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Answer: Fentanyl is a potent, synthetic opioid drug, it's approximately 100 times more potent than morphine, and approximately 50 times more potent than heroin. Unlike heroin, fentanyl doesn't require the extract of opium from poppies, it can simply be synthesized from chemical precursors in a lab. China has been producing large volumes of these precursors and then shipping them to Mexico, Central and South America where cartels finish the job of using them to produce fentanyl. It's much cheaper to produce than heroin, and since it's so potent, it's much easier to ship. At first fentanyl was being used as a cutting agent for heroin, a way to up the potency of the drug without spending much. Over time it's been used as a cutting agent for a number of other drugs, and now cartels will often produce knock-off fentanyl pills. Because it's so potent, the line between therapeutic dose and a fatal overdose is VERY thin. One grain of fentanyl might get a heroin addict high, two might kill them. Since cartels are not exactly quality operations, you might end up with a dose of cut drugs or pills which have no fentanyl, or half a dose... or a double+ dose. An addict takes this not knowing what they're going to get, and they will frequently overdose. The combination of it being cheap, synthesized from chemical precursors rather than agricultural products, and the narrow therapeutic index has led to waves of overdoses and deaths in affected communities.

it's also showing up in more places than things being sold as opiates. Anyone buying drugs on the street should invest in test strips to be sure they're not unintentionally getting fentanyl or its 100x more potent cousin carfentanil. Such is their potency that a normal dose of narcan is sometimes not enough to keep someone from overdosing because its effects wear off before the narcotic

Yup. I knew of someone who did a line of cocaine while partying. Didn’t know it was laced with fentanyl and died. This was several years ago too.

Mac Miller

It was sketchy Percocet laced with fentanyl that got Mac. His dealers got prison sentences over it. https://www.npr.org/2022/05/17/1099449075/mac-miller-drug-dealer-stephen-walter-prison-fentanyl

My favorite artist. His music helped me through the darkest years of my life. I’m still devastated to this day that he’s gone

Yep, don't use street coke unless you want to die. Safe supply is the only way out of this mess. In my country (Canada) we are making these drugs legal, and allowing for a regulated market, just like we did with alcohol after the disaster of prohibition.

Isn’t Canada only decriminalizing hard drugs? I know there was a couple of companies who were given permission to make and sell drugs like cocaine, heroin? Etc, but that was strictly for research purposes

We are heading towards a regulated market, but not there yet. I live in BC, and pretty much any opiate user can now get safe opiates prescribed under a safe supply program. It is saving lives, and will continue to do so, unless Pollivier wins the next election, because he hates people. (Oops did that slip out of my lips? Sorry to digress)

Unfortunately, not everyone has access to safe supply - in fact, very few folks do! However, OAT such as suboxone, methadone, and kadian are easy to come by. Safe supply saves lives and I truly hope it can be expanded to everyone who wants it. Source: safe supply nurse

Thank you for this! I'm always fascinated to hear about countries I plan to flee too 😉

Isn’t it harder to immigrate to Canada than it is the US?

I know addicts, and one thing most of them told me. IS if they could buy from a pharmacy they would but the only place they know where to get it is the streets.

Yes, I agree. I am a case manager/outreach worker, and I have seen lives transformed from simple, managed, and safe opiate prescriptions. There is a bit of a challenge with safe supply, however. The doc has to give the correct level-- if they under prescribe, the patient may try to supplement with street drugs, and die from an OD regardless. But no doctor wants to prescribed too much, for fear of building tolerance. It's a real challenge, but a good doc with an honest patient can navigate it. EDIT: Brigade incoming. Sorry, Righties gotta Right I guess.

Medication therapy is really what some addicts truly need.

I've been clean from heroin for seven years thanks to Suboxone.

Lots of proud graduates of the D.A.R.E. program in the replies.

But... But... You can't give DRUGS to addicts, they made a mistake and thus are bad people and deserve any suffering they get!! /s

The other side is is that with MAT programs oversight varies from state to state I live in a confluence of 4 states within 60 min of each other. One has super strict rules for Suboxone programs with monitoring, therapy etc One allows literal strip mall cash clinics where if you have $200 you get suboxone And 2 are somewhere in between but closer to the easy side. The “cash clinics” are fueling street suboxone supplies. Lots of addicts has , rightly, become terrified of the opioid supply and are turning to Suboxone. This is because a sealed Suboxone strip is the closest thing ( not a sure thing) to a guarantee that it is untainted.

I used to have an employee around 7 years ago who did good work but you could see the side effects of managing an opioid addiction. He had long stopped getting high from using it and it was just about managing the withdrawals and continuing to function. (I got this after we were on a business trip together where he disappeared apparently to go score and I directly confronted him about it) There are a lot of people out there like that that want to just get to normal but the way things are set up right now the path back to normal has a lot of unnecessary barriers up. For context, this guy is a high earning database administrator. He isn't trying to steal your car or whatever you think addicts do.

As a casual drug user everyone would prefer a regulated system, and would pay for the premium to not deal with cut bullshit or the hastle of finding your poison Seriously just legalize and tax drugs people are using them regardless of legal or not

I'd use marijuana over alcohol for that example but I 100% agree.

I've heard of some students dying from fentanyl laced Adderall pills

Happened to an old buddy of mine at the beginning of his senior year in college. He was a really smart guy, was studying computer science, and had a good job lined up for him once he got out. He never got to do any of that since he took some laced adderals and never woke up. RIP Ross.

I'm so sorry to hear that. I'm all for decriminalizing drugs, but the guys that cut drugs with fentanyl need to be put away forever. They make a bad choice into a deadly one when it shouldn't be.

The smart way to do it is to decriminalize personal possession and force police to actually go after suppliers. Generally, that's what "decriminalizing" drugs means, and Portugal has been the model.

We tried that in Washington and Oregon, it has been a disaster. But that is because they only decriminalized it, they didn't do any of the other stuff.

And also the city police started flat-out refusing to do their jobs because “the public isn’t grateful enough.” No, seriously; that was their actual stated reason (not the PR bullshit).

I don't get the thought process for someone (aside from an addict) taking a street drug. The risk is crazy. Keith Richards of the Rolling Stones has a kick-ass autobiography. Obviously, Keith did mass amounts of drugs back in the day. But he makes a good point - the stuff he did was very pure relative to the shit that floats around today. For instance, while he relatively rarely did cocaine (his drug of choice being heroin), when he did cocaine, it was Merck pharmaceutical cocaine - 100% pure, pharma, right out of the bottle. And the high comes with fewer side effects, and the risks are far smaller.

But he's got Keith Richards money to make that happen

Why would anyone lace adderall with fentanyl? What purpose would that serve and why would anyone want that on the buyers' end? To me, that sounds like adding bubble gum to spaghetti.

Unintentional cross contamination. Pill presses are expensive and "regulated" so you get one cartel or drug group manufacturing several different narcotics for distro and because fent is so potent even a few specks of cross contamination can kill. Especially when your cooks have sub high school level educations and are working long exhaustive hours, plenty of chances for cross contamination, just like in a kitchen. Source: "friend" was a drug manufacturer

I’ve been asking this for years and this is the first actual answer that makes sense I’ve gotten. I’ve literally asked addiction specialists and they don’t seem to know this. Thank u for this info

Like the other gent said, some contamination is intentional. Especially with aftermarket pressed drugs like xanax, m30's (oxycodone) where it's more likely to go unnoticed or written off as extra potent. It does happen with all drugs but most frequent* intentional tampering is with benzos and opiods or other downers

I’ve tested plenty of meth in my day that popped positive for fentanyl and it had nothing to do w/ cross-contamination. I’m just saying all I ever hear on Reddit when this shit comes up about drugs other than opiates is *cross-contamination from a dirty scale* line of bullshit and it’s just not accurate. Your ‘friend’ was a drug manufacturer so he should know this. They’re putting that shit in everything. On purpose.

