OpioidsJ O S H U A C . Y O H A N N A NA L L E G H E N Y C O U N T Y O F F I C E O F T H E M E D I C A L E X A M I N E RJ U LY 2 0 1 9

Papaver somniferumAnnual plant

Can grow to ~40 in

Main alkaloids:◦ Morphine (8-19%)

◦ Codeine (1 – 3%)

◦ Thebaine (5%)

◦ Noscapine (5 – 8%)

◦ Papaverine (~1%)

Collection Opium Gum/Latex

Various Poppy Pods

Medicines from Opium Alkaloids•Morphine

• Oxymorphone

• Hydromorphone

•Codeine

• Oxycodone

• Hydrocodone

•Thebaine

• Oxycodone

• Oxymorphone

• Naloxone

• Buprenorphine

• Etorphine

Heroin▪Diacetylmorphine

▪Metabolizes to 6-MAM and then to Morphine

▪May have acetic acid odor

Heroin – ECP vs. BT

Local Packaging

Fentanyl

3-Methylfentanyl~400 – 6000 x potency of

morphine

N

N

CH3

O

CH3

H

H

N

N

CH3

O

CH3

H

H

More potent

TRANS

N

NCH3

O

O

CH3O

Carfentanil~10,000 x potency of

morphine

More Potent than Fentanyl

“Fentalogues”

FentanylAcryl fentanyl

para-fluorobutyrylfentanyl

4’ methyl Acetyl fentanyl

β hydroxy fentanyl

Other common substituents, the possibilities are endless…

12

National Forensic Laboratory Information System - Allegheny

16% 19%25% 29%

6%14%

29% 27%

69%58%

36% 33%

2% 3% 4% 4%7% 6% 6% 7%

0%

20%

40%

60%

80%

100%

2015 2016 2017 2018

Allegheny (Total Drug Seizures: 18,985)

Cocaine Fentanyl & FRS Heroin

Methamphetamine Rx Opioids

32% 32% 30% 30%

3% 9%21%

27%

50%44%

33%27%

6% 7% 9% 9%10% 8% 7% 6%

0%

20%

40%

60%

80%

100%

2015 2016 2017 2018

State (Total Drug Seizures: 139,747)

Cocaine Fentanyl & FRS Heroin

Methamphetamine Rx Opioids

* 2018 data are approximately through Q3, 2018 (as of February, 2019)** One drug seizure may contain multiple drugs.

Transportation – Then & Nowhttps://www.cbp.gov/newsroom/local-media-release/dulles-cbp-arrests-alleged-nigerian-heroin-smuggler

https://www.mirror.co.uk/news/uk-news/class-drugs-post-secret-website-3604058

Two different issues

htt

p:/

/ww

w.w

sbtv

.co

m/n

ews/

loca

l/b

arto

w-c

ou

nty

/lo

cal-

de

pu

ties

-mak

e-o

ne-

of-

the-

larg

est-

fen

tan

yl-b

ust

s-in

-th

e-co

un

try/

32

65

93

03

9

Two different issues

htt

p:/

/ww

w.g

lon

goo

.co

m/r

esu

lts.

asp

x?M

Typ

e=&

C=A

ny%

20

Co

un

try&

K=f

enta

nyl

%2

0fu

f%2

0fu

fhex

ten

Skyp

eliv

esan

dy5

13

7

Siegfried Synthesis

Hosted on www.erowid.org

Starting materials:◦ 2-phenethylbromide

◦ 4-piperidone HCl

PTC = phase transfer catalyst

NPP = list I chemical

ANPP = Sch II substance

http://www.erowid.org/

https://www.bostonglobe.com/metro/2017/06/09/dea-seizes-kilograms-fentanyl-precursor-northborough/4mQr0SAhZSNsFdbgJWNXoJ/story.html

50 kg Seizure of ANPP in MA

Illicit Tablet Threat➢Typically oxycodone medications

➢Sometimes alprazolam mimics

➢Unknown concentrations

http

://ww

w.d

esere

tnew

s.com

/article/9

00

00

00

59

/from

-mo

rmo

n-kid

-to-allege

d-d

rug-kin

gpin

-insid

e-the-rise

-and

-fall-of-aaro

n-sh

amo

.htm

l

Illicit TabletingDecontamination?Court Presentation?

Pill Presses

Tramadol• In 2017, estimated 1 billion tablets

seized leaving India

• In May 2017, 37 million tablets seized destined for ISIS

•Seizures:• 2010: less than 10kgs

• 2013: ~9 tons

• 2017: ~125 tons

https://www.csis.org/npfp/dangerous-opioid-indiahttps://www.voanews.com/africa/un-drug-report-opioid-use-booming-tramadol-crisis-emerges-africa

https://www.csis.org/npfp/dangerous-opioid-indiahttps://www.voanews.com/africa/un-drug-report-opioid-use-booming-tramadol-crisis-emerges-africa

MITRAGYNA SPECIOSE

GROWS IN SOUTHEAST ASIA

TYPICALLY SOLD AS A POWDER/CAPSULE

MADE INTO TEA OR TAKEN ORALLY

MULTIPLE VARIETIES

kratom

C O M P O U N D S O F I N T E R E S T: M I T R A G Y N I N E ( ~ 1 – 2 % I N D R I E D L E A F ) A N D 7 - H Y D R OX Y M I T R A G Y N I N E

B OT H C O M P O U N D S A R E U - O P I O I D A G O N I S T S

O V E R 2 5 A L K A LO I D S P R E S E N T I N T H E P L A N T

Kratom

Pain relief

Addiction treatment

Reduce stress/anxiety/depression

Anti-inflammatory

Improves focus

Boosts immune system

Addiction

Withdrawal symptoms similar to opioids

Hangover effects

Dizziness

Nausea/vomitting

Tremors

itching

Benefits Side effects

https://drugabuse.com/library/the-effects-of-kratom-use/https://www.healthline.com/health/food-nutrition/is-kratom-safe#controversy

Kratom varieties

Joshua C. YohannanAllegheny County Office of the Medical ExaminerJuly 2019