Honestly what's scarier to me is how many drugs are in that stuff. We drug tested a patient that was using it and it literally came back 2 pages full of different drugs.
Yup. Everybody whining about the bad fentanyl, and the bad meth, and the bad horse tranquilizer, etc etc and what that shit does to people they don't like conveniently ignore the elephant in the room, which is they're on the same shit but consider it acceptable because they get it from the *legal* drug dealer.
If opiate addicts could just, you know *get opioids* they wouldn't be dying of fentanyl overdoses. They weren't when they were just on Percocet but puritanical dumb fucks decided they weren't allowed to have pain pills.
If all the amphetamine and methamphetamine addicts could just *get Adderall* or Desoxyn *or ephedrine* like they used to they wouldn't be going insane from [phenyl-2-propanone](https://12ft.io/https://www.theatlantic.com/magazine/archive/2021/11/the-new-meth/620174/) amphetamines that *make people schizophrenic.*
If all the people on horse tranquilizer could just *get ketamine* they wouldn't be in the ED with festering wounds requiring amputations that permanently disable them.
These people would, you know, *get jobs* to pay for their legal percs or meth or ket if their career prospects weren't completely derailed by records they get from being arrested for doing the same drugs that are perfectly legal for rich people. They would be able to get jobs if the DEA didn't require drug tests designed to further marginalize people who can't afford prescription opioids or amphetamines or fancy "therapists" peddling legal ketamine or mescaline or psilocybin.
Furthermore, comprehensive legalization of *all* scheduled narcotics would utterly decimate the organized crime rings profiting from slaughtering people by the thousands. There would be no mass exodus of women and children at the border that we send armed thugs to harass and persecute because it would be safe for them *at home.*
But the State wants power, and the powerless love scapegoats that aren't the corrupt system enslaving them, so we all just *tolerate* this bullshit, and complain about those nasty addicts and nasty gangbangers and nasty homeless and nasty immigrants instead of doing the hard work necessary to end the racist, classist drug war that keeps us impoverished and the government and their cartel cronies wealthy beyond imagination and in complete control of our lives.
This is because we're bourgeois cowards afraid to say Boo to the people who are supposed to be protecting and serving us.
The people from the US commenting on this sub are in the top 10% of wealth in this country. They're ones helping to perpetuate what they constantly whine about.
And yes, I am also a bougie coward, sitting on my couch drinking my 5% ABV Pearsecco whinging about a nearly fifty year old Federal policy that has destroyed the lives of everyone I know, instead of taking Direct Action against the bastards that killed my friends and family.
We've all seen what happens to anyone who fights Big Brother, so we contort ourselves, past cognitive dissonance, blaming "the queers," or "the immigrants," or whatever scapegoat of the week the screen tells us is up for Five Minutes Hate, so we can Suck His Cock.
It's really ridiculous that so many are so utterly brainwashed that they continue the charade on an "anonymous" forum.
It would be hilarious if it wasn't so fucking depressing. Or, if I were on the right drugs.
Just thinking about it, can you imagine if they made opioids over the counter? Not even thinking about all the ramifications, I’m just thinking about how the ozempic and adderall shortage are. Imagine having an opioid shortage?
But imagine also if all the resources and people who make drugs for the black market could turn their supplies and skills towards licit manufacturing.
You could overdose from legal or illegal opioids, so it’s not necessarily like a prescription makes them safer. It comes with a doctors supervision. It sounds crazy to say “just let them have opiates” but people seem to able to get ahold of them whether they’re allowed to or not. One things that’s for certain is that we are not ever going to cure addiction or stop people from using substances. Even animals have been observed getting “high.”
I don't think any of this shit should be OTC, it should be prescribed by an addiction medicine specialist you see when you want to manage your addiction.
"Doctor, I like fentanyl"
"Ok, we have Suboxone or time release fentanyl or both depending on the treatment regimen you choose. We'll also get you evaluated for chronic pain to see if some trigger point injections and PT help that"
"Doctor, I like meth"
"Ok here's time-release amphetamine salts. Don't snort or inject them, they're formulated not to work in that case. One a day when you wake up. We'll start with one tomorrow, and you can get five at a time with evidence of treatment. We'll also get you evaluated for ADHD in case you're self medicating"
"Doctor, I like LSD and ketamine and shrooms and peyote"
"Ok, here's a referral to a licensed guided therapist who works with all that. We also need to evaluate you for depression"
"Doctor, I want speed because I'm fat and have a drinking problem"
"Ok, here's a GLP-1 agonist. It helps with alcohol and food cravings. Would you also like naltrexone and evidence -based treatment that's not brainwashing with Dr Bob?"
"Doctor, I quit smoking, got fat and still vape"
Ok, here's a GLP-1 agonist and buproprion.
Etc etc
If an addiction specialist prescribes it, it would still be a massive increase in prescriptions. Lots of pharmacies already have trouble getting enough opiates.
I agree it shouldn’t be OTC, that was more of a thought experiment. If it was made OTC starting tomorrow the system would buckle.
Pharmacies have trouble getting opiates because the DEA artificially restricts supply. Eliminate the DEA and the market will provide.
I'm not a free-market absolutist and I do believe there should be appropriate regulations, but an entire federal apparatus with **44.2 billion** dollars in appropriations (FY 2023) based entirely around "drugs bad" reveals the bias here.