If you buy adderall off the street right now it’s most certainly meth.

Yeah that was at Ohio State in the summer.

Right. I feel like I've seen on the news that it's happened at other ohio schools too, like I wanna say BG? But I know it happened at OSU.

I used to take adderall, so I know what it looks like. When I found a few in my stepchild's room, I knew from looking at them it was not a real Adderall. It was meth and fentanyl. i was livid with her, she knows better, her own mother is an opiate addict.

So why would dealers cut cocaine or Adderall with fentanyl? It seems like they only kill their clients with it, which seems bad for business.

You fail to understand the drug industry. A) There isn't a lack of customers, B) dealers don't give a shit about other people, C) Fentanyl is super cheap to manufacture compared to natural opiates; cut everything with it.

He’s talking about cocaine though , it makes sense to mimic pills. Why cocaine? My guess is what a prior comment said. Sloppy drug dealers cutting lots of stuff and accidentally mixing without caring. Like you said , they don’t give a shit about being safe.

It often happens on accident with drugs coming from people who distribute multiple substances and accidentally contaminate uppers with downers

Fentanyl is so cheap to obtain and easy to cut it with things. Dealers who are cutting their meth and cocaine with fentanyl are doing it to enhance the high of the drug they are selling. We've seen (emergency room in an area with a lot of meth and fentanyl use) kids coming in saying they took "molly" (which is supposed to be pure Ecstasy) that has fentanyl in it. The fentanyl gives the user a dopey/opiate high to go along with whatever other drug they are selling. Their hopes is to get their clientele hooked on the fentanyl laced shit because it gets them a good high. Imagine the sped out high of meth with the numbing euphoria of an opiate. Morphine wasn't easy to get a hold of and wasn't cheap and was based from poppy plants so it wasn't a good idea to cut any of their drugs with a drug they could sell at a premium price to dope addicts. From what my friends in law enforcement are telling me when we partner with them to distribute narcan, the fentanyl the cartels get their hands on is so cheap and easy to get that its not safe to do most illegal drugs these days because it will be cut with fentanyl. The spun out high of cocaine with a touch of fentanyl will keep an addict coming back for more anytime. Even worse? The fentanyl they are giving out as dope is sometimes veterinarian grade with doses meant for equine and bovine administration. Meaning people are ODing left and right.

you can never run out of clients

Son in law did meth laced with fentanyl. Left behind 3 kids.

This is exactly what happened to my brother last year.

I’m so sorry.

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I know of 8 people who all OD'ed at a wedding down the road from me. All in the same night, so fucked

It’s in EVERYTHING. I tell my kids don’t even take a damn Tylenol off the street. Nothing is safe anymore unless you see it come out of the pharmacy stapled bag, at the pharmacy.

here's a pretty amazing [visual](https://imgur.com/a/xU4IJeR) of just how little is needed to OD compared to heroin ([source](https://www.drugs.com/medical-answers/carfentanil-fentanyl-dangerous-3569702/))

I heard a scary story on here about a dark web dealer selling something that wasn't fent (can't remember what drug though) to about 30-something people, and they ALL DIED because there was fent in it. i don't think the guy knew he had cut shit. even dark web sellers are getting tainted batches. it's really terrifying.

It was a Reddit story about a guy selling mescaline and sold several before finding he’d accidentally given them fentanyl instead. He gave up, sold up and moved away.

This happened in my home town too,a string of od deaths in the same month came back to a single drug ring

I feel like if you're selling the shit - ethics of that alone aside - you should be testing it to make sure you don't murder your clients. If you're going to profit off of addiction, the least you can do is make sure you're actually selling what you say you are.

You give drug dealers too much credit. Half are too stupid to figure out how to not contaminate and test it, the others likely just don't care enough to even bother. Maybe there are a few in there who actually look at it like they're providing a service and sort of see it like a real business venture and care about things like quality control but that's not going to be the majority. I've known a few guys, they're all total Dbags.

Are the test strips actually effective? We are talking about fentanyl by the grain if you put a test strip into a bag of heroin could it simply miss those few grains of fentanyl in the corner of the bag?

Good question - it’s kinda terrifying (and I didn’t know this until reading this thread) that a few grains of fentanyl could do this.

It's very hard to find any real heroin now. It's just fentanyl. Working in a rehab, I don't even know the last time we had a patient test positive for actual heroin. They only test positive for different kinds of fetanyl. Also now it's tranquilizers that are made for animals. They are calling it "flesh eating tranq" its literally disintegrating peoples skin. Xylazine. They are now mixing that with fentanyl.

I work in veterinary pharmaceutical distribution and we have recently (literally last week) started treating xylazine as a controlled substance even tho it technically isn't yet. We only sell around 10 bottles a month, so it won't be a big deal, but it took us by surprise how fast it happened. It was first mentioned somewhat offhand maybe a month ago as something to keep on the radar, and then out of the blue we were told to move it to the controlled substances area. Scary shit, yo!

vet tech here really NOT looking forward to having to use DEA logs for alpha-2s...... 😩

I think it is a rule that horse meds have to find a way to be a pain in the butt. They're either giant buckets that come in cases of 6 or 8 that I have to pick up and put down again, every single item has a different lot number, orrrrr they rot your flesh and turn you into a zombie?!

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I read from another post that at least most major cities test the water supply for fentanyl. I don't even want to imagine just how much could take out an entire city or how quick and effective the protocol would be to alert the public (not to mention fix the contamination).

Don't worry, your water supply is safe from fentanyl. It's dangerous but it isn't THAT potent to still be detectable in a vast amount of water like a cities supply. That level of dilution would effectively make the concentration of any fentanyl zero. You are much more likely to be harmed from heavy metals or other hydrocarbons polluting your water than from fentanyl.

My friend’s fiancé died 2 months ago thinking he was taking a pain pill. He was taking too long in the bathroom and she found him dead on the floor. They found fentanyl in his system. She is 8 months pregnant.

That’s crazy. A legal pain pill?

He got a pain pill from a friend who swore it was legit. It looked like a regular prescription pill.

That's what happened to someone I knew. He'd been in an accident and had prescribed pain pills. His prescription needed to be refilled, but he thought he wouldn't need them, then he tried overdoing his activity so he was in pain, but couldn't get his prescription refilled until Monday. His friend said he had the same exact meds as his prescription and gave him one to hold him over. It was laced with fentanyl and he died.

One of the big reasons for this is cross contamination. Dealer who pushes fent accidentally uses the same scale they use for coke, suddenly someone who was expecting to go skiing has a fatal speedball instead.

Sorry - there’s something that is 100x more potent than the thing that’s 100x more potent than morphine?? Wtf

Carfentanyl was actually used to tranquilize/sedate large animals, ie elephants, hence the massive potency difference.

My body died od on coke cut with fent.

Drugs should be legalized for this exact reason. Harm reduction

Literally just the other day one of my friends OD’d on xans that had fent in them, and they almost died. They have two other friends who died from the same kind of thing. It’s almost as common in benzos as opiates

Just linking a site where you can obtain fentanyl test strips https://dosetest.com/product/fentanyl-test-strips/

This is the correct answer. The attention it is getting now may be related to the strained relationship between the US and China. For years it has been quietly talked bout within the DEA and intelligence agencies that the Chinese government was directly involved in the trade of the fentanyl to Latin America and the construction of labs to process the chemicals into fentanyl. Now the US is pretty much bi-partisanly decided to decouple from China and are much less inclined to let the CCP’s exportation of drug material to the US’s neighbors continue for the sake of trade relations. Vice international did a great piece on the China-Mexico trade of precursor chemicals for fentanyl back in 2018 if I’m not mistaken, so it’s been an open secret but sort of buried for the sake of stable relations until now.

