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sea of losers posted:also i guess we should do this for alcohol as well right? You can give them GHB instead of alcohol. https://www.sciencedirect.com/science/article/abs/pii/S0924977X07001009 sea of losers posted:do we cut the “bad cases” off after they pass an arbitrary metric and arent “bad cases” anymore? No. If their health is improving or stabilising then they are responding to treatment so they should stick with it. KingEup fucked around with this message at 02:39 on Jul 19, 2019 |
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Jul 19, 2019 02:21
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lol you can buy oxycodone pill press tools on Amazon now: https://www.amazon.com/Stamp-Punch-Equipment-Stamping-Punching/dp/B07TLL95MF/ref=sr_1_1?keywords=B07TLL95MF&qid=1566272603&s=gateway&sr=8-1
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Aug 20, 2019 04:46
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Here's an interesting read. The author describes his own experiences, and the institutional and legal failings surrounding his treatment and recovery. https://twitter.com/NewYorker/status/1185657350960627717?s=19
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Oct 19, 2019 22:33
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Reminds me of something Denis Johnson would write. It's very good.
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Oct 20, 2019 00:16
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deoju posted:Here's an interesting read. The author describes his own experiences, and the institutional and legal failings surrounding his treatment and recovery. This is interesting. This part stood out to me from my own experiences: quote:The most profitable kind involves inflated charges for urinalysis reports—a practice that has come to be called the “liquid gold rush.” I remember being stunned at how much this cost years back when I first started taking suboxone (my time on suboxone is sort of split into two separate periods - one in my mid-to-late twenties followed by a very long relapse followed by getting back on suboxone). At the time my suboxone doctor was having me come in weekly and doing urinalysis each time, and it had to be sent in for chromatography because the early results were extremely inaccurate and kept saying I was on PCP for some reason. I remember it being more than $1000 each time billed to insurance. While I know it obviously varies heavily based on the person, in my case immersing myself in "addiction treatment culture" (for lack of a better term) was basically a recipe for failure. The stress of constant meetings and constantly talking about addiction ironically caused me to repeatedly relapse. After my suboxone doctor committed suicide (yes this actually happened) and my long relapse, my next suboxone doctor was very relaxed and low pressure. This is probably bad for many addicts, but it was good for me. For many years at that point using had been motivated entirely by fear of withdrawal, and this enabled me to just get suboxone like any other medication and live more or less normally. I'm probably a bit of an exception in that addiction was always solely a solitary thing for me and I don't know anyone else who uses; I imagine for addicts with addiction intertwined with their social lives, this is less of an option (since they'll constantly be reminded of drugs whether they want to be or not).
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Oct 20, 2019 20:10
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Interesting slice of life piece from a Ohio high school class of 2000. https://www.nytimes.com/interactive/2019/12/02/us/opioid-crisis-high-school-teenagers.html
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Dec 2, 2019 15:30
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pangstrom posted:Interesting slice of life piece from a Ohio high school class of 2000. All DEA approved too: https://oig.justice.gov/reports/2019/e1905.pdf
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Dec 3, 2019 12:23
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in case anyone cares: street heroin probably continues to be fentanyl/fentalogues, because they are easy to make in clandestine chinese/mexican labs using precursors more easily available than ones for heroin. there have also been concerns about x-tonitazenes, a class of opioids that are almost as powerful as fentanyl however, for experimental opioids the focus has largely turned to modifying a medically-used chinese opioid called bucinnazine. the most popular modification, 2-methyl-bucinnazine, is quite cheap and potent, however it is also rather abrasive (tho not nearly as much as u-47700). there are some speculative further opioids further modifying this structure such as ap-238. o-desmethyltramadol is still legal (as it is probably going to be turned into a prescription drug in the US), but it is very weak in comparison to bucinnazine analogs.
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Jun 5, 2020 07:37
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sea of losers posted:in case anyone cares: Abrasive in what way?
