Big uptick in street narcotic overdoses due to drug from China

[MillCreek]

http://www.npr.org/sections/health-shots/2016/09/02/492108992/an-even-deadlier-opioid-carfentanil-is-hitting-the-streets

I was aware that Fentanyl is being used to cut heroin, but carfentanil is a whole different ball game.  I have read in the EMS literature that some of these patients are requiring several doses of Narcan to bring them out of respiratory depression, and more of the patients are dying before EMS can get there.

Also of interest is the link to an article in the analytical chemistry literature showing that the aerosol used by Russian special forces in the Moscow theater siege was a couple of Fentanyl analogs.  The analysis was done at Porton Down, which is the headquarters of British chemical/biological warfare.

[brimic]

I was aware of fentanyl being used by the Russians in that incident.

I wasn't aware of carfentanyl though...

Fwiw,I used to work in a lab making fentanyl- this stuff was taken a lot more seriously than our cytotoxic or cancer drugs- we used airlocks, moonsuits, and Decon procedures handling this stuff and everyone was trained to give narcan injections. A milligram of this stuff can be lethal.

[BobR]

All I know about fentanyl is it works really good when giving (or receiving) conscious sedation for medical procedures. Also if you push it IV too fast you can get rigid chest wall syndrome, which makes it nearly impossible to provide adequate ventilation. I wonder if some of the respiratory deaths are from this instead of just respiratory depression?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516388/pdf/anesthprog00110-0022.pdf


bob

[Fly320s]

Sounds like a self-correcting problem.

[cassandra and sara's daddy]

Sounds like a self-correcting problem.

It is. And I will bet folks are all trying to score some of that "good" dope.

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[HankB]

Just think about all the good stuff China will be including in the ingredients as they expand their market for the electronic vapor smokers.

[Boomhauer]

http://www.npr.org/sections/health-shots/2016/09/02/492108992/an-even-deadlier-opioid-carfentanil-is-hitting-the-streets

I was aware that Fentanyl is being used to cut heroin, but carfentanil is a whole different ball game.  I have read in the EMS literature that some of these patients are requiring several doses of Narcan to bring them out of respiratory depression, and more of the patients are dying before EMS can get there.

Also of interest is the link to an article in the analytical chemistry literature showing that the aerosol used by Russian special forces in the Moscow theater siege was a couple of Fentanyl analogs.  The analysis was done at Porton Down, which is the headquarters of British chemical/biological warfare.

Tell them to stop interrupting Darwin with that Narcan *expletive deleted*it

[BobR]

Tell them to stop interrupting Darwin with that Narcan *expletive deleted*it

They have stopped Narcan, or gotten there too late in Walla Walla.

http://www.khq.com/story/33009661/walla-walla-police-investigate-3-overdose-deaths


bob

[Scout26]

Sounds like a self-correcting problem.

Careful, or Microbalrog will come back and rage quit again.




(Anyone know if he's "out" yet?)

[Mannlicher]

evidently there is no shortage of morons wanting to get high.  Funny we can find all the Narcan you could imagine to save these self medicating druggies, but we can't seem to help the folks that need an EpiPen and can't afford it now.   Narcan is another drug that is escalating in price, but that gets no air time.

[cassandra and sara's daddy]

The type of folks using heroin has evolved.  Lots of folks denied oxy by the new pain medication regs are shifting over.  Literally changing complexion of problem

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[Fly320s]

Careful, or Microbalrog will come back and rage quit again.




(Anyone know if he's "out" yet?)

Didn't know he was gone.  Didn't miss him.  What do you mean "out?"  Is he in prison, rehab, or the closet?

[MillCreek]

The type of folks using heroin has evolved.  Lots of folks denied oxy by the new pain medication regs are shifting over.  Literally changing complexion of problem

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This is precisely what we are seeing in my clinics.  Illicit Oxy/Norco/Vicodin, etc., is so expensive now, that Mexican heroin is much cheaper and more available.

[MillCreek]

They have stopped Narcan, or gotten there too late in Walla Walla.

http://www.khq.com/story/33009661/walla-walla-police-investigate-3-overdose-deaths


bob

With the Fentanyl/Carfentanil contamination of the heroin, Narcan may not be enough.  Naltrexone may be necessary, and not even all the aid/Medic One units carry that.  Certainly not the police, who many of whom in Washington state are now carrying the nasal Narcan kits, since they often arrive on scene first.

[cassandra and sara's daddy]

With the Fentanyl/Carfentanil contamination of the heroin, Narcan may not be enough.  Naltrexone may be necessary, and not even all the aid/Medic One units carry that.  Certainly not the police, who many of whom in Washington state are now carrying the nasal Narcan kits, since they often arrive on scene first.

You can take a class here and get narcan otc

I plan on it.be hard to play Darwin for me. Especially since dc emt's saved me once.

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[MillCreek]

I have taken the nasal Narcan class.  We now stock it on our crash carts.

[BobR]

The problem with every Tom, Dick and Joe having narcan available that I can see is they use it for the immediate OD and then think all is good. Then they start breathing and go about their business, that is until about 45-60 minutes later when it quits working and the drug depresses them again. Does the class teach that once the narcan is given a trip to the ER is mandatory? There is a reason we will put ODs on a narcan drip and admit them until the next morning at least. Some make it, some AMA because we have killed their high and they need to get out to do it again. :(

bob

[Northwoods]

Careful, or Microbalrog will come back and rage quit again.




(Anyone know if he's "out" yet?)

Didn't know he was gone.  Didn't miss him.  What do you mean "out?"  Is he in prison, rehab, or the closet?

I recall the rage quit, but otherwise, yeah, what do you mean?

[Northwoods]

The rage quit was March 15 2015.  According to his profile he logged in as recently as Feb 13 of this year.

[KD5NRH]

Sounds like a self-correcting problem.

Yeah, overall, my sympathy meter is barely out of the "mild twitch" range.  Maybe some for the dumb kid who tries it once, but the junkies know the risks, whether they're willing to admit that or not.

[cordex]

I get the "don't cheat Darwin" argument, but when I saw a teenage girl laying in her bed turning blue and breathing raggedly only every once in a while I was glad the cops had the Narcan.

[MillCreek]

The problem with every Tom, Dick and Joe having narcan available that I can see is they use it for the immediate OD and then think all is good. Then they start breathing and go about their business, that is until about 45-60 minutes later when it quits working and the drug depresses them again. Does the class teach that once the narcan is given a trip to the ER is mandatory? There is a reason we will put ODs on a narcan drip and admit them until the next morning at least. Some make it, some AMA because we have killed their high and they need to get out to do it again. :(

bob

And some of the patients, when we kill their high, use such nasty language to us, and then they often book it right out of there before we can arrange for an admit or before EMS arrives.

[Firethorn]

Yeah, overall, my sympathy meter is barely out of the "mild twitch" range.  Maybe some for the dumb kid who tries it once, but the junkies know the risks, whether they're willing to admit that or not.

"The risks" shouldn't include getting drugs laced with Fentanyl/Carfentanil without their knowledge.  Supposedly that's what took Prince out.

An "experienced" druggie isn't likely to overdose unless he gets something that he's not expected - more pure, laced with something more powerful, etc...

And remember, the addiction is powerful enough to make them to stupid things.  In the case of opiate addictions, in far too many cases the addiction started with an injury or illness where they were prescribed an opiate, got addicted, and it went from there