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I'm seeing a lot of nonsense in this thread and I'd just like to point out a few things that seem to be commonly misunderstood and misrepresented by the media:

by janhle 8y ago

I'm seeing a lot of nonsense in this thread and I'd just like to point out a few things that seem to be commonly misunderstood and misrepresented by the media: - Fentanyl is only more dangerous than heroin because it is not properly prepared. This means the dilution is not homogeneous, and users unexpectedly come across a stronger dose or batch. - If properly prepared, fentanyl is safer than heroin. Its therapeutic index is 400 vs 70 for heroin (this measures the ratio between active dose and toxic dose). Proper preparation means diluting it so that users can take a dose similar to heroin for the same effects. With correctly diluted fentanyl, users have a wider margin of error before an overdose. Dilution is never done as a last step by the user, it's done in labs that prepare large amounts of the drug. - For addicts, the ritual is the same for both drugs. The feeling is mostly the same, but lasts a little shorter for fentanyl. The addiction potential being higher for one or the other is disputable. - Once again, it having a lower active dose ("stronger") does not make it inherently more dangerous. It just makes dilution more technical, and this is where the problem comes from. Edit: Of course, I am in no way defending recreational use of the drug. Like all opioids, it's very addictive and can easily lead to a self-destructive habit. And with recreational users, overdoses will probably happen even with a perfectly diluted batch.

