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THMG142 – Synthetic Opioids

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Reading through a few of our favorite references (like CBRNE) we picked this synthetic opioid out of the heap and decided to give a little light of exposure. Enjoy the journey.

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  1. First let's talk about synthetic opioids
    1. Something like oxycodone, and the hip and totally cool U47700 is a synthetic opioid.
    2. what then is a synthetic opioid. Is it any different than a non synthetic opioids
      1. not really. The only difference is one is created in a lab and the other is derived from plants.
  2. medical uses
    1. legal opioids in general are used for pain management.
      1. Looking back in time it's actually one of the first meds we really cultivated as a dug. from as far back as 3000 bc People in mesopotamia would use the poppy plant for its euphoric effects. It quickly spread to other cultures
        1. Hippocrates back in 440 bc were using it for internal medicine. Although i am sure they didn't have the type of screwtony that we do today they recognized its ability to change the body and tried in on all types of illness and even some epidemics.
        2.  As early as 200 AD chinese surgeons were using opium and cannabis together . people would take it prior to getting cut open.
        3. in 1527 a German alchemist created a "drug he derived from the optimum plants dissolved in alcohol that gave insane relief to pain. This drug he called Laudanum is still a prescribed drug today here in the US
    2. in the 1800 morphine was derived from opium as well. With the onset of the civil war morphine soon became a major drug. Along with its increase use came soldiers disease.
      1. This was the first time western culture really started see the impact of the additive property of opioid based drugs
    3. As the 1900 charged forward The US started to curb the free flow of opioids around the country.
      1. At this time heroin was literally being given away to anyone who was addicted to morphine.... What a great time to be alive.!
      2. just before the roaring 20s oxycodone was created in response to the increased awareness of the effects of morphine and heroin. It was hoped they could find a substance that was as strong a pain kill but without the additive properties of morphine and heroin.
      3. As of today many of the drugs we see today have come around because of this drive to create something that is a powerful pain reliever but will not be additive. Unfortunately there has been little ability to advance this agenda.
      4. While the history is interesting there is a takeaway from this. This chemical additions and the power of opioids is so strong that it was recognized 5 thousand years ago. It was some of the first medicine ever synthesized or drawn from nature. It effects are very powerful. Many of the additions that we see today are from an over-prescription of the drug. A drug so powerful that once your doctor stops prescribing it people turn to the black market to continue to satisfy a craving they can't control.
  3. illicit uses
    1. It can be injected into the bloodstream like many other opiods.
    2. The powder can be drawn into neat little lines and picked up with a straw right into nose.
    3. It can be found and formed into pills and swallowed.
    4. It even has the ability to be smoked.
  4. where is it coming from
    1. It was originally created in a lab back in the 70s.
    2. It was only put on the DEA Schedule 1 for controlled substance back in nov 14th if 2016
      1. effectively making them illegal because they have a high abuse potential or no medical use or they have some serious safety concerns.
    3. it was one of these drugs that was created in a lab but never received any kind of FDA approval.
    4. Like fentanyl many of the synthesized opioids that we see on the street are being brought in by china.
      1. We can follow the flow path from either canada of mexico then over the border.
      2. what about created it in illicit labs.
        1. Ya that potential definitely exists for opioides in general. I think as we start to see them gain control over the flow into the us we will see an increase in lab production.
          1. but for now its not worth it, this stuff is so damn cheap from china
  5. What does it look like
    1. Tends to be a pink powder. In Fact the color gives rise to two of its street names, pink and pinky.
      1. very original
        1. well i guess it's easier than asking for U 47700
      2. well U4 is another street name for this stuff.
  6. What situations are we seeing this drug in
    1. We are seeing this drug just like fentanyl. It is being cut up and placed into other things as the “active drug for opioids.
    2. Although unlike fentanyl it can be a stand alone drug. Although it ability to get it via legit means has deminstioned since it was placed on that schedule one list
  7. Pathophysiology
    1. what does it affect
      1. Like so many other Opiods the way we would sense that something was wrong was feeling numbness or a feeling like you were being sedated
        1. this is about 7 to 8 times as strong as morphine. Nothing really compared to some if not most of the fenylol diritivities.
      2. The feeling of having cold and clammy skin. This is good to know who recognize in others although we don't do too much hand holding on drug runs. we save cuddle time for after clean up.
