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This is the most unsettling HN comment ever. Thank you for sharing it.

zappo2938 9y ago
The most unsettling moment of the whole situation is when I first had the operation and the doctor handing me the consent form says that the procedure itself kills 1 in 400 people. I said those odds are shitty thinking about the one time I had 4 aces in Texas Hold'em and lost to a royal flush and all the other times I had a bad beat. The doctor said for someone off the street those are bad odds but my odds of surviving without the procedure are probably much worse. I didn't have any family there with me. My friends had no idea that I was in that situation. I was a chef for a long time and said what I would say to the cooks before a busy night. We are all human, we all make mistakes, I just ask you do your personal best. I survived. The feeling I had on fentanyl under those conditions was the same the night I was in the hot baths at Esalon looking at the expansive milky way while the waves crashed on the rocks below. Awe and wonder and it's all ok.
- blubb-fish 9y ago
  Reminds me of the way too few times I felt during or after meditating.
- emmelaich 9y ago
  Great comments but > 4 aces in Texas Hold'em and lost to a royal flush is not possible. Maybe four nines? Or a (non-royal) straight flush.
  - zappo2938 9y ago
    Maybe it is one of those things where I should take Bill Murray's advice and I can't tell anyone because nobody is going to believe me. It is possible at 1 in 165 million odds. http://imgur.com/a/Kb9Oa http://imgur.com/a/Kb9Oa
    - emmelaich 9y ago
      Ah yeah oops my bad.
microcolonel 9y ago
How is this unsettling? They didn't develop Fentanyl to make people's lives worse, they developed it to relieve severe pain and prevent dangerous instinctive reactions to surgeries like these; most of the time that Fentanyl is used, it is used for the right reasons. The oral version is purportedly amazing, it is basically an off switch for pain, exactly the sort of thing you'll want if some day you get shot or stabbed, or fall over onto a hard surface and break something. Sometimes the brain is not well equipped to handle exceptional scenarios which none of our ancestors would have survived anyway. For those scenarios, there's Fentanyl.
- zdkl 9y ago
  The scenarios you describe are excellent use cases for Ketamine which is an incredibly strong hypnotic. French EMT-equivalents use it for severe out-of-hospital cases while opioid derivates are used for diagnosed, chronic needs. What are the economics or pharmacology that make fent apparently widely used in US medicine?
  - microcolonel 9y ago
    > What are the economics or pharmacology that make fent apparently widely used in US medicine? Let me say that I am not qualified to answer that directly, but I can point to some things that I am led to believe. > French EMT-equivalents use it for severe out-of-hospital cases while opioid derivates are used for diagnosed, chronic needs. First of all, I don't think EMTs are regularly administering fentanyl at the scene. I could be wrong about that. Ketamine can keep producing (a very wide range of) primary and side effects for a good 24 hours after it's administered, whereas with Fentanyl you get a lot more control since it comes on and wears off rather quickly. I know people who have used Ketamine recreationally, and the types of intense hallucinations they report seem like they would be pretty incompatible with restraints or some forms of surgery. Other than that, I think the U.S. seems to have deployed it more quickly because the patients and their insurers are not as cost sensitive as in single payer systems. Common forms of Ketamine are not new to anyone, whereas the most common fentanyl products are from the '90s or later. People say Americans pay a lot for health care, and this is true, but they also get most of the cool new toys, drugs, and procedures first; and so take the first-mover advantages with the first-mover disadvantages. That said, I don't think the (local) medical uses of fentanyl are particularly important to the abuse problem. I live in Canada, and I don't think we use fentanyl medically as much, but there's a lot of it on the street. It seems to be mostly coming from independent producers rather than theft or fraud against the pharmaceutical companies that package it for use in the U.S. and Canada.
rm_-rf_slash 9y ago
If it makes you feel any better I had fentanyl administered as a part of an endoscopy, but because it was paired with an amnesia drug (used to keep me from moving, as I was awake but unaware during the procedure), I have no memory of its effects, and obviously no desire to use it or any other opioid, so fentanyl is not exactly an absolute evil that latches into your brain and never legs go regardless of the circumstances. Still, lot of heroin addicts around where I live. Most you wouldn't even recognize as addicts, but they're there.
- JauntTrooper 9y ago
  My wife was given fentanyl during childbirth. They sent it directly into her spine via the epidural. Apparently it's a common use.

