A significant issue with fentanyl related mortality is accidental consumption. Fentanyl is so potent and because of its relative ease of synthesis and a careless illegal drug supply chain, contamination is common. Not all but many of these deaths are a result of teens consuming a drug that they percieve as "safe" like marijuana or "adderall" or "oxy" etc but through careless handling by dealers or intentional misrepresentation, end up receiving a fatal dose of fentanyl. I think it is an important point as many comments reference decrimilization and other "fentanyl policy" items.
I keep reading this, but I haven't been able to find much data on intentional vs. accidental consumption with the exception of people who thought they were taking heroin. Do you have any sources on how many deaths can be attributed to laced or misrepresented non-opiates (e.g. marijuana, adderall, mdma)?
I don't think this is someting that is well recorded. I mean the way these encounters are documented there isn't necessarily a box to tick that is "meant to take a different illegal drug but accidentally got fentanyl". I speak anecdotally from having been party to tens of thousands of acute care admits and a lot of public health operations. You see "a lot" of "I just smoked a joint" or "we thought we were getting LSD/X/oxy etc" in teenage fentanyl ODs that recover. Also having had exposure to the drug dealing side via public health interactions and community support groups, my visibility into it has told me these are not careful meticulous people as a whole.
When do we say "enough" to all of these death and just legalize opiates?
Fentanyl's rise is 100% attributable to smuggling in drugs due to the War on Drugs. It allows the smugglers to move the maximum potency with the minimum risk and minimum quantity. Drug smuggling is a business, and as long as opiates remain illegal to posses without a prescription than this incentive will dominate.
Legalizing opiates, providing safe and clean areas for people to use, and using those safe and clean areas to get people help to quit, help finding a place to live, help getting food to eat, and help reintegrating into society will go much, much further than continued prohibition.
Legalization of hard drugs doesn't work long term. If you provide all resources to people to enjoy opiates - they will have no incentive to quit. Why is this utopian view so persistent?
> If you provide all resources to people to enjoy opiates - they will have no incentive to quit.
Many people, including myself, quit smoking normal cigarettes although it was highly addictive, because it was bad for health, not because of legality or cost. Of course opiates are a very different beast, but the point is that if someone wants to get drugs they will succeed, period. Expecting them to disappear just because they are made illegal is 100% fantasy. Legalizing drugs would move their production and sale in the open and more regulated markets, with less risks of them being made by improvised chemists in their basement, plus lower costs and much less involvement by organized crime which once prices drop would move to more lucrative businesses. remember what happened in the US when alcohol was banned: people searching for drinks would still find where to buy them, but it was organized crime that started making profits out of the ban.
And alcohol can be used in quite a benign way. Good reason to think opioids would see an even larger decline as they are high impact and unlikely to be openly consumed for group socialization the way alcohol is.
You can argue for legalization but it is a fallacy to believe that prohibiting something is bad if you can't eliminate it 100%.
Which is better for habitual, problem opiate users: a) they can get a clean supply of their drugs, a safe place to do them, medical support if they encounter issues, and connection to treatment programs and social services even if they keep using or b) they cannot get a clean supply of their drugs and needles which means increased spread of HIV and hepatitis (both preventable diseases), increased chance of interaction and overdose due to adulteration, active pressure to not admit use or seek addiction treatment for fear of criminal punishment, and active exclusion from social services?
Yes, not _everyone_ will stop using opiates if they’re made legal. THAT'S THE POINT - more users will quit when provided resources and the ones who don’t quit are better off than they were before while they work toward sobriety if they choose.
>Are you suggesting there should be no controlled chemicals? No pharmacist
This is what I advocate for. Probably way more killed by regulation here than saved. I recall accompanying someone in Mexico who had to get their life saving asthma medication in one of those unregulated pharmacies that don't ask questions, because they can't afford to see a doctor to get a prescription.
> Are you suggesting there should be no controlled chemicals? No pharmacist?
