I am glad to see this being discussed somewhere. My downtown is full of people bent over, walking, or huddling in little intense groups messing with pipes and bits of tinfoil. One rainy spring day I came home from running some unimportant errands and was in emotional tatters at who I had seen lying in the rain on the busy sidewalks. I was shaken at the devastated lives I walked past. I still am. Who can it possible benefit to not take care of our citizens when they need it the most? I am a sober person who counts my lucky star everyday that my pain did not lead me to the streets 💔
The potency of meth on the streets is another issue. Young men are now seen in states of heat exhaustion in San Francisco in public places. Clearly there blood pressure is extremely high. Their risk of a stroke or heart attack under the influence of this high potency metb has to be extremely high.
Yes, I've seen/heard similar from drug counselors and ER personnel. btw, not sure how you come to your knowledge, but if you're interested in talking more, i'd be interested in hearing your story....i'm at samquinones7 at yahoo.com....
The thing is that some of the# wealthy seem to have died or succumbed to fentany too. They just aren't as open about it. They are not exempt. Fentanyl isn't being address by treating overdoses. Every overdose is a massive health interruption.
The thing is that some of the# wealthy seem to have died or succumbed to fentany too. They just aren't as open about it. They are not exempt. Fentanyl isn't being address by treating overdoses. Every overdose is a massive health interruption.
The Europeans discovered in the 1990s that open air drug markets don't work. America ignored that knowledge. It's like it never existed. Or ideology is more important than reality.
I noticed this bent over posture when the town I used to live in the UK became overrun with synthetic cannabinoids- ‘spice’ users. Maybe just more related to being completely stoned than what drug it is?
Thanks for the continuous coverage of this plague on our streets, Sam. I appreciate your willingness to say the quiet parts out loud—especially when so many others are still tiptoeing around the realities on the ground. You're one of the best journalists working today.
One place the tranq from PHL seems to have gone next is Knoxville, TN. they got a real problem there, I'm told. Seems to me that Philadelphia is a kind of test market area. what works there goes elsewhere.
The major issue in homelessness is not the lack of housing. It's the refusal of society to say no. No, you can't camp in this city. No, you can't shit in the streets. No, you can't panhandle aggressively. No, you can't shoot up publicly and leave your used needles lying around. The fact that we are not going to allow you to destroy our city by doing these things is not our problem. It's your problem. You can solve your problem by not doing drugs, getting help for your mental problems, getting a job, and sharing rent with others so inclined until you can afford a place of your own, probably in a lower cost community.
This is not going to happen because the people we have elected allow the homeless to wallow in their victimhood rather than accept personal responsibility for their self destructiveness.
What specific steps should be taken by cities to deal with the problem? Cities should use all existing shelters and further provide simple shelter space with surplus military tents with mess and recreational tents, a medical tent and restroom and shower facilities (the way I lived in the army) on leased or purchased unused commercial or industrial sites on the outskirts of the city. As many who want to and are able to work should be hired to help feed others and to maintain the facilities. Individuals could use surplus military squad tents or their own for sleeping. When those facilities are available the city should send in crews to clean up existing encampments, without arresting anyone who does not physically resist.
Custodial care should be mandatory for those who are so mentally or drug addicted that they cannot care for themselves. We did a huge disservice to the mentally ill when we closed rather than reform our state mental hospitals. We need them back. This approach actually would cost far less and be far more effective than the current housing first attempts to fix the problem. Most of the homeless lack the capacity to live unassisted in modern society but that is not an excuse to destroy our beautiful cities and drive out our productive citizens.
I heard you deliver the keynote address at the American Society of Anesthesiologists last October, and it was an epiphany for me. Thank you to your dedication to raising awareness about the drug plague in this country and what courageous citizens are doing to turn the tide.
Fentanyl is powerfully sedating and if a person has a higher blood concentration of it than he is used to, he will doze off. Since it's also a respiratory depressant, overdose and death are common. The developed tendency to fight off sleep and experience the euphoric effects of the drug, coupled with the near-collapsed state of profound muscle relaxation, folds the user in half.
