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pangstrom posted:I don't really know the street scene but seems like you would at least sell them as speedballs. Sometimes dealers don't really know what they have and fentanyl is cheap as heck to make though so that's probably part of why it's showing up in everything. As someone who has speedballed and/or done back to back shots of coke and heroin on hundreds of occasions, I can never once recall any of my dealers pre-mixing uppers and downers, packing that mixture for resale. I've always received separate bags for my separate drugs. Garbage-can mystery pills sold as (ecstasy) have always been a thing, but the IV user tends to buy their choices of dope as advertised, if perhaps sometimes weaker than expected. The market seems to recognize that people prefer to believe that they have a decent idea of what's in their needles. Apart from being good business, this tends to keep cops away and the addicts alive, high, and coming back. I tend to agree with the sloppy chemist hypothesis moreso than the willfully dangerous addict-killer narrative. As a sidenote, I'm drug tested twice a month through my methadone clinic. While I've failed for heroin more than I'd care to admit, they've never detected metabolites of fentanyl. Same story with everyone else I know who can't always stick to sobriety. While people are certainly dying from fentanyl-boosted dope here in ATL, I apparently don't see any of it.
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May 25, 2017 23:51
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No, it's a drug problem, caused by the drug war and it will go away if the drug war ends. Hyperbole is not helpful.
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May 25, 2017 23:52
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empty whippet box posted:No, it's a drug problem, caused by the drug war and it will go away if the drug war ends. Hyperbole is not helpful. It's a drug problem until a package pops in a FedEx warehouse or someone decides to shake a flour bag over a sports stadium. Fentanyl in the meth supply should be a pretty big red flag.
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May 26, 2017 00:28
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Rhandhali posted:The "super labs" are in the same places that legitimate fentanyl &c come from. Namely, China, India, etc. honestly i dont think that was the sole reason they went away like the DEA loves to say. benzodiazepines were becoming more commonplace, were safer, and fulfilled the same function that mandrax did, and i think that has more to do with it. ergotamine is heavily controlled but LSD still gets made.
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May 26, 2017 00:34
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Dmitri-9 posted:It's a drug problem until a package pops in a FedEx warehouse or someone decides to shake a flour bag over a sports stadium. Fentanyl in the meth supply should be a pretty big red flag. the point is that if we let addicts have their heroin safely none of them would want fent
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May 26, 2017 00:36
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If we'd start solving the problems people look to addiction to escape in the first place we'd have fewer addicts overall but that's soooo haaaaarrrrrrrrdddddd. The war on drugs is not only a massive failure but it's trying to solve the wrong problem. While some people just become addicts with no real "reason" stuff like poverty, social isolation, stress, mental illness, etc. inspire addiction something fierce. It's just far, far easier to say "those people are icky" and lock them in cages.
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May 26, 2017 00:41
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sea of losers posted:honestly i dont think that was the sole reason they went away like the DEA loves to say. benzodiazepines were becoming more commonplace, were safer, and fulfilled the same function that mandrax did, and i think that has more to do with it. ergotamine is heavily controlled but LSD still gets made.
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May 26, 2017 00:52
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ToxicSlurpee posted:It's just far, far easier to say "those people are icky" and lock them in cages. Yeah, if we stopped treating addicts like criminals that would put more of a dent in the problem than any police raid. Actually funding cheap/free detox, rehabilitation centers, and providing more options for aftercare than a single group working from a book written in the 30's would be nice too. ( spoken from the perspective of someone who's been there- there's almost never an empty bed at the lower cost places. My state doesn't provide free rehab, only detox. )
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May 26, 2017 01:38
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The only reason people are paying attention now is that white kids from Bucks and Delaware County are ending up in Philadelphia dead or permanently disabled from anoxic brain injury. When it was "just those junkies in the badlands" you didn't see Dr. Oz going down to the tracks for a big, sad photo op. Naturally, increased funding for "nice" rehab centers has ended up with its own subset of scams, with detox brokers taking kickback fees to refer people seeking rehab/detox, while those centers charge insurance huge sums for doing little more than a weekly UDS, and reportedly extending "treatment" -- and therefore billing -- based on positive tests where said positive results never actually are released for review.
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May 26, 2017 01:49
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Rhandhali posted:ODs are the number one source of brain death and spare parts for the transplant machine at my hospital.  reason for lovely drug policy, right? Like, it's horrible and stupid, but it's like a more comprehensible evil. An explanation.
