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The study mentioned makes no effort to show causation. And the correlation can very easily be backwards. In fact, its more likely backwards. Counties which ar
by rhaway84773 4y ago
The study mentioned makes no effort to show causation.
And the correlation can very easily be backwards. In fact,
its more likely backwards.
Counties which are facing an increasing barrage of opioids and all the issues related to it, especially spread of disease and an increase in deaths due to unsafe use are almost certainly
more likely to create safe needle exchanges.
For the economist to write this article as if causation is established, and further to moralize is insane.
Especially since the Economist famously doesn’t provide bylines so this becomes the official view of the magazine as opposed to a specific editor’s.
And finally, even if the causation is correct, all it indicates is that needle exchange programs need to also provide drug testing capabilities so the presence of fentanyl can easily be identified.
- vorpalhex 4y agoYou're assuming the fentanyl is accidental, not intended.
- htag 4y agoI agree with most of what you said, but I think one line is out of touch. > And finally, even if the causation is correct, all it indicates is that needle exchange programs need to also provide drug testing capabilities so the presence of fentanyl can easily be identified. This assumes that there are no individuals that are knowingly injecting fentanyl or that a drug user would not take drugs in their possession if they knew it contained fentanyl. Yes, there are individuals that unknowingly take a fentanyl containing substance but I am doubtful that those deepest in opioid addiction avoid it.
- ThrowawayTestr 4y agoFentanyl is not a pleasurable drug. Someone buying heroin wants heroin, not a drug that will just knock them out or kill them.
- xyzzyz 4y agoThis is wrong. There is no heroin anymore, only fentanyl. The addicts know what they are getting.
- jeffreyrogers 4y agoYou're getting downvoted but I have heard the same thing directly from addicts. And many prefer fentanyl.
- deleted 4y ago[deleted]
- ROTMetro 4y agoWhy is this being downvoted? I'd expand it to almost all pills are now just mexi's being called 'xyz' as well. Dudes are just ordering fentanyl analogs off the web from China, testing it on themselves so they don't get hit for selling bunk work, then moving it. If you are desperate and addicted yourself this route is preferred to sketchy alternatives and dealing with super scary individuals. Your biggest risk of getting caught isn't the trafficking but people so easily dying sticking you with a case with a body on it. The reverse opium war has begun with China but no one wants to talk about it. Over half the dudes I did time with with drug charges went this route and got it all over the intermail/international shipping vs cartel and the only reason a case would get strong enough to convict was if it got a body put on it.
- throwaway82388 4y agoThat is a reasonable assumption, however, many opioid users deliberately use fentanyl. https://www.sciencedirect.com/science/article/abs/pii/S095539592100308X https://www.sciencedirect.com/science/article/abs/pii/S09553...
- rhaway84773 4y agoThat’s interesting. I had no idea that was the case. That being said, a needle exchange program could always require the testing of fentanyl and if fentanyl is found decline service. So the people who apparently want fentanyl and are encouraged by the needle exchange programs would not have them as an incentive anyways.
- rhaway84773 4y agoTo be clear, I think the research is excellent and important. My problem is with the spin the Economist puts on it (and it’s always more egregious with the economist because of the lack of a byline). The Economist predisposes it’s readers to believe that this indicates needle exchange programs are bad, as opposed to leaving open the possibility that due to changing circumstances needle exchange programs which have proven to be extremely successful, also need to adapt, much like every other individual, program, company or non-profit at any time.
- throwaway82388 4y agoOne thing is clear: the problem—the problems—are too multivariate for any one solution. Programs like these are triage, the root causes are distant and largely unaddressed.
- hotpotamus 4y agoThe only opioid I've ever taken was fentanyl when I had my wisdom teeth taken out. I highly recommend it if it's an option, and frankly there are many calls I've been on where I wish that sedation was available.
- newaccount74 4y agoI got a local anesthetic and Ibuprofen when my wisdom teeth were taken out. Worked fine. I don't understand why doctors are still so quick to prescribe opioids.
- jeffbee 4y agoYeah I don’t get that either. I took a Motrin after I got my teeth removed and I gave the Vicodin to my friends. And these days Vicodin looks like Pez because the dentists are dealing fentanyl for reasons nobody can understand.
- saltcured 4y agoHaving wisdom teeth removed can range from a simple tooth extraction to invasive oral surgery. In the heavier cases, a flap of gum tissue and covering jaw bone are cut away to expose a submerged tooth that is oriented the wrong way. The tooth is then demolished in place so that the chunks can be lifted out. The patient would be sedated during this procedure, and the wound and recovery period is significantly different.
- effingwewt 4y agoI had impacted (the aforementioned submerged and inward-facing) wisdom teeth- one of which had fractured from the pressure. Went from fine one day with the caveat that one day I'd need oral surgery to have them removed, to burning with a fever while finding an oral surgeon ASAP. Needed invasive oral surgery. Had to be put under twice-once before operation, and once when bringing me out after, as I had a paradoxical reaction and was thrashing about. Me screaming I didn't know the surgeon and anesthesiologist and thrashing about isn't super good after oral surgery. Hurt like the dickens afterwards and had to eat soup for a good while. They gave me ibuprofen and tylenol with codeine afterwards. I only used the ibuprofen and was fine. It only blunted the pain but was definitely manageable after the first day or so. I've had doctors try and prescribe narcotics for some weird things. I've always denied them as I had a friend who became addicted to heroin after being prescribed oxys for serious 3rd degree burns. Every time I have to deny narcotics multiple times before they relent and offer something non-narcotic. Anyways just one person's experience.