No, that was not my point.
> What if the expectation is for fewer people to use less of them due to higher hurdles?
That's the very reason why "first dose is free". Many people are sucked into drugs consumption either for fun at parties or because they're lured into substances by "friends". Unfortunately, once they're dependent it's too late to put obstacles on their way.
This is a good point. Only prohibition works, which is why the number of opioid deaths have been going down since its inception. It is mystifying why anyone would question the efficacy of the current system
Exactly. Prohibition puts people into prisons (another word for treatment), where they are rehabilitated in a drug-free environment and emerge productive members of society. This is obvious because
Any statistics on success rate and cost of treatments?
It is hard enough to treat alcohol addiction, and that makes people feel awful. I am skeptical about broadly treating opiate addiction, which surely makes people feel much better than being high on alcohol.
I am not necessarily arguing for treatment. Drug addiction is a very serious chronic disease, so treatment would be a better choice than enablement. However, I do agree that success rate of treatment must be pretty low.
This makes sense. “Treatment works” is not an argument for treatment, it may in fact not work very well. Nonetheless we must focus solely on prohibition because treatment either does or does not work to an acceptable degree and criminalization obviously increases the amount and/or efficacy of treatment
I acknowledge that treatment works and decriminalization of (highly addictive hard) drugs does not. I don't necessarily advocate for treatment because we already spend too much money on this problem.
This makes sense. Treatment works but isn’t quite worth advocating for because it is too expensive, as compared to the cost of policing and incarcerating people, which municipalities pay nothing for
When was this document written? Today Portugal has nearly the same level of drug-addiction problems as they had in the early 2000s when they legalized all drugs.
The banning of hard drugs hasn't seemed to work long term either. Do you think they have incentives to quit now? It doesn't seem so to me. People want to do drugs. They're fun.
Fentanyl only exists because it's cheap and easy to make. Anyone with a choice would always take something like oxycodone, and there are a ton of occasional recreational oxy users in the world.
> there are a ton of occasional recreational oxy users in the world.
Today, virtually all of the ‘oxycontin’ that is used recreationally is actually fentanyl and binders that looks like an oxycontin. Unless it’s in a prescription bottle (and even then,) it’s almost certainly fentanyl.
> In 2023, DEA seized more than 80 million fentanyl-laced fake pills and nearly 12,000 pounds of fentanyl powder. The 2023 seizures are equivalent to more than 381 million lethal doses of fentanyl. [0]
If they seized 80 million, just imagine how many weren’t seized.
Tar heroin cheaper to make probably. If it were legalized we wouldn't be optimizing for ease of smuggling which is largely dictated by potency instead of manufacturing costs.
yes you can. they put it in patches and prescribe them at the hospital. people go to work on those. dead addicts can't go to work the next day, but you don't hear about the ones who haven't died yet unless you know them very well personally.
Nobody is looking to overdose, ask any opiate user and they'd rather be taking pills than random shit from dealers. The issue is that pressed pills are now fentanyl, too, and those who want to dose responsibly end up overdosing anyway.
You're revealing your bias by calling one group "addicts" but not calling the other "alcoholics". Both drugs are possible to use responsibly, and both drugs are possible to OD on.
The more we have to pay for each other's healthcare (insurance costs going up, ACA subsidies, maybe a future "single payer" situation), the more other people's health decisions are going to be our business.
Oh! so we should be supporting fentanyl killing people because it makes our healthcare costs go down because now they're dead NEETs instead of a drain on society? how modest.
Technically, that is only if fentanyl is disproportionately killing young people who are already addicted due to some other cause and not likely to be economically productive again.
By the societal benefit model, yes. By the more libertarian model yes because of bodily autonomy. Either way yes. Trying to protect them from themselves is worse from virtually any angle and especially the humanitarian one.
There are millions of people on opioids like Suboxone, Tramadol, hydrocodone, etc that aren't "rotting to death". Opioids, in general, don't have many deleterious effects on the body the way that things like alcohol, cigarettes or amphetamines do.