refurb 8y ago
Indeed. Fentanyl is used thousands of times per day in the medical setting because it is a safe drug. I do agree that the potency makes preparation difficult. Few dealers have the equipment to either accurately weigh it out or dilute it such that the product is homogenous. When you move up to even more potent opioids like carfentanyl or sufentanyl, the risk is even higher. Who has the ability to accurately weigh out 0.030 mg? That said, dying of a “hot dose” of heroin is not exactly uncommon either. Interestingly, opioids are toxic at high doses as they depress the breathing response to blood CO2 levels. If someone overdosed and you breath for them (CPR or ventilator), you can just wait for the effects to wear off and they’ll be none the worse for wear. I’ve read case reports where a users friends maintain CPR for an hour plus until they started breathing on their own.
- VectorLock 8y ago
  >I’ve read case reports where a users friends maintain CPR for an hour plus until they started breathing on their own. Were they doing CPR or Rescue Breathing or both? I'm not a doctor but an hour of chest compressions to someone with a functioning heart seems bad.
  - refurb 8y ago
    Sorry! You are right, not CPR. Just rescue breathing!
- jacques_chester 8y ago
  > Indeed. Fentanyl is used thousands of times per day in the medical setting because it is a safe drug. It's the painkiller I was given in the recovery room after a shoulder surgery and let me tell you, I can see why folks would grow fond of that feeling. There followed possibly the best nap of my life.
  - csours 8y ago
    Likewise for a small procedure I had done.
  - KitDuncan 8y ago
    Off topic, but it's insane to me, people in the US get opioids for small surgeries. Here in Germany I had a motorcycle accident resulting in multiple (around 12) face fractures and later I had to get an incredibly painful eye surgery and both times I was given large doses of ibuprofen for the pain (which didn't do much). At the time I wished for better painkillers, but maybe it's actually better that way...
    - DanBC 8y ago
      Opioids are probably ok for short term pain like surgery, where they're given by healthcare professionals in a medical setting. A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. They then have some opioids spare which they keep insecurely in a cupboard. A relative or neighbour gains access to these and starts their addiction.
GordonS 8y ago
The first 3 points you make are technically correct, but I think the point is that fentanyl is so potent that it's difficult to correctly prepare (dilute) safely. Of course, it can be done in a professional pharmaceutical setting, but that's not necessarily where the fentanyl bound for the darknet is prepared.
- deleted 8y ago
  [deleted]
sintaxi 8y ago
Facts and Truth are not entirely the same thing. To property discuss the dangers of Fentanyl we must first agree on what "safe" means. Even though Fentanyl is unlikely to kill you, in terms of living a meaningful and fulfilling life an addition to fentanyl is effectively a death sentence and it is highly addictive, affordable, and readily available. Fentanyl is destroying families and crippling our social services.
- janhle 8y ago
  Your comment is a bit hard to interpret, but maybe you're saying that compared to other opioids, fentanyl could be more damaging to society because it's cheaper. Which might be a good point. In my original comment, I only focused on the pharmacology because that's what I know, but approaching the topic with a broader perspective is important.
forapurpose 8y ago
How does a reader know that these statements are accurate and others are the misunderstandings or misrepresentations? Are you a pharmacologist? A fentanyl user?
- peteretep 8y ago
  They’re trivially confirmed with a bit of Googling?
mabbo 8y ago
So would it be fair to make the analogy that fentanyl is to heroin as vodka is to wine? Vodka is much stronger, and you can accidentally make a mixed drink that will knock your socks off. Wine has a large range of potency amounts, but is generally less potent. The answer for alcohol is that, in most countries, every dose of it has the exact active ingredient ratio listed, accurately.
- peteretep 8y ago
  No. Fentanyl is 25-50 times stronger than Heroin, where Vodka is 3-4 times stronger than wine. If you drank a glass of wine and discovered it was 3-4 times stronger than you expected, that would suck. If you drank a bottle of wine, and it was 3-4 times stronger, you’d be in a lot of trouble, but you’d probably live. 25 to 50 times stronger? You’re fucked.
  - bdcravens 8y ago
    The closest you could get would be something like Everclear (which is more like 8x - swig that like wine you're in a LOT of hurt, and maybe in hospital, but not fucked)
    - TheGrumpyBrit 8y ago
      Everclear is around 95%, so it would be more like drinking Everclear when you were expecting a 4% beer. And given the difference between medical and recreational doses, it would be like having 5-6 beers, all at 95%. That would probably leave you pretty fucked.
DanBC 8y ago
> Dilution is never done as a last step by the user, it's done in labs that prepare large amounts of the drug. People with substance misuse disorders aren't using medical grade fentanyl that is pre-diluted, they're using illicit fentanyl made in mexico. People are smuggling fentanyl in because it's easily available, and because it's so small it's easier to smuggle, and because it's much more profitable than heroin. The product entering the US is undiluted, and it's the dark web dealers or their customers who are doing the dilution.
bdcravens 8y ago
I had thumb surgery earlier this year, and just after I came to, the nurse told me they were giving me fentanyl. I recall being a little worried based on all the press I heard. Miraculously, that one dose didn't cause me to go into cardiac arrest, and I'm proud to say I'm not an opioid junky today.

by janhle 8y ago

refurb 8y ago

Indeed. Fentanyl is used thousands of times per day in the medical setting because it is a safe drug. I do agree that the potency makes preparation difficult. Few dealers have the equipment to either accurately weigh it out or dilute it such that the product is homogenous. When you move up to even more potent opioids like carfentanyl or sufentanyl, the risk is even higher. Who has the ability to accurately weigh out 0.030 mg? That said, dying of a “hot dose” of heroin is not exactly uncommon either. Interestingly, opioids are toxic at high doses as they depress the breathing response to blood CO2 levels. If someone overdosed and you breath for them (CPR or ventilator), you can just wait for the effects to wear off and they’ll be none the worse for wear. I’ve read case reports where a users friends maintain CPR for an hour plus until they started breathing on their own.

