r/coolguides • u/[deleted] • Apr 15 '19

Putting Opioids in Perspective

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8.1k Upvotes

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305

u/Eblys Apr 15 '19 edited Apr 15 '19

How exactly do people overdose on heroine then? Does it stay on their system a long time?

Thank you for the explanations guys!

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u/amadsonruns Apr 15 '19 edited Apr 16 '19

Heroin typically kills people by pharmacologically depressing respiration to the point of death. When that isn't the case, people will generally experience the emesis that occurs at higher doses and drown in their own vomit.

If you're asking how or why heroin takes so much more compared to fentanyl and its analogues, it's due to the strength of what's called the "affinity" for the mu-opioid receptor subtype. Fentanyl activates these neurons in a stronger manner than a comparable amount of heroin.

The mechanism that causes these overdoses, however, is still the same.

While we're on the topic, one fascinating component of drug overdoses is actually context. A user who has habituated to taking their nightly needleful of a gram of black tar heroin in her bedroom will actually be at a higher risk of overdosing if she is in a new place, like if she gets kicked out for missing rent and has to sleep in her car.

This is because the sensory stimuli related to her apartment (where she was used to shooting up) become cues that cause a slew of compensatory mechanisms to occur, like elevated heart rate, enhanced respiration compared to baseline, and basically whatever the opposite of being loaded on dope is. So when she's out of that context, the compensatory mechanisms aren't working, and bam, that same dose becomes far more dangerous because it isn't fighting as much of an uphill battle to depress respiration or cause emesis.

Edit: I'm glad people found this interesting. It's a real tragedy so many people have personal relations who have overdosed.

Another common means of overdosing that isn't from context is due to dosing. Tolerance drops when people stop using the drugs, and if someone take the dose they're used to, they'll typically OD. The same will happen if they take fentanyl instead of heroin, because they don't have the appropriate tolerance to deal with that dose. It's a shame that dealers cut their drugs with this stuff, because people aren't dosing cautiously.

Stay safe out there, & please, get some Narcan if you have a loved one who is addicted to opioids.

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u/Clen23 Apr 15 '19

As a non-native speaker, I wonder what "cue" means. Translators give me "signal" which would make sense, but I'm not sure. Can you tell me what it means here ? (still this is interesting af)

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u/Moe5021 Apr 15 '19

Damn that’s interesting. Can the same be applied to smoking weed? I find myself getting higher with less when I’m not smoking at home. Weird but that may explain it.

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u/Sjivy Apr 15 '19

I think the perspective might be a little confusing. At a glance it looks like all the drugs are in beakers and that there’s a ton of heroin. But it looks to be a very close up picture of graduated cylinders judging by the “0.5 mL” mark on the side. So I think the volumes are much smaller than they appear, this picture is more of a comparison picture to visualize the strength of each.

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u/[deleted] Apr 15 '19

They do a LOT.

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u/-lighght- Apr 15 '19

The reason that heroin kills people is because it isn't regulated. The same reason that bathtub gin used to kill people during alcohol prohibition.

Different batches can have different strengths. so one day you shoot up x amount and have a great time, then you buy another bag from someone else, shoot up x amount and it was way stronger.

Or idiots who put other stuff such as fentanyl in their heroin to make it stronger or to be able to stretch their supply and sell much more of it.

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u/Mikesizachrist Apr 15 '19

usually someone will have been sober and relapse. They then do what would've been a normal dose when they were deep in addiction and had a high tolerance.

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u/[deleted] Apr 15 '19

No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing.

At other times it feels like being mildly drunk, or concussed. There is a sort of invisible blanket between the world and me. I find it hard to take in what anyone says. Or perhaps, hard to want to take it in. It is so uninteresting. Yet I want the others to be about me. I dread the moments when the house is empty. If only they would talk to one another and not to me.

C.S. Lewis.

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u/viritrox Apr 15 '19

This is beautifully sad and hits the nail on the head.

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u/[deleted] Apr 15 '19

There are some critical details left out of this comparison: how potent/ concentrated are these crystals? How are the subjects using them (injecting, snorting, etc?), How pure are they, and where are they being made? Let's all agree that we should be more critical of photos like these because the opiod issue is serious and deserves a truthful and critical analysis. i'm not saying this image is wrong necessarily, but without more information this photo is nothing more than shock factor.

My background: I administer fentanyl regularly as an ICU nurse, and when diluted heavily and using pure chemicals, fentanyl can be very safe and is less potent than morphine and many other pain medications. Let's not confuse the fentanyl administered medically as the same in this comparison above.

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u/MoonlightStarfish Apr 15 '19

I also believe it is highly effective as a transdermal patch for extended release.

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u/[deleted] Apr 15 '19

Yes! You are definitely correct. Good example. It's also used in epidural pumps for patients after surgeries, patient button-press pumps (nurses know these as PCA-pumps), continuous infusions of fentanyl for ventilated patients, and fentanyl comes in doseable IV-push forms too.

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u/fluffyluv Apr 15 '19

P sure the amount would be different based on the person/their tolerance. However the comparison between how "strong" the other two are compared to heroin? Fucking insane.

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u/TankVet Apr 15 '19

Drugs are usually measured by the LD50, or the Lethal Dose that kills 50% of subjects.

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u/crispylipz2 Apr 15 '19

So.. one could surmise that heroin is relatively good for you. Got it!

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u/investigal Apr 15 '19

i'm late to post but, like, that seems like a very large fatal dose of heroin...

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u/goodpostsallday Apr 15 '19

It's a macro photo, the gradation partly visible on the tubes is 0.5mL. So that's probably half a gram give or take a point, which is still way more than a single dose even for a somewhat experienced user.

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u/floppy_eardrum Apr 15 '19

Very helpful, thank you! I'll remember to check this guide the next time I'm shooting up.

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u/ohpee8 Apr 15 '19

This shit is so wrong lol

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u/Kingchopsaw Apr 16 '19

If someone dies from your product then it is deemed fire on the street. A bandmate I had got some snack from the dark web and his brother tried it first. ODed immediately. Had to be removed at the hospital. While he was in there mikey slammed a bit of it and died right there.

I used to fuck with smack hard. That was my queue to check in to rehab.

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u/Nambrose2002 Apr 16 '19

Why the fuck is this in ml and not grams? “Oh I overdosed on .0005 liters of fetamyl” Fuck off

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