +.

Only time I went to the doctor was when the physical shit got bloody.. literally..

Lots of practicing alcoholics out there fully functional but avoiding professionals who might nag them to stop drinking/drugging..

More are avoiding than showing up for routine care.. You don't want to admit you're not 100% healthy... period.

[Trackhead]

Can’t even ask a patient about covid vaccine status or test for covid when they come in hypoxic because all the nut job conspiracies. Now we can’t ask about alcohol consumption when your fucking liver function tests come back elevated. Should we fucking guess? Run a hepatitis panel and dead end? Or try get a valid history? You have a giant abscess on your arm from shooting. Should I ask how it got there? Or just guess? If you lie, and I don’t think it’s from shooting, I’m not thinking about endocarditis. Want me to miss that?

Healthcare workers don’t care if you have a 10” dildo in your ass. You might think we do, but we don’t. We just take it out and move on. Same goes for substance abuse. Don’t…give…a…shit. Just trying to do our job. Your embarrassment is your own.

[Jacques Strap]

Quick interlude to recognize Jacques's handle. It's a good one.

Right on. I think I got it from a Bart Simpson prank call to Moe's.

One thing's for sure, no other drug is anywhere near as overtly poisonous as ethanol.

I've gotta argue, or at least clarify, on that one.

In terms of quantifying acute toxicity (risk of OD), ethanol is way on the other side of the scale from fentanyl. The classic measurement for this is LD50 (I'm not going to get into debate on using animal data to estimate effect on humans, because for these compounds human data mirrors animal endpoint pretty closely). Basically, the LD50 is the average dose that would be expected to be fatal for a given route of exposure (inhalation, ingestion, etc). The bigger the number, the "safer" the drug.

The LD50 in rats via intraperitoneal injection (which is reasonably similar to intravenous and has typically been used to approximate IV) for fentanyl is 3 mg/kg, for heroin is 15-20 mg/kg, and for ethanol (not that anyone would shoot ethanol, but just so we have an apples to apples comparison) is 6,700 mg/kg. By this measure, fentanyl is ~6 times more toxic than heroin, and ~2,300 times more toxic than ethanol. That's another ballpark in another sport in another country in another era.

Which is why the amount of fentanyl that covers Lincoln's nose on the head of a penny (2 mg) is routinely a lethal dose for humans, but the average bottle of beer has 14 grams (14,000 mg) of ethanol.

I'm not saying alcohol isn't dangerous or destructive. I recognize that laboratory animal assessments of effective and lethal concentrations are only part of the evaluation of the safety of a compound. I appreciate that you used the word "poison" as opposed to "toxicant" when talking about ethanol in the context of risk and cost to individuals and society. I know you fully recognize the degrees of magnitude of difference between the toxicity of fentanyl and ethanol, but I just wanted to make sure we were being completely clear for anybody else.

[BCMtnHound]

Isn’t an alcohol addiction the only one that could lead to death from withdrawal?

[Trackhead]

Isn’t an alcohol addiction the only one that could lead to death from withdrawal?

And benzodiazepines.

[SumJongGuy]

Can’t even ask a patient about covid vaccine status or test for covid when they come in hypoxic because all the nut job conspiracies. Now we can’t ask about alcohol consumption when your fucking liver function tests come back elevated. Should we fucking guess? Run a hepatitis panel and dead end? Or try get a valid history? You have a giant abscess on your arm from shooting. Should I ask how it got there? Or just guess? If you lie, and I don’t think it’s from shooting, I’m not thinking about endocarditis. Want me to miss that?

Healthcare workers don’t care if you have a 10” dildo in your ass. You might think we do, but we don’t. We just take it out and move on. Same goes for substance abuse. Don’t…give…a…shit. Just trying to do our job. Your embarrassment is your own.

It's nothing personal.. And, it doesn't even matter whether you ask or not really.. They don't want to know that the choice might be to quit or die.. The substance is driving and making all the decisions not the human.. Point is, you only see the tip of the iceberg of addiction disorders.. Because once fully engaged, they're avoiding you until it's REALLY bad, and often too late.

It's all over the place.. Let's at least find a way to cut the sketchy dealers out and reduce the costs.. and add a little to the common coffer to fund more treatment programs s (tax it!).. And, stop sending them to jail of course once it's legal to possess and sell in a properly regulated environment.. EIther make it ALL legal or ban alcohol again too.... and tobacco..

[ötzi]

@Jacques: I don't think the lethal dose is as relevant as the effects on the body of of the continual use of the substance at sublethal doses. I don't have a clue what Fentanyl does to the body. However I've often read that Heroin is lot easier on the system over time than alcohol is.

The problems with H mainly come from dirty needles, poverty, being engaged in crime to get money for more H, etc. etc. But the substance itself is fairly benign unless overdosed on. That obviously is not the case with alcohol. Legal H would most likely mitigate the harm it does. Legal alcohol does the opposite.

[Trackhead]

Legal H would most likely mitigate the harm it does. Legal alcohol does the opposite.

