>Opiates in and of themselves are relatively safe, only slightly worse for you than caffeine, although clearly (arguably?) more addictive.
I've heard this claim so much but I can't possibly comprehend the basis of it.
Virtually nobody is out there overdosing and dying of caffeine (although it does happen). It's very addictive, yes, but if you deprived someone of their coffee for a month, they'll call you an asshole but they'll go about their normal life. With opiates, people are willing to live on the streets because they're more driven to put the drug over their personal well-being. I've known people who talked about having to empty their bowels with a spoon because they can't do it normally. Withdrawal is described as absolute hell and many people accept the possibility of overdose rather than the agony of going without it. People who built up a tolerance, quit using, then return often die because they took a little beyond their current tolerance. One major long term effect is that many people find it hard to find any joy in life as great as heroin.
It's not reefer madness. Thousands are dying and people are oftentimes knowingly sacrificing their lives for opiates. The argument that it's not bad when used responsibly and in small amounts is true of virtually every drug ever. In practice, many people aren't using them responsibly, and the nature of some drugs makes them even more apt to be abused than others.
People are desperate enough to see all the examples of people dying or otherwise destroying their lives for the drug but still deciding it's worth trying. The prohibition isn't the problem. The problem is people are struggling in life and opiates are providing an out. Making them more open and available will not help, and the oft-cited example of Portugal decriminalizing drugs doesn't mean every society should make opiates available. Drug overdoses recently increased in Portugal. [1]
People progress from routine prescription opiates to hard-core stuff like oxycodone and fentanyl (which is also a prescription opiate) to heroin and street fentanyl. It's not saying much to point out that the terminus of the addiction process is a product that Purdue doesn't itself sell.
For some, but it's complicated. 45% of opioid addicts started with prescription opioids, but a significant number of those were prescription opioids diverted from legal sources (i.e. they were taking opioids that weren't prescribed for them).[1]
Fentanyl is actually a very safe opioid. It doesn't have metabolic products that can cause side effects. If I'm remembering correctly, it has a larger therapeutic index (toxic dose / therapeutic dose) than other opioid options like morphine or oxycodone.
The problem is it's incredibly potent. For an adult, you might start at 25 ug. Not a big deal when you're drawing up a 100 ug/mL solution, but it's a big problem when you're trying to eyeball a powder of unknown purity. Plus fentanyl is showing up as an adulterant in street drugs like cocaine, where no one is expecting it.
I was reading that in Canada there were seeing a number of overdoses where the blood levels of fentanyl were >200ng/L. That's an absolutely massive overdose as typical therapeutic concentrations are 1-3 ng/L. People end up needing a naloxone infusion for a day or more until their body metabolizes all of the drug.
It has also much shorter half-life than most opioids making managing the overdose much easier (in hospital setting). For anesthetic it is a valid and safe choice.
It is of course different in non-hospital setting and non-pharmaceutical grade products - since fentanyl is very potent it requires much more precision in measuring the dosage which, when combined with unknown and varying purity makes overdose much more likely than with less potent opioids. If that is in turn combined with lack of or a significant delay of naloxone administration the risk of death is significantly higher than with less potent opioids
I've heard this claim so much but I can't possibly comprehend the basis of it.
Virtually nobody is out there overdosing and dying of caffeine (although it does happen). It's very addictive, yes, but if you deprived someone of their coffee for a month, they'll call you an asshole but they'll go about their normal life. With opiates, people are willing to live on the streets because they're more driven to put the drug over their personal well-being. I've known people who talked about having to empty their bowels with a spoon because they can't do it normally. Withdrawal is described as absolute hell and many people accept the possibility of overdose rather than the agony of going without it. People who built up a tolerance, quit using, then return often die because they took a little beyond their current tolerance. One major long term effect is that many people find it hard to find any joy in life as great as heroin.
It's not reefer madness. Thousands are dying and people are oftentimes knowingly sacrificing their lives for opiates. The argument that it's not bad when used responsibly and in small amounts is true of virtually every drug ever. In practice, many people aren't using them responsibly, and the nature of some drugs makes them even more apt to be abused than others.
People are desperate enough to see all the examples of people dying or otherwise destroying their lives for the drug but still deciding it's worth trying. The prohibition isn't the problem. The problem is people are struggling in life and opiates are providing an out. Making them more open and available will not help, and the oft-cited example of Portugal decriminalizing drugs doesn't mean every society should make opiates available. Drug overdoses recently increased in Portugal. [1]
[1] https://www.emcdda.europa.eu/countries/drug-reports/2019/por...
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