Pubdate: Thu, 29 Oct 2015
Source: SF Weekly (CA)
Column: Chem Tales
Copyright: 2015 Village Voice Media
Author: Chris Roberts

A Synthetic Opiate Is Showing Up in Heroin and Street Pills


On Sept. 24 of last year, Joseph Briones and a friend walked into the 
Westfield Centre mall on Market Street and headed towards the 
bathrooms, in search of a safe place to get high.

The pair, heroin users with no fixed addresses, knew that the upscale 
mall has toilets off the beaten track.

Briones went into a stall and prepared his shot. It was his last. By 
the time his friend realized that Briones had overdosed, mall 
security was on the scene. The friend pleaded with security to be 
allowed to give his friend another shot - this time of naloxone, the 
overdose antidote that's sold under the brand name Narcan.

Whether out of ignorance or a liability-averse mall policy, the mall 
cops refused, according to the story repeated to me by a former 
member of the S.F. Drug Users Union. Briones died. He was 32 years old.

That was almost 14 months ago, but there's still no official cause of 
death for Briones. The Medical Examiner's Office has yet to process 
his file; the fact that Briones was a street person may have 
something to do with the delay. But the street knows the reason. 
Briones took a shot of heroin laced with fentanyl, the synthetic 
opiate that's led to an unprecedented increase in overdoses, and is 
now appearing in other street drugs.

Fentanyl is a synthetic opiate designed for advanced-stage cancer 
sufferers in acute pain. It's "50 to 100 times" more powerful than 
morphine, according to the Centers for Disease Control and 
Prevention, which sent out an advisory on fentanyl earlier this week.

Whether it's illegally diverted shipments from pharmaceutical 
companies, stolen fentanyl patches, or fentanyl cooked in labs, 
there's a nationwide trend afoot. The nation's drug cops have 
reported a huge boom in seizures of the drug from 618 seizures in 
2012 to 4585 last year. If the "10 percent" rule - cops seize 10 
percent of what's on the street - is true, fentanyl-tainted drugs 
appears to now be a considerable problem.

Briones' preventable death aside, this is (for now) a mostly positive 
story. Fatal heroin overdoses in San Francisco have been on a steady 
decline from the early 2000s, when the city averaged more than 100 
per year. Now it's closer to five or 10 per year, according to the 
DOPE Project, a harm reduction advocacy group that works with the 
city's intravenous drug users.

People are still overdosing: about 30 to 35 overdose reversals are 
reported every month. But something changed this summer. Things got 
bad. There were 109 overdoses reported in August - all of them 
reversed with a shot of naxolone, the user's life saved.

"That's the most we've had in one month," says Eliza Wheeler, 
executive director of DOPE Project. "People were just Narcanning 
their friends left and right, sometimes multiple times a day."

Heroin use is on a slight upswing nationally, the result of cops 
shutting down "pill mills" where doctors write prescriptions for 
opiate-based painkillers willy-nilly. Wherever a pill mill closes, 
enterprising narco-traffickers arrive to service the drug users who 
are now bereft of a heroin supply - a fascinating tale of underground 
capitalism told in detail in journalist Sam Quinones's recent book, Dreamland.

The deadly twist is that fentanyl is now appearing in other drugs 
sold on the street, bought by people unfamiliar with heroin culture 
and inexperienced with reversing an overdose.

The country's most abused drug is prescription medication, and 
somebody is distributing fake Xanax laced with fentanyl in San 
Francisco, according to the Department of Public Health.

At least four people have been sent into an opiate overdose after 
popping the bunk Xanax, according to DPH, including one person found 
dead with a fentanyl-laced Xanax nearby.

This is troubling. Heroin users are prepared for an overdose in a way 
pill users are not. Though Narcan has never been more readily 
available - you can buy it at CVS without a prescription - the 
knowledge that a pill user should be prepared for an overdose is not.

Fentanyl is not new in San Francisco. However, according to anecdotes 
from users and advocates, it appears to be here in a new way. "It 
used to come in waves," Wheeler says. "Now we're just seeing it 
consistently more in place."

The city has done a good job managing its opiate problem. DPH was an 
early adopter of naloxone, which has been distributed for over a 
decade among the city's heroin users, whose mortality rates improved. 
But this latest development suggests that everyone who uses 
prescription medication needs to have an overdose kit handy - as well 
as the knowledge that that $5 anti-anxiety pill might have fake heroin inside.
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MAP posted-by: Jay Bergstrom