We let people smoke cigarettes and alcohol, both of which are physically more dangerous than opiates. There's even research that tobacco is as addictive as or more addictive than most opiates. I wouldn't call this argument "progressive" and instead call it "consistent with what Americans do with some drugs that are taxed".
Oh I am sorry, I forgot that we spend hundreds of billions of tax dollars on providing safe spaces for smoking cigarettes, free smoking paraphernalia, treating smoking overdoses in public spaces. Great analogy!
I never heard of fentanyl until the government did their crackdown on pills in the 2010s. Regular doctors (not pill mills) were terrified of getting arrested for prescribing them legitimately. When the they started the crackdown, I predicted heroin use would start to spike again, and as we all know, heroin doesn't have the dosage written on the side of a bottle.
We've been doing the same shit for 50+ years, and the results are always the same: more drug use of ever harder drugs, more deaths, more destitution, more prison, more homelessness. We should try something else, but when all you have is a hammer ...
>How do you explain the failed drug decriminalization in Oregon?
Oh it will take a generation. Most people who are currently heavily addicted to fentanyl, meth, crack or even alcohol are lost causes. I think 10% of current addicts getting into recovery is extremely optimistic. The objective is to reduce addiction in future generations. At our current trajectory, the next generation will be more addicted than the current. The last 10 years after the crackdown have been an utter disaster with drug deaths doubling in that time and opioid deaths quadrupling.
Oregon already has a large number of safe injection sites, support groups, rehabs, soup kitchens, etc. Like the failed homelessness industrial complex - it's never enough, we just need to spend a few more billions, and then just a few more.
Run them out... where? Into the woods? Into other cities? This whole "just make homeless people go somewhere else" mindset is part of why things are screwed on the national level. It just results in money being set on fire to bus people around in giant circles.
To a place with cheaper cost of living. There shouldn't be any homeless people in California. It doesn't make economic sense. They will never be able to get back on their feet again.
Tons of homeless people gathering in any place that has a good social safety net and draining it ruins any city's ability to have a good social safety net. It punishes and ruins the cities that try to lead with compassion.
The motivation isn't 'economic sense', it's not dying when sleeping outside in a cold snap.
> Tons of homeless people gathering in any place that has a good social safety net
Maybe the answer here is to actually have a social safety net at the national level, instead of trying to shuffle people around in exactly the same way that hasn't accomplished anything useful since before the Dust Bowl.
> The motivation isn't 'economic sense', it's not dying when sleeping outside in a cold snap.
You keep misrepresenting the situation by dramatizing it. People sleep on the streets of San Francisco (one of the most expensive cities in the US) not because it's literally the only place in the country or even the state where they would not die in a cold snap. SF is brutally expensive, it's unreasonable to expect it to solve homelessness by housing people. It hasn't happened and it will never happen. Ever. We can spend $100B more on this next year, and we will just have more homeless people.
>Maybe the answer here is to actually have a social safety net at the national level, instead of trying to shuffle people around in exactly the same way that hasn't accomplished anything useful since before the Dust Bowl.
This is not a realistic goal, and it would still result in homeless people gathering in cities.
>The motivation isn't 'economic sense', it's not dying when sleeping outside in a cold snap.
There is an entire southern half of the country where that won't happen.
I've seen several interviews with opioid addicted homeless and they've said they prefer the street, because if they OD, someone will call 911. If they were in abandoned houses, they would just die there with no one to see them in trouble.
Totally agree with you - great point! HN is known as the hub for drug addicted homeless people from Portland, OR. I should probably find a different forum since I don't share this experience first hand.
> When do we say "enough" to all of these death and just legalize opiates?
That's not enough. You have to legalize everything with restrictions like cigarettes and alcohol.
The problem is that fentanyl is so powerful that it contaminates everything.
Consequently, you get people who bought drugs completely unrelated to fentanyl still overdosing from it (currently a problem in Austin, for example).
