This article goes out directly to the party people & Burners who think they can party like rockstar gods. While the measure of any varsity party person is the ability to handle multiple types of substances concurrently, that game has become intensely more dangerous in the last 5 years. In case you missed it, the coroner’s reports on Tom Petty & Dolores O’Riordan’s deaths came back. The lead singer of The Cranberries & one of the most distinctive voices of a generation is suspected of killing herself via fentanyl poisoning. And Tom Petty’s toxicology is so startling, I’ll just quote TMZ (yes, it’s beencorroboratedelsewhere put the pitchforks down) directly:
Tom’s autopsy report shows the singer was on several pain meds, including Fentanyl patches, oxycodone (Oxycontin), temazepam (Restoril), alprazolam (Xanax), citalopram (Celexa), acetyl fentanyl and despropionyl fentanyl. The reason doctors prescribed the meds was because of a number of medical problems, including emphysema, knee problems and a fractured hip. ~Tom Petty Died From Massive Accidental Drug OD. TMZ.com 1.19.18
In the immortal words of Alex Shulgin, that is a “heroic” cocktail. For all my psychonauts and chem nerds out there, Kevin Shanks has an exceptional review of the chemicals here. For people out there that might not be too familiar with pharmacology, I’d like to explain why this combination of drugs is terrifying and a perfect example of the crisis currently afflicting all 50 states. While many have seen that pile of substances and flagged it as an “opiate overdose,” in a lot of toxicology reports, autopsies revealing multiple drugs are categorized in similarly incorrect ways. Some counties would flag it as a synthetic opiate overdose, while others only bucket many different types of opiates under the umbrella term “drug overdose.” Still others might even classify it as a benzo or Xanax overdose. While New York City differentiates between fentanyl and heroin in its reporting, this is not the norm. And that is a huge problem. Especially now that it’s easier than ever to be on half a dozen different drugs.
Enough people sent me the NY Times article about Fentanyl overtaking Heroin that I had to say something about it. If you’ve not seen it and the plurality of think pieces surrounding it, the only piece you need to read on it is by the person who runs The Dose Makes The Poison, Kevin Shanks. He’s been one of my go to sources on novel psychoactive substances for years now, and he, along with a handful of others have been yelling as loud as they possibly can. The point he raised almost a month ago is one I’ve not seen a single mainstream medical journal begin to grapple with in any kind of meaningful way.
As I’ve said for a while now, this ain’t your father’s heroin. At what point do we stop calling it heroin and refer to the standard “heroin” product on the street as fentanyl? ~Kevin Shanks (9/2/17)
While drug overdose deaths are up 22% from 2015 alone, fentanyl deaths doubled. That’s not including the fact that cases are severely under counted, given the volume of fentanyl analogs in circulation right now. I previously reported on the report coming out of Ohio with 24 analogs & active metabolites being identified. That, combined with the increased cost in testing for analog substances, we’ve arrived at a place where medical staff have no idea how many chemicals they’re not testing for. How many rural communities are testing for acrylfentanyl or butyrylfentanyl? How many rural communities are seeing analogs that we don’t even know about yet? Communities along the migratory arc that fentanyl takes from China into Western Canada or Mexico into border communities, that see these substances first, are they still getting the same analogs, or is there already something new? At this point, it’s likely the unknown unknowns are already on the ground and slowly being consumed for the first time.
I wasn’t sure how to start this piece, a feeling I think mirrors the paralysis many policymakers feel when it comes to moving away from puritanical, expensive & needlessly harmful criminalization of controlled substances. In the case of the city policymakers, the opioid overdose epidemic has gotten so bad, they may be getting over it. The SF Department of Public Works collected 13,333 syringes in San Francisco. In March. That’s 430 a day. In Ohio, there were 100 accidental drug overdoses in Mongomery County, Ohio in January & February alone, with an average age of 40. Here’s the kicker, 99 tested positive for fentanyl, and, 56% tested positive for acryl-fentanyl, 3 carfentanil cases, and 24 total fentanyl analogs and metabolites were found in total. 24. The majority of the cases tested positive for more than one “fentalog.” But of course, straight from the report:
One of the biggest problems with writing about the War on Drugs is the almost exclusive focus on problems. There’s this myth that drug use is a combination between a ratchet & Russian roulette. It’s going to keep getting worse, and it gets harder and harder to “not be addicted” the longer you do it. This continued narrative is believed widely (just ask your family at Easter dinner), while being only lightly supported with evidence. Harm reduction & physician/client education is surprisingly effective at mitigating a lot of the factors that contribute to this “it’s probably going to kill you” problem, but outside of needle exchange/safe injection sites & drinking water while partying, complex harm reduction ideas rarely make it into non-academic circles. So, I’m going to start talking about constructive, modern ideas and research that have been either theorized, published or put into practice, about how to fight this deluge.
With the country currently gripped in fear that ACA will be repealed, I’ve started to ponder what options will be left for Americans in the throes of physical dependency if the cuts to medical/addiction funding are as deep as the ones currently being floated. While some proponents of the 21st Century Cures Act note that there’s been a scheduled $1 billion increase in funding for treatment, a repeal would remove at least $5.5 billion in funding to almost 3 million people suffering from substance use disorders. As dozens of states grapple with ever-increasing rates of opiate addiction and overdose, states that have legalized cannabis have discovered something startling.
A study published in the Journal of Pain by a trio of researchers out of the University of Michigan documents a reduction in opiate consumption in Chronic Pain patients who use cannabis. Specifically, medical cannabis uses was associated with a 64% reduction in opioid use. Additionally, 45% of the patients (118 out of the 244 sampled), reported reduced side effect frequency & intensity. In states that have medical marijuana available for their citizens, drivers between the age of 21 and 40 who were killed driving accidents tested positive for opiates significantly less often than drivers of the same age in states that didn’t have medical marijuana available. For example, Montana saw a 1.7% reduction in the number of drivers who tested positive for opioids after their MMJ laws went into effect. And that’s just numbers associated with people behind the wheel. When we evaluate the effect of cannabis consumption on opiate overdoses, the evidence becomes even more compelling.