Tag: synthetic opioids

USPS, FedEx Remain Easiest Way To Ship Fentanyl Into US

“The sheer logistical nature of trying to pick out which packages contain opioids makes it much more challenging,” said a Customs and Border Protection official.

A recent federal court case involving 43 members of a methamphetamine distribution network with ties to the Sinaloa Cartel again highlighted the relative ease with which the United States Postal Service (USPS) and private carriers like FedEx can be used to deliver powerful synthetic opioids into the United States.

The case involved a San Diego-based network that shipped methamphetamine and the “club drug” gamma-hydroxybutyrate (GHB) to locations throughout the U.S. using the postal service and FedEx.

Coverage in Quartz detailed how increases in express shipping, combined with a lack of sufficient staffing at the U.S. Customs and Border Protection (CBP) agency and carriers like the UPS allow such transactions to take place.

Former FBI agent Dennis Franks said that the current method of stopping drugs from entering the country through the mail is like “putting your finger in a dike, but there’s just not enough fingers to put in all the holes.”

The 43 defendants in the federal case used the USPS and fraudulent FedEx accounts to mail drugs to sub-distributors. The FedEx accounts were “billed to and paid for” by large corporations in the belief that the companies would not notice smaller shipment costs.

A joint task force involving the Drug Enforcement Administration, Internal Revenue Service, U.S. Attorney’s Offices, sheriff’s and police departments, the United States Postal Inspection Service and Federal Bureau of Prisons collaborated to file indictments against 43 members of the network on May 21.

Despite efforts like these, the practice of importing drugs through the USPS and private carriers remains a serious problem for state and federal law enforcement.

According to congressional testimony from the union that represents CBP officers, the agency needs more than double the number of inspectors currently on duty at mail sorting facilities to keep up with the volume of packages to “ensure successful interdiction.”

In the past five years, express shipments have increased by nearly 50%, while international mail shipments have risen more than 200%. But at shipping and receiving hubs like the one maintained by FedEx in Memphis, Tennessee, there were only 15 CBP officers working on the overnight shift to process 86 million shipments in 2018.

“The sheer logistical nature of trying to pick out which packages contain opioids makes it much more challenging,” said Robert E. Perez, an acting executive assistant commissioner for CBP. “It’s unlike anything we’ve encountered.”

Policy changes incurred by the change in government administrations, as well as the necessity of a warrant to search any package sent via the USPS, also contribute to the overwhelming issues that confront law enforcement with mail shipments.

And as Franks noted, the cartels and related networks have their own means of assuring that their deliveries go unchallenged.

“Don’t think that these cartels don’t have their own ‘intelligence services,’” he told Quartz. “Friends, family members working on the inside. So they’re going to know how many agents or officers are assigned to which FedEx facility, when they’re working, and when they’re not.”

View the original article at thefix.com

6 June 2019
New York Launches Fentanyl Education Campaign

The campaign will target neighborhoods that have been hit hardest by the opioid epidemic and will promote the carrying and use of naloxone.

The New York Health Department launched a public information campaign Tuesday designed to prevent overdose deaths by educating opioid users on safe use and especially on the dangers of fentanyl.

The campaign will target neighborhoods that have been hit hardest by the opioid epidemic and will promote the carrying and use of naloxone, a medication that blocks opioid receptors in the brain and can stop a dangerous overdose.

According to New York Health Commissioner Dr. Oxiris Barbot, fentanyl – the synthetic opioid that’s up to 50 times more potent than heroin – is “driving the overdose epidemic in New York City.”

“People who use drugs should know there are ways to reduce their risk of overdose,” said Barbot in a statement. “If you use drugs, don’t use them by yourself; if you overdose, someone else will need to call 911. This information can save lives.”

Campaign posters and ads on subways, bus shelters, billboards, and the Staten Island Ferry Terminal, to name a just a few spots, will warn drug users that fentanyl can be found in illicit batches of heroin, cocaine, crack, and other common street drugs. Its tasteless and odorless, making detection impossible without special kits, and can easily cause rapid and deadly overdose. Other advice includes never using alone, avoiding mixing drugs, and carrying naloxone whenever possible.