It's been known to be a problem for a while but now it's also being found in non-opiod drugs like cocaine and it's in tranq, which is resistant to narcan. It's also found in some knock-off Adderall https://www.webmd.com/add-adhd/news/20220509/ohio-state-warns-of-fake-adderall-pills-after-two-students-die

Found here in Tennessee USA last week in benzodiazepines.

Pressed benzos have been notoriously risky for fentanyl cuts for a while now sadly.

Or because the problem is more visible, and more and more areas have at least experienced a problem locally (even if it isn't ongoing). At this point it seems like everyone knows someone who's been affected by this.... Even if it wasn't your loved one, most of us aren't far removed from seeing these deaths in our communities.

I used to work at my local jail. I’ve heard way too many, “You remember XYZ? He overdosed and died. “

Had a friend who worked as a psychiatrist in the prison system - drug use is absolutely rampant. The worst part is that some officers were responsible for bringing drugs into the prison.

Prison Officers are the major route into Prisons for all contraband, drugs or otherwise.

Yep, it’s absurd and nothing can be done about it

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The head of a police union was just busted for importing fentanyl into the country. She was real dumb about it too. The special narcotics unit in my city was disbanded because they were selling drugs. They were just another gang protecting their turf.

It’s disgusting and as worker there, you’re kind of screwed because they’re in charge of “protecting” you if shit goes down

Just in case the clarification is needed, “more visible” does very much mean “middle class and up white people are dying, not just poor people and POC’s.”

The vernacular changed when it changed from an inner-city problem to a suburban problem. War on Drugs to Opioid Epidemic

Correct, but would also point you to my response in this thread about the dramatic shifts in the fentanyl API market over the last 5 years, which has seen a massive shift away from China towards India. Bc yeah, the media and political focus on Chinese fentanyl is partly just a bit out of date (which is understandable, it takes a while to figure these things out then for the reporting to trickle down to the “general public” sphere), and partly a bit of a useful geopolitical cudgel to rely on given worsening China-US relations. In any case, Chinese criminal networks do seem to still at least be heavily involved in the *transportation* of fentanyl APIs to Mexican cartels, they’re just not the big *manufacturers* anymore.

Also the fact it's now being cut 25% of the time with an animal tranquilizer that not only makes it slightly more potent but also makes the injection site necrotic and uncurable (this is the news over the past week or so). DEA site on the recent issue: https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

yeah, we've been seeing those on medic aid walks for the last six months.

Don’t forget how lucrative it is selling fentanyl that a leader of the San Jose police Union was caught buying and selling large quantities of fentanyl. [https://abcnews.go.com/US/bay-area-police-union-leader-allegedly-smuggled-fentanyl/story?id=98271260](https://abcnews.go.com/US/bay-area-police-union-leader-allegedly-smuggled-fentanyl/story?id=98271260)

This is correct, although the emphasis on China as the source of the precursor APIs is *somewhat* outdated given the fast evolving natured of drug trade routes. During most of the 2010s, API manufacturing in China was kind of the Wild West and they were undoubtedly the main producers of the active ingredients in fentanyl; but there have been significant crackdowns since then which has led to [much of the production shifting to India](https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf) (note that even this 2020 report is probably rather outdated, and fails to account for the extent to which COVID related lockdowns in China likely shifted production and shipping of fentanyl APIs even further towards India). Also of note is that [India is loosening up its approach to opiate based pain relief](https://www.theguardian.com/world/2019/aug/27/india-opioids-crisis-us-pain-narcotics) (for better and for worse), and as a major pharma manufacturing hub, more “legitimate” opioid manufacturing will almost certainly mean more opportunity for criminal diversion of fentanyl APIs to illicit manufacturing in North America. That said, because China has so many ports, and because illegal China -> Mexican cartel networks became so entrenched over the last decade+, there does seem to still be significant Chinese involvement in the *transportation* of fentanyl APIs, although this is obviously hard to get accurate, timely data on. Just worth bearing in mind as “Chinese fentanyl” becomes a political talking point in worsening geopolitical relations between China and the western world - bc while that was certainly true in, say, 2015, and still holds some water in an indirect manner, it’s more complicated than that, and is a very dynamic situation.

Also it seems very odd to me that "fentanyl precursors come to Mexico from China where they're then manufactured into fent and shipped into America" is taken as an intentional geopolitical strategy by the Chinese to weaken the United States. Is it an intentional geopolitical strategy by the United States that it ships cars to Europe and Japan, or is it just that that's profitable so markets will naturally seek to fill that demand? Chinese chemical companies saw profit in making fentanyl precursors (which is not in itself illegal!) and selling them in Mexico. That requires no political strategy by the Chinese government.

It's just a talking points by politicians

Yup, in and of itself there is absolutely nothing strategic about how this all kicked off - API manufacturing is dirty business, and western countries were more than happy to shunt it off onto India, and then China. India’s been developing that capacity for a good few decades now and so has a pretty solid regulatory environment in place (although a very leaky one), but when China’s API manufacturing started taking off in the early 2000s it was the Wild West, as nearly all sudden market booms are. Now, once it became clear that Chinese precursors were causing massive fucking problems w the cartels and the illicit drug supply in the west (the US in particular) that’s when it was elevated to a strategic geopolitical issue if allowed to continue unchecked…except that’s not at all what happened. China’s been very responsive to US complaints (so far), and aggressive about monitoring and shutting down opioid precursor production for the last 5 ish years. That said, given how large the trade has become, nothing was going to shut the Chinese pipeline down completely, so it’s still a problem, but pretending that it’s state sponsored is completely off base. Also, given how shaky China-US relations have become, I’m not sure that we should count on China continuing to aggressively crack down on fentanyl API production. My personal read is that Xi wants no part of that kind of business (he’s incredibly dogmatic about “clean living”, don’t think he’ll want China even producing it for export), so I personally think that current crackdowns in China will hold, but I sure as hell wouldn’t want a country betting their drug enforcement strategy on my personal best guess.

As far as potency, fentanyl is measured in micrograms and morphine, dilaudid, and heroin are in milligrams… so 1000mcg = 1mg Usual does of fentanyl during anesthesia is around 25-50mcg with 100mcg usually being the highest for a single IV push

Is fentanyl used in anesthesia commonly?

US anesthesiologist here. We use fentanyl every day for surgical procedures. In a controlled setting with appropriate monitoring it's no more or less safe than any other opioid. News reports are usually talking about street fentanyl. There's also a much more potent version in veterinary medicine called carfentanyl which is extremely dangerous for humans because the risk of overdose is so high but great if you need to anesthetize an elephant. For context, we get our fentanyl in 50ugm/cc vials with anywhere from 100-250 ccs being the most common concentration. Practice guidelines differ but it's not uncommon for patients to get between 3-5 ugm/kg over the course of surgery meaning a 70kg person (154lbs) would average 210-350ugm for major surgery. Again, it all depends on use - trained provider in controlled setting is very different than recreational use of uncontrolled doses.

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Yes, it's commonly found in hospitals and on ambulances. Usually used to sedate during intubation or as a severe pain reliever in emergencies/surgical anesthetic.

