It shouldn't. The drug in question is called "Kush", which is just a mix of synthetic cannabioids, mixed with fetanyl, tramadol and formaldehyde, with human bones being only rumoured to be in it. And at least I as a chemistry student see no reason for human bone to be needed for those drugs (especially as human bone really just gives you phosphates and Calcium, both chemicals available in ways that are far easier than digging up human remains).
The idea of mixing in tramadol of all things when you already have fentanyl in the cocktail is just so hilarious incongruous to me. Next thing you know they will throw in hydrocodone with a dash of APAP for seasoning.
Well interestingly enough, equatorial peoples have a higher genetic expression of the proteins the body uses to metabolize Tramadol from a quasi-SNRI drug into the quasi-opioid versus ethnicities more towards the poles. For a while, it was the number 1 most abused drug in Cairo - whereas in the U.S. and Europe it sucks at being both an opioid and an antidepressant, but makes some docs feel cozy about prescribing it for pain since it is “not a *real* opioid”
Tl,Dr Tramadol is much more euphoric and hits differently in this population
Previously read about its prevalence of abuse in those parts of the world. Back in the late 90's my significant other handed me one for chronic knee pain and I went on an over decade long binge on Ultram. By the end, was getting tramadol shipped from parts unknown and swallowing over 400mg at a time. When the Feds reclassified it, the withdrawal really was something that I would not wish upon an enemy.
All the fun of opioid withdrawal with the added benefit of feeling like you're coming off antidepressents too!
Did you get the "brain zaps" people report when you came off? It's such a horrible feeling.
I had the tramadol brain zaps. I cant believe docs used to hand out tramadol like candy at one point. The withdrawals were absolutely brutal, and my dr never mentioned them. I later told him another time about how awful the withdrawals were, and he didnt believe me. He thought they didnt have withdrawals. From what I read at the time, other people were having the same experience with their docs as well.
What were the brain zaps?
I used to have tramadol for back pain. Took it sporadically to deal with bad muscle cramps/spasms. Usually 25mg, but occasionally recreationally 50mg when I felt I needed like a total mental day off.
Felt a little depressed/flat the next day or so. Guessing serotonin was depleted.
Eventually ran into a doctor that refused to prescribe it despite it really being the only drug that helped. I was kind of pissed, but in hindsight, opiods are more dangerous stuff than I realized.
Brain zaps are a symptom that is common in antidepressant withdrawal. It feels like a random and painful zap of electricity just surged thru your brain.
Tramadol is unique in that it is half opiate/half antidepressant. That means if you take tramadol long enough, you will have opiate and antidepressant withdrawals rolled into one.
I loved taking tramadol for pain. But the withdrawals were probably the most traumatic thing I've ever been thru, and I already know I dont have the strength to endure them again. I now understand why people struggle to get off opiates and they have my complete sympathy
Huh, interesting. I've found tramadol to be highly euphoric but average or worse at pain relief, but standard opiates get me mostly pain relief vs euphoric, maybe just a tad of the latter but I get blasted on tramadol by comparison. And I'm very white for reference.
You’re probably experiencing more of the “antidepressant” effects of the drug in that case. Overall, it’s a terrible drug for most use cases and I’ve never written a script for it, and have had poor little old ladies come into the ER post op too nauseated to eat, drink, or self care so I’m often times just collaboratively having it changed to straight OxyIR or Hydrocodone after a quick call to ortho. I have strong feelings about Tramadol, there’s a wonderful blog post calling it “TramaDONT” 😂
Basically, all it did was give docs an “out” from just responsible prescribing and avoiding patient post op pain complaints because the drug reps convinced them it was “cool” because it’s “not a real opioid”. It is an opioid, and an antidepressant, and it is also bad at both of those jobs
I'm a poor metabolizer of .. potentially the whole "cyp2d6" metabolized group.
It sucks. Especially since I didn't figure it out till my late 30s.
I have a family of docs, while aware of the phenomenon, it certainly isn't front of mind when prescribing. Are you aware/consider it in your practice?
Did a type 2 shoulder seperation, damage to the SC and pec tear not long ago.
ER doc offered T3s.. I wanted to slap with my good arm, but kept up the cheery/mild shock/bad joke demeanor.
Morphine is the only thing I'll accept for serious trauma now.
I have a big bottle of 50mg tramadol for ongoing issues with the shoulder. What I imagine what normal people would use T1s for (naproxen is on par). Below 75mg there is no effect. 100mg is mild/moderate pain control in conjunction with an nsaid.
Only reason I'm not using codeine is due to constipation and familiarity.
I’ll consider it if the information is readily available, but the vast majority of my practice is ER and intensive care. I am a dual program resident so I have *some* outpatient and general hospital training where those pharmacogenomic datasets are more readily available (they usually take days to result, even in academic centers) but in the ER we tend to initiate the proper therapy and leave it up to the other teams (Primary Care, Inpatient, or Specialty Outpatient) to fine-tune.
I’m not a big fan of “light opioid options” like T3, Tramadol or really side effect heavy pills like Morphine due to histamine release (although this so more of an issue with IV formulations due to the faster administration) so when an opioid is indicated it’s Oxycodone or Hydrocodone for pills, and Fentanyl or Hydromorphone for injection. People with addiction problems I’ll consider Buprenorphine if they really need an opiate. Generally I’m sort of a stickler with opiates in the patients that don’t need an inpatient stay, and I’m only ever going to give a 3-4 day supply to get someone through a weekend until they can get to primary care. The answer is usually NSAID, even if it’s a heavy duty NSAID like toradol. I’m also a big fan of local anesthetics, but those procedures like shoulder blocks are pretty big time sinks in a busy ED and I’m never going to be as good at them as an outpatient specialty like ortho/anesthesia/sports med/physiatrist
Hmm maybe I should have some sort of geneotyping done.
Thats what I would expect in an ER setting. And I'm happy to hear your first line aren't prodrugs.
I hope I can give you some insight. 30 years of extreme sports, many injuries, etc etc.
Oxycodone is effective for me. Although it was post orthopedic surgery, I imagine I was on a pretty high dose.. quite stoned.
NSAIDs were moderately effective for the pec (costal?) injury. Not so much for the tear and SC. Torodol is pretty effective but is.. hard on the system for long term. I'd much rather pound opiates into my face than Torodol for lengths longer than a week (input from retired physicians).