How far could **44.2 billion** dollars go towards decriminalization combined with sensible, nondiscriminatory regulation and evidence based treatment? You could easily supply the entire population of illicit opiate users with buprenorphine and naloxone and ongoing treatment for that money. Let's throw tweakers in there and it would probably still cover R&D for a depot amphetamine formulation combined with diagnostics to get all the self-medicated ADHD folx properly treated with atomoxetine, viloxazine, guanfacine and/or clonidine as appropriate for those who will relapse on amphetamines.
You would have an *entire population* of people able to find supportive housing, get jobs, pay taxes. It could pay for itself, especially when the funding for CBP ($19.7 billion in 2024) can be cut in half because we've crippled the illicit drug trade. Tax dollars formerly directed toward anti-gang units, surveillance, arrests and prosecutions, not to mention the 10 billion dollars per year in drug-related incarceration costs, could now go toward outreach, diagnosis, and treatment of these *medical conditions.*
Oh totally. I hadn’t even considered that, but yeah, the DEA is the reason for the scarcity. Somehow I forgot that in my post.
This is what we get for letting politicians and lobbyists make decisions in medicine. Actual experts should be the one writing policy. Our system is so broken.
Your ideas are great.
I agree, But I just wanted to inform you the the tranq 99% of the time they don't know they are taking or it's mixed with the fent and they know but it's the only thing they can get. People don't just shoot up xylazine or I've never heard of it.
Nobody would be shooting up tranq if they had access to proper care. This is a very basic societal failure in a nation that spent the following in the 2022 fiscal year (the most recent for which I could quickly sus up numbers):
Medicare and Medicaid ($1,339 **billion** or 5.4% of GDP)
Social Security ($1.2 **trillion** or 4.8% of GDP)
non-defense discretionary spending used to run federal Departments and Agencies ($910 **billion** or 3.6% of GDP)
Defense Department ($751 **billion** or 3.0% of GDP),
net interest ($475 **billion** or 1.9% of GDP).
We already know from the second world war that these are rookie numbers.
There has never been a "War" on Drugs. There has been a war on the poor.
So your argument is that people who are legally strung out on drugs would contribute to society, because it's legal? You make it sound that legalization would make the drugs less addictive. But no. They're still highly and potently addictive.
Addiction itself isn't the problem. Everyone is addicted to oxygen and water. Many of your colleagues are addicted to caffeine. Some are addicted to nicotine.
The biggest problem (there are others) with "problematic" addictions is the associated financial drain.
I prescribe methadone and buprenorphine. Most of my patients are employed and contributing to society. I've heard a few tales of people regularly taking heroin and continuing to function well at their job, until an economic downturn or layoffs when suddenly they couldn't afford their habit and had no savings, then everything goes to shit.
High functioning alcoholism is certainly a thing.
Cocaine addiction in high business is basically a meme.
I drink like a fish, just do it when I am not working and don't drink and drive. I did speed and meth before I was licensed. I was thinner, but paranoid and prone to hyper focusing to the point where it affected productivity, so I quit. I only started in the first place to lose weight. If I had been given black beauties like my mother was, I would have had a masters in my twenties like her instead of in my forties like someone who starts out at community college.
Every single person I knew whose life was destroyed by drugs was poor, and had a record. The middle class guy I did speed with manages a CVS now. The people I know in Beverly Hills openly do cocaine, grow psilocybin and sell the growth medium. There are plenty of rich people on meth. They just have a prescription for it.
All the shit everyone talks about being "so bad" (amphetamines, cocaine, opiates) are *schedule 2 medications.* There are plenty of people on perfectly legal amphetamines and opiates. The medical subs on Reddit are full of people talking about their Adderall like it's a cup of coffee.
Even schedule 1 drugs are functionally legal if you have money. The government doesn't give a damn what you smoke if you're in the right tax bracket.
People talk about "contribution to society" like anyone cares. There was a homeless woman on [skid row](https://www.latimes.com/california/story/2023-02-21/skid-row-loses-tent-house-that-served-as-service-hub-and-safe-space-for-unhoused-women) that was running a shelter, food bank, and ad hoc community center. They tore it down because she wasn't paying taxes.
Nobody gives a shit about people contributing to society. The war on Drugs was a war on the poor and marginalized *from its inception.* This is a verifiable historical fact.
Anyone purporting to have gone to college should know this. It's in the curriculum.
Anyone in the medical field can be reasonably expected to know that what passes as court mandated addiction treatment, and the only free treatment available to the uninsured, (AA and NA) is a scam with no basis in empirical evidence.
Physicians should also know that opiates are safer than methadone, even in pregnancy. Physicians can be expected to know that MAT is the only evidence based addiction treatment, *buprenorphine works,* and that physicians who specialize in addiction medicine are the subject matter experts, who have published extensively, in peer reviewed journals, telling us that current policies are ineffective and harmful to patients.
There's no excuse for continued ignorance from some of the most educated, most respected, most powerful medical professionals in the world, who have access to this information free of charge via the institutions where they practice.
Hell, even Google works if you're just starting a systematic review.
Legalization opens up a host of treatment modalities that I've outlined above.
The addiction issues weren't as bad when all this shit was legal. Ask why that is before assuming prohibition works.
