The first vial has only a little powder. The second one is virtually empty. Both are lethal doses. Vile indeed.

By all accounts the opioid crisis is intensifying and the country’s failure to address it has less to do with its lethality and everything to do with the weird optics of the word opioid. Who can relate to an opioid that sounds more like the kid on The Andy Griffith Show than a serious public health issue? If 4 of the first 5 letters weren’t vowels we might not be ankle deep in overdoses and the opioid crisis may have gone the way of smallpox, polio and disco. Instead this deadly wave has become a tsunami and all because the public at large can’t warm-up to the word opioid. The same thing happened with the word Hillary in the last election.

Cancer, ALS and Muscular Dystrophy are all familiar public health issues we support with donations and research. Those diseases may have been accepted into the American body politic, but you’ll never find Vanna spinning the letters to the word opioid on Wheel of Fortune. The word opioid sounds like some strange vestigial organ in the throat that once helped humans digest feathers; back when pterodactyls ruled the world. Maybe during the prehistoric Avian Era feather digesting organs were indispensable, but today that’s just not gonna fly. Until the opioid crisis changes its name to something relatable, or gets its own ribbon that sports teams wear to raise awareness, the country will continue to think of the Opioid Crisis as a sequel to Breaking Bad.

Our Not So Funny National Epidemic

From the New York Times:

The current opioid epidemic is the deadliest drug crisis in American history. Overdoses, fueled by opioids, are the leading cause of death for Americans under 50 years old — killing roughly 64,000 people last year, more than guns or car accidents, and doing so at a pace faster than the H.I.V. epidemic did at its peak.

And since you can only die once, opioids are continuously soliciting new members to join their deadly club. In the past I would rarely take advice from Nancy Reagan, but she was dead right on this one: “Just say no.” No, because you can never be sure of the dose you’re getting (and it’s illegal). I believe the hundreds of thousands who’ve accidentally overdosed on opioids would tell you the same thing – if they could. You’re better off finding less toxic ways to float your boat. For example I might suggest visiting Dollywood, monitoring your Facebook “likes” or trying to name all the Bee Gees brothers. These activities will keep you alive and eligible to collect Social Security whereas experimenting with opioids; not so much. 

Anyway, it’s not exactly an Opioid Crisis. It’s a Fentanyl Crisis 

Opioid crisis? About 60% of lethal opioid overdoses are fentanyl based – meaning not heroin, morphine, codeine, OxyContin or other poppy plant derivatives. So what is fentanyl? Fentanyl is a synthetic version of morphine and is an incomprehensible 50 to 100 times more powerful than poppy plant-derived opiates. That’s why it’s so deadly (see comparative picture). Drug dealers (who learned their pharmaceutical dosing on the streets, if they leaned any) are deficient in formulating therapeutic doses – which is just a nice way of saying they don’t know WTF they’re doing. They’re not exactly Walter Whites. But like a friendly bartender who tries to do you a favor by pouring you a stiff one, drug dealers often try to do you a similar favor and end up making you a stiff one. 

The Fentanyl Dossier

Fentanyl was first synthesized (produced chemically in a lab from simple ingredients) in 1960 by the brilliant and laudable Dr. Paul Janssen (See Bio). Its chemical formula reads like a Bulgarian license plate: C22H28N2O. Its primary use was as an anesthetic until it was discovered to alleviate pain. And that’s when the Pandora’s Box of unintended bliss was opened. In fact fentanyl doesn’t just alleviate pain, it eliminates it by acting as an agonist (binding with opioid receptor sites), thereby preventing pain receptor sites from relaying any kind of bodily distress. And when fentanyl is operating in the absence of pain (that is if one were to take it recreationally), it produces a kind of enduring euphoria usually associated with…ummm, uh, well, I hate to say it but: taking drugs.

When compared to heroin, fentanyl is off the charts in orders of magnitude. Heroin is to fentanyl as firecrackers are to atom bombs. Put another way, on the Richter scale an 8 earthquake is not a little stronger than a 7 earthquake – it’s 30 times more powerful than a 7. Analogized to fentanyl; about 50mg of heroin can kill you, whereas it takes a mere 2-3 mg of fentanyl to suppress the nervous system enough to cause respiratory failure. Comparing heroin to fentanyl is not like comparing apples to apples. It’s like comparing apples to TNT. And in one bizarre testament as to the scale of fentanyl’s potency; first responders to overdoses have actually died by accidentally inhaling residual amounts of fentanyl present at the scene.

Fentanyl is made of cheap chemicals like N-phenyl-N propenamide. It was originally synthesized by employing a 4-step process including condensing N-benzyl-4-piperidone and reducing it to LAH (Lithium aluminum hydride). I’m sure that previous sentence was not especially helpful in your understanding the manufacture of fentanyl. However (and this is true), the final step in producing the drug involved performing the Finkelstein reaction. Hmmm…and I always thought the Finkelstein reaction was how Mrs. Finkelstein responded when she found out her daughter was pregnant. In any event this easily concealed drug has been flooding into the United States from China and Mexico, and now America is up to its pleasure centers in fentanyl powder.

