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
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.
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
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]
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.
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?
Following your limk it appears to me that only 46.6% [1], or 23132 deaths, of the unintentional poisoning deaths are classified as X42, or “Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified” [2]. I can”t find any further split into fentanyl and non-fentanyl among those.
It is surprisingly hard to get the actual data for fentanyl/opioid overdoses, even though the numbers are on the CDC site, just spread out in multiple places.
You suspect the CDC would massage their messaging to manipulate (nudge?) public opinion towards achieving a desired outcome, rather than just straightforward factual scientific reporting the likes of which most people would expect?
Hard to speculate on motivation, but it's very odd that the information is arranged in a way that makes it very difficult to figure out "overdoses are the #1 killer of people aged 1-44".
All these links are wapo internal. I can't find the CDC corroborating this.
It looks like the authors are comparing numbers from different methodologies and then claiming a quantitative rank order can be deduced and it can't unless you can demonstrate the methodologies yield equivalencies especially when you're looking at small population percentages...
I had a good friend lose a multi-year battle with opioids about 7 years ago who ended up sleeping on my couch for months when his family had abandoned him. It's a life changing and terrible thing and I've never been through anything more difficult than helping someone struggling with opioids but I don't think these claims in the article are well supported.
I wish nothing but the best for others going through these troubles. I wish compassion worked as better medicine
> 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.
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.
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.
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.
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.
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.
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).
The TV advertising is really gross and annoying. And IMO, gotten much worse in recent years.
I hadn't watched TV in years before I went to Southeast Asia. I always laughed that it seemed all the commercials were for coffee and beauty products, rarely anything else.
Then I happened to catch live TV for the first time in a while after I returned, and realized it seemed 80% of the commercials were for random drugs. It made me wish we had more coffee and beauty product commercials!
I recently went sober from alcohol and afterwards realized how much alcohol advertising there is, it's actually pretty insane. For certain programs (like football) it's almost %50 of the ads.
Prescription drug sales reps market to doctors, attempting to convince them to prescribe certain drugs more frequently. Who pays for the drugs is largely irrelevant to that interaction, but I wouldn't be shocked to learn it's illegal in the UK.
I worked in the industry and it’s not really like that (at least the ones following rules).
Certain hotels and resort chains are banned for those types of events (Ritz Carlton, etc). All payments are “fair market value” based on the doctor’s typical compensation rate (say $500/hour for oncologist). All payments are reported to the government under the Sunshine Act.
To be honest, it’s not that lucrative for the doctors at all. They could be making more money elsewhere.
Not really. The speakers are paid for their time and get a free meal. But those in the audience get a free meal, which you can't bring a non-medical person to, and which most doctors could easily afford on their own.
Medical students and residents will attend these, because they can't afford to eat those meals.
Now, the device industry... that does not operate under the PhRMA rules.
The one drug I've ever given a talk for (sugammadex, trade name Bridion) is an excellent drug that has a unique mechanism of action for which there is absolutely no equally-efficacious substitute. It is expensive, at around $90 a vial cost to the hospital, but it can and has prevented overnight ICU stays that would have cost the hospital far more. I was a big fan of the drug even before it was released in the US, so I didn't need a bribe to do the talk. But if they're going to pay someone, I saw no reason it shouldn't be me. I didn't say anything I didn't already believe.
Back in the early 2000's I drove for a proto-doordash (no apps, cell phones, or GPS, just two way radios and a local map book) food delivery service. The best jobs were always the pharma reps buying $500 of lunch for a 5 person doctors office. Could walk away with $100 in tips from a lunch shift.
>if a doctor has a question about a drug, who better to ask than the rep from the company who makes it?
ideally a third party in the form of a board of scientists who don't have a direct conflict of interest. Look at the billion dollar settlements of J&J in the last decade alone for misleading marketing and health risks from products including hip replacements, psychoactive drugs and implants.
But if your patient is having a specific side effect and you want to know what information is available, your only choice is the company because they collect the information.
To ban sales reps is like running a garage to repair cars and never talking to the manufacturer.
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
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.
Viagra is now over-the-counter in the UK. It's only legal to advertise General Sales List (stuff anyone can sell, like aspirin) and Pharmacy (can only be sold by a pharmacist, like co-codamol) medicines to the public. Prescription drugs can only be advertised to medical professionals.
