Why is the government pushing Fentanyl?

[nec209]

Why are they pushing Fentanyl these days? I know before they where pushing Oxycontin/Oxycodone and hyrdromorphone and so on and there was people getting addicted and people overdosing!! But now it seems to have done the opposite and now there are hundreds of people overdosing on Fentanyl every month. It is now a major epidemic.

And small speck of Fentanyl like size like a speck of sand can kill the person. Why don't they ban Fentanyl and just go back to Oxycontin and morphine or some thing else to there is some thing safer?

 

 

[CharonY]

What makes you think that the government is pushing fentanyl? Or oxycontin for that matter? Or do you equate not banning with pushing? 

[StringJunky]

9 minutes ago, CharonY said:

What makes you think that the government is pushing fentanyl? Or oxycontin for that matter? Or do you equate not banning with pushing? 

I'm surprised that people get issued fentanyl when they are not suffering dire chronic pain and terminal. I understood it as intended as a breakthrough pain reliever in those patients that were already being given addictive analgesics in a therapeutic situation, such as terminal cancer. in those patients the addictiveness of a medicine becomes moot.

Could it be symptomatic of a privately-driven healthcare system that these substances are so, relatively, available and reduces the effectiveness of government oversight in controlling prescriptions?

Edited August 1, 2017 by StringJunky

[nec209]

29 minutes ago, CharonY said:

What makes you think that the government is pushing fentanyl? Or oxycontin for that matter? Or do you equate not banning with pushing? 

The government and DEA putting pressure to subscribe fentanyl not Oxycontin/Oxycodone or hyrdromorphone. Because of the abuse of Oxycontin/Oxycodone,  hyrdromorphone or morphine.

 

 

[nec209]

31 minutes ago, StringJunky said:

I'm surprised that people get issued fentanyl when they are not suffering dire chronic pain and terminal. I understood it as intended as a breakthrough pain reliever in those patients that were already being given addictive analgesics in a therapeutic situation, such as terminal cancer. in those patients the addictiveness of a medicine becomes moot.

Could it be symptomatic of a privately-driven healthcare system that these substances are so, relatively, available and reduces the effectiveness of government oversight in controlling prescriptions?

I think has more to do if you had sport injury, car accident or surgery or some thing they would give Oxycontin/Oxycodone or hyrdromorphone. Now they seem to give fentanyl.

 The media all over Oxycontin/Oxycodone and hyrdromorphone is dirty drug and people using it to get high thus try fentanyl some thing new and safer. But fentanyl turn out to be much worse.

That why they should just ban fentanyl and go back to Oxycontin/Oxycodone and hyrdromorphone to some thing is safer out there.

 

Edited August 1, 2017 by nec209

[CharonY]

 

17 minutes ago, StringJunky said:

I'm surprised that people get issued fentanyl when they are not suffering dire chronic pain and terminal. I understood it as intended as a breakthrough pain reliever in those patients that were already being given addictive analgesics in a therapeutic situation, such as terminal cancer. in those patients the addictiveness of a medicine becomes moot.

Could it be symptomatic of a privately-driven healthcare system that these substances are so, relatively, available and reduces the effectiveness of government oversight in controlling prescriptions?

There are several things to consider. One is the fact that illegal production and distribution of fentanyl has increased since 2012. There is also an increased scrutiny for legal distribution. But even in health care systems that are public (as Canada) the rate of opioid deaths have been increasing in recent years. Interestingly in some areas oxyconting were removed from drug plans, yet overall death rates increased. The reason being that other opioids just rise in popularity. The rate is higher still in the US, but a private vs public health system is clearly insufficient to describe the effects. In both countries there is an overprescription, which ultimately indicates inadequacy in dealing with chronic pain.

[StringJunky]

3 minutes ago, CharonY said:

 

There are several things to consider. One is the fact that illegal production and distribution of fentanyl has increased since 2012. There is also an increased scrutiny for legal distribution. But even in health care systems that are public (as Canada) the rate of opioid deaths have been increasing in recent years. Interestingly in some areas oxyconting were removed from drug plans, yet overall death rates increased. The reason being that other opioids just rise in popularity. The rate is higher still in the US, but a private vs public health system is clearly insufficient to describe the effects. In both countries there is an overprescription, which ultimately indicates inadequacy in dealing with chronic pain.

Right. OK.

[CharonY]

19 minutes ago, nec209 said:

The government and DEA putting pressure to subscribe fentanyl not Oxycontin/Oxycodone or hyrdromorphone. Because of the abuse of Oxycontin/Oxycodone,  hyrdromorphone or morphine.