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May 26, 2017 02:44
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Rockopolis posted:So, there's no way this is a People that use IV drugs almost always have Hepatitis C. A decent number have HIV.
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May 26, 2017 02:46
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Rhandhali posted:The "super labs" are in the same places that legitimate fentanyl &c come from. Namely, China, India, etc. China can't even police adulteration of their own domestic food supply. If they somehow do succeed in reducing the heroin supply won't there just be an increased incentive for traffickers to adulterate the heroin supply and lead to more overdose deaths? Have you ever heard of the iron law of prohibition? quote:The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases. Cowan put it this way: "the harder the enforcement, the harder the drugs"
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May 26, 2017 02:52
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sea of losers posted:the point is that if we let addicts have their heroin safely none of them would want fent Well I'm totally in favor of heroin maintenance programs and decriminalizing all drugs but I think we can be even more proactive than that.
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May 26, 2017 02:53
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OhFunny posted:lol fentanyl. That's weak poo poo. Here in New Hampshire people are overdosing on Carfentanil. Which is 100x stronger. Its sole purpose is for tranquilizing large game such as elephants. Misleading bullshit: https://twitter.com/davidjuurlink/status/859227636400349184
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May 26, 2017 03:03
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This being based on a rat study makes me pause. 3mg/kg LD50 for fentanyl? 300mcg total IVP is enough to render the average person completely apneic in my clinical experience. Sure, it's short acting, but that'll last long enough for hypoxemia and that fun spiral into a brady-down code even in a pre-oxygenated patient.
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May 26, 2017 03:22
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You get withdrawal at a super low dose and the ratio between the dose that will get you high and the dose that will kill you is much narrower than that of fentanyl by a factor of 40. Also this is a drug where doseage is measured in micrograms. Sounds safe.
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May 26, 2017 04:03
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Lote posted:People that use IV drugs almost always have Hepatitis C. A decent number have HIV. We transplant hepc livers now, they just get harvoni afterwards. I actually have not had an IV OD, it's always pills here.
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May 26, 2017 04:14
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Lote posted:You get withdrawal at a super low dose and the ratio between the dose that will get you high and the dose that will kill you is much narrower than that of fentanyl by a factor of 40. Also this is a drug where doseage is measured in micrograms. I just noticed that the effective dose on the chart is also ten times higher than that which we'd use when doing conscious sedation -- 1 mcg/kg works GREAT for people. Likewise, it's 0.1 mg/kg of morphine in humans, and often half that is plenty. Weird that the original tweeter skipped all that, as he's a clinician.
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May 26, 2017 04:15
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Dmitri-9 posted:Well I'm totally in favor of heroin maintenance programs and decriminalizing all drugs but I think we can be even more proactive than that. i agree with you, but getting someone stabilized chemically has to happen before you start digging into their issues, ime
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May 26, 2017 04:31
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sea of losers posted:the point is that if we let addicts have their heroin safely none of them would want fent except, as mentioned, folks who want to kill a shitload of people because fent is extremely loving good for that e: like, garden variety fentanyl has legitimate uses, but the RC analogues are straight up loving terrifying
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May 26, 2017 07:52
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tetrapyloctomy posted:This being based on a rat study makes me pause. 3mg/kg LD50 for fentanyl? 300mcg total IVP is enough to render the average person completely apneic in my clinical experience. Sure, it's short acting, but that'll last long enough for hypoxemia and that fun spiral into a brady-down code even in a pre-oxygenated patient. If it is being injected into a rat tail, is it forming a depot and throwing their results off? Alternative: Hilarious typo?
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May 26, 2017 15:08
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The_Book_Of_Harry posted:As someone who has speedballed and/or done back to back shots of coke and heroin on hundreds of occasions, I can never once recall any of my dealers pre-mixing uppers and downers, packing that mixture for resale. I've always received separate bags for my separate drugs. Garbage-can mystery pills sold as (ecstasy) have always been a thing, but the IV user tends to buy their choices of dope as advertised, if perhaps sometimes weaker than expected.
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May 26, 2017 15:24
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I don't think it's manufacture sloppiness. Almost all of the cocaine in the USA is now adulterated with levamisole - a drug that treats worms and parasites. Apparently it increases the cocaine high. This is happening when they make the drug. If there's cocaine or amphetamine sneaking in, it's probably to make the high bigger so you're more likely to get addicted. Hit that addiction pathway two ways instead of one.
