If You Think Fentanyl Is Bad...

September 11, 2019 5:14 AM

The second to last thing the world needs now is a more efficient way to make fentanyl—the "super heroin" that is killing heroin addicts like never before. The very last thing we need ...

The very last thing we need is a list of fentanyl analogs that are so strong that they make the drug itself look like cotton candy, and procedures for how to make them. But, we get have both in one PLOS paper.

Lethal Doses of Opioids (Heroin Fentanyl Carfentanyl) using a dime for scale

posted by dancestoblue (31 comments total)

Two year old story, which indicates that the underworld needs a more dumbed down version of the paper to put this to use, thank $DEITY.
posted by ocschwar at 5:18 AM on September 11, 2019 [7 favorites]

Yeah this isn't like meth say, which people can/are making in their home/garage/shed/RV ect. but these techinques are being used by large overseas labs (mainly China). Last few years have seen a major uptick in the Fentanly Analogs because, being so new, they weren't "illegal" per-say in either China or the US so they could be easily imported.

Both countries have finally started adding "fentanyl analog" entries to their drug schedule lists which has actually helped cut down a little on trafficking (basically if you get in as much trouble for the analogs as you do for the actual drug you may as well just traffic the real thing).
posted by Captain_Science at 5:58 AM on September 11, 2019 [5 favorites]

(╯°□°)╯︵ ┻━┻
posted by sugar and confetti at 6:23 AM on September 11, 2019 [1 favorite]

Ohmefentanyl sounds like it should be in the same category as nerve gas or a dirty bomb. A weapon of mass destruction.
posted by Bee'sWing at 6:37 AM on September 11, 2019 [7 favorites]

Holy shit:

Doing the math (5), the estimated lethal dose of ohmefentanyl is 0.16 micrograms, which means that one poppy seed's worth (300 micrograms) of ohmefentanyl is enough to kill 1900 people. Another way of looking at it is even scarier: One ounce of the stuff (28 grams, 28,000,000 micrograms) would be enough to kill 175 million people—half the population of the United States (7).

posted by Ouverture at 6:57 AM on September 11, 2019 [10 favorites]

Whenever I read a piece like this I can't help but think how thoroughly the economics are tilted in favor of the traffickers. When a little vial of this stuff can get an entire city high, it becomes cost-effective for it to be hidden in ever smaller crevices inside vehicles carrying legit shipments. They can then dilute the drug down to a more street-friendly strength once they get it over the border.

A wall won't do anything to stop it.
posted by droro at 7:06 AM on September 11, 2019 [7 favorites]

I gotta say, if I gotta go in the elites' upcoming WW3, I'd rather go by super fentanyl than by nuke.
posted by Caduceus at 7:06 AM on September 11, 2019 [13 favorites]

Ironically, properly dosed, fentanyl and carfentanyl can be much safer than morphine due to the much higher therapeutic indexes. Morphine for instance has an effective dose to lethal dose ratio of 70:1. Fentanyl analogues can reach 10,000:1 making it far safer for use in a therapeutic setting.
posted by Your Childhood Pet Rock at 7:16 AM on September 11, 2019 [15 favorites]

I have to say, as someone who benefited from fentanyl in a therapeutic setting, e.g. getting my wisdom teeth out, it's a great drug. You get an IV, the anesthesiologist pushes a few buttons on the controller, and in a minute you cannot feel any pain. And when the surgeon is done, they push a few more buttons, and the drug wears off. It took longer for the Versed to take effect (because who wants to remember that shit), and I never once felt high; I just kinda faded out and then back in with four fewer teeth. In and out of the office in less than two hours with zero side effects.

On the other hand, given the ease with which a toy drone or sling-shot launched device could produce an aerosolized amount of one of the analogues that could wipe out a stadium, I'm surprised any politician goes outside any longer.
posted by seanmpuckett at 7:44 AM on September 11, 2019 [4 favorites]

A tweaker is as capable of making these compounds in their meth-laden home, as a hobo is capable of making weapons-grade sarin in the local dumpster. (Interesting article, tho'.)
posted by Schadenfreude at 7:44 AM on September 11, 2019 [1 favorite]

Whenever I read a piece like this I can't help but think how thoroughly the economics are tilted in favor of the traffickers. When a little vial of this stuff can get an entire city high, it becomes cost-effective for it to be hidden in ever smaller crevices inside vehicles carrying legit shipments. They can then dilute the drug down to a more street-friendly strength once they get it over the border.

If you have a chemist to do the dilution right. Otherwise you can easily kill your clientele. Bad business.
posted by ocschwar at 8:00 AM on September 11, 2019 [2 favorites]

To quote Dr. Goodspeed: "It's very, very horrible sir. It's one of those things we wish we could disinvent. This isn't a training exercise, is it?"

