Fentanyl can surpass your ability to control yourself.

Lol.

At least the anti-gun crusaders have the pretense that guns are used to harm people other than the one voluntarily using them.

The oxy in oxycontin is exactly the same as the oxy in percocet.  There was no "extra potency."   The mg per tablet were higher because it was delivered over 12-24 hours, not 30-45 minutes, with the idea that someone in 24 /7 pain would be well served with a med that worked 24/7. The concept is correct.  The problem is that junkies were able to bypass the time release coatings and get all the drug at once.

Drug companies lied, docs took perks for writing scripts & patients are idiots.

This. People seem to not fully grasp what fentanyl does. This is not the same as alcohol addiction.

Lawyers became billionaires overnight and not a single person has stopped smoking and your taxes taken to "take care of people" have not dropped a single cent.

thats also part of the problem

Bullshit.  It is a wonderful peri-operative drug that is much easier to titrate than morphine due to rapid metabolism. It is a great drug when not misused just like...wait for it...the AR15 is a great gun when not misused.

So, ...for the children!!

And yes it was happening 10 years ago; the media just hadn't told you to start hyperventilating about it yet.

I always wanted to know where the pain management push came from into the hospitals and EMS. I dont think it was a self review

Maybe someone could explain the difference between blaming the pill manufacturer for opioid deaths, and gun manufacturers for gun deaths?

So detoxing from it won't literally kill you  like alcohol can?

Where do people get this nonsense? It is a strong synthetic opiate. It is not magical .

Morphine and Fentanyl are being phased out. Turns out the Nitrates and getting reprofused are what stops the pain

This is all I got.  But “rare” as you call it in this study is 0.0003 percent of people experienced addiction.  I have no more arguing to do.

Now hold on there, don't go on injecting logic into the conversation.

Lawyers and politicians.  In fact, if you wonder where some crap originates, the correct answer is usually lawyers and politicians.

No, They walk in and push it through an IV before even explaining what can happen

So you were just spouting off incorrect nonsense then?

State governments just looking for another cash cow instead of addressing their budgets.  It was the government that approved and regulated this stuff.  Just like with cigarettes, it is basically extortion.

Please explain to us what happens with an IV push of fentanyl, oh wise one.

That’s all I got.  But it was enough to get docs to prescribe them and patients to take them.

We can professionally disagree. The morphine epidemic cant even hold a candle to fentanyl. Its a multifaceted problem that starts with the design of the drug. The expedited metabolism is a perfect example

I don't want to waste a lot of time on yet another opioid thread with misinformation and people who want something banned because they don't like that people can get high with it.

I will say that this decision is very bad. More government in healthcare is bad. Less options in healthcare are bad. More expensive expensive medications in healthcare are also bad.

The war on drugs is stupid, the war on opioids in idiotic. And I'm out.

Agreed.

If I had a dollar for every scumbag doc overprescribing, Medicare, Medicaid, insurance fraud all attributed to opioids I’d be rich. Pharma is always the big scary monster to blame like big oil. Had a pain doc client who would travel to multiple clinics in the state. On the day he would come into the town where I usually would see his staff or him the “patients” would be jam packed in the parking lot hours before his arrival. All hanging out. Smoking cigarette after cigarette. Obese. Dirty. Nasty dirty Inkies. The Feds indicted and convicted him on 22 counts. Did he abuse these people. Yes. Did I feel sorry for them? No. They were addicts and as soon as he went to jail they were already doctor shopping for the next scum bag doc who would do the same thing.

But, but.....but your average soccer mom can take just one pill and be addicted for life!  That's why it's an Opioid Crisis.

No it wasn't. It was a single study that didn't even mentioned the drugs in question.

And you said, specifically, that these drugs were marketed by the drug companies as non addictive.  I've yet to see any evidence of that marketing campaign.

Now you just are being insulting

That's exactly what is fueling the ODs.

HELL YES IT DOES!

"Professionally?" What profession would that be?