The Fentanyl Experience

And while fentanyl will not necessarily transport you directly to Nirvana, it will certainly take you Near-vana. So it’s understandable why people would be attracted to its charms (however fatal that attraction may be) and why addictive types fall prey to its siren call. They’re not doing it because they’re bad, they’re doing it because it’s a better bargain – even if it’s a Faustian Bargain. Addicts aren’t someone other than us. They are us. And although it’s easy to demonize or separate those who do bad things from the rest of us, who do good things, we are all connected nonetheless and need to support each other to feel god’s pleasure. We now end the Sunday school section of this essay.

Fentanyl is well-suited to eliminating pain from compound fractures, sucking chest wounds or the aftermath of accidentally sitting on a hood ornament. It is unsurpassed in knocking you out prior to surgery (just ask Michael Jackson’s doctor). In fact it is the most effective drug (along with certain Seinfeld episodes) in walling-off pain in end-stage cancer patients. And it is these powerful analgesic properties that entice relatively healthy people to take it recreationally because it plugs-in perfectly to opioid receptor sites and bathes you in the blissful warmth of unaccountable well-being. In actuality though the drug has merely shut down and bypassed your familiar earthly senses and delivered you into a higher vibratory dimension where finer parameters hold sway. The problem with fentanyl is that it can provide an out-of-body experience to such a degree that the arrangement becomes permanent and you’re not allowed back into your body. In other words fentanyl’s actions are similar to an NDE (Near Death Experience) except it can easily result in an actual DE (Death Experience). We now end the hallucinogenic description and dire warning section of this essay.  

And there’s the rub. Fentanyl can take you to places you can’t easily get to by yourself. It’s cheap. It promotes a sustained sense of euphoria and, in the words of singer Tammy Wynette, it helps to: ♫Make the world go away ♫. So why shouldn’t more people do it? Well let me put on my narcotic warning hat and amplify on what I mentioned in the previous dire warning section of the essay. When traveling to some unknown or previously unexperienced destination it’s important to know how you got there – so you can make your way back and understand what you’re experiencing once you’ve arrived there. In this way you may comprehend the journey and can peaceably and predictably return there. A lot can go wrong when you play Russian roulette with a fentanyl-addled consciousness. I’m not saying recreational drug use is bad per se, I’m just stating fentanyl is a different kind of animal. So different it isn’t even an animal – it’s a powerful Central Nervous System modifier. Not Popeye powerful, but thermonuclear powerful.  

Opioids Comes from the Earth. Did Mother Nature Intend We Should Experience Them?

It’s always a slippery slope when humans try to assign cause and effect from the earthbound perspective to something unfathomable or indescribable (listening religions?). Suffice to say natural opiates are plant based substances – poppy plant based. And of the several species of poppies only one contains the basic alkaloids from which opium is derived. It is known as the opium poppy. However, among non-opium poppy plants it is known as the “She-thinks-she’s-all-that-poppy.” And why a li’I ‘ole poppy plant happily swaying its innocent petals in an amber-waves-of-grain kind of way was weaponized with milky secretions capable of transporting one to Shangri-La, I’ll never know. I do know that profits from opium exports manage to fund the Taliban in Afghanistan and finance “Hello Kitty” backpacks purchased for the daughters of filthy rich drug lords. If Karl Marx were alive today he’d have to modernize his famous quote “Religion is the opiate of the masses” to read: “Fentanyl is the opiate of the masses.”

The Siren Call of Smack

The allure of the ecstatic experience, either through earned methods (meditation, lucid dreaming etc.) or unearned methods (drugs, amusement park rides), has been with us since primitive man first realized there were more satisfying alternatives to life than “Me happy when make fire and sleep on animal skins.” Simple pleasures may be the best and it’s a good thing we are able to content ourselves with these pleasant, but meager gifts. When compared to the enormity of bliss available in the entire ecstatic universe, relying on quaint little pleasures for succor is an adaptive human trait. It helps to ground and perpetuate the species while tamping down counterproductive chaos. In other words appreciating small pleasures promotes a society of productive, focused people who do useful things like build roads and sewage systems. We don’t want a nation of addicted hedonistic hermits who indulge their pleasure centers while neglecting trash collection and air traffic control services. Enjoying simple pleasures and remaining high-functioning is preferable to seeking recondite bliss through drugs and lapsing in to an irrevocable torpor. I’ll take that trade-off any day.  

So we earthlings settle. We settle while recognizing there are wondrously gratifying riches to be had by other means. Sometimes we placate ourselves with small doses of simple pleasures and this is a healthy thing. Who wants an agitated mind or an envious disposition? For example. it’s a slippery slope romanticizing about the brilliant Sherlock Holmes stoned to high heaven in a Chinese opium house, puffing on his “Shanghai Sally” filled “dream stick” (translation: smoking his opium-filled pipe). I revel in imagining the steely languor he draws from to penetrate and solve the world’s most mystifying crimes. I wouldn’t mind being dimensionalized in that manner. In fact this tantalizing scenario has got me considering converting my cozy family room into an even cozier opium den. But I won’t because I’ve really come to depend on, and enjoy indoor plumbing. That is, I’m not going to sacrifice material success for a beguiling gateway drug to divine oblivion. I’ll wait for my divine oblivion or seek it through more natural means. And this ends the somewhat preachy section of this essay. 