For $730,000, a small bill for a city of this size, HealingNYC estimates that up to 400 lives could be saved before 2022. City Council Health Committee Chair Mark Levine stressed that saving as many lives as possible needs to be the goal, regardless of whether the drugs involved are legal.

“Every New Yorker should know that if you use drugs, there are things you can do to mitigate the chances of a deadly overdose,” said Levine. “We need to be open and honest about drug use in New Your City and make the use of drugs, even if illegal, as safe as possible. This program will save lives.”

A related public awareness campaign to provide free fentanyl testing kits to the public has seen a fair amount of success. According to Junior Bazile, Director Of Programs for New York Harm Reduction Educators, the organization has seen “considerable increase in the uptake of those testing kits.”

Nationally, synthetic opioids (mostly fentanyl) were involved in 19,413 of the 42,249 opioid overdose deaths in 2016, according to the National Institute on Drug Abuse.

In New York City alone, there were 1,487 overdose deaths in 2017, with 57% of them involving fentanyl. Information campaigns and efforts to distribute and train people in the use of naloxone seem to be helping, but nothing will be certain until more recent numbers from the Centers for Disease Control and Prevention are published.

View the original article at thefix.com

31 May 2019
China Promises Tighter Ban On Fentanyl Production

Officials are hopeful that this will help curb the amount of fentanyl on the streets in America.

China has promised to ban all “fentanyl-related substances,” in a move to appease the Trump administration.

According to The New York Times, Chinese President Xi Jinping promised the ban during a meeting with President Trump last December.

Although China had already placed restrictions against fentanyl and related drugs, manufacturers skirted these regulations by tweaking the drugs’ formulations to avoid legal recourse while still supplying a drug with the same effects.

The new ban, which takes effect on May 1st, will cover all “fentanyl-related substances.” The law removed the need for Chinese officials to review and ban analogues one by one, replacing it with a sweeping ban.

Officials are hopeful that this will help curb the amount of fentanyl on the streets in the United States.

“We look forward to our continued collaboration with China to reduce the amount of this deadly poison coming into our country,” said Drug Enforcement Administration (DEA) spokeswoman Mary Brandenberger.

However, other officials caution that Chinese drug manufacturers can still produce the precursors of fentanyl, which can then be shipped to Mexico and assembled by cartels before being smuggled into the United States.

In announcing the ban, Chinese officials insisted that China’s contribution to the American fentanyl problem is “extremely limited.”

“We believe that the United States is the main cause of the problem of the abuse of fentanyl in the United States,” said vice commissioner of the National Narcotics Control Commission Liu Yuejin.

Amid trade tensions between the U.S. and China, the fentanyl policy change may signal an olive branch rather than a tough intervention. Robert Lighthizer, a trade negotiator for the Trump administration, had previously said that he would try to get a commitment from China to crack down on fentanyl production.

University of California researcher Dr. Daniel Ciccarone said that the move may be a way for Chinese officials to claim they are cracking down, without actually having much of a real-world difference.

“Do they have the capacity?” he said. “Or will they, like U.S. regulatory agencies often do, brag about the ‘one they got’ while whitewashing the ones that got away?”

Ciccarone added that it’s hard to intercept fentanyl shipments because the drug is shipped in much smaller quantities than cocaine or marijuana, making it difficult to detect.

He said, “Stopping production and shipping of a much smaller-volume drug is wishing big.”

Still, he said, with fentanyl killing tens of thousands of Americans each year, the Chinese ban is a step in the right direction.

“This effort is worthwhile even if it has a small chance of success,” he said.

View the original article at thefix.com

3 April 2019
Naloxone-Based Antidote For Fentanyl, Synthetic Opioids Is In Development

The naloxone-based antidote has already shown promise in tests involving animal subjects.

The opioid overdose reversal drug naloxone, or Narcan, has proven useful in preventing fatalities from the use of heroin or prescription opioids.

But its duration in the human body – about 30 to 60 minutes – is less effective in countering the effects of powerful synthetic opioids like fentanyl, which can remain in an individual’s system for hours and may require multiple doses of naloxone.

But researchers have begun work on a naloxone-based antidote that may outlast synthetic opioids, and which has already shown promise in tests involving animal subjects.

