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Public Health: DEA Puts Fentanyl OD Death Toll at More Than a Thousand

Last year's wave of overdose deaths from heroin cut with fentanyl, a powerful synthetic opioid pain reliever, killed more than a thousand people, according to the US Drug Enforcement Administration (DEA). The deaths began early in the year in the Mid-Atlantic states before spreading to the Midwest, with significant clusters in Chicago and Detroit.

http://stopthedrugwar.com/files/fentanyl-packet.jpg
fentanyl packet
Early official responses to the wave of deaths was slow and spotty, but concern spread as the death toll mounted. By December, more than 120 public health experts signed an open letter to Health and Human Services Secretary Mike Leavitt calling for a more aggressive response. The deaths have continued, but not at the torrid pace of last fall and summer.

The DEA estimate of the death toll came in an interim rule regulating a fentanyl precursor chemical, N-phenethyl-4-piperidone (NPP), published in
Monday's federal register. "The recent distribution of illicitly manufactured fentanyl has caused an unprecedented outbreak of hundreds of suspected fentanyl-related overdoses, at least 972 confirmed fentanyl-related deaths, and 162 suspected fentanyl-related deaths occurring mostly in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey, and Pennsylvania," the agency reported.

Noting that fentanyl is 30 to 50 times more powerful than heroin, the DEA went on to warn of its dangers. "The legitimate medical use of fentanyl is for anesthesia and analgesia, but fentanyl's euphoric effects are highly sought after by narcotic addicts," the agency explained. "Fentanyl can serve as a direct pharmacological substitute for heroin in opioid dependent individuals. However, fentanyl is a very dangerous substitute for heroin because the amount that produces a euphoric effect also induces respiratory depression. Furthermore, due to fentanyl's increased potency over heroin, illicit drug dealers have trouble adjusting ("cutting") pure fentanyl into proper dosage concentrations. As a result, unsuspecting heroin users or heroin users who know the substance contains fentanyl have difficulty determining how much to take to get their "high" and mistakenly take a lethal quantity of the fentanyl. Unfortunately, only a slight excess in the amount of fentanyl taken can be, and is often, lethal because the resulting level of respiratory depression is sufficient to cause the user to stop breathing."

The death toll suggests the DEA is not exaggerating in this instance. Let's be careful out there, kids.

U.S. will limit use of fentanyl ingredient

Location: 
Washington, DC
United States
Publication/Source: 
Detroit Free Press
URL: 
http://www.freep.com/apps/pbcs.dll/article?AID=/20070508/NEWS05/705080338/1007