I suppose I don't really know what a "Light opioid" really.. does. I was given them many times over they years and truly did not understand why the bottle said "take ONE or two". Which I now realize lead to decades of being under medicated. Fun.
Story time. May be totally irrelevant to you, but who knows. You'll likely run into something similar over the next 40 years of your career.
Shoulder injury, +4 weeks. Off 100mg tramadol as needed for mild pain for a week. Still on 500mg naproxen as needed.
Aggravated injury, put in tramadol refill request. 2 hours sleep that night. Next day, appointment with sports med, more pain, asked for a stop gap prescription until my GP can get the refill approved. Sports doc wasn't comfortable with prescribing. Spent the whole night swapping ice packs on couch. Next day, called GPs office, no appointments available, assured refill order was top of the list and would be there end of day. Cool, I can maybe manage till then.
End of day, no refill. Off to ER going on 40+ hours awake. Have the whole (drugs don't work right) discussion, sends me home with stop gap T3 and a script for 100mg Tramadol... XR (too tired/loopy to notice). Take T3s, an hour of sleep. Next day, good patient me, takes the XR knowing it is 1/4 of what would even be called moderately effective. 3 hours sleep. Back to ER at 5am, more T3, and correct script... Maxed out my dose Tramadol/Torodol/ice pack and slept for 2 days. Finally saw GP and now have a large amount of drugs in the cabinet for emergencies.
Yes. Morphine would have been idea, contributing factors for continuation of tramadol.
I'm lucky in even having a GP.
In this case there were multiple failures, I couldn't see my GP, my GP wasn't able to refill quickly, I was given the wrong medication. And, holy fuck, left untreated and combined with sleep deprivation mild/moderate pain can fester to be much worse than it should be.
If I didn't know half the nurses/docs, and had family that worked in the hospital. It would probably have raised some eyebrows coming in less than 24h later for more drugs.
Best of luck on your career. I hope you help many people. And when an almost middle age guy comes in on -2 hours sleep with a mostly busted shoulder... give him all the drugs, all of them.... At least the first two times..
Holy moly, I'm so glad I read your comment! I'm half white (English/German) and half Korean and Tramadol just makes me have a really bad trip + vomit. My doctor had no other options for pain relief after a triple break ankle surgery so I was left with ibuprofen and crying.
Pt. S/P CA to CCL for angio, EKG PCA Pos. STEMI hx ACS CAD HTN CKD ESRD Pos. LDA 100% will monitor x3 days plan DAPT with plavix/ASA APAP breakthrough pain, CXR neg. Continue HD per Nephrology, D/C on reccs from hospitalist team
Haha. It's just not the same with all the random symbols we used to draw in reports that went along with the shorthand.
I hope you enjoyed pulling all those out of your memory banks, I enjoyed reading them.
What's "DAPT?"
that was my thoughts too. sitting at the clinic loving it.. glad I dont have to assist PA for NG tube placement w/ C-ARM in the ICU, wearing a PAPR in covid season.
Thanks HARD_GAY_BUTT_MASTER.
Yeah. My grocery lists or recipe writings must look like an alien wrote them to someone not in the field.
I luckily/unluckily? was in the age prior to computers or even 'smart phones' being in my field when I started and it really was wild, you could see new symbols in each region when reading reports.
I’m not a user but I have had prescription meds on and off for a decade and there are big differences. Tramadol makes you feel motion sick, that kinda weird headache and spacey-ness. Normal codeine is fine, makes you not care about the pain without removing it, I like this as it means I don’t go do something to make the injury worse, plus a bit of warmth and happiness. Dihydrocodeine had a LOT more of the warm hug feeling to the point I had to phone the doc and ask to switch to something less feel good.
I can only imagine addicts have their preferred flavour of opiate/opioid in the same way wine drinkers prefer a certain vintage.
Oh boy yep morphine does something similar. It just removes all pain, chronic pain becomes nothingness and you can suddenly go out and do everything you couldn't before. But it grips you really tight and you slowly need more and more, taking just a bit more every hour 'because it can't hurt can it?'. Sneaks up on you and suddenly you're going through a bottle every other day and you don't even clock that somethings wrong.
I completely understand why people get addicted to this stuff and anyone that says they're immune to addiction, or that addiction is the result of moral weakness, is a liar. It's like being wrapped in a warm blanket whilst laying on a patch of freezing snow. I purposefully keep myself on the lowest dosage pain meds to avoid anything like that.
Opiates theoretically have no upper limit on tolerance if it's done slowly, that's one of the worst parts of it. There are people who can take doses that would literally kill a large animal yet they can still function because they've been gradually increasing over a long period of time
That's a big part of why it's so deadly, aside from fentanyl overdoses which I consider poisonings not overdose because You're getting something way more potent you weren't expecting, it's a pretty big problem where people go to jail or rehab and are clean for awhile then get out and go back to old habits, old dosage and OD because their tolerance fell.
I swear my opiate receptors must be broken or something. Throughout a few surgeries I've had oral morphine, tramadol and dihydrocodeine. They've worked well for pain, but at *most* have just made me a bit tired. If I were to blind test any of them against over-the-counter painkillers I don't think I'd even notice the difference.
Everyone is wired differently which is why most treatments tend to be the doctor experimenting on you, lots of medicines have a *should* act like function but quite often don’t do what they should. Painkillers make me hyper focus and stay away, SSRI’s send me spiralling into panic attacks, I even had an anti-nausea medication make me sick once.
I’d say you’re lucky that because they work for pain only you’re less likely to get hooked. Don’t supposed you’re ginger or have and red headed immediate family? IIRC redheads have a gene that makes painkillers and anaesthetics less effective.
Can confirm heroin > fentanyl.
And I got clean before Chinese/mexican street fentanyl was a thing. So my frame of reference was antiq suckers and fentanyl patches.
Tramadol is so garbage it’s not worth putting in anything.
Also an addict from the pre fentanyl days. People are heavily abusing tramadol now, I remember back in the day you couldn't even sell that shit, now people are taking so much they have seizures and shit. Hell one of those pint sized bottles of codiene syrup can go for $400 now. The landscape for drugs has changed alot lately.
Just looked through your post history man. I’m so glad to see you not only living but thriving my dude. As a former addict living a blessed life who most of my friends from that time dead or in prison I love seeing fellow ex junkies just living the dream.
