Carfentanil

 

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

 

Election Forecast

 

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.

Got Narcan App

 

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.

The Price is Right

 

I have been writing much lately about heroin with the backdrop of Hartford's Park Street which is one of many epicenters of the current heroin epidemic. Today, I am going to briefly change the backgrounds. Instead of Park Street with its back drop of bakeries, bodegas, Spanish restaurants, and young tattooed men, with crooked baseball caps, standing in the doorways minding their own business, we are going to your typical elderly housing/assisted living facility. Imagine a room of geriatrics in the common room, with their walkers on tennis balls or canes at the side of their chairs. Imagine perhaps also a 50 gallon aquarium, with clean bubbling water and a large lazy fish or two.

Now let us focus on our subject -- a Caucasian woman of 62.  She is obese, maybe two hundred sixty pounds, her hair is grey and tied back behind her head in a pony tail.  Her clothing is threadbare and could use a laundering. She has two canes beside her with which she walks slowly and painfully on skinny legs that can barely support her girth. Instead of the fish tank, she and her mates are watching The Price is Right.

The host challenges a contestant to guess the price of the next item -- not a toaster or blender or even a new TV.  The item is --wallah! -- a bag of heroin.

While the contestant ponders on TV, the guesses start from others in the common room. $50, $100,

Our heroine shakes her head. Well, it depends, she says. The going rate is $5. If you are buying a bundle and you're a good customer, your dealer might give it to you for $4 a bag if the junk's not primo.  Course if you're a sucker, or live in the suburbs, and your friend/dealer is jacking the price he paid on Park Street like that mutherfucker Monte did to me for six months so he can afford his own habit, you might be asked to pay more.

I said I would change backdrops so I am going to do that again. Let's lift the geriatric common area backdrop up, and then lower behind a new backdrop. Lower Albany Avenue in Hartford.  Six in the morning.  Still dark. Our old lady and her canes sit on a concrete barrier near the bus stop. She fell walking down the avenue and her leg is killing her. 10 of 10 pain. It doesn't help that she's been up doing crack cocaine all night. When my partner asks her about her medical history, she says arthritis and cardiac arrest. The cardiac arrest was from an overdose earlier in the week in the South end. She says her chest is still sore from the CPR. They intubated her and also gave her Narcan. (Hopefully not after the intubation).

We ask her if she remembers what the bag of heroin she overdosed on looked like. She says it was white -- no stamp.  She says she bought it from a King, who was not her regular dealer. She only bought two bags and it knocked her out. She says it was white heroin. We show her the pictures of some of the bags we have been seeing lately. She nods her familiarity with some and others she says she has not seen. She says the generic one was particularly strong and there is also a potent batch going around in yellow bags with no markings.

We ask her how a 62 year old woman from the suburbs came to be buying heroin in Hartford.  She says she has bad arthritis and the medicine her doctor gave her was expensive and after awhile, didn't help.   Monte, the maintenance guy who sometimes sold her Percocets offered her heroin. He wanted $10 a bag.  She learned she could get it herself for $5 a bag. A girl in her beauty salon with tattoos gave her a beeper number she could call for a hookup, and she'd take the bus in to meet the man. $5 a bag was cheaper than $30 for a Percocet 30mg.  Of course now she is homeless (she maintains a friend's suburban address for her mail), has hep c, and sore ribs from the CPR she got on the day she couldn't find her regular dealer, and ended up getting the white heroin from a Latin King.

I ask her how she knew she bought it from a King. The Latin Kings used to boldly wear their colors-black and gold, but they have gone somewhat underground now so as not to stand out to law enforcement or the public (should they want to use a stolen credit card or commit another nonviolent crime). Better for business.  They still control much of the drug trade in the city. By the tattoo on his arm, she says. A lion with a crown. Plus everybody knows the Kings rule the Park.

Street gangs tone down use of colors, tattoos

I bet she would beat her old neighbors in the elderly housing common room at Heroin Jeopardy.

Yes, Alex, I'll have gangs for $400."

Their colors are blue and red?

Who are the Los Solidos.

Drug Administration for $500.

Skin popping.