HRC Press Release: Harm Reduction Experts Urge Feds To Stem Overdose Epidemic

For Immediate Release: December 18, 2006 Media Contact: Dr. Sharon Stancliff Medical Director Harm Reduction Coalition (917) 653-3104 stancliff@harmreduction.org Harm Reduction Experts Urge Feds To Stem Overdose Epidemic Deadly Opiate Linked To Hundreds Of Deaths WASHINGTON D.C. – Today over 120 medical experts, drug user health advocates, and urban public health departments issued an urgent call to the federal government to expand efforts to address a deadly wave of overdoses that have plagued injection drug users and their communities this year. The Harm Reduction Coalition (HRC), a national health and human rights advocacy group working to reduce drug-related harm, is leading the effort. Heroin contaminated with fentanyl, an opioid-based pain medication that is 50-80 times stronger than morphine, has killed well over 600 people in at least 8 states this year, including nearly 200 in Chicago, over 200 in the Detroit area, and nearly 200 in the Philadelphia area. Corey Davis, Legal Services Coordinator at Prevention Point Philadelphia, noted, "A client told us she watched her friend die in front of her and there was nothing she could do. If she had naloxone [a legal, non-scheduled prescription medication that reverses an opioid overdose] and was trained to use it, she could have saved her friend's life. We've lost a lot of our people due to fentanyl. This has to stop.” Experts believe that the number of deaths is vastly underreported, as many jurisdictions near these epicenters may lack resources, coordination, or expertise to monitor overdose trends. “This wave of overdose deaths poses an acute public health emergency and immediate threat to the lives of opiate users, while highlighting persistent weaknesses in health officials’ response to the increasing epidemic of both legal and illegal opiate overdose,” said Dr. Sharon Stancliff, HRC's Medical Director. A five-point strategy to reduce death by overdose is detailed in a letter to the Secretary of Health and Human Services, Mike Leavitt. It includes recommendations ranging from surveillance of overdose related deaths, to street drug testing, to increased availability of naloxone for use by laypersons. The letter was sent in conjunction with the 5th anniversary of HRC’s Overdose Project, which began giving drug users training and tools to recognize, prevent and reverse overdoses in December 2001. The five recommendations in the letter call upon Secretary Leavitt to ensure that: 1. The Centers for Disease Control (CDC) create surveillance systems to monitor overdose trends and threats. 2. The National Institute of Drug Abuse (NIDA) provide emergency funds for research projects to answer urgent questions that will allow jurisdictions to immediately and effectively address the overdose epidemic. 3. The Substance Abuse and Mental Health Services Administration (SAMHSA) rapidly replicate existing overdose prevention programs, and fully fund them. 4. The Drug Enforcement Administration (DEA) inform CDC of levels of purity and presence of fentanyl and other hazardous contaminants in local drug supplies so CDC can notify the public. 5. The Department of Health and Human Services (HHS) prepare an emergency report of the current overdose epidemic for Congress. This report should make emergency recommendations for prevention measures including: § Supporting community-based responses to overdose, including the use of naloxone by users and their loved ones; § Improving police and emergency medical services responses to overdoses; and § Enhancing the availability of substance abuse treatment. For full text of the letter, with complete list of signatories, see: http://harmreduction.org/news/pressreleases/leavitt_overdose_letter.pdf Overdose is one of the leading causes of accidental death in several cities across the country, including San Francisco, New York, and Portland, Oregon. In response to this public health crisis, several jurisdictions in the United States have developed overdose prevention programs that include education, instruction in mouth-to-mouth resuscitation and the provision of naloxone for use by lay persons. These programs are associated with significant decreases in overdose deaths. # # # # For more information about the Harm Reduction Coalition, visit http://www.harmreduction.org/. For more information about overdose prevention, visit http://www.harmreduction.org/OVERDOSE/.
Location: 
Washington, DC
United States

It Was the Worst of Times: Drug Reform Defeats, Downers, and Disappointments in 2006

As Drug War Chronicle publishes its last issue of the year -- we will be on vacation next week -- it is time to look back at 2006. In a companion piece, we looked at the highlights for drug reform this year; here, we look at the lowlights, from failures at the polls to bad court rulings to negative trends. Below -- in no particular order -- is our necessarily somewhat arbitrary list of the ten most significant defeats and disappointments for the cause of drug law reform. (We also publish a "best of 2006" list in this issue, above.)

The drug war continues unabated on the streets of America. Despite two decades of drug reform efforts, the war on drugs continues to make America a country that eats its young. In May, we reported that the US prisoner count topped 2.1 million -- a new high -- and included more than 500,000 drug war prisoners. In September, the FBI released its annual Uniform Crime Report, showing nearly 800,000 marijuana arrests and 1.8 million drug arrests in 2005 -- another new high. And just two weeks ago, we reported that more than seven million people are in jail or prison or on probation or parole -- yet another new high.

Methamphetamine hysteria continues unabated and becomes an excuse for old-school, repressive drug laws and bad, newfangled ones, too. The drug war always needs a demon drug du jour to scare the public, and this year, like the past few years, meth is it. Never mind that the stuff has been around for decades and that there is less to the "meth epidemic" than meets the eye. The "dangers of meth" have been cited as a reason for everything from targeting South Asian convenience store clerks to restricting access to cold medications containing pseudoephedrine to harsh new penalties for meth offenses to more than 20 states defining meth use or production as child abuse. Michigan even went so far as to pass legislation banning meth recipes on the Internet, while Arizona voters felt impelled to roll back a decade-old sentencing reform. Under that reform, first- and second-time drug possession offenders couldn't be sentenced to jail or prison, but now Arizona has created an exception for meth offenders. The drug warriors like to say meth is the new crack, and in the way meth is used as an excuse for "tough" approaches to drug policy, that is certainly true.

