Not All Drug Abuse Is From Health Providers and Oxycodone

http://www.anesthesiologynews.com/Commentary/Article/10-16/Not-All-Drug-Abuse-Is-From-Health-Providers-and-Oxycodone/38050/ses=ogst?

Over the last few months, there has been an explosion of interest in the legislature to rein in oxycodone and to limit its use for pain management. Health care providers are painted as the major culprits who are causing an explosion of drug abuse, as reported by the media. Many excellent physicians in the field of pain medicine have been put under the microscope regarding their management of narcotics prescribed for certain patients, including those with terminal disease pain. This is not to say that health care providers should not be policed with medically based data on how to balance pain management with narcotics and nonnarcotic modalities.

The media is also filled with reports of raids on methamphetamine laboratories in our communities. This ongoing battle with illicit drugs has become a major political issue at both the local and federal level. Political debate has focused on how oxycodone and fentanyl are overprescribed, diverted and at the heart of our drug problem.

Public health care providers and politicians may not be aware of a more overwhelming supply chain of illicit addictive drugs. These drugs that are flooding our streets are being manufactured not in a debilitated trailer in rural America, but in a factory at an industrial level. Want to get your hands on the latest designer street drug or slightly tweaked version of fentanyl? It’s as easy as typing “Research Chemicals” into Google. You can scroll through an endless list of websites such as Alibaba.com and Guidechem.com, to name a few. Some of these offer free samples, bargain prices and home delivery by Express Mail. All you have to do is wire a few thousand dollars or use your credit card with an English-speaking customer service representative, and you get drugs delivered to your door. No need to doctor-shop or use criminal drug dealers.

This globalized marketplace, in which Chinese chemical companies pump out large volumes of ever-changing isomers that are too new to be banned in the United States or internationally, leaves our local and federal law enforcement officials virtually powerless to slow the influx of synthetic drugs. Those companies also manufacture some of the precursors of illicit drugs, which are used by many of the major drug cartels. In a country that has perfected the art of internet censorship and electronic spying, the open online drug market is a blatant example of what law enforcement has said is China’s reluctance to take action, as it has today become the major supplier of deadly synthetic drugs.

Since 2008, the number of new psychoactive substances added to the United Nations Office on Drugs and Crime has soared more than eightfold to 541, far more than the 244 drugs listed as controlled substances that are sold on these websites as “legal highs,” “research chemicals,” “not for human use” and fertilizers.

Our local governments have to deal with these temporarily legal substances until legislation can be passed. A great example is “spice” or “synthetic marijuana,” which flooded smoke shops and gas stations and was sold alongside tobacco products. Some of the most popular names included K2, Yucatan Fire, Skunk and Moon Rocks. Spice was often promoted as being “natural,” but in reality it was plant material treated with manufactured psychoactive chemicals and synthetic cannabinoid compounds. Spice users and poison control centers across the country have reported rapid heart rates, agitation, confusion, hallucinations, self-destructive behavior and psychosis. These agents have triggered heart attacks, strokes and permanent neurologic damage.

Bath salts are another drug that has triggered a major drug problem and has filled our ERs and ICUs. Websites market these compounds as keyboard cleaners, plant food and jewelry cleaners. The main component of most bath salts is methylenedioxypyrovalerone or new derivatives to skirt the law. Popular types of bath salts include “Ivory Wave,” “Purple Wave,” “Vanilla Sky” and “Bliss.” These drugs trigger agitation, paranoia, hallucinations, hypertension, tachycardia and suicidal thinking. A major danger is depression or suicidal behavior that can last even after the stimulatory effects of the drugs have worn off. There have been cases of suicides reported a few days after use.

Flakka (or alpha-PVP), which is manufactured in China, is sold by over 150 companies. It is a highly addictive synthetic drug that has overwhelmed hospital systems, some of which report 20 Flakka-related emergencies a day. Many deaths also have been attributed to this cheaply priced drug. Some of the dealers even guarantee that if your shipment is seized, they will send you another package. To elude U.S. Customs and Border Protection agents, the shipment may be labeled as industrial solvent or cleaner. A kilogram can be purchased for $1,500 online and sold for many-fold more on our streets.

These chemical companies may be responsible for the explosion in narcotic overdose deaths that have affected all social classes across the country. The media is filled with reports of fentanyl deaths and ever-increasing drug-related deaths. This has triggered the wide availability of Narcan (naloxone, Adapt Pharma) to first responders and the public. However, much of the problem may be triggered by the widespread availability of industrially produced fentanyl analogs.

The Drug Enforcement Administration is working to classify these specific analogs. An example of the frustration that law enforcement must deal with is a compound called furanylfentanyl. Once it is listed as illegal, the laboratories in China will be automatically changing the formula to come up with the next analog acetyl fentanyl drug configuration.

What can we do as health care providers who must deal with these problems on a daily basis in our ERs, operating rooms and ICUs? I believe that education is a key factor. We need to educate our political leaders about any and all industrially produced, addictive drugs and their terrible effects on our society. Our national government should address this problem with authorities in China. At the grassroots level, health care providers must educate the public on these dangerous, synthetic drugs with widely varying potencies.

Filed under: General Problems