Heroin / fentanyl...

[mdc630]

Well to keep Yummy from looking bad I'LL give details of the runs she mentioned. First one; lady walks into our office says her son acting "weird" and that he like pills. Son ( 23 Y/O) in front seat agonal respiration's that stopped completely on the way into ER. Dr. tries to tube him and unable to, pulls blade out of his mouth along with couple of Fentanyl patches. We told Dr. about his pill habit so they push some Narcan and wake pt. up. While talking to pt. Dr. has pt. open wide and say AHH and puts the blade back into his mouth still no gag reflex. Patient admitted. Back out on pt. week or so later when his wife and kids find him dead on couch with patches in mouth. Second patient was same day as first pt. about 1 hour later. We are called out for unresponsive pt., by chance my partner is a deputy coroner and had worked an OD death at this address about 1 year prior. On arrival find 28 Y/O male supine on floor with BLS truck bagging him no spontaneous respiration's. " Friends" of pt. say he might have ate a morphine patch. Find a patch in his mouth and remove it, start a line and push Narcan pt. comes up fighting. Patient calmed down after seeing the ET tube hanging out! Taken to hospital no contact with a pt. since. Last pt. is 19 Y/O male drank bottle of Methadone per his girlfriend. Patient unresponsive but breathing, pulse in the 130's, BP crappy. Start 2 IV gave little bit of Narcan (after last pt. beat the crap out of us) with no response so gave little bit more and now 3 people not able to control the kid. Finally able to control him and taken to ER. In ER pt. goes from responsive and rude to not breathing. Poison control contacted and told ER that they could not give pt. enough fluid to keep lines wide open. They also said to give certain amount of Narcan which happened to be more than is kept in the hospital. Patient flown to other hospital and remained in critical condition. Have not heard anything about him since. I am not sure if Heroin has been a factor in any of these cases but with some of the friends I used to have that would know about that stuff it is coming back around again. Also for clarification our office is attached to the hospital ER.

[Ace844]

Hello Everyone,

I have been busy, and I am just now catching up on the threads I have missed. This caught my attention. Here are the total threads by this poster, and then below, I’ll illustrate how we are still waiting for him to prove his points…!!! AS USUAL!!!

Here’s the original post:

So...

Whats everyones experiences with this new cut of heriin? Were killing people here left and right...

4 arrests last weekend...all under 30....

Im sure im not the only one...

Not only does he not answer the ? but Here’s his responses provided below…!!

Giddy up what a party starter.......or party stopper I guess.

All I can say is 125 mcg can kill someone. That is equivalent by weight to 4 grains of table salt.

The fact that it undetectable by sight or smell.

Gonna be a fun summer.........................

Maybe we should wait till next year to study the effects of the new CPR guidelines. They might be a little skewed.

Well you wrong. Services can begin implementing the new guidlines as there personell are trained.

Imagine that I didnt even have to quote anything.

Here is the number for the AHA.

AHA: 1-800-AHA-USA-1

We wouldnt want the fact to get out around here that you just might not know everything. It will be our little secret.

Dial the number sir its a 24 hour information line.

Like you stated before be armed with the facts before you insert your foot.

You want to argue. I want you to know your facts.

Good day

Sorry for hijacking the thread.

ACE wrote:

As I'm sure you're already aware, the AHA has 0 say on either the 'PROTOCLS' or practice parameters which you are so fond of referring to, and or the changes to them or the way in which you practice in EITHER OF THE STATES IN WHICH YOU ARE CERTIFIED OR LISCENCED! So again,

My protocols have nothing to do with the fact that we do CPR in accordance with AHA guidelines.

Sorry again. The fact that you do not agree with me. Dosent change the facts. With this issue or the previous one.

The new AHA guidelines are now in use. So stop trying to pick a fight and admit you were wrong on this one.

