Tuesday, March 6, 2018

Opioid overdoses in the ER

Among approximately 45 million ED visits reported by the 16 ESOOS states from July 2016 through September 2017, a total of 119,198 (26.7 per 10,000 visits) were suspected opioid overdoses. Opioid overdose ED visits increased 34.5% from third quarter 2016 to third quarter 2017 (Table 2). Ten states experienced significant increases in prevalence during this period, although substantial variation was observed among states in the same region. For example, in the Northeast, significant increases occurred in Delaware (105.0%), Pennsylvania (80.6%), and Maine (34.0%), but other states, including Massachusetts, New Hampshire, and Rhode Island experienced nonsignificant (<10%) decreases. In the Southeast, a significant increase (31.1%) occurred in North Carolina, a significant decrease (15.0%) occurred in Kentucky, and a small, nonsignificant decrease (5.3%) was observed in West Virginia. In the West, a significant increase (17.9%) occurred in Nevada. All states in the Midwest reported significant increases, including Wisconsin (108.6%), Illinois (65.5%), Indiana (35.1%), Ohio (27.7%), and Missouri (21.4%).
All urbanization levels experienced large and significant increases in ED opioid overdose visits from third quarter 2016 to third quarter 2017, including large central metropolitan (54.1%), medium metropolitan (42.6%), small metropolitan (36.9%), micropolitan (23.6%), large fringe metropolitan (21.1%), and noncore (20.6%) areas. Large central metropolitan areas experienced significant linear increases (Figure 2).

most are in urban areas in the midwest.

 one interesting item is that xanax laced with fentanyl is now being sold in the street.


Most buyers simply don’t realize they’re getting something totally different than what they intended to purchase, especially when this new counterfeit Xanax is made to look exactly like a 2mg Xanax pill. It even bears the fake “XANAX” label, along with boasting a similar size, shape and color. Some of these fake pills are so good, in fact, even forensic scientists can’t tell the difference just by looking at them. That’s just how good these counterfeiters have become at manufacturing Xanax dupes.

what is not being said: Most of the fentanyl comes from China, as does these "counterfeit" xanax pills.

FoxNews: it is a popular "party" drug and popularized by the hip hop music industry types:

Xans have been glorified by hip hop artists in the music industry, they’ve appeared in numerous of their music videos, and they’re being sold all over social media, especially Instagram, including by a popular DJ in the San Fernando Valley.
“I think the reason Xanax is popular with the kids is it’s being popularized in music, social media platforms, it’s in almost every song, my son even asked me what’s molly Percocet, and he’s nine years old,” Whitfield said. “Fentanyl has been pouring in from China, where there are looser regulations and an abundant amount of pharmaceutical companies...
 The DEA told FOX 11 that fentanyl has been pouring into the United States from China, where there are looser regulations and numerous pharmaceutical companies, and that between 2014 and 2016 the amount that was seized coming into the US went up eighteen fold.
2017 is expected to be even worse.
CNN report here.

Pill presses -- which can easily be bought online -- allow someone to take powder and press it into a pill that looks legitimate. "People have died from ingesting what they think is a legitimate painkiller, (but really) it's a counterfeit pill that contains fentanyl," Martin said.
Across the country, authorities have seen this play out.

The Fentanyl comes from China, often is bought via the dark net, and the pill making machines are also from China.

 Most come from China. That's where much of the illegal fentanyl is manufactured, as well. Clandestine Chinese labs manufacture a synthetic version of fentanyl that is easily bought on the dark Web. Mexican drug cartels later began to buy it and resell it across the border.
the problem? This was not an unforseen problem.

This April 2016 article on STAT warned of the problem. and the article notes that the CDC first noted the problem as far back as 2015...

in other words, while the Obama administration was making it hard for docs to give pain pills to their old folks who were hurting, they knew most of the problem was illicit opioids.

lots of details in the article:

he dozen packages were shipped from China to mail centers and residences in Southern California. One box was labeled as a “Hole Puncher.”
In fact, it was a quarter-ton pill press, which federal investigators allege was destined for a suburban Los Angeles drug lab. The other packages, shipped throughout January and February, contained materials for manufacturing fentanyl, an opioid so potent that in some forms it can be deadly if touched.
When it comes to the illegal sale of fentanyl, most of the attention has focused on Mexican cartels that are adding the drug to heroin smuggled into the United States. But Chinese suppliers are providing both raw fentanyl and the machinery necessary for the assembly-line production of the drug powering a terrifying and rapid rise of fatal overdoses across the United States and Canada, according to drug investigators and court documents.
and the article notes that it is also a problem in Canada:

In British Columbia, police took down a lab at a custom car business that was allegedly shipping 100,000 fentanyl pills a month to nearby Calgary, Alberta where 90 people overdosed on the drug last year. The investigation began when border authorities intercepted a package in December containing pharmaceutical equipment. Police would not describe the equipment but told STAT it came from China.
the "opioid" crisis was blamed on doctors, of course. Ignoring that it wasn't patients in pain who were overdosing but druggies, young people who were into the party culture, etc.

Yes, we often hear of all those tragic deaths about a teen/young person who just borrowed a pill to go to sleep and died. But you know, I am cynical: how did that young person know who was selling pills?

It's not like our old ladies who would sell their pain pills when they needed cash, or lend them to a friend who was hurting, but also buy one when their arthritis kicked up. That is friends to friends.

In these cases, it is bought from street dealers who are known.


one note: it's nice to say give non opioids to people for pain.

I take a lot of NSAIDS for various problem in the past, and now for osteoarthritis.

But the dirty little secret is that these pills have side effects on the kidney (and heart) and cause bleeding ulcers if you take a lot, or even at normal doses in the elderly. Long review article from AgingDis:

Table 1

NSAIDs’ common adverse effect profile.
Gastrointestinal toxicity•Dyspepsia
•Gastroduodenal ulcers
•GI bleeding and perforation
Cardiovascular adverse effects•Edema
•Congestive heart failure
•Myocardial infarction
•Stroke and other Thrombotic events
Nephrotoxicity•Electrolyte imbalance
•Sodium retention
•Reduce glomerular filtration rate
•Nephrotic syndrome
•Acute interstitial nephritis
•Renal papillary necrosis
•Chronic kidney disease

update: Article from the PhilInquirer (9-2017) about Chinese illicit drug business in the Philippines.

here the main problem is "Shabu" aka meth.

Whether the Senate inquiry amounts to substantive amendments to Republic Act No. 9165 (or the Comprehensive Dangerous Drugs Act of 2002) remains to be seen. But the probe highlights the fact that China, President Duterte’s newfound ally, is the biggest exporter of shabu and its precursors not only to the Philippines but also to other countries.
Known in the trade as “cooks” and “chemists,” meth production experts are flown into the Philippines from China by drug syndicates to work in laboratories like the one recently dismantled on Mount Arayat in Pampanga.
Synthetic drug manufacturers in China have been able to ply their trade due to the country’s large and loosely monitored chemical industry.
One report said the lack of regulatory practices in China has made it easy for crime syndicates to divert chemicals with legitimate uses, such as fertilizer, pesticides and medicine, toward the production of addictive drugs.

Read more: http://opinion.inquirer.net/107267/drugs-china-bigger-threat-ph#ixzz590s2SJ37 Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook

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