On a positive note, if you have any worries about a colonoscopy, I can assure you that my own experience a year ago, which included fentanyl as the anesthetic, was a very positive one. In that I was "out" almost immediately, woke up briefly enough to groggily dress, leave and be driven home, then needed to go right to sleep at home. And was groggy the entire next day.

This is one scary drug, if you consider how powerful a single therapeutic dose is.

Nevertheless, I won't be worried at all about a follow-up colonoscopy at the same clinic, when they phone me down the road.

Don't even try it on your own!

What with all the fentanyl being pumped out by the drug manufacturers, how are their stocks doing. Should we invest in their bonanza of death earnings or charge them with incompetence?
Oh!
And does the Donald and the other billionaires invest in their earnings? Maybe that's why our Government hasn't hastened to shut off the this river of death.
Come on!
Doesn't anybody care about the dead? Dosn't anyone out there fear the surge in residential break-ins and murders?
You better, because if you open your door and find a thug with a gun or knife in your house after a cheery dinner out, it may be a last dinner for you, too.

We will never be able to stop people from abusing drugs.

It has now become clear that the non-medical use of fentanyl and its derivatives has become the leading source of death due to illicit opioid use. This is the reality of the “opioid epidemic.”

This, and not the prescription by physicians of opioids for pain control, is now obvious. Fentanyl is not, except under controlled conditions, (e.g., cutaneous patches, oral controlled absorption “sticks”), and for appropriate medical indications, (e.g., surgery, progressive intractable pain, as in cancer) prescribed by physicians, or illicitly purveyed for gain by domestic pharmaceutical manufacturers.

It is manufactured in and illegally imported primarily from China, entering into the country through ineffective border control, and via uncontrolled mail order. Lethal fentanyl derivatives are synthesized in China and in Mexico, and enter the United States via its porous, inadequately policed, Mexican border.

No amount of liberalization of any form of drug use, of “education” of “addicts,” or potential “addicts,” or “treatment” of “addiction,” or the panicked restriction of the prescription of opioids by physicians for the control of otherwise intractable pain, will stem the tide of illicit importation and death.

This time, it is a matter of determinate, enhanced, and indeed costly, domestic and international law enforcement, to limit illicit availability of the agent and its derivatives.

Arthur Taub MD PhD
Clinical Professor (ret.)
Yale University School of Medicine

At the same time, Mr. Trump wants to cut funding to mental health and substance abuse treatment agencies. Many of these folks use drugs to self-medicate undiagnosed (and diagnosed) mental illness. Yet our local mental health agency only takes crisis cases.

Clearly the goal should be to help people before they reach a crisis point. Only then will the death toll go down.

Out of control gun violence...opiate deaths in small town America...high school drop out rate in some major cities exceed 30%. And this is the America we are so proud of?

I practice law in Massachusetts. In the past 10 years I have lost over 30 clients to heroin overdoses. None of these folks were older than 40.

There is a fundamental point made by presently no. 1 Readers' PIcks choice Let Your Motto Be Resistance that must somehow become the subject of serious discussion in the Times.

LYMBR notes that when heroin and crack were destroying black lives the problem was not seen as a public health problem. Instead LYMBR sees it as having been couched as black pathology, in other words as a phenomenon rooted perhaps in the nature of a "race" different from the USCB American white "race".

This way of looking at health problems in America is not restricted to drug problems but rather is deeply rooted in American medical research practice. In common practice, researchers use self reported "race" as a variable and turn out 100s of papers with titles in the format Mortality among blacks is greater than among whites.

Professor Dorothy Roberts alone and with colleagues explains clearly why this practice should be ended. The short version is readily available in her TED talk, longer versions in a Science paper and in her book "Fatal Invention-How Science, Politics, and Big Business Re-create Race in the Twenty-First Century".

In the gradual move to Universal Health Care the medical profession and genome researchers should be acting to end the use of race as a variable and should be supporting former USCB Director K. Prewitt in his proposal to end classification by race/ethnicity.

Give us American Public Health for all.

Only-NeverInSweden.blogspot.com
Dual citizen US SE

Too many are transfixed at the wound on the victim, and not enough are looking into the origin and trajectory of the weapon and its source.

