“Ultra-Deadly” Street Drugs Make Their Way to San Diego

If you’ve ever suffered from catastrophic pain, there may be no greater gift than fentanyl.

For acute pain, fentanyl is the nuclear option. It is 50 to 100 times stronger than morphine and 30 to 50 times more powerful than heroin. Because of its potency, strict prescribing guidelines must be followed. People without previous exposure to opioids should not be candidates for the drug. Fentanyl can cause central nervous system depression, dangerously low blood pressure, impaired breathing and death. When prescribed fentanyl, great care should be taken to make sure the drug is carefully titrated – i.e. determining a dose that delivers the most pain relief while using the least amount of the drug – and the user’s progress should be carefully monitored. This drug should absolutely not be used without medical supervision. Even under these circumstances, a study has shown that prescribing is still not safe in 50 percent of prescriptions¹.

Ultra-deadly

“Ultra-deadly” is often the way fentanyl is described – deadlier even than heroin. This is because fentanyl crosses the blood-brain barrier and binds with the brain’s μ-opioid receptors faster than any opioid including morphine and heroin. It also results in even greater euphoria. It takes milligrams of other opioids to have the same effect as micrograms of fentanyl. An average clinical dose of fentanyl is 125 micrograms, about the equivalent of two grains of table salt. Miniscule amounts of fentanyl can have devastating consequences. Trace amounts can easily be absorbed through inhalation or absorbed through the skin. Young children accidentally exposed to a transdermal fentanyl patch can become seriously ill or die².

To repeat: Fentanyl is painkilling mega-bomb that should only be used for the treatment of catastrophic pain and then only under the strictest of conditions. To use recreationally or to otherwise abuse this “ultra-deadly” drug is extremely dangerous and life-threatening. Never buy fentanyl – or other opioids – from questionable sources. An overdose with fentanyl, more than any other opioid, is most likely to be fatal.

The Devil Comes to San Diego

In February a man crossing the Mexican border into San Diego was discovered to be carrying more than 1,000 counterfeit pills in his underwear. Labeled as oxycodone, after testing by the Drug Enforcement Administration (DEA) lab, the pills were found to contain fentanyl³. Had these drugs made it to the streets of San Diego, or wherever they were going, they would’ve been taken by people who had no idea how powerful these pills were. Many would’ve overdosed.

Fentanyl has been seized in San Diego County in the last nine months. During one incident, straight fentanyl was found disguised as a brick of heroin. Fentanyl-related overdose deaths have also been surging across the country. Presently, they are highest in West Virginia, New Mexico, New Hampshire, Kentucky, and Ohio. Just this year in Sacramento, counterfeit fentanyl-tainted pills caused 42 overdoses over two weeks resulting in 10 deaths. In 2013, there were 84 fentanyl and heroin related deaths in Ohio; by 2014 that number rose to 503. And the rates could be much worse: Very often, fentanyl as cause of death is not reported.

The Dealer’s Ideal

From a seller’s viewpoint, fentanyl is an ideal product. Unlike heroin which must be grown from a plant, extracted, converted, and transported, fentanyl’s synthesis process is relatively easy. Because it is of higher potency, it can be moved more compactly than heroin. It’s also cheaper. So cheap, in fact, that it has been used increasingly to cut heroin and cocaine. According to the DEA, some traffickers have been selling 100 percent fentanyl and calling it “heroin.” Already in many parts of the U.S., fentanyl is killing more people than heroin. According to the CDC investigators, that number will likely keep growing⁴. From 2013 to 2014 alone the number increased by 79 percent. At the same time in San Diego county, fentanyl deaths increased by 75 percent.

And That’s Not Even the Worst of It

It sounds like science fiction: A synthetic opioid that’s 100 times more potent than fentanyl and 10,000 times more potent than morphine.

But it’s not fiction. It’s called W-18 and it has no known clinical use outside of scientific research. It was originally developed by a group of Canadian scientists in the early 1980s and has never been studied on humans or manufactured by a pharmaceutical company though its chemical structure was published in medical journals. Because of the low quality of its manufacture, poor mixing of active ingredients can create concentrated “hot spots” which can cause deadly overdoses, requiring only microscopic amounts of the drug. It is speculated that W-18 is being made in clandestine Chinese laboratories and shipped through couriers like FedEx. It was recently found in Canada and it appears to be on its way to the U.S. This even ultra-deadlier drug was discovered being sold in pills. Investigators believe it is being sold on the streets as oxycodone and heroin.

Another novel synthetic opioid hitting the streets is U-47700. Not as powerful as fentanyl or W-18 – it is 7.5 times more powerful than morphine – but it has one insidious advantage: It is cheap. Its street value is about half the cost of fentanyl.

How to Spot the Deadly

How can you tell if fentanyl is in a drug?

In pill forms, it is often impossible to know. Both fentanyl and W-18 can’t be detected by smell or taste. When used to cut heroin, fentanyl can be detected by its color. Heroin is a powder usually with a brownish or yellowish tint; fentanyl can appear as bright white. Fentanyl overdose symptoms are similar to those of heroin in that the victim acts lethargic and disoriented, experiences shallow and slowed breathing, a slowed heart rate and low blood pressure. It’s the respiratory depression that causes death. A victim may not respond to naloxone, an antidote medicine that can block or reverse the effects of opioids. If a victim doesn’t respond to an initial dose of naloxone this can be an indication of fentanyl use. More naloxone will be needed.

As for W-18, most hospital labs are not even equipped to spot the chemical. Pills manufactured W-18 are often greenish in color. There’s no evidence to suggest that naloxone is effective against W-18. According to the Director of the Center of Forensic Science and Education, W-18 has been responsible for 50 deaths nationwide in the last four months alone.

Then There’s the Problem of Counterfeiting

It is generally impossible to tell if a counterfeit pill has been made with fentanyl. Counterfeits are often made in homemade labs. By appearance they may not be shaped as consistently, color may be slightly off, or they may appear dirty as they are often made in unhygienic conditions. Fakes can sometimes crumble more easily. The imprints may not be as clean and crisp or as centered as they would be on legitimately manufactured pills.

Counterfeits are primarily manufactured in Mexico and China. FDA Commissioner Margaret Hamburg said that “in some parts of the world, somewhere between 30 percent 50 percent of drugs to treat serious diseases are actually counterfeit⁶.” The World Health Organization (WHO) says that 100,000 to a million people die every year worldwide due to falsified drugs, and the numbers of counterfeit drugs in the market are increasing rapidly. A study shows that 90 percent of drugs purchased online come from a different country than the website claims and that internet pharmacies often buy drugs from countries with lax regulatory systems. This means that it can be hard to know the quality and constituents of the drug you’re buying. According to the FDA, drugs sold on online may contain the wrong ingredients, incorrect quantities of ingredients, or may be composed of inferior materials like drywall and eggshells.

And it’s not just fentanyl being found in counterfeit pills: In one survey, the FDA found that customers who had ordered drugs like Ambien, Xanax, Ativan, and Lexapro online instead received pills of Haldol, a potent anti-psychotic that can be extremely dangerous. Worldwide, lifesaving medications like antibiotics and anti-malarial drugs have been found to contain a fraction of the necessary active ingredients.

What’s the world’s most counterfeited drug? Viagra.

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