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Washington faltered as fentanyl gripped America

149 points by ajay-d 4y ago

spicyusername 4y ago
And yet marijuana is still illegal in my state. The impact of legislation like Citizens United and the outsized influence of large institutions on American politics is really unfortunate.
- tiffanyh 4y ago
  I think you’re conflating things. Fentanyl is a Schedule II controlled substance. So while yes, it’s “legal” - it’s an extremely controlled narcotic. Said differently, it’s illegal if you’re in position of it and it wasn’t prescribed by a medical doctor. Unlike marijuana that doesn’t need a prescription where it’s allowed.
  - ffsoftboiled 4y ago
    Except marijuana does require a prescription in certain states.
    - tiffanyh 4y ago
      Ah, interesting. I wasn’t aware of that. Thanks for clarification.
    - lovich 4y ago
      That's separate from the Schedule system which is a Federal system, where it is illegal to have marijuana always. The Biden admin has instructed the DEA to look into rescheduling it and is turning a blind eye to marijuana now, but on the books fentanyl has a legal way to acquire it and marijuana does not from the Federal point of view.
  - cies 4y ago
    It's not about the legitimate/medical/supervised usage, it the recreational use that kills. Marijuana (MJ) is used a lot recreationally; if people to use MJ instead of Fentanyl the OD cases would not pile up like they do today.
    - tiffanyh 4y ago
      It's just weird logic to say "X causes more deaths than Y, Y should be legal then". E.g. car accidents kill more people per year than marijuana. Does that mean driving a car should become illegal, and marijuana legalized? https://www.cdc.gov/injury/wisqars/LeadingCauses.html https://www.cdc.gov/injury/wisqars/LeadingCauses.html https://www.huffpost.com/entry/marijuana-deaths-2014_n_56816417e4b06fa68880a217 https://www.huffpost.com/entry/marijuana-deaths-2014_n_56816...
      - TheOtherHobbes 4y ago
        That's not comparing like for like. For better or worse driving is considered to have huge social utility. Fent addiction has huge negative utility for everyone - except its manufacturers and their investors. MJ is probably more or less neutral. In terms of broad social effects, refined sugar is probably the deadliest of all drugs, but its direct effects - especially in sodas - are much smaller than its indirect contribution to obesity and diabetes. And unlike a dramatic overdose death, it's very slow-acting. So it's barely considered a problem.
      - mitchdoogle 4y ago
        > Does that mean driving a car should become illegal, and marijuana legalized? Honestly, yes. Or at least driving a car should require a much more strict licensing process. My daughter got a license during the pandemic and all that was required of her was driving around a parking lot once and then parking parallel. Skills which can be acquired in a couple of hours just prior to the test. Yes there is usually a written test as well, so there is some reason to believe people know what the basic road signs mean, but to let people loose on public roads traveling at 70 mph after a 5 minute driving test is just asking for widespread vehicle collisions.
    - 4y ago
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- throwaway6734 4y ago
  > the outsized influence of large institutions on American politics is really unfortunate. The current populist wave has shown that the opposite is true. The threats posed by citizens united were overblown as small dollar donors are generally significantly more radical than large institution.
  - alldayeveryday 4y ago
    Disagree in the sense that politicians, even when receiving the majority of their donations from small donor citizens, still end up beholden to major non-citizen interests. In fact, I see this development as a kind of optimization the system took. Large institutional interests figured out they can save money and motivate private citizens to fund the puppet politician's campaigns.
- x86_64Ubuntu 4y ago
  What do institutions and Citizens United have to do with marijuana legalization? MJ has been illegal for decades in the U.S., before Citizens United. The fact of the matter is that this is a problem with the electorate, not CU or institutions.
- MockObject 4y ago
  How is Citizens United a factor here? If it were, it would be the cannabis companies using their earnings to successfully legalize it in other states, and on the federal level. Perhaps we need more lobbying money happening.
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lzuuz 4y ago
- seszett 4y ago
  > Reminds me of heroin overdoses in Europe in the 80s Regardless of your comment (which will likely soon be dead) I don't think heroin was the leading cause of death in Europe at any point.
  - lzuuz 4y ago
    No, you are right. This is indeed much much worse. But back at the time heroin use here was so so common, it was bad. I can't imagine how bad whatever is happening in America is given it's the leading cause of death now.
- peatfreak 4y ago
  What a revolting attitude.
- throwaway0x7E6 4y ago
DrBazza 4y ago
Sort-of-related, for Americans reading this, from a Brit, when I watch US TV programmes, the inclusion of drugs (prescription and illegal) in scripts is so matter-of-fact, it's actually shocking. Comparing like-for-like programs (police dramas, hospital dramas, thrillers), the UK version will invariably have entirely different plots. Sure the US != UK, but it's so weird. Isn't the USA the only country other than NZ that allows advertising of drugs on TV? Also sales reps from drugs companies isn't a thing we have here either (largely because the NHS is The Buyer of all drugs in the UK).
- cies 4y ago
  Single buyer, is not what the lobbyists wanted. It would make the lobbying sellers less powerful...
- MonkeyMalarky 4y ago
  Does the UK have those bizarrely obtuse not-an-ad-for-prescription ads like in Canada?
  - ndsipa_pomu 4y ago
    I can't think of any although maybe some erectile dysfunction drugs are (don't know if they're prescription only or not). Otherwise, there's ads for cold remedies, cough medicine and analgesics. The idea of advertising prescription drugs seems bizarre to me as surely you'd want your doctor's opinion, not whatever's on daytime TV
    - Zak 4y ago
      US ads for prescription drugs typically say "ask your doctor about [drug]". I think there's a regulation saying that an ad describing what the drug treats must also discuss risks and side effects, but there are sometimes ads that don't say what the drug is for, merely suggesting anyone watching talk to their doctor about it.
    - the_other 4y ago
      In my limited experience, you get better results from GP visits if you come with opinions and data about your own conditions and care hopes. They’re too busy; the current system that has forced 10min bookings weeks ahead as the only means of access means it goes better if you do the research for them.
jpm_sd 4y ago
Opium Wars Round 3 is getting pretty intense. https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Fentanyl https://en.wikipedia.org/wiki/Fentanyl https://www.brookings.edu/research/china-and-synthetic-drugs-control-fentanyl-methamphetamines-and-precursors/ https://www.brookings.edu/research/china-and-synthetic-drugs...
- 082349872349872 4y ago
  Heh. Apparently poppy cultivation is down because synthetic opiate production is cheaper and faster. O Brave New World!
- wil421 4y ago
  Exactly. I watched a few podcasts with a Mexican reporter who now lives in the US. He claims the same thing, opium wars 3.0. There’s another video here where a guy explains how the cartels went from super labs to many smaller apartment style labs. Chinese chemists come and train each small lab for 90 days until they can do it on their own.[1] [1] https://youtu.be/jZFjV9BRyNw https://youtu.be/jZFjV9BRyNw
- zoklet-enjoyer 4y ago
  I've been saying this since 2010 but most people thought I was talking about some bullshit conspiracy theory
- Aunche 4y ago
  You'd think that they'd try to get revenge on the UK first, but fentanyl abuse isn't nearly as popular there. Why not Mexican-American war round 2? Or maybe the same gangs who could no longer profitably sell pirated media found a new way to profit on a country which has historically been completely incompetent when dealing with drugs.
Gordonjcp 4y ago
Is this somehow different fentanyl for the stuff that in the UK gets handed out in litre bottles to old ladies with dodgy hips? Because the whole point of fentanyl is the massive therapeutic window and difficulty of overdosing.
- ramesh31 4y ago