What is injecting drugs under the skin rather than in a vein?

Packaging for $300.

5 Bundles

What is a brick?

She could buy a lot of $5 bags with her winnings.

Plus some crack cocaine to share with the old North end dudes she was partying with last night.

* Recently several drug dealers have been charged with murder for selling drugs that caused a fatal overdose as the guy who boasted of his "KD" stamp found out last April (see below Hartford article). Some dealers have responded by going to blank bags so it is harder to be linked to the killing powder.  Some have speculated it may eventually lead to the demise of stamped bags.

Prosecuters Charging Drug Dealers in Heroin Deaths

The New War on Drug Dealers

After Two Deaths, Feds Charge Alleged Hartford Heroin Dealers

 

I mentioned that we had a patient this week who said she stayed away from the white powdered heroin because of her fear of Fentanyl.  Powdered Fentanyl is white and very hard to distinguish visually from white powdered heroin.

A number of years ago drug dealers started enhancing their heroin with Fentanyl. Fentanyl is stronger than heroin, so adding it was a good way to boost the reputation of their product. Deaths increased as users were hit with more potency than they expected, or in some cases, the heroin and Fentanyl were not evenly mixed and so even a user with high tolerance might die with the syringe in their arm if they got a hot spot of disproportionate Fentanyl in their buy.

The deaths and subsequent warnings of dangerous heroin only drew more users to the brands as many users sought the powerful mixtures. More dealers began adding Fentanyl to their batches. Also, while years ago, it was common practice to cut heroin to increase profits, many dealers now keep their heroin strong in order to compete with the Fentanyl brands as well an ever increasing supply.

Fentanyl can be obtained in two ways.  The low rent way to extract it from Fentanyl patches. The other way is to make it in a lab or get it from a lab. Most of the street Fentanyl in the United States now comes from labs in Mexico or China, and is smuggled into the country in the same matter as heroin.  Because it is stronger, more can more smuggled for the same potency. The prevalence of Fentanyl is increasing to such an extent that some law enforcement officials have on occasional found 100% pure Fentanyl being sold as heroin.

This week in Hartford, a SWAT team broke into a drug dealer's home and detonated a flash grenade to stun the suspects who were known to have firearms.  The explosion aerosolized some of the Fentanyl and heroin in the apartment and 11 of the team members were hospitalized for nausea, dizziness and vomiting. This bust yielded over 50,000 bags of Fentanyl-laced heroin.

11 Hartford SWAT Officers Exposed To Heroin, Fentanyl During Drug Raid

The woman we talked to used the bag stamp system to know which brands to avoid as she was not a death seeker like many users. 

Back in 1991 when Tango and Cash stamped heroin bags that were laced with Fentanyl were killing people on the streets of Hartford, the New York Times wrote about officials driving the streets using loud speakers to warn people about the deadly mixture. At the same time, the alerted junkies suddenly sought the brand out much like Super Bowl tickets or people today seek the latest I-phone.

Toxic Heroin Has Killed 12, Officials Say

While our woman friend avoids the dangerous Fentanyl mixture, others seek it. This is reflected in the branding. I found a heroin bag labeled "Dead Man," another bag had a picture of the Grim Reaper on it and the words Strike Dead. Some bags just have a skull and crossbones on them.  This does that necessarily mean that those brands are the baddest of the bad.  It could just be marketing.  A user who trusts their regular dealer will hopefully learn what brand will fit their needs.  

Another problem with Fentanyl for the user (besides higher risk of death) is that it does not last as long as heroin.  Users need to fix again sooner and end up having to buy more. I suppose the dealers are willing to lose a few clients to overdose to gain the added volume from other customers.  Talk about business ethics. 

The picture in the paper of the Hartford bust and the 50,000 bags of heroin all laid out on a table seems like a lot, but if a user had a two bundle a day habit - 20 bags, 50,000 is a year's supply for just 7 addicts.  I don't think the users in Hartford will have to look too far tomorrow to get their fix. Someone on Park Street will be hawking Undertaker,Six Feet Under, or Dead Man. And money will change hands.  

And another 911 dispatch will go out.