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Tag: synthetic opioids

  • Are Police At Risk Of Overdose From Accidental Fentanyl Exposure?

    Are Police At Risk Of Overdose From Accidental Fentanyl Exposure?

    Medical professionals discuss the likelihood of first responders overdosing from accidental fentanyl exposure.

    Since fentanyl use has become widespread, there have been many reports of first responders overdosing accidentally through exposure at emergency calls. The Drug Enforcement Administration even issued an officer safety alert urging first responders to be careful to avoid exposure.

    However, medical professionals say the risk of accidental overdose to first responders is vastly overstated. 

    Toronto-based doctor David Juurlink, a researcher at Sunnybrook Health Sciences Centre, said that police officers and other first responders overdosing is highly unlikely.

    “I would say it’s extraordinarily improbable that a first responder would be poisoned by an ultra-potent opioid,” he 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.”

    Still, officers and other first responders are regularly warned about the dangers of being exposed to even trace amounts of synthetic opioids. Some people are concerned that being overly cautious will cause first responders to hold back on potentially life-saving treatments for people who call 911, in much the same way some doctors were afraid to treat HIV patients during the AIDS epidemic. 

    At Brigham and Women’s Faulkner Hospital in Boston, emergency room doctor Jeremy S. Faust, has a message for first responders.

    “I want to tell first responders, Look, you’re safe,” Faust 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.”

    Despite the fact that an overdose from accidental exposure is very unlikely, police officers sometimes report feeling symptoms of overdose when they respond to opioid-related calls. Scottie Wightman, a Kentucky emergency medical technician, went unresponsive after one call. He was treated with naloxone, but a drug test later showed there were no drugs in his system. These symptoms are essentially a placebo effect, experts say. 

    Still, many people have been charged with crimes after calling 911 for fentanyl-related emergencies. Eric Weil, of New Hampshire, called police when a person staying in his house overdosed. Weil found fentanyl in his house, and after handling it, blew the drug off his hands.

    Police later said that Weil blew “a large cloud” toward them. He was charged with reckless conduct, the same charge he could get for brandishing a gun. He was convicted, but the verdict was eventually overturned. Still, Weil said he will not be calling 911 again. 

    “If ever I go into a situation where somebody’s O.D.-ing, I’m going to stand over them and watch them die,” he said. “If they say, why didn’t I call? Are you out of your mind? The last time I called somebody, I got a Class B felony.”

    Still, the police chief in the town where Weil was charged said that he needs to be proactive about protecting officers from synthetic opioids. 

    “I never want to be in a position where I have to go see a family member, a wife, kids, and explain to them why their father or husband is not coming home that evening, or ever, for that matter,” he said. “Everybody knows it’s a dangerous substance.”

    View the original article at thefix.com

  • Fentanyl Officially The Deadliest Drug In America

    Fentanyl Officially The Deadliest Drug In America

    According to a new report, fentanyl is responsible for more US deaths than any other drug.

    Fentanyl has become the most deadly drug in the nation, involved in more overdose deaths than any other illicit substance, according to a new report. 

    According to the National Center for Health Statistics’ “Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016” report, fentanyl was involved in 18,335 overdose deaths last year, far surpassing heroin, the second most deadly drug, which was involved in 15,961 deaths.

    Overall, fentanyl was present in 28.8% of overdose deaths in 2016, the report found. 

    Often, fentanyl was present alongside other drugs, including opioids and cocaine. The prevalence of fentanyl in the opioid supply and now the cocaine supply across the country is striking fear into health care workers and drug users alike, since the powerful synthetic opioid can cause an overdose in tiny amounts. In 69% of the deaths that involved fentanyl, another drug was also found, according to the report. 

    “We’ve had a tendency to think of these drugs in isolation. It’s not really what’s happening,” Dr. Holly Hedegaard, lead author of the report and injury epidemiologist at the National Center for Health Statistics told The Huffington Post.

    Oftentimes, drug users don’t even know they’re being exposed to the drug. This can be particularly problematic for people who don’t typically use opioids and therefore don’t have a tolerance built up. That can leave them more vulnerable to overdose, but participants in one Rhode Island survey said the drug is nearly impossible to avoid.  