Ace I believed you did the hijacking as usual. Check your track record

Rid so the fact that these people do not live in most circumstances, wouldn't skew a study that was being performed in these areas? I believe this is not a normal standard of deviation. I understand that we have cases in areas which are normal deviation, but when half of your cardiac arrests are due to a certain factor it does not represent the population as a whole.

PRPG:

Here is an article from one of your local papers.

http://www.nj.com/news/jjournal/index.ssf?....xml&coll=3

This Steve Marcus executive director of the New Jersey Poison Information and Education System was also quoted in a piece of literature, that was used in our in service/notifications.

All I was stating is it was going to be a fun summer. Deputy ACE decided he would chime in with more of his useless garble.

By the way he will let us know when he sees fit for us to begin implementing the new AHA guidelines.

Fentanyl can be produced in powder form. In are training it was based on the powder form. We also have the patch lickers around here.

Sorry about the punctuation still trying to get the hang of this.

Here is another article I read when this scare began.

http://www.csac.counties.org/images/public...tanyl_alert.pdf

Another article.

http://www.streetdrugs.org/pdf/fentanyl.pdf

The AHA 2005 guidelines have been in effect since January 1' date=' way to go Whit. You got something right. Since that statement, you've accomplished nothing in the form of usable information. [/quote']

So from the above lets see what this individuals ‘points’ which he has made and have yet to supply the requested evidence..

1.)

Now let’s first see what the definition of ‘skewed’ is”

Now, in addition, since this individual obviously has no idea what the inclusion/exclusion criteria are for AHA studies and has yet to post evidence as requested supporting his claim. I will help him out with some info. As he obviously has no idea as to how the AHA structures it’s evidence base. Here are some pages, which will help, and links:

AHA study eval. info..

http://circ.ahajournals.org/cgi/content/fu...2_suppl/III-128

http://www.guideline.gov/summary/summary.a...80&nbr=4731

http://circ.ahajournals.org/cgi/content/fu...24_suppl/IV-206

Here’s a link on how to read and interpret ‘Medical Studies’!::

http://www.emtcity.com/phpBB2/viewtopic.php?t=3128

Also, here’s a post from someone else who tried to help him understand how his point was ‘flawed’:

2.)

[whit72]

Hey ACE

Little secret for you. Don't really care. Neither does anyone else.

But I will humor you.

Ace wrote:

Not only does he not answer the ? but Here’s his responses provided below…!!

I was commenting on the issue, not answering a question. Unlike yourself I do not have the answer to everything.

Ace wrote:

I’m still waiting on the evidence this person has to support the above point…!!!

What above point? The new guidelines were implemented on January 1st. What more do you need to know.

Ace wrote:

UNFORTUNATELY FOR YOU, the entire practice and profession of medicine disagrees and also, medicine is ‘evidenced based’ now, so your claim is ludicrous at best!! But for giggles for the group, why don’t you post ‘PROOF & VERIFIABLE EVIDENCE’ which shows-supports your claim

When you are a little older then 28 you will understand that not everything is black and white.

Well I have some evidence for you. I have yet to meet the 28 year old that knows everything, including you sir. My 12 yo nephew can quote articles and studies, does that translate into him being able to do this job, I don't think so.

I am 100% sure of one thing, you have an ego problem. Whatever the reason, but you should probably get that figured out, Cause whatever the case a EMT or medic (whatever you are, It seems to be a big secret) with an ego problem will cause more harm, then the good he will ever do. Little advice, its about Pt's. sir not about you. So check that ego at the door. You will thank me in the long run.

Oh and I will admit you are probably 100 times smarter then me, and probably more educated then me. You have certainly made that apparent. In this forum you are the man.....however we don't do this job in cyberspace, and out there buddy you couldn't hold my lunchbox.

Godspeed ACE.

[Ace844]

Yet another well constructed, factual, verifiable lacking in intelligence on topic post from "Whit72,"....Strong work.... :roll: :shock: Anyone want to help this poor misguided soul before the thunderbolts start?!?!?

ACE844

P.S.: The fentanyl-heroin combo is great, Had 2 yesterday with the 'stuff' still on them...YAY!!!