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Jun 5, 2020 17:36
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https://www.cnn.com/2020/10/21/business/purdue-pharma-guilty-plea/index.html Purdue pleads guilty.    
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Oct 21, 2020 20:42
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I too wish to part with 2% of my wealth to get off my drug charge.
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Oct 21, 2020 22:50
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Thread's been dead for a year, I'm sure convo has moved to another one, but drat the latest fatal OD counts are brutal.
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Nov 18, 2021 17:16
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pangstrom posted:Thread's been dead for a year, I'm sure convo has moved to another one, but drat the latest fatal OD counts are brutal.
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Nov 18, 2021 20:34
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Anyone else watching dopesick? If you aren't. loving watch it and yes it's brutal and will radicalize you.
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Nov 18, 2021 22:11
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pangstrom posted:Thread's been dead for a year, I'm sure convo has moved to another one, but drat the latest fatal OD counts are brutal. I am up in New England and I think the pandemic sucked all the opioid stories out of the air. What's the number?
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Nov 18, 2021 22:35
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WAR CRIME GIGOLO posted:Anyone else watching dopesick? How are the DEA portrayed?
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Nov 19, 2021 01:38
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Mooseontheloose posted:I am up in New England and I think the pandemic sucked all the opioid stories out of the air. What's the number? https://twitter.com/jstein_wapo/status/1461011012539322368?s=21
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Nov 19, 2021 01:47
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KingEup posted:How are the DEA portrayed? Coerced by corporate interests.
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Nov 19, 2021 06:03
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Albino Squirrel posted:I'm losing about 4 patients a month to ODs (up here in Canada). I've lost patients I've known for years. Covid won't burn me out but this might As a fellow Canadian: what do we do about it? Personally, as a layperson, I'm in favour of full legalization and safe/cheap supply. I've had friends and family die from overdoses, and at the same time I've had friends who've been hosed around for legitimate pain relief waiting for a surgery the needed, to the point they made a scene and said "I don't give a gently caress anymore, if you're worried I'm abusing the pills, come and count my loving pills at 3AM any day of the week, count the pills if you're worried I'm a drug seeker, just give me the loving medication I need." He's since got the surgery and weaned off the painkillers, he said it was hell but better than continuing to take them, for what it's worth. Alcoholics drink hand sanitizer if they can't get booze, opiate addicts do dangerous things if they can't get a supply. Harm reduction simply makes sense to me, because honestly I'd rather my cousin was dependent on opiates that he could get from a clinic or whatever... than loving dead, which he is, because he died from an overdose.
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Nov 19, 2021 07:03
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WAR CRIME GIGOLO posted:Coerced by corporate interests. But there's a dedicated agent who sees the bigger picture and she's determined to hold the Sacklers responsible. A well written series with unforgettable characters.
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Nov 19, 2021 20:50
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PT6A posted:As a fellow Canadian: what do we do about it? I find the issue isn't so much getting opioids into my patients these days - I mean, I provide a LOT of suboxone, and if you're only dealing with the physical dependence this is enough for most people to achieve sustained remission - but it's more that a) we have limited ability to deal with the underlying trauma that drives a lot of people to keep using, and b) we have an acute housing crisis which makes it very very hard for people to stabilize if they're more worried about where they're going to sleep tonight than how to work on their issues. What we need isn't so much easy access to opioid dependence programs; we have those, I work at one, and we are very much low barrier. We need more general trauma-informed mental health supports, and we need major amounts of social housing because most people can't afford a place to live. But we'll never get the latter because 
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Nov 20, 2021 00:00
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WAR CRIME GIGOLO posted:Coerced by corporate interests. lol. They can interfere in foreign nations and have a budget of billions but they just can’t say no to corporate America.