    “It’s like you notice that there’s fentanyl and it’s not the drug you’re going for. It’s like, what’s the point, unless you have a little lab kit or something. That’s the only way you can tell,” a user said.  

    “I don’t think you can avoid it now,” another user said.

    The government report examined overdoses between 2011 and 2016 by looking at the data on death certificates to see which drugs were present in the most deaths. In 2011, fentanyl was the 10th most deadly drug in the country, present in just 1,662 deaths. In 2012 and 2013 it was the ninth most deadly, before moving to the fifth spot in 2014, when it was involved in 4,223 deaths.

    By 2015 it was the second most deadly drug, involved in 8,251 deaths, before its impact grew massively in 2016. 

    “Fentanyl is so deadly, in the geographic regions where it’s been flooding in, deaths soared like we’ve never seen before,” Dr. Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, told CNN.

    View the original article at thefix.com

  • Trump Calls For China To Use Death Penalty For Fentanyl "Pushers"

    Trump Calls For China To Use Death Penalty For Fentanyl "Pushers"

    “If China cracks down on this ‘horror drug,’ using the death penalty for [fentanyl] distributors and pushers, the results will be incredible!” Trump said on Twitter.

    President Trump said that one of the highlights of his meeting with Chinese President Xi Jinping is that fentanyl will now be classified as a controlled substance in China, meaning that people who manufacture and distribute the drug could face the death penalty. 

    “One of the very exciting things to come out of my meeting with President Xi of China is his promise to me to criminalize the sale of deadly fentanyl coming into the United States. It will now be considered a ‘controlled substance.’ This could be a game changer on what is […] considered to be the worst and most dangerous, addictive and deadly substance of them all,” Trump tweeted, according to CNN.”Last year over 77,000 people died from Fentanyl. If China cracks down on this ‘horror drug,’ using the Death Penalty for distributors and pushers, the results will be incredible!”

    A release from The White House called the reclassification of fentanyl “a wonderful humanitarian gesture.”

    “President Xi… has agreed to designate Fentanyl as a Controlled Substance, meaning that people selling Fentanyl to the United States will be subject to China’s maximum penalty under the law,” the release said. 

    In China, the maximum penalty is death, CNN reported. 

    President Trump has in the past praised capital punishment for people who traffic and sell drugs. 

    “He often jokes about killing drug dealers… He’ll say, ‘You know the Chinese and Filipinos don’t have a drug problem. They just kill them,’” a senior White House official said in February. 

    Another source confirmed that. 

    “[Trump] says that a lot,” the source said. “He says, ‘When I ask the prime minister of Singapore do they have a drug problem [the prime minister replies,] ‘No. Death penalty.’” 

    While he was campaigning, Trump told a crowd in New Hampshire, a state that has been heavily affected by opioid abuse, that the death penalty should be considered. 

    “If we don’t get tough on the drug dealers, we are wasting our time,” he said. “And that toughness includes the death penalty.”

    Trump justified this position by saying dealers “will kill thousands of people during their lifetime” but won’t be punished for these deaths. He said the death penalty would only be used against the “big pushers, the ones who are really killing people.”

    Trump has also congratulated Philippine President Rodrigo Duterte for his anti-drug campaign that involved killing thousands of people. 

    “I just wanted to congratulate you because I am hearing of the unbelievable job on the drug problem,” Trump said to Duterte in a phone call in 2017. “Many countries have the problem, we have a problem, but what a great job you are doing and I just wanted to call and tell you that.”

    View the original article at thefix.com

  • China Agrees To Increase Fight Against Fentanyl

    China Agrees To Increase Fight Against Fentanyl

    China was labeled the “primary source” of fentanyl in the United States in a 2016 intelligence report by the Drug Enforcement Agency.

    Chinese President Xi Jinping has pledged to crack down on trafficking and manufacturing of the deadly synthetic opioid fentanyl as part of larger negotiations between the United States and the Asian superpower.

    Speaking after a dinner meeting on December 1, 2018 between Xi and President Donald Trump at the Group of 20 meeting in Buenos Aires, Chinese Foreign Minister Wang Yi said in a statement that China will enforce stricter rules in regard to the drug and work more closely with US law enforcement.