[stream:e8685c7322]http://www.rampart-sar.com/sounds/Davecd1.WAV[/stream:e8685c7322]

[stream:e8685c7322]http://www.rampart-sar.com/sounds/911.wav[/stream:e8685c7322]

[PRPGfirerescuetech]

<b> Dear Ace, you've proven yourself booksmart <b>

<b> Whit, You've proven yourself strong through the tearing apart of every stupid thing youve said on this forum<b>

But the usefulness of the thread has run its course.

Lets stop dancing around the truth...

And realize that...

Unless we kill it.

Enough stupid things have been said in what would have been a productive thread....but unfortunately....everyone has to whip them out to see which one is bigger...every third post.

Is all I have to say about THAT

I have a preciction...and it is this.....

That this thread will soon be locked...

[marq=left:d2a35bc962]Why you say will it be locked? Because every god damn thread ends up like this![/marq:d2a35bc962]

The pain of watching whiny tear fests like this....makes me want to do this...

I hope ive gotten my point across.

XoXo

PRPG

_____________________________________________

Fin'

[Ace844]

They even have a place which teaches them soem of these wonderful habits... READ ON!!

http://www.heroinhelper.com/angry/fentanyl.shtml

How to Not Remove Fentanyl From Patches

We get great letters at Heroin Helper. A lot of them are heartbreaking; many simply shatter stereotypes; but every once in a while, we get a letter that contains an idea so brilliant or creative or just downright weird that we feel ashamed of ourselves for not thinking of it first, and afraid for the writer. Such is the case for the following letter.

Dear HEROIN Helper,

As a long term (yet moderated) heroin user, I'm always looking for ways to make my usage more cost effective and less harmful so that my own personal choice(s) do(es) not have to interfere with my "public" life any more than they absolutely must. Your site (and books) have been extremely helpful in this pursuit and so it is to you I turn with this question.

About a year ago I had the privilege [!] of wearing a "Duragesic Transdermal System." This is of course an adhesive patch which is meant to be worn by the patient, and which slowly allows the Fentanyl within to be absorbed by the wearer.

What I really wish to know though is quite simple I suppose; can the Fentanyl within the patch be safely removed (and isolated from the alcohol USP gelled with hydroxyethyl if needs be) from the patch for IV usage? I know Fentanyl parading as "China White" is often responsible for death, but I also know that injectable Fentanyl is made use of in modern medicine. What this suggests to me is that if one has the ability to accurately measure a dose, then it would be safe to use. Given that each patch contains between 2.5 and 10 mg of Fentanyl, and given the extreme strength of Fentanyl as an opioid, it seems to me that if a user could extract said Fentanyl from a "Duragesic Transdermal System," then said user would have a VERY affordable habit, and also lessen the overall frequency of copping--which is of course the most dangerous part of any careful user's routine. All this seems to me that it would allow a user the ability to live very subtly with regards to their drug use.

In closing, I apologize for the anonymity of the letter, but we live in dangerously fascist times. I'm sure you'll understand, and I look forward to reading a response to this letter in the coming issue of HEROIN Helper. Thank you in advance...

Sincerely,

A Conscientious User

Dear Conscientious,

You are to be commended because none of us had even thought of trying to do what you suggest. But you are correct--there is gold in them thare patches. Or poison, because even 2.5 mg of Fentanyl could kill you. The largest ampule of which I am aware contain only 2.5 mg, so you are right that this is a lot of Fentanyl: 100 doses, to be exact.

The truth is that I do not have an answer to your question, but I will look into it. I would think that rinsing the patch in some substance would make the Fentanyl dissolve into the rinse. If it was simply water, that would be the end of it. More likely, whatever you rinsed with would cause the Fentanyl to become Fentanyl-something and the something would then need to be removed. Or that Fentanyl-something might be one of those Fentanyl derivatives that are 1000 times as potent as morphine instead of the usual (paltry) strength of Fentanyl: 100 times as potent as morphine.