The most unsettling moment of the whole situation is when I first had the operation and the doctor handing me the consent form says that the procedure itself kills 1 in 400 people. I said those odds are shitty thinking about the one time I had 4 aces in Texas Hold'em and lost to a royal flush and all the other times I had a bad beat. The doctor said for someone off the street those are bad odds but my odds of surviving without the procedure are probably much worse. I didn't have any family there with me. My friends had no idea that I was in that situation. I was a chef for a long time and said what I would say to the cooks before a busy night. We are all human, we all make mistakes, I just ask you do your personal best. I survived. The feeling I had on fentanyl under those conditions was the same the night I was in the hot baths at Esalon looking at the expansive milky way while the waves crashed on the rocks below. Awe and wonder and it's all ok.

blubb-fish 9y ago
Reminds me of the way too few times I felt during or after meditating.
emmelaich 9y ago
Great comments but > 4 aces in Texas Hold'em and lost to a royal flush is not possible. Maybe four nines? Or a (non-royal) straight flush.
- zappo2938 9y ago
  Maybe it is one of those things where I should take Bill Murray's advice and I can't tell anyone because nobody is going to believe me. It is possible at 1 in 165 million odds. http://imgur.com/a/Kb9Oa http://imgur.com/a/Kb9Oa
  - emmelaich 9y ago
    Ah yeah oops my bad.

microcolonel 9y ago

How is this unsettling? They didn't develop Fentanyl to make people's lives worse, they developed it to relieve severe pain and prevent dangerous instinctive reactions to surgeries like these; most of the time that Fentanyl is used, it is used for the right reasons. The oral version is purportedly amazing, it is basically an off switch for pain, exactly the sort of thing you'll want if some day you get shot or stabbed, or fall over onto a hard surface and break something. Sometimes the brain is not well equipped to handle exceptional scenarios which none of our ancestors would have survived anyway. For those scenarios, there's Fentanyl.

zdkl 9y ago
The scenarios you describe are excellent use cases for Ketamine which is an incredibly strong hypnotic. French EMT-equivalents use it for severe out-of-hospital cases while opioid derivates are used for diagnosed, chronic needs. What are the economics or pharmacology that make fent apparently widely used in US medicine?
- microcolonel 9y ago
  > What are the economics or pharmacology that make fent apparently widely used in US medicine? Let me say that I am not qualified to answer that directly, but I can point to some things that I am led to believe. > French EMT-equivalents use it for severe out-of-hospital cases while opioid derivates are used for diagnosed, chronic needs. First of all, I don't think EMTs are regularly administering fentanyl at the scene. I could be wrong about that. Ketamine can keep producing (a very wide range of) primary and side effects for a good 24 hours after it's administered, whereas with Fentanyl you get a lot more control since it comes on and wears off rather quickly. I know people who have used Ketamine recreationally, and the types of intense hallucinations they report seem like they would be pretty incompatible with restraints or some forms of surgery. Other than that, I think the U.S. seems to have deployed it more quickly because the patients and their insurers are not as cost sensitive as in single payer systems. Common forms of Ketamine are not new to anyone, whereas the most common fentanyl products are from the '90s or later. People say Americans pay a lot for health care, and this is true, but they also get most of the cool new toys, drugs, and procedures first; and so take the first-mover advantages with the first-mover disadvantages. That said, I don't think the (local) medical uses of fentanyl are particularly important to the abuse problem. I live in Canada, and I don't think we use fentanyl medically as much, but there's a lot of it on the street. It seems to be mostly coming from independent producers rather than theft or fraud against the pharmaceutical companies that package it for use in the U.S. and Canada.

rm_-rf_slash 9y ago

If it makes you feel any better I had fentanyl administered as a part of an endoscopy, but because it was paired with an amnesia drug (used to keep me from moving, as I was awake but unaware during the procedure), I have no memory of its effects, and obviously no desire to use it or any other opioid, so fentanyl is not exactly an absolute evil that latches into your brain and never legs go regardless of the circumstances. Still, lot of heroin addicts around where I live. Most you wouldn't even recognize as addicts, but they're there.

JauntTrooper 9y ago
My wife was given fentanyl during childbirth. They sent it directly into her spine via the epidural. Apparently it's a common use.