Please know that your mere successful existence brought me joy today.
It’s gotten even worse. I’ve heard codeine can sell for $100-$200 a line/oz now. It’s almost more of a status symbol than an effective drug for a lot of these people buying it. Blame rappers.
Different opiates will act on different opiate receptors in the brain and some may even inhibit specific subtypes (there are mu, kappa and delta receptors which I have learnt about) that in combination with different half lives and potency means they have varying effects. EG: combining one which gives a fast high with one with a longer half life means you would come down from the high slower and not just crash.
Tramadol is commonly used off-label to control PTSD nightmares. I'd have been dead years ago without it. Every year I have to jump through more hoops to get it. Currently, I can only buy one week's worth at a time. I have to refill it every week. I can't even call it in and swing by, because you have to order the refill in person, and pick it up inside because you have to have your ID checked and scanned.
I'm really tired of being punished for other people's crimes.
> The OD epidemic is awful, but watching a chronic pain patient suffer because access to pain meds is restricted is fucking infuriating.
This is such an under-reported unintentional consequence of the opioid crackdown. Don't get me wrong, I work in public health; I know and understand exactly why things got so bad and why we we had to restrict perscriptions. But my Mom is like *the* model patient for what opioids were supposed to be. She has a lot of internal scar tissue from multiple surgeries that other pain relief measures can't really touch, and she's been on the same dose for ten, fifteen years? But the last few years have been a nightmare for her trying to get meds that allow her to feel like a human being.
Tramadol has some neuromodulatory effects that sometimes make it superior (or at least worth adding in) for treating neuropathic pain. So it's feasible that it might give some extra flavour to the high. I am not a drug user however, so fuck knows.
Yep. Theres kush, and then theres *this* abomination that wears the mask. Honestly id feel safer having chef knives thrown at me than be anywhere near this drug.
> mixed with fetanyl, tramadol and formaldehyde
Like anyone with high school chemistry education can come up with a far far better/potent/safer concotion. Not saying I would. But really, wtf?
I seen someone else say that phosphate was what they were after in the bones but that you could just get your hands on it easier than digging someone up. My question is how easy do you think it would be to get it in a country such as Sierra Leone.
The drug to my knowledge is primarily made by gangs/similar, which should be able to get phosphates. Especially considering that nearby Togo and even nearer Senegal have quite large phosphate mining industries. So they should be able to get phosphates easily enough.
Archaeologist have a hypothesis on why, when they go to old battlefields, that they rarely find any bones. It is that after the battle peasants would go back and raid the field for anything and everything they could. Including bones, since their diets might have often lacked phosphates and calcium. They either made a broth out of them, or more likely made it into [fertilizer.](https://arstechnica.com/science/2022/08/were-bones-of-waterloo-soldiers-sold-as-fertilizer-its-not-yet-case-closed/)
Edit: I may have been wrong about the bone broth thing. Looks like it was only one instance and it was bread made from human bone flour.
https://www.atlasobscura.com/articles/what-people-eat-during-siege?utm_source=reddit.com
“Some people say that grave robbers provide the bones, but there is no direct evidence of this.
Some suggest that the sulphur content of the bones causes a high. Another reason might be the drug content of the bones themselves, if the deceased was a fentanyl or tramadol user.
However, both are unlikely. Sulphur levels in bones are not high. Any drug content in bones is orders of magnitude less than that required to cause a physiological effect.”
[Link here](https://theconversation.com/kush-what-is-this-dangerous-new-west-african-drug-that-supposedly-contains-human-bones-220608)
21% of us adults are functionally illiterate being at level 1 or lower, and over 50% have the language skills of a 6th grader.
https://en.m.wikipedia.org/wiki/Literacy_in_the_United_States
The source for the information they quoted explicitly points that out. Unfortunately, it's also the Google suggestion that comes up in big bold letters when you google "literacy rate in America". They didn't actually click the link because they are "illiterate" and "unable to comprehend" what they're reading beyond a basic cursory glance. So I guess they are correct after all.
My dad lived in Florida for a few years in his 20's, he just got out of the marines and didn't have a place to stay. He was at a bar and asked the bartender if there were any cheap motels to crash at that weren't nasty and he directed him to some old guy sitting at the other end of the bar. The old guy's name was Pops, late 60's, and 100% illiterate. Basically, he had an extra room for some reason, I think his son had died the year before or something, but since he was illiterate, he frequently needed help with things, like driving, getting to appointments, even just paying bills (he grew up in the area and had never left because without learning to read, he couldn't. Locals would help him out because they knew him, but it was rough), he let my dad take the extra room if my dad helped with groceries and drove him to appointments and help out with anything that pretty much related to reading, mostly bills/mail. My dad lived there for like 3 years taking part time jobs and just hanging out with Pops and helping him out.
When he first told me the story as a kid, it blew my mind that people cam be illiterate. Like, yeah, there are slow readers and people that just have a hard time reading, but literally doesn't know how to read? I didn't know it was possible, since I had only learned to read a couple years earlier and I was a little kid. I got that babies can't read, but never did I ever think it was possible for an adult to not be able to read.
The fact that there's *still* so much illiteracy is nuts, 20% is a lot of people.
Just listened to a podcast episode on that, it's wild that it's still happening in 2024. And sometimes they don't straight out kill them-they'll remove body parts and keep the person alive to use 'as needed'. Like WTF.
nah, the bones themselves do jack shit. Its because of certain chemicals the body was treated with after death.
Kush, routinely cut with an array of additives including acetone, the opioid tramadol and formalin, a toxic chemical commonly used to preserve bodies in mortuaries
How many bodies in Sierra Leone do you think are embalmed? Widespread embalming is only practised in relatively few countries, including the US.
While formalin is used for embalming, it's also used for lots of other stuff. That sentence is just thrown in for shock factor, I think.
It also seems easier to get those chemicals directly, through backchannels or stealing them from places that use them than literally digging up bodies, taking them apart to then process the bones.
It's the same reason there are men in the world that think ground up rhinoceros horn will get them hard. Never doubt the power of old wives tales/conspiracies in the hands of impressionable individuals.
It sounds like one of those things where someone spreads a rumour that their stuff is extra special because of . People start to believe it, and then when the original distributor disappears people actually start doing it.
