Why is Fentanyl such an issue in the US?

[AnnaQuayInTheUk]

I've just been reading something on Threads about someone dying from a Fentanyl OD. I also read Demon Copperhead recently (brilliant novel) which is about the Fentanyl crisis.

Why is this such an issue in the US but not (as far as I know) in Europe? Use of other drugs such as heroin seem to be roughly the same across the US and other parts of the world. So why is Fentanyl different?

Also, does anyone have a recommendation for a documentary about the issue? I'm interested in learning more.

It's because of the way the US healthcare system works. Not a documentary but a drama based on real events - Dopesick is excellent. It's the story of the growth of synthetic opioids and takes you through the shady activities carried out by a family owned pharmaceutical company that basically led to the high levels of opioid use across the country.

As above, Dopesick is a good watch.

Also 'Painkiller' on Netflix is another good drama about the Oxycontin/opiod crisis in America.

Louis Theroux also did a good documentary on it. I’ll never forget him interviewing a beautiful young mum with two gorgeous toddlers who’d been clean for a year. I think she got hooked after being prescribed it for a sporting injury. She was saying she was doing everything she could to stay clean for her kids, then burst into tears saying she still struggled every day thinking about it. The post script said she ODd a month later - still makes me cry thinking about her and how she she screwed over by supposed healthcare. What a fucked up system - we need to protect the NHS at all costs.

Thanks everyone. I'll look up some of the suggestions. We don't have Netflix but hopefully I can get Dopesick on another platform.

Its interesting that people have become hooked after getting a prescription for an injury. Over here, loads of people (including myself) are prescribed very strong painkillers after an injury but it doesn't seem to lead to.addiction. I was prescribed something (can't remember the name) for a back injury a few years ago, it was a fairly high strength codeine based tablet. I didn't end up addicted. So what's different about the US?

@Userxyd that sounds very tragic

There is a series on yt called Fentanyl Kills on a yt channel called texas picture documentaries. The series documents individual stories of people who become hooked on and die of fentanyl use. I think fentanyl is so very strong (x1000? Stronger than heroine?) So much easier to od on, it is also much cheaper than pharma opioids.

I also watched the Louis Theroux documentary and found it haunting.

He was filming in a small town in West Virginia. The local dealer lived in a tent and looked rough as rough could look. A stunning 19 year old wandered up and disappeared inside with him to pay for her next 'hit.' This woman was articulate, and model level beautiful. And she was throwing it all away for (heroin? meth?). I wanted to reach through the screen and stop her. Its one of the most tragic things I have ever seen.

@AnnaQuayInTheUk Codeine is not in the same league as Fentanyl and Oxycodone. Although it comes in different strengths, it's a weak not a strong opioid. People do become addicted to it, however it is much harder to get it prescribed in the UK.

Dopesick is great at explaining how people in the US were prescribed strong opioids after surgery or an injury, and the pharma company drove an environment where doctor/hospitals were concerned about being sued if patients weren't prescribed strong opioids and experienced pain, even after minor injuries or surgery,

While I recognised some of the practices in Dopesick from the UK, it was never as extreme as in the US. In the UK you are likely to be told to get moving after surgery/an injury and weaned off painkillers very fast.

Part of the reason is it’s being cut into other drugs so that they can get a high without needing to be as pure. So people are oding after taking coke laced with fentanyl.

I was listening to a podcast about the murder rate in the U.S. and how in many major cities it’s down by a third. There were Biden initiatives which helped but a contributing factor was the cheapness of fentanyl selling street drugs is not the lucrative endeavour it once was which I found really interesting.

There’s definitely a genetic component to how you react to opioids. I’ve been prescribed codiene after surgery to recover from a nasty injury and oramoph( liquid morphine) and although it’s an effective painkiller I don’t feel euphoric in fact I felt a bit depressed and spacey and quick to cry. Not something I’d pay to replicate.

The Sinaloa Cartel also floods it into Texas. Once people are hooked, it’s easy to find via dealers

It's imported into Mexico from China and finds its way to the US where it's mixed with other drugs and sold on the streets.