 

 

The DEA has no medical authority in the end it is the medical professional who makes the decision. There was a crackdown on illegal oxycontin distribution, which first led to a rise in heroin and fentanyl use. Much of the deaths by fentanyl are caused by heroin laced with fentanyl. If we consider prescription drugs as one route of addiction, it does not really matter on which drugs people get hooked on. If opioids of any kind are used for long-term treatment, addiction is almost a certain result. For this specific route alternatives have to be sought.

[nec209]

11 minutes ago, CharonY said:

The DEA has no medical authority in the end it is the medical professional who makes the decision. There was a crackdown on illegal oxycontin distribution, which first led to a rise in heroin and fentanyl use. Much of the deaths by fentanyl are caused by heroin laced with fentanyl. If we consider prescription drugs as one route of addiction, it does not really matter on which drugs people get hooked on. If opioids of any kind are used for long-term treatment, addiction is almost a certain result. For this specific route alternatives have to be sought.

There where many doctor's getting arrested by police and DEA in some of pill mill states. Some doctor's where giving out like candy some people where doctor shopping to try to get pills.

This lead to media hype of pill abuse and tighter restrictions when doctor can and cannot give to you. More federal guidelines and pharmacy monitoring

More monitoring and oversight of doctors.

 

 

[CharonY]

You are telling a weird story. The arrest of MDs who were prescribing massive amounts of unneeded or fraudulent prescriptions is clearly not an example of government pushing fentanyl. Also, can you kindly point me  to the regulations that would specifically target oxycodone but exempt fentanyl?

Edited August 1, 2017 by CharonY

[nec209]

13 minutes ago, CharonY said:

You are telling a weird story. The arrest of MDs who were prescribing massive amounts of unneeded or fraudulent prescriptions is clearly not an example of government pushing fentanyl. Also, can you kindly point me  to the regulations that would specifically target oxycodone but exempt fentanyl?

What I'm saying is in beginning doctors where prescribing it for every thing and giving it out like candy.

This is what the feds started to stop. The media had field day. There even signs posted on the roads in Florida.

Every thing was Oxycontin/Oxycodone and hyrdromorphone AND morphine back in that time line!! In news people abusing morphine or Oxycontin/Oxycodone.!!!

Now every thing is Fentanyl and overdose and more overdose every month in hundreds.

There was people getting hooked on Oxycontin/Oxycodone and hyrdromorphone AND morphine  and people using it to get high back in that time line. But now they replace it with Fentanyl that is causing skyrocketing overdose.

 

[CharonY]

In other words you cannot point to any specific regulation. Sorry, but you are pushing a narrative without evidence. In order to have discussion you should read some reports and maybe look at the odd graph. Let me ask you a few questions: a) which class of opioids has caused the most deaths in the last five years? b) are illegal or legal sources more commonly connected to fentanyl deaths? c) what are the currently the most commonly prescribed opioid drugs? d) are there regulations, and guidelines that affect opioids but exempts fentanyl?

Unless you start to look and discuss data I see little value in continuing the conversation.

Edited August 1, 2017 by CharonY

[Sicarii]

Good questions. Thought I'd contribute:

1 hour ago, CharonY said:

a) which class of opioids has caused the most deaths in the last five years?

Source: https://www.cdc.gov/drugoverdose/data/analysis.html

1 hour ago, CharonY said:

b) are illegal or legal sources more commonly connected to fentanyl deaths?

Illegal sources seem to be more connected with fentanyl deaths.

From the following study:

"Given the strong correlation between increases in fentanyl submissions (primarily driven by IMF) (3,4) and increases in synthetic opioid deaths (primarily fentanyl deaths), and uncorrelated stable fentanyl prescription rates, it is hypothesized that IMF is driving the increases in fentanyl deaths. Findings from DEA (3,4), state, and CDC investigations (5) documenting the role of IMF in the observed increases in fentanyl deaths further support this hypothesis."

Source: https://www.cdc.gov/mmwr/volumes/65/wr/mm6533a2.htm

IMF = illicitly manufactured fentanyl

1 hour ago, CharonY said:

c) what are the currently the most commonly prescribed opioid drugs?

Seems to be hydrocodone, oxycodone, and morphine.

One source: https://www.washingtonpost.com/news/to-your-health/wp/2014/04/14/ban-some-pain-killers-here-are-6-common-opioids/?utm_term=.5ed1ac292f52

These three kept coming up as I was doing a search.

1 hour ago, CharonY said:

d) are there regulations, and guidelines that affect opioids but exempts fentanyl?

