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.

Also we have NICE guidelines about medication and strict rules in the NHS about doctors interaction with drug companies ….which the US does not

it is very sad what has happened in the US and we are very lucky to have the NHS in this respect.

You can have all the money in the world with the best doctors money can buy and look what happened to Prince 😭

It was an absolutely shockingly cynical business model by the Sackler family that started it all. They basically created armies of attractive mainly female salespeople, who pushed the drug onto GPs and pretty much persuaded them to prescribe Fentanyl for almost every pain related ailment.

That’s why it will never happen in the UK.

Because drs are private, they need customers and customers demand solutions, they are happy there to keep writing prescriptions because they get paid to do so. It’s obviously a lot more complex and lack of annual leave, sick pay and wider benefits means people are begging for pills so they can work on through pain when in most European countries they take time off to recover. Lots more factors but they are two I observed myself along with pharmacy reps bribing drs with gifts and advertising pills on tv

I can’t help thinking that the money-driven aspect of US healthcare must have an impact on prescribing. Patients must seem more like “customers” than they do in the UK.

I’m a UK GP and although I have to consider drug costs when I’m prescribing, whether or not I prescribe anything, and what I actually prescribe, has no bearing on my income at all. Also, if I patient demands opiates and I say no, and they leave the list and register elsewhere, it has no impact on my income. (We do get money per patient registered, but unless hundreds left we wouldn’t notice). So I imagine there is more of a “give the patient what they want” culture in the US.

You've nailed it @SetSail

I have some Tramadol at home and use it for gallstone attacks. I don't like taking them, but they start working almost immediately - magic stuff.

There is a brilliant documentary on Netflix but I forget the name. It showed a woman doctor that was setting up 'pain clinics' in random hotels and business units at all hours of the day and night. Literally hundreds of people were showing up and getting prescriptions for drugs on the same day, they just had to wait around and pay the money. They were clearly addicts and not just people in pain needing relief. A man that had lost his daughter (I think) to an overdose was filming everything that was going on and handing the evidence to police but they did nothing as it was technically legal. This doctor was nothing more than a drug dealer and was even an addict herself.

Sackler family and business model yes but I don’t think they were prescribing fentanyl? It was an opium based drug.

Fentanyl is far stronger and some moved onto it when they couldn’t get OxyContin for whatever reason.

Because of the government controlled nature of our (and other European) healthcare system, there are more checks in place and it’s a very difficult, lengthy process to get new drugs licensed for use (this is what NICE is for). The checks and pace of our system is often criticised, but in this case protected us from a dangerous situation.

The other factor is the consumer-led nature of the US system. When you have a free market where the customer is paying, there is more of a tendency to give them what they want. The structure of this system also means that the individual companies that make up their healthcare provision can easily be lobbied and sold to by pharmaceutical companies.

Someone I know was recently bereaved when her (mid 20s) family member and a large roomful of mates took what they thought was cocaine but was cut with fentanyl, they all died and were discovered days later. Utterly harrowing, so completely overpowered and presumably cut into other drugs as it’s relatively cheap?

Very much already here!

How on earth can a ‘chemical’ addiction be attributed to an addictive personality? We’re not talking about gambling or compulsive spending. You’ve said yourself they just allowed you to get some sleep -great, good for you and I hope your op goes just as well.
However, if someone takes their prescribed dose and it doesn’t even touch the sides pain wise, OR it numbs unbearable, excruciating pain on the very first instance, then there is no way we should judge them for inevitably taking more which then leads to PHYSICAL dependancy. It’s got nothing to do with their ‘personality’.
I have also never been addicted to anything in my life which I’m sure is true of the majority of the population, but I’m not smug about it.

The Drug Death Detectives - mentioned above and available on BBC Sounds - about nitazenes, which are lethal in the tiniest amount, the size of a grain of sand, is worth listening to. I’ve warned my kids (and told them to tell their friends) that it’s the most dangerous time in history to be taking illegal drugs, including counterfeit prescription drugs bought online.