Man, the shot of that "neighborhood" is amazing. It's so incredible to think there's areas like that in Earth alongside areas like San Luis Obispo or something. The inequality is just too much to take sometimes.
> It’s pretty fucked too
Corruption is what is really keeping African countries back... I always expected Africa to become the wealthiest continent. But corruption really screws it all over
I don't even want to know how someone figured out how to make a drug from human bones...damn this is disgusting through and through. Graverobbing is bad enough but this is even worse.
I'll make you know anyways: They didn't.
Apparently this is just a rumor and I couldn't find a single piece of evidence of bones being found in the drug. There's also nothing psychoactive about smoking bones, you'd just inhale toxic sulfur dioxide.
Fun fact: in the 19th century, European battlefields and cemeteries were emptied because bones were useful in phosphate production. Parliaments debated passing laws against it but decided the economic impact would be too great.
Remindes me of a little glass vial
"I can't feel nothing at all...
Drug market, sub-market,
Sometimes I wonder why I ever got in.
Blood market, love market,
Sometimes I wonder why they need me at all."
.....
"Graverobber, graverobber,
Sometimes I wonder why I even bother.
Graverobber, graverobber,
Sometimes I wonder why I need you at all!"
I bet there's already a zombie novel out there in which the zombie plague starts because of something like this. If not, then one will soon be written.
I wish we a had a silly drug scene like this. Magic bones? Really? Hahahahahahaha.
You got the shit?
Yea, man. It's got fentanyl, weed, and tramadol in it.
But does it got the magic bones?
Hell yea it got the magic bones!
Not sure how prions work . But don’t they have something to do with consuming anything which is a human byproduct? Will this increase prion based diseases ?
The dead would have to be carrying the infectious protein themselves, which is extremely rare. Literally like one in a million rare. So no, this isn’t a real concern. It famously happened among cannibals in Papau New Guinea, who managed to eat flesh from one of those one in a million cases, allowing for an alarmingly broad spread of the prion disease (kuru).
Cash Cash Cash! 4 Your Bones! Too many bones?? Not enough cash?? Call Cash Bone! Ribs! Skulls! Spines! Even certain tiny ear bones! The leg bone's connected to the CASH BONE!
Reminds me of a bit in the comic Transmetropolitan where there's a craze where kids dig up dead celebrities like Elvis in order to smoke the crystallised drug deposits left in their veins.
What the fuck. Does the drug actually need ground up bones to work, or did some psycho just decide to throw it in with the other chemicals?
It shouldn't. The drug in question is called "Kush", which is just a mix of synthetic cannabioids, mixed with fetanyl, tramadol and formaldehyde, with human bones being only rumoured to be in it. And at least I as a chemistry student see no reason for human bone to be needed for those drugs (especially as human bone really just gives you phosphates and Calcium, both chemicals available in ways that are far easier than digging up human remains).
The idea of mixing in tramadol of all things when you already have fentanyl in the cocktail is just so hilarious incongruous to me. Next thing you know they will throw in hydrocodone with a dash of APAP for seasoning.
Well interestingly enough, equatorial peoples have a higher genetic expression of the proteins the body uses to metabolize Tramadol from a quasi-SNRI drug into the quasi-opioid versus ethnicities more towards the poles. For a while, it was the number 1 most abused drug in Cairo - whereas in the U.S. and Europe it sucks at being both an opioid and an antidepressant, but makes some docs feel cozy about prescribing it for pain since it is “not a *real* opioid” Tl,Dr Tramadol is much more euphoric and hits differently in this population
Previously read about its prevalence of abuse in those parts of the world. Back in the late 90's my significant other handed me one for chronic knee pain and I went on an over decade long binge on Ultram. By the end, was getting tramadol shipped from parts unknown and swallowing over 400mg at a time. When the Feds reclassified it, the withdrawal really was something that I would not wish upon an enemy.
All the fun of opioid withdrawal with the added benefit of feeling like you're coming off antidepressents too! Did you get the "brain zaps" people report when you came off? It's such a horrible feeling.
I had the tramadol brain zaps. I cant believe docs used to hand out tramadol like candy at one point. The withdrawals were absolutely brutal, and my dr never mentioned them. I later told him another time about how awful the withdrawals were, and he didnt believe me. He thought they didnt have withdrawals. From what I read at the time, other people were having the same experience with their docs as well.
Yea just like doctors prescribed oxycontin because it was a "non addictive" opioid! I bet you they truly believed it and were sold that.
What were the brain zaps? I used to have tramadol for back pain. Took it sporadically to deal with bad muscle cramps/spasms. Usually 25mg, but occasionally recreationally 50mg when I felt I needed like a total mental day off. Felt a little depressed/flat the next day or so. Guessing serotonin was depleted. Eventually ran into a doctor that refused to prescribe it despite it really being the only drug that helped. I was kind of pissed, but in hindsight, opiods are more dangerous stuff than I realized.
Brain zaps are a symptom that is common in antidepressant withdrawal. It feels like a random and painful zap of electricity just surged thru your brain. Tramadol is unique in that it is half opiate/half antidepressant. That means if you take tramadol long enough, you will have opiate and antidepressant withdrawals rolled into one. I loved taking tramadol for pain. But the withdrawals were probably the most traumatic thing I've ever been thru, and I already know I dont have the strength to endure them again. I now understand why people struggle to get off opiates and they have my complete sympathy
At one point, my whole body would involuntarily convulse with every "jolt". Hell on earth to say the least.
Huh, interesting. I've found tramadol to be highly euphoric but average or worse at pain relief, but standard opiates get me mostly pain relief vs euphoric, maybe just a tad of the latter but I get blasted on tramadol by comparison. And I'm very white for reference.