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May 26, 2017 15:32
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Lote posted:I don't think it's manufacture sloppiness. Almost all of the cocaine in the USA is now adulterated with levamisole - a drug that treats worms and parasites. Apparently it increases the cocaine high. This is happening when they make the drug. If there's cocaine or amphetamine sneaking in, it's probably to make the high bigger so you're more likely to get addicted. Hit that addiction pathway two ways instead of one. levamisole doesnot improve the effects of cocaine, it simply is much harder to detect as a cut than flour or inositol or baking soda or w/e
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May 26, 2017 23:08
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Rhandhali posted:We transplant hepc livers now, they just get harvoni afterwards. I could almost see transplanting HCV+ hearts, but one of the most common causes for needing a liver transplant is hep C. And even if it's not cirrhotic, your hepatoma risk is always elevated, even after viral clearance. sea of losers posted:levamisole doesnot improve the effects of cocaine, it simply is much harder to detect as a cut than flour or inositol or baking soda or w/e The fact that it causes acute-onset neutropenia is probably of secondary concern to the producer.
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May 27, 2017 06:10
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Rhandhali posted:That's a little extreme, but the stuff is dosed medically in micrograms. Look up the phenazepam threads in TCC if you want an idea of what a great idea it is to eyeball something that potent. I remember one my brief foray into attempting to use phenazepam (the context was actually me looking for something to take the edge off of opiate withdrawals). I took what should have been lower than the recommended dose and entered this extremely unpleasant and scary disassociated state for like over a week. I think it ended up taking 2 weeks before I felt completely normal again, which scared the poo poo out of me because the internet told me it should have stopped working within a day or two. Permanently scared me away from any sort of non-prescription benzos (not that I really find benzos appealing in a recreational sense to begin with).
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May 27, 2017 06:26
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Lote posted:I don't think it's manufacture sloppiness. Almost all of the cocaine in the USA is now adulterated with levamisole - a drug that treats worms and parasites. Apparently it increases the cocaine high. This is happening when they make the drug. If there's cocaine or amphetamine sneaking in, it's probably to make the high bigger so you're more likely to get addicted. Hit that addiction pathway two ways instead of one. People already went into the levamisole thing already, but "get that addiction pathway two ways" is also kinda bullshit. You can't get addicted to something you don't know you're taking. Like, even if a tweaker started to get hooked on the fentanyl, they wouldn't even know what that feeling was. Like, they might think that a particular batch was "really good", or that some subsequent (non-laced) batches they get aren't as good, but having dope of varying quality is basically the junkie's life story. Cross-contamination is 1000% more likely, and it wouldn't even have to be "sloppy chemists". I'm sure the stash bags and backpacks of a lot of street-level guys are a veritable cornucopia of random drug particles.
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May 27, 2017 18:44
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In my limited experience, coke dealers are incredibly sloppy, so I can 100% believe that it's cross-contamination.
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May 27, 2017 19:51
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wrong thread
OwlFancier fucked around with this message at 22:38 on May 27, 2017 |
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May 27, 2017 22:32
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Albino Squirrel posted:Haha, seriously? That seems... weird to me. Well not everyone with HepC gets cirrhosis, so if the liver is good and works, gently caress it, stick it in there and start harvoni on discharge. They have only done HCV+ livers in people that already had HCV though. They're doing HCV+ kidneys to HCV+ donors too. It's been a great thing since we are so drat short of spare people parts anything that increases the available number by even a few hundred a year has a huge impact.