    Trump praised Xi’s decision to reporters aboard Air Force One, calling it a “game changer” for the American people. 

    China was labeled the “primary source” of fentanyl in the United States in a 2016 intelligence report by the Drug Enforcement Agency, which further claimed that production of the drug – which was the cause of death in nearly half of the more than 70,000 overdose mortalities in 2017, according to the Centers for Disease Control and Prevention – and its analogues faced lax regulation in China, allowing for widespread production and sale through the internet.

    The Chinese government has attempted to correct the situation through arrests of drug traffickers and seizure of analogues, but its top drug official, Yu Haibin, told reporters in 2017 that there was “little evidence” that the country was producing the chemicals used to create fentanyl.

    Congressional investigations in 2018 found that Chinese opioid manufacturers were easily exploiting loopholes in the US Postal Service to ship large quantities of fentanyl and other drugs to the US, which prompted lawmakers from both political parties to press Trump on making fentanyl part of the upcoming meeting with China to avert a looming trade war between the two countries

    At the December 1 dinner, Trump told reporters in the room that he would address these concerns as part of his conversation with President Xi. As Bloomberg News noted, Wang, the Chinese Foreign Minister, later said the country will not only “tighten supervision of fentanyl and revise rules on the drug” but also work more closely with US law enforcement. Wang also said that the country would impose stiffer penalties on fentanyl traffickers.

    “What he will be doing to fentanyl could be a game changer for the United States and what fentanyl is doing to our country in terms of killing people,” said Trump at the press conference aboard Air Force One. “If [traffickers] get caught, they have the highest level of punishment.”

    View the original article at thefix.com

  • Drug-Related Deaths Plunge In Ohio: How They Did It

    Drug-Related Deaths Plunge In Ohio: How They Did It

    The fading presence of carfentanil may have played a major role in the decline of drug-related deaths in some parts of Ohio.

    Overdose deaths in Montgomery County—in Dayton, Ohio—have dramatically decreased in 2018. The county has seen an incredible 54% decline in overdose deaths: there were 548 by November 30 last year; this year there have been 250.

    Dayton is an economically-challenged city, deserted of jobs after manufacturers left in droves. Some speculate that this is part of the reason why Dayton had the highest opioid overdose death rates in the nation in 2017.

    The overdose deaths were so rapid and unrelenting that according to Wral.com, the coroner’s office continuously ran out of space, and ended up renting refrigerated trailers. So what has changed?

    The New York Times did extensive research and reporting on the ground to look into the positive changes in Dayton. Dayton Mayor Nan Whaley believes the largest impact on the rate of overdose deaths came from Gov. John Kasich’s decision to expand Medicaid in 2015. This expansion allowed almost 700,000 low-income adults access to free addiction and mental health treatment.

    In addition to the treatments being free for low-income residents, the expansion of Medicaid pulled in more than a dozen new treatment providers within a year. Some of these providers are residential programs and outpatient clinics that utilize methadone, buprenorphine and naltrexone for their patients. These are the three FDA-approved medications to treat opioid addiction.

    “It’s the basis — the basis — for everything we’ve built regarding treatment,” NYT reported Mayor Whaley said at City Hall. “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

    Dayton’s East Held holds a bimonthly event called Conversations for Change, which lays out the available addiction treatment options. Food is served, and anyone attending can meet treatment providers. The New York Times reported the evening they attended there were more than a dozen tables of providers.

    Significant to a large degree is the fading presence on the streets of Dayton of carfentanil, an analog of the synthetic opioid fentanyl. Carfentanil is described by the CDC as 10,000 times more powerful than morphine.

    In recent years carfentanil was very present in Ohio street drugs, for unknown reasons. Mid-2017 carfentanil’s hold began to loosen, possibly because drug traffickers realized they were losing money due to the large upsurge in overdose deaths, said Timothy Plancon, a DEA special agent in charge of Ohio.

    A crucial decision was made by Richard Biehl, Dayton police chief, in 2014. Chief Biehl ordered all officers to carry naloxone, directly contrary to some of his peers in other Ohio cities. Naloxone, or Narcan, is the well-known medication that reverses opioid overdoses if administered in a timely manner.