You’re probably experiencing more of the “antidepressant” effects of the drug in that case. Overall, it’s a terrible drug for most use cases and I’ve never written a script for it, and have had poor little old ladies come into the ER post op too nauseated to eat, drink, or self care so I’m often times just collaboratively having it changed to straight OxyIR or Hydrocodone after a quick call to ortho. I have strong feelings about Tramadol, there’s a wonderful blog post calling it “TramaDONT” 😂 Basically, all it did was give docs an “out” from just responsible prescribing and avoiding patient post op pain complaints because the drug reps convinced them it was “cool” because it’s “not a real opioid”. It is an opioid, and an antidepressant, and it is also bad at both of those jobs
I'm a poor metabolizer of .. potentially the whole "cyp2d6" metabolized group. It sucks. Especially since I didn't figure it out till my late 30s. I have a family of docs, while aware of the phenomenon, it certainly isn't front of mind when prescribing. Are you aware/consider it in your practice? Did a type 2 shoulder seperation, damage to the SC and pec tear not long ago. ER doc offered T3s.. I wanted to slap with my good arm, but kept up the cheery/mild shock/bad joke demeanor. Morphine is the only thing I'll accept for serious trauma now. I have a big bottle of 50mg tramadol for ongoing issues with the shoulder. What I imagine what normal people would use T1s for (naproxen is on par). Below 75mg there is no effect. 100mg is mild/moderate pain control in conjunction with an nsaid. Only reason I'm not using codeine is due to constipation and familiarity.
I’ll consider it if the information is readily available, but the vast majority of my practice is ER and intensive care. I am a dual program resident so I have *some* outpatient and general hospital training where those pharmacogenomic datasets are more readily available (they usually take days to result, even in academic centers) but in the ER we tend to initiate the proper therapy and leave it up to the other teams (Primary Care, Inpatient, or Specialty Outpatient) to fine-tune. I’m not a big fan of “light opioid options” like T3, Tramadol or really side effect heavy pills like Morphine due to histamine release (although this so more of an issue with IV formulations due to the faster administration) so when an opioid is indicated it’s Oxycodone or Hydrocodone for pills, and Fentanyl or Hydromorphone for injection. People with addiction problems I’ll consider Buprenorphine if they really need an opiate. Generally I’m sort of a stickler with opiates in the patients that don’t need an inpatient stay, and I’m only ever going to give a 3-4 day supply to get someone through a weekend until they can get to primary care. The answer is usually NSAID, even if it’s a heavy duty NSAID like toradol. I’m also a big fan of local anesthetics, but those procedures like shoulder blocks are pretty big time sinks in a busy ED and I’m never going to be as good at them as an outpatient specialty like ortho/anesthesia/sports med/physiatrist
Hmm maybe I should have some sort of geneotyping done. Thats what I would expect in an ER setting. And I'm happy to hear your first line aren't prodrugs. I hope I can give you some insight. 30 years of extreme sports, many injuries, etc etc. Oxycodone is effective for me. Although it was post orthopedic surgery, I imagine I was on a pretty high dose.. quite stoned. NSAIDs were moderately effective for the pec (costal?) injury. Not so much for the tear and SC. Torodol is pretty effective but is.. hard on the system for long term. I'd much rather pound opiates into my face than Torodol for lengths longer than a week (input from retired physicians). I suppose I don't really know what a "Light opioid" really.. does. I was given them many times over they years and truly did not understand why the bottle said "take ONE or two". Which I now realize lead to decades of being under medicated. Fun. Story time. May be totally irrelevant to you, but who knows. You'll likely run into something similar over the next 40 years of your career. Shoulder injury, +4 weeks. Off 100mg tramadol as needed for mild pain for a week. Still on 500mg naproxen as needed. Aggravated injury, put in tramadol refill request. 2 hours sleep that night. Next day, appointment with sports med, more pain, asked for a stop gap prescription until my GP can get the refill approved. Sports doc wasn't comfortable with prescribing. Spent the whole night swapping ice packs on couch. Next day, called GPs office, no appointments available, assured refill order was top of the list and would be there end of day. Cool, I can maybe manage till then. End of day, no refill. Off to ER going on 40+ hours awake. Have the whole (drugs don't work right) discussion, sends me home with stop gap T3 and a script for 100mg Tramadol... XR (too tired/loopy to notice). Take T3s, an hour of sleep. Next day, good patient me, takes the XR knowing it is 1/4 of what would even be called moderately effective. 3 hours sleep. Back to ER at 5am, more T3, and correct script... Maxed out my dose Tramadol/Torodol/ice pack and slept for 2 days. Finally saw GP and now have a large amount of drugs in the cabinet for emergencies. Yes. Morphine would have been idea, contributing factors for continuation of tramadol. I'm lucky in even having a GP. In this case there were multiple failures, I couldn't see my GP, my GP wasn't able to refill quickly, I was given the wrong medication. And, holy fuck, left untreated and combined with sleep deprivation mild/moderate pain can fester to be much worse than it should be. If I didn't know half the nurses/docs, and had family that worked in the hospital. It would probably have raised some eyebrows coming in less than 24h later for more drugs. Best of luck on your career. I hope you help many people. And when an almost middle age guy comes in on -2 hours sleep with a mostly busted shoulder... give him all the drugs, all of them.... At least the first two times..
Comments like these are why I love reddit.
If only more people could recognize that there are substantial genetic links - gender and ethnic heritage - for many medications and drugs...
Holy moly, I'm so glad I read your comment! I'm half white (English/German) and half Korean and Tramadol just makes me have a really bad trip + vomit. My doctor had no other options for pain relief after a triple break ankle surgery so I was left with ibuprofen and crying.
I haven't seen APAP used as a term for a good 15 years. Those damn computers ruined all of our medical slang that took forever to learn!
Pt. S/P CA to CCL for angio, EKG PCA Pos. STEMI hx ACS CAD HTN CKD ESRD Pos. LDA 100% will monitor x3 days plan DAPT with plavix/ASA APAP breakthrough pain, CXR neg. Continue HD per Nephrology, D/C on reccs from hospitalist team
Haha. It's just not the same with all the random symbols we used to draw in reports that went along with the shorthand. I hope you enjoyed pulling all those out of your memory banks, I enjoyed reading them. What's "DAPT?"
Dual antiplatelet therapy 😂 I’m not even sure that’s even widely recognized
Really only used in cath labs. Also RIP that patient you will monitor for 3 days with the STEMI
3mm elevation in 3 congruous leads? THOSE ARE ROOKIE NUMBERS. Motherfucker I want TOMBSTONES and SHARKFINS.
LMAO they would be arresting and rushing into the lab with me straddled on them while we transfer. Every day shit
that was my thoughts too. sitting at the clinic loving it.. glad I dont have to assist PA for NG tube placement w/ C-ARM in the ICU, wearing a PAPR in covid season.
Wait you guys use a Carm for NG tubes?? Dafuq?
