COUNTERFEIT OXYCODONE WARNING!

COUNTERFEIT PAIN PILLS CONTAINING DANGEROUS SYNTHETIC OPIOIDS!

Originally posted July 18, 2017
National Institute of Drug Abuse
https://www.drugabuse.gov/

Health and safety agencies in Iowa have issued an advisory to warn Iowans of counterfeit pain pills containing dangerous synthetic opioids. The Iowa Division of Criminal Investigation’s (DCI) laboratory analyzed pills made to resemble the prescription pain reliever oxycodone, finding them to contain more powerful and illicit synthetic fentanyl and U-47700, putting users at higher risk of opioid overdose. U-47700, also known as “Pink” or “U4” on the streets, is a synthetic opioid pain medication currently being distributed as a dangerous designer drug. Since 2015, reports have surfaced of numerous deaths due to street use of U-47700. Law enforcement agencies have traced illegal importation into the United States primarily from clandestine chemical labs in China. It is available through the Dark Web.

Heroin and a Handgun

U-47700 has been seized by law enforcement on the street in powder form and as tablets. Typically, it appears as a white or light pinkish, chalky powder. It may be sold in glassine bags stamped with logos imitating heroin, in envelopes and inside knotted corners of plastic bags. In Ohio, authorities seized 500 pills resembling a manufacturer’s oxycodone immediate-release tablets, but they were confirmed by chemical analysis to contain “Pink.” U-47770 has also been identified and sold on the Internet misleadingly as a “research chemical” at roughly $30 per gram.

Pink is very toxic or deadly in even small doses. Labels on the packaging may state NOT FOR HUMAN CONSUMPTION or FOR RESEARCH PURPOSES ONLY, most likely to avoid legal detection. Fatalities due to U-47770 in the United States join the growing incidents of drug overdose deaths from opioid pain medication. Those who abuse U-47770 may be at high risk of addiction and substance abuse disorder, overdose and death. Fatalities have been reported in New York, New Hampshire, Ohio, Texas, Wisconsin and North Carolina.

In July 2016, a toxicology case report was published in the Annals of Emergency Medicine that detailed events in which fentanyl and U-47700 were being sold misleadingly as the prescription opioid pain medication Norco or Vicodin (acetaminophen and hydrocodone) on the streets of Northern and Central California. In one patient who presented to the emergency room, nalaxone (Narcan) was administered which reversed respiratory depression and pinpoint pupils. After additional chemical analysis, it was found the Norco contained hydrocodone, fentanyl, and U-47700.

Reports indicated that Pink and prescription fentanyl may have been contained in the drug cocktail that led to the death of pop star legend Prince in April 2016. In Utah, two 13-year old boys died in September 2016 reportedly due to use of U-47770 purchased from an Internet website. U-47700 (“Pink”) is a novel synthetic opioid agonist with selective action at the mu-opioid receptors in the brain and on the spinal column. It was originally developed by chemists at Upjohn Pharmaceuticals in the 1970’s as a potent pain reliever for use with cancer patients, post-operative patients with intractable pain, or extremely painful trauma injuries. Although it was never commercially made available, the patent and chemical details remained available, and have been produced on the black market.

prince_slide.jpg

U-47700 has a similar chemical profile as morphine and other mu-opioid receptor agonists; however, it has been reported by the National Institute of Drug Abuse (NIDA) that Pink is “far more potent than morphine” –  possibly by seven to eight times. Unfortunately, the strength of the product can never be assured, and may be much stronger, especially when manufactured overseas in illicit labs as a designer drug. On November 14, 2016, the DEA placed U-47700, as well as its related isomers, esters, ethers, and salts into Schedule I of the Controlled Substances Act due to an imminent hazard to public safety and health. Substances in Schedule I have a high potential for abuse, no currently accepted medical use, and a lack of accepted safety for use under medical supervision.

Temporary emergency scheduling of dangerous illicit drugs is one tool the DEA uses to help restrict potentially fatal and new street drugs. Scheduling will last at least 24 months, with a possible 12-month extension if the DEA needs more time to determine whether the chemical should remain permanently as a Schedule I drug. According to the Federal Register, there are no current experimental or approved new drug applications for U-47700, which can typically hinder its permanent placement in Schedule I if approved. DEA’s Final Order is available in the Federal Register with details on threats to public safety. Prior to DEA’s scheduling, several states had already outlawed the drug under emergency orders, including Florida, Ohio, Wyoming and Georgia.

BOTTOM LINE

U-47700, known on the streets as “Pink” or “U4”, is a dangerous designer drug exported from illegal labs in China to the U.S. It is a strong opioid analgesic, reportedly 7 to 8 times more potent than morphine. Authorities in many U.S. cities have reported that Pink is sold on the streets or over the Internet, often falsely promoted as a prescription opioid like Norco or Percocet, or as heroin. In fact, many of these products have contained the potent designer drug Pink, as well as fentanyl. U-47700 is now illegal in all forms, and the DEA has temporarily placed the substance into Schedule I of the Controlled Substances Act, pending further review, due to an imminent hazard to public safety and health. It is considered not safe for human consumption, and has no acceptable medical use.

Clusters of overdoses and deaths of Pink were reported in U.S. cities in 2015 and 2016. Some of these deaths involved children. According to one case report, the use of naloxone (Narcan) in an emergency setting reversed the effects of U-47700, but this may not always be the case. Emergency physicians should contact their local poison control center, medical toxicologist or public health department in cases where there is a reasonable suspicion of ingestion of designer drugs to help protect the surrounding community. Special lab analysis is typically needed to identify drugs like “Pink,” leaving communities at risk.

The public should be aware that drugs obtained on the street, even though they look like an authentic prescription medication, may be fake and deadly. Don’t take any prescription drug, legal or otherwise, unless it is prescribed specifically for you by a doctor and is dispensed by a reliable pharmacy.

Community: The Answer to the Opiate Epidemic

The following is taken directly from the Afterword of Sam Quinone’s bestselling book “Dreamland: The True Tale of America’s Opiate Epidemic.” You can purchase a copy of this vital publication here.

