Pubdate: Mon, 18 Aug 2014
Source: Baltimore Sun (MD)
Copyright: 2014 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Melissa Healy

QUASI-LEGAL STREET DRUG POSES NEW LETHAL THREAT TO USERS

Emergency physicians are bracing for a new rash of overdoses of a drug
that looks like heroin but may not respond to commonly used doses of
the opiate-reversal drug naloxone because it is so powerful, a new
study reports.

The threat comes from an emerging street drug called acetyl fentanyl
- -- an opiate that is five to 15 times as powerful as heroin and is
being mixed with street drugs sold as heroin. An article appearing in
the Annals of Emergency Medicine on Monday warns emergency physicians
to expect "an upswing in what appear on the surface to be heroin
overdoses" but are in fact tied to acetyl fentanyl.

Acetyl fentanyl, an analog of the prescription opiate fentanyl, has no
recognized medical use. But it is not specifically regulated, and
loopholes in its distribution position the drug in a legal gray area,
which makes it easier to get -- and hence cheaper on the streets --
than fentanyl.

In large quantities, acetyl fentanyl can be titled, labeled and stored
as a product with industrial or non-human research purposes. As long
as it's labeled "not for human consumption," the transportation and
sale of a large package of the stuff would be technically legal.

As a result, drug dealers may be tempted to cut their supplies of
heroin with it.

Many users knowingly inject acetyl fentanyl directly as a substitute
for heroin or prescription-grade opiates. For those who use the
extraordinarily potent drug unknowingly, overdoses are highly likely.

"What's frightening about this emerging street drug is that users
themselves may not be aware they are ingesting it," wrote lead author
John Stogner, a professor of criminal justice and criminology at the
University of North Carolina at Charlotte. If acetyl fentanyl is
responsible for a drug overdose, Stogner cautioned, physicians may
find that larger or additional doses of naloxone are necessary to
reverse the overdose.

"One of the many downsides of illegal drugs is you just can't trust
your drug dealer," wrote Stogner and colleagues in the Annals. With
the use of adulterants in street drugs growing -- and delivering more
potent highs -- "the significant potential for overdose of acetyl
fentanyl necessitates more medical research and policy reform," they
wrote.  
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