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Nov 20, 2021 02:18
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Albino Squirrel posted:Safe supply is part of it, substantial expansion of safe consumption sites is part of it, and I'm personally a big fan of injectable opioid agonist therapy for patients who have tried and failed suboxone and methadone and continue to inject. It's funny, I'm usually trying to convince my chronic pain patients to severely limit their opioid use - because opioids do stop working as you become tolerant, and because opioids in general aren't particularly effective for most types of chronic pain - but the second someone tells me they've been injecting fentanyl my mind shifts and I'm all 'have all the opioids you need, my child.' Boston has been talking about Safe Injection sties and it has some support but (and somewhat rightly) Boston is concerned with other localities dumping people into Boston to deal with the addicts in their city. If I had my policy druthers I would try to open up a bunch of Safe Sites around the same time in geographically diverse areas with some economic diversity but we face the problem in New England of people saying, we love that idea... ...in a city, not here. Could you imagine if there were addicts in this town?!
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Nov 20, 2021 15:22
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Albino Squirrel posted:I'm personally a big fan of injectable opioid agonist therapy for patients who have tried and failed suboxone and methadone and continue to inject. Why wait until people fail bupe or methadone before offering injectable agonist therapy? Surely more people would be attracted into treatment earlier in their opioid using career if IV formulations were available as first line treatments.
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Nov 20, 2021 23:03
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KingEup posted:Why wait until people fail bupe or methadone before offering injectable agonist therapy? Surely more people would be attracted into treatment earlier in their opioid using career if IV formulations were available as first line treatments.
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Nov 20, 2021 23:21
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Mooseontheloose posted:I am up in New England and I think the pandemic sucked all the opioid stories out of the air. What's the number? over 100k April 2020-April 2021, over 75k opioid, though that's tricky obv... Saying definitive things about cause of death / related statistics involves a morass of issues so you can argue on the edges in "good faith", you can semi-plausibly lie (lot of this in COVID denialism, e.g. The Ethical Skeptic), you can do all sorts of things... but the forest here is lots of OD deaths.
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Dec 1, 2021 16:15
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KingEup posted:Why wait until people fail bupe or methadone before offering injectable agonist therapy? Surely more people would be attracted into treatment earlier in their opioid using career if IV formulations were available as first line treatments. Isn't that basically what they used to do in England? I think they used to give registered addicts a fixed ration of morphine (and sometimes cocaine) with sterile injection equipment. But that was decades ago, when opioid addiction was rare in the UK. I understand the newer patients are given methadone; injectable if that's what the patient wants. Does anyone know for sure what the policy is today?
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Dec 1, 2021 22:03
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Aside but there is a podcast called "Hooked", basically the story of opiate addict Anthony Hathaway who goes from pain pills to heroin, starts living out of car with his also-addicted son, loses his job at Boeing, and then starts robbing banks. The writing/narrator Josh Dean IMO sort of drifts between being decent and sucking, doesn't "get" addiction, resorts to morality tale frames etc. Hathaway's own words are much more interesting, though, even though he is clearly euphemistic about some aspects of the robberies. Anyway, I think the 8th and final episode hasn't been released, and I'm not optimistic about it creating much understanding (yet alone empathy or decent policy recs) but it's kind of a hit as podcasts go might be worth listening to just as like a temperature check. https://podcasts.apple.com/us/podcast/hooked/id1592401710
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Dec 3, 2021 18:35
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I wrote something - specific to Alberta, where I live and work, but probably not all that different wherever you are. I mostly needed to get my thoughts in order, and writing helps. Maybe posting it will, too, IDK. I lost another patient to overdose recently. I suppose that’s not that surprising – about once a week I have a patient die from an opioid OD, these days – but this one hits harder than most. He was a young guy, and like me he enjoyed playing video games. We’d had discussions about which DLC for Witcher 3 was better (he said Blood and Wine, I liked Hearts of Stone) in between discussing how best to treat the giant monkey on his back. However, recently we’d lost touch – he’d stopped going in for his methadone, and sometimes that just means that someone’s had a relapse, but sometimes it means that they’ve overdosed and I’ll find out later. Usually I get a call from the medical examiner or, in this case, when his partner told us a couple of months later that’d he’d died in his dad’s basement. This has happened so much in the past two years, frequently with patients I’ve