If you have been keeping your eyes open to the growing epidemic of opioid addiction in the USA, you will be aware of the increased risk of fatal overdose that street drug users in Wales face from mixing opiates and opioids, and from street heroin being doctored with Fentanyl.
To play our part in keeping safe, Living Room Cardiff has trained 10 volunteers in a technique to save a live in the case of an overdose.
During the past two decades, our transatlantic cousins have seen the trade in opioids such as oxycontin and vicodin spill from the doctor’s surgery to backstreet clinics and the street. Whereas opiates like heroin, morphine and its precursor opium have long been part of America and Britain’s illicit drug cultures, the new wave of synthesised pain relief has introduced a fresh generation to addiction. What might begin as a temporary pain relief can develop into a recreational party drug, and finally a gateway to injection and addiction.
Whereas heroin had previously been associated with hard core illegal drug use, staying at the fringes of society, the new opioids are reaching “respectable” communities like college kids and other generally privileged and conservative markets due to their medically and pharmaceutically sanctioned use. The Guardian newspaper[1] reported that prescriptions issued for OxyContin in the US increased tenfold between 1996 to 2002, from 670,000 a year to more than six million.
By 2002 prescription opioids were killing 5,000 people a year in America and that number tripled to 15,000 over the following decade – over 250,000 US citizens died from opiod-related deaths during that time! In 2011 the US government reported that deaths from prescription opioid overdoses had overtaken combined fatalities from heroin and cocaine.
By 2012, sales of prescription opioids were grossing $11bn in the US annually. As interestingly reported in The New Yorker Magazine[2], the Sakler family – whose company Purdue Pharma developed Oxycontin to the market – were also responsible for the development of Valium and Librium, both of which have been responsible for similar adverse and unintended consequences across the world to both prescribed and non-prescribed users.
A double whammy – born in the USA but beginning to make itself felt over here – is the emergence of a new generation of significantly stronger synthetic opioids. Fentantyl is 50 to 100 times stronger than morphine, and Carfentanyl is 100 times stronger still. Originally synthesised legally and administered in patches for slow relief, it is now also being made in illegal labs and sold for intravenous use.
While some celebrities might feel comforted at their ability to use fentanyl for its pharmaceutical purity and can take the drug under the safety of medical supervision, the death of pop star Prince is a cautionary tale here. Even more dangerous, however, is the impregnation of street heroin with fentanyl – hence a steady and growing stream of stories of drug deaths on both sides of The Pond.
Fentanyl is bought on the dark web and imported to the UK, where – due to its potency – it can be easily stored, and used to boost the strength of a batch of street heroin way beyond the tolerance levels of street users. Naïve dealers might casually mix batches without understanding how strong their product is becoming, and users who are looking for an immediate fix will generally not test the batch before shooting up a potentially fatal dose.
In Wales, mercifully the problem has not yet become significant. Fentanyl-related deaths have been reported recently in North Wales and the Swansea valleys, and arrests made in Newport, but while they are still isolated and while New Psychoactive Substances like Spice understandably dominate the headlines, this is a ticking time bomb. And that is why ten volunteers at Living Room Cardiff recently underwent training to be accredited to administer Naloxone to people who may have taken a potentially fatal overdose of opiates and opioids.
Naloxone acts to temporarily strip opiates and opioids from receptors in the brain, thus reversing the effect of their use. It is perhaps most infamous in popular culture from the scene in Quentin Tarrantino’s “Pulp Fiction” when Uma Therman has Naloxone plunged into her heart following an overdose (although – as quickly became clear from the training delivered by Taith – such a lurid and dramatic act would most likely be fatal in itself!) In fact it should be simply injected intramuscularly in small, measured doses, and the cohort of 10 were soon practising on oranges conveniently provided by the trainer.
The Living Room volunteers learnt about how to administer the treatment, and also a host of useful information to spot the signs of an overdose, the causes of an overdose, and to bust common myths about overdoses. We learned that opiate users will usually also be taking drugs other than heroin, potentially mixing with opioids like oxycodone and methadone which can increase the risk of overdose. Tolerance to opiates quickly reduces after a few days of abstinence, so for instance people coming out of prison may be surprised to find that they are not able to take as much heroin as they were used to without overdosing.
Ironically, administering Naloxone can also present risks of more serious overdose, as the drug temporarily sends the user into withdrawal, in which state their over-riding wish may be to inject more heroin. This is why we were trained that after administering Naloxone we should stay with the user until paramedics could provide more ongoing care until the levels of opiate in the user’s bloodstream had reduced below a fatal level.
A sobering training event! While the chances of one of our team needing to administer Naloxone are quite small, we are pleased to be forewarned and forearmed, and we have also broadened and deepened our understanding of non-prescribed use of opiates and opioids.
[1] https://www.theguardian.com/us-news/2017/oct/25/americas-opioid-crisis-how-prescription-drugs-sparked-a-national-trauma
[2] https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain