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Drugs of Abuse

Brian Sallee

BBS Narcotics Enforcement

Training & Consulting, LLC

Prescription Drugs

More overdose related deaths from prescription

drugs than any illegal street drug

More drug overdose deaths than traffic

accidents

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Prescription Drugs

Methods to obtain drugs

Mom and Dad are #1 dealer to kids

Theft from medicine cabinet

Steal for friends medicine cabinets

Most people don’t keep track of the number of pills they have

Types of Opioid Drugs

There are three basic of types of opioid drugs

Natural opiates from the resin of the poppy plant

Morphine and Codeine

Term opiate technically describes only natural

opiates others are opioids

Semi-synthetic opioids are created from natural

opiates with use of other chemicals

Hydrocodone, oxycodone, buprenorphine

Synthetic opioids are chemical/drug which mimics the

effects of an opiate drug

Fentanyl, Tramadol, Lorcet, Methadone4

Effects of Opioids

Opioids increase feelings of pleasure by

altering activity in the limbic system,

which controls emotion. Abuse and

misuse of Opioids can lead the user to

feel a rush of euphoria and pleasure

Opioids can block pain messages

transmitted through the spinal cord up to

the brain

Opioids act by attaching to specific

proteins that are located in our brain,

spinal cord, and organs. Opioids will bind

to these protein receptors, and reduce

the perception of pain

Side Effects of Opioids

There is a tolerance build up with all different

types of opioids

With street opioids the user needs the drug

more often as the high does not last as long

and then they will have to use more of the

drug

With prescription opioids the time frame of the

elimination of the pain shortens so the user

uses more of the drug to obtain pain relief

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Side Effects of Opioids

Withdrawal of prescription opioids has the same

difficulties as we have learned from heroin

addicts

Symptoms include nausea, vomiting, chills,

insomnia, muscle and joint pains, slowed

breathing and headaches

Treatment for withdrawal often needs medical

treatment

Detox, rehabilitation, 12 step program or other

types of therapy 7

Effective Use of Opioids

Bioavailability- This is a pharmacology term, the absorption method

or route in which a medication or substance enters the body and

how much of the substance is absorbed by the body

Taking an Opioid orally the bioavailability is 20% because the

substance is filtered through the organs such as kidneys and liver

So you only feel 20% of the effects

So instead you decide to use a different delivery method to increase

the percent of the substance so the effects are more enhanced.

Smoking or snorting may bump that 20% up to 60%

Injecting intravenously may bump the bioavailability up to

90%!!!!!!!

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Effective Use of Opioids

It is very common for first time drug users to

favor the least intrusive method of absorption

Unfortunately as the addiction grows and gets

worse, these individuals switch to a different

method

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Prescription Opioids

There are many legitimate reasons for a person

to use a prescription opioid drug

Even using an opioid drug properly there is a

risk of becoming addicted

Over prescribing the different opioid drugs is

part of the problem

Over 207 million opioid prescriptions were

written in 2013

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Prescription Opioids

Some of the reasons to use a prescription opioid drug

besides pain reliever, which is the most common reason

Cough suppressant- liquid form

Suppress diarrhea- opioids cause constipation

Shortness of breath- advanced diseases such as

cancer or COPD (chronic obstructive pulmonary

disease)

Seems odd since one dangerous side effect is

severe respiratory depression

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Prescription Drugs

United States has

5% of the world’s

population but

uses 80% of all

prescription opioids

91+ opioids

overdoses each

day in the US

Unit

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Prescription Drugs

5 top states with drug overdose deaths:

West Virginia

New Mexico

New Hampshire

Kentucky

Ohio

2015

NM now ranked

#813

Prescription Drugs

Methods to obtain drugs

Mom and Dad are #1 dealer to kids

Theft from medicine cabinet

Steal for friends medicine cabinets

Most people don’t keep track of the number of pills they have 14

Prescription Drugs

The prescription drug getting the most media attention is OxyContin

OxyContin is the trade name for the narcotic drug Oxycodone hydrochloride

OxyContin is time released Oxycodone hydrochloride

Available in different does amounts

10mg, 20mg, 40mg and 80mg

mg is milligrams

Pill had OC or OP on one side and the dose amount on the other side

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Oxycodone

Legitimate use of oxycodone is for long term

pain relief

Used by cancer patients, arthritis and injuries

Designed to give pain relief for 12 hours

Doses from 10mg to 80mg per pill

Certain pills contain other drugs in them

Percodan- oxycodone and aspirin

Percocet- oxycodone and acetaminophen

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Oxycodone

With the use of opioid prescription there will be

tolerance build up with the user

This is normal over time with any user of

opioid drugs

Not everyone considers this addiction

Can be considered addicted if they have to use

drugs to avoid any type of pain

Emotional pain

Physical pain

Familiar pain17

Oxycodone

Within the medical profession there is a fear of

being investigated by law enforcement or being

accused of over prescribing the drug

OxyContin is listed as a drug of concern by the

DEA

This increases oversite and investigations

involving OxyContin

Monitoring is also being done by Perdue

Pharma the maker of OxyContin

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Oxycodone

OxyContin

OC pills were time released but it was easy to crush the pill and defeat the time release

Now pills have been reformulated and have OP stamped on them

Purdue pharmacy claims pills cannot be crushed and defeat the time release

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Oxycodone

Drug abusers report the OP can be defeated

Heat it up until it is melted and then freeze it

Then crush the remains

Then smoke or inject it

Pharmacists advise people are not refusing the OP pills like they used to

Perception is reality in the drug trade20

Smoking Oxycodone

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Oxycodone

Effects of abused OxyContin

Produces an euphoric rush and feeling to the user

How is it used determines how quickly the effects hit

the user

Injecting and smoking give the quickest effects

Effect is very similar to heroin

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Oxycodone

Abuse of OxyContin will result in the user

developing a tolerance to the drug

Requiring more of the drug to get the euphoric

effect being sought

Long term abuse can create a physical addiction

Short term will create a psychological

addiction

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Oxycodone

OxyContin abusers switch to heroin due to the cheaper cost for the same type of high

Pills can run $1.00 per milligram so a single pill can cost as much as $80.00

Dose of heroin $20.00

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Oxycodone

As users find it more difficult to buy or steal

OxyContin they switch to heroin which is much

cheaper per dose

Danger with heroin versus OxyContin

Heroin is unknown purity

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Hydrocodone

Hydrocodone is the #1 abused opioid- even

more than Oxycodone (OxyContin)

Due to abuse drug was moved from Schedule III

to a Schedule II

This creates more control and restrictions on

its prescribing to the public

Estimates 99% of worldwide supply of

hydrocodone was used in the U.S. (2007)

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Hydrocodone

Hydrocodone is a semi-synthetic opioid

synthesized from codeine

Synthesized in 1920 by German chemists

Pharmaceutically only designed to be taken

orally

Many brand names- Vicodin, Lortab, Lorcet,

Maxidone, Norco, Zydone

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Hydrocodone

Hydrocodone is habit forming as with other opioid drugs

It has both physical and psychological addiction qualities

Some adverse side effects

Nausea, vomiting, dizziness,

constipation and anxiety

Abnormally happy and sad

moods

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Hydrocodone

Hydrocodone is designed for moderate to

severe pain (pill) and cough (liquid form)

Potency is less than Oxycodone (OxyContin)

Oxycodone is 50% more potent than

Hydrocodone

When used for pain relief both have

approximately same effectiveness

Many have mixture of other drugs

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Hydrocodone

One form of hydrocodone is in pure form and brand

name is Zohydro ER (Zogenix Pharmaceuticals)

Approved by FDA in 2014

This form is up to 5 times more active opioid as the

highest strength in mixture form

Zohydro ER is intended to be slowly released over 12

hours

Doses from 10mg to 50mg per

pill- increments of 5mg

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Heroin

The illicit heroin trade started up right after the

passage of The Federal Heroin Act (Harrison

Narcotics Tax Act of 1914)

Demand did not go away just because heroin was

outlawed

Heroin is smuggled into the United States from

different locations around the world

Illicit labs are created around the world to manufacture

heroin

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Heroin

Heroin is a schedule I drug

Active chemical is Diacetylmorphine

Opium to Morphine which is treated with

acetic anhydride changing it into Heroin

Heroin does not require a chemistry lab to

produce

It can be made outside with the proper

chemicals

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Heroin

Increase in quantity and quality of heroin coming from

Mexico

Mexican Drug Cartels are increasing their involvement in

the heroin trade

More poppy fields being grown in Mexico than ever

Poppy plants provide the opium for making heroin

Profits and increased use in the U.S. are reasons for

Mexican Cartels involvement

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Heroin

Over 47,000 drug overdose deaths a year

Over 24,000 of these deaths are heroin/opioids

overdose deaths

Increase of heroin users in United States

2007 had 106,000 users

2014 had 212,000 users

This increase mirrors the increase of opioid prescription

drugs abuse

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Heroin

There are three basic types of heroin

Tar heroin

Brown heroin

White heroin

The type or color of the heroin does not determine the quality of the heroin (purity)