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May 27, 2017 22:53
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Albino Squirrel posted:poo poo, we get it as 0.4 mg up here in Canada. Even that'll wake someone way the hell up if they're down on morphine or hydromorphone or whatnot. Takes two or three vials to reverse a fentanyl shot though. I did naloxone training a few weeks ago. The woman giving it was from the local CDC. She reckoned that there basically isn't any actual heroine left in Vancouver. Pretty much everything being sold as heroine is now fentanyl (or carfentanyl). And yeah, standard naloxone kits in Canada have three vials of 0.4mg each. My understanding is that paramedics carry a stronger dose. E: but she said that was 1mg, not 2mg like apparently they do in the US. Lead out in cuffs fucked around with this message at 23:54 on May 27, 2017 |
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May 27, 2017 23:34
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tetrapyloctomy posted:This being based on a rat study makes me pause. 3mg/kg LD50 for fentanyl? 300mcg total IVP is enough to render the average person completely apneic in my clinical experience. Sure, it's short acting, but that'll last long enough for hypoxemia and that fun spiral into a brady-down code even in a pre-oxygenated patient. I haven't thought about mouse or rat opioid usage for years (school, really), but I know that buprenorphine in mice is dosed about 0.03 mg/kg to 0.05 mg/kg (for HCl) or 0.6 mg/kg for the SR. How do you dose people with buprenorphine? I think mice need higher opioid doses for effect.
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May 28, 2017 02:21
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HelloSailorSign posted:I haven't thought about mouse or rat opioid usage for years (school, really), but I know that buprenorphine in mice is dosed about 0.03 mg/kg to 0.05 mg/kg (for HCl) or 0.6 mg/kg for the SR. How do you dose people with buprenorphine? I think mice need higher opioid doses for effect. And if all the mice need higher opioid doses, then we should probably start using opioid-naive mice in studies 
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May 28, 2017 06:48
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Albino Squirrel posted:And if all the mice need higher opioid doses, then we should probably start using opioid-naive mice in studies lol. HelloSailorSign posted:I haven't thought about mouse or rat opioid usage for years (school, really), but I know that buprenorphine in mice is dosed about 0.03 mg/kg to 0.05 mg/kg (for HCl) or 0.6 mg/kg for the SR. How do you dose people with buprenorphine? I think mice need higher opioid doses for effect. Dosing for 180lb generally healthy males, except for that IV heroin issue: My personal prescription was 3.5 of the 8mg tablets qd (opioid replacement therapy) 16 mg qd is a comfortable dose; you won't have to worry about getting sick. You don't have to worry if you forget to dose for half a day or more. 8mg will usually bring a mild to moderate addict out of early withdrawal. 4mg will sometimes be enough With respect to 'ceiling effect,' I feel the same at 8mg as I do at 28mg. It's not "high" it's just "not sick." My personal maximum one-time dose was maybe 48mg. I noticed no additional benefit. _____ I tentatively plan to return to a bupe regimen at some point. For now, the counseling, accountability and social support I receive through my (rare and exceptional) methadone clinic is the perfect fit.
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May 28, 2017 08:06
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Well, if the bad news is that it will get worse before it gets better, then maybe you can spin this as good news. Hopefully the black tar stuff will stay popular and available in the West. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html
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Jun 5, 2017 19:36
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pangstrom posted:Well, if the bad news is that it will get worse before it gets better, then maybe you can spin this as good news. Hopefully the black tar stuff will stay popular and available in the West. The fact that this epidemic has easily eclipsed total deaths at the peak of the AIDS crisis just stops me in my tracks. If we're on track for 75,000 overdose deaths this year (and rising fast), and there are approximately 650,000 total users in the US, are we just going to see the overwhelming majority of heroin users die off over the next decade?
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Jun 6, 2017 23:22
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I've been waiting for somebody to make a forecast page like that (assume adjustable X new addiction rate, Y death rate, Z "cure" rate and see how bad things will get before the iceberg melts). Maybe get fancy and see how it might look without fentanyl or with increasing fentanyl prevalence. I'm not great at time-series forecasting but maybe I'll do a quick shiny page this weekend.
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Jun 6, 2017 23:56
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the black husserl posted:The fact that this epidemic has easily eclipsed total deaths at the peak of the AIDS crisis just stops me in my tracks. No. There will be more addicts. If memory serves the number of addicts and how many new ones we get are also going up.
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Jun 7, 2017 00:04
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More people are killing themselves with opiates because life in America increasingly sucks, as that trend accelerates expect ToxicSlurpee's prediction to play out
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Jun 7, 2017 00:07
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call to action posted:More people are killing themselves with opiates because life in America increasingly sucks, as that trend accelerates expect ToxicSlurpee's prediction to play out Also there will be the people suddenly cut off from pain meds by their doctor as people become more lawsuit happy. Which will lead to many of these patients looking for pills on the street, which will likely remain far more expensive than heroin. And then its only one overly strong mix of fentanyl and heroin away from yet another OD death.
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Jun 7, 2017 00:24
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