You must have more self control than me. I dont even want controlled substances in my house (say left over Percocet from knee surgery) because I’ll take one every night to sleep,then eventually I’ll be an addict. I know myself, dad was a “functional alcoholic”.

I personally don’t think legalization will go well for many people. Maybe the rates of addiction won’t climb much? I could accept that as a valid hypothesis, much like some folks won’t smoke cigarettes or drink because it’s not their thing. But I wonder about people on the fringe of self control, or the chronically depressed or anxious. Those folks might “self medicate” with legal opioids and get hosed. There are a ton of people in this country with refractory anxiety/depression acute and chronic that I would be concerned about.

[SumJongGuy]

What's more difficult for a 14 year old to maintain a steady supply of right now, alcohol, or their illegal substance of choice?

[ötzi]

@ TH: This is more devil's advocate than a real viewpoint, I need to think about this more, but why would they be hosed? If the substance is legal, and they can afford it, and it's not particularly hurting them physically, and it makes them feel better, are they hosed? Or are they just self-medicating and making it through?

Somebody who uses alcohol for the same purpose and in the same framework is poisoning themself, to me they seem like the ones who are hosed.

[Trackhead]

@ TH: This is more devil's advocate than a real viewpoint, I need to think about this more, but why would they be hosed? If the substance is legal, and they can afford it, and it's not particularly hurting them physically, and it makes them feel better, are they hosed? Or are they just self-medicating and making it through?

Somebody who uses alcohol for the same purpose and in the same framework is poisoning themself, to me they seem like the ones who are hosed.

Because I fear that it will escalate from one a night to all day long for a significant number of people. People who are otherwise functional will become shitty parents, be high on the job (can’t smell it like booze), become dysfunctional shitty parents/employees/etc.

A fairly legitimate concern, I think.

[Cisco Kid]

"Winston Churchill once famously observed that Americans will always do the right thing, only after they have tried everything else."

American exceptionalism is our greatest weakness. IMO. A Gov't and populace that really doesn't really care about the individual, only it themself is a big hurdle.

We could look at how decriminalization has worked in Portugal.
https://www.cbc.ca/news2/interactive...iminalization/

[Trackhead]

A complex topic. The Portuguese model:

Most analyses about the Portuguese case tend to focus on the encouraging resultsFootnote 1 regarding drug use prevalence, which stayed reasonably low when compared to other European countries [19], including those that criminalize drug use; the drop of infectious diseases rates, high in 2000 [21], as well the decline of the equally high incarceration rates for drug-related offenses [22, 23]. These tendencies cannot be, however, linearly related with the decriminalization law per se, as Laqueur (10) and Quintas [24] have shown.

https://substanceabusepolicy.biomedc...394-7#ref-CR24

[BCMtnHound]

Because I fear that it will escalate from one a night to all day long for a significant number of people. People who are otherwise functional will become shitty parents, be high on the job (can’t smell it like booze), become dysfunctional shitty parents/employees/etc.

A fairly legitimate concern, I think.

But isn’t that exist regardless of legality, or even availability of a particular substance? Going to that study about rats and cocaine - subject isolated and under stimulated was given free access to cocaine, and the subject became an addict. Provided stimulus and community and the drive to utilize the drug diminished significantly.

I think there will always be circumstance coupled with propensity to create an opportunity for addiction. But for the vast majority, if the social environment is engaging and supportive, the risk of abuse is significantly limited. Like the MUnicorn said, this seems more a societal problem, not a legal or an accessibility one.

[Trackhead]

^^i think (hope) you’re probably mostly correct in your assumptions. But the what if remains for me. Are we, like some have proposed, suggesting narcotic dispensaries akin to marijuana?

[BCMtnHound]

With a drug like fentanyl, with the risk associated with it, I can’t see open public access like alcohol or mj. I remember in the early 90’s with alcohol use in the poor area of Edmonton. The addicts were jonesing early in the day and resorting to aerosol cans to mitigate their withdrawals until the liquor store opened. Many were ending up in the ER or worse. So in the area this population frequented, they opened the liquor store at 8, and city wide they put the commonly used alcohol-based aerosols behind the counter. It worked, not perfect but deaths were significantly reduced.

There must be a middle ground for dispensing of the H and other such drugs. Just get the supply cleaned up, and provide a safe place to use. We can work on the social support to keep people from using/abusing but this shouldn’t be stopping us from limiting the current personal risk to abuse occurring across our society.

[Cisco Kid]

A complex topic. The Portuguese model:

Most analyses about the Portuguese case tend to focus on the encouraging resultsFootnote 1 regarding drug use prevalence, which stayed reasonably low when compared to other European countries [19], including those that criminalize drug use; the drop of infectious diseases rates, high in 2000 [21], as well the decline of the equally high incarceration rates for drug-related offenses [22, 23]. These tendencies cannot be, however, linearly related with the decriminalization law per se, as Laqueur (10) and Quintas [24] have shown.

https://substanceabusepolicy.biomedc...394-7#ref-CR24

So are you saying that the Portuguese plan failed to reduce dependency and incarceration?