This is not a story about drugs, its rather a story about a major transformation of the economics, sociology, matrimony, and future viability of the jewel of American 20th century, the engine of advancement and progress.

The American laborer is no longer needed.

No overdose deaths from cannabis, yet it continues to be a Schedule 1 drug, meaning supposedly it's just as dangerous and addictive as the drugs noted in this article. It's time for this country to get real about cannabis. How many overdose deaths will it take from a prescription drug handed out to patients for pain,which has proven to be addictive ? Once people have become dependent on these opioids, and can no longer get renewals for their prescriptions, they often turn to heroin because it's cheaper and easier to get. Various strains of cannabis can effectively relieve pain without lasting side effects.Half the states in this country have realized that cannabis has value as a medicine and have changed the laws in it's state to decriminalize it and to make it available as a medicine. The alarming rise in overdose deaths from opioids sold by big pharmaceuticals to doctors who prescribe this stuff without enough info about the addictive side effects will only continue. It's time for the whole country to be smart about a natural plant that causes no deaths from overdoses.

"Deaths involving prescription opioids continue to rise, but many of those deaths also involved heroin, fentanyl or a fentanyl analogue. There is a downward trend in deaths from prescription opioids alone. At the same time, there has been a resurgence in cocaine and methamphetamine deaths. Many of these also involve opioids, but a significant portion of drug deaths — roughly one-third in 2015 — do not."

is there double or triple counting for the graph? the graph shows a rising trend for prescription opioids. it also shows a rising trend for cocaine and methamphetamine, but i wonder if solely cocaine overdoses have a falling trend, like is claimed for prescription opiods, or constant trend. and 2/3 of the "cocaine" overdoses are also attributable to opioid overdoses? please clarify.

these drug overdoses are frightening, and deaths attributable to alcohol--including overdoses, chronic diseases, DWI and other "accidents"--are just as frightening. but the good news is DWI deaths have been falling during the past few decades as enforcement and penalties have become more strict. alcohol-related deaths could be added to the graph for comparison.

n.b. deaths attributable to cannabis are also not in the graph.

There are several comments here that erroneously imply that addiction is a behavioral issue. The science of addiction terms it as a brain disease. Once a person has become addicted, perhaps after using a number of times for pain relief, fun, or escape, the brain changes and demands the drug. The addict becomes a prisoner of his own biological cravings. Addiction is a physiological phenomenon, not a behavioral one. The harmful behaviors become symptoms of addiction, not the cause.

Ultimately, all that matters is whether the stock is up or down.

This drug was a godsend for the final four years of my mother's life. She wore the brand name transdermal patches and she still had to supplement them with liquid morphine. She was never pain-free but it gave us four more years of our mother. She died in 2001 at 75 with metastatic breast cancer in her bones. Before those patches, she would cry for hours from the pain and no pill seemed to give her any relief.

Clamp down on the abuse so people are dying on the street but please always remember that there are people in this world with cancer pain, which is worse pain than any you have ever known.

Consider the patients first and foremost, please.

Merely a side effect of Big Pharma's "We got a pill for that" marketing.

This overdose brought to you by Big Pharma.

This is the rotten lethal drug that killed Prince on April 21, 2016.

After he spent a lifetime making fantastic music, bringing joy to millions of us who, even now, would give anything to have him back.

This is a highly toxic, highly addictive drug. Why are so many people dying from this drug? Who is prescribing this toxin to so many people - given how horrible it's track record is?

Why not close the gateway; opioid painkillers. These drug were used in Hospitals and palliative cancer treatment for years without major problems. We can go back.
This will not help the currently affected but will stop priming the pumps with new addicts in waiting.
It was a deliberate effort to make these drugs widely available that led to this epidemic and a deliberate action can stop it.
The american medical community only cares about money and the doctors are the main culprits. This for profit medical system is bankrupting your country and destroying your society.

I don't think any drug expert has the answers for this cheap synthetic stuff that gets produced at higher dose-equivalents than anything ever used before.

I believe an awful lot of it is produced in China and as it isn't costly to make, it's likely cheap to sell as well.

