Fentanyl Current trends and dangers

2017

Todd Waselovich

Detective Sergeant Niagara Regional Police Service

How Did We Get To This Point

It was over 5 years ago that the OxyNeo was introduced to replace Oxycontin®. The switch to the new formulation OxyNeo®, was designed to prevent users from defeating the time release and delivery mechanism, and to curb the oxycodone epidemic.

Oxycodone

• Individuals who were abusing Oxycodone for the most part have switched their drug of choice mainly for the convenience and ease of abuse in other prescription opioids such as hydromorphone ((brand names Dilaudid ®, Hydromorph Contin ®), fentanyl (Teva®), and now powder.

• Oxycodone is still available in Percocet and OxyNeo, however, Niagara and most areas are not seeing much in the way of OxyNeo in their investigations.

Hydromorphone

Hydromorphone

Fentanyl

• Fentanyl was first introduced more then 50 years ago. Its original use was for sedation of patients for surgery.

• During the 90’s fentanyl patches were being prescribed for people with chronic pain associated to cancer and severe back pain etc.

• Fentanyl is approximately 80-100 times more potent then morphine, 40 times more potent than heroin.

• Currently fentanyl comes in several different forms. Patches, lozenges, liquid, and powder.

• Our street users and legitimate patients are in possession of either patches or powder.

• There has been reports of liquid fentanyl being in the hands of our users. This has yet to be confirmed by the NRPS.

• Liquid fentanyl is the form that is abused in the hospital setting. Medical professionals.

• NRPS has not made any seizures involving lozenges.

Lozenge and Liquid Fentanyl

Fentanyl Patches

Fentanyl Patch

Fentanyl Patch

Proper Usage: • Patients prescribed patches are to wear the patch

on their skin for 48-72 hours at a time. • In 2016 the government brought in legislation for

the Patch for Patch program. • This program requires patients to return used

patches prior to being dispensed their next batch of patches.

• The program was put in place in an attempt to stop the street usage and sales of the patches.

Street Usage of Patches

• Users will cut the patch into small strips and place in their mouth to absorb the fentanyl.

• Users also smoke the patch by cutting the fentanyl into strips. The strip is then placed on a piece of tin foil. The user then holds a lighter under the tin foil and the patch backing peals off leaving the gel/fentanyl on the foil. The gel is then heated and inhaled.

• IV users will heat/cook strips or the whole patch in liquid to extract the fentanyl from the patch. The resulting mixture is then drawn into the syringe and injected.

Street Usage of Patches

• Fentanyl patches come in various sizes. 25mcg, 50mcg, 75mcg, and 100mcg.

• New legislation is restricting the dispensing of 75 and 100mcg patches. However that just means more 25’s and 50’s.

• Street dealers then turn around and sell the patches for $3-$4 per mcg. 50mcg patch sells for $150-$200 per patch.

• Users will use 1 - 2 patch per day, or as much as they can afford.

Fentanyl Patch out of Package

POWDER

• Fentanyl powder and analogs are the most recent trend which is now spreading across the country and causing the majority of overdoses and deaths.

• Powder is produced in illegal laboratories in North America, and also produced in China/Asia and mailed to Canada.

• Dealers are mixing the powder into bulking agents, poor quality heroin, and producing fake tablets for sale to customers.

Powder Continued • The users use powder similarly to patches.

They will inject, smoke, and snort the drug. • The reason the powder is so dangerous is

because of the poor mixing techniques used by the dealers. Hotspots or unknown to the user.

• The commonly used mixing ratio for fentanyl is 100 bulk- to 1 part fentanyl.

• Mixing instructions are found on the Internet. • Dealers mixing into cocaine now as well.

Powder Mixed / Hot Spots

Tableting Operations • Commercial pharmaceutical tableting

equipment was being imported from China to produce very large quantities of professional counterfeit Oxycodone.

• These machines were non-regulated in Canada and could be purchased via EBay and Alibaba etc..

• Provinces are currently working to pass regulations to regulate pill pressing machines.