The US Supreme Court upholds unannounced police searches. In a June decision, the court upheld a Michigan drug raid where police called out their presence at the door, but then immediately rushed in before the homeowner could respond. Previously, the courts had allowed such surprise entries only in the case of "no-knock" warrants, but this ruling, which goes against hundreds of years of common law and precedent, effectively eviscerates that distinction. "No-knock" raids are dangerous, as we reported that same month, and as Atlanta senior citizen Kathryn Johnston would tell you if she could. But she can't -- Johnston was killed in a "no-knock" raid last month.

Marijuana legalization initiatives lose in Colorado and Nevada. After four years of effort, the Marijuana Policy Project still couldn't get over the top with its "tax and regulate" initiative in Nevada, although it increased its share of the vote from 39% to 44%. In Colorado, SAFER Colorado took its "marijuana is safer than alcohol" message statewide after successes at state universities and in Denver last year, but failed to convince voters, winning only 41% of the vote.

South Dakota becomes the first state where voters defeat an initiative to legalize medical marijuana. In every state where it had gone to the voters as a ballot measure, medical marijuana had emerged victorious. But voters in the socially conservative, lightly populated Upper Midwest state narrowly rejected it in November. The measure lost 48% to 52%.

California's medical marijuana movement is under sustained attack by the feds and recalcitrant state and local officials and law enforcement. This year, it seems like barely a week goes by without a new raid by the DEA or unreconstructed drug warriors in one county or another. San Diego has been particularly hard-hit, but we also reported on a spate of raids in October, and there have been more since. The feds have also started their first medical marijuana prosecution since the 2003 Ed Rosenthal fiasco, with Merced County medical marijuana patient and provider Dustin Costa going on trial last month.

Hundreds die from overdoses of heroin cut with fentanyl, but the official response is almost nonexistent -- except for increased law enforcement pressure. With injection drug users falling over dead from Boston to Baltimore, Philadelphia to Detroit and Chicago, an estimated 700 people have been killed by the deadly cocktail. We reported on it in June, but the wave of deaths continues to the present. Just last week, more than 120 medical experts, public health departments, and drug user advocates sent a letter to Health and Human Services Secretary Mike Leavitt urging him to take aggressive action. Ho-hum, who cares about dead junkies? Not the federal government, at least so far.

Plan Colombia continues to roll along, adding fuel to the flames of Colombia's civil war while achieving little in the realm of actually reducing the supply of cocaine. The US Congress continues to fund Plan Colombia to the tune of hundreds of millions of dollars a year, even though despite six years of military assistance and widespread aerial eradication using herbicides, it now appears that production is higher than anyone ever thought. Perhaps a Democratic Congress will put an end to this fiasco next year, but Democrats certainly can count influential Plan Colombia supporters among their ranks -- incoming Senate Foreign Relations Committee chairman and presidential hopeful Joe Biden (DE), to name just one.

Afghanistan is well on its way to becoming a true narco-state. The US war on terror and the US war on drugs are on a collision course in Afghanistan, which now, five years after the US invaded, produces more than 90% of the world's illicit opium. This year, Afghanistan's opium crop hit a new record high of 6,100 metric tons, and now, US drug czar John Walters is pressuring the Afghans to embrace eradication with herbicides. But each move the US and the Afghans make to suppress the opium trade just drives more Afghans into the waiting arms of the Taliban, which is also making enough money off the trade to finance its reborn insurgency. Meanwhile, the Afghan government is also full of people getting rich off opium. Everyone is ignoring the sensible proposals that have put on the table for dealing with the problem, which range from an economic development and anti-corruption approach put forward by the UN and World Bank as an alternative to eradication, and the Senlis Council proposal to license production and divert it to the legitimate medicinal market.

Australia is in the grips of Reefer Madness. While some Australian states enacted reforms to soften their marijuana laws in years past, the government of Prime Minister John Howard would like to roll back those reforms. The Australians seem particularly susceptible to hysterical pronouncements about the links between marijuana and mental illness, and they also hold the unfathomable notion that marijuana grown hydroponically is somehow more dangerous than marijuana grown in soil. Over the weekend, the national health secretary announced he wants to ban bongs. That's not so surprising coming from a man who in May announced that marijuana is more dangerous than heroin. Hopefully, saner heads will prevail Down Under, but it isn't happening just yet.