- refurb 4y agoThis isn’t correct. Fentanyl is definitely a pleasurable drug just like heroin, morphine, oxycodone. Users often have preferences for which is most pleasurable, but nobody would say fentanyl doesn’t get you high.
- d0mine 4y ago«SEPs increase rates of opioid-related mortality» is a direct quote from the study. https://news.ycombinator.com/item?id=33845544 https://news.ycombinator.com/item?id=33845544
- theptip 4y agoThe paper opens with a discussion of causation. > the data from the studies included in the aforementioned literature reviews (i.e. General Accounting Office (1993); World Health Organization (2004)) rely on small sample sizes and self-reported data regarding individ- uals’ drug use, and do not typically consider attrition nor spillover effects on those not directly treated. Additionally, many studies use data from Canada, Sweden, or New Zealand to serve as a comparison group for drug rates in the US. Such methods are problematic for addressing causality, given that other developed countries have differing policies on the operations of SEPs and greater access to substance abuse treatment.1 I overcome these existing limitations by cre- ating a novel dataset that combines information on SEP opening dates with restricted administrative county-level data on HIV diagnoses. These data proxy for drug use without relying on self-reporting behavior, and are representative of counties across the US. It’s using newly-opened SEPs for a discontinuity analysis, which does provide evidence of causation (and furthermore notes that previous studies were correlational).
- iudqnolq 4y agoI'm probably missing something, but about 2/3 of the time I see discontinuity analysis it seems obviously wrong in a stupid way. Your parent comment said they expected counties facing a crisis to open SEPs. That would be a newly opened SEP caused by drug deaths. So how does using newly-opened SEPs for discontinuity analysis make any sense at all?
- theptip 4y agoWell, have a look at the paper and let us know how this one is obviously wrong. It was linked elsewhere in the thread, but here it is: https://apackham.github.io/mywebsite/opioidpaper_webcopy.pdf https://apackham.github.io/mywebsite/opioidpaper_webcopy.pdf
- iudqnolq 4y agoThe second paragraph of my comment is why it seemed obviously wrong. Emphasis on seemed. I started with "I'm probably missing something" because I haven't studied anything relevant .
- photochemsyn 4y agoOpiate users can't distinguish any 'quality of intoxication' differences across the opiate analog spectrum. Remember, this class of drugs exert their effects via the endorphin system: https://en.wikipedia.org/wiki/Endorphins https://en.wikipedia.org/wiki/Endorphins > "Endorphins are released from the pituitary gland, typically in response to pain, and can act in both the central nervous system (CNS) and the peripheral nervous system (PNS). In the PNS, β-endorphin is the primary endorphin released from the pituitary gland. Endorphins inhibit transmission of pain signals by binding μ-receptors of peripheral nerves, which block their release of neurotransmitter substance P. The mechanism in the CNS is similar but works by blocking a different neurotransmitter: gamma-aminobutyric acid (GABA). In turn, inhibition of GABA increases the production and release of dopamine, a neurotransmitter associated with reward learning." All that matters is that the drug molecule binds to the receptor proteins in the brain and peripheral nerves. Studies show that the active dose is directly related to the binding strength of that specific molecule (fentanyl binds more strongly than heroin, so less is needed to get the same effect, oxycontin is about as strong a binder as heroin, about twice as potent as morphine). Overdose deaths are generally due to (1) unusually high concentrations of active substances or (2) Users who've lost tolerance for some reason taking too much. Legalization would likely eliminate most accidental overdose deaths as products would be clearly labeled as to contents.
- refurb 4y agoUsers can distinguish between some opioids, but not all. Opioids aren’t pure mu-agonists, they also have sigma agonists effects which produce non-opioid effects and also have off effects (histamine release). Combine that with the onset and duration of action, users can definitely tell if they got fentanyl versus say morphine. But not really between heroin and morphine.
- xkcd-sucks 4y agoThis is just not true. There are 3 major subtypes of opioid receptor, and various drugs have substantially different selectivity ratios for each (I.e. some drugs are different re: sedation, respiratory depression, psychosis). Even analgesia, the prototypical mu effect, is also a delta effect and the two might be different for acute vs chronic pain. As neuropharmacology and biology remain fields of active investigation, there are several other putative opioid receptors which aren't characterized very well at all but probably have some relevance. Diverse multiple-receptor heteromers are beginning to demonstrate pharmacological relevance (e.g. different binding profiles at mu-delta heteromers) and also at other protein-protein interaction sites (e.g. some drugs inhibit arrestin recruitment and activity dependent receptor internalization). Also the pharmacokinetics/dynamics matter, things like the central/peripheral availability (e.g. how much constipation) and speed of availability to CNS. Metabolites may be psychoactive or may affect metabolism of the primary drug. Off-target activity is present in everything and may be meaningful especially in some analogues (e.g. pethidine has significant dopamine transporter inhibiton) or in plant-derived morphine/heroin which comprise a complex mixture of compounds with diverse activities). All of these things color the subjective experience of a drug. There is not much study made of subjective qualia because the models to describe this sort of thing are not very nuanced or descriptive, but more because it is not very relevant to clinical clinical practice. However, people who use tons of these drugs all the time do report subjective differences along dimensions such as "speediness", sedation, euphoria, "rushiness", malaise, therapeutic index, timecourse, etc. For example a user might report "Compared to heroin, oxycodone feels more energetic, while fentanyl has a nice initial rush but is much more sedating and wears off quicker", stuff like that. TL;DR in vitro mu-opioid activity is not sufficient to explain objective or subjective variance between opioid drugs, and like much other biology there is much work to be done for all the nuance to be well understood.