‘Waiting to Exhale’: Heroin Laced with Elephant Tranquilizer Pushing Human Limits,Response Resources Part 1

Overdoses Out of Control

If you haven’t been following the latest storyline – and it hasn’t been developing for all that long now – you might very well think you misread the headline: 174 Overdoses in 6 days in Cincinnati.

One-hundred-and-seventy-four…in just short of a week!  And more than 70 of those overdoses, that had law enforcement and emergency personnel struggling to field calls and resuscitate victims all across the Ohio city, came within a 48 hour reporting period. It was mind-boggling but unfortunately not isolated.

In the last few months, a similar onslaught of opiate overdoses has gripped much of the Ohio Valley and New Jersey. In August alone, 13 were reported in Jennings County, Indiana, 12 occurred in a single day in Montgomery County, Kentucky, and 29 overdoses linked to free heroin samples marked with a Batman symbol were recorded in three days in Camden, New Jersey.

These incidents punctuated a late summer in which it started to seem less than surprising when 27 people overdosed during a five-hour period in Huntington, West Virginia.

A New Norm?

But not surprising in these circumstances is clearly relevant. And this new “norm” is clearly not normal. Neither is the drug, however, that seems to be the culprit for such extraordinary rates of opiate emergencies.

Much of the recent surge in ODs has been attributed to heroin laced with carfentanil, a sort of “nuclear grade” synthetic opioid often used to disable large animals like elephants. Whereas fentanyl – another drug of concern that has been instrumental in driving up heroin overdose rates recently (and the super-opioid blamed for the death of rock legend Prince) – is 100 times as powerful as morphine, carfentanil is 10,000 times a potent.

It is the strongest opiate commercially produced and its only legally approved use is in veterinary applications, where just two milligrams or so of the substance is needed to knock out a 2,000-pound African elephant or similarly sized moose. Even in these enormous animals, carfentanil overdoses have been known to occur, sometimes triggering heart attacks and internal bleeding at speck sized dosages.

With that kind of staggering strength, it’s easy to imagine that, when injected into human veins (the way users are most commonly ingesting it, though in powder form it can be smoked or snorted), death from carfentanil can come quite quickly. Since late summer, at least 19 users have died in the Detroit area from drug product that appeared to be straight heroin, but was later discovered to contain the increasingly infamous elephant tranquilizer.

They Will Slowly Kill

In the end, all opiates and their synthetic cousins kill in the same way. Once they’re in the body, opiates bind themselves to myriad opioid receptors, which are scattered liberally over the parts of the brain that control the central nervous system and functions like breathing.

Lodged there, they slow down breathing patterns. At high enough doses, breathing becomes slower and shallower until it doesn’t happen at all. Respiratory depression is a term that is now commonly heard in clinics and emergency rooms that treat opioid users. If they’re admitted early enough — and if they live in the right state — patients could be lucky enough to get an injection of naloxone, a drug that reverses the fatal symptoms of an overdose.

Narcan

Unfortunately, carfentanil is so strong that the normal doses of naloxone have become all but ineffective. Narcan is the FDA-approved nasal spray version of naloxone. It was approved in November 2015, and has been credited with saving countless lives. Across the country, first responders have been stocking up on Narcan and some agencies have even begun to train civilians on how to use it on each other.

Usually, one, maybe two, doses of Narcan will help revive someone overdosing on pure heroin. But when the drug is cut with carfentanil, it can take as many as a half-dozen doses, maybe more. And most EMS and law enforcement units simply don’t have that many units of the drug to carry around each day to combat the overdose rate as it now stands.

Hamilton County, Ohio, where 20 to 25 overdoses a week is the norm on pure heroin, has already used up 94% of its more than $450,000 2017 budget on life saving drugs and supplies in the last 4 to 5 months. What’s more, because carfentanil is so concentrated, it can stay in users’ systems for hours at a lethal level. So some patients are waking up with several doses of narcan, walking off, and hours later OD’ing again once out of medical care.

Read Part 2

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