CDC warns of carfentanil, an opioid that’s 100 times more potent than fentanyl
by Fox News – Published Dec. 10, 2024, 11:13 a.m. ET
Originally Published by Centers for Disease Control

Fentanyl has made headlines for driving overdose deaths, but the and Prevention (CDC) is warning of the rise of an even deadlier drug.
Last year, nearly 70% of all U.S. overdose deaths were attributed to illegally manufactured fentanyls (IMFs).
One of those was carfentanil, an altered version of fentanyl that is said to be 100 times more potent, the CDC warned in a Dec. 5 alert.
Deaths from carfentanil rose by more than 700% in the past year, according to the same source — there were 29 deadly overdoses between January and June 2023, and 238 in that same time frame in 2024.
This data came from the CDC’s State Unintentional Drug Overdose Reporting System (SUDORS).
The numbers could actually be higher, as the 2024 data is preliminary and not all overdose deaths have been reported, the agency noted.
Since an outbreak of carfentanil-linked deaths in 2016 and 2016, the drug had “largely disappeared” until this recent reemergence, the CDC noted.
Based on the increase in fatal overdoses, the CDC is calling for “rigorous monitoring” of carfentanil and other opioids more potent than fentanyl.
Fentanyl has made headlines for driving overdose deaths, but the Centers for Disease Control and Prevention (CDC) is warning of the rise of an even deadlier drug.MOLEQL – stock.adobe.com
As with other illicit drugs, its “high profitability” likely drives its prevalence, according to Dr. Chris Tuell, clinical director of addiction services at the University of Cincinnati College of Medicine.
“Very small amounts can produce thousands of doses,” he told Fox News Digital.
“Synthetic opioids like carfentanil are relatively easy to manufacture in illicit labs,” Tuell went on. “Since the drug is a synthetic, it is easier to produce — unlike heroin, which is dependent on a plant like opium.”
Why is carfentanil so dangerous?
Carfentanil is 10,000 more times more potent than morphine and 100 times more potent than fentanyl, Tuell confirmed.
“Even a small amount can be fatal, as it can cause respiratory failure,” he said.
Last year, nearly 70% of all U.S. overdose deaths were attributed to illegally manufactured fentanyls (IMFs).Seth Harrison, The Journal News
One of the major concerns with carfentanil and fentanyl is that they are frequently mixed with other drugs, such as benzodiazepines, cocaine and opioids, which can lead to accidental overdoses, according to Tuell.
“Carfentanil can also resemble cocaine and heroin, so it blends right in with the other drugs,” he warned.
“Even a tiny amount can increase the potency of a drug mixture, leading to a stronger and longer-lasting high.”
Carfentanil often appeals to drug users who have a high tolerance to opioids because they seek a stronger substance, “making the drug attractive despite the risk,” Tuell noted.
How is the drug administered?
Carfentanil can be injected and is frequently mixed with other opioids or heroin, Tuell said. In a powder form, it can be inhaled.
“Inhaling the drug can be quickly risky because it can enter the bloodstream, resulting in an overdose,” Tuell warned. “This can happen intentionally or accidentally, as the drug can become easily airborne.”
Carfentanil can sometimes be in the form of “pressed pills” that resemble prescription medications, the expert said.
“Carfentanil can be lethal at the 2-milligram range depending on the route of administration,” he cautioned.
What parents should know
“Children are now the generation of artificial intelligence and deepfakes, as illicit drugs are posing like regular prescription medications,” Tuell cautioned.
To help protect kids from the dangers of illicit drugs, the expert emphasized the importance of open communication and education.
“Educate your child about the dangers and risks of drug use, including synthetic opioids like carfentanil,” he advised.
Parents should provide monitoring and supervision of their children, be aware of their social circles and limit unsupervised online activities, Tuell recommended.
“I also believe it is important that parents realize that 84% of individuals with a substance use disorder also have a co-occurring mental health issue,” he added.
Carfentanil often appeals to drug users who have a high tolerance to opioids because they seek a stronger substance, “making the drug attractive despite the risk,” Tuell noted.luchschenF – stock.adobe.com
“Seeking out mental health services for your child could help address the underlying issues that may have led to a substance use disorder.”
The CDC called for specific efforts in preventing deaths from illegally manufactured fentanyls, “such as maintaining and improving distribution of risk reduction tools, increasing access to and retention of treatment for substance use disorders, and preventing drug use initiation.”

Source: https://nypost.com/2024/12/10/us-news/cdc-warns-rise-in-opioid-thats-100-times-more-potent-than-fentanyl/

Source: https://nativenewsonline.net/health/president-biden-s-overdose-awareness-week-proclamation-2

GMP is to launch a pilot scheme in which officers would carry an ‘antidote’ to super-strength drugs containing nitazenes, which have been linked to 100 deaths across the UK since last summer.

Nitazenes are a group of synthetic opiate drugs which can be more potent than fentanyl, and their use is spreading across Europe and North America, the United Nations drug agency has warned. They have been detected in the UK, US, Slovenia, Estonia, Latvia, Belgium and Canada, the UN Office on Drugs and Crime (UNODC) wrote last month in its latest World Drug Report.

In April the government classified 15 types of nitazenes as Class A drugs, with the Advisory Council on the Misuse of Drugs warning they are highly addictive and pose a greater risk of overdose.

It is feared the substances may be bought and consumed unwittingly by people who think they are purchasing prescription drugs like diazepam from suppliers in countries such as China.

And now it can be revealed that Greater Manchester Police is expected to launch a pilot aimed at saving lives.

Detective Superintendent Joe Harrop told the M.E.N: “GMP is to launch a pilot scheme in which officers would carry an ‘antidote’ to super-strength drugs containing nitazenes, which have been linked to 100 deaths across the UK since last summer.

Nitazenes are a group of synthetic opiate drugs which can be more potent than fentanyl, and their use is spreading across Europe and North America, the United Nations drug agency has warned. They have been detected in the UK, US, Slovenia, Estonia, Latvia, Belgium and Canada, the UN Office on Drugs and Crime (UNODC) wrote last month in its latest World Drug Report.

In April the government classified 15 types of nitazenes as Class A drugs, with the Advisory Council on the Misuse of Drugs warning they are highly addictive and pose a greater risk of overdose.

It is feared the substances may be bought and consumed unwittingly by people who think they are purchasing prescription drugs like diazepam from suppliers in countries such as China.

And now it can be revealed that Greater Manchester Police is expected to launch a pilot aimed at saving lives.

Detective Superintendent Joe Harrop told the M.E.N: “We have launched a drug strategy which is about prevention, treatment and diversion. We are looking at launching a pilot where some officers in high risk drug areas would carry naloxone which is an antidote to opioids. At the moment there is little evidence to say nitazenes use is widespread in Manchester but there is a national issue with it. I do imagine it will get more widespread.”

In May the Manchester Evening News reported how experts in the city are bracing themselves for the impact on Manchester’s drug scene of nitazenes – which can be hundreds of times more potent than heroin.

One heroin user, who spoke to the Manchester Evening News anonymously, told us he feared he had inadvertently taken it recently.

“It’s in town now,” he said. “People ’round the gardens [Piccadilly Gardens] are worried about it because you can’t tell until you’ve had it. It’s horrible. It makes your heart start beating too fast. You feel sick. You feel like you’re overdosing straight away. It’s too strong.”

Meanwhile, back in March, Harry Durose, 21, was found dead at his supported accommodation in Hyde, Tameside, on March 3. Drugs containing nitazenes were also discovered inside the address, and the M.E.N understands Greater Manchester Police is investigating whether his death was linked to the synthetic opioids.

Officers are currently awaiting the results of a post-mortem examination that will determine whether he had taken drugs containing nitazenes, and if that resulted in his death.

Harry’s mother, Amy Durose, said she believed her son had unknowingly taken the drug after buying items he believed to be diazepam on the black market, having previously been prescribed diazepam to treat a chronic joint condition.

“They just posted it to him and nobody had any idea,” said Ms Durose. “I just wish he had told me. He was very clued up on prescription drugs. If he had known these nitazenes existed, he would not have risked it.”

As previously reported in the M.E.N, Detective Superintendent Joe Harrop’s team is targeting the international postal trade in drugs, following a surge in packages delivered to Greater Manchester addresses.

“There is a risk – people think they are ordering diazepam, valium, or other controlled drugs online that they are buying from China, that’s not necessarily what they are getting in the post, which does link in with the nitazenes threat,” Det Supt Harrop said.

He added: “We are seeing a lot of cannabis coming in from North America, where it is legal to buy in some parts, and the Netherlands for the same reason. An emerging area is Thailand. China is more your prescription medication – and the threat of synthetic opioids.”

“There are different risks,” he went on. “If you avoid that face to face conversation with a criminal you don’t know what you are getting. You are still giving your address, credit card details to international criminals – so you are leaving yourself open to being a victim of other types of crime.”

In December it was reported that 30 overdose fatalities in Birmingham were being examined for the involvement of nitazenes and the sedative xylazine, after a coroner concluded nitazenes were the primary cause of death of two drug addicts in one night at a hostel in the city.

Det Supt Harrop added: “West Midlands have had quite a large number of nitazenes linked deaths. We have not yet. But we have a specific strategy to deal with nitazenes – if we identify them we will put something in place straight away.

Nitazenes were first developed in the 1950s, but never approved for sale. Their re-emergence has been put down to China’s crackdown on fentanyl, a synthetic opioid estimated to have caused 75,000 deaths in the US in 2022, and problems with heroin supplies caused by the Taliban’s ban on harvesting opium poppies in Afghanistan.

Speaking back in April, then-Home Secretary James Cleverly said: “We are highly alert to the threat from synthetic drugs and have been taking a range of preventative action, learning from experiences around the globe, to keep these vile drugs off our streets. Placing these toxic drugs under the strictest controls sends a clear message that the consequences for peddling them will be severe.”

While GMP and agencies are alive to the threat, confirmed sightings and recoveries of nitazenes remain rare.

Back in May, Dr Oliver Sutcliffe, director of Manchester-based drugs testing agency MANDRAKE, said no evidence of nitazenes had been found in any of the samples analysed in Greater Manchester.

“We’re not saying it’s not out there, we just haven’t detected it,” he said. “If it’s in other parts of the UK, it’s likely to be somewhere within the wider supply. The pragmatic approach is to make sure the people who might be exposed to it that they are at least offered the chance to test their heroin.

“We also need education to explain it could be in the supply. But we are not just waiting for a nitazene death – we are testing samples and we will continue to do so.”

Meanwhile, Michael Linnell, who runs Greater Manchester’s Local Drug Information System, said drugs services and the authorities were ‘prepared for the worst’.

It is a concern,” said Michael. “It’s certainly something we are taking very seriously. It’s not unusual for heroin users to overdose and die. It’s not unusual for heroin to be adulterated But it is unusual for it to be adulterated with something that’s stronger than the heroin itself.”

“We could get 20 deaths tomorrow. Anyone who tells you they know what’s going to happen is not telling the truth. We have to plan for the worst, so we are planning for adulterants in heroin and for nitazene to be substituted for heroin. That’s our worst fear.

“The information about how potent nitazenes are are guesstimates. But some of them are thought to be 150 times stronger than heroin. You only need a tiny bit and it would be very, very easy to get the mix wrong.”

Source: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/gmp-officers-carry-antidote-super-29513328 July 2024

Source: https://www.osce.org/secretariat/566953 April 2024

Press Release: Ambassador Linda Thomas-Greenfield Launches Alliance to Prevent Drug Harms in Collaboration with United Nations and Tech Industry

Today, Ambassador Linda Thomas-Greenfield, Representative of the United States to the United Nations, launched the Alliance to Prevent Drug Harms (Prevent Alliance), alongside representatives from the United Nations and the tech industry, including Meta, Snap Inc., and X Corp.

“Two out of every five Americans know someone who has died of an opioid overdose…in every corner of the world…we’re seeing a rapid rise in synthetic drug use, dependence, and overdose death,” said the Ambassador. “This is an international crisis…we’ve seen the criminal groups that produce these drugs adapt quickly.”

That adaptation includes the use of technology platforms, including social media, to promote the illicit use of non-medical synthetic drugs.

“This alliance between the United States, the United Nations, and our partners in the private sector, holds immense potential to make a meaningful difference. To disrupt this crisis, both here in the United States and all across the globe, and adapt with the same agility, the same resourcefulness, of those we’re up against. This is a good step, but we all know much more needs to be done to address this problem.” Ambassador Thomas-Greenfield continued.

The Prevent Alliance, a public-private partnership effort, is committed to ending the use of online platforms to aid the flow of illicit substances. Through a framework for cross-industry cooperation, the Prevent Alliance will work to disrupt the availability of synthetic drugs online, promote drug-prevention content across platforms, and enables cross-sector communication establishing the best evidence-based practices for drug-prevention campaigns.

The alliance builds upon the work of the Global Coalition to Address Synthetic Drug Threats, a multilateral effort to combat the threats posed by synthetic drugs launched by Secretary Blinken last year, and the U.S.-led adoption of new controls targeting the synthetic drug manufacturing process at the UN Commission on Narcotic Drugs earlier this year.

Maggie Nardi, the Deputy Assistant Secretary of State of the Bureau for International Narcotics and Law Enforcement Affairs (INL), said, “Governments alone cannot shield people from the dangers of synthetic drug misuse; we must forge stronger alliances with public health, civil society, affected communities, academics, and industry to combat their illicit manufacture, distribution, and promotion.”

Under the Biden Administration, the United States is dedicating more resources to tackle the demand for drugs, including more resources for public awareness, health interventions and services to prevent and reduce the implications of drug use, as well as measures to prevent, detect, and stop the illicit manufacturing and trafficking of drugs. These efforts include support for the UN Office on Drugs and Crime (UNODC) and Commission on Narcotic Drugs, as well as U.S. leadership in rallying countries around the Global Coalition to Address Synthetic Drug Threats.

“Evidence-based prevention is key to respond to the drug use situation globally, especially in a rapidly digitalized world. Social media nowadays carries an important influence on the individual. To harness this influence positively, science can help,” said Delphine Schantz, director of UNODC’s New York office. “UNODC together with WHO reflected on that science through the International Standards on Drug Use Prevention. This science aims at creating a healthy and safe environment for children and youth, fostering resilient generations against drugs and any risky social and health behaviors. Working through this science, social media could be one of those added layers of prevention.”

“Families and communities around the world are struggling with the opioid crisis,” said Nell McCarthy, Vice President of Trust and Safety at Meta. “From governments to the private sector, and health care systems to civil society organizations, we must all do our part to combat this crisis, which is why Meta is proud to be part of the Prevent Alliance.”

Source: https://usun.usmission.gov/ambassador-linda-thomas-greenfield-launches-alliance-to-prevent-drug-harms-in-collaboration-with-united-nations-and-tech-industry/ July 2024

This is the Executive Summary of the DEA’s 2024 National Drug Threat Assessment 

Fentanyl is the deadliest drug threat the United States has ever faced, killing nearly 38,000 Americans in the first six months of 2023 alone. Fentanyl and other synthetic drugs, like methamphetamine, are responsible for nearly all of the fatal drug overdoses and poisonings in our country. In pill form, fentanyl is made to resemble a genuine prescription drug tablet, with potentially fatal outcomes for users who take a pill from someone other than a doctor or pharmacist. Users of other illegal drugs risk taking already dangerous drugs like cocaine, heroin, or methamphetamine laced or replaced with powder fentanyl. Synthetic drugs have transformed not only the drug landscape in the United States, with deadly consequences to public health and safety; synthetic drugs have also transformed the criminal landscape in the United States, as the drug cartels who make these drugs reap huge profits from their sale.
Mexican cartels profit by producing synthetic drugs, such as fentanyl (a synthetic opioid) and methamphetamine (a synthetic stimulant), that are not subject to the same production challenges as traditional plant-based drugs like cocaine and heroin – such as weather, crop cycles, or government eradication efforts. Synthetic drugs pose an increasing threat to U.S. communities because they can be made anywhere, at any time, given the required chemicals and equipment and basic know-how. Health officials, regulators, and law enforcement are constantly challenged to quickly identify and act against the fentanyl threat, and the threat of new synthetic drugs appearing on the market. The deadly reach of the Mexican Sinaloa and Jalisco cartels into U.S. communities is extended by the wholesale-level traffickers and street dealers bringing the cartels’ drugs to market, sometimes creating their own deadly drug mixtures, and exploiting social media and messaging applications to advertise and sell to customers.
The Sinaloa Cartel and the Cartel Jalisco Nueva Generación (also known as CJNG or the Jalisco Cartel) are the main criminal organizations in Mexico, and the most dangerous. They control clandestine drug production sites and transportation routes inside Mexico and smuggling corridors into the United States and maintain large network “hubs” in U.S. cities along the Southwest Border and other key locations across the United States. The Sinaloa and Jalisco cartels are called “transnational criminal organizations” because they are not just drug manufacturers and traffickers; they are organized crime groups, involved in arms trafficking, money laundering, migrant smuggling, sex trafficking, bribery, extortion, and a host of other crimes – and have a global reach extending into strategic transportation zones and profitable drug markets in Europe, Africa, Asia, and Oceania.

Source: https://www.dea.gov/sites/default/files/2024-05/NDTA_2024.pdf May 2024

US DRUG CZAR EXPLAINS CAUSES AND RSDT TOOL TO PREVENT TEEN DRUG USE AND OVERDOSE DEATH INTERVIEW WITH U.S. DRUG CZAR JOHN WALTERS

Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them. 

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to act.  And I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.”

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect them.  They have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215, DZR@prodigy.net

A new report from Montreal public health indicates a new drug that’s stronger than fentanyl has hit the city’s streets.

MONTREAL — A new drug that is even more powerful than fentanyl is circulating on Montreal’s streets, according to public health officials.

Isotonitazene, a chemically manufactured opioid, has killed at least one person in Montreal. Jean-Francois Mary of harm reduction organization Cactus Montreal said similar drugs are often made in illegal labs, where cross-contamination and dosage size are risky variables.

Mary said he believes part of the solution the problem posed by opioids is legalization.

“People die because drug traffickers have had to divert into substances that are more portent and more profitable, but this potency kills,” he said. “Look in the pharmacy, there are very dangerous substances that are prescribes, they are given and people sometimes abuse them. But we don’t have so many deaths from because the quantity is controlled. Even when people abuse them, they can know how much they took.”

He said illegally-made pills don’t let users know how much Isotonitazene or fentanyl they’re ingesting.

Montreal public health seized 2,000 astonishment pills in August and is advising users that naloxone can be used to reverse the effects of an overdose.

Naloxone kits are available at most pharmacies. Anyone calling 911 to report an overdose has immunity from simple drug possession charges under the Good Samaritans Rescuing Overdose Victims Act.  

Source: New drug on Montreal’s streets even more potent than fentanyl: public health | CTV News November 2020

The 2018 Monitoring the Future College Students and Young Adults survey shows trends in the use of marijuana, alcohol, nicotine, and synthetic drugs in college students and non-college peers.

Marijuana Use

Annual Marijuana Use at Historic Highs among College and Non-College Peers*
Marijuana use is nearly the same for college students and their non-college peers at about 43%. This is approximately a 7% increase over five-years for college students. These rates for both groups are the highest in 35 years.

Daily/Near Daily Use** of Marijuana Twice as High among Non-College Group
Approximately one in nine non-college respondents reporting daily or near daily use, (11.1%) compared to about one in 17 college students (5.9%).

** Used on 20 or more occasions in the past 30 days

Past Month Nicotine Vaping Doubles Among College Students

This jump is among the greatest one-year increase seen for any substance in the history of the survey.
Between 2017 and 2018, nicotine vaping increased in college students from 6.1% to 15.5% and from 7.9% to 12.5% in non-college adults. 

Rx Drug Misuse has Mixed Results

Rx Opioid Misuse: Significant Five Year Drop in Both Groups
Past year misuse of prescriptions opioids dropped from 5.4% in 2013 to 2.7% among college students and from 9.6% in 2013 to 3.2% among non-college adults.

Adderall® Misuse: Significant Gender Differences
Past year misuse rates of Adderall® were 14.6% among college men and 8.8% among college women.  Rates were higher, however, in non-college women than in non-college men (10.1% and 5.3% respectively).

Overall Adderall® misuse is higher among college students (11.1%) than their non-college peers (8.1%)

Binge Drinking (five or more drinks in a row in the past two weeks) Fell Below 30% for the First Time among College Students

In 2018, binge drinking declined among college students (28%) and non-college adults (25%).

*Please note, the college-age adults are ages 19-22.

Source: Drug and Alcohol Use in College-Age Adults in 2018 | National Institute on Drug Abuse (NIDA) (nih.gov) September 2019

The rise in prescription opioid and heroin abuse creates countless problems for healthcare professionals, law enforcement, the drug abusers themselves and society as a whole. It’s a complex issue that continues to claim lives. Unfortunately, Fentanyl, a painkiller 100 times more powerful than morphine, is showing up on the streets disguised as other drugs, such as Norco and Xanax. The results are an increase in fatal overdoses.

Problems with fentanyl are not new. As recently as last year, we wrote about the dangers of fentanyl when it is mixed with heroin, and Dr. A.R. Mohammad, the founder of Inspire Malibu, did a recent interview with FOX 11 News in Los Angeles regarding the rise in fentanyl on the streets. What is new, however, are reports of synthetic fentanyl, likely manufactured in illegal labs in the states, China and Mexico, sold under different drug names to unsuspecting users.

In March of this year, Sacramento County, California, saw six deaths and 22 overdoses as a result of fentanyl peddled as Norco, which is supposed to be a mix of acetaminophen and hydrocodone. “In reality, they’re taking fentanyl, which is much, much, much more potent,” Laura McCasland, a spokeswoman for the Department of Health and Human Services, told The New York Times.

Legally manufactured fentanyl is an injectable opioid often administered before surgeries. It also comes in a time release lozenge or patch for patients coping with severe chronic pain from conditions like pancreatic, metastatic and colon cancer.

Fentanyl is so strong, fast-acting and creates such a high tolerance, many patients find that other opiates no longer work for them. This is also one of the reasons that fentanyl is so addictive.

With abuse and addiction to fentanyl, quitting “cold turkey” can cause severe withdrawal.

What are the Withdrawal Symptoms of Fentanyl?

• Fast heart rate and rapid breathing
• Muscle, joint and back pain
• Insomnia, yawning and restlessness
• Sweating and chills
• Runny nose and eyes
• Anxiety, depression and irritability
• Lethargy and weakness
• Vomiting, nausea, diarrhea, loss of appetite and stomach cramps

Even a tiny amount of fentanyl can be deadly. The president of the American Society of Anesthesiologists, J.P. Abenstein, told National Public Radio, “What happens is people stop breathing on it. The more narcotic you take, the less your body has an urge to breath.”

Abenstein added that people who don’t know how much to take will easily overdose. This no doubt also applies to users who aren’t even aware they’re taking the dangerous opiate when it’s sold under another name or mixed with heroin.

The Centers for Disease Control and Prevention (CDC) reported that of the estimated 28,000 people who died from opioid overdoses in 2014, almost 6,000 of those deaths were fentanyl related.

The agency also suggests that states make Naloxone (Narcan), an overdose-reversal drug, more widely available in hospitals and ambulances to prevent deaths.

Abstinence from illicit drug use is the only guaranteed way to avoid an accidental overdose on fentanyl. Addiction, however, changes the brain’s chemistry and drives those affected to make decisions and behave in a manner that continues to put them at risk.

Source:  https://www.inspiremalibu.com/blog/drug-addiction/fentanyl-hits-the-streets-disguised-as-xanax-and-norco/  19^th June 2019

ANDRI TAMBUNAN FOR THE WALL STREET JOURNAL

By Julie Wernau

Updated Jan. 3, 2024 2:58 pm ET

The opioid crisis has only intensified as more illicit drugs have entered the market. Drug overdose deaths reached a record high in 2022, with more than 100,000 people lost to the continuing epidemic, fueled by the potent synthetic opioid fentanyl. The drug, according to the Centers for Disease Control and Prevention, can be up to 50 times more potent than heroin and 100 times that of morphine. Illicit forms of fentanyl are mainly manufactured by drug cartels in Mexico and are spreading in the U.S.

Last year, members of Congress introduced a bill that would add the veterinary tranquilizer xylazine to a list of controlled substances. The drug has worsened the fentanyl crisis as it has been showing up in drug users’ fentanyl supply at an alarming pace.

What is fentanyl?

Fentanyl is a heavily regulated legal medication, prescribed largely for pain relief in cancer patients, postsurgery and for people with chronic pain who have developed tolerance for other opioids.

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is placed on a person’s skin, as lozenges that are sucked like cough drops or film that sits between the cheek and gum, according to the American Society of Health-System Pharmacists Inc. It also can be sprayed in the nose or under the tongue.

The illicit form of fentanyl, a powder that is often mixed into other drugs, has overtaken the drug market in the U.S. Fentanyl is made in clandestine labs in Mexico from easily sourced chemicals.

Drug overdose deaths reached a record high in 2022, with more than 100,000 people lost to the continuing epidemic. PHOTO: ALYSSA SCHUKAR FOR THE WALL STREET JOURNAL

What is “tranq” drug xylazine?

Xylazine is a veterinary tranquilizer that has increasingly been showing up in illicit drugs, including in fentanyl. The drug, which is authorized only for animals, has been complicating overdoses and producing severe wounds for users that can lead to serious infection and amputation.

Dealers may mix xylazine into fentanyl to save money, federal law-enforcement authorities have said. The drug—known as “tranq” among some users—can be purchased at low prices from Chinese suppliers and offset some of the opioid in the mix.

Drug users often don’t know that xylazine is being mixed into their fentanyl batch and unknowingly become hooked on both substances. Drug users say xylazine can prolong a high from fentanyl but that also often means being unconscious, sometimes for hours at a time.

In February, the FDA said it would restrict imports of xylazine and more carefully scrutinize shipments of the drug into the U.S. to check that they are bound for legitimate use in animals.

The Drug Enforcement Administration said in March that about 23% of seized fentanyl powder and 7% of fentanyl pills contained xylazine last year. The Senate and House bills introduced in March would make xylazine a Schedule III drug, a category that includes ketamine. The bill would require producers and distributors to report order volumes to the DEA.

Drug test results also show xylazine is spreading throughout the U.S. About 43% of fentanyl-positive urine samples in Pennsylvania from April to July contained xylazine, according to Millennium Health, a drug-testing laboratory. The rate in North Carolina was second-highest at 40%. Rates in Ohio and Maryland were close behind.

Which drugs are typically laced with fentanyl?

Drug manufacturers mix illicit fentanyl with other materials to create a powder that can be dissolved into liquid and injected. PHOTO: MORIAH RATNER FOR THE WALL STREET JOURNAL

Fentanyl is often found mixed into heroin, cocaine and methamphetamine, according to the CDC. The drug is also made into fabricated pills that are often indiscernible from commonly prescribed medications such as Percocet (the narcotic oxycodone), Xanax (the sedative alprazolam) or even Adderall (an amphetamine).

Chinese chemical companies are making more ingredients for illegal fentanyl than ever, including N-Phenyl-4-piperidinamine, which Mexican cartels purchase to make into fentanyl.

Drug manufacturers in Mexico also mix illicit fentanyl with other materials, such as baking soda, starch and sugar, to create a powder that can be smoked or dissolved into liquid and injected, a process called “cooking,” or fabricated pills purchased on the illicit market.

Fentanyl is so powerful that in pure form the amount in roughly two sugar packets can provide a year’s supply for a user. When drug suppliers mix fentanyl into drugs or press it into illicit pills, a few grains too many can be enough to trigger a fatal overdose. It is unclear why fentanyl is showing up in such a large array of drugs. Evidence that fentanyl is showing up in more places comes from laboratory tests of drug seizures, toxicology testing and death certifications that take months to complete, according to the National Institute on Drug Abuse. Law-enforcement officials believe that in some cases, the drug is mixed in accidentally by drug manufacturers working with multiple white powders in the same lab, while at other times, drug manufacturers are experimenting in the attempt to create new psychoactive substances.

Fentanyl can be made into fabricated pills that are often indiscernible from commonly prescribed medications. PHOTO: ANDRI TAMBUNAN FOR THE WALL STREET JOURNAL

How often are illicit drugs laced with fentanyl?

Fentanyl has infiltrated virtually every channel of the illicit drug supply, according to U.S. law officials. The proportion of seized counterfeit pills in the U.S. containing a potentially lethal dose of fentanyl increased to 60% in 2022 from 10% in 2017, according to samples analyzed by the DEA.

WHAT’S NEWS

Tainted drugs are so common in cities across the country, including Columbus, Ohio, that the city offers a program for distribution of fentanyl testing strips to users so they can determine whether substances are contaminated with the drug.

In New York City, authorities have been warning of the risks of unknowingly taking fentanyl in cocaine and of its increased presence in cocaine seized by police. Of 980 cocaine deaths in 2020, 81% involved fentanyl, according to recent New York City health department data.

People who use methamphetamine are also sometimes accidentally exposed to fentanyl. But many users are intentionally using meth and opioids simultaneously or in sequence in search of balancing or offsetting effects, researchers say. The drug combination is becoming an emerging driver of U.S. overdoses.

What is fentanyl’s effect on the human body?

Fentanyl works by binding to the body’s opioid receptors—found in the areas of the brain that control pain and emotions, according to the National Institute on Drug Abuse. Some of the effects of fentanyl include euphoria, relaxation, pain relief, drowsiness and sedation, among others, according to the DEA. With repeated use, the brain adapts to the drug, making it hard to feel pleasure without it. Stopping the use of fentanyl leads to withdrawal, or “dope sickness,” which can include extreme anxiety, vomiting, muscle pain, chills, racing heartbeat and profuse sweating. Many chronic users have long since stopped feeling the euphoric effects of fentanyl and use it to avoid feeling sick.

Drug users who are accustomed to using heroin or prescription pain pills say illicit fentanyl’s effect can be more dramatic and shorter lasting than other opioids, making it more difficult to hold down a job as they seek out drugs every few hours.

Naloxone is an antidote to opioids that can reverse the effects of an overdose within two to three minutes. PHOTO: ASH PONDERS FOR THE WALL STREET JOURNAL

What are some of the signs and symptoms of someone overdosing on fentanyl?

Fentanyl slows the body down and reduces respiration but becomes deadly when it suppresses breathing to such slow shallow breaths that a person can’t sustain life and their heart stops. If someone is unconscious, awake but unable to talk, or their breathing slows sharply, that could be an early sign of an overdose. According to the New York State Department of Health, that person’s skin may soon turn bluish purple or ashen. In some cases, a person overdosing will have a faint heartbeat. An overdose can also lead to hypoxia, the decrease in oxygen to the brain, according to neuropsychopharmacologists.

Still, it can be difficult to tell if a person is just very high or experiencing an overdose, according to the National Harm Reduction Coalition. People who are high may display slurred speech or seem dazed, but still be able to respond to a loud noise or someone lightly shaking them, the group says.

How do you treat an overdose?

Naloxone is an antidote to opioids that can reverse the effects of an overdose within two to three minutes, according to the Mayo Clinic. Naloxone has virtually no effect in people who haven’t taken opioids, according to the World Health Organization.

---

The overdose-reversal drug binds to opioid receptors and reverses or blocks the effects of opioids. It comes in two forms: nasal sprays and injectables. Nasal sprays such as Narcan are often stocked by first responders and at healthcare facilities. Groups working with drug users typically have an injectable version of the drug on hand that can be injected into the muscle of an arm or leg to reverse an overdose. The Substance Abuse and Mental Health Services Administration recommends performing cardiopulmonary resuscitation, also known as CPR, if the person isn’t breathing on their own and said it can save a person’s life regardless of whether naloxone is present. The agency says it is important to stay with the person until medical personnel arrive, reassure them and explain what is happening, as they may reawaken agitated, confused or could overdose again if the naloxone wears off before the opioid.

Recently, the U.S. Food and Drug Administration encouraged pharmaceutical companies to apply for approval for over-the-counter versions of overdose-reversal medications such as Narcan to help address a swelling overdose crisis from bootleg versions of the powerful opioid fentanyl.

The FDA on March 29 approved Emergent BioSolutions Inc.’s Narcan brand of naloxone nasal spray for over-the-counter sale. The company said its nasal spray-version of the medication will likely become available on store shelves by late summer.

The pharmaceutical nonprofit Harm Reduction Therapeutics Inc. has already received priority review from the agency to make an inexpensive naloxone nasal spray for use without a prescription. The company said the FDA gave it a target approval date of April 28.

Supplies for drug users at an overdose prevention center in New York. PHOTO: SARAH BLESENER FOR THE WALL STREET JOURNAL

What is harm reduction?

Harm reduction is a public-health strategy aimed at reducing as much harm as possible to people while they are using drugs, rather than stopping them from taking substances altogether.

