The other day I was trying to find out, roughly, whether the Sackler family and Perdue Pharma were a bigger drug crisis than the “Fentanol” coming in over our borders.
First off, one thing worth mentioning is that with compact, powerful, drugs like synthetic opiates, you don’t have to haul large amounts of the stuff over a border. It’s sufficient to just mail it. In 2016 I did a piece [stderr] about the then statistics regarding drug deaths. In 2016, no surprise, it was Oxycodone that lead the way, although I suspect that the attribution is wrong, it was probably Oxycodone and alcohol that led the way. Except when you start talking about drugs, alcohol is always the gigantic lethal elephant in the room – it is utterly stupid to have a “war on drugs” in a society that sells alcohol, cigarettes, and soy milk lattes. In fact, it’s utterly stupid to have any kind of campaign against a specific form of mortality, without taking into account the whole spectrum of mortality at the time. Right? Right.
So, while the 1st Trump administration tried to declare opiate abuse an emergency, the actual chart from CDC looked like this: (from my 2016 piece)
(I got these numbers from CDC’s report on 2015 deaths, 2016 deaths for opioids will be higher)
I have no idea how they score alcohol and pills, whether those be opiates or benzos, but a lot of mortality statistics should exist somewhere in a venn diagram, not a pie chart. In fact, come to think of it, that would allow you to factor in some of the other big killers – guns and cars. Which is more lethal, a drunk with a gun or a guy on fentanyl? What about bystander deaths? I’m not going to belabor this point but if you look at the local police blotter, as I sometimes do, there are often reports like “so and so shot his friend over how they split the meth during a drinking and tweaking binge.” I don’t think that real doctors try to sort this stuff out, because it is complicated and probably not worthwhile.
Anyhow, I hadn’t really re-thought this topic, and decided to do a bit of research before the CDC is completely shut down. I’ll note that being a republican was more lethal in 2022 than prescription and illegal drugs combined: 186,552 deaths (and more the next years…) Being fat and out of shape (AKA: heart disease) is – it so happens – vastly more lethal than all drugs combined. I’m not going to worry about fentanyl, in other words, until I lose 30lbs and get back into condition to run 10 miles without dying. By the way, the president who was trying to declare an emergency about “fentanol” might want to consider his own much hoped-for mortality: we’re all cheering for the cheeseburgers. I will spare you any lies about how I wish no ill to anyone.
The reason I got started on this post, though, was because I came across a piece about the opiate emergency that pretty much blew my mind because it was incoherent or contradictory or stupid. I’m not sure which. It’s from the Drug Enforcement Agency (DEA) and, until recently, I’d say they ought to know better:
[DEA which appears to be based on a release from CDC]
For the first time since 2018, the United States has seen a decrease in drug overdose deaths and poisonings, with the Centers for Disease Control and Prevention noting a 14.5 percent decrease in deaths between June 2023 and June 2024. More than 107,000 people lost their lives to a drug overdose in 2023, with nearly 70 percent of those deaths attributed to opioids such as fentanyl.
Well, OK, that’s interesting but you’d think that if fentanyl is, itself, a crisis, we would not be seeing fentanyl deaths counted in with general drug overdoses. For one thing I can’t tell if alcohol is counted in the general drug overdoses, or not. (Remember: the chart above is not from DEA) So 107,000 deaths because of drugs 70% of which are opiates but you still haven’t told me what the deaths are attributable to fentanyl. Roughly in the opiates department the killers are heroin, fentanyl, and oxycodone. Tramadol comes in there, as well, but it’s a pretty small contribution. But if fentanyl is such a great big disaster, why did they have to lump it in with other, equally legitimate, disasters? (By the way, 90,000 or so deaths are attributed to alcohol in 2023)
If you’re trying to make the point that fentanyl is an emergency, wouldn’t you expect to publish a statistic showing that more people died of fentanyl than any other opiate? And perhaps break out the legal/regulated opiates from the illegal ones? It doesn’t make sense the way they are doing it, to the point where I kind of think this may be some poor propaganda we’re looking at:
“While we are grateful to see a decline in the number of lives lost, we know that this holiday season, there are more than 107,000 families missing their loved one because of the tragic consequences brought about by fentanyl,” DEA Omaha Division Special Agent in Charge Steven T. Bell said.
