Remifentanil is one of the fentanyl analogs which has been approved for use in human patients, and this drug is marketed under the brand name Ultiva by Abbott and GlaxoSmithKline. This is a synthetic opioid drug which is short acting but very potent, and it is used during surgery for both anesthesia and pain management purposes. Sedation is another purpose that remifentanil may be used for, and when combined with other drugs it can be ideal for general anesthesia. Some anesthesiologists use remifentanil because it is strong enough to do the job but it has a fairly fast recovery time when compared to other opioid drugs that could be used instead. This opioid has a shorter half life than many alternatives so the patient becomes alert and aware in less time and the drug leaves the patient’s system quicker.
Just like other fentanyl analogs there have been cases of abuse reported with remifentanil. Because it is an opioid this drug can cause euphoria and the typical opioid high, however the extremely short half life means that this drug would be low on the preference list when compared to most other drugs in this class. Fentanyl is only half as potent as remifentanil, and the fentanyl analog has a potency that is between 100-200 times what morphine has. In fact remifentanil is so strong that there have been cases where the drug has successfully circumvented naltrexone for those who need adequate pain management. This potency is also what makes the drug such a dangerous one when it is bought and sold illicitly.
Carfentanil, sometimes called carfentanyl or by the brand name Wildnil, is a drug that is the synthetic version of fentanyl and it is an extremely powerful opioid. This specific fentanyl analog is not approved in the USA for use in humans but it is allowed in small quantities for zoo veterinarians and others who may need to sedate very large wild animals. A related drug, sufentanil, is less potent and is the strongest fentanyl analog that is used for medical purposes in people in the United States of America. Carfentanil was first created in 1974 by a Janssen Pharmaceutica chemist team, and Paul Janssen was one of the chemists responsible for the synthesis of the drug. Carfentanil is 100 times stronger than fentanyl, and it is 10,000 times stronger than morphine. Imagine the addiction and overdose potential that this drug threatens when used by people, and it had been found in the USA mixed with heroin.
Carfentinal is such a powerful opioid that in the year 2015 the drug had a DEA ACSCN of 9743, and is a Schedule II Narcotic controlled substance. The 2015 annual aggregate manufacturing quota of 19 grams was also kept in place from the previous year. As a fentanyl analog the drug can have side effects which include respiratory depression which can be serious or even life threatening, and it can cause nausea and itching. Hundreds of individuals in Europe and What was once the Soviet Republic have died from overdoses that involved fentanyl analogs. Law enforcement is always trying to play catch up because novel and new derivatives are synthesized all the time.
Prescription drug abuse is one of the biggest threats facing North America today, and another is the epidemic of heroin abuse and overdose deaths in recent years. Many people who start to use heroin do not start with this drug, they begin with prescription opioid use and then progress to heroin as time goes on and the prescription drugs become harder to obtain. When an individual is given opioid medications these can cause a tolerance to develop and the user may start taking more than prescribed or taking doses earlier than directed. Eventually a new prescription is needed, and doctors are becoming more wary of giving out these drugs because they have such a high potential for abuse. This can lead to doctor shopping as the person tries to get a legitimate prescription for the drugs they are seeking.
Over time the prescription drug abuse gets worse, and the opioids may not be available. Purchasing these drugs illegally off the street is the next step, but the high demand means that opioids can be very expensive especially in larger doses when they are even available on the street market. In contrast heroin use is a much less expensive habit, with a packet of the drug selling for as low as $10 in some areas compared to $1-$2 per milligram for oxycontin and other powerful opioids in some areas. A 100 mg oxycontin pill may fetch between $75-$200 while the same strength of heroin costs a small fraction of this price.
According to a recent article in the journal Current Pain and Headache Reports there is no substitute for education when it comes to opioid abuse prevention strategies. The article titled “Current State of Opioid Therapy and Abuse” points out that there are limits to what newer medical technologies designed to thwart opioid abuse can do. According to the author of the article, University of the Pacific professor of pharmacy Dr. Adam Kaye “Education is the foremost strategy. We must educate primary care providers, surgeons, pharmacists, and other health professionals, as well as patients. That education must take place prior to the starting point of opioid therapy — and it needs to be independent of the pharmaceutical industry. Pharmacists have a big responsibility for cutting down opioid abuse and deaths, whether it’s Prince or other celebrities or the guy down the street. We have to be part of primary education efforts.”
The article on opioid abuse prevention strategies looked at 3 medical technologies designed to prevent abuse of these drugs. There are physical barriers, sequestered aversion agents, and sequestered opioid antagonists. There are limits for each type of strategy covered, and education can be the most effective way of preventing a patient from abusing this category of drugs. Both physical barriers and sequestered aversion agents can prevent accidental overdose but these will not stop someone intent on abusing the drug if they are motivated to do so. The opioid antagonist method can prevent intentional misuse but it could also result in severe withdrawal symptoms for anyone who is already addicted to these drugs.
