How to deal with the fentanyl crisis

[ripcord]

Charge anyone dealing fentanyl with attempted murder and push for the maximum sentence, if someone dies from an OD hunt down their dealer and charge them with murder. The dealers know fentanyl kills but they just consider it the cost of doing business. Since fentanyl busts are now reported by the number of people that could be killed it seems very appropriate.

[Hugh_Lebowski]

1. Yeah, no.

Expand access to buprenorphine, make it not so expensive, and not so few doctors prescribing it, and get people inexpensive help in terms of counselling.

More criminalization is not the answer.

[Eliot Rosewater]

4. I thought they loosened the rules for which docs could prescribe it.

But this is a great way to help with the addiction crisis.

[Hugh_Lebowski]

12. They did, or at least expanded how many people an individual doc could be treating at one time

Which was a great step in the right direction.

It's still too hard to access though, and part of the reason for that is that the intake process is expensive. A lot of these doctors are essentially cherry-picking by requiring like $400-$500 cash to get started. And many of them won't accept insurance, or only accept PPO's, for ongoing treatment. There's an awful lot of addicts that don't have that kind money. Being friggin broke and having no insurance (let alone PPO) kinda goes hand in hand with opioid addiction.

That combination of conditions eliminates the 'lower class' (if you will) from accessing this life-saving treatment. It makes some (coldly logical) sense particularly for docs who do Bupe treatment kinda 'on the side'. You don't want strung-out looking/acting people in your waiting rooms, freaking out the grandma who's there for her cholesterol test, for instance.

More could definitely be done, put it like that.

[Eliot Rosewater]

13. It might be different state to state, but I thought those stipulations were gone.

It is hard to google it and get the exact up to date info, as I have tried. Do you have a link to a definitive statement on this?

I actually need to know for a reason I wont go into here in the open.

[Hugh_Lebowski]

17. Just had my PA GF look into it, and yeah, you're right, no patient count limit anymore for anyone

with a DEA number (which can be MD, NP, or PA). This is new as of 2023, thanks Biden!

But prescribers can still do whatever they want in terms of 'filtering the clientele' if you will.

They can decide they require urinalysis (and most do) and they can kick you out of treatment for any violation if they want and/or just don't like you for whatever reason ... maybe you've just often showed up and begged for meds early because your dog ate them or you wrote a bad check, etc.

The prescribers can have as many patients as they want, but there's nothing to stop them from cherry-picking patients, and many if not most ... do.

https://www.deadiversion.usdoj.gov/faq/buprenorphine_faq.htm

[Eliot Rosewater]

21. 2023? Wow, I thought it was a few years ago...thanks for the info

It is a wonder drug for addiction.

AS I recall we have a 12 step forum here...although to call it 12 step would be wrong to do for anonymous reasons.

Yes, we do

https://www.democraticunderground.com/?com=forum&id=1144


I might post there about some stuff.

[Hugh_Lebowski]

22. Prior to that there was a special dispensation for unlimited patients available

Something with an X in it, like X license. That had been around for awhile.

And yes it is a wonder drug in many ways ... it actually can stop someone OD'ing all most as well as narcan does as well. Even pure buprenorpine (Subutex) works, not just the Suboxone formula that actually HAS narcan in it (but it does not absorb sublingually, only if you inject it).

Frankly suboxone is a bullshit formulation, you really only need buprenorphine for proper treatment, and there's cheap generic Subutex, but not generic Suboxone, so it costs way more for a patient to get a formula that has 0 additional value, you're paying way more to a bupe/naloxone mix ... where the naloxone does nothing because it's not absorbed.

Another thing we need here in the US though is a lot more 'step down' dosages. They have those in Europe but here it's (last I checked) 8mg or 2mg doses. Quitting off a dosage of 2mg/day is pretty brutal. There should be 1mg, 1/2mg and 1/4mg dosages for people weaning off.

We've talked about this in the past, you and I

[mucifer]

15. My patient was able to go to college with

VERY high doses of fentanyl patches in hospice. It was amazing at controlling his complicated cancer pain along with other meds.

But we could find other meds for him if we didn’t have his fentanyl might not work as well for him. But I do understand far more people suffer from fentanyl than benefit from it.

[Hugh_Lebowski]

18. The thing is, fentanyl is highly concentrated, with correct dosages in micrograms

Which means delivering accurate doses requires very expensive lab-level equipment. Your average street dealer or even a big-time pill pressing operation ... often doesn't have the proper gear to do what's needed to control dose levels.

You add to this, the fact that:
1) Outside of time-release situations like Rx-patches, fentanyl has a very short half-life, and
2) Its ratio of 'euphoria' to 'respiratory depression' is very LOW compared to actual 'good drugs' (for an abuser) like Heroin, Hydro/Oxycodone, or Hydro/Oxymorphone (Dilaudid/Opana). In other words, despite all the 'ZOMG IT'S 100X MORE POWERFUL THAN HEROIN!!11!" hype you read, in reality it's like 'dirt weed that came over the border from Mexico in a spare tire in the 70's' in terms of a 'high' ... but at same time, it heavily depresses your breathing.

And it doesn't last for shit (in street form), which leads people to keep taking it and taking it, trying to catch a buzz. And then dying.

In Rx form, properly-managed for pain relief, it's an effective pain-relieving drug.

As a drug of abuse in the hands of street dealers, it's incredibly shitty and dangerous.

The fact that all any 'user' can get anymore is this hyper-concentrated synthetic shit that SUCKS as a drug to get you high compared to real dope ... is killing tons of people.

[WhiskeyGrinder]

2. Uh no. Cops defund us in precisely this manner.

[MichMan]

5. Worked good for crack cocaine

[RockRaven]

6. So, like, sort of a "war on fentanyl dealing" kind of strategy?

Hey, what could go wrong?

[ripcord]

7. It is better than doing nothing and watching people die

Soft of crime always hurts democrats but we always double down on it.

[RockRaven]

8. What if -- and this may sound radical -- those aren't the only two options?

Crazy notion, I know...

[ripcord]

9. We tried your option

Ask the people of San Francisco how they are enjoying their quality of life.

[RockRaven]

11. Perhaps you should reread what I have written. It is not possible to have tried "my option" b/c

I have not proposed anything specific.

[Tetrachloride]

10. ++ OP. Some countries take a hard line

[Blues Heron]

14. fentanyl itself is the result of the crackdown on milder opiates like codeine, percocet etc.

your idea would just cause something even worse to emerge. Fentanyl is a creation of the war on drugs.

The ODs are more than just the cost of doing business - its unbelievable but people will seek out that dealer because he must have the `good` stuff.

[Tetrachloride]

16. Overseas is me. In 3 years, i saw 1 drunk and 1 something else

Yall got what you paid for and more.

Kind of like 2016

[LudwigPastorius]

19. So, you're down with Trump's plan?

https://www.politico.com/story/2018/03/15/exclusive-trump-finalizing-opioid-plan-death-penalty-418488

[Kali]

20. wrong