BY THE TIME I BEGAN research for this book in 2012, we had, I believe, spent decades destroying community in America, mocking and clawing at the girdings of government that provide the public assets and infrastructure that we took for granted and that make communal public life possible. Meanwhile, we exalted the private sector. We beat Communism and thus came to believe the free market was some infallible god. Accepting this economic dogma, we allowed, encouraged, even, jobs to go overseas. We lavishly rewarded our priests of finance for pushing those jobs offshore. We demanded perfection from government and forgave the private sector its trespasses.

Part of the private sector developed a sense of welfare entitlement. Certainly, in this opiate scourge, it is the private sector that has taken the profits; the costs of dealing with the vast collateral damage have fallen to the public sector. A couple months after this book’s publication, Forbes counted the Sackler family ¹, and Raymond Sackler, the last remaining of the brothers, as the richest newcomer to the magazine’s list of “America’s Richest Families” – with an estimated net worth of $14 billion. All of that was due to sales of OxyCotin, which the magazine estimated at $35 billion since the drug’s release in 1996.²

We seemed to fear the public sphere. Parents hovered over kids. Alarmed at some menace out in public, they accompanied their kids everywhere they went. In one case, a couple was actually charged with allowing their nine-year-old daughter and her sister to go to the park alone. The term “free-range parenting” was coined to describe the daring parents who let their kids out of their sight. No wonder so many kids – boys mostly – were diagnosed with ADHD and prescribed Adderall and other drugs. (I wish someone would study the incidence of opiate addiction [in] teens and young adults of people who as kids were diagnosed with ADHD and prescribed drugs like Adderall.) They spent their lives indoors, cooped up, bouncing off the walls. I can say this because I was one: Boys are like dogs; they need to run and run and run.

When I was a boy in suburban Southern California, we spent our entire free time outside playing – football, basketball, riding bikes, or just running around. We probably ran three or four miles a day every day. My knees were in an almost permanent state of being skinned, with scabs growing and being torn off by my roughhousing. My mother had a bell from her family’s farm in Iowa that she used to ring us home at dinnertime – because we were always running around out of the house. I’ve been back to the street where I grew up eight times in the last few years and have yet to see a human being outside. The park where I used to play is always empty.

Keeping kids cooped up seems to be connected to the idea that we can avoid pain, avoid danger. It doesn’t surprise me to hear that in universities, students, raised indoors on screens, apparently lived in some crystalline terror of any kind of emotional anguish. A 2015 story in the Atlantic called “The Coddling of the American Mind” reported on the phenomenon of college students – kids who grew up in the era of hyper-protection from physical pain – demanding to be protected as well from painful ideas. They were demanding professors provide “trigger warnings” in advance of ideas that might provoke a strong emotional content – for example, a novel that describes racial violence. This new campus ethos, the authors wrote, “presumes an extraordinary fragility of the collegiate psyche, and therefore elevates the goal of protecting students from psychological harm. The ultimate aim, it seems, is to turn campuses into ‘safe spaces’ where young adults are shielded from words and ideas that make some [people] uncomfortable.”

Psychology Today ran a story on “Declining Student Resilience” that [sic] noticed increased neediness in college students, that students had called campus police after seeing a mouse, blaming teachers for poor grades, and “increasingly seeking help for, and apparently having emotional crises over, problems of everyday life.” Professors, the authors continued, “described an increased tendency to see a poor grade as reason to complain rather than reason to study more, or more effectively. Much of the discussions had to do with the amount of hand-holding faculty should do versus the degree to which the response should be something like, “Buck up, this is college!” All of this seems the predictable result of the idea that we should be protected from pain at all costs.

As a country, meanwhile, we acted as if consumption and the accumulation of stuff was the path to happiness. We leave family Thanksgivings to go stand in line to buy products – Xboxes, tablets, and the like – that keep us isolated and that poison our kids, and we go do it as if we have no choice in the matter. We have built isolation into our suburbs and called it prosperity. Added to that mix is the expansion of technology that connects us to the world but separates us from our next-door neighbor. We wound up dangerously separate from each other – whether in poverty or in affluence.

Kids no longer play in the street. Parks are underused. Dreamland lies buried beneath a strip mall. Why then do we wonder that heroin is everywhere? In our isolation, heroin thrives; that’s it’s natural habitat. And our very search for painlessness led us to it. Heroin is, I believe, the final expression of values we have fostered for thirty-five years. It turns every addict into narcissistic, self-absorbed, solitary hyper-consumers. A life that finds opiates turns away from family and community and devotes itself entirely to self-gratification by buying and consuming one product – the drug that makes being alone not just all right, but preferable. [Emphasis added.]

I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often. Form your own Dreamland and break down those barriers that keep people isolated. Don’t have play dates; just go out and play. Bring people out of their private rooms, whatever forms those rooms take. We might consider living more simply. Pursuit of stuff doesn’t equal happiness, as any heroin addict will tell you. People in some places I’ve been may emerge from this plague more compassionate, more grounded, willing to give children experience rather than things, and show them that pain is part of life and often endurable. The antidote to heroin may well be making your kids ride bikes outside, with their friends, and let them skin their knees.

Sam Quinones

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1 The richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers. How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century – OxyContin. Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995. Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue’s operation in the United States.

2 OxyContin is a dying business in America. Literally. With the nation in the grip of an opiate epidemic that has claimed more than 200,000 lives, the U.S. medical establishment is turning away from painkillers. Top health officials are discouraging primary care doctors from prescribing them for chronic pain, saying there is no proof they work long-term and substantial evidence they put patients at risk. Prescriptions are declining amid increased scrutiny over drug addiction, down 12% since 2012 according to data from healthcare information firm IMS Health. OxyContin saw prescriptions fall 17%.