The rapid metabolism makes it less addictive if you remember the pharmacology and physiology classes you took when you got your PhD or MD.  You've got one of those yes? Shorter receptor binding time means less changes in the expression of the receptors in question.  Rapid onset and offset means easier titration that equals better analgesia without overdose and overall use of less medication.

The only reason why you see fentanyl in illegal junk is not because of some magical and imaginary addictive design but rather it is so stronger than morphine that one can cut much more doses of drug without having to smuggle the bulk of heroin. When one gram of fentanyl can be cut into a thousand hits of "heroin" , the profit motive is quite clear.

This however, is, like gun crime, entirely due to criminal misuse of a very useful tool, not a flaw in the tool itself.

Which, oddly enough, if done in the right setting could have actually reduced the subject group of addicts' addictions.

A psychiatrist in Liverpool UK named John Marks came up with a novel way to treat drug addicts in the 90s.
Instead of prosecution, or attempting to ramp them down with their dosage, or put them on suboxone, methadone etc, he just prescribed for them an ongoing dose of each addict's drug of choice, up to and including heroin.

His intent was helping the addicts to live otherwise healthy lives* and stay out of the criminal justice system, the thinking being that drug abuse is a health issue, not a criminal issue (gee novel concept, right?).

Remember this was in the UK.  What happened?  The US government pressured the UK to cease this project, but the UK did allow it to go on for some time.

The results of this project were absolutely successful.  His patients who were in his "heroin maintenance" group, for whom he prescribed it, didn't suffer from all the diseases (HIV, Hep C, etc) that street drugs and dirty needles pass.  There were far fewer overdoses and deaths, because the drugs they used were of precise dosage and unadulterated with bullshit that the cartels stuff in.  The patients didn't commit crimes, simply because there was no reason to do so - the drug was readily available.

These addicts had jobs, were healthy, and had intact families that weren't broken by a loved one being on the street or in prison.  You know..like many families where a far more dangerous drug is being abused (alcohol).  We've all heard the term "functional alcoholic."

Get this though - over time addiction rates actually decreased.  Giving the addicts heroin didn't make them consume more of it, nor did more people decide to start taking it.  In other words, this study did what the war on drugs couldn't:  it stopped the spread of abuse and new usage of heroin.

Why did this happen?  Well true drug addicts are overcome and obsessed with getting their next fix, and with anxiety about that.  It takes up a large part of the time and emotional energy in their lives, not to mention commingling with shady people and an ever-present fear of prosecution.

The project removed that element from their lives.  The addicts got their drugs in the morning and spent their lives with their families or at their jobs.  You know, just like the majority of addicts before 1930 when laudanum was legal and over the counter.

When the fulfillment of their now much more normal lives began to bear fruit, many of the addicts were inspired to start removing the drugs from their lives.

Each year, 5 percent of the heroin addicts in that group quit using heroin  all on their own.  No methadone, no rehab center, they just quit.  This rate of success is unprecedented.

Alas, with increased pressure by the US on the UK government, the project was shut down.

Within 24 months, 25 of his patients were dead.

The rest were all back on the streets or in prison.

A similar study was done by the Swiss after Marks' study with 1,000 addicts.
800 were prescribed heroin, 100 prescribed methadone, 100 morphine.
After 3 years, crime among the addicts dropped 60 percent.
Half of the previously unemployed had found jobs.
A third who had been on welfare were self-supporting and none of them were homeless.
83 patients  on their own  gave up heroin.

The only thing US drug policy does is provide an opening for cartels  our laws and practices actively promote them  they are good businesspeople and they won't let an opportunity to sell product go unanswered.  So here we are, with contaminated drugs on the street, all in the name of our puritanical crusade against drugs.

There's so much misinformation out there that at one point, the fucking DARE program had to be overhauled because a study showed it was actually increasing the rates of adolescent drug use.

* This was a common thing in the 30s and 40s, lots of laudanum addicts out there held steady jobs and had families and houses.  They were addicts, sure.  But their quality of life, and the lives of those around them didn't revolve around a ghetto criminal element.

