6 ms·

Why does fentanyl kill? Because people buy it and don't understand the strength. Regulation would take care of that. So what's your argument here?

tptacek 3y ago
That is not why fentanyl kills.
- 4RealFreedom 3y ago
  So are you going to tell me what it is then?
  - tptacek 3y ago
    I don't have to. We've had a nationwide epidemic of deaths from regulated, labeled opiates, which is a fact that refutes your argument without requiring me to provide an alternative.
    - loeg 3y ago
      The overdoses per abuser from regulated, labeled opiates is on the order of at least 100x lower than illicit opioids. The consistent formulation is hugely safer than street drugs with inconsistent dose.
      - tptacek 3y ago
        Assuming arguendo that's true, that's a different argument than the one made upthread.
        loeg 3y ago
        Sure. But I am responding to you, not that guy upthread. Your implied claim, as I read it, is that "opioid-ness" is "why fentanyl kills," and there's nothing special going on because we had a bunch of deaths from licit opioids in the early 2000s. But I think that there's actually something special about illicit fentanyl in particular, as opposed to regulated opioids, and dose inconsistency is one plausible difference. Anyway, you could just share what your thoughts are more explicitly, and that would be interesting and maybe harder to misunderstand.
        tptacek 3y ago
        I was responding to a particular argument. I've lost track of what we would be arguing about here. My point was pretty straightforward: high-test opiates don't simply kill because they're unregulated; they do a very good job of killing simply by being widely available at all.
        4RealFreedom 3y ago
        By that logic, we shouldn't have many opiate deaths because they are currently controlled.
        tptacek 3y ago
        They are not at all meaningfully controlled. There are drive-thru markets for this stuff with people doing traffic control in Chicago, and presumably in every other major market.
        CyberDildonics 3y ago
        Assuming double arguendo, you were saying that prescription pain killer dangers are aequalis to street fentanyl and statistics show that is falsus.
        tptacek 3y ago
        I don't believe it much matters. The death stats on oxycodone are staggering. I'm sure the street drugs are much more dangerous dose-for-dose, but given free access to oxycodone, you're just as likely to die, perhaps on a marginally longer schedule (there are survivor high-functioning maintenance addicts on both natural and synthetic/street opioids, obviously). Remember as well that a great many street fentanyl deaths were pts started on regulated, labeled opioids who spun off into addiction; they transitioned to fentanyl because it was easier to get, not because it was stronger.
        CyberDildonics 3y ago
        I don't believe it much matters. The original claim was having a controlled dose matters, so it not only matters, that's the whole conversation here. The death stats on oxycodone are staggering You make these claims about stats but don't give stats. but given free access to oxycodone People don't have free access oxycodone you're just as likely to die This is not verum. "16 million individuals worldwide have had or currently suffer from opioid use disorder (OUD)" https://www.ncbi.nlm.nih.gov/books/NBK448203/ https://www.ncbi.nlm.nih.gov/books/NBK448203/ Remember as well that a great many street fentanyl deaths were pts started on regulated, labeled opioids Primis, this is an unbacked claim. Secundo, why didn't they die from prescription opiods? The truth is fentanyl has a low safety index which makes the dose more important. "The calculated safety index (ORantinociception/ORrespiratory depression) for fentanyl of 1.20 suggests that fentanyl has a low safety margin, implicating that fentanyl needs to be titrated with caution." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190336/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190336/
        tptacek 3y ago
        More people die from oxycodone, even today, I think? than from heroin. Labeled regulated opioids are not safe.
    - CyberDildonics 3y ago
