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First responders react to overdose increases

From The Journal Times:

There are myriad dangers present when first responders, whether police or EMS, arrive at any emergency scene. Typically they are walking into unfamiliar territory.

With a recent influx of designer drugs, namely synthetic opioids, responders are now dealing with additional stress from more calls and a range of potencies in drugs.

Overdoses are becoming commonplace in Racine County and around the nation, according to Chris Eberlein, medical adviser for the southwest region of the Department of Health Services. And he sees increased wear on EMS personnel.

With so little information, it is difficult to determine the correct treatment to combat the effects of the illegal drugs. With drugs like Narcan, which is used to reverse the effects of opiate substances, the drug is usually harmless even if administered to a patient that had not taken an opiate substance.

A problem arises when responders have to administer drugs that may not react well with whatever the patient used. This has become more of an issue with the national influx of designer drugs. The chemical compounds are similar, but when mixed to create a drug cocktail, the effects increase.

Even with Narcan sometimes, there isn’t a guarantee drugs like it will have the same reactions.

“It’s important for responders to know that designer-drug users may not respond to naloxone in the same way a heroin user would respond,” said Barry Logan, chief of forensic toxicology at NMS Labs in Pennsylvania.

Kratom to join heroin, LSD on Schedule I drug list

From CNN Health:

Beginning September 30, kratom will be considered a Schedule I drug, a substance that has "no currently accepted medical use and a high potential for abuse," the Drug Enforcement Administration announced today.

Other Schedule I drugs include heroin, LSD, marijuana and ecstasy.

In this week's Federal Register, the DEA proposes designating the drug as Schedule I for up to three years. After that time, the status could be extended permanently. Up until this point, it has been considered a supplement, loosely regulated by the Food and Drug Administration.
 
Posted: 9/1/2016 3:57:00 PM

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Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs

From The New York Times:

They call it the poor man’s methadone.

The epidemic of opioid addiction sweeping the country has led to another form of drug abuse that few experts saw coming: Addicts who cannot lay hands on painkillers are instead turning to Imodium and other anti-diarrhea medications.

The active ingredient, loperamide, offers a cheap high if it is consumed in extraordinary amounts. But in addition to being uncomfortably constipating, it can be toxic, even deadly, to the heart.

A report published online in Annals of Emergency Medicine recently described two deaths in New York after loperamide abuse. And overdoses have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.

Most physicians just recently realized loperamide could be abused, and few look for it. There is little if any national data on the problem, but many toxicologists and emergency department doctors suspect that it is more widespread than scattered reports suggest.

Some toxicologists argue that the sales of loperamide should be limited, much as the nonprescription drug pseudoephedrine was restricted a decade ago to help prevent the manufacturing of crystal meth.

Posted: 8/29/2016 11:17:00 AM

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Party drug ketamine closer to approval for depression

From CNN:

The Food and Drug Administration put the experimental drug esketamine (also known as ketamine) on the fast track to official approval for use in treating major depression, Janssen Pharmaceutical announced Tuesday. This designated "breakthrough therapy" would offer psychiatrists a new method for treating patients with suicidal tendencies and would qualify as the first new treatment for major depressive disorder in about half a century.

In some quarters, though, this potentially effective medicine can't escape its reputation as "Special K," a street drug known for producing a high similar to an out-of-body experience -- and sometimes used as a date rape drug.

Ketamine was first synthesized in 1962 by Calvin Stevens at Parke Davis Laboratories, according to Encyclopedia Britannica. It received FDA approval for use in humans in 1970, and shortly after, Army doctors used the drug on American soldiers fighting in Vietnam as an analgesic and sedative. Yet its minor hallucinogenic side effects soon warned doctors off treating people. Today, ketamine's most common use is as a veterinary anesthetic.

A concern with using ketamine to treat depression is that it can reverse tolerance to opioids, Coffman said. Essentially, patients will get a higher dose of pain medicines, she explained, so any psychiatric uses would require "close oversight" by a multidisciplinary team of doctors.
Iosifescu said the short-term effects are known, but the long-term effects remain mysterious.
 
Another concern is the similarity between prescription ketamine and the street drug, a substance of abuse.

These are all reasons why Janssen's formulation will be provided and administered in doctors' offices or clinics, not distributed by pharmacies.
Posted: 8/22/2016 10:21:00 AM

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People Are Overdosing on ‘Game of Thrones’ Heroin

From TIME:

A dangerous strain of heroin with a “Game of Thrones” label has been circulating in Vermont and New Hampshire, where officials have counted nearly a dozen recent overdoses.

Vermont’s Department of Health said the strain of heroin is possibly laced with fentanyl, which makes the drug 50 times stronger. Fentanyl is a powerful opioid that is similar to morphine but is 50 to 100 times more potent, according to the National Institute on Drug Abuse. It’s usually used to treat severe pain.

The heroin bags being passed around bear the logo of the hit HBO show, which may be bolstering its popularity on the streets.

It was also involved in a 32-year-old man’s overdose in New Hampshire.

Posted: 8/16/2016 2:18:00 PM

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Another Powerful Painkiller Found in Prince's System: U-47700

From Eyewitness News 5 (Minneapolis/St. Paul):

Although it was a fentanyl overdose that killed Prince April 21, the medical examiner said it was part of a deadly chemical cocktail.

