Fentanyl and Other Opioids: Adapting to a Changing Landscape

Written by: Joe Mangiardi, NES, Inc.


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Written by: Brian Escamilla and Joe Mangiardi of NES, Inc.


Fentanyl and Other Opioids: Adapting to a Changing Landscape Fentanyl and other opioids are being manufactured and consumed in more ways than ever before, requiring vigilance on the part of law enforcement, first responders, and NES to know how to be prepared for potential encounters with these hazardous substances.

 

NES Featured in U.S. Army Article

On February 28, 2018 the U.S. Army published an article about training for fentanyl and other opioids conducted by NES for law enforcement personnel in South Carolina. The article, entitled South Carolina National Guard Partners with First Responders to Combat Synthetic Opioids, describes multi-agency micro lab training provided February 20 – 22, 2018 on behalf of South Carolina Army National Guard.

As the article reports, “The instructors at NES, Inc. consist of police officers, former DEA and chemical experts. The micro lab class is a combination of classroom and hands-on training, allowing students to familiarize with technical chemical terms and see first hand the processes drug dealers go through to create the products sold on the street to ensure incident responders handle lab investigations and entries safely and effectively.”

NES clandestine laboratory instructor Michael Cashman is interviewed for the article and relays the seriousness of fentanyl (and its derivatives) by stating, “One of the biggest concerns we have right now is dealing with fentanyl exposure. . . . Fentanyl is not just a police problem, or a CST problem. It’s everyone’s problem. We are seeing more and more fatalities from fentanyl exposure. The goal of this training is safety. We want to make sure that when these guys enter a situation and see evidence of fentanyl, they know what to do.”

 

Hash and PantyhoseNarcotics can be cooked up in some unique ways (left: pantyhose used for making hash; right: butane hash oil).

 

The article goes on to reference comments made by South Carolina Army National Guard commander of the 43rd CST Lt. Col. James Bowling, who helped to coordinate the training. Bowling says, “The threat environment has changed. What we are seeing is that homemade explosives, weapons of mass destruction, hazardous materials and even clandestine lab processes often look very much the same and have a lot of the same ingredients and precursors. What this training does is increase our situational awareness. When the CST and our civilian partners respond to a call, we have to know what to look for to ensure everyone’s safety.”

As has been the case for the past 30 years, NES is committed to helping all personnel who may potentially be exposed to hazardous materials be prepared to engage with these substances as safely and competently as possible. This is achieved by providing the best training available delivered by highly experienced and competent instructors.

 

NES Training for Encounters with Fentanyl and Other Opioids

The increasing prevalence of fentanyl and other opioids on the streets has forced law enforcement to adapt to keep up with the changes. The U.S. Army article phrases the problem as follows: “In the last several years, U.S. Law Enforcement has seen a dramatic increase in the availability of dangerous synthetic opioids; a large majority of these synthetic opioids are derivatives of ‘fentanyl.’ The presence of synthetic opioids in the illicit U.S. drug market is extremely concerning as the potency of these drugs has led to a significant increase in overdose incidents and overdose-related deaths throughout the nation.”

 

Fentanyl and Other Opioids - Death or Prison Misuse of fentanyl and other opioids often results in one of two outcomes: death or prison.

 

As the industry leader in clandestine laboratory (clan lab) training, NES has also been adapting to shifting narcotics trends. With a focus on fentanyl and other opioids, NES has developed a series of training courses entitled Fentanyl for First Responders. Presented on numerous occasions throughout recent years as a 2-hour webinar, in-class courses have now been established in 2-, 4-, and 8-hour iterations, varying by subject matter depth, detail, and hands-on activities.

The January 18, 2018 NES article NES Awarded DEA Clandestine Laboratory Training Contract describes NES’ contiguous 30-year history of providing clan lab training on behalf of the U.S. Drug Enforcement Administration (DEA). That tenure has been extended yet again with the recent award of a new contract with DEA, which includes an expanded catalog of clan lab training courses to address the growing need for clan lab training approached from varying angles and with differing areas of emphasis.

Course Series Description: Fentanyl for First Responders

The Fentanyl for First Responders courses incorporate the most recent scientific narcotic data, field testing equipment, and personal protective equipment (PPE) available for students to better prepare themselves for the hazards that exist in the narcotics field today. They are designed for patrol officers, clan lab responders, narcotics and clan lab investigators, firefighters, code enforcement employees, social workers, EMS personnel, hazmat operators, SWAT team members, or any other HAZWOPER-certified first responders who handle suspected fentanyl or fentanyl synthetics and other related clandestine operations. Courses involve classroom and live practical training on the history, dangers, toxicology, sampling, PPE, site control, and protocols for assessing and processing fentanyl synthesis operations. Fentanyl and other opioids as well as the use of naloxone are also covered.

 

Fentanyl and Other Opioids: The Cocktails of Choice

The growing popularity of drug “cocktails” paired with the typically unreliable cutting and portioning methods of illicit drug manufacturers, particularly when dealing with far more potent narcotics than previously encountered (fentanyl and synthesized derivatives thereof), makes for an often deadly combination. The following article, Making a Better Cocktail with Fentanyl, was written by NES instructor and Clan Lab Program Manager Brian Escamilla. The article explains the appeal of fentanyl and other opioids for street level recreational use and originally appeared in the July 2017 edition of the CSAlert, NES’ own periodical published exclusively for law enforcement personnel for the last 16 years.