Wait, wait, wait, Special Agent in Charge Bell made a horrible error – he just attributed all opiate deaths to fentanyl. Which, we know, is hardly true. It’s like they’re trying to – you know – manufacture fentanyl as a great big crisis or something.
The latest DEA laboratory testing, announced earlier this fall, indicates that 5 out of 10 pills tested contain a potentially deadly dose of fentanyl. This is down from 7 out of 10 pills in 2023 and 6 out of 10 pills in 2022. Two milligrams of fentanyl is considered a lethal dose.
Personally, I expect the DEA to use technically correct language like LD50, not “lethal dose” especially when discussing drugs for which habituation is a big part of the dose lethality. My understanding is that a lot of opiate deaths result from addicts who go clean for a while, then fall back on the wagon and hit themselves with their old dose, which – now that they have de-habituated – may push them over the line.
But there’s another part of that that just doesn’t wash: 5 out of 10 pills containing a potentially deadly dose? Wouldn’t that mean that half of the people taking fentanyl are dead? There is simply no way that “potentially deadly doses” is a decent metric to use. Any dose is potentially deadly, right? If I have fake pills that have an amount of fentanyl in it that’s ~1mg, and I take 5, it’s probably a fatal dose. Or, in DEA parlance, it was a potentially fatal dose. I realize that a lot of the problem here is that unregulated fentanyl tablets do not have consistent dosages like the nice lab-made pills from Purdue Pharma – they’re made in labs without strict quality control. This is problem. I was talking to a friend the other day who was complaining that it’s impossible to get good cocaine anymore because mostly you’re buying chalk and a bit of meth and fentanyl. Obviously, I do not wish to toot a line of that, because it’s got a bit of the “russian roulette” (AKA: “putin poker”) effect. But the fact is that if you’re not stupid you can control for that kind of stuff. Just give Fred over there, who you don’t particularly like, a big fat line and get the hell out of there if he starts looking droopy?
There’s an obvious answer to all of this, and we dealt with it in the 90s when there were a lot of people selling homebrew MDMA cut with various other recipes from Shulgin – you didn’t know what you were eating. So, you buy a test kid and do controlled buys. [OK, I mis-typed “test kit” as “test kid” and I find that sufficiently Freudian that I’m going to leave it]
I am genuinely surprised that republicans haven’t hit on the obvious answer, yet – which is to make it all the victim’s problem. Or, more precisely: delegitimize their victimhood. Make it legal to buy all the nice well-manufactured oxycodone you want, once you’re 21, and your insurance company adds a rider saying that if you drink yourself or oxycodone yourself to death, it’s on you. That seems to me to be a perfectly anarcho-capitalist approach and besides, it’s effectively the regulatory environment for wealthy people. Do you think Elon Musk is doing street ketamine? Hell, no. Don’t do it, but a quick search about “deaths due to ketamine 2024” came up with about 900 – far too few to register on the charts. But, they say “Ketamine deaths are creeping upward, and ketamine was involved in Matthew Perry’s death…” Well, Matt probably would have been happy with some on-label oxy and probably would be alive today if he could have just gone to the pharmacy and bought some nice OTC opiates.