Anyone attempting such an extraction would need a GC/MS to test what and how much they were extracting.

I would be lax in my duties if I did not take a moment to point out that Fentanyl (should you have missed it from the discussion above) is a very strong opioid. Note also that Fentanyl has a very short half-life (a half hour as opposed to three hours for morphine), and so is not very helpful to addicts as a way to stop the withdrawal syndrome (unless you have it in patch form, of course).

Sincerely,

Dr. H

Follow-Up

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Dear HEROIN Helper,

I saw the article about Fentanyl, etc... I get the patches for pain, but would like to use them other ways also... Please advise... Serious substance... Don't want advice for kids on NGs [news groups]... Thanks in advance...

Leke

Dear Leke,

Thank you for bring this issue back to mind. I discussed this matter with a retired anesthesiologist who used Fentanyl recreationally for a long period of time. He did not have the answer to the question, but he did have some useful information that I will add here. The main thing on his mind was that the Fentanyl in the patches is in a glisserine base and that removing that is the issue. I know that the problem could be solved with alacrity if I had an Uncle Fester work on the problem. (As though there could be more than one!) Unfortunately, I don't, and really, there isn't a chemist I know that I would trust enough. A big issue is that minor chemical changes to Fentanyl can turn its normal 100 times morphine potency into 2000 times morphine potency.

I'm trained as a theoretical physicist, although professionally, I did almost exclusively chemistry. I suspect that if I worked on it, I could come up with a recipe for extracting Fentanyl from patches. But there are various problems. First, I've never come up with a theoretical solution to a chemical problem that didn't require experimental tweaking (maybe because I'm not that good a theoretical chemist, but mostly I just think that's the way it is--theory only takes you so far). I don't have Fentanyl patches to test any theories I developed. But even if I did, the testing would be so dangerous that I don't think I'd be willing to do it.

Second, one of my favorite sayings is "a little knowledge is a dangerous thing." If I posted a recipe based only on theory, people would try it regardless of how much I told them it was just theory and how extremely dangerous it was. If someone died as a result, I would certainly be sued for everything I have (mostly debts) and I would certainly be convicted of murder. And to be honest, in that case I would lean little in agreeing with that verdict. (I still think it is wrong that people are held accountable for how other people use the information they provide. And in the end, Uncle Fester may end up in jail because of his drug books. The irony is that he will never be bothered about Home Workshop Explosives or Vest Busters or Silent Death. We live in strange times.)

Third, Fentanyl terrifies me. A milligram is a very small amount and a normal Fentanyl dose is about 1/20 of a milligram. Even with pharmaceuticals, you need to be really careful with the stuff. Did you ever see the movie Drugstore Cowboy? In it, Bob say, "You gotta be careful with this stuff--it'll kill you." He was talking about Dilaudid. Dilaudid is only 1/15 as potent as Fentanyl. I'm sure you see my point. And if you've read my books or looked at the website, you must have noticed that I worry a lot. I'm sick of people dying just because they're trying to have a good time. I suppose that's problem number four: I just don't think the risk-benefit analysis justifies doing it.

The guy who originally wrote, wanted to do this because he wanted to limit the number of times he had to score given that scoring is when an illegal drug user is most likely to be arrested. That's good thinking. But he is a chipper, and his logic is a lot like the logic: "If I had a regular supply of heroin, I wouldn't obsess about it and so I would actually do less." It sounds reasonable, but I've known a number of people who have told me that exact same thing. In each case, when they succeeded in getting that regular supply they increased their use and eventually became addicts.

I guess this is all just my justification for copping out on this question. I don't want to know the answer and if I did, I wouldn't want to pass it around. But if I did have the information and I was sure it was correct and I could be clear and detailed in the problems, I would provide the information to readers of this site. But this is a near impossibility because I don't see myself doing drugs--opioids especially--any time in the near future. But if I do go back to using opioids, I'm sure I'm not going to be doing anything even close to the strength of Fentanyl. Drugs like that really don't seem like recreational substances to me. Like true methamphetamine, I understand that Fentanyl has no rush associated with it (another reason why it is dangerous). And I see both drugs as being practical: meth for people who need to stay awake for a long period of time; Fentanyl for people suffering from incredible pain. Tools, not toys.