No. You seems to be so certain of the malfeasance of thousands of anesthesiologists who have used fentanyl without problem for decades--after all, it has been around since 1959 and used regularly in the OR since the 1960's.   You make these wild declarations, specifically mentioning something about the evils of docs pushing it. Show your work. How and why is it more addictive than any other opiate?  What receptor activity is different?  Can you name the opiate receptors?  Why after 40 years of common use, is it suddenly a problem? Did is magically suddenly become more addictive today than it was in 1959 or perhaps you just think it's new because you, not having that level of practice, just heard about it with the "crisis?"

That would be pussy, my friend.  I've been given fentanyl in the hospital.  No addictive effect on me at all - it was nice, but that's about it.

Now pussy on the other hand, yeah man we've all done some really crazy shit for pussy.  It definitely makes me lose my ability to control myself or make good decisions.  I guess you might say I'm addicted to it.  I'm a (somewhat) functional pussy addict for now, until my preoccupation for it makes me neglect other important areas of my life.....oh wait....fuck.  

I sure hope the government doesn't schedule it, because that would be.....bad.  

No I am not a doctor. I see you feel your level of education makes everyone else in the medical field incorrect, misguided or somehow less informed. However I appreciate your insight. Maybe you can tone it down and participate in the conversation with us cretins . We get you are a doctor. But attempting to interact with people by insulting them wont get you very far . Thanks

It was horrible watching my wife in agony from her botched surgery having to jump through hoops trying to get relief as the doctors here are terrified of prescribing. One Dr even told us that her brother with chronic back pain supplemented what opiods he could get with alcohol and that my wife might consider that. It was unreal and was bad enough that I as a retired cop had the thought of obtaining from other sources cross my mind, which is a fucked up situation to be in. After many weeks of taking her to a Dr every 3 days to get another prescription she was able to get into a pain management clinic. Made a huge difference and over time they stepped her dosage down as it should be without making a patient go cold turkey. Some of the problem could be resolved with streamlining the process to get into a clinic quicker instead of waiting months to establish chronic pain. Her clinic had frequent urinalysis for other drug usage and random pill counts. Any violation of the plan of treatment gets one booted out. They assumed every patient on those drugs would have developed a dependency and worked to get them down to a drug free state if possible. Cutting off truly injured patients will make them go outside and take God knows what into their bodies.

Perhaps you could start out with dropping the whole "evil doctor conspiracy" shit and docs would not give you a rash back.  That is one of  my pet peeves. Medical conversations here can be just as annoying as gun conversations on facebook.  People don't know anything about guns other than what they are fed on the media and around their friends but they just "know" everything. Same here. When one hears nonsense just as bad as "shoulder thing that goes up" level of ignorance and hysteria, it really grates on the ears.

Agree with many people having no issue with narcotics. I think there are many drugs that can be given prior to fentanyl to do the same thing. powerful narcotics should be given with caution. In the past few years early use of specifically fentanyl for almost all complaints was the standard in EMS here. Maybe it is regional. Im telling you from my own insight that the first "issue" was poor management of pain, fentanyl then gained popularity in the Emergency Room and EMS and then we have a massive problem much larger than the already present problem with narcotics.

All narcotics should be given carefully but there really is  no difference in strength between 25mcg of IV fentanyl and 2mg IV morphine. They are equal analgesic doses. The advantage is that fentanyl is faster on and faster off so in the ER it would be a better choice for a bandage change or a closed reduction of a broken or dislocated limb, for example.

I respectfully disagree with anybody who thinks this is a good thing.

Anyone who thinks this is a good thing take a moment and think that this is another step towards removing personal responsibility and creating a "victim" mentality in this country. It's not the person who let themselves get addicted who is to blame, it's the evil company that created it. Let's get .gov involved and they'll make it all better.

Just enabling junkies to get all the free shit in the world at the taxpayer expense. They've all got excuse after excuse and do it over and over again..... and society enables if not outright encourages it. Tell me you don't see it every day in your line of work?

Oh and guess what else this sets up for people to go after the manufacturer on........