Not having much luck finding information about laws or guidelines exempting fentanyl. This is a useful resource though, listing state by state prescription guidelines: https://docs.google.com/spreadsheets/d/1A32tM1nNFvjyKuFjowFcRu4M14aKgxJUbO4xsjtLqMw/edit#gid=492287167. None of them allude to fentanyl being exempt. The spreadsheet was accessed through: http://blog.aapainmanage.org/state-state-laws-regulations-guidelines-pain-management/.

Federal drug penalties are the same according to the following link: https://www.dea.gov/druginfo/ftp3.shtml. But that doesn't say much.

[CharonY]

Excellent. I had hoped for didactic reasons, that OP would search for it, but since you did all the work, it should be sufficient to challenge the assumptions. One thing that I forgot to mention is the formulation of tamper-free oxycodone, which cannot be easily crushed. Its introduction is strongly correlated with the sharp increase in heroin use, further showing that addicts turn to illegal sources when deprived of one. Controlling legal routes of the substance in itself does not seem to be sufficient to curb deaths.

Edited August 4, 2017 by CharonY

[StringJunky]

25 minutes ago, CharonY said:

Excellent. I had, for didactic reasons, that OP would search for it, but since you did all the work, it should be sufficient to challenge the assumptions. One thing that I forgot to mention is the formulation of tamper-free oxycodone, which cannot be easily crushed. Its introduction is strongly correlated with the sharp increase in heroin use, further showing that addicts turn to illegal sources when deprived of one. Controlling the substance in itself does not seem to be sufficient to curb deaths.

Thwarting drug addicts in one way only makes them find another way... it just moves the problem around. I remember in the eighties I heard people  lost limbs to Diconal (dipipanone/cyclizine) because of the large amount of insoluble materials in it but people still persisted. It's another world being a drug addict; safety is some abstract concept to many of them. Drug-induced amnesia is the real obstacle to dealing with the problem. That's why there is an endless pattern of reoffending.

Edited August 2, 2017 by StringJunky

[CharonY]

4 minutes ago, StringJunky said:

Thwarting drug addicts in one way only makes them find another way... it just moves the problem around. I remember in the eighties I heard people  lost limbs to Diconal (dipipanone/cyclizine) because of the large amount of insoluble materials in it but people still persisted. It's another world being a drug addict; safety is some abstract concept to many of them. Drug-induced amnesia is the real obstacle to dealing with the problem. That's why there is an endless pattern of reoffending.

Indeed. The problem is clearly multidimensional and at minimum better means for the treatment of addicts are needed, but also alternatives to pain control to reduce the significant proportion of addictions that arise from the legal use of prescription drugs. Unfortunately, as history has shown, if there is a demand, supply finds its way.

[John Cuthber]

One possible reason why a Western government might prefer the Drs to use fentanyl is that it isn't made from opium which might be grown by "foreign people".
Having said that, I'm not really convinced there is any real pressure to change prescribing habits.

 

 

[CharonY]

11 minutes ago, John Cuthber said:

One possible reason why a Western government might prefer the Drs to use fentanyl is that it isn't made from opium which might be grown by "foreign people".
Having said that, I'm not really convinced there is any real pressure to change prescribing habits.

 

 

One tricky bit is that for prescription typically only total opioid prescriptions are monitored, but not the individual types. That information is more often indicated in overdose cases. However, as shown above, the number of fentanyl prescriptions remained steady over the last ~5 years, whereas overdose cases massively increased. So even if there were some kind of pressure, it apparently had no effect on prescription rates. 

[nec209]

I'm not sure what you mean by it? They use to give out hydrocodone, oxycodone, and morphine like candy before and sure there was people getting addicted to it or people using it to get high and not really in pain.

But now Fentanyl is major epidemic now days with skyrocketing overdose. That why I said why don't they go back to use hydrocodone, oxycodone, and morphine and ban Fentanyl.

 

 

[CharonY]

5 minutes ago, nec209 said:

I'm not sure what you mean by it? They use to give out hydrocodone, oxycodone, and morphine like candy before and sure there was people getting addicted to it or people using it to get high and not really in pain.

But now Fentanyl is major epidemic now days with skyrocketing overdose. That why I said why don't they go back to use hydrocodone, oxycodone, and morphine and ban Fentanyl.

 

 

Take a look at Sicarri's post and try to reconcile it with your assumption that fentanyl is a) replacing oxycodone in use, b) that it is pushed by the government and c) that its ban would solve the overdose deaths. 

[nec209]

On 2017-08-02 at 5:35 PM, CharonY said:

Take a look at Sicarri's post and try to reconcile it with your assumption that fentanyl is a) replacing oxycodone in use, b) that it is pushed by the government and c) that its ban would solve the overdose deaths. 

