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It’s Not Just Heroin: Drug Cocktails Are Fueling The Overdose Crisis

neversickanymore

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It’s Not Just Heroin: Drug Cocktails Are Fueling The Overdose Crisis
Martha Bebinger
November 13, 2015

CHELSEA, Mass. A bald man in gray sweats bounds into the brick plaza next to City Hall.

“Hey,” someone calls out, “where you been?”

“At the hospital,” the man named Anthony says. “I OD’d.”

A half dozen people watching shake their heads. It’s a bad week in Chelsea, they say, with three overdose deaths.

“They’re dropping like flies,” says Theresa, a woman who manages a rooming house and does not want to share her last name.

Anthony, whose last name we’ve also agreed not to use, says he overdosed the night before on a particularly strong bag of heroin, laced with fentanyl, the dealer said, or something like it.

“[The dealer] told me how strong it was,” Anthony says, “but everyone says that to sell their dope.”

Fentanyl, an opiate that is many times more powerful than heroin, was present in about 37 percent of overdose deaths from January through June of last year, based on 502 cases analyzed by the Office of the Chief Medical Examiner in Massachusetts.


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What this chart from two Harvard researchers shows: “The most frequent drug category cited in overdose deaths was heroin (39.1%), followed by non-specified opioids (36.9%) and fentanyl (also 36.9%). Cocaine was cited in 23.4% of cases, ethanol (alcohol) 18.8%, and benzodiazepines 13.0%. “Chronic substance use,” a vague description which did not refer to a specific drug class but infers that drug use was implicated in the death, was cited in 2.4% of cases. … The vast majority of opioid-related overdose deaths in the first half of 2014 involved more than one drug.”


continued here http://commonhealth.wbur.org/2015/11/drug-overdose-cocktails
 
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These numbers actually over-represent the number of drug deaths involving only one substance, as an additional drug that is present in the body at the time of death will not necessarily be included in the coroner's report as being "implicated." This is due to systemic biases. I wrote a short article about it for a magazine, but they refused to publish it because apparently it was too controversial, so I might as well post it here:

Everywhere you turn today, you will hear that we are in the midst of a painkiller overdose epidemic. There is no doubt about one thing: the number of poisoning deaths associated with opioids in Canada has risen sharply in the past decade (1). What exactly is causing these deaths? The common perception is that drugs like heroin and oxycodone are unilaterally lethal and can easily cause death when a larger-than-average dose is taken. Yet, these drugs are considered safe medicines by the pharmaceutical regulatory agencies of every developed country in the world. How can this disconnect be explained?

The truth is that drug poisoning deaths are almost exclusively caused by the simultaneous consumption of multiple drugs. More often than not, these deaths involve the consumption of a benzodiazepine (such as Valium or Xanax) in combination with one or more other depressants (usually alcohol, opioids, or other benzodiazepines). At least two depressants are present in almost every death. For example, mortality data gathered in Scotland in 2012 showed that 97.6% of all people who had died by drug poisoning had multiple drugs in their system at the time of death, with 72.1% having consumed at least one benzodiazepine (2). Similarly, a study done in the province of New South Wales in Australia showed that every single poisoning death involving oxycodone over a decade occurred while at least one other drug was present, and again, in 68.6% of these cases a benzodiazepine was found. In fact, the term “overdose,” as it is popularly used, is a misnomer. The term technically applies to toxicity caused by the consumption of an overly-large dose of a single drug. The actual phenomenon that is causing so many fatalities is properly known as combined drug intoxication (CDI) or multiple drug intake (MDI).

Why is there so much misinformation regarding the true cause of so-called “overdose” deaths? A lot of it has to do with the massive biases in how post-mortem toxicology results are reported. When a coroner finds drugs in a person’s blood after death, he has to choose which drugs were “involved” in the death and which were not. For example, a coroner might see that both heroin and alcohol had been consumed, and in most cases only heroin would be written down as a cause of death, given the coroner’s drug-war-instilled biases against heroin in comparison to his social experience with non-lethal alcohol consumption. This would be an erroneous judgement, as it has been shown that even a small amount of alcohol will increase the lethality of a given dose of morphine, and there is no reason to suspect that this would not be case with any combination of depressants (3). Agencies like the Center for Disease Control in the United States collect this flawed data and assimilate it into flawed statistics which are used to promote flawed legal and health policies. Only by scouring the data of the few countries that include all drugs present at death in epidemiological data sets can the true cause of these deaths be deduced.