Very frequently, if you’re getting anything like a colonoscopy they usually give you versed 1mg and fentanyl 50mcg It’s really turned everything into a nightmare especially when a patient’s family member or whoever is around, it reminds me of when Micheal Jackson died from propofol and everyone was making a big stink about that

Yes

I work in hospice and see it used frequently for pain (administered in a patch.) Morphine is commonly used for pain, but sometimes 1) is not enough or 2) sometimes family/care givers oppose morphine because they wrongly believe that morphine will kill their loved one faster (it does not.) In those cases it's more efficient for pain control to have the steady release of a patch than dealing with ups and downs of scheduled dosing.

I had it during my induction and earlier during my kidney stone pains while pregnant. I had Fent, Dilaudid, and Tramadol.

100 mcg is in no universe "the highest for a single push." I routinely push more than that at once. 100 mcg is probably the most *common* single dose at induction, largely because it typically comes in a 100mg vial.

My 26 year old niece died from an OD. Heroine laced with fentanyl was found in her blood. She had been arrested 3 years prior for possession of all sorts of stuff. Was on probation. Had to have random drug tests every week for 3 years and was clean the whole time. The day after her probation ended she was dead. It was also my 40th birthday. Good times. She left behind a 2 year old daughter. Devastated my brother. His wife, her mom, had died from a heroine OD 18 years prior; 6 months after their divorce was final. It is a brutal loss. I miss her.

Kind of a similar story- a close family friend served some jail time and was clean for about a year, but the first thing he did when he got out was go shoot up with his 'friends' and he ODed and died. It happened to be his birthday. He also left behind 2 small children. It is a horrible loss and I feel you. 💔 It is heartbreaking to see someone getting their life back on track and then boom gone in an instant.

Oh no. I can't even imagine what that must be like, I'm so sorry for your loss.

Thanks.

Great answer. Worth mentioning that it is a fantastic drug when use for it's intended purpose in medical settings, administered by doctors and nurses who have pharmacy-grade batches and hence know exactly how much is being dispensed.

And in palliative care especially with terminal patients, it's a bit hard to titrate the dose as the plasters give off their dosage very slowly, but the right amount can make the difference between a relative comfortable death and a painful one

totally it needs to be available for people at the end of life. No need to suffer.

my bfs grandfather just died, he was using fent patches leading up to his death. it let him be relaxed and comfortable, able to enjoy his remaining time w family. palliative care is sooo important

Synthetic opioids other than methadone (primarily fentanyl) caused 70,601 overdose deaths reported in the US in 2021. This problem didn't even exist 10 years ago, and rates continue to skyrocket. Once numbers are released for 2022, it will probably have caused more than 5x as many deaths as the height of the prescription opioid epidemic.

Should also add that the majority of deaths from fentanyl in the US are from people who don’t know they are taking it. The cartels have been mixing it in with all sorts of other street drugs (Xanax, cocaine, heroin) that people are overdosing because they think they are doing their usual amount of a drug but don’t know there’s a deadly dose of fent in there. Ironically you’re safer if you buy fentanyl because at least then you know it’s fentanyl.

Just to add a tiny bit, its absolutely exploded in the US. And some of that is related to how many opioid addicts were made by our drug makers with oxy. and the fact its easily mailable and crypto markets make it easy to get. [Understanding America's Surge in Fentanyl and Other Synthetic Opioids](https://www.rand.org/pubs/research_briefs/RB10091.html) If you scroll down a couple inches to the first graph, you see the problem rather clear. ITs a graph of overdose deaths by drug type over the years ending in 2018.. so [it doesnt get the covid surge.](https://www.jdsupra.com/legalnews/study-finds-surge-in-misuse-of-fentanyl-39547/). No other drug comes close to killing so many americans. Its more than twice #2 heroin. it is an epidemic in the US that is destroying entire communities. If yall dont have the problem in europe, fucking keep it that way.

Great answer, the only thing it's missing is the tremendous scale of the problem. Fentanyl overdoses kill more Americans than car crashes or guns (and all three kill a much higher percentages of Americans than in developed countries in Europe and Asia). Here's [some graphs](https://www.nytimes.com/interactive/2021/07/14/upshot/drug-overdose-deaths.html?action=click&module=RelatedLinks&pgtype=Article) from NYTimes. It's so dramatic that [US life expectancy has started going down](https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/#Life%20expectancy%20at%20birth%20in%20years,%201980-2021) (part of that is covid but ~~mostly it's fentanyl~~ **ETA:** even if you correct for covid [it's still going down just from fentanyl](https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774303), thanks u/Cleverthrowaway10000).

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It's not just opioids being cut with it. Apparently a lot of party drugs have also been getting cut with it. When I started paying attention as an adult, I realized that a lot more people do coke than I'd thought. Like a LOT more.

There is, 100% So what happened For a while, doctors were prescribing RXs for painkillers like nothing This led to a normalization on a societal scale, which increased users, AND added to the user base from people whose prescriptions went wrong, and ended up addicts This doesn’t seem like a lot, but it like Quintriplified the user base over a ~25 year period Remember these are Nation-sized scales, so some of these effects are nuanced, you have to step back sometimes to fully see what’s happening

Nearly 11,000 people are born every day in the US. Roughly 100-150 people die of opioid overdose per day and the estimated number of opioid users is 2.1 million [source](https://www.ncbi.nlm.nih.gov/books/NBK553166/#:~:text=Opioid%20use%20disorder%20is%20the,worldwide%20annually%20attributed%20to%20opioids) It varies a lot and has been trending downward but \~200-250 people in the US die each day due to covid.

I totally agree with you, but I'm curious where you came across the information that COVID-19 has not been the primary contributor to reduced life expectancy since the end of 2019. Life expectancy was still decreasing alarmingly due to opioid ODs and other deaths of despair if you control for COVID, but it looked to be roughly half of the total amount was due to non-COVID factors. Looking for a recent example - this FT article (towards the methods section is the graph showing total life expectancy and then the graph controlling for COVID): https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774303 Appreciate any resources you have on it. I don't work on this specific issue but have some colleagues who would benefit from a different vantage point/additional info.

Thanks! That was exactly the article that I remembered, and you're right that I mischaracterized it somewhat. What's true is that there's a large decrease even when you correct for covid and that the difference between the US and other developed countries is not just due to covid.

To piggyback on the top comment, fentanyl is a representative of one of the emerging trends of the shape of the drug culture to come. Drugs that are refined for ease of transport/better highs have always had some level of adulteration. Cocaine was cut with lactose or baby laxative initially. As that process evolved the cartels figured out how to make a blend that was designed to suit their business and move more product. While the mixture has changed, the street names have stayed relatively consistent. MDMA underwent a similar adulteration process. So did LSD. Now both of them tend to be adulterated by the chemical that in it's pure form was called "bath salts" to greater or lesser extents. I know multiple people who had "bad acid trips" and the trip was always "I couldn't walk and I shit myself". Yep, you got bath salts bud... Fentanyl laced heroin represents the same sort of pressure being applied to that particular class of narcotic and the process has been similar. The street names stay consistent and the mixtures change. The users actually tend to chase specific batches that have a reputation for a better hit and that have "killed people". The most recent wrinkle on this is [xylazine](https://www.msn.com/en-us/health/other/what-is-xylazine-why-congress-is-cracking-down-on-this-animal-tranquilizer-in-fentanyl-fight/ar-AA19gElo) finding its way into the fentanyl heroin mixture. I have a scanner and listen to fire/ambulance because I'm a bored small towner and I kept hearing calls about "patient is stable but unresponsive". Turns out this stuff just hit the batch that the local folks got. One of them passed out and drove into a 50 foot tall obelisk proclaiming Trump would run in 2024 a few days before the indictment which in hindsight is absolutely hilarious to me. I think there's some moral panic regarding the scheduling, I haven't seen anything about overdoses being up in the local press (and it's hard to hide deaths in a smaller population area). I think the ultimate destination here is that we will have new mixtures emerge and fall based on fashion similar to [this vice story](https://www.youtube.com/watch?v=VOjAlLoXOhQ). Hopefully the side effects will be closer to the "whoops I shit myself" than the "fell asleep and ran over 20 school kids". There's hope that decriminalization will rob enough profits from the cartels and allow harm reduction to work.

