Misc How Are OD's on Prescription Drugs So Common?

[Kingoffrogs]

Under the influence, some people make bad decisions with drug combos, or bad decisions on doses. That "one more" hydrocodone might be the difference between a good time nodding off or passing out.

Some people don't know how to handle the increase in tolerance and simultaneously chase the dragon, so they are increasing their dosage at an exponential rate.

If you take scripts as prescribed most people are fine, even still some people have negative effects from taking their prescribed dose of a med but mix it with something else.

 

[Keif' Richards]

We have a lot of the same opinions @tryptakid probably because we've been through a lot of the same stuff, in the same places. I think the biggest issue with all of these drug liberalization programs is that they haf-ass everything, They are afraid to fully commit to a path. They do it half-way and like everything in life that is done halfway, it fucks everybody over.

You can't just decriminalize possession and allow the Fentanyl market to explode. You need to legalize drugs completely, sell them at pharmacies yand have quality control measures in place. What we are seeing with the current phase of the Opioid Epidemic is a program done halfway. I knoq people make the argument that there will always be a black market. I know this is true, as we see it with Cannabis. However, I feel hard drugs like Cocaine or Heroin, people will be willing to pay for a pure product from a reliable source. The black market wouldn't disappear overnight, but it would disappear to a significant extent.

I don't think this whole Fentanyl/Xylazine mixture would ever appeal to someone naive to hard drugs. I believe they only have their place as they were applied to a population that was already hopelessly dependent upon Opioids.

 

[tryptakid]

We have a lot of the same opinions @tryptakid probably because we've been through a lot of the same stuff, in the same places. I think the biggest issue with all of these drug liberalization programs is that they haf-ass everything, They are afraid to fully commit to a path. They do it half-way and like everything in life that is done halfway, it fucks everybody over.

You can't just decriminalize possession and allow the Fentanyl market to explode. You need to legalize drugs completely, sell them at pharmacies yand have quality control measures in place. What we are seeing with the current phase of the Opioid Epidemic is a program done halfway. I knoq people make the argument that there will always be a black market. I know this is true, as we see it with Cannabis. However, I feel hard drugs like Cocaine or Heroin, people will be willing to pay for a pure product from a reliable source. The black market wouldn't disappear overnight, but it would disappear to a significant extent.

I don't think this whole Fentanyl/Xylazine mixture would ever appeal to someone naive to hard drugs. I believe they only have their place as they were applied to a population that was already hopelessly dependent upon Opioids.

Spot on.

Legalization and dispensing through non-profit entities with strict regulation on fee structures for production and distribution. Eliminate the profit and dispense it like you do suboxone. Make it boring, make it accessible but not too accessible, and focus on prevention, education, and recovery treatment.

You're absolutely right about the half-assed response. Most of what I've seen during the past 15 years has been sizable amounts of money dispensed to "expand access" without any plan. 54 million dollars was awarded to a major hospital system for this reason, and so much of that money was absorbed into innumerable tiny research projects to fund staffing. Staff get hired by project managers who are A) over-extended and under supported B) incompetent C) have no real understanding of addiction or D) All of the above. I've been hired into projects like this before, and I've been laid off because of incompetent project oversight, while being left to deliver the bad news to the caseload of people I had to break the news to. Some of those folks never made it back into care, but those bureaucrats got reallocated onto something else - rinse and repeat.

Former Reality Television Host DJT declared opioids a public health emergency in 2017, earlier still in other states (ours was 2014 IIRC).

In that time, what actual progress has been made? How many deaths have occured (my cousin is one of them) since it was recognized as a public health emergency... I live somewhere that has expressed interest in an SCS, hell I sat on an advisory committee for the project - in 2021/2022 and the city is still 'working on it'. We still just keep pumping out buprenorphine and billing for UToxs, hoping for the best.

I have grown to be so jaded!

The xylazine thing is even more abysmal because we had a 10 year+ lead up to it... they were beta-testing it in Puerto Rico since the 00s. Nevermind the fact that the US actively abandoned it's own citizens by failing to take action then, but we just whistled right past the graveyard until it was suddenly in 40-60% of the fentanyl supply. The level of ignorance about what xylazine is, how it works, how it can hurt people, and how to address it, is incredibly high in health care. But I'm sure there'll be yet another zoom call (get those CEUs) about it again sometime soon.

 

[Keif' Richards]

@tryptakid I'll have a more detailed response when I get back home this morning. Regarding the money being "invested" into addiction resources... they might as well just burn the fucking money.

