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I think I mentioned it in this thread already, but I've heard ~3 former opiate addicts say that they found people OD'ing much more enticing than scary, though they were (obviously) in deep at the time. Also, things are different now with fentanyl everywhere... I think those were all from pre- or at least early-fentanyl days.
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Feb 22, 2018 18:44
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Rhandhali posted:It's the same problem that the people taking phenazepam had. Have? You have a drug that has to be dosed an extremely tiny amounts that requires specialized equipment to even measure, being taken by people that think that you can dose micrograms with an eyeball and a toothpick. You might get lucky, or you might lose a week of your life and wake up with a new piano. Or you might end up dead. except that benzos are notably difficult to fatally overdose on (unless combined with alcohol or other sedatives), and opiates will just straight kill you with respiratory depression pretty quickly. People don't tend to be morish with benzos in exactly the same way as opioids, though clearly idiocy does happen. Also, things have gotten much worse since the Phenazepam days; some of the novel RC benzos floating around have weird toxicity associated with them; there is one in particular that killed a few people, though I can't remember which. Seems like the confluence of Chinese labs, the internet, and 50 years of pharma research has created a real shitshow of a situation. When I was in high school in the late 90s, LSD was "safe" because blotter paper was either acid or just bunk blank paper (yes, the DO* series existed but it was very rare). These days... blotters, pills, tinctures, whatever -- they might be LSD or MDMA, might be fentanyl, might be weird neurotoxic cannabinoids, who knows. Ironically the darknets have also made pure, genuine drugs much more available, but unless you've got a GC/MS handy it's all a dice roll. Cabbages and VHS fucked around with this message at 19:47 on Feb 22, 2018 |
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Feb 22, 2018 19:38
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I have a question that I haven't been able to find a good answer for and I don't know who to ask without looking like a huge idiot so here we go: Is it possible for someone to have a brain issue or something going on that causes them to get zero effects from opioids/opiates? I have been prescribed oxycontin/vicodin/etc in the past and I don't ever remember feeling...anything, really. Like I never took it at all. I never got any kind of high from it, my pain didn't go away (wisdom tooth surgery and then a knee surgery to repair torn ligaments from tennis), it was like I was taking placebos or something. This has happened every time I've taken opiate based pain meds to the point where if I get hurt or something and the doctor wants to prescribe them, I just tell them not to bother because they apparently just don't work on me. I have a theory that whatever chemical receptors in my brain that are responsible for opioid binding are currently closed for business but I know gently caress all about neurochemistry or brains in general. I loving love my stimulants though, my Adderall prescription makes me feel like a living, breathing human being instead of an ADHD riddled mess that tornadoes from task to task throwing poo poo everywhere and doing nothing useful but making everything messy in the process.
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Feb 22, 2018 19:56
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CellBlock posted:I think you're joking, but I watched an episode of Drugs, Inc. where a heroin dealer basically said that. He mixed a drop or whatever of fentanyl into his whole batch of heroin, so that people would hear about one bag or something that was crazy and want to buy more of the same "brand." I was being mostly serious. If you cut your product, only people without tolerance are going to overdose. If the addicts are the ones dying, then you know it’s strong.
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Feb 22, 2018 20:34
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HonorableTB posted:I have a question that I haven't been able to find a good answer for and I don't know who to ask without looking like a huge idiot so here we go: It's very possible; it's not a "brain issue", it's an enzyme deficiency. I believe a deficiency in the CYP450 enzyme will make one or both of these drugs ineffective. It is possible to get blood testing done to prove that you have this deficiency, and once that's documented in your medical record it would likely be possible to be prescribed a different drug in the event you needed surgery again. I think that many people who do not respond to hydrocodone do respond to actual morphine... which is generally harder to get a prescription for (for reasons I find mostly dubious, but that's another story). Here's some relevant reading: https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/non-responsive-pain-patients-cyp-2d6-defect https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/ People in TCC can probably sketch in the details better.
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Feb 22, 2018 20:48
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HonorableTB posted:I have a question that I haven't been able to find a good answer for and I don't know who to ask without looking like a huge idiot so here we go: Some people are just extremely resistant or practically immune to some things. It's part of why dosing drugs is pretty difficult; one person will get a response from 10 mg while another can take 100 mg and still feel nothing. It's why "L.D. 50" is a thing; that's the dose that will kill 50% of people. Do some Googling to see some of the absurd amounts of various substances that people have consumed and survived. I have the same problem with sleeping pills; I have insomnia but none of them do much of anything. They'll work for a few days kind of sort of a little bit but within a week or two they do absolutely nothing. Benedryl doesn't make me feel the least bit drowsy. You're probably one of the weird outliers that opiates just don't do much to. There's over 7,000,000,000 people in the world; there's a lot of room for variation there and it sounds like you landed somewhere on the far end of a bell curve on that one.