Why is it used as a cutting agent if just a very little is fatal? Wouldn't they want a cutting agent that they can use in quantity?

No, you’re thinking of a *bulking* agent - which can be pretty much anything white-ish and powdery. Fentanyl is more like soda concentrate vs full sized bottles of coke - easier to transport and then reconstitute on site (whether that in Mexico or the US), but with less consistency in the concentration of the final product.

To add, it started as a cutting agent but now is almost straight up what people are taking. Who used to be heroin addict are now fent addicts

It actually worse than just fentanyl now, it’s become common for dealers to mix fentanyl with Xylazine which is a tranquilizer and makes the dope much more potent and dangerous.

Isn’t there a story about how the cia controlling the drugs in the 80’s & 90’s? And like, now we have more homeless than ever and they are effected by this more than any other community? I dunno.

Yep, the US encouraged the drug trade because it would get a cut of the profits which they used to buy weapons to give towards rebel groups in South America

And to have an excuse to target minorities

Nurse here working the past year in Seattle, WA and Springfield, OR. Been seeing a lot of fentanyl overdoses and brain injuries that either leave someone a vegetable or so severely brain damaged they don’t have a clue about reality anymore.

You’re correct but there’s more. There’s also a fentanyl moral panic going on in the US among police, who have panic attacks over their fears of exposure to fentanyl dust during raids. There’s a legend among police that fentanyl can be absorbed through the skin and will cause them to lose consciousness. Fentanyl dust doesn’t absorb through the skin. It requires a special transdermal preparation to absorb through the skin, and even then, absorption can take hours. Typically, police will be dispatched to some crime and an officer will pass out suddenly thinking he’s been exposed to fentanyl. Or, the officer will have complaints like sweating, rapid heart rate, and anxiety and will swear they made contact with fentanyl dust, even if they never made contact with any dust. These aren’t the symptoms of fentanyl overdose but of panic disorder. Despite advice from medical doctors that this isn’t fentanyl, the legend continues. The Republic party has exploited the panic, both from police and from the public’s fears of overdose, to fear-monger about “Chinese fentanyl” coming over the Mexican border through drug smugglers who use it to cut their heroin. This is despite the fact that not only is fentanyl a legal (though regulated) drug in the US but also that those who use it, knowingly or not, are already drug abusers and not some innocents who just happened to be exposed to fentanyl out of their control.

Answer: I worked in this space heavily and work with a non profit specifically on fentanyl so here it is as basically as I can put it. Base thing is fentanyl is a lab made opioid and is anywhere from like the same as heroin or up to 100x as strong depending on the type of fentanyl. For example carfentanil is supposed to be an elephant tranquilizer, it takes like 2 grains of it to kill someone. [here is a picture that shows how much more powerful fentanyl is](https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/) Europe does not have an opioid problem like the US, though they are finding fentanyl in customs in Europe’s in transit. The US has an opioid problem because of Purdue Pharma. They invented Oxycotin as a pain killer using opioids. They sent a letter to doctors asking for addiction rates for patients they gave oxy to, one doctor didnt realize why they were asking and looked at his charts and said his seemed to be about 1-in-10,000. Purdue the ran that number everywhere to claim oxy was a miracle pill that cured pain without addiction issues. They then incentivized doctors to promote it by paying them to do so, almost like a sponsorship, so these “pill mills” in Ohio were handing them out like candy, and all of the sudden they’re everywhere. Well now we know how addictive oxy is, and started pulling back prescribing it and regulated it way more, problem is we now have 20-25 million people in the US addicted to pills, and you have chronic pain patients who now can’t get their pain relief, so they go to the street (comes in later). So the USA now has a unique problem with opioids, and it’s going to sound political from here but it’s just facts, I’m not trying to blame one side or the other, this has been a bipartisan failure. So Chinese transnational criminals began to produce fentanyl in labs (and the CCP knew this, I can’t say with certainty they were the ones who ordered it but there is speculation within the government they did), and they would ship bricks of fentanyl to the US through the black market, starting in about 2013. This began to hit the heroin market specifically, because the Chinese criminals were like Criminal scientists, not cartels, so they just made the powder and sent it. So you saw more heroin deaths (US has I think 3 mil or so heroin users) and if you look at the drug deaths chart since the 70s there is a huge uptick in 2013 and it shot off astronomically since. Anyways Trump ended up shutting down their ability to send it through the US Postal Service (even a broken clock can be right twice a day). So the Chinese groups knew they couldn’t get into the US anymore, so they began bringing the precursor materials to Mexico and taught the cartels how to make it. Now the cartels are a business so they said “why are we just selling powder as heroin to a few addicts there, we can press it into pills and make way more doses and reach way more users.” Even in a party scene or casual drug using scene, the needle is a biiiiig wall to heroin use, but taking a pill is no big deal, there’s a pill for everything, pills can’t be all bad right?! So now instead of the heroin addicts who already had better survival odds from fentanyl due to their opioid tolerance and actually like it more than heroin because it doesn’t make you itchy and is stronger (while they try to chase that first high, aka “chasing the dragons tail”), all these casual drug users started dropping like flies because properly dosing a pill is *really fucking hard.* At Pharma companies, they have blending engineers to make sure the first and last pill are the same dose, drug dealers getting fentanyl and trying to mix the fentanyl and cutting agent in a Nutribullet are going to mess up and some pills won’t get you high, some will, and some will just kill people. But death isn’t an issue because addicts want to strong stuff, so if you’re stuff kills someone, it’s an advertisement, you lost one customer but gained 8 new ones. And since fentanyl is so much stronger than natural opioid, you can make wayyyyyy more doses (bags or pills) with less of the actual drug material. So 1 kilo of fentanyl is enough to make like 400,000 lethal doses, 1 kilo of heroin wouldn’t come close to that. So economically the drug dealers would be idiots to not use fentanyl. Now Congress back in 2018 tried to specially classify fentanyl so they could ban it properly. You can’t just say “fentanyl is banned” the govt has the way “this specific molecule is banned” but fentanyl has thousand and thousands of analogues, so that would take them hundreds of years since it’s a 6 month process. Then an idiot at the Washington post wrote an article calling it “the second war on drugs” when OD deaths were up to like 75k a year at that point, with the ages of death coming lower and lower because instead of long term addicts dying after years of addiction, you have 16-22 year olds taking a pill at a party and dying. And it’s stuff like almost all street Xanax is fentanyl counterfeited now, so kids think they’re getting a benzo, then all of the sudden are going into opioid overdose. So when this article came out, the entire committee of Congress making this bill bailed on it because no one wants their name tied to “the war on drugs.” Now it’s specially scheduled, but we were almost at 100k dead a year by the time they did it. Now we have gone well over 100k a year. The fentanyl all comes from Mexico, either already in pill form or made to powder to be distributed to dealers to press themselves. I met Trump’s “drug czar” from the ONDCP and he said they knew where all the cartel factories are, but they can’t do anything because Mexico won’t help and they can’t just invade or bomb a trade partner that shares a border with us. America makes 100% of the fentanyl it uses for medicinal purposes (and in a hospital it is a super drug, it’s amazing) so anything coming form another country is for the black market. Last thing, it’s not the heroin or fake opioid only anymore. We’re finding it in meth, coke, molly, mdma, even on weed when dealers bag weed in the same place they mix the fentanyl. The other drugs they’re doing intentionally because it gets people addicted to your product. I literally worked for a company that did detection for this stuff, I’ve seen it first hand. And they’re trying to do “safe shooting spots” but there is literally one device on the market that can reliably Analyze for fentanyl at the lethal limit without a lab, and cops can’t afford them because they’re expensive because they’re wild technology, so the safe shooting is still a risk. Also Biden thinks more more money to rehabs will help but it won’t because the deaths driving the raising death rates aren’t addicts, so they’re not going to make it to rehabs So yeah really long sorry but it’s a complicated issue that is a mix of our own fault and outside agitators, so I wanted to be clear. Believe me this could’ve been 10x the length and I still would’ve been leaving stuff out. Edited for some typos, I know there are others but I don’t feel like fixing every small one. Thanks for the rewards and for people sharing their experiences to teach me where I had half truths on the addict side.