Harm Reduction: Experts Call for Urgent Action as Fentanyl-Related Overdose Death Toll Climbs

More than 120 medical experts, public health departments, and drug user health advocates have called on the federal government to take more aggressive steps to deal with a wave of overdose deaths caused by heroin cut with fentanyl, an opioid pain medication 50 to 80 times stronger than heroin. The call came in an open letter to US Health and Human Services Secretary Mike Leavitt drawn up by the Harm Reduction Coalition, a national health and human rights advocacy group working to reduce drug-related harm.

http://stopthedrugwar.com/files/fentanyl.jpg
fentanyl
The ongoing epidemic -- Drug War Chronicle reported on it in June -- has killed more than 750 injection drug users this year from Chicago to the East Coast. Chicago, Detroit, and Philadelphia all have around 200 fatalities.

The actual number of deaths may be far higher because many jurisdictions near these large cities may lack the resources and expertise to monitor overdose trends. "This wave of overdose deaths poses an acute public health emergency and immediate threat to the lives of opiate users, while highlighting persistent weaknesses in health officials' response to the increasing epidemic of both legal and illegal opiate overdose," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition.

The letter makes five recommendations, calling on Secretary Leavitt to ensure that:

  1. The Centers for Disease Control (CDC) create surveillance systems to monitor overdose trends and threats.
  2. The National Institute of Drug Abuse (NIDA) provide emergency funds for research projects to answer urgent questions that will allow jurisdictions to immediately and effectively address the overdose epidemic.
  3. The Substance Abuse and Mental Health Services Administration (SAMHSA) rapidly replicate existing overdose prevention programs, and fully fund them.
  4. The Drug Enforcement Administration (DEA) inform CDC of levels of purity and presence of fentanyl and other hazardous contaminants in local drug supplies so CDC can notify the public.
  5. The Department of Health and Human Services (HHS) prepare an emergency report of the current overdose epidemic for Congress. This report should make emergency recommendations for prevention measures including: Supporting community-based responses to overdose, including the use of naloxone, a legal medication that reverses opioid overdoses, by users and their loved ones; improving police and emergency medical services responses to overdoses; and enhancing the availability of substance abuse treatment.

"A client told us she watched her friend die in front of her and there was nothing she could do," said Corey Davis, legal services coordinator at Prevention Point Philadelphia. "If she had naloxone and was trained to use it, she could have saved her friend's life. We've lost a lot of our people due to fentanyl. This has to stop."