Things have progressed way beyond the opioid crisis/ overprescription, though that remains a part of the picture, especially in places where PAs or nurse practitioners are the main deliverers of healthcare (impoverished rural areas where doctors are very thin on the ground).

The reason it's a problem is ultimately the 'war on drugs'

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You can watch Dopesick on BBCi player :-).

And it's coming soon to a street near you in the UK.

When I read Demon Copperhead, I also read a non fiction book called Empire of Pain which explains the opioid crisis brilliantly and was an excellent companion read for DC.

Is Demon Copperhead about Fentynal? I found it boring & depressing book, I didn't care about the characters, so gave up trying to read it. The bits I read weren't about Fentanyl.

My understanding is that fentanyl became huge problem because of the way it was marketed and promoted as 'safe' and 'non addictive'. The direct marketing to patients and to individual doctors of something that turned out to be highly addictive... that free market way of treating it is what resulted in modern crisis.

Painkillers are more regulated in UK and how they end up getting prescribed is highly regulated. Meanwhile, the inertia of NHS bureaucracy means sticking with highly-proven-safe&effective drugs, not offering meds that only get revealed as highly addictive when it's too late to prevent addiction.

ps: last night one of the BBC radio programmes, file on four maybe?, was covering the problems of not detecting ODs from another synthetic opiod....

Nitazenes. Now that I google it, there are a lot of alarm bells being rung about this one in UK.

i have some family in the States, and one thing that has stood out to me is that there seems to be a different attitude to prescribing pain medication.

One cousin has three kids (sporty active kids so a few A&E trips between them) and all of them have been given morphine, almost as a first course of action, when they’ve been taken to A&E in pain from sports injuries. My young cousin went in with stomach ache and she was put on a morphine drip, where I think over here in that situation you’d most likely be given paracetamol until they know more and it turned out not to be anything serious requiring that level of medication. I also have three kids and only one has had morphine following surgery and it was very much limited and he was weaned off very quickly.

My adult cousin recently had a repeat surgery and going into it she told me she became nauseous with Oxy and so she was going to ask for something milder. The solution offered was to prescribe the Oxy and an anti nausea medication which worked. I do wonder if there was a need to prescribe that level of pain relief to someone asking for something milder.

I watched Dopesick pretty much with my jaw on the floor throughout.

When I had my gallbladder out I was sent home the same day with not so much as a paracetamol. And TBH while it was miserable, the pain was gone in a few days.

They were showing people getting repeat prescriptions for Oxycodone after minor injuries.

There is a very interesting book about this, empire of pain.

It's an issue here. There was a problem with heroin cut with it when I worked in drug services and that was several years ago.

In the US, there is a constant stream of TV adverts about prescription medication, including a long list of possible side effects that the announcer races through at the end. People are indoctrinated to think there is a pill out there to fix any problem (and that the strongest dose possible is needed to do so). This, combined with the twisted dynamic between the healthcare system and the pharmaceutical companies, creates a completely different set of circumstances than in the UK, leading to sky-high levels of addiction in the US.

Presumably you weren't given something addictive. It seems they do give addictive drugs in the US.

It’s really hard to get codine prescribed here. I’ve been in agony for ages and they wouldn’t prescribe it for me for chronic pain as they said I’d get addicted. Then I got a diagnosis which explained the pain and now they will prescribe it!

My GP knows I’m a hcp and I have promised I won’t take it daily…..things have got to be bad for me to take it.

also I was once admitted to hospital and came out after a week with some sort of morphine addiction. Was on oramorph and slow release morphine tablets. Stopped taking them when home as pain was better and a few hours later had terrible stomach pain, felt sick, sweating. Had a glug of oramorph and felt fine within ten minutes. Had to slowly reduce the dose. Scary how quick that happened.

I remember being given fentanyl in hospital amazing drug im not surprised people abuse it the difference is it's not readily available here and we can't dr shop like in the US.