You don't want random kids doing marijuana dying from fentanyl. The only way to avoid that it to clean up the manufacturing. And the only way to do that is to force it to be made in actual medical manufacturing facilities.
> Consequently, you get people who bought drugs completely unrelated to fentanyl still overdosing from it (currently a problem in Austin, for example).
> You don't want random kids doing marijuana dying from fentanyl.
Nobody is dying from fentanyl laced marijuana.
However, people are dying due to buying and eating pills that contain fentanyl when they think they’re buying xanax or oxycontin. None of the fentanyl is accidentally in these pills. The manufacturer knows about the fentanyl, but the customer might not be aware.
People have died from doing cocaine that had allegedly unknown fentanyl in it, as this news story details the deaths of three people who claimed to have done cocaine with unknown fentanyl in it: https://www.latimes.com/california/story/2021-09-05/three-de...
> “The thing that makes this surge so different than others is most of these people weren’t trying to take opioids,” Stedman said. “They were trying to use multiple different substances — crack cocaine, methamphetamine, K2.”
They're not putting it in marijuana intentionally, as I understand it. It's simply so hard to keep from contaminating it that it is practically impossible to avoid the contamination.
The 4D chess game there is cartel B is undercutting cartel A. Cartel A gets wind of this and gets pissed. they get some of their guys to put fentanyl in their bricks, but instead of marketing it as coming from cartel A, they mark it with the cartel B stamp. voila, fentanyl-laced cocaine
That's the point though. Most addicts don't want fentanyl, they want other opioids. If they could legally buy said product, they would. But they can't, so they buy the on the street, and they get the easiest drug to smuggle: fentanyl.
> Drug smuggling is a business, and as long as opiates remain illegal to posses without a prescription than this incentive will dominate.
I don't really have an opinion on opiates legalization, but I'm not sure I follow your reasoning. It could be legal, but smugglers could still sell cheaper drug with higher potency.
One may wonder why these people get addicted in the first place. It seems rather specific to the US.
People seeking illegal drugs ( Fentanyl ) stems from the fact that the government went after pill mills and illegal prescriptions, so people started seeking these elsewhere.
I would rather people do Heroin than fentanyl which is 10X worse and a small dose can kill.
The problem is that regular pills from the street like oxycodone are being laced with fentanyl. Someone seeking a cheap high, but with the laced pill can end up on the deathbed.
At this point, I would rather legalize opiates than people killing themselves with these tainted pills.
having to manufacture something clandestinely costs more than manufacturing it with the full force of the industrial revolution. What dealer is going to compete with $5/gram of drugs that's actually pure and hasn't been stepped on?
Legal, regulated opiate availability implies a known quality, purity and therefore dosage. Any drug user who prefers heroin takes uncut heroin in the precise amount they choose. They would not choose to take cut fentanyl where they can be precise about nothing, including the knowledge that it is fentanyl not something else they might prefer.
The secondary argument is the reduction in crime committed to finance addiction. Burglary, mugging, prostitution all are said to expect to decline.
The tertiary argument is the reduction in corruption of law enforcement enabled by the sugar bags of cash in the illegal drug trade, a trade that just got undercut by the government to the point where it is out of business. In addition the additional police resource made available by the collapse of the illegal drug trade and reduction in "drug use financing" crime is very useful in reducing other crime and corruption.
Whether you believe it or not is up to you. If you have strong views either way it would pay to research results from countries where it has been tried while noting it's a hugely emotive issue so your bullshit detector has to be well tuned. Also keeping in mind any good idea can be ruined in implementation through incompetence, inexperience or malice. Also people do get very excited about ideas they think are fantastic but turn out not to be.
> It allows the smugglers to move the maximum potency with the minimum risk and minimum quantity.
Mostly true but there's another factor: fentanyl is synthetic. There's no dealing with opium poppy crops, farmers, processing of crops (in places like Mexico and Afghanistan), transportation and as a result it's cheap.
