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>The damages from the opioid epidemic are almost entirely due to the unpredictable quality of street drugs and, especially, the resulting fentanyl overdoses. W

>The damages from the opioid epidemic are almost entirely due to the unpredictable quality of street drugs and, especially, the resulting fentanyl overdoses. Wow. I knew the unpredictable quality was bad, but didn't know that the damages were almost entirely due to them. Any chance you have a source there?

kragen 7y ago
I dug around trying to find the link to the study I'd seen, but I haven't been able to. I'd be much obliged if you could share whatever links you dig up.
- elliekelly 7y ago
  It's not exactly on point but this comment[1] from HN user UglyToad links to a Guardian article[2] that mentions several studies. The article is specific to Heroin, not Fentanyl, but (admittedly knowing nothing about street drugs) I think they're quite similar, chemically. [1] https://news.ycombinator.com/item?id=21270553 https://news.ycombinator.com/item?id=21270553 [2] https://www.theguardian.com/politics/2001/jun/14/drugsandalcohol.socialsciences https://www.theguardian.com/politics/2001/jun/14/drugsandalc...
  - kragen 7y ago
    The issue with fentanyl is that it's much more powerful than heroin, in the sense that the dose to reach a given effect is much smaller. This makes it much harder to prevent the smuggling of, but also means that insufficient mixing can give you a fatal overdose much more easily. I don't know if heroin has a safer therapeutic index than fentanyl. Possibly. The Grauniad article is correct about the relatively low risks of properly prepared heroin and the dangers of adulteration. I wouldn't be confident that fentanyl in properly prepared doses is equally safe; it might be safer or less safe, but the major difference is in ease of smuggling, which is associated with lack of accountability. The article mentions amphetamine briefly in an unjustified aside: "It is the same with black-market amphetamines: speed alone may not kill, but speed with a blindfold is highly likely to finish you off." The truth is that amphetamine is fairly safe at therapeutic doses—safer than many common psychiatric drugs, anyway—but at the much higher recreational doses, it reliably generates progressive damage to multiple organs, including the brain. This is not a problem shared by the opiates, aside from the much milder constipation problem. I had seen somewhere an empirical study comparing deaths from prescription opiates and black-market opiates. I'd like to find it again.

kragen 7y ago

I dug around trying to find the link to the study I'd seen, but I haven't been able to. I'd be much obliged if you could share whatever links you dig up.

elliekelly 7y ago
It's not exactly on point but this comment[1] from HN user UglyToad links to a Guardian article[2] that mentions several studies. The article is specific to Heroin, not Fentanyl, but (admittedly knowing nothing about street drugs) I think they're quite similar, chemically. [1] https://news.ycombinator.com/item?id=21270553 https://news.ycombinator.com/item?id=21270553 [2] https://www.theguardian.com/politics/2001/jun/14/drugsandalcohol.socialsciences https://www.theguardian.com/politics/2001/jun/14/drugsandalc...
- kragen 7y ago
  The issue with fentanyl is that it's much more powerful than heroin, in the sense that the dose to reach a given effect is much smaller. This makes it much harder to prevent the smuggling of, but also means that insufficient mixing can give you a fatal overdose much more easily. I don't know if heroin has a safer therapeutic index than fentanyl. Possibly. The Grauniad article is correct about the relatively low risks of properly prepared heroin and the dangers of adulteration. I wouldn't be confident that fentanyl in properly prepared doses is equally safe; it might be safer or less safe, but the major difference is in ease of smuggling, which is associated with lack of accountability. The article mentions amphetamine briefly in an unjustified aside: "It is the same with black-market amphetamines: speed alone may not kill, but speed with a blindfold is highly likely to finish you off." The truth is that amphetamine is fairly safe at therapeutic doses—safer than many common psychiatric drugs, anyway—but at the much higher recreational doses, it reliably generates progressive damage to multiple organs, including the brain. This is not a problem shared by the opiates, aside from the much milder constipation problem. I had seen somewhere an empirical study comparing deaths from prescription opiates and black-market opiates. I'd like to find it again.