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 not different. Lots of people here are addicted to opioids often starting from a genuine medical necessity. People are very good at hiding their addiction, because they have to. I promise you there will be people you know who rely on a substance to get them through every day and you’ll have no clue about it.

My DS broke his collarbone really badly last year. He wasn't given any painkillers in A&E. He was discharged in a sling and I was told to go to the pharmacy to buy OTC cocodamol and paracetamol.

Thanks, I'll have a look at that.

I was in Seattle a few years ago and seeing the fentanyl zombies on the street was horrifying. They are literally shuffling around the streets contorting their bodies. The smell is horrendous. it was one of the saddest and scariest things I've seen - not scary because of an impact on me, but the impact on society.

The Nan Goldin documentary ‘All the beauty and the bloodshed’ is very much worth watching around how philanthropic giving was used by the Sacklers to launder their reputation. It’s on iplayer as well.

I'm on daily dihydrocodeine and paracetamol and need it to cope with daily life or I would honestly struggle to get through the day supporting my family. Osteoarthritis was diagnosed before I turned 40 so I have years of taking this drug as nothing else helps....

Anaesthetist

About 95% of people having surgery in the UK will get fentanyl its our most commonly used opiate for surgery

Outside of theatres it's typically reserved for kidney failure (often the frail/elderly) patients as patches or palliative care cancer patients (lollypop sticks but these are crazy expensive so quite restricted in prescribing)

All opiates are addictive hence there's many international pain consensus guidelines as strictly limiting the duration they are prescribed for. Not giving a whole box, just the exact no of days needed (so people don't just keep the spares and start self medicating random pains)

Codeine is the weakest of opiates. We try to combine other drugs like nerve agents and anti-inflammatories to reduce the opiate need

Officially you can't get addicted to opiates if are in genuine pain due to the receptors, many will become tolerant and need higher doses. This is why should rotate between different opiates

Theres tons and tons of opiate addicted patients we manage in chronic pain clinics, often started by GPs and uptitrated when ineffective rather than stopped

Fentanyl hasn't really hit our black market thank God but I'm sure it will one day in the same way oxycodone is becoming far more frequent

It's so sad. I watched Dopesick and Painkiller and then read a lot about how the crisis has unfolded in USA. It's so sad. There were massive incentives for Dr to prescribe strong painkillers so lots did, and many many people got hooked (whikst pharma companies made billions). Once the authorities realised what had happened they started regulating the industry and reducing lots of prescriptions. Many people who were hooked on prescribed opiods then sought out black market drugs to prevent withdrawal symptoms, hence so many got addicted to heroin then fetanyl.
Of course not everyone who is prescribed opiods will go on to get addicted, things like poverty and poor mental health is a factor. Both of which America has high levels of. It's a very sad and cautionary tale - protect the NHS at all costs, and ensure big businesses (ie big pharma) is heavily regulated

Can I just say of subject how much i love anaesthetists iv had loads of surgeries (lost count) and iv never met a bad one, you lot are the calmest and kindest people ever and great hand holders. Thankyou for everything you do you really are appreciated ❤️

We covert all opiates back to morphine equivalents

Fentanyl is 100x as strong as oral morphine
Diamorphine (heroins medical name) is 3x as strong as oral morphine

afaik the EU medicines agency never licensed synthetic opioids specifically because they could see the dangers, so the common experience in the USA of people who were prescribed them after injury then becoming addicted just didn't happen this side of the Atlantic.

Like food poisoning being much rarer in Europe (including the UK) than it is in America because of food safety regulations that protect us.

We prescribe and use synthetic opiates every day in the uk

Awww thanks!! We are often the totally forgotten souls of surgery, the surgeons get all the credit normally. If you ever give cards out after, a 2sec card utterly makes our day (I still have my 4 cards in a special folder and they make me smile when work is awful at times 😀

I think it's self selected as a personality type, as we only have about 10mins to chat to someone enough to entrust us with their lives and minimise their stress response. Tbh I've only met 2 moody anaesthetists in 10y of the speciality, who really just need to retire

I'm always amazed when I go to the US at their TV ads for various medications. I'm very proud of our NHS and terrified that it will be dismantled.

A US based relative lost her brother in law due to a sprained ankle. He was prescribed Oxy by the ER, ODd on the prescribed amount and died 2 weeks after hurting his ankle. There is no EU based GP or ER handing out these drugs for sprains or minor injuries thankfully. It really crazy.
Edited to add that this was after Dopesick, the court cases and everything else.

*lljkk, *just found it. It was "The Drug Death Detectives" on bbc sounds.

Because the makers of OxyContin managed to persuade everyone their drug wasn’t addictive and could be prescribed long term for chronic pain and also for fairly trivial things like headaches. It’s stronger than heroin.

Apropos of nothing, it’s threads like this that remind me why I read Mumsnet thanks @AnnaQuayInTheUk , feeling more informed this morning and special thanks @Destiny123 and all your anaesthetist pals!

@Arrestedforit it's why I love MN too!

Ditto to Dopesick - we’re watching it. Highly recommended.

I was seriously shocked at how lax the US FDA was, in approving a drug that was so addictive. Not to mention at the determination of the producers to keep pushing it, despite a growing tsunami of evidence. Many billions of $$ at stake, of course….

Everything you've said about pharma sales is correct except the strength.

Intravenous or subcut (under the skin) oxycodone is the same strength equivalent as heroin. The oral oxycodone is weaker than heroin equivalent

https://www.palliativedrugs.org/download/090714_opioid_conversions.pdf

Here if you're interested

@AnnaQuayintheUK, I was prescribed a strong painkiller (with codeine) when I had shingles, but was told not to take it for more than 3 days. AFAIK codeine is an opiate derivative, but less strong than others.

This is interesting- I had morphine for the first time for my C-section and it made me feel really spaced out, sick and anxious - I kept telling my husband and the medical team I didn’t like it!

Fentanyl is stronger and more addictive.

I had a minor op recently and remember the anaesthetist mentioning fentanyl… obvs the right thing for me at the time (and all went well) but it gave me a funny feeling. I had post op codeine prescribed - I didn’t take many. Didn’t give any “nice” feeling and did give me shocking constipation!

Demon Copperhead is a great book which I read while in Virginia. Terribly sad. The Louis Theroux documentary was excellent too.