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Chemical Health Hazard – Fatal Opioid Drug Poisoning (Alert): British Columbia, Canada

2017/02/03

Carfentanil or carfentanyl (Wildnil)

CARFENTANIL OVERDOSE – CANADA: FATALITY, ALERT
***************
Published Date: 2017-02-02 23:03:23
Subject: PRO/AH/EDR> Carfentanil overdose – Canada: fatality, alert
Archive Number: 20170202.4811717

Date: Wed 1 Feb 2017 7:17PM EST
Source: The Canadian Press and CTV news [edited]

The appearance of the deadly opioid carfentanil may explain the dramatic spike in overdoses in British Columbia, despite efforts to slow the carnage, the provincial health officer says.

Dr. Perry Kendall said as the number of [drug] overdose deaths climbed to record levels in November and December [2016], officials suspected the synthetic drug (Wildnil) normally used as a tranquilizer on large animals like elephants was to blame.

B.C.’s Health Ministry announced [Wed 1 Feb 2017] a small number of urine tests conducted over a 2-week period at drug treatment facilities across Metro Vancouver tested positive for carfentanil.

“It’s not good news, it’s confirmation of what we had feared,” Kendall says. “It means the drug supply has become considerably more dangerous than it was beforehand.”

The ministry says carfentanil can be 100 times more toxic than fentanyl, the drug at the root of the province’s overdose crisis.

The tests were done on 1766 urine samples. Fifty-seven were positive for carfentanil.

Kendall said because the samples were collected from people already in treatment, the numbers may not be representative of what’s happening on the streets.

“It may under-represent the actual extent to which carfentanil is present,” he said.

There is no reliable way for people to know if carfentanil is laced with other illicit drugs, and the Health Ministry is urging users to follow harm-reduction measures, such as having someone sober present and carrying the opioid antidote naloxone.

Kendall said overdose prevention sites that have been set up in a number of cities become even more important in light of the increased risks.

He also urged occasional drug users who may experiment with substances like ecstasy to steer clear.

“You don’t know what you’re getting. It’s much more dangerous,” he said.

The drug testing is part of surveillance measures related to a public health emergency declared last April [2016]. There were 914 illicit drug overdoses last year in B.C., the highest number on record.

Kendall said the presence of carfentanil doesn’t change the way the province has responded to the crisis, but it does make matters more urgent.

Officials are working to create more options for treatment and make it easier to access, he said.

“It’s a little hard to imagine how we could be running any faster, to be honest, but we have to try.”

The ministry said it is getting weekly surveillance reports on carfentanil and police are giving priority to investigations into drug trafficking because of the overdose crisis.

The RCMP (Royal Canadian Mounted Police) and China’s ministry of public security are working together to disrupt the supply of illegal carfentanil, fentanyl and other opioids coming into Canada. [Hopefully, synthetic opiods as well. – Mod.TG]

British Columbia’s toxicology centre, which provides forensic analysis on overdose fatalities to the coroner, recently bought new instruments that are more sensitive and accurate in testing for carfentanil and other opioids, and regular testing is expected to begin next month [March 2017].

The ministry said carfentanil was already found at the site of one overdose fatality in the province, but results are still pending on whether it was the cause of the death.

The total number of fentanyl-related overdose deaths for 2016 is expected to be updated in March [2017], however, previous data shows the substance was detected in about 60 percent of deaths between January and October.

[Byline: Linda Givetash, The Canadian Press]


Communicated by:
ProMED-mail
<promed@promedmail.org>

[Carfentanil is a synthetic opioid. The question on my mind is how did the individual (s) acquire the drug? What was the source? The internet? A photo on the original site shows the drug in a printer cartridge but it does not explain how the individual(s) acquired the drugs. It is a controlled substance, and as such it clearly must have an underground market.

According to the US Drug Enforcement Agency (DEA), several warnings have been issued (https://www.dea.gov/divisions/hq/2016/hq092216.shtml):

22 Sep 2016
Contact: DEA Public Affairs
(202) 307-7977
DEA Issues Carfentanil Warning to Police and Public
Dangerous opioid 10 000 times more potent than morphine and 100 times more potent than fentanyl.

22 Sep 2016 (Washington) – DEA has issued a public warning to the public and law enforcement nationwide about the health and safety risks of carfentanil. Carfentanil is a synthetic opioid that is 10 000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin. DEA, local law enforcement, and 1st responders have recently seen the presence of carfentanil, which has been linked to a significant number of overdose deaths in various parts of the country. Improper handling of carfentanil, as well as fentanyl and other fentanyl-related compounds, has deadly consequences.