Low cost, ubiquity, and a certain "fame" (or misperceptions) make it inviting to try. In addition to higher addictive nature of this stuff to, say alcohol or some street drugs, few seem to understand (until it's too late) how much is too much. I've hard that the doses sold on the streets would kill an elephant, and that a single "flake" of dry fentanyl can be very harmful even without ingestion.

Unless the government decides to follow their own commission's recommendations, we can expect more of the same: a rising death rate that crosses all ages, ethnicities, and races.

This opioid crisis is worse than any other drug or substance abuse problem I've read about in my lifetime.

The reason for the increase is that there are a large number of inexperienced people getting involved in selling opiates who do not understand how to cut, mix and package the drug in a way that is "safe" for the user.

Street heroin used to be a remarkably safe drug, considering the number of users vs. the number of deaths from overdose or poisoning. Fentanyl is easy to get - do a web search for it and see how easily you can order it from overseas. These sellers do not appreciate how difficult it is to mix this potent drug safely.

The widely made assumption is that the majority of US opioid deaths are accidental. Many are not. Patients with horrific chronic pain are often so desperate for relief they'll "chase the dragon," and take a dose that'll either provide knock-out relief or kill them, not really caring all that much which. They'll combine their prescription with illicit drugs and alcohol, tripling their chances of death. After years, or decades of horrific pain, failed surgeries, disability, frustration at inadequate medical care and being made to jump through endless hoops just to obtain prescription refills from a pain professional, cheap and powerful fentanyl may seem like the answer to many. Contrary to popular belief most pain patients are not drug-seekers. They're relief seekers. Death, like it or not, provides such relief.

What the cold-hearted business world doesn't seem to care or want to understand about the Fentanyl problem, beyond their limited capabilities to constantly regurgitate cold statistical drug addiction factoids, is how such a dangerous drug as Fentanyl truly is, was allowed to be unleashed so cavalierly into the public market place like it was.

I've worked in clinical health care for nearly all of my adult life, over thirty years. Fentanyl is a HIGHLY toxic drug. A hundred times more toxic than morphine, even in the tiniest doses. Fentanyl is so dangerous, it was and still is only recommended to be used by terminal cancer patients as a last ditch effort to relieve unbelievable bone and tissue pain when they've used up all other pain control resources. Fentanyl is so toxic, one of very few drugs which never should have been given approval for 'generic' manufacture. By doing so, all accountability, for it's previously LIMITED use, went down the drain. And, that is where I hold the corporatists 100% responsible for our current Fentanyl death epidemic. Over-distribution, much too easy access, for a drug which needed to be kept safely corralled from, not only drug addicts, but from greedy, medically illiterate business 'open market' morons.
Room is running out here, but I challenge the next writer of the fentanyl addict to research the history of the drug and of our current obtusely unregulated Pharma industry. Tragic.

In my opinion, there's nothing inherently with doing drugs. In fact, many drugs can be a really positive force in someone's life when used sparingly and correctly. It becomes a problem however when people use drugs to escape. This sort of behavior is always a reflection of some other sort of problem: not enough opportunity, poverty, you name it.

there is a percentage of humans that want drugs. they have been with us through out the centuries. the idea that Government or Society can mitigate the want these people have is complete hubris. the trick is to help them have a maintenance type habit. they may not get high but the illness from abstaining does not arrive. there is no easy fix. it is a part of humanity. always has been

Yes, blame the user, try to help the user, it all seems far away until i found out the man, age 28, across the street nearly over dosed. He's now home to be watched 24/7, no driving, and i don't know if he sustained any life long brain damage. I feel like the problem has landed in my lap and in a way it has. What to do is now the question. What to do?

When heroin and crack were destroying Black lives and ravishing Black communities, it was not couched as a public health issue by white law makers or the white president.

Rather, it was couched as “black pathology” and met with a vicious, racist, war on drugs policy that continues to this day and has led to the mass incarceration of Black people and the further destruction of already impoverished and challenged communities and families.

Now that white people are dying of overdoses from heroin and opioid usage, it is not couched as White pathology. Rather, their drug usage is humanized and put in the context of a public health issue - WHITELIVESMATTER!