  You must be thinking of something else. Pure fentanyl has a lethal dosage in the microgram range.
  - Zak 4y ago
    Both things can be true, and are in the case of fentanyl. The lethal dose is small in absolute terms, perhaps as low as 2mg[0]. The therapeutic window is large in that doses around 50mcg[1] are useful for pain relief in adult patients. That's 1/40 the potentially lethal dose. [0] https://www.dea.gov/resources/facts-about-fentanyl https://www.dea.gov/resources/facts-about-fentanyl [1] https://www.drugs.com/dosage/fentanyl.html https://www.drugs.com/dosage/fentanyl.html
- chownie 4y ago
  Are you thinking of Oramorph? I know a bunch of older ladies who use it because they have nerve pain, it's derivative of poppies/opium so it's morphine rather than fentanyl.
  - Gordonjcp 4y ago
    No, definitely Fentanyl. Oramorph is pretty tightly regulated.
    - swores 4y ago
      Fentanyl is definitely as, if not more, restricted in the UK than morphine (oramorph being a brand name for liquid morphine).
chunderblunder 4y ago
Do you have a link to the raw data on this?
dizhn 4y ago
The phrase "leading cause of death" has circular reference there. Each article is pointing to the other. I wanted to see where they got that figure. At the bottom of the current article it says "in a provisional tally seven months ago, [The Centers for Disease Control and Prevention] calculated the overall number of drug overdoses at 107,622. Two-thirds were due to fentanyl." So fentanyl is the drug most people overdose on, or is it killing more people than heart diseases, traffic accidents, etc do?
- blanketlamp 4y ago
  > So fentanyl is the drug most people overdose on, or is it killing more people than heart diseases, traffic accidents, etc do? The numbers for other types of fatalities are available so you could do a quick comparison: 42,000 motor vehicle fatalities in the US for 2021 (all ages), so way above that Heart disease is more unclear, I mostly found age-adjusted risks/etc. It looks like at best I could find, around ~400,000 americans in that age group have heart attacks (eg. MI) each year, though the death rate is obviously going to be lower than that. So, it's definitely possible. IIRC "death by misadventure" and the like are super high on the list of causes of death for young people (18-25), so very possible fentanyl is way up there if not at the top.
  - asmithmd1 4y ago
    Here is a Snopes article from a year ago that claims to have duplicated the Fox News article using CDC data: https://www.snopes.com/fact-check/fentanyl-overdose-death/ https://www.snopes.com/fact-check/fentanyl-overdose-death/ Interesting that Google searches for this info return RT results
    - blanketlamp 4y ago
      Oh great find! I didn't see that in my search results but might've just had the wrong keywords. Yeah, I'm not surprised - motor vehicle accidents were always super high on the list for that demographic so if fentanyl is even remotely close to the number reported above it would easily surpass everything else.
nradov 4y ago
Orthopedic surgeon Dr. Chris Raynor recently released a video explaining how doctors use fentanyl in hospital environments and why it's so dangerous in other contexts. It's worth watching to understand the basic pharmacology involved. https://youtu.be/VguWPDPg3sU https://youtu.be/VguWPDPg3sU
323 4y ago
All drugs should be legalized. That is the only solution. You should be able to buy cocaine, heroin, fentanyl at the local grocery store. No question asked. Maybe even subsidize it for poor people who can't afford market prices. The local pharmacy should provide training on how to inject/consume them safely and give for free the associated consumables.
- ndsipa_pomu 4y ago
  I don't understand why politicians (in the UK) always seem to be scared of legalisation when there's a huge amount of tax that could be generated from it and meanwhile, criminals get all the money and taxpayers have to spend more money trying to catch those criminals.
  - Aicy 4y ago
    Because it would be hugely unpopular with a mostly conservative voter base, and tax revenue is not what wins elections.
    - ndsipa_pomu 4y ago
      Those older Tory voters were likely having a wild time back in the sixties - they need to get a grip on reality and stop reading the Daily Heil. Anyone that continues voting Tory after all the damage done to the UK is unlikely to be change their vote just due to drug laws being changed.
  - dfxm12 4y ago
    How popular is it among voters? Below a certain threshold and you'll lose votes if you approach the subject. Once it gets to a certain point, it then becomes useful as a wedge issue, and a wedge issue is only useful to talk about and not really do anything about. That said, only 30% or so support the status quo criminalisation of marijuana. That's past due for some change.
  - kodyo 4y ago
    The last thing a bureaucracy built to solve a problem wants to do is solve the problem.
chillingeffect 4y ago
Human: Write me the longest possible article on the dangers of drugs while obfuscating around the living and working conditions that make fentanyl seem like a viable aternative to life.
- borski 4y ago
  I’m certain ChatGPT can help you out with this prompt.
jack_pp 4y ago
This would be solved if drugs were decriminalized and testing kits were very easy to use and come by but I guess a lot more people have to die before society as a whole acquires common sense
- thepasswordis 4y ago
  Parts of San Francisco have implemented these exact policies and they have made the problems a LOT worse.
  - jack_pp 4y ago
    Unfortunately I don't know the exact specifics of the situation there as I don't live in the US. I know there's a large homeless problem but not the details. Maybe the policies I mentioned also need other policies to balance them out, policies like you're not allowed to camp on the street and you're not allowed to steal, at all. Maybe don't allow people to drive under the influence of any drug that's not a stimulant, or improve tests that measure the dose a person is on so we know if they're on normal dose adderal or high on huge doses of meth. I know law isn't easy to test and iterate but we need something like that in order to improve things, maybe invent temporary laws, specific to certain test cities, which require direct voting to enforce, have a maximum test period and require another vote to lengthen.
    - umeshunni 4y ago
      Yeah, everything you laid out is perfectly logical and what they should be doing, but unfortunately, progressive politics in the US philosophically opposed to enforcing camping and theft laws. E.g., in San Francisco, it’s legal to steal under $900.
      - giraffe_lady 4y ago
        No it's not, stop spreading misinformation. It's illegal as it always has been, and stop listening to police about why they do what they do. They are not honest about it and their incentives and motives are easy to decipher once you choose to. Homeless people aren't camping! That's where they live. If you want to make homelessness a crime you could prosecute landlords who evict people with nowhere to go. Why isn't that the crime? Just think for a minute please about the propaganda you've internalized and are now spreading with these positions. These are complex issues and the view of the police, and police-based solutions, are not the only or best approaches.
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slfnflctd 4y ago
Black market opiate & opioid users need to get off the danger train and start taking kratom. It may not get you quite as 'high', but it can stave off cravings and withdrawal symptoms, and help you find stability. Harm reduction is a viable solution.
- alphabettsy 4y ago
  You’re probably right, but Kratom would then be banned. They’re not going for harm reduction, otherwise they would make it easier for people to get and use drugs like Methadone.
  - pksebben 4y ago
    doesn't necessarily follow. there is a huge disconnect between the facts and what "they" make legal.
- CharlesW 4y ago
  Reputable sources seem to indicate that "nature's opioid" may be more of a sidegrade. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/kratom/art-20402171 https://www.mayoclinic.org/healthy-lifestyle/consumer-health... "In a study testing kratom as a treatment for symptoms of opioid withdrawal, people who took kratom for more than six months reported withdrawal symptoms similar to those that occur after opioid use. Too, people who use kratom may begin craving it and require treatments given for opioid addiction, such as naloxone (Narcan) and buprenorphine (Buprenex)."
sklargh 4y ago
