Unlike the stuff coming from a pharmacy window, those in the black market don't get any sort of guarantee of purity or (relative) safety. They get whatever.

20 Aug 2014

The American opiate crisis just gets worse. On the one hand, we have the lingering aftereffects of many years of often careless opiate prescribing, with the result being an entirely new population of substance abusers. 

On the other, we have the compounding fallout of equally careless policy reactions designed to cut the newly dependent off from their doctor-suppliers—actions that frequently have the effect of sending the suddenly cut-off into the narcotics black market: heroin. Except, unlike the stuff coming from a pharmacy window, those pursuing highs in the black market don't get any sort of guarantee of purity or (relative) safety. They get whatever.

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According to a new paper in the Annals of Emergency Medicine, that "whatever" increasingly consists of a highly dangerous form of "fake" or substitute heroin. The paper cautions that emergency room doctors can expect to see "an upswing in what on the surface appear to be heroin overdoses," but are actually overdoses related to the quasi-legal opiate acetyl fentanyl. The added danger comes from the fact that acetyl fentanyl boasts about five to 15 times the punch of heroin itself (40 times the punch, according to some sources); meaning, what looks like a standard dose of heroin is in actuality something like 10 equivalent doses of heroin.

What makes it worse is that an overdose victim (or those around them) may have no idea that something other than heroin is at work. So, ER docs would most likely go about administering the heroin antidote, naloxone—something of a wonder drug, boasting the ability to shut down an overdose within seconds, bringing someone back from the brink just as soon as they got there. Naloxone, however, doesn't have the same effect on an acetyl fentanyl overdose, which requires a much higher "megadose" of the drug to work. 

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