The Worst Man-Made Epidemic in History

The following is comprised of excerpts from Sam Quinones’ Dreamland: The True Tale of America’s Opiate Epidemic. I want to praise Quinones for this seminal work. Personally, it has defined for me the very nightmare I, and countless others, have lived, each to his or her own level, after discovering the morphine molecule through seemingly acceptable pain medications like Vicodin, Percocet and OxyContin. You can purchase a copy of Dreamland here: Dreamland

AS HEROIN AND OXYCONTIN addiction consumed the children of America’s white middle class, parents hid the truth and fought alone. Quietly. Friends and neighbors who knew shunned them. “When your kid’s dying from a brain tumor or leukemia, the whole community shows up,” said a mother of two addicts. “They bring casseroles. They pray for you. They send you cards. When your kid’s on heroin, you don’t hear from anybody, until  they die. Then everybody comes and they don’t know what to say.”

These parents made avoidable mistakes, and when a son died or entered rehab for the fourth time, they again hid the truth, believing themselves alone, which they were as long as they kept silent. This pervasive lie was easily swallowed. It often lay buried beneath lush lawns, shiny SUVs, and the bedrooms of kids who lacked for nothing. It was easier to swallow, too, because some of these new addicts were high school athletes – the charismatic golden youth of these towns. Athletes opened the door for other students who figured that if cool jocks were using pills, how bad could it be?

One addict was Carter, from one of of California’s wealthiest communities, the son of a banker. Carter had been a high school star in football and baseball. With no break from sports during the year, he battled injuries that never healed. A doctor prescribed Vicodin for him, with no warning on what Vicodin contained, or suggestions for how it should be used. Sports were king in Carter’s town. It was a place of gleaming mansions, but he felt no sense that education was of value in providing choices in life, much less for the love of learning. These kids’ futures were assured. Sports were what mattered. Dads would brag to friends about their sons’ athletic exploits, then berate their boys for poor play, urging greater sacrifice. From the athletic director down to parents and teachers they heard, “You need grades so you can play. That was the vibe we got,” said Carter.

Many new athlete-addicts were not from poor towns where sports might be a ticket out for a lucky few. The places where opiate addiction settled hard were often middle- and upper-class. Parents were surgeons and developers and lawyers who provided their kids with everything. Yet sports were as much a narcotic for these communities as they were to any ghetto. Love of learning seemed absent, while their school weight rooms were palatial things, and in many of them pain pills were quietly commonplace. Just as opiates provided doctors with a solution to chronic-pain patients, Vicodin and Percocet provided coaches with the ultimate tool to get kids playing again.

Carter’s coach told him stories of players years before who were gulping down Vicodin before practices and games. “In my town, the stands were always filled. You wanted to be the hero. So you think, ‘I can’t look weak. I gotta push myself.’ I would get these small injuries. The coaches wouldn’t pay any attention. I taught myself to not pay attention to any injuries.” Most athletes on every team on which Carter played used pills, for injury or recreation. Soon Carter grew addicted to Vicodin, and then to OxyContin. From there, as a student athlete at a Division I university, he began using heroin.

Football players were seen as symbols of this American epidemic. Their elevated status on campus left some of them unaffected by consequences. Carter was caught selling pills and was told not to do it again. Above all, though, players were in constant pain and were expected to play with it. If opiates were now for chronic pain, well, football players endured more chronic pain than most. Necks, thighs, and ankles ached all season. Medicating injuries to get athletes playing through the pain was nothing new. But as oxycodone and hydrocodone became the go-to treatment for chronic pain, organized sports – and football in particular – opened as a virtual gateway to opiate addiction in many schools. Thus, with the epidemic emerged the figure of the heroin-addicted football player. Though, of course, few wanted to talk too much about that.

By 2008, when Jo Anna Krohn’s son died, these kinds of delusions had been accepted for almost a decade in places like Salt Lake, Albuquerque, Charlotte, Minneapolis, and other cities that had for that same decade been the drivers and beneficiaries of the greatest boom in the history of U.S. consumer spending. But it was in beat-down Portsmouth, Ohio, where one mother had the gumption to own the truth and say something about it.

***

ACROSS PORTSMOUTH, AT THE Counseling Center, Ed Hughes thought silence was a huge part of the story. Opiates had exploded all those plans Hughes had in the mid-1990s to consolidate the Counseling Center’s operations and focus on improving its internal workings. The center opened years before in a small house. By 1992 it began residential treatment with 16 beds. This quickly increased to 150 beds, with a huge waiting list, and a staff of close to 200. It moved its outpatient center into an abandoned three-story school due entirely to the swarms of new opiate addicts.

“We’ve never seen anything move this fast,” said Hughes. A decade and a half in, Ed Hughes was still waiting for the arc of addicted clients to plateau and curve downward. Kids were coming to the center from across Ohio. Many, said Hughes, grew up coddled, bored, and unprepared for life’s hazards and difficulties. They’d grown up amid the consumerist boom that began in the mid 1990s. Hughes believed parenting was changing as well. “Spoiled rich kid” syndrome seeped into America’s middle class. Parents shielded their kids from complications and hardships, and praised them for minor accomplishments – all as they had less time for their kids.

“You only develop self-esteem one way, and that’s through accomplishment,” Hughes said. “You have a lot of kids who have everything and look good, but they don’t have any self-esteem. You see twenty-somethings: They have a nice car, money in their pocket, and they got a cell phone… a big-screen TV. I ask them, ‘Where the hell did all that stuff come from? You’re a student.’ ‘My mom and dad gave it to me.’ And you put opiate addiction in the middle of that?” Hughes added, “Then the third leg of the stool is the fifteen-year-old brain.”

Hughes saw this all the time: Adult drug users incapable of making mature choices. This happened because opiates stunted the part of their brain controlling rational action. ¹ “We’ve got twenty-five- to thirty-year-old, opiate-addicted people who are going on fifteen. Their behavior, the way their brain works, is like an adolescent,” said Hughes. “It’s like the drug came in there and overwhelmed that brain chemistry, and the front of the brain did not develop.” He added, “The front of the brain has to develop through mistakes. But the first reaction to the addicted person is to head back to the family: ‘Will you rescue me?’ Whatever the person’s rescued from, there’s no learning. There’s no experiences, no frontal brain development. They’re doing well and then some idea comes into their head and they’re off a cliff. It may not be a decision to use [drugs]. Most relapse comes not from the craving for the drug. It comes from this whole other level of unmanageability, putting myself in compromising situations, or being dishonest, being lazy – being a fifteen-year-old.”