I try not to be a pompous asshole, but it's hard. It's a day to day process of mindfulness for know-it-alls like myself. However, I think the people who need to have serious input in these matters are people like you, myself and others who have knowledge and experience.

For instance, most doctors I talk to regarding Restless Legs/Akathisia during withdrawal actually consider it something along the lines of unconscious fidgeting. We all know that this Akathisia is one of the most horrific, torturous experiences we have ever endured... the doctors think it's twitching. There are serious gaps in the knowledge that could be so easily filled in.

I'd say ~80%-85% of doctors I've ever spoken to, including doctors in the field of addiction/psychiatry have no idea what the Kindling Effect is. A cornerstone of the addict's experience in chronic dependency is not ever discussed and is rarely, rarely understood, even more rarely known by its actual name as stated above. It's such an in your face, obvious phenomenon that is practically never discussed. Doctors with experience in writing prescriptions for Opioids for individuals not addicted/dependent, they are only familiar with the initial phase of dependence/withdrawal that often takes weeks or months to manifest. This leads to a frequent admonishment of addicts for getting re-addicted in a matter of days. They don't put these pieces together.

We all know the world of medicine/psychiatry are not interested in the opinions of drug addicts whatsoever. Everything we have to say is bullshit. If we could have an honest discourse, combining our "street knowledge" with the more formal aspects of medicine, we could do so much good.

I was in education for a long time, though I now work in the field of social work. I primarily have managed homeless shelters here in my town and done work for the syringe exchange and other Harm Reduction stuff.

Other staff who work with me at the shelters, almost all of whom have no history of addiction, are often flabbergasted by how I am able to communicate with addicts. We speak the language, we know the behavior, it makes sense to us... the motivations of people. Situations that could have escalated into fairly extreme violence can be diffused instantly simply by offering the person a cigarette (most of these folks are utterly destitute and picking up dog ends to resmoke is an entrenched practice).

While my colleagues are consulting their college educations and textbooks for how to diffuse what seems like such an incredibly complex situation. Meanwhile, I know that offering this person a substance, even as mild as a cigarette, that is enough to calm them down and take them out of that moment.

I am seriously concerned at this point for our future as Harm Reduction workers. As the financial situation worsens in Western Civilization and elsewhere, I fear all it will take is for a Republican candidate to be elected for the shit to absolutely hit the fan for those in active addiction. Things are so bad right now. There are very few resources... and we allegedly have a leader who cares about these things. Imagine what this is gonna look like if conservatives come to power. It will be a fucking bloodbath.

 

[Coffeeshroom]

First off, I apologise if this comes across as ignorant, that is not my intention.

I just don't understand how serious/fatal overdoses on prescription drugs are so common? Like, twice as many as heroin and cocaine combined?
And I don't mean like street fent or fake pressed pills, I mean genuine prescription drugs?
Because you literally know EXACTLY what you are taking and EXACTLY how much?

I've been addicted to prescription drugs (primarily opioids, but also benzo's, barbs, muscle relaxers, amphetamines, sleeping pills etc) for 14 years and have never OD'd*. I mean, I've absolutely taken too much and like blacked out on benzos (like when you get blackout-drunk) or fallen asleep** but never a serious or dangerous OD. Never stopped breathing, had to go to hospital, or needed narcan or any kind of medical intervention.

Surely you'd have to knowingly even take a much higher dose than usual, or mix shit you've never mixed before?

*accidentally, I mean

**I actually have a small cluster of circular scars below my collar bone from falling asleep with a lit cigarette in my mouth

This. This is cut out a book.

 

[Coffeeshroom]

I get morphine, clonazepam, bromazepam and zopiclone all prescribed. I have never come close to a overdose from my script meds but i have had a minor od on coke before but iv coke is a different beast altogether. Also you can only fit 60mg's of morphine in one syringe which isnt enough for anyone with any tolerance to od on

Here we get 1ml insulin syringes that can easily take up 4 bags for a very comfortable shot

 

[ChemicallyEnhanced]

Just as a random anecdote that might help people understand the accidental side of this:

I'm prescribed the maximum possible daily does of gabapentin, and I've been recommend by my physician and pharmacist to get my kidney function checked every now and them. The drug is processed by the kidneys, so if your kidney function gets worse gradully, you'll get more of the drug in your body while still taking the same dose, and you might have no other symptoms that point towards your kidneys being messed up. Gabapentin is not exactly super dangerous in overdose, but if you replace that with a different drug and its respective processing-organ, you can kind of see how easily you could end up with an overdose before even realizing your organ function has decreased.