The results of the test were presented in Orlando, Florida at a meeting of the American Chemical Society on March 31, 2019; there, researchers from Duquesne University, the Allegency Health Network Research Institute and the Edgewood Chemical Biological Center showcased their development of a naloxone-based antidote that used microscopic particles called nanoparticles to deliver a combination of naloxone molecules and a biodegradable polymer, or plastic, called polyactic acid.

As Science News noted, once introduced to an individual’s system, water and enzymes in the body dissolve the nanoparticles and slowly release the naloxone.

According to the researchers, a single dose using this delivery system proved effective in countering the effects of morphine in tests involving mice for up to 96 hours.

Reseacher Saadyah Averick of the Allegheny Health Network Research was quoted as saying that the next phase of testing will involve actual synthetic opioids, such as fentanyl and carfentanil, as well as increased testing to determine if the antidote can prevent a test animal from undergoing overdose.

Data from the National Vital Statistic System’s record of all U.S.-based deaths found that overdose deaths involving synthetic opioids had surpassed overdose fatalities caused by prescription opioids.

A study published in the May 1, 2018 issue of the Journal of the American Medical Association found that of the 42,249 opioid-related deaths in 2016, 19,413 involved synthetic opioids, while 17,087 were due to prescription opioids and 15,469.

More than 79% of synthetic opioid deaths also involved another drug or alcohol, with another opioid and heroin listed as the most commonly co-involved substances (47.9% and 29.8%, respectively).

View the original article at thefix.com

2 April 2019
White House Says Fentanyl Is Turning Up In Marijuana, Experts Say It's Fake News

“This is part of a wider fentanyl panic that goes beyond having alternative facts [and] leads to bad decisions,” says one drug policy expert.

The White House and the National Institute on Drug Abuse (NIDA) are leading Americans to believe that there is a real risk of marijuana users accidentally consuming fentanyl, say drug policy experts.

White House counselor Kellyanne Conway used a news briefing last week to announce that illicit fentanyl is turning up in many drugs—including marijuana.

“People are unwittingly ingesting it,” Conway said. “It’s laced into heroin, marijuana, meth, cocaine, and it’s also just being distributed by itself.”

Drug policy and public health experts disagreed. “This is part of a wider fentanyl panic that goes beyond having alternative facts [and] leads to bad decisions,” Northeastern University drug policy expert Leo Beletsky told BuzzFeed News.

“It’s crazy that this story is coming out from our leaders,” epidemiologist Dan Ciccarone of the University of California, San Francisco, told BuzzFeed News. “It shows that concerns about fentanyl have reached the level of moral panic. Fear outweighs rational evidence. There is scant evidence for cannabis laced with fentanyl.”

Jill Head, a senior chemist at the Drug Enforcement Administration (DEA), stated at a National Drug Early Warning System briefing that no marijuana laced with fentanyl has been found.

What has been called “fentanyl hysteria” is based on the fact that fentanyl is deadly in small amounts, and when it is added to other drugs the user often does not know they are ingesting it, or how much.

As illicit fentanyl is mixed with other drugs in non-clinical settings, it is near impossible to evenly distribute. People using the same supply might get wildly different doses of the same drug.

Incorrect information on fentanyl and marijuana has come partly from police reports that show data from ultra-sensitive test strips that can detect fentanyl at concentrations as low as one-billionth of a gram. As BuzzFeed notes, it’s not a stretch for trace amounts of fentanyl to be detected in marijuana handled by people who sell or use many kinds of illicit drugs.

And synthetic cannabinoids (known as K2 or spice), which are chemicals sprayed onto plant matter, can be incorrectly reported as marijuana. This occurred in Connecticut where 71 people overdosed in one day. News outlets speculated that the synthetic marijuana was laced with fentanyl.

View the original article at thefix.com

28 March 2019
California Jail Guards Get Narcan After Possible Fentanyl Exposure

This is not the first time that an officer has been hospitalized or received Narcan after being exposed to fentanyl.

Two guards at a California jail were given Narcan and taken to the hospital after they began showing symptoms of opioid exposure.

According to SF Gate, guards at Santa Rita Jail in Dublin searched a woman who was being booked in the jail. They found a black substance on the woman, but could not identify the drug. They examined it closely trying to discern what type of drug it was, while wearing gloves.