***

FIVE YEARS AFTER PORTSMOUTH found itself swept up in a national epidemic, the victims of America’s opiate scourge had emerged from the shadows and the silence. They were everywhere now. Heroin had traveled a long way from the back alleys of New York City and William Burrough’s Junky. The town of Simi Valley agonized over a spate of opiate overdose deaths – eleven in a single year. Simi Valley, conservative and religious, has long been an enclave for cops. Many LAPD officers live in the town. Simi’s vice mayor at the time was a Los Angeles police officer. So for years Simi was one of America’s safest towns. According to the crime statistics, it still is. But with pills everywhere and heroin sold in high schools, its kids were now also dying of dope. Simi youths clogged the methadone clinic. Nearby, Thousand Oaks, Moorpark, and Santa Clarita told similar stories. Low crime and high fatal overdoses was the new American paradigm.

Susan Klimuski, whose son Austin died from a heroin overdose, formed a coalition to fight back. It was called Not One More. It received support from city council and the town’s retail core. Yet these were times when heroin was still invisible, conveniently hidden away, at least to anyone who wasn’t a junkie, or a parent of one. Then, on Super Bowl Sunday 2014, America awoke to the news that one of its finest actors was dead. Philip Seymour Hoffman, forty-six, was found that morning in his Greenwich Village apartment, a syringe in his arm and powder heroin in packets branded with the Ace of Spades near his corpse. Blood tests showed he had heroin in his system, combined with cocaine, amphetamine, and benzodiazepine. The Oscar-winning actor – a father of three- had checked into rehab the previous May for ten days, and then, pronouncing himself sober again, left to resume a hectic film schedule. This death hit me right between the eyes. I was a die-hard fan of Hoffman’s acting. He had a heroin habit in college (twenty years ago), but managed to get clean. At least for two decades. Hoffman’s death awoke America to the opiate epidemic.

Within days of covering the story of Hoffman’s death, media outlets from coast to coast discovered that thousands of people were dying. Heroin abuse, the news reports insisted, was surging. Almost all the new heroin addicts were hooked first on prescription painkillers. It was not just the pain, however. This scourge was connected to the conflation of bigger forces: of economics, of aggressive prescription drug marketing, of poverty and prosperity. But this was tough to articulate in four-minute interviews, and a lot of it got lost in the media’s rush to discover and report the new plague. Attorney General Eric Holder described an “urgent and growing public health crisis,” and called on police and paramedics to carry naloxone, an effective antidote to opiate overdose. The problem also prompted Surgeon General Vivek H. Murthy, M.D., M.B.A. to issue a report in November 2016 on alcohol, drugs and health. This is the most comprehensive health crisis report issued by a surgeon general since cigarette smoking. You can read a PDF of the entire report here.

Two decades since the evolving pain revolution,² a consensus emerged that opiates are not helpful for some varieties of chronic pain, including back pain, migraines, and fibromyalgia. In fact, it was finally decided that opiate use is risky. Many clinics and physicians developed policies against using opiates for chronic non-cancer pain. One 2007 survey of studies of back pain and opiates found that “use disorders” were common among patients, and “aberrant” use behavior occurred in up to 24 percent of the cases. It was unclear whether opiates had a positive effect on back pain in the long term. Personally, I have found that opiates do nothing more than create a euphoria that tends to distract me from the pain for a few hours, only to ebb, thus requiring more opiates. By the end of the 2000s, it was already common for people to go from abusing opiate painkillers to a heroin habit. Purdue Pharma, the inventor of OxyContin (who paid a $635.5 million fine for falsely claiming their formulation of the drug oxycodone in time-released pills was far less addictive) recognized this, and in 2010 they reformulated OxyContin with an abuse deterrent, supposedly making the drug even harder to deconstruct and inject.

Unfortunately, by this time, heroin had spread to most corners of the country because the rising sea level of opiates flowed there first. “What started as an OxyContin and prescription drug addiction problem in Vermont as now grown into a full-blown heroin crisis,” said Governor Shumlin. What made New York City the dominant heroin market for much of the twentieth century – its vast number of addicts, and its immigrants from poppy-rich regions of the globe – was now true of most of America. Most of the country’s heroin was coming from Mexico, through the Southwest, trucked into New York. The entrepreneurial Xalisco brothers from Nayarit, Mexico, devised a system for selling heroin across the United States that resembles pizza delivery. An addict calls and places an order, and an operator directs him to an intersection or parking lot. The dealer carries balloons of heroin in his mouth. He simply spits out what the addict ordered. If the cops move on the dealer, he washes the balloons down his throat with a swig from a nearby bottle of water. No evidence, no arrest. The dealers have also been known to deliver to the door for “clients” that are home-bound due to illness or disability.

What started as a concern among physicians for a solution to chronic pain was hijacked by greedy Big Pharma, eventually morphing into nationwide heroin use and addiction resulting from the medical community and the government tightened the reins on prescriptions. Of course, whenever drugs are involved, there is always someone at the ready to provide a system of delivery to dope-sick addicts and chronic pain sufferers hankering for release.

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¹ Adolescence and young adulthood is a period of continued brain growth and change. The frontal lobes, key to executive functioning, such as planning, working memory, and impulse control, are among the last areas of the brain to mature. Age is a risk factor that is associated with the onset of drug use in adolescence and young adulthood. Adolescence is a developmental period associated with the highest risk for developing a substance use disorder.

² During the 1990s changes in attitudes and techniques in pain treatment were coming quickly. In 1996, the president of the American Pain Society, Dr. James Campbell, proposed that pain should be assessed in the same manner as other vital signs. They trademarked the slogan, “Pain: The Fifth Vital Sign.” This led to the 0-10 pain intensity scale now prevalent in every ER and doctor’s office in America. Essentially, doctors were finally given more power in prescribing opiates to patients suffering from chronic pain who were not cancer patients.