Same with the Gabapentin. I didn't know that about the kidneys which is kinda scary as I'm diabetic, which also damages the kidneys.

Although...Is it fucked up that I sometimes wish my liver/kidneys were...not like failing..but functioning not very well so I could take less meds and get the same effect, or get more out of what I take?
You'd think my liver WOULD be bad considering I was an alcoholic for 7-8 years and had hep c for 18 months, but it seems fine.

EDIT: ^ while there was overlap, there was no link between the alcohol and the hepatitis. I actually have no idea how I got the hep c.

 

[ChemicallyEnhanced]

Try telling that to to Canadians. It will work, because they, when it fails they will blame someone or something else. There is no heroin, and apparently from what,I have read fent users need to shoot up more frequently. So is a person just going to ride back and forth all day from a bus to shoot up and back again all day long. Seems like that might get in the way of getting, the needed money. Besides, who to ride the wants bus, subway, train all day? Back and forth, yeah right, I will not even go outsides to smoke a cigarette.

Fent actually keeps you well longer than heroin iirc (6 hours rather than 4)

 

[ChemicallyEnhanced]

I've been an opioid addict for 16, almost 17 years.
I also did a lot of cocaine, crank, xtc, shrooms, etc.. when I was a teenager.
Lots & lots of meth through out my 20's, along with benzos, opioids, alcohol & DXM.

I found that I didn't like alcohol when I had opioids or better drugs though. So if I had opioids or even good bud, I'd often skip drinking.
I didn't like the way alcohol mucked up the feeling of other drugs either.


I think it's because our shitty education system doesn't teach people the reality of drugs. "Just say no" doesn't teach people the dangers of poly-drug use. So people end up drinking & popping pills & doing whatever without realizing they're endangering themselves.

Most people who OD often have alcohol in their bodies at the same time. People think because alcohol is legal, that it must be "safer" than other drugs, when it's really not.

There's also the fact that many street drugs can be contaminated.

Then there's people who get sober from things like heroin due to incarceration, or not being able to find any & then think once they start using again they can just go back to taking the same amount that they did when their tolerance was higher.


The reason people like us are less likely to OD is because we're more educated. We know how to assess our tolerance. I also don't drink, so alcohol doesn't play a role in my usage.


I think there could be more to it too. I dunno. I mean, I've done things like mix DXM with meth & tramadol (incredibly dangerous, nobody should EVER think about doing this). And yet I've done this at least 10 times in my 20's. I don't think I'd be able to handle doing something like this at my age now but I do wonder how the hell I survived doing that so many times. No seizures, no overdose. I think my brain & body were more resilient in my 20's. Maybe it did do some damage though that I'm not even aware of.

Never overdosed on heroin or anything either.

Only time I came come to feeling like I was gonna OD was one of the first times I tried fentanyl. That shit had me nodding so hard that it felt like my consciousness was slipping from me. I didn't like it at all. Never have I ever felt that way while nodding on heroin or other opioids, only fentanyl. It wasn't a very good feeling honestly & I could see how people would OD from it if they did even just a little bit more than they should.



I think a persons mind state also plays a role. Most of the time I use drugs just to help me function & get me through my day. But there are people (including myself) at times who use drugs as a form of masochistic self destruction. So they go out & take as much as they can & do whatever drug they can find just to get more & more fucked up. And if you approach drugs in this way, then an OD is almost inevitable. It's the difference between some one like me who uses opioids & weed to improve mood & function every day & some one who just uses to get as fucked up as possible.

I find the opposite can be true with mixing stuff. When I was put on Methadone, they were like "ONE DRINK can KILL YOU if you're on Methadone". But after a year and a half of sobriety from alcohol with on Methadone, I relapsed and was immediately drinking like a liter of vodka a day and was TOTALLY FINE :/

 

[Jnowhere]

Fent actually keeps you well longer than heroin iirc (6 hours rather than 4)

I have read on here many times, that fent users need to shoot up more often than heroin addicts.

 

[Coffeeshroom]

Cause fent is just higher and stronger.

 

[Jnowhere]

Cause fent is just higher and stronger.

118,000+ dead in 2023 in America, when Narcan is widely available. Yeah, you are definitely right about it being stronger as opposed to 3-4 thousand on heroin when Narcan, was not available.
Throw in all those pills that where available when doctors and pharmacists didn't treat you like shit. Before the bipartisan war on legal opiods.
You still have 95-100 thousand more deaths from illegal fent and traq dope.
Making pain patients suffer and killing off an extra, 95-100 thousand more opiod users, great job by both parties. here in America.