> Legalizing opiates ...
I agree that the legalizing these drugs is better than prohibition but, by itself, is an insufficient solution.
As an aside, the US loves criminalizing things. Building prisons is jobs. Prisoners are slave labor. Felons count for the census but can't vote. Often you'll have private prisons thrown in there too. These are an abimination but still represent only a small minority of prisoners.
The Louisiana State Prison, known colloquially as "Angola", is basically a cotton plantation with slave labor.
People need access to their basic needs like housing, food and water. A lot of drug addiction comes out of homelessness as people self-medicate. A bunch of heroin addicts were originally on an opiate prescription. The American medical system compared to other countries hands out opiates like candy.
People need access to mental health care, have security and have hope and dignity in their lives. All of these things are substantially cheaper than our carceral state but there's no profit in it and nobody wants to live near "homeless" people.
At the core of this is the American belief in the myth of meritocracy because the other side of that coin is that homelessness, drug addiction and other awful circumstances are viewed as deserved or at least a personal moral failure. As such, such people almost deserve those outcomes.
So my point is that legalization just barely scratches the surface.
War on Drugs I was a failure. Time to declare a War on Drugs II, fought with counseling, mental health resources, government assistance programs for food, housing, jobs, hope.
Lol people still talking about Fent but then you have Tranq which is even worse, 5 years from now you'll have the streets filled with limbless people from tranq, horrifying
I don't regret it. I just think how lucky i am, that i didn't lose myself completely.
There were a few close calls though back then they didn't scare me. They were cool stories (in my and my friends minds back then).
Today i think differently about that. My close calls were with very clean drugs. Seeing all these crazy new drugs & what they're mixed with, i believe these close calls would have been final ones for me.
I think the experiences did a lot of damage to my young brain, but also, everyone is damaged one way or the other.
But man, i got fun memories. Alongside sad & scary ones.
The last 10 years i was so "focused" on creating something and spent most of time working on stuff (on the computer). Pulling 12-14 hour days or 1-2 days no sleep at all regularly... A lot of less real life memories. That is something i regret much more. Especially now that i am a father and turned 30. I still spend my working hours too focused on trying something big, now that i have already wasted my good years on the computer. This is actually something i regret. Because i feel now that i still didn't do much of significant work & always struggle financially, i am a loser. But i'd rather feel like a loser with less of a "wannabe change the world entrepreneur focused" past and more of a "man, was i really still such an idiot when i was 25" kind of past.
While it doesn't encompass the entire issue, China's involvement in the fentanyl (and other US drug crises) should be mentioned more often. America needs to wake up and do something—anything—about this asymmetrical warfare attack.
Opioid addition is a major cause, yet Fentanyl is popular because the margins are INSANE while access to prescription opioids became much more restricted.
In 2019, Indian companies were a major source of precursors as well [0], yet Indian authorities cracked down on this path [1]. Meanwhile, Chinese authorities turned a blind eye [0].
That said, China is semi-federal as well, and depending on which Province the companies are from, it might be difficult to crack down, especially given that Chinese organized crime has transnationalized in Myanmar and Cambodia [2]
None of this can actually work at scale without financing and ease of operation, and the fact that authorities in multiple countries are turning a blind eye and sometimes actively using Organized Crime as a hybrid tool of power projection (eg. Triads in the Chinese diaspora, Punjabi Organized Crime in the Indo-Canadian Diaspora, the Russian and Caucuasian Vorys, etc)
That's how you have a DoJ lead brothel crackdown in DC and Boston that was because they were being used as an attempted honeypot [3]
> To fund their ever-increasing desire for Chinese produced tea, Britain, through their control of the East India Company, began smuggling Indian opium to China. This resulted in a soaring addiction rate among the Chinese and led to the Opium Wars of the mid-1800s. Subsequent Chinese immigration to work on the railroads and the gold rush brought opium smoking to America.