Additionally, the increased cerebral blood flow in the head-down position fosters staying in this posture when standing upright would lower cerebro-vascular pressure. FWIW, aluminum toxicity does not present this way. Acute toxicity appears like seizures or rigidity. Chronic aluminum toxicity presents as neurodegenerative changes and cognitive decline.
Hi, I am a nurse who works with people who use fentanyl. Fentanyl is highly potent and addictive - WAY more so than the others you listed. You can look up how many more times potent - it’s quite a lot. Buprenorphine is a partial agonist whereas fentanyl is a full agonist at the mu opioid receptors. One will make you feel high, whereas Suboxone can treat users without producing the same “high” feeling, dependence, and withdrawal if the user quits Suboxone. It also is effective in reducing cravings so people can continue their lives. The cycle of using and then seeking out drugs to get your next use before you withdraw is really tough.
Thanks for the reply. Given that the others (morphine, oxycodone etc) are potent enough at some dosage to induce unconsciousness and even death....why is the "fold" phenomenon NOT observed somewhere on the sober-intoxicated-dead gradient for those drugs?
In other words...why do users of fentanyl adopt the "fold" while users of other opiates transition to a reclined position? All of these are potent enough to kill..but the fold is associated specifically with fentanyl.
It seems like there is something physiological going on here aside from elevated potency. Fentanyl is qualitatively different, not just quantitatively. If we look at an oxycodone user laying dead/unconscious on the ground and a fentanyl use folded up but awake...fentanyl being higher potency doesn't really explain the difference in outcome.
Re-reading you comment - Suboxone/Buprenorphine definitely causes euphoria...and quite an intense and long lasting one. I've observed it sold as a drug of abuse in a couple different states.
Adam, there is certainly something qualitatively different about fentanyl as well. For example, you wouldn’t snort oxycodone in a medical setting. Please Google this.
Neither snorting nor medical settings are pertinent to the question.
I am asking about what causes one opiate to produce a different physiological effect than another when ingested in large amounts.
Oxycodone can cause a user to lose consciousness or die regardless of the ingestion method. My question is: Why don't they fold up like fentanyl users as the amount ingested increases? While death and loss of consciousness are well know to result from over ingestion of pretty much all opiates, the fold seems to be associated specifically with fentanyl. Why?
Oxycodone: Sobriety>Sleepiness and Euphoria>Reclined Position>Death
Fentanyl: Sobriety>Sleepiness and Euphoria>Standing Fold>Death
sounds like you should do a more detailed study of this. i haven't heard anyone else with that much to say about it, though it's unsettlingly prevalent.
Remarkable that you wrote an article about the “fentanyl fold” but couldn’t take the time to research why this physical response happens. Poor quality journalism.
So sorry to disappoint you. Actually, newsletters are, or at least mine is, different from published newspaper articles. They are -- or mine is -- intended to be a place to report on stories as I write them, without the full reporting of a published newspaper/magazine story. That's the point of the newsletter. Should I come across information on why the "fold" is so prevalent with fentanyl when it was not with heroin, then I'll certainly repost. My hunch is that there is no one with more than an educated guess as to the reasons behind it as this phenomenon is so new, which shouldn't be surprising as the supplies of fentanyl covering the country are themselves unprecedented and date only to 2019. But I'm open to hearing new ideas.
I am glad to see this being discussed somewhere. My downtown is full of people bent over, walking, or huddling in little intense groups messing with pipes and bits of tinfoil. One rainy spring day I came home from running some unimportant errands and was in emotional tatters at who I had seen lying in the rain on the busy sidewalks. I was shaken at the devastated lives I walked past. I still am. Who can it possible benefit to not take care of our citizens when they need it the most? I am a sober person who counts my lucky star everyday that my pain did not lead me to the streets 💔
That explains it.
The potency of meth on the streets is another issue. Young men are now seen in states of heat exhaustion in San Francisco in public places. Clearly there blood pressure is extremely high. Their risk of a stroke or heart attack under the influence of this high potency metb has to be extremely high.
