Post on 08-Jul-2020
transcript
1/10/2018
1
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
addiction66
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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?
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Brian Sallee
BBS Narcotics Enforcement Training &
Consulting, LLC
Email: brian@bbsnarctraining.com
Website: www.bbsnarctraining.com
Phone: 505-459-5554