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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 (historic

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).

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).