VX looks like a joke compared to this stuff.
posted by SPrintF at 8:17 AM on September 11, 2019 [1 favorite]

One ounce of the stuff (28 grams, 28,000,000 micrograms) would be enough to kill 175 million people—half the population of the United States

So dump a pound into the NYC water distribution system and decimate the population of NYC?

it becomes cost-effective for it to be hidden in ever smaller crevices inside vehicles carrying legit shipments.

Why use a vehicle when there are numerous body cavities and medical implants that are immune to search?
posted by Mitheral at 8:26 AM on September 11, 2019 [1 favorite]

If you have a chemist to do the dilution right. Otherwise you can easily kill your clientele. Bad business.

Dilution would seem to be as simple as calculating the ratio and then adding the appropriate amount to a measured volume of water. Is there more too it than that?
posted by Mitheral at 8:32 AM on September 11, 2019

How does it degrade? If it is used as a drug, mustn't it be metabolized? Does narcan work?

I can see why cops and drug enforcement workers fear this stuff. And why deaths from OD are up.
posted by theora55 at 8:38 AM on September 11, 2019

Dilution would seem to be as simple as calculating the ratio and then adding the appropriate amount to a measured volume of water. Is there more too it than that?

Yes because you're trying to work with micrograms of potentially lethal stuff. You can't just eyeball it on a kitchen scale like a butcher. You need to be able to check the concentration after the fact and know that you're right.
posted by Your Childhood Pet Rock at 8:38 AM on September 11, 2019 [7 favorites]

Dilution would seem to be as simple as calculating the ratio and then adding the appropriate amount to a measured volume of water.

Sure, if you're customers want a liquid. My impression of the illicit supply chain is that it's based on moving around crystalline solids literally up until the point of use.

And ensuring a homogeneous mix of a solid like this with the huge dilution ratios of a non-active ingredient would be difficult. - So good luck users.
posted by achrise at 8:51 AM on September 11, 2019 [1 favorite]

Another way of looking at it is even scarier: One ounce of the stuff (28 grams, 28,000,000 micrograms) would be enough to kill 175 million people—half the population of the United States (7).

Promises, promises. Back about 18 years and a month all of NYC was freaking the fuck out because of the Anthrax which, if let loose in the subway could kill the whole city! Everyone! All dead! But of course the truth is... no, it might be the right concentration to hurt a lot of people (first responders initially) but delivering it effectively to 170,000,000 people would be a serious logistical undertaking.
Nice idea though!
posted by From Bklyn at 9:20 AM on September 11, 2019 [3 favorites]

Not to go off on a tangent but what I don't understand about the opiate epidemic is why it is necessary for patients to be cut off from prescription opiates. If the story is that hordes of patients became addicted because of being given prescription opiates and then have to move on to street drugs because they are cut off why does it make sense to cut them off? Oregon had a big kerfuffle as the medicaid plan here planned to cut off any patient who had a condition that evidence didn't support the treatment of with opiates. Leaving aside the dubious moralizing about the difference between addicts who come to their addiction through extra legal means vs victims of prescription is there a concrete reason that just letting somebody keep taking large amounts of opiate pain killers legally wouldn't help keep the destructive aspects of opiate addiction down?
posted by Pembquist at 9:49 AM on September 11, 2019 [11 favorites]

Dilution would seem to be as simple as calculating the ratio and then adding the appropriate amount to a measured volume of water.

Oh, oh, oh, can we somehow convince people seeking dangerous, illicit drugs that homeopathic doses are the best?
posted by davejay at 9:49 AM on September 11, 2019 [4 favorites]

I was surprised to hear via a local drug testing organization that there is no heroin at all on Vancouver Island, it has all been replaced by fentanyl and carfentanyl. I wonder if we will ever move to prescribing measured doses for users.
posted by not_that_epiphanius at 9:51 AM on September 11, 2019

Dilution would seem to be as simple as calculating the ratio and then adding the appropriate amount to a measured volume of water. Is there more too it than that?

Process controls for pharmaceutical manufacturers are tight, extremely well regulated, inspected by regulators, point-checked at multiple stages of manufacture, triple checked (etc.) in final form, and checked off the shelf again by regulators. Every pharma company employs a small regiment of highly trained people whose only jobs are to ensure this one thing. And things still go wrong from time to time.
posted by late afternoon dreaming hotel at 9:56 AM on September 11, 2019 [6 favorites]

Otherwise you can easily kill your clientele. Bad business.

Not bad enough, apparently.

