Codeine and Designer Fentanyls

Codeine (Syrup, Sizzurp, Purple Drank, Lean, Texas Tea, Memphis Mud)

 

Codeine is an opiate used for managing pain; however, teens and young adults are abusing large amounts of it. Known as Syrup, Lean, Sizzurp, Texas Tea, Memphis Mud, or Purple Drank on the street, it is often consumed in a white Styrofoam cup. It is prescription strength cough medicine with codeine (narcotic), promethazine (antihistamine), and mixed with sugary candy, soda, or Arizona Tea to make it sweet and palatable. The combination is illegal and dangerous. The amount of cough syrup consumed can exceed up to 25 times the recommended dose.

 

The consumption of large amounts of liquid cough medicine with codeine is glamorized in Hip-Hop music, all over the internet, and YouTube. Among rappers and football players, there have been a number of arrests and deaths related to this drug combination. Most famously, rapper Lil Wayne talks and raps about use of this drink – he spent days in a coma recently from abusing it. It is also glamorized by the group Three Six Mafia. At least three hip hop rappers or producers have died, including DJ Screw and musician Big Hawk, both from Houston.  

 

Signs of use include: slurred speech, blurred vision, euphoria, dissociation from one's body, impaired motor skills, lethargy, sedation, and drowsiness.

 

Effects of Purple Drank may include:

  • Constricted pupils that do not respond well to light
  • Rough, raspy voice
  • Slow, slurred speech
  • Uncontrolled eye movement
  • Droopy eyes
  • Slowed heart rate
  • Drowsiness & weakness
  • Loss of balance & coordination
  • Paleness
  • Constipation
  • Urinary tract infection
  • Dental problems
  • Addiction
  • Death  (fatal respiratory depression)

 

Dangers arise in higher dosages because promethazine is a depressant of the central nervous system and codeine is a respiratory depressant. When codeine is taken in very large amounts, it can cause the taker to stop breathing (fatal respiratory depression). It is possible to overdose on codeine when abusing Drank or Lean, resulting in an opiate overdose and death. If the use of the drink is combined with alcohol or other drugs, it can result in death.

Fentanyl and Designer Fentanyls

Fentanyl Abuse:  

Fentanyl is one of the strongest opiate drugs on the market. It is a synthetic drug, is 50-100 times more potent than morphine, and 15 times more potent than Heroin. It is used to treat severe pain in individuals with injuries or chronic illness, after surgery or prescribed for individuals who are tolerant to other opiates. It can be powdered out, liquid, pill, lollipop, or gel patch form. It can be ingested, smoked, snorted, injected, or addicts will chew on the patch. Fentanyl is often stolen from hospitals, pharmacies, and home hospice care.

Fentanyl is often added to Heroin on the street when Heroin is dirty or of poor quality. Powdered fentanyl is indistinguishable from heroin so users have no way of knowing if it’s mixed in heroin or being sold in replacement of heroin (china white). This potent drug can be used alone or in combination with another substance and just one use, can kill you. More and more states are seeing death from fentanyl overdose alone, indicating it is being sold as heroin or being used as its replacement.

Indicators of Fentanyl abuse:

Dizziness and lightheadedness        Difficulty seeing

Dry mouth                                           Depression

Retention of urine                              Hallucinations

Suppression of breathing                 Bad dreams                           

Severe constipation                           Insomnia

Itching or hives                                  Sweating

Nausea and vomiting                        Tremors

Loss of appetite                                 Swelling of arms and legs

Weight loss                                        Headaches

Designer Fentanyls

 

Acetyl Fentanyl:

Acetyl fentanyl is a new and lethal drug and is becoming more popular among narcotic abusers. The drug looks similar to heroin and is being sold as heroin. Numerous deaths among intravenous users of this drug have been reported across the US. In fact, the drug came to the attention of authorities after several deaths of narcotic addicts were investigated and the drug was identified in blood samples by ELISA testing (using antibodies) but not detected by GC/MS (detects chemical molecules). The drug is not available by prescription and said not to be available in the US. However, the drug is available online and sold without questions as a “research chemical.” Overdoses are treated the same as any opiate overdose. However, the drug is 15X more potent than heroin and larger doses of rescue medications are often necessary.