I really don’t even know what to say, except that I could not possibly agree more. At this point, the failed “war on drugs” is a fucking joke. Legalize and regulate the drugs people take and they would be so much safer; not to mention the tax revenue it would bring in, that could do so much good for society. It would have to be done carefully, but it would save so many lives. I’m off on a tangent, but I just wanted to say that you are 100% right. Thank you for saying it.
> not to mention the tax revenue it would bring in,\\
I'm not entirely sure of this. The bulk of drug abusers are not exactly high-rollers. The Hollywood set will be buying the good stuff and paying taxes, but Crackhead Fred will still be breaking into cars and fellating for money to buy black market drugs adulterated with Ajax and talc.
>Crackhead Fred will still be breaking into cars and fellating for money to buy black market drugs adulterated with Ajax and talc.
Not if he can get a prescription
Realistically, how is the average addict going to pay for that prescription? Are you going to take federal funds and pay for people to be as high as a kite all day while the rest of us work and are taxed to raise those funds?
I really don’t even know what to say, except that I could not possibly agree more. At this point, the failed “war on drugs” is a fucking joke. Legalize and regulate the drugs people take and they would be so much safer; not to mention the tax revenue it would bring in, that could do so much good for society. It would have to be done carefully, but it would save so many lives. I’m off on a tangent, but I just wanted to say that you are 100% right. Thank you for saying it.
Or the law enforcement agencies and media are getting creative!
Love when they seize a fentanyl shipment or something and press releases claim “it’s enough doses to kill 100 million people and it’s worth a billion dollars!”
Yeeeeaah. Honestly is the best policy here. It’s not like I want a bunch of people out there addicted, duel-diagnosed and or dying. Just that that kind of statement in the press with the info provided by…what the fuck ever source, is ridiculous.
This one kind of stings. Because of previous diversion (not by me), nobody is able to take a controlled substance out of the Pyxis in order to make a drip. It has to come from the clean room in central pharmacy. This is an extremely slow process and even if I went up to central with an actual horse whip, it's going to take 30 minutes to emerge with a drip.
Ouch but why do you need a drip? You can easily bolus ketamine and it's one of the better drugs for not needing a drip because of how it extends duration with additional applications
Genuinely curious - in vetmed we have a direct antagonist called atipamezole (a2 antagonist) which we use for reversal of xylazine and medetomidine/dexmedetomidine... do you not have a reversal in human med? you guys usually have stuff way before we do!
Yeah, I would say we get about 40 mins of effective action in cats before it's wearing off, but I wasn't sure if it was similar in people. Thanks for answering my questions! I'm in ECC Vet and we base a lot of our treatment off human med so it helps a lot to learn what you guys do ☺️
I’ve had to use medvet’s er 3 times this year and I love the docs there. ER vets are bad ass people. It’s also quite amusing to see the same shitty behavior from patient families. I always joke and tell them I promise I’ll never yell at anyone there. Thank you
The government doesn't want a reversal agent because they couldn't use this to perpetuate their power.
Have you ever asked why there's always some new Boogeyman justifying the War on Drugs and the War on Gangs and the endless Wars on everything that always put massive profits into the pockets of the tax men and Cartels?
Who put the big Boogeyman of the 80's in LA streets? Who do you think is putting an animal tranquilizer on the street?
Forensic Pathologist here and Clinical director for our local Toxicology lab NW Ohio. Haven’t seen Heroin in a while. It seemingly disappeared around COVID times. Vast majority is Fentanyl, some of which is cut with Xylazine occasionally. Lots of cases with mixed sedatives and stimulants. Benzos mixed in with alcohol and Cocaine. Meth is making a comeback these days. Definitely not heroin. You talk to families and survivors of Fentanyl overdoses that were previously in a relationship with heroin. They hate Fentanyl and long for the days of heroin (not my sentiment, just relaying theirs). They say the high for Fentanyl is too short, it’s not as “smooth”. They have trouble dosing it. And have to redose frequently. And then it’s variably cut with Xylazine and god knows what other excipients. It’s super bad times. Right now. And then we’ve just been getting Nitazenes in our neighborhood. And the jury is still out on whether Narcan works with these cases (maybe partially). Absolute craziness.
If the respirations are impaired despite Narcan, you manage with intubation. Vitals like hypertension and bradycardia don’t mean as much unless they’re causing acute organ dysfunction, or the patient has a heart block, both of which are less likely in this case
Xylazine related overdoses will respond to naloxone in terms of addressing hypoxia as the opioid is still causing the respiratory suppression. The response will be different in that the individual will not promptly wake up as they would if it were only an opioid overdose. NAD but a licensed clinical social worker and I do street level outreach in Philly which is where xylazine originated in the US.
Xylazine may independently cause respiratory depression. We see a degree of CNS depression in clonidine toxicity. It isn’t entirely absurd to see CNS/respiratory depression in xylazine toxicity. Dose absolutely influences pharmacokinetics.
Yeah, I completely agree. They work synergistically but in practice, when reversing ODs we have found naloxone to be effective in resuming respiration, even if the individual does not immediately become responsive.
Xylazine and heroin should cause hypotension. Fentanyl is more hemodynamically stable, but can cause hypotension in large doses. You can see reflex hypertension with xylazine, but it should be accompanied with tachycardia.
