Hydrocodone...or Fentanyl?

[Dhedmo (OP)]

http://www.sacbee.com/news/local/health-and-medicine/article71592282.html

http://www.npr.org/2016/04/21/475161589/deadly-fentanyl-trade-linked-to-chinese-companies

If fentanyl is cheaper to make than illicit hydrocodone or heroin, what implications does that have for public health?

Fentanyl is not new to the street drug trade. "China White," heroin spiked with fent, has been on the scene seemingly forever. But when I was taking fentanyl, I had never really heard of the drug except on the Phile and in drug literature, and had yet to ever hear the word "fentanyl" on the news.

But there have been several feature stories on it in the last week (see above for two).

I've always thought that lacing heroin with fentanyl was one of the more cold-blooded marketing techniques ever: someone dies from a hot shot, and everybody wants that good dope.

But fentanyl's place in the illicit marketplace is changing from an additive to a standalone product. It's freaking me out to hear of fentanyl being sold on its own, masquerading as Norcos, of all things.

As Quincy, the TV Medical Examiner would have said, "I think it's murder."

But it also raises questions about the future of opioid use.

I was prescribed fentanyl for nearly 2 years (75mcg x 48, or 3 boxes of 75s per month) from 2007-2009 and without Opiophile, I probably would have been one of the early-adopting departed.

It chills me to recall Dek's experiments with smoking fent, and all the cautionary tales of those (often with relatively high tolerances) who tried that once and died. I'd be lying if I said these tales of keyboard faceplants and miraculous survival didn't give me a vicarious, Icarian thrill. But they also scared the hell out of me.

When my doctor left his practice (however it happened), and his partner refused to prescribe any opioids except 120 norcos, it was Dek's death that motivated me to go to a pain clinic and get off the fent in a month (talk about explosive withdrawals), rather than keep courting higher and higher tolly.
 

But when I envision a world where people are taking oral and IV fentanyl as their DOC, in milligrams instead of micrograms, I am staggered by the idea of millions of people trying to maintain habits with such high tolerance that nothing else will make them well.

And what happens to all of the users if this market develops and for whatever reason the supply is interrupted? What can you take to stay well if you have a fent habit and there ain't no fentanyl?

For those of us who pass the point where this game is about getting high, but just about functioning, about staying well, maintaining, or even getting free of our yoke o' dope, I can't think of a more terrifying prospect than carrying around a fentanyl tolerance bigger than a cartoon ham.

In any case, if you get your pills sideways, be fucking careful out there.

A pill press like the one shipped from China with the "fentanyl starter set" can make "fentcos" that are indistinguishable from norcos.
And they don't come with Narcan.

I'm wondering if anyone here has been affected by this.
And do others feel like I do, or do you welcome the Brave New Junk?

[rcrumb]

When some celebrity like Prince ods on fent, then we'll hear about some move to shut it down.

Me, I'm not into it. Because I know kids are gonna look for norcos and end up with fentcos and then its sayonara. Fent was even ending up in zany bars a while back. Bad sh!t.

[Thoms]

Opanas will hold a dent habit. We were smoking fent though and our tolly did blow up. Then the love of my life od'd and scared the living fuck out of me, I thank god all the time she lived. Be careful with fent. Pro tip: it works a fuck ton better if the gel is dried into a thin plasticky thin piece.

[Griffin]

I wouldn't be surprised if people did worse things to get money or their fix if they had a large fent habit that came with extreme withdrawals. I mean w/d's are bad regardless, I have done a jailhouse kick off 280 mg of done and been through pwd's, and I can't imagine it getting worse than that. It would have a quicker onset because of the shorter half life and if the w/ds are amplified by the increased tolerance you could see the amount of crazy shit people would do to get well rise.

My counselor is part of some organization that discusses drug use trends in CO and thats pretty much all we have talked about our last 2 sessions. They got a memo last month from the national group about all of the RC's, and fent laced stuff. That was the first time he had heard of the RC's but he knew that the fent laced bags were getting more common and causing more deaths over the last few years. It was mainly about w-18 and u4770 but it included a lot of other stuff.

He had no idea how easy it is to get and how much more prevalent the fent analogues are even just compared to last year. It has made me wonder about it's effect on the heroin trade, like are they going to try and sell a cheaper and/or more pure product to keep up with the fent use, or are they just going to add fent to all of their H and start selling fent by itself in the open air markets as well as H. Do you guys think that the cartels are the ones who are mixing it or do you think that is the distributors that are doing it right before it goes to market? 

It is scary to me and I don't take pills. The fact that there are people out there faking hydrocodone and xanax with fent is terrifying and asking for nothing but more deaths. I am all for getting more bang for your buck but it's not worth risking death on each use. I really hope that harm reduction is pushed heavily these next few years to the point where they are required to give you narcan with any opiate prescription and to every single MMT and bupe patient.

At my clinic you are required to do an orientation group when you start which tells you all about methadone and its use, and all the clinic stuff like getting take homes, diversion policy, and all that. It should be a required that they teach everyone how to use narcan at clinics and give it to every single patient. Also have groups for family members of the patients on how to use it and give it to everyone after the group, they could open it up to the public for all opiate users and any of their family members. They do that at the local NX but it needs to be advertised.

They also need to do what they did in CO, nationwide where you don't have to have a prescription to get Narcan you can goto any pharmacy and ask for it and they will give it to you without a prescription. Require all insurance providers to cover it so that if you get an opiate prescription you are required to buy narcan atleast once every 2 years or something. Also making sure every single emergency responder has it on them at all times and knows how to use it like cops, firemen, and ambulances. 

That is the only way they are going to lower the death rate, more education to the users, doctors, emergency responders, and family so that they know about fent and how to combat an OD. If you hit someone with narcan a few times should they be able to come out of an OD as long as they aren't dead? Would there be a way, chemically speaking, to increase naloxones' binding affinity so that it would be stronger than fent, like making a fent/naloxone antagonist of some kind? That way it could rip huge fent doses off the receptors and cover them.