Groups that practice harm reduction for drug users teach about using clean needles to prevent infection and the spread of disease. Some groups provide fentanyl test strips so that users can test drugs for fentanyl and hand out naloxone to prevent deaths from overdose. An increasing number of groups supervise drug consumption. The Biden administration is the first to name harm reduction as a priority for drug policy.

Who is affected by overdose rates?

Disparities in access to treatment are driving up overdose rates among Black and Native American people, the CDC has said. Overdose deaths per 100,000 people increased 44% for Black people and 39% for Native Americans in 2020 from a year earlier, compared with a 22% increase among white people, according to a study in which the CDC analyzed 25 states and Washington, D.C.

Deaths from fentanyl have affected every age group, but particularly the 25-to 34-year-old and 35-to 44-year-old populations. These two groups combined made up more than half of all synthetic opioid overdose deaths in 2021, according to preliminary CDC data.

Young children have also been directly affected by fentanyl. There were 133 opioid-related deaths among children younger than 3 last year, according to federal mortality data.

Overdose rates were higher in areas with more opioid-treatment programs than average, a finding that the study’s authors said demonstrated other barriers to access for some people. Overdose rates were also higher in counties with higher income inequality, according to the study. The findings show how the escalating overdose crisis is exacting a mounting toll on minority groups that are in some cases marginalized by the healthcare system, CDC researchers said.

Some prisons and jails have programs that dispense antiaddiction medications to help put inmates who are addicted to opioids on a path to sobriety and curb overdose rates. The Biden administration has said it wants medication available for drug users in federal custody and at half of state prisons and jails by 2025.

This explanatory article may be periodically updated.

Brian Spegele, Margot Patrick, Arian Campo-Flores and Jon Kamp contributed to this article.

SOURCE: https://www.wsj.com/health/healthcare/what-is-fentanyl-drug-opioid-health-safety-explained-11658341650

At the center of America’s deadly opioid epidemic, non-pharmaceutical fentanyl appears to be finding its way into illegal stimulants that are sold on the street, such as cocaine. Adulteration with fentanyl is considered a key reason why cocaine’s death toll is escalating. Cocaine and fentanyl are proving to be a lethal combination – cocaine-related death rates have increased according to national survey data. This has important emergency response and harm reduction implications as well—naloxone might reverse such overdoses if administered in time. A recent study by Nolan et. al. assessed the role of opioids, particularly fentanyl, in the increase in cocaine-involved overdose deaths from 2015 to 2016 and found these substances to account for most of this increase.

Fentanyl and Cocaine

Fentanyl is a synthetic, short-acting opioid that is 50 to 100 times more powerful than morphine and increasingly associated with a heightened risk of fatal overdose. The combination of heroin and cocaine, also known as “speedballing,” was popular in the 1970s.  Recently, there has been an uptick in cocaine being adulterated with other powerful substances like the synthetic opioid fentanyl. Unlike in the intentional combination of cocaine with other substances in the 70s, many modern users are not aware that their cocaine may be mixed with another substance, leaving them vulnerable to an accidental overdose.

Cocaine deaths have moved up to the second most common substance present in fatal overdoses—after opioids. Before 2015, fentanyl was involved in fewer than 5% of all overdose deaths each year. This rate increased to 16% in 2015 and continues to rise. At the beginning of 2016, 37% of cocaine-related overdose deaths in New York City involved fentanyl. By the end of the year, fentanyl was involved in almost half of all overdose deaths in NYC. Since then, several US cities have reported similar outbreaks of overdose fatalities involving fentanyl combined with heroin or cocaine. The combination of fentanyl and cocaine has been a considerable driver of the rising death toll since 2015, and opioid-naive cocaine users are at an especially high risk of unintentional opioid overdose.

Why is Fentanyl Appearing in Cocaine?

One theory is that the adulteration is an accident and occurs by residual fentanyl being present in the same space and on the same surfaces where cocaine is being processed. Another theory is that the increasing presence of fentanyl in cocaine concerns cost and supply. Drug cartels can add other cheaper drugs and medications as fillers to stretch out their product.1 By adding fentanyl they may also be producing a more potent and addictive product to expand their market. This, however, is risky since even a small amount of fentanyl can result in death. The Drug Enforcement Agency (DEA) explains that even 2 milligrams of fentanyl, about the size of a grain of rice, can be deadly to an adult. In light of that fact, it’s distinctly possible that street-level illicit drug dealers do not have insight into the contents of their product and are unknowingly selling cocaine adulterated with fentanyl.

Present Study

Data in this study was acquired from death certificates from the New York City Bureau of Vital Statistics and toxicology results from the New York City Office of the Chief Medical Examiner. Age-adjusted rates per 100,000 residents were calculated for 6-month intervals from 2010 to 2016.

Results suggested that individuals using cocaine in New York City were vulnerable to a greater risk of a fatal overdose due to the increasing presence of fentanyl in the city’s drug supply. In fact, 90% of the increase in cocaine overdose fatalities from 2010 to 2016 also involved fentanyl.

Public Health Challenges

This study highlighted some public health challenges caused by fentanyl-adulterated cocaine:

1. First responders and those present at the scene of a cocaine overdose may consider administering Naloxone even if the patient denied using opioids.

2. Fentanyl is very dangerous and powerful and dramatically increases the risk of lethal overdose.

3. Opioid-naïve individuals that have been using fentanyl-free cocaine lack a potentially life-saving tolerance for opioids. Adding fentanyl to their drug of choice puts this group at an even higher risk of fatal overdose.

4. Opioid-naïve cocaine users are typically not targeted by current harm reduction strategies and public messages concerning opioid overdose. A lack of education and access to critical resources, including naloxone —the lifesaving overdose reversal drug— render this population more vulnerable to a fatal overdose.

Looking to the Future

As the issue continues to get worse — 19,000 of the 42,000 reported opioid overdose deaths in 2016 were related to fentanyl — the authors of the study emphasize the importance of overdose prevention intervention for cocaine users, with a strong emphasis on access to naloxone and information about fentanyl.

Future prevention efforts must be widened to include cocaine users, especially those who are opioid-naïve, to prevent more fatal overdoses. Cocaine overdose awareness, treatment for dependence, and relapse prevention must be prioritized in a comprehensive response to addiction that puts us on a better path forward and ensures that this country does not repeat past mistakes by implementing substance-centric policy and education efforts.

Citation

Nolan, M. L., Shamasunder, S., Colon-Berezin, C., Kunins, H. V., & Paone, D. (2019). Increased presence of fentanyl in cocaine-involved fatal overdoses: implications for prevention. Journal of Urban Health, 1-6.

Source: Fentanyl-adulterated Cocaine: Strategies to Address the New Normal (addictionpolicy.org) Updated October 16th 2022

DEA says Houston is both a big market for synthetic pot and a major source

More than 1 million packets of a dangerous, unpredictable new breed of drug were seized in the Houston area by the DEA in the past two years, yet criminal charges are rare for those who make, sell or use them.

The packets, sold as potpourri or incense, are among the more popular brands of so-called synthetic marijuana taking center stage in a new front in the war on drugs.

Source: https://www.houstonchronicle.com/news/investigations/article/Houston-gains-key-role-in-synthetic-marijuana-5024607.php  November 2013

Abstract
Aim: To evaluate the effectiveness of an online school-based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS).

Design: Cluster randomized controlled trial with two groups (intervention and control).

Setting: Eleven secondary schools in Australia.

Participants: A total of 1126 students (mean age: 14.9 years).

Intervention: The internet-based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4-week period, during health education classes. Control schools received health education as usual.

Measurement: Primary outcomes were self-reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life-time use of ecstasy and NPS. Surveys were administered at baseline, post-intervention and 6 and 12 month post-baseline.

Findings: At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31-78.91]. However, students’ intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01-34.73). There was a significant group difference in the change from baseline to post-test for NPS knowledge (β = -0.42, 95% CI = -0.62 to -0.21, Cohen’s d = 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post-test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = -0.54, 95% CI = -0.97 to -0.12, P = 0.01, d = 0.73).

Conclusions: The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school-based prevention program, appeared to reduce students’ intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term.

Keywords: Adolescents; ecstasy; internet; new psychoactive substance; prevention.

Source: https://pubmed.ncbi.nlm.nih.gov/26880476/ April 2016

Polysubstance use—when more than one drug is used or misused over a defined period of time—can occur from either the intentional use of opioids with other drugs or by accident, such as if street drugs are contaminated with synthetic opioids. In the first half of 2018, nearly 63% of opioid overdose deaths in the United States also involved cocaine, methamphetamine, or benzodiazepines, signaling the need to address polysubstance use as part of a comprehensive response to the opioid epidemic. Fentanyl, a highly potent synthetic opioid, has been identified as a driver of overdose deaths involving other opioids, benzodiazepines, alcohol, methamphetamine, and cocaine.

Two classes of drugs are frequently co-used with opioids: depressants and stimulants. Although there are medical uses for some drugs in these classes, they also all have high potential for misuse. Mixing opioids—which are depressants—with other depressants or stimulants, either intentionally or unknowingly, has contributed to the rising number of opioid overdose deaths, which have more than doubled since 2010. Efforts to reduce opioid overdose deaths should incorporate strategies to prevent, mitigate, and treat the use of multiple substances. 

Depressants

Depressants act on the central nervous system to induce relaxation, reduce anxiety, and increase drowsiness. Opioid use concurrent with the use of another sedating drug compounds the respiratory depressant effect of each drug, creating a higher risk for overdose and fatal overdose than when either drug is used alone.

Benzodiazepines

Benzodiazepines are prescribed for medical use as sedatives but are commonly misused for nonmedical purposes and in combination with prescription and illicit opioids. In 2018, just over 9,000 U.S. deaths involved both opioids and benzodiazepines, more than twice the number of 2008 deaths due to such co-use. Moreover, in 2018, nearly half (47.2%) of benzodiazepine overdose deaths involved synthetic opioids (e.g., fentanyl). Fatal overdoses involving both prescription opioids and benzodiazepines nearly tripled from 2004 to 2011.

Alcohol

In 2017, 15% of opioid overdose deaths involved alcohol. From 2012 to 2014, more than 2 million people who misused prescription opioids were also binge drinkers of alcohol (defined as more than five drinks for a man or more than four drinks for a woman within a two-hour period); compared with nondrinkers, binge drinkers were associated with being twice as likely to misuse prescription opioids. Evidence indicates that about 23% of people with an opioid use disorder have a concurrent alcohol use disorder.

Stimulants

Stimulants increase arousal and activity in the brain. In 2017, opioids were involved in more than half of stimulant-involved overdose deaths—about 15,000 total. The co-use of stimulants with synthetic opioids such as fentanyl either intentionally or through drug contamination has increased the number of stimulant-involved overdose deaths. The opposing impacts of increased arousal from stimulants and sedation from opioids on the body can make the outcomes of co-use less predictable and raise the risk of overdose.

Methamphetamine

About 12% of opioid overdose deaths from January to June 2018 involved methamphetamine, an illicit drug. In 2017, opioids were involved in 50% of methamphetamine-involved deaths, and recent data suggests synthetic opioids are driving increases in methamphetamine-involved deaths. One study found that 65% of those seeking opioid treatment had reported a history of methamphetamine use, with more than three-quarters of them indicating that they had used methamphetamines and opioids mostly at the same time or on the same day.

Cocaine

Of the nearly 15,000 cocaine overdose deaths in 2018, nearly 11,000 also involved opioids; this number accounts for about 23% of the total opioid overdose deaths that year. In fact, since 2010 the number of deaths caused by a combination of opioids and cocaine has increased more than fivefold. People who primarily use cocaine but sometimes co-use opioids are at high risk for overdose because of the increasing presence and potency of fentanyl in the drug supply and a lower tolerance for opioids than someone who regularly uses them.

What should be done?

It is critical that state policies addressing the rise in polysubstance use and its link to increased risk of overdose span across prevention, harm reduction, and treatment strategies. To effectively accomplish this, states should:

• Enact policies that increase provider use of prescription drug monitoring programs (PDMPs) to reduce the co-prescription of opioids and benzodiazepines. PDMPs, state-based electronic databases that contain information on controlled substance prescriptions, allow prescribers and pharmacists to monitor patients’ prescription drug use and can promote safer prescribing practices that help prevent overdoses. High rates of benzodiazepine prescribing are correlated with the drug’s involvement in opioid overdose deaths.
• Expand naloxone distribution to reach people who use stimulants. Naloxone reverses the respiratory depression effects of opioids to safeguard against a fatal overdose and remains effective when people use opioids in combination with other drugs. Considering that opioids are frequently implicated in cocaine and methamphetamine overdose deaths, people who primarily use stimulants are recognized as an at-risk population for opioid overdose. Laws that allow for increased community distribution of naloxone can help safeguard against polysubstance use overdoses.
• Amend drug paraphernalia laws to allow possession of fentanyl test strips. Fentanyl test strips can detect the presence of fentanyl in a person’s drug supply when dipped into a solution of a small amount of the drug in water. People who use drugs have indicated that if a test strip found fentanyl in their supply, they would take measures to prevent an overdose, such as injecting at a slower pace or using less of the drug at a time. Fentanyl test strips are mainly used by people who inject opioids but can also be helpful for those who use stimulants and fear fentanyl contamination by preventing unintentional co-use that could lead to a fatal overdose. Amending drug paraphernalia laws to allow the possession of drug-checking devices, including fentanyl test strips, would permit agencies and organizations to distribute test strips to people who use drugs and help to prevent fentanyl-related overdose deaths.
• Prohibit the discharge of patients from publicly funded opioid use disorder (OUD) treatment programs for their continued substance use. Treatment programs often discharge patients from treatment involuntarily because of their continued illicit drug use (a practice commonly called administrative discharge). This practice poses a particular risk for patients being treated for OUD with methadone or buprenorphine who are at high risk for overdose if discharged without medication. Although co-use of other drugs, such as stimulants, with medications for OUD can interfere with treatment, it remains safer for patients to continue medication treatment because of their high risk for overdose from using illicit opioids. People with OUD who use benzodiazepines are particularly at higher risk for overdose when not on medication treatment. Federal guidelines recommend avoiding administrative discharge and instead suggest that treatment programs re-evaluate a patient’s needed level of care if the current treatment plan proves ineffective.

Conclusion

As the increase in opioid use evolves into an increase in polysubstance use, understanding how different substances interact may inform strategies that help prevent overdose. Though some individuals knowingly combine or co-use opioids with stimulants or other depressants, an additional and growing concern is the adulteration of other drug supplies with fentanyl. Strengthening policy efforts across the continuum of prevention, harm reduction, and treatment to address the risks of polysubstance use can slow the rates of drug overdose deaths in the United States.

Source: https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2020/10/opioid-overdose-crisis-compounded-by-polysubstance-use October 2020

They were the mind-altering drugs of the Sixties, but now lysergic acid diethylamide (better known as LSD), magic mushrooms and a range of other banned psychedelic drugs are making a comeback.

Not on the party scene, but as the focus of researchers who believe they could treat a variety of mental health problems, including depression.

British researchers are at the forefront of this renaissance of hallucinogenics. But, as Good Health can reveal, a key organisation funding their work is a pressure group with a parallel agenda.

Source: How you have paid to help legalise lethal party drugs | Daily Mail Online May 2018

Fentanyl is a synthetic opioid chemically similar to other substances like hydrocodone, oxycodone, heroin, and morphine. In recent years, fentanyl has played an increasingly prominent role in the opioid crisis, alongside other prescription medications like Dilaudid. Synthetic opioids are the most common drugs responsible for overdose deaths. In 2010, fentanyl was involved in 14.3% of drug overdose deaths. However, by 2017, fentanyl use accounted for nearly 59% of opioid-related deaths.

Fentanyl was created in 1959 and began being manufactured and distributed in the United States throughout the 1960s. Its original use was as an intravenous medication to treat cancer pain. According to the Drug Enforcement Administration (DEA), fentanyl’s pain-relieving properties are about 100 times more powerful than morphine’s and 50 times more potent than heroin’s.

Fentanyl as a Prescription Medication

To obtain fentanyl legally, a prescription from a doctor is required. Fentanyl is only prescribed to patients experiencing severe pain from cancer and who have developed a physical tolerance to other opioids. Building a tolerance means that a person’s body has gotten used to the drug and requires higher and/or more frequent doses to relieve the pain.

Fentanyl should not be used to treat any other types of pain, especially pain caused by migraines, headaches, an injury, or pain from a medical or dental procedure. Its primary purpose is to treat sudden episodes of pain that occur despite ongoing continuous pain management with other medications. Prescription fentanyl can be taken as an oral lozenge, sublingual tablet or spray, skin patch, nasal spray, or injection.

Fentanyl as an Illegal Street Drug

Fentanyl sourced on the street is often produced illegally in a lab. However, there have been documented cases of distribution through other pathways, including theft and fraudulent prescriptions. Patients, physicians, and pharmacists have also been complicit in contributing to fentanyl’s unlawful circulation. There are several ways fentanyl is misused.

The gel contents of patches can be removed and injected or ingested. Patches can also be frozen, cut into pieces, and put under the tongue or between the gums and cheek. Street-bought fentanyl is sold in similar forms as its prescription counterpart. However, it can also come as a powder, in eye droppers, on blotter papers, and in pills that look like prescription opioids.

On the street, it may be called:

• Apache
• China Girl
• China Town
• Dance Fever
• Friend
• Goodfellas
• Great Bear
• He-Man
• Jackpot
• King Ivory
• Murder 8
• Tango & Cash

What Effects Does Fentanyl Have? 

Besides being very effective at relieving pain, fentanyl causes sensations similar to those produced by other opioid analgesics like morphine: relaxation and euphoria. These are the effects that individuals who use fentanyl illegally are looking to achieve. Some negative side effects of use can include:

• Nausea
• Vomiting
• Sedation
• Dizziness
• Confusion
• Drowsiness
• Constipation
• Urinary retention
• Unconsciousness
• Constricted pupils
• Problems breathing
• Respiratory depression

What Happens When Fentanyl Is Misused? 

Two key conditions can result from the misuse of fentanyl: overdose and addiction. An overdose can occur when too high of a dose of the drug is taken, resulting in life-threatening symptoms like hypoxia. Hypoxia occurs when the brain does not receive enough oxygen, in this case, because a person’s breathing has slowed down or stopped. Hypoxia can cause a person to fall into a coma, suffer permanent brain damage, and die.

Coma, pinpoint pupils, and respiratory depression are strong indicators that a person may be experiencing an opioid overdose and requires emergency medical care. Other signs and symptoms of a fentanyl overdose can include:

• Stupor
• Dizziness
• Confusion
• Cold and clammy skin
• Drowsiness or sleepiness
• Being unable to respond or wake up
• Bluish discoloration of the skin

Naloxone, also known as NARCAN®, is used to reverse the effects of opioids and can save a person from dying from an overdose. Because fentanyl is so strong, multiple doses may be required for its lifesaving effects to occur.

What Makes Fentanyl So Dangerous?

Fentanyl is a powerful drug, even in very small quantities. Its potency is what makes the possibility of overdose so high. Another major problem with illegal fentanyl is that it is being mixed with other drugs like cocaine, meth, heroin, and MDMA. A person looking for a party drug might end up using fentanyl for the first time without knowing it and accidentally overdose.

Like other opioid painkillers, a person that misuses fentanyl can become addicted. Fentanyl binds to opioid receptors in the brain that are associated with pain and emotions. The brain quickly becomes used to the drug and requires more to achieve euphoria. Additionally, users will begin to suffer withdrawal effects after their high wears off. Once addicted, an individual becomes consumed with seeking out and using the drug, despite the negative consequences their behavior has on their lives and those around them.

How Is Fentanyl Addiction Treated?

Before entering residential treatment, fentanyl addiction may first require medical detox. After withdrawing safely, addiction therapy will likely include a combination of medication and behavioral therapy.

Three medications commonly used to treat fentanyl addiction are buprenorphine, methadone, and naltrexone. Like fentanyl, buprenorphine and methadone bind to opioid receptors in the brain, but they can be used in therapeutic doses to help reduce cravings and lessen withdrawal symptoms. Naltrexone works differently. Instead of binding to the receptors, it blocks them so fentanyl won’t have any effect.

What Behavioral Therapies Help With Fentanyl Addiction?

Behavioral therapies used to treat fentanyl and other opioid addictions include cognitive behavioral therapy (CBT), contingency management, and motivational interviewing. CBT is based on the idea that one’s thoughts, feelings, and behaviors are connected. CBT can modify distorted thought patterns and improve emotional regulation.

Contingency management is also called the “prize method” or the “carrot and stick method.” This approach to addiction therapy is based on the idea that behavior can be shaped by enforcing consequences. Positive behaviors, like passing drug tests or meeting treatment goals, are reinforced by offering rewards. The goal of contingency management is to encourage healthy living.

Motivational interviewing is a process by which a therapist helps enhance a client’s motivation to change negative behaviors regarding substance use. A vital component of this therapy is that the client must want to want to change and improve their lives.

These behavioral treatment approaches are effective at treating opioid addiction, especially when used in combination with medication. You can learn more about addiction therapies at Laguna Shores here.

Source: America’s Killer New Drug​: A Guide to Fentanyl (lagunashoresrecovery.com) 2019

Cannabis Use and Health 2014
Introduction

Cannabis is a group of substances from the plant cannabis sativa. Cannabis is used in three main forms: flowering heads, cannabis resin (hashish) and cannabis oil. There are more than 60 psycho-active chemicals in cannabis, including the cannabinoids:
 delta-9 tetrahydrocannabinol (THC), which is found in the resin covering the flowering tops and upper leaves of the female plant and which alters mood and produces the feeling of a ‘high’;
and
 cannabidiol, which can offset the effects of THC.

Cannabis is usually smoked, either in a hand-rolled cigarette (a ‘joint’) containing the leaf, heads or resin of the plant, or through a water-pipe (a ‘bong’) where water is used to cool the smoke before it is inhaled. In Australia, cannabis is also commonly known as gunja, yarndi, weed and dope.

Patterns of Cannabis Use in Australia and its Public Health Impacts

In 2010, cannabis was the most commonly used illicit drug in Australia. Over one third of Australians (35.4%, approximately 6.5 million) aged 14 years and over had used cannabis at least once in their lifetime, and 1.9 million of these had used cannabis recently (i.e., in the last 12
months). Recent cannabis use among those 14 years and older has increased from 9.1% in 2007 to 10.3% in 2010, though daily users decreased from 14.9% in 2007 to 13% in 2010. In 2010, approximately 247,000 Australians 14 years and over used cannabis daily. For most cannabis users, use is relatively light. Most young people have used it once or twice. However, the younger people start using cannabis, and the greater the frequency with which they use it, the greater the risk of harm.
Based on current use patterns, alcohol abuse and tobacco pose much greater harms to individual and public health in Australia than cannabis. Cannabis-related psychosis, suicide, road-traffic crashes and dependence were estimated to account for 0.2% of the total disease burden in Australia in 2003. This compares to 7.8% of the total burden attributable to tobacco use and 2.3% attributable to alcohol use. In 2004-05, the estimated social costs of cannabis use (including health, crime, road crash and labour costs) was $3.1 billion. Ninety percent of this cost was due to dependent cannabis use. In comparison, the health, crime, road-crash and labour costs of alcohol use in 2004-05 are estimated to be more than three times as much ($9.4 billion).

The Health Effects of Cannabis Use

There is a dose-response relationship between cannabis use and its effects, with stronger effects
expected from larger doses.
 Intoxicating effects occur within seconds to minutes and can last for three hours;
 Effects last longer with larger doses;
 Effects on cognitive function and coordination can last up to 24 hours;
 Short-term memory impairment may last for several weeks; and
 A single dose in a chronic user can take up to 30 days for the metabolites to be excreted.

Short-term effects of small doses
The most common short-term effects of using cannabis are:
 a feeling of euphoria or ‘high’ – with a tendency to talk and laugh more than usual;
 impaired balance, reaction time, information processing, memory retention and retrieval, and perceptual-motor coordination;
 increased heart rate;
 decreased inhibitions such as being more likely to engage in risky behaviour, e.g. unsafe
sexual practice; and
 if smoked, increased respiratory problems including asthma.

Short-term effects of large doses
The most common short-term effects of a large dose can include:
 hallucinations and changed perceptions of time, sound, colour, distance, touch and other sensations;
 panic reactions;
 vomiting;
 loss of consciousness; and
 restlessness and confusion.

The severity of these short-term effects depend on a person’s weight, tolerance to the drug, amount taken, interactions with other drugs, circumstances in which the drug is taken, and the mode of administration.

Long-term effects
The evidence associating regular cannabis use with specific long-term health conditions and adverse effects is of variable quality. Cannabis use is highly correlated with use of alcohol, tobacco and other illicit drugs, all of which have potential adverse health effects. There is sufficient evidence, however, to indicate that cannabis is a risk factor for some chronic health effects and conditions.

Regular and prolonged cannabis use may cause:
 cannabis dependence, characterised by impaired control over its use and difficulties in ceasing use; increased tolerance (meaning more of the drug is needed to produce the same effect) and possible withdrawal symptoms, including anxiety, insomnia, appetite disturbance, and
depression;
 increased risk of myocardial infarction in those who have already had a myocardial infarction;
and
 deficits in verbal learning, memory and attention (in heavy users).

While not conclusive, there is evidence that regular cannabis use can cause chronic bronchitis and impaired immunological competence of the respiratory system. Occasional cannabis use however, is not associated with adverse effects on pulmonary function. Cannabis smoke contains many carcinogens, but there is variable evidence concerning the relationship between cannabis smoking and lung cancer.

Evidence supporting an association between cannabis use and sexual and reproductive effects is weak. However, some studies show an association between cannabis use and increased risk of testicular cancer.
Daily consumption of large quantities of cannabis may lead to the neglect of other important personal and social priorities such as relationships, parenting, careers and community responsibilities.

Pregnant women
Cannabis is the most commonly used illicit drug in women of child-bearing age. Cannabis use during pregnancy has been consistently associated with lower birth-weight babies and pre-term birth, but does not appear to increase the risk of miscarriage or birth abnormalities. Some studies suggest that children exposed to cannabis in utero may have slight impairment in higher cognitive processes such as perceptual organisation and planning. There is insufficient evidence of an association between prenatal cannabis use and postnatal behaviour.

Accidental ingestion by young children
Accidental ingestion of cannabis can cause coma in young children. Cannabis ingestion can be confirmed by positive urine screening for cannabinoids. Cannabis ingestion needs to be considered in toddlers and children with impaired consciousness.

Driving under the influence of cannabis
Cannabis slows reaction time and increases the risk of having a car crash. Other risk factors are blurred vision, poor judgement and drowsiness which can persist for several hours. The effects are increased by alcohol.

Dependence and tolerance
Cannabis dependence is usually defined as impaired control over continued use and difficulty ceasing despite the harms of continued use.19 Dependence can negatively affect personal relationships, education, employment and many other aspects of a person’s life. Data from Australia and other countries indicates that demand for professional help related to cannabis is increasing. Cannabis dependence is the most frequent type of substance-dependence in Australia after alcohol and tobacco. It has been estimated that cannabis dependence will affect around one in ten cannabis users, and around half of those who use it daily. Animal and human studies demonstrate that tolerance to many of the psychological and behavioural responses to cannabis occurs with repeated exposure to the drug. The symptoms of withdrawal from cannabis appear similar to those associated with tobacco, but less severe than withdrawal from alcohol or opiates.

There is a view that the cannabis being used today has a higher THC content and potency than in the past. This may be a perception caused by changes in the mode of use (i.e. through ‘bongs’ rather than ‘joints’, and with more consumption of the heads of the cannabis plant). However, there is some independent evidence that cannabis used today can be of a higher potency. The cannabis in recent street-level seizures in Sydney and the North Coast of NSW has been shown to have a high potency, with around 15% THC, with little or no cannabidiol.

Cannabis as a Gateway Drug
The gateway hypothesis is that cannabis use may act as a causal ‘gateway’ to the use of other illicit drugs such as cocaine and heroin. It is a controversial hypothesis with proponents arguing that because the use of so-called harder drugs is almost always preceded by cannabis use, this means that cannabis use physiologically and/or psychologically causes people to progress to harder drugs. The alternative theory is known as the ‘common cause’ theory whereby a person’s use of cannabis and their later use of other illicit drugs are both seen as effects of common causes such as personal or socio-economic factors, or exposure to illicit drug distribution networks. Evidence for the gateway hypothesis is inconclusive given the difficulties in disentangling the effect of other potential influences in drug use progression. Meta-analyses suggest that the progression in use that has been observed is likely to be due partially to the influence of independent common
causes.

Cannabis and Mental Health

Cannabis and psychosis
Cannabis use is associated with poor outcomes in existing psychosis and is a risk factor for developing psychosis. For those with existing psychosis, using cannabis can trigger further episodes of psychosis, worsen delusions, mood swings, hallucinations and feelings of paranoia, as well as contributing to poor compliance with medication regimes. The research base on cannabis and psychosis has expanded in recent years with studies showing a consistent association between early-aged onset of cannabis use, regular use and a later diagnosis of schizophrenia. Meta-analyses have noted a doubling of the risk of psychotic outcomes in regular cannabis users, and earlier onset (by 2.7 years) among cannabis users who develop psychosis.
There is increasing evidence that the association between cannabis and onset of psychosis is not due to other co-occurring factors. The most plausible view is that cannabis use is a ‘contributory cause’ of psychosis in vulnerable individuals, and that it is one of a number of potential factors that can bring on psychosis (including genetic predisposition)’

Cannabis and depression
The association between cannabis use and depression is weak and insufficient to establish a causal connection. Studies that have found an association are likely to have been affected by confounding variables such as family and personality factors, other drug use and marital status.
There is currently insufficient evidence available to conclude whether cannabis use is associated with suicide. Research is made difficult by confounding factors such as the stresses of an illicit drug-dependent life and pre-existing poor mental health.

Cannabis and anxiety
There is emerging evidence associating cannabis use with anxiety disorders. However, the current level of evidence is not yet sufficient to establish a causal relationship.

Medical Uses Of Cannabis
In addition to psychoactive compounds, cannabis has constituents with other pharmacological effects, including antispastic, analgesic, anti-emetic, and anti-inflammatory actions. These constituents may have therapeutic potential.

Cannabis extracts and synthetic formulations have been licensed for medicinal use in some countries, including Canada, the USA, Great Britain and Germany, for the treatment of severe spasticity in multiple sclerosis, nausea and vomiting due to cytotoxics, and loss of appetite and cachexia associated with AIDS. The synthetic cannabis product Nabiximols (Sativex), which is delivered as a buccal spray and so avoids the harms of cannabis smoke inhalation, is effective in the management of spasticity and pain associated with multiple sclerosis. The psycho-active effects of Nabiximols can also be managed through controlling dosage.

In Australia, the synthetic cannabinoids nabilone and dronabinol are scheduled by authorities for medicinal use. Sativex is also being trialed in Australia for cancer and cannabis withdrawal. Canada has allowed the medical use of smoked cannabis if this is authorised and monitored by a doctor.
There is a growing body of evidence that certain cannabinoids are effective in the treatment of chronic pain, particularly as an alternative or adjunct to the use of opiates, when the development of opiate tolerance and withdrawal can be avoided. Controlled trials have also shown positive effects of cannabis preparations on bladder dysfunction in multiple sclerosis, tics in Tourette syndrome, and involuntary movements associated with Parkinson’s disease. Based on existing data, the adverse events associated with the short-term medicinal use of cannabis are minor.
However, the risks associated with long-term medicinal use are less well understood, particularly the risk of dependence, and any heightened risk of cardiovascular disease. Though there is a growing body of evidence regarding the therapeutic use of cannabinoids, it is still experimental.

Synthetic Cannabis
Synthetic cannabis products have been developed, usually in herbal form for smoking. These products have been marketed in Australia as ‘legal highs’ with product names such as ‘Spice’, ‘K2’, and ‘Kronic’. The psychoactive components are usually THC analogues that bind to cannabinoid receptors in the brain. These analogues are not easily detectable by routine testing, and until recently have not been captured by legislation. These synthetic cannabis products are attractive to their users because they are perceived as safe, are not easily detectable in drug tests, and until recently have not been illegal.
The synthetic cannabis products can not be considered safe given that the synthesized psychoactive substances in them have not been rigorously tested, and little is known about their long or short-term health effects, dependence potential or adverse reactions. Psychotic
symptoms have been associated with use of some synthetic cannabinoids, as well as signs of addiction and withdrawal symptoms similar to those of cannabis. Adverse outcomes have been reported from the use of Kronic in Australia.