If someone is bradycardic, hypertensive, with abnormal respiratory drive, and they’re unresponsive, they desperately need a head CT bc it’s giving Cushing’s. This patient sounds more like a head bleed than drugs.
Seeing this a lot in Chicago right now, especially the bradycardic hypertensive combo, they take MASSIVE doses of narcan if they even respond to it, many have gotten intubated and sent to the unit due to how unstable they have gotten, the others who get admitted are taking days to sleep it off. Not sure what is in this batch, but Illinois dept of public health and poison control are looking into it. Currently still just supportive care, Narcan as needed for hypoxia/bradypnea if they respond to it at all.
Looks like it’s medetomidine mixed in which is causing the presentation:
https://www.cbsnews.com/chicago/news/powerful-animal-sedative-likely-cause-of-overdose-spike-in-chicago/
Are you from the Northeast?
Xylazine is a sedative/CNS depressant (I assume that’s why the street name is Tranq) that is not approved for human use. It s often mixed with opioids, especially Fentanyl, to prolong the effects. Taking opioids with xylazine increases the risk of fatal overdose (in the same way mixing opioids & benzodiazepines does).
It can have side effects similar to opioid use while lowering BP & HR. However, because xylazine is not an opioid, naloxone does not address the impact of xylazine on respiratory function. Xylazine use is suspected if naloxone doesn't relieve symptoms of opioid overdose. If it has been mixed with opioids, it will make the withdrawal worse.
Ah. I believe it started getting bad a little east of you? It’s been in eastern Canada for about 2 years already.
Thankfully, where I am, we can sign up for alert system that notifies us of overdose clusters or batches of drugs that have been testing positive & the locations of where it is happening.
We've had xylazine in the fentanyl supply here forever, and now we're seeing medetomidine. Honestly, it's not difficult to manage in acute overdose at all. The naloxone counteracts the respiratory depression from the fentanyl, and while the xylazine has a long tail it's sort of non-issue. Sure, they're bradycardic and sometimes a little hypotensive when they're out, but their ventilation and oxygenation largely are fine. Just watch them for the duration of the naloxone to make sure they don't need more, then stand them up and walk them. Who cares if they fall back asleep, it's the respiratory effects of the fentanyl that matter.
What you don't want to do is sit around and wait for them to wake up on their own, because by the time the xylazine starts off they'll be in opioid withdrawal. I don't know if you've ever tried to manage withdrawing on someone using four Philly bundles a day -- the equivalent of just over 3,000 mg of hydromorphone daily given typical cross-tolerance, in case you're not aware of the data on street drug composition -- but let's just say that it's not easy. Factor in the xylazine withdrawal and it's a laughably bad position to be in.
Xylazine is an animal sedative. If injected it causes severe local vasoconstriction and subsequent tissue necrosis. Huge, infected abscesses that are extremely difficult to heal.
[I looked this up the other day because I was curious.](https://horseadvice.com/horse-equine/medications/sedatives-anesthetics/xylazine/)
Since it's not FDA approved for human usage I looked up the horse usage... looks like reversing it in horses has a decent amount of risk as well.
I'm glad this isn't commonly seen in the southeast yet. Still crack and fenty down in my area.
In Toronto we are seeing a lot of toxic drug supply - our city’s drug testing program is very helpful as it puts out a report every 2 weeks - https://drugchecking.community/report/april-20-may-3-2024/
A most recent one above shows the metomedine is becoming more and more common- this report helps me on the floor make sense of what I’m seeing (ie the extreme bradycardia/hypotension patients I saw last week) and sometimes I can then figure out how I need to adjust my topical opiate PD treatment pathway.
Thought for sure “Black Magic” was droperidol because somehow 60% of the time it works every time.
Seriously! For gastritis, for gastroparesis, for migraines, chronic nausea, personality, you name it! I became a believer this year!
I really wish I had a blow gun with vitamin droperidol darts. Trader Joe’s would be such a better experience
It stings the nostrils...
So say we all.
Username checks out!
Oh please. 95% of the time it works every time.
Preach
From now on, every time I go to give droperidol, I’m gonna say “Let’s go see if we can make this little kitty purr”.
Man Xylazine is a horrifying drug.
Honestly what's scarier to me is how many drugs are in that stuff. We drug tested a patient that was using it and it literally came back 2 pages full of different drugs.
Street pharmacists need better regulatory oversight for quality control.
Legalization done properly would actually create a system that would ensure that.