• Ontario passed its first reading of Bill 126 in April this year.

Counterfeit Oxy Tablets

Currently Niagara has only seen two seizures of counterfeit tablets. However these types of tablets are more common in other areas across Canada.

Commercial Tableting Machines: • Cost: $6000 -

$10,000 US

• Origin: China

• Production Capacity: • 10,000 – 18,000

tablets per hour

•

Commercial Tableting Machines:

Fentanyl Analogs

• Analogs of Fentanyl such as Carfentanil, Ohme and Pharaoh-Fentanyl are significantly stronger. Carfentanil is 100 times more potent than Fentanyl. Carfentanil is not meant to be used in any capacity on humans and is used to tranquilize large game animals (elephants). However, it is being sold on the streets.

• In 2016 the Niagara Regional Police Service conducted a controlled delivery of 54 grams of Furanyl Fentanyl to a Welland residence.

Fentanyl Analogs

• Niagara has had one confirmed case of Carfentanil. This case was from an overdose death.

• Carfentanil has been seized in other areas is Ontario.

• Many different analogs were created in China due to their laws. New analogs are created as known substances are outlawed after pressure from the DEA. Fentanyl is outlawed there. However underground labs still create it.

Analogs of Fentanyl

Analog Potency X Morphine

Fentanyl 80-100

Alpha methylfentanyl 300

Sufentanyl 400-800

Alfentanyl 200

Lofentanyl (3-methylfentanyl) 4,000-7,000

Carfentanil 7,000-10,000

Ohmefentanyl 20,000-50,000

Furanyl-Fentanyl 16-20

Furanyl Fentanyl

Furanyl Fentanyl

Domestic Synthesis of Fentanyl

• Fentanyl can also be made domestically in a ‘one pot lab’. This process involves three separate reactions occurring in one container.

• No heat or special equipment is required. • This process can produce roughly 26.2 grams

of powdered fentanyl. • Cost to purchase ingredients - $375.95

http://www.google.ca/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCOSPi_TwlckCFQLxYwodmMsCeA&url=http://onschallenge.wikispaces.com/Exp029&psig=AFQjCNGav2Lwd1VqusIKCExdbadnUKsxZQ&ust=1447795549985245http://www.google.ca/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCOn1yZjxlckCFQ_tYwodN4AECg&url=http://longhaichem.vn/san-pham/fuchsin-basicscharlautbn-95.html&psig=AFQjCNG5pw2AO8Z1aA2tP8pDcA-FqKLw_Q&ust=1447795614576264

Domestic Synthesis of Fentanyl

• The chemicals required to manufacture fentanyl can be acquired domestically as there currently are no regulations in place to prevent their acquisition.

W- Series Compounds (W18)

• W-18 is a Canadian-made chemical created at the University of Alberta between 1977 and 1979 as part of a drug-design project aimed at creating a compound for pain relief. It was never produced commercially and the series was eventually shelved.

• However, even though this compound was shelved in the 70’s, it has been found and produced for use on the street.

W- Series Compounds Potency

Recent Research 2017

• The Ontario Drug Policy Research Network put out a report in April of this year.

• The report covers opioid related deaths and how the trend continues to climb.

• One statistic covered in the report is that in 2014, opioid related deaths exceeded deaths from motor vehicles collisions.

• From 1991- 2015, opioid related deaths increased in Ontario by 285%.

Dangers Fentanyl Presents to First Responders

• Fentanyl Patches- Fentanyl patches pose the least level of risk to a first responder. These patches are time released and they are meant to be worn on the skin. If a patch was to come into contact with the skin of a first responder there would be minimal transfer. However medical assistance should be sought.

Fentanyl Dangers Continued

• Fentanyl Powder- Fentanyl powder and its analogs are what pose the greatest threat to first responders and the public.

• The risk of contamination at the site of an overdose call or any other call for service is high.

• Service Dogs- Animals can be affected by fentanyl. (drug search, homes, cars etc)

Fentanyl Dangers Continued

• LD50 (lethal dose level) is 2 mg! 2 grains of salt. • 100mcg Patch contains 16.5mg total. • Fentanyl is skin permeable. • Pure Fentanyl (powder) may appear to be other

illicit drugs such as Cocaine, Heroin, or fake tablets.