The Control of Cannabis Use and Supply

Australian legislation
The possession, cultivation, use, and supply of cannabis is prohibited in all Australian States and Territories. In some Australian jurisdictions there are criminal penalties for the possession, cultivation and use of cannabis, and in others there are less severe civil penalties. Legislation in Australia often distinguishes between possession of small amounts of cannabis (for personal use) possession of larger amounts (trafficable quantities), and possession of even larger “commercially trafficable” quantities. The supplying of cannabis and the possession of large quantities attract criminal penalties in all Australian jurisdictions. All Australian States and Territories have diversionary schemes for minor and early cannabis offenders which require them to undertake educative and treatment programs as an alternative to receiving a criminal penalty.

Criminalisation and health
It is often thought that criminal penalties are a deterrent to cannabis use and, therefore, an effective way to prevent the health impacts and other harms associated with cannabis use. These beliefs have little foundation. A system of criminal prohibition for cannabis use applied in Australia for many years, but the incidence of cannabis use was still significant. The introduction of less serious civil penalties and diversionary alternatives to criminal sanctions did not significantly increase the rates of uptake and use among Australians.

For those who are not deterred from use by criminal penalties, criminalisation can add to the potential health and other risks to which cannabis users are exposed. These include:

 exposure of cannabis users, including teenage and occasional users, to ‘harder drugs’. Those who acquire cannabis from large scale illicit drug distribution networks will also become exposed to more harmful drugs, including the direct marketing of those drugs to them;
 exposure of cannabis users to criminal networks and activity, including exposure to the threat of violence and the risk of taking part in criminal distribution;
 the personal and health-related costs of a criminal conviction. A criminal conviction can negatively impact on a person’s employment prospects and their accommodation and travel opportunities. Limited employment and accommodation prospects can lead to poor health,
including mental health. Individuals with a criminal record are also at a disadvantage in any subsequent criminal proceedings;
 a deterrent to individuals seeking health advice, treatment and support regarding their cannabis use;
 the inability to collect high quality, reliable data regarding patterns of use and harms.

Harm reduction
A harm-reduction approach is defined as policies and initiatives that aim to reduce the adverse health, social and economic consequences of substance use to individual drug users, their families and the community. Harm reduction considers both the potential harms to individuals using substances like cannabis and the potential harms and negative impacts of the different approaches for controlling the use and supply of these substances. When harm reduction is the primary goal, the key policy focus will be on measures to reduce individuals’ harmful levels of cannabis use, or cannabis use among individuals who are most vulnerable to adverse health impacts, or cannabis use in contexts which involve serious risks to users.

Harm-reduction measures include targeted efforts to reduce the supply of cannabis and to reduce demand for it among vulnerable groups. In certain contexts, and with certain groups, measures emphasizing abstinence may also contribute, in a preventive way, to reducing harms. Policy and legislative approaches that do not effectively address cannabis-related harms or create
significant risks and adverse impacts are not consistent with harm-reduction. Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. The effectiveness of criminal prohibition of cannabis use in reducing the health-related harms
associated with cannabis use is questionable.

Treatment Options
The number of people seeking treatment for cannabis use is increasing, but most of those who experience cannabis dependence do not seek help. Many regular cannabis users do not believe they need treatment, and there is also a low awareness of the treatment options available and how to access them.
There are fewer treatment options for cannabis dependence than for alcohol or opiate dependence, and limited research on the effectiveness of different cannabis treatment options. Treatments for problematic cannabis use include psychological interventions such as cognitive
behavioural therapy and motivational enhancement, and pharmacological interventions with medications to ease the symptoms of withdrawal or block the effects of cannabis. The research on pharmacological interventions for cannabis is in its infancy, with medications still in the experimental stages of development.

Cognitive behavioural therapy helps the cannabis user develop knowledge and skills to identify risk situations when using cannabis and to modify behaviour accordingly. Motivational enhancement techniques build the cannabis user’s desire to address their problematic use. These counseling interventions are increasingly available online as web-based programs, as well as face-to-face with a counselor. Online programs have the advantage of convenience and anonymity, for those who are concerned about possible stigma. Difficulties in maintaining motivation, and limitations in personalising the programs to individual needs, are drawbacks. According to current research, web-based treatment programs may not be as effective as in-person treatment. Some problematic cannabis users have particular treatment needs, including those with cannabis dependence and mental health issues. These individuals require integrated treatment and coordinated care. General practitioners can play an important role in developing a coordinated care plan to suit the needs of these patients.

The Australian Medical Association Position
The AMA acknowledges that cannabis use is harmful and can lead to adverse chronic health outcomes, including dependence, withdrawal symptoms, early onset psychosis and the exacerbation of pre-existing psychotic symptoms. While the absolute risk of these outcomes is low and those who use cannabis occasionally are unlikely to be affected, those who use cannabis frequently and for sustained periods, or who initiate cannabis use at an early age, or who are susceptible to psychosis, are most at risk.
The AMA also recognises that cannabis use has short-term effects on cognitive and perceptual functioning which can present risks to the safety of users and others. The AMA believes that cannabis use should be seen primarily as a health issue and not primarily as a matter for law enforcement. The most appropriate response to cannabis use should give priority to policies, programs and regulatory approaches that reduce the harms potentially associated with cannabis use, and particularly the health-related harms. The positions outlined below should be read in the light of this harm-reduction principle. The AMA believes the following are the important considerations and central elements in an appropriate harm-reduction response to cannabis use.

Prevention and Early Intervention
 As younger people and those who use cannabis frequently are most at risk of harm, prevention and early intervention initiatives to avoid, delay and reduce the frequency of cannabis use in these populations are essential.
 All children should have access to developmentally appropriate school-based life-skills programs to assist in preventing or reducing potential substance use problems.
 Evidence-based information on the potential risks of cannabis use and where to seek further assistance should be widely available, particularly to young people.
 Medical professionals can play an important role in the early identification of patients they believe to be at risk of adverse health outcomes from cannabis use.
 When a cannabis user comes into contact with law enforcement or justice administration agencies this should be used as an opportunity to direct them to education, counseling or treatment. This is particularly important with young and first time or early offenders.

Diagnosis and Treatment
 Medical professionals have the knowledge and opportunity to screen for and diagnose cannabis-related disorders, including dependence, withdrawal symptoms, and cannabis induced psychosis. Referral networks and linkages should be established within regions between primary care and specialist mental health and drug and alcohol services, to ensure integrated and coordinated treatment support for cannabis use problems.
 Medical professionals, particularly general practitioners, have the opportunity to counsel patients who are at risk of cannabis-related harms, and they should be supported to provide education and advice about those potential harms.
 Targeted treatment regimens should be developed and resourced for groups with particular needs, including those with dual diagnoses, multiple drug use, young teenage users and culturally appropriate services for Aboriginal peoples and Torres Strait Islanders. Of particular importance are suitable treatment services for cannabis users with mental health needs.
 Every effort should be made to address the personal and systemic barriers that cannabis users face in seeking treatment and support when they need it. These include barriers associated with perceptions of stigmatisation, users’ and professionals’ awareness of treatment options, and users’ beliefs that they do not have a health problem.
 Doctors should consider accidental cannabis ingestion in the differential diagnosis of children with impaired consciousness.
 Cannabis users should have access to the rehabilitative services and support they require to manage associated disorders and particularly the risk of relapse.

Medical Uses of Cannabis
The Australian Medical Association acknowledges that cannabis has constituents that have potential therapeutic uses.
 Appropriate clinical trials of potentially therapeutic cannabinoid formulations should be conducted to determine their safety and efficacy compared to existing medicines, and whether their long-term use for medical purposes has adverse effects.
 Therapeutic cannabinoids that are deemed safe and effective should be made available to patients for whom existing medications are not as effective.
 Smoking or ingesting a crude plant product is a risky way to deliver cannabinoids for medical purposes. Other appropriate ways of delivering cannabinoids for medical purposes should be developed.
 Any promotion of the medical use of cannabinoids will require extensive education of the public and the profession on the risks of the non-medical use of cannabis.

Law Enforcement, Cannabis Regulation and Health
 In assessing different legislative and policy approaches to the regulation of cannabis use and supply, primary consideration should be given to the impact of such approaches on the health and well-being of cannabis users.
 The AMA does not condone the trafficking or recreational use of cannabis. The AMA believes that there should be vigorous law enforcement and strong criminal penalties for the trafficking of cannabis. The personal recreational use of cannabis should also be
prohibited. However, criminal penalties for personal cannabis use can add to the potential health and other risks to which cannabis users are exposed. The AMA believes that it is consistent with a principle of harm reduction for the possession of cannabis for personal
use to attract civil penalties such as court orders requiring counselling and education (particularly for young and first time offenders), or attendance at ‘drug courts’ which divert users from the criminal justice system into treatment.
 When cannabis users come into contact with the police or courts, the opportunity should be taken to divert those users to preventive, educational and therapeutic options that they would not otherwise access.
 In allocating resources, priority should be given to policies, programs and initiatives that reduce the health-related risks of cannabis use. Law enforcement should be directed primarily at cannabis supply networks.
 The AMA believes that the availability and use of synthetic cannabis products (including herbal forms) poses significant health risks, given that the psychoactive chemical constituents of these products are unknown and unpredictable in their effect. There are
particular challenges in regulating these products, and Australian governments must make a concerted effort to develop consistent and effective legislation which captures current and emerging forms of synthetic cannabis.

Research
 Further research is needed into the relationship between cannabis use and psychosis and other mental health problems, including the identification of those at greatest risk of cannabis-induced psychosis.
 There should be continuing research to identify the risk factors that contribute to individuals developing problematic or early onset cannabis use, and the factors and interventions that can protect against these.
 Australian governments should fund research into best practice treatment methods, including suitable pharmacotherapies, for those who are cannabis-dependent or who wish to reduce or cease their use.
 There should be systematic ongoing monitoring of the different legislative and policy approaches on cannabis operating in overseas jurisdictions to assess their health and harm-related impacts. The evidence obtained should inform critical reviews of the
approaches that operate in Australia.

Source: 1 (ama.com.au) 2014

Government warnings about fentanyl hitting UK streets have inadvertently sparked a demand for the deadly opioid among drug users, a community leader has told IBTimes UK.

Last month, the National Crime Agency (NCA) revealed that 60 drug deaths had been linked to fentanyl and its cousins, including the elephant tranquilizer carfentanyl, since December 2016.

This followed a warning in April from Public Health England (PHE) that the synthetic opiates, which are 50 to 10,000 times stronger than heroin, were being mixed with the street drug.

But these announcements have merely whetted the appetite of some heroin users, according to Martin McCusker, chair of the Lambeth Service User Council, a support network for drug users in south London.

“The warnings have generated a lot of interest among drug users who think ‘wow – this fentanyl stuff is sh*t cool – it must be really strong’,” he said.

McCusker said he was not surprised by the response of his peers when they learned that fentanyl, which is ravaging communities across North America, was becoming more prevalent in this country.

“We get these warnings about overdoses but that’s not what we hear,” he said, adding that a drug user’s typical thought process might be: “Wow, people are overdosing in Wandsworth. Oh right, they must have good gear in Wandsworth.”

As little as 0.002g of fentanyl and 0.00002g of carfentanyl – a few grains – can be fatal. When dealers mix this with heroin the resultant product may contain “hotspots” – unintended concentrations of the more potent substances.

People experiencing an opioid overdose effectively forget to breathe as their respiratory systems shut down.

McCusker acknowledged agencies’ predicaments when it comes to safeguarding drug users without giving harmful substances undue publicity.

But he said the government warnings, combined with media coverage about the spate of fentanyl-related deaths in the UK, had acted as “adverts” for the extra-strong painkiller, which killed the pop musician Prince.

“It’s not that people want fentanyl. It’s that people want stronger opioids and if fentanyl comes along then great,” he said. “Just today I was talking to this guy and he said ‘this dealer in [redacted] estate has got fentanyl.'”

McCusker claimed fentanyl was not being discussed among people who use heroin in the Brixton area until about six months ago, when reports of it being mixed with UK street supplies hit the mainstream press.

Recent interventions from government agencies had only heightened the buzz surrounding the drug, he added.

A spokesperson for PHE said: “The alert we put out was aimed primarily at emergency, medical and other frontline professionals. But we are aware that the decision about whether, and when, to issue an alert about a dangerous drug is a delicate balance between informing the right people to prevent overdoses and not driving demand for it.”

No UK opioid epidemic – for now

At least 60 drug-related deaths have been linked to fentanyl and its analogues in the last eight months, according to figures released by the NCA at a briefing on 31 July. That number refers to cases where the substances showed up in toxicology reports and does not mean they were the outright cause of death.

The synthetic substances, largely imported from Chinese manufacturers, were not instrumental to the recent surge in UK opiate deaths, which jumped from 1,290 in 2012 to 2,038 in 2016. That rise has been attributed to an ageing heroin-using population more prone to underlying health problems, and the increased purity of street heroin.

McCusker pointed out that it was impossible for users to know they were buying fentanyl-laced heroin “unless you’ve got an amazing drug testing kit at home”. He said that some of the excitement surrounding fentanyl was “just hype”.

NCA Deputy Director Ian Cruxton told reporters at the July briefing he was “cautiously optimistic” that the UK heroin market would not be flooded with fentanyl.

He said there had been a significant reduction in fentanyl-related deaths after major busts on mixing ‘labs’ in Leeds and Wales as well as the seizure of dark web marketplaces Alpha Bay and Hansa by law enforcement agencies.

In an April briefing paper, the NCA said: “We have not seen any evidence to date of UK heroin users demanding fentanyl-laced heroin.” McCusker’s testimony suggests the tide may have turned.

Source: https://www.ibtimes.co.uk/heroin-addicts-now-want-fentanyl-after-government-campaign-advertises-how-much-stronger-it-1634152 August 2017

Abstract

President Donald Trump took a few minutes in his State of the Union address to acknowledge what he called the “terrible crisis of opioid and drug addiction – never been has it been like it is now”.

The American President told Congress that “we have to do something about it”, stating that 174 drug-addiction caused  deaths a day meant that “we must get much tougher on drug dealers and pushers”.

This should come as no surprise. The crisis, which claimed well over 100,000 lives between 2015 and 2016, is now so widespread and catastrophic it was declared a public health emergency by President Trump in October.

The rate of American deaths caused by overdoses of heroin-like synthetic opioids has doubled since 2015, in a tragic symptom of the opioid epidemic ravaging the United States.

The US’s Centre for Disease Control and Prevention has published figures showing that the rate of deaths due to synthetic opioids excluding methadone, such as fentanyl and tramadol, jumped from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016.

The total number of deaths due to opioid overdoses also climbed from 52,400 to 63,600, a 21 per cent increase – marking a steady rise since 1999.

Synthetic opioids are the biggest killers

The dramatic rise in the use of synthetic opioids owes more to practicality than demand, Dr David Herzberg, a University of Buffalo expert in the history of drug addiction, told The Telegraph.

“Fentanyl [the most widely used synthetic opioid] is much easier to smuggle than heroin because you need less of it,” he said.

Since synthetic opioids are made in labs rather than from plants, like traditional heroin, they can be made anywhere in the world, and vary dramatically in strength.

Fentanyl is around 50 times stronger than heroin – and some new strains are up to 10,000 times stronger.

This huge variation in potency is what makes makes synthetic opioids so deadly, since users are often completely unaware of the strength of the substance they are injecting, said Dr Jon Zibbell, a Senior Public Health Scientist at RTI International, a nonprofit that funds opioid research.

“I know a kid who buys carfentanil [a newer strand of fentanyl] online and that’s all he injects; he argues it’s totally safe but people mixing it with other stuff don’t really know what they’re doing.

“It’s not the drugs themselves that are killing people but the inability of people to adapt to the uneven potency in the illicit market,” he said.

The rise in fentanyl dates back to 2013, when drug traffickers in Mexico started adding it to heroin to stretch their product further to meet growing demand.

Now fentanyl has also grown in popularity with small drug dealers within the US who buy it online from China, which Dr Zibbell said has led to a bloated supply of fentanyl with no standardization of strength.

Rise of drug overdose death most pronounced among men

Fentanyl is not the only heroin-like drug experiencing a boom in users in the US; the country’s mushrooming opioid crisis is well documented, with the overall rate of opioid drug overdoses increasing every year since 1999.

This owes much, Dr Herzberg said, to a history of over-prescription of painkillers dating back more than three decades to the Reagan administration, when tight controls on opioid sales were relaxed: “Opioid markets were opened up to the full range of strategies drug companies use to sell their products. So a large volume of these drugs were pumped into the market without adequate warnings about the risks.”

While data shows a higher rate of overdoses in men, recent research has found the serious health impacts for women are just as severe.

A recent paper by Dr Zibbell published in the American Journal of Public Health demonstrated that those regions of the US particularly ravaged by the opioid epidemic have also seen an outbreak of new cases of the degenerative blood disease hepatitis C.

While the rate of death by opioid overdose is lower for women, the rate of new hepatitis C cases developing is much higher. This is particularly concerning as researchers have also documented a large increase in babies born to infected mothers, along with a rise in neonatal abstinence syndrome (babies born physically dependent on opioids).

The trouble in poor, white states may be spreading

Rust belt states such as Ohio, Pennsylvania and West Virginia – with an astonishing rate of 52 drug overdose deaths per 100,000 – have shouldered the brunt of the opioid crisis.

This is partly due to the poverty of these states, but race is also a huge factor – areas with large white populations are disproportionately impacted since the epidemic is rooted in prescription drug abuse, said Dr Herzberg.

“Studies prove that physicians are less likely to prescribe opioids to African Americans or other racial minorities – even when they need them – because of the stereotypes associating them with drug abuse,” he said.

There are signs, however, that the problem has spread to other communities. The mostly non-white District of Columbia, for example, had a rate of death by drug overdose of 38.8 per 100,000 – almost most twice the national average of 19.8.

Dr Zibbell’s research also found high rates of drug treatment and new hepatitis C cases among hispanics. “That was a big deal because the epidemic has been described as mostly affecting the white population,” he said.

Experts say the spread of the opioid crisis beyond the mostly white rust belt states is particularly worrying as it highlights the nationwide extent of the crisis.

“The Trump administration is not putting action or money behind its pronouncements on the problem. If the present trajectory continues it will claim many more young lives,” he said.

President Trump remained defiant in his speech, however.

“The struggle will be long and it will be difficult,” he acknowledge, before adding “we will succeed”.

Source: https://www.telegraph.co.uk/news/2018/01/31/deadly-fentanyl-behind-dramatic-doubling-synthetic-opioid-death/ January 2018

What is synthetic cannabis?

Synthetic cannabis is a new psychoactive substance that was originally designed to mimic or produce similar effects to cannabis and has been sold online since 2004. However, some of the newer substances claiming to be synthetic cannabis do not actually mimic the effects of THC (delta-9 tetrahydrocannabinol, the active ingredient in cannabis).

Reports suggest it also produces additional negative effects. These powdered chemicals are mixed with solvents and added to herbs and sold in colourful, branded packets. The chemicals usually vary from batch to batch as manufacturers try to stay ahead of the law, so different packets can produce different effects even if the name and branding on the package looks the same.

Other names

Synthetic cannabis is marketed under different brand names.

Spice was the earliest in a series of synthetic cannabis products sold in many European countries. Since then a number of similar products have been developed, such as Kronic, Northern Lights, Mojo, Lightning Gold, Blue Lotus and Godfather.

Synthetic cannabis is also marketed as aphrodisiac tea, herbal incense and potpourri.

How is it used?

It’s most commonly smoked and is sometimes drunk as a tea.

Effects of synthetic cannabis

There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug.

Synthetic cannabis affects everyone differently, based on:

• Size, weight and health
• Whether the person is used to taking it
• Whether other drugs are taken around the same time
• The amount taken
• The chemical that is used and its strength (varies from batch to batch)

Synthetic cannabis is relatively new, so there is limited information available about its short- and long-term effects, including how safe or unsafe it is to use. However, it has been reported to have similar effects to cannabis along with some additional negative and potentially more harmful ones including:

• Fast and irregular heartbeat
• Racing thoughts
• Agitation, anxiety and paranoia
• Psychosis
• Aggressive and violent behaviour
• Chest pain
• Vomiting
• Acute kidney injury
• Seizures
• Stroke
• Death

Long-term effects

There has been limited research into synthetic cannabis dependence. However, anecdotal evidence suggests that long term, regular use can cause tolerance and dependence.

Withdrawal

Giving up synthetic cannabis after using it for a long time is challenging because the body has to get used to functioning without it.

It has been reported that some people who use synthetic cannabis heavily on a regular basis may experience withdrawal symptoms when they try to stop, including:

• Insomnia
• Paranoia
• Panic attacks
• Agitation and irritability
• Anxiety
• Mood swings
• Rapid heartbeat

The risk of tolerance and dependence on synthetic cannabis and their associated effects may be reduced by taking regular breaks from smoking the drug and avoiding using a lot of it at once.

Health and safety

There is no safe way to use synthetic cannabis. If you do decide to use the drug, it’s important to consider the following

Regulating intake

• It is difficult to predict the strength and effects of synthetic cannabis (even if it has been taken before) as its strength varies from batch to batch.
• Trying a very small dose first (less than the size of a match head) could help gauge the strength and possible effects. Dose size should only be increased slowly – time should be given for the previous dose to wear off.
• Taking synthetic cannabis on its own without a ‘mixer’ such as tobacco or dried parsley should always be avoided. Similarly, inhaling the drug via bongs or pipes can increase the risk of an overdose or bad reaction.

Misleading packaging

• The packaging of synthetic cannabis can be misleading. Although contents may be described as ‘herbal’, the actual psychoactive material is synthetic.
• Not all ingredients or their correct amounts might be listed, which can increase the risk of overdose.
• Chemicals usually vary from batch to batch, so different packets can produce different effects, even if the packaging looks the same.

Mental health risks

• People with mental health conditions or a family history of these conditions should avoid using synthetic cannabis. The drug can intensify the symptoms of anxiety and paranoia.
• Taking synthetic cannabis in a familiar environment in the company of people who are known and trusted may alleviate any unpleasant emotional effects. Anxiety can be counteracted by taking deep, regular breaths while sitting down.

When it absolutely shouldn’t be used

Use of synthetic cannabis is likely to be more dangerous when:

• Taken in combination with alcohol or other drugs, particularly stimulants such as crystal methamphetamine (‘ice’) or ecstasy
• Driving or operating heavy machinery
• Judgment or motor coordination is required
• Alone (in case medical assistance is required)
• The person has a mental health problem
• The person has an existing heart problem

In an emergency

There have been a number of deaths caused by synthetic cannabis. Call triple zero (000) immediately if someone is experiencing negative effects such as:

• Fast/irregular heart rate
• Chest pain
• Breathing difficulties
• Delusional behaviour

Ambulance officers don’t have to involve the police.

Synthetic cannabis statistics

National

• 2.8% of Australians aged 14 years and over have used synthetic cannabis at some stage in their lives.
• 0.3% of Australians aged 14 years and over have used synthetic cannabis in the previous 12 months.

According to Australian data from the Global Drug Survey, synthetic cannabis was the 33rd most commonly used drug – 1.1% of respondents had used this type of drug in the last 12 months

Synthetic cannabis and the law

The laws surrounding NPS are complex, constantly changing and differ between states/territories, but in general they are increasingly becoming stronger.

In Queensland, New South Wales, South Australia and Victoria there is now a ‘blanket ban’ on possessing or selling any substance that has a psychoactive effect other than alcohol, tobacco and food.
In other states and territories in Australia specific NPS substances are banned and new ones are regularly added to the list. This means that a drug that was legal to sell or possess today, may be illegal tomorrow. The substances banned differ between these states/territories.

Source: https://adf.org.au/drug-facts/synthetic-cannabis/ May 2019

Oxford academics say sales of synthetic opioid drug are proliferating on illicit websites, with Britain a significant player

Drug paraphernalia seized by North Yorkshire police in a recent case. Photograph: North Yorkshire police/PA

The UK is the largest host of fentanyl sales on the darknet in Europe, with 1,000 trades being made in the last few months, research shows.

Experts at the Oxford Internet Institute said the UK was a “significant player” in the trade of the synthetic opioid, a controlled class A drug that can be up to 100 times stronger than heroin. They warned that the drug was increasingly appearing on illicit websites.

It follows repeated warnings from the National Crime Agency for people to be “vigilant about fentanyl to protect themselves and their loved ones”, following at least 60 deaths linked to the substance.

A team at the institute has been scraping the world’s largest darknet marketplaces since April 2017. It found that the US accounts for almost 40% of global darknet trade, followed by Canada (15%) and Australia (12%). The largest seller in Europe is the UK (9%), followed by Germany, accounting for 5% of sales.

Joss Wright, a research fellow at the institute, said: “Why is the UK a significant player? … It’s because we have a relatively strong tech sector and users of the web, but also geographically the UK is quite well placed for trade coming from the US.”

He said that since data gathering began in April, there had been 4,850 trades in the US and about 1,000 in the UK.

Darknet markets or cryptomarkets have been operating since the launch of Silk Road in February 2011. On the darknet, those selling substances are able to remain relatively anonymous as their IP addresses are masked. People buy drugs using the online currency bitcoin.

Mark Graham, a professor of internet geography at the institute, said: “Many of the sellers in places like the US, Canada, and western Europe are likely intermediaries rather than producers themselves. While darknet marketplaces can, in theory, be accessed from anywhere in the world, our data suggests that there is often a local geography of trading. In other words, buyers tend to buy from domestic rather than international sellers.”

Two men were jailed last month for importing fentanyl and other class A drugs before selling them on the darknet. Ross Brennan, 29, from York, was sentenced to more than 13 years after making hundreds of thousands of pounds with 27-year-old Aarron Gledhill from Huddersfield, who was sentenced to just under four years for his part in the crime.

In what has been described as the first case of its kind in the UK because of their sophisticated use of technology, police searched Brennan’s property and found drugs with a street value of tens of thousands of pounds. They also seized a Chemistry for Dummies book, address labels, bags of cutting powder, a mixing machine, a microscope, a set of scales and packages from around the world.

The offences took place between 2013 and 2016. Between June and September 2015 alone, Brennan made 225 transactions using a dark website called AlphaBay, which has since been shut down.

Wright said fentanyl was appearing “more and more” on the dark web. “There has been a rise in the number of sales of that product … the darknet is a good place to buy things with extra guarantees of security and there is increasing trade there,” he said.

In response, some darknet marketplaces – including the drug market Hansa, which was shut down in July – had started banning fentanyl sales amid concerns it would attract too much attention from law enforcement, he said.

Judith Aldridge, a criminologist at the University of Manchester, said she would be surprised if sales of fentanyl did not increase. “Interestingly, over the past 12 months we’ve seen a demonisation of fentanyl, with many in the darknet community opposed to their sales on crypto-markets.”

Dr Andres Baravalle, from the University of East London, said research showed that 398 of 36,000 darknet adverts had mentioned fentanyl so far in 2017.

The Global Drug Survey 2017 said: “Despite disruptions from law enforcement efforts and scams, the size and scale of darknet markets for drugs continues to grow. At the time of the report there were over 20 functioning markets, according to dnstats.net.”

Graham, from the institute, said this had not deterred dealers. “Our research so far shows that shutting down these marketplaces has not reduced the total amount of trade. It’s a whack-a-mole game, so it is not reducing demand and supply … when you shut down one website another pops up. There is no indication it’s radically reducing demand or supply on these markets.”

Source: https://www.theguardian.com/society/2017/oct/16/uk-accounts-for-largest-share-of-darknet-fentanyl-sales-in-europe October 2017

Narcotics experts are warning against dangerous drugs being mis-sold as MDMA.

According to reports from the UK, this substance can lead to psychosis and some users claim it has the ability to keep them awake for up to three days. These undesired side effects are not typical of MDMA or “Molly.”

Instead, this “fake MDMA” — drug N-Ethyl-Pentylone — is made three times as strong. It was first discovered in the US in 2016, which spread to Australia in 2017 and most recently has been found at the Manchester music festival, Parklife.

This drug has been linked to mass casualties around the world. Dr. David Caldicott, an expert in emergency medicine, explained the dangers of N-Ethyl-Pentylone as follows:

“It has been clearly responsible for the deaths of people overseas, and a rather unfortunate phenomenon known as ‘mass casualty overdoses’, where 10-20 people drop simultaneously. So, it’s of great concern to the music festival environment.”

While this was discovered in the UK, it’s possible for partakers to happen upon this in North America too, so please exercise every caution if you do take the risk of doing drugs at a show or festival this summer.

Source:  https://www.youredm.com/2018/06/10/mdma-lookalike-drug-makes-its-way-into-festivals/   June 2018

By Christopher Ingraham

Drug overdose deaths surpassed 72,000 in 2017, according to provisional estimates recently released by the Centers for Disease Control and Prevention. That represents an increase of more than 6,000 deaths, or 9.5 percent, over the estimate for the previous 12-month period.

That staggering sum works out to about 200 drug overdose deaths every single day, or one every eight minutes.

The increase was driven primarily by a continued surge in deaths involving synthetic opioids, a category that includes fentanyl. There were nearly 30,000 deaths involving those drugs in 2017, according to the preliminary data, an increase of more than 9,000 over the prior year.

Deaths involving cocaine also shot up significantly, putting the stimulant on par with drugs such as heroin and the category of natural opiates that includes painkillers such as oxycodone and hydrocodone. One potential spot of good news is that deaths involving those latter two drug categories appear to have flattened out, suggesting the possibility that opiate mortality may be at or nearing its peak.

Overdose estimates for selected drug types in 2017.

The CDC cautions that these figures are early estimates based on monthly death records processed by the agency. The CDC adjusts these figures to correct for underreporting, because some recorded deaths are still pending full investigation. Final mortality figures are typically released at the end of the following calendar year.

The CDC updates these provisional numbers monthly. The recent inclusion of December 2017 means that a complete, albeit early look at 2017 overdose mortality is now available for the first time.

Geographically the deaths are distributed similarly to how they’ve been in prior years, with parts of Appalachia and New England showing the highest mortality rates. Once again, the highest rates were seen in West Virginia, with 58.7 overdose deaths for every 100,000 residents. The District of Columbia (50.4), Pennsylvania (44.1), Ohio (44.0) and Maryland (37.9) rounded out the top five.

At the other end of the spectrum, states in the Great Plains had some of the lowest death rates. Nebraska had the fewest with just 8.2 deaths per 100,000, a rate less than one-seventh the rate in West Virginia.

Despite the nationwide increase, the CDC’s preliminary data also shows overdose rates fell in a number of states, including North Dakota and Wyoming, compared with the prior year. Particularly significant were the decreases in Vermont and Massachusetts, two states with relatively high rates of overdose mortality.

Beyond that, the month-to-month data brings some potentially good news: Nationwide, deaths involving opioids have plateaued and even fallen slightly in recent months, from an estimated high of 49,552 deaths in the 12-month period ending in September 2017 down to 48,612 in the period ending January of this year. While it’s too early to say whether that trend will continue through 2018, those numbers are somewhat encouraging.

Opiate death estimates through January 2018.

A chief concern among substance abuse experts is the ubiquity of fentanyl, a synthetic opioid that’s roughly 50 times more potent than heroin. Because it’s cheap and relatively easy to make, it’s often mixed with other drugs such as heroin and cocaine.

Policymakers have struggled to come up with an adequate response to the opioid crisis. Overdose deaths initially ballooned during the Obama administration, which was criticized by experts for being slow to respond to the problem. Last year, the Trump administration declared the epidemic a “public health emergency” but allocated no new funding for states to address the issue. Former congressman Patrick Kennedy (D-R.I.), a member of the task force that the administration convened to tackle the epidemic, criticized President Trump late last year for being “all talk and no follow-through” on opioids.

https://www.washingtonpost.com/business/2018/08/15/fentanyl-use-drove-drug-overdose-deaths-record-high-cdc-estimates/?utm_term=.9c9d31666886

This is a very powerful and heartbreaking story –  let us hope many young people will take notice and never ‘try’ drugs offered by ‘a friend’

Connor Reid Eckhardt added a new video.

“THIS IS SO IMPORTANT TO SHARE….THIS IS NOT A MOVIE!! OUR 19 YEAR OLD SON CONNOR IS NOT WAKING UP FROM THE SINGLE HIT OF “SPICE, K2,” HE TOOK. It has over 600 names. The credits are not going to roll. He is not going surfing this morning. He is GETTING “THAT HAIR CUT” we never wanted to give before he goes into surgery to donate 4 of his organs to SAVE FOUR OTHER LIVES. Connor died. Our son, our only son died from a legal high purchased at the corner market. No drugs or alcohol in his system. Most, not all legal highs are made in CHINA and sold to our youth. Millions are being affected by these legal highs. Please help us get the attention of presidential candidates. We must get this stopped. An entire generation of children and youth are at risk. Please get educated. The Connor Project Foundation is about Education, Awareness, and Prevention. Doit4connor. Do it for your kids and for your communities.