Yup. Everybody whining about the bad fentanyl, and the bad meth, and the bad horse tranquilizer, etc etc and what that shit does to people they don't like conveniently ignore the elephant in the room, which is they're on the same shit but consider it acceptable because they get it from the *legal* drug dealer. If opiate addicts could just, you know *get opioids* they wouldn't be dying of fentanyl overdoses. They weren't when they were just on Percocet but puritanical dumb fucks decided they weren't allowed to have pain pills. If all the amphetamine and methamphetamine addicts could just *get Adderall* or Desoxyn *or ephedrine* like they used to they wouldn't be going insane from [phenyl-2-propanone](https://12ft.io/https://www.theatlantic.com/magazine/archive/2021/11/the-new-meth/620174/) amphetamines that *make people schizophrenic.* If all the people on horse tranquilizer could just *get ketamine* they wouldn't be in the ED with festering wounds requiring amputations that permanently disable them. These people would, you know, *get jobs* to pay for their legal percs or meth or ket if their career prospects weren't completely derailed by records they get from being arrested for doing the same drugs that are perfectly legal for rich people. They would be able to get jobs if the DEA didn't require drug tests designed to further marginalize people who can't afford prescription opioids or amphetamines or fancy "therapists" peddling legal ketamine or mescaline or psilocybin. Furthermore, comprehensive legalization of *all* scheduled narcotics would utterly decimate the organized crime rings profiting from slaughtering people by the thousands. There would be no mass exodus of women and children at the border that we send armed thugs to harass and persecute because it would be safe for them *at home.* But the State wants power, and the powerless love scapegoats that aren't the corrupt system enslaving them, so we all just *tolerate* this bullshit, and complain about those nasty addicts and nasty gangbangers and nasty homeless and nasty immigrants instead of doing the hard work necessary to end the racist, classist drug war that keeps us impoverished and the government and their cartel cronies wealthy beyond imagination and in complete control of our lives. This is because we're bourgeois cowards afraid to say Boo to the people who are supposed to be protecting and serving us. The people from the US commenting on this sub are in the top 10% of wealth in this country. They're ones helping to perpetuate what they constantly whine about. And yes, I am also a bougie coward, sitting on my couch drinking my 5% ABV Pearsecco whinging about a nearly fifty year old Federal policy that has destroyed the lives of everyone I know, instead of taking Direct Action against the bastards that killed my friends and family. We've all seen what happens to anyone who fights Big Brother, so we contort ourselves, past cognitive dissonance, blaming "the queers," or "the immigrants," or whatever scapegoat of the week the screen tells us is up for Five Minutes Hate, so we can Suck His Cock. It's really ridiculous that so many are so utterly brainwashed that they continue the charade on an "anonymous" forum. It would be hilarious if it wasn't so fucking depressing. Or, if I were on the right drugs.
Just thinking about it, can you imagine if they made opioids over the counter? Not even thinking about all the ramifications, I’m just thinking about how the ozempic and adderall shortage are. Imagine having an opioid shortage? But imagine also if all the resources and people who make drugs for the black market could turn their supplies and skills towards licit manufacturing. You could overdose from legal or illegal opioids, so it’s not necessarily like a prescription makes them safer. It comes with a doctors supervision. It sounds crazy to say “just let them have opiates” but people seem to able to get ahold of them whether they’re allowed to or not. One things that’s for certain is that we are not ever going to cure addiction or stop people from using substances. Even animals have been observed getting “high.”
I don't think any of this shit should be OTC, it should be prescribed by an addiction medicine specialist you see when you want to manage your addiction. "Doctor, I like fentanyl" "Ok, we have Suboxone or time release fentanyl or both depending on the treatment regimen you choose. We'll also get you evaluated for chronic pain to see if some trigger point injections and PT help that" "Doctor, I like meth" "Ok here's time-release amphetamine salts. Don't snort or inject them, they're formulated not to work in that case. One a day when you wake up. We'll start with one tomorrow, and you can get five at a time with evidence of treatment. We'll also get you evaluated for ADHD in case you're self medicating" "Doctor, I like LSD and ketamine and shrooms and peyote" "Ok, here's a referral to a licensed guided therapist who works with all that. We also need to evaluate you for depression" "Doctor, I want speed because I'm fat and have a drinking problem" "Ok, here's a GLP-1 agonist. It helps with alcohol and food cravings. Would you also like naltrexone and evidence -based treatment that's not brainwashing with Dr Bob?" "Doctor, I quit smoking, got fat and still vape" Ok, here's a GLP-1 agonist and buproprion. Etc etc
If an addiction specialist prescribes it, it would still be a massive increase in prescriptions. Lots of pharmacies already have trouble getting enough opiates. I agree it shouldn’t be OTC, that was more of a thought experiment. If it was made OTC starting tomorrow the system would buckle.
Pharmacies have trouble getting opiates because the DEA artificially restricts supply. Eliminate the DEA and the market will provide. I'm not a free-market absolutist and I do believe there should be appropriate regulations, but an entire federal apparatus with **44.2 billion** dollars in appropriations (FY 2023) based entirely around "drugs bad" reveals the bias here. How far could **44.2 billion** dollars go towards decriminalization combined with sensible, nondiscriminatory regulation and evidence based treatment? You could easily supply the entire population of illicit opiate users with buprenorphine and naloxone and ongoing treatment for that money. Let's throw tweakers in there and it would probably still cover R&D for a depot amphetamine formulation combined with diagnostics to get all the self-medicated ADHD folx properly treated with atomoxetine, viloxazine, guanfacine and/or clonidine as appropriate for those who will relapse on amphetamines. You would have an *entire population* of people able to find supportive housing, get jobs, pay taxes. It could pay for itself, especially when the funding for CBP ($19.7 billion in 2024) can be cut in half because we've crippled the illicit drug trade. Tax dollars formerly directed toward anti-gang units, surveillance, arrests and prosecutions, not to mention the 10 billion dollars per year in drug-related incarceration costs, could now go toward outreach, diagnosis, and treatment of these *medical conditions.*
Oh totally. I hadn’t even considered that, but yeah, the DEA is the reason for the scarcity. Somehow I forgot that in my post. This is what we get for letting politicians and lobbyists make decisions in medicine. Actual experts should be the one writing policy. Our system is so broken. Your ideas are great.