However, after the examination was complete, one officer began feeling sick and showing signs of confusion. Soon after, the other officer complained of sickness as well. The staff at the jail suspected that the pair had been exposed to an opioid, and administered Narcan before transporting them to the hospital.

First responders and law enforcement officials have been warned about the dangers of accidental fentanyl overdose, and this is not the first time that an officer has been hospitalized or received Narcan after being exposed to the drugs.

“The presence of [synthetic opioids] poses a significant threat to first responders and law enforcement personnel who may come in contact with this substance. In any situation where any fentanyl-related substance, such as carfentanil, might be present, law enforcement should carefully follow safety protocols to avoid accidental exposure,” the Drug Enforcement Administration said in an officer safety alert issued last year.

However, some research indicates that it is unlikely that first responders or others could accidentally overdose on even the most powerful synthetic opioids by touching the substance.

“I would say it’s extraordinarily improbable that a first responder would be poisoned by an ultra-potent opioid,” Dr. David Juurlink, a researcher at Sunnybrook Health Sciences Centre, told The New York Times. “I don’t say it can’t happen. But for it to happen would require extraordinary circumstances, and those extraordinary circumstances would be very hard to achieve.”

According to Vox, reports have shown that fentanyl is not easily absorbed through the skin, so accidental overdose is very unlikely. In one video by harm reduction advocate Chad Sabora, he tries to dispel this myth.

Some people believe that the reports of first responders being harmed by exposure to synthetic opioids can trigger a type of placebo effect. That may have been the case with Scottie Wightman, a Kentucky emergency medical technician who became unresponsive after one call. Wightman was treated with Narcan and was seemingly revived, but drug tests later showed there were no drugs in his system.

Jeremy S. Faust, an emergency room doctor in Boston, emphasized that first responders shouldn’t let fear of opioid exposure deter the care they give to the public.

“I want to tell first responders, Look, you’re safe,” he said. “You can touch these people. You can interact with them. You can go on and do the heroic lifesaving work that you do for anyone else.”

View the original article at thefix.com

27 March 2019
Dramatic Rise In Fentanyl Deaths Marks Third Wave Of Opioid Crisis

From 2011 to 2016, Black Americans experienced the sharpest rise in fentanyl-related deaths with a 141% increase.

Fentanyl overdose rates have been rising at very sharp rates among minorities, including African Americans and Hispanic Americans, according to new data compiled by the Centers for Disease Control and Prevention (CDC).

The data looked at fentanyl overdose rates between 2011 and 2016. Researchers found that the fentanyl overdose rate for African Americans rose the fastest out of any ethnic group—increasing, on average, 141% each year.

Hispanic Americans also showed a dramatic increase of 118% each year. Non-Hispanic whites saw their rates of fentanyl overdoses increase 61% each year, on average.

African Americans and Hispanic Americans still have lower overdose rates overall—5.6 and 2.5 deaths per 100,000 respectively. Whites, by comparison, continue to have the highest fentanyl overdose rates at 7.7 deaths per 100,000.

However, lead study author, Merianne Rose Spencer, said it’s important to note that the overdose rate for Black Americans is rising at more than double the rate of white Americans, according to The Washington Post.

Overall, the data showed shocking increases in fentanyl overdoses in all demographics.

“Beginning in the fourth quarter of 2013, the number of deaths increased every quarter. From 2013 through 2014, the death rate more than doubled, nearly doubled again from 2014 through 2015, and more than doubled again from 2015 through 2016,” report authors wrote.

The CDC’s mortality statistics branch’s chief, Robert Anderson, said that the severity of the fentanyl overdose crisis is clear. “We’re seeing it across the board,” he said.

The rate of overdose accelerated in 2014, when, according to Ohio Senator Rob Portman, fentanyl “came on with a vengeance.” “We were making progress, starting to get this stuff in the right direction, and the fentanyl just overwhelmed the systems,” he said this week.

Although the recently released data didn’t cover 2017 or 2018, there are indications that the pace of increase of overdoses has slowed in the last two years. Preliminary numbers show that 70,424 died by August of 2018, compared with 72,287 deaths by November of 2017.