Operational question, why do the DEA and ATF exist? It seems that they are A. Failures* and B. Lack any distinctive law enforcement mission. Couldn't we just roll their missions up into the FBI? Perhaps the Secret Service as well? This feels far more efficient than several fragmented failures occurring simultaneously. *Eyeballing success by the number of murders with illegal firearms and drug deaths.
- jeffal 4y ago
  There are articles on how/why the DEA knew about and allowed the prescription opioid epidemic to happen.
- adolph 4y ago
  > why do the DEA and ATF exist At some point organizations exist for the benefit of the organization only. What would success look like for people at DEA/ATF/etc? The only true business value is trying to put oneself out of business.
- ladeagaytf 4y ago
  Political handcuffs. What can the DEA do to prosecute more internally and externally? We would have to revert back to the ways of less human-rights friendly warfare. We would have to build physical and surveillance barriers. On borders. We would have to more heavily control shipments of goods and overall freedom of navigation of waters. We would have to turn our nation into a prison-island. As for the ATF, well, only so much one can do for stolen arms… and even then we may have a critical mass problem. Unless we abolish the right to self-defense and start violating civil rights to clear the possession of weapons. All politically untenable, and so what would rolling up these departments do other than consolidating power? They would have the exact same set of issues. Much like invading Afghanistan, it’s a winnable issue in theory. After all, Alexander the Great did. However, modern political reality defeats you before the boardgame is out of the box.
- dsfyu404ed 4y ago
  >Operational question, why do the DEA and ATF exist? Same as every other specialty law enforcement agency (campus police, transit system police, etc), prioritizing stuff that the "real police" would get raked over the coals for wasting resources on. You couldn't have the FBI kicking down the doors of medium time drug dealers and suburban dads who violated some arcane statute the way the DEA and ATF do in the same way that a city police department can't justify pissing away man-hours chasing every bum that Karen calls in for pissing on the train tracks. Easier to just spend the money on a bespoke enforcement agency than to have the hard conversations about political will and how much the long tail of stuff these organizations do actually matters.
bloopernova 4y ago
Why are people using Fentanyl? Maybe tackle that instead of further marginalizing people who use it? Are they using it to escape the grinding anxiety and desperation of their shitty lives? Are they using it instead of alcohol, again as escapism from reality? Is this use any different from how people used alcohol in past decades? I guess the point I'm poorly trying to make is that people aren't suddenly different to those in the 1970s, 1920s, or the 1800s. They have a similar environment with similar anxieties, pains, responsibilities, etc etc. I'm very, very biased on this subject. I suffer from constant pain, this comment being written while I sit down to recover from walking my dog. I've been given Morphine and Vicodin, Suboxone and Lyrica. Currently I'm lucky enough to be on Zubsolv, which is a better formulation of Suboxone that doesn't disrupt my sleep as much nor give me horrible muscle spasms. I've tried edibles, as I live in Michigan which has legalized Marijuana. Unfortunately I tolerate them way too fast and they just send me to sleep. People I know across the USA have wildly different results to seeing a doctor for pain relief. Some can't even see a doctor who will even discuss pain with them. Others, like me, have been accused of drug seeking. Or ripped off by hospitals promising to help with nerve abrading, injections, implants, etc. Those hospitals eager to help are also very proficient at billing to extract the most money from insurance and patient. If I were 16 again, armed with what I know now, I'd go into medical research. Specifically tolerance, because in my opinion that's the keystone of the building that is drug dependence. People get tolerant of their drug of choice, take more to get the same effect, chasing that dragon around and around not noticing that the circle has become a downward spiral. Plus so many overdoses are from people taking an old high dose that used to work, when they've been off the drug for a while and are no longer as tolerant. There has to be a way of factory resetting people's tolerance for drugs without harming the person. I wish that could be found and added to opiates especially. My apologies for the rambling rant. Just realize that these statistics you read about are all people. All lives that may have tried to feel better about themselves and ended up drowning in their dependence. Please don't write us all off as junkies who deserve punishment for stumbling in life.
- HideousKojima 4y ago
  >Why are people using Fentanyl? Maybe tackle that instead of further marginalizing people who use it? As far as the common narrative I've seen in the media goes, it's not that they are actively seeking out fentanyl to use (generally). It's that they are seeking out opioids in general, and a lot of unscrupulous distributors and dealers are cutting their product with fentanyl to make it more potent, or something to that effect. Whether or not this is actually the case, I'm not sure.
jdmtheNth 4y ago
There needs to be more focus on why people need drugs to cope, rather than whether or not to legalize them.
- ajross 4y ago
  Opium/oid abuse and dependency has a thousand year history. You aren't going to fix this with This One Psychology Trick, and trying to imagine that by projecting your priors onto the problem is just going to lead you into a conspiracy theory. Fentanyl is notable because it's more concentrated and cheaper, so there's more available and it's easier to dangerously overdose. But the "why" behind the market for it hasn't changed in hundreds of years.
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- mitchdoogle 4y ago
  That is the whole point of legalizing them. Take away the criminal aspect and focus entirely on the medical and psychological aspects.
- tayo42 4y ago
  You can use drugs without needing to cope. Look at anyone's experiment phase...
the__alchemist 4y ago
Getting a needle inserted for blood draw sucks. Getting one of the fatter ones that can inject things into a vein hurts! How good could the high be that it's worth that, if you're not suffering from a serious injury or disease that would warrant painkillers?
- supergeek133 4y ago
  Fentanyl is insanely powerful, you can get it in "lollipops" and it can be delivered nasally. Source: My mother used fentanyl for many many years.
- dkarras 4y ago
  Not everyone is that averse to needles. I am not a drug user but I don't mind needles, so I wouldn't care.
erdos4d 4y ago
Since Washington's only response to drug problems has been to try to literally destroy everyone involved, this sounds like a massive improvement in public policy to me. Seriously though, this is a white person's problem and they aren't going to attack the white community like they did the black community during the crack epidemic. But they don't know how to do anything actually helpful either (new skills are hard for the elderly I hear), so they just sit there and stare at it. I just don't see the zeal to lock these people in cages forever that I'm used to. Funny how that works.
5440 4y ago
I audit a lot of these Fentanyl API (Active Pharma Ingredient) factories in China. Its noticeable to me when I go through the warehouses as to how much product is going to Mexico. Other segments go to India for legal fill finishing prior to North America, while other small shipments are going to compounding facilities across the US. I always thought FDA might want to relay this information to homeland security, because its pretty easy for FDA inspectors to sneakily gather information during site inspections. At quite number of sites I often run into a mix of legal and nefarious activity at these massive API sites
- DontchaKnowit 4y ago
  Is there any way you could point me to more information about these facilities and or the auditing process? Back in college, I was a fiend for all type of stuff that was presumably made at these facilities. I would purchase styff from american and canadian resellers who had labs in china that would synth specific drugs for them. Always wondered what the lab conditions were like, what likelihood I was supporting nefarious business practices, how likely it was that I got harmful byproducts etc.
- rnk 4y ago