VectorLock 8y ago
>I’ve read case reports where a users friends maintain CPR for an hour plus until they started breathing on their own. Were they doing CPR or Rescue Breathing or both? I'm not a doctor but an hour of chest compressions to someone with a functioning heart seems bad.
- refurb 8y ago
  Sorry! You are right, not CPR. Just rescue breathing!
jacques_chester 8y ago
> Indeed. Fentanyl is used thousands of times per day in the medical setting because it is a safe drug. It's the painkiller I was given in the recovery room after a shoulder surgery and let me tell you, I can see why folks would grow fond of that feeling. There followed possibly the best nap of my life.
- csours 8y ago
  Likewise for a small procedure I had done.
- KitDuncan 8y ago
  Off topic, but it's insane to me, people in the US get opioids for small surgeries. Here in Germany I had a motorcycle accident resulting in multiple (around 12) face fractures and later I had to get an incredibly painful eye surgery and both times I was given large doses of ibuprofen for the pain (which didn't do much). At the time I wished for better painkillers, but maybe it's actually better that way...
  - DanBC 8y ago
    Opioids are probably ok for short term pain like surgery, where they're given by healthcare professionals in a medical setting. A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. They then have some opioids spare which they keep insecurely in a cupboard. A relative or neighbour gains access to these and starts their addiction.

GordonS 8y ago

The first 3 points you make are technically correct, but I think the point is that fentanyl is so potent that it's difficult to correctly prepare (dilute) safely. Of course, it can be done in a professional pharmaceutical setting, but that's not necessarily where the fentanyl bound for the darknet is prepared.

deleted 8y ago
[deleted]

sintaxi 8y ago

Facts and Truth are not entirely the same thing. To property discuss the dangers of Fentanyl we must first agree on what "safe" means. Even though Fentanyl is unlikely to kill you, in terms of living a meaningful and fulfilling life an addition to fentanyl is effectively a death sentence and it is highly addictive, affordable, and readily available. Fentanyl is destroying families and crippling our social services.

janhle 8y ago
Your comment is a bit hard to interpret, but maybe you're saying that compared to other opioids, fentanyl could be more damaging to society because it's cheaper. Which might be a good point. In my original comment, I only focused on the pharmacology because that's what I know, but approaching the topic with a broader perspective is important.

forapurpose 8y ago

How does a reader know that these statements are accurate and others are the misunderstandings or misrepresentations? Are you a pharmacologist? A fentanyl user?

peteretep 8y ago
They’re trivially confirmed with a bit of Googling?

mabbo 8y ago

So would it be fair to make the analogy that fentanyl is to heroin as vodka is to wine? Vodka is much stronger, and you can accidentally make a mixed drink that will knock your socks off. Wine has a large range of potency amounts, but is generally less potent. The answer for alcohol is that, in most countries, every dose of it has the exact active ingredient ratio listed, accurately.

peteretep 8y ago
No. Fentanyl is 25-50 times stronger than Heroin, where Vodka is 3-4 times stronger than wine. If you drank a glass of wine and discovered it was 3-4 times stronger than you expected, that would suck. If you drank a bottle of wine, and it was 3-4 times stronger, you’d be in a lot of trouble, but you’d probably live. 25 to 50 times stronger? You’re fucked.
- bdcravens 8y ago
  The closest you could get would be something like Everclear (which is more like 8x - swig that like wine you're in a LOT of hurt, and maybe in hospital, but not fucked)
  - TheGrumpyBrit 8y ago
    Everclear is around 95%, so it would be more like drinking Everclear when you were expecting a 4% beer. And given the difference between medical and recreational doses, it would be like having 5-6 beers, all at 95%. That would probably leave you pretty fucked.

DanBC 8y ago

> Dilution is never done as a last step by the user, it's done in labs that prepare large amounts of the drug. People with substance misuse disorders aren't using medical grade fentanyl that is pre-diluted, they're using illicit fentanyl made in mexico. People are smuggling fentanyl in because it's easily available, and because it's so small it's easier to smuggle, and because it's much more profitable than heroin. The product entering the US is undiluted, and it's the dark web dealers or their customers who are doing the dilution.

bdcravens 8y ago

I had thumb surgery earlier this year, and just after I came to, the nurse told me they were giving me fentanyl. I recall being a little worried based on all the press I heard. Miraculously, that one dose didn't cause me to go into cardiac arrest, and I'm proud to say I'm not an opioid junky today.