I would have to check more of Ofcom guidelines, but it's likely in there somewhere that drugs (with exceptions you mentioned), like cigarettes are explicitly prohibited from adverts.
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.
It's not, but it's hard to argue that TV advertising is (or was until very recently) a great way to get your drug's name out to the public. It's hard to research something you don't know about, especially before the Internet was commonly available.
Of course, the drugs with ads are usually the most expensive name brand drugs that will earn the pharma companies a lot of money.
In the UK, we don't see a drug on the TV (other than headache tablets and cough syrups) and then demand our doctors prescribe them. We visit a doctor who makes a diagnosis and prescribes the appropriate medicine, if necessary.
The FDA’s own research suggests otherwise. DTC isn’t perfect but has a lot of benefits according to doctors surveyed:
- Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.
- Many physicians thought that DTC ads made their patients more involved in their health care.
- Physicians thought the ads did not convey information about risks and benefits equally well. Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.
- Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.
- DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.
- Doctors believe that patients understand that they need to consult a health care professional about appropriate treatment. Eighty-two percent responded either "very well" or "somewhat" when asked whether they believe that their patients understand that only a doctor can decide whether a drug is right for them.
My experience if you do your research your labeled as a hypochondriac and given anxiety meds. At least until you are nearly dead, then they sort of listen
Oh you show signs of strokes and autoimmune condition? Here’s some chill pills.
Imagine the TV asking if you're feeling down, not quite right and many other euphemisms for depression while being very careful to not use medical terminology, then suggesting you to go see your doctor.
I though it was brought partially by wealth gaps and hopelessness. The drugs epidemic in the US is now at least 50 years old (maybe a bit better between 2000 and 2008?). Two generations were raised while it existed and that more that anything banalized drugs. Fentalyn might be the latest one to trend, but it was Opioid, Meth, Cocaine, Crack and LSD before, all the way to the 70's.
I suppose Isolation during Covid might play a role, but I have not seen any stats relating drugs and the pandemic so far.
A culture hyping 70-hours weeks and over-employment as solutions to cost-of-living issues is not healthy, and drugs are just one of the symptom.
Fentalyn isn't really the problem. The need for drugs to escape/cope is.
I think there might also some incentive to pad media runtimes for streaming services to make it look like they have a lot of content. And a drug induced high sequence is cheap to film.
Lots of content that should be 90min or 2 hours at most is now 4 hours or more.
I simply stop watching or fast forward through that nonsense. If I wanted to see people get high and drunk over and over, there are more entertaining venues.
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.
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.
>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.
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.
Although I think it is hard to get firm numbers on this, a lot of other drugs are being cut with Fentanyl or outright substituted, including comparatively benign drugs like Xanax. There is a growing movement to classify a lot of fentanyl drug deaths as poisoning since it wasn't that the person took too much, it was that they were unaware that they were taking it at all. (Source: lost a daughter to what she thought was Xanax that was pure Fentanyl)
> 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.
Not in agreement on this. 2020 looks profoundly different than 1920, for example from the lens of western societies. People are more atomized, have less friends, are having less kids, are getting married less often, divorced more often, job prospects for blue collars workers have diminished, etc etc. Not to mention the simple fact that Fentanyl did not exist in 1920. While man might not have changed much inherently, their environment has changed profoundly and seemingly not for the better.
You can't be serious. In 1920, still a significant part of the population lived in absolutely abhorrent slums. People on average worked 60 hours weeks, and often in extremely unhealthy and dangerous conditions (for example, molten iron being accidentally spilled on some poor soul in Carnegie's steel mill wasn't an uncommon occurence). There were no antibiotics, so family deaths were much more common (leading to grief and depression). Overall, the conditions of living were so harsh that people were numbing themselves with alcohol on a massive scale, ultimately leading to Prohibition Act.
> In 1920, still a significant part of the population lived in absolutely abhorrent slums.
Define significant part. There are people in 2020 living in absolutely abhorrent slums. Most major US cities have areas meeting this definition.
> People on average worked 60 hours weeks,
Unsure if this is true. Even if it is, probably more accurate to say of those people who worked, they worked an average of 60 hours per week. But in 2020 a higher percentage of the population is working. Women in the workforce has grown exponentially. This too is a major shift / difference.
> Overall, the conditions of living were so harsh that people were numbing themselves with alcohol on a massive scale, ultimately leading to Prohibition Act.