  You are an auditor, you see legal and nefarious activity and apparently you don't report the nefarious activity? Because then it would probably stop.
  - Yiin 4y ago
    They never said that.
  - jesterson 4y ago
    Auditor checks adherence to particular rules. You can assert nefarious activities at higher level, but it's likely out of job scope to do something about it
hardwaresofton 4y ago
This seems like a huge problem to solve. Anyone know of anyone going after solving it from interesting new angles? Are there any VCs funding ideas like this? I can think of at least a few angles that might be interesting since I'm too uninformed to know any better: Is it possible to create mRNA vaccine that block opioid receptors? What happened to the scanning tech mentioned in the post? That thread seems to just stop with "failure to innovate". We have ML that feels like it could do that now. There's that open robotics repository of scanned objects -- it sounds silly, but why not scan every single car (maybe with some help from automakers) so there's a reference and train with that? As far as the physical problem of scanning, can we scan cars/trucks/containers/etc with sonar rather than visually and let a computer figure it out?
pfkurtz 4y ago
We have 2 options for dangerous things: 1) Regulate. 2) Criminalize. If lots of people do it, (1) is better, even though it normalizes the danger, because we get seat belts and pharmaceutical controls and the ability to innovate and discuss changes in public. If the people involved can be cast as lower moral status / other, then it becomes a problem of "Dealing with THEM", and we get (2). This is correct if the primary activity is a real, moral crime (theft, extortion rackets), which changing consciousness and numbing pain aren't. This is almost NEVER correct in the case of voluntary economic transactions (for which the societal benefits of regulation have proven to be enormous), unless those interactions are inherently theftlike/extortionate/exploitative-involuntary, because it creates a spiral of violence. So the questions are: Should pain numbing / consciousness altering be the province of organized crime? Should we devote substantial societal resources to a failed project of stopping people from altering consciousness and numbing pain, or change to make that fact less damaging? Should one part of society get to impose the violence-filled option on everyone else?
TheCenterSeat 4y ago
I thought ycombinator tried to stay away from political stuff? I've been around for years and that was usually the case. Why is there a popular post about drug addiction and the response from "Washington"? This isn't tech related. https://news.ycombinator.com/newsguidelines.html#comments https://news.ycombinator.com/newsguidelines.html#comments I'll quote the guidelines here: "Please don't use Hacker News for political or ideological battle. That tramples curiosity." Most comments here are political. Did I miss a blog post that says to be politicans?
- tyingq 4y ago
  The article doesn't seem to be favoring either party. "Presidents from both parties failed to take effective action"
- Zircom 4y ago
  The guidelines also say not to comment complaining that a submission is off topic or inappropriate for HN, so you need to make up your mind on whether you actually wanna follow them or not.
- dang 4y ago
  Some intellectually interesting stories have political overlap. It's possible to discuss them in a thoughtful way, without descending into political or ideological battle. Past explanations on this point: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&sort=byDate&type=comment&query=political%20overlap%20by:dang https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so...
NDizzle 4y ago
The US would really benefit from a strong southern border. That's obviously a politically loaded statement, but just take it at face value. There is such a thing as borders. The US needs to stop the flow of illegal shit across the southern border. I know this won't solve 100% of the fentanyl issues. Low hanging fruit, and all that. Start somewhere.
- alphabettsy 4y ago
  Most of the Fentanyl comes through the border checkpoints, not around it according to everything I’ve seen. It’s security theater just like the TSA.
htag 4y ago
Why is Washington to blame? I don't see silver bullets or practical solutions being offered in the article.
diogenescynic 4y ago
Washington (democrats and republicans, including Obama and Trump) did as they were paid to do. The Sackler family did this on purpose, as their parents did with Benzos and other painkillers. They purposely increased the addictiveness then lied about it. Then the government gave them immunity after their deadly product killed hundreds of thousands to millions of Americans.
- alphabettsy 4y ago
  Maybe, but all of the addicts I know or have known started out using them recreationally and got addicted. People taking them for physical pain also know when they’re getting addicted, when you get sick from missing your dose. Maybe there’s still too much stigma to ask for help.
deathclassic 4y ago
The fact that vivitrol is both rare and stupidly expensive is a tradgedy. Like, if the goverment just forced pharma companies to supply the stuff for free or extremely cheap it would help addicts immensely. Also why not hit people with the vivitrol shot the second they get caught with opioids or show up in the emergency room because of an OD? Don't bother with criminal charges or forced rehab, just mandate the person comes in and gets the shot for a few months, free of charge. I know vivitrol isn't perfect but it's the closest thing we have to a vaccine for opiod addiction, we should be giving it out like a flu shot.
- refurb 4y ago
  Addicts need to detox before getting Vivitrol or they go into massive withdrawal. Plus forcing people to take medicine against their Will is fraught with civil rights issues.
vikasnair 4y ago
It’s important to note a significant percentage of these deaths are cases in which other substances with trace amounts of fentanyl are consumed unbeknownst to the user. Dealers often use the same scales, which is one risk factor for cross-contaminating supply. My mother is a physician, she just last night told me about a case she saw over the weekend in which a young 20-something nearly OD’d on fentanyl from taking ecstasy. She survived, but with life-altering brain trauma rendering her unable to remember who she is. She needs tubes for her food supply, and a ventilator to breathe. Here you can see a few images of what is a lethal dose of fentanyl: https://www.dea.gov/galleries/drug-images/fentanyl https://www.dea.gov/galleries/drug-images/fentanyl Scary stuff, and maybe there’s an argument there to be made in favor of legalizing current black-market drugs. Definitely a PSA to test your drugs. CDC on cross-contamination: https://www.cdc.gov/drugoverdose/deaths/other-drugs.html https://www.cdc.gov/drugoverdose/deaths/other-drugs.html
- HybridCurve 4y ago
  This is the core problem, I rarely ever hear of someone using fentanyl by itself. Fentanyl is incredibly potent which maximizes profit/volume for traffickers. This creates a tremendous financial incentive for them to adopt since it provides a competitive advantage. If it's easier and cheaper to obtain fentanyl than Alprazolam (xanax), then illicit manufacturers will produce a counterfeit using fentanyl as the active ingredient. Fentanyl overdoses are also frequently caused by improper mixing techniques (powder to powder) and the non-uniform distribution will result in someone getting a hot dose. In that case, testing might not even help.
- Tiktaalik 4y ago
  This is the core issue. It’s not a fentanyl crisis, it’s a toxic drug crisis. The drugs are often completely different from what they’re sold as, with all sorts of toxic things added. People do a dose that is sensible based on their assumption of what the drug is, but the drug is something else, so their dose is completely incorrect and they overdose and die. No drug user at this point should expect their drugs are what they’re advertised as.
- sonjat 4y ago
  Really we need to start changing terminology. A great deal of these deaths are not overdoses in the sense that people took too much of a drug but poisonings in that people took something they did not intend to take. It might seem like a minor detail, but if helps drive home the point that even users who do not take opiods are at risk, it is worth doing.
coorski 4y ago
surprised ? find a solution
lazyeye 4y ago
Fentanyl is greyzone warfare from the CCP. It's astonishing how complacent the West is.
_zfxr 4y ago
https://archive.vn/tltVm https://archive.vn/tltVm