This isn't good

Which is why I am saying that the people who produce the drug and literature are more responsible than any doctor that write a script or orders the administration. Pain clinic doctors here being shut down caused an increase in demand for heroin.Now thats an evil doctor conspiracy

There is a cabal of attorneys that are constantly planning lawsuits at this level, they just have to find the right states at the right time with the right big pockets...mike Moore and his cronies come to mind

Mr. Moore said he isn’t pursuing the opioid litigation as “a money grab.” He said he is spending a lot of time advising on cases in which he has no financial stake because he wants to share his expertise to bring about a resolution. A young relative’s struggles with addiction also motivated him, he said.

“I want there to be a huge amount of resources available for treatment, and I want the industry to change its practices,” he said.

There is money to be had. Opioid painkillers are a $9 billion-a-year market in the U.S., and pharmaceutical companies have earned many billions from their sale.

Mr. Moore has been crisscrossing the country to meet with what he calls a coalition of two dozen lawyers to coordinate arguments and work with government lawyers. He has been reaching out to some state attorneys general and fielding calls from others.

How much money did cronies make....

https://www.cato.org/publications/commentary/great-tobacco-robbery-lawyers-grab-billions

Well, according to my friend, who shared it with me and just graduated from pharmacy school, that little editorial WAS used by the drug companies to tout their drugs as non [rarely, as you like to call it, 0.0003%] addictive.  Sorry, I don’t have the actual marketing documents.  I’m speaking in good faith, to the best of my knowledge, unsure of why you’re so hostile.  How are you so certain that study wasn’t used in the manner I’ve been told it was?  I know you can’t prove a negative but why are you so vehement in your belief it wasn’t?

Everyone's favorite talking head on Fox (Gerraldo) commented that many didn't understand the nature of the lawsuit.   He stated that the $572mil award was just for year one of 20 alleged years of bad conduct.  He expects that once the total of all years in Oklahoma are counted, the awards will total more than $20billion.   Watch the stock price tomorrow and Wednesday.

What I am saying is that a drug that has been around for 60 years, nobody is ignorant of it's effects. People try to assign blame where it logically does not exist--exactly like the blame laid at the feet of gun manufacturers by the left.   What culpability can you find for a manufacturer of fentanyl?

Also bear in mind that all of this black market fentanyl is manufactured in China so I can't see Pfizer being blamed for a single microgram of it.

Same wondering here

Yea street fentanyl is a different animal. Im more concerned with the people that begin the path of addiction at a visit to an ER or an office. More hesitation to administer I feel would go a long way. The way I see it is that the demand for narcotic management of pain has always been too high and J and J met that demand with a better hammer.  I mean "Better" by more dangerous , more habit forming and never pausing to ask why all of the sudden they saw a major increase in demand and if they had as obligation as a producer to limit production or access

Because I keep hearing this lie over and over again but, 23 years in medicine and I have never heard such a claim in real life once.  Not in person. Not in the literature. Not in the texts. Not in a lecture.  Your friend just graduated from pharmacy school? Just now? LOL. Perhaps he is simply repeating crap he heard?

Hostile? More like frustrated. You ever get frustrated when people you know repeat anti-gun lies like gospel? Same stuff with medicine.  Like those people deluded by anti-gun propaganda, people deluded by "evil pharma" propaganda will vote for idiots who will make it harder for real people with real problems to get the help they need. We are already seeing the "unintended consequences" with cancer patients, trauma/burn patients, failed surgery patients, having less and less access to medications and providers willing to risk writing them.

All because people repeat false crap they here--well, that's an exaggeration. There is a lot more than that to it.  It's just one facet of the problem.

And I've yet to see any evidence of "more habit forming."  All opiates carry the risk of addiction and we've known this since the civil war.  Fentanyl is a good and useful drug and it has been around for almost 60 years.

The sudden surge in fentanyl is due to the lack of real heroin so this fake heroin is manufactured by using fenanly and no, those junkies are not junkies because they got a single hit in the ER.

Why is drug abuse in general on the rise? In spite of the WOD? Most likely due to the moral decline of the society. No law is going to change that.

The Dow Corning bankruptcy scam will be reborn by J&J.