Making a Better Cocktail with Fentanyl

One question that is repeatedly asked is, “why would somebody mix fentanyl with [fill in the drug(s) here]?” Combining narcotics can produce a more desired effect for the user than if the drugs were taken individually. Mixing a drug cocktail can produce a unique product for the user, but the heightened experience often comes with an elevated health risk. Analyses of street level narcotics samples have found fentanyl to have been mixed with cocaine, methamphetamine, ketamine, heroin, and various other drugs. Fentanyl is cheap, easy to obtain, and extremely potent, which makes the drug attractive to anybody formulating street level narcotics.

Mixing drug cocktails is not a new idea. For years street level drugs have been mixed with a variety of controlled substances and new designer synthetic narcotics in an effort to achieve a cheap yet desirable product for the end user. The availability of synthetic cannabinoids (spice products), substituted cathinones (bath salt drugs), fentanyl, and many other synthetics from the dark web allows for hundreds of different drug combination possibilities. Each of the potential drug combinations will have unique side effects and a level of overdose risk that will vary depending on the mix.

 

Making a Better Cocktail with Fentanyl While not commonly presented in classically recognizable cocktail form, cocktails made with fentanyl and other opioids offer users a dangerously tempting blend of effects.

 

To understand the intent of the chemist mixing the drugs and the potential harmful effects to the consumer, the types or classes of drugs being mixed (stimulants, hallucinogens, opioids, etc.) can be evaluated. Fentanyl and other opioids (oxycodone, hydrocodone, heroin, etc.) bind to the same opioid receptors in the body, but each of the compounds may vary in potency and duration of effects. By adding fentanyl to heroin, the effects of both drugs are amplified and the user may experience a more intense high and feeling of euphoria. Due to the synergistic effects of taking both opioid drugs together, trying to guess the proper dose becomes difficult and often results in the subject overdosing.

Adding an opioid drug to a stimulant is a combination that has been around since the 1980s and creates what is often referred to as a “speedball”. Historically, to make a speedball, heroin was mixed with cocaine. Today’s speedball may include fentanyl mixed with cocaine or methamphetamine. Ironically, the stimulant (the cocaine part of the mix) will increase the heart rate while the opioid drug will slow the heart rate down. Combining a stimulant drug with an opioid drug may allow for slightly higher doses of each drug, as some of the side effects become masked, but when one drug wears off, the remaining drug may be at such an elevated dose that it can overwhelm the subject.

Ketamine is an analgesic drug that, when combined with fentanyl, will heighten the euphoric and sedative effects of fentanyl. Ketamine is in wide use as a veterinary medicine, which also allows for greater opportunity for the drug to be diverted and abused as a street drug. Although ketamine is a pain management drug, it is different from opioid drugs in that it acts as an NMDA receptor antagonist – similar to PCP and dextromethorphan. Ketamine may produce additional effects in the body, such as hallucinations and “out-of-body” experiences, which may make it a prime candidate for use in making unique combinations of drugs. Unfortunately, in high enough doses, ketamine may also slow down the heart rate and, in combination with fentanyl, result in severe respiratory depression that medically compromises the subject.

There appears to be a growing trend to mix the drugs mentioned above into new street level products; compounding the issue is the addition of previous research chemicals, such as U-47700, AH-7921, MT-45, and many of the fentanyl analogs, which has created a virtual guessing game regarding the toxicity of these mixtures. As new compounds emerge on the street, law enforcement, first responders, forensic chemists, and medical personnel are left with the questions of:

  • Are the compounds transdermal?
  • What is the lethal dose?
  • What is the half-life (duration of effects in the body)?
  • What is the pharmacology of the compound(s) – are other toxic compounds formed or are the metabolites active in the body?
  • WILL NALOXONE REVERSE THE EFFECTS?

Today’s white powders are definitely more troublesome, not only in the identification of the compound(s), but in the toxicity of the compounds or mixtures that have been created. Law enforcement and first responders need to ensure adequate personal protective equipment is being worn when handling narcotics. Procedures should be implemented that reduce the risk of inhalation and skin exposure and that limit the potential for the drug to be spilled and contaminate the surrounding area. Engineering controls, such as the use of a ductless exhaust fume hood in the booking room, may help reduce the risk to law enforcement personnel who are field testing and packaging unknown narcotic evidence. Agencies may also want to consider training personnel in the use of naloxone and providing naloxone kits to those who may need to use them.

For more information on naloxone and the opioid epidemic, see the July 20, 2017 NES article Increased Access to Naloxone is Saving Lives.

 

NES Clan Lab Training

Course listings for currently scheduled NES open enrollment clan lab training can be found by clicking here. For more information about NES’ clan lab training capabilities, please feel free to contact us at 916-353-2360 / 800-637-2384 or via email at office@nesglobal.net.

 


References:

U.S. Army Article: South Carolina National Guard Partners with First Responders to Combat Synthetic Opioids

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