I don’t remember when I fell asleep or when I woke up, but I was in another room. My wife, Jody, said that, when I started talking again, I would repeat the same stories, three, four, even five times in a row.
That’s what a little fentanyl will do for you.
Don’t worry, I didn’t surreptitiously buy some street-corner cocaine that turned out to be laced with fentanyl, nor was I hooked on counterfeit OxyContin or Vicodin that increasingly contains fentanyl at wildly inconsistent – and often deadly – doses.
After years of soaring OxyContin deaths, fentanyl has now surpassed Purdue Pharma’s highly-touted, once-presumed “non-addictive” pain medicine as the world’s deadliest opioid. Fentanyl itself is now responsible for close to 80,000 deaths a year in the U.S. alone. The drug is 10 to 20 times more potent than heroin, 50 times more powerful than oxycodone and 100 times stronger than morphine.
Fentanyl has long been used for pain reduction and sedation in medical settings; it was approved for use in the U.S. in 1968 and plays a critical role in post-surgery recovery and managing end-of-life cancer pain. Because it has such a short time-to-action peak (about five minutes), fentanyl is routinely used in obstetric epidurals. In the military, fentanyl lollipops are given to soldiers following an injury from an IED.
In 2017, fentanyl was the most widely used synthetic opioid in medicine in the U.S.
Because fentanyl is so hardy, even very small amounts can create profound change – from feelings of bliss to fatal overdose. You can pack a lot of fentanyl into a tiny pill, which makes it easily smuggled. NBC News reports that drug cartels “made the business decision that an increase in deaths among their customers was a small price to pay for the profitability of using fentanyl in nearly every illegal drug.”
The musician Prince reportedly overdosed on fentanyl in 2016. Two years later, Tom Petty died from an accidental overdose that included fentanyl in its cocktail mix, as did Michael K. Williams, one of the stars of TV’s The Wire.
Fentanyl has become a left-right political hot potato, too, with Democrats perceived as being soft on prevention while President Donald Trump has taken a tougher line. The GOP national convention in July, for example, featured a speech from a mother who had lost a child to fentanyl. At the DNC, no prime-time speaker mentioned the opioid crisis.
Given all this background, when I saw fentanyl on the list of meds about to be injected into my arm, I was a tad alarmed. But I trusted my doctor who needed to put me under in order to perform a colonoscopy – my first in 13 years.
The colonoscopy’s timing was entirely coincidental and unrelated to my cancer diagnosis, although there is some evidence that Crohn’s disease, which I’ve had since I was 12 years old, is correlated with an increased risk of lymphoma, my personal cancer bugaboo.
Fentanyl – and the other two sedatives in the injection – dormicum and propofol – are a far cry from the first colonoscopy I had when I was pre-teen. In those days, the protocol was “semi-sedation.” The docs wanted you awake enough to tell them, “Ow, that hurts.” Then, at the end of the procedure, they’d give you an extra dose, and you would forget the whole thing.
For my first colonoscopy, the doctor told me afterward about the long and philosophical conversations we had while he was poking around.
I couldn’t recall a thing,
Which got me wondering: If you feel pain but you don’t remember it, did you really feel the pain?
The American Cancer Society recommends that everyone over the age of 50 get a little fentanyl every 10 years – that is, to perform a colonoscopy to rule out colon cancer – which, because it grows so slowly, is usually treatable if caught early. After age 70, most people can stop the scopes (even without an Ezekiel Emmanuel-style “declaration” that you’re ceasing all screening at 75) because it’s more likely that something else will kill them before any colon cancer does.
Colonoscopy is not without risk: Three out of every 1,000 colonoscopies result in some sort of problem, from excessive bleeding after a biopsy to a potentially deadly perforation of the intestinal wall.
Because of the Crohn’s, my gastro doc wants me to come back for another colonoscopy in three years. I won’t be 70 yet; still, I’m not sure I’ll agree.
If I do demur, I’ll be in the right country.
Israeli doctors argue it’s better to do a stool test every year instead of the more invasive procedure only once every decade.
American doctors say no way – colonoscopy is the only way to be sure. (My doctor moved to Israel from the U.S. several years ago, so he’s in favor of the latter approach.)
When I became aware I was about to receive fentanyl in my IV drip, I pointed it out to my gastro.
“You should wake up very happy,” he quipped before I passed out.
I can’t tell you if I was fentanyl-induced giddiness after the procedure, but in the days after the colonoscopy, I was unstoppable, writing articles, conducting Zoom interviews, playing with my grandchildren, and energetically hosting guests that Shabbat.
That doesn’t mean I’ll be frantically seeking my next fentanyl hit on one of Telegram’s illicit drug channels. But I suppose, if I absolutely must be put under again, I won’t say no to a little more of modern medicine’s miracle narcotic.
I first posted about taking this miracle narcotic at The Jerusalem Post.
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