149 points by ajay-d 4y ago

And yet marijuana is still illegal in my state. The impact of legislation like Citizens United and the outsized influence of large institutions on American politics is really unfortunate.

tiffanyh 4y ago
I think you’re conflating things. Fentanyl is a Schedule II controlled substance. So while yes, it’s “legal” - it’s an extremely controlled narcotic. Said differently, it’s illegal if you’re in position of it and it wasn’t prescribed by a medical doctor. Unlike marijuana that doesn’t need a prescription where it’s allowed.
- ffsoftboiled 4y ago
  Except marijuana does require a prescription in certain states.
  - tiffanyh 4y ago
    Ah, interesting. I wasn’t aware of that. Thanks for clarification.
  - lovich 4y ago
    That's separate from the Schedule system which is a Federal system, where it is illegal to have marijuana always. The Biden admin has instructed the DEA to look into rescheduling it and is turning a blind eye to marijuana now, but on the books fentanyl has a legal way to acquire it and marijuana does not from the Federal point of view.
- cies 4y ago
  It's not about the legitimate/medical/supervised usage, it the recreational use that kills. Marijuana (MJ) is used a lot recreationally; if people to use MJ instead of Fentanyl the OD cases would not pile up like they do today.
  - tiffanyh 4y ago
    It's just weird logic to say "X causes more deaths than Y, Y should be legal then". E.g. car accidents kill more people per year than marijuana. Does that mean driving a car should become illegal, and marijuana legalized? https://www.cdc.gov/injury/wisqars/LeadingCauses.html https://www.cdc.gov/injury/wisqars/LeadingCauses.html https://www.huffpost.com/entry/marijuana-deaths-2014_n_56816417e4b06fa68880a217 https://www.huffpost.com/entry/marijuana-deaths-2014_n_56816...
    - TheOtherHobbes 4y ago
      That's not comparing like for like. For better or worse driving is considered to have huge social utility. Fent addiction has huge negative utility for everyone - except its manufacturers and their investors. MJ is probably more or less neutral. In terms of broad social effects, refined sugar is probably the deadliest of all drugs, but its direct effects - especially in sodas - are much smaller than its indirect contribution to obesity and diabetes. And unlike a dramatic overdose death, it's very slow-acting. So it's barely considered a problem.
    - mitchdoogle 4y ago
      > Does that mean driving a car should become illegal, and marijuana legalized? Honestly, yes. Or at least driving a car should require a much more strict licensing process. My daughter got a license during the pandemic and all that was required of her was driving around a parking lot once and then parking parallel. Skills which can be acquired in a couple of hours just prior to the test. Yes there is usually a written test as well, so there is some reason to believe people know what the basic road signs mean, but to let people loose on public roads traveling at 70 mph after a 5 minute driving test is just asking for widespread vehicle collisions.
  - 4y ago
- deleted 4y ago
  [deleted]
throwaway6734 4y ago
> the outsized influence of large institutions on American politics is really unfortunate. The current populist wave has shown that the opposite is true. The threats posed by citizens united were overblown as small dollar donors are generally significantly more radical than large institution.
- alldayeveryday 4y ago
  Disagree in the sense that politicians, even when receiving the majority of their donations from small donor citizens, still end up beholden to major non-citizen interests. In fact, I see this development as a kind of optimization the system took. Large institutional interests figured out they can save money and motivate private citizens to fund the puppet politician's campaigns.
x86_64Ubuntu 4y ago
What do institutions and Citizens United have to do with marijuana legalization? MJ has been illegal for decades in the U.S., before Citizens United. The fact of the matter is that this is a problem with the electorate, not CU or institutions.
MockObject 4y ago
How is Citizens United a factor here? If it were, it would be the cannabis companies using their earnings to successfully legalize it in other states, and on the federal level. Perhaps we need more lobbying money happening.

deleted 4y ago

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lzuuz 4y ago

seszett 4y ago
> Reminds me of heroin overdoses in Europe in the 80s Regardless of your comment (which will likely soon be dead) I don't think heroin was the leading cause of death in Europe at any point.
- lzuuz 4y ago
  No, you are right. This is indeed much much worse. But back at the time heroin use here was so so common, it was bad. I can't imagine how bad whatever is happening in America is given it's the leading cause of death now.
peatfreak 4y ago
What a revolting attitude.
throwaway0x7E6 4y ago

DrBazza 4y ago

Sort-of-related, for Americans reading this, from a Brit, when I watch US TV programmes, the inclusion of drugs (prescription and illegal) in scripts is so matter-of-fact, it's actually shocking. Comparing like-for-like programs (police dramas, hospital dramas, thrillers), the UK version will invariably have entirely different plots. Sure the US != UK, but it's so weird. Isn't the USA the only country other than NZ that allows advertising of drugs on TV? Also sales reps from drugs companies isn't a thing we have here either (largely because the NHS is The Buyer of all drugs in the UK).

cies 4y ago
Single buyer, is not what the lobbyists wanted. It would make the lobbying sellers less powerful...
MonkeyMalarky 4y ago
Does the UK have those bizarrely obtuse not-an-ad-for-prescription ads like in Canada?
- ndsipa_pomu 4y ago
  I can't think of any although maybe some erectile dysfunction drugs are (don't know if they're prescription only or not). Otherwise, there's ads for cold remedies, cough medicine and analgesics. The idea of advertising prescription drugs seems bizarre to me as surely you'd want your doctor's opinion, not whatever's on daytime TV
  - Zak 4y ago
    US ads for prescription drugs typically say "ask your doctor about [drug]". I think there's a regulation saying that an ad describing what the drug treats must also discuss risks and side effects, but there are sometimes ads that don't say what the drug is for, merely suggesting anyone watching talk to their doctor about it.
  - the_other 4y ago
    In my limited experience, you get better results from GP visits if you come with opinions and data about your own conditions and care hopes. They’re too busy; the current system that has forced 10min bookings weeks ahead as the only means of access means it goes better if you do the research for them.

jpm_sd 4y ago

Opium Wars Round 3 is getting pretty intense. https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Fentanyl https://en.wikipedia.org/wiki/Fentanyl https://www.brookings.edu/research/china-and-synthetic-drugs-control-fentanyl-methamphetamines-and-precursors/ https://www.brookings.edu/research/china-and-synthetic-drugs...

082349872349872 4y ago
Heh. Apparently poppy cultivation is down because synthetic opiate production is cheaper and faster. O Brave New World!
wil421 4y ago
Exactly. I watched a few podcasts with a Mexican reporter who now lives in the US. He claims the same thing, opium wars 3.0. There’s another video here where a guy explains how the cartels went from super labs to many smaller apartment style labs. Chinese chemists come and train each small lab for 90 days until they can do it on their own.[1] [1] https://youtu.be/jZFjV9BRyNw https://youtu.be/jZFjV9BRyNw
zoklet-enjoyer 4y ago
I've been saying this since 2010 but most people thought I was talking about some bullshit conspiracy theory
Aunche 4y ago
You'd think that they'd try to get revenge on the UK first, but fentanyl abuse isn't nearly as popular there. Why not Mexican-American war round 2? Or maybe the same gangs who could no longer profitably sell pirated media found a new way to profit on a country which has historically been completely incompetent when dealing with drugs.

