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.

I had an operation in the US for a condition that was painful and after fixing was also painful. My surgeon was pretty good about the painkillers, only on a schedule in hospital, only limited after hospital and then transferred to a strong NSAID as quickly as possible - I think I was given 2 weeks worth of the opiates.
But we were aware of the issues and a bit scared too.

Did you mean codeine? Its actually very easy to prescribe in the uk but they give you a short prescription not for a long term use

Is fentanyl just a brand name for OxyContin or are they different things? I also found the various dramas about the US opioid crisis fascinating - the recruitment of the sales people etc.

There are several reasons that prescription drug abuse is more commonplace in the US. Firstly because of the healthcare system which treats healthcare as a commodity that can be purchased and sold, not as a basic human right. It sets patients up as ‘customers’ and doctors as ‘providers’. It is a marketplace, and in a capitalist marketplace profit and meeting customer demand are prioritised over what is best for their health and wellbeing. Secondly, pharmaceutical companies are allowed to price gouge and so have an incentive to get people hooked on drugs, as evidenced in the excellent Dopesick series.

Then there are the sociopolitical and cultural reasons, among them a normalisation of the over medicalisation and over treatment of even minor ailments, to the point where ever experiencing pain is seen as a negative thing that must be eradicated. But there’s a more insidious reason why that narrative is pushed and that is because people who are in pain can’t work and productivity is the number one American value. Employees have far fewer rights and protections and their health insurance is linked directly to their jobs so they are far less able to take time off to recover from illness or injuries, leading to the need for pain medication to help them manage.

There is also the crushing poverty and deprivation that many areas experience, especially in rural communities or inner cities. The opioid crisis is worst in the poorest parts of the country, unsurprisingly, though it’s become a very middle class affliction too as people seek escapism from their overworked, high stress lives in a deeply divided and violent country. The American psyche is one of distrust and fear these days, which is very sad.

I personally know 3 people who have died from fentanyl overdoses in the US just in the last two years, and more before that. It’s a very worrying epidemic that is killing many thousands of people every day. Many of my US friends and family carry Narcan with them in case they come across an OD’ing person. It happens at gatherings with teens and 20s a lot too, as ‘party drugs’ like cocaine, speed and MDMA are increasingly laced with fentanyl.

I pray every day that the UK does not go down the privatised healthcare route and completely destroy itself.

@wordywitch

Thank you. Really interesting - I’d never thought about it in terms of productivity / limited sick leave but it makes perfect sense.

No totally different. Oxycontin is the brand name for oxycodone. They're all opiates just have different benefits for different situations

Can only agree the anaesthetists I’ve met have all been absolutely lovely and kind and taken the time to explain what was happening (caesareans, surgery, son’s surgery - that was the scariest time) . My mum still speaks about how amazing her anaesthetist was (he’s a dad at school so I’ve told him - he blushed).

I was put on oxycodone and tramadol for a few days after a major op and then sent home with paracetamol. The withdrawal was so bad I couldn't get out of bed for 2 weeks. I can understand why people get addicted to this stuff it's horrendous.

Yes, on a recent trip to NYC, I was amazed at the adverts for medicine, a pill for every single complaint under the sun. Some of them aimed at children's illnesses. Then the massive list of side effects.

My mum died from an accidental Fentanyl overdose from fentanyl patches. She was prescribed them for a bad neck. I honestly think they need to be better regulated. It has ruined my family's lives. This is in the UK. This was almost twenty years ago, I don't think they are prescribed so much now maybe or just reserved for palliative care ( i hope so ).

it may not be a problem as such here, but it’s definitely available. I personally know two people (living at opposite ends of England) who have both been prescribed Fentanyl and Oxy respectively. One has permanent, severe pain from a serious accident/injury over 10 years ago but is not disabled, and seems to manage, the other unfortunately, has a recently diagnosed lifelong, serious illness that needs constant treatment/monitoring and is addicted to the opioids. She is a ghost of herself and I was shocked that nobody had heard of the drugs. The doctors are very much aware and have said the next step is to wean her off…

I has the same experience in San Francisco last year. It made me wonder whether the popularity of the Walking Dead series and the various modern zombie films in the US is in part a reaction to that.