Yes, I've seen/heard similar from drug counselors and ER personnel. btw, not sure how you come to your knowledge, but if you're interested in talking more, i'd be interested in hearing your story....i'm at samquinones7 at yahoo.com....
The thing is that some of the# wealthy seem to have died or succumbed to fentany too. They just aren't as open about it. They are not exempt. Fentanyl isn't being address by treating overdoses. Every overdose is a massive health interruption.
I'd say that could be true. it happened with pain pills. when it affected the middle and upper classes, they were ashamed and hid it.
The thing is that some of the# wealthy seem to have died or succumbed to fentany too. They just aren't as open about it. They are not exempt. Fentanyl isn't being address by treating overdoses. Every overdose is a massive health interruption.
It’s the xylazine, stupid.
The Europeans discovered in the 1990s that open air drug markets don't work. America ignored that knowledge. It's like it never existed. Or ideology is more important than reality.
I’ve seen the fentanyl fold here in the Boston area,It’s heartbreaking.Let’s end the stigma they need help and no one wants to see this horror
I noticed this bent over posture when the town I used to live in the UK became overrun with synthetic cannabinoids- ‘spice’ users. Maybe just more related to being completely stoned than what drug it is?
Thanks for the continuous coverage of this plague on our streets, Sam. I appreciate your willingness to say the quiet parts out loud—especially when so many others are still tiptoeing around the realities on the ground. You're one of the best journalists working today.
'thanks so much Jonathan! very kind of you....hope to be keeping it going here on the newsletter....
Do yall have tranq out there yet? I'm a recovered heroin addict from Philadelphia. It is hopeless here. Hopeless.
the answer is yes, but perhaps not like what you see in PHL and other nearby areas….
One place the tranq from PHL seems to have gone next is Knoxville, TN. they got a real problem there, I'm told. Seems to me that Philadelphia is a kind of test market area. what works there goes elsewhere.
The major issue in homelessness is not the lack of housing. It's the refusal of society to say no. No, you can't camp in this city. No, you can't shit in the streets. No, you can't panhandle aggressively. No, you can't shoot up publicly and leave your used needles lying around. The fact that we are not going to allow you to destroy our city by doing these things is not our problem. It's your problem. You can solve your problem by not doing drugs, getting help for your mental problems, getting a job, and sharing rent with others so inclined until you can afford a place of your own, probably in a lower cost community.
This is not going to happen because the people we have elected allow the homeless to wallow in their victimhood rather than accept personal responsibility for their self destructiveness.
What specific steps should be taken by cities to deal with the problem? Cities should use all existing shelters and further provide simple shelter space with surplus military tents with mess and recreational tents, a medical tent and restroom and shower facilities (the way I lived in the army) on leased or purchased unused commercial or industrial sites on the outskirts of the city. As many who want to and are able to work should be hired to help feed others and to maintain the facilities. Individuals could use surplus military squad tents or their own for sleeping. When those facilities are available the city should send in crews to clean up existing encampments, without arresting anyone who does not physically resist.
Custodial care should be mandatory for those who are so mentally or drug addicted that they cannot care for themselves. We did a huge disservice to the mentally ill when we closed rather than reform our state mental hospitals. We need them back. This approach actually would cost far less and be far more effective than the current housing first attempts to fix the problem. Most of the homeless lack the capacity to live unassisted in modern society but that is not an excuse to destroy our beautiful cities and drive out our productive citizens.
The essence of mercy is being allowed to experience the consequences of willful behavior.
This from the UK in 2017, on the phenomenon of “Spice Zombies”.
https://metro.co.uk/2017/03/11/shocking-images-show-people-turning-into-zombies-after-taking-drug-spice-6502676/
Welcome to Wrexham.
Sam won’t say it, but I will:
If you haven’t read “The Least of Us” yet, get to it.
Few books I’ve read in my decades on this earth have filled me so full of both sadness and hope.
that's so kind of you. thank you....
I heard you deliver the keynote address at the American Society of Anesthesiologists last October, and it was an epiphany for me. Thank you to your dedication to raising awareness about the drug plague in this country and what courageous citizens are doing to turn the tide.
aw, that’s nice. i had such a great time there. it was a terrific event.
