Monday, October 31, 2016

Trick or Treat

 sun2cas

Some heroin dealers in Hartford have switched up their drug stamps to celebrate Halloween. Drug Users are being treated to brands such as Killer Clowns, Freddy vs. Jason and Casper (the Friendly Ghost).

The question for the users on Halloween (and one every day they buy): is their special envelope a trick or treat?Are they getting heroin? And what is it being cut with? Brown sugar, baby formula, Benadryl, rat poison, caffeine, paracetamol, chloroquine, quinine, flour, chalk, talcum powder, sucrose, starch, powdered milk, acetaminophen, Fentanyl, or Carfentanil? (1) Will the bag get them high or will it kill them?
I wonder when they buy, did the dealer wear a Scream mask? Was he dressed like a killer clown? Did he wear a Donald Trump mask, or was he dressed like Superman? Did he hang skeletons and carve and light jack o'lanterns to guide the drug users to his evil drug lair?

And when the drug users look at themselves in the mirror on Halloween, do they hope that it is all just a scary dream that they will wake up from and everything will be normal again? Instead of finding themselves alone in a public restroom, will they be in their own bathroom off the master bedroom where their pretty wife waits for them, and their darling children are asleep nestled in their bedrooms of the house built with hard work and sweat.

All just a dream

Just a dream.

Please just be a bad Halloween dream.

(1) Wouldn't it be nice if heroin dealers had a better business accreditation in which they certified their product was free of impurities? Users then wouldn't have to play Russian Roulette every time they scored. I am not there yet, but every day I grow closer and closer to thinking we need a model where addicts are allowed to purchase their dope in an inspected pharmacy and use in a clean setting, oversee by medical people with access to narcan and substance abuse treatment.

Saturday, October 29, 2016

he Wolf and the Sheepdog

 peacezz2

In the Looney tunes cartoon, Ralf E. Wolf and Sam the Sheepdog go to work each morning, exchanging greetings while punching the clock.

"Morning, Ralph," the dog says.

"Morning, Sam," the wolf replies.

Then it is down to business. The wolf spends his hours trying to steal the sheep and the sheepdog spends his hours trying to stop the wolf.

At the end-of-the-day when the factory whistle blows, Ralph and Sam punch out, wishing each other good night, before heading home presumably to their families, a hot dinner, and a sound sleep. They return the next day to do it all over again.

It is a vision of the world that I would like to believe in. I sometimes think of Hartford in the same terms. In the morning at the bakery on Park Street, there are drug dealers, drug users, police and paramedics all in line for their coffee, doughnuts, or breakfast sandwiches. Everyone is convivial. Then it is off to work.

The dealers try to sell their product, the cops try to stop them. The users try to use, and we try to see that no one gets hurt.

When I respond to the city lockups or even on arrest scenes where we are called to evaluate a person in handcuffs who may have fallen during a foot pursuit, there is often a common courtesy, even friendliness, among everyone in the same way that players from rival sports teams may chat at halftime or during timeouts. This, of course, is not always true as there are often times where there is a certain chest-puffing, accompanied by profanity and anger, between victor and the fallen. Still, I like to think there is a comradeship of us all belonging to the same city and same species. I remember after the UConn Men's basketball team won their first national championship in 1999, shocking the world by upsetting Duke, everyone in the jail house was in high spirits, cops and robbers both, saying "How bout those Huskies!"

An idealist, I believe we are all, at essence, just people, following the course of our lives that we don't always control. I was more likely to become a paramedic than a drug dealer. The cop came from a family of cops, the drug dealer from a family of drug dealers, the drug user found himself there after an accident, prescription painkillers that he grew too fond of, or maybe a childhood of abuse that rewired his brain and made him less likely to make the proper choices. I, of course, ended up there because I watched the TV show Emergency and had a crush on Dixie McCall.

As a paramedic, I have had, in my ambulance, injured cops, shot drug dealers, overdosed users, and fellow EMS responders with blown-out backs. They are all patients and I treat them the same. We have conversations, we talk about our families. I believe there is a fundamental goodness in most of us.

But clearly there is darkness in the world. There are cops who cross the line, there are paramedics who don't give a shit, and there are drug dealers without conscience.