      You are making a claim then saying you don't have to back it up while making another dubious claim. Among synthetic opioid–involved overdose deaths in 2016, almost 80% involved another drug or alcohol, such as: another opioid, heroin, cocaine, prescription opioids, benzodiazepines, alcohol, psychostimulants, and antidepressants. https://www.cdc.gov/drugoverdose/deaths/other-drugs.html https://www.cdc.gov/drugoverdose/deaths/other-drugs.html
      - loeg 3y ago
        FWIW, 2016 is somewhat dated as far as fentanyl goes. It has really exploded since that time. > In 2021, nearly 71,000 drug overdose deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid. Synthetic opioid-involved death rates increased by over 22% from 2020 to 2021 and accounted for nearly 88% of all opioid-involved deaths in 2021. The number of overdose deaths involving synthetic opioids in 2021 was nearly 23 times the number in 2013. Same CDC page, "opioid" tab. https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html
        CyberDildonics 3y ago
        What I posted wasn't about fentanyl. They implied that overdoses happen just as much with prescription pain killers that have consistent doses and what I posted shows that people aren't overdosing on known doses, they die when they combine drugs.
        loeg 3y ago
        Sure.
- more_corn 3y ago
  Fentanyl kills by overdose.
  - tptacek 3y ago
    Very few opioids kill by underdose.
- swells34 3y ago
  Fentanyl is administered daily by medical professionals in all sorts of situations. If "not understanding it's strength" is not what causes people to overdose on it, then why aren't millions of people dying from its administration in a medical setting?
  - tptacek 3y ago
    The claim upthread is that regulation in labeling would materially curb fentanyl deaths. It would not. Materially restricting access to high-test opiates might, but we have ample experience from well-labeled high-test opiates to suggest that uncontrolled access to any of them is likely to be deadly. If by "regulation" you mean "restriction", then, sure, I buy that, stipulating that it's somehow possible to restrict access. But what the preceding commenter meant by "regulation" was labeling. No, that won't work.
    - 4RealFreedom 3y ago
      How do you know that? We can't eliminate opiate deaths completely but we can make them as safe as possible. Restricting access isn't working.
      - tptacek 3y ago
        Because we had (and still do have) an epidemic of fatal abuse of labeled, regulated opioids. I'm not saying restriction works either; I'm rejecting the pat solutionism of the original comment and acknowledging how difficult the problem is. Maybe legalization is a good idea, maybe not; what it certainly isn't is a solution to opioid deaths.
        cm2187 3y ago
        And I believe the problem isn't so much that those legal opioids are dangerous, because in theory you still have a medical system to curb access. It is that they are addictive, and that users who get addicted will either abuse them or switch to illegal drugs if they can't access them. I am not against drug legalisation, on libertarian grounds. If you want to kill yourself, kill yourself, it's your life not mine. But I don't buy that banning drugs results in more harm that making them freely available. And it's very paradoxical for liberal societies to want to ban or heavily control the use of alcohol and cigarettes and to consider legalising hard drugs at the same time.
nradov 3y ago
Lack of understanding isn't the issue. Most fentanyl deaths are accidental poisoning. Mexican drug cartels are manufacturing counterfeit prescription drugs like Xanax and Oxycodone but substituting fentanyl for the active ingredient because it's cheaper. They have bad quality control and sometimes put in a fatal dose. https://peterattiamd.com/anthonyhipolito/ https://peterattiamd.com/anthonyhipolito/
akerl_ 3y ago
I would recommend https://podcasts.apple.com/us/podcast/why-are-drug-dealers-putting-fentanyl-in-everything-part-2/id1614253637?i=1000624865502 https://podcasts.apple.com/us/podcast/why-are-drug-dealers-p... , but the TL;DR is roughly "drug addicts are highly motivated by their addiction to find the most powerful drugs they can, to get the most powerful high they can get. Fentanyl being so strong that people overdose is, in this regard, a selling point"