It is an indicator where it was produced

Tar and brown heroin indicates South America or Mexico

White heroin from Middle East or Southeast Asia

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Heroin

Powder Heroin

White powder most likely from Golden Triangle or Golden Crescent

Brown powder indicates that it comes from Mexico

Powder tends to be granular in appearance

similar to sugar

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Heroin

Tar Heroin

Looks like roofing tar

Sticky like tar

Odor of vinegar

Controlled Substances not

one of the four basic food

groups do not taste or smell

Tar Heroin comes from

Mexico

Most common type of

heroin in Southwest

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Heroin

When a person first shoots up there is a

euphoric feeling

This can last for several minutes

Next the person goes into the nod stage

This can last for hours

A person can go into withdrawals 6-12 hours

after shooting up

Withdrawal can last for days to weeks

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Heroin

Danger with the heroin use is lack of control

Heroin can range from 7% to 80% purity

This lack of control of purity can result in “hot

shots” of heroin

Overdose from too high of purity of heroin

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Trends of Mixtures w/Heroin

Xanax

Is a benzodiazepine which is used to assist

people anxiety disorders and panic disorders

Oral dose is 0.25 to 0.5 mg per pill

Generic name: Alprazolam

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Heroin/Fentanyl

Heroin is not always strong enough for the

addict so dealers/users want to increase the

high by adding other drugs

One method which has made a comeback

around the country is adding fentanyl to

heroin

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Heroin/Fentanyl

This was trend in the Upper Midwest area approx. 20+

years ago

Chicago PD had so many overdose deaths they

made PSA warning public

Increased drug sales in areas where

heroin/fentanyl combination was sold

George Marquardt

Considered main

person responsible

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Heroin/Fentanyl

Trend now in the Northeast portion of the country

DEA estimates that nationwide over 2000 overdose

deaths from heroin laced with fentanyl

Over 755 overdoses in Massachusetts and 247 in Rhode

Island

In 2014- One of the worst years ever

Nearly half of these overdoses were heroin/fentanyl

mixture

Mix just a few tablespoons of fentanyl with one

kilogram of heroin

It is in New Mexico too

How much? Who knows? 43

Fentanyl

History of Fentanyl

Fentanyl has several brand names

Actiq, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl

and others

First synthesized in 1959 by Paul Janssen

Used as a surgical anesthetic

Safe when properly monitored

Accurate measurement of a dose of pure fentanyl cannot be

measured without proper scientific equipment

Amount between lethal dose and effective dose is not

detectable with naked eye

Fentanyl doses are in micro-grams or one millionth of a gram

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Fentanyl The Duragesic (fentanyl transdermal system) patch is a powerful

opioid pain medication for moderate to severe chronic pain.

Fentanyl is a pain killer which is 80 times stronger than morphine and 50 times stronger than heroin

Schedule II drug

Often prescribed in a patch for time release

Patch contains Fentanyl in gel form

Powder form has a similar appearance to cocaine

Because the drug is not completely eliminated from the patch even after a three-day period of use, discarded patches remain a sought-after commodity by some abusers, and can pose a risk to young children who may come into contact with them.

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Fentanyl

Also sold in liquid form

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Fentanyl

Different influxes of illicit fentanyl over years

2005-2007 over 1,000 overdose deaths

Currently DEA has identified 15 other fentanyl related

compounds

These are not pharmaceutical grade and are

Schedule I substance

Coming from Mexico and China

Often produced in illicit labs in Mexico

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Fentanyl

Illicit forms of fentanyl first came up from

Mexico

A few fentanyl labs have been seized in the

US

In 2015 Canada saw an uptick in fentanyl

overdoses

Imported in from Asia

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Fentanyl

Side effects of Fentanyl

Many side effects are similar to other opioid type

depressants

Slow heart rate

Unusual thoughts or behavior

Dry mouth

Constipation

White patches or sores inside of the user’s

mouth or lips

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Fentanyl

Other effects

Nervous system side effects which include

mental and respiratory depression

Stupor

Muscle rigidity often involving the respiratory

system which will further effect the depression

Seizure like events- which could be as result

of rigidity

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Fentanyl

Counterfeit pills containing fentanyl

Seizures around the country where pills appear

to be Oxycodone or hydrocodone pills

One example in Arizona over 2,000 pills were

blue in color and stamped with an “M” on one

side and 30 on the other

30 is common designation for 30 milligrams

or amount of drug in a pharmaceutically

made pill

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Fentanyl

Approx. 1,000 counterfeit pills can be made from

1 kilo of fentanyl

With 1 mg per pill

Profit can be potentially $20,000,000

Sales at $20 per pill

Requires a pill press,

fentanyl and other

powder

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Fentanyl

Routes of exposure

Inhalation, ingestion or skin contact

Adverse reactions can be:

Disorientation, coughing, sedation, respiratory

distress and cardiac arrest

Reactions can be extensive and sudden;

occurring within minutes

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Fentanyl Officer safety issues

Lethal dose of heroin can be approx. 30mg and lethal dose of fentanyl can be 3mg

Fentanyl can be absorbed through the skin or inhaled

Recommend use of nitrile gloves and unknown respiratory protection-

Avoid field testing inside rooms or car

Done in well ventilated area

DEA recommends testing in lab

Extreme danger to drug canines

Broward County SO had 3 dogs exposed

and treated for overdose of fentanyl

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Carfentanil

Carfentanil is a synthetic opioid and is a schedule II

drug

Used to tranquilize/immobilize large animals such as

elephants

It is 10,000 times more potent than morphine

100 times more potent than fentanyl

Lethal dose for humans is unknown

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Carfentanil

Carfentanil comes in several forms

Powder- appearances similar to heroin or

cocaine

Blotter paper

Pills

Spray

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Carfentanil

Carfentanil is being shipped into the U.S. from several

different foreign countries

Primary country appears to be China

Listing of many Chinese companies selling

Carfentanil over the Internet

One listing for a kilogram of Carfentanil was

$8,000.00

Mixed with heroin but danger is such a small amount

is lethal

Dealer cannot be sure it was mixed or diluted down

in heroin

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Carfentanil

Carfentanil may have the appearance of heroin or

cocaine

Over 400 seizures of Carfentanil in U.S.

Confirmed seizures in 8 states- Ohio, Florida,

Kentucky, Indiana, Michigan, Georgia, Illinois and

Rhode Island

34 seizures in Florida

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Carfentanil

Ohio has seen an increase in overdose deaths with

heroin now mixed with Carfentanil

There has been more overdose deaths in the first

six months of 2016 than all of 2015

There has been 118 overdose deaths in the first six

months of 2016

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Synthetic Heroin Substitute

UT47700

An opioid analgesic drug developed in the 1970s

Analgesic is

It has only been used in research and not on the open

market

No legitimate use of the drug

Chemical is 7 to 8 times more potent than morphine

based on animal testing

Primarily manufactured in China and sold on the internet

on various websites

Often sold openly until noticed

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Synthetic Heroin Substitute

U47700

Appearance

Sold as powder- often a bright white or

yellowish

Light consistency powder

Powder can be pressed into pill form

Gram of U47700 costs $35.00 to $55.00

Liquid form in droppers or spray bottle

Similar drugs are U-77891 and AH-792161

Synthetic Heroin Substitute

Street names- “Pink”, “Pinky”, U-4 or PH

The U is for Upjohn Pharmaceutical

U47700 suspected for deaths of two 13 year olds 62

Synthetic Heroin Substitute

W-18

W-18 is a chemical first synthesized at the

University of Alberta in 1981

It is mistakenly thought to be a opioid

Research has shown it does not bind to opioid

receptors so it is not an opioid though many

claim it as an opioid

Narcan is not effect in case of an overdose

Potency is 100 times more than fentanyl and

10,000 more than morphine63

Synthetic Heroin Substitute

Appearance of W-18

Powder form is a bright white in color

Similar appearance to fentanyl

Sold over the internet due to not being

scheduled as of July 2016

It is a scheduled I drug in Canada

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Synthetic Heroin Substitute

“Grey Death”

This drug is not a single drug but a mixture of various

opioids

Often mixture of UT47700, heroin and fentanyl

Quantities of each drug will vary with each mixture

Its appearance- looks like powder concrete or a greyish

powder or chunky material

Grey Death can be injected, ingested orally or smoked

Overdose from this drug in Georgia and Alabama

2 in each state- one of the overdoses in Alabama

resulted in death65

Suboxone

Suboxone is the brand name of a combination of

two drugs

Buprenorphine and Naloxone

Buprenorphine is an opioid medication which

produces less euphoric high so it is easier (or

thought to be) to stop taking the drug

Naloxone is a drug which blocks the effects of

opioids (Narcan)