And an excellent documentary,, Crime if the Century, about the same thing.

I am so sorry for your loss.

I broke a bone and ended up in a hospital in Chicago as it needed surgery . I couldn’t understand why they wanted to give me narcotics and refused them, asked for paracetamol instead. I had numerous conversations with nurses about how US patients wanted to be totally numb and didn’t accept any pain, asking for drugs from staff. At every handover they had to tell their colleague that I did not want narcotics. I have never felt so vulnerable, it made me realise how nhs staff have zero interest in the money and will treat as to clinical need first. Amen to that. And the bill from the USA hospital for pinning surgery, anaesthetic and three days as an inpatient was over $40k ten years ago. We must protect our NHS.

This is shocking. I’m so sorry for your loss x

I think you're right about the genetic thing - I've had several surgeries and had to ask them not to give me morphine because it just makes me vomit and vomit! So badly that I ended up being kept in overnight after a 'day surgery'. Likewise I was prescribed Tramadol after surgery and only ever took a couple. I was amazed years later when I learned they are a popular street drug. I never understood the high that people got from these drugs, I just don't experience it.

I have ADHD and take medication. I was afraid it would make me more 'hyper' but it just makes me very calm and sometimes sleepy! I just don't 'sweat the small stuff' on it. So obviously different brains react differently to substances.

I just wish she has never been prescribed it although it did seem to be the only thing that helped the pain. After the coroners case I believe the drug company made some amendments to the literature that comes in the box . Ultimately if she had not been on the patches and accidently wrongly used them she would likely be alive today. I wish to god she had never been prescribed them. It's obviously not the same as addicts overdosing on them, I just think it's a very dangerous drug that should only be used in very limited circumstances.

Gosh I just saw this and the two drugs you described do absolutely nothing for me. I'm sorry you were affected so badly and really glad you didn't become addicted to them.

Pp have mentioned Dopesick which is very good, and Empire of Pain as a book to read.

Fentanyl doesn’t require fields of poppies and as I understand is just synthetically made. A very small amount is needed and the outcomes are faster but with high withdrawal. It’s cut into a lot of drugs in US in particular so causes injury or worse that way too.

Canadian here. Same fentanyl crisis as the US, completely different healthcare system. It’s not the healthcare system. In fact the current fentanyl crisis doesn’t really have anything to do the OxyContin/prescription opioid crisis. It’s being driven by the illicit drug trade- fentanyl is cut into absolutely everything on the street, and that is what is fuelling the crisis and the overdoses and the deaths.

I was given tramadol to take home after a cosmetic op at a private hospital and only took a couple in the end. Threw the rest away as I hated the spaced out feeling! Even taking it for a couple of days gave me withdrawal symptoms. Was awful and sweating in bed.

Those two tv dramas are great, it’s so shocking what’s happened in the US. Strong prescription meds are just so normalised there. The ads on tv are something Trump/RFK are trying to get banned. Too much treating of the symptoms and not the causes there unfortunately (as that would make less money).

Dopesick is an excellent watch

I was recently in a bad car crash and spent a month in agony. I was taking oral morphine and high dose codeine during that time. The only effects, apart from pain relief, were allowing me some sleep. No highs, no fuzzy feelings, nothing. I stopped them as soon as the pain became more bearable and I had no withdrawal symptoms. I have major surgery ahead to repair some of the damage and I expect I’ll take oramorph again. I’ve never been addicted to anything in my life including alcohol and nicotine. Is there such a thing as an addictive personality?

I was prescribed 30/500 x 2 tablets x 4 times a day of co-codamol for three months by a GP in the UK so please don't assume opiods aren't being freely given out. Admittedly I did have genuine serious pain after a back injury, but I had to ask the doctors to reduce the amount as I cut back to one tablet, and then requested lower dose tablets. I'm relieved to say that I didn't get addicted, but it could have easily gone the other way if I hadn't been so careful and managed it so well myself. Also very pleased that I wasn't in the US and given Fentanyl instead.