I believe fentanyl is never used in pure form but always mixed with filler. What if fentanyl manufacturers/ packagers have improved their quality control such that a single pill will never have enough fentanyl to cause an accidental overdose? And IV users will have access to better controlled potency less likely to cause accidental overdose?
Fentanyl enters the illegal market in two forms. Either legally available, but heavily controlled pills, patches, etc which have an extremely well controlled dosage of fentanyl are diverted through fraud, theft, etc into the black market; or more or less pure fentanyl is introduced completely illegally, then mixed with whatever filler the seller chooses to use.
One pill, when following prescription guidelines, will not cause on overdose. Taking multiple pills, without a prescription, might. Quality control cannot, and should not, account for gross user error. And people who smoke or inject are using the same source they always have. Remember, we pay people called anesthesiologists hundreds of thousands of dollars to administer straight fentanyl in the appropriate doses; expecting an addict to do the same is simply not feasible, especially when the difference between a high and an overdose is so slim as to be nonexistent.
It never stops being weird that the NIDA director is Trotsky's great granddaughter though I guess no weirder than Stalin's granddaughter running an antique shop in Portland.
It is a standard generalized logistic curve which is a family of parametric growth curves, like a Gompertz curve. You can use excel and with your data do a curve fit and determine the carrying capacity, and growth rate.
Great essay. The delay from eastern and western states is a really interesting (albeit disconcerting) way to explain the decline in overdoses.
The lack of significant results from the Community-Based OUD treatment study is a little surprising given the efficacy of buprenorphine as a drug, though I read another study (doi:10.1056/NEJMc2312906) with a similar finding — the elimination of the X-waiver increased prescriber capacity, but it didn't significantly increase the actual number of prescriptions.
Even though the process of getting buprenorphine is becoming less tedious, maybe the demand for it isn't high enough that greater supply has much of an impact? I wonder if this is due more to lack of awareness of successful treatment options or just lack of motivation for seeking treatment.
Based on my experience, largely the latter. Buprenorphine is an effective assistance for someone genuinely interested in reducing their physical dependence on narcotics, with the intention of fully weaning themselves off all substances. This kind of person is nowhere near as representative of drug users as optimistic advocates claim.
I believe fentanyl is never used in pure form but always mixed with filler. What if fentanyl manufacturers/ packagers have improved their quality control such that a single pill will never have enough fentanyl to cause an accidental overdose? And IV users will have access to better controlled potency less likely to cause accidental overdose?
Fentanyl enters the illegal market in two forms. Either legally available, but heavily controlled pills, patches, etc which have an extremely well controlled dosage of fentanyl are diverted through fraud, theft, etc into the black market; or more or less pure fentanyl is introduced completely illegally, then mixed with whatever filler the seller chooses to use.
One pill, when following prescription guidelines, will not cause on overdose. Taking multiple pills, without a prescription, might. Quality control cannot, and should not, account for gross user error. And people who smoke or inject are using the same source they always have. Remember, we pay people called anesthesiologists hundreds of thousands of dollars to administer straight fentanyl in the appropriate doses; expecting an addict to do the same is simply not feasible, especially when the difference between a high and an overdose is so slim as to be nonexistent.
It never stops being weird that the NIDA director is Trotsky's great granddaughter though I guess no weirder than Stalin's granddaughter running an antique shop in Portland.
check this out: https://www.seattletimes.com/seattle-news/health/what-could-be-behind-king-countys-recent-drop-in-fatal-fentanyl-overdoses/
i think in WA at least it's starting to slow down too, even if it's not showing up on your graphs yet
If it keeps growing exponentially forever, we'll all be dead.
I would not consider this exponential.
It is a standard generalized logistic curve which is a family of parametric growth curves, like a Gompertz curve. You can use excel and with your data do a curve fit and determine the carrying capacity, and growth rate.
https://en.m.wikipedia.org/wiki/Logistic_function
You could also use a SIRD model, just as easy in excel.
https://en.m.wikipedia.org/wiki/Compartmental_models_in_epidemiology
It’s best treated as an epidemic.
Great essay. The delay from eastern and western states is a really interesting (albeit disconcerting) way to explain the decline in overdoses.
The lack of significant results from the Community-Based OUD treatment study is a little surprising given the efficacy of buprenorphine as a drug, though I read another study (doi:10.1056/NEJMc2312906) with a similar finding — the elimination of the X-waiver increased prescriber capacity, but it didn't significantly increase the actual number of prescriptions.
Even though the process of getting buprenorphine is becoming less tedious, maybe the demand for it isn't high enough that greater supply has much of an impact? I wonder if this is due more to lack of awareness of successful treatment options or just lack of motivation for seeking treatment.
Based on my experience, largely the latter. Buprenorphine is an effective assistance for someone genuinely interested in reducing their physical dependence on narcotics, with the intention of fully weaning themselves off all substances. This kind of person is nowhere near as representative of drug users as optimistic advocates claim.