References

Quinones, Sam. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. New York, NY: Bloomsbury Press

Winters, K. and Arria, K. (2011). “Adolescent Brain Development and Drugs.” The Prevention Researcher, 18(2), 21–24.

Fentanyl Becomes Deadly Force

Some Excerpts taken from an article By Eric Scicchitano
The Daily Item
July 10, 2017

Fentanyl

The deadly heroin and opioid epidemic is expected to become even deadlier with the increasing presence of Fentanyl in America. According to the DEA, Fentanyl is 50 to 100 times more powerful than morphine, and substantially more potent than heroin. As little as 2 grams of Fentanyl can be deadly. Alarmingly, it is fast becoming the most prevalent active ingredient in counterfeit drugs like Adderall, Xanax, and OxyContin being sold on the streets. During the first quarter of 2017, heroin combined with Fentanyl was detected in 61% of opioids seized for evidence and inspected in DEA labs. It is also frequently laced into marijuana and smoked.

The DEA’s Philadelphia Division warns that Fentanyl is on the rise, with seizures of shipments more than doubling from 167 kilos in 2015 to 365 kilos in 2016. Investigators are trying to determine if an outbreak of Fentanyl is responsible for 51 overdoses which occurred in Williamsport (Pennsylvania) in forty-eight hours. [See my post 51 overdoses in 48 hours] Three of those cases ended in death. According to the National Institute on Drug Abuse (NIDA), heroin and opioids killed an estimated 280,000 people nationwide between 2002 and 2015. Based upon preliminary figures put together through state coroners, more than 4,800 people died of an overdose in Pennsylvania last year. Experts are concerned that the next chapter in the opioid crisis could dwarf what we’ve seen so far. Their concern is based on the proliferation of Fentanyl.

Fentanyl Deaths Map

Let’s take a few moments to discuss Fentanyl. It is a man-made (synthetic) opioid, meaning it is manufactured in a laboratory, but it acts on the mu-opioid receptors in our brain and spinal column in the same manner as the morphine molecule found naturally in opium. Typically, these receptor sites are meant for naturally-occurring endorphins, our “feel good” chemical released by the pituitary gland. Fentanyl is usually prescribed to patients suffering from intractable cancer-related pain and, in some cases, debilitating back pain. My father was given Fentanyl patches for compression fractures near the end of this life. Initially, it was believed Fentanyl would not be abused. Unfortunately, addicts decided to start opening the patch in order to scrape out the medicine and abuse it.

Fentanyl Mapping.gif

As if that were not enough, Fentanyl is being illegally manufactured in labs (primarily in China). It is produced in powder form, and is also pressed into pills, and smuggled into the United States. These knock-off pills are catching users off guard. Fentanyl is 50 to 100 times more powerful than morphine. DEA and border patrol seized more than 10,000 counterfeit pills containing Fentanyl in 2015. An amount as small as 2 milligrams can be deadly. First responders and ER physicians have to use extreme caution in order to avoid accidental exposure. According to the article in The Daily Item, an Ohio police officer accidentally overdosed in May of this year after brushing Fentanyl powder from his uniform during an arrest.

After the recent overdose surge in Lycoming County (Pennsylvania), Todd Owens, Mount Carmel police chief and head of the Northumberland County Drug Task Force, advised first responders to take measures to protect themselves. Chief Owens said his own department stocks medical masks, coveralls and heavy-grade gloves in their cruisers to be worn in the event they encounter heroin.

Heroin Fentanyl and Carfentanil Pics

The above is an illustration of potency betwen heroin, Fentanyl, and Carfentanil.

Carfentanil

Carfentanil is an extremely powerful derivative of Fentanyl. While Fentanyl is up to 100 times more potent than morphine, Carfentanil is 100 times more powerul than Fentanyl. In other words, it is 10,000 times more powerful than morphine. It is not approved for use in humans; rather, it is used in veterinary medicine to sedate large animals, primarily elephants. Yes, elephants! Carfentanil is so powerful that when veterinarians handle it, they use protective gear to avoid breathing it in or absorbing it through their skin. The amount of Carfentanil that can be safely administered to a human is 0.1 mg., compared to 13 mg. needed to sedate an elephant. It is obviously rather easy for an addict to accidentally take too much Carfentanil.

Interestinly, there are no statistics showing Carfentanil leading to addiction. That’s because even in the case of a seasoned addict a dose the size of a grain of salt can rapidly lead to an overdose and death. Frighteningly, drug dealers have begun cutting heroin with Carfentanil because it is extremely cheap to acquire. Even more disturbing is the fact that addicts in search of the ultimate high are deliberately trying this deadly drug. Rangers at Yellowstone National Park have recently begun issuing warnings to avoid eating the meat of bison killed in the park because the bison might have been sedated with Carfentanil for tagging or medical treatment. The drug can easily enter the bloodstream of those who eat the bison meat. It is most chilling to note that Carfentanil rapidly latches on to the mu-opioid receptors in humans, causing overdose almost immediately.

Moving Forward

Fentanyl moved up the rankings, from the 9th most common drug involved in overdose deaths in 2013, to the 5th most common drug involved in overdose deaths in 2014. The singer-songwriter Prince died of an overdose of Fentanyl in April 2016, according to officials in Minnesota. Philip Seymour Hoffman, a very successful indie film star (and one of my favorites), died of a heroin overdose on February 2, 2014. Although he had a drug problem while in college, he was clean for twenty years. No doubt his system was not able to handle the strength of today’s heroin.

Reports from the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) showed that deaths from heroin more than tripled during a five-year period, from 3,020 deaths in 2010, to 10,863 deaths in 2014. These deaths are yet another symptom of the broader epidemic of opioid addiction. Just as deaths from AIDS are due to untreated HIV, deaths from overdose are frequently due to untreated addiction. I know of many addicts attending 12-step meetings who are positive for hepatitis-C secondary to sharing needles while injecting heroin. Prince’s death is a reminder that opioid addiction is a disease that can and does affect people from all economic classes and all walks of life.

References

Scicchitano, E. (July 10, 2017). Fentanyl Becomes Deadly Force. Daily Item. Sunbury, PA.

