Top coment from the Reddit thread:
Just as a point of reference: fentanyl is the most commonly used opioid (morphine-like drug) used in surgeries. We generally dose 50-100 micrograms/0.05-0.1 milligrams initially. This amount is enough to get most people to stop breathing for a few seconds to a few minutes, until the body’s respiratory stimulation defenses kick in. The body then immediately begins downregulating the number of opioid receptors.This happens so quickly that a second, identical dose given a few minutes later will likely not cause the person to stop breathing at all. It also explains the constant need to increase the dose to get a similar high when abusing an opioid, and why it’s so hard for anyone taking opioids to feel “normal” without them - the body literally adjusts to create a new normal. Without more opioids, feeling “normal” just isn’t possible.The fentanyl used in hospitals comes in a liquid form, with a concentration of 50 micrograms/ml. There’s very few problems with overdosing, since most of our pain/sedation drugs are given one ml at a time. (Example: morphine is given at 1mg/ml.) So even though the potency of fentanyl is greater than morphine, the dose that is given is less.As mentioned below, much of the problem with street fentanyl is that it comes in a powdered form that has variable potency, especially after it’s cut. It doesn’t take much fentanyl to “improve” low-grade heroin. If your first hit of fentanyl-laced heroin is mostly heroin, no problem (lower potency heroin = lower dose opioid). If your second hit is mostly fentanyl, you’re dead (higher potency fentanyl = higher dose opioid). That’s how someone can die even when multiple hits have been taken out of the same bag.TLDR: Medical-grade fentanyl has a very consistent potency and is relatively easy to dose, street fentanyl/heroin is a crap shoot.Source: am an anesthesiologist.
I took a friend to the ER a while back. They said they were going to give her Fentanyl. I said "I've heard some bad things about Fentanyl".
ReplyDeleteHe grinned and said "We are really good at it".
I didnt tell him my story, but I'll share it here.
https://srevestories.blogspot.com/2016/06/what-do-prince-and-my-sister-have-in.html
I'm a psychiatric social worker, and spend a lot of time in ERs doing crisis work.
ReplyDeleteLet there be no mistake - it is absolutely the case that pharmaceutical marketing and uncritical prescribing is what launched our opioid crisis. The cross-section of people that I meet who are struggling with opioid addiction is pretty close to the demographics of the (fairly well-to-do) communities in which I work. The most common story I hear is some variation of "well, I had knee surgery..."
It is also absolutely true that people don't know what's in their drugs. I have the pleasure of regularly telling people that their heroin is ONLY fentanyl (and therefore much more dangerous to prepare safety) and that there are amphetamines or cocaine in their cannabis.
Then we play my favorite game: "is it psychosis or is it drugs?"
Fun times we live in.
Interesting read as to one of the sources of drugs:
ReplyDeletehttps://www.vice.com/en_us/article/3kxdbb/how-i-infiltrated-a-chinese-drug-lab How I Infiltrated a Chinese Drug Lab