But you have to remember that even though I know a whole lot more about Fentanyl than just about anyone you'll ever meet (including most M.D.'s), I am in no way an expert. A lot of my fear may be hysteria--the same kind of fear that I rant about when other people experience it over heroin. Regardless, the facts are that everyone has their limits. I was really pushing mine when I put the heroin purification recipe on the website. Providing an untested recipe to allow my readers (many of whom really trust me) to acquire 10 mg of injectable Fentanyl is past my limits. Way past them.

Sincerely,

Dr. H

© 2002

Last Modified:

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A Reader Cautions

I read your stories on Fentanyl and the contents of the Duragesic® patches. A relative of mine works for an in-home nursing care program where they administer strong drugs to the patients. When they die, the nurses confiscate these so they don't fall into the "wrong" hands. Needless to say, I have gotten my hands on some pretty heavy stuff over the years: 160 mg OxyContin®, morphine ampuls, and especially Duragesic®.

These patches come in various strengths that have a total Fentanyl content of between 2.5 mg (releasing 25 micro-grams per hour) and 10 mg (releasing 100 micro-grams per hour). In other words, huge amounts. I have cut any number of these open, and ran a q-tip inside to extract some of the fluid. After all the juice inside the patch was gone, I would cut the remaining empty patch into pieces and chew on it with delight.

After about 4 months of doing this with a case of 35 10 mg patches, I was admitted to the hospital with a liver problem. The solution inside Duragesic® caused my liver to nearly explode. My enzymes were over 10,000--unbelievably high. This was not the result of the Fentanyl; it was the result of the other stuff in the patches.

My advice is: don't mess with these patches. Use them as directed unless you are one seriously knowledgeable chemist and know how to extract the Fentanyl from the glycerine and the alcohol. Even then, who would be ballsy enough to test your first draft? Death row inmates?

That's just my two cents. Happy using!

by Yeah Right © 2003

Last Modified: 10 January 2004

1: Pharmacol Biochem Behav. 1995 Nov;52(3):591-4. Related Articles, Links

Oxytocin blocks the development of heroin-fentanyl cross-tolerance in mice.

Krivan M, Szabo G, Sarnyai Z, Kovacs GL, Telegdy G.

Department of Pathophysiology, Albert Szent-Gyorgyi, Medical University, Szeged, Hungary.

The development of cross-tolerance to an analgesic effect was observed between two mu-receptor agonists, heroin and fentanyl. Repeated treatments with heroin twice a day for 4 days resulted in a decreased nociceptive effect to fentanyl on day 5. The fentanyl dose-response line shifted to the right, and was considered to be a sign of the development of cross-tolerance. Peripheral treatment with oxytocin did not block the development of heroin-fentanyl cross-tolerance. However, intracerebroventricular administration of oxytocin blocked the development of tolerance, causing a leftward shift in the dose-response curve and supporting the assumption that oxytocin blocks the development of heroin-fentanyl cross-tolerance via CNS mechanisms.

PMID: 8545479 [PubMed - indexed for MEDLINE]

[Scaramedic]

To Admin & PRPG:

Please do not lock this thread or give up on its subject. I feel it is an important issue to EMS workers across the nation to know if this new batch of smack is in their area. Unfortunately in EMS we do not have a strong network capability to get this kind of info to the street level personnel. A thread like this is a good resource for people to learn what new threats are out there for patients and EMS personnel.

I myself learned from this thread that indeed this new mix is on the West coast, this is not the kind of info you kind find in your daily fish wrapper. Lets put aside the personal sniping and let this thread continue as a good source to track this new issue.

Just my two cents on this.

Peace,

Marty

:joker:

[EMT City Administrator]

LOCKED