Heroin is a very dangerous and highly addictive drug that is causing a public health crisis, and there are some warning signs of substance abuse that parents need to watch for in order to protect their teens from this drug. Many parents of teens did not recognize the warning signs which could have alerted them to the problem before it was too late. Heroin can cause addiction from the first use, and as time goes by the addiction grows stronger. Parents need to consider that a teen who is getting high on this drug will want to have easy access to the substance, so they will generally keep it close by. Small torn scraps of paper are commonly folded and used to hold heroin powder so search every area of the home and the personal belongings of your teen. Look in books, backpacks, garbage cans, under the bed, and other areas where these packages or other paraphernalia could be thrown or stashed.
One of the signs that a teen is using heroin is suddenly finding matches, lighters, razor blades, small mirrors, syringes, or spoons with soot marks. All of these can indicate that a teen is using heroin, either shooting, snorting, or smoking the drug. Check every item in the home very carefully, many specialty shops sell a variety of containers that look like normal household products but that include a hidden compartment. These products can be found in books, pop cans, calculators, food item packages like cereal, and even fake electrical sockets.
Pharmaceutical grade heroin, diacetylmorphine, is being considered as an option for opioid dependence treatment under a new proposal in Canada. According to a news release from federal health agency Health Canada there are plans in the works which would amend regulations to allow certain people who need opioid dependence treatment to receive a prescription for diacetylmorphine. The release explained that “A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine.” The change would move heroin into a lower controlled substance category so that the medical equivalent can be considered for use using a Special Access Programme. This would allow patients who have not responded to more conventional drug treatment and approaches to request emergency access to specific drugs.
Allowing pharmaceutical grade heroin or diacetylmorphine for heroin addiction treatment may seem like a drastic move but something must be done to fight the growing opiod crisis in Canada and other countries. The war on drugs has failed and alternative treatment methods are being sought. Crosstown Clinic operator Providence Health Care is supportive of the change, and the clinic has already been involved in a clinical study heroin maintenance program. According to a release from Providence to the Vancouver Sun “Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use.”
Hydromorphone, a strong opioid pain medication, could be used as one method of treatment for heroin addiction according to a new study out of Canada. Over 200 heroin addicts from the Vancouver area were involved in the study and these individuals did not respond well to other common treatments including suboxone or methadone. This study was the first ever to look at how effective hydromorphone can be for heroin addiction treatment. Study subjects received either a pharmaceutical-grade prescription heroin product called diacetylmorphine or hydromorphone, and both drugs were delivered via supervised injection in a clinical setting. According to University of British Columbia lead study investigator Eugenia Oviedo-Joekes “Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care.”
During the study on hydromorphine as a possible treatment for heroin addiction over 88,000 injections were given by the medical professionals, and there were just 14 cases of overdose reported and 11 incidents of seizures. No deaths resulted because the medical professionals successfully managed these complications, but the outcome would have been far different if the problems had occurred outside of a medical setting on the street. In a news release from the school Oviedo-Joekes explained “Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder.” According to Vancouver Coastal Health chief medical officer Dr. Patricia Daly “Diacetylmorphine isn’t available in many countries. Hydromorphone has a significant advantage as a legal, licensed pain medication. No single treatment is effective for all individuals. Every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death.”
Headlines in newspapers across North America, especially the USA and Canada, detail an opioid crisis that seems to be steadily growing. Experts debate on how to stop this problem from growing and there are many possible solutions that have been discussed. While everyone points out the increase in overdose deaths from heroin and prescription opioid drugs few address the lack of suitable substance abuse treatment programs and other resources that are needed to overcome addiction. Outpatient programs are usually not very effective when it comes to this type of addiction but there are few inpatient programs available in many areas and these often have long waiting lists. When a user actually wants help they are frequently told that it will be weeks or even months before they can get into the treatment program.
There really is an opioid crisis in North America, but this crisis could be addressed with the proper substance abuse treatment programs which are available on demand. Physicians would not dream of telling someone with appendicitis that they must wait for a month or two to have the treatment that they need but this is often exactly what happens when someone with a full blown addiction seeks help. Any delay could lead to further use of these drugs, and that can mean an overdose which could cause death. Opioid addiction should be classified as an emergency and the individual should be able to receive effective substance abuse treatment in a reasonable amount of time. The shortage of quality substance abuse treatment programs makes this impossible though, and those who sought help often go back to using when they do not receive it right away.
North America, especially Canada and the USA, is experiencing a heroin epidemic that is gaining in strength and destroying families everywhere. The number of drug overdose deaths from this illegal street drug each day is staggering, and while authorities try to stem the tide and turn things around the use of heroin continues to grow. The exact cause of the most recent epidemic is a mix of things. Prescription pain medications are used for legitimate reasons at first, but then the user becomes dependent. Over time physicians may be less likely to prescribe a specific opioid drug in order to prevent abuse, and the user may turn to the street and heroin in order to get high instead. Since heroin is far less expensive than other opioids on the street but it offers the same effects it is often used as a substitute.
What can be done to stop the heroin epidemic though? One step is to provide treatment for those who are addicted, and to inform the public on how to reverse a drug overdose until help can arrive. Many areas are allowing heroin addicts and family members to get a prescription for Narcan, a drug that can quickly reverse an overdose of heroin and possibly save the life of the individual. Another issue is the lack of quality substance abuse treatment programs with inpatient treatment facilities, and the fact that even health insurances that cover addiction often will not pay for inpatient treatment for heroin abuse but they will for alcoholism.