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Feb 23, 2018 14:03
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Lote posted:I was being mostly serious. If you cut your product, only people without tolerance are going to overdose. If the addicts are the ones dying, then you know it’s strong. For the last year or two, nothing I've ever gotten from my dude when tested has shown anything fent-related, and I've been very vocal about appreciating dude keeping it real. But over the last couple weeks, he wound-up with a blended batch. He let me know immediately, and I could definitely tell the difference. Fent hits pretty hard on the rush, but it doesn't have much in the way of legs (duration of intoxication). And that's not really what I want from my drugs. Unfortunately, my connect is getting pressured by consumers who represent much larger accounts than me to keep stocking the blended poo poo. So far, he's carrying both, but I have my doubts that unblended dope is gonna be around much longer. Ugh. gently caress it. I've cut way back on my dope intake, but this is extra incentive to just quit. My counselors, nirses and doctor at the methadone clinic would be happier, too.
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Feb 23, 2018 17:48
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Shorter/Punchier "what Purdue did" semi-listicle that Discendo Vox posted in the pseudoscience thread. https://www.washingtonpost.com/graphics/2018/national/amp-stories/oxycontin-how-misleading-marketing-got-america-addicted/
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Feb 23, 2018 19:20
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^^^^ You know, articles like that really make you lose faith in the reliability of doctors. Like, how can you trust them if they can so easily be convinced to prescribe a bunch of addictive opiates (and with a "religious fervor" nonetheless)? I've had enough bad experiences that I learned to never just take a doctor/psychiatrist's word for it and always at least look up the medication's side effects online.ToxicSlurpee posted:Some people are just extremely resistant or practically immune to some things. It's part of why dosing drugs is pretty difficult; one person will get a response from 10 mg while another can take 100 mg and still feel nothing. It's why "L.D. 50" is a thing; that's the dose that will kill 50% of people. Do some Googling to see some of the absurd amounts of various substances that people have consumed and survived. What Tim Raines mentioned seems far more likely, because it's not unusual at all for (as in your example) someone with insomnia to not respond to weak over-the-counter sleep aids like benedryl, while it is very unusual for someone to not respond at all to opiates (unless there's some specific condition causing that). Benedryl (and I believe other anti-histamine sleep aids) won't do anything for certain types of insomnia, and can actually make it worse when the cause is something like restless legs. Ytlaya fucked around with this message at 19:33 on Feb 23, 2018 |
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Feb 23, 2018 19:26
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Ytlaya posted:What Tim Raines mentioned seems far more likely, because it's not unusual at all for (as in your example) someone with insomnia to not respond to weak over-the-counter sleep aids like benedryl, while it is very unusual for someone to not respond at all to opiates (unless there's some specific condition causing that). Benedryl (and I believe other anti-histamine sleep aids) won't do anything for certain types of insomnia, and can actually make it worse when the cause is something like restless legs. I probably should have been more specific; even prescription sleep aids do gently caress all for me. I've tried several of them and they just don't work. It was really just an example to point out that some random people have a crazy resistance to some things for various reasons. Some people are just unusual in weird ways like that.
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Feb 23, 2018 23:06
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Tim Raines IRL posted:It's very possible; it's not a "brain issue", it's an enzyme deficiency. I believe a deficiency in the CYP450 enzyme will make one or both of these drugs ineffective. I don't respond at all to Oxy or Hydrocodone (half a dozen prescriptions and no luck) and my doctor said it was likely this issue. I get all the nausea though, fun! Hope I never encounter any actual pain or I'm screwed 
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Feb 24, 2018 05:41
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the black husserl posted:I don't respond at all to Oxy or Hydrocodone (half a dozen prescriptions and no luck) and my doctor said it was likely this issue. I get all the nausea though, fun! Hope I never encounter any actual pain or I'm screwed This is one of the downsides to being on suboxone. If I ever need to have emergency/immediate surgery I'll be in a very bad situation as far as opiate-based pain management options, since the suboxone would block them unless you increased the dose to some extremely high level (that the physician would likely be uncomfortable with unless they had experience with that specific situation). If you can postpone the surgery a few weeks it's possible to switch to a shorter-acting opiate that won't block other opiates like the suboxone, though even then you're pretty much at the mercy of the physician regarding whether or not they give the correct dose to account for existing tolerance.