The absolute best thing a drug user can do to avoid dying is to refrain from combining depressants. This fact is far too important to be hidden from the public any longer.

(1) http://drugpolicy.ca/progress/getting-to-tomorrow/
(2) http://www.nrscotland.gov.uk/files/statistics/drug-related-deaths/2012/drugs-related-deaths-2012.pdf
(3) http://www.ncbi.nlm.nih.gov/pubmed/7595326
 
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Fuck prohibition. This would be (more or less) entirely avoidable with legal, pure, well-labeled and standardised drugs available to those wanting to do them!
 
Fuck prohibition. This would be (more or less) entirely avoidable with legal, pure, well-labeled and standardised drugs available to those wanting to do them!

Yeah but will the powers-that-be ever realise this? Actually I think they already do, but too many other factors making them completely unwilling to consider it, and actually making them go in the other direction. <sigh> So stupid and so fucking sad.
 
What this chart from two Harvard researchers shows: pharmaceutically pure opioids with their dosage known to the user are alot safer to recreational users than illegally manufactured and impure heroin and fentanyl! FACT!
 
I just watched an episode of Drugs Inc. about staten island heroin. There is a dealer from new jersey that was putting a bag with fentanyl in with other bags so at least one addict per fifty bags would OD. He looks at that as marketing. If we take the power to offer the heroin (which people need and will do anything to get) we might be able to save some deaths.

The harrison act has made it so doctors will no longer maintain their addicts on morphine. This would be the safest bet. Appeal this act so that people that have a crippling addiction that abstinence, methadone, and buprenorphine don't work for can at least be functional and safe.
 
Yea, it has long been a practice among a small minority of dealers, for some reason especially in NYC/Manhattan and the boroughs, to "spike" one or two bags per load. This is to get more customers like you said, the idea being that addicts will hear about someone ODing from some strong shit and then they will go seek out that shit because they think it is very potent.

To be clear, this practice seems to be very, very rare. Does happen though.

And Harrison Act and even more so the practice of the newly formed FBI forced doctors to stop prescribing opioids to anyone who wasn't seriously disabled (with very, very few exceptions), making any maintenance clinics/practices illegal, arresting doctors who didn't follow suit.
 
The Scottish data actually implies that alcohol + one benzodiazepine rarely leads to death. Check out p. 51 of the latest Scottish report on drug deaths. There was only one death where a benzodiazepine alone or a benzodiazepine + alcohol was found, out of 613.

Yeah alcohol+benzos not even close to a strong opioid i.e. heroin+another cns depresssant especially when the opioids being injected. Still not a safe combo obviously, but not in the same league in terms of danger. That plus the fact that a strong fentanyl mix has and will kill even people with a high heroin tolerance and there's no way to tell what's in street bags unless you're super careful and test it carefully which a lot of users don't even consider and it makes for alot of dead people that could have lived....so fuckin sad.
 
At my clinic , the most indemand combo is your meth dose, .3mg clonidine, 50mg promethazine and a bunch of bars or kpins...ativans or Valium work, but kpins and "yo u's gots dem bahhrs" is the no 1. I know no exact prices but even a pressed one which none of them know the diff sell for the price of a pack of cigs for a single

...on a side note this idiot said he knows a guy who knows a guy with 1k x2 bars. He's like theybrobbed a pharmacy... when the city was all crazy..first off that rioting was back in April and a ton of pharmacies gott raided but its safe to assune their stolen treasue has been longgone.

Also you can just tell by the taste and over all sbape. They are pretty strong and def not bunk. I just like knowing whatbim paying for.
..
 
