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most black market fentanyl does not come from diverted prescriptions. the only thing this would do would be to prevent physicians prescribing fentanyl in cases

most black market fentanyl does not come from diverted prescriptions. the only thing this would do would be to prevent physicians prescribing fentanyl in cases where it's the ideal drug for pain management.

phkahler 6y ago
I dont think it's ever the ideal drug for pain management. Its fast acting and short duration, not ideal for chronic pain. Those characteristics also make it more addictive. There were drugs for pain management before and nobody complained about them not being good enough. There would not be much of a black market for it if physicians and pharma were not getting people addicted.
- leetcrew 6y ago
  > I dont think it's ever the ideal drug for pain management. this is a bold claim to make. it's worth having a wide range of drugs in a particular class, because they all have different side effect profiles and will affect individual patients differently. the short duration makes it ideal for use as an anesthetic, for instance. it is also safer than many of the older opioids, in the sense that the difference between an effective and lethal dose is much larger. when the short duration is not desired, this can be easily fixed with a time release mechanism. the main danger with fentanyl is it's high potency by weight. this is not an issue in a controlled medical setting, nor with the transdermal patches that are typically used in outpatient. > There would not be much of a black market for it if physicians and pharma were not getting people addicted. this reflects a misunderstanding of the psychology of addicts imo. the exact opioid is usually fungible to an addict; they want whatever gets them the most high for the least money. they probably have a favorite, but you rarely hear of people who specifically seek out fentanyl. in other words, I don't think there are many people who are addicted to fentanyl specifically.
- proverbialbunny 6y ago
  The problem is fentanyl is super cheap to make, so it's used as a filler in other opioid based drugs on the street right now. Problem is the OD threshold is so low, you don't know if you're going to get super weak heroin or heroin that will kill you when taking a quarter of your normal dose. Because of this people start defaulting to buying fentanyl, not because it's better, but because they have no other option. These are the kind of people who aren't smart enough or well enough to get a prescription of what they need, so they have to turn to the streets. In the 1950s there was an antidepressant that worked on the kind of depression today we call treatment-resistant depression. You can still get it prescribed, but it's a pain in the ass, because it's opioid based. It's a long lasting 12 or 24 hour patch that normalizes the persons pain and emotional state. It doesn't get them high but it normalizes them. It's not ideal for physical pain, but for most forms of mental pain, which is why many turn to the street, it is ideal. These people should be getting prescribed with this, but they don't know about it and getting it is near impossible because of the stigma. Every new iteration of drug is worse than the last. People were not out in the street shooting up when the drug war started, but before the drug war heroin was easy for anyone to obtain. They had better tools then. As counter intuitive as it is, the drug war created this mess.

phkahler 6y ago

I dont think it's ever the ideal drug for pain management. Its fast acting and short duration, not ideal for chronic pain. Those characteristics also make it more addictive. There were drugs for pain management before and nobody complained about them not being good enough. There would not be much of a black market for it if physicians and pharma were not getting people addicted.

leetcrew 6y ago
> I dont think it's ever the ideal drug for pain management. this is a bold claim to make. it's worth having a wide range of drugs in a particular class, because they all have different side effect profiles and will affect individual patients differently. the short duration makes it ideal for use as an anesthetic, for instance. it is also safer than many of the older opioids, in the sense that the difference between an effective and lethal dose is much larger. when the short duration is not desired, this can be easily fixed with a time release mechanism. the main danger with fentanyl is it's high potency by weight. this is not an issue in a controlled medical setting, nor with the transdermal patches that are typically used in outpatient. > There would not be much of a black market for it if physicians and pharma were not getting people addicted. this reflects a misunderstanding of the psychology of addicts imo. the exact opioid is usually fungible to an addict; they want whatever gets them the most high for the least money. they probably have a favorite, but you rarely hear of people who specifically seek out fentanyl. in other words, I don't think there are many people who are addicted to fentanyl specifically.
proverbialbunny 6y ago
The problem is fentanyl is super cheap to make, so it's used as a filler in other opioid based drugs on the street right now. Problem is the OD threshold is so low, you don't know if you're going to get super weak heroin or heroin that will kill you when taking a quarter of your normal dose. Because of this people start defaulting to buying fentanyl, not because it's better, but because they have no other option. These are the kind of people who aren't smart enough or well enough to get a prescription of what they need, so they have to turn to the streets. In the 1950s there was an antidepressant that worked on the kind of depression today we call treatment-resistant depression. You can still get it prescribed, but it's a pain in the ass, because it's opioid based. It's a long lasting 12 or 24 hour patch that normalizes the persons pain and emotional state. It doesn't get them high but it normalizes them. It's not ideal for physical pain, but for most forms of mental pain, which is why many turn to the street, it is ideal. These people should be getting prescribed with this, but they don't know about it and getting it is near impossible because of the stigma. Every new iteration of drug is worse than the last. People were not out in the street shooting up when the drug war started, but before the drug war heroin was easy for anyone to obtain. They had better tools then. As counter intuitive as it is, the drug war created this mess.