4 ms·

Not to comment on the politics, but... I had fentanyl during a medical procedure a while back, and I can totally see why it's so addictive. It was wonderful. Bo

by beat 8y ago

Not to comment on the politics, but... I had fentanyl during a medical procedure a while back, and I can totally see why it's so addictive. It was wonderful. Both pain and anxiety were totally wiped out, and and the comedown was clean and fast, with no ill effects at all. It's the most pleasant drug I've ever experienced. As long as this kind of high exists, people are going to take it.

JshWright 8y ago
As a paramedic, it is absolutely a double-edged sword. It is a phenomenal tool for pain management. Used as intended it much better than other options (historically, morphine). It is not the least bit uncommon to have weeks that include administering fentanyl therapeutically for acute pain management, and administering Narcan to counteract the effect of Fentanyl taken "recreationally".
- girvo 8y ago
  I find that interesting. Heroin and morphine both have a much nicer high than Fentanyl, taking IV recreationally — at least they did for me, back when I was an addict
  - ShabbosGoy 8y ago
    I took Hydrocodone recreationally once, as I had some leftovers from my ribcage injury. Aside from enhanced dreams and occasional hypnogogia, I still didn’t really see the appeal. You can achieve the same euphoria with THC (IIRC, OPRM1 gene expression is altered upon consumption of THC). OPRM1 is an interesting gene, though. Habitual use of morphine (and other substances like alcohol, OPRM1 expression is implicated in risk-taking behavior) would create reinforcement effects and increased gene expression of OPRM1. That would lead you down the dark path of addiction.
    - girvo 8y ago
      Hydrocodone is comparatively weak, and as it’s a codeine derivative it’s at the mercy of your particular genes and how they express CYP2D6 — my girlfriend is a terrible metaboliser of it, and so a lot of narcotics don’t work very well for her. It’s fascinating stuff. Edit: also, you really can’t get the same euphoria from THC. Similar, sure, but not the same — THC doesn’t build life destroying addiction though, so definitely recommend instead!
      - ShabbosGoy 8y ago
        > Edit: also, you really can’t get the same euphoria from THC. Similar, sure, but not the same — THC doesn’t build life destroying addiction though, so definitely recommend instead! I can see that. THC feels like a “cleaner” mental euphoria to me, especially without the synergistic effects of cannabinoids like CBD and CBN. I noticed both physical and mental euphoria with Hydrocodone. Not unlike the pleasure of wearing a warm sweater and sitting by the fire on a bitingly cold winter’s day. In my case, I didn’t like the sluggishness (and itchiness!) associated with that feeling, though.
    - beat 8y ago
      Hydrocodone is deliberately weak, to the point where it's hard to get high from it. It's like comparing the pleasant burn of a sip of whiskey to getting hammered drunk. It's not really representative of a true opiate high experience.
  - JshWright 8y ago
    Using it for (other people's) pain management, I don't really care about how "nice" the high is (and I don't have any experience with it personally). The main reason I like fentanyl is that it peaks much earlier than morphine. The most common reason I administer opioids is due to a musculoskeletal injury of some sort. Often those patients would experience a significant amount of pain while being moved and loaded into the ambulance. Fentanyl acts quickly enough that it's worth it to administer it before starting to move them. With morphine that's just a waste of time. Better to get them moved and then medicate them on the way to the hospital.
    - girvo 8y ago
      I wasn’t suggesting you were :) was more discussing a tangential point. In Australia, if they are conscious they typically get them to use methoxyflurane (the “green whistle”). It’s quite nice, and very effective!
      - JshWright 8y ago
        Yeah, but it also does very unkind things to your liver and kidneys... It was never used in EMS in the United States, and surgical anesthesiologists stopped using back in the 90's. Some parts of the US do use nitrous oxide in an EMS setting though (technically it's in my protocols, but I don't know of any agencies around here that carry it).
e40 8y ago
I had nausea for 2 days following a procedure where I had it. Compared to the same procedure a few years before with Demerol, which I cleared from my system in a few hours, fentanyl was horrid.
- madengr 8y ago
  I woke up from surgery feeling great. I don’t know what anesthesia they used, but it was fucking awesome. Contrast that to 40 years ago when I woke up vomiting.
- beat 8y ago
  I took Demerol a few times as a kid, and heroin once as an adult. As an anesthetic, fentanyl was perfect. I was pain free, felt lucid, and then went right back to normal, no side effects at all. As a kid, I suffered terrible migraines, and I am old enough to predate migraine medication. My parents also suffer migraines (as do two of my three sisters, yay genetics). Dad had a Demerol prescription for his. They wouldn't give me Demerol, because it was a dangerous addictive drug. Instead, they gave me the safe, effective state of the art circa late 1970s - phenobarbitol. I'd take one, stumble to the couch, wake up 14 hours later, and not remember what happened. I'll never put that poison in my body again! (Later, as an adult, a drug counselor friend told me barbituates were the only drugs he'd seen to be more addictive than tobacco.) But if my parents needed me to be functional while fighting migraine? I got one of Dad's Demerol instead. Which was awesome, because I still had a migraine, but I didn't care anymore. I could stay awake and follow instructions and converse as needed, from my warm numb blanket of drug. Working from memory here, I was a lot more "high" on Demerol, and it lasted longer. Fentanyl was much cleaner. Best of all was the one time I tried heroin, though. Holy crap. Never touching that again. One of humanity's best and most dangerous inventions.

