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THMG142 – Synthetic Opioids

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In this episode, Mike and Bob discuss all things synthetic opioids, with a focus on U-47700.

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Complete Show Notes

3:55 What Are Synthetic Opioids?

  • Examples include oxycodone and U-47700
  • The only difference between synthetic and non-synthetic opioids is that one is created in the lab and the other is derived from plants

5:20 Medical Uses of Synthetic Opioids

  • In general, legal opioids are used for pain management
  • Brief history of opioid use in medicine
    • Physicians as far back as Hippocrates (440 BCE) were using it for internal medicine – tried it on all types of illnesses and even some epidemics
    • Chinese surgeons used opium and cannabis together as early as 200 CE – patients took it prior to being operated on
    • In 1527, a German alchemist created a drug derived from opium plants dissolved in alcohol that provided incredible pain relief – called it laudanum, which is still prescribed in the United States today
    • With the onset of the Civil War, morphine soon became a major drug – increased use brought on so-called ”soldier’s disease” (drug addiction)
    • During the 20th century, the United States government started to curb the free flow of opioids around the country – at this point, heroin was literally being given away to anyone who was addicted to morphine
    • Just before the Roaring 20s, oxycodone was created in response to the increased awareness of the effects of morphine and heroin – scientists were hoping it would offer the same painkilling properties without the addictive nature
    • Unfortunately, this didn’t (and still hasn’t really) happened – opioids remain drugs so powerful that people turn to illegal means to acquire them once their doctor is no longer prescribing them

10:30 How Do We Use Synthetic Opioids?

  • Synthetic opioids can be injected into the bloodstream like many other opioids
  • Powder can be drawn into neat little lines and picked up with a straw right into the nose
  • It can also be formed into pills and swallowed
  • It can even be smoked

11:00 Where Do Synthetic Opioids Come From?

  • U-47700 originally created in a lab back in the 1970s
  • Put on the DEA Schedule I drug list for controlled substances on November 14, 2016
  • This effectively made it illegal due to a high abuse potential, lack of medical use, and serious safety concerns
  • Like fentanyl, many of the synthesized opioids we see on the street are being imported from China
  • Some synthetic opioids are created in illicit labs, but at the moment, it’s not really worth it since it’s so cheap to import it from China

13:25 What Does U-47700 Look Like and Where Are We Seeing It?

  • U-47700 tends to be a pink powder – thus two of its street names, “pink” and “pinky”
  • Just like fentanyl, it’s being cut up and placed into other substances as the “active” drug
  • Unlike fentanyl, though, it can also be a standalone drug

16:30 Pathophysiology of U-47700

  • Like all opioids, there’s a feeling of numbness or the sensation of being sedated
  • 7-8 times as strong as morphine, but still “mild” in comparison to fentanyl and its analogues
  • There’s also a feeling of cold and clammy skin
  • Feelings of general euphoria have also been reported
  • Users also experience pinpoint pupils and often constipation
  • Tachycardia is another possible side effect
  • Larger doses can lead to coma or complete respiratory failure

18:30 Why are Synthetic Opioids So Addictive?

  • Everything we do and feel as humans is driven by chemicals and chemical interactions within our body (and specifically our brain)
  • Opioids make our brains extremely sensitive to the chemicals that act like dopamine
  • Your body and brain chemistry becomes altered, and your brain and neurosystem become unable to operate without the opioid

20:30 How Does U-47700 Affect Us as Responders?

  • You can feel the effects of exposure to synthetic opioids within a few minutes depending on the exposure – effects can last for a few hours
  • The quicker it gets into your bloodstream, the faster it takes affect
  • LD 50 and LD 100 are very hard to come by, but there’s a dosing chart to give us an idea
  • The threshold effect is about 1-4 mg, and a heavy dose is around 10 mg
  • Onset is about 5-10 minutes, with peak effects in 1-2 hours
  • Inhalation is a concern – beyond the normal opioid effects, it can also cause scarring in the lungs

23:10 Detecting U-47700

  • Immunoassays cannot detect U-47700, but a combination approach of untargeted followed by targeted chromatographic and spectral technologies can
  • Like all FTIR and Raman, it must be in your meter’s library – check this out beforehand

24:15 Protecting Ourselves from U-47700

  • Wear the same PPE you would with fentanyl – typically Level B
  • You can also wear Level C, as long as you’re in a well-fitting P100, respirator, or PAPR (and wear eye protection)
  • Keep in mind that these are only suggestions – always do what’s best in your unique situation
  • Treat affected individuals with Narcan
  • If you don’t have Narcan, rescue breaths will sustain life – stay calm and make sure they’re getting good airflow

27:20 Decontamination and U-47700

  • Decon with soap and water – don’t use bleach or alcohol-based hand disinfectants, as these can aid in skin absorption
  • Make sure you don’t kick powder up into the air when deconing your PPE – a light wet cloth can help
  • Like fentanyl, 5% peracetic acid is your best choice – if need be, you can use a 10% hydrogen peroxide solution
  • You can also use these solutions to decon your tools, along with Dahlgren and 12% tichlor solutions (don’t use these on your PPE, though)

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