Monday, February 29, 2016

Lookalike Drugs With Fentanyl -- Deadly Roulette

Authorities are sounding the alarm about a new and deadly twist in the country's drug-addiction crisis in the form of a potent painkiller disguised as other medications.

Tennessee officials say they've seen two dozen cases in recent months of pills marked as the less potent opiates oxycodone or Percocet that turned out to contain fentanyl, a far more powerful drug. One official likened the danger to users playing Russian roulette each time they buy a pill on the street.

In San Francisco, the health department blamed several overdoses last summer on lookalike Xanax containing fentanyl, while Canada has issued warnings about multiple recent cases of lookalike oxycodone pills containing fentanyl.

And in suburban Cleveland, federal agents arrested a man this month after seizing more than 900 fentanyl pills marked like oxycodone tablets.

"'These pills are truly a fatal overdose waiting to happen,' said Carole Rendon, acting U.S. attorney in Cleveland.”

(Andrew Welsh-Huggins. “New twist in addiction crisis: Deadly painkiller impostors. The Virginian-Pilot. February 29, 2016.)

Lookalike Substances

Let's recap:

1. Fentanyl marked as oxycodone.

2. Fentanyl marked as Percocet

3. Fentanyl marked as Xanax

This deception = death. Fentanyl is fairly cheap to manufacture illicitly, so dealers are disguising it for higher return. What results? Abusers of opiates can get their hands on something much more lethal than they bargained for – lookalike substances containing fentanyl.

In Cuyahoga County, Ohio, lookalike pills were likely to blame for some of the 19 fentanyl-related overdose deaths in January, 2016, alone, according to Dr. Thomas Gilson, Cuyahoga County medical examiner. "This is all the more alarming because this is a much more lethal drug being dressed up as another popular drug abused by the same population," he said. Gilson added that lookalike pills point to the dangers of buying what appear to be pharmaceutical drugs off the street.

(Mark Gillispie. “Ohio officials say fentanyl pills being sold as oxycodone lookalikes.” Nordonia Hills News-Leader. February 15, 2016.)

Fentanyl, typically used for treatment of chronic pain in end-stage cancer patients, is 25 to 40 times more powerful than heroin. Fentanyl produced for the illegal market comes from Mexico, while chemically similar components have been traced to China, according to the U.S. Drug Enforcement Administration.

Make no mistake, fentanyl can be a deadly substance. The DEA says fentanyl-related overdoses killed more than 700 people nationwide between late 2013 and early 2015. Ohio experienced 502 fentanyl-related deaths in 2014, up from 84 the year before. In all, 2,482 people in Ohio died from accidental overdoses in 2014, an 18 percent increase over the previous year.

For some addicts, death by fentanyl is an unwitting mistake, as they often do not know the composition of what they buy on the street.

But, for others, something else drives the appeal to the substance.

Carole Rendon, acting U.S. attorney in Cleveland, told a tragic, unbelievable outcome of overdose deaths. She said, "When there is an overdose death, users do tend to flock to that drug dealer, because they think that he or she must have incredibly potent - either heroin or fentanyl or a combination thereof.” What a sad, sad commentary on the devastating power of opioid addiction.

Nora D. Volkow, Director of the National Institute on Drug Abuse says, “The reason for this behavior is addiction, or one of its fundamental features: the ability to alter people's brains such that they can no longer exercise proper judgment or experience normal pleasures. Along with displacing natural "reinforcers" such as food, family, and friends, drugs of abuse also eventually lose their ability to reward, placing the addict on a compulsive quest for more drug and for greater drug potency as their reward circuitry becomes increasingly blunted and desensitized.”

Some good news? China announced in October it would regulate the sale and distribution of 116 chemical compounds used in the production of synthetic drugs, including acetyl-fentanyl.

The National Institute on Drug Abuse says that fentanyl is a Schedule II prescription drug. It is a powerful synthetic opiate analgesic similar to but more potent than morphine. Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions.

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form.

Combined with heroin and used in powder form, fentanyl represents an intersection of prescription drug with street drug and reminds us of the potential dangers associated with the abuse of both -- particularly as the abuse of prescription painkillers continues to grow in young adults and youth.”
--Nora D. Volkow, Director of the National Institute on Drug Abuse

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