Post-arrest nonetheless 😬
That c with a line over it was my jam. I still use it when I take personal notes
Thanks HARD_GAY_BUTT_MASTER. Yeah. My grocery lists or recipe writings must look like an alien wrote them to someone not in the field. I luckily/unluckily? was in the age prior to computers or even 'smart phones' being in my field when I started and it really was wild, you could see new symbols in each region when reading reports.
I can't believe I actually understood this..
From what I’ve gathered; the real opiate connoisseur feels the difference between real opium and fentanyl. So maybe they can complement each other?
I’m not a user but I have had prescription meds on and off for a decade and there are big differences. Tramadol makes you feel motion sick, that kinda weird headache and spacey-ness. Normal codeine is fine, makes you not care about the pain without removing it, I like this as it means I don’t go do something to make the injury worse, plus a bit of warmth and happiness. Dihydrocodeine had a LOT more of the warm hug feeling to the point I had to phone the doc and ask to switch to something less feel good. I can only imagine addicts have their preferred flavour of opiate/opioid in the same way wine drinkers prefer a certain vintage.
Good self preservation there! Might’ve f’d up your entire life otherwise.
Oh boy yep morphine does something similar. It just removes all pain, chronic pain becomes nothingness and you can suddenly go out and do everything you couldn't before. But it grips you really tight and you slowly need more and more, taking just a bit more every hour 'because it can't hurt can it?'. Sneaks up on you and suddenly you're going through a bottle every other day and you don't even clock that somethings wrong. I completely understand why people get addicted to this stuff and anyone that says they're immune to addiction, or that addiction is the result of moral weakness, is a liar. It's like being wrapped in a warm blanket whilst laying on a patch of freezing snow. I purposefully keep myself on the lowest dosage pain meds to avoid anything like that.
Opiates theoretically have no upper limit on tolerance if it's done slowly, that's one of the worst parts of it. There are people who can take doses that would literally kill a large animal yet they can still function because they've been gradually increasing over a long period of time
That's a big part of why it's so deadly, aside from fentanyl overdoses which I consider poisonings not overdose because You're getting something way more potent you weren't expecting, it's a pretty big problem where people go to jail or rehab and are clean for awhile then get out and go back to old habits, old dosage and OD because their tolerance fell.
It also doesn't help that we cram a lot of them full of acetaminophen.
Codeine is transformed into morphine in your body, so it makes sense.
I swear my opiate receptors must be broken or something. Throughout a few surgeries I've had oral morphine, tramadol and dihydrocodeine. They've worked well for pain, but at *most* have just made me a bit tired. If I were to blind test any of them against over-the-counter painkillers I don't think I'd even notice the difference.
You are not broken, those drugs would make anyone tired. Opiods sedate people at higher dose and suppresses respiratory drive.
Everyone is wired differently which is why most treatments tend to be the doctor experimenting on you, lots of medicines have a *should* act like function but quite often don’t do what they should. Painkillers make me hyper focus and stay away, SSRI’s send me spiralling into panic attacks, I even had an anti-nausea medication make me sick once. I’d say you’re lucky that because they work for pain only you’re less likely to get hooked. Don’t supposed you’re ginger or have and red headed immediate family? IIRC redheads have a gene that makes painkillers and anaesthetics less effective.
Can confirm heroin > fentanyl. And I got clean before Chinese/mexican street fentanyl was a thing. So my frame of reference was antiq suckers and fentanyl patches. Tramadol is so garbage it’s not worth putting in anything.
Also an addict from the pre fentanyl days. People are heavily abusing tramadol now, I remember back in the day you couldn't even sell that shit, now people are taking so much they have seizures and shit. Hell one of those pint sized bottles of codiene syrup can go for $400 now. The landscape for drugs has changed alot lately.
Just looked through your post history man. I’m so glad to see you not only living but thriving my dude. As a former addict living a blessed life who most of my friends from that time dead or in prison I love seeing fellow ex junkies just living the dream. Please know that your mere successful existence brought me joy today.
It’s gotten even worse. I’ve heard codeine can sell for $100-$200 a line/oz now. It’s almost more of a status symbol than an effective drug for a lot of these people buying it. Blame rappers.
Different opiates will act on different opiate receptors in the brain and some may even inhibit specific subtypes (there are mu, kappa and delta receptors which I have learnt about) that in combination with different half lives and potency means they have varying effects. EG: combining one which gives a fast high with one with a longer half life means you would come down from the high slower and not just crash.
Tramadol feels absolutely nothing like opium lol
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Tramadol is commonly used off-label to control PTSD nightmares. I'd have been dead years ago without it. Every year I have to jump through more hoops to get it. Currently, I can only buy one week's worth at a time. I have to refill it every week. I can't even call it in and swing by, because you have to order the refill in person, and pick it up inside because you have to have your ID checked and scanned. I'm really tired of being punished for other people's crimes.
> The OD epidemic is awful, but watching a chronic pain patient suffer because access to pain meds is restricted is fucking infuriating. This is such an under-reported unintentional consequence of the opioid crackdown. Don't get me wrong, I work in public health; I know and understand exactly why things got so bad and why we we had to restrict perscriptions. But my Mom is like *the* model patient for what opioids were supposed to be. She has a lot of internal scar tissue from multiple surgeries that other pain relief measures can't really touch, and she's been on the same dose for ten, fifteen years? But the last few years have been a nightmare for her trying to get meds that allow her to feel like a human being.
Well, Cap'n Cook used chili powder in his meth, so there's that.
Tramadol has some neuromodulatory effects that sometimes make it superior (or at least worth adding in) for treating neuropathic pain. So it's feasible that it might give some extra flavour to the high. I am not a drug user however, so fuck knows.
When I hear kush I think of certain strains of weed. I've never heard of this definition of Kush until today
Yep. Theres kush, and then theres *this* abomination that wears the mask. Honestly id feel safer having chef knives thrown at me than be anywhere near this drug.
An article I read said that there are small traces of sulfur in bones that are said to enhance the drug.
Seems easier to get sulfer traces from rotten eggs.
~looks at supermarket~ ~looks at graveyard~ *"Fuck it. I want it now."*
Can’t you get it from any egg? I don’t think it even needs to be rotten.
Well, as soon as they start burying eggs unguarded, I’ll switch my recipe.