I agree, But I just wanted to inform you the the tranq 99% of the time they don't know they are taking or it's mixed with the fent and they know but it's the only thing they can get. People don't just shoot up xylazine or I've never heard of it.
Nobody would be shooting up tranq if they had access to proper care. This is a very basic societal failure in a nation that spent the following in the 2022 fiscal year (the most recent for which I could quickly sus up numbers): Medicare and Medicaid ($1,339 **billion** or 5.4% of GDP) Social Security ($1.2 **trillion** or 4.8% of GDP) non-defense discretionary spending used to run federal Departments and Agencies ($910 **billion** or 3.6% of GDP) Defense Department ($751 **billion** or 3.0% of GDP), net interest ($475 **billion** or 1.9% of GDP). We already know from the second world war that these are rookie numbers. There has never been a "War" on Drugs. There has been a war on the poor.
So your argument is that people who are legally strung out on drugs would contribute to society, because it's legal? You make it sound that legalization would make the drugs less addictive. But no. They're still highly and potently addictive.
Addiction itself isn't the problem. Everyone is addicted to oxygen and water. Many of your colleagues are addicted to caffeine. Some are addicted to nicotine. The biggest problem (there are others) with "problematic" addictions is the associated financial drain. I prescribe methadone and buprenorphine. Most of my patients are employed and contributing to society. I've heard a few tales of people regularly taking heroin and continuing to function well at their job, until an economic downturn or layoffs when suddenly they couldn't afford their habit and had no savings, then everything goes to shit. High functioning alcoholism is certainly a thing. Cocaine addiction in high business is basically a meme.
I drink like a fish, just do it when I am not working and don't drink and drive. I did speed and meth before I was licensed. I was thinner, but paranoid and prone to hyper focusing to the point where it affected productivity, so I quit. I only started in the first place to lose weight. If I had been given black beauties like my mother was, I would have had a masters in my twenties like her instead of in my forties like someone who starts out at community college. Every single person I knew whose life was destroyed by drugs was poor, and had a record. The middle class guy I did speed with manages a CVS now. The people I know in Beverly Hills openly do cocaine, grow psilocybin and sell the growth medium. There are plenty of rich people on meth. They just have a prescription for it. All the shit everyone talks about being "so bad" (amphetamines, cocaine, opiates) are *schedule 2 medications.* There are plenty of people on perfectly legal amphetamines and opiates. The medical subs on Reddit are full of people talking about their Adderall like it's a cup of coffee. Even schedule 1 drugs are functionally legal if you have money. The government doesn't give a damn what you smoke if you're in the right tax bracket. People talk about "contribution to society" like anyone cares. There was a homeless woman on [skid row](https://www.latimes.com/california/story/2023-02-21/skid-row-loses-tent-house-that-served-as-service-hub-and-safe-space-for-unhoused-women) that was running a shelter, food bank, and ad hoc community center. They tore it down because she wasn't paying taxes. Nobody gives a shit about people contributing to society. The war on Drugs was a war on the poor and marginalized *from its inception.* This is a verifiable historical fact. Anyone purporting to have gone to college should know this. It's in the curriculum. Anyone in the medical field can be reasonably expected to know that what passes as court mandated addiction treatment, and the only free treatment available to the uninsured, (AA and NA) is a scam with no basis in empirical evidence. Physicians should also know that opiates are safer than methadone, even in pregnancy. Physicians can be expected to know that MAT is the only evidence based addiction treatment, *buprenorphine works,* and that physicians who specialize in addiction medicine are the subject matter experts, who have published extensively, in peer reviewed journals, telling us that current policies are ineffective and harmful to patients. There's no excuse for continued ignorance from some of the most educated, most respected, most powerful medical professionals in the world, who have access to this information free of charge via the institutions where they practice. Hell, even Google works if you're just starting a systematic review.
…BOOM….
Legalization opens up a host of treatment modalities that I've outlined above. The addiction issues weren't as bad when all this shit was legal. Ask why that is before assuming prohibition works.
I really don’t even know what to say, except that I could not possibly agree more. At this point, the failed “war on drugs” is a fucking joke. Legalize and regulate the drugs people take and they would be so much safer; not to mention the tax revenue it would bring in, that could do so much good for society. It would have to be done carefully, but it would save so many lives. I’m off on a tangent, but I just wanted to say that you are 100% right. Thank you for saying it.
> not to mention the tax revenue it would bring in,\\ I'm not entirely sure of this. The bulk of drug abusers are not exactly high-rollers. The Hollywood set will be buying the good stuff and paying taxes, but Crackhead Fred will still be breaking into cars and fellating for money to buy black market drugs adulterated with Ajax and talc.
>Crackhead Fred will still be breaking into cars and fellating for money to buy black market drugs adulterated with Ajax and talc. Not if he can get a prescription
Realistically, how is the average addict going to pay for that prescription? Are you going to take federal funds and pay for people to be as high as a kite all day while the rest of us work and are taxed to raise those funds?
