Fentanyl Fact and Fiction: The Rise of America s Narcotic Crisis. Dan

Transcription

1 Fentanyl Fact and Fiction: The Rise of America s Narcotic Crisis Dan Batsie

2

3 "Opium Throughout History". PBS Frontline. Retrieved 22 October 2006

4

5 Jim Edwards for Business Insider. 17 November 2011 Yes, Bayer Promoted Heroin for Children Here Are The Ads That Prove It

6

7 Pain Stress Temperature Respiration Endocrine activity Gastrointestinal activity Mood Motivation Williams, J. T. et al. Regulation of μ-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol. Rev. 65, (2013).

8 Tolerance Demand Brooks M. FDA clears hydrocodone with abuse-deterrent properties. Medscape Medical News. November 20, 2014

9 Discontinuation Syndrome Rhinorrhea, sneezing Yawning Lacrimation Abdominal cramping Nausea/vomiting/diarrhea Leg cramping Piloerection (gooseflesh) Dilated pupils

10

11

12

13

14

15

16

17

18

19

20 Havens J.R. et al. The impact of a reformulation of extended-release oxycodone designed to deter abuse in a sample of prescription opioid abusers. Drug Alcohol Depend Jun 1;139:9-17.

21 Muhuri P, et al. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. (2013).

22

23

24

25

26

27

28

29 1981 $3,620 Today $622

30 Number of Fentanyl Exhibits in NFLIS,

31 Retail % Today 40%

32

33

34 Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina. Fentanyl seizures up 426% Fatal OD up 174%

35 : 79% increase in deaths related to synthetic opioids U.S. Department of Justice, Drug Enforcement Administration, DEA Investigative Reporting, January Centers for Disease Control, National Center for Health Statistics, Number of drug-poisoning deaths involving synthetic opioids: United States, , December 2015.

36 What percentage of the liquid market do we really have?

37

38

39

40

41 2014 and 2015 China-based fentanyl sold for $3,500 per kilogram. Counterfeit Prescription Pills Containing Fentanyls: A Global Threat

42

43 March and April 2016 Sacramento, CA 52 overdoses and 10 deaths from counterfeit pills. Lab showed pills contained fentanyl doses between mg/pill 2 mg of fentanyl is lethal dose for non-opioid users)

44 March 2016 Lorain County, Ohio PD seized 500 pills that visually appeared to be oxycodone. Laboratory analysis indicated that the pills did not contain oxycodone, but were instead the research chemical U-47700

45 carfentanil acetyl fentanyl beta-hydroxythiofentanyl W-18 U-47700

46

47 Gas 'killed Moscow hostages', BBC News, 27 October 2002 Modest Silin, Hostage, Nord-Ost siege, 2002, Russia Today, 27 October 2007

48 The lethal dose range for carfentanil in humans is unknown; however, carfentanil is approximately 100 times more potent than fentanyl, which can be lethal at the 2- milligram range (photograph), depending on route of administration and other factors.

49

50

51 Opioid epidemic s hidden hazard: SWAT officers treated for fentanyl exposure during drug raid

52

53 Opioids #1 cause of pharmaceutical death in US Mortality = Respiratory ARDS Cardiac toxic

54

55

56 Narcotic Toxidrome Opiate Triad Altered mental status Decreased respiratory rate Pinpoint pupils (miosis)

57 Miosis

58 Opiate/Narcotic Toxidrome Hypotension Decreased Bowel Sounds nausea & vomiting Flushed skin and pruritus Local histamine release Urinary Retention Hypoglycemia Hypothermia

59

60

61

62

63

64

65 Unresponsive and known or suspected to have used narcotics End goal of adequate oxygenation and ventilation

66 Support Respirations Naloxone

67 Naloxone (Narcan) Blocks opiate receptors Clinical half-life of naloxone is roughly minutes Can elicit withdrawal symptoms Should not be used in neonates

68

69 Intranasal Medication Administration Equipment Small syringe Atomizing device (preferred)

70

71 Intranasal Medication Administration Precautions: Beware damage to the nasal mucosa that may effect absorption of medications Vasoconstrictors (EG cocaine) prevent absorption Bloody nose, nasal congestion, mucous discharge Destruction of nasal mucosa from surgery or cocaine abuse

72

73 Insert in nostril and rapidly compress the syringe plunger. Brisk brief compression results in controlled atomization. Gently pushing the plunger will not result in atomization Consider pinching nose shut

74

75 Reversal Reaction

76

77

78

79 Long Lasting Opioids Methadone Propoxyphene Norpropoxyphene Normeperidine

80 Barbiturates Benzodiazepines Alcohol GHB Rohypnol Sleep agents Chloral Hydrate Ethchlorvynol (Placidyl) Sedative-Hypnotics

81 Sedative-Hypnotic Toxidrome CNS depression Ataxia Nystagmus Slurred speech Hyporeflexia

82

83

84

85 The U.S. heroin user population is slightly smaller than the estimated methamphetamine user population and significantly smaller than the population reporting current use of marijuana, prescription pain relievers, or cocaine. However, the heroin user population is increasing in size at a much faster rate than any other drug of abuse. The number of people reporting current heroin use nearly tripled between 2007 (161,000) and 2014 (435,000), according to the Substance Abuse and Mental Health Services Administration (SAMHSA) annual National Survey on Drug Use and Health

86

87

88 heroin seizures in the United States increased 80 percent over five years, from 3,733 kilograms in 2011 to 6,722 kilograms in 2015.

89

90