Together the drugs are used to treat Opiate

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Suboxone

While this drug is used to assist people with

getting off opiates such as heroin/Oxcontin it has

an addiction quality to it also

Suboxone is being used as a replacement for

methadone

This is when the drug is taken properly for this

purpose which is orally

Can be used by persons

over the age of 16

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Suboxone

Suboxone comes in two forms

Tablets

Film

The drug is placed under the user’s tongue and let it

dissolve

This is for both tablets and film

The film was designed to dissolve quicker than a tablet

Tablet takes 2-10 minutes to dissolve

Film is said to taste better than a tablet

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Suboxone

As with any opiate drug Suboxone effects

the user’s brain and body

Suboxone has a physical and

psychological dependency quality to it

Over time the brain no longer functions

normally without Suboxone

Effecting many functions especially

those involved with judgment and

caution69

Suboxone

Common effects on user of Suboxone

Headache- 36%

Insomnia- 14%

Nausea- 15%

Constipation- 12%

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Suboxone

Side effects/overdose of the drug

Yellowing of the skin or eyes

Nausea

Slow breathing

Dizziness or confusion

Coma

Similar effects to heroin

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Suboxone

Smuggling of Suboxone can be done different

ways

Pill form- crush the pill up and smuggle the

crushed pills

In pill form can try to claim it is another pill but

if someone checks it is easy to ID as

Suboxone

Shape of the pill and markings on the pill

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Suboxone

The film makes to an ideal drug to

smuggle into a controlled environment

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Suboxone

Another method is smuggling the strips between items

Such as paper, pages in books

Strips can be concealed easily

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Trends of Mixtures w/Heroin

Watch for new trends as heroin becomes more

popular people will look for ways to make the

drug stronger or give a different high

This will increase the danger of overdose by the

users

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How Opioids kill

People die because they stop breathing

Prolonged hypoventilation complications

include hypercarbia, hypoxia, aspiration,

respiratory arrest and death

Generally occurs between 1-3 hours. The

chances of a person dying with the needle

in their arm is only about 15%

Opioid Overdose

Normal

Heavy uncontrollable

nodding

Drooling

Heavy breathing or

snoring

Responsive with

stimulation

(sternum rub)

Overdose

Very shallow breathing

Gurgling sounds

Blueish lips and

fingernails

Nonresponsive

Narcan

Naloxone hydrochloride is the name of Narcan

It is a liquid which is administered through

different methods

Injection- remember the scene in Pulp Fiction

Nasal spray- this is method police

departments are issuing to their officers

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Why Intranasal?

Works almost as quickly as IV route since

nasal mucosa is highly vascularized and

absorbs drugs directly into the blood stream

Narcan

Considered an antagonist

Blocks the ability of opioids to do what they do

Part of what opioids do is get the body to slow down including

breathing

With an overdose the person’s breathing slows to a point where

they stop breathing

Think of it as heroin wraps around the receptor and shuts the

respiratory system down

Narcan knocks the heroin off the receptor so the person

breathes again

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Narcan

Narcan only works on opioid overdose

It removes the effects of the opioid and can have the

user feel like they are in withdrawal

It takes effect in 2-5 minutes

Effect of Narcan is short lived in comparison to the

effects of the opioid

Narcan will last 20-90 minutes

So if person is not watched they can overdose again

when the Narcan wears off

Recommend they are watched by medical personnel

for several hours

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Narcan

Harmless- for people without opioids in their

systems

Will not reverse overdoses caused by non-

opioids

Cocaine, Meth, Benzos, Alcohol, Ecstasy

Narcan

Danger for first responders is the reaction of the

person when they come out of the overdose

Most common response is anger

“You blew my high”

Even physically attacking the first responders

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Narcan

OD or overdose party

People will intentionally overdose because

that is the greatest high

Have someone there with Narcan to

administer it before it is too late to bring

the person back

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Narcan

Should the police be given Narcan to administer

to people overdosing?

Does it differ between urban versus rural

police officers?

Is it a police function or a medical function?

85 86

Brian Sallee

BBS Narcotics Enforcement Training &

Consulting, LLC

Email: brian@bbsnarctraining.com

Website: www.bbsnarctraining.com

Phone: 505-459-5554