The Proportionality Bugaboo

How can what looks like a few straggling grains of sweetener in an otherwise empty sugar bowl, possibly get me high? Users think: “I’m gonna need more.” So they double the dose and consequently they’re not so much given a ticket to another dimension – they’re given a ticket to a permanent dirt nap. Fentanyl’s potency is not an easily understood arithmetic progression, it’s an impossibly conceptualized geometric time bomb.

*Such concentrated power means fentanyl can be shipped in small, unassuming packages. An investigative report by the Globe and Mail, a Canadian newspaper, revealed that fentanyl was being imported from China inside little silica-desiccant packets and packaged with urine-test kits. Because the packets weighed less than 30 grams, Canadian border guards were not allowed to open them without getting the permission of the recipient. Ingenious.

Potency not only makes smuggling easier: it makes dealing more profitable. According to an official from America’s Drug Enforcement Administration, quoted in the House of Representatives earlier this year, a kilo (2.2 lbs.) of heroin can be purchased for roughly $6,000 and sold wholesale for $80,000 before fetching a few hundred thousand dollars on the street. The price for a kilo of fentanyl might be $3,500-5,000; stretched out into 16-24kg of product it might be worth $1.6m.

*Sourced from Economist Magazine, May 20, 2017.

What’s the Answer?

While the DEA might say something obviously logical like, “Interdiction, penalization and treatment.” Critics of treatment centers say methadone clinics are like throwing good heroin after bad heroin and does nothing but enable addiction. Recreational drug have a different take on the drug dynamic and might say something perfectly frivolous like, “♫More, more, more! How do you like it? How do you like it♫” There is no answer as such owing to fentanyl’s’ ability to transport one to transcendent places not regularly available to the earthbound human. That’s it really. Fentanyl (and other drugs) do something special. They allow you to self-medicate. So you may be taken out and away from where you’re at and place you into a space of enduring well-being – a place where you’re not so tied to your human circumstances. Religion tries to do this too, but theirs is a very slow burn whereas drugs are more immediately gratifying and, in some cases, deadly. Quite the trade-off.

If the question is how do you induce potential users from not experimenting with the stuff, I’d say they’d first have to have an awareness of their own eternalness, thereby negating (or at least perspectivizing) the allure of momentary (and potentially lethal) bliss. I know the previous sentence on how drug-taking can be disincentivized was poorly expressed, but sometimes that’s the best way to convey your meaning as you (the reader) must use other faculties to determine its meaning and in doing so you activate synergies heretofore dormant. Anyway it’s something like that.

It’s difficult to present a clinical description of something that knows no bounds. Put another way, consider the relentless efforts we humans undertake just to experience an orgasm with another person; and I’m told that in the scheme of things, orgasms pale in comparison to a fentanyl high. The equivalency isn’t even close. Combine this differential with a genetic predisposition, grinding circumstances and ready accessibility and you’ve got a recipe for ruin. That’s the kind of gravitational pull these drugs can have. You just have to innately know better to stay away – and most of us do. That’s why so many are here reading this instead of pursuing the drug experience. Dare I say it – you have to honor your incarnation and not short-circuit it. And that concludes the New Age, touchy-feely section of our essay.   

When you take into account the dangers of ingesting unregulated drugs and combine it with the carnage of overdoses, one wonders why anyone experiments with them at all, let alone allow themself to become addicted to them. So why do they? Because for better or worse they deliver. Opioids in general and fentanyl specifically transport people away from money problems, relationship troubles and mental misery. It shuts down those receptor sites and imbues one with an ecstatic feeling of internal well-being. Your external world may be an insoluble complication in comparison to the warm fuzzies available when your drug-fueled nervous system cannot access the downside to anything.

It seems to me you have to honor your incarnation here while it lasts. I could be wrong though. I have beliefs but I try not to cling to them too unshakably. That’s just another attachment. That’s probably why I’m not so attached to achieving the fentanyl experience. It might be ecstatic, but it’s an artificial shortcut to pleasurable oblivion and while it’s a great place to visit I want to know how I got there so I can navigate once I arrive there. OK I promise, that really concludes the New Age, touchy-feely section of our essay.  

So We Shall Not Perish

I am painfully cognizant of all that was not said here today. This pitiable topic is far above my poor power to fully illuminate it, let alone remedy it. All I can offer are my puckish, yet sincere observations and hope the scourge of drug abuse is made obsolete by virtue of man elevating his consciousness in ways that render drugs redundant. Meanwhile I thank goodness for sustaining pleasures like a loving wife, the joy of formulating essays like this and the occasional full body massage. And this concludes our essay on how to avoid Murder on the Opioid Express.

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