Since I appear to be being supportive of/advocating drug abuse – I’m not. I just want people to survive this complex tragedy we are born into, and whatever means they choose is not my problem. (I also support being able to go to the pharmacy and buy enough OTC benzos that you can go home, wash them down with bourbon, and die an easy painless death). I have tried lots of drugs and I’m unfortunate that marijuana doesn’t do shit for me, cocaine makes me an uncontrolled blabbermouth (I have done it twice) and opiates make me think of poetry and death and listen to a lot of Ligeti and Arvo Part. I had a really interesting conversation with my doctor, 2 years ago, when I was trying to deal with my brain damage by sometimes tranquilizing myself with vodka. Apparently that’s not approved so now I have a prescription for pharmaceutical anxiety and sleep drugs that will only kill me – just like alcohol – if I take the whole bottle. My main interest in drugs is regarding their political and historical effect. I read an interesting theory that Alexander of Macedon stopped being great after he got to Afghanistan and started mixing opium poppy juice with his wine. His sudden death after a drinking binge may be the imperialist equivalent of pulling a Matthew Perry. 10% tincture of opium and alcohol is called “laudanum” and it used to be available OTC until 1911 or so. (I have had laudanum and it is frickin’ amazingly bad tasting but definitely brings a positive mood shift as long as your heart keeps going). It’s funny that all these people promoting Adolf Hitler’s ideas don’t realize he was a total drug-puppet – his doctor was giving him amphetamines to wake up in the morning, and opiates to get to sleep. Add on top of that the stress of losing WWII and you might even get a little suicidal. Winston Churchill’s drug, of course, was alcohol – prodigious quantities of it, from the moment he woke up until the moment he finally surrendered to Morpheus. I suppose an argument could be made that drugs might turn someone into a vicious murdering imperialist like Alexander or Hitler (There is no evidence that Julius Caesar was into drugs, but Marcus Aurelius was so into opium tincture, wine laudanum, that he had the illusory crawling bugs on his flesh)
Anyway, just say “no” to drugs so that you can experience, in its full radiance, every minute of your life – especially the last ones, where our civilization absolutely tries to prevent a person from checking out with a big smile, and prefers us to creep painfully into our grave.
Oh, yeah, I forgot the concluding point: fnord be afraid fnord of “fentanol” fnord. [reuters] The bunch of hard trippers in the white house in 2017 want everyone to “just say no to drugs.”
WASHINGTON, Jan 28 (Reuters) – The White House Medical Unit during the Trump administration provided prescription drugs, including controlled substances, to ineligible staff and spent tens of thousands of dollars more on brand-name drugs than what generic equivalents would have cost, a Pentagon report shows.
Hey, I think I found your crisis.
I tried to decorate this with an image of “winston churchill tripping on LSD with the hippies at woodstock” but the face didn’t come out great. Bummer!
The Fred Eaglesmith track above is a favorite from the period of Peak Fred.
I actually used to work in a toxicology lab, and there were a few studies involving fentanyl and it’s analogs.
Mostly testing urine/serum from patients that tested positive on a standard drug screen, but sometimes we’d also test actual pills/powder that came in with people. It’s been a while, but I think almost all of the heroin we tested had some amount of fentanyl added to it.
It’s also hard to tell with the patient samples, since a lot of them came from individuals who used multiple drugs, and just looking at the metabolites in urine doesn’t really make it clear whether they took something laced with fentanyl, took fentanyl directly, or whether everything they took was laced with fentanyl.
At the time, I think fentanyl patches were a fairly common pain treatment, and there were a few methods people would use to try and get around the time-release aspect of the patch. I have no idea how effective, dangerous, or whatever they were, either from the fentanyl itself, or from other compounds in the patch… Stuff like using solvents, burning the patch, scraping and snorting the patch, eating the patch, etc.
CDC: Understanding the Opioid Overdose Epidemic
This answers some of your questions. It has the break out between heroin, synthetic opioid (mostly fentanyl and analogs) and prescription opioids. Essentially since 2017 fentanyl has dominated the charts for opioid deaths. The peak for prescription opioids was 2010/2011 and has let off slightly since then.
The DEA screws up statistics for drug abuse all the time because their public relations gets paid to make illegal drugs scary, not to provide good information.
Violence associated with alcohol and other drug use would be reported as a social cost of alcohol use. The methodologies are all a bit complex, so accuracy is a bit iffy
Alcohol and tobacco still come out as the biggest problems with that approach
It’s well known that punitive policies don’t work for addressing harm from drug use, but it’s good for private prisons, oppressing Black people, and making a certain sort of arsehole feel satisfied that “undesirables” are being hurt
I think almost all of the heroin we tested had some amount of fentanyl added to it.
