Cocaine, “Narcan Resistance” & the Grey Death: Fentalogs in 2017

By Terry Gotham

If you follow the news about adulterants in the recreational drug supply, it’s easy to get overwhelmed with the news breaking every day. Last Friday, the medical examiner’s office of Cuyahoga County in Ohio disclosed that they’re on track to obliterate their overdose record from last year. With 187 heroin/fentanyl overdoses on the books since Jan 1st, if things don’t change substantially, they’ll blow past their 2016 total of 660 overdose deaths by over a hundred people. If you missed my last article, multiple types of fentanyl are now being found in overdoses & drug seizures. And I don’t mean one or two. 24 fentanyl analogs & metabolites were found in blood/urine in Ohio overdoses alone:

1-3-Methylfentanyl; 4ANPP; Acetyl Fentanyl; Acetyl Fentanyl 4-Methylphenethyl; Acryl fentanyl; AH7921; Alfentanil; Beta-Hydroxythiofentanyl; Butyryl Fentanyl/Isobutyryl Fentanyl; Butyryl Norfentanyl; Carfentanil; Despropionyl Para-Fluorofentanyl; Fentanyl; Furanyl Fentanyl; Furanyl Norfentanyl; Norfentanyl; ParaFluorobutyryl/4-Fluoroisobutyrylfentanyl; Para-Methoxyfentanyl; Remifentanil; Remifentanil Metabolite; Sufentanil; U-47700; Valeryl Fentanyl
~Research Update on Fentayl Outbreaks in the Dayton, OH Area, Boonshoft School of Medicine, Wright State University, 4/28/17

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Do No Harm: Safe Injection Facilities in Fentanyl’s World

Analysis by Terry Gotham

But until recently, politicians dismissed the idea of a safe-injection site as being too controversial. More controversial than people dying in libraries and babies picking up needles on the beach? Please. San Francisco has essentially become one big unsafe injection site.
~Heather Knight, SF Chronicle “Safe injection sites offer hope in scourge of discarded syringes”

I wasn’t sure how to start this piece, a feeling I think mirrors the paralysis many policymakers feel when it comes to moving away from puritanical, expensive & needlessly harmful criminalization of controlled substances. In the case of the city policymakers, the opioid overdose epidemic has gotten so bad, they may be getting over it.  The SF Department of Public Works collected 13,333 syringes in San Francisco. In March. That’s 430 a day. In Ohio, there were 100 accidental drug overdoses in Mongomery County, Ohio in January & February alone, with an average age of 40. Here’s the kicker, 99 tested positive for fentanyl, and, 56% tested positive for acryl-fentanyl, 3 carfentanil cases, and 24 total fentanyl analogs and metabolites were found in total. 24. The majority of the cases tested positive for more than one “fentalog.” But of course, straight from the report:

All acryl fentanyl and furanyl fentanyl cases also tested positive for fentanyl; about 45% of acryl fentanyl cases also tested positive for furanyl fentanyl.
~Research Update on Fentanyl Outbreaks in the Dayton, OH Area: Acryl Fentanyl & Furanyl Fentanyl Commonly Found in Overdose Death Cases.

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Do No Harm: Initial Prescription Details Influence Chance of Opiate Dependence

By Terry Gotham

One of the biggest problems with writing about the War on Drugs is the almost exclusive focus on problems. There’s this myth that drug use is a combination between a ratchet & Russian roulette. It’s going to keep getting worse, and it gets harder and harder to “not be addicted” the longer you do it. This continued narrative is believed widely (just ask your family at Easter dinner), while being only lightly supported with evidence. Harm reduction & physician/client education is surprisingly effective at mitigating a lot of the factors that contribute to this “it’s probably going to kill you” problem, but outside of needle exchange/safe injection sites & drinking water while partying, complex harm reduction ideas rarely make it into non-academic circles. So, I’m going to start talking about constructive, modern ideas and research that have been either theorized, published or put into practice, about how to fight this deluge.

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The Elephant In The Emergency Room: Heroin & “Standard” Treatment

By Terry Gotham

I know that sometimes I can seem all doom & gloom about the state of the drug-consuming universe, but once and a while I happen upon something that justifies my concern. This letter by Dr. Leon Gussow, published in the Emergency Medicine News (March 2017) journal is one of those things.

The filtration of fentanyl & fentanyl analogs into the recreational opiate supply has pushed us into a place where the simple “opiate overdose” prognosis in emergency rooms & EMT visits is no longer simple. Previously, treating an opiate overdose involved a single dose of narcan/naloxone, with a few hours of observation before the patient was back on their feet. The patient was then assessed for discharge and removed from the workload of the emergency room if released. This allowed even severe opiate overdoses to be handled in a timely, almost mundane fashion, if the EMTs were timely and the staff was experienced. But as Dr. Gussow explains, this is no longer the case.

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W-18: A Novel Opioid The Media Is Getting All Wrong

By Terry Gotham

I try not to use Burners.me as a megaphone, but as I read about this substance & how it was being covered in the media, I needed to make an exception. To be clear, we have no evidence of this substance being found or consumed at Burning Man, but I believe it will become a problem in the painkiller consuming community on the West Coast over the next 18 months. W-18 is a novel analgesic that was patented as the 18th in a 32 compound series by a trio of Canadian researchers in 1984. First flagged by the European Monitoring Centre for Drugs & Drug Addiction in 2014,W-18 started turning up in prescription oxycodone pills seized by Canadian law enforcement in early 2015. It’s been banned by China, but the reasons why are unclear. The news stories on it started to pile up in April, so started digging. I found two scoops of sloppy reporting and a shocking lack of real information.

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