Fentanyl is sought out or a known risk, not a surprise or an unknown in street economies of illicit drug use – its lethal risk chosen over Medical MAT “treatment”

By Clark Miller

Published June 11, 2021

From a previous post – 

New research affirms a body of direct observations and reports of the ecology, psychology and behaviors driving illicit economies of compulsive opioid misuse “on the street” –

fentanyl is used knowingly, sought out, used with knowledge of its potency and associated risks

according to research from the British Columbia Centre for Disease Control (BCCDC).

The fact more relevant and important than users knowing they are getting fentanyl in the drug they intentionally obtain illicitly is that they know the real risk of high likelihood that fentanyl will be present, whether sought out or not, in any substance obtained on the street. That is, users are choosing – and have been over past years while opioid overdose mortality increases – increasingly to risk overdose and lethal overdose instead of accessing or benefitting from widely and increasingly available substitute opioid medical “treatment” (medical provision of the substitute opioids methadone or buprenorphine) programs, or from hypothesized “Do-It-Yourself” use of diverted suboxone widely available on the street for “treatment” or to avoid high risk use.

High-risk use constitutes lack of benefit attributable to the never-validated medical “fix“.

And they are not retaining in those programs, or do and continue to abuse illicit opioids and other drugs, divert and abuse the prescribed opioids, and engage in high-risk opioid use including injection, as evidenced by increasing rates of injection-related infectious diseases.

But that doesn’t make sense at all in the context of mass consensus assurances from the same medical-media alliance that fabricated evidence to generate the lethal opioid epidemic – that the medical OST fix is effective treatment. Does it? Because available not just from medical providers but on the streets are opioids like buprenorphine and heroin that are much safer and as easily accessible as fentanyl if the user’s purpose and motivation is for withdrawal management while trying to quit, to moderate use, or to manage pain.

Users knowing the risks associated with fentanyl and having been exposed to assurances of an effective medical “treatment” for compulsive opioid use are weighing the alternative of that medical “treatment”, increasingly widely available in medical settings or in “DIY” form on the street, and are sticking with, compelled to continue, high-risk use. At risk of death and fueling continuously worsening mortality and public health costs of high-risk opioid use fueled partly by a street economy that includes prescribed buprenorphine and other opioids as currency and abused substances. New reporting “from the street” in San Francisco in the U.S. affirms that picture of a new fentanyl (and naloxone) evolving culture of high-risk opioid abuse.

Now from Minnesota, where medical authorities can only surmise that users on the street are shocked to learn that the drugs they buy and use have fentanyl in them !

That’s the medical explanation for the worsening lethal opioid crisis – users had no idea that the pills they bought would include fentanyl. And the relentlessly mounting overdoses and deaths are attributed to the unpredictable and uncontrollable, a really bad chance outcome that was against the odds, should not have happened, a surprise. A nefarious, deceptive lacing of their purchased street drugs. We can imagine a street opioid user’s conversation with medical or emergency personnel after being saved with naloxone: “Wait, you’re saying there’s a legit risk of fentanyl being in the drugs I get on the street to get fucked up !  Are you fucking kidding me! I’ve never, ever heard of that happening!  Who saw that coming?

Maybe that type of conversation has been the experience of Dr. Halena Gazelka. She’s an addiction expert and authority, it goes without saying from her title: Halena Gazelka,  Mayo Clinic anesthesiologist and chairwoman of the clinic’s Opioid Stewardship Program. 

Dr. Helena Gazelka

“I think one of the things that is particularly alarming is there used to be a margin of safety,” said Dr. Halena Gazelka, a Mayo Clinic anesthesiologist and chairwoman of the clinic’s Opioid Stewardship Program. “People would believe that they were buying an oxycodone pill that was made as an oxycodone pill medically and distributed from a pharmacy, so they knew what they were getting.”

“But now with the pill presses that are being used, or pills being brought in or manufactured here that look just like an oxycodone that you could buy at a pharmacy — but are in fact laced with fentanyl or one of the synthetic analogs — people aren’t getting what they think they are getting.”

people aren’t getting what they think they are getting

But they are. They are getting exactly what they think they’re getting – illicit street drugs with a high probability of being laced with fentanyl because those drugs have been for years now, and because that’s what they want, what they’re trading their doctor-supplied bupe for, because the fentanyl is what they need now to get off. Or they’re willing to take a chance on getting too much fentanyl, because they’ve become psychologically and physiologically dependent on opioids, sedatives, and doctor-prescribed drugs with sedative properties like quetiapine (Seroquel) and gabapentin.

They know the risks. And are choosing the risks, including death, instead of accessing American Medicine’s “anti-addiction” drugs that are a “fix” for problem opioid use. That’s why there’s never been a medical fix for the medically-created opioid crisis, why opioid-related high-risk use, overdose, and death by overdose has been increasing steadily all along, including during the years before fentanyl was everywhere and  in the months before the pandemic became a possible factor –

“The rise in overdose deaths during 2020 appears to have preceded the onset of the coronavirus pandemic. Emergency room data published in February in JAMA show the U.S. saw a 30% increase in opioid overdoses in the first three months of 2020, a period prior to the arrival of COVID-19 in America.”

“At Mayo we’ve been encouraging individuals get a prescription for Naloxone,” Gazelka said, “even if they are not a user of opioids. It may be someone you meet or encounter in an overdose. It’s a very safe medication to use. I have some in my home and car and which I carry in case I could be in an emergency situation. I compare it to those defibrillators that we use in public spaces.

“There’s way more people overdosing than are having heart attacks in the street.”

Dr. G did not explain, was not likely asked to explain, the increasing need to carry and have available naloxone, when there is a widely and increasingly available medical fix, an anti-addiction drug, only requiring a doctor’s prescription to protect against high-risk use of opioids with risk of overdose and death. Medication Assisted Treatment (MAT) is effective, isn’t it

If an increasingly lethal epidemic of heart disease was leading to defibrillators being distributed to more and more Americans to carry with them, we would question whether American healthcare’s treatment approaches to heart disease were effective versus worsening public health.

On the street, everybody knows what’s going on, how could they not? 

In Winnipeg, Canada for example –

Marion Willis, founder of Morberg House, noticed a rise in opioid use, specifically fentanyl, around the same time. She attributes it to pricier and harder-to-find meth, which she believes was caused by significant drug busts by police and the coronavirus pandemic.

“Addicts don’t stop using,” Willis said. “They just look for something else to use and we found that it seems like the next popular drug to use these days is actually fentanyl.”

The more medical cure provided to diseased brains, the more deaths

graphs of increases in U.S. drug overdose deaths and provision of opioid substitute medications

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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