    Police in Ohio and others elsewhere oppose harm reduction tools like naloxone due to a belief that they simply enable drug use. Still, the evidence is overwhelming that they save lives.

    View the original article at thefix.com

  • Mac Miller’s Official Cause Of Death Revealed

    Mac Miller’s Official Cause Of Death Revealed

    The 28-year-old rapper passed away in early August.

    A coroner has confirmed Mac Miller’s cause of death. The 26-year-old rapper and music producer (born Malcolm McCormick) died at home in Studio City, California on Sept. 7. Given his history of substance use, early reports pointed to drugs.

    On Monday (Nov. 7), the Los Angeles County Department of Medical Examiner-Coroner confirmed that McCormick had died from an accidental overdose of fentanyl, cocaine and alcohol due to mixed drug toxicity.

    The rapper, who had a tour planned for October following the Aug. 3rd release of his album Swimming, was discovered by his personal assistant in his bedroom. McCormick “struggles with sobriety and when he ‘slips’ he consumes them in excess,” his assistant said, adding that he’d had “several recent ‘slips’” including one three days prior to his death.

    In a 2015 interview with Billboard, the rapper said he was in a good place. “I’m not doing as many drugs. It just eats at your mind, doing drugs every single day, every second. It’s rough on your body,” he said.

    Fentanyl, the synthetic opioid painkiller said to be 50 times stronger than heroin, has also been cited in the deaths of Prince (April 2016) and Tom Petty (October 2017). According to the National Center on Health Statistics, fentanyl was involved in 60% of opioid-related deaths in 2017, an 11% increase from five years prior.

    While fentanyl was created for cancer pain, it is now fueling rising rates of drug overdose deaths. This has prompted the need for a stronger opioid overdose “antidote” to match the strength of increasingly potent fentanyl analogs.

    And this month, the Food and Drug Administration approved a new, more powerful opioid painkiller called Dsuvia. This new drug is said to be 10 times stronger than fentanyl and 1,000 times stronger than morphine.

    While Dsuvia is intended for restricted use only in health care settings—the FDA promised to place “very tight restrictions” on the drug—critics worry that it will only worsen the opioid crisis.

    “We have worked very diligently over the last three or four years to try to improve the public health, to reduce the number of potent opioids on the street,” said Dr. Raeford Brown, who chairs the FDA advisory committee that voted to approve Dsuvia, despite his opposition. “I don’t think this is going to help us in any way.”

    View the original article at thefix.com

  • Opioid 10 Times Stonger Than Fentanyl Approved By FDA Amid Controversy

    Opioid 10 Times Stonger Than Fentanyl Approved By FDA Amid Controversy

    “It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” said one critical health expert. 

    Amid controversy and despite warnings from some in the medical community, the Food and Drug Administration (FDA) last week green-lit a new opioid called Dsuvia, a drug estimated to be 10 times as strong as fentanyl. 

    The powerful painkiller is an under-the-tongue version of sufentanil, available in a pre-filled single-dose applicator, according to the federal agency. In theory, it would be used in hospitals, surgery centers and emergency departments.

    Though it wouldn’t be available for take-home prescriptions, some worry that it will be diverted and abused—to deadly effect.

    “It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” Dr. Sidney Wolfe of Public Citizen’s Health Research Group said in a press release. “It will be taken by medical personnel and others for whom it has not been prescribed. And many of those will overdose and die.”

    FDA Commissioner Scott Gottlieb released a statement defending his agency’s decision, highlighting the drug’s potential for use in war in light of its specific packaging and formulation.

    Because it is sublingual, the painkiller doesn’t necessitate venous access and doesn’t require that the patient be alert enough to swallow. That could make it incredibly useful in extreme emergency situations, such as on the battlefield—and that’s what drew the Department of Defense to take interest in the drug. 

    “This opioid formulation, along with Dsuvia’s unique delivery device, was a priority medical product for the Pentagon because it fills a specific and important, but limited, unmet medical need in treating our nation’s soldiers on the battlefield,” Gottlieb wrote.

    Indeed, the Pentagon has poured millions of dollars in funding research by AcelRx, the drug company behind Dsuvia, according to the Washington Post.