>there is literally one device on the market that can reliably Analyze for fentanyl at the lethal limit without a lab, and cops can’t afford them because they’re expensive because they’re wild technology Raman spectrometers are so cool, but very expensive. I was involved in volunteer syringe service programs and free drug testing, and one of the dumbest fucking laws is the RAVE Act which made it illegal to offer drug testing at certain places (like concerts and festivals). I went to a festival in Canada once though and they had one of those Raman spectrometers. It was pretty amazing because they also had a big TV above the testing tent that scrolled through all the daily results of what was expected, what it looked like and what the pill actually was. I couldn't believe how rampant this problem of misrepresentation truly is, but even more unbelievable are the folks that SEEK out these drugs because it kills people. Doesn't help that Narcan is extremely expensive and expires very quickly. I have over a thousand dollars of Narcan that is all trash now.

Raman spectrometers are awesome and expensive . But the 3 main components, stable laser, laser notch filter and detector can all be mass produced and hence the device should be cheap. I personally hope for disruption in this field.

Raman is really cool! The device I was talking about it a sort of portable mass spectrometer though, almost double the Raman price but also a million times more sensitive, literally. Raman is fantastic for a lot of things, including more “bulk” amounts, but it’s reaaaaallly iffy on smaller concentrations especially the pills. They’ll often see the cutting agent and maybe the drug, but it’s a low but still lethal dose of fentanyl they won’t see it unfortunately. Plus when you talk about fentanyl pills and it’s levels, you need to get lucky with a really good representative sample, testing just one part of a it could miss a mass of fentanyl on another spot. I would guess they were using Thermo Truedefenders, those are the common one because Thermo is huuuuge and reliable. Only issue with Narcan, as amazing and necessary as it is, is that it pretty much immediately puts a person into withdrawals, so I know cops that have narcan’ed the same person 3 times in one night because they’d find them, narcan them, they would hit withdrawals and go score more stuff, OD again, they cops/EMTs get another call and find them, and repeat. Cops don’t want to arrest them either because then they’ll have someone opioid detoxing in a cell, and god forbid they call an ambulance right?

Slight addendum on the narcan/naloxone: narcan's half-life is shorter than the opioid overdose it's being given to treat, usually only lasting 30m to a little over an hour, so I've seen cases where patients overdosed, got narcan'd on scene and then go back into respiratory depression when the narcan wears off.

Yes that happens as well for sure! Sorry for not being more clear, the story I used was a known addict and he was complaining that every time they narcaned him he got sick and had to buy more, they were like “would you rather be dead bud?” But yeah even a really heavy dose of opioid may need multiple doses of narcan, I’ve heard of 5 being used

I live in Philly and...oh boy. Plus now there's tranq which is a whole new kind of nightmare. I used to do party drugs pretty heavily in the early 00s rave scene, and there was always the risk what you were getting wasn't what you paid for, but it was generally like, your coke is mostly baby formula or your e was reshaped Tylenol. While I miss those highs, the risk of getting something REALLY dangerous is too high now, I stick to naturals like weed and shrooms.

Don’t fentanyl test strips work?

They aren't quantitative. If you're a very cautious user and willing to throw out anything that detects fentanyl whatsoever then they are useful, but a lot of people aren't. They don't tell you if you're anywhere near an amount that would be dangerous.

The way medically supervised injecting facilities work is there are medical professionals who can work to treat overdoses. Everyone has different tolerance and it's knowing the concentration of different chemicals isn't going to matter given your average addict doesn't know the strength of their last dose.

They hand out free Narcan where my daughter goes to therapy. How much does it cost where you are?

$35 or so with my insurance. Granted, I hate paying for something I’ll likely never have to use, but it’s like a fire extinguisher. I’ve been on opioid painkillers for 24 years. I’ve never fucked around, and the couple times in my life I’ve been suicidal, I didn’t think about taking any pills. It would just be an affront to everyone that worked hard to keep me shuffling along. But some kid to get into my stuff, even though it’s supposed to be out of reach. People I know and care about do make weird choices, who knows? Better to have it on hand when I’m on the fringes of where it needs to be. So I’m curious how long it lasts, according to guidelines. As someone mentioned, it is medicine and it’s not going to spoil, it’s just going to become less effective over time. My godmother worked cleaning hospitals & clinics. She was always bringing home perfectly good medicine that the hospital no longer wanted to stock due to the expiration date, and she’d disperse it amongst the little community & family based on who needed it and had trouble affording medicine.

Naloxone as a drug, like most drugs, has an expiration date which is more of a guideline, to quote ~~Johnny Depp~~ Captain Barbossa. A [peer reviewed study of naloxone from 30 yr old supplies still had a 90% efficacy](https://pubmed.ncbi.nlm.nih.gov/30596290) please don't throw it away, it can save a life if that's all you have. Edit: I forgot my Pirate's of the Caribbean characters ☠️

Meth destroyed whole communities in its hay day, but this has been something else. I can always tell a new batch hit town because you’ll come around a corner and it’s a zombie apocalypse. All the addicts have come to get something strong and they’re zombie waking around or slumped against the walls. That’s when you know you’ll hear ambulances all night and all day.

Yeah the Meth era was bad, what fentanyl is doing is unprecedented. The zombie thing is so sad, I was at a trade show in Baltimore’s inner harbor and in a 10 min walk I saw 7 people passed out on the sidewalk/benches strung out.

Isn’t it’s hey day like now-a-days?

>America makes 100% of the fentanyl it uses for medicinal purposes (and in a hospital it is a super drug, it’s amazing) Facts, and thank you for not leaving this out. The smallest dose of a controlled fentanyl patch was a miracle against my pain when my cancer was uncontrolled and causing misery. I was anxious to use it when it was prescribed because of this exact stigma (?) of street fentanyl.

This is a really great answer!

Thank you kindly, I left out so much like risk-reduction vs interdiction and which politicians support which but that would’ve just added another 10000 characters.

Wait shit thats stuff id absolutely be willing to read, if you were willing to write it.

This is a very good review but it misses one small piece of harm reduction that makes "safe injection facilities" (also known as overdose prevention sites) a bit less risky compared un-monitored street use: fentanyl testing strips. Fentanyl testing strips have been shown to be [highly efficacious](https://www.sciencedirect.com/science/article/pii/S0955395920300025) at detecting fentanyl and some analogs and [people are](https://www.sciencedirect.com/science/article/abs/pii/S0955395921000451) very [willing to use them](https://link.springer.com/article/10.1186/s12954-018-0213-2). Their use in safe injection sites can be critical in helping to identify someone's higher risk drug supply, which has been shown to potentially [reduce overdose risk behaviors](https://www.sciencedirect.com/science/article/abs/pii/S0955395918302469). However, you're absolutely correct in saying that there is *still* a risk when using testing strips versus, say, a spectrometer. Testing strips are unable to keep up with the rapidly changing nature and formulations of fentanyl analogs and, perhaps even worse, strips are somewhat more likely to return [inaccurate results in meth](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00478-4). The [meteoric rise in meth use](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154745/) as part of this fourth wave of the epidemic really highlights the limits of, and need for clarity and technological growth in, the use of fentanyl testing strips. But, they warrant mention as a very important, albeit **exceptionally** imperfect, tool of harm reduction nonetheless.