A source close to the investigation says U47700 was part of the mixture.  The potent painkiller is a synthetic opioid, eight times stronger than morphine.

Investigative sources told reporter Beth McDonough that Prince may have thought he was taking a legitimate painkiller, like hydrocodone or fentanyl, that unknowingly also had U-47700 in it.

The pills often look just like other medications.  Plus, U47700 can be resistent to the life-saving antidote Narcan. 

Because U-47700 is not considered a controlled substance by state or federal agents, it's not regulated.  The Drug Enforcement Administrations says it tends to be produced overseas in China or Eastern Europe.  It's widely available, easily accessible and affordable, about $40 online. 

New Synthetic Drug U-47700 Has States Rushing to Stop Spread

From The Associated Press:

A new synthetic drug that can be purchased online and is connected to at least 50 deaths nationwide has several states scrambling to stop its spread, with Kansas law enforcement agencies seeking an emergency ban.

At least three other states — Ohio, Wyoming and Georgia — already have taken action to ban U-47700 after it was connected to overdoses. A spokeswoman for the U.S. Drug Enforcement Administration said that the agency is studying the opioid but hasn't yet moved to control it.

Nearly eight times more potent than morphine, U-47700 comes in various forms and can be injected, snorted or taken orally.

The U in the name stands for Upjohn, a pharmaceutical manufacturer that developed the drug in the mid-1970s as scientists were looking for a synthetic alternative to morphine, said Barry Logan, chief of forensic toxicology at NMS Labs in Willow Grove, Pennsylvania, which provides lab services for government and private clients.

"They were searching for a novel painkilling drug, the holy grail of analgesics that didn't have the addictive or respiratory depression properties of opiates or heroin," said Logan, who recently spoke about synthetic opioids at an international conference in Budapest.

The Upjohn researchers devised and patented several different compounds in search of their super drug, Logan said. Some of the compounds were written about in scientific literature, including methods for making them.

Chemists in China and Eastern Europe can find recipes for many of the drugs — including U-47700 — by combing through online patent records and old scientific journals, he said.

NMS has identified about 50 deaths across the U.S. that can be connected to U-47700, which came onto the company's radar screen in December, Logan said.

A deadlier drug: Doctors suspect W-18 is spiking overdoses

From The Philadelphia Inquirer:

Legal synthetics have caused "upwards of 50 deaths" nationwide during the last four months, according to Barry Logan, director of the Center of Forensic Science and Education. The center is the nonprofit research arm of NMS Labs, which tests for the substances at its Willow Grove headquarters.

NMS confirmed one death in Illinois caused by W-18 and is investigating its role in another.

"The bigger problem right now is the designer opioid U-47700 and the designer fentanyl, furanyl, fentanyl," Logan said, adding that NMS had detected the two substances in a string of fatal overdoses that reached from Florida to Maine.


AAA: Driver pot test shown to be invalid

From the Rutland Herald:

A report recently released by the American Automobile Association backs up what Vermont lawmakers heard during the debate over legalizing marijuana: There is no scientific way to prove if someone is under the influence of the drug while driving.

The AAA report looked at the states of Colorado, Washington and Montana, which all have thresholds in place for how much THC can be in someone’s system before they are considered to be under the influence. Those states established a threshold of five nanograms of THC per milliliter of blood.

The report argues that the five nanograms threshold doesn’t work. After looking into the cases of drivers who were pulled over for DUI and had THC in their systems, AAA says a substantial number of those arrested would be misclassified as impaired and those who are actually impaired would not have been flagged by the test for THC.

The report looked into having thresholds from one nanogram to 10 nanograms of THC per milliliter, but it found no level of THC that would back up what police see while conducting field sobriety tests.

Those who frequently use marijuana can show high levels of THC despite not being impaired while occasional users will have the THC leave their system quickly, according to the report.

The report was put together by the Center for Forensic Science Research and Education in Willow Grove, Pennsylvania. That lab also gave the state the same results about not being able to scientifically prove someone is stoned when the state commissioned its own study last year.


A drug ovedose epidemic is hitting Northeast Florida

From The Florida Times-Union (jacksonville.com):

An epidemic of opioid use has been escalating in recent years, but a potent new painkiller has made a deadly appearance on the streets.

The culprit — fentanyl — is a synthetic pain-relieving drug 50 times more powerful than heroin and 100 times more powerful than morphine.

It can be a lethal killer when laced with its weaker cousin, heroin, or even sold undiluted as heroin itself.

A resurgence in heroin use means Jacksonville’s streets have become a killing field for fentanyl.

It is taking lives in escalating rates from California to Florida. Statistics weren’t even collected on fentanyl deaths as recently at 2014 in this state; but since then its use and its victims have skyrocketed.

“I signed out three (fentanyl-caused death) cases today,” Matthew McMullin, the toxicologist for NMS Labs, which conducts all the toxicological studies for the local medical examiner, said earlier this week.

Two of the bodies were originally suspected to be heroin overdoses but turned out to be fentanyl.

The other person had died due to an overdose caused by fentanyl patches usually used for pain relief. Four patches were on the body when usually one is enough to relieve pain.

Posted: 5/12/2016 12:02:00 PM

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