Suicide rate in the US has been steadily climbing decade over decade. What does that say about our living conditions?
> Define significant part. There are people in 2020 living in absolutely abhorrent slums. Most major US cities have areas meeting this definition.
The 1920 slums meant living at 5-10 people per room, with no running water, in constant stench from the nearby factories. I doubt you can find many places like that in US today.
> Unsure if this is true.
That's what the data I've found says - average time worked in non-agriculture was close 3000 hours per year (so, 60 hours per week for 52 weeks per years - no sick days, no vacation). Plus constant risk of death or maiming, plus obviously inhaling all the deadly pollution etc. (Communist countries at least started recognizing that conditions of working in a coal mine or steel mill will literally kill you over time, and gave those workers full retirement after "just" 15-20 years of work there). Conditions were bad enough that people were risking their lives trying to start trade unions. Many were killed for it, too. How many trade union members were killed in 2022 in the US?
Women didn't worked at jobs, but slaved away at homes. Living without modern amenities plus large families meant a mountain of work. For example, my grandmother didn't have a washing machine and washed the bed linen by hand, which meant 10+ hours of physical labor. She insisted on doing that every 3 weeks or so.
> Suicide rate in the US has been steadily climbing decade over decade. What does that say about our living conditions?
Hard to say? For example, during wartime (cannot imagine harsher living conditions than war), number of suicides can go down significantly - they did in the UK during WWII for example. The relation between living conditions and suicides are complex at best.
So you seem to agree that 2020 and 1920 look very different, as far as the environment that people found themselves in. You seem to take issue with my claim that things have not improved for the better. Lets agree here instead that that some aspects of the environment are better and others are worse.
Going back to the subject at hand (fentanyl use), I think one can safely state that more people are dying from drug overdoses and suicide than they were in other decades in US history. Is it people who have changed, or their environment? And do you disagree that there is a correlation? Certainly there has to be. Availability of fentanyl correlates with fentanyl deaths, whereas unavailability of fentanyl would correlate with lack of fentanyl deaths. And so all the ways that the environment of 2020 is now better than in 1920, seems not to translate to less drug overdoses and suicides. And I can think of no better indicator of quality of life, than the indicator of how many people are choosing death over living.
What fraction of fentanyl deaths are by choice? The accidental OD's where it was unexpected are definitely not by choice. That's why fentanyl is being colored brightly, to help you see that something has been adulterated with it. Other drugs are being messed with by the middlemen, there is a supply chain problem.
Yes, less fentanyl in the supply chain would be the right answer.
People still look to escape the drudgery of their world, that doesn't change. You're right that we have far fewer social supports. Although I do wonder if a study would confirm that people with smaller in person social networks use or overuse drugs less than more isolated people.
>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.
This has the same energy as “we don’t have a gun control problem. We have a mental health problem” which every Republican says after every mass shooting
Their view is mental health breakdown is a part of a larger social-structure breakdown and no amount of spending will fix that problem.
Not all solutions can be fixed with infinite dollars.
So no, it isn’t “worse than that.”
Meanwhile we have folks creating problems then taxing the populace then shifting tax dollars to unaccountable private sector friends and donors. True problems.
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.
"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)."
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.
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
Nah. You need legalization and regulation so that people can buy known doses of known substances. Decriminalization is nice for keeping users out of jail, but as long as manufacture and sales are illegal the supply is still going to be fucked.
I think the U.S. overall has low single digits. And even those exist in an extremely dubious legal space, requiring the cops to turn a blind eye to their existence.
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.
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.
So if I don’t have the money to pay rent, what should I do?
Should I commit suicide?
And the extremely high rents means in the US you don’t even need to be jobless to not be able to afford rent. The lowest 10-20% of paying jobs may not pay enough money for a person to live in the area the job exists.
Homelessness in the US is a massive problem. But the homeless are not the cause of homelessness. They’re the victims. The U.S. has multiple failed policies which allows homelessness to exist in the richest country in the world.
And there are solutions across the ideological spectrum. You can go left and have the government give them housing. This is cheap (way cheaper than shelters) and extremely effective. On the extreme right you can stop NIMBYs from allowing housing to be built, which will in itself drop costs and rent.
The answer probably lies somewhere in the middle. But the US has chosen to simply ignore the solutions altogether.