Carfentanil:

This new opiate was first created by Janssen Pharmaceuticals in 1974 and is an analogue of Fentanyl. It is marketed under the trade name Wildnil and used as a general anesthetic for large animals, i.e. elephants, rhino’s, hippo’s and bears. It is extremely potent, and claimed to be 10,000 times more potent than Morphine. It is a white powder that can be used anyway, and sold on the street as Heroin. It can be added in Heroin to make it more potent, and can be mixed with Cocaine as a “speed ball.” It is causing deaths across the nation.

U-47700: 

Known as “pink” on the street, it has been a problem since beginning of 2016. It is a designer opiate being made in drug labs in China. The U in the name stands for Upjohn, a pharmaceutical manufacturer that developed the drug in the mid-1970s. Scientists were looking for a synthetic alternative to morphine. Effects are similar to Tramadol.  It is about 8X more potent than Morphine, and can be used any way - injected, snorted, smoked or put in pills and swallowed. Some people have “plugged” it, meaning dissolving it in a little water and using rectally, it will absorb very quickly like a supositoryU-47700 works as a selective µ-opioid receptor. The drug is sold in pill, powder and liquid form, and can be bought online for less than $40 for a bottle of pills. It has been linked to 50 deaths across the nation. It is mixed with Heroin, sold as Heroin, and can be mixed with Cocaine. 

Effects from use can be: Muscle aches, nausea & vomiting reported, irritable, mood swings, euphoria, pain relief relaxation, constipation, itching, difficulty urinating, constricted pupils, respiratory depression, death, anxiety suppression, depression. Short duration of effects can cause double dosing. It is corrosive to mucous membranes, and vaporizing the substance can damage the lungs. Sublingual administration is likely to damage the skin in the mouth.

At least three states — Ohio, Wyoming and Georgia — already have taken action to ban U-47700 after it was connected to overdoses. Wisconsin has banned it - it is illegal to buy or possess. A spokeswoman for the U.S. Drug Enforcement Administration said that the agency is studying the opioid but hasn't yet moved to control it. Since Sept of 2016, 15 fatalities have been confirmed. Belgium had a death from U-47700 being mixed with Fentanyl. 

Furanyl Fentanyl:

This is an illicit designer version of fentanyl being mass-produced in clandestine labs in China - then smuggled into the United States via traditional distribution routes through Mexico. It was first described in patent literature in 1986 and has no approved medical use, and it has also not been approved by the FDA for human consumption. Research shows it to be 5X more potent than fentanyl - has an ED50 value of 0.02 mg/kg in mice.

It has been encountered as a single substance as well as in combination with other substances of abuse, including heroin, fentanyl, butyryl fentanyl, and U-47700. This potent drug has killed hundreds of people throughout Europe and the former Soviet republics, and the US has confirmed 128 fatalities associated with furanyl fentanyl in 2016.  It was detected in 24 states in 2016, and is still available across the country. DEA reports use of powder can cause seizures, and treatment centers report users are not responding to normal protocol when trying to get someone off of these powerful drugs - requires higher doses of methadone for detox.

W-18:

This designer opiate is likely coming from Chinese drug labs where little-known drugs and analogues of known drugs are mass-produced and sold online. It is 100 times more powerful than fentanyl and 10,000 times more powerful than morphine. It is known on the street as W-18, “beans” or “shady 80’s” - a play on 80mg OxyContin pills. This drug can be in powder form and it can also come as little green round pills looking similar to 80mg OxyContin. Close examination reveals they are not Oxy pills. Recently it has been seen on the street sold as Fentanyl pills. The powder has been mixed with heroin, and found cut with Cocaine.

This drug was first synthesized in 1980 at the University of Alberta where scientists were looking at new analgesic drugs, where studies in animals showed it had pain-killing activity in mice. It has no therapeutic use, and due to potency is causing deaths all over Canada and the USA.

Due to the potency of these new designer opiates, Narcon (Naloxone) needs to be administered in high doses. Doctors and EMS across the country report using upwards of 10+ doses to an IV Narcon drip. Even with high doses, the lifesaving efforts often are resulting in death.

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