# "Heroin" Overdoses



## Jon (Apr 24, 2006)

Recently there have been several news stories locally regarding a "bad batch" of "heroin" - it seems to be superpotent and is killing people. There have been several cases recently in Camden, NJ and Philadelphia, PA.

Since I'm less than an hour from both... I'm slightly concerned.

The following bullitin was posted on a local forum, attributed to the Maryland State Poison Control folks.... I haven't been able to find it online anywhere yet... so I'm not SURE of the EXACT source for this, *and I'm not sure how correct it is.*

I still wanted to post this here for everyone to see... and get the heads up.

This is PROBABLY a local problem, but you can never tell.

Jon



> ******Opioid Overdoses in Maryland******
> 
> 
> 
> ...


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## emtI (Apr 24, 2006)

I received an alert from our state board of health today on this very subject.  I assume it's accurate, but I'll compare it tomorrow with what I received at work.


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## podmedic@mac.com (Apr 25, 2006)

*The Overdose Alert is correct*



			
				emtI said:
			
		

> I received an alert from our state board of health today on this very subject.  I assume it's accurate, but I'll compare it tomorrow with what I received at work.



:excl: I got this by email as part of my subscription to the Maryland Poison control newsletter.  I posted the letter here on the MedicCast Podcast blog.

You can subscribe to the newsletter here.  You don't have to be a Maryland provider.  They send out a lot of great general info about a variety of topics like plant poisonings in the spring, new club drugs, and alerts like the one reported above.


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## Jon (Apr 25, 2006)

What is funny is that they don't post the alert on thier webpage.... so I couldn't confirm it.


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## Jon (May 31, 2006)

*Drug Cocktail Causing Overdoses from Philadelphia to Chicago*

OAS_AD('POS_300x250');




*SARAH KARUSH*
Associated Press Writer


Larry, a 53-year-old heroin addict, has two cardinal rules: Never shoot up alone, and shoot up only one person at a time. If one overdoses, "you need someone there to bring you back," he said.

Larry, who asked that his last name not be used because of his habit, recited his rules after hearing that a mixture of heroin and a powerful painkiller has been killing users who believe they are taking heroin alone.

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=3474

AP article in the paper Saturday or Sunday...

We've been seeing this locally... County-wide, I think we've had a couple of OD's that were DOA, and a bunch that came back with a LOT more Narcan than they should have needed.

This has become such a problem that the medics are carring an extra 2 or 4 MG of narcan in their bags.


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## MMiz (May 31, 2006)

This is a huge issue in Michigan right now.  I saw several notices posted in the crew lounge.

There are something like over 100 deaths in Detroit because of the "bad batch."


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## Jon (May 31, 2006)

MMiz said:
			
		

> This is a huge issue in Michigan right now. I saw several notices posted in the crew lounge.
> 
> There are something like over 100 deaths in Detroit because of the "bad batch."


Yeah... the article says Detroit is sort of the "epicenter" but Camden NJ (just east of Philly) was where it first started showing up earlier this year in quanities.

The other thing - it isn't so much a "bad batch" - some of this is supposed to be 98% pure fentanyl... I want to know where they are getting it in such large quantities. It isn't really "bad" but mis-labeled...


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## Imagine (May 31, 2006)

This reminds me of a film I just saw in psychology where this crazy chemist made a super strong batch of heroin and sold it to dealers, knowing well it could kill people. It's probably not the same thing at all, but that's what it made me think of. 

Luckily I'm a few hundered miles away.


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## podmedic@mac.com (Jun 1, 2006)

Imagine said:
			
		

> Luckily I'm a few hundered miles away.



:wacko: A few hundred miles distance may not be enough.  Here's a link from a UK paramedic's blog about some potent opiates they've run into recently.

Random Acts of Reality blog

Check it out, he writes about some pretty cool stuff.


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## Wingnut (Jun 1, 2006)

Wow. We haven't seen that here, yet. I wonder what made them think to do that, I was on fentanyl patches last year for pain management for my ankle and I loved it because it didn't make me high or loopy and it got rid of the pain.


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## Tactical Medic (Jun 6, 2006)

it's all a "bad batch" thats why it illigal <_<  

I remember having 6 people all OD within a half hour on the same intersection, Just my suggestion, and go by your local proticals but if you can avoid an IV do it.... Most of these IVDA's are HIV/HBV etc.  Worse thing you can do to yourself is give a rapid dose of Narcan and have them puke or ripping their IV out in your bus.  I usually do a 1-2mg (depending on resp rate) IM, and massage the site.  

