Alarm Over New Synthetic Opioids, San Francisco Safe Injection Site Saves Lives, More... (8/29/23)

Garden State Democrats take flak for voting for a harsh fentanyl analog bill, a clandestine San Francisco safe injection site saved lives, and more. 

Drug Policy

New Synthetic Opioids Raising Alarms. A group of new synthetic opioids called nitazenes are emerging in illicit drug markets and may be more powerful than fentanyl, a thousand times more potent that morphine, and may require even greater doses of opioid overdose reversal drugs to reverse overdoses, according to a study published Tuesday in the journal JAMA Network Open.

Researchers found most patients who overdosed on nitazenes required two doses of the overdose reversal drug naloxone to recover, while most patients overdosing on fentanyl required only a single dose.

"Clinicians should be aware of these opioids in the drug supply so they are adequately prepared to care for these patients and anticipate needing to use multiple doses of naloxone," the researchers, from the Icahn School of Medicine at Mount Sinai in New York, Lehigh Valley Health Network based in Pennsylvania, and other US institutions, wrote in the study. "In addition, to date there has been a lack of bystander education on repeat naloxone dosing."

The data came from a small study of 537 adults admitted to emergency rooms between 2020 and 2022, 11 of which tested positive only for fentanyl and nine who tested positive only for nitazenes. The researchers found that two-thirds of patients overdosing on nitazenes required two or more doses of naloxone, compared with only one-third of those overdosing on fentanyl.

Among the nitazenes are brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene. Metonitazene appears to be the most dangerous.

"In the present study, metonitazene appears to have the most severe clinical toxicity given that both patients in which metonitazene was detected presented in cardiac arrest," the researchers wrote. Among those two patients who were found to have metonitazene, one patient died despite receiving six milligrams of naloxone in three separate doses. The other patient survived after receiving a total of 10 milligrams of naloxone in three doses.

New Jersey Congressional Democrats Take Flak for Voting for Mandatory Minimums for Fentanyl Analogs. Three New Jersey Democrats joined with three New Jersey Republicans to vote for the Halt All Lethal Trafficking of Fentanyl (HALT) Act (HR 467), which ramped up mandatory minimum sentences for fentanyl analogs, and now they are facing bitter criticism for doing so. The bill assumes that fentanyl analogs are harmful and criminalizes people despite a lack of scientific evidence.

Supported the drug war legislations were conservative Democrats Josh Gottheimer, Mikie Sherrill, and Donald Norcross, as well as Republicans Jeff Van Drew, Chris Smith, and Thomas Kean Jr.

"This shoot-first, ask-questions-later legislation would permanently schedule all fentanyl-related substances as Schedule I without first testing them for benefits or harm," said civil rights advocate Lisa McCormick. "By putting fentanyl-related substances on that list, they are among the most harshly criminalized drugs regardless of the science."

"This bill also imposes mandatory minimum sentences of 10 to 20 years in prison for fentanyl analog cases, hearkening back to failed drug war strategies of the past that have led to a stronger, more potent illicit drug supply," said McCormick. "Yet, Republican members of Congress and their corporate-controlled Democratic allies continue to double down on the disproven, failed approach of drug prohibition at the expense of people’s lives. "Of the nearly two million people incarcerated in the U.S. today, one in five is locked up for a drug offense," said McCormick, who said the legislation was strongly condemned by a variety of non-partisan civil rights, public health, drug policy, faith, law enforcement, criminal legal reform, and public policy research organizations.

"Our communities deserve real health solutions to the overdose crisis, not political grandstanding that is going to cost us more lives," said Maritza Perex Medina, director of the Office of Federal Affairs at the Drug Policy Alliance. "Yet, sadly, in passing the HALT Fentanyl Act, the House seems intent on doubling down on the same failed strategies that got us here to begin with."

"It’s sad to see lawmakers revert to over-criminalization once again when we have 50 years of evidence that the war on drugs has been an abject failure," said Laura Pitter, deputy director of the US Program at Human Rights Watch. "A vote for this bill was a vote against evidence and science."

Advocates are calling on Congress to reject drug war-style legislation and instead support public health approaches like the Support, Treatment, and Overdose Prevention of Fentanyl (STOP Fentanyl) Act of 2021 (HR 2366) and the Test Act (SB 1950). The former proposes increased access to harm reduction services and substance use disorder treatment, improved data collection, and other evidence-based methods to reduce overdose, while the latter would require the federal government to test all fentanyl-related substances that are currently classified as Schedule I substances and remove those that are proven medically beneficial or otherwise unharmful.

Harm Reduction

San Francisco's Clandestine Safe Injection Site Saved Hundreds of Lives. According to a study published Tuesday in the International Journal of Drug Policy, the Tenderloin Center, a clandestine safe injection site that operated throughout 2022 saw 333 overdoses—with no fatalities and every single one of them reversed. That was out of 124,000 visits.

The Tenderloin Center was "an effective harm-reduction strategy to save lives," wrote lead author Dr. Leslie Suen of the University of California, San Francisco. " 

The site has since shuttered, with neither City Attorney David Chiu nor Mayor London Breed willing to keep it open against federal law. Now, the city is on track for its highest recorded number of drug overdoses yet.