DDN June 2017 DDN July2017 - Page 8

AwAreness

With a vast range of forms and potencies , the fentanyl family bring too many unknowns . Kevin Flemen gives an essential guide

Meet the fentanyls

another day , another drug warning – lately

we ’ ve had drug scare after drug scare . There was flesh-eating Krokodil , Bath Salt cannibals , Hippy Crack , Zombie Spice and , in the May issue of DDN , concerns about an increase in Xanax use .
Most recently came warnings about fentanyl-type drugs . Such bulletins can risk losing impact , but if the evidence from North America and elsewhere is anything to go by , fentanyl and its derivatives have the potential to become a huge problem and cause significant loss of life .
Although fentanyl-type drugs have featured sporadically in the UK drug scene for a while , concern about them has increased markedly in the past few months , leading to official warnings from the National Crime Agency ( NCA ) and Public Health England ( PHE ). So , it ’ s time ( and some would argue , long overdue ) to get up to speed with the fentanyls .
Fentanyls are opioids , with fentanyl ( Duragesic ) used for severe pain . It has numerous analogues and derivatives , with new ones emerging – Wikipedia lists 42 and this may be an underestimate . Several of the fentanyls have legitimate medical use and so are better understood in terms of potency , doses , and metabolites , but others have been developed to sidestep legislation or restriction on precursors . Less is known about these newer compounds .
The potency and half-life of different fentanyls varies massively . To illustrate relative potency , fentanyls are compared to morphine – but this is a crude indicator , especially when the composition and purity of street-sourced fentanyls is unclear .
To further complicate the issue , some analogues have more than one isomer , which in turn vary in potency . So 3-methylfentanyl ranges in potency , from 300 times the potency of morphine to 6,000 times stronger , depending on which isomer is present .
Given such a wide range of products and potencies , the risk of overdose cannot be understated . There is every chance of misidentification and misselling throughout the supply chain , from producers inadvertently supplying the wrong analogue or isomer through to suppliers mis-identifying their product .
To reduce the potency to usable levels , fentanyls need to be bulked out with a non-psychoactive filler agent , such as mannitol . This demands correct identification of the drug , careful calculation of the amount of filler to be added , and thorough mixing of drug and filler .
Such mixing is at best prone to errors . When fentanyl is mixed with more granular substances , such as brown heroin , it is impossible to achieve a thorough mix , and so the risk of separation and ‘ hotspots ’ is greater still .