The only times I've OD'd off an opioid it was an extremely potent opioid AND a potent GABAergic drug in constellation. Even when I'd injected them, I've never OD'd to the point my own body didn't naturally revive itself off potent opioids alone.
 
I have od'd on benzos and heroin. I know I have posted the story before. I ate a bunch of bars the night before. Ended up copping the next day, only four bags. Shot my bags, next thing I know I am being pulled out of my car by paramedics and shot up with narcan. Not a fun experience.

I have had other ODs. I can post pictures of me in the hospital but I would rather not because it brings a tear to my eye when I see just how bad I was and how many times I was staring death in the face and instead of changing, I just used more.

I would love to see some safe injection sites pop up around the us. It would really help with ODs considering someone would be there to safely administer narcan and get you the medical help you need.
 
I have od'd on benzos and heroin.

]

Me too Back in 2008 i had a mate who would shoot for me and one time the gear my friend organised was a fine loose white powder as opposed to a white rock and i for the one and only time over dosed after using heroin IV. Luckily my friend called the paramedic's quickly and it really was a touch or go situation as my heart had stopped and they had to take me to the main hospital to revive me. The next day the doctor told me i had opiates and benzo's in my system. I hadn't had any valium for years so the shot must have been a mix of potent china white heroin and some crushed up benzo pill. I know talk about a dodgy hook up

I would love to see some safe injection sites pop up around the us. It would really help with ODs considering someone would be there to safely administer narcan and get you the medical help you need.[/QUOTE
In my country Australia NSW has safe injecting rooms. Im not sure how many sites they're are in NSW but the main one is in kings cross sydney seeing as St vincents hospital is within walking distant .

I wish my home city had safe IV rooms but i have quit using drugs IV. Smoking my gear is good enough now.

As for legal safe injecting rooms in the USA they will never happen. Even though safe sites are a huge harm ministration factor American law makers are way to conservative and won't take a step backwards in their "war on drugs". But then again weed is legal in a few states so possibly a more progressive state my implement safe injecting rooms
 
I wish my home city had safe IV rooms but i have quit using drugs IV. Smoking my gear is good enough now.

As for legal safe injecting rooms in the USA they will never happen. Even though safe sites are a huge harm ministration factor American law makers are way to conservative and won't take a step backwards in their "war on drugs". But then again weed is legal in a few states so possibly a more progressive state my implement safe injecting rooms

I wouldn't be so sure. The head of the Harm Reduction Coalition just retired to take a job in the New York State Department of Health, as some sort of administrator to help push HR initiatives through the bureaucracy. Enough (middle and upper class) white people are dying from opiates in America now that it's become ok to talk about helping addicts instead of just hoping they die.
 
^^^it is still going to be an uphill battle. Think of all the people in congress and local government that are bible thumpers. It is fortunate that cops are now carrying narcan in some cities...but that is the last sight I want to wake up from an overdose to...a cop putting me in handcuffs for posession and public intoxication. We need more needle exchanges as well. There were some streets in syracuse that no one wore sandals or flip flops on because of all the used needles. If they had a place to dispose of those needles in a healthy sterile way those problems won't exist. However, the biggest law that needs to be changed is paraphernalia charges for having a syringe. This is just a way to put addicts away and put that red flag on their record. Fuck Police! Fuck The Grandstanding Lawmakers That Give Them The Right To Fuck an Already Fucked Life
 
^^yes, but that is changing, and it's highly dependent on state and even county. I don't have firsthand knowledge but I believe a syringe isn't paraphenalia in California anymore (or maybe you have to register? not really sure), and I know that ANY possession charge is not a felony. And first offense possession is never jailable, only treatment.
 
Just a syringe isn't considered paraphenalia in CA, correct. You can go buy them at almost any pharmacy and I've been stopped before by cops with them without incident (well, related to them... for used syringed its a bit different in practice, but technically the say policies apply). And the rest of your post monk deals with prop 47 stuff, which is correct (although the amount that fits the definition of simple possession is limited, as in personal use).
 
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