Fentanyl is turning up in street drugs here. Please warn your teens and young people. And consider getting the antidote for your family medical bag. (A poster further up mentions the name)
it’s very scary as it is not something we have control over and the “just say no” approach to street drugs does not work.

So We need a way to make it safer with places to get street drugs tested (The Loop are in Bristol now on some Fri / Sat nights and make this service available. Would be good if it was more broadly available)

Empire of Pain by Patrick Radden Keefe will explain the whole thing to you. I vaguely knew about it before reading it (it's also on Spotify and audible as an audiobook) but my mind was absolutely blown by the grim focus of the Sackler family on systematically getting as many people as possible addicted to strong opiates. The lies they told are jaw dropping. Doctors were told it was appropriate to prescribe these wildly addictive opiates for things like headaches or back pain, then give out stronger and stronger formulations when the person got used to the pills. It is one of the most evil and cynical things I've ever read, especially when the family used their vast wealth made from suffering on philanthropy and whitewashing their reputation through the Arts. The actions of the Sacklers has caused a continental-wide epidemic of suffering and a generation of people lost to addiction.

Thats how it started. But as others have explained, OxyContin and the like became more restricted-plus expensive-and people had moved onto heroin as it was cheaper. So many drugs are cut with fentanyl now as it's so much cheaper and more addictive. It's more deadly in small amounts wh is h is why so many people are dying of it.

Tramadol is very strong stuff, I was on it for 5 weeks in hospital and then a month at home , the withdrawal was like something out of Trainspotting! My GP gave me an extra month's worth and I cut down slowly and was fine.

I think an addictive personality is the wrong way to express it. Some people are predisposed to opiod addiction. Opiods can permanently change the physical chemistry of the brain, causing compulsion/ addiction.

This doesn’t happen for everyone. I’ve taken opiods ( prescribed) and I don’t get a high just an unpleasant spacey feeling. It’s not a personality trait though it’s part of your genetic makeup.

I had Fentanyl last year after an op when I woke up in recovery in agony. Morphine doesn't do much for me apart from make me itch and give me a rash but this stuff was magic. Can totally understand why people get addicted as it works but REALLY strong.

Basically US drug laws have nothing to do with harm prevention.
Once you start there, everything makes perfect sense.

The UK market is much smaller so it's less sense to get into a drug that kills it's users so quickly. Every dead user means you have to find another to keep the profits flowing. However, in a similar vein (yes, I did type that) UK drug laws also have nothing to do with harm prevention.

It’s on player and is absolutely brilliant

Interesting comments about the US attitude to medicines/over prescribing and the desire for numbness rather than any pain. I have friends scattered across the US in states which are very different but all are used to being prescribed Vicodin for dental work, even fillings or extraction. I've had some horrendous infections from an impacted wisdom tooth and then dry socket (and I can't have NSAIDs) but even then the attitude was that painkillers will make it tolerable not that you shouldn't feel anything.
I had diamorphine when in labour with my daughter as I was induced and I basically forgot I was having a baby. I absolutely adored my anaesthetist when he gave me an epidural and then stayed chatting to me while my baby was hauled out with forceps and then when I had a PPH he was so calm and the dread I'd felt soon faded as he made me feel so confident in the theatre team

Yes, I was there two years ago and had the exact same experience.

it was the same in San Francisco, Portland and Vancouver to an extent.

In Seattle, the ironic thing was, that there are signs on every building saying they contain carcinogens. My mil who was 63 at the time was refused a glass of wine in a rooftop bar as she did not have ID, and yet there were people down on the pavement below defecating on the street, high on fentanyl. It was mind blowing.

I can testify that Codeine is nothing compared to US painkillers. I was visiting my sister in the US and broke a tooth, so she gave me a bottle with two Oxycontin tablets. I took them back home after my tooth was taken out and had what I understand now a proper opioid experience - intense feeling of comfort and warmth, feeling so lovely and cosy, no problems or pain, sleeping/ dozing for hours. I can see how this can get addictive. I had nothing like this from codeine - it simply killed the pain.

All these drugs are basically anaesthetics - they dull your pain. Its so sad so many people feel the need for this.