    Despite the assurances Gottlieb sought to offer, his agency generated controversy not just for its decision to approve the drug, but also for the way in which they did it.

    The FDA advisory committee that recommended allowing the painkiller voted 10-3 in favor of the drug—even though committee chair Dr. Raeford Brown was out of town speaking at a medical conference, according to the Washington Post.

    Brown condemned the decision, raising concerns about the efficacy data and the sponsor’s response to safety questions.

    “Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” Brown wrote. “I will continue to hold the agency accountable for their response to the worst public health problem since the 1918 influenza epidemic.”

    View the original article at thefix.com

  • New Opioid 500 Times Stronger Than Morphine Nears FDA Approval

    New Opioid 500 Times Stronger Than Morphine Nears FDA Approval

    Sufentanil is currently used intravenously in operating rooms in tightly-controlled circumstances.

    The chair of an FDA advisory panel is speaking out against the approval of a powerful new opioid that is even stronger than fentanyl, but despite his public stances it appears likely that the FDA will approve the drug. 

    “Opioids are substantially different than almost any other classification of drugs in that they carry with them the risks of tolerance, addiction, and death, and what we’ve been trying to get the FDA to come to grips with is that this class of drugs needs to be treated differently,” Raeford Brown, Jr., MD, chair of the Anesthetic and Analgesic Drug Products Advisory Committee and professor at the University of Kentucky told MedPage Today. “Some of the methodology they use to manage other drug classes are perhaps not reasonable with this.”

    The drug in question is DSUVIA, a form of sufentanil, a synthetic opioid that is 500 times more powerful than morphine. Sufentanil is currently used intravenously in operating rooms in tightly-controlled circumstances, but DSUVIA would make it available in a tablet that is administered under the tongue.

    On Oct. 12, the FDA’s advising committee voted 10-3 to allow the drug to go to market. 

    However, Brown said that many committee members — himself included — were absent for that vote because they were attending the American Society of Anesthesiologists conference.

    “That’s one of the reasons I felt that I needed to speak up, because people that are regulating this drug need to be very thoughtful about the public health in this particular circumstance,” he said.

    The drug would be approved with a Risk Evaluation and Mitigation Strategy (REMS) program, but Brown said that is not enough of a safeguard. 

    “There’s no indication whatsoever that any of the REMS programs for opioids have been effective in improving the safety,” he said. 

    Brown is so against the approval of DSUVIA that he penned an open letter to the FDA, saying that sufentanil has “substantial risks of respiratory depression, diversion, abuse, and death,” and that its benefits do not outweigh these risks.  

    “It is my observation that once the FDA approves an opioid compound, there are no safeguards as to the population that will be exposed, the post-marketing analysis of prescribing behavior, or the ongoing analysis of the risks of the drug to the general population relative to its benefit to the public health,” he wrote. “Briefly stated, for all of the opioids that have been marketed in the last 10 years, there has not been sufficient demonstration of safety, nor has there been post-marketing assessment of who is taking the drug, how often prescribing is inappropriate, and whether there was ever a reason to risk the health of the general population by having one more opioid on the market.”

    Further information on the approval of DSUVIA is expected in early November. 

    View the original article at thefix.com

  • HHS Secretary Discusses "Plateau" Of The Opioid Epidemic

    HHS Secretary Discusses "Plateau" Of The Opioid Epidemic

    Health Secretary Alex Azar discussed the state of the opioid epidemic at a recent health summit.

    Drug overdose deaths in the U.S. may be plateauing, but it’s still too soon to know for sure.

    “We are so far from the end of the epidemic, but we are perhaps, at the end of the beginning,” said U.S. Health Secretary Alex Azar at a recent Future of Health Summit in Washington, D.C. on Tuesday (Oct. 23).

    Azar said that the rate of drug overdose deaths had “begun to plateau” toward the end of 2017 and beginning of 2018. More than 70,000 Americans died of drug overdose in 2017, a 10% increase from 2016, according to preliminary figures by the Centers for Disease Control and Prevention (CDC).

