Posts Tagged ‘overdose death’

U-47700

Illicit U-47700

Illicit U-47700

 

 

 

My patients are sometimes my best teachers, so when one of them mentioned a new opioid drug, I searched for information online. This new drug is called Pink, or Pinky, but its chemical name is U 47700.

This drug was first developed in the 1970’s by a scientist at Upjohn, a pharmaceutical company. This drug has never been studied in humans, but produces a strong opioid-type effect due to its action at the mu opioid receptor. It’s quite powerful, with estimated potency at seven or eight times that of morphine.

Last year, forty to eighty overdose deaths in the U.S. were attributed to this drug, depending on which source you read. As a man-made research drug, it was legal to obtain until late last year, when the DEA placed U-47700 on Schedule 1 status. This means it is no longer legal to buy online, and that it has a high potential for causing addiction and harm.

Rolling Stone did an article on this drug last fall, saying it was one of the drugs that contributed to Prince’s death, found in his blood at autopsy along with fentanyl. When Rolling Stone published their article, it was still an unscheduled drug. According to that report, there had been around 80 deaths attributable to U 47700, which is usually combined with fentanyl or other drugs. [1]

In some areas, fake Norco tablets were peddled by drug dealers. These pills actually contained U-47700, or a combination of U-47700 and fentanyl. At least a dozen people died from these fake pills, because they believed they were buying hydrocodone, but actually ingested the much more powerful opioids U-47700 and/or fentanyl.

When I listened to an online lecture from last year’s American Society of Addiction Medicine’s fall conference, one of the speakers, Robert DuPont M.D., said the drugs of the future will be synthetics. We’ve already seen this in the rise of synthetic marijuana products, and now it appears we are seeing synthetic, novel opioids hit the streets.

These drugs are cheaper to make by the big drug labs in China and Mexico than traditional heroin, as I said in a former blog post.

It’s impossible to tell how big a problem U-47700 is at this time. Routine toxicology may not detect this substance, unless the lab is told to test for it specifically. It’s quite possible this drug could be a component of much of what is sold as heroin. We already know heroin is frequently mixed with fentanyl because it’s cheaper to manufacture. If U- 47700 is cheap to make, it’s also likely to become a common component.

Synthetic drugs present legal problems. A chemist who is experimenting may come up with a new psychoactive product, and it can hit the market before any law can be passed against its use.

These novel drugs aren’t illegal until after they appear on the streets and cause harm. Then governmental agencies like the DEA rush to change laws to cover these drugs.

There’s another big danger to synthetics. Sometimes the chemists making drugs aren’t that careful. Not all chemists are Walter White, the character on “Breaking Bad.” Walter was an educated chemist who wanted to make the purest product possible, in order to please his customers and maintain his reputation. I dare say most chemists aren’t as educated as Walter, and aren’t as meticulous with details.

There’s always the risk that these people will inadvertently make a similar drug with completely different properties and side effects.

MPTP is a great example of a drug manufacturing error.

MPTP, chemically known as 1-Methyl-4-phenyl-1,2,3,6-tetrahydrophyridine, can be accidently manufactured instead of MPPP, a closely related drug with opioid-like effects. In the 1980’s a handful of people injected what they thought was MPPP, and developed severe Parkinson’s disease. This happened because the chemist accidently made MPTP, which destroys cells in the brain that control movement of the body. MPTP caused Parkinson’s disease in these drug users. This error, though tragic for the people affected, led to useful information to better understands Parkinson’s disease and its treatments.

And some of what I read online seemed overblown. For example, one section of the Rolling Stone article said the drug could cause rectal bleeding. Upon closer reading of the article, the rectal bleeding was reported by people who had used the drug rectally. So yeah, that might cause problems down there.

In another online article, the police chief of Park City, Utah, is quoted as saying, “This stuff is so powerful that if you touch it, you could go into cardiac arrest.” [2]

I am skeptical about that statement. Unless there’s something in it allowing it to pass through the barrier of the skin, that’s doubtful.