OUR 19 OLD SON CONNOR IS DEAD FROM ONE HIT OF A SYNTHETIC DRUG called spice. WHERE DOES MOST OF THIS POISON COME FROM??? CHINA!!! Who sells this poison to our kids? Go check out these shop owners. WE LET THESE CHEMICALS INTO THE USA?? Why?? Connor made a decision that night that changed our lives forever. He chose to try legal high offered to him “by a friend”. It is sold over the counter in gas stations, mini marts, smoke shops, etc. Targeted at our youth. Stop the madness and share with at least one person. We must take a stand for Connor and all the others who have died or are institutionalized because of these killer legal highs.”

Source:

https://www.facebook.com/270455916494386/videos/436695296537113/

The Sun’s brief item describing a frightening new threat in Maryland’s drug addiction crisis (“Person who used synthetic marijuana suffers bleeding,” April 6) reveals the necessity of a renewed focus on substance abuse prevention and public education.

On April 4, the National Drug Early Warning System at the University of Maryland issued an alert about the detection of rat poison (brodifacoum) in synthetic marijuana in Illinois that resulted in two deaths and 81 emergencies. This drug, known on the street as spice or K2, causes severe bleeding, vomiting of blood, and other painful side effects. Two days later, as The Sun reports, this potentially-fatal fake weed arrived in Baltimore. The implication from this news calls for a renewed emphasis on prevention as part of Maryland’s overall response to the opioid crisis.

Specifically, while it’s essential that policymakers, health care and treatment providers, and related organizations stay steadfast in increasing the number of treatment beds, outpatient facilities, sober living houses, medication-assisted treatment and other evidence-based strategies, it also is vital to understand the treatment medications like Vivitrol, Suboxone, and Methadone are not effective in treating synthetic marijuana analogs like spice and K2.

This is another aspect of the tragedies and family horror stories caused by substance use disorder, the clinical term for drug addiction. Medications that are effective with one drug are ineffective with a different drug. This devastating dynamic requires that everyone in their respective communities work together to spread and reinforce prevention strategies and activities.

Source: http://www.baltimoresun.com/news/opinion/readersrespond/bs-ed-rr-addiction

Erie police and local hospitals are dealing with a rash of overdoses involving the synthetic marijuana known as K2, which police said is highly addictive and is sold in packages such as this packet, which was recently seized in a drug investigation. The packets typically sell for $20 to $30, according to police.

A form of synthetic marijuana is filling local emergency rooms. Authorities said seven teenagers ended up in hospitals after attending a party Thursday night in Erie that involved the drug, known as K2. At least some of the teens were later transferred to a Pittsburgh hospital for follow-up care.

Shortly before 1 p.m. Friday, Erie police and EmergyCare were sent to the 400 block of East 15th Street on a report of a K2 overdose. The call was separate from the call about the party, whose location police are still investigating. The incidents were among the latest in what Erie police and hospital officials are calling a recent spike in overdoses involving K2, a form of synthetic marijuana also known by such names as Spice and Potpourri.  Officials said they have no reports of fatal K2 overdoses in Erie, but that the overdoses trigger erratic and dangerous behavior. The emergency room at UPMC Hamot had handled more than 20 K2 overdose cases in the past week as of Friday morning, said Ferdinando Mirarchi, D.O., the hospital’s medical director of emergency medicine.

“It’s kind of like marijuana on steroids,” he said. Saint Vincent Hospital has also treated K2 overdose cases, including some of the teenage victims from the Thursday night party, said James Amsterdam, M.D., the hospital’s chief medical officer.  Erie police and the Erie County District Attorney’s Drug Task Force are investigating.

 K2 is a mixture of spices or plant material that is typically sprayed with a synthetic compound that is chemically similar to THC, the psychoactive ingredient in marijuana. K2 is typically sold in small bags and marketed as incense that can be smoked, according to information on the Partnership for Drug-Free Kids website and is treated with chemicals that come from overseas, said Mike Nolan, of the Erie Bureau of Police Drug & Vice Unit.

The K2 that is winding up in Erie is made in clandestine labs in the West and is treated with chemicals that come from overseas, said Lt. Mike Nolan, of the Erie Bureau of Police Drug & Vice Unit.

“The thing is, you don’t know what (the chemical) is,” he said.  The packets of K2, under various names, are typically sold out of stores illegally, police said. They cost $20 to $30 for a 3-to-5-gram packet, city drug investigators said.

Investigators are learning from users that K2 is highly addictive, Nolan said. One person in a recent investigation told detectives that the only thing more addictive than K2 is heroin, he said. Unlike marijuana, which typically has a calming effect, K2 can produce hyper-excitability in those who smoke it, Hamot’s Mirarchi said. Users can get very agitated or very depressed, and then can develop seizures and respiratory problems, he said.

The more typical symptom of K2 overdose patients who come into the ER is excitability to the point of acting psychotic, Saint Vincent’s Amsterdam said. Users can be extremely violent, resulting in injury to themselves as well as to hospital staff, he said.  “It might take actual sedation and muscle paralysis to control the patient, in which case they need to be put on a ventilator,” Amsterdam said. “Some patients can present, after the excited state, more of an exhausted state. They could be hard to arouse, and could need airway protection.” Amsterdam said there is no antidote, and the length of time it takes for the drug to wear off typically results in a two- to three-day hospital stay. “The frustrating thing is, these places don’t stop selling it,” Nolan said.

An amendment to Pennsylvania’s Controlled Substances, Drugs, Device and Cosmetic Act in 2013 included synthetic cannabinoids, which makes them illegal, and provided a list of specific chemicals, said former Erie County Assistant District Attorney Roger Bauer, who was recently hired as a deputy attorney general in Erie for the state Attorney General’s Office Drug Strike Force Section. Bauer prosecuted K2 cases for the District Attorney’s Office.

“Everyone knows what marijuana does to the body. These chemicals are clandestine manufactured. No one really knows what goes into them until after the fact. That’s why you have cases of people dying or getting high and acting in a different manner,” Bauer said.  Erie Police Deputy Chief Donald Dacus said his department is still actively investigating and serving search warrants on local businesses suspected of selling K2. Anyone who knows of anyone actively selling it is asked to call the bureau’s Drug & Vice Unit at 870-1199.

Source: Erie Times-News, Erie, Pa., Oct. 17, 2015.  

A string of recent deaths in New Zealand is being attributed to the rise of so-called synthetic cannabis is made to look like normal cannabis

A man in his 20s died on Tuesday night, bringing the number of fatalities this month linked to the illegal substance to eight.  The drug consists of dried plants sprayed with synthetic drugs – it triggers effects similar to cannabis but is more powerful and dangerous.  Synthetic cannabis has already caused huge concerns in the US and Europe.

In each of the eight deaths this month, the victim was thought to have used the drug before dying or was found with the drug on them.  The actual substance in the drug responsible for the deaths is not yet known.

All eight deaths have occurred in Auckland and authorities say there is a much higher number of non-fatal cases where people had to be taken to hospital.

Earlier this month, the Auckland City District Police issued a warning on Facebook over the drug use and the apparent link to the rising number of victims.

“This is not an issue unique to Auckland,” the statement warned. “Police are also concerned at the impact of synthetic cannabis in other communities in New Zealand.”

Auckland police also took the rare step of releasing CCTV footage of a man violently ill and barely able to stand after smoking synthetic cannabis.

“We have grave concerns as users don’t know what poisonous chemicals they are potentially putting into their bodies when they’re smoking this drug,” Det Insp Lendrum said.

What is synthetic cannabis?

§ Actual cannabis contains an active ingredient which interacts with certain receptors in the brain.

§ Synthetic cannabis is dried plant matter sprayed with chemicals that interact with the same receptors.

§ Produced and sold illegally, the chemicals used vary a lot. That means the effect of the drug is a lot less predictable, so a lot more dangerous.

§ Effects can be extreme, including increased heart rates, seizures, psychosis, kidney failure and strokes.

Cannabis-simulating substances – or synthetic cannabinoids – were developed more than 20 years ago in the US for testing on animals as part of a brain research programme.  But in the last decade or so they’ve become widely available to the public.

In the UK, synthetic cannabis was also temporarily legal, being sold under a variety of names most prominently Spice and Black Mamba.  The drugs were banned in 2016 but continue to cause widespread problems in the country.

Synthetic cannabis has also been banned in the US but continues to be widely available as an illegal drug.

Source:   http://www.bbc.co.uk/news/world-asia-40724390      26 July 2017

Deputy Attorney General Rod Rosenstein said on Tuesday morning. Rosenstein, along with acting head of the Drug Enforcement Agency, Chuck Rosenberg, and other prominent officials in law enforcement addressed the media at the DEA’s headquarters in Arlington, VA to discuss the ongoing response to the nation’s staggering opioid epidemic.

“We’re not talking about a slight increase. There’s a horrifying surge of drug overdoses in the United States of America. Some people say we should be more permissive, more tolerant, more understanding about drug use. I say we should be more honest and forthcoming with the American people on the clear and present danger that we know face,” opened Rosenstein.

“Fentanyl is especially dangerous. It is 40 to 50 times more deadly than heroin. Just two milligrams, a few grains of salt, an amount you could fit on the tip of your finger, can be lethal. Fentanyl exposure can injure or kill innocent law enforcement officers and first responders. Inhaling a few airborne particles can have dramatic effects,” he continued.

Rosenstein, Rosenberg, and their colleagues used the event to roll out new precautions for first responders in dealing with fentanyl. Such measures predominately featured hazmat suits as a means of avoiding airborne inhalation.

“Fentanyl’s everywhere and it’s killing people,” Rosenberg solemnly remarked.

Despite such a bleak update, Rosenberg claimed reasons for careful optimism in the midst of this epidemic. He has spoken extensively with his Chinese counterparts in law enforcement, given that China is the major source of Fentanyl that enters America. According to Rosenberg, the Chinese government banned 116 synthetic opioids for export and 4 more after his trip to China this March. Additional synthetics are scheduled to be banned as well.

“I do not want to understate such gains, nor do I want to overstate them,” he cautioned. More progress in international cooperation, he said, still has to be made in cutting off fentanyl shipments from China.

Rosenberg and other law enforcement officials such as Jonathan Thompson of the National Sheriffs’ Association assessed the difficulty associated with training first responders in such new duties and admitted that such efforts would strain already stretched resources in fighting what is an overwhelming epidemic.

Rosenberg’s daunting assessment of fentanyl put in perspective the existential danger of the ongoing opioid crisis that, according to Rosenstein, has contributed to the largest yearly increase in overdose deaths on record in America.

Rosenberg pointed out that such statistics tend to “wash over you.” To grasp the enormity of the epidemic he claimed that if three mass-shootings as deadly as the Pulse Nightclub Attack occurred three times every day for 365 days, then the death toll would roughly reach that of drug overdoses in 2015.

Source:   http://www.breitbart.com/big-government/2017/06/07/doj-drug-overdose-now-leading-cause-of-death-for-americans-under-50/

DATE: June 1, 2017

DISTRIBUTION: All First Responders

ANALYST: Ralph Little/904-256-5940

SUBJECT: Grey Death compound in Jacksonville & Florida

NARRATIVE:  The compound opioid known as Grey Death has been detected for the first time in North Florida. Although Purchased in March in St. Augustine, the basic drugs were from Jacksonville and may have been purchased pre-mixed.  Other  samples have occurred from March through May. Delays are due to testing requirements.  Grey Death has been detected in Florida since November 2016 in four counties south of NFHIDTA. Palm Beach reported a related death on May 19th.  Grey Death has been reported in the Southeast, with overdoses and at least  two deaths in Alabama and Georgia. It has  also been found in Ohio, Pennsylvania and Indiana. The compound is  a mixture of U-47700, heroin and fentanyl. Overall, different fentanyls, including carfentanil, have been detected and the amount of each ingredient varies.  The substance’s appearance is similar to concrete mixing powder with a varied texture from fine powder to rock-like. While grey is most common and is the color seen in St. Augustine, pictures indicate tan as well. The potency is much higher than heroin and can be administered via injection, ingestion, insufflation and smoking.

DANGER: Grey Death ingredients and their concentrations are unknown to users, making it particularly lethal. Because these strong drugs can be absorbed through the skin, touching or the accidental inhalation of these drugs  can result in absorption. Adverse effects, such as disorientation, sedation, coughing, respiratory distress or cardiac  arrest can occur very rapidly, potentially within minutes of exposure. Any concoction containing U-47700 may not respond to Narcan, depending on its relative strength in the mix.   Light grey powder in a test tube.

CONCLUSION: Responders are advised to employ protective gear to prevent skin absorption or inhalation. Miniscule (grains) of this substance are dangerous. Treat any particles in the vicinity of scene or potentially adhering to your or victim outer clothing or equipment as hazardous.

Source:  HIDTA Intelligence brief.   1st June 2017

As Cpl. Kevin Phillips pulled up to investigate a suspected opioid overdose, paramedics were already at the Maryland home giving a man a life-saving dose of the overdose reversal drug Narcan.

Drugs were easy to find:  a package of heroin on the railing leading to a basement; another batch on a shelf above a nightstand.

The deputy already had put on gloves and grabbed evidence baggies, his usual routine for canvassing a house.  He swept the first package from the railing into a bag and sealed it; then a torn Crayola crayon box went from the nightstand into a bag of its own.  Inside that basement nightstand:  even more bags, but nothing that looked like drugs.

Then—moments after the man being treated by paramedics come to—the overdose hit.

“My face felt like it was burning.  I felt extremely lightheaded.  I felt like I was getting dizzy,” he said.  “I stood there for two seconds and thought, ‘Oh my God, I didn’t just get exposed to something.’ I just kept thinking about the carfentanil.”

Carfentanil came to mind because just hours earlier, Phillips’ boss, Harford County Sheriff Jeffrey Gahler, sent an e-mail to deputies saying the synthetic opioid so powerful that it’s used to tranquilize elephants had, for the first time ever, showed up in a toxicology report from a fatal overdose in the county.  The sheriff had urged everyone to use extra caution when responding to drug scenes.

Carfentanil and fentanyl are driving forces in the most deadly drug epidemic the United States has ever seen.  Because of their potency, it’s not just addicts who are increasingly at risk—it’s those tasked with saving lives and investigating the illegal trade.  Police departments across the U.S. are arming officers with the opioid antidote Narcan.  Now, some first responders have had to use it on colleagues, or themselves.

The paramedic who administered Phillips’ Narcan on May 19 started feeling sick herself soon after;  she didn’t need Narcan but was treated for exposure to the drugs.

Earlier this month, an Ohio officer overdosed in a police station after bushing off with a bare hand a trace of white powder left from a drug scene.  Like Phillips, he was revived after several doses of Narcan.  Last fall, SWAT officers in Hartford, Connecticut, were sickened after a flash-bang grenade sent particles of heroin and fentanyl airborne.

Phillips’ overdose was eye-opening for his department, Gahler said.  Before then, deputies didn’t have a protocol for overdose scenes; many showed up without any protective gear.

Gahler has since spent $5,000 for 100 kits that include a protective suit, booties, gloves, and face masks.  Carfentanil can be absorbed through the skin and easily inhaled. and a single particle is so powerful that simply touching it can cause an overdose, Gahler said.  Additional gear will be distributed to investigators tasked with cataloguing overdose scenes—heavy-duty gloves and more robust suits.

Gahler said 37 people have died so far this year from overdoses in his county, which is between Baltimore and Philadelphia.  The county has received toxicology reports on 19 of those cases, and each showed signs of synthetic opioids.

“This is all a game-changer for us in law enforcement,” Gahler said.  “We are going to have to re-evaluate daily what we’re doing.  We are feeling our way through this every single day . . . we’re dealing with something that’s out of our realm.  I don’t want to lose a deputy ever, but especially not to something the size of a grain of salt.”

Source:  – Erie Times-News, Erie, Pa. – May 28, 2017 – www.goerie.com  The Associated Press

Misleadingly marketed as a legal and safe alternative to marijuana, synthetic cannabinoids have a variety of adverse health effects. A new review summarizes the clinical cases that have so far been linked to the use of the synthetic substances.

A new review warns that so-called synthetic marijuana is actually very different from cannabis and is potentially unsafe. Synthetic cannabinoids (SCBs) are a type of psychotropic chemical increasingly marketed as a safe and legal alternative to marijuana.

They are either sprayed onto dried plants so that they can be smoked, or they are sold as vaporizable and inhalable liquids.

A new review from the University of Arkansas for Medical Sciences (UAMS) warns against the dangerous side effects of the compounds popularly (and misleadingly) referred to as “synthetic marijuana.”

Referring to the SCBs currently sold as “K2” and “Spice,” Paul L. Prather, a cellular and molecular pharmacologist at UAMS and corresponding author of the review, explains the motivation behind it:

“In the United States, in 2007 or so, we started seeing all kinds of people coming into emergency rooms saying they smoked marijuana, but they had these really bizarre symptoms that did not correspond with the effects you see with marijuana.”

The report, therefore, set out to give an overview of the existing literature on SCBs, and to show that not only are they different from marijuana, but also that they do not constitute an appropriate substitute for cannabis. On the contrary, SCBs are drugs in their own right, with many toxic – and sometimes even fatal – effects. The review has been published in the journal Trends in Pharmacological Sciences.

SCBs are different from marijuana

SBCs are known to create psychotropic effects in much the same way as marijuana – by activating the CB1 cannabinoid receptor, which is found primarily in the brain and the central nervous system. Additionally, in the case of marijuana, its main active ingredient is tetrahydrocannabinol (THC), which also activates the CB2 receptor (found mainly in the immune system).

However, as the authors warn, SCBs activate the CB1 receptor to a much higher intensity than THC does.

William E. Fantegrossi, a behavioral pharmacologist at UAMS and co-author of the review, notes that SCBs “are highly efficacious drugs; they tend to activate the CB1 receptor to a greater degree than we can ever get to with THC from marijuana.”

Additionally, the authors caution that because SCBs are chemically different from THC, they may activate other receptors aside from CB1. These cellular receptors, so far unknown, may be causing the negative health effects noticed in SCB users.

SCBs linked to serious adverse health effects and even death

As reported in the review, some of these effects suggest that SCBs cause much more toxicity than marijuana. Toxicity has been reported across a wide range of systems, including the gastrointestinal, neurological, cardiovascular, and renal systems.

The clinical cases documented in the review include acute and long-term symptoms, such as:

•  Seizures
•  Convulsions
•  Catatonia
• Kidney injury § Hypertension
•  Chest pain
•  Myocardial toxicity
•  Ischemic stroke

Common adverse effects include prolonged and severe vomiting, anxiety, panic attacks, and irritability. Additionally, SCBs reportedly caused extreme psychosis in susceptible individuals, whereas marijuana only causes mild psychosis in those predisposed.

Furthermore, 20 deaths have been linked to SCBs between 2011 and 2014, whereas no deaths were reported among marijuana users during that time.

Finally, SCBs are likely to result in tolerance, dependence, and withdrawal.

SCBs are not safe, authors warn

Because SCBs cannot be detected by standard drug screening, they are particularly popular among users who want to avoid detection, such as teenagers and army personnel. These users often purchase the drugs online, but as Prather and colleagues warn, customers often do not know what they are purchasing because they get something different each time.

“Not only does the amount of the active pharmacological agent change with different batches of drugs, made by different labs, but the active compound itself can change,” says Fantegrossi. Prather adds that “there are usually a minimum of three, if not five, different synthetic cannabinoids in a single product.”

However, the potential therapeutic benefits of cannabinoids should not be dismissed entirely, write the authors. As with opioids in general, misuse or abuse can have severely adverse or even fatal consequences, but proper use may offer significant benefits.

Overall, though, SCBs should be viewed with suspicion and treated with caution.

“The public sees anything with the marijuana label as potentially safe, but these synthetic compounds are not marijuana […] You never know what they are, and they are not safe.”

Source:  http://www.medicalnewstoday.com/articles/315634.php?mc_cid=4a0d722034&mc_eid=46cee4286 0  Feb 2017

As Manchester police report a spike in spice related incidents, homeless people say the highly addictive drug is causing deaths.

When Alex first tried spice in 2014, he thought it was cannabis. The 23-year-old had been sleeping on the streets in Manchester after his mum had lost her council house. He was just looking to take his mind off his problems, but at lightning speed he became addicted, buying increasing quantities of the drug to feed his habit.

“I was waking up, buying it, smoking it, going to sleep, waking up, buying it, smoking it, going to sleep again,” he says.

Alex spent about a year addicted to spice, while he was living in tents in the city centre, before kicking the habit near the start of 2016. At the peak of his addiction, he was spending around £200 a week on the drug. “It was horrible,” he says. “Every morning I was waking up being physically sick. I was worn out and tired. I couldn’t eat. I couldn’t drink. My bones kept on aching.”

Spice, one of the names used for a group of substances known as synthetic cannabinoids, has been in the UK for more than a decade and was initially marketed as having effects similar to those of cannabis. The highly addictive psychoactive substance, an illegal class B drug since December, induces an inactive state and in recent years has become commonly used among the UK’s homeless population.

Although charities in other big UK cities report spice addiction as an issue among their homeless communities, Manchester’s problem is particularly visible. Between the city’s main train station and Piccadilly Gardens, a transport and shopping hub, it is common to see figures slumped in doorways apparently passed out after smoking the drug.

Earlier this week, Greater Manchester police released figures showing the burden the drug has placed on the city’s emergency services. The force attended 58 spice-related incidents in the city centre on Friday, Saturday and Sunday last week. There were also 23 incidents to which an ambulance was called, and 18 dispersal orders or directions to leave were issued.

Researchers estimate that 90-95% of homeless people in Manchester smoke the drug. And while there is very little research into the effects of spice on the body, there are scores of reports of people dying after smoking it. “We try and keep our outreach teams away from Piccadilly Gardens,” says Yvonne Hope, operations and resources director at the Manchester-based homelessness charity Barnabus. “It’s so unsafe there now.”

The release of police figures prompted a flurry of media interest in the problem. A series of photographs of homeless spice users in Manchester city centre, some covered in vomit and being helped by emergency services, were published by local and national newspapers. Local charities were critical of the coverage, describing it as dehumanising and sensationalist.

Spice’s main attractions are that it is cheap and strong. It is thought to be imported from China in liquid form, then sprayed on an inert plant such as marshmallow before being sold to be smoked. Only the tiniest amount of the chemical is needed to have an effect.

Alex, who has been helped into supported accommodation by the homelessness charity Depaul UK, is due to start a new job next month. He realised he needed to kick the habit when his former partner refused him access to his daughter. “I went cold turkey,” he says. “I got my cousin to lock me in the back of a van and just leave me there to sweat it out.” The withdrawal symptoms include sweating, vomiting, stomach cramps and headaches, he says.

Standing outside Barnabus’s Beacon drop-in centre – which provides showers, cooked breakfasts and cups of tea to Manchester’s rough sleepers – John and Steve, 52 and 35, agree spice has largely replaced heroin, crack and even alcohol as the drug of choice.

“You can go get a fiver, buy half a gram and it’ll knock you out for a few hours,” says John, who has been homeless since 2014. “It’s better than buying a bottle of White Ace [cider].”

“I have tried heroin and it’s worse than that,” says Steve, adding that friends of his have died after taking spice. The last time he smoked a joint of spice he woke up in a hospital bed, he says. “I don’t touch the stuff any more, it doesn’t agree with me.”

Hope says there has been a rise in crime associated with the drug since it was banned in May last year, with fights breaking out among people who visit the drop-in centre. “Up until about 2015, we had people who were mostly a community and people who respected each other, and spice just seems to have killed that,” she says. The use of spice has also reached crisis point in Britain’s prisons, helped by the fact that it does not show up in routine drugs tests. Dr Robert Ralphs, a senior lecturer in criminology at Manchester Metropolitan University, who has conducted research into the use of spice in the city, says the drug is used partly because of its ability to make hours pass in what feels like a few minutes. “People have told me they’ve used [spice] for the last two or three years, but that it seems like a couple of months,” he says.

Dr Oliver Sutcliffe, a senior lecturer in psychopharmaceutical chemistry at Manchester Metropolitan University, says the strength of the drug can vary wildly, which poses serious health risks. Tests on samples of the drug provided by police show the most recent batch to hit the streets in Manchester was 10 times stronger than is usual.

Sutcliffe says that although the packets look the same, they can contain a range of different cannabinoids at varying strengths. “You’re playing Russian roulette,” he adds. The chemicals found in spice in Manchester have been linked to 10 deaths in Japan.

Peter Morgan, a support worker with Depaul UK who is helping Alex in his transition back to work, says there is a need for rehabilitation programmes like those provided for heroin addicts. “Spice is clearly the strongest drug in the country right now,” he says.

Alex agrees with Morgan and swears he will not touch the drug again. He wants to rebuild his life with his girlfriend and hold down his new job. He says he has seen homeless friends in tears because they want to stop using spice. “But they can’t,” he continues. “Because no one’s going to help them do it.”

Some names in this article have been changed.

What is spice?

Spice, or synthetic cannabis, is not a single drug, but a range of laboratory-made chemicals designed to mimic the effects of the main psychoactive compound in cannabis, tetrahydrocannabinol (THC).

The active substance in spice is mass-produced in underground labs, often in China, and sent to Europe in powder form where suppliers typically spray the chemical on to mixes of herbal leaves that are then sold on. The precise chemical formulation of the drug is constantly shifting, meaning there are potentially hundreds or even thousands of variations available.

The THC in natural cannabis works by travelling through the blood to the brain, where it binds to cannabinoid receptors. The synthetic version does the same thing, but can be 100 times more potent, binding to the receptors more efficiently and in some cases for far longer. This has led to anecdotal reports of people remaining under the “high” of the drug for more than a day.

The precise effects are likely to depend on the chemical formula and, probably more importantly, on the concentration of the substance in the product. Since the drug is sprayed on, even within a single bag of the product there can be highly concentrated “hot spots”. This has made it difficult for scientists to come up with a typical profile of the effects of the drug and associated risks.

The positive short-term effects of spice appear to be approximately similar to that of herbal cannabis: users report feeling warm, happy and relaxed, and sometimes report confusion, paranoia and anxiety. But the adverse effects appear to be more severe and wide-ranging. A characteristic side-effect of smoking cannabis is an increased heart rate and there is some evidence that the cardiovascular effects of synthetic cannabis can be more extreme, with case reports of people having heart attacks and strokes after taking the drug. Cases have also been reported of kidney and liver damage and psychosis.

Little is known about the long-term effects of synthetic cannabis, since these products have only been in widespread recreational use since around 2008.

Source:  https://www.theguardian.com/society/2017/apr/15/its-worse-than-heroin-how-spice-is-ravaging-homeless-communities

Formerly inconceivable ideas—like providing drug users a safe place to inject—are gaining traction.

America’s opioid problem has turned into a full-blown emergency now that illicit fentanyl and related synthetic drugs are turning up regularly on our streets. This fentanyl, made in China and trafficked through Mexico, is 25 to 50 times as potent as heroin. One derivation, Carfentanil, is a tranquilizer for large animals that’s a staggering 1,000 to 5,000 times as powerful.

Adding synthetic opioids to heroin is a cheap way to make it stronger—and more deadly. A user can die with the needle still in his arm, the syringe partly full. Traffickers also press these drugs into pills that they sell as OxyContin and Xanax. Most victims of synthetic opioids don’t even realize what they are taking. But they are driving the soaring rate of overdose—a total of 33,091 deaths in 2015, according to the Centers for Disease Control and Prevention.

Hence the ascendance of a philosophy known as “harm reduction,” which puts first the goal of reducing opioid-related death and disease. Cutting drug use can come second, but only if the user desires it. As an addiction psychiatrist, I believe that harm reduction and outreach to addicts have a necessary place in addressing the opioid crisis. But as such policies proliferate—including some that used to be inconceivable, such as providing facilities where drug users can safely inject—Americans shouldn’t lose sight of the virtues of coerced treatment and accountability.

What does harm reduction look like? One example is Maryland’s Overdose Survivor Outreach Program. After an overdose survivor arrives in the emergency room, he is paired with a “recovery coach,” a specially trained former addict. Coaches try to link patients to treatment centers. Generally this means counseling along with one of three options: methadone; another opioid replacement called buprenorphine, which is less dangerous if taken in excess; or an opioid blocker called naltrexone. Overdose survivors who don’t want treatment are given naloxone, a fast-acting opioid antidote. Coaches also stay in touch after patients leave the ER, helping with court obligations and social services.

Similar programs operate across the country. In Chillicothe, Ohio, police try to connect addicts to treatment by visiting the home of each person in the county who overdoses. In Gloucester, Mass., heroin users can walk into the police station, hand over their drugs, and walk into treatment within hours, without arrest or charges. It’s called the Angel Program. Macomb County, Mich., has something similar called Hope Not Handcuffs.

Another idea gaining traction is to provide “safe consumption sites,” hygienic booths where people can inject their own drugs in the presence of nurses who can administer oxygen and naloxone if needed. No one who goes to a safe consumption site is forced into treatment to quit using, since the priority is reducing risk.

In Canada, staffers at Vancouver’s consumption site urge patrons to go into treatment, but they also distribute clean needles to reduce the spread of viruses such as HIV and hepatitis C. Naloxone kits are on hand in case of overdose. One study found that opening the site has reduced overdose deaths in the area, and more than one analysis showed reduced injection in places like public bathrooms, where someone can overdose undiscovered and die.

There are no consumption sites in the U.S., but in January the board of health in King County, Wash., endorsed the creation of two in the Seattle area. A bill in the California

Assembly would allow cities to establish safe consumption sites. Politicians, physicians and public-health officials have called for them in Baltimore; Boston; Burlington, Vt.; Ithaca, N.Y.; New York City; Philadelphia and San Francisco. Drug-war-weary police officers and harm reductionists would rather see addicts opt for treatment and lasting recovery, but they’ll settle for fewer deaths.

When all else fails, handcuffs can help, too. A problem with treatment is that addicts often stay with the program only for brief periods. Dropout rates within 24 weeks of admission can run above 50%, according to the National Institute on Drug Abuse. Courts can provide unique leverage. Many drug users are involved in addiction-related crime such as shoplifting, prescription forgery and burglary. Shielding them from the criminal-justice system often is not in society’s best interests—or theirs.

Drug courts, for example, keep offender-patients in treatment through immediately delivered sanctions (e.g., a night in jail) and incentives (e.g., looser supervision). Upon successful completion of a 12- to 18-month program, many courts erase the criminal record. This seems to work. The National Association of Drug Court Professionals reports that 75% of drug court graduates nationwide “remain arrest-free at least two years after leaving the program.”

What’s more, if the carrot-and-stick method used by drug courts is scrupulously applied, treatment may not always be necessary. This approach, called “swift, certain and fair,” has been successful with methamphetamine addicts in Hawaii and alcoholics in South Dakota. Some courts in Massachusetts and New Hampshire have now adopted it with opioid addicts. I predict that the combination of anti-addiction medication plus “swift, certain, and fair” will be especially effective.

With synthetic drugs similar to fentanyl turbocharging the opioid problem, the immediate focus should be on keeping people safe and alive. But for those revived by antidotes and still in a spiral of self-destruction, the criminal-justice system may be the ultimate therapeutic safety net.

Source:  https://www.wsj.com/articles/saving-lives-is-the-first-imperative-in-the-opioid-epidemic-1491768767  April 9, 2017

Chairman Murphy, Ranking Member DeGette, and Members of the Committee: thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), to participate in this important hearing to provide an overview of what we know about the role of fentanyl in the ongoing opioid overdose epidemic and how scientific research can help us address this crisis.