Detroit Deaths From Fentanyl-Laced Heroin Could Be Reduced By Medical Treatment

Press Release Source: Reckitt Benckiser Pharmaceuticals Inc. Detroit Deaths from Fentanyl-Laced Heroin Overdoses Could Be Reduced by Medical Treatment Tuesday October 3, 7:30 am ET Physician training sessions will increase patient access to medical office-based treatment for opioid addiction DETROIT, Oct. 3 /PRNewswire/ -- A recent string of opioid overdoses and deaths in Detroit and elsewhere in Wayne County highlights the devastation of a dangerous new illegal drug mixture: the combination of heroin with fentanyl, a powerful opioid painkiller used in anesthesia and to treat cancer pain. According to the Medical Examiner's office, so far there have been at least 122 fatal overdoses in the Detroit area attributable to heroin laced with fentanyl, while several times this many have occurred nationwide. ADVERTISEMENT "Fentanyl-related overdoses in the Detroit area serve as a tragic reminder that there is a need for better patient access to aggressive and effective medical treatment for opioid addiction," said Mark Menestrina, MD, addiction medicine physician at Brighton Hospital. "Opioid addiction is a chronic disease that can afflict anyone and needs to be treated much like we treat other chronic conditions. Medical treatment is oftentimes prescribed in the privacy of a doctor's office, creating a confidential, convenient, and respectful atmosphere. Currently, there are not enough certified doctors in Detroit available to handle the increasing number of people seeking help for opioid addiction. It is critical that office-based medical treatment become more widely available in order to contain this crisis and prevent more deaths throughout the greater metropolitan Detroit area." Addiction to opioids, which includes heroin as well as the prescription painkillers oxycodone, hydrocodone, fentanyl, and morphine, is a growing public health problem that affects people from all walks of life. In Michigan, misuse of prescription opioid painkillers continues to be a major problem and, in Detroit, heroin remains widely available, according to a report by the U.S. Drug Enforcement Administration (DEA). And as evidenced by the current surge in fentanyl-heroin use, drug dealers are targeting this mixture in the Detroit area. The recent problems in Detroit and throughout Michigan reflect a national public health crisis -- according to the most recent National Survey on Drug Use and Health (2006), published last month by the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 4.7 million people currently misuse prescription pain relievers, second only to marijuana use. Among young adults, nonmedical use of prescription drugs increased from 5.4 percent in 2002 to 6.3 percent in 2005. In addition, in terms of new users, in 2005 more people 12 years and older -- 2.2 million -- misused opioid painkillers for the first time than any other drug, including marijuana and cocaine. Many people do not fully understand the danger of misusing opioid painkillers such as fentanyl. A recent national survey on the public's perceptions of opioid addiction, Prescription Painkiller/Heroin Addiction and Treatment, revealed that nearly half of the U.S. public does not know that misusing prescription opioid painkillers is as harmful to the body, and fully as addictive, as heroin abuse. Physician Certification Training Available at Sessions and Online Any doctor may become certified to treat opioid dependence in his or her private office using an FDA-approved medicine called buprenorphine. Many patients prefer the privacy, convenience, and discretion that office-based treatment offers. According to Dr. Menestrina, access to buprenorphine treatment for patients addicted to opioids is vital to reduce the number of deaths due to drug overdoses. Doctors will find information about becoming certified to treat with buprenorphine at http://www.docoptin.com. Additionally, information about online and CD-ROM training options may be obtained from 1-877-782-6966. "An increase in the number of doctors certified to treat opioid addiction is an important step in the fight against the problem we're facing in Detroit," said Dr. Menestrina. "It is unfortunate that patients seeking buprenorphine treatment are turned away simply because not enough doctors are certified to prescribe this medication. This is especially upsetting considering the great success I have seen in my practice with buprenorphine. I strongly urge other physicians to learn about this treatment option and seriously consider becoming certified to treat the exceedingly high number of chemically dependent individuals in the Detroit area." Resources for Opioid Dependence and Its Treatment Addiction to opioids is defined as a long-term brain disease by the World Health Organization (WHO) and the National Institute on Drug Abuse (NIDA). It is a treatable medical condition that is caused by changes in the chemistry of the brain. This dependence can start with use of medicine that a doctor prescribes for serious pain but that a person continues to use after the medical need for pain relief has passed. Or it may begin as recreational drug use that spins out of control. Individuals who need more information about opioid dependence and its treatment, either for themselves or for someone they are concerned about, have several options. Educational materials on opioid dependence are available to answer questions about this often-misunderstood disease and the treatments that are available for it. To receive a free educational Resource Kit on these topics, visit http://www.turntohelp.com or call 1-866-455-TURN, both provided by Reckitt Benckiser Pharmaceuticals. Additionally, the non-profit patient advocacy group NAABT -- National Alliance of Advocates for Buprenorphine Treatment -- is dedicated to helping educate the public on opioid dependence and treatment in a private doctor's office. NAABT now offers a nationwide confidential matching service to pair individuals seeking buprenorphine treatment with available doctors. "Increasingly more people are contacting NAABT for information on opioid dependence and treatment and for help finding doctors who can prescribe buprenorphine," said Timothy Lepak, president of NAABT. "This is a disease that does not discriminate. It affects people from all walks of life and all socioeconomic and demographic levels." For more information on Detroit-area physicians who can prescribe medicine to treat opioid dependence in a private medical office, visit http://naabt.org. SAMHSA's Web site also provides a physician locator and other valuable information at http://buprenorphine.samhsa.gov. In the United States, buprenorphine is marketed as Suboxone® (buprenorphine HCl/naloxone HCl dihydrate) C-III Sublingual Tablets and Subutex® (buprenorphine HCl) C-III Sublingual Tablets, the only controlled medications under the Drug Addiction Treatment Act of 2000 approved by the FDA for treatment of opioid dependence in a doctor's office. Suboxone and Subutex are manufactured by Reckitt Benckiser Pharmaceuticals. About Reckitt Benckiser Pharmaceuticals Inc. Reckitt Benckiser Pharmaceuticals Inc. is a specialty pharmaceutical company that manufactures and markets Suboxone® (buprenorphine HCl/naloxone HCl dihydrate [2 mg/0.5 mg and 8 mg/2 mg]) C-III Sublingual Tablets and Subutex® (buprenorphine HCl [2 mg and 8 mg]) C-III Sublingual Tablets, formulations of buprenorphine used to treat opioid dependence. Suboxone and Subutex are the only controlled medications under the Drug Addiction Treatment Act of 2000 approved by the FDA for office-based treatment of opioid dependence. Reckitt Benckiser Pharmaceuticals Inc. is committed to expanding access to medical therapies for patients suffering from the chronic, relapsing brain disease of opioid dependence. For more information, visit http://www.suboxone.com or http://www.opioiddependence.com. Reckitt Benckiser Pharmaceuticals Inc. is a wholly-owned subsidiary of Reckitt Benckiser PLC, a publicly traded UK firm. Important Safety Information Intravenous use of buprenorphine, usually in combination with benzodiazepines or other CNS depressants has been associated with significant respiratory depression and death. Suboxone® and Subutex® have potential for abuse and produces dependence of the opioid type with a milder withdrawal syndrome than full agonists. Cytolytic hepatitis and hepatitis with jaundice have been observed in the addicted population receiving buprenorphine. There are no adequate and well-controlled studies of Suboxone or Subutex (a pregnancy category C medication) in pregnancy. Due caution should be exercised when driving cars or operating machinery. The most commonly reported adverse events with Suboxone have included headache (36%, placebo 22%), withdrawal syndrome (25%, placebo 37%), pain (22%, placebo 19%), nausea (15%, placebo 11%), insomnia (14%, placebo 16%), sweating (14%, placebo 10%). See full prescribing information for complete information. Suboxone and Subutex are registered trademarks of Reckitt Benckiser Pharmaceuticals Inc. Media Contact: Cory Tromblee 617-761-6715 Cory.Tromblee@fkhealth.com
Location: 
Detroit, MI
United States