I am going to take the position that not all drug dealers are evil at core. Bear with me on this. There are some dealers who I believe are honest businessmen who just want to make a living, and who adhere to basic principles. They provide a product to people who would be sick without it, people who come to them freely. They pay their associates fairly, they charge fair prices, and they deliver the product they advertise. They don't rip their customers off. They develop a clientele, who they look out for, sometimes extending credit during hard times, maybe giving them an extra bag at Christmas or on their birthday. These dealers do not want their patients to die.(1) They want them to be Happy, to feel Passion, to find Peace. These dealers and there may only be a few -- I do not know --are a different breed from those who have only darkness in their hearts. Those dealers are the ones spiking select doses of their heroin with fentanyl to deliberately cause fatal overdoses to increase advertising for their brands. Those predators are the ones who put Carfentanil in their bags a drug that could kill not only the patient, but the cop, the medic, the lower level drug dealer selling it on the street and the child who picks up the wrapper with the panda bear on it . They are the villains who cross the line in the same way a rogue police officer delivers an unnecessary beat down or a paramedic lets a patient die out of laziness or spite. There was no pure evil in the Looney Tunes world, but that was after all just a cartoon.

happyt6pred2

1) Writing this, I had a vision of a benevolent dealer who along with the bundle of Crazy Monkey gives each customer a small plastic shopping bag containing clean needles, Narcan, and pamphlets about where to get substance abuse treatment.

k1

Friday, October 14, 2016

Carfentanil

 bag30

It hasn't come to Hartford yet, but EMS in states such as Michigan, Ohio, West Virginia and Florida have encountered patients who have overdosed on heroin laced with Carfentanil, an opiate of the synthetic fentanyl family that is 10,000 times stronger than morphine and usually used to tranquilize elephants.  Carfentanil is basically a chemical weapon of mass destruction that drug dealers are getting from Mexico via labs in China to give their heroin an extra kick to help increase their profits.  The drug is so powerful it poses a threat to police and EMS responders if they come into contact with it either through touch or inhalation.

Drugs like Fentanyl and Carfentanil made in a laboratory are a much cheaper, cleaner way for the drug trade to maximize their profits than to have to rely on growing acres of opium and harvesting them, and all the handoffs required to get from the foreign poppy field to the USA city streets. Cut your heroin with baby formula and sprinkle some fentanyl on top to boost the potency.

While these new opiates have increased the rate of overdose deaths, this is not particularly bad news for the dealers.  In the Northeast where most dealers brand their product with their own stamp, such as Black Jack, Ferrari, and Night Owl, a death or two and a spat of overdoses can do wonders for a particular dealer's brand.  I recently watched an episode of Drugs, Inc. called Heroin Island, covering drug dealing in New Jersey and Staten Island, New York. In the episode, a dealer admitted to pouring liquid fentanyl into random bags of a new batch of heroin to achieve just that effect  to cause an overdose or death and highlight word of his brand's potency  to generate more business.  Here in Hartford, I have had addicts ask me what the hot brands are.  When I have asked them if they are worried about Oding themselves, that is not much of a fear for many of them.  They are not looking to off themselves; they are just looking for high grade dope to give themselves a better high.  For many addicts, the longer they do heroin, the less shooting up is about getting high as it is about feeling normal again, chasing away the sickness of constant withdrawal.  They long for the first glorious experience they had with the white powder that still eludes them.

I doubt this will change should the King Kong sleepy time powder come to town.  Heroin does, after all, rewire the medulla oblongata to disable the addict's ability to think rationally. It's all about the next fix. The future isn't really a concept for them beyond a few hours.

The Cafentanil story, the use of chemical weapons grade powder as an additive to your product with the intent of killing some of your customers to boost marketing and profits, is chilling.  But when I think about it longer, I don't know if it makes me inclined to reserve a special place in hell for these dealers. Where they are going, they will have company. How different are their practices from those of mainstream business who ignore or hide evidence of their products causing cancer, heart disease, obesity, or are known to them to be unsafe, capable of killing or maiming? At least you can't accuse the heroin dealers of false advertising, particularly when they brand their product with deadly slogans and imagery like Strike Dead, R.I.P, Dead Man, Black Widow, Pray for Death, and Skull and Cross Bones.