"bad batchs" are IMO "bad" if mixed with hullicinigins, then it can get ugly after you "rob" them of their high, another reason for no IV, if you suspect that, first restraint the junkie  

Remember to play safe out there....


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## Jon (Jun 6, 2006)

great point, Tactical Medic.

We are the "suburbs." Around here, everyone gets an IV, enough Narcan to wake them up, and then they go to the ED.


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## Jon (Jun 6, 2006)

*Drug czar: U.S. shuts down key source of deadly drug*

*Drug czar: U.S. shuts down key source of deadly drug*




		Monday, June 5, 2006; Posted: 2:53 p.m. EDT (18:53 GMT) 
​*CHICAGO, Illinois (AP) -- U.S. drug czar John Walters said Monday that federal agents, working in cooperation with the Mexican government, have closed down a lab in Mexico that might be the main source of the powerful painkiller fentanyl, which has killed heroin users in eight states.*

Walters, the director of the White House Office of National Drug Control Policy, said it's still not clear whether the fentanyl was mixed with heroin at the lab in Mexico or after it entered the United States. Fentanyl-laced cocaine also has turned up in some cities, he said.

<snip>

http://www.cnn.com/2006/WORLD/americas/06/05/mex.bust.ap/index.html


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## fyrdog (Jun 11, 2006)

In the early 90s in Hartford we had herion cut with fentanyl. it's street name was Tango&Cash. We had to give 4mg or more of narcan to get these guys breathing again followed by a narcan drip to keep breathing. Mix the narcan same as a lido drip and adjust the rate for effect.

Many of the drug wrappers have some type of logo on them. If you can find them you can better know what your dealing with.


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## Flight-LP (Jun 11, 2006)

I am curious as to why some people insist on waking their OD patients up with Narcan?


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## MMiz (Jun 12, 2006)

Flight-LP said:
			
		

> I am curious as to why some people insist on waking their OD patients up with Narcan?


I'm guessing it's the same reason they he work a 90 year old coding patient.  It's our job.

Detroit and the burbs have been seeing an absurd about of the heroin/fentanyl lately.  It's bad stuff.


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## Tactical Medic (Jun 12, 2006)

fyrdog said:
			
		

> In the early 90s in Hartford we had herion cut with fentanyl. it's street name was Tango&Cash. We had to give 4mg or more of narcan to get these guys breathing again followed by a narcan drip to keep breathing. Mix the narcan same as a lido drip and adjust the rate for effect.
> 
> Many of the drug wrappers have some type of logo on them. If you can find them you can better know what your dealing with.




T&C was the same stuff sold in The Bronx, I'm sure the quick 45min ride to Ct can transport a bunch of the stuff up there...


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## Flight-LP (Jun 12, 2006)

MMiz said:
			
		

> I'm guessing it's the same reason they he work a 90 year old coding patient.  It's our job.
> 
> Detroit and the burbs have been seeing an absurd about of the heroin/fentanyl lately.  It's bad stuff.



Might be yours, but my OD patient that present unconscious, stay unconscious. They are receive a nice ET tube and OG tube to help keep open the items that need to stay open, but the last thing I want to do is wake 'em up. Consider the risks vs. the benefits, keeping them down can be benefical...


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## fyrdog (Jun 13, 2006)

No need to wake them all the way up. Just enough so they can breath and maintain their own airway is enough.


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## Tactical Medic (Jun 13, 2006)

fyrdog said:
			
		

> No need to wake them all the way up. Just enough so they can breath and maintain their own airway is enough.




I concur


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## MMiz (Jun 13, 2006)

I think we're on the same page actually.  Many medics have said that they've "saved" just as many heroin OD patients with a BVM and ET tube.  I was just getting a bit worried you were totally avoiding the pt.


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## Jon (Jun 13, 2006)

fyrdog said:
			
		

> No need to wake them all the way up. Just enough so they can breath and maintain their own airway is enough.


I gotta agree with this point - get their respiratory drive back, don't wake them up.

I've seen both versions in Philly... and boy, it makes it a lot easier if we get them into the ED and tied down before we go to wake them up...

Out in our nice, quiet area, where we really rarely saw OD's (until the Fentnyl came out) - it is really hit or miss. The medics who worked/rode in the city and remember what a PITA an OD is when you take their $20 high away, they just get them breathing... they might even tube them (becuase our medics NEVER get to tube).


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