    Azar’s remarks also reflect recent CDC figures from this month which show that from December 2017 to March 2018, the rate of increasing drug overdose deaths over the last 12 months has gone down from 10% to 3%, suggesting a slow-down. However, these figures won’t be final until all death investigations are completed.

    “It appears at this point that we may have reached a peak and we may start to see a decline,” says Bob Anderson, senior statistician with the National Center for Health Statistics, according to AP. “This reminds me of what we saw with HIV in the ‘90s.”

    Azar, who heads the U.S. Department of Health and Human Services, cited the success of multi-pronged efforts to mitigate the opioid crisis.

    Promoting medication-assisted treatment (with drugs like buprenorphine, naltrexone and methadone), the use of naloxone, and increasing scrutiny on doctors’ prescribing practices have all played a part.

    However, AP reports that while opioid deaths may be leveling off, “deaths involving fentanyl, cocaine and methamphetamines are on the rise.”

    The New York Times reported in February that “meth has returned with a vengeance.”

    “At the United States border, agents are seizing 10 to 20 times the amounts they did a decade ago,” the Times reported. “Methamphetamine, experts say, has never been purer, cheaper or more lethal.”

    Fentanyl is now notorious for being the synthetic opioid that is 50-100 times more potent than morphine. Though traditionally it is a pharmaceutical drug, illicitly-made fentanyl is said to have fueled rising rates of drug overdose deaths in the U.S.

    This month, the maker of Narcan (naloxone) announced plans to release a new opioid overdose antidote that will match the strength of increasingly potent fentanyl analogs.

    “Compounds like fentanyl, carfentanil and other synthetic opioids act for longer periods of time. The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood,” said Roger Crystal, the creator of Narcan and CEO of Opiant Pharmaceuticals, in a past interview.

    View the original article at thefix.com

  • Fentanyl In Cocaine Could Be Unintended

    Fentanyl In Cocaine Could Be Unintended

    One harm reduction expert thinks cross-contamination may be to blame for cocaine “laced” with fentanyl.

    More often, fentanyl is being found in cocaine, increasing the risk of opioid overdose and leaving officials scrambling to figure out why the drugs are being mixed, and if dealers actually intend to combine them.

    “It’s something we have to be very concerned about,” Dan Ciccarone, a public health researcher, told Rolling Stone. “[We have] to keep following the data.”

    Fentanyl is dangerous enough in the heroin and opioid supplies. However, it is especially deadly for users of cocaine, many of whom do not know what they are ingesting. Because these people are not regular opioid users they have not built up a tolerance to the drug and are therefore more susceptible to overdose.

    “Part of the challenge is just how potent fentanyl is that even a small amount, particularly in someone who doesn’t regularly use opioids, can be so deadly,” said Dr. Sarah Wakeman, an addiction medicine physician. “More and more, we’re hearing stories of people who either have only used cocaine and are not a person who uses opioids, or who says ‘I bought what I thought was cocaine,’ and they suffer an overdose and it turns out to be fentanyl.”

    To make matters worse, most dealers don’t even realize that their product contains fentanyl. “The street dealers are just as clueless as the users are at this point,” Ciccarone said.

    In order to address the issue, experts are trying to figure out how and why fentanyl is making its way into the cocaine supply. 

    “Lots of experts are being asked this question and making guesses, but they are all guesses,” said Keith Humphreys, a Stanford professor and drug policy expert. “It’s quite possible that this is happening way up stream over the head of dealers, and it’s something higher up in the supply chain that isn’t very well understood.”

    Although putting fentanyl in cocaine might seem malicious, experts say that likely isn’t the intent. 

    “Nobody wants to kill off their customer,” said Tino Fuentes, a harm reduction and overdose reversal specialist. Some people have hypothesized that dealers are trying to get customers hooked on opioids, which are more addictive than cocaine, but Fuentes said this is unlikely.

    “Nobody’s trying to put fentanyl in their shit to get their coke customers [to switch] over to heroin when their business is coke,” he said.

    Fuentes says that cross-contamination may be to blame. 

    “They’re not cleaning the scales. They’re not cleaning the grinders. They’re not cleaning the strainers,” he said. “So whatever’s left there is going to be picked up in the first batch of coke.”

    View the original article at thefix.com