 

[DeathIndustrial88]

I find the opposite can be true with mixing stuff. When I was put on Methadone, they were like "ONE DRINK can KILL YOU if you're on Methadone". But after a year and a half of sobriety from alcohol with on Methadone, I relapsed and was immediately drinking like a liter of vodka a day and was TOTALLY FINE :/

Yeah this is true too.


One of my closest friends that I use to do heroin with was an alcoholic. She was able to drink, take klonopin & do heroin & some how she never once overdosed.
I was always worrying about her cause I figured she would eventually. She only used heroin & then subs for about 2-3 years though. But I've often wondered how the fuck she did it.

So you're right. Some people are able to mix shit & are fine. Although I think still think it's playing with fire. Especially if you're using fentanyl & try to attempt mixing shit. I've never felt like I was in danger on any opioid, except fent.

I think tolerance plays a huge role too. In your case, you were tolerant to your methadone, so you were fine. And in my friends case, she was tolerant to her alcohol, so she was fine.

I think it's people with low to no tolerance that mix shit that need to worry the most. For example if some one with a measly codeine habit goes & takes fent & then downs a liter of vodka, they may end up overdosing.


I've noticed a lot of "opioid overdoses" are really poly-drug overdoses, with alcohol always being in the mix. I've seen people OD on alcohol alone, so I'd imagine in many of these cases, it was the alcohol that OD'ed the person, but it gets label as an "opioid overdose" so that it can be used to fear monger & stigmatize opioids further.



As far as fent keeping some one well longer, that's the first I've ever heard of that.
Fentanyl will stay in the body longer, but it's duration of action is very short. It was always over in like 15 minutes for me.
Where as really good heroin can have legs that last 6-8hrs (especially if your tolerance is low). I've done heroin in the evening & woken up the next day still itchy.
Once your tolerance goes up on heroin though, those legs start to shorten to about 2-4hrs. Heroin has a pretty short half-life too. So it's kind of ironic that fentanyl lasts so long in the body but is shorter acting & heroin has a much, much shorter half-life but seems to last longer.

 

[Antares]

I've noticed a lot of "opioid overdoses" are really poly-drug overdoses, with alcohol always being in the mix. I've seen people OD on alcohol alone, so I'd imagine in many of these cases, it was the alcohol that OD'ed the person, but it gets label as an "opioid overdose" so that it can be used to fear monger & stigmatize opioids further.

This trash really irritates me. They always do this kind of thing. I've actually looked into the reasoning given for etizolam being temporarily placed as a Schedule I drug in the US, and it's literally just because there were people overdosing with a combo of it and opioids. It's like, what the fuck? The individual drug is an extremely super dangerous emergency because mixing the drug with another CNS depressant killed some people? I mean, what a shocker that they died, I've never ever heard that mixing CNS depressants is dangerous, so I guess these individual drugs those people died on truly are the scourge of humanity.

 

[tryptakid]

@tryptakid I'll have a more detailed response when I get back home this morning. Regarding the money being "invested" into addiction resources... they might as well just burn the fucking money.

Some of the grant funding I brought in for a former job was essentially doing this - '200k over 2 years to expand access to buprenorphine' or '125k over 2 years to take on MSW interns' - ironically the latter was awarded in October of 2017 (IIRC) but backdated to the beginning of the FY meaning that MSW internships had already started when the grant awards were given, so unless you happened to have an addiction focused MSW intern, you lost the entire first year's opportunity, nor was there enough lead in time to develop any specialized supervision curricula or work with the university to develop any specialized trainings. Building the car while you're already 1/4 down the highway. We lucked out and got a late transfer who was dynamite, but we would have had to return the funds otherwise. Nonetheless, the press releases still go to to highlight how many millions were being devoted to Addiction Workforce development....without any real guidance, plan, or goals.

I try not to be a pompous asshole, but it's hard. It's a day to day process of mindfulness for know-it-alls like myself. However, I think the people who need to have serious input in these matters are people like you, myself and others who have knowledge and experience.

That's why I post here/reddit - it's why I hope to write a book - it's why I am participating in podcast later this year being developed by some MD/MPH students - it's why I go to conferences and network (though I need to do more of this again admittedly).