Gordonjcp 4y ago

Is this somehow different fentanyl for the stuff that in the UK gets handed out in litre bottles to old ladies with dodgy hips? Because the whole point of fentanyl is the massive therapeutic window and difficulty of overdosing.

ramesh31 4y ago
You must be thinking of something else. Pure fentanyl has a lethal dosage in the microgram range.
- Zak 4y ago
  Both things can be true, and are in the case of fentanyl. The lethal dose is small in absolute terms, perhaps as low as 2mg[0]. The therapeutic window is large in that doses around 50mcg[1] are useful for pain relief in adult patients. That's 1/40 the potentially lethal dose. [0] https://www.dea.gov/resources/facts-about-fentanyl https://www.dea.gov/resources/facts-about-fentanyl [1] https://www.drugs.com/dosage/fentanyl.html https://www.drugs.com/dosage/fentanyl.html
chownie 4y ago
Are you thinking of Oramorph? I know a bunch of older ladies who use it because they have nerve pain, it's derivative of poppies/opium so it's morphine rather than fentanyl.
- Gordonjcp 4y ago
  No, definitely Fentanyl. Oramorph is pretty tightly regulated.
  - swores 4y ago
    Fentanyl is definitely as, if not more, restricted in the UK than morphine (oramorph being a brand name for liquid morphine).

chunderblunder 4y ago

Do you have a link to the raw data on this?

dizhn 4y ago

The phrase "leading cause of death" has circular reference there. Each article is pointing to the other. I wanted to see where they got that figure. At the bottom of the current article it says "in a provisional tally seven months ago, [The Centers for Disease Control and Prevention] calculated the overall number of drug overdoses at 107,622. Two-thirds were due to fentanyl." So fentanyl is the drug most people overdose on, or is it killing more people than heart diseases, traffic accidents, etc do?

blanketlamp 4y ago
> So fentanyl is the drug most people overdose on, or is it killing more people than heart diseases, traffic accidents, etc do? The numbers for other types of fatalities are available so you could do a quick comparison: 42,000 motor vehicle fatalities in the US for 2021 (all ages), so way above that Heart disease is more unclear, I mostly found age-adjusted risks/etc. It looks like at best I could find, around ~400,000 americans in that age group have heart attacks (eg. MI) each year, though the death rate is obviously going to be lower than that. So, it's definitely possible. IIRC "death by misadventure" and the like are super high on the list of causes of death for young people (18-25), so very possible fentanyl is way up there if not at the top.
- asmithmd1 4y ago
  Here is a Snopes article from a year ago that claims to have duplicated the Fox News article using CDC data: https://www.snopes.com/fact-check/fentanyl-overdose-death/ https://www.snopes.com/fact-check/fentanyl-overdose-death/ Interesting that Google searches for this info return RT results
  - blanketlamp 4y ago
    Oh great find! I didn't see that in my search results but might've just had the wrong keywords. Yeah, I'm not surprised - motor vehicle accidents were always super high on the list for that demographic so if fentanyl is even remotely close to the number reported above it would easily surpass everything else.

nradov 4y ago

Orthopedic surgeon Dr. Chris Raynor recently released a video explaining how doctors use fentanyl in hospital environments and why it's so dangerous in other contexts. It's worth watching to understand the basic pharmacology involved. https://youtu.be/VguWPDPg3sU https://youtu.be/VguWPDPg3sU

323 4y ago

All drugs should be legalized. That is the only solution. You should be able to buy cocaine, heroin, fentanyl at the local grocery store. No question asked. Maybe even subsidize it for poor people who can't afford market prices. The local pharmacy should provide training on how to inject/consume them safely and give for free the associated consumables.

ndsipa_pomu 4y ago
I don't understand why politicians (in the UK) always seem to be scared of legalisation when there's a huge amount of tax that could be generated from it and meanwhile, criminals get all the money and taxpayers have to spend more money trying to catch those criminals.
- Aicy 4y ago
  Because it would be hugely unpopular with a mostly conservative voter base, and tax revenue is not what wins elections.
  - ndsipa_pomu 4y ago
    Those older Tory voters were likely having a wild time back in the sixties - they need to get a grip on reality and stop reading the Daily Heil. Anyone that continues voting Tory after all the damage done to the UK is unlikely to be change their vote just due to drug laws being changed.
- dfxm12 4y ago
  How popular is it among voters? Below a certain threshold and you'll lose votes if you approach the subject. Once it gets to a certain point, it then becomes useful as a wedge issue, and a wedge issue is only useful to talk about and not really do anything about. That said, only 30% or so support the status quo criminalisation of marijuana. That's past due for some change.
- kodyo 4y ago
  The last thing a bureaucracy built to solve a problem wants to do is solve the problem.

chillingeffect 4y ago

Human: Write me the longest possible article on the dangers of drugs while obfuscating around the living and working conditions that make fentanyl seem like a viable aternative to life.

borski 4y ago
I’m certain ChatGPT can help you out with this prompt.

jack_pp 4y ago

This would be solved if drugs were decriminalized and testing kits were very easy to use and come by but I guess a lot more people have to die before society as a whole acquires common sense

thepasswordis 4y ago
Parts of San Francisco have implemented these exact policies and they have made the problems a LOT worse.
- jack_pp 4y ago
  Unfortunately I don't know the exact specifics of the situation there as I don't live in the US. I know there's a large homeless problem but not the details. Maybe the policies I mentioned also need other policies to balance them out, policies like you're not allowed to camp on the street and you're not allowed to steal, at all. Maybe don't allow people to drive under the influence of any drug that's not a stimulant, or improve tests that measure the dose a person is on so we know if they're on normal dose adderal or high on huge doses of meth. I know law isn't easy to test and iterate but we need something like that in order to improve things, maybe invent temporary laws, specific to certain test cities, which require direct voting to enforce, have a maximum test period and require another vote to lengthen.
  - umeshunni 4y ago
    Yeah, everything you laid out is perfectly logical and what they should be doing, but unfortunately, progressive politics in the US philosophically opposed to enforcing camping and theft laws. E.g., in San Francisco, it’s legal to steal under $900.
    - giraffe_lady 4y ago
      No it's not, stop spreading misinformation. It's illegal as it always has been, and stop listening to police about why they do what they do. They are not honest about it and their incentives and motives are easy to decipher once you choose to. Homeless people aren't camping! That's where they live. If you want to make homelessness a crime you could prosecute landlords who evict people with nowhere to go. Why isn't that the crime? Just think for a minute please about the propaganda you've internalized and are now spreading with these positions. These are complex issues and the view of the police, and police-based solutions, are not the only or best approaches.

deleted 4y ago

[deleted]

slfnflctd 4y ago

Black market opiate & opioid users need to get off the danger train and start taking kratom. It may not get you quite as 'high', but it can stave off cravings and withdrawal symptoms, and help you find stability. Harm reduction is a viable solution.