I wonder if I should go find and caress my small supply of 80’s cocaine… It’s probably worth quite a bit more than I paid for it…
At the time, I think fentanyl patches were a fairly common pain treatment
I have heard scary things about people trying to dissolve the drug in alcohol and drink that.
Of course, I’ve heard scary things about people trying to squeeze the alcohol out of sterno cans and drink that.
It has always seemed to me that the problem is the general meaninglessness of life and our endless pointless pursuits and work. As Townes VanZandt says, “beats sitting around waiting to die.”
speaking of cocaine, when I started at that job, there were a bunch of studies going on about the use of Levamisole in cocaine – I think it was primarily used as an agricultural anti-parasitic? (dewormer, maybe?), but it had some mild psychoactive properties. I think something like upwards of 80-90% of the people who tested positive for cocaine, also tested positive for levamisole.
I can’t remember any of the details, but there was also some autoimmue type disorder triggered in some women who were chronic/habitual cocaine users that sometimes led to necrosis of fingers/ears, due to the cocaine being adulterated with levamisole.
Due to the saturation, there was speculation that the levamisole-cutting was happening fairly high up in the supply chain.
On the less depressing side, I also heard some news and such about a project in Vancouver(?) where they had a designated site for people to consume illegal drugs, with medical staff and addiction counslers and such present to offer help to those who were seeking it. Generally positive news, aside from the moral scolds that were always trying to get it shut down.
That matches my experiences as an alcoholic
@lochaber
Safe using sites have been tried a bunch over the last ~20 years. They generally help
Meanwhile poorly supervised boozing businesses is considered good for the neighbourhood
Perhaps relevant to discussion: Thistle, Glasgow: treatment rather than prosecution. Also reported on BBC. Opened Jan ’25.
IME, cocaine turns everyone into a uncontrolled blabbermouth, though my experience also involves pharmaceutical grade medical cocaine from a nurse- anesthesiologist. I did not see the fun in a bunch of drunk and high people all talking AT each other.
Marijuana is highly variable in its effects. Good Indica weed is similar to good wine. Tasty and mellowing, with few unwanted side effects like dying or headaches.
It also appears to prevent most cancers, and habitual users often have amazing lung capacity.
It’s no surprise that the lumpen administration is trying to claim there is a yuge fentonol problem. All addicts think everyone is secretly doing drugs too.
In reality, the spineless shit-gibbon wants to wage a war against foreigners in any way possible, so obviously the femtonol is being imported by tattooed Venezuelan drug gangs over our totally out of control borders.
Sadly, the domestic drug dealers who created ( and profited from) the entire opioid crisis aren’t getting their vile selves deported to prison camps in El Salvador.
They should include whatever portion of deaths via auto accident while drunk driving in their totals. There were slightly more than 45,000 fatalities in 2022, and over half of those involved drugged drivers.
Apparently, they got tired of waiting around to die.
I love the Be Good Tanya’s cover of Townes.
https://m.youtube.com/watch?v=-0SmXVrLlZ4&pp=ygUQdG93bmVzIHZhbiB6YW5kdA%3D%3D
#2 @JM
Thank you that link was helpful and interesting.
The thing is: there always has to be a “Big Scary Drug ™” upon which all current social problems can be blamed.
I’ve been a conscious being through at least four of them:
The first was “china white” heroin, so pure that it can be lethally dangerous to addicts used to more adulterated product (this may have been regional in Vancouver).
The second was crack cocaine. This was promoted as a mystery substances with addictive properties almost as overblown then as the overdose properties of Fentanyl are now. I vividly remember a conservative talk-radio host in Alberta talking about how he had heard “from a senior police officer” of “gangs” and “thugs” coming into the playgrounds of “good schools” and how just by blowing some crack smoke into the faces of the (presumably innocent and non-drugseeking) teenage girls there, they could instantly hook them on crack and turn them into prostitutes. The regular readers here can easily determine the various social and racial codes hidden underneath the euphemisms there.