For instance, most doctors I talk to regarding Restless Legs/Akathisia during withdrawal actually consider it something along the lines of unconscious fidgeting. We all know that this Akathisia is one of the most horrific, torturous experiences we have ever endured... the doctors think it's twitching. There are serious gaps in the knowledge that could be so easily filled in.

MDs are experts on the objective, and often lack respect for/understanding of the subjective. Having behavioral health as part of medical practices has its benefits, but one of the main drawbacks is that we are working in spaces where the folks running them have no idea what we do or why it's important. Translating the subjective into objective terms can be quite challenging.

I'd say ~80%-85% of doctors I've ever spoken to, including doctors in the field of addiction/psychiatry have no idea what the Kindling Effect is. A cornerstone of the addict's experience in chronic dependency is not ever discussed and is rarely, rarely understood, even more rarely known by its actual name as stated above. It's such an in your face, obvious phenomenon that is practically never discussed. Doctors with experience in writing prescriptions for Opioids for individuals not addicted/dependent, they are only familiar with the initial phase of dependence/withdrawal that often takes weeks or months to manifest. This leads to a frequent admonishment of addicts for getting re-addicted in a matter of days. They don't put these pieces together.

As I mentioned earlier, I think the lack of subjectivity is partially to blame here... it's difficult to measure, you can't test for it, and you're really dealing with such a complicated phenomena which bumps up against patients being able to express honest vulnerability about what's helpful and what's potentially harmful. Obvious yet complex and nuanced.

We all know the world of medicine/psychiatry are not interested in the opinions of drug addicts whatsoever. Everything we have to say is bullshit. If we could have an honest discourse, combining our "street knowledge" with the more formal aspects of medicine, we could do so much good.

I was in education for a long time, though I now work in the field of social work. I primarily have managed homeless shelters here in my town and done work for the syringe exchange and other Harm Reduction stuff.

But *you* and *I* are the forces of change with regards to this. We are people with lived experience, who are now professionals. There are so few people with lived addictions experience who have gone on to get trained to even be in these spaces. We are the products of an opioid generation and we have found a path to healing amidst waves and waves of suffering unseen by anyone in our lifetimes. While they haven't always valued our input, it doesn't mean that we can't be the vanguard of changing that tone. I've worked at doing just this - I'm very up front with my past addiction and how it informs that work that I do. I also work to establish myself as an expert in the things I am authentically an expert in. It's an uphill battle but I've seen the conversation change during my 15 years in the field (also social work!)

Other staff who work with me at the shelters, almost all of whom have no history of addiction, are often flabbergasted by how I am able to communicate with addicts. We speak the language, we know the behavior, it makes sense to us... the motivations of people. Situations that could have escalated into fairly extreme violence can be diffused instantly simply by offering the person a cigarette (most of these folks are utterly destitute and picking up dog ends to resmoke is an entrenched practice).

The people you work with see through the bullshit and know that you're a real one. It's a gift that most people are oblivious to, and it will serve you well. At the same time, the closeness can be a vulnerability - we are forging a path with very little guidance/support in a time of tremendous suffering. Self-care and boundaries are so very important and yet so easy to struggle at doing.

While my colleagues are consulting their college educations and textbooks for how to diffuse what seems like such an incredibly complex situation. Meanwhile, I know that offering this person a substance, even as mild as a cigarette, that is enough to calm them down and take them out of that moment.

I am seriously concerned at this point for our future as Harm Reduction workers. As the financial situation worsens in Western Civilization and elsewhere, I fear all it will take is for a Republican candidate to be elected for the shit to absolutely hit the fan for those in active addiction. Things are so bad right now. There are very few resources... and we allegedly have a leader who cares about these things. Imagine what this is gonna look like if conservatives come to power. It will be a fucking bloodbath.

My neighbors on average make about 2.5x my annual salary. There's a point in which I will no longer be able to afford to live here despite having grown up here, having family that lives here, and having no other 'home'. It's why I'm cutting down on the public health side of the work and moving into private practice, training, and consulting. Just started an LLC a month ago, let the journey begin.

I worry more that apathy will kill funding and attention. Opioids are old news, now it's Migrants and Russia. Our homeless are very rightly pissed off because they're seeing all of this attention and related funding suddenly emerge that is going to people from other countries. It's not those people's faults, they're trying to find safety from tremendous pain and suffering, but it's pretty hard for some of our folks who are feeling forgotten about time and time again. It's been a decade since overdoses were declared a state of emergency, how many hundreds of thousands more will die while we wait for leadership?