Making speculative statements without proof can lead to hysteria, and can undermine the credibility of people who are trying to inform drug users of some very real dangers.

For me, the message is “buyer beware” with heroin. It may or may not be heroin. It could be fentanyl, it could be U-47700, and it could be a whole lot of other things.

This means it’s even more important for drug users to try “tester shots,” meaning use a fraction of drug to assess its potency. It’s important not to use alone, and to stagger injection times, so that there’s always someone able to call for help if needed. Drug users of opioids should have up-to-date naloxone kits on hand in case the worst happens and someone overdoses.

And above all, consider getting into opioid use disorder treatment: https://findtreatment.samhsa.gov/

  1. http://www.rollingstone.com/culture/news/u-47700-everything-you-need-to-know-about-deadly-new-drug-w443344
  2. http://www.inquisitr.com/3600359/new-drug-pink-causing-deaths-nationwide-opioid-u-47700-easily-purchased-online-despite-federal-ban/

In Utah, Pain Medicine Specialists have the Highest Death-to-Prescription Rates

Of all fifty states in the U.S., Utah has the fourth highest opioid overdose death rate. In a study presented at this year’s American Academy of Pain Medicine conference, one researcher compared data from Utah’s prescription monitoring program with information regarding prescription opioid deaths in that state. She did this to discover which physician specialties have the highest death-to-opioid prescription rates. (1)

The results were somewhat surprising. Though pain medicine specialists wrote only 1% of all opioids prescribed in the state, their patients accounted for 3% of the state’s overdose deaths. Family practice physicians prescribed the highest amounts of opioids in Utah, but had half the death rates of pain medicine specialists. Other specialties with high death-to-prescription rates were anesthesiologists, physiatrists (physical medicine and rehabilitation doctors), and physician extenders (nurse practitioners and physicians’ assistants).

Specialties with the lowest risk were internal medicine doctors, orthopedic surgeons, emergency room doctors, and dentists.

Of course, pain medicine specialists correctly responded to this data by reminding us that association doesn’t prove causation. The pain medicine specialists say they care for the most complicated of patients, referred when primary care physicians feel they need expert help.

This is an important point. You have to look at the population being treated.

I’m reminded of a similar example in my region. A few years ago, a local suburban community hospital claimed that patients admitted to their hospital had the lowest complication rates of any hospital in the area. They were correct, but it was because they referred very sick patients to a nearby urban tertiary care hospital. That hospital, caring for the sickest of the sick, had a high complication rate for their inpatients. In other words, the data was accurate but still misleading, due to the marked differences in the patient population treated by each hospital.

In the same way, pain medicine experts aren’t likely to be caring for uncomplicated, easily treated patients. The tough, complicated cases will be referred to them from primary care doctors.

Pain medicine specialists also point out that dentists and primary care doctors may be prescribing for many patients with acute, short-term pain. This type of patient is likely at less risk than patients with chronic pain from serious illnesses. The amount and strength of opioids that dentists and primary care doctors prescribe is likely to be lower than the amount and strength of opioids prescribed by pain specialists. And we know that the higher the dose of opioids prescribed, the more likely the patient is to suffer an overdose death.

The author of the study acknowledged the difficulty in interpreting the data, but also said she felt this information indicated a need for education for all the state’s physicians. Adding support for her recommendation is a report released last fall that describes the results of a survey of pain medicine specialists. (2) Only 70% of these specialists answered questions correctly about opioid abuse and the FDA’s new Risk Evaluation and Mitigation Strategies. Thirteen percent say they don’t assess their pain patients for risk of opioid misuse, which is now the recommended standard of care for all patients receiving long-term opioid prescriptions.

Getting back to the Utah study: It’s important to note that even in this state with a high overdose death rate, only .475% of all opioid prescriptions were associated with fatalities

1.Drug and Alcohol Dependence News, Feb. 28, 2012, citing Porucznik C, et al, “Physician specialty and opioid prescribing in the Utah controlled substance database 2005-2009 AAPM; Abstract 201.

2. http://www.medscape.com/viewarticle/749713