Opioids - OverdoseFreePA · 11/07/2019 · opioids joshua c. yohannan allegheny county office of...
Transcript of Opioids - OverdoseFreePA · 11/07/2019 · opioids joshua c. yohannan allegheny county office of...
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OpioidsJ O S H U A C . Y O H A N N A NA L L E G H E N Y C O U N T Y O F F I C E O F T H E M E D I C A L E X A M I N E RJ U LY 2 0 1 9
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Papaver somniferumAnnual plant
Can grow to ~40 in
Main alkaloids:◦ Morphine (8-19%)
◦ Codeine (1 – 3%)
◦ Thebaine (5%)
◦ Noscapine (5 – 8%)
◦ Papaverine (~1%)
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Collection Opium Gum/Latex
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Various Poppy Pods
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Medicines from Opium Alkaloids•Morphine
• Oxymorphone
• Hydromorphone
•Codeine
• Oxycodone
• Hydrocodone
•Thebaine
• Oxycodone
• Oxymorphone
• Naloxone
• Buprenorphine
• Etorphine
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Heroin▪Diacetylmorphine
▪Metabolizes to 6-MAM and then to Morphine
▪May have acetic acid odor
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Heroin – ECP vs. BT
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Local Packaging
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Fentanyl
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3-Methylfentanyl~400 – 6000 x potency of
morphine
N
N
CH3
O
CH3
H
H
N
N
CH3
O
CH3
H
H
More potent
TRANS
N
NCH3
O
O
CH3O
Carfentanil~10,000 x potency of
morphine
More Potent than Fentanyl
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“Fentalogues”
FentanylAcryl fentanyl
para-fluorobutyrylfentanyl
4’ methyl Acetyl fentanyl
β hydroxy fentanyl
Other common substituents, the possibilities are endless…
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National Forensic Laboratory Information System - Allegheny
16% 19%25% 29%
6%14%
29% 27%
69%58%
36% 33%
2% 3% 4% 4%7% 6% 6% 7%
0%
20%
40%
60%
80%
100%
2015 2016 2017 2018
Allegheny (Total Drug Seizures: 18,985)
Cocaine Fentanyl & FRS Heroin
Methamphetamine Rx Opioids
32% 32% 30% 30%
3% 9%21%
27%
50%44%
33%27%
6% 7% 9% 9%10% 8% 7% 6%
0%
20%
40%
60%
80%
100%
2015 2016 2017 2018
State (Total Drug Seizures: 139,747)
Cocaine Fentanyl & FRS Heroin
Methamphetamine Rx Opioids
* 2018 data are approximately through Q3, 2018 (as of February, 2019)** One drug seizure may contain multiple drugs.
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Transportation – Then & Nowhttps://www.cbp.gov/newsroom/local-media-release/dulles-cbp-arrests-alleged-nigerian-heroin-smuggler
https://www.mirror.co.uk/news/uk-news/class-drugs-post-secret-website-3604058
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Siegfried Synthesis
Hosted on www.erowid.org
Starting materials:◦ 2-phenethylbromide
◦ 4-piperidone HCl
PTC = phase transfer catalyst
NPP = list I chemical
ANPP = Sch II substance
http://www.erowid.org/
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https://www.bostonglobe.com/metro/2017/06/09/dea-seizes-kilograms-fentanyl-precursor-northborough/4mQr0SAhZSNsFdbgJWNXoJ/story.html
50 kg Seizure of ANPP in MA
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Illicit Tablet Threat➢Typically oxycodone medications
➢Sometimes alprazolam mimics
➢Unknown concentrations
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http
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Illicit TabletingDecontamination?Court Presentation?
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Pill Presses
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Tramadol• In 2017, estimated 1 billion tablets
seized leaving India
• In May 2017, 37 million tablets seized destined for ISIS
•Seizures:• 2010: less than 10kgs
• 2013: ~9 tons
• 2017: ~125 tons
https://www.csis.org/npfp/dangerous-opioid-indiahttps://www.voanews.com/africa/un-drug-report-opioid-use-booming-tramadol-crisis-emerges-africa
https://www.csis.org/npfp/dangerous-opioid-indiahttps://www.voanews.com/africa/un-drug-report-opioid-use-booming-tramadol-crisis-emerges-africa
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MITRAGYNA SPECIOSE
GROWS IN SOUTHEAST ASIA
TYPICALLY SOLD AS A POWDER/CAPSULE
MADE INTO TEA OR TAKEN ORALLY
MULTIPLE VARIETIES
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kratom
C O M P O U N D S O F I N T E R E S T: M I T R A G Y N I N E ( ~ 1 – 2 % I N D R I E D L E A F ) A N D 7 - H Y D R OX Y M I T R A G Y N I N E
B OT H C O M P O U N D S A R E U - O P I O I D A G O N I S T S
O V E R 2 5 A L K A LO I D S P R E S E N T I N T H E P L A N T
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Kratom
Pain relief
Addiction treatment
Reduce stress/anxiety/depression
Anti-inflammatory
Improves focus
Boosts immune system
Addiction
Withdrawal symptoms similar to opioids
Hangover effects
Dizziness
Nausea/vomitting
Tremors
itching
Benefits Side effects
https://drugabuse.com/library/the-effects-of-kratom-use/https://www.healthline.com/health/food-nutrition/is-kratom-safe#controversy
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Kratom varieties
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Joshua C. YohannanAllegheny County Office of the Medical ExaminerJuly 2019