Alert #20
05/26/2006
Ohio Early Warning Alert
Ohio Resource Network for Safe and Drug Free Schools and Communities
“Bad” Heroin Found After Epidemic of Overdoses
This information is provided as a supplement to the earlier alert on Heroin and Fentanyl abuse, and contains detailed information provided by the Cincinnati Drug and Poison Information Center.
In late April, 2006, the Cincinnati Drug and Poison Information Center was alerted to details involving an increased number of reported heroin overdoses in South New Jersey. Two deaths were reported at the time along with 30 additional cases. Many of those seeking treatment required higher than normal amounts of the antidote naloxone (Narcan®) to be administered.
What does all this mean?
At the time, it was one alert, in one place, at one time, but we have come to learn that this was not an isolated incident. Since this alert went out, other reports starting coming in, and increased numbers of heroin overdoses were reported in other states as well, including Maryland, Delaware, Illinois, Michigan, Virginia, and Pennsylvania. Combined, SEVERAL HUNDRED DEATHS have now been reported in these states, along with one related death in Ohio. This indicates that what was considered an isolated incident is actually a widespread epidemic.
The investigation begun at the time revealed that heroin being distributed in these areas contained another, more potent narcotic, fentanyl. The addition of fentanyl to the heroin supply creates a much higher risk of overdose and death to the population using it.
What is Fentanyl?
Fentanyl is synthetic opioid that has a very high potency, reported to be more than 80 times the potency of morphine. It is a short-acting opioid, and is legally manufactured as a transdermal patch (Duragesic®), an oral transmucosal lozenge (Actiq®), and as an injectable product (Sublimaze®). Fentanyl is commonly used for pain control, either from surgery in a hospital, or pain related to chronic conditions such as cancer. While fentanyl acts on the brain to decrease pain sensation, it also causes nervous system depression resulting in profound drowsiness, and slowing of both heart and lung function. In the case of an overdose, these effects may be deadly.
What slang names describe this designer Fentanyl?
Some of the first slang names to be coined for the designer fentanyl included Capone and Flat line. Several others have emerged over time, and include the following: Infamous, TNT, THA truth, Snowman, Lethal injection, Tango, Tsunami, and DOA. It is expected that other slang terms may transpire over time, and at the same time it is also expected that dealers will use these terms to sell drugs other than this particular designer drug. Slang terms may not be consistent with actual content expected.
What makes these cases with Fentanyl special?
Fentanyl that is legally produced can be found as a particular salt form, that is, fentanyl citrate. All of the above listed FDA-approved fentanyl products contain the citrate salt. The type of fentanyl found in the overdose cases was a different salt form, fentanyl hydrochloride (HCl). The two salt forms start with different precursor chemicals that may be found in the finished product. The designer drug, fentanyl HCl, is illicitly produced in clandestine labs, and the precursor chemical, 4-Anilino-N-Phenethyl-Piperidine (4-ANPP or ANPP) has been showing up in samples obtained from overdose victims and drug confiscated from the street. The ANPP “signature” that can be identified in samples indicates the particular recipe used to create the fentanyl, often referred to as the “Siegfried method”. Authorities are encouraged to identify the type of salt form when faced with overdose victims suspected to be related to this designer drug fentanyl.
What are the dangers of using Fentanyl in combination with, or in place of, heroin?
There is an increased risk of toxic effects when fentanyl is put into the heroin supply chain. Toxicity is similar to other opioids, with the expected side effects of drowsiness, decreased breathing, lowered blood pressure and heart rate, coma, and death. In combination with other drugs, the effects may be enhanced and toxicity may occur with smaller amounts. The higher potency of fentanyl as a heroin additive or substitute increases the risk of coma and death for the unsuspecting user.
Why would someone make bad heroin?
The Drug Enforcement Administration (DEA) has been attempting to answer this question since the epidemic was identified. Was there short supply of real heroin? Supplying a more potent narcotic in its place may make sure that demand is met while new supplies are created and shipped. Could it be a marketing ploy? The old adage of “more is better”, or “bad” = “good”? Are sales driven purely by monetary reasons? The sale of illicit substances has always been profitable to the seller and as it turns out, it is no different in this case. Return on investment for making designer fentanyl is phenomenal. For less than $200 in precursor chemicals, a street value profit of close to $500,000 may be obtained from sale of the finished product.
Why would people use “bad” heroin?
While many heroin users have steered clear of the “bad heroin”, many others deliberately seek the drug. Why would a person seek a drug that could kill them with one use? When an active drug user is asked the question, the answer may not be too surprising. The high experienced with initiation to heroin is powerful, and the euphoria intense. The intensity of the “rush” becomes the feeling that is sought after with subsequent use. Over time, however, users develop tolerance, and require more heroin to achieve the same desired effect. When a new drug hits the street that promises a “bigger bang for the buck”, users flock to it, rather than away from it. They repeatedly chase that intense feeling produced with drug initiation. So even if use could result in death, users seek out combinations or perceptually more powerful drugs to produce an enhanced euphoria.
How do you detect Fentanyl?
Fentanyl is not typically detected using routine opiate screens, which primarily identify morphine and codeine. Therefore, an exposure to fentanyl cannot be ruled out based upon initial screening that is negative for opiates. Special gas chromatography screening is necessary to identify fentanyl in a blood or urine specimen. More detailed screening may be necessary to further differentiate the particular fentanyl salt used to make the drug to separate illicit from legitimate manufacture. While it may not be routinely performed, testing for fentanyl should be considered whenever an opiate/opioid overdose is suspected due to the recent epidemic with designer fentanyl on the street.
Investigation into the spread of designer fentanyl into the heroin supply is ongoing, and details continue to emerge as to the scope of the problem. As it continues to unfold, the danger associated with the epidemic is threatening the health of our children, families, and patients in our communities.
Product information input from: Jan Scaglione, BS, MT, PharmD, DABAT Cincinnati Drug and Poison Information Center (1-513-636-5111).
This warning is being sent to inform parents, prevention and treatment professionals, law enforcement, and educators of this emerging trend. Please distribute this information through list serves, newsletters or bulletin boards, etc. using the Ohio Early Warning Network as your source.
For additional information on the above alert contact: The Ohio Resource Network for Safe and Drug Free Schools and Communities, P.O. Box 210109, 2624 Clifton Ave Cincinnati, Ohio 45221-0109 Phone # 1-800-788-7254 or fax# 1-513-556-0782.
To participate in this OEWN initiative, visit www.ebasedprevention.org and fill out the OEWN registration form. Anyone in Ohio can report an issue to the Ohio Early Warning Network by calling the toll-free non-emergency InfoLine at 1-866-OhioEWN.
This alert is brought to you by the Ohio Early Warning Network initiative sponsored by: the Ohio Department of Alcohol and Drug Addictions Services, The Ohio Department of Education, and the Ohio National Guard
The information appearing on this alert is presented for educational purposes only. While the information published on this site is believed to be accurate, it is not intended to substitute for your own informational gathering or professional medical advice.