The misuse of and addiction to opioids – including prescription pain medicines, heroin, and synthetic opioids such as fentanyl – is a serious national problem that affects public health as well as social and economic welfare.  The Centers for Disease Control and Prevention (CDC) recently estimated that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.1  In 2015, over 33,000 Americans died as a result of an opioid overdose.2  That year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain medicines (including fentanyl), and 591,000 suffered from a heroin use disorder (not mutually exclusive).3

This issue has become a public health epidemic with devastating consequences including not just increases in opioid abuse and related fatalities from overdoses, but also the rising incidence of neonatal abstinence syndrome due to opioid use during pregnancy, and the increased spread of infectious diseases, including HIV and hepatitis C.4-6  Recent research has also found a significant increase in mid-life mortality in the United States particularly among white Americans with less education.  Increasing death rates from drug and alcohol poisonings are believed to have played a significant role in this change.7

The Pharmacology of Fentanyl and Other Synthetic Opioids

Prescription opioids, heroin, and synthetic opioid drugs all work through the same mechanism of action.  Opioids reduce the perception of pain by binding to opioid receptors, which are found on cells in the brain and in other organs in the body.  The binding of these drugs to opioid receptors in reward regions in the brain produces a sense of well-being, while stimulation of opioid receptors in deeper brain regions results in drowsiness and respiratory depression, which can lead to overdose deaths.  The presence of opioid receptors in other tissues can lead to side effects such as constipation and cardiac arrhythmias through the same mechanisms that support the use of opioid medications to treat diarrhea and to reduce blood pressure after a heart attack.  The effects of opioids typically are mediated by specific subtypes of opioid receptors (mu, delta, and kappa) that are activated by the body’s own (endogenous) opioid chemicals (endorphins, enkephalins).  With repeated administration of opioid drugs (prescription or illicit), the production of endogenous opioids decreases, which accounts in part for the discomfort that ensues when the drugs are discontinued (i.e., withdrawal).8

The rewarding effects of opioids – whether they are medications, heroin, or illicitly produced synthetic opioids – are increased when they are delivered rapidly into the brain, which is why non-medical users often inject them directly into the bloodstream.9 Fentanyl, in particular, is highly fat-soluble, which allows it to rapidly enter the brain, leading to a fast onset of effects. This high potency and rapid onset are likely to increase the risk for both addiction and overdose, as well as withdrawal symptoms.10  In addition, injection use increases the risk for infections and infectious diseases.  Another important property of opioid drugs is their tendency, when used repeatedly over time, to induce tolerance.  Tolerance occurs when the person no longer responds to the drug as strongly as he or she initially did, thus necessitating a higher dose to achieve the same effect.  The establishment of tolerance results from the desensitization of the brain’s natural opioid system, making it less responsive over time.11  Furthermore, the lack of sufficient tolerance contributes to the high risk of overdose during a relapse to opioid use after a period of abstinence whether it is intentional – for example, when a person tries to quit using – or situational – for example, if a person cannot obtain opioid drugs while incarcerated or hospitalized.  Users no longer know what dose of the drug they can safely tolerate, resulting in overdoses.

While all of these opioids belong to a single class of drugs, each is associated with distinct risks. The risk of overdose and negative consequences is generally greater with illicit opioids due to the lack of control over the purity of the drug and its potential adulteration with other drugs.  All of these factors increase the risk for overdose, since users have no way of assessing the potency of the drug before taking it.  In the case of adulteration with highly potent opioids such as fentanyl or carfentanil, this can be particularly deadly.12-14  Another contributing factor to the risk of opioid-related mortality is the combined use with benzodiazepines or other respiratory depressants, like some sleeping pills or alcohol.15

The Role of Fentanyl in the Opioid Crisis

The emergence of illicitly manufactured synthetic opioids including fentanyl, carfentanil, and their analogues represents an escalation of the ongoing opioid overdose epidemic.  Fentanyl is a µ-opioid receptor agonist that is 80 times more potent than morphine in vivo. While fentanyl is available as a prescription – primarily used for anesthesia, treating post-surgical pain, and for the management of pain in opioid-tolerant patients – it is the illicitly manufactured versions that have been largely responsible for the tripling of overdose deaths related to synthetic opioids in just two years – from 3,105 in 2013 to 9,580 in 2015.2  A variety of fentanyl analogues and synthetic opioids are also included in these numbers, such as carfentanil (approximately 10,000 times more potent than morphine), acetyl-fentanyl (about 15 times more potent than morphine), butyrfentanyl (more than 30 times more potent than morphine), U-47700 (about 12 times more potent than morphine), and MT-45 (roughly equivalent potency to morphine), among others.17

The opioid crisis began in the mid-to late 1990’s, following a confluence of events that led to a dramatic increase in opioid prescribing, including: a regulatory, policy and practice focus on opioid medications as the primary treatment for all types of pain;18 an unfounded concept that opioids prescribed for pain would not lead to addiction;19 the release of guidelines from the American Pain Society in 1996 encouraging providers to assess pain as “the 5th vital sign” at each clinical encounter; and the initiation of aggressive marketing campaigns by pharmaceutical companies promoting the notion that opioids do not pose significant risk for misuse or addiction and promoting their use as “first-line” treatments for chronic pain.19-21

The sale of prescription opioids more than tripled between 1999 and 2011, and this was paralleled by a more than four-fold increase in treatment admissions for opioid abuse and a nearly four-fold increase in overdose deaths related to prescription opioids.22  Federal and state efforts to curb opioid prescribing resulted in a leveling off of prescriptions starting in 2012;23 however, heroin-related overdose deaths had already begun to rise in 2007 and sharply increased from just over 3,000 in 2010 to nearly 13,000 in 2015.2  We now know prescription opioid misuse is a significant risk factor for heroin use; 80 percent of heroin users first misuse prescription opioids.24  While only about four percent of people who misuse prescription opioids initiate heroin use within 5 years,24,25 for this subset of people the use of the cheaper, often easier to obtain street opioid is part of the progression of an opioid addiction.26

The opioid overdose epidemic has now further escalated, with the rise in deaths related to illicitly manufactured synthetic opioids.  Often, the population of people using and overdosing on fentanyl looks very similar to the population using heroin. However, the drivers of fentanyl use can be complicated as the drug is often sold in counterfeit pills – designed to look like common prescription opioids or benzodiazepines (e.g. Xanax) – or is added as an adulterant to heroin or other drugs, unbeknownst to the user.14  And there are also market forces supporting the proliferation of higher-potency opioids, as people with opioid addictions develop increasing tolerance to these drugs.27

History of Fentanyl Misuse

The first fentanyl formulation (Sublimaze) received approval by the Food and Drug Administration (FDA) as an intravenous anesthetic in the 1960s.  Other formulations, including a transdermal patch, a quick acting lozenge or “lollipop” for breakthrough pain, and dissolving tablet and film, have since received FDA approval.28  Misuse of prescription fentanyl was first described in the mid-1970s among clinicians,29 and continues to be reported among the people misusing prescription opioids.3  More recently, between April 2005 and March 2007 there was an uptick in deaths related to illicitly manufactured fentanyl that was traced to a single laboratory in Mexico. Once the laboratory shut down the rate of overdose declined.30  However, over the last few years there has been a growing production of illicitly manufactured fentanyl, much of which is imported from China, Mexico, and Canada.14  The increase in illicitly manufactured fentanyl availability in the U.S. is reflected by the substantial increase in seizures of fentanyl by law enforcement which jumped from under 1,000 seizures in 2013 to over 13,000 in 2015.31 Research shows that the increasing availability of illicitly manufactured fentanyl closely parallels the increase in synthetic opioid overdose deaths in the U.S.32

HHS Response and NIDA-Supported Research Related to Fentanyl

Within HHS, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) has been leading a targeted and coordinated policy and programmatic effort to reduce opioid abuse and overdose, including fentanyl use and overdose. The effort focuses on strengthening surveillance, improving opioid prescribing practices and the treatment of pain, increasing access to treatment for opioid addiction, expanding use of naloxone to reverse opioid overdose, and funding and conducting research to better understand the epidemic and identify effective interventions. Under this effort, NIDA is engaged in number critical activities.

NIDA supports the National Drug Early Warning System (NDEWS), which monitors emerging drug use trends to enable health experts, researchers and others to respond quickly to potential outbreaks of illicit drugs.  In partnership with the NDEWS, the Northeast Node of the NIDA’s Clinical Trials Network (CTN) has been funded to complete a Fentanyl Hot Spot Study in New Hampshire.  In 2015, New Hampshire had the highest rate of fentanyl-related deaths in the country and this study is investigating the causes of increased fentanyl use and related deaths in this region.

In the first phase of the study, multiple stakeholders throughout the state, including treatment providers, medical responders, law enforcement, state authorities and policymakers were interviewed about their perspectives on the fentanyl crisis.33  Many expressed that better user-level data was imperative to answer pointed questions to more accurately inform policy, such as the trajectory of fentanyl use, supply chain, fentanyl-seeking behavior versus accidental ingestion, value of testing kits, treatment preferences, etc. The researchers reported that, “Some may seek out a certain dealer or product when they hear about overdoses because they think that it must be good stuff.”  According to the group leader, only approximately a third of users knowingly use fentanyl, but the number of users is slowly increasing.

The second phase of the study is conducting a rapid epidemiological investigation of fentanyl users’ and first responders’ perspectives, so that real-time data can inform policy in tackling the fentanyl overdose crisis.

Another ongoing NIDA funded study is characterizing the fentanyl crisis in Montgomery County, Ohio – an area experiencing one of the largest surges of illicitly manufactured fentanyl in the country. This study will explore the scope of the fentanyl crisis in this area, collecting data from postmortem toxicology and crime laboratories, and will explore active user knowledge and experiences with fentanyl.  Other NIDA funded research is working to develop faster methods for screening for fentanyl and other synthetic opioids to track overdoses through emergency department screening and improve surveillance of the fentanyl threat across the country.

NIDA-supported research is also working to develop new treatments for opioid addiction, including treatments targeting fentanyl specifically. One ongoing NIDA-funded study is in the early stages of developing a vaccine for fentanyl that could prevent this drug from reaching the brain.34

Evidence-Based Approaches

With the emergence of very high potency opioids addressing supply becomes increasingly difficult because the quantities transported may be much lower.  Thus, it is critical to address demand reduction through the deployment of evidence-based prevention and treatment strategies to reduce the number of people developing an opioid addiction and treating the population of Americans who already suffer from this addiction.

Evidence-Based Treatments for Opioid Addiction

Three classes of medications have been approved for the treatment of opioid addiction : (1) agonists, e.g. methadone , which activate opioid receptors; (2) partial agonists, e.g. buprenorphine, which also activate opioid receptors but produce a diminished response; and (3) antagonists, e.g. naltrexone, which block the opioid receptor and interfere with the rewarding effects of opioids.35  These medications represent the first-line treatments for opioid addiction.

The evidence strongly demonstrates that methadone, buprenorphine, and injectable naltrexone (e.g., Vivitrol) all effectively help maintain abstinence from other opioids and reduce opioid abuse-related symptoms.  These medications have also been shown to reduce injection drug use and HIV transmission and to be protective against overdose.36-40  These medications should be administered in the context of behavioral counseling and psychosocial supports to improve outcomes and reduce relapse.  Two comprehensive Cochrane reviews, one analyzing data from 11 randomized clinical trials that compared the effectiveness of methadone to placebo, and another analyzing data from 31 trials comparing buprenorphine or methadone treatment to placebo, found that38,39:

* Patients on methadone were over four times more likely to stay in treatment and had 33 percent fewer opioid-positive drug tests compared to patients treated with placebo;

* Methadone treatment significantly improves treatment outcomes alone and when added to counseling; long-term (beyond six months) outcomes are better for patients receiving methadone, regardless of counseling received;

* Buprenorphine treatment significantly decreased the number of opioid-positive drug tests; multiple studies found a 75-80 percent reduction in the number of patients testing positive for opioid use;

* Methadone and buprenorphine are equally effective at reducing symptoms of opioid addiction; no differences were found in opioid-positive drug tests or self-reported heroin use when treating with these medications.

To be clear, the evidence supports long-term maintenance with these medicines in the context of behavioral treatment and recovery support, not short-term detoxification programs aimed at abstinence.41  Abstinence from all medicines may be a particular patient’s goal, and that goal should be discussed between patients and providers.  However, the scientific evidence suggests the relapse rates are extremely high when tapering off of these medications, and treatment programs with an abstinence focus generally do not facilitate patients’ long-term, stable recovery.42,43

Treatment Challenges

Unfortunately, medications approved for the treatment of opioid abuse are underutilized and often not delivered in an evidence based manner.44,45  Fewer than half of private-sector treatment programs offer these medications; and of patients in those programs who might benefit, only a third actually receive it.45  Further, many people suffering with opioid addiction do not seek treatment. Identifying the need for and engaging them in treatment is an essential element of addressing the opioid crisis. For example, recent research suggests that initiating patients on buprenorphine following an opioid overdose can increase treatment retention and improve outcomes.46  Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the opioid crisis.

In addition, to achieve positive outcomes, treatments must be delivered with fidelity. To be effective, methadone and buprenorphine must be given at a sufficiently high dose.38,39  Some treatment providers wary of using methadone or buprenorphine have prescribed lower doses for short treatment durations, leading to treatment failure and the mistaken conclusion that the medication is ineffective.38,47

As of 2011, more than 22 percent of patients in a methadone treatment programs were receiving less than the minimum recommended dose of methadone.48  Interestingly, a recent study identified a genetic variant near the mu opioid receptor gene associated with a higher required dose of methadone (corresponding to a need for about an additional 20 mg per day) in African American patients but not European Americans with this gene variant.49  This highlights the need for dosing flexibility to achieve the effective dose for an individual patient.  The NIH Precision Medicine Initiative and other ongoing research projects are working to define the genetic, biological, and clinical factors that influence the efficacy of treatment to help clinicians deliver care precisely tailored for a specific patient to improve outcomes.

Research has also shown that tapering off of buprenorphine can present significant risks for relapse.43,50  A recent analysis of five studies that examined outcomes following buprenorphine taper found that on average only 18 percent (a range of 10 to 50 percent) of patients remained abstinent one to two months after tapering off of buprenorphine.50  In addition, some state programs and insurance providers limit the duration of treatment a patient may receive.  There is no evidence base to support this practice, and the available evidence suggests that it poses a significant risk for patient relapse.  This is also an important consideration in the context of the two years of funding for the opioid crisis authorized through the 21st Century Cures Act. This funding will be critical for helping states address the ongoing opioid epidemic, however, opioid addiction is a chronic condition and many patients will need ongoing treatment for many years.  It will be important to develop sustainability strategies to ensure that patients do not lose access to these life-saving medications when a particular funding program is discontinued.

While users seeking treatment are on a wait list they generally continue to engage in opioid use and this may contribute to failure to enter treatment when a slot becomes available.  Research has shown that providing interim treatment with medications while patients are awaiting admission to a treatment program increases the likelihood that they will engage in treatment.  In one study, over 64 percent of study participants receiving interim methadone entered comprehensive care within six months, compared with only 27 percent in the control group, and the group receiving methadone had lower rates of heroin use and criminal behavior.51 One model for interim treatment with buprenorphine would use urine testing call backs and a special medicine dispensing device to prevent diversion.52  Implementation would require a regulatory change because take home buprenorphine is not allowed under interim regulations currently. When this model was tested, patients showed strong adherence to the interim treatment plan and reported strong satisfaction with the treatment. State regulations and payment system issues (bundled payment that does not accommodate billing for interim treatment) are often barriers to this type of program and they are not frequently used.

Fentanyl specific challenges

While specific data on treatment outcomes for patients addicted to fentanyl or other high potency synthetic opioids are not available, the same principles of treatment still apply.  In addition, patients regularly using these substances and surviving would be expected to have a strong opioid dependency. At this time we are not sure how many people fit this clinical picture. In this scenario the withdrawal symptoms are likely to be severe, and could lead to life threatening cardiac arrhythmias and seizures if untreated or if extreme opioid withdrawal is potentiated during overdose reversal.53 There is an urgent need for more research to determine if people using fentanyl or other high potency opioids respond differently to medications for overdose reversal as well as treatment and to determine the most effective approaches for utilizing medications and psychosocial supports in this population.

In general outcomes are better predicted by the strength of the psychosocial supports around patients to support their recovery – educational or job opportunities, supportive friends and family, stable housing, access to child care – than the severity of their addiction.  Providing behavioral counseling and wrap around services to address these needs is important for achieving the best outcomes.

Prevention of Opioid Misuse and Addiction

Since the majority of people who develop an opioid addiction begin by misusing prescription opioids, the Department of Health and Human Services (HHS) continues to focus efforts on improving opioid prescribing and preventing the misuse of prescription drugs as the long-run strategy to stop the opioid epidemic.  NIDA supports research to understand the impact of federal and state policy changes on rates of opioid abuse and related public health outcomes.  This and other federally supported research has demonstrated the efficacy of multiple types of interventions, including:

* Educational initiatives delivered in school and community settings (primary prevention)54

* Supporting consistent use of prescription drug monitoring programs (PDMPs)

* Aggressive law enforcement efforts to address doctor shopping and pill mills56,57

* Providing healthcare practitioners with tools for managing pain, including prescribing guidelines and enhanced warnings on drug labels with expanded information for prescribers58-61

In states with the most comprehensive initiatives to reduce opioid overprescribing, the results have been encouraging.  Washington State’s implementation of evidence-based dosing and best-practice guidelines, as well as enhanced funding for the state’s PDMP, helped reduce opioid deaths by 27 percent between 2008 and 2012.58  In Florida, new restrictions were imposed on pain clinics, new policies were implemented requiring more consistent use of the state PDMP, and the Drug Enforcement Administration (DEA) worked with state law enforcement to conduct widespread raids on pill mills, which resulted in a dramatic decrease in overdose deaths between 2010 and 2012.62  These examples show that state and Federal policies can reduce the availability of prescription opioids and related overdose deaths.  However, the increasing supply of heroin and illicit fentanyl in the United States is undermining the effects of these improvements. While we have seen a leveling off of overdose deaths related to commonly prescribed opioids over the last few years, overdose deaths related to illicit opioids have risen dramatically during this time.

In early 2016 CDC released guidelines for prescribing opioids for chronic pain.60  We believe they represent an important step for improving prescriber education and pain prescribing practices in our nation.  NIDA is advancing addiction awareness, prevention, and treatment in primary care practices through seven Centers of Excellence for Pain Education.63  Intended to serve as national models, these centers target physicians-in-training, including medical students and resident physicians in primary care specialties (e.g. internal medicine, family practice, and pediatrics).

Addressing the Public Health Consequences of Opioid Misuse

Other evidence-based strategies can be used to reduce the health harms associated with opioid use, including increasing access to the opioid-overdose-reversal drug naloxone.

Preventing Overdoses with Naloxone

The opioid overdose-reversal drug naloxone can rapidly restore normal respiration to a person who has stopped breathing as a result of an overdose from heroin or prescription opioids.  Naloxone is widely used by emergency medical personnel and some other first responders.  Beyond first responders, a growing number of communities have established overdose education and naloxone distribution programs that make naloxone more accessible to opioid users and their friends or loved ones, or other potential bystanders, along with brief training in how to use these emergency kits.  Such programs have been shown to be effective, as well as cost-effective, ways of saving lives.64,65  CDC reported that, as of 2014, more than 152,000 naloxone kits had been distributed to laypersons and more than 26,000 overdoses had been reversed since 1996.66  In addition, the majority of states now allow individuals to obtain naloxone from retail pharmacies without a patient-specific prescription.67

Two naloxone formulations specifically designed to be administered by family members or caregivers have recently been developed.  In 2014 the FDA approved a handheld auto-injector of naloxone, and in late 2015 the FDA approved a user-friendly intranasal formulation that was developed through a NIDA partnership with Lightlake Therapeutics, Inc. (a partner of Adapt Pharma Limited).68

The availability of naloxone is critical to reduce opioid-related fatalities.69  However, research examining past fentanyl outbreaks shows that higher than typical naloxone doses were required to reverse fentanyl overdose.70  As the use of fentanyl and other highly potent opioids is increasing, it would be prudent to promote the use of naloxone while recognizing that multiple doses may be needed to revive someone experiencing a fentanyl overdose.71  It is also important for first responders to know that, while fentanyl has a short duration of action (30-90 minutes), it can stay in fat deposits for hours, and patients should be monitored for up to 12 hours after resuscitation.72  More research may be needed to develop new naloxone formulations tailored to higher-potency opioids.

Ongoing Opioid-Related Research: Implementation Science

Despite the availability of evidence based treatments for opioid abuse, we have a significant and ongoing treatment gap in our Nation.  Among those who need treatment for an addiction, few receive it.  In 2014, less than 12 percent of the 21.5 million Americans suffering with addiction received specialty treatment.3   Further, many specialty treatment programs do not provide current evidence based treatments – fewer than half provide access to MAT for opioid use disorders.45  In addition, it is clear that preventing drug use before it begins—particularly among young people—is the most cost-effective way to reduce drug use and its consequences.73  Evidence based prevention interventions also remain highly underutilized.

Ongoing NIDA research is working to better understand the barriers to successful and sustainable implementation of evidence based practices and to develop implementation strategies that effectively overcome these barriers.  This work also seeks to understand the role environment—be it social, familial, structural, or geographic—plays in preventing opioid use and in the success of prevention and treatment interventions, as well as how to tailor prevention and treatment interventions to individuals with unique needs, including those in the criminal justice system or with HIV.

Other NIDA supported research is looking at how to improve access to treatment among other high risk populations.  For example, patients with opioid addiction are at increased risk of adverse health consequences and often seek medical care in emergency departments (EDs). NIDA is also collaborating with the Baltimore County Health Department on a pilot study to explore the possibility of providing methadone through pharmacies to increase access to treatment in underserved parts of the city. In the pilot, pharmacies would be considered satellite locations of licensed methadone treatment facilities; this model has been used in Pennsylvania and New York. Discussions are underway to explore whether regulatory exceptions can be granted to make this possible. Similarly, ongoing research is examining on the impact of providing opioid addiction treatment within infectious disease clinics.  This type of research is essential for translating evidence based strategies into real-world interventions that will reach the greatest number of people and get the most out of limited prevention and treatment resources.

Implementation Research to Address the Opioid Crisis in Rural Communities

Our efforts are also focused on addressing the opioid crisis in the epicenter of the epidemic – Appalachia.  NIDA is partnering with the Appalachian Regional Commission (ARC) to fund one-year services planning and needs assessment research grants to provide the foundation for future intervention programs and larger scale research efforts to test interventions to address opioid misuse in rural Appalachia.  Four grants were awarded in FY 2016 that will address issues related to injection drug use and associated transmission of infectious disease as well as the coordination of care for prisoners with opioid addiction as they re-enter the community.

A second funding opportunity announcement in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, and ARC was released in October 2016 to support comprehensive, integrated approaches to prevent opioid injection and its consequences, including addiction, overdose, HIV and hepatitis C, as well as sexually transmitted diseases.  High rates of injection drug use in Appalachia has led to a rapid increase in the transmission of hepatitis C, raising concern about an outbreak of HIV.6 These projects will work with state and local communities to develop best practices that can be implemented by public health systems in the Nation’s rural communities including opioid abuse treatment  and other strategies to increase the testing and treatment for HIV.

HIV Testing and Treatment

NIDA supported research has helped to develop the seek, test, treat, and retain model of care (STTR) that involves reaching out to high-risk, hard-to-reach drug users who have not been recently tested for HIV; engaging them in HIV testing; engaging those testing positive in antiretroviral therapy; and retaining patients in care. Research has shown that implementation of STTR has the potential to decrease the rate of HIV transmission by half.75

Ongoing Opioid-Related Research: Development of Pain Treatments with Reduced Potential for Misuse

NIDA is one of multiple institutes of the NIH supporting research into novel pain treatments with reduced potential for misuse and diversion, including abuse resistant opioid analgesics, non-opioid medication targets, and non-pharmacological treatments. Some of the most promising potential therapies include:

* Abuse Resistant Opioid Analgesics: Efforts are underway to identify new opioid pain medicines with reduced misuse, tolerance, and dependence risk, as well as alternative delivery systems and formulations for existing drugs that minimize diversion and misuse (e.g., by preventing tampering) and reduce the risk of overdose deaths.  Multiple recent NIH-funded studies have reported progress in the discovery of opioid compounds with selective analgesic effects with reduced respiratory depressive effects and reduced abuse liability.76-78

* Non-Opioid Medications: Some non-opioid targets with promising preliminary data include fatty acid binding proteins, the G-protein receptor 55, cannabinoids, and transient receptor potential cation channel A1.

* Nervous Stimulation Therapies: Several non-invasive nervous stimulation therapies – including transcranial magnetic stimulation and transcranial direct current stimulation, as well as electrical deep brain stimulation, spinal cord stimulation, and peripheral nerves/tissues stimulation – have shown promise for the treatment of intractable chronic pain.  These devises have been approved by the FDA for treatment of other conditions but more research is needed on their effectiveness for pain.

* Neurofeedback: Neurofeedback is a novel treatment modality in which patients learn to regulate the activity of specific brain regions by getting feedback from real-time brain imaging.  This technique shows promise for altering the perception of pain in healthy adults and chronic pain patients and may also be effective for the treatment of addiction.

*

Ongoing Opioid-Related Research: Accelerating Development of New Treatments for Addiction

While the three available medications have represented significant advances in the ability to treat opioid use disorders the efficacy of these medications is far from ideal.  NIDA is funding research to accelerate development of new treatments.  This includes development of non-pharmacological interventions including biologics – such as vaccines, monoclonal antibodies, and bioengineered enzymes designed to prevent a drug from entering the brain – and novel brain stimulation techniques – such as TMS and transcranial direct current stimulation (tDCS), that target brain circuits impaired in addiction with improved specificity and temporal and spatial resolutions, and thus, with less adverse effects.  One ongoing NIDA-funded study is in the early stages of developing a vaccine for fentanyl that could prevent this drug from reaching the brain.34

Since the pharmaceutical industry has traditionally made limited investment in the development of medications to treat SUDs, NIDA has focused on forming alliances between strategic partners (pharmaceutical and biotechnology companies as well as academic institutions) with the common goal of advancing medications through the

development pipeline toward FDA approval.  NIDA conducts research to decrease the risks associated with medications development to make it more appealing for pharmaceutical companies to complete costly phase IIb and III clinical studies.  An example of such a project is a partnership with US World Meds, is in late stage development of lofexidine, a medication for the treatment of opioid withdrawal symptoms that might also hold promise for the treatment of other addictions.

Conclusion

NIDA will continue to closely collaborate with other federal agencies and community partners with a strong interest in preserving public health to address the interrelated challenges posed by misuse of prescription opioids, heroin, and synthetic opioids such as fentanyl.  We commend the committee for recognizing the serious and growing challenge associated with this exceedingly complex issue.  Under the leadership of the Department of Health and Human Services and the Office of National Drug Control Policy, NIDA will continue to support the implementation of the multi-pronged, evidence-based strategies to improve opioid prescribing and pain management, reduce overdose deaths, and increase access to high quality opioid abuse treatment.

Source:https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse 

March 2017

The Centers for Disease Control and Prevention (CDC) stated that 33,091 people died from opioid overdoses in 2015, which accounts for 63 percent of all drug overdose deaths in the same year. A recent report from the CDC found that drug deaths from fentanyl and other synthetic opioids, other than methadone, rose 72 percent in just one year, from 2014 to 2015. Last year, the death of music icon Prince was linked to fentanyl and the prescription drug has become a source of concern for government agencies and law enforcement officials alike, as death rates from fentanyl-related overdoses and seizures have risen across the country.

What exactly is fentanyl?

According to the National Institute on Drug Abuse, fentanyl is a powerful synthetic opioid analgesic that is similar to morphine – but is 50 to 100 times more potent. It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®. Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.

When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. But fentanyl’s effects resemble those of heroin and include drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma and death.

So why is abuse and misuse of fentanyl so dangerous?

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch or in lozenges. However, the fentanyl and fentanyl analogs associated with recent overdoses are produced in clandestine laboratories.

This non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids. Fentanyl sold on the street can be mixed with heroin or cocaine, which markedly amplifies its potency and potential dangers.

Users of this form of fentanyl can swallow, snort or inject it, or they can put blotter paper in their mouths so that the synthetic opioid is absorbed through the mucous membrane. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Can misuse of fentanyl lead to death?

Opioid receptors are also found in the areas of the brain that control breathing rate. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death. The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl.

The United States Drug Enforcement Administration issued a nationwide alert in 2015 about the dangers of fentanyl and fentanyl analogues/compounds. Fentanyl-laced heroin is causing significant problems across the country, particularly as heroin use has increased in recent years.

Source: http://drugfree.org/newsroom/news-item/overdose-deaths-fentanyl-rise-know/   Jan 18th 2017

More than 900 people died in British Columbia last year from illicit drug overdoses, but the provincial health minister says the toll could have been far higher and he warned the federal government Wednesday the epidemic is spreading across Canada.

The arrival of the powerful opioid fentanyl pushed the provincial death toll to a new peak of 914 overdose deaths in 2016. The BC Coroners Service reported the figure is almost 80 per cent higher than the 510 deaths due to illicit drugs in 2015.

Chief coroner Lisa Lapointe said December was the worst month at 142 deaths, the highest monthly death total ever.

“The introduction of fentanyl to our province is a game-changer,” Lapointe told a news conference. “We’ve now got this contaminant in the illicit drug system that is not manageable.”

Health Minister Terry Lake said B.C.’s death toll would have been much higher if it had not been for overdose prevention measures undertaken by the province and the often heroic efforts by first-responders and others who rushed to provide aid to victims.

“The evidence suggests many, many more lives would have been lost had we not done what we have done,” he said.

Lake said he has records of 96 overdose reversals at community overdose prevention sites where addicts can use drugs under supervision of health officials. There were no overdose deaths at the Insite safe-injection site in Vancouver’s Downtown Eastside, he said.   “We’ve seen the mobile medical unit, over 600 overdoses treated,” he said.

The B.C. government declared a public health emergency last spring in an attempt to reduce the rising numbers of drug overdose deaths.  The B.C. Centre For Disease Control also launched a take-home naloxone program for residents to reverse the effects of opioids.

The government also announced late last year that overdose prevention sites would be established in communities across the province where people could take illicit drugs while being monitored by trained professionals equipped with naloxone.

Lake said the federal government should declare a nationwide public health emergency, saying the problem is spreading across the country.

“It would focus, from a national perspective, action on this epidemic,” he said. “We haven’t had any additional funding from Ottawa to help us with this. Declaring a national public health emergency would focus all Canadians on an issue that is wracking B.C. at the moment.”

Lapointe couldn’t forecast an end, saying it will require long-term vigilance and programs on the part of governments, health providers, first-responders, families and drug users themselves.

She said she recognizes that those who are dependent on illicit drugs aren’t going to be able to abstain, but she urged them to take the drugs in front of someone who has medical expertise or at least with a sober friend.

An average of nine people died every two days from overdoses last month, she said.

“We know that this represents suffering and devastation in communities across our province.”

The coroner’s service said fatalities aren’t just happening among those who use opioid drugs, such as heroin.

“Cocaine and methamphetamines are also being found in a higher percentages of fentanyl-detected deaths in 2016,” Lapointe said.

People aged 30 to 49 accounted for the largest percentage of overdose deaths last year, and males accounted for more than 80 per cent of the overall toll.  Dr. Perry Kendall, the province’s chief medical health officer, said the number of deaths is difficult to confront.

“This was unexpected and disheartening,” he said. “We still have not as yet been able to reverse the trend. This is frankly a North America-wide problem.”

He said he will review European drug treatment programs that prescribe heroin-like medicines to addicts.

Source:  THE CANADIAN PRESS Published on: January 18, 2017 |

Chandigarh: In a first of its kind strike in Punjab, the Narcotics Control Bureau (NCB) on Tuesday raided a wholesaler of ayurvedic drugs in Amritsar and recovered over 1,600 tablets of a drug called ‘Kamini’ containing afeem (laudanum), the purest form of opium. In the run-up to the elections, the Election Commission is keeping a close watch on drug abuse in the state.  Apart from Kamini Vidrawan Ras, which is sold at chemist shops as a herbal formulation, 44 small packs of Barshasha, a Unani preparation that contains pure opium, were also recovered from S A Medicine Center at Galia Road in Amritsar. Though the quantity of the drug recovered is not high, NCB zonal director Kaustubh Sharma confirmed that this was first such bust aimed at curtailing the misuse of ayurvedic drugs in Punjab.

“We had written to the ayurvedic department of the state government stating that some chemists were selling these drugs without maintaining proper records. Acting on a specific input we raided the wholesaler and found that he did not even have authorization to stock the medicine,” Sharma said.

Till late evening on Tuesday, officials were checking the records to find out how much drug the wholesaler was selling on a daily basis. An ayurvedic practitioner can prescribe the medicine and the chemist has to get a ‘Form C’ filled before selling the drug and maintain a record of the same. Though, the sale of these medicines is regulated by the ayurveda department of the state government but the chemists have to take authorization from the state drug controller (SDC) office as well.  After TOI reported unmonitored production of opioid-based painkiller tramadol, which is not covered under the NDPS Act, this is second major incident of medicine meant of other purposes being abuse by addicts.

In June 2015, TOI had first reported misuse of these ayurvedic formulations by drug addicts in Punjab, citing a study by PGI, Chandigarh. There had, however, been no major action taken by the authorities since.

Source:  http://timesofindia.indiatimes.com/city/chandigarh/ayurvedic-chemist-selling-afeem-meds-raided-in-pb/articleshow/56331364.cms

Fentanyl is a painkiller that is 50 times stronger than heroin. It has already killed thousands, including Prince. Chris McGreal reveals why so many are playing Russian roulette with this lethal drug Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.”

