Primer on Synthetic Opioids I/S Brian Dempsey

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1 Primer on Synthetic Opioids I/S Brian Dempsey

2 Sources - ACOME - Overdose Free PA Website - Pennsylvania Opioid Overdose Reduction Technical Assistance Center (TAC) DEA Testimony Before the Subcommittee on Crime, Terrorism, Homeland Security & Investigations on June 27, 2017

3 Synthetic Designer Drugs New Psychoactive Substances (NPS)

4 Synthetic Cannabinoids

5 Synthetic Cannabinoids

6 Synthetic Cathinone's

7 Synthetic Hallucinogens (Phenethylamines)

8 Synthetic Hallucinogens (Phenethylamines)

9 Opiates - Narcotic Analgesic derived from an Opium Poppy (Natural) - Not manufactured by chemical synthesis - Derived for the Opium Poppy Plant Law Enforcement Sensitive Synthetic Opioids Fentanyl and its Analogues Opiates VS Opioids Opioids - A synthetic narcotic that mimics the natural poppy plant - Chemically manufactured narcotics - Narcotic analgesic that is not found in nature

10 Synthetic Opioids Fentanyl and its Analogues

11 Review of NPS New Psychoactive Substances ( NPS ) - Synthetic Cannabinoids - Synthetic Cathinone - Synthetic Opioids - Synthetic Hallucinogens (Phenethylamines)

12 Fentanyl Citrate/Fentanyl HCL Schedule II

13 Primer on Synthetic Opioids

14 DEA National Forensic Laboratory Information System (NFLIS)

15 DEA National Forensic Laboratory Information System (NFLIS) January 2013 December 2016: 50,440 Fentanyl Reports 2013: 1,041 Fentanyl Reports 2016: 28,751 Fentanyl Reports CDC Morbidity & Mortality Weekly Report dated December 2016: The death rate from Synthetic Opioids (other than Methadone), which includes fentanyl, from 2014 to 2015, increased by 72.2% from 5,544 to 9,581.

16 Primer on Synthetic Opioids (CDC) reported 33,091 deaths in 2015 which were the result of opioid overdoses alone. Of those deaths 9,581 were caused by synthetic opioids

17 Primer on Synthetic Opioids Fentanyl & Fentanyl-Related Substances have been Identified in: - Powder - Pill - Capsule - Liquid - (and on) Blotter Paper

18 Primer on Synthetic Opioids

19 Primer on Synthetic Opioids On March 1, 2017, as a result of meeting with DEA, China agreed to regulate the following four fentanyl-related Substances under Chinese law: - Carfentanil - Furanyl Fentanyl - Acryl Fentanyl - Valeryl Fentanyl

20 First Quarter 2017 Emerging Threat Report

21 Grey Death

22 2016 Fentanyl 4-methoxybutyrylfentanyl Acetylfentanyl Butyrylfentanyl 3-methylfentanyl (cis and trans) Furanyl fentanyl Para-fluoroisobutyryl fentanyl U Law Enforcement Sensitive Western Pennsylvania Seizures of Synthetic Opioids 2017 Butyrylfentanyl Carfentanil Cyclopropylfentanyl Furanyl fentanyl Methoxyacetyl fentanyl Acrylfentanyl U-47700

23 DEA Seizure of 50 Kilograms Of ANPP on June 28, 2017

24 The Drug Control Process Under The CSA

25 The Drug Control Process Under The CSA DEA utilized the CSA Authority a total of 13 times to control 25 substances. March 2011 Present DEA utilized the CSA Authority a total of 14 times to control 46 synthetic designer drugs temporarily (emergency control) under Schedule I, including seven fentanyl analogues: Acetyl fentanyl Butyryl fentanyl Beta-hydroxythiofentanyl Furanyl fentanyl 4-fluoroisobutyryl fentanyl U Acryl Fentanyl

26 Availability of Fentanyl Products Via the Internet

27 Acetyl Fentanyl Internet Sales

28 Acetyl Fentanyl Internet Sales

29 Acetyl Fentanyl Internet Sales

30 Availability of Fentanyl Products Via the Internet Product Form Description U HCl powder, nasal spray, vape juice, edibles (gummy bears) Synthetic opioid MethoxyAcetylFentanyl Powder, nasal spray Fentanyl analog Gabapentin Pill Pill that treats nerve pain Epitalon Injection Anti-aging drug Elavil (Amitriptyline) Pill Treats neuropathic pain and mental illnesses Selank Injection Nootropic mental stimulant

31 Availability of Fentanyl Products Via the Internet 4-MEC a-php a-pvp AH-7921 Fentanyl powder (Attachment 2) Dibutylone crystal MDPV Furanyl fentanyl Pentedrone Methylone Crystals 25 I-NBOMe 2-FMA Hydrocodone Watson 853 Crystal Meth Soma Cocaine Vicodin Hydrocodone Watson 540 5F-AKB48 RoxiCodone AB-Chminaca Tramadol AM-2201 Actavis promethazine with codeine cough syrup Zolpidem 5fur 144 Methoxetamine AB-Pinaca Molly MDMA Pills PB-22 LSD pills Soma LSD powder Ketamine-Racemic LDS blotters Pure MDMA Diazepam Zopiclone

32 Availability of Fentanyl Products Via the Internet

33 Heroin 101 Heroin Stamp Bag Weighs Approximately.01 to.03 gms Heroin Stamp Bags Cost $5 to $15 Heroin BUNDLE Consists of 10 Individual Stamp Bags Heroin BUNDLE Costs $50 to $80 Heroin BRICK Consists of 50 Individual Stamp Bags Heroin BRICKS Cost $150 to $400 One (1) Gram of Heroin Sells for $150 One (1) Ounce of Heroin Sells for $2,000 to $3,000 One (1) Kilogram of Heroin Sells for $50,000 to $80,000

34 Drug-Related Overdose Demographics & Drug Presence, Allegheny County, PA, 2016 Gender Race Age TOTAL OVERDOSE DEATHS 649* Drugs: Fentanyl 63.5% Alprazolam 19.1% Methadone 6.8% Heroin 50.8% Oxycodone 11.2% Hydrocodone 5.5% Cocaine 34.1% Clonazepam 8.3% Ethanol 29.7% Diazepam 6.8%

35 2016 4,642 DRUG RELATED OVERDOSE DEATHS This Number Represents a 37% increase in Overdose Deaths from This Number Established a Death Rate of 36.5 per 100,000 People. In 2016, approximately 13 people died of a drug-related overdose each day.

36 2016 4,642 DRUG RELATED OVERDOSE DEATHS In 2016, the presence of a prescription or illicit opioid was identified in 85% of the overdose deaths. Fentanyl and fentanyl-related substances were the most frequently identified (52% of deaths), exceeding heroin (45 % of deaths) for the first time.

37 Fentanyl

38 CARFENTANIL

39 Fentanyl

40 Primer on Synthetic Opioids

41 Primer on Synthetic Opioids