by beat 8y ago

JshWright 8y ago

As a paramedic, it is absolutely a double-edged sword. It is a phenomenal tool for pain management. Used as intended it much better than other options (historically, morphine). It is not the least bit uncommon to have weeks that include administering fentanyl therapeutically for acute pain management, and administering Narcan to counteract the effect of Fentanyl taken "recreationally".

girvo 8y ago
I find that interesting. Heroin and morphine both have a much nicer high than Fentanyl, taking IV recreationally — at least they did for me, back when I was an addict
- ShabbosGoy 8y ago
  I took Hydrocodone recreationally once, as I had some leftovers from my ribcage injury. Aside from enhanced dreams and occasional hypnogogia, I still didn’t really see the appeal. You can achieve the same euphoria with THC (IIRC, OPRM1 gene expression is altered upon consumption of THC). OPRM1 is an interesting gene, though. Habitual use of morphine (and other substances like alcohol, OPRM1 expression is implicated in risk-taking behavior) would create reinforcement effects and increased gene expression of OPRM1. That would lead you down the dark path of addiction.
  - girvo 8y ago
    Hydrocodone is comparatively weak, and as it’s a codeine derivative it’s at the mercy of your particular genes and how they express CYP2D6 — my girlfriend is a terrible metaboliser of it, and so a lot of narcotics don’t work very well for her. It’s fascinating stuff. Edit: also, you really can’t get the same euphoria from THC. Similar, sure, but not the same — THC doesn’t build life destroying addiction though, so definitely recommend instead!
    - ShabbosGoy 8y ago
      > Edit: also, you really can’t get the same euphoria from THC. Similar, sure, but not the same — THC doesn’t build life destroying addiction though, so definitely recommend instead! I can see that. THC feels like a “cleaner” mental euphoria to me, especially without the synergistic effects of cannabinoids like CBD and CBN. I noticed both physical and mental euphoria with Hydrocodone. Not unlike the pleasure of wearing a warm sweater and sitting by the fire on a bitingly cold winter’s day. In my case, I didn’t like the sluggishness (and itchiness!) associated with that feeling, though.
  - beat 8y ago
    Hydrocodone is deliberately weak, to the point where it's hard to get high from it. It's like comparing the pleasant burn of a sip of whiskey to getting hammered drunk. It's not really representative of a true opiate high experience.
- JshWright 8y ago
  Using it for (other people's) pain management, I don't really care about how "nice" the high is (and I don't have any experience with it personally). The main reason I like fentanyl is that it peaks much earlier than morphine. The most common reason I administer opioids is due to a musculoskeletal injury of some sort. Often those patients would experience a significant amount of pain while being moved and loaded into the ambulance. Fentanyl acts quickly enough that it's worth it to administer it before starting to move them. With morphine that's just a waste of time. Better to get them moved and then medicate them on the way to the hospital.
  - girvo 8y ago
    I wasn’t suggesting you were :) was more discussing a tangential point. In Australia, if they are conscious they typically get them to use methoxyflurane (the “green whistle”). It’s quite nice, and very effective!
    - JshWright 8y ago
      Yeah, but it also does very unkind things to your liver and kidneys... It was never used in EMS in the United States, and surgical anesthesiologists stopped using back in the 90's. Some parts of the US do use nitrous oxide in an EMS setting though (technically it's in my protocols, but I don't know of any agencies around here that carry it).

e40 8y ago

I had nausea for 2 days following a procedure where I had it. Compared to the same procedure a few years before with Demerol, which I cleared from my system in a few hours, fentanyl was horrid.

madengr 8y ago
I woke up from surgery feeling great. I don’t know what anesthesia they used, but it was fucking awesome. Contrast that to 40 years ago when I woke up vomiting.
beat 8y ago
I took Demerol a few times as a kid, and heroin once as an adult. As an anesthetic, fentanyl was perfect. I was pain free, felt lucid, and then went right back to normal, no side effects at all. As a kid, I suffered terrible migraines, and I am old enough to predate migraine medication. My parents also suffer migraines (as do two of my three sisters, yay genetics). Dad had a Demerol prescription for his. They wouldn't give me Demerol, because it was a dangerous addictive drug. Instead, they gave me the safe, effective state of the art circa late 1970s - phenobarbitol. I'd take one, stumble to the couch, wake up 14 hours later, and not remember what happened. I'll never put that poison in my body again! (Later, as an adult, a drug counselor friend told me barbituates were the only drugs he'd seen to be more addictive than tobacco.) But if my parents needed me to be functional while fighting migraine? I got one of Dad's Demerol instead. Which was awesome, because I still had a migraine, but I didn't care anymore. I could stay awake and follow instructions and converse as needed, from my warm numb blanket of drug. Working from memory here, I was a lot more "high" on Demerol, and it lasted longer. Fentanyl was much cleaner. Best of all was the one time I tried heroin, though. Holy crap. Never touching that again. One of humanity's best and most dangerous inventions.