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Feb 24, 2018 20:37
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In my experience, some opioid drugs blow right through bupe. We used to shoot opana with little to no diminished effect, while heroin was completely worthless while medicated. Maybe somebody more science-minded could explain the particulars, but both myself and others will attest to this.
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Feb 25, 2018 22:16
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fent/sufentanil is usually used for anesthetics and im p sure it can get past naloxone, so it might be able to defeat bupe with regards to affinity
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Feb 27, 2018 14:39
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sea of losers posted:fent/sufentanil is usually used for anesthetics and im p sure it can get past naloxone, so it might be able to defeat bupe with regards to affinity No, we reverse fentanyl with naloxone all the time. Edit: subdissociative ketamine is a great option, but people are going to give you side-eye for, "No, really, some doctor online told me 200 to 300 mcg per kilo run over twenty to thirty minutes would help." tetrapyloctomy fucked around with this message at 14:46 on Feb 27, 2018 |
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Feb 27, 2018 14:42
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tetrapyloctomy posted:No, we reverse fentanyl with naloxone all the time. does that not require larger doses though?
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Feb 27, 2018 14:42
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sea of losers posted:does that not require larger doses though?
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Feb 27, 2018 14:52
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i see. thank you. i wonder what opioids would reliably defeat a bupe blockade.
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Feb 27, 2018 14:53
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sea of losers posted:i see. thank you. i wonder what opioids would reliably defeat a bupe blockade. I mean no matter your deal, I have more medicine than you have pain, and I'll give what's needed. But once someone is out of the ED, at BEST people are on a PCA, and people with a lot of tolerance will be underdosed, let alone someone with an antagonist on board.
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Feb 27, 2018 15:02
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sea of losers posted:this can easily be solved by volumetric dosing (dissolving in a solvent then taking an amount of that solvent), but apparently lots of drug users dont believe the drugs are real if you present them with a vial of clear liquid instead of sketchy powder. people suck. I mean it's not just that - dealing liquids is a huge pain in the rear end. Liquid is heavy and requires special containers (you can deal powders using nothing but paper), can be adulterated indefinitely so you're always reliant on your customer's trusting your potency, (admittedly powders have this problem to some degree too but much more pronounced), carrying around a bunch of little bottles is noisy and conspicuous as gently caress and it harder for the user to dose - much harder orally, basically impossible nasally. You also have sterilization issues - all sorts of poo poo will grow in standing liquid - particularly water- so you have to be much more careful with your product - require refrigeration etc. Opiate addicts are not typically the most hygienic bunch either. LSD is the only stuff I know of that was consistently sold on the black market back in the day in any volume in a liquid, and even then that's mostly so you can stick it on blotters or sugar cubes and resell - and only because acid is so idiotically potent and valuable. Outside of rarities like PCP or GHB liquid dealing is just impractical. Nowadays you have a ton of THC concentrates for e-liquids being sold on the darknet and similar, but it's still very niche comparatively.
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Mar 3, 2018 16:59
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tetrapyloctomy posted:No, we reverse fentanyl with naloxone all the time. So that is where that stupid dose came from? One of those ED/trauma blogs?
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Mar 4, 2018 16:37
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Ytlaya posted:^^^^ You know, articles like that really make you lose faith in the reliability of doctors. Like, how can you trust them if they can so easily be convinced to prescribe a bunch of addictive opiates (and with a "religious fervor" nonetheless)? I've had enough bad experiences that I learned to never just take a doctor/psychiatrist's word for it and always at least look up the medication's side effects online. It's not a very good article because it ignores a lot of much larger movements in the profession itself, mainly that the main accrediting organization in 2001 moved towards making pain control a major issue. It's concerned with pushing a particular narrative that places blame on drug companies alone, and so portrays doctors as just brainwashed stooges instead of the fact that they were acting in part on the concern that pain was undertreated, in reaction to the old-fashioned idea that some pain was ok OXBALLS DOT COM fucked around with this message at 16:55 on Mar 4, 2018 |
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Mar 4, 2018 16:51
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reagan posted:So that is where that stupid dose came from? One of those ED/trauma blogs? I'm not sure where it originated, I was referring to me as "some doctor online." 200-300 mcg/kg over 20-30 minutes is my go-to subdissociative dose, because it works great with a minimum of side effects. I used it Thursday night on a guy with a huge intramuscular abscess and a healthy-even-for-my-catchment-area heroin habit, and he was rapidly comfortable. Some people use 150 mcg/kg, some use 250 mcg/kg, and other people use none of it and chase their loving tail sticking to narcotics while the patient suffers.
