Important Overdose Update!

I got this announcement from the Maryland (USA) Poison Center. It has to do with an extremely potent opiate that has been causing a number of serious overdoses with at least one fatality. You can check out the Maryland Poison Center site here. There is a newsletter you can subscribe to by email as well as access to lots of great information on all sorts of poisoning related issues.

Here’s the text of the email newsletter I got from Pharmacologist Lisa Booze of the MD Poison Control Center:

******Opioid Overdoses in Maryland******

Wicomico County, MD, reported an outbreak of 6 opioid overdoses on Thursday April 20th 2006. Patients presented with respiratory depression, CNS depression and circumstantial evidence of IV drug use. Urine toxicology was negative in all 6 cases. Some patients responded to naloxone. One patient died.

A highly potent opioid (e.g.fentanyl, sufentanil, methyl fentanyl, remifentanil, alfentanil,…) was suspected.

New Jersey and Philadelphia have encountered similar cases during the same time frame.

Analysis by the Wicomico County Police Crime Lab of drug paraphernalia samples from Wicomico County and Somerset County revealed the following:
- 4/4 positive for fentanyl
- 4/4 positive for procaine
- 3/4 positive (very weakly) for heroin.

These results provide the first solid evidence that fentanyl was involved. There is still a possibility that a fentanyl analogue was implicated, but that determination has not been made yet. Clinically, this will not make a difference.

Fentanyl is a short-acting, highly potent opioid agonist. It is approximately 50-100 times more potent than morphine. Regional outbreaks of “super potent heroin” (e.g. alpha-methyl fentanyl) are reported in 1988 (Pittsburgh), 1992 (Philadelphia), and more recently in New York City.

Because of the extreme potency of fentanyl, a larger-than-normal dose of naloxone may be required for reversal of the opioid effects. If the patient is apneic, start with 2 mg naloxone IV every 2 minutes until 10 mg is reached. If there is no response to 10 mg naloxone IV, then fentanyl is unlikely to be responsible for the respiratory depression. Fentanyl will not cross react with the opiate urine toxicology screen.

++++++ She later sent this addition +++++++++++

I have since learned that the urine toxscreen of the fatal opiate overdose in Wicomico County was positive for opiates. Fentanyl will not produce a positive urine for opiates; therefore, it is likely that the positive result was due to a mixture of drugs that included heroin.

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That’s all. Stay on your toes and watch out for this one!

Jamie
The Podmedic