alphabettsy 4y ago
You’re probably right, but Kratom would then be banned. They’re not going for harm reduction, otherwise they would make it easier for people to get and use drugs like Methadone.
- pksebben 4y ago
  doesn't necessarily follow. there is a huge disconnect between the facts and what "they" make legal.
CharlesW 4y ago
Reputable sources seem to indicate that "nature's opioid" may be more of a sidegrade. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/kratom/art-20402171 https://www.mayoclinic.org/healthy-lifestyle/consumer-health... "In a study testing kratom as a treatment for symptoms of opioid withdrawal, people who took kratom for more than six months reported withdrawal symptoms similar to those that occur after opioid use. Too, people who use kratom may begin craving it and require treatments given for opioid addiction, such as naloxone (Narcan) and buprenorphine (Buprenex)."

sklargh 4y ago

Operational question, why do the DEA and ATF exist? It seems that they are A. Failures* and B. Lack any distinctive law enforcement mission. Couldn't we just roll their missions up into the FBI? Perhaps the Secret Service as well? This feels far more efficient than several fragmented failures occurring simultaneously. *Eyeballing success by the number of murders with illegal firearms and drug deaths.

jeffal 4y ago
There are articles on how/why the DEA knew about and allowed the prescription opioid epidemic to happen.
adolph 4y ago
> why do the DEA and ATF exist At some point organizations exist for the benefit of the organization only. What would success look like for people at DEA/ATF/etc? The only true business value is trying to put oneself out of business.
ladeagaytf 4y ago
Political handcuffs. What can the DEA do to prosecute more internally and externally? We would have to revert back to the ways of less human-rights friendly warfare. We would have to build physical and surveillance barriers. On borders. We would have to more heavily control shipments of goods and overall freedom of navigation of waters. We would have to turn our nation into a prison-island. As for the ATF, well, only so much one can do for stolen arms… and even then we may have a critical mass problem. Unless we abolish the right to self-defense and start violating civil rights to clear the possession of weapons. All politically untenable, and so what would rolling up these departments do other than consolidating power? They would have the exact same set of issues. Much like invading Afghanistan, it’s a winnable issue in theory. After all, Alexander the Great did. However, modern political reality defeats you before the boardgame is out of the box.
dsfyu404ed 4y ago
>Operational question, why do the DEA and ATF exist? Same as every other specialty law enforcement agency (campus police, transit system police, etc), prioritizing stuff that the "real police" would get raked over the coals for wasting resources on. You couldn't have the FBI kicking down the doors of medium time drug dealers and suburban dads who violated some arcane statute the way the DEA and ATF do in the same way that a city police department can't justify pissing away man-hours chasing every bum that Karen calls in for pissing on the train tracks. Easier to just spend the money on a bespoke enforcement agency than to have the hard conversations about political will and how much the long tail of stuff these organizations do actually matters.

bloopernova 4y ago

Why are people using Fentanyl? Maybe tackle that instead of further marginalizing people who use it? Are they using it to escape the grinding anxiety and desperation of their shitty lives? Are they using it instead of alcohol, again as escapism from reality? Is this use any different from how people used alcohol in past decades? I guess the point I'm poorly trying to make is that people aren't suddenly different to those in the 1970s, 1920s, or the 1800s. They have a similar environment with similar anxieties, pains, responsibilities, etc etc. I'm very, very biased on this subject. I suffer from constant pain, this comment being written while I sit down to recover from walking my dog. I've been given Morphine and Vicodin, Suboxone and Lyrica. Currently I'm lucky enough to be on Zubsolv, which is a better formulation of Suboxone that doesn't disrupt my sleep as much nor give me horrible muscle spasms. I've tried edibles, as I live in Michigan which has legalized Marijuana. Unfortunately I tolerate them way too fast and they just send me to sleep. People I know across the USA have wildly different results to seeing a doctor for pain relief. Some can't even see a doctor who will even discuss pain with them. Others, like me, have been accused of drug seeking. Or ripped off by hospitals promising to help with nerve abrading, injections, implants, etc. Those hospitals eager to help are also very proficient at billing to extract the most money from insurance and patient. If I were 16 again, armed with what I know now, I'd go into medical research. Specifically tolerance, because in my opinion that's the keystone of the building that is drug dependence. People get tolerant of their drug of choice, take more to get the same effect, chasing that dragon around and around not noticing that the circle has become a downward spiral. Plus so many overdoses are from people taking an old high dose that used to work, when they've been off the drug for a while and are no longer as tolerant. There has to be a way of factory resetting people's tolerance for drugs without harming the person. I wish that could be found and added to opiates especially. My apologies for the rambling rant. Just realize that these statistics you read about are all people. All lives that may have tried to feel better about themselves and ended up drowning in their dependence. Please don't write us all off as junkies who deserve punishment for stumbling in life.

HideousKojima 4y ago
>Why are people using Fentanyl? Maybe tackle that instead of further marginalizing people who use it? As far as the common narrative I've seen in the media goes, it's not that they are actively seeking out fentanyl to use (generally). It's that they are seeking out opioids in general, and a lot of unscrupulous distributors and dealers are cutting their product with fentanyl to make it more potent, or something to that effect. Whether or not this is actually the case, I'm not sure.

jdmtheNth 4y ago

There needs to be more focus on why people need drugs to cope, rather than whether or not to legalize them.

ajross 4y ago
Opium/oid abuse and dependency has a thousand year history. You aren't going to fix this with This One Psychology Trick, and trying to imagine that by projecting your priors onto the problem is just going to lead you into a conspiracy theory. Fentanyl is notable because it's more concentrated and cheaper, so there's more available and it's easier to dangerously overdose. But the "why" behind the market for it hasn't changed in hundreds of years.
- deleted 4y ago
  [deleted]
mitchdoogle 4y ago
That is the whole point of legalizing them. Take away the criminal aspect and focus entirely on the medical and psychological aspects.
tayo42 4y ago
You can use drugs without needing to cope. Look at anyone's experiment phase...

the__alchemist 4y ago

Getting a needle inserted for blood draw sucks. Getting one of the fatter ones that can inject things into a vein hurts! How good could the high be that it's worth that, if you're not suffering from a serious injury or disease that would warrant painkillers?

supergeek133 4y ago
Fentanyl is insanely powerful, you can get it in "lollipops" and it can be delivered nasally. Source: My mother used fentanyl for many many years.
dkarras 4y ago
Not everyone is that averse to needles. I am not a drug user but I don't mind needles, so I wouldn't care.

erdos4d 4y ago

Since Washington's only response to drug problems has been to try to literally destroy everyone involved, this sounds like a massive improvement in public policy to me. Seriously though, this is a white person's problem and they aren't going to attack the white community like they did the black community during the crack epidemic. But they don't know how to do anything actually helpful either (new skills are hard for the elderly I hear), so they just sit there and stare at it. I just don't see the zeal to lock these people in cages forever that I'm used to. Funny how that works.