• Overdose can quickly lead to respiratory depression and cardiac arrest.

Call Taker Considerations

• Overdose 911 call ( always think the worst), powder fentanyl and analogs are being mixed into many different types of drugs.

• Most overdose calls Niagara is seeing has a fentanyl connection. (users usually know their dose when using hydros etc)

• Unconscious person (vehicle, public place, residence etc..), scene dangers.

• Biological Hazards ( body fluids) • Listen for street names

Fentanyl Patch Street Names

• Stickers • Sticky • China White • Tango and Cash • Murder 8 • Apache • Good Fella • Popcorn (heroin mixed with fentanyl) • Powder

Call Taker Considerations

• If you know its an overdose or call for service involving fentanyl. Best practice is to have 2 officers respond. Status checks more often??

• EMS/ FIRE/ Some Police carry Naloxone. Obviously medical is attending to overdose calls. However there could be welfare checks, assistance calls etc.

• If dispatched units attend and describe what looks like a possible lab… You could be into a hazmat situation.

Fentanyl Laboratory

Mail Packaging from Fenatnyl

House in Niagara

Safe Handling

Levels of Personal Protective Equipment

– drugs in tableted form or powdered drugs 3.5g or less in a clean package.

• PPE guidelines: double gloves (double nitrile gloves), if possible, keep arms covered, N95 while handling in field or respirator if available and double bag sample and put into hard container.

Levels of Personal Protective Equipment

larger bulk volumes of powder, consistent with trafficking

• PPE guidelines: double gloves, disposable coveralls(Tyvek), safety glasses, fit tested respirator, double bag and place in hard container.

Levels of Personal Protective Equipment

• High Risk – large volumes of powder consistent with processing or synthesizing operations. Powder contamination, equipment (mixers, blenders, presses etc)

• Remove yourself from location and secure it. Do not handle exhibit unless required to do so and contact Drug Unit / Hazmat team for assistance.

NARCAN/ NALOXONE

• -Narcan / Naloxone will reverse exposures.

• Emergency services are being issued this opioid/opiate reversal kit across Canada.

• These kits now come in nasal spray form, and are given to at risk individuals at pharmacies and addiction clinics.

• Person still needs to attend hospital as it only lasts for short period of time

Narcan / Naloxone Kits (auto-injector)

• Currently having these issued to our officers in Niagara.

Questions?

Detective Sergeant Todd Waselovich

Niagara Regional Police Service Todd.Waselovich@niagarapolice.ca

905-733-8901

mailto:Todd.Waselovich@niagarapolice.ca

Slide Number 1How Did We Get To This PointOxycodoneSlide Number 4Slide Number 5HydromorphoneFentanylSlide Number 8Lozenge and Liquid FentanylFentanyl PatchesFentanyl PatchFentanyl PatchStreet Usage of PatchesStreet Usage of PatchesFentanyl Patch out of Package Powder ContinuedSlide Number 18Powder Mixed / Hot SpotsTableting OperationsCounterfeit Oxy TabletsCommercial Tableting Machines:Commercial Tableting Machines:Fentanyl AnalogsFentanyl AnalogsAnalogs of FentanylFuranyl FentanylFuranyl FentanylDomestic Synthesis of FentanylDomestic Synthesis of FentanylW- Series Compounds (W18)W- Series Compounds PotencyRecent Research 2017Dangers Fentanyl Presents to First RespondersFentanyl Dangers ContinuedFentanyl Dangers ContinuedCall Taker ConsiderationsFentanyl Patch Street NamesCall Taker ConsiderationsFentanyl LaboratoryMail Packaging from FenatnylHouse in NiagaraSafe HandlingLevels of Personal Protective EquipmentLevels of Personal Protective EquipmentLevels of Personal Protective EquipmentNARCAN/ NALOXONENarcan / Naloxone Kits (auto-injector)