“Carfentanil is surfacing in more and more communities.” said DEA Acting Administrator Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous. Synthetics such as fentanyl and carfentanil can kill you. I hope our 1st responders — and the public — will read and heed our health and safety warning. These men and women have remarkably difficult jobs and we need them to be well and healthy.”

Carfentanil is a Schedule II substance under the Controlled Substances Act and is used as a tranquilizing agent for elephants and other large mammals. The lethal dose range for carfentanil in humans is unknown. However, as noted, carfentanil is approximately 100 times more potent than fentanyl, which can be lethal at the 2-milligram range, depending on route of administration and other factors.

Carfentanil and other fentanyl-related compounds are a serious danger to public safety, 1st responder, medical, treatment, and laboratory personnel. These substances can come in several forms, including powder, blotter paper, tablets, and spray; they can be absorbed through the skin or accidental inhalation of airborne powder. If encountered, responding personnel should do the following based on the specific situation:

Exercise extreme caution. Only properly trained and outfitted law enforcement professionals should handle any substance suspected to contain fentanyl or a fentanyl-related compound. If encountered, contact the appropriate officials within your agency.

Be aware of any sign of exposure. Symptoms include: respiratory depression or arrest, drowsiness, disorientation, sedation, pinpoint pupils, and clammy skin. The onset of these symptoms usually occurs within minutes of exposure.

Seek IMMEDIATE medical attention. Carfentanil and other fentanyl-related substances can work very quickly, so in cases of suspected exposure, it is important to call EMS immediately. If inhaled, move the victim to fresh air. If ingested and the victim is conscious, wash out the victim’s eyes and mouth with cool water.

Be ready to administer naloxone in the event of exposure. Naloxone is an antidote for opioid overdose. Immediately administering naloxone can reverse an overdose of carfentanil, fentanyl, or other opioids, although multiple doses of naloxone may be required. Continue to administer a dose of naloxone every 2-3 minutes until the individual is breathing on his/her own for at least 15 minutes or until EMS arrives.”

Naloxone, the reversal agent for many opiod and synthetic opiods is readily available at may overdose treatment centers, hospitals and other treatment facilites

Remember that carfentanil can resemble powdered cocaine or heroin. If you suspect the presence of carfentanil or any synthetic opioid, do not take samples or otherwise disturb the substance, as this could lead to accidental exposure. Rather, secure the substance and follow approved transportation procedures.

Carfentanil is a fentanyl-related substance not approved for use in humans. In June [2016], DEA released a Roll Call video to all law enforcement nationwide about the dangers of improperly handling fentanyl and its deadly consequences. Acting Deputy Administrator Jack Riley and 2 local police detectives from New Jersey appear on the video to urge any law enforcement personnel who come in contact with fentanyl or fentanyl compounds to take the drugs directly to a lab.

“Fentanyl can kill you,” Riley said. “Fentanyl is being sold as heroin in virtually every corner of our country. It’s produced clandestinely in Mexico, and (also) comes directly from China. It is 40 to 50 times stronger than street-level heroin. A very small amount ingested, or absorbed through your skin, can kill you.”

Two Atlantic County, NJ detectives were recently exposed to a very small amount of fentanyl, and appeared on the video. Said one detective: “I thought that was it. I thought I was dying. It felt like my body was shutting down.” Riley also admonished police to skip testing on the scene, and encouraged them to also remember potential harm to police canines during the course of duties. “Don’t field test it in your car, or on the street, or take if back to the office. Transport it directly to a laboratory, where it can be safely handled and tested.” The video can be accessed at: http://go.usa.gov/chBgh.

The warning from the DEA is especially important as it includes animals. Pets are especially sensitive as well and could encounter the substance from the paraphernalia of an owner-user. Do not neglect signs of sudden collapse in your pets. – Mod.TG

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/12.]

See Also

Carfentanil overdose – USA (PA): fatality, alert 20170114.4764919
………………………………………….sb/tg/ec/mpp

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


Related

2016/10/25

Synthetic Fentanyl Fueling Surge in Overdose Deaths: CDC

THURSDAY, Aug. 25, 2016 — Deaths from overdoses of the synthetic narcotic fentanyl have surged in recent years, government health officials say in a troubling new report.

As more fentanyl was sold illegally on the streets, the number of fatal overdoses jumped 79 percent in 27 states from 2013 to 2014, the government report found, while law enforcement seizures of the drug increased 426 percent in eight of those 27 states.

“Fentanyl is a powerful opioid that is 50 to 100 times more potent than morphine, and it is available by prescription, but evidence indicates that illicitly made fentanyl is more likely a powder mixed with heroin and or sold as heroin,” said report author R. Matthew Gladden. He’s a behavioral scientist at the U.S. Centers for Disease Control and Prevention.