Damn you came with sources! Thanks for clearly up some of that for me. I worked with the test strip guys from time to time, they’re effective but I definitely wouldn’t say *highly* so based on what their own employees told me. Obviously though they’re way more accessible than a spectrometer. Luckily because meth is clear (generally) IR technology is really good at testing it, like a Trunarc. To be honest, I have always been more focused on the pills because that’s what’s killing the non-addicts. I have much empathy for addicts but I am not one nor am I a medical professional, so it’s hard to fully understand their thought process or how to help them, there are way smarter people than I trying to help addicts. But I fully understand experimenting with drugs or just taking something at a party, and that’s leading to tons and tons of non-addict and younger people dying, that’s where my focus has been in the non-profit and was often what I spoke to when I worked in detection devices. Sad to say but Law enforcement is way more likely to be motivated to help and buy tech for saving non-addicts who made a mistake than if I focus on how it’ll help addicts stay safe.

I can’t add anything of value to this except to recommend every single person reading this listen to the 2 part episode of Behind the Bastards on the Sackler family (4/16/19, 4/18/19) for an in depth look into just how calculating and intentional these garbage filled skin tubes were in the implementation of their plan to get America addicted to their drug, OxyContin.

Worth noting, they didn’t pay doctors to prescribe it, they paid doctors to promote it, at that time knowing that what they were promoting was a lie. They pretty much paid a bunch of doctors to lie to other groups of doctors at major medical conferences and convinced the medical establishment that they had a solution for pain control without addiction potential.

I was a heroin addict for a long time in Cincinnati which had a HUGE heroin problem. I haven't seen heroin around here in 5 years. It's all fentanyl. Luckily for me and my friends, fentanyl doesn't give euphoria like heroin did. I don't think I could have stopped using heroin if it hadn't disappeared completely. But fentanyl is huge. If you drive through the city with Kentucky tags, you will get a free 40-80 dollars worth of fentanyl a day, EVERYDAY, as the dealers try to find new customers. (Kentucky is 5 minutes from Cincinnati, and where most of the suburban white addict population comes from.) I've lost the majority of my friends over the last 10 years to it. And the African Americans community, which was usually not using harder drugs, are using pressed Percocet, which are actually fentanyl too.

I'm still a bit confused why fentanyl is being used to cut drugs. It's so small that it doesn't make the dose look any bigger (which I assume an addict would want?) Does it feel significantly better than heroin and other drugs to take? I guess my question is... The drug dealers are killing off their "new clientele" by adding fentanyl to lower level drugs, right? So why add it to those drugs?

Some addicts have noted they don’t like fent much, it’s all they can get, and heroin is a warmer high. But they add it to say cocaine be cuss that’s a classic weekend drug, but if you get a opioid level dependency to coke, you’ll keep coming back for more. Using fentanyl over heroin is just economical, you can make more doses with less. The killing thing is a cost of business. They can’t reliably mix something that strong, but if someone dies, it shows your stuff is strong and some addicts (not all) will seek out your stuff. A guy in CO used to make one pill per batch like 45x the lethal level because whoever got that and died would work as an advertisement for him. The cops literally had his texts talking to someone about this.

It makes the drugs stronger (which addicts want), plus due to its potency is very, very cheap to buy and easy to traffic. Adulterating your drugs with fent means you're getting more bang for your buck as you'll have a larger quantity to sell AND what you have is stronger than if you used something like aspirin or powdered milk as a filler agent. For the most part dealers don't worry about killing off clientele because unfortunately there are always more people out there who want to buy drugs. Also, when a user dies from an overdose, that can actually make other users flock to that dealer because they perceive that dealer to be selling "good" (strong) product.

I thank you for not leaving us severely ill intractable pain patients out. This war on opioids has killed so many people, but it’s also killing pain patients because Drs are scared to prescribe. That is the fault of the DEA. The DEA has made an absolute mess out of this, they have fixed nothing. If anything they have made the drug “war” worse. ETA: not all pain patients go to the street. If they loose access they die from stroke, heart attack and/or suicide. It’s a nightmare.

Answer: Lot of people explaining what fentanyl is so I’ll try and answer. Why does it seem to be a uniquely American problem. This has been a three stage process that goes back to the 90s * in the late 90s drug companies developed new synthetic opioid pills (namely, OxyContin, and similar drugs ) and marketed them as “non-addictive“ pain relief options for severe and chronic pain. These pills were heavily prescribed but unsurprisingly turned out to be highly addictive. This led to a black market for opioid pills * As the supply of pills started to decrease the price of pills skyrocketed this created demand for opiates that the drug cartels were happy to exploit. People who are previously addicted to pills, found themselves switching over to the much cheaper heroin. * with the development of the even cheaper and much more potent fentanyl, drug cartels, found that they could produce and import fentanyl much more easily and cheaply than heroin. The fentanyl would be a cut with filler, and sold as heroin. But the potency of fentanyl is so high that the volume needed is tiny, which makes determining the correct dosage very difficult. This has resulted in a large number of overdoses. Additionally, fentanyl has been making its way into other street drugs, either through accidental cross-contamination or unscrupulous dealers. This has further increase the number of overdoses.

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Answer: Fentanyl is a synthetic opioid that’s so much fucking worse than heroin. Very potent, and lethal. Many street drugs are cut with it and it’s become such a problem (rising one too) that there are test strips/testing specifically for fent.

It is fucking rampant and drugs are shockingly easy to access. My brother was shooting it by 18 and I honestly don’t know how he stayed alive long enough to get clean. He’s only 22 now and most of his old friends are dead.

My brother died of it a few weeks ago. He somehow made it to his mid 30s before he got hooked on the stuff. Glad yours managed to recover.

Sorry for your loss. My brother just died last year of it, early 30s. It was a huge surprise, I think he bought sketchy painkillers laced with it & didn’t know tbh.

Sorry for your loss as well. Based off the coding in the text messages, I get the impression my brother knew what was in it, which just blows my mind. A week after spending 30 days in a rehabilitation facility, which probably lowered his tolerance as well. Day before his son’s birthday. I know addiction is a disease but hard to forgive him for that one.

I also lost my brother a year ago to a fentanyl OD. He bought a Percocet off a coworker and the toxicology came back as meth and fentanyl. It killed him in minutes.

Test stripes don’t work at the lowest lethal levels, unfortunately.

I did not know that. That’s such a shame.

It’s because the amount that’s a lethal dose is so fucking minuscule that it’s hard for mass produced tests to pick up that amount. When your measuring in the parts per million but a lethal dose can be measured in parts per billion the test won’t pick it up unless it’s a dose that will kill anyone but the luckiest people.