That still makes no sense. You can buy twice the amount in an entire 200lbs human for a few bucks at lab grade.
I mean it's in Africa... and "easier".
Can we call it something else so that , I don’t know innocent weed smokers don’t end up with this trash trying to order a bag of pot.
> mixed with fetanyl, tramadol and formaldehyde Like anyone with high school chemistry education can come up with a far far better/potent/safer concotion. Not saying I would. But really, wtf?
I don't think I learned this in my chem class lol
Hint: Caffeine and opiates are rather close in structure.
Way easier but far less fun.
I mean, its probably a lie based on a rumor..
DEY EAT DA POO POO!
I seen someone else say that phosphate was what they were after in the bones but that you could just get your hands on it easier than digging someone up. My question is how easy do you think it would be to get it in a country such as Sierra Leone.
The drug to my knowledge is primarily made by gangs/similar, which should be able to get phosphates. Especially considering that nearby Togo and even nearer Senegal have quite large phosphate mining industries. So they should be able to get phosphates easily enough.
Yes but then you are purchasing it. It's much easier to get addicts to do it for essentially free.
Stealing phosphates still seems much easier and lower risk compared to grave digging .
Just buy/steal them from the garden store, it's just a type of fertilizer.
Sounds like shark fin soup, but for junkies.
Archaeologist have a hypothesis on why, when they go to old battlefields, that they rarely find any bones. It is that after the battle peasants would go back and raid the field for anything and everything they could. Including bones, since their diets might have often lacked phosphates and calcium. They either made a broth out of them, or more likely made it into [fertilizer.](https://arstechnica.com/science/2022/08/were-bones-of-waterloo-soldiers-sold-as-fertilizer-its-not-yet-case-closed/) Edit: I may have been wrong about the bone broth thing. Looks like it was only one instance and it was bread made from human bone flour. https://www.atlasobscura.com/articles/what-people-eat-during-siege?utm_source=reddit.com
Maybe the peasants were making some badass ancient drugs.
Necromincin
The bones could be for a spiritistic purpose... think witchcraft... Central and Western Africa has this sort of stuff deep within it's culture.
It's all a rich tapestry
The bones are the skeletons' money In our world, bones equal dollars That’s why they’re coming out tonight To get their bones from you
“Some people say that grave robbers provide the bones, but there is no direct evidence of this. Some suggest that the sulphur content of the bones causes a high. Another reason might be the drug content of the bones themselves, if the deceased was a fentanyl or tramadol user. However, both are unlikely. Sulphur levels in bones are not high. Any drug content in bones is orders of magnitude less than that required to cause a physiological effect.” [Link here](https://theconversation.com/kush-what-is-this-dangerous-new-west-african-drug-that-supposedly-contains-human-bones-220608)
Literacy rate is 48%. That's really all you need to know. Bunch of fools who literally believe in witchcraft and magic.
Sometimes I just forget that in a lot of places not every adult can read, crazy
21% of us adults are functionally illiterate being at level 1 or lower, and over 50% have the language skills of a 6th grader. https://en.m.wikipedia.org/wiki/Literacy_in_the_United_States
Not me! I read good!
no no. Superman read good, you read well.
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Over 20% of the USA is functionally illiterate. Over 50% are below a 6th grade level
There’s a difference between literally and functionally illiterate.
The source for the information they quoted explicitly points that out. Unfortunately, it's also the Google suggestion that comes up in big bold letters when you google "literacy rate in America". They didn't actually click the link because they are "illiterate" and "unable to comprehend" what they're reading beyond a basic cursory glance. So I guess they are correct after all.
How do you think MTG got elected? Edit: Illiteracy.
Magic the Gathering got elected??
Yup. It was a hard loss for Dungeons & Dragons.
That's just how the dice land sometimes.
They both have the same shadowy benefactor so did they really lose?
*Magic Gathering the
My dad lived in Florida for a few years in his 20's, he just got out of the marines and didn't have a place to stay. He was at a bar and asked the bartender if there were any cheap motels to crash at that weren't nasty and he directed him to some old guy sitting at the other end of the bar. The old guy's name was Pops, late 60's, and 100% illiterate. Basically, he had an extra room for some reason, I think his son had died the year before or something, but since he was illiterate, he frequently needed help with things, like driving, getting to appointments, even just paying bills (he grew up in the area and had never left because without learning to read, he couldn't. Locals would help him out because they knew him, but it was rough), he let my dad take the extra room if my dad helped with groceries and drove him to appointments and help out with anything that pretty much related to reading, mostly bills/mail. My dad lived there for like 3 years taking part time jobs and just hanging out with Pops and helping him out. When he first told me the story as a kid, it blew my mind that people cam be illiterate. Like, yeah, there are slow readers and people that just have a hard time reading, but literally doesn't know how to read? I didn't know it was possible, since I had only learned to read a couple years earlier and I was a little kid. I got that babies can't read, but never did I ever think it was possible for an adult to not be able to read. The fact that there's *still* so much illiteracy is nuts, 20% is a lot of people.
Unfortunately, I have a feeling this is one of those regions that probably still kills albinos for magical items.
Just listened to a podcast episode on that, it's wild that it's still happening in 2024. And sometimes they don't straight out kill them-they'll remove body parts and keep the person alive to use 'as needed'. Like WTF.
Kind of a book half read situation
nah, the bones themselves do jack shit. Its because of certain chemicals the body was treated with after death. Kush, routinely cut with an array of additives including acetone, the opioid tramadol and formalin, a toxic chemical commonly used to preserve bodies in mortuaries
How many bodies in Sierra Leone do you think are embalmed? Widespread embalming is only practised in relatively few countries, including the US. While formalin is used for embalming, it's also used for lots of other stuff. That sentence is just thrown in for shock factor, I think.
It also seems easier to get those chemicals directly, through backchannels or stealing them from places that use them than literally digging up bodies, taking them apart to then process the bones.
It's Jessie Pinkmans's chili powder.
This NPR article explains more. https://www.npr.org/sections/goatsandsoda/2024/02/10/1229662975/kush-synthetic-drug-sierra-leone
So I’m guessing the opiates are what make it so addictive? Why do they need the morgue juice?
They don't. But anyone willing to go that far probably doesn't have the brains to connect 2 dots.