[SumJongGuy]

Good discussion here. Nobody's "wrong". We all just have different perspectives. and different opinions based n our own experiences.

[frorider]

Agree. It’s complicated. I thought this article was a good summary of the various metrics and data: https://transformdrugs.org/blog/drug...ecord-straight

[baron]

Making something that it mentally and physically addictive legal seems like a bad idea.

Though, tobacco and alcohol are just like that and they have been staples of society for hundreds of years.

The difference between those 2 and Opioids is> those two are purely recreational. Opioids have found a home with the medical industry and are one of the few things that can manage Extreme Pain. Opioids have had a long human history of recreational use but, education has shown that they are not good idea to recreate with.

Got to agree that Alcohol is brutal when misused... but everything is bad when misused>Humans need better education. Controlling any of this shit is not going to help but, opening opium dens will just create more problems that they solve.

Also>not on our tax dollar>seems like our leaders want to be legal drug dealers at this point...if some private groups want to form some charity that's fine by me
...call it Heroin Hero's!

[Trackhead]

So are you saying that the Portuguese plan failed to reduce dependency and incarceration?

It’s a complex article. You should read it. Seems many things at play. Not a simple answer.

[MagnificentUnicorn]

Making something that it mentally and physically addictive legal seems like a bad idea.

Though, tobacco and alcohol are just like that and they have been staples of society for hundreds of years.

The difference between those 2 and Opioids is> those two are purely recreational. Opioids have found a home with the medical industry and are one of the few things that can manage Extreme Pain. Opioids have had a long human history of recreational use but, education has shown that they are not good idea to recreate with.

Got to agree that Alcohol is brutal when misused... but everything is bad when misused>Humans need better education. Controlling any of this shit is not going to help but, opening opium dens will just create more problems that they solve.

Also>not on our tax dollar>seems like our leaders want to be legal drug dealers at this point...if some private groups want to form some charity that's fine by me
...call it Heroin Hero's!

You’re kind of all over the place with this post. Reads like an opinion piece without any real experience or evidence for your opinion. Drugs bad, just say no!


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[baron]

You’re kind of all over the place with this post. Reads like an opinion piece without any real experience or evidence for your opinion. Drugs bad, just say no!


Sent from my iPhone using TGR Forums

yea...feels like we have reached the point in this discussion that there is no ''right'' way to deal with this stuff. Both sides have good points but there's not a middle ground that can satisfy either argument for legalizing or not.

In personal experiences I have seen it comes down to each person's case individually. There's to many variables to dealing with addiction. My buddy in Cali was on the streets for about 8+years and trying to transition to a non user and get his life back. Long road; was eating out of dumpsters at one point. My neighbor (he grew up with) helped him with a room and some meals as well as getting back to work. He relapsed more times than we could count + he totally turned to alcohol. we had to kick him out when he relapsed each time>you cant have that shit around a family. Seems that was what finally broke him into sobriety. He was at my house getting drunk and smokin' pot... but drinking was close to destroying his liver. He would be super sloppy drunk on only a few drinks. Finally I had to tell him he can't come back. He was off heroin but alcohol was a horrible substitute. Something clicked finally when I kicked him out, and a month later he was sober and working full time. The thing that helped IMO was we would keep trying *when he was ready* and not hold it against him >so he kept trying to recover until finally he did

So yea I like drinking > in his case it almost killed my friend ..every person is different as is the way they got there. Stories look similar from addict to addict but it seems there's way more to it. It's like the gun problem is a user of gun problem more than the guns themselves. Same with drinking and drugs.

[MagnificentUnicorn]

yea...feels like we have reached the point in this discussion that there is no ''right'' way to deal with this stuff. Both sides have good points but there's not a middle ground that can satisfy either argument for legalizing or not.

In personal experiences I have seen it comes down to each person's case individually. There's to many variables to dealing with addiction. My buddy in Cali was on the streets for about 8+years and trying to transition to a non user and get his life back. Long road; was eating out of dumpsters at one point. My neighbor (he grew up with) helped him with a room and some meals as well as getting back to work. He relapsed more times than we could count + he totally turned to alcohol. we had to kick him out when he relapsed each time>you cant have that shit around a family. Seems that was what finally broke him into sobriety. He was at my house getting drunk and smokin' pot... but drinking was close to destroying his liver. He would be super sloppy drunk on only a few drinks. Finally I had to tell him he can't come back. He was off heroin but alcohol was a horrible substitute. Something clicked finally when I kicked him out, and a month later he was sober and working full time. The thing that helped IMO was we would keep trying *when he was ready* and not hold it against him >so he kept trying to recover until finally he did

So yea I like drinking > in his case it almost killed my friend ..every person is different as is the way they got there. Stories look similar from addict to addict but it seems there's way more to it. It's like the gun problem is a user of gun problem more than the guns themselves. Same with drinking and drugs.

Empathy and compassion are what work, if that means decriminalizing/legalizing that’s fine. Most of the criminal problems associated with drugs are because our drug are illegal. Fix that and then address the addiction problem. It’s a long row to hoe and we all stand to lose or gain a lot. What we’re doing now isn’t working.


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