"Heroin" Overdoses

[Jon]

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******



Wicomico County, MD, reported an outbreak of 6 opioid overdoses on
Thursday April 20th 2006. Patients presented with respiratory
depression, CNS depression and circumstantial evidence of IV drug use.
Urine toxicology was negative in all 6 cases. Some patients responded to
naloxone. One patient died.



A highly potent opioid (e.g.fentanyl, sufentanil, methyl fentanyl,
remifentanil, alfentanil,…) was suspected.



New Jersey and Philadelphia have encountered similar cases during the
same time frame.



Analysis by the Wicomico County Police Crime Lab of drug paraphernalia
samples from Wicomico County and Somerset County revealed the following:

- 4/4 positive for fentanyl

- 4/4 positive for procaine

- 3/4 positive (very weakly) for heroin.



These results provide the first solid evidence that fentanyl was
involved. There is still a possibility that a fentanyl analogue was
implicated, but that determination has not been made yet. Clinically,
this will not make a difference.



Fentanyl is a short-acting, highly potent opioid agonist. It is
approximately 50-100 times more potent than morphine. Regional outbreaks
of “super potent heroin” (e.g. alpha-methyl fentanyl) are reported in
1988 (Pittsburgh), 1992 (Philadelphia), and more recently in New York City.



Because of the extreme potency of fentanyl, a larger-than-normal dose of
naloxone may be required for reversal of the opioid effects. If the
patient is apneic, start with 2 mg naloxone IV every 2 minutes until 10
mg is reached. If there is no response to 10 mg naloxone IV, then
fentanyl is unlikely to be responsible for the respiratory depression.
Fentanyl will not cross react with the opiate urine toxicology screen.

 

[emtI]

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.

 

[podmedic@mac.com]

The Overdose Alert is correct

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.

 

[Jon]

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

 

[Jon]

Drug Cocktail Causing Overdoses from Philadelphia to Chicago

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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.

 

[MMiz]

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."

 

[Jon]

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...

 

[Imagine]

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.

 

[podmedic@mac.com]

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.

 

[Wingnut]

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.

 

[Tactical Medic]

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....

 

[Jon]

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.

 

[Jon]

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

 

[fyrdog]

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.

 

[Flight-LP]

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

 

[MMiz]

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.

 

[Tactical Medic]

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...

 

[Flight-LP]

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...

 

[fyrdog]

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

 

[Tactical Medic]

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

I concur