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Mar 4, 2018 18:44
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CoolCab posted:I mean it's not just that - dealing liquids is a huge pain in the rear end. Liquid is heavy and requires special containers (you can deal powders using nothing but paper), can be adulterated indefinitely so you're always reliant on your customer's trusting your potency, (admittedly powders have this problem to some degree too but much more pronounced), carrying around a bunch of little bottles is noisy and conspicuous as gently caress and it harder for the user to dose - much harder orally, basically impossible nasally. You also have sterilization issues - all sorts of poo poo will grow in standing liquid - particularly water- so you have to be much more careful with your product - require refrigeration etc. Opiate addicts are not typically the most hygienic bunch either. your comments about noise / some of the impracticalities are definitely valid, but sterilization issues are much less of an issue if you use propylene glycol, which is a foodgrade solvent used frequently in medicine and e-liquids and even in some liquors (fireball cinnamon whisky looking at you). i've made several solutions with it myself and have never had issues with any unwanted growths or bacteria. i don't know much about how much pure PG one can inject but i believe it is at least somewhat usable for that purpose. i believe water can be made bacteriostatic as well by adding a small amount of benzyl alcohol, though i don't know how safe this is for IV use. more drugs are sold that way than you may think. grey-market benzodiazepines are especially sold this way in pre-made solutions because noone wants to gently caress with a drug that's active in 1mg range. dosing orally is trivial, you'd just use a cheapass plastic 1mL syringe. pretty much the same stuff that anyone IVing would have around. on that note, it would be alot more handy for the IV user to have an injectable solution already made instead of having to cook a powder. anyway this is all pointless conjecture anyway but it'd be so much better than the situation with powders right now. at least a fully-dissolved drug in solution wouldn't have issues with hotspots anyway, every 0.1mL in the bottle would be just as strong as the other mL. sea of losers fucked around with this message at 13:30 on Mar 5, 2018 |
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Mar 5, 2018 13:27
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tetrapyloctomy posted:I mean no matter your deal, I have more medicine than you have pain, and I'll give what's needed. But once someone is out of the ED, at BEST people are on a PCA, and people with a lot of tolerance will be underdosed, let alone someone with an antagonist on board. i was under the impression that bupe was a partial agonist and that the naloxone in suboxone was barely bioavailable orally tho?
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Mar 5, 2018 13:33
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sea of losers posted:i was under the impression that bupe was a partial agonist and that the naloxone in suboxone was barely bioavailable orally tho? The naloxone in Suboxone shouldn't be a problem, but buprenorphine's high receptor affinity is an issue. Really, though, the bigger issue is that inpatient doctors and nurses are really reticent to administer the relatively high doses of medications that many tolerant patients require.
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Mar 5, 2018 17:37
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tetrapyloctomy posted:The naloxone in Suboxone shouldn't be a problem, but buprenorphine's high receptor affinity is an issue. Yeah, I imagine that unless the physician in question is already familiar with dealing with opiate-dependent individuals they would balk at the incredibly high (relative to a "normal" person) doses that would be required for someone on suboxone. sea of losers posted:i was under the impression that bupe was a partial agonist and that the naloxone in suboxone was barely bioavailable orally tho? To clarify a bit more what tetrapyloctomy said, receptor affinity is a different thing than being a full/partial agonist. The latter is basically about how strong the effect is once it binds to the receptor, but not the rate at which it binds to receptors.
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Mar 5, 2018 18:22
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Thanks again, NA Bulletin #29 wherein NA condemns medication-assisted therapy ps - another dead associate has been added to my circle
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Mar 6, 2018 20:38
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How many loving studies will it take??? Economic Evaluations of Opioid Use Disorder Interventions: A Systematic Review
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Mar 6, 2018 20:40
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The_Book_Of_Harry posted:Thanks again, NA Bulletin #29 Ugh, I had this problem with trying to find meetings due to being on suboxone. I had to lie about it, which defeats the entire purpose of those meetings. It's really dumb, since people on replacement therapy have to deal with a lot of the same stuff as any other sober addicts (assuming they're using the medicine as prescribed anyways). I was able to find a meeting specifically for suboxone patients, and it was really good but also an hour+ drive away and extremely inconvenient (since it was a couple hours after work it basically tied up my entire evening). There was another meeting called (IIRC) Smart Recovery that was also objectively superior to NA in every way, but it was even more prohibitively far from where I live.