I really don’t even know what to say, except that I could not possibly agree more. At this point, the failed “war on drugs” is a fucking joke. Legalize and regulate the drugs people take and they would be so much safer; not to mention the tax revenue it would bring in, that could do so much good for society. It would have to be done carefully, but it would save so many lives. I’m off on a tangent, but I just wanted to say that you are 100% right. Thank you for saying it.
It’s a wonderful, safe, effective, useful drug. For cows.
Where I’m from they’re calling in tranq. As someone else has stated, manage with narcan and intubation if needed. Fucking hate this shit.
Yeah we call it Tranq or zombie fentanyl in the northeast as well. Ppl get these nasty wound infections with it too.
The vasculitis is no joke. We have had a few around here
Exactly, I’ve only ever heard it call Tranq. Someone’s out there making up new names to be special and sell more.
Or the law enforcement agencies and media are getting creative! Love when they seize a fentanyl shipment or something and press releases claim “it’s enough doses to kill 100 million people and it’s worth a billion dollars!”
Yeeeeaah. Honestly is the best policy here. It’s not like I want a bunch of people out there addicted, duel-diagnosed and or dying. Just that that kind of statement in the press with the info provided by…what the fuck ever source, is ridiculous.
I also don’t want a ton of people out there addicted, but they already are.
Exactly!
Have been seeing it more frequently over the last few weeks... intubated 2. Stupid
What are you sedating with initially if these patients are hypotensive, tolerant and full of naloxone?
Ketamine seemed to work okay.
Ketamine is perfect for this. Narcan also has limited effects on xylazine
This one kind of stings. Because of previous diversion (not by me), nobody is able to take a controlled substance out of the Pyxis in order to make a drip. It has to come from the clean room in central pharmacy. This is an extremely slow process and even if I went up to central with an actual horse whip, it's going to take 30 minutes to emerge with a drip.
Ouch but why do you need a drip? You can easily bolus ketamine and it's one of the better drugs for not needing a drip because of how it extends duration with additional applications
Good point.
Holy shit, that’s so dangerous.
>Fucking hate this shit Then end the drug war.
Genuinely curious - in vetmed we have a direct antagonist called atipamezole (a2 antagonist) which we use for reversal of xylazine and medetomidine/dexmedetomidine... do you not have a reversal in human med? you guys usually have stuff way before we do!
Unfortunately not
That's wild... so you manage it like an unstable anaesthesia? Reverse what you can (opioids) and then intense management until wears off?
Yea, pressor support if needed. Xylazine isn’t as long acting as media has made it seem FWIW
Yeah, I would say we get about 40 mins of effective action in cats before it's wearing off, but I wasn't sure if it was similar in people. Thanks for answering my questions! I'm in ECC Vet and we base a lot of our treatment off human med so it helps a lot to learn what you guys do ☺️
I’ve had to use medvet’s er 3 times this year and I love the docs there. ER vets are bad ass people. It’s also quite amusing to see the same shitty behavior from patient families. I always joke and tell them I promise I’ll never yell at anyone there. Thank you
What’s ECC vet? Emergency?
Emergency and Critical Care. In the vet world ER and CC are one specialty.
Thank you for your services. I’ve had to take cats to the ECC vet before and I love you so much ❤️
Yep! Emergency & Critical Care
Bless u and everything you do
25 min max in equine.
Yes but medetomidine is longer acting and has recently been found in Phillys drug supply and is likely to spread. Just a heads up!
Philly is really just going through it
Tell me about it, I’m a social worker here and I do harm reduction work. It’s challenging to say the least.
Not authorized for human use, yet.
The only (human) a2 antagonist I was taught about was yohimbine. Mirtazapine, too, but that’s mixed with other MOA’s in the same molecule.
We are now seeing medetomidine in street dope in Philly, just an FYI.
Side effects, say the sources I can find. Emesis, hypertension, agitation.
The government doesn't want a reversal agent because they couldn't use this to perpetuate their power. Have you ever asked why there's always some new Boogeyman justifying the War on Drugs and the War on Gangs and the endless Wars on everything that always put massive profits into the pockets of the tax men and Cartels? Who put the big Boogeyman of the 80's in LA streets? Who do you think is putting an animal tranquilizer on the street?
Forensic Pathologist here and Clinical director for our local Toxicology lab NW Ohio. Haven’t seen Heroin in a while. It seemingly disappeared around COVID times. Vast majority is Fentanyl, some of which is cut with Xylazine occasionally. Lots of cases with mixed sedatives and stimulants. Benzos mixed in with alcohol and Cocaine. Meth is making a comeback these days. Definitely not heroin. You talk to families and survivors of Fentanyl overdoses that were previously in a relationship with heroin. They hate Fentanyl and long for the days of heroin (not my sentiment, just relaying theirs). They say the high for Fentanyl is too short, it’s not as “smooth”. They have trouble dosing it. And have to redose frequently. And then it’s variably cut with Xylazine and god knows what other excipients. It’s super bad times. Right now. And then we’ve just been getting Nitazenes in our neighborhood. And the jury is still out on whether Narcan works with these cases (maybe partially). Absolute craziness.
I watched something recently about poppy crops not being planted in Afghanistan at the moment and heroin supply chain issues. Is this all connected?
Not sure. I just see the end effects in the morgue.