The third was synthetic/designer drugs. This likely followed Shulgin’s publication of PiHKAL and TiHKAL when amateur chemists were reproducing those recepies and distributing colorful mystery pills. “Could your innocent child take a pill at a party and end up permanently comatose or believing they’re a chicken? [stay tuned for the next segment]/[buy this magazine] (delete as appropriate)”
Now we get to Fentanyl. A drug whose use is a direct consequence of prohibition, and which would be basically completely safe if addicts could get it in regulated doses (I had some at the hospital last year, and shockingly didn’t die). The hysteria drumbeat around this one is nuts. I was in my last year of policing around the time it started to show up, though it wasn’t really in our area at all, and the degree of fear/hype being spread around in police circles at the time was immense. You’d have thought it was possible to OD just from looking at a picture of the stuff. It doesn’t surprise me that even now cops having panic attacks are able to successfully blame ‘exposure’ to fentanyl, despite not sharing many of the symptoms of Fent OD, and not being treated with Narcan and not showing any signs of fentanyl on subsequent bloodwork. As far as I know, there is literally not a single verified case of an officer being ‘exposed’ to fentanyl through the course of their work and suffering an OD. (though there are cases of officers stealing/using fentanyl contaminated drugs from suspects and experiencing negative reactions).
There have been various other moral panics about Ecstasy (“Literally rots your brain. Makes ‘good girls’ do ‘bad things’ with ‘undesirable boys'”) and probably several other drugs by now.
Each of these moral panics serves the same function as other moral panics – they excuse society for it’s failings (eg: ‘good’ girls from ‘good’ families don’t end up in sex work because of childhood trauma, unaddressed mental health issues, or bad parenting, it must be because some ‘bad’ boys with ‘bad drugs’ got them hooked), they empower law enforcement and the courts to hand out harsher and harsher punishments to marginalized people in the interests of ‘safety’, they sell newspapers, magazines, TV news segments, get clicks for websites, and provide guaranteed “ripped from the headlines” stories for the fantasists who write medical and police dramas for TV.
Personally, I think it should all be legal and regulated – any adult should be able to go to a pharmacy or dispensary, present ID, and receive the substance of their choice in a guaranteed purity and dosage. With market forces keeping the prices minimally above costs, all but the least-functional drug addicts should be able to support their habits through employment or social assistance. Addicts on social assistance should recieve subsidies for their substances of choice, so they don’t have to choose between eating/shelter and getting high.
I’ve had a predictable set of responses to this assertion, all along the lines of: “I don’t want to pay for some zombie’s drug habit”, to which I invariably reply: “You already do. Who do you think pays for it now? You pay in insurance premiums and deductibles, when your catalytic converter goes missing. You pay for it at retail stores, where organized shoplifting raises the price for everyone else. Make drugs safe and affordable, and a substantial amount of the property crime in our society would just. stop. happening. People who can spend all day on the nod aren’t sneaking around stealing copper wire. And with my plan, you’re not also paying for dozens of layers of criminal middlemen, scrap dealers, smugglers, pushers, cartel bosses, etc who make sure that of each dollar worth of material stolen to buy drugs, only a few cents of drugs get bought.”
@snarkhuntr@#11:I want to be able to stipulate in my will that the state and government take a chunk of my estate in taxes (/me waves) and then execute my will and pass whatever I left to my heirs. That’s it. Simple.
Oh, and I want to be able to get a pill I can swallow that makes me 1) dizzy, feel warm, 2) philosophize for 5 minutes, 3) die.
I know we’ve got that. I put down my two best friends (my dogs) and 2 horses (twisted intenstines, they needed it) and it was peaceful and pleasant for them – they closed their eyes and fell over. That’s what I want. It’s nothing fancy. Call it “Quietus(tm)” and don’t just restrict it to people who are dying of some inevitable disease or who are in their right mind.