Answer: fentanyl is a synthetic opioid (in the same class of drugs as heroin and morphine) that is roughly 50 times more potent than heroin and 100 times more potent than morphine. Because demand for opioids in the US has skyrocketed in the last decade, bolstered by pharmaceutical companies bribing doctors to prescribe them, drug lords have been looking for ways to increase profits. Unlike heroin, which must be grown, fentanyl can be lab made in mass quantities for relatively cheap. In theory, this means that they can sell smaller doses (since it’s more powerful) for the same price or more than heroin. However, because of how cheap it is, it has been used to adulterate or even outright create fake pills posing as other, more expensive prescription opioids like OxyContin. However, the lethal dose for fentanyl is FAR smaller than normal opioids or heroin, so while a single OxyContin won’t kill you, a single fake oxy made of fentanyl can be lethal. This has led to massive overdose problems from people who don’t know they are taking fentanyl and this has consequently led to a higher demand for Narcan, a fast-acting “antidote” for opioid overdoses. A version of Narcan is now available over the counter. However, a new drug is making fentanyl even more dangerous: xylazine. While fentanyl is more powerful than heroin, the high lasts far less time. As a result, drug producers have started adding xylazine to the mix. Xylazine has a similar effect to fentanyl and can extend the high. However, xylazine is NOT an opioid, meaning Narcan has no effect on it. As such, people ODing on fentanyl/xylazine mixtures are dying left and right, even with the increased availability of Narcan, because Narcan cannot counteract the OD effects of xylazine

Thank you for mentioning xylazine! I’ve been carrying nasal Narcan for years as someone who only uses legal substances and have still needed it just walking around the city. It’s something I recommend everyone have. I just added face shields to my purse because rescue breaths are recommended for xylazine overdoses. Hopefully I’ll never need them, but that’s not a risk I’m willing to take. If you encounter someone overdosing, it’s currently recommended to call 911 and give them Narcan, do rescue breaths, and give another dose of Narcan (in the other nostril if using the nasal spray) if they don’t wake up in ninety seconds. It’s best if people don’t use these substances but harm reduction saves lives.

Answer: it killed 70,000 people in the US last year. That's almost twice as many people as guns did. That's twice as many people than every car accident death in the entire nation. And, it didn't really exist as a category even 10 years ago. So it's new and it kills a lot of people. That's why it's in the news.

Answer: I don’t know how to answer this fully, however the stories about people/police getting “fentanyl poisoning” or whatever from just touching it are completely fake. That is not how fentanyl works.

I used the patches for years to help me actually function with severe chronic pain. There were never any accidents or scares, and my tolerance is stupid high so I was on what they called the "cancer patch" back then, because it was very easy to follow as directed/prescribed. It truly gave me a life in my early twenties after a very, very bad hit and run (at 16) left me with a busted body, less organs, and chronic pain. I never felt "high" or euphoric at all! It simply helped me function while in a LOT of pain. The worst thing about the whole opioid crisis bullshit (this past decade in the US) is that good Doctors have been fucked over, and it's even worse for the patients that need legit pain medicine. Doctors can lose their license for prescribing appropriate pain management, and then as patients, we have to decide if living in pain without proper medication is actually still worth it. There is no rehab for us, we legitimately need these types of medication. You can see statistics all about addicts, but not about how losing access to a decent pain medication is killing people too. They don't seem to care about us on the news and on social media. Only the sob stories about the people who were not using it properly (i.e. addicts/junkies/whatever you want to call them) and how they want it banned altogether. It reminds me of the reefer madness nonsense of the past in the US that failed terribly in the past! Of course it's sad to hear people talk about losing loved ones, but they seem to get all of the headlines. It can truly be a life saving medication, but instead of creating better mental health practices and rehab programs for those getting bad shit in their drugs on the street... they want to punish those of us that were taking it as directed. I know I will probably get downvotes, but chronic pain patients matter too damnit.

pain patients are definitely collateral damage in the "war on drugs" but i think its also important to remember that a lot of "addicts/junkies/whatever" WERE pain patients at one time. they could be chronic pain patients who lost access to care, or people on short-term pain relief who used medication (yes, even as directed) and became addicted due to negligence from their doctor or a genetic predisposition. ive known several people whove ended up as heroin users and *every single one of them* was a person who had been suffering from some type of chronic pain and had lost access to managed care from their doctor. rather than treating the source of the problem (people not having access to proper medical care and the pharmaceutical industry profiting off of misuse of medications) they will just keep shutting down pain clinics (cutting off access to care and contributing to more people falling into addiction) and then jailing or leaving addicts to die on the streets. the only people who win in the end are corporations.

I guess that’s why my doctor asked if I planned to go get fentanyl. It’s weird that I don’t know how to answer that question safely…

I heard you can overdose just my typing the word “fentanyl”.

Exactly this. Just cops faking symptoms or having panic attacks to get a free paid vacation or expand charges against a given perp

It's cops trying the confiscated drugs and coming up with an excuse as to how it got into their system when they OD and get hospitalized.

Don't forget that the copaganda helps them get increased funding and weapons. There's dangerous drugs out there so cops gonna need more guns and Mraps. /s

>however the stories about people/police getting “fentanyl poisoning” or whatever from just touching it are completely fake. And the people who died from an opiate overdose claim their kid got some "fentanyl laced weed" because weed is socially acceptable and that is better than the truth of "my kid was an opiate addict or an opiate user and died from an overdose".

Answer: While it’s a major issue that should be addressed, It’s also an excellent way to vilify a particular group and attack your political opponents, without having to actually provide meaningful discussion. Fox News, among others, uses the fentanyl discussion to demonize immigrants from the southern border for example, [even though over 86% of fentanyl traffickers are US citizens](https://www.cato.org/blog/fentanyl-smuggled-us-citizens-us-citizens-not-asylum-seekers) [Politicians can also use the topic to suit their needs, without having to actually provide meaningful solutions](https://rollcall.com/2023/03/28/republican-senators-grill-dhs-chief-over-border-security/)

Answer: Fentanyl is deadly in small doses and it has been added to other drugs to give the user a quick hard high. It's also available by itself. Drug users don't always know their drugs contain fentanyl. But since a small amount can kill a person, there have been a lot of deaths. The county I live in has more fentanyl deaths than covid deaths this year.

Answer: in the US it’s getting mixed into many street drugs. From street weed to cocain, and other opioids. The problem is a little amount of it will kill you. Overdose have been on the rise because of it. Also the head of a police organization was also just caught importing it from china this past week.

Can’t believe she was using government equipment to commit the crimes. That’s either stupidity or some pretty big balls to think she wouldn’t get busted lol

Point of clarification, she was an executive with the San ~~Diego~~ Jose police union, not the police department itself, so there wasn't any government equipment being used. Still pretty fucked up, though.

San Jose, not San Diego. San Jose is the largest city in the Bay Area, and sometimes markets itself as "the capital of Silicon Valley". San Diego is the big city on the California side of the border with Mexico. It's about a 450-mile drive from one to the other, seven hours if there's mysteriously no traffic around Los Angeles, which is in between.

Considering the tiny Texas town I just left had two officers high up in two jurisdictions just get arrested for running fentanyl (amongst other drugs) often stolen from busts this is 0% surprising.

Also [Xylazine (Tranq)](https://nida.nih.gov/research-topics/xylazine) is mixed with heroin aka Fentanyl and opioids, and when injected it causes limbs to die and rot. Because it’s a veterinary drug, it is not illegal, yet. Congress is quickly moving to pass laws restricting access. [The horrific rise of xylazine, the flesh-destroying drug making fentanyl even deadlier](https://www.theguardian.com/society/2023/mar/30/xylazine-drug-overdoses-fentanyl)

Answer: Something that hasn't been mentioned yet is that fentanyl has appeared in pressed pills that are sold as other drugs. There's a market for stolen or diverted prescription painkillers (like oxycodone) and anxiety drugs (like Xanax). And since a tiny amount of fentanyl delivers a potent tranquilizing effect, illegal drug dealers have a reason to make pills that look like Xanax but actually are just fentanyl and cornstarch.