known for over a decade. When I get a chance to sit with this, when my pandemic hours revert back to ‘normal’, I’m sure I’m going to have to deal with all this death and grief. But for now I’m just left with a profound sense of hopelessness. Unlike with a lot of additions, I essentially had a magic bullet in my toolkit when it comes to opioids in the form of buprenorphine; magic stuff, it treats opioid cravings as well as preventing overdose from most other opioids. But the problem is that the fentanyl and, latterly, carfentanil coming in during the pandemic is so powerful that bupe isn’t strong enough to treat everyone. And this makes sense, in a way. Like most mental illnesses, most people don’t seek treatment for their issues for addictions – part of that is stigma, part of that is lack of availability, and part of it is simply denial that it constitutes a problem. Moreover, in my experience most addiction is deeply rooted in trauma, and serves as a coping mechanism to deal with the consequences of cruelty I can’t even comprehend. When you stop using, you have to deal with all of that horror flooding up. My drugs can help, but they can’t do this alone. So what can we do to stem this tide, this epidemic that’s killing as many Albertans as COVID? Access to buprenorphine would help – not every physician offers it as part of their practice, even though it doesn’t require a triplicate. Teaching it well in med school and residence would be a start. Encouraging and incentivizing providers to do it as part of their practice – especially in the corrections system – would help as well. For patients who fail the traditional therapies of suboxone and methadone, and there are many reasons why that may be, injectable opioid agonist therapy is an option that’s well supported by evidence – that’s where physicians and nurse practitioners prescribe an opioid that’s much safer to inject than anything found on the street, and the outcomes I’ve seen from that are much better than patients continuing to inject street drugs. Unfortunately, our present government in Alberta is opposed to this on principle, and has tried to close our iOAT programs. After winning a court battle, iOAT is allowed to continue to treat its present clients, but they can’t take on any new patients. If patients can’t get into iOAT or can’t manage the scheduling required for that, what else can they do to keep themselves safe? Well, they can use in a safer consumption site (SCS)… or at least, they could, if this government wasn’t also trying to close all of those. The availability of this has dropped substantially, and now there’s essentially none in any smaller centres. It also doesn’t solve the issue that the substances they are injecting are so powerful that there’s still a high risk of overdose, although in SCS at least there’s a very good chance the overdose can be reversed. There’s been some talk and movement towards the concept of ‘safe supply’, wherein the patient gets pharmaceutical grade opioids with the intent that they will be injecting them; it’s substantially safer than injecting whatever the hell is in the fentanyl that’s out there. I don’t know how I feel about this, fully, as a provider – it’s certainly not the safest option, compared to the previously listed treatments, and the amount of opioid you’d have to prescribe to compensate for the weapons-grade street stuff they’ve been taking is… substantial. But the point of harm reduction is meeting patients where they are to try to a) keep them alive, and b) move them towards safer options. Anyhow, it’s a moot point, because our enlighted government is presently hosting yet another sham committee that’s preordained to tell us how bad safe supply is and how we can never use it. What IS the Alberta government trying to do? Well, they’ve been focussed on providing ‘treatment’ beds for patients. For some people, having a bed in a residential treatment facility can help give them time away from their addictions and give them some coping skills. However, in my experience it doesn’t do enough to treat the underlying causes of continued use i.e. untreated trauma and dire housing situations. Also, getting completely off of opioids is hard; “detox” and residential treatment, if not combined with opioid agonist therapy, is no better than no treatment at all. Finally, I have not seen a substantial increase in the availability of treatment beds for my patients – maybe if they had enough money to go to private facilities (coincidentally run by donors and friends of the present government) they’d have access, but alas, I have chosen to work in an inner-city environment. It certainly doesn’t help that housing is more of a crisis than it’s ever been. Rent is going up, but funds for people who can’t work aren’t. I used to be able to get ‘housing allowances’ from Alberta Works for my patients, but those are nearly impossible to get now. People on ‘medical welfare’ get $330 in rental funds per month. This will not get you a place literally anywhere in Alberta. Also, if you’re homeless you don’t get even that because your housing needs are being met by homeless shelters! Nothing wrong with that whatsoever! I have never seen anyone who’s not housed get their addictions under control. I can’t argue with that; if I were on the street, or jammed cheek by jowl into the shelters here, I’d want to be as messed up as possible. There are solutions for the drug poisoning epidemic, but they require foresight and investment, neither of which are in copious supply in Alberta in 2022. Until that situation improves, I’m going to continue seeing my patients die, one by one. And I’m going to get around to writing the medical examiner for information on the deaths of dozens of people I’ve known for years. When it doesn’t hurt quite so much.