      3. Sometime a general euphoria has been noted.
      4. Pinpoint pupils
      5. constipation too
        1. But that more of a long term or chronic exposure.
      6. tachycardia is a possible side effect as well.
      7. Larger dose can bring into a coma or complete respiratory failure.
  8. why it is so addictive
    1. We like to pretend that we as humans in fact have our own ability to make decisions. but we fail to fully understand that we are biological machines. everything we do and feel is driven by chemicals and chemical interaction within our body and specifically our brain.
      1. Our brain treats us like a dog. We do something it like we get a reward. When your a dog you get bacon, when your a brain you dopamine. Opioids screw with this system making your brain insanely sensitive to the chemicals that act like dopamine.
      2. There literally become physical changes inside your brain very very quickly. Your chemistry becomes altered and your brain and neuro system lacks the ability to function properly with the chemical in it.
        1. So think about this your body needs food. So when you are low on energy or nutrients you body starts to crave food. We senese this as hungry. When we need water we sense this craving as thirst.
        2.  We have a word for angry because your hungry. We call it hangry. My wife says it to me all the time. The desire for opioids are many many many times stronger
  9. how long
    1. lucky the effects can be within a few moments to min depending on the exposure. It can last a few hours.
      1. obviously the quicker it gets into your bloodstream the faster it will take affect.
        1.  I can remember after my RPLND from the cancer i was getting injected with an opioid called dilaudid. Great stuff. Now to give you a reference for my pain in an RPLND I was filleted open from the diaphragm to my my pelvis, my internal organs were for the most part moved out and off to the side and lyphondes there scraped off my back. So it was a major surgery. The pain the first few days was excruciating. When i would get injected in my thigh with this point the pain started to go away before the needle was pulled out of my leg. That's some fast acting shit.
  10. routes and harm for us
    1. LD 50 and LD 100 are really hard to come by. IF you know them please let us know. however there is a dosing chart to give an idea.
      1. The threshold effect is about 1-4mg and a heavy dose is about 10mg.
      2. on set is about 5 to 10 min with peak effects in 1-2 hours.
    2. We want to be careful with inhalation of this. Beyond the opioid effects it can cause scarring in the lungs. so all the more reason to wear the air.
  11. detection
    1. According to the NIH in a paper released in oct of 2017, Immunoassays cannot detect U-47700, but a combination approach of untargeted followed by targeted chromatographic and spectral techniques have been utilized to detect U-47700 [4].
    2. Like all FTIR and roman it must be in the library. So check you meter library to see what they got.
    3. I know from commorra that there 908 is doing really good on hitting this stuff.
  12. how would we protect ourselves
    1. PPE
    2. So when all is said and done it really boils down to our PPE. After looking at this chemical I would say that i would were the same things as i would with fentanyl. No issue in a level B because we so used to being on air.
    3. With that said I don't see any issue with a level C as long as the your in a well fitting p100 or respirator or papr.
    4. These are all situationally dependent. and if you look back to many of our shows in the pass we highlight this idea by saying it depends.
      1. And it does depend. If i am going into a place where there is power everywhere because the cops just did a raid and i can't walk around without getting powder on my scba then may i might lean toward a encapisated B. But each situation is different so make sure you making choices that are specific to your run.
  13. Antidote
    1. if we get hit with this stuff our basic narcan will do just fine
    2. and remember if you don't have narcan or you don't have enough rescue breaths will sustain life. Just stay calm and make sure they are getting good airflow
      1. if you going to a level C for god sake grab a pair of lab goggles. Not just safety glasses but the kind that would block the power from getting your eyes. I am pretty sure they have to meet the ANSI/ISEA Z87.1. Don't know what that is go look it up. jesus we can do everything for you.
  14. Decon
    1. if this gets on us, like our skin we should decon with soap and water . Do not use things like bleach this can aid in skin absorption.
      1. The same is true with alcohol based hand disinfectants.
    2. If your looking to decon your ppe you should first try to keep the powder from getting kicked up in the air.
      1. This is where a light wet cloth can help
      2. Ya like the fibertect wipe
    3. were going to shoot back over to the same things we would do for fentanyl. 5 % peracetic acid is really a nice choice
      1.  if need be you can do a 10% hydrogen peroxide solution.
    4. you can use the same things for tools as well.
      1. along with dahlgren solution and 12% tichlor solution..
        1.  don't use that on PPE. its a can degrade your ppe. just on tools.
    5. These are also similar recomonations that the IAB has put out.
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