Fentanyls – a comparative

Fentanyl is rated as approximately 100 times * the potency of morphine – so 1g of fentanyl is equivalent to 100g of morphine .
Some analogues are weaker : acetylfentanyl is around 15 times the potency of morphine . Others are far stronger : 4-fluorofentanyl is reported to be twice the strength of fentanyl – some 200 times the strength of morphine .
Carfentanil , legitimately used to tranquillise large mammals , is reportedly around 10,000 times the potency of morphine ( 100 times stronger than fentanyl ). So , in theory , 1g of carfentanil is the equivalent of 10kg morphine .
* This dose equivalence is a very crude way of indicating relative potency . Variables such as speed of onset , duration of effect , level of analgesia versus level of sedation , and therapeutic index cannot be summarised by a simple drug A is x times stronger than drug B .
SOURCES AND SUPPLY Synthesised in China and elsewhere , fentanyls have become increasingly available on the dark web . Products reputedly on sale included fentanyl , furanylfentanyl , carfentanil and other analogues .
Given their very high potency , they are an appealing option for international smuggling . They offer a low bulk / high potency alternative to heroin and are available via labs online , rather than engaging with heroin suppliers .
Fentanyls have become a very significant factor in drug deaths in North America and the major cause of opiate deaths in British Columbia , with the number almost doubling between 2015 and 2016 . Closer to home they have been an issue in the EU , but it has primarily been Baltic countries , especially Estonia , which have seen the biggest problems .
There may also be some European production . In April , West Yorkshire Police raided a ‘ drugs lab ’ where fentanyl was involved , although is not clear from the reporting if the ‘ lab ’ was synthesising fentanyl , or compounding imported fentanyls with heroin for onward sale .
THE UK MARKET Medically diverted fentanyl is abusable , but the combination of limited prescribing and transdermal preparations has meant it has not been a massive issue in the UK to date . Fentanyl analogues have been around here for a while , cropping up sporadically in drugs analysed ( for example ) by the drug identification service WEDINOS , but difficulties in detecting newer fentanyls make it hard to gauge their presence . It may be that they have been a factor in opiate drug deaths for longer than thought , and reviews of post-mortem samples are being conducted to see if this is the case . Routine drug testing and screening won ’ t show up fentanyls and even fentanyl-specific tests won ’ t detect all analogues .
While fentanyl is most likely to appear as a cut in heroin , it is also sold online as a white powder and has been offered in liquid and blotter forms . It can be smoked , snorted , injected , or taken rectally , and while all routes are risky , smoking carries the lowest risk of fatal overdose . At street level in the UK , it is most likely
8 | drinkanddrugsnews | June 2017 www . drinkanddrugsnews . com
AwAreness With a vast range of forms and potencies, the fentanyl family bring too many unknowns. Kevin Flemen gives an essential guide Meet the fentanyls a nother day, another drug warning – lately we’ve had drug scare after drug scare. There was flesh-eating Krokodil, Bath Salt cannibals, Hippy Crack, Zombie Spice and, in the May issue of DDN, concerns about an increase in Xanax use. Most recently came warnings about fentanyl-type drugs. Such bulletins can risk losing impact, but if the evidence from North America and elsewhere is anything to go by, fentanyl and its derivatives have the potential to become a huge problem and cause significant loss of life. Although fentanyl-type drugs have featured sporadically in the UK drug scene for a while, concern about them has increased markedly in the past few months, leading to official warnings from the National Crime Agency (NCA) and Public Health England (PHE). So, it’s time (and some would argue, long overdue) to get up to speed with the fentanyls. Fentanyls are opioids, with fentanyl (Duragesic) used for severe pain. It has numerous analogues and derivatives, with new ones emerging – Wikipedia lists 42 and this may be an underestimate. Several of the fentanyls have legitimate medical use and so are better understood in terms of potency, doses, and metabolites, but others have been developed to sidestep legislation or restriction on precursors. Less is known about these newer compounds. The potency and half-life of different fentanyls varies massively. To illustrate relative potency, fentanyls are compared to morphine – but this is a crude indicator, especially when the composition and purity of street-sourced fentanyls is unclear. To further complicate the issue, some analogues have more than one isomer, which GW&f'FV762WFfVF&vW2FV7g&У3FW2FRFV7b'RFbFW07G&vW"FWVFrv66W"2&W6VBvfV7V6vFR&vRb&GV7G2@FV6W2FR&6bfW&F6R6B&RVFW'7FFVBFW&R2WfW'66Rb֗6FVFf6FB֗2Ч6VƖrF&VvWBFR7Wǒ6g&&GV6W'0GfW'FVFǒ7WǖrFRw&rwVR 6W"F&VvF7WƖW'2֗2֖FVFgrFV &GV7BF&VGV6RFRFV7FW6&RWfV2fVF0VVBF&R'VƶVBWBvF767FfRfW vVB7V62FF2FVG26'&V7@FVFf6FbFRG'Vr6&VgV67VFbFPVBbfW"F&RFFVBBF&Vv֗r`G'VrBfW"7V6֗r2B&W7B&RFW'&'2vVfVF2֗VBvF&Rw&V"7V'7F6W27V62'&vW&B276&RF6WfRF&Vv֗B6FR&6b6W&FB( BЧ7G>( 2w&VFW"7FfVF2( 26&FfPfVF2&FVB2&FVǒFW2FRFV7b'R( 26rbfVF0WVfVBFrb'R6RwVW2&RvVW#6WGfVF2&VBRFW2FRFV7b'RFW'2&Rf"7G&vW#BfV&fVF2&W'FVBF&RGv6RFR7G&VwFbfVF( 06R#FW2FR7G&VwFb'R6&fVFVvFFVǒW6VBFG&VƗ6R&vR22&W'FVFǒ&VBFW0FRFV7b'RFW27G&vW"FfVF’6FV'rb6&fVF0FRWVfVBbr'RࢥF2F6RWVfV6R2fW'7'VFRvbF6Fr&VFfRFV7f&&W27V627VVBb6WBGW&FbVffV7BWfVbvW6fW'7W2WfVb6VFFBFW&WWF2FW6B&R7V&6VB'6RG'Vr2FW27G&vW"FG'Vr"ࣂG&FG'Vw6Ww2VR#p4U$4U2B5UŐ7FW66VB6BV6WvW&RfVF2fP&V6R7&V6vǒf&RFRF&vV"&GV7G2&WWFVFǒ6R6VFVBfVFgW&ЦfVF6&fVFBFW"wVW2vfVFV"fW'vFV7FW&RVƖrFf"FW&F6VvvƖrFWffW"r'VƲvFV7FW&FfRFW&@&Rf&Rf'2ƖR&FW"FVvvrvFW&7WƖW'2fVF2fR&V6RfW'6vf6Bf7F"G'VrFVF2'FW&6BFR"6W6R`FRFVF2'&F66V&vFFRV&W 7BFV&Ɩr&WGvVV#RB#b66W"FRFWfR&VV77VRFRUR'WBB0&&ǒ&VV&F26VG&W2W7V6ǒW7Fv6fR6VVFR&vvW7B&&V2FW&R6&R6RWW&V&GV7F&vW7B&6&RƖ6R&FVB( G'Vw2.( vW&PfVFv2ffVBFVv2B6V"g&FP&W'FrbFR( .( v27FW66rfVF 6VFr'FVBfVF2vFW&f v&B6RDRT$U@VF6ǒFfW'FVBfVF2'W6&R'WBFP6&FbƖ֗FVB&W67&&rBG&6FW&&W&F22VBB2B&VV76fP77VRFRTFFFRfVFwVW2fR&VV&VBW&Rf"vR7&rW7&F6ǒG'Vw2Ǘ6VBf"WR'FRG'VrFVFf6F6W'f6RtTD2'WBFff7VFW2FWFV7FrWvW fVF2RB&BFvVvRFV"&W6V6RB&RFBFWfR&VVf7F"FRG'VrFVF0f"vW"FFVvBB&WfWw2b7B'FVЧ6W2&R&Vr6GV7FVBF6VRbF22FR66R&WFRG'VrFW7FrB67&VVrv( B6rWfVF2BWfVfVF7V6f2FW7G2v( BFWFV7@wVW2vRfVF27BƖVǒFV"27WBআW&B266BƖR2vFRvFW"B0&VVffW&VBƗVBB&GFW"f&2B6&P6VB6'FVBV7FVB"FV&V7FǒBvP&WFW2&R&66r6'&W2FRvW7B&6`fFfW&F6RB7G&VWBWfVFRTB27BƖVǐwwrG&FG'Vw6Ww26