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I was talking to a patient recently about her different experiences using heroin vs fentanyl. She’s been using opioids a long time. Too long, by her count.
She explained the difference to me like this (shared with permission):
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She explained the difference to me like this (shared with permission):
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With heroin, she had a 6-12 hour period after using when she could reliably expect to feel well. She could work, or visit with family. She could get a full night’s sleep and know she had enough left over to get well in the morning. She managed this way for years.
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With the transition of our street drug supply from heroin to fentanyl, all that relative stability and predictability was lost. Because fentanyl is so short acting, she has to use every 3-4 hours to stay well. She wakes up in the middle of the night sick, forced to use.
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August 31 is International #Overdose Awareness Day. Every year I reflect on all the people we’ve lost, but especially Arielle. Here we are at 18 - careless, happy assholes. She was brilliant, snarky, a talented musician, and she died at age 26 from a poisoned drug supply. 
In the last 2 years of her life, Arielle went to jail, went to rehab, and “got clean.”
Jail didn’t save her.
Rehab didn’t save her.
Abstinence didn’t save her.
#SCS could’ve saved her. #safesupply could’ve saved her.
#MOUD could’ve saved her.
#Naloxone could’ve saved her.
Jail didn’t save her.
Rehab didn’t save her.
Abstinence didn’t save her.
#SCS could’ve saved her. #safesupply could’ve saved her.
#MOUD could’ve saved her.
#Naloxone could’ve saved her.
There is no excuse for her death or for any of the 71,000 overdose deaths in 2019, not when evidence-based treatments for #OUD exist. Not one damn more person should die alone from a treatable condition in the year #2020.
Thanks @UTMBFamilyMed for inviting me to present Grand Rounds today! I'm going to share a few pearls for other interested folks in #FamilyMedicine, #TwitteRx, & beyond.
A long but extremely visual🧵🧵🧵
A long but extremely visual🧵🧵🧵
To understand the "opioid crisis", you have to accept that the first wave was driven by excessive prescribing. BUT you also have to accept that reactionary supply reduction interventions drove a totally preventable second wave of deaths due to heroin.
In order to help the people who are actually dying today, you must recognize that deaths to Rx opioids accounted for fewer than ⅓ of all opioid overdose deaths, and that proportion is shrinking every year.