Painkiller addiction claims more lives in the US than guns, cutting across class, race and region

The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.  “I had to remove him from life support. That’s the hardest thing to ever do. I had him at 15 so we grew together. He was 28 when he died,” she said. “I had to let him die but after that I needed some answers. What is fentanyl and how did he get it?” That was a question asked across Sacramento after Jerome and 52 other people in and around California’s capital overdosed on the extremely powerful synthetic opioid, usually only used by hospitals to treat patients in the later stages of cancer, over a few days in late March and early April 2016. Twelve died.

Less than a month later, this mysterious drug – largely unheard of by most Americans – killed the musician Prince and burst on to the national consciousness. Fentanyl, it turned out, was the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades, claiming close to 200,000 lives. But Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.

“The number of people overdosing is staggering,” said Lieutenant Tracy Morris, commander of special investigations who manages the narcotics task force in Orange County, which has seen a flood of the drug across the Mexican border. “It is truly scary. They don’t even know what they’re taking.” The epidemic of addiction to prescription opioid painkillers, a largely American crisis, sprung from the power of big pharmaceutical companies to influence medical policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most powerful prescription painkiller yet sold over the pharmacist’s counter. Even though it was several times stronger than anything else on the market, and bore a close relation to heroin, Purdue claimed that OxyContin was not addictive and was safe to treat even relatively minor pain. That turned out not to be true.

It spawned an epidemic that in the US claims more lives than guns, cutting across class, race and geographic lines as it ravages communities from white rural Appalachia and Mormon Utah to black and Latino neighbourhoods of southern California. The prescription of OxyContin and other painkillers with the same active drug, oxycodone, became so widespread that entire families were hooked. Labourers who wrenched a back at work, teenagers with a sports injury, just about anyone who said they were in pain

was put on oxycodone. The famous names who ended up as addicts show how indiscriminate the drug’s reach was; everyone from politician John McCain’s wife Cindy to Eminem became addicted.

Clinics staffed by unscrupulous doctors, known as “pill mills”, sprung up churning out prescriptions for cash payments. They made millions of dollars a year. By the time the epidemic finally started to get public and political attention, more than two million Americans were addicted to opioid painkillers. Those who finally managed to shake off the drug often did so only at the cost of jobs, relationships and homes.

After the government finally began to curb painkiller prescriptions, making it more difficult for addicts to find the pills and forcing up black market prices, Mexican drug cartels stepped in to flood the US with the real thing – heroin – in quantities not seen since the 1970s. But, as profitable as the resurgence of heroin is to the cartels, it is labour intensive and time-consuming to grow and harvest poppies. Then there are the risks of smuggling bulky quantities of the drug into the US.

The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. The drug was originally concocted in Belgium in 1960, developed as an anaesthetic. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.

At first the cartels laced the fentanyl into heroin to increase the potency of low-quality supplies. But prescription opioid painkillers command a premium because they are trusted and have become increasingly difficult to find on the black market. So cartels moved into pressing counterfeit tablets.  But making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”

The authorities liken buying black market pills to playing Russian roulette. “These pills sold on the street, nobody knows what’s in them and nobody knows how strong they are,” said Barbara Carreno of the DEA.

After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.  Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.

Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.  “I didn’t even know,” she said. “You find stuff out after. It’s killing me because they’re saying, ‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was doing what?’”

Jerome may have had a prescription, but like many addicts he will have needed more and more. The pill that killed him was stamped M367, a marking used on Norco pills made of an opioid, hydrocodone. It was a fake with a high dosage of fentanyl.   This is fentanyl. The first time you take it you’re not coming back. You’re gone

“If Jerome had known it was fentanyl he would never have took that,” said Natasha. “This ain’t like crack or a recreational drug that people been doing for so many years and survived it but at 60 or 70 die from a drug overdose because their heart can’t take it no more. This is fentanyl. The first time you take it you’re not coming back. You’re gone.”

That wasn’t strictly true of the batch that hit Sacramento. It claimed 11 other lives. The youngest victim was 18-year-old George Berry from El Dorado Hills, a mostly white upscale neighbourhood. The eldest was 59. But others survived. Some were saved by quick reactions; doctors were able to hit them with an antidote before lasting damage was done. Others swallowed only enough fentanyl to leave them seriously ill but short of death.

It was a matter of luck. When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal. The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills.

That probably explains the unpredictable mass overdosing popping up in cities across the US. In August, 174 people overdosed on heroin in six days in Cincinnati, which has one of the fastest-growing economies in the Midwest. Investigators suspect fentanyl because the victims needed several doses of an antidote, Naloxone, where one or two will usually suffice with heroin. The same month, 26 people overdosed on fentanyl-laced heroin in a four-hour period in Huntington, a mostly white city in one of the poorest areas of West Virginia. In September seven people died from fentanyl or heroin overdoses in a single day in Cuyahoga County, Ohio.

The US authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death. The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.

The police did not have to look far for the source of the drug that killed Jerome. He and his girlfriend were staying at the house of her aunt, Mildred Dossman, while they waited for their own place to live. Jerome was smoking cannabis and drinking beer with Dossman’s son, William. Shortly before 1am, William went to his mother’s bedroom and came back with the fake Norco pill. Jerome took it and said he was going to bed.  Jerome’s girlfriend was in jail after being arrested for an unpaid traffic fine and so he was alone with their 18 month-old daughter, Success, lying next to him.

“The doctors explained to me that within a matter of minutes he went into cardiac arrest,” said his mother. “Then as he lay there that’s when time progressed for the organs to be poisoned by fentanyl. He was dying with his daughter next to him.” Natasha said other people in the house heard her son in distress, complaining his heart was hurting. But they did nothing because they were afraid that calling an ambulance would also bring the police.

It was not until 10 hours later that the Dossmans finally sought help from a neighbour who knew Jerome. He tried CPR and then called the medics. The police came, too, and in time Mildred Dossman, 50, was charged with distributing fentanyl and black market opioid painkillers. She was the local dealer.

The DEA is tightlipped about the investigation into the Sacramento deaths as its agents work on persuading Dossman to lead them to her suppliers. But it is likely she was getting the pills from Mexican cartels using ingredients from labs in China where production of fentanyl’s ingredients is legal.  Carreno said some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.

Packages of fentanyl are often moved between multiple freight handlers so their origins are hard to trace. Larger shipments are smuggled in shipping containers. Last year, six Chinese customs officials fell ill, one of them into a coma, after seizing 72kg of various types of fentanyl from a container destined for Mexico. American police officers have faced similar dangers. In June, the DEA put out a video warning law enforcement officers across the US that fentanyl was different to anything they have previously encountered and they should refrain from carting seizures back to the office.   “A very small amount ingested, or absorbed through the skin, can kill you,” it said.   A New Jersey detective appears in the video after accidentally inhaling “just a little bit of fentanyl puffed into the air” during an arrest: “It felt like my body was shutting down… I thought that was it. I thought I was dying.”

Along with the Mexican connection, a home-grown manufacturing industry has sprung up in the US. Weeks after Jerome died, agents arrested a married couple pressing fentanyl tablets in their San Francisco flat.

Candelaria Vazquez and Kia Zolfaghari made the drug to look like oxycodone pills. They sold them across the country via the darknet using Bitcoin for payment – on one occasion Zolfaghari cashed in $230,000. The couple shipped the drugs through the local post office. Customers traced by the DEA thought they were buying real painkiller pills. The couple ran the pill press in their kitchen. According to a DEA warrant, a dealer said Zolfaghari made large numbers of tablets: “He could press 100 out fast as fuck.”

The pair made so much money that agents searching their flat found luxury watches worth $70,000, more than $44,000 in cash and hundreds of “customer order slips” which included names, amounts and tracking numbers. The flat was stuffed with designer goods. The seizure warrant described Vazquez’s shoe collection as “stacked virtually from floor to ceiling”. Some still had the $1,000 price tags on them. Zolfaghari was arrested carrying a 9mm semi-automatic gun and about 500 pills he was preparing to post. The dealers made so much money that their flat was stuffed with luxury goods and cash.

Even as Americans are getting their heads around fentanyl, it is being eclipsed. In September, the DEA issued a warning about the rise of a fentanyl variant that is 100 times more powerful – carfentanil, a drug used to tranquilise elephants.

“Carfentanil is surfacing in more and more communities,” said the DEA’s acting administrator, Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”

The drug has already been linked to 19 deaths in Michigan. Investigators say that with its use spreading, it is almost certainly claiming other lives. Dealers are also getting it from China, where carfentanil is not a controlled drug and can be sold to anyone.

Natasha Butler is still trying to understand the drug that killed her son. She wants to know why it is that it took Jerome’s death for her to even hear of it. She accuses the authorities of failing to warn people of the danger, and politicians of shirking their responsibilities.   A bill working its way through California’s legislature stiffening sentences for fentanyl dealing died in the face of opposition from the state’s governor, Jerry Brown, because it would put pressure on the already badly crowded prisons.

“I’m so dumbfounded. How does that happen?” says Natasha. Her tears come frequently as she sits at a tiny black table barely big enough to seat three people. She talks about Jerome and the tragedy for his three children, including Success, who she is now raising.

But some of the tears are to mourn the devastating impact on her own life. “Look where I’m at. I was in Louisiana. I had a house. I had a job. I had a car. I had a life. I worked every day. I was a manager for a major company. I came here, I became homeless. I had to move into this apartment to help out my granddaughter,” she said. “You see me. This is what my kitchen table is. My son is dead. He had three kids and those two mothers of those kids are depending on me to be strong. I want answers and help. I say, you got the little fish. Where did they get it from? How did they get it here? You are my government. You are supposed to protect us.”

Source:  https://www.theguardian.com/global/2016/dec/11/pills-that-kill-why-are-thousands-dying-from-fentanyl-abuse–

Cannabinoid AMB-FUBINACA in New York

ABSTRACT

BACKGROUND

New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a “zombie” outbreak because of the appearance of the intoxicated persons.

METHODS

We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal “incense” product “AK-47 24 Karat Gold,” which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography–quadrupole time-of-flight mass spectrometry.

RESULTS

The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter.

CONCLUSIONS

The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the “zombielike” behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of “ultrapotent” synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.

Source: New England Journal of Medicine;  10.1056/NEJMoa1610300

Robert J. Tait, et al

Abstract

Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption.

Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data.

Method: We searched online databases  and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption.

Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours.

Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their

incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown. Keywords: Emergency medical services, street drugs, drug overdose, mental disorders, drug-related side effects and adverse reactions

Discussion

The prevalence of SC consumption is low in the general population.   However, the risk of requiring medical attention following use of SC seems to be greater than that for cannabis consumption.  Our systematic review of adverse events found that typically events were not severe, only required symptomatic or supportive care and were of short duration.

Nevertheless, a number of deaths have been attributed either directly or indirectly to SC consumption, together with other major adverse sequelae, including a significant number with persistent effects including new on-set psychosis with no family history of psychosis

We did not include popular media reports or the grey literature in the search, which would probably reveal further cases but would be less likely to contain reliable medical information. We were unable to determine the exact number of cases in the scientific literature due to the potential overlap between poison centre data and hospital reports. We could not even definitively establish the number of deaths attributed to SC consumption. Of the 28 531 ED visits in 2011 recorded in the DAWN database, 119 (0.4%) led to death potentially related to SC use

Our review of published cases identified only 22 fatal cases in the USA through to the end of 2014. As not all presentations especially for psychiatric problems or palpitations will include assessment of SC use, SC presentations may currently be seriously underreported. This suggests that the magnitude of the health burden due to SC use is considerably greater than that currently documented. Most of the data were based on self-reported consumption of SC, with no simple screening test available yet for clinicians.

Some of the information on adverse effects of SCs arises from poison centre data. Wood et al. outlined the strengths and weakness of poison centre data for novel psychoactive substances.  In brief, poison centres may detect new and unfamiliar exposures, but the rates of detection may decline with familiarity with the substances involved. In addition, the data depend upon voluntary reporting, often lack analytical confirmation, and may not discern which symptoms to attribute to a given substance, in cases of poly-drug exposure. Similarly, novel adverse events and events involving new SCs are more likely to be reported or published in the medical literature.

The consumption of cannabis affects the cardiovascular system and increases the risk of myocardial infarction.  Similarly, cannabis has been implicated in ischemic stroke, especially multifocal intracranial stenosis among young adults.   Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction, a prospective study in 48 consecutive young patients. The potential mechanisms include cardiac ischemia due to increased heart rate, postural hypotension, impaired oxygen supply arising from raised carboxyhemoglobin levels, especially in conjunction with tobacco smoking, and catecholamine-mediated pro-arrhythmic effects.  Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? It is thus perhaps unsurprising that similar adverse outcomes have occurred following the use of SCs given their increased potency at CB1 receptors. Whether these compounds have significant direct effects on other receptors is still unknown.

The comparatively short period for which SC have been available and used in the general community means that long-term outcomes are currently unknown. However, the occurrence of AKI has implications for future health with a meta-analysis estimating a nearly nine-fold increase in the risk of developing chronic kidney disease, and a three-fold increase in the risk of end stage renal disease, compared to those who have not had AKI.   Thus, even low prevalence events with apparently limited duration, like AKI, have the potential to result in significant health costs following the resolution of acute symptoms. The other effects with long-term potential health consequences are initiation or exacerbation of psychiatric disorders, particularly psychosis. These are extremely debilitating and disabling conditions with large societal and health impacts for patients, families and the health system.

Clinical implications

SC intoxication appears to be a distinct and novel clinical entity. Use of SCs can cause more significant clinical effects than marijuana. There also appear to be qualitative differences in the nature of the symptoms with which patients present. The sheer number of SCs available and the rate at which they continue to change confound examinations of the scale and extent of the problem.   More recent formulations (in the UK termed “Third Generation”) are typically more potent that earlier SCs and seem to be associated with greater harms.  Trecki and colleagues report that the incidence of clusters and severity of adverse events involving SCs appears to be increasing.   This increase could be due to greater familiarity with presentations, better coordination between public health authorities and laboratories or the characteristics of newer SCs.   The overall effects of SC can resemble those of cannabis, but other than anxiety and paranoia these are not usually the symptoms associated with acute hospital presentation. Instead, patients seem to present in EDs because of behavioural abnormalities (agitated behaviour, psychosis, anxiety) or symptoms associated with acute critical illness. The latter includes seizures (which if prolonged can lead to rhabdomyolysis and hyperthermia), AKI, myocardial ischaemia and infarction in demographic groups where this would be most unusual. The majority of mild intoxications only require symptomatic treatment and generally do not require hospital admission. Severe intoxications, involving seizures, severe agitation or mental health disturbances, arrhythmias and significant chest pain, should be admitted to hospital for further investigation.

The lack of an antidote to SCs, analogous to that for opioid overdose, complicates management, as does the unpredictable effects and lack of a clear toxidrome to distinguish SCs from other recreational drugs.   The differential diagnosis requires the elimination of diverse conditions including hypoglycaemia, CNS infection, thyroid hyperactivity, head trauma and mental illness.  Benzodiazepines are usually sufficient to control agitation: while the use of haloperidol has also been described.  Caution is advised in undifferentiated agitation. Benzodiazepine failure should prompt consideration of definitive airway control. In addition to intravenous fluids for dehydration, the primary goals are protecting the airway, preventing rhabdomyolysis and to monitor for either cardiac or cerebral ischemia.

Traditionally, most recreational drug overdoses have been easily explicable based on clinical presentation alone. From an epidemiological perspective, this position should be revisited. Both the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) and the Australian Capital Territory Novel Substances (ACTINOS) projects, routinely analyse raw product samples in the possession of patients, associated with severe or unusual presentations. This protocol has been able to characterize novel products well before their identification by law enforcement, arguably generating important information, not just for the patient concerned but also for population health services.

Conclusions

Data from poison centres and drug monitoring systems in Europe, the UK, the USA, and Australia illustrate trends of increased use of SCs. The number of unique SCs appears to continue growing, but the SCs seem to share common characteristics within the class. The most common effects include tachycardia, agitation and nausea; these generally respond to supportive care. However, physicians should be aware of the severe cardiovascular, cerebrovascular, neurological, psychiatric and renal effects, which occur in a minority of cases.

Differences among compounds in the class are difficult to assess. Methods to detect, identify and confirm new SCs lag behind the appearance of these drugs. Further, many of the cases depend upon self-report of the patients, whose information may be unreliable or inaccurate. Improving the availability of advanced laboratory resources will improve our ability to recognize SCs with higher risk of severe toxicity.

Source:  Extracts from Clinical Toxicology  Volume 54, 2016 – Issue 1  Nov.2015

Blames it in part for scores of deaths around the U.S.

The Drug Enforcement Administration placed a synthetic opioid called U-47700 on the most restrictive list of controlled substances, calling the drug a threat to public health and blaming it in part for scores of deaths around the U.S.

The ban, which is scheduled to take effect Monday, is the latest action by the DEA to try to crack down on the growing peril of synthetic narcotics. Unlike opioids such as heroin and the painkiller oxycodone that derive from the opium poppy, synthetic narcotics can be produced more easily and more cheaply in labs. They are worsening the country’s already severe crisis of opioid abuse, which killed more than 28,000 people in the U.S. in 2014, according to the Centers for Disease Control and Prevention. The designer drugs come mostly from Chinese labs, many of which sell them openly online and dub them “research chemicals” to provide a patina of legitimacy, according to the DEA. Many of the substances are variants of fentanyl, a powerful synthetic opioid.

The labs can rely on existing scientific papers and patents to produce new drugs. That was the case with U-47700, a relic of 1970s pharmaceutical research that never made it to market and was the subject of an investigation by The Wall Street Journal published last week. When law enforcement moves to ban one substance, the labs can simply turn to another that hasn’t been restricted yet.

“Because substances like U-47700 are often manufactured in illicit labs overseas, the identity, purity and quantity are unknown, creating a ‘Russian Roulette’ scenario for any user,” the DEA said in a news release announcing the ban. The agency placed the drug on Schedule I, the category for chemicals the DEA says have no medical purpose and present high potential for abuse.

U-47700 was associated with 46 fatalities in 2015 and 2016, according to the DEA. The Journal investigation noted that NMS Labs, a major private lab outside Philadelphia that works with states, tallied 105 overdose deaths related to U-47700 just this year, through September. Axis Forensic Toxicology, a private lab firm in Indianapolis, linked another 20 deaths to the drug. The fatalities occurred in at least 31 states, from Alaska to Florida.

Some users take U-47700 knowingly. They can frequent online drug forums to discuss the drug and its effects. And they can order it online from Chinese labs or intermediaries and have it shipped directly to their homes. In interviews with the Journal, users have said U-47700 provides a euphoric high but is short-lasting and can quickly create intense cravings.

Other users, however, may take U-47700 unknowingly, the DEA said. Dealers sometimes mix it with other opioids and it also has appeared in counterfeit prescription painkillers.

Source:  (Wall Street Journal, 11/12/16)

Two 13-year-old boys in the ski town of Park City, Utah died within 48 hours of each other in September, likely overdosing on a powerful heroin substitute that had been delivered — legally — to their homes by the U.S. mail, and is now turning up in cities across the nation.

Ryan Ainsworth was found dead on his couch two days after his best friend Grant Seaver passed away. “I wish I had been better warned,” sang one of their friends at a massive memorial service. “But now it’s too late.”

The death toll could have been worse, say investigators, since as many as 100 Park City students had apparently been discussing the drug “Pink” on SnapChat and other social media.

“This stuff is so powerful that if you touch it, you could go into cardiac arrest,” Park City Police Chief Wade Carpenter told NBC News. “The problem is if you have a credit card and a cell phone, you have access to it.”

One toxicology lab has linked 80 deaths to the synthetic opioid known as Pink. DEA

Pink, better known by chemists as U-47700, is eight times stronger than heroin, and is part of a family of deadly synthetic opioids, all of them more powerful than heroin, that includes ifentanyl, carfentanil and furanyl fentanyl. By themselves or mixed with other drugs, in forms ranging from pills to powder to mists, they’re killing thousands of people across the country, say law enforcement and health officials. The powerful, ersatz opioids are part of a surge of synthetic drugs, including bath salts and mock-ups of ecstasy, being shipped into the U.S. from China and other nations.

So far, however, only four states have made Pink illegal. It can still be ordered legally on-line and delivered to your home. The internet has many websites a Google search away where the drug is available for as little as $5 plus shipping.

Melissa Davidson, mother of a Park City teen who had friends in common with the dead boys, showed NBC News on her home computer screen how easy it was to find the drug for sale with just a few keystrokes. “Look! There are like pages and pages that you can buy this stuff online.”

According to the U.S. Centers for Disease Control, total opioid overdose deaths nearly quadrupled between 1999 and 2014, rising from 8,050 to 28,647. The portion of those deaths caused by synthetic opioids, however, rose almost twice as fast, from just 730 in 1999 to 5,544 in 2014.

Because of the surge in opioid-related deaths, and the regular appearance of new synthetics on the market, there is a time lag in toxicology reports from coroners, and the possibility that some deaths are mistakenly linked to other, better known substances.

But Pink, a relative newcomer among the synthetics, has been implicated in 80 deaths across the country in just the past nine months, according to Pennsylvania-based NMS Labs, which conducts forensic toxicology tests.

The Drug Enforcement Administration said it is aware of confirmed fatalities associated with U-47700 in New Hampshire, North Carolina, Ohio, Texas, and Wisconsin. Though its own tally is only 15 deaths, an agency spokesperson said the number was probably higher because of challenges and delays in reporting.

On Sept. 7, the DEA took initial steps toward banning the drug nationally by giving notice of its intent to schedule the synthetic opioid temporarily as a Schedule 1 substance under the federal Controlled Substances Act.

Some states aren’t waiting for a permanent federal ban. In late September, Florida Attorney General Pam Bondi signed an emergency order outlawing the drug after it was tied to eight deaths in recent months. Florida joins Ohio, Wyoming and Georgia in outlawing the compound and other states are looking to do the same.

In some states, law enforcement is just learning about a threat that is especially challenging because so many transactions are done by computer and through the mail. And the chemists who manufacture the drugs can invent new variants as fast as the states can outlaw them.

“The hardest part is when something new comes up, and no one in the country or world has seen it in a forensic setting yet and trying to decide what that actual structure or drug is,” said Bryan Holden, senior forensic scientist with the Utah Department of Public Safety. “Sometimes we have had cases where the substance sat for months and months — no one had ever seen it before, and until someone else sees it or manufactures it then we kind of know what it is.”

The DEA has been using so-called temporary bans more and more often to combat designer synthetic drugs have made their way into the U.S. from China and other parts of the world. The U47700 ban allows them three years to research whether something should be permanently controlled or whether it should revert back to non-controlled status.

But experts say the most effective prevention may start in the home, at the computer and the mailbox.

“I’m worried about you,” Melissa Davidson told her 17-year-old daughter Jane.

Jane, however, was worried about her friends at school. “I can’t imagine the kids I’m in math class with, just not being there one day. One bad decision can have permanent consequences.”

Source:  http://www.nbcnews.com/storyline/americas-heroin-epidemic/pink-stronger-heroin-legal-most-states-n666446     15th Oct.2016

BY JOIN TOGETHER STAFF

September 25th, 2013

The club drug “Molly” is often laced with other synthetic drugs such as bath salts, making it more dangerous, according to law enforcement officials.

Molly, a club drug blamed for several recent deaths among young people attending music festivals, is sold as a pure form of Ecstasy, or MDMA. Drug dealers are now selling a variety of potentially more dangerous drugs under the name Molly, according to The Wall Street Journal.

Jeff Lapoint, an attending physician at Kaiser Permanente in San Diego, says while Molly generally leads to feelings of empathy, bath salts “are potent stimulants and tend to induce paranoia and hallucinations. It’s like the worst combination: While they’re agitated, now they’re seeing things, too.”

“Molly is just a marketing tool,” said Rusty Payne, a spokesman for the Drug Enforcement Administration, told the newspaper. “It could be a whole variety of things.”

MDMA is difficult to manufacture, so some drug makers get bath salts ingredients and repackage them as Molly, explained James Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities in Miami. Payne noted bath salts ingredients, such as methylone, are much less expensive than MDMA. Molly is suspected of causing two deaths at a recent New York City music festival. A19-year-old girl in Boston died of a suspected overdose of Molly following a concert, and a man in Washington state died after taking the drug, with dozens more treated for Molly overdoses.

Source:  http://www.drugfree.org/news-service/bath-salts-often-added-to-molly-making-the-drug-more-dangerous-officials/  25th Sept. 2013

By Celia Vimont

September 21st, 2016

There are many misperceptions about MDMA, also known as Ecstasy or Molly, according to a researcher on substance abuse at the University of South Florida. One of the most common myths is that Molly is a pure form of Ecstasy, says Khary Rigg, PhD.  In fact, Molly is simply a powder or crystal form of MDMA, while Ecstasy is the pill form, said Dr. Rigg, who spoke about MDMA at the recent National Prevention Network annual conference. “Molly has a reputation for being a pure form of MDMA, but it is often as adulterated as Ecstasy is,” he said.

“I became interested in Molly when I was watching the 2013 MTV Video Music Awards, and noticed Miley Cyrus was singing a song and one of the lyrics was bleeped out,” Dr. Rigg recalled. “I looked it up and realized she had made a reference to Molly in the song.” That is when Dr. Rigg first realized that Molly had crossed over into mainstream popular culture. Before that, Molly and Ecstasy were mostly used by gay men and fans of electronic dance music. “Now it’s being used more widely, including in minority communities,” he said. Dr. Rigg recently completed a study on MDMA use among African Americans and will be publishing his findings in the next few months.

Molly, short for molecule, first became popular in the early 2000’s, but figuring out exactly how many Americans use Molly hasn’t been easy. “It has been difficult to get national data on the popularity of Molly because national surveys have only asked about people’s use of Ecstasy,” said Dr. Rigg. This has recently changed, however, and surveillance systems such as the National Survey on Drug Use and Health have started including Molly in their definition of MDMA. Molly is typically sold in capsules or in a baggie and is usually swallowed, although it can also be snorted.

In recent years, MDMA overdoses at concerts and music festivals have been receiving headlines. But Dr. Rigg warns that, “Many so-called overdoses of Molly or Ecstasy are not really overdoses. When we call them overdoses, the real causes of these deaths are obscured. MDMA deaths are almost never due to taking too much of the drug. The real culprits are heatstroke, hydration issues, and having a pre-existing health condition.”

Many people who take Molly believe that drinking water makes it safe. “You’ll hear that Molly can dehydrate you, and that’s true, but it can also cause you to retain water. So, while it’s important to remain hydrated, people should also be careful not to drink too much water. As a rule of thumb, you only need to replenish the water that you sweat out,” Dr. Rigg says. Certain health conditions are also to blame for some MDMA deaths. Dr. Rigg cautions, “Using MDMA can be dangerous and even fatal for people with conditions such as high blood pressure, heart disease, and seizure disorder.” Organizations like Dance Safe are trying to reduce the number of MDMA deaths at electronic music festivals and clubs by distributing educational materials about the risks of MDMA. They also provide free water and electrolytes to prevent dehydration and heatstroke, and offer drug-testing kits that instantly indicate whether there are “unknown and potentially more dangerous adulterants” in powder and tablets. Dr. Rigg says that this harm-reduction approach to MDMA use is more widespread in other countries, particularly in Europe, but is gaining traction in the United States.

There is some question about whether MDMA can cause Parkinson’s disease. “Some research indicates that prolonged Ecstasy use can damage the brain’s ability to produce dopamine which could hasten the onset of the disease,” he notes. “An underlying cause of Parkinson’s is a decreased ability to produce dopamine, so there could be a link, but we need more research to say for sure.” Dr. Rigg points out that because of its Schedule I status, research on MDMA is heavily restricted in the U.S. which has hampered how much is known about the long-term effects of the drug.

Dr. Rigg says that before MDMA was banned in 1985, some therapists would give the drug to clients during counseling sessions, because they found it helped them talk about their feelings. Currently, there are several clinical trials taking place to evaluate the potential of using MDMA to help treat PTSD and anxiety.

Despite misinformation surrounding MDMA, Dr. Rigg expects use of the drug to continue rising. He notes that Molly’s popularity has soared in hip-hop/rap music and is now being endorsed by top artists as a sexual enhancer. MDMA use is also being depicted in many popular television shows and movies which serves to normalize use of the drug. He says that for prevention efforts to be effective, we must go beyond simple “just say no” messages, and incorporate aspects of supply reduction, drug education, and harm reduction.

Source: http://www.drugfree.org/news-service/many-myths-surround-molly-ecstasy-expert/   21st Sept. 2016

Meeting held to discuss ways to improve and enhance U.S.-China joint drug investigations

This week the heads of the national drug-control agencies for the United States and the People’s Republic of China, Drug Enforcement Administration (DEA) Acting Administrator Chuck Rosenberg and Director General (DG) Hu Minglang from the Narcotics Control Bureau (NCB) of the Ministry of Public Security, met at DEA Headquarters in Arlington, Virginia to discuss ways to stop the flow from China to the United States of deadly synthetic drugs.  This meeting follows an announcement by America’s President Obama and China’s President Xi Jingping during the G20 Summit held earlier this month in Hangzhou, China that the U.S. and China will continue to work together to address the illicit supply of fentanyl and its compounds.

Chemical makers in China are the United States’ primary source of synthetic drugs such as fentanyl and its compounds.  They are smuggled into the country either directly from China by Americans who order them over the Internet or from Mexico by cartels that purchase the drugs in bulk and then smuggle them, alone or mixed with heroin, across America’s Southwest Border.  When China controlled 116 chemicals, including certain fentanyl-related compounds, in October of 2015, seizures of those drugs here in the United States dropped significantly.

Recently, the DEA and the NCB have seen an increased level of cooperation andintelligence sharing.  Last month, at the invitation of the NCB, a senior-level DEA delegation travelled to China to learn about their drug control efforts and examine steps to further bilateral cooperation.

Fentanyl, a synthetic opiate painkiller, and related compounds are often mixed with heroin to increase its potency, but dealers and buyers may not know exactly what they are selling or ingesting. These drugs are deadly at very low doses and come in several forms, including powder, blotter paper, tablets, and spray.  Overdoses in the U.S. due to these drugs have increased exponentially in recent years, and DEA has issued national warnings about the danger.    More information about fentanyl and other dangerous synthetic opiates can be found at www.dea.gov.

Source:  U.S. Drug Enforcement Administration: dea@public.govdelivery.com Press Release 29th Sept.2016  

Problems resulting from abuse of opioid drugs continue to grow

JUL 22 (WASHINGTON) – Hundreds of thousands of counterfeit prescription pills, many containing deadly amounts of fentanyl and fentanyl-related compounds, have made their way into the U.S. drug market, according to a DEA intelligence report released today.  Law enforcement nationwide report higher fentanyl availability, seizures, and known overdose deaths than at any other time since the drug’s creation in 1959.

Fentanyl is a synthetically produced opioid that, when produced and administered legitimately, is used to treat severe pain. Overseas labs in China are mass-producing fentanyl and fentanyl-related compounds and marketing them to drug trafficking groups in Mexico, Canada and the United States.

In addition to being deadly to users, fentanyl poses a grave threat to law enforcement officials and first responders, as a lethal dose of fentanyl can be accidentally inhaled or absorbed through the skin. DEA recently released a Police Roll Call video nationwide to warn law enforcement about this danger. The video can be accessed at www.DEA.gov.  Other findings from the report:

* Fentanyl and fentanyl-related compounds are traditionally mixed into or sold as heroin, or on its own, oftentimes without the customer’s knowledge. Since 2014, U.S. law enforcement agencies have been seizing a new form of fentanyl—counterfeit prescription opioid pills containing fentanyl or fentanyl-related compounds. The counterfeit pills often closely resemble the authentic medications they were designed to mimic, and the presence of fentanyl is only detected upon laboratory analysis.

* Fentanyl traffickers have been successful at expanding the fentanyl market and introducing new fentanyl-laced drug products to the U.S. drug market. The DEA National Forensic Laboratory Information System (NFLIS) reported that there were 13,002 fentanyl exhibits tested by forensic laboratories across the country in 2015 (the latest year for which data is available), which is a 65 percent increase from the 7,864 fentanyl exhibits in 2014. There were approximately eight times as many fentanyl exhibits in 2015 as there were during the 2006 fentanyl crisis, clearly demonstrating the unprecedented threat and expansion of the fentanyl market.

* The rise of counterfeit pills that contain fentanyl in the illicit drug market will likely result in more opioid-dependent individuals, overdoses, and deaths. There were over 700 fentanyl-related deaths reported in the United States between late 2013 and 2014. During 2013-2014, the Centers for Disease Control (CDC) reported that deaths from synthetic opioids increased 79 percent, from 3,097 to 5,544. Although the synthetic opioid category does contain other opioids, this sharp increase coincides with a sharp increase in fentanyl availability, and the CDC reports that a substantial portion of the increase appears to be related to illicit fentanyl.