The Heroin Overdose Wave Continues...

WFMZ-TV in Allentown, Pennsylvania, has reported another overdose from the fentanyl-laced heroin batch that is ravaging drug injecting communities in cities around the nation. Meanwhile, officials in South Jersey are trying to figure out what is causing the rash of overdoses in Vineland and are wondering if something may be contaminating the heroin supply there -- five people had to be rushed to the South Jersey Healthcare Regional Medical Center on Tuesday, according to The Press of Atlantic City. We need legalization! Heroin use can't be stopped, at least not in this way -- only a legal, regulated supply will allow for any reliable degree of control over the drug supply -- until prohibition is ended, drug users will always be at risk of this kind of often fatal harm, especially the addicted ones. It is indecent that we are subjecting these people to this kind of situation -- and it certainly means longer emergency room waits when the rest of us need the help. WMFZ-TV accepts comments here. The Press has information on submitting a letter to the editor, or a longer guest column, online here. Also click here to take action to support of a bill sponsored by Sen. Richard Durbin (D-IL) to fund overdose prevention. And click here for a Drug War Chronicle report on the heroin/fentanyl overdose outbreak.
Location: 
Atlantic City, NJ
United States

Overdose Deaths Outpacing Homicides in Philadelphia

The Philadelphia News reported Monday that despite the city having seen one of its deadliest weekends, drug overdoses, particularly from a batch of heroin laced with the even more powerful opiate fentanyl are claiming even more lives. The important thing to remember is that heroin users aren't dying simply because fentanyl is more potent than heroin. They are dying because the substance they are buying on the black market is more powerful than they believe it to be -- they think they are getting heroin, or if they're not sure they crave their fix so strongly that they are willing to take the chance. The illegal drug supply is uncertain in this way, because it is illegal, and for no other reason. Among legalization's many benefits will be increased safety for users, particularly addicts, and fewer accidental deaths. Send a letter to the editor to views@phillynews.com.
Location: 
Philadelphia, PA
United States

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