Many lives were changed in 2019 as fentanyl replaced heroin as the opiate of the masses on the streets of Philadelphia. Ten times more potent than heroin, fentanyl lasts half the time between fixes. It cost many lives.

But look deeper. Look away from the streets and towards the medical-industrial complex. The state of pain management is in its infancy. In some hundred years we’ll look back on this period and cringe in the same manner as when we regard bloodletting and humours. We have myriad solutions, but as many cases have none. Opiates fill some of this void, whether by prescription or on the streets, but even this only masks the symptoms. 

The goal is not always to obviate physical pain, but for some mental torment feels as real. Those with mental anguish are marginalised whilst the rest are accused of  overreacting. It all in their heads, too. Drug-seekers. Mental illness. Bollox. 

Medical science in this arena is in its Infancy. Not quite yet toddlers, but they won’t admit it. Better to blame the patients and victims.  Better to make it a moral issue. Public health regulations are in the same state of maturity. Hubris kills. Capitalism kills. Calvinistis protestant work ethic kills. Fetanyl kills, too.

Ninety per cent of fetanyl is cut with Xylazine, tranq, a veterinary tranquiliser. This makes fetanyl cheaper and is reported by some to extend the euphoric effects, but it’s not an opioid, so interventions are different to opiate-induced overdose. 

Xylazine renders the user to sleep, but it doesn’t stop withdrawal symptoms. Addicts awaken to  need another fix. If there isn’t enough opiate, one may awaken already in withdrawal. 

Whilst heroin might last eight hours between fixes, fentanyl lasts closer to four. The addict needs to seek twice as often.

But I’m rambling. I’ve been in hospital since 9 March. It’s still difficult to focus. My girlfriend died the next day, on the 10th. She overdosed on a chemical cocktail of fentanyl, alcohol, and who knows what. 

Her pain was psychological, but that’s a topic for another day. She was in recovery. This is where some are most susceptible to overdose. 

I’m tired. More to follow…