The fentanyl crisis is being driven by products made illegally, not by the diversion of prescription fentanyl, Gladden noted.

Recently, the U.S. Drug Enforcement Administration reported that synthetic fentanyl was showing up mixed with prescription narcotic painkillers, and “this is a new and emerging threat,” Gladden said.

Most of the victims of these overdoses were men and those aged 15 to 44, the researchers reported.

Eight states from the 27 studied were more dramatically affected than the others: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

In those states, the synthetic opioid death rate (mostly fentanyl) jumped 174 percent during 2013-2014, the researchers said.

In addition, seven states reported an increase of more than 100 deaths in 2013-2014 tied to synthetic opioids (mostly fentanyl), the authors said.

The report was published Aug. 26 in the CDC’s Morbidity and Mortality Weekly Report.

“The sharp increase in overdose deaths indicates a need for an urgent response, not just in the states that are currently impacted but in other states, because the problem seems to be spreading and taking on new dimensions,” Gladden said.

For example, heroin spiked with fentanyl may be responsible for 75 overdoses in Indiana and Ohio since last Friday. More than 30 overdoses occurred in Cincinnati last weekend, with 33 more overdoses — including one death — in the city since Tuesday. Authorities responded to 14 overdoses — including one death — late Tuesday and early Wednesday in Jennings County, Ind., USA Today reported.

But one expert noted even more deadly compounds might have been added to those drugs.

“It’s likely that the heroin being distributed on the streets in the recent string of overdoses in Cincinnati may have contained such illicitly manufactured compounds as carfentanil and a drug known as W-18,” said Dr. Robert Glatter. He’s an emergency physician at Lenox Hill Hospital in New York City.

Both compounds are most likely manufactured in China and sold online to dealers in the United States, who use them to produce the heroin and fake Oxycontin pills they sell on the street, he said.

Carfentanil, which is used as an elephant tranquilizer, and W-18 are nearly 10,000 times more potent than morphine, he noted. And W-18 is almost 100 times more potent than fentanyl, Glatter added.

“People who buy heroin from dealers on the street may not even be aware that they are taking the drug,” he said. “Dealers often cut their heroin with such synthetic drugs to make their supply last longer, while also making it more potent.”

In a separate MMWR report, researchers honed in on Florida and Ohio. In Florida, drug seizures rose 494 percent, and deaths rose 115 percent. In Ohio, they rose by 1,043 percent and 526 percent, respectively.

According to Gladden, a multi-pronged approach is needed to quell the fentanyl epidemic.

“We need to get information about these overdoses, so we can respond faster with more knowledge,” he said.

In addition, availability of naloxone (Narcan), which can reverse the effects of a narcotic overdose, has to be increased, “so people can get treatment as quick as possible to save their lives,” Gladden said.

However, fentanyl is so toxic that a single dose of naloxone might not be enough to reverse an overdose, so patients or bystanders should call 911 in the event of an overdose, he said.

Gladden believes doctors need to be cautious about prescribing narcotics for pain, because it’s important to prevent abuse and addiction in the first place.

U.S. Surgeon General Dr. Vivek Murthy is also hoping to prevent addiction from occurring. For the first time ever, the Surgeon General is sending a letter to all practicing physicians in the country urging them to educate themselves on the safer prescribing of opioid painkillers to lessen the risk of addiction.

“We arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely,” Murthy wrote.

“Many of us were even taught — incorrectly — that opioids are not addictive when prescribed for legitimate pain,” Murthy said. “The results have been devastating.”

More information

For more information on opioid epidemic, visit the U.S. Department of Health and Human Services.


2016/09/16

Powerful Animal Drug Linked to Spike in Overdoses in Cincinnati 

An animal tranquilizer called carfentanil is believed to be most of the more than 200 drug overdoses, including three deaths, in the Cincinnati area in the past two weeks.

Carfentanil is a synthetic drug used on livestock and elephants and is 100 times more powerful than the synthetic painkiller fentanyl, which is 50 times stronger than heroin. An amount of carfentanil smaller than a snowflake can kill a person, an expert told The New York Times.

Carfentanil has been confirmed as the cause of several recent overdose deaths, the first confirmed cases in the United States, according to Hamilton County coroner Dr. Lakshmi Kode Sammarco.

Deaths dating back to early July are now being investigated to determine if carfentanil was the cause.

“We’d never seen it before,” Sammarco told The Times. “I’m really worried about this.”

Similar spikes in overdoses have occurred recently in Indiana, Kentucky and West Virginia.

Officials believe the carfentanil is being made in China or Mexico and arriving the Cincinnati area in heroin shipments that come north on Interstates 71 and 75, The Times reported.  — Drugs.com


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