Elephant tranquilizer carfentanil linked to 19 deaths in Wayne County

Deadly Opioid Overwhelms First Responders And Crime Labs in Ohio

Heroin Is Being Laced With a Terrifying New Substance: What to Know About Carfentanil

Deadly Powder Overwhelms First Responders

Opioid Epidemic Fueled by Carfentanil Imported from China

 

ro6ro24mon4ro29mon3cobra

Thursday, October 06, 2016

Election Forecast

 trump

The early returns are in. Heroin addicts in the greater Hartford area have cast two votes for Donald Trump (Using empty heroin bags I found in an area commuter lot as a proxy).

Questions.  Did the dealer stamp half his bags with Donald Trump and the other half with Hillary Clinton in order to provide proper choice to all his clients. I got Clinton and I got Trump, what do you want? You're a libertarian?  F-you.  Its Trump or Clinton, make up your mind or move along!"  If he only has Trump and the user is a Hillary Supporter, does the Clinton backer say, "Well, I've got the shakes and I'm gonna be sick, but under no circumstances will I buy Donald Trump heroin. Guess I'll have to just deal with withdrawal on my own or until my dealer gets some Hillary in.

When given a choice between the two, who would you expect a heroin user to really prefer? The candidate who promises hard time for drug offenses? Or the one who promises free room and board at a rehab facility of their choice?  A possible fellow criminal or a fellow non-taxpayer? Did this heroin user or users even know who Donald Trump is? Is the heroin user a business professional who had to shoot up in the commuter lot to have the strength to go to work? Or did they meet their dealer on their lunch hour? Or were they divorced and out work and living out of their car because heroin had caused them to throw everything precious to them away in pursuit of the next fix? Do they say to the dealer "F -Donald Trump and F-Hillary Clinton, I just want the heroin."

Let's say the dealer only has Donald Trump. So what was he thinking? In what way is the dealer using Donald Trump for his heroin marketing? Does he really love Donald Trump and think Trump is an marker for excellence in the same way some dealers put A+, check mark, "Great job!" or a light bulb on their bags? Maybe the dealer thinks Trump represents a strong military so instead of putting an AK47  or Trojan helmet he puts Donald Trump. Maybe because of Trump's casinos, he fits in with the gambling theme seen on so many bags like Money Bags, Black Jack and Lucky 7? Maybe he is putting Trump on his heroin bags in the same way other dealers put on the Grim Reaper, Bio Hazard and Skull and Cross Bones? Or maybe he stamps "Donald Trump" on the bags to send the same message other dealers send when they put OMG on theirs? Maybe his pitch is simply "Trump -- it will F-you up!"

Ah, to be omnipotent and all-knowing.

Come election day we'll see if the heroin bag indicator proves to be a positive or negative forecast, and in the meantime, you can count on Medicscribe to keep you updated on the latest counts.

Sunday, October 02, 2016

Got Narcan App

 s16

Last year we heard about a CPR app that alerted people who knew CPR to nearby cardiac arrests so they could race to the scene and perform bystander CPR, potentially saving precious minutes that could mean the difference between life and death, or between anoxic brain injury and the life of a taxpayer.

This week I read that the FDA has opened up a competition for software experts or software laymen to develop a similar application for opiate overdoses. A sort “Got Narcan? app” where if someone came upon an opiate overdose they could activate the app, sending out a signal to anyone will a cellphone and access to Narcan to grab the kit and atomizer and hustle to the scene.

Searching for naloxone to cure a heroin overdose? The FDA wants an app for that.

FDA launches competition to spur innovative technologies to help reduce opioid overdose deaths

There is already an app for that. It’s called 911.

Reading the article though, it did make some sense. They give the example of an apartment building where a neighbor could arrive quicker than the ambulance. An apartment with perhaps a clientele into tattoos and Kurt Cobain music. (They may have Narcan, but don’t strike me as candidates with lightening response instincts)t. Or I suppose, say someone discovered someone passed out and blue in the ladies room of the McDonald's. Hit the app, and you never known with heroin addiction as widespread as it is, perhaps several diners may have Narcan on them. Not just addicts, traveling in twos, but family members of addicts who live in fear of coming upon a loved on Oded. Car stopped at the intersection in front of you, not going even though the light turned green. Twenty-five year old driver slumped over with agonal resps. Grab your Samsung phone or any mobile phone and hit the new Narcan app. Oh wait, grab the Narcan you carry in your glove box, next to your CPR mask, and registered handgun (those of you who are always prepared).

The Got Narcan app is easy to make fun of, but it is just another example, not only of the seriousness of the opiate crisis, but people’s fear in the face of the growing dragon, the opiate epidemic.