What is the deal with fentanyl?

I was broke. Again. During my last year of medical school interest rates were 13%, so yet another loan was out of the question. I took a job at Herfy’s Hamburgers (home of the Hefty Burger) in Seattle. I wore a paper cow on my head.

That wasn’t quite enough, at $2.75 an hour, so I participated in medical experiments, getting paid to have bone marrow biopsies (not worth it), upper endoscopies with no anesthesia (worse), and a weekend taking cold medicine.

One experiment sounded intriguing—all I had to do was wear some monitors and suck on a lollipop. A fentanyl lollipop. The idea was that children would be more receptive to a lollipop before surgery than a shot.

A nice young woman put some monitors on me and gave me the lollipop. It was pleasantly flavored. After just a few minutes I ascended onto a warm, fluffy cloud. I began gnawing rather than licking the lollipop. My cloud soared higher. I was filled with love, for everyone, including the dastardly professor who had written the execrable cardiovascular exam.

Apparently, my monitors communicated something amiss to the young woman, and she told me to surrender the lollipop.

I giggled. “Noooooo m’am, not a chance.’” She repeated her demand, rather aggressively I thought. I no longer loved her. I clung to the lollipop.

A large, baleful male then appeared and growled “Give me the lollipop”. I didn’t love him either, as he appeared willing to harm me.

I sobered up on the walk home. And I knew then, as I do now, that I could never, ever, go to that cloud again.

Narcotics have been with us long as the opium poppy has been. The British imported opium into China in hopes of keeping the population wasted and submissive.

Narcotic addiction has always been a part of American life, but beginning with the “legal” rise of Oxycontin and its relatives, narcotic use and addiction has exploded in this country. The more recent entrant on the scene is fentanyl, a super potent narcotic that can be chemically produced (don’t need the poppies), and efficiently shipped.

Some terminology can be confusing. Opiates are drugs, such as heroin, morphine, and codeine, that are produced from natural substances such as poppies. Synthetic (man-made) drugs such as fentanyl are opioids. The brain has opioid receptors, and both classes of drugs work on these receptors.

A lot of illicit fentanyl is made in labs in Mexico, with precursors from China. Some is made in this country. Needless to say, quality control is--well, it isn’t. Two milligrams of fentanyl can kill you--40% of the tablets tested by the Drug Enforcement Agency from busts have 2 mg or greater. One kilogram (2.2 pounds) of fentanyl can kill 500,000 people. And just for fun, if you get a little off making a batch, the result is carfentanyl, a relative, that is another 100 times more powerful than fentanyl, which is itself 100 times more potent than morphine.

So why is it so popular? The drug dealers love it—one kilo of heroin costs you $6,000 and sells for $80,000. A kilo of fentanyl will net $1.6 million. It is pressed into pill form (no messy needles or snorting), which can be made to resemble conventional Xanax, Percocet, Oxycontin, and so forth.

Most recently fentanyl has been mixed with Xylazine, a veterinary tranquilizer, to prolong the effect of the relatively short-acting narcotic. Overdose deaths have been piling up from that cocktail.

Another reason for the “success” of fentanyl is the very savvy online and app driven marketing, making it possible to obtain the pills without any medical oversight. Analysis of seized pills reveals than no matter how the drug is labeled, most are amalgams of different drugs in different doses.

The problem with that high fluffy cloud is that it takes more and more drug each time to get there, until only a lethal dose is enough to quiet the frantic, gnawing craving that takes over a life.

If you or a friend or a loved one has ever contemplated using a non-prescription pill such as this, think about who made it, think about the 40% probability it carries a lethal dose.

There is no winning the human chemistry game—play it straight. There are plenty of buzzes out there—boats, power tools, nice trucks, nooky, fishing, music, exercise—whose hangovers are only warm glows and pleasant memories.

 

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