When the U.S. does pick a solution, it chooses to incarcerate them. Which is the worst possible solution because now you’ve led them to joining a gang and predictably becoming real criminals themselves who now learn know how to rob and steal and commit violence to satisfy their need for money.
And it’s also ridiculously more expensive than all the other solutions above.
Not everyone needs to concentrate in a couple big cities. You can't afford to rent in the city go somewhere else that's cheaper. There is an abundance of land in the US not being utilized.
Why must people be subjected to witnessing others misery and self-destruction? If you care so little about their public camping would you also let someone camp in your yard?
You seem to have no sympathy for shop owners that get robbed constantly, if someone robbed you on your way to the car from the grocery store would you also be ok with it?
Even if rent is arguably cheaper outside of the big cities, the costs of living for the poor are more expensive as transportation costs increase, and economic opportunity plunges.
Of course it makes sense for economically precarious people to move to the city. We should expect and applaud them for making this decision. It’s where all the jobs are.
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.
Half-assed solutions lead to half-assed results. Decriminalization sounds nice to liberals, but when you continue to criminalize the production and sale of drugs you still get almost all of the same problems you had before decriminalization.
People keep saying this. I don't get it. What's the proposed cause/effect of decriminalization on drug overdoses specifically? Testing kits, sure. And I see the argument for much softer sentences for small amounts with regards to reducing the egregious number of people in the prison system, although that is also a tangential issue to overdoses.
I think part of the problem is that criminalization of heroin is what made fentanyl so wide spread, since it is much smaller volume and easier to smuggle about. A side effect is that it's much easier to dose incorrectly and kill people. If opioids could be decriminalized, then people may be given access again so safer versions of the drug. Also other benefits like getting testing kits from police etc. without the fear of jail time.
If drugs are legalized and regulated, overdoses and deaths from contamination would mostly disappear, as would black market violence. Decriminalization simply stops users from being thrown in jail, it does little to prevent suffering and death.
I think this sentiment usually comes from people who have no experience with the problem, and who are used to being contrarians, especially with regards to drugs like marijuana.
The authority figure in their lives lied to them about marijjana, and now they think they they’re lying again about fentanyl.
Fentanyl is a poison. It’s killing people. It is not like marijuana.
I disagree. I think this sentiment comes from people who are very close to the problem. Users or former users, friends and family of users. People who have seen someone who needs medical help get treated with disdain and arrested instead. People who have a loved one who bought adulterated drugs and overdosed because they didn't know what they were taking.
It is naive to think the war on drugs was ever about protecting people. If the protection of people is a goal, you don't treat the people who need the most help as criminals. Imagine if you discover your brother has a drinking problem and it's destroying his health and finances - is your first instinct to call the police and have him arrested? Most people I think would not even think about that - they would urge him to get help, somehow, through rehab, counseling, any number of things, but no one would say he needs to go to prison.
The only actual criminals involved with drugs are organized crime cartels, gangs, etc that use violence in controlling their market. If you make their product legal and obtainable, they no longer have any incentive to sell it and you eliminate a big chunk of their profits.
Legalizing drugs is about treating addiction as a medical issue instead of a criminal one and eliminating the illicit drug trade which contributes to violence and profits for organized crime.
Isn't the suggestion that if there were not police/criminals as an interface to getting high, there would be
a) the ability to know whether the drug one is purchasing contains a Fentanyl OD (labeled contents from auditable sources)
b) more access to resources for dealing with addiction, less dangerous circumstances, etc
What has drug prohibition done to help the problem of addiction and violence in the United States?
Drug abuse is a much smaller problem in east Asia where it is intensely criminalized. In Singapore drug trafficking is a capital offense.
Drug abuse is a massive problem in those parts of the US where it is de-facto decriminalized on the west coast.
I think the evidence is fairly clear on what would constitute a solution, rather the debate is on whether we’d be willing to pay the costs of that solution.
I do not mean to say it is just a west coast issue. But I do know that in the places where I have seen people selling drugs without fear, the drug problem is very, very bad.
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.
> 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.
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.
Hard line policing is the problem, not MJ/opiates itself.
If you get in as much trouble doing/buying/selling/etc MJ as Fentanyl, you might as well do the latter.
If MJ is legal, many would stick to that.
Same for MJ-to-alcohol: and the alc producers know it, they lobbied fiercly against legal MJ and when it became legal (like in Canada) they were the first to invest heavily in it.
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.
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.
> 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.