Wakeman, S. (Aug. 5, 2016). Fentanyl: The Dangers of this Potent “Man-Made” Opioid. [Web Blog Comment.] Retrieved from: http://www.health.harvard.edu/blog/fentanyl-dangers-potent-man-made-opioid-2016080510141

Rettner, R. (Dec. 20, 2016). Deaths From Fentanyl Overdoses Double in a Single Year. LiveScience.com. Retrieved from: https://www.livescience.com/57268-fentanyl-overdose-deaths-double.html

 

Local Opioid Abuse: A Piece of the Nation’s Newest Health Crisis

By Steven Barto

I am no stranger to addiction. I started drinking and getting high the summer after high school graduation. It was 1977 and pot and southern rock went hand-in-hand. I found my answer to all the anger, anxiety, depression, insomnia, and feelings of not belonging. Of course, I had no idea where it would lead, or that it would take me nearly four decades to get clean. I’ve said it before: No one wakes up one day and says, “I think I want to be a full-blown alcoholic or drug addict when I grow up. I want to loose all self-respect, most of my teeth, two wives, four jobs, three cars, and my sense of ambition. I’d love to be estranged from family and friends. It’ll be great. Just me and my drugs!” Anyone whose not an addict or alcoholic and thinks it is a moral or deliberate choice doesn’t understand addiction.

Opiate Use Map (2)

Map shows areas of opiate use, with the most prevalence noted in dark pink.

Nationally

The “perfect storm” that got us to a nationwide opiate epidemic is intertwined with influences you’d never expect. Heroin used to be limited to the beatniks, poets, jazz musicians, wild-and-crazy rock stars of the 1950s, 60s and early 70s. But things were about to break loose. Congressmen Robert Steele (R-CT) and Morgan Murphy (D-IL) released an explosive report in 1971 covering the growing heroin epidemic among U.S. servicemen in Vietnam. America saw thousands of military personnel coming home from Southeast Asia addicted to heroin. As a result, President Richard Nixon declared a “war on drugs.” In fact, Nixon called drug abuse “public enemy number one.” Initially, the lion’s share of monies thrown at the drug problem went for treatment, which was a good thing. Unfortunately, this did not remain so in subsequent years. Politicians saw the opportunity to “take back the streets” of America from hippies, druggies, liberals, love children, people of color, and other “subversives” who did not seem to be conforming to the American lifestyle. Emphasis changed to criminalizing addicts and locking them up.

Admittedly, cocaine and crack became a serious concern before America fell face-first into the current opiate epidemic. Interestingly, one of the major factors contributing to increased cocaine trafficking was the North Atlantic Free Trade Agreement (NAFTA) signed into law under President Bill Clinton. Goods began to flow into the United States from Mexico at such an increase that border patrol was unable to adequately assure drugs were not coming over the border. There simply were not enough agents to keep up with inspection and enforcement. Prior to the climate of unrestrained trade, President Nixon had ordered that every vehicle returning from Mexico must be searched for drugs. Long lines ensued, and there was no appreciable reduction in drug trafficking.

Heroin and a Handgun

In 1995, The Food and Drug Administration (FDA) approved OxyContin for prescription use. Its active ingredient, oxycodone, was believed since the 1960s to be highly addictive. Purdue Pharma, the inventor of OxyContin, claimed their formula of delayed-release oxycodone would all but eliminate the “rush” experienced by taking the drug in its original form. Purdue launched an extremely aggressive marketing progam, sending drug reps to virtually every family practitioner and pain management specialist, armed with what was eventually deemed a falsified report that less than 1% of OxyContin patients became addicted. Doctors were offered outrageous incentives to prescribe the drug. Purdue Pharma began the practice of sponsoring trade shows and symposiums, often plying physicians with lavish meals and “entertainment.” On the heels of this marketing blitz, the American Pain Society began arguing for medical providers to view pain as the “fifth vital sign.” This is precisely the basis for the How would you rate your pain on a scale of 0-10? question that is asked in every emergency department in America today. Well-intentioned doctors believed it was unconscionable to let patents suffer through severe pain. They didn’t believe Oxy would do more harm than good.

By 1996, Purdue Pharma reported $45 million in sales of OxyContin. As of 2000, the number jumped to over $1 billion. That’s a two-thousand fold increase. Misuse and abuse of opiate painkillers (OxyContin, Vicodin, Lortab, oxycodone) increased significantly beginning in 2000. In 2002, 6.2 million Americans were abusing prescription drugs, and emergency room visits resulting from the abuse of narcotic pain relievers had increased dramatically. By 2009, the total number of visits to ERs for overdose on opiates was 730,000, which was double the number of five years before. More than 50,000 Americans died of a drug overdose in 2016. Heroin accounted for 12,898 of those deaths that year. Synthetic opioids (such as Fentanyl) killed 5,880. Prescription painkillers like OxyContin and Vicodin claimed 17,536 lives.

Companies like Purdue Pharma have restructured the formula of opiate medications in order to make them even harder to abuse. No doubt this had a lot to do with the $635.5 million fine levied against Purdue for intentionally misleading the medical community regarding the potential to become addicted to OxyContin. Typically, addicts crush and snort the drug, or cook it down and inject it. What’s disheartening today is that most people who started out taking and then abusing OxyContin and other opiate pain medication are now using heroin because it’s cheaper – $5 to $7 dollars for enough to be high most of the day versus $10 to $80 for one Oxy, depending on its strength. Heroin is readily accessible virtually everywhere you go, and it is easily converted to a form that can be smoked or injected.