5440 4y ago

I audit a lot of these Fentanyl API (Active Pharma Ingredient) factories in China. Its noticeable to me when I go through the warehouses as to how much product is going to Mexico. Other segments go to India for legal fill finishing prior to North America, while other small shipments are going to compounding facilities across the US. I always thought FDA might want to relay this information to homeland security, because its pretty easy for FDA inspectors to sneakily gather information during site inspections. At quite number of sites I often run into a mix of legal and nefarious activity at these massive API sites

DontchaKnowit 4y ago
Is there any way you could point me to more information about these facilities and or the auditing process? Back in college, I was a fiend for all type of stuff that was presumably made at these facilities. I would purchase styff from american and canadian resellers who had labs in china that would synth specific drugs for them. Always wondered what the lab conditions were like, what likelihood I was supporting nefarious business practices, how likely it was that I got harmful byproducts etc.
rnk 4y ago
You are an auditor, you see legal and nefarious activity and apparently you don't report the nefarious activity? Because then it would probably stop.
- Yiin 4y ago
  They never said that.
- jesterson 4y ago
  Auditor checks adherence to particular rules. You can assert nefarious activities at higher level, but it's likely out of job scope to do something about it

hardwaresofton 4y ago

This seems like a huge problem to solve. Anyone know of anyone going after solving it from interesting new angles? Are there any VCs funding ideas like this? I can think of at least a few angles that might be interesting since I'm too uninformed to know any better: Is it possible to create mRNA vaccine that block opioid receptors? What happened to the scanning tech mentioned in the post? That thread seems to just stop with "failure to innovate". We have ML that feels like it could do that now. There's that open robotics repository of scanned objects -- it sounds silly, but why not scan every single car (maybe with some help from automakers) so there's a reference and train with that? As far as the physical problem of scanning, can we scan cars/trucks/containers/etc with sonar rather than visually and let a computer figure it out?

pfkurtz 4y ago

We have 2 options for dangerous things: 1) Regulate. 2) Criminalize. If lots of people do it, (1) is better, even though it normalizes the danger, because we get seat belts and pharmaceutical controls and the ability to innovate and discuss changes in public. If the people involved can be cast as lower moral status / other, then it becomes a problem of "Dealing with THEM", and we get (2). This is correct if the primary activity is a real, moral crime (theft, extortion rackets), which changing consciousness and numbing pain aren't. This is almost NEVER correct in the case of voluntary economic transactions (for which the societal benefits of regulation have proven to be enormous), unless those interactions are inherently theftlike/extortionate/exploitative-involuntary, because it creates a spiral of violence. So the questions are: Should pain numbing / consciousness altering be the province of organized crime? Should we devote substantial societal resources to a failed project of stopping people from altering consciousness and numbing pain, or change to make that fact less damaging? Should one part of society get to impose the violence-filled option on everyone else?

TheCenterSeat 4y ago

I thought ycombinator tried to stay away from political stuff? I've been around for years and that was usually the case. Why is there a popular post about drug addiction and the response from "Washington"? This isn't tech related. https://news.ycombinator.com/newsguidelines.html#comments https://news.ycombinator.com/newsguidelines.html#comments I'll quote the guidelines here: "Please don't use Hacker News for political or ideological battle. That tramples curiosity." Most comments here are political. Did I miss a blog post that says to be politicans?

tyingq 4y ago
The article doesn't seem to be favoring either party. "Presidents from both parties failed to take effective action"
Zircom 4y ago
The guidelines also say not to comment complaining that a submission is off topic or inappropriate for HN, so you need to make up your mind on whether you actually wanna follow them or not.
dang 4y ago
Some intellectually interesting stories have political overlap. It's possible to discuss them in a thoughtful way, without descending into political or ideological battle. Past explanations on this point: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&sort=byDate&type=comment&query=political%20overlap%20by:dang https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so...

NDizzle 4y ago

The US would really benefit from a strong southern border. That's obviously a politically loaded statement, but just take it at face value. There is such a thing as borders. The US needs to stop the flow of illegal shit across the southern border. I know this won't solve 100% of the fentanyl issues. Low hanging fruit, and all that. Start somewhere.

alphabettsy 4y ago
Most of the Fentanyl comes through the border checkpoints, not around it according to everything I’ve seen. It’s security theater just like the TSA.

htag 4y ago

Why is Washington to blame? I don't see silver bullets or practical solutions being offered in the article.

diogenescynic 4y ago

Washington (democrats and republicans, including Obama and Trump) did as they were paid to do. The Sackler family did this on purpose, as their parents did with Benzos and other painkillers. They purposely increased the addictiveness then lied about it. Then the government gave them immunity after their deadly product killed hundreds of thousands to millions of Americans.

alphabettsy 4y ago
Maybe, but all of the addicts I know or have known started out using them recreationally and got addicted. People taking them for physical pain also know when they’re getting addicted, when you get sick from missing your dose. Maybe there’s still too much stigma to ask for help.

deathclassic 4y ago

The fact that vivitrol is both rare and stupidly expensive is a tradgedy. Like, if the goverment just forced pharma companies to supply the stuff for free or extremely cheap it would help addicts immensely. Also why not hit people with the vivitrol shot the second they get caught with opioids or show up in the emergency room because of an OD? Don't bother with criminal charges or forced rehab, just mandate the person comes in and gets the shot for a few months, free of charge. I know vivitrol isn't perfect but it's the closest thing we have to a vaccine for opiod addiction, we should be giving it out like a flu shot.

refurb 4y ago
Addicts need to detox before getting Vivitrol or they go into massive withdrawal. Plus forcing people to take medicine against their Will is fraught with civil rights issues.

vikasnair 4y ago

It’s important to note a significant percentage of these deaths are cases in which other substances with trace amounts of fentanyl are consumed unbeknownst to the user. Dealers often use the same scales, which is one risk factor for cross-contaminating supply. My mother is a physician, she just last night told me about a case she saw over the weekend in which a young 20-something nearly OD’d on fentanyl from taking ecstasy. She survived, but with life-altering brain trauma rendering her unable to remember who she is. She needs tubes for her food supply, and a ventilator to breathe. Here you can see a few images of what is a lethal dose of fentanyl: https://www.dea.gov/galleries/drug-images/fentanyl https://www.dea.gov/galleries/drug-images/fentanyl Scary stuff, and maybe there’s an argument there to be made in favor of legalizing current black-market drugs. Definitely a PSA to test your drugs. CDC on cross-contamination: https://www.cdc.gov/drugoverdose/deaths/other-drugs.html https://www.cdc.gov/drugoverdose/deaths/other-drugs.html

HybridCurve 4y ago
This is the core problem, I rarely ever hear of someone using fentanyl by itself. Fentanyl is incredibly potent which maximizes profit/volume for traffickers. This creates a tremendous financial incentive for them to adopt since it provides a competitive advantage. If it's easier and cheaper to obtain fentanyl than Alprazolam (xanax), then illicit manufacturers will produce a counterfeit using fentanyl as the active ingredient. Fentanyl overdoses are also frequently caused by improper mixing techniques (powder to powder) and the non-uniform distribution will result in someone getting a hot dose. In that case, testing might not even help.
Tiktaalik 4y ago
This is the core issue. It’s not a fentanyl crisis, it’s a toxic drug crisis. The drugs are often completely different from what they’re sold as, with all sorts of toxic things added. People do a dose that is sensible based on their assumption of what the drug is, but the drug is something else, so their dose is completely incorrect and they overdose and die. No drug user at this point should expect their drugs are what they’re advertised as.
sonjat 4y ago
Really we need to start changing terminology. A great deal of these deaths are not overdoses in the sense that people took too much of a drug but poisonings in that people took something they did not intend to take. It might seem like a minor detail, but if helps drive home the point that even users who do not take opiods are at risk, it is worth doing.

coorski 4y ago

surprised ? find a solution

lazyeye 4y ago

Fentanyl is greyzone warfare from the CCP. It's astonishing how complacent the West is.

_zfxr 4y ago

https://archive.vn/tltVm https://archive.vn/tltVm