It was announced by Emergent BioSolutions Inc. on Dec. 21, 2022, that the Food and Drug Administration (FDA) is going to review the potential classification of Narcan spray as an over-the-counter medication making it widely available as early as March 29th. This is great news considering that the U.S. Drug Enforcement Agency (DEA) is reporting that in 2022 the agency seized over 50 million fake fentanyl prescription pills, and over 10,000 pounds of fentanyl powder. Fentanyl is 50x stronger than heroin and a pencil tip’s worth is potentially fatal.
The DEA has identified two Mexican drug cartels as the biggest producers/smugglers of fentanyl into the U.S., the Sinaloa and Jalisco Cartels. The DEA stated that these cartels are making fentanyl in secret factories and using chemicals that they are sourcing from China. Two years ago, the DEA put out a Public Safety Alert stating that the fake prescription pills, made to look like OxyContin, Percocet, and Xanax, are really fentanyl combined with a filler. In DEA also announced last year that 6 out of 10 fake pills contained a lethal level of fentanyl up from 2021 when it was 4 out of every 10.
A friend of my wife’s found this news out in the worst way possible in central Arizona that same year. Her son, 15 years old, had been struggling with addiction, went outside to talk to a group of friends one night. After a bit he came back inside and went to his room. He was found the next morning unconscious, cyanotic, and barely breathing. He had suffered massive brain damage from the hypoxia and was blind. He lived for several weeks in a vegetative state before succumbing to the event. It was determined that he thought he was taking a Percocet.
To make matters worse, we also have to worry about Carfentanil and Acryl-Fentanyl. Carfentanil is 10,000 time more potent than morphine and is illegal in most countries and was developed as a tranquilizer for elephants and other large mammals. The drug is being used to lace heroin and OxyContin, as if these drugs were not already addictive enough. It is unlikely that the patient will respond to the first dose of Narcan.
Acryl-Fentanyl is reportedly created in China and then smuggled into the U.S. The drug is strictly designer, it has no medical purpose and was added to the DEA Schedule 1 drug list in 2017. The patient may not respond to Narcan at all depending upon how much was taken.
If you suspect the patient has consumed these drugs, wear your PPE and stay vigilant! And keep an eye on your partners. The symptoms of exposure include the traditional opioid toxidrome symptoms of “respiratory depression or arrest, drowsiness, disorientation, sedation, pinpoint pupils, and clammy skin.”
To learn more about how we got into this mess join us for ALS L2 Oxygenation and Opioids!
References:
Drug Enforcement Agency. (n.d.). Carfentanil: A Dangerous New Factor in the U.S. Opioid Crisis. Retrieved from https://www.justice.gov/usao-edky/file/898991/download#:~:text=Carfentanil%20is%20a%20synthetic%20opioid,and%20overdose%2Drelated%20deaths%2C%20even.
Good, J. (017, May 3). Narcan-Resistant Fentanyl Found in Pennsylvania. Retrieved from http://www.narconon-suncoast.org/blog/narcan-resistant-fentanyl-found-in-pennsylvania.html.
Hunter, G. (2023, Jan. 12) Federal fentanyl pill seizures double in 2022. EMS1.com. Retrieved from https://www.ems1.com/opioids/articles/federal-fentanyl-pill-seizures-doubled-in-2022-beqin6YkttebbE8t/.
Merrill, L. (2022, Dec. 21). FDA to review OTC Narcan spray. EMS 1. Retrieved from https://www.ems1.com/naloxone/articles/fda-to-review-otc-narcan-spray-KYxsgPUcOTL1blNc/.