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.
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.
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?
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.
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.
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.
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.
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.
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?
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?
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.
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.
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.
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.
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.
> 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.
I think that a basic familiarity of the Chinese experience with British opium would suggest that full legalization for the more dangerous drugs is not a panacea.
One marvels as to why e.g. Russia or China don't covertly push funds and efforts into drug legalization in the US if that would widely harm its population and weaken it as a whole. But to the best of my knowledge, they apparently don't, so this is a (somewhat weak) argument in favour of legalization.
Because they are interested in destabilizing the country in order to make themselves more powerful on a global scale. Although I think they are doing much better in that front by manufacturing all of our stuff (china anyway)
I don't necessarily subscribe to this belief, but they wouldn't care about the random individuals but rather the societal level impacts of such a policy should they think it would be disruptive.
There is a theory that seems correct - when a drug is banned, the black market moves towards the most potent version available.
Even during prohibition it was way easier and profitable to make bootleg whiskey than beer.
Why? It’s easier to conceal, packs the most punch, and is the most profitable by weight.
Instead of making heroin legal, make opium legal. Or even weaker opioids like codeine. Then people who wanted an opioid high would have access to legal, clean, less potent opioids that could be taken in a less harmful way than IVing black tar heroin.
Well ya duh. The substance is addictive. There will be addicts whether it is legal or not. But addiction isn't a criminal issue. It's a medical one, so we should treat it as such and stop sending users to prison and stop creating a market for organized crime to make billions
I don't know that that follows. Fentanyl's cost to the end user is like 100x cheaper than 19th century opium (or more? I can't find data but that's probably about right). Don't market economics explain the issue better than regulatory decisions?
1 out 200 people addicted to opiates during that time is worse than the reported 10 million users[1] of opiates in the country. Overdoses is higher because Fentanyl is stronger and easier to overdose off of than morphine.
Death and disability from methanol-contaminated alcohol decreased when alcohol sales were re-legalized in the US. This is partly due to the government mandating the inclusion of methanol in denatured alcohol for industrial purposes.
Many of the current overdose deaths are not the result of people knowingly taking an acutely risky dose; they are instead the result of black market drugs having unpredictable composition and purity. It is likely that drug legalization would reduce that kind of overdose.
Note I wrote legalization rather than decriminalization. The distinction is that with legalization, production and distribution are legal, while decriminalization just removes serious penalties for end users.
Yep! We already have gone through the creation of a safe supply of drugs and the creation of safe consumption sites. With alcohol they’re called “bars.”
Can't find any numbers nationwide for that (though I didn't search too hard) but I did find estimates that there were ~700 prohibition related gang deaths in Chicago over the 13 years of prohibition, and ~1,000 in NYC. I'm going to assume that the vast majority of gang-related prohibition deaths were in major cities. There was an overall increase in the US murder rate by ~2.5 per 100k over the course of Prohibition, but that can't be exclusively attributed to Prohibition since the murder rate has already been rising steadily since 1904, and even though it dropped after 1933 we have the economic effects of the Great Depression as a major confounder.
Chicago had a population of 2.7 million in the 1920 census and 3.3 million in the 1930 census. NYC had a population of 5.6 million in the 1920 census and 6.9 million in the 1930 census.
Even if we use the lower 1920 numbers, that works out to ~2 Prohibition gang related murders per 100k population in Chicago per year. For NYC it's ~1.4.
Cirrhosis deaths during Prohibition ranged from 7.1 to 7.5 per 100k for the US as a whole. The study I linked attributes only 10-20% of the reduction to Prohibition, but other studies attribute more than that. The pre-Prohibition peak of 14.8 per 100k in 1907. It's likely that the temperance movement generally (which is what led to Prohibition) as well as state-level Prohibition acts prior to constitutional prohibition, contributed to this decline.
In any case, if we assume only 10% of the reduction was due to Prohibition, and we use the lowest of the Prohibition era cirrhosis numbers (7.1 per 10k), that works out to ~.7 per 100k fewer deaths per year due to alcoholism nationwide, as opposed to the gang murders focuses in cities (or about 13k total for the 1920 us population, or about 14k for the 1933 US population). If we assume 20% those numbers double, obviously, and if we attribute any more of the drop from the 1907 peak to state level prohibition movements, we have an upper bound of ~156k, though that's unlikely since cultural forces like the temperance movement probably played a significant role there as well.