Anderson said the numbers suggest that the rate has plateaued, but is not yet truly reversing. “We would look at that and say that’s pretty flat. We’d be reluctant to call it a real decline,” he said.

Still, Portman said that the numbers show a step in the right direction, particularly after a long period of dramatic increases.

“It is a very significant story that for the first time in eight years we’re not seeing an increase in overdose deaths,” he said. “We feel like it’s still unacceptably high, but we’re cautiously optimistic that we’ve finally turned the corner after eight years.”

View the original article at thefix.com

22 March 2019
Obama Administration Failed To Act On Fentanyl Crisis

Health experts reportedly urged the administration to declare a public health emergency during the drug’s rise in 2016.

The Obama administration was warned about the spiking rates of fentanyl overdoses in 2016 but took no action, according to a report in The Washington Post.

A group of 11 national health experts pleaded with high-level officials in the administration in an urgent letter to declare a public health emergency in response to the influx of new, extremely potent opioids on the illicit drug market. The letter addressed then-President Obama’s appointed drug czar and the chief of the Centers for Disease Control and Prevention (CDC).

“The fentanyl crisis represents an extraordinary public health challenge—and requires an extraordinary public health response,” it read.

The opioid epidemic had been ramping up for years, but new policies cracking down on the over-prescription of drugs like OxyContin and Vicodin could not properly combat the scourge of illegal fentanyl that was being shipped into the country from Mexico and China.

Cities were now contending with mass overdose cases as street heroin became contaminated with fentanyl, making it many times more potent.

The administration declined to act, according to the Post.

Fentanyl is a synthetic opioid that is 50 times more powerful than heroin and is largely responsible for the spikes in overdose deaths from 2015 to 2017 that shocked the nation. In 2017, fentanyl was involved in nearly as many overdose deaths as heroin and prescription opioids combined.

While the Obama administration did take some steps to address the increasing threat of opioids in 2016 and early 2017, any news over the dire warnings about the drugs was overshadowed by the unexpected results of the 2016 presidential election.

By this time, fentanyl overdose rates had risen by 800% in the state of Maryland over the space of four years.

In 2017, President Donald Trump declared the long-overdue national health emergency over the still-raging opioid epidemic. However, other than making the declaration, the Trump administration has taken little action on the problem, according to a 2018 report by the Government Accountability Office.

While the CDC has issued new guidelines for prescribing opioid painkillers like OxyContin and increased funding for addiction treatment is beginning to see positive results, local police and hospitals are still struggling to cope with overdose cases caused by fentanyl.

Unfortunately, those hit hardest by fentanyl are those with addiction disorders and chronic pain patients—many of whom turned to heroin as prescription opioids became harder to access as the government cracked down on opioids. The stigma of addiction has stood in the way of many individuals who need treatment.

Luke J. Nasta, executive director of the largest drug treatment facility on Staten Island, compared it to the AIDS epidemic of the ’80s.

“There was a stigma about being gay,” he said. “There is also a stigma about being addicted to drugs. The entire society is suffering and the government can’t seem to get their arms around this epidemic.”

View the original article at thefix.com

22 March 2019
Fentanyl Disguised As Oxycodone Seized In Ohio

Ohio officials are warning those who buy pills on the street to exercise caution.

Authorities in Ohio are warning drug users to be extra cautious, after law enforcement in the state seized fentanyl that had been pressed into pills meant to resemble oxycodone, which were to be sold on the street.

The Community Overdose Action Team, which focuses on reducing opioid-related deaths in Montgomery County, Ohio, said in a statement reported by the Dayton Daily News that drug users need to realize the dangers of fentanyl.

“The Community Overdose Action Team reminds you that any illegal drug you purchase and use could contain fentanyl,” the statement read. “Fentanyl is a highly potent drug which greatly increases your chance of an overdose. It is 100 times more potent than morphine and 50 times more potent than heroin.”

The Montgomery County Sheriff’s Office Range Task Force and Dayton police also warned people that fentanyl is becoming widespread in Ohio’s drug supply.

Christine Ton, media director for the sheriff’s office, said that the blue pills even have the markings of oxycodone. Some people get the pills thinking they’re buying Oxycontin, while others seek out the fentanyl pills for a powerful, cheap high.