I've also heard the claim that that spike in "mainly fentanyl" deaths is actually underselling the problem, because heroin dealers will cut their more-expensive-to-smuggle product with some combination of fillers (which don't need to be smuggled) and fentanyl (which is cheap to smuggle and keeps the final product from losing potency), so some large number of ostensibly heroin overdoses are actually deaths caused by the fentanyl additive.

Is it time to surrender yet? There's no way we're ever going to prevent smuggling of micrograms-per-dose chemicals.
posted by roystgnr at 10:32 AM on September 11, 2019 [1 favorite]

The paper with the list of analogs is from 2014, and most of the stuff in it wasn't new then. I'm not sure you meant to imply that it was but I just wanted to clarify - the people who make these drugs already know about these compounds, trust me.
posted by atoxyl at 10:33 AM on September 11, 2019 [1 favorite]

A big issue is the "chocolate chip cookie" problem.

Fentanyl is generally sold as a powder. As least round these parts, the people buying fentanyl are trying to buy heroin. Users know how much heroin should be in a capsule/wrap/baggie, so dealers pad it out the tiny amounts of fentanyl with fillers such as sugar and then measure out saleable doses.

So, how well mixed is the fentanyl and the sugar? Turns out that mixing powders is a bastard to get right and you end up with lumps of fentanyl unevenly spread though the mix.

You know how the chocolate chips in a cookie can be unevenly spread? One bite might have none; one bite might have lots? That's the problem. Sometimes a dose will have many lumps, sometimes none. Each saleable dose might be too weak or it might contain a lethal amount of fentanyl.

That's how people die.
posted by happyinmotion at 12:26 PM on September 11, 2019 [13 favorites]

Sad to hear old heroin users talk about the good old days when they used to get more or less "high" after shooting up. Now they say that with all the fentanyl they just get knocked out, which is good if you're in an operating room, not so much when you're a recreational user. Or you get killed, of course. Not a gamble any but the truly addicted would want to take.
posted by kozad at 1:29 PM on September 11, 2019 [1 favorite]

Not to go off on a tangent but what I don't understand about the opiate epidemic is why it is necessary for patients to be cut off from prescription opiates

I may have mentioned here before that I have a paradoxical reaction to opiates. They make me super alert and functional. Well, turns out that I have narcolepsy and opiates have recently been found to increase hypocretin levels. So here's this potential to reverse the symptoms of narcolepsy which are caused by hypocretin loss, but I'm so afraid the baby is going to be thrown out with the bathwater because of the opiate epidemic.
posted by Ruki at 2:45 PM on September 11, 2019 [4 favorites]

Not to go off on a tangent but what I don't understand about the opiate epidemic is why it is necessary for patients to be cut off from prescription opiates.

Because the DEA says "drugs bad" and busts pain doctors. Those who aren't busted (yet) are cowed into lowering doses or rationing.

There are conditions that are only pain, and without pain management the person is constantly in pain until the end of time. For these cases sometimes opiates are the only relief, but the body has only so much tolerance to build up and sadly, this is where overdoses happen. However, it's only a matter of policy whether patients are forced to endure their pain at this point.
posted by rhizome at 3:18 PM on September 11, 2019 [5 favorites]

Now they say that with all the fentanyl they just get knocked out

Likely depends on the market. The story around here is that there are custom mixes of analogues with varying onset times. So, an initial wave of feel-good, and as it comes down, another wave (that probably hits a differnt opioid receptor subclass, or in a different way), and sometimes a third.

Apparently, this makes methadone completely worthless as it only compensates for the lack of the first wave, junkies are expecting successive waves and relapse.

The Moscow theatre hostage thing of 2002 involved diazepam (Valium). Switching over to using super opioids for similar situations is not unbelievable.
posted by porpoise at 6:48 PM on September 12, 2019 [1 favorite]

The Moscow theatre hostage thing of 2002 involved diazepam (Valium). Switching over to using super opioids for similar situations is not unbelievable.

If you read the rest of that article it says they did use a fentanyl derivative.
posted by atoxyl at 10:21 PM on September 12, 2019 [1 favorite]

The picture in OP Lethal Doses of Opioids (Heroin Fentanyl Carfentanyl) is "based on DEA data", but the DEA is hardly an impartial source. If the caption in the photo is to be believed, carfentanyl would be a hundred times deadlier than fentanyl, which seems completely wrong.

The original paper introducing carfentanyl measured that it had about 35x better pain relief effect than fenatyl (in rats), but about the same LD50. In other words it would be strictly safer, since it has a higher therapeutic index. It seems that this is still the only quantitative study of carfentanyl lethality (a recent survey article cites only this number, plus some case reports), so the "DEA data" seems to be based on nothing at all.
posted by youzicha at 9:49 AM on September 15, 2019 [1 favorite]