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Tuesday, September 19, 2023

The Fourth Wave

The United States continues to be the target of an illogical madness. The British Broadcasting Corporation (BBC) recently explained How the fentanyl crisis' fourth wave has hit every corner of the US. I remember in the 1990s when I first heard of Fentanyl and the various doctors who expressed their eager and adoring attitudes toward it. There were many orthopedic patients suffering intractable pain and we were all led by the physicians into the opioid expansion.

I have been less than a fan of opioids as the trend has turned toward death and destruction. In Florida Workers' Comp: Florida's 2018 Session - Opioids (March 2018), I reviewed various prior posts that address opioids. In the end, these drugs are killing thousands of people each year. Much of it started in a prescription world and evolved into illicit use. Today, perhaps more of it begins with illicit use. There is a certain population that is willing to use these substances despite the associated risks.

The Centers for Disease Control (CDC) says that Heroin overdose is on the decline. The current threat is from synthetic opioids, including fentanyl. There is an apparently inexhaustible supply of this substance and a ready population of consumers ready and willing to expose themselves to it. That said, it is practical to believe some are being exposed unintentionally. That is, they seek illicit drugs voluntarily but do not intend to include this one in particular.

Time and again in Hollywood productions, we see the all too familiar police interview. Hollywood loves to make police and lawyer movies and shows. In that context, there is a persistent theme of motive for this crime or that. Often, in the context of motive, there is "the victim owed you a lot of money." The savvy suspect so often reminds the intrepid investigators, "why would I kill someone that owes me money, dead men never pay." That is an interesting line of thought. 

Do dead drug addicts pay? 

Why are these powerful opioids being pushed? They are killing a great many people. It seems illogical to kill your customers. However, it is likely I am ignorant of the intricacies of the drug trade. 

The BBC explains that the "fourth wave" involves the integration of Fentanyl into other drugs. Victims and advocates are convinced that users are surreptitiously being exposed to this drug. They intend to use illicit drugs, voluntarily use illicit drugs, but are not specifically seeking this killer.  The reader is urged to sympathize with these users and suggestion that the government could do more to facilitate their illegal drug use in some safer environment. 

Some insist that there is a lack of awareness of the threat of Fentanyl. Grassroots organizations are featured in the article. Their agents are visiting the public in broad efforts directed at consciousness-raising. Some complain that awareness campaigns have used the wrong models for their billboards and other efforts. 

The evidence cited is compelling. The volume of overdose deaths unrelated to Fentanyl is decreasing (as a percentage of overall overdose deaths). The increases are in Fentanyl used alone and Fentanyl with stimulants. Some contend this is intended, with the stimulant allowing an extended experience of the high. Others seem to suggest that the Fentanyl is being surreptitiously included in illicit stimulants as an inexpensive extender or filler. 

Regardless, there is evidence supporting that the Fentanyl is highly addictive. The people who are choosing to be exposed to this, or who are being inadvertently exposed through their intent to consume other street drugs, are becoming addicted to this. It is likely perhaps that they then seek it out intentionally in order to satisfy the demands of that addiction. 

According to the National Institute on Drug Addiction, overdose deaths exceeded 106,000 in 2021. I can remember when the rate was half that. That was in 2014. In less than a decade, overdose deaths have essentially doubled. Will they double again in the next ten years? 

Will people suddenly heed the threat and the warnings and quit using drugs? Doubtful. Will the continued push for ever-increasing access to pot lead to less drug use and overdose? Doubtful. Is there an answer that affords some promise of fewer deaths? The situation is puzzling from various perspectives. But more so perhaps in the riddle. Why is there anyone in the distribution chain who is not concerned about the high death rate among consumers? 

It seems that the suppliers are all incentivized to keep customers alive and using. And yet, the death rates continue to grow. The riddle, it seems, is not in the fact that there are users and addicts, but in the ease of recruiting an ever-growing population of new consumers. Who needs the old consumers when there are new ones so ready? How can there be so many new ones, despite the overwhelming prevalence of news coverage and public awareness?

It is indeed difficult to understand. It is a riddle whose solution escapes our government and an effect that seems destined to grow. The CDC says the leading causes of death are
  • Heart disease: 695,547
  • Cancer: 605,213
  • COVID-19: 416,893
  • Accidents (unintentional injuries): 224,935
  • Stroke (cerebrovascular diseases): 162,890
  • Chronic lower respiratory diseases: 142,342
  • Alzheimer’s disease: 119,399
  • Diabetes: 103,294
Perhaps when drug overdose reaches comparable figures to stroke it will be enough? If the rates of overdose double in the next ten years, it will equal or exceed accidents. Perhaps then it will be enough? or will it require another ten years and a doubling to equally COVID to get the word out? What distinguishes drug overdose from the causes listed here? Overdose is perhaps the easiest to avoid completely.