None of us are in our right mind and none of us aren’t dying of an inevitable disease
By the way, good luck getting an AI to produce an image of a tiger tank, even with input examples.
speaking of weird fad drug scares, anybody remember “jenkem” – supposedly people were spreading the rumor on line (mid-late aughts?) you could “ferment” feces, and then get high off the fumes. If I remember correctly, a couple rural/suburban police departments were holding meetings on this, and warning parents to check their kid’s closets in case they were bottling/canning their shit to let it ferment…
And then there was a brief bit when smartphones started becoming routine about “hypnotic drug apps”, where they would play a hypnotic pattern that would get the teens “high”
It’s like people did a full 180 from “drugs have side affects that can be harmful” to “things that are enjoyable are harmful” to “things that are enjoyable are morally bad”
As to cops, I grew up in a very rural, very homogeneous area. we’d get cops to come speak to us in elementary school (I think this was a bit before the whole D.A.R.E. program…), and I remember, as a third or fourth grader, being told that gangs were moving in on rural PA farmland, and they liked to use pizzacutters as weapons, and at the time I thought that was one of the most absurd, ridiculous, absolutely fucking bullshit thing I had ever heard. Other great memories were that we would be charged with open container/alcohol possession if we were caught recycling beer cans, and that if we ever moved a hand from the handlebars of our bike, we would be charged with reckless driving. They were certainly trying their best to inoculate people with an ACAB mindset…
As to fentanyl and analogs, I think there are valid concerns, but not for the cops that are having panic attacks and fainting over it. Mostly it’s really damned potent, and I believesynthetic, and somewhat easy/cheap to produce (not quite on the level of meth, though…), so that it’s really usefull for cutting heroin, etc., but really easy to throw the dosage off by quite a bit. And then it’s compounded by the opioid crisis, with people having chronic pain, or addictions from overprescription, and not being able to get their pain management needs met, so they turn to somewhat less than legal sources, and in comes all the problems with questionable doses, sources, concentrations, etc.
And that ties into the whole “drug seeking behavior” bullshit, where a lot of doctors are afraid of the DEA coming after them, so there are various “drug seeking behavior” checklists, where if a patient in pain ticks too many boxes, is denied a prescription. I’ve looked over a couple compilations of some of the “drug seeking behaviors”, and they are full of mutually exclusive/paradoxical entries, like: “uses entire prescription” and “does not use entire prescription”, “specifically requests pain treatment” and “does not request pain treatment”. And, like most things, tends to be used more to harm black/brown people and other oppressed demographics. Good luck getting a doctor to take your chronic pain complaint seriously if you aren’t a cis-het white guy. :/ (plus that whole bit about how even recent med school text books claimed that people of African descent have higher pain thresholds…(but I’m getting tangential at best, if not entirely off topic…))
Catch-22, since if you never did you might be ticketed for failing to signal …
Probably for the best. I don’t know whether they truly all are, but enough of them are that the only safe assumption to make about an unfamiliar cop is that they’re a predator in uniform looking for, at best, a bust/ticket to bring in and at worst a full-blown Nazi with an agenda and an axe to grind. By analogy with the concept of “Schrodinger’s Rapist”, a cop ought to be treated as “Schrodinger’s Derek Chauvin” until proved otherwise. I try to give them as wide a berth as I would a coiled rattlesnake astride my path, and for the same reason. As, I expect, do most lower income, non-neurotypical, GNC/LGBTQ, and/or BIPOC people.
@marcus, 12
I fully agree with you there. A dignified death of one’s choosing should be a fundamental human right. I do know that after Canada implemented MAID (medical euthanasia), there have been a lot of stories of people being ‘pushed’ towards that option when they have complicated medical needs, but I don’t know how true or representative they actually are. Still, I believe that I should have that right, and therefore so should everyone else. Personally, my plan in the event that I decide to off myself is to go out into the deep woods in the coldest parts winter with a large quantity of alcohol and/or psychedelics.
Between police work and search-and-rescue volunteering, I’ve recovered maybe a half-dozen winter exposure deaths. They all seemed pretty damn peaceful, some even smiling (usually the ones who had alcohol on board).
@BB, Lochaber
Yes. ACAB. Though much like dangerous animals, your personal results with any individual cop can be highly variable.
The problem with MAID and other euthanasia programs is that its cheaper to kill us disabled people than reform society
But i agree people should be able to choose to die
It’s a problem, and shows the radical change we need in society and how we support people