As James Baldwin wrote, “Race was—is—the fundamental America issue, underlying not only all matters of public policy (economic inequality, criminal justice, housing, education) but the very psyche of the nation.”

The root problem is that we're treating drug use as a crime rather than a medical problem, which *increases* deaths.

According to the chart in this article, deaths from fentanyl and analogues were more in 2016 than heroin or prescription opioids.

When law enforcement cracked down on heroin, prescription opioid deaths went up. When they cracked down on prescription opioids, heroin deaths went up. Now they're cracking down on both, and fentanyl deaths are going up -- worse than before.

Don't take my word for it. Read the draft "President's Commission on Combating Drug Addiction and the Opioid Crisis" https://www.washingtonpost.com/news/wonk/wp/2017/07/31/white-house-opioi...

QUOTE

In response, state and federal authorities began cracking down on prescription opiate availability....

But in response to these interventions, many painkiller abusers appear to have switched to illicit street drugs. As prescription painkiller deaths started to fall, heroin overdoses increased dramatically. The latest development has been the emergence of powerful synthetic opiates like fentanyl, which are sometimes mixed with heroin with fatal consequences for unsuspecting users.

UNQUOTE

The best methods for dealing with opioid addiction are well known to public health doctors: decriminalization, clean needles, methadone or buprenophine, injection rooms, and general health care.

Not news

From The Economist, May 20th 2017:

"Fentanyl is the next wave of America’s opioid crisis"

Showing this graph

https://cdn.static-economist.com/sites/default/files/images/print-editio...

Most interesting in The Economist report

"Most of the fentanyl making its way to America has been made, often legally, in factories in China "

" In March the government in China, under pressure from America and the UN, agreed to make four variants of fentanyl illegal."

Will this be enforced ? Consider this Chinese saying on efforts to control China from the Capital : : "Mountains High, Emperor Far Away"

Society's ills will always follow the path of least resistance. It has migrated from cocaine to heroin to prescription pills and now to fentanyl. ( being cut in all sorts of different ways with other drugs )

It is a problem that needs to be looked at from all angles and from start to end result. You cannot just throw money into more prisons and militarized police units. We need to look at the root causes of the epidemic from the detachment of many from our society ( or their feeling thereof ) to readiness of the drug\prescribing, to the reduction of serious treatment to the situation.

Downloading budgets from top to bottom, to the point that there is no money left ( or prioritized for anything ) is a recipe for disaster and we are seeing the results.

Everyone in our society needs to be paying taxes progressively ( their fair share ) so that the less well off are taken care of. ( there is money to do so ) )

Continue on the way we are going, and this epidemic will overtake us all.

Yes, the dead toll is staggering. What journalists overlook however, is that every one of those deaths was a criminal; they broke the law by obtaining, selling, transporting, or consuming illegal drugs. An many had been resuscitated multiple times by local EMS, at great cost to the taxpayer. And many among them also had been through multiple drug rehabs, paid for with Medicaid funding, therefore also at taxpayer expense.
These were often not our best and brightest.

This is exactly what you expect when pain meds are given out like candy to people who think that any discomfort is actually pain that needs to go away. Unfortunately this is what happens.

Mr. Katz, please correct me but you do not mention the manufacturer of 'Fentanyl' and how it is reaching the vulnerable in our population. The topic of drug abuse is discussed in the rural region of Upstate New York and it would help some of the readers to recognize how it is dispensed, the symptoms.

If we could have a follow-up on the above, this might save some lives. A young woman died two summers last of a heroin overdose in this small house where she was trying to get well.

Fentanyl sounds as lethal as drinking drano, and urgent to spread the word fast, because it is rising to a degree where the Public needs to be informed. Facts and figures are helpful, but preventive measures are imperative and there appear to be no 'second chances'.

Taking drugs is nothing new so how just one drug could be the cause of being more fatal when overdosed seems strange when considering any drug can be fatal in too big of a quantity. Maybe this legal drug is proving to be most effective in achieving the desired end result so people opt to take it as opposed to something else considered less sure fire. Having the make the horrible decision of how to do it must be agony for those who feel they must so perhaps it's merciful when the drug companies come along with something that only makes that decision easier. And who says they don't have a heart?