“It is more potent than heroin and cheaper to buy,” Ton said.

She added that the department seizes all varieties of drugs, not just opioids. “We routinely see meth, fentanyl, marijuana and are also running across cocaine. Crack and heroin are also located frequently.”

Benjamin Glassman, U.S. Attorney for the Southern District of Ohio, said that his office is aggressively going after fentanyl-related cases as the drug becomes more prevalent.

“We are prosecuting more and more fentanyl-related narcotics-trafficking cases, both in Dayton and district-wide,” he said. “Fentanyl and its analogs are incredibly dangerous and are at the heart of the overdoses and deaths plaguing our region.”

Recently, The Washington Post reported that public health officials had pressured the Obama administration to declare fentanyl a national health emergency as far back as 2016, but the administration did not act. John P. Walters, who served as chief of the White House Office of National Drug Control Policy between 2001 and 2009, said this likely contributed to the ever-increasing rate of fentanyl overdoses.

“This is a massive institutional failure, and I don’t think people have come to grips with it,” said Walters. “This is like an absurd bad dream and we don’t know how to intervene or how to save lives.”

Derek Maltz, former agent in charge of the Drug Enforcement Administration’s Special Operations Division in Washington, agreed that it was a missed opportunity to save lives.

“Fentanyl was killing people like we’d never seen before. A red light was going off, ding, ding, ding. This is something brand new. What the hell is going on? We needed a serious sense of urgency.”

View the original article at thefix.com

13 March 2019
Report: Fentanyl Distribution Mishandled By Drug Companies, Feds

Nearly half of all patients who were prescribed fentanyl should have been denied the drug, according to a new report.

A report published Tuesday in the Journal of the American Medical Association (JAMA) is alleging widespread failure to keep the extremely potent opioid fentanyl out of the hands of patients who were ineligible to receive it.

Using the Freedom of Information Act, researchers obtained around 5,000 pages of documents from the US government that they say show that nearly half of all patients who were prescribed fentanyl should have been denied the drug.

Fentanyl is a relatively new opioid painkiller that is 50 to 100 times more powerful than morphine. It is meant only for patients experiencing severe pain, including “breakthrough” pain so bad that opioids such as OxyContin or even morphine cannot control, and who have already developed a tolerance to these drugs. Without an established tolerance to opioids, taking fentanyl presents a high risk of overdose due to its extreme potency.

Due to the dangers of fentanyl, the US government has established a strict protocol that was supposed to prevent anyone other than opioid-tolerant patients with severe pain, such as cancer patients, from being prescribed this drug.

The researchers of this new report claim that this protocol has not been followed across the system, implicating the Food and Drug Administration, drug companies, and doctors.

“The whole purpose of this distribution system was to prevent exactly what we found,” said study leader and co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Caleb Alexander. “It should never happen. It’s a never event. And yet we found it was happening in 50% [of cases reviewed].”

According to the report, between 34.6% and 55.4% of patients surveyed who were given fentanyl were “opioid-nontolerant.” Researchers also found that a substantial amount of pharmacists and drug prescribers (7.9% and 11.6%, respectively) reported believing that they were allowed to give fentanyl to patients who had not developed a tolerance to opioids 12 months after the protocol was put in place.

This number increased as time went on, reaching 18.4% among prescribers and close to 50% among patients.

In spite of this, no substantial changes were made to the protocol by the FDA.

“What we found was that several years after the program was started, there were alarming deficiencies identified, and yet little was done by the FDA and drug manufacturers to effectively address these problems,” said Alexander.

Researchers and addiction experts are finding that fentanyl has played a large role in the opioid epidemic. A 2018 study found that deaths related to fentanyl use increased by 520% from 2009 to 2016, while deaths from other prescription opioids increased by 18% in the same time frame.

The fentanyl deaths were primarily from illicit use, but the high rates of death from fentanyl overdose demonstrate just how dangerous the drug is to those who are not approved for its use.

“These drugs are dangerous enough, they should never be used in patients who aren’t already on around-the-clock opioids,” said Alexander.

View the original article at thefix.com

26 February 2019