Fentanyl is powerfully sedating and if a person has a higher blood concentration of it than he is used to, he will doze off. Since it's also a respiratory depressant, overdose and death are common. The developed tendency to fight off sleep and experience the euphoric effects of the drug, coupled with the near-collapsed state of profound muscle relaxation, folds the user in half.
Additionally, the increased cerebral blood flow in the head-down position fosters staying in this posture when standing upright would lower cerebro-vascular pressure. FWIW, aluminum toxicity does not present this way. Acute toxicity appears like seizures or rigidity. Chronic aluminum toxicity presents as neurodegenerative changes and cognitive decline.
May I ask if fentanyl is qualitatively or quantitatively different from oxycodone, dilaudid, morphine, methadone, buprenorphine and others?
To my knowledge, these drugs have been on the street for decades....yet the "fentanyl fold" is rather novel.
Hi, I am a nurse who works with people who use fentanyl. Fentanyl is highly potent and addictive - WAY more so than the others you listed. You can look up how many more times potent - it’s quite a lot. Buprenorphine is a partial agonist whereas fentanyl is a full agonist at the mu opioid receptors. One will make you feel high, whereas Suboxone can treat users without producing the same “high” feeling, dependence, and withdrawal if the user quits Suboxone. It also is effective in reducing cravings so people can continue their lives. The cycle of using and then seeking out drugs to get your next use before you withdraw is really tough.
Thanks for the reply. Given that the others (morphine, oxycodone etc) are potent enough at some dosage to induce unconsciousness and even death....why is the "fold" phenomenon NOT observed somewhere on the sober-intoxicated-dead gradient for those drugs?
In other words...why do users of fentanyl adopt the "fold" while users of other opiates transition to a reclined position? All of these are potent enough to kill..but the fold is associated specifically with fentanyl.
It seems like there is something physiological going on here aside from elevated potency. Fentanyl is qualitatively different, not just quantitatively. If we look at an oxycodone user laying dead/unconscious on the ground and a fentanyl use folded up but awake...fentanyl being higher potency doesn't really explain the difference in outcome.
Re-reading you comment - Suboxone/Buprenorphine definitely causes euphoria...and quite an intense and long lasting one. I've observed it sold as a drug of abuse in a couple different states.
Adam, there is certainly something qualitatively different about fentanyl as well. For example, you wouldn’t snort oxycodone in a medical setting. Please Google this.
Neither snorting nor medical settings are pertinent to the question.
I am asking about what causes one opiate to produce a different physiological effect than another when ingested in large amounts.
Oxycodone can cause a user to lose consciousness or die regardless of the ingestion method. My question is: Why don't they fold up like fentanyl users as the amount ingested increases? While death and loss of consciousness are well know to result from over ingestion of pretty much all opiates, the fold seems to be associated specifically with fentanyl. Why?
Oxycodone: Sobriety>Sleepiness and Euphoria>Reclined Position>Death
Fentanyl: Sobriety>Sleepiness and Euphoria>Standing Fold>Death
INTERESTING! I have been wondering how they maintain enough consciousness to stay balanced.
sounds like you should do a more detailed study of this. i haven't heard anyone else with that much to say about it, though it's unsettlingly prevalent.
Remarkable that you wrote an article about the “fentanyl fold” but couldn’t take the time to research why this physical response happens. Poor quality journalism.
So sorry to disappoint you. Actually, newsletters are, or at least mine is, different from published newspaper articles. They are -- or mine is -- intended to be a place to report on stories as I write them, without the full reporting of a published newspaper/magazine story. That's the point of the newsletter. Should I come across information on why the "fold" is so prevalent with fentanyl when it was not with heroin, then I'll certainly repost. My hunch is that there is no one with more than an educated guess as to the reasons behind it as this phenomenon is so new, which shouldn't be surprising as the supplies of fentanyl covering the country are themselves unprecedented and date only to 2019. But I'm open to hearing new ideas.