There are plenty of arguments that can be made in favor of or against prohibition, but the most common arguments that I see ("It didn't actually reduce drinking!" and "Gang related killings outweigh the lives saved!") don't really hold water.
What do you mean it doesn't work? The point is for people to know what they are buying. If it's legal then products would be better regulated and consistent. Heroin should be completely heroin, not heroin with a bit of fentanyl thrown in.
The article mentions fentanyl is more deadly but also 5-10 times cheaper than the opiates it replaces. $4 for an oxy clone is wildly accessible. No telling if I would have tried it as a teenager had they been that cheap and available.
> 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.
One of the most unhinged things I've read on this site, and that's saying something.
Wouldn't the more reasonable approach be over-the-counter legalization of a safer opiate? Fent is inherently dangerous because it is difficult to dose safely. Addicts want an opiate, and fent is the cheap and available one.
Pretty much. Most modern drugs are a far, far more potent version of something that came before. Depending on how far you go with it, you could even apply this principle to the cigarette. The safer, lower-dose version is to chew tobacco leaves.
There are many reasons for the popularization of more concentrated drugs, but the two big ones are that more potent drugs generally make for cheaper doses, and that it's more profitable to create addicts than to create satisfied customers.
The latter is also an increasing problem outside the drug space, e.g. gambling and pay-to-win video games.
I think a reboot of Bayer Heroin (tm) would be better received - from my understanding Fentanyl and similar drugs don't have the euphoria or length of effect of OG Diacetylmorphine.
But that would upset the teetotalers and puritans. Also if drugs were legal, how would one look down on poor people and blame them for their situation in life on moral failings like addiction?
> But that would upset the teetotalers and puritans.
It's easy to cater to them. In the packet that legalizes all drugs you also remove all gun control laws.
So you make all drugs and all guns legal in all circumstances and at all times, just like it should be in a free country. The state should not control what you put in your mouth or veins or what you carry in your pocket.
The last time someone tried to shoot up a mall they got clapped by some rando who was carrying. The last time someone tried to shoot up a school the police prevented anyone from interfering while they went at it for 40min. Your selection of examples seem specifically chosen to highlight the failure of the policy you are at least pretending to advocate for.
Existing gun laws do basically nothing to stop the kind of pre-meditated violence of which you speak. At best they act as a marginal deterrent and that marginal effect carries over into the actual results.
Frankly, I don't think that crimes of pure possession (for guns, drugs or any other vice) should be crimes except with some specific time and place qualifiers (bomb at home -> ok, bomb in airport -> not ok).
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.
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.
That is the problem according to the article that prompted this post. Organized crime is selling $4 pills that contain fentanyl and look like oxycodone pills when black market oxycodone (the real thing) sells for $30 a pill.
I don't think very many users want Fentanyl at all; short high, little to no euphoria. What users really want is diamorphine or similar, which is way less dangerous, but fentanyl is commonly used because it's cheaper to produce. Pure, consistent drugs would allow users to dose correctly and avoid overdoses.
If you think alcohol should be legal then why not opioids? I just don't see how people can square these view points. We admit that alcohol can cause all sorts of health issues, including addiction and abuse, but it is legal anyway. And as a result it is well regulated (we know what we're getting) and it is easy to obtain (we don't have to deal with shady people in potentially dangerous situations). If someone is an alcoholic, then their family may ask them to seek help, but most of us will just ignore it because it is that person's problem and is not affecting us. There isn't any restrictions on alcohol content in most places - you can buy 180 proof grain alcohol just as easily as weak beer.
So why not treat other drugs the exact same way? There is no way to be logically consistent about this UNLESS you think that alcohol should also be illegal.
Whatever the US is doing is working great! Annual drug overdose deaths have only quintupled since 2000: https://www.bloomberg.com/news/articles/2022-05-11/u-s-overd.... Almost 40 times higher than Bangladesh with only double the population. Bang up job guys.
I know you are jesting in a terrible and frankly evil way. But why would it kill anyone faster? The whole issue with fentanyl is that people either don't know they are taking it or they are ignorant about its potency. Legalizing it would solve the former and probably help the latter through informative labeling and more openness among users about responsible and safe use.
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.
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.
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.
Some intellectually interesting stories have political overlap. It's possible to discuss them in a thoughtful way, without descending into political or ideological battle.
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.