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Feb 20, 2022 19:47
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Albino Squirrel posted:I wrote something - specific to Alberta, where I live and work, but probably not all that different wherever you are. I mostly needed to get my thoughts in order, and writing helps. Maybe posting it will, too, IDK. This is an incredibly powerful post and I hope you will consider sharing far and wide outside of these dead forums. Send this to your newspapers and elected officials.
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Feb 23, 2022 22:22
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hell send it to my newspapers and elected representatives
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Feb 23, 2022 22:25
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shame on an IGA posted:This is an incredibly powerful post and I hope you will consider sharing far and wide outside of these dead forums. Send this to your newspapers and elected officials.
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Feb 24, 2022 00:27
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yeah it was a great post. Aside but it struck me that those conditions are 1) very hopeless and 2) still marginally better than what a doctor in Philadelphia or West Virginia etc. has to deal with.
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Feb 24, 2022 01:58
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Albino Squirrel posted:For patients who fail the traditional therapies of suboxone and methadone, and there are many reasons why that may be, injectable opioid agonist therapy is an option that’s well supported by evidence – that’s where physicians and nurse practitioners prescribe an opioid that’s much safer to inject than anything found on the street, and the outcomes I’ve seen from that are much better than patients continuing to inject street drugs. What is the difference between the two please? In my opinion, 'safe supply' or legalized opiates of some sort is the only way to improve things. In the 'before' times I don't think this was the best approach but now that Fentanyl & analogues have infiltrated all types of narcotics--powder heroin, pills, cough syrup--its the only approach I can see working. If you have to buy these products off the street, it's just a matter of time before you overdose.
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Feb 27, 2022 21:51
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shame on an IGA posted:This is an incredibly powerful post and I hope you will consider sharing far and wide outside of these dead forums. Send this to your newspapers and elected officials. I don't know how good an idea it is to send it to my local newspaper. I would... except that my clinic is publically funded. And the current Alberta government is nothing if not vindictive. And it's not just my job on the line, but several other people, many of whom aren't doctors and can't afford to take the hit of unemployment as well as I. Maybe I'll run it by my clinic boss. Also, the local newspapers - both are owned by the same company and now share a newsroom - are explicitly owned by Conservative donors. So though some journalists may be sympathetic, editorial is not. BIG-DICK-BUTT-gently caress posted:What is the difference between the two please? Supervised consumption (or safe consumption, or SCS) is where a user takes their own drugs sourced from wherever and injects them in a location under the supervision of medical staff, who can reverse overdose and link them with other services. iOAT is where a patient receives a prescription for an injectable opioid - generally hydromorphone IV - and injects it under the supervision of medical staff. Broadly, it's the combination of safe supply (eliminating some risks from the drug supply) and SCS (eliminating some risks from the method of use). The other difference is that in this model physicians and NPs can prescribe IV hydromorphone, which is meant to be injected. Injecting crushed up oral meds can introduce poo poo that was never meant to see the inside of a vein, and that can be very problematic in the case of e.g. time release beads from HM Contin caps which can lacerate heart valves and increase the risk of endocarditis. Also, you can get much higher doses of IV hydromorph - I've seen up to 220 mg IV three times daily - than is practical with crushed up tabs - the highest single tab we have here is 8 mg of hydromorph which ain't that much. Albino Squirrel fucked around with this message at 18:10 on Feb 28, 2022 |