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Mar 9, 2018 17:46
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https://twitter.com/jdawsey1/status...genumber%3D1942 This was inevitable for Trump. He full endorsed Duterte style "kill drug users" tactics in like the second month of his Presidency and now he's taking the first steps to get that started. We will definitely get some kind of "kill the bastards, I've got your back" speech to law enforcement, a la the "beat up your suspects more" he gave last year.
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Mar 10, 2018 05:55
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the black husserl posted:https://twitter.com/jdawsey1/status...genumber%3D1942 You can really accelerate this process by just dropping an 88 gal drum of pure fentanyl / carfentil in every major city with a heroin problem. Basically go for the plot line of Kingsmen 2.
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Mar 10, 2018 08:55
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Ytlaya posted:Ugh, I had this problem with trying to find meetings due to being on suboxone. I had to lie about it, which defeats the entire purpose of those meetings. It's really dumb, since people on replacement therapy have to deal with a lot of the same stuff as any other sober addicts (assuming they're using the medicine as prescribed anyways). I'm glad you were able to find a group of reasonable people. After 15 years of addiction and 3 of successful medication-assisted therapy (and multiple failed rehabs and outpatient programs concurrant with hundreds of *A meetings), I gave-into pressure to quit medication, leading soon into the mother of all relapses. I blame myself primarily, since I had done enough homework to know this was likely a stupid idea, but I have lingering resenment about the arguments I allowed to sway my decision process. I lost a girlfriend, a cushy living situation, a job and a sweet-rear end convertable...and very nearly my life. I'm also fighting several criminal/felony charges, which will likely lead to further incarceration. Getting back into the methadone program saved my life, as it did the first time. I know that withdrawal in jail (hopefully not prison) will be a particular sort of hell, but I'm choosing life...even when (as Irvine Welsh says) I could choose junk. The_Book_Of_Harry fucked around with this message at 21:55 on Mar 10, 2018 |
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Mar 10, 2018 21:48
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https://twitter.com/thehill/status/974384786755211264?s=20 There's a certain magical combination of dumb and evil.
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Mar 16, 2018 00:16
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TapTheForwardAssist posted:https://twitter.com/thehill/status/974384786755211264?s=20 Thats his brand. 
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Mar 16, 2018 00:47
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Did no one ever sit down and explain the opiod crisis? I think it's pretty basic stuff how people get hooked off prescription medication.
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Mar 16, 2018 00:59
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Sinners Sandwich posted:Did no one ever sit down and explain the opiod crisis? I think it's pretty basic stuff how people get hooked off prescription medication. Iatrogenic addiction is more rare than folks might think. Overprescription led to diversion, however, and this gave rise to a massive epidemic. metastudy
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Mar 16, 2018 01:39
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That 2008 meta-analysis been posted before and I said I would critique it but haven't got around to it because it's kind of a huge task and involves a lot of academic inference stuff that are foreign to most people, and the distinction between iatrogenic and diversion is a little who-cares, ultimately. "What proportion of current addicts started with a prescription?" is a much simpler question that might get more to the heart of that distinction, in any case. Medicare is going to start limiting opiate prescriptions. My gist is: good for slowing creation of new addicts, bad for some current addicts. https://www.nytimes.com/2018/03/27/health/opioids-medicare-limits.html
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Mar 27, 2018 20:08
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Sinners Sandwich posted:Did no one ever sit down and explain the opiod crisis? I think it's pretty basic stuff how people get hooked off prescription medication. Wouldn't matter; this is Trump and the Republicans we're talking about. If you look at the real reasons you'd have to confront everything that's wrong with America right now. It's easier and feels better to just severely punish some people we don't like already anyway.
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Mar 28, 2018 02:23
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ToxicSlurpee posted:Wouldn't matter; this is Trump and the Republicans we're talking about. If you look at the real reasons you'd have to confront everything that's wrong with America right now. It's easier and feels better to just severely punish some people we don't like already anyway. FYI Slavoj Žižek has a take on the opioid crisis: https://health.spectator.co.uk/trump-wants-to-end-the-opioid-crisis-but-what-if-he-is-himself-its-prime-symptom/
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Mar 28, 2018 05:45
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