* In March 2016, law enforcement officers in Lorain County, Ohio, seized 500 pills that visually appeared to be oxycodone. The pills were blue and had “A 215” markings, consistent with 30 milligram oxycodone pills. Laboratory analysis indicated that the pills did not contain oxycodone, but were instead the research chemical U-47700.  U-47700 is an unscheduled synthetic opioid

not studied for human use that has caused at least 17 overdoses and several deaths in the United States.

* Many Chinese laboratories illicitly manufacturing synthetic drugs, such as fentanyl and their precursors, also manufacture legitimate chemicals for purchase by U.S. companies. This means that laboratories responsible for supplying fentanyl in counterfeit pills can also run legitimate businesses. Although Chinese clandestine laboratories may be contributing to the fentanyl supply, legitimate laboratories may also be sources of supply.

* Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier, transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit. If a particular batch has 1.5 milligrams of fentanyl per pill, approximately 666,666 counterfeit pills can be manufactured from 1 kilogram of pure fentanyl. The entire intelligence brief, “Counterfeit Prescription Pills Containing Fentanyls: A Global Threat” can be accessed at www.DEA.gov.

Source:  https://www.dea.gov/divisions/hq/2016

NEW YORK — More than two dozen people were sickened in an apparent mass drug overdose on a New York City street corner, sparking warnings from police and health officials about the dangers of using K2, also known as synthetic marijuana.

Calls started coming in Tuesday morning that numerous people appeared to be overdosing in the Bedford-Stuyvesant neighbourhood of Brooklyn. Witnesses reported seeing victims lying on the sidewalk, shaking and leaning against trees and fire hydrants.

Thirty-three people were taken to area hospitals with non-life-threatening injuries, police said. It was not immediately clear what drugs the victims had ingested, but police said some of the victims had been smoking K2.

Dennis Gonzalez of Bushwick told WNBC-TV that K2 use in that part of Brooklyn is out of control.

“It’s gotten out of hand,” Gonzalez said. “They even sleep in the street, we have to walk around them. It’s just too much to keep under control.”

The Health Department issued a statement Tuesday saying it “recorded a spike in K2-related emergency room visits” connected to the incident in Brooklyn. The department said it’s investigating and monitoring emergency rooms across the city.

“We remind New Yorkers that K2 is extremely dangerous,” the Health Department said in its statement. “The city’s public awareness efforts and aggressive enforcement actions over the past year have contributed to a significant decline in ER visits related to K2.”

Though K2 affects the same area of the brain as marijuana, it contains chemicals made in laboratories and sprayed onto dry leaves. These chemicals are not derived from the marijuana plant, according to the Health Department.

K2 can cause extreme anxiety, confusion, paranoia, hallucinations, rapid heart rate, vomiting, fainting, kidney failure and reduced blood supply to the heart.

The production and sale of the drug was outlawed in New York City in October 2015.

Source: http://www.ctvnews.ca/health/33-sick-after-apparent-mass-drug-overdose-in-new-york-city-1.2984643    13th July 2016

SPICE IN THE CITY: NEW YORK DEA LEADS HUGE ATTACK

AGAINST SYNTHETIC DRUG TRAFFICKERS

Money flow from synthetic drug sales to Yemen, Syria, Lebanon and Jordan continues

 Contact: DEA Public Affairs   (202) 307-7977

MANHATTAN, N.Y.- DEA, NYPD and a host of other state, local and federal agencies today announced a massive takedown that targeted the local sale of dangerous designer synthetic drugs manufactured in China.  The scheme, which operated in all five boroughs of New York City, allegedly involved the unlawful importation of at least 100 kilograms of illegal synthetic compounds, an amount sufficient to produce approximately 1,300 kilograms of dried product, or approximately 260,000 retail packets.  As part the operation, five processing facilities were searched, as well as warehouses used to process, store, and distribute the drugs. In addition, over 80 stores and bodegas around New York City were searched.

Communities, families, and individuals across the United States have experienced the scourge of designer synthetic drugs, which are often marketed as herbal incense, bath salts, jewellery cleaner, or plant food. These dangerous drugs have caused significant abuse, addiction, overdoses, and emergency room visits. Those who have abused synthetic drugs have suffered vomiting, anxiety, agitation, irritability, seizures, hallucinations, tachycardia, elevated blood pressure, and loss of consciousness. They have caused significant organ damage as well as overdose deaths. Over the past several years, DEA has identified over 400 designers drugs from eight different structural classes, the vast majority of which are manufactured in China. Smoke able synthetic cannabinoids (SSC) represent the most common class of designer drugs. In addition, DEA cases involving synthetic drugs often reveal the movement of drug proceeds from the United States to Middle East countries such as Yemen, Syria, Lebanon and Jordan. ……..

DEA Special Agent in Charge James J. Hunt said:  “There is a misconception that synthetic cannabinoids, known on the street as ‘synthetic marijuana,’” ‘K2,’ and ‘spice,’ are safe.  Synthetic cannabinoids are anything but safe.  They are a toxic cocktail of lethal chemicals created in China and then disguised as plant material here in New York City. Today’s arrests represent law enforcement’s efforts to combat this emerging public threat.  By investigating and arresting manufacturers and distributors of ‘spice’ in the city, we have cut off the accessibility for those feeding the beast.”

Manhattan U.S. Attorney Preet Bharara said:  “Today, we launch an aggressive assault on a public health crisis that is reaching epidemic proportions: the scourge of dangerous new drugs that are killing people and sending thousands upon thousands to emergency rooms in New York City and around the country.  Despite sometimes being called synthetic marijuana, this is not marijuana – it can have unpredictably severe and even lethal effects.  What is more, use of these drugs aggravates all manner of other societal ills: it is entering prisons; preying on the homeless; burdening our hospitals and emergency rooms; fuelling addiction; exacerbating mental health problems; and increasing risks to cops who must deal with people high on this poison.  Synthetic cannabinoids are a deadly serious problem that demands an equally serious response.  Today’s collective action is just the start of that response, one that will not end until this poison in a packet no longer endangers our community.”

NYPD Commissioner William Bratton said:  “This is a scourge on our society, affecting the most disadvantaged neighbourhoods and our most challenged citizens. It affects teenagers in public housing, homeless in the city shelter system, and it’s quite literally flooding our streets. This is marketed as synthetic marijuana, some call it K2. It is sold by the names of Galaxy, Diamond, Rush, and Matrix. But its real name is poison.”

HSI Acting Special Agent in Charge Glenn Sorge said:  “Synthetic marijuana is rapidly becoming a huge problem in our communities.  It is cheap and dangerous, especially for our teens and young adults.  We are working side by side with our law enforcement partners both here and abroad to combat the sale of this hazardous alternative to marijuana.”

Sheriff Joseph Fucito said:  “The Sheriff’s Office stands ready with our partners in law enforcement in addressing the sudden proliferation of synthetic drugs sales in licensed retail locations throughout New York City. Owners and operators of licensed locations have an obligation to keep illegal and highly dangerous substances out of the hands of our children. The Sheriff’s Office is committed to agency partnerships and enforcement strategies that advance this goal.”

…….The SSC retail packets were sold under names such as “AK-47,” “Blue Caution,” “Green Giant,” “Geeked Up,” “Psycho,” “Red Eye,” and “Black Extreme,” each containing between approximately three and six grams of product, and sometimes marked “not for human consumption,” or “potpourri.”  The illegal SSC retail packets were sold to individual customers for approximately $5 per packet.

.SSC are widely accessible because they are inexpensive and commonly sold at otherwise legitimate retail locations.  The colorful logos used on the SSC retail packets and the flavors used, such as lime, strawberry, and blueberry, make SSC attractive to teenagers and young adults.  Physical effects of SSC include agitation, rapid heart rate, confusion, dizziness, nausea and vomiting, paranoia, panic attacks, and acute kidney injury.  In addition, SSC products have inconsistent potencies, often containing more than one synthetic compound, and are sometimes laced with other toxic chemicals.  In a recent two-month period, use of SSC resulted in 2,300 emergency room visits in New York State.  Nationally, calls to poison centers in the United States related to synthetic cannabinoid use between January and May 2015 increased 229% over the same period in 2014.

 Source:  Press Release   US Drug Enforcement Administration.  16th Sept. 2016

Between January 1, 2015 and April 22, 2015, the American Association of Poison Control Centers reported getting 1900 calls related to synthetic cannabinoid exposure, proving that the popularity of this alternative to natural marijuana has been steadily increasing. Synthetic cannabinoids, when smoked or ingested, act on the endocannabinoid receptors, similar to delta-9 tetrahydrocannabinol, the primary psychoactive ingredient in marijuana.  While dyspnea related to synthetic cannabinoid use is common, other pulmonary adverse effects have rarely been reported, specifically inhalation fever which is discussed in a recent case published in the American Journal of Case Reports.

The patient, a 29-year-old male, presented to the emergency department with severe agitation after smoking the synthetic cannabinoid K2. Medical history included a diagnosis of schizoaffective disorder for which he was not receiving treatment. To sedate him, multiple doses of lorazepam and haloperidol were used. Physical examination of the patient showed the following:

* Temperature: 100.2º F

* Blood pressure: 110/50 mmHg

* Heart rate: 109/min

* Respiratory rate: 18/min

* Oxygen saturation: 95%

* Chest exam: No crackles, wheeze, rhonchi on auscultation; chest radiograph: diffuse reticular-nodular and interstitial infiltrates

* Cardiovascular exam: JVP not elevated, S1 and S2 heard, no additional heart sounds, murmurs, rubs; rate/rhythm regular

* Lab tests: Leukocytosis with predominant neutrophilia (83.4%); blood culture samples showed no growth after 5 days

* Urine toxicology: Negative for cannabinoids, benzodiazepine, phenycyclidine, opiates, cocaine, barbiturates

The patient was given ceftriaxone 1g IV, azithromycin 500mg IV, magnesium sulfate 2g IV (for hypomagnesemia), potassium phosphate 22mEq IV (for hypophosphatemia), famotidine 40mg daily for GI prophylaxis and heparin 500 Units SC twice daily for prophylaxis of venous thromboembolism. His mental status improved and his fever dissipated 24 hours after admission; repeat chest radiograph showed resolution of the pulmonary infiltrates. Clinicians were unable to re-evaluate his blood levels, as the patient refused repeat blood draws.

Once in stable condition, he was discharged with a diagnosis of inhalation fever due to synthetic cannabinoid and was told to abstain from use of this substance. For empirical treatment of pneumonia, he was given levofloxacin 750mg daily for seven days; he was also given a prescription for risperidone 1mg twice daily for two weeks for his schizoaffective disorder. Though an outpatient appointment was scheduled, the patient did not follow-up and so his long-term outcome is uncertain.

In the United States, there are over 50 types of synthetic cannabinoids; the substances are typically available in herbal blends, potpourri, and incense.  In this patient, given the fever and transient pulmonary infiltrates, inhalation fever is believed to have developed as a consequence to K2 inhalation. Symptoms associated with inhalation fever may include cough, dyspnea, headache, malaise, myalgia and nausea, however, this patient did not experience any of these, apart from leukocytosis which is a feature of this condition.

Treatment generally includes supportive care and avoidance of the causative agent. Other diagnoses considered for this patient included acute hypersensitivity pneumonitis (which may present in a similar manner), chemical pneumonitis (an inflammatory reaction to a particulate), or bacterial pneumonia (given the fever, tachycardia, leukocytosis, and pulmonary infiltrates). Infection, however, was not considered likely given a repeat chest radiograph 24 hours later showed resolution of the pulmonary infiltrates and blood culture was negative.

Given this is the first case to report on inhalation fever as a side effect of synthetic cannabinoid inhalation, further research is needed to understand the mechanism by which this reaction occurred. In the meantime, the authors warn that “as the Emergency Department visits by synthetic cannabinoid abusers are increasing, the importance of physicians being aware of these adverse effects cannot be overstated.”

Source:   Thiru Chinnadurai, Srijan Shrestha, Raji Ayinla. A Curious Case of Inhalation Fever Caused by Synthetic Cannabinoid. American Journal of Case Reports. 2016, doi: 10.12659   6th July 2016    http://www.empr.com/

Roll Call Video Advises Law Enforcement to Exercise Extreme Caution

DEA has released a Roll Call video to all law enforcement nationwide about the dangers of improperly handling fentanyl and its deadly consequences.  Acting Deputy Administrator Jack Riley and two local police detectives from New Jersey appear on the video to urge any law enforcement personnel who come in contact with fentanyl or fentanyl compounds to take the drugs directly to a lab.

“Fentanyl can kill you,” Riley said. “Fentanyl is being sold as heroin in virtually every corner of our country. It’s produced clandestinely in Mexico, and (also) comes directly from China. It is 40 to 50 times stronger than street-level heroin. A very small amount ingested, or absorbed through your skin, can kill you.”

Two Atlantic County, NJ detectives were recently exposed to a very small amount of fentanyl, and appeared on the video.

Said one detective: “I thought that was it. I thought I was dying. It felt like my body was shutting down.”

Riley also admonished police to skip testing on the scene, and encouraged them to also remember potential harm to police canines during the course of duties.

“Don’t field test it in your car, or on the street, or take if back to the office. Transport it directly to a laboratory, where it can be safely handled and tested.”

The video can be accessed at: http://go.usa.gov/chBWW

More on Fentanyl:

On March 18, 2015, DEA issued a nationwide alert on fentanyl as a threat to health and public safety.

Fentanyl is a dangerous, powerful Schedule II narcotic responsible for an epidemic of overdose deaths within the United States. During the last two years, the distribution of clandestinely manufactured fentanyl has been linked to an unprecedented outbreak of thousands of overdoses and deaths. The overdoses are occurring at an alarming rate and are the basis for this officer safety alert.

Fentanyl, up to 50 times more potent than heroin, is extremely dangerous to law enforcement and anyone else who may come into contact with it. As a result, it represents an unusual hazard for law enforcement.

Fentanyl, a synthetic opiate painkiller, is being mixed with heroin to increase its potency, but dealers and buyers may not know exactly what they are selling or ingesting. Many users underestimate the potency of fentanyl.

The dosage of fentanyl is a microgram, one millionth of a gram – similar to just a few granules of table salt. Fentanyl can be lethal and is deadly at very low doses.

Fentanyl and its analogues come in several forms including powder, blotter paper, tablets, and spray.

Risks to Law Enforcement

Fentanyl is not only dangerous for the drug’s users, but for law enforcement, public health workers and first responders who could unknowingly come into contact with it in

its different forms. Fentanyl can be absorbed through the skin or accidental inhalation of airborne powder can also occur. DEA is concerned about law enforcement coming in contact with fentanyl on the streets during the course of enforcement, such as a buy-walk, or buy-bust operation.

Just touching fentanyl or accidentally inhaling the substance during enforcement activity or field testing the substance can result in absorption through the skin and that is one of the biggest dangers with fentanyl. The onset of adverse health effects, such as disorientation, coughing, sedation, respiratory distress or cardiac arrest is very rapid and profound, usually occurring within minutes of exposure.

Canine units are particularly at risk of immediate death from inhaling fentanyl.

In August 2015, law enforcement officers in New Jersey doing a narcotics field test on a substance that later turned out to be a mix of heroin, cocaine and fentanyl, were exposed to the mixture and experienced dizziness, shortness of breath and respiratory problems.

If inhaled, move to fresh air, if ingested, wash out mouth with water provided the person is conscious and seek immediate medical attention.

Narcan (Naloxone), an overdose-reversing drug, is an antidote for opiate overdose and may be administered intravenously, intramuscularly, or subcutaneously. Immediately administering Narcan can reverse an accidental overdose of fentanyl exposure to officers. Continue to administer multiple doses of Narcan until the exposed person or overdose victim responds favorably.

Field Testing / Safety Precautions

Law enforcement officers should be aware that fentanyl and its compounds resemble powered cocaine or heroin, however, should not be treated as such.

If at all possible do not take samples if fentanyl is suspected. Taking samples or opening a package could stir up the powder. If you must take a sample, use gloves (no bare skin contact) and a dust mask or air purifying respirator (APR) if handling a sample, or a self-contained breathing apparatus (SCBA) for a suspected lab.

If you have reason to believe an exhibit contains fentanyl, it is prudent to not field test it. Submit the material directly to the laboratory for analysis and clearly indicate on the submission paperwork that the item is suspected of containing fentanyl. This will alert laboratory personnel to take the necessary safety precautions during the handling, processing, analysis, and storage of the evidence. Officers should be aware that while unadulterated fentanyl may resemble cocaine or heroin powder, it can be mixed with other substances which can alter its appearance. As such, officers should be aware that fentanyl may be smuggled, transported, and/or used as part of a mixture.

Universal precautions must be applied when conducting field testing on drugs that are not suspected of containing fentanyl. Despite color and appearance, you can never be certain what you are testing. In general, field testing of drugs should be conducted as appropriate, in a well ventilated area according to commercial test kit instructions and training received. Sampling of evidence should be performed very carefully to avoid spillage and release of powder into the air. At a minimum, gloves should be worn and the use of masks is recommended. After conducting the test, hands should be washed with copious amounts of soap and water. Never attempt to identify a substance by taste or odor.

Historically, this is not the first time fentanyl has posed such a threat to public health and safety. Between 2005 and 2007, over 1,000 U.S. deaths were attributed to fentanyl – many of which occurred in Chicago, Detroit, and Philadelphia.

The current outbreak involves not just fentanyl, but also fentanyl compounds. The current outbreak, resulting in thousands of deaths, is wider geographically and involves a wide array of individuals including new and experiences abusers.

In the last three years, DEA has seen a significant resurgence in fentanyl-related seizures. In addition, DEA has identified at least 15 other deadly, fentanyl-related compounds. Some fentanyl cases have been significant, particularly in the northeast and in California, including one 12 kilogram seizure. During May 2016, a traffic stop in the greater Atlanta, GA area resulted in the seizure of 40 kilograms of fentanyl – initially believed to be bricks of cocaine – wrapped into blocks hidden in buckets and immersed in a thick fluid. The fentanyl from these seizures originated from Mexican drug trafficking organizations.

Recent seizures of counterfeit or look-a-like hydrocodone or oxycodone tablets have occurred, wherein the tablets actually contain fentanyl. These fentanyl tablets are marked to mimic the authentic narcotic prescription medications and have led to multiple overdoses and deaths.

According to DEA’s National Forensic Lab Information System, 13,002 forensic exhibits of fentanyl were tested by labs nationwide in 2015, up 65 percent from the 2014 number of 7,864.  The 2015 number is also about 8 times as many fentanyl exhibits than in 2006, when a single lab in Mexico caused a temporary spike in U.S. fentanyl availability.  This is an unprecedented threat

Source:  U.S. Drug Enforcement Administration dea@public.govdelivery.com  11th June 2016

Law enforcement officials in Florida say use of the synthetic drug known as “flakka” is surging there, ABC News reports.

The drug, also called gravel, is available for $5 a vial or less, the article notes. Officials say people are ordering small quantities of flakka through the mail. Its main ingredient is a chemical compound called alpha-PVP.

According to the National Institute on Drug Abuse (NIDA), alpha-PVP is chemically similar to other drugs known as “bath salts,” and takes the form of a white or pink crystal that can be eaten, snorted, injected, or vaporized in an e-cigarette or similar device.

Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose, NIDA notes. Alpha-PVP can cause a condition called “excited delirium” that involves extreme stimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. “The drug has been linked to deaths by suicide as well as heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure,” NIDA explains on its website.

The laboratory of the Broward Sheriff’s Office in Fort Lauderdale reports 275 flakka submissions already in the first three months of 2015, compared with fewer than 200 in all of last year.

Flakka makers are continually changing the chemical makeup of the drug, and often mix it with other substances such as crack cocaine or heroin, according to Don Maines, a drug treatment counselor with the Broward Sheriff’s Office. In as little as three days of use, a person’s behavior can undergo striking changes, he said.

“It actually starts to rewire the brain chemistry. They have no control over their thoughts. They can’t control their actions,” Maines said. “It seems to be universal that they think someone is chasing them. It’s just a dangerous, dangerous drug.”

Source: drugfree.org 5^th May 2015

• There is high risk of overdose with flakka, which can lead to violent behavior, hyperthermia and superhuman strength
• The chemical in flakka is similar to a key ingredient in “bath salts,” which were banned in 2012
• Flakka and “bath salts” could be more dangerous than stimulants such as cocaine

(CNN)It goes by the name flakka. In some parts of the country, it is also called “gravel” because of its white crystal chunks that have been compared to aquarium gravel.

The man-made drug causes a high similar to cocaine. But like “bath salts,” a group of related synthetic drugs that were banned in 2012, flakka has the potential to be much more dangerous than cocaine.

“It’s so difficult to control the exact dose [of flakka],” said Jim Hall, a drug abuse epidemiologist at Nova Southeastern University in Fort Lauderdale, Florida. “Just a little bit of difference in how much is consumed can be the difference between getting high and dying. It’s that critical.”

A small overdose of the drug, which can be smoked, injected, snorted or injected, can lead to a range of extreme symptoms: “excited delirium,” as experts call it, marked by violent behavior; spikes in body temperature (105 degrees and higher, Hall said); paranoia. Probably what has brought flakka the most attention is that it gives users what feels like the strength and fury of the Incredible Hulk.

Flakka stories are starting to pile up. A man in South Florida who broke down the hurricane-proof doors of a police department admitted to being on flakka. A girl in Melbourne, Florida, ran through the street screaming that she was Satan while on a flakka trip. Authorities in the state are warning people about the dangers of the drug.

Florida seems to be particularly hard hit by flakka overdoses.

Hall said that there are about three or four hospitalizations a day in Broward County in South Florida, and more on weekends. It is unclear why the Sunshine State is a hotbed for flakka abuse; “it’s a major question in our community,” Hall said.

Cases have also been reported in Alabama, Mississippi and New Jersey.

Flakka, which gets its name from Spanish slang for a beautiful woman (“la flaca”), contains a chemical that is a close cousin to MDPV, a key ingredient in “bath salts.” These chemicals bind and thwart molecules on the surface of neurons that normally keep the levels of mood-regulating neurotransmitters, dopamine and serotonin, in check. The result is to “flood the brain” with these chemicals, Hall said. Cocaine and methamphetamine have similar modes of action in the brain, but the chemicals in flakka have longer-lasting effects, Hall said.

Although a typical flakka high can last one to several hours, it is possible that the neurological effects can be permanent. Not only does the drug sit on neurons, it could also destroy them, Hall said. And because flakka, like bath salts, hang around in the brain for longer than cocaine, the extent of the destruction could be greater.

Another serious, potentially lingering side effect of flakka is the effect on kidneys. The drug can cause muscles to break down, as a result of hyperthermia, taking a toll on kidneys. Experts worry that some survivors of flakka overdoses may be on dialysis for the rest of their life.

Like most synthetic drugs, the bulk of flakka seems to come from China and is either sold over the Internet or through gas stations or other dealers. A dose can go for $3 to $5, which makes it a cheap alternative to cocaine. Dealers often target young and poor people and also try to enlist homeless people to buy and sell, Hall said. These are “people who are already disadvantaged in terms of chronic disease and access to health care,” he added.

It is unclear at this point whether flakka is more dangerous than the “bath salts” that came before it. But it does have one advantage over its predecessor: it has not been banned — yet.

“Flakka largely emerged as a replacement to MDVP [in ‘bath salts’],” said Lucas Watterson, a postdoctoral researcher at Temple University School of Medicine Center for Substance Abuse Research.

Although the Drug Enforcement Administration has placed a temporary ban on flakka, drug makers can work around this ban, such as by sticking a “not for human consumption” label on the drug, Watterson said. It will probably take several years to get the data necessary to put a federal ban on flakka, he added. And a ban can be effective, at least in discouraging potential users.

“The problem is when one of these drugs is banned or illegal, the drug manufacturer responds by producing a number of different alternatives,” Watterson said. “It’s sort of a flavor of the month.”

Source:  http://edition.cnn.com/2015/05/26

The young woman was shocked when the addiction-treatment clinic’s drug test showed extraordinary levels of THC in her system. She knew she had a drug problem. But she wasn’t like those acquaintances who sat around smoking pipes, bongs and joints all day.

“We asked how she could have had such an extremely high level of THC in her system,” explained Joanie Lewis, founder of Insight Services, an outpatient addictions treatment facility in Colorado Springs. “We learned her parents were preparing almost all of their food in a marijuana butter. You got the feeling they didn’t really consider it drug abuse. But her level of intoxication was much higher than if she had been a traditional user who sat down and smoked pot several times a day. The impairment crept up on her slowly but profoundly. This kind of thing may be why we’re seeing more impairment, more addiction and more serious withdrawals.”

The proliferation of foods infused or coated with THC has become a growing concern, even among some marijuana advocates. Several high-profile marijuana crimes and deaths involve consumption of edible THC products.

“When THC is available in food, it’s even harder for people to see it as a drug,” Lewis said. “But it is a drug. It is a depressant, a hallucinogen and an addictive substance that changes chemistry in the brain. Research shows all of the above.”

Given the United States’ hard-fought and continuing battles against tobacco and illness caused by its use, Americans would rebuff sales of lemon drops, cookies and soda pops infused with nicotine. Yet, the marijuana industry — quickly emerging as Big Tobacco 2.0 — infuses child-friendly snacks and drinks with doses of mind-
altering and brain-damaging THC up to 50 times stronger than 1960s-era pot.

“Practically nobody had even heard of THC concentrates until after Colorado voted to legalize marijuana, and, honestly, this state had no idea what it was unleashing before it made that decision,” said Dr. Ken Finn, a Colorado Springs physician who is board certified in pain medicine. “Even today, a lot of people don’t seem to understand how potent and addictive this drug is or how easily it is concealed.”

When voters enacted Amendment 64, which sanctioned marijuana for recreational use, many did not envision a cookie more potent than dozens of Woodstock joints. Concealed in Amendment 64’s definitions of “marijuana” and “marihuana” is the phrase “marihuana concentrate.” It means the law allows sale, transport, possession and use of up to one1 ounce of leafy marijuana. It also means one 1 ounce of any form of THC concentrate, which can compare to 50 ounces or more of traditional pot that is smoked.

“I would appreciate it very much if people would send me links to news stories or government-sponsored communications explaining the THC levels that were established by Amendment 64,” Dr. Christian Thurstone, an associate professor of psychiatry at the University of Colorado who treats adolescent addiction and serves on the board of Safe Approaches to Marijuana, wrote on his website in February 2013. “I am unaware of any attempt of this nature to educate the public before Election Day, Nov. 6, 2012.”

Now the threats THC concentrates pose to public health and safety loom large. A new study from researchers at Ohio’s Nationwide Children’s Hospital finds more American children are exposed to marijuana before reaching their fifth birthday. The report, published in the peer-reviewed journal Clinical Pediatrics, found that between 2006 and 2013, the marijuana exposure rate rose 147.5 percent among children age 5 and under. In that same period, the rate rose nearly 610 percent in states that sanctioned medical marijuana before 2000, the year Colorado followed suit.

While consequences of most exposures reportedly were minor, the study’s researchers found 17 marijuana-exposed children fell comatose and 10 had seizures.

In Colorado, the number of exposures to THC-infused edibles in young children increased fourfold in one year, from 19 cases in 2013 to 95 in 2014, according to the Rocky Mountain Poison and Drug Center.

Experts overwhelmingly attribute spikes in marijuana exposure among children to THC-infused “edibles.” The drug-laced food is the most promising aspect of Big Marijuana’s economic future. Edibles make up about 45 percent of Colorado’s marijuana sales, based on state figures, and are projected to quickly surpass the sale of THC products that are smoked.

Advocates for edibles say the products provide a healthy alternative to inhaling smoke. Others go further, marketing drug-infused foods and drinks as health food.

“Here comes the Whole Foods-
ification of Marijuana,” states the headline for a story published by Fast Company, a news organization founded by former editors of Harvard Business Review, touting its focus on “ethical economics.” . The report describes the author’s experience with ordering front-door delivery of a jar of “organic, sun-grown marijuana from farmers Casey and Amber in Mendocino, Calif.”

“There’s a whole industry being built around the upscale branding of weed,” author Ariel Schwartz explains. “Marijuana is now something that should be organic, grown by friendly farmers…”

For marijuana sellers, edibles mean a potentially boundless market share. “Edibles are the future of the industry due to their familiarity,” explains an article on a website that markets “The Stoner’s Cookbook.” “Non-smokers are not inclined to medicate with a joint, but an infused cookie is something familiar that they’re comfortable ingesting.”

Indeed, THC-infused foods and drinks — all fashioned from marijuana the state doesn’t yet test for contaminants — are sold in hundreds of store-front establishments throughout the state. They are shared and traded on the campuses of middle schools and high schools, where young users with developing brains are especially susceptible to addiction. They are stowed in lunch boxes in the workplace.

Employers, law enforcement officials, educators and addiction treatment providers say Colorado has cooked up a poorly regulated THC-food fiasco that crisscrosses the country with the ease of exporting gummy bears in glove compartments, pockets and handbags. For taxpayers, the growing edibles market means an array of social costs — including hospitalizations, traffic accidents, school dropouts and lost work productivity — that state and federal officials haven’t fully investigated, estimated and made public.

Known as hash oil, wax, dabs, and shatter, concentrates deliver a high so fast and intense many users refer to them as “green crack.” One ounce of the highest potency THC concentrate can yield 560 average tokes on an electronic cigarette. In edibles, Colorado law defines an average serving of THC as 10 milligrams.

“That average serving size? That’s a political number, not anything rooted in real, reputable science,” said Kevin Sabet, a former senior White House drug policy advisoer and co-founder of Smart Approaches to Marijuana, an organization opposed to marijuana legalization and supported by several of the country’s top addiction treatment experts.

The 10-milligram serving size established by Colorado lawmakers means one1 ounce of high-potency THC oil — the amount one adult is allowed to buy or possess at any given time — also can equal 2,800 average servings. That’s a well-stocked bakery.

“I don’t need scientific evidence to show me that students are completely zoned out and that more stoned kids are showing up for class,” said Kelly Landen, a high school teacher in Denver. “If they’ve smoked marijuana, you smell it on them. But students also show up with candy and cookies and whatever … and there’s no way to know for certain what’s in that food. They could be eating (THC) right in front of me.”

Unregulated by the U.S. Food and Drug Administration, concentrated THC is practically undetectable. There is no pill. Unlike alcohol and cigarettes, there is no smell. Users can get high on food and beverages while hiding in plain sight in almost any location.

“There is great danger in how easy these food products are to conceal,” said Frank Szachta, director of The Cornerstone Program, an adolescent addiction treatment center in Centennial. “Someone could do this drug in front of you, or in front of a teacher, in front of the boss. … No one would have to know.”

Colorado legislators have grappled with the problem of people — particularly children and adolescents — consuming marijuana in common snacks that land them in emergency rooms with panic attacks and hallucinations. Authorities have linked at least three deaths in Colorado, including a murder, to excessive consumption of THC-laced foods.

When ingested through the stomach, the user may not experience effects for an hour or more. The delayed effect is blamed in part for new users becoming impatient and eating too much.

“Like a bottle of vodka, you can’t just drink the entire bottle. You have to take it slow and understand what you’re doing,” said Julie Berliner in a YouTube video. She’s the founder of Sweet Grass Kitchen, an edibles manufacturing company in Denver.

But edibles are not like a bottle of vodka in important ways. The vodka’s contents are exactly known, and drinks can be measured precisely. The label on a THC-infused brownie or candy bar might state “servings per package: 10,” but the maker can’t say whether the consumer will ingest all of those servings in one small bite. The folly is akin to cutting a cupcake into tenths and presuming each piece contains exactly one serving of vanilla extract.

Making matters worse, said Lewis of Insight Services, is that many people are not inclined to follow recommended serving sizes.

“The state says a serving size is 10 milligrams, so that’s how much THC you might find in one small piece of candy,” she said. “But very few people sit down with a bag of candy and eat only one piece.”

State lawmakers’ efforts to regulate edibles and their packaging have done little to stop accidental overdoses and deter underage use — in part because they haven’t applied to homemade goods infused with THC, health professionals say. State law also is undermined when someone removes the contents of a package and stores the THC-infused food in a bowl, jar or other container.

A law enacted in 2014 instructs the Colorado Department of Public Health and the Environment to devise standards and procedures that will make unpackaged, commercial food products easily stand out if they contain THC. It’s a tall order when dealing with small pieces of food — such as crumbs of granola — and the agency continues to grasping for a solution.

Since legalization and the mass marketing of highly potent, THC foods began, Colorado addiction treatment providers have reported increasing levels of toxicity among clients, more severe addiction and poorer prognoses for recovery from substance use disorders.

For example, the average level of THC found in the urine of about 5,000 adolescents ages 13-19 by researchers at the University of Colorado jumped from 358 nanograms per milliliter in 2007 through 2009 — just before the state’s boom in medical marijuana dispensaries — to 536 milliliters from 2010 through 2013.