Locally

Front page news in my hometown paper, The Sunday Item, indicates that drug overdoses in Pennsylvania killed nearly 11,000 people in the last three years, fueled largely by heroin and prescription painkillers. The number of deaths has steadily increased year after year. As fatal overdoses have increased, so has public awareness, access to addiction treatment, and legislative initiatives against an epidemic the U.S. Department of Justice describes as the leading cause of death of Americans under the age of 50. It is important to note that this is a disease that affects everybody. Let’s stop playing the New Jim Crow game and stigmatizing, criminalizing, and institutionalizing drug addicts based upon skin color. Heroin and opiate drug addiction is rampant today in all socioeconomic classes, to be sure, but surprisingly it is most prevalent in white males age 18 to 25.

heroin-graph_1185px

The Sunday Item interviewed a man named Steven C., 27 years old, who is a recovering heroin addict attempting sobriety after fifteen years of opioid abuse. When he heard the news of an overdose outbreak in the Williamsport (Pennsylvania) area that sent 51 patients to the hospital in 48 hours, with three patients now dead, Steven couldn’t help but realize, “That could have been me.” Steven was brought back to consciousness from a heroin overdose on August 9th of last year. EMTs adminstered naloxone, which is used in the field to reverse the effects of an overdose, but it didn’t work. His heart had stopped. Thankfully, CPR eventually restarted his heart.

The Official Response

Federal and state funding for the opioid and heroin problem in Pennsylvania has been increased 19% to $76 million for the current fiscal year. The funds include $5 million for grant money to provide naloxone for emergency responders, which is proven to reverse the effects of narcotic overdose in most cases, and $2.3 million to establish specialty courts for handling drug-related criminal cases. Great strides have already been taken in fighting this epidemic. Pennsylvania restricts opioid prescriptions to seven days for minors and those discharged from hospital ERs. Emergency room physicians are not allowed to see patients for follow-up visits or refills. Each instance where an opioid prescription is filled is recorded on a state-wide database in order to stop “doctor shopping” or getting refills “too early.” According to the Sunday Item article, the prescription database has been accessed by doctors 8 million times since it was launched.

An estimated 2 million Americans are addicted to painkillers, and another 591,000 are addicted to heroin. Although we’re beginning to made headway regarding opioid prescriptions, much remains to be done regarding heroin addiction. It is noteworthy that taking opioid pain medication for longer than three months makes patients up to forty times more likely to become addicted to heroin. Senator Gene Yaw (R-23) of Williamsport told reporters, “I have said many times that I don’t expect to see positive results for at least ten years. It took a long time to get into the situation we find ourselves and we can’t expect a change to happen overnight. We are addressing many issues and eventually together they will make a difference.” It is abundantly clear that there is a risk of progression from alcohol and other drugs (especially opioid painkillers) to heroin.

heroin-use_1185px

Concluding Remarks

What can you do? Most importantly, as public service announcements state on TV in Pennsylvania, “Mind your meds.” Please don’t react to this suggestion by simply saying drug addicts should be able to be trusted, otherwise they’re just thieves. Or, that they should have better impulse control. Addiction is not about willpower, nor is it a matter of a moral deficiency. Virtually anyone who uses opiates for pain for longer than three months can become addicted. That is the very nature of the morphine molecule found in these medications. It is extremely difficult for an opiate addict to “just say no” to the screaming of their mu-opioid receptors in the brain and spinal cord once the morphine molecule has latched “lock-and-key” into place. Opiates are far more potent than naturally occurring endorphins.

I really had no idea how difficult it can be to quit drinking or taking opiates once your body gets used to the chemical reaction and the euphoria. I have not had a drop of alcohol, a line of cocaine, or a joint since 2008. It was not so easy for me to give up opioid painkillers. It’s a two-edged sword. First, there’s the initial legitimate need for pain relief. Doctors recognized this in the 90s when they decided to not let their patients suffer in chronic agony. Although I was in recovery for other substances, I thought I could use pain medication safely. I’d abused it in the past, sure, but now I was “sober” and I needed help with severe back pain. I didn’t want the drug in order to “party.” The other edge of the sword is the neuropsychology of the addiction itself. These types of medications actually restructure the brain. Sometimes the effects are permanent, as when memory or IQ or motor skills are compromised. Thankfully, this is not the case for me.

If you or someone you know is struggling with a drug or alcohol problem, please consult your physician for a phone number to the nearest help line. You will also find AA and NA phone lines in the phone book or online. If you are a Christian facing addiction, consider Celebrate Recovery. Facebook has numerous groups you can join. You call also email me at stevebarto1959@gmail.com and I will reply as soon as I can.

References

The Sunday Item. (Sunday, July 9, 2017) Sunbury, PA http://dailyitem.com

Karlman, J. (February 16, 2017). Timeline: How Prescription Drugs Became a National Crisis. Retrieved from: http://fox5sandiego.com/2017/02/16/timeline-of-how-prescription-drugs-became-national-crisis/

Moghe, S. (October 14, 2016). Opioid History: From Wonder Drug to Abuse Epidemic. CNN Online. Retrieved from: http://www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html

Sandino, J. (May 13, 2015). A Timeline of the Heroin Problem in the U.S. Addictionblog.org Retrieved from: http://drug.addictionblog.org/a-timeline-of-the-heroin-problem-in-the-u-s/

Tribune News Services. (December 8, 2016). More than 50,000 Overdose Deaths. Chicagotribune.com. Retrieved from: http://www.chicagotribune.com/news/nationworld/ct-us-overdose-deaths-20161208-story.html

Governor Tom Wolf Signs Opioid Bills Into Law

Gov. Tom Wolf signed into law a package of legislation meant to curb addiction to prescription painkillers and heroin in a state that saw more than 3,500 people die last year of drug overdose. New laws mandate seven-day limits on painkiller prescriptions like oxycodone for both minors and emergency room patients who are treated and released.

Legislation also establishes curriculum on safe prescribing for medical school students and professionals seeking license renewal, boosts the frequency prescription drug prescribers and dispensers utilize and update the Pennsylvania Prescription Drug Monitoring Program (PDMP), and widely expands potential drop-off locations for unused prescription drugs. The move came five weeks after a rare joint meeting of the state House of Representatives and Senate at which Wolf called for action addressing the opioid and heroin addiction crisis as the end drew near in the 2015-2016 legislative session.