tptacek 3y ago

That is not why fentanyl kills.

4RealFreedom 3y ago
So are you going to tell me what it is then?
- tptacek 3y ago
  I don't have to. We've had a nationwide epidemic of deaths from regulated, labeled opiates, which is a fact that refutes your argument without requiring me to provide an alternative.
  - loeg 3y ago
    The overdoses per abuser from regulated, labeled opiates is on the order of at least 100x lower than illicit opioids. The consistent formulation is hugely safer than street drugs with inconsistent dose.
    - tptacek 3y ago
      Assuming arguendo that's true, that's a different argument than the one made upthread.
      - loeg 3y ago
        Sure. But I am responding to you, not that guy upthread. Your implied claim, as I read it, is that "opioid-ness" is "why fentanyl kills," and there's nothing special going on because we had a bunch of deaths from licit opioids in the early 2000s. But I think that there's actually something special about illicit fentanyl in particular, as opposed to regulated opioids, and dose inconsistency is one plausible difference. Anyway, you could just share what your thoughts are more explicitly, and that would be interesting and maybe harder to misunderstand.
        tptacek 3y ago
        I was responding to a particular argument. I've lost track of what we would be arguing about here. My point was pretty straightforward: high-test opiates don't simply kill because they're unregulated; they do a very good job of killing simply by being widely available at all.
        4RealFreedom 3y ago
        By that logic, we shouldn't have many opiate deaths because they are currently controlled.
        tptacek 3y ago
        They are not at all meaningfully controlled. There are drive-thru markets for this stuff with people doing traffic control in Chicago, and presumably in every other major market.
      - CyberDildonics 3y ago
        Assuming double arguendo, you were saying that prescription pain killer dangers are aequalis to street fentanyl and statistics show that is falsus.
        tptacek 3y ago
        I don't believe it much matters. The death stats on oxycodone are staggering. I'm sure the street drugs are much more dangerous dose-for-dose, but given free access to oxycodone, you're just as likely to die, perhaps on a marginally longer schedule (there are survivor high-functioning maintenance addicts on both natural and synthetic/street opioids, obviously). Remember as well that a great many street fentanyl deaths were pts started on regulated, labeled opioids who spun off into addiction; they transitioned to fentanyl because it was easier to get, not because it was stronger.
        CyberDildonics 3y ago
        I don't believe it much matters. The original claim was having a controlled dose matters, so it not only matters, that's the whole conversation here. The death stats on oxycodone are staggering You make these claims about stats but don't give stats. but given free access to oxycodone People don't have free access oxycodone you're just as likely to die This is not verum. "16 million individuals worldwide have had or currently suffer from opioid use disorder (OUD)" https://www.ncbi.nlm.nih.gov/books/NBK448203/ https://www.ncbi.nlm.nih.gov/books/NBK448203/ Remember as well that a great many street fentanyl deaths were pts started on regulated, labeled opioids Primis, this is an unbacked claim. Secundo, why didn't they die from prescription opiods? The truth is fentanyl has a low safety index which makes the dose more important. "The calculated safety index (ORantinociception/ORrespiratory depression) for fentanyl of 1.20 suggests that fentanyl has a low safety margin, implicating that fentanyl needs to be titrated with caution." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190336/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190336/
        tptacek 3y ago
        More people die from oxycodone, even today, I think? than from heroin. Labeled regulated opioids are not safe.
  - CyberDildonics 3y ago
    You are making a claim then saying you don't have to back it up while making another dubious claim. Among synthetic opioid–involved overdose deaths in 2016, almost 80% involved another drug or alcohol, such as: another opioid, heroin, cocaine, prescription opioids, benzodiazepines, alcohol, psychostimulants, and antidepressants. https://www.cdc.gov/drugoverdose/deaths/other-drugs.html https://www.cdc.gov/drugoverdose/deaths/other-drugs.html
    - loeg 3y ago
      FWIW, 2016 is somewhat dated as far as fentanyl goes. It has really exploded since that time. > In 2021, nearly 71,000 drug overdose deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid. Synthetic opioid-involved death rates increased by over 22% from 2020 to 2021 and accounted for nearly 88% of all opioid-involved deaths in 2021. The number of overdose deaths involving synthetic opioids in 2021 was nearly 23 times the number in 2013. Same CDC page, "opioid" tab. https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html
      - CyberDildonics 3y ago
        What I posted wasn't about fentanyl. They implied that overdoses happen just as much with prescription pain killers that have consistent doses and what I posted shows that people aren't overdosing on known doses, they die when they combine drugs.
        loeg 3y ago
        Sure.
more_corn 3y ago
Fentanyl kills by overdose.
- tptacek 3y ago
  Very few opioids kill by underdose.
swells34 3y ago
Fentanyl is administered daily by medical professionals in all sorts of situations. If "not understanding it's strength" is not what causes people to overdose on it, then why aren't millions of people dying from its administration in a medical setting?
- tptacek 3y ago
  The claim upthread is that regulation in labeling would materially curb fentanyl deaths. It would not. Materially restricting access to high-test opiates might, but we have ample experience from well-labeled high-test opiates to suggest that uncontrolled access to any of them is likely to be deadly. If by "regulation" you mean "restriction", then, sure, I buy that, stipulating that it's somehow possible to restrict access. But what the preceding commenter meant by "regulation" was labeling. No, that won't work.
  - 4RealFreedom 3y ago
    How do you know that? We can't eliminate opiate deaths completely but we can make them as safe as possible. Restricting access isn't working.
    - tptacek 3y ago
      Because we had (and still do have) an epidemic of fatal abuse of labeled, regulated opioids. I'm not saying restriction works either; I'm rejecting the pat solutionism of the original comment and acknowledging how difficult the problem is. Maybe legalization is a good idea, maybe not; what it certainly isn't is a solution to opioid deaths.
      - cm2187 3y ago
        And I believe the problem isn't so much that those legal opioids are dangerous, because in theory you still have a medical system to curb access. It is that they are addictive, and that users who get addicted will either abuse them or switch to illegal drugs if they can't access them. I am not against drug legalisation, on libertarian grounds. If you want to kill yourself, kill yourself, it's your life not mine. But I don't buy that banning drugs results in more harm that making them freely available. And it's very paradoxical for liberal societies to want to ban or heavily control the use of alcohol and cigarettes and to consider legalising hard drugs at the same time.

nradov 3y ago

Lack of understanding isn't the issue. Most fentanyl deaths are accidental poisoning. Mexican drug cartels are manufacturing counterfeit prescription drugs like Xanax and Oxycodone but substituting fentanyl for the active ingredient because it's cheaper. They have bad quality control and sometimes put in a fatal dose. https://peterattiamd.com/anthonyhipolito/ https://peterattiamd.com/anthonyhipolito/

akerl_ 3y ago

I would recommend https://podcasts.apple.com/us/podcast/why-are-drug-dealers-putting-fentanyl-in-everything-part-2/id1614253637?i=1000624865502 https://podcasts.apple.com/us/podcast/why-are-drug-dealers-p... , but the TL;DR is roughly "drug addicts are highly motivated by their addiction to find the most powerful drugs they can, to get the most powerful high they can get. Fentanyl being so strong that people overdose is, in this regard, a selling point"