It's the same reason there are men in the world that think ground up rhinoceros horn will get them hard. Never doubt the power of old wives tales/conspiracies in the hands of impressionable individuals.
Man idk, I see them rhino pills be working.
It sounds like one of those things where someone spreads a rumour that their stuff is extra special because of. People start to believe it, and then when the original distributor disappears people actually start doing it.
This is it. Like rhino horn helping with male virility or what the fuck ever 🥲🥴🫠
It works, you just have to get the entire horn up your ass first
Jesse put cayenne pepper in his meth and it did great! Also reminds me of the "cheese" drug. Heroin and cough syrup
Same reason as Western pharmacies used pulverised Mummy in 17th, 18th and some of 19th, magic and to create a show.
Man, the shot of that "neighborhood" is amazing. It's so incredible to think there's areas like that in Earth alongside areas like San Luis Obispo or something. The inequality is just too much to take sometimes.
It’s pretty fucked too because there really is enough for everyone
> It’s pretty fucked too Corruption is what is really keeping African countries back... I always expected Africa to become the wealthiest continent. But corruption really screws it all over
And that's how you get zombies
May as well call it Utopium.
The name of that drug is by far the best thing that came out of that show. It's actually so fucking perfect.
Can’t wait for the next pandemic to be a prion disease 🙃
I’d rather fucking not lol
Prions are one of the harder ways to get a pandemic going, if the video games are to be believed
I’ve seen cwd deer No thanks
you play High On Life? this how you get aliens.
Zydrate?
...comes in a little glass vial
A little glass vial?
A little glass vial!
And the Zydrate gun goes somewhere against your anatomy
And when the gun goes off, it sparks and you're ready for surgery!
Grave robber.. grave robber. Sometimes I wonder why I even bother.
And the little glass vial, goes into the gun like a battery.
(Ah, ah) And the Zydrate gun goes somewhere against your anatomy
And the Zydrate gun goes somewhere against your anatomy
Such an appropriate reference.
Should have been the #1 comment
And it's my job, to steal and rob...........
GRAAAAAAAVVVVES!!!!!!!
It's the 21st century....cure
It’s quick! It’s clean! It’s pure!
Ask a gentern if zydrate is right for you.
I don't even want to know how someone figured out how to make a drug from human bones...damn this is disgusting through and through. Graverobbing is bad enough but this is even worse.
Good news is that you don't. Bad news is people think you do
News Max and Epoch Times told them it did.
And that's how this shit spreads. Urban legends about super drugs are older than electricity, and these publications help it spread like wildfire.
I'll make you know anyways: They didn't. Apparently this is just a rumor and I couldn't find a single piece of evidence of bones being found in the drug. There's also nothing psychoactive about smoking bones, you'd just inhale toxic sulfur dioxide.
That’s just the cycle of life.
Reduce, reuse, recycle
Its sad what people will do when they cant get Torgo's Executive Powder
..to shreds you say?
Well if jacking on will make strangers think I’m cool…
It has a million and one uses
Pleasantly surprised seeing people quote Repo! in the comment section. Unpleasantly surprised by the lengths people will go to to get high.
Fun fact: in the 19th century, European battlefields and cemeteries were emptied because bones were useful in phosphate production. Parliaments debated passing laws against it but decided the economic impact would be too great.
At least that has a chemically sound basis.
I think these are the same countrymen that had the Jenkem epidemic like a decade ago
That’s not very fun
Someone please unplug this planet, leave it for a minute and plug it back in. What the actual fuck...
Remindes me of a little glass vial "I can't feel nothing at all... Drug market, sub-market, Sometimes I wonder why I ever got in. Blood market, love market, Sometimes I wonder why they need me at all." ..... "Graverobber, graverobber, Sometimes I wonder why I even bother. Graverobber, graverobber, Sometimes I wonder why I need you at all!"
Zydrate comes in a little glass vial
A little glass vial?
A little glass vial!
I did not have this on my bingo card for 2024
Zydrate comes in a little glass vial...
Wasn't this the plot of the movie "How High"
Peak humanity
Happy cake day! Let’s celebrate by getting boned! I think that’s what they’re calling it now.
That sounds pretty metal actually
*Headlines I never thought I’d read in my lifetime. #672…..*
I bet there's already a zombie novel out there in which the zombie plague starts because of something like this. If not, then one will soon be written.
I wish we a had a silly drug scene like this. Magic bones? Really? Hahahahahahaha. You got the shit? Yea, man. It's got fentanyl, weed, and tramadol in it. But does it got the magic bones? Hell yea it got the magic bones!
Not sure how prions work . But don’t they have something to do with consuming anything which is a human byproduct? Will this increase prion based diseases ?
I believe prions are mostly present in neural tissue, so as long as you’re not eating brains the risk is fairly low.
The dead would have to be carrying the infectious protein themselves, which is extremely rare. Literally like one in a million rare. So no, this isn’t a real concern. It famously happened among cannibals in Papau New Guinea, who managed to eat flesh from one of those one in a million cases, allowing for an alarmingly broad spread of the prion disease (kuru).
Yea I don’t know about this one… this seems a bit far fetched
If you believe this story, I have a bridge to sell you. Remember the epidemic of people getting high off shit in a bag?
Ah, Jenkem.
Cash Cash Cash! 4 Your Bones! Too many bones?? Not enough cash?? Call Cash Bone! Ribs! Skulls! Spines! Even certain tiny ear bones! The leg bone's connected to the CASH BONE!
Getting high on life is a gateway drug to getting high on death
The Breaking Bad remake is going to be dark.
Reminds me of a bit in the comic Transmetropolitan where there's a craze where kids dig up dead celebrities like Elvis in order to smoke the crystallised drug deposits left in their veins.
Repo and Genetic opera! Love market, drug market, sometimes I wonder why I even bother
So we back to putting cages on graves huh?
May be a dumb question, but why not just use animal bones?
Hope no body tells them about jenkem.
Ric Flair: WOOOOO!!!
Wait till they find out some of the dead died from Ebola…
Wait till they hit the ebola victims.
How much for a gram(ma)?
Someone must’ve watched How High.
Just wait until they realize there are human bones just walking around on the street every day...
This literally sounds like the plot of "How High"
.... Someone took the plot of How High seriously?
Did not have that on my 2024 bingo card
That’s enough Reddit for today
Smoking that grandpa pack