The rapidly widening scope of THC-infused food is shaping up to be a recipe for great losses for individuals, families and the entire state, Lewis said.

“People are coming to us later in the addiction cycle than they used to,” she said. “When people get high on food, there is the perception that they’re not really using a drug. It seems less harmful than taking pills or smoking. By the time they realize there’s a problem, some of them are quite a ways further into the addiction than if they had been smoking it.”

Source: http://m.gazette.com/clearing-the-haze-thc-extracts-concentrate-problems/article/1554097   June 2015

Production of a dangerous street drug called ‘Moon Rocks’ is soaring and the DEA can’t keep up

Moon Rocks, otherwise known as Spice, K2, or Skunk is a lab-produced, mind-altering drug that’s been soaring in popularity in recent years.

Giant  underground laboratories , many of which are in China, are churning out  thousands of pounds  of the stuff.  This week, the DEA arrested a man whose lab likely produced the chemicals in some  70% of the spice sold in the US,  the New York Times reports .

Although it’s often marketed as a “safer alternative to traditional marijuana,” spice is dangerous and can be deadly.

This is spice. It looks fairly harmless — like herbs in a shiny package — but it isn’t.  Reports suggest that since 2009, drugs like spice, or synthetic marijuana, have killed roughly 1,000 Americans — many of them young people in high school.

The drugmakers change up the specific ingredients in the drugs so fast — and produce them in such massive quantities — that drug enforcement can’t keep up.  The drugs are created in powdered form in giant underground laboratories . Many of the labs are in China. Then they are packed up in large bags……and shipped to the US in huge containers labelled “fertilizer” or “industrial solvent.” A small bag of the powdered drug is liquefied and added to plant material.

Then wholesale buyers purchase the drugs and turn them into liquids by dissolving them in acetone or alcohol. Next, they use the liquid to douse dry plant matter, and package it up in shiny metallic baggies. The stuff inside is then rolled up and smoked.

Often, the drugs are packaged as “plant food” or “potpourri” so they can be legally sold in stores. The back of these packages often includes the coy warning, “Not intended for human consumption.” Regardless, the drugs have continued to soar in popularity. So far this year, poison centers received reports of 3,548 exposures to synthetic marijuana, according to the American Association of Poison Control Centers.

Many experts say “synthetic marijuana” is a huge misnomer for these drugs, since they produce far different effects and can be up to 100 times more potent than traditional marijuana. For example, the first form of the psychoactive ingredient used in spice was called JWH-018, named for the initials of the scientist John W. Huffman who first invented it in 2008.

Just like with the main psychoactive ingredient in traditional marijuana, THC, the psychoactive ingredients in synthetic marijuana bind to the brain’s CB1 receptors. Because spice is so much stronger, however, it is much more likely to cause everything from seizures to psychosis.

Source:   http://www.msn.com/en-us/health/medical/production-of-a-dangerous-street-drug-called-moon-rocks-is-soaring-and-the-dea-cant-keep-up/ar-BBkmxRN?ocid=iehp  May 2015

Officials in cities across the United States are reporting a rise in overdoses related to synthetic marijuana, CNN reports. Police chiefs meeting in Washington this week said they need field tests to help them quickly determine whether suspects have taken the drug.

Synthetic marijuana, sold under names such as “K2,” “Spice” and “Scooby Snax,” is very different from marijuana, according to the American Association of Poison Control Centers. It is made with dried herbs and spices that are sprayed with chemicals that induce a marijuana-type high when smoked. The drug is not tested for safety, so there is no way for a person to know what chemicals they are using.

Health effects can include severe agitation and anxiety; fast, racing heartbeat and high blood pressure; nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes; and suicidal and other harmful thoughts and/or actions.  From January 1 to August 2, 2015, poison control centers received calls about 5,008 exposures to synthetic marijuana, compared with 3,682 in all of last year.

According to a survey of 35 major city police departments, 30 percent have attributed some violent crimes to synthetic marijuana, the article notes. Overdoses in some cities are clustered in homeless populations.

On Tuesday, New York Police Commissioner William Bratton called the drug “weaponized marijuana,” and called it “a great and growing concern.”

The products are widely available, despite laws prohibiting them. With the passing of each regulation to control synthetic marijuana, drug manufacturers and suppliers are quickly changing the ingredients to new, non-controlled variations.

Source:  http://www.drugfree.org/join-together/   5^th August 2015

On the street, it’s also called “gravel” for its white, crystal chunks. In the lab, it’s known as a stimulant, part of a chemical class called cathinones, with the amphetamine-like effects of Molly and Ecstasy. In the media it’s been dubbed “the insanity drug.”

Indeed, flakka has fuelled a recent, bizarre a spate of public behavior, all occurring in Fort Lauderdale, Florida. On April 4, a man who had smoked flakka ran naked in the streets, claiming people had stolen his clothes. In March, a man on flakka impaled himself on a spiked fence outside the police station. He survived. In February, a man on flakka tried to kick in the police station door, claiming cars were chasing him.

“This is bad stuff,” said epidemiologist James N. Hall, co-director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University in Florida.

“The biggest danger is these are guinea pig drugs and the users are like lab rats.”

Flakka simulates the effects of the khat plant, which grows in Somalia and in the Middle East. Experts say that in high doses, it can cause an “excited delirium,” during which a user’s body temperature can rise to as high as 105 degrees. It can also create heart problems like tachycardia and life-threatening kidney failure.

“Some get high and some get very sick and may become addicted,” Hall said. “Some go crazy and even a few die. But they don’t know what they are taking or what’s going to happen to them.” In 2013 alone, cathinones, created in China and sold over the Internet, caused 123 deaths in Florida, according to the United Way of Broward County Commission on Substance Abuse.

Flakka, which can be crushed and snorted, swallowed or injected, is peddled under many brand names, including the less-potent cathinone, “Molly.” Flakka is often mixed with other drugs like methamphetamine.

Ecstasy or MDMA is a different class of chemical altogether, but Molly, though often touted as “pure” MDMA, is a first-generation cathinone. Because flakka is sold under so many different brand names, including “Molly,” users can be fooled, not knowing the potency of this new synthetic drug.

Flakka is “very dose specific,” said Hall. “Just a little (of it) delivers the high effect. It produces energy to dance and euphoria. But just a little more — and you can’t tell by looking at the capsule or baggie. Its name comes from the Spanish word “flaco” for thin. Latinos also use “la flaca” as a clubbing term for a pretty, skinny girl.

Spelled “flakka,” it’s “an eloquent collegial term — a beautiful, skinny woman who charms all she meets,” said Hall. “They give [synthetic drugs] names that are hip and cool and making it great for sales.”

Flakka emerged in South Florida last year, and has been seen in parts of Texas and Ohio, but is still not illegal in many states, according to Hall.

The abuse of synthetic drugs is a well-worn story in the United States — the largest consumer market of illicit drugs, according to Dr. Guohua Li, an epidemiologist and founding director of the Center for Injury Epidemiology and Prevention at Columbia University.

“Each generation is exposed to different drugs of choice,” Li said. “The signature substances and their particular effects become a unique feature of the birth cohort.”

“Designer drugs must stay ahead of the authorities and medical communities to keep their illegal business afloat,” Li added.

In the 1940s, a Swiss chemist synthesized a drug from the ergot fungus and discovered the psychedelic properties of lysergic acid diethylamide or LSD. But in 1966, after Timothy Leary urged a generation to, “turn on, tune in, drop out,” the drug was made illegal.

In the 1980s, the all-night rave scene gave birth to the synthetic drug MDMA or ecstasy, giving users the euphoric high of amphetamines and the psychedelic effects of hallucinogens.

By the 1990s, the scourge of lab-produced meth appeared on the West Coast and increased in popularity throughout a decade.

Synthetic marijuana dubbed K2 or Spice, emerged in 2006, and was eventually banned in 2011.

At the same time, MDMA, which is a phenethylamine, saw a resurgence, but by 2010, synthetic cathinones — “bath salts” and the drug Molly — arrived on the club scene.

But now, use of MDMA has tapered off, due to the growing popularity of flakka, which costs only about $5 a dose.

“It’s emerging as the crack cocaine of 2015 with its severe effects high addiction rate for a low cost,” said Hall. “People are terrified of the drug. It’s because the consequences are so devastating.”

Source: http://www.nbcnews.com/health/health-news/flakka-attack-new-synthetic-drug April 15th 2015

The drugs sent 28,000 people nationwide to the emergency room in 2011.

Attorneys general are fighting the illegal sale of synthetic marijuana with their pens.

A letter signed by 43 attorneys general — including Roy Cooper from North Carolina — was sent to nine major oil companies last Tuesday, urging them to eliminate synthetic marijuana from their gas stations’ convenience stores and retail locations.

Use of the drugs is a national problem — sending 28,000 people to the emergency room in 2011.

“Given the significant danger synthetic drugs present to users, especially our young people, we are extremely troubled that these drugs have been readily available in well-known retail locations,” the attorneys’ letter said.

Synthetic marijuana is often marketed under names like “K2” and “Spice” and is not tested for safety, according to the American Association of Poison Control Centers, which received 3,679 calls due to exposure to the drug in 2014.

Kelly Alanis-Hirsch, a researcher who studies substance abuse disorders at UNC, said the synthetic drug is not comparable to the organic drug, and the lack of regulation poses a serious threat to users’ health.

“It is created by spraying various chemicals on herbs or other leafy material,” Alanis-Hirsch said. “The chemicals mimic the effect of THC that appears naturally in organic marijuana, but the synthetic marijuana compounds vary by manufacturer.”

Federal and state laws prohibit the manufacture, sale and consumption of synthetic marijuana. Synthetic marijuana was made illegal in the state in 2011 when the N.C. General Assembly classified it as a controlled substance.

In 2012, President Barack Obama signed the Synthetic Drug Abuse Prevention Act, which categorized 26 synthetic cannabinoids as Schedule 1 drugs under the Controlled Substances Act — outlawing the drugs at the federal level.

But Alanis-Hirsch said that drug companies have evaded the federal law by manufacturing substances similar, but not identical, to those prohibited by the federal government.

“Recipes are changed in response to governmental efforts to make the product illegal; thus, it’s marketed as a ‘legal high,’” she said.

Mary-Nel Saarloos, a medical doctor in Asheville, said she often treats patients who have overdosed, but the constantly changing chemical components make it difficult to diagnose. Blood and urine tests often can’t detect these components of the drug, she said.

The National Association of Attorneys General called for major oil companies to revoke franchises of gas stations that violate the federal controlled substances laws.

“Young people should not die or be seriously injured from using products bought at gas stations or convenience stores,” the letter says.

Source: www.dailytarheel.com17^th February 2015

Durand D1, Delgado LL1, Parra-Pellot DM1, Nichols-Vinueza D2.

Abstract

BACKGROUND:

Synthetic cannabinoid (SC) or “spice” refers to a variety of herbal/chemical mixtures, which mimic the effects of marijuana. They are generally marked as “herbal incense” and best known by the brand names of “K2,” “spice,” “aroma,” “Mr. Nice Guy” and “dream.” Little data are available on the psychopathological and physical effects of SC.

CASE DESCRIPTION:

We reported on a 23-year-old man without prior psychiatric history who developed acute psychosis and severe rhabdomyolysis (creatine phosphokinase [CPK]: 44,300 UI/L) associated with “Mr. Nice Guy” consumption. To our knowledge, this is the first case report of severe rhabdomyolysis associated with SC use in the U.S.

CONCLUSIONS:

Physicians should be aware of the possibility of new-onset psychotic symptoms and rhabdomyolysis in patients that use SC.

Source: Clin Schizophr Relat Psychoses. 2015 Jan 1;8(4):205-8. doi: 10.3371/CSRP.DUDE.031513.

Synthetic cannabinoids, better known on the street as “K2” or “Spice,” have pharmacological effects that are up to 100 times more potent than THC, the active ingredient in cannabis, says a new study.  Scientists from the University of Maryland and the National Institute on Drug Abuse (NIDA) wrote an article, giving an overview of the effects of synthetic marijuana. In order to replicate the effects of using natural marijuana, laboratories illegally manufacture cannabinoid compounds that act on the same cell receptors that THC does. Users find synthetic cannabis appealing because the substance often does not appear when drug tested.  Studies showed that the pharmacological effects of synthetics can be 2-100 times more potent than THC, including analgesic, anti-seizure, weight loss, anti-inflammatory and anti-cancer growth effects. Synthetics mimic physiological and psychoactive effects of THC, but are more intense, commonly resulting in medical and psychiatric emergencies.  Side effects in humans after using synthetic marijuana include nausea and vomiting; shortness of breath or depressed breathing; hypertension; tachycardia; chest pain; muscle twitches; acute renal failure; anxiety; agitation; psychosis; suicidal ideation and cognitive impairment.  The long-term or residual effects of using synthetic cannabis is still unknown.

Source:  www.cadc.org    18th Sept 2014

Emergency rooms in Denver, Colorado reported a surge in visits related to synthetic marijuana in the late summer and early fall, according to the Los Angeles Times. Experts say similar patterns may emerge in other parts of the country.

Between August 24 and September 19, area emergency rooms saw 263 patients, mostly young men, with symptoms related to synthetic marijuana. Most patients were treated in the emergency room, but seven were admitted to intensive care units. In a letter in this week’s New England Journal of Medicine, Dr. Andrew A. Monte of the University of Colorado School of Medicine writes synthetic marijuana appears to be growing more potent. “Although the effects of exposures to first-generation synthetic cannabinoids are largely benign, newer products have been associated with seizures, ischemic stroke and cardiac toxicity, possibly due to potency,” he wrote.

Synthetic marijuana is sold under names including K2, Spice and Black Mamba. It is made with dried herbs and spices that are sprayed with chemicals that induce a marijuana-type high when smoked, the article notes. The products are widely available, despite laws prohibiting them.

“These substances are not benign,” Monte said. “You can buy designer drugs of abuse at convenience stores and on the Internet. People may not realize how dangerous these drugs can be — up to 1,000 times stronger binding to cannabis receptors when compared to traditional marijuana.”

In September, the Colorado Department of Public Health and the Centers for Disease Control and Prevention announced they were investigating whether three deaths and 75 hospitalizations were caused by synthetic marijuana.

Short-term effects of using synthetic marijuana include loss of control, lack of pain response, increased agitation, pale skin, seizures, vomiting, profuse sweating, uncontrolled/spastic body movements, elevated blood pressure, heart rate and palpitations.

Source: www.drugfree.org            Jan 23rd 3014

Fans enjoy Madeon’s set at last year’s Ultra Music Festival. Starting Friday, Ultra Music Festival is expected to attract more than 160,000 young people from across the world to party with hundreds of international DJs and music artists. This year, it’s attracting something else: Molly.

Molly is a party drug that is a derivative of Ecstasy, which has fuelled dance parties for decades. It appeared on the dance-music and hip-hop scenes around early 2011 — billed as pure MDMA, the amphetamine that is the prime ingredient of Ecstasy. It comes as crystals or as a white powder inside a capsule and can cause high blood pressure, a rapid heart rate, possible brain injury and even heart attacks, depression and suicidal thoughts after the drug is out of the body, especially if the user has an underlying mental illness.

“They tend to have a psychiatric phenomenon,” Bernstein said. “That seems to be a phenomenon that we are seeing with the bath salts that we don’t see as much with amphetamines or methamphetamines.” Mick Elle, 37, a musician and former DJ raised in Miami, had a three-month depression that he blames on Molly. “What I hate about Molly is I had a hangover of two or three weeks. Took me three months to recover,” Elle said. “It’s such a blowup. But when you go up, eventually you will have to go down.”

The Florida Poison Information Center at Jackson Memorial Hospital received its first calls related to Molly in 2011. From 2011 to 2012, the number of calls more than doubled, from eight to 20 calls. Katie Victoria, 27, a student at Broward College, first heard about Molly when she moved to Miami four years ago from Maryland. “Before I moved to Miami, I never had heard of such a term,” Victoria said. “I don’t think anywhere else in the United States it’s as popular as here.” But as popular as it may be, Molly is not a high law enforcement priority because it is not nearly as prevalent as cocaine and marijuana and leads to far less street violence, said Lt. Dan Kerr, commander of the Crime Suppression Unit of the Miami Police Department.

That changes during Ultra. “Ultra is really when we work the buys,” Kerr said. “That’s when big shipments come in.” Victoria went to Ultra in 2010 and doesn’t plan to go again. “A lot of the 18-year-old kids cannot even buy alcohol, so obviously what they are doing is Molly,” said Victoria. She reported seeing partiers take 10 pills in one Ultra night. “You really think they’re gonna do one Molly and that’s it? No, because kids are not that responsible,” she said. “They don’t think about their health that way.”

A spokesman for Ultra said no one was available to comment, as they were too busy preparing for the event. The festival’s policy, listed on its website, says the possession of any illegal substance is not tolerated. Security is extremely tight and all bags are searched at the gate. Jose Gutierrez, 24, an events promoter in Miami who has been going to Ultra for five years, said everyone is on drugs. “If they are not on drugs, they are not having fun,” said Gutierrez, who says he has taken Molly at Ultra since 2010. “You feel the music in your body. It’s like tickling in the inside and that’s what makes you smile,” he said. “You smile and you don’t stop dancing.”

By the end of an Ultra weekend as many as 50 people might overdose and need medical treatment after taking Molly and other drugs, Kerr said. The Miami Police Department’s Special Events unit, which will coordinate the officers that will staff the event, have met with local merchants and residents about possible route changes during the event.

Documented health effects aside, Molly is popular in the music world. Kanye West, Lil’ Wayne and 2 Chainz have referenced the drug in their lyrics. Madonna used her Molly remark to release MDNA, her 12th studio album, at last year’s Ultra — wearing its controversial title emblazoned on a T-shirt at the festival. And Miami-based international DJ Cedric Gervais, 33, released a single in April 2012 called Molly. “It’s about a girl because I was looking for this girl called Molly,” said Gervais, a resident at the Fontainebleau Hotel club LIV. “The crowd is thinking MDMA, that’s the controversy of it.”

Read more here: http://www.miamiherald.com/2013/03/12/v-print/3281778/police-expect-club-drug-molly.html#storylink=cpy

—

Source: Posted on Tue, Mar. 12, 2013 South Florida News Service

Not many of us are chemists. Yet by removing one oxygen atom average people here in Missouri regularly are turning common decongestants like Sudafed and Claritin-D into the illicit drug methamphetamine. Nationwide those explosive mom and pop meth labs were estimated by a Rand study to cost taxpayers more than $23 billion a year in health care costs, child endangerment and clean-up. But as St. Louis Public Radio’s Maria Altman reports a local pharmaceutical company may have the answer.

In a non-descript office building in suburban St. Louis a little company was busy developing big technology; a binding agent to make a tamper-resistant drug. They weren’t yet sure exactly what drug Westport Pharmaceuticals they would tackle. Paul Hemings is the General Manager and Vice President of the Highland Pharmaceuticals subsidiary. He says looking back, it was staring them in the face.

“It started with our patent attorney who also has a chemistry background and lives out in Pacific where this meth problem is huge and one day she just mentioned ‘have you thought about this?” That is how to prevent pseudoephedrine, a common ingredient in nasal decongestants, from being turned into methamphetamine. Zephrex-D was the result.

How It Works

Hemings points out the pills’ waxy white coating. He says the new drug works just as well as other pseudoephedrine products, but meth cooks can’t extract the key ingredient. That means they can’t make meth. “We can end meth labs in the U.S. starting right here in our backyard where the problem is the biggest,” Hemings said. Last year alone law enforcement seized more than 1,800 clandestine labs in Missouri, the most of any state in the country. Detective Sgt. Jason Grellner is with the Franklin County Narcotics Enforcement Unit and is considered the expert on Missouri’s meth lab epidemic.Grellner says he was skeptical of Zephrex-D after years of being told by large pharmaceutical companies that a tamper-resistant drug couldn’t be made.

Now he says he’s a believer. “I’ve seen the testing by independent laboratories; I’ve personally tested the product in a one-pot meth lab setting; and I know of other testing that has been done,” he said. “They have manufactured a product that is meth lab resistant.”

Requiring A Prescription?

Grellner doesn’t expect “big pharma,” as he calls it, to change their pseudoephedrine products, at least not yet. He says for now the best way to keep the pills that still can be converted into meth away from criminals is to require prescriptions. “They have manufactured a product that is meth lab resistant.” – Detective Sgt. Jason Grellner

That faces strong opposition, including from the St. Louis Chapter of the Asthma and Allergy Foundation. “We do know that meth is a terrible problem in Missouri, we just disagree on how to take care of this,” said Joy Krieger, the foundation’s executive director and a registered nurse. Krieger says they support a proposed law to further limit the amount of pseudoephedrine people can buy each month, but she says getting a prescription is an expensive hassle. “Pseudoephedrine is safe for those purchasing it for proper reasons, so penalizing

residents and citizens who have done nothing wrong we think is not a fair way to look for a solution,” she said.

The Legal Perspective

State Representative Jeff Roorda has sponsored legislation for the state-wide prescription law every year since 2005. The Democrat from Jefferson County, the heart of Missouri’s meth country, says with Zephrex-D, there is a good alternative available for cold and allergy sufferers, so there can be no more excuses. “Now we have a pseudoephedrine that’s incapable of being converted into methamphetamine, I mean arguments against this just hold absolutely no water anymore,” Roorda said. The impact of Zephrex-D remains to be seen.

Westport Pharmaceuticals officials say they’re open to selling their binding technology to other drug-makers. Right now Zephrex-D is only available in Missouri and the Metro East. Officials say they plan a national roll-out this summer.

Source: http://www.news.stlpublicradio.org 13th March

Comment:
Amid all the talk about what to do about this particular nasty drug-no one in politics or the media is addressing the fundamental question. How did the UK get to have this terrible drug using culture? Did influential legalisation and liberalisation drug lobbyists adversely affect the drug use culture? Was “media advocacy” a big factor? Where some pro liberalisation/legalisation Members of Parliament (in all political parties) guilty of proselytising without working out the inevitable consequences? Are those members of the “great & (supposedly ) good” , (even some members of the Police & Judiciary), who advocated drug legalisation/liberalisation, also guilty parties? It has been said nations get the drug problem they deserve. We certainly deserve ours. It is surely time for some honesty a rethink and some more competent political leadership.
David Raynes  National Drug Prevention Alliance
*****************************************************
Desperate father pleads for action as legal party drug destroys his teenage son An accountant has made a dramatic nationwide plea for help to stop his son killing himself with the new party drug known as Miaow Miaow.

Stephen Welch, rang BBC Radio 4’s Today programme in desperation because he did not know how to stop his son Daniel’s addiction to mephedrone and his appeals for specialist support had been rejected.
The 58-year-old spelt out the reality of life with a teenager who is destroying his health with a legal substance.

And he revealed that the drug can be bought freely over the phone on an 0800 number “like a Chinese takeaway” and delivered in 15 minutes at a cost of less than £1 a hit.  He also revealed that many of his son’s friends in the affluent, medieval market town of Saffron Walden, were also dependent on mephedrone and experiencing physical and mental problems as a result.

Speaking to The Sunday Telegraph, Mr Welch, a self-employed accountant, described how last week, Daniel collapsed in front of him after a heavy weekend taking the killer drug.  “He had heart pains, his blood pressure was all over the place, his body went numb,” said Mr Welch. “Then he went into a bout of intense depression and suicidal tendencies. We were very, very scared.  “We thought that maybe we were going to loose him. It was a terrifying situation.”

The close-knit Welch family is desperate for help but have been told by mental health experts that their son’s drug taking is a “lifestyle choice” which they can do little about.  “The said they were not able to offer us any assistance, apart from saying, if necessary, take him to accident and emergency,” said Mr Welch, 58. “There has been an offer of acupuncture sessions but no mention of rehabilitation or even counselling.”

Evidence is growing of a mephedrone epidemic among young people across the social range. A survey published yesterday revealed that more than one in 13 students who attend Cambridge University have tried the drug.

Last week, it was linked to the deaths of Louis Wainwright, 18, and Nicholas Smith, 19, in Scunthorpe. Police have also confirmed that a partygoer’s death from a heart attack in February was caused by mephedrone poisoning.   Despite escalating fears, the Government has taken no action to ban the drug. The substance is actively marketed on dozens of websites as plant food, with the companies and individuals who sell it making millions of pounds unhindered by the authorities.

“It is like ordering a Chinese takeaway but it comes quicker and is cheaper,” said Mr Welch. “The teenagers ring the 0800 number and it is delivered in little packets that say ‘plant food, not for human consumption’.  “Four grams costs £35 and is enough to give two hits to 20 people, that is under £1 a hit. Four grams of cocaine costs about £200.

“All of his friends are taking it, including some who wouldn’t have touched any drugs before but take this one because it is legal.  “They are all having the same problems. They are all, within a very short space of time, becoming dependant on it.”

Before discovering the drug, Daniel had completed his GCSEs at a private Quaker school and was studying a vocational course at a college near Norwich.  But the effects of his habit have left the teenager muddled, depressed and unable to work. While he has tried other drugs and has used cannabis regularly, the high he experienced with mephedrone was in a different league.  Mr Welch, whose three other children have never had drugs issues, said the availability of the drug made it so much harder to protect Daniel and break his dependency.

“It needs to be banned, if only to make it more difficult to get hold of,” he said. “I’m not naive enough to think it will not still be there.  It will go underground but it will become more expensive and it will put some children off taking it if it is illegal.  “It is no good the Government saying ‘we need to wait for this committee or that report’. People are dying from this substance.

“We have had a terrifying experience with our own son. People are making a fortune out of supplying this stuff and it is causing absolute havoc with our children.”  Meanwhile, until the Government acts, the Welch family try to cope with the day-to-day consequences of Daniel’s addiction.

“My wife is affected the most as she is at home most. It is emotionally just draining,” said Mr Welch. “We are absolutely distraught by this.
“The possibilities are too horrendous to think about – those two poor boys in Scunthorpe who died. My son said ‘I looked at their pictures and they looked like normal kids’. I said to him ‘Daniel, you look like a normal kid’.

“He has been very frightened by what has happened this week. We can only support him and hope that he is coming around to realising what a lethal substance this is.” Daniel said that the public and Government officials did not realise how bad the situation had become with mephedrone.  “I want to get across the massive effect it has had on my life and on the lives of people similar to me,” said the teenager.
“Something needs to happen. People are doing the drug who would never think of doing illegal drugs. It is affecting normal people.  “It is so readily available, a phone call away. And it is so cheap that someone always has it. You can swap a cigarette for a line. And that makes it hard to break away from it.

“I’ve got a lot of big decisions to make now about who I see and who I don’t. The problem is these are normal friends, people at university.
“But if I carry on in the way I have been I could be dead in three months. I’m losing weight, I’m not the person I was.”
Source:  www.telegraph.co.uk/health  21st March 2010

Teachers UK-wide given emergency training after some as young as 12 fall victim to £3-a-go ‘plant food’ drug linked to two deaths.

Teachers are dealing with the behavioural consequences in their classrooms of a new “legal high” – known as “meow meow” or “plant food” – which is being taken by pupils as young as 12 or 13.
Classroom staff are now receiving training in the dangers of the new craze after an explosion in its use and recent cases of children falling seriously ill after taking the drug, which is believed to have similar effects to ecstasy. While the drug is not illegal, its abuse in the hands of pupils has prompted officials around the country to add warnings about the substance to PSHE lessons. It has been linked to the deaths of Swedish teenagers and 14-year-old Gabi Price from Worthing last November.
“Meow meow”, or mephedrone as it is formally named, is marketed by suppliers as plant food to avoid detection and can be acquired for as little as £3 a hit (a gram, containing four capsules, costs £12).

In Brighton there are reports of children as young as 12 and 13 taking the drug on school buses. College students have even started a trend of trying to drive home after taking legal high drugs, with five teenage boys in County Durham taken to hospital after indulging – with one suffering a drug-induced high for 36 hours.
Police around the country worried about the trend have now started taking action. Pupils at Brighton schools have already begun learning about the dangers of the drugs in assemblies and through the PSHE curriculum, while children in Teesdale have been given information leaflets. Police are also working with Harrogate headteachers after a growth in legal-high use among the town’s young people.

“It’s clear that increased numbers of 14- and 15-year-olds started using ‘meow meow’ at the end of last summer and we have big concerns about this,” said Sam Beal, acting healthy schools team leader for Brighton and Hove City Council. “Teachers hear about this more and more and they are concerned that the drugs are being brought into schools.”
The symptoms of using meow meow can include nosebleeds, headaches and breathing problems. Limbs can also turn purple and the user may have trouble urinating, leading to stomach cramps.
“It seems when bought over the internet you get discounts for buying larger quantities,” said Sgt Geoff Crocker, safer neighbourhoods officer for Harrogate. “It’s easily available and cheap and we’ve seen enterprising pupils start selling it in school. Staff in our pupil referral unit service have noticed a very rapid physical and mental decline in pupils using legal high drugs – and some just aren’t there any more. One young girl we know is addicted to mephedrone and she is active sexually with a number of men for money to pay for it. I know our schools are concerned about this, and are working hard to deal with it.”

In County Durham, drug workers have been warning pupils that legal does not mean safe following the incident when five boys fell ill last August. This has also meant an increased local police interest in the issue. “We’ve mostly seen it used as part of a ‘risk-taking’ culture among young people, particularly in colleges,” said Darren Archer, manager of the County Durham drugs and alcohol action team. We’ve had anecdotal reports of it causing bad behaviour and now we are trying to offer comprehensive support to teachers and children.” It scared the life out of us, seeing him like that’
It was the wake-up call no teacher wants – but witnessing the distressing effects of legal high drugs has revolutionised one school’s drug education programme. Horrified teachers at Woldgate College, near York, watched as a sixth-form student became seriously ill after taking mephedrone off-site during lunchtime earlier this month. He was taken to hospital suffering from an irregular heart beat, chest pains and breathing problems. Headteacher Jeff Bower (pictured) is now calling for the drug to be made illegal.
“You can’t think anything else after seeing that young man struggling like that, it scared the life out of everyone here,” he said. We are not extremely receptive to this problem – it’s been a big wake-up call. It was the first time he had taken it and he admits it was because of peer pressure. This has just hit us completely between the eyes. We held a special assembly about the situation and built it into our drugs education programme. We have also been in contact with parents. This goes on out of school hours so it’s vitally important they know about the dangers.”
A correction to the above story:

The only link between the death of Gabi Price and mephedrone was made by some ill informed reporting in the Daily Mail, and the Sun and the Telegraph that reported that this was a drug death before the coroners report was published. The coroner in reality found no drugs in her body and that she died of broncho-pneumonia following a streptococcal A infection (see here http://bit.ly/7td8FN ). Such is the nature of drug story reporting that none of the newspapers that ran the original story printed a correction or follow up.

It is also the case that the unregulated vendors of this drug reported a leap in sales when the (false) Gabi Price death story received free advertising (it works, its legal, its cheap, you can buy online) from the massive national tabloid coverage (and the broadcast coverage that followed).

This is undoubtedly a dangerous drug, and serious public health and regulation policy concern – particularly regarding young people, but that does not excuse
Steve Rolles 28th Jan 2010-01-29
Source: www.tes.co.uk Jan 2010

What is miaow drug?

A 14 year old girl, Gabi Price, has died after apparently taking a new drug, known as miaow.

Gabi Price died after apparently taking a new drug, known as miaow “Miaow” is sold as plant food on the internet where it is described as being not for human consumption.

It was made illegal in Sweden, Norway, Denmark, Finland and Israel due to growing evidence of harm, including a reported possible cause of death.

Apart from the euphoria and alertness it is said to induce anxiety, paranoia and a risk of fits. It is known as a “legal high” and its popularity is increasing sharply because it is legal to buy.

Police forces are aware of its existence, but because of its recent emergence onto the market are unsure of how widespread its use is.
Some internet forum users have described it as “the saviour of clubland” should it not be outlawed soon.

Source:http://www.telegraph.co.uk/news/uknews/6645673/14-year-old-girl-dies-after-taking-legal-drug-at-party.html

In the first such case in New Jersey, federal authorities yesterday charged an Atlantic County man with possessing a large amount of the hallucinogen ‘Foxy Methoxy,’ which is said to be similar to ecstasy.
It was one of the largest such seizures in the nation. Foxy is so new and seizures so rare that nationwide statistics are not readily available, Ed Childress, a spokesman for the federal Drug Enforcement Administration in Washington, said yesterday. Every bit as rare, authorities said, is the manner in which they got hold of the drugs: The defendant, from Absecon, notified them and led them straight to the stash. The man is in federal custody and undergoing psychiatric evaluation.
Foxy began appearing at all-night dance parties in 1999, and municipal police departments began seize amounts in 2001 Only a handful of large seizures have followed.

Source: www.momstell.com, Oct 2003