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Feb 28, 2022 18:03
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Albino Squirrel posted:Thank you, that feedback does mean quite a bit to me. I did send it to my local MLA and the leader of the opposition party. Wowwwwwwwww 220mg hydromorphone IV??? No typo?? I was hooked on fentanyl for a couple years and couldn't go over 500mcg without losing consciousness (diverted from pharmacy so I know it was accurately dosed). And I did 1-2mg/day. 220mg hydromorphone is ~30x that much. Jesus Christ Lol. Thanks for elaborating. One other question: why favor hydromorphone? Ease of dosing due to potency? From experience I'll tell you it's the most euphoric opiate, so I think people would be less likely to seek a 'better' street drug. Here in the US it's all Suboxone & methadone--neither of which have much recreational value. Addicts who aren't motivated to quit will often trade/sell their Suboxone for better drugs, slim chance of that happening with Dilaudid lol.
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Feb 28, 2022 19:34
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BIG-DICK-BUTT-gently caress posted:Wowwwwwwwww 220mg hydromorphone IV??? No typo?? I'd always heard the injectables given in these clinics was pharmaceutical grade heroin. I had a friend* who put it very well when he said Dilaudid is the crack of the opioid world because of the rush. So at first glance it does seem an odd choice for harm reduction, but if it keeps people alive until they're ready for treatment, that's a good thing. *My buddy was a regular in this thread until he OD'd and died in June 2020.
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Feb 28, 2022 20:42
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BIG-DICK-BUTT-gently caress posted:Wowwwwwwwww 220mg hydromorphone IV??? No typo?? And yes, iOAT sometimes uses enormous doses, but for the past two years the availability and potency of fentanyl and carfentanil here have been ridiculous. You literally need to dose that much sometimes to stop someone going into withdrawal. Yeah, it's certainly euphoric, but the goal of care is to prevent w/d and that's a reasonable clinical assessment to make - there's a bit of room between 'no longer dope sick' and 'high as gently caress.' If sometimes there's a bit of aggressive dosing and someone gets a little happy... enh, not the end of the world, but it's not the point of the therapy. Also, because it's dosed in the clinic, the risk of diversion is... well, not zero, but certainly lower than if it was provided at the pharmacy. I also wanna point out that iOAT is intended as rescue therapy. The gold standard of opioid care is buprenorphine, and somewhat below that methadone. You couldn't get into iOAT without trying and failing both of those. I personally try to steer as many patients as possible towards suboxone because it's just so much drat safer. The problem sometimes is that they take it on the street and then go into precipitated withdrawal and then never want to touch it again. Well, of course it wasn't fun, you took 2 mg when you were high as hell on fentanyl and then felt like you were dying.
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Feb 28, 2022 21:10
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King Possum III posted:I'd always heard the injectables given in these clinics was pharmaceutical grade heroin. I don't want to glamorize it but yeah shooting Dilaudid feels almost exactly like an orgasm. And if the ultimate goal is to reduce deaths, overdoses and illnesses associated w street drugs, I think it makes perfect sense to give addicts "the good stuff". Pure, precisely dosed, administered in a reasonably safe manner -much better than the alternative, for all parties involved. Very sorry you and all the other loved ones in his life had to experience that loss. With time, i hope you all find some sort of peace.
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Mar 1, 2022 00:43
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My medical knowledge is extremely limited, but would it be possible to have a slow release implant like they use for birth control or an implanted pump like they use for insulin, keeping a constant concentration of (appropriate drug) in the bloodstream to prevent craving while being very difficult to misuse / increase the concentration?
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Mar 1, 2022 00:56
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