I really hardly hear hydrocodone, oxycodone, and morphine these days. Drug addiction and overdose has been around for years but never like fentanyl. There are hundreds of people that overdose on fentanyl every month. Like I say small speck of sand of fentanyl can kill you.

Fentanyl is worse than heroin. The overdose of fentanyl is astronomical that many communities people are protesting.

I don't know what the government and FDA things why they are pushing fentanyl and why fentanyl is not banned.  If some how they think hydrocodone, oxycodone, and morphine been tarted as drug people use to get high.

I mean it would would be safer for them doctors to give out heroin than fentanyl. There where people overdose on heroin but nothing like fentanyl.

I hardly heard of fentanyl before and now every day I hear of fentanyl!!  Well before it was hydrocodone, oxycodone, and morphine and heroin and sure there where people using it to get high, addicts and overdose but nothing like fentanyl.

Edited August 4, 2017 by nec209

[Cap'n Refsmmat]

5 minutes ago, nec209 said:

I really hardly hear hydrocodone, oxycodone, and morphine these days. Drug addiction and overdose has been around for years but never like fentanyl. There are hundreds of people that overdose on fentanyl every month. Like I say small speck of sand of fentanyl can kill you.

Fentanyl is worse than heroin. The overdose of fentanyl is astronomical that many communities people are protesting.

I don't know what the government and FDA things why they are pushing fentanyl and why fentanyl is not banned.  If some how they think hydrocodone, oxycodone, and morphine been tarted as drug people use to get high.

I mean it would would be safer for them doctors to give out heroin than fentanyl. There where people overdose on heroin but nothing like fentanyl.

I hardly heard of fentanyl before and now every day I hear of fentanyl!!  Well before it was hydrocodone, oxycodone, and morphine and heroin and sure there where people using it to get high, addicts and overdose but nothing like fentanyl.

You don't seem to be reading anyone's posts in this thread.

Why do you think the FDA is pushing fentanyl? It is not. The people overdosing on fentanyl are getting it illegally, not from their doctors. The FDA was not involved.

Banning fentanyl would not help, because people who overdose on it get it illegally, mixed in with illegal heroin. People who make heroin are mixing in fentanyl, because it's cheap and strong, and saves them money, not because the FDA told them to.

[nec209]

18 minutes ago, Cap'n Refsmmat said:

You don't seem to be reading anyone's posts in this thread.

Why do you think the FDA is pushing fentanyl? It is not. The people overdosing on fentanyl are getting it illegally, not from their doctors. The FDA was not involved.

Banning fentanyl would not help, because people who overdose on it get it illegally, mixed in with illegal heroin. People who make heroin are mixing in fentanyl, because it's cheap and strong, and saves them money, not because the FDA told them to.

May be so but why do hear less hydrocodone, oxycodone, and morphine these days.

[Cap'n Refsmmat]

I strongly recommend the book Dreamland, by Sam Quinones, about the opiate epidemic, if you'd like to read the full story.

I think there are a few reasons:

• The media goes through obsessions. Now that they've heard about fentanyl, it's the only thing they want to talk about.
• Drugs like OxyContin have been modified to make them harder to abuse.
• The DEA has been cracking down on pharmacies that sell enormous amounts of hydrocodone and oxycodone, along with "pill mill" doctors who give prescriptions to anyone who has cash.
• Doctors are more hesitant about prescribing pills, so it's harder to get pills to use or sell.

People who were already addicted are finding it harder to get hydrocodone or oxycodone pills, so they have to switch to illegally produced heroin. And some of that heroin contains fentanyl.

[CharonY]

27 minutes ago, Cap'n Refsmmat said:

I strongly recommend the book Dreamland, by Sam Quinones, about the opiate epidemic, if you'd like to read the full story.

I think there are a few reasons:

• The media goes through obsessions. Now that they've heard about fentanyl, it's the only thing they want to talk about.
• Drugs like OxyContin have been modified to make them harder to abuse.
• The DEA has been cracking down on pharmacies that sell enormous amounts of hydrocodone and oxycodone, along with "pill mill" doctors who give prescriptions to anyone who has cash.
• Doctors are more hesitant about prescribing pills, so it's harder to get pills to use or sell.

People who were already addicted are finding it harder to get hydrocodone or oxycodone pills, so they have to switch to illegally produced heroin. And some of that heroin contains fentanyl.

I also wonder how one managed to make the leap from "the media is highlighting increasing deaths from a drug" to "the government is replacing drugs with a more lethal version".