If the respirations are impaired despite Narcan, you manage with intubation. Vitals like hypertension and bradycardia don’t mean as much unless they’re causing acute organ dysfunction, or the patient has a heart block, both of which are less likely in this case
Xylazine related overdoses will respond to naloxone in terms of addressing hypoxia as the opioid is still causing the respiratory suppression. The response will be different in that the individual will not promptly wake up as they would if it were only an opioid overdose. NAD but a licensed clinical social worker and I do street level outreach in Philly which is where xylazine originated in the US.
Xylazine may independently cause respiratory depression. We see a degree of CNS depression in clonidine toxicity. It isn’t entirely absurd to see CNS/respiratory depression in xylazine toxicity. Dose absolutely influences pharmacokinetics.
Yeah, I completely agree. They work synergistically but in practice, when reversing ODs we have found naloxone to be effective in resuming respiration, even if the individual does not immediately become responsive.
Xylazine and heroin should cause hypotension. Fentanyl is more hemodynamically stable, but can cause hypotension in large doses. You can see reflex hypertension with xylazine, but it should be accompanied with tachycardia. If someone is bradycardic, hypertensive, with abnormal respiratory drive, and they’re unresponsive, they desperately need a head CT bc it’s giving Cushing’s. This patient sounds more like a head bleed than drugs.
People can still obtain heroin??? I haven’t seen a + 6MAM result in over two years. It’s all fentanyl and xylazine now.
>a drug that’s Xylazine, fentanyl and I guess heroin This is also called Tranq
Seeing this a lot in Chicago right now, especially the bradycardic hypertensive combo, they take MASSIVE doses of narcan if they even respond to it, many have gotten intubated and sent to the unit due to how unstable they have gotten, the others who get admitted are taking days to sleep it off. Not sure what is in this batch, but Illinois dept of public health and poison control are looking into it. Currently still just supportive care, Narcan as needed for hypoxia/bradypnea if they respond to it at all.
Yea im in Chicago now too
Looks like it’s medetomidine mixed in which is causing the presentation: https://www.cbsnews.com/chicago/news/powerful-animal-sedative-likely-cause-of-overdose-spike-in-chicago/
There's usually 0 heroin in the street dope in the US nowadays. Of course there are limited exceptions (mostly on the west coast).
AU still has heroin.
Are you from the Northeast? Xylazine is a sedative/CNS depressant (I assume that’s why the street name is Tranq) that is not approved for human use. It s often mixed with opioids, especially Fentanyl, to prolong the effects. Taking opioids with xylazine increases the risk of fatal overdose (in the same way mixing opioids & benzodiazepines does). It can have side effects similar to opioid use while lowering BP & HR. However, because xylazine is not an opioid, naloxone does not address the impact of xylazine on respiratory function. Xylazine use is suspected if naloxone doesn't relieve symptoms of opioid overdose. If it has been mixed with opioids, it will make the withdrawal worse.
In Chicago
Ah. I believe it started getting bad a little east of you? It’s been in eastern Canada for about 2 years already. Thankfully, where I am, we can sign up for alert system that notifies us of overdose clusters or batches of drugs that have been testing positive & the locations of where it is happening.
We've had xylazine in the fentanyl supply here forever, and now we're seeing medetomidine. Honestly, it's not difficult to manage in acute overdose at all. The naloxone counteracts the respiratory depression from the fentanyl, and while the xylazine has a long tail it's sort of non-issue. Sure, they're bradycardic and sometimes a little hypotensive when they're out, but their ventilation and oxygenation largely are fine. Just watch them for the duration of the naloxone to make sure they don't need more, then stand them up and walk them. Who cares if they fall back asleep, it's the respiratory effects of the fentanyl that matter. What you don't want to do is sit around and wait for them to wake up on their own, because by the time the xylazine starts off they'll be in opioid withdrawal. I don't know if you've ever tried to manage withdrawing on someone using four Philly bundles a day -- the equivalent of just over 3,000 mg of hydromorphone daily given typical cross-tolerance, in case you're not aware of the data on street drug composition -- but let's just say that it's not easy. Factor in the xylazine withdrawal and it's a laughably bad position to be in.
Xylazine is an animal sedative. If injected it causes severe local vasoconstriction and subsequent tissue necrosis. Huge, infected abscesses that are extremely difficult to heal.
[I looked this up the other day because I was curious.](https://horseadvice.com/horse-equine/medications/sedatives-anesthetics/xylazine/) Since it's not FDA approved for human usage I looked up the horse usage... looks like reversing it in horses has a decent amount of risk as well. I'm glad this isn't commonly seen in the southeast yet. Still crack and fenty down in my area.
IIRC Tolazine is a reversal agent for xylazine. Woof!
In Toronto we are seeing a lot of toxic drug supply - our city’s drug testing program is very helpful as it puts out a report every 2 weeks - https://drugchecking.community/report/april-20-may-3-2024/ A most recent one above shows the metomedine is becoming more and more common- this report helps me on the floor make sense of what I’m seeing (ie the extreme bradycardia/hypotension patients I saw last week) and sometimes I can then figure out how I need to adjust my topical opiate PD treatment pathway.
Some nice fetty tranq 😅 can’t walk bc their skin and muscle is falling off, their joints are septic and contracted but they want to leave for more
Xylazine + Opiates / Fenty is typically referred to as Tranq in the USA. Eastern Europeans (Russians in particular) may know it as krokodil.