Last week, the General Assembly adopted the bills

Governor Wolf said, “I am proud to sign a package of bills that represents the work that we have all done together to address the heroin and opioid abuse crisis and begins to curb the effects of this public health epidemic in Pennsylvania.” State Senator  Gen Yaw (R) of Williamsport, PA was the prime sponsor of two of the bills. He compared the Legislature’s work to the strength of a rope. Each bill represents a single strand. “Alone, they might not be fully effective, but together, they can strengthen the rope and our collective efforts.” He said he appreciates the support of the legislative leadership, and remarked that he is thankful for the governor’s prompt signing of the bills into law.

Glenda Bonetti, director of Northumberland County’s Drug and Alcohol Program, fully supports the prescribing limits. She estimates the average age of first-time opioid users who seek help through her office as 17. In her experience, many who become addicted tend to progress to heroin. Bonetti is grateful for the legislative action, but said it took opioid abuse to become prevalent in the middle and upper classes to get noticed. She said, “The reason it’s becoming more publicized is because it’s not just the impoverished who are affected. It’s affecting wealthy families, not just poor people.”

– by Eric Scicchitano, The Daily Item, November 3, 2016

Me Included

I recently took the time to read President Obama’s report Epidemic: Responding to America’s Prescription Drug Abuse Crisis (2011), published on the monthly blog of Dr. Nora Volkow, director of the National Institute on Drug Abuse. (Sept. 14, 2016) According to the president’s report, prescription drug abuse is the nation’s fastest-growing drug problem. While there has been a marked decrease in the use of such illegal drugs as cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and older who used drugs for the first time in 2009 began by using a prescription drug non-medically. The survey found that over 70 percent of people who abused prescription pain relievers got them from friends or relatives, me included.

I started taking opioid pain medication for severe low back pain in 2004. The pain became debilitating, and I was approved for Social Security Disability Income in 2009. Being an addict and an alcoholic, I should have realized that one pill was too many and a hundred was not enough. At one point, I was seeing three different doctors and going to several different pharmacies in order to avoid suspicion. I could not keep up with my cravings. When I could no longer get enough pain meds through doctors and  ERs, I started stealing medication from everyone in my family. I realized just the other day that I have been taking medication from loved ones since 1984 when I started helping myself to my mother-in-law’s Tylenol with Codeine. Although there have been periods where I was able to stop taking opiates, it started all over again about a year before my father died. Following a family intervention, I went to a rehab center for 21 days. I relapsed ten months after I left the rehab. I managed to get clean again until August 20 of this year when I stole oxycodone tablets from my mother. It appears I may have done irreparable damage to my relationship with her. Ironically, that was my greatest fear.

Although a number of classes of prescription drugs are currently being abused, the president’s 2011 action plan primarily focuses on the growing and often deadly problem of prescription opioid abuse. The number of prescriptions filled for opioid pain relievers (some of the most powerful medications available) has increased dramatically in recent years. From 1997 to 2007, the milligram-per-person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, which amounts to 402 percent. In 2000, retail pharmacies dispensed 174 million prescriptions for opioids. By 2009, 257 million prescriptions were dispensed, which is an increase of 48 percent. Opiate overdoses, once almost always due to heroin use, are now increasingly due to the abuse of prescription painkillers.

A crucial first step in tackling the problem of prescription drug abuse is to raise awareness through the education of parents, youth, patients, and healthcare providers. Although there have been great strides in raising awareness about the dangers of using illegal drugs, many people are still not aware that the misuse or abuse of prescription drugs can be as dangerous as the use of illegal drugs, leading to addiction and even death. In addition, prescribers and dispensers, including physicians, dentists, and pharmacists, all have a role to play in reducing prescription drug misuse and abuse. Most receive little training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion, and addiction.

Outside of specialty addiction treatment programs, most healthcare providers receive minimal training in how to recognize substance abuse in their patients. Most medical, dental, pharmacy, and other health professional schools do not provide in-depth training on substance abuse; often, substance abuse education is limited to classroom or clinical electives. Moreover, students in these schools only receive limited training on treating pain. A national survey of medical residency programs in 2000 found that, of the programs studied, only 56 percent required substance use disorder training, and the number of curricular hours in the required programs varied between 3 to 12 hours. A 2008 follow-up survey found that some progress has been made to improve medical school, residency, and post-residency substance abuse education; however, efforts have not been uniformly applied in all residency programs or medical schools.

Educating prescribers on substance abuse is critically important, because even brief interventions by primary care providers have proven effective in reducing or eliminating substance abuse in people who abuse drugs but are not yet addicted to them. In addition, educating healthcare providers about prescription drug abuse will promote awareness of this growing problem among prescribers, so they will not over-prescribe the medication necessary to treat minor conditions. This, in turn, will reduce the amount of unused medication sitting in medicine cabinets in homes across the country.

The president’s report indicates that all of this will take tracking and monitoring. Forty-three states have authorized prescription drug monitoring programs (PDMPs). PDMPs aim to detect and prevent the diversion and abuse of prescription drugs at the retail level, where no other automated information collection system exists, and to allow for the collection and analysis of prescription data more efficiently than states without such a program can accomplish. However, only 35 states have operational PDMPs. These programs are established by state legislation, and are paid for by a combination of state and Federal funds. PDMPs track controlled substances prescribed by authorized practitioners and dispensed by pharmacies. PDMPs can and should serve a multitude of functions, including assisting in patient care, providing early warning of drug abuse epidemics (especially when combined with other data), evaluating interventions, and investigating drug diversion and insurance fraud.

In summary, the president’s report states that research and medicine have provided a vast array of medications to cure disease, ease suffering and pain, improve the quality of life, and save lives. This is no more evident than in the field of pain management. As with many new scientific discoveries and new uses for existing compounds, the potential for diversion, abuse, morbidity, and mortality are significant. Prescription drug misuse and abuse is a major public health and public safety crisis. As a nation, we must take urgent action to ensure the appropriate balance between the benefits these medications offer in improving lives and the risks they pose. No one agency, system, or profession is solely responsible for this undertaking. We must address this issue as partners in public health and public safety. Therefore, ONDCP will convene a Federal Council on Prescription Drug Abuse, comprised of Federal agencies, to coordinate implementation of this prescription drug abuse prevention plan and will engage private parties as necessary to reach the goals established by the plan.