Fentanyl Park, Connecticut

Fentanyl Park, Connecticut| What the heck is going on here?

As many as 76 people have overdosed in less than a day in a park in New Haven, CT. The park is called the New Haven Green but it might as well be called “Fentanyl Park, Connecticut.” Up to now, nobody has died, but the ER at Yale/New Haven hospital has been slammed pretty severely trying to help the individuals involved (they received 12 patients in 40 minutes on Wednesday morning). The really tragic part of this story is – how many people were delayed help for their heart attacks or strokes or broken bones because the paramedics were tied up caring for all these overdose individuals?

https://www.nytimes.com/2018/08/15/nyregion/new-haven-overdose-k2.html

One overdose patient was brought to the hospital, released after being treated and went back to the Green and overdosed again, Fire Chief John Alston, Jr. said.

There are conflicting reports about what the mystery drug at Fentanyl Park, Connecticut might be. Apparently, representatives from Connecticut’s public health bureau – very smart people I’m sure – have identified an opioid in at least some of the samples.

Rick Fontana, the New Haven director of emergency operations, said the drug appeared to be a bad batch of K2 laced with an opioid. “Whether it be a synthetic opioid or fentanyl, we are not sure at this time until we have confirmation on the analysis from the D.E.A.,” Fontana said.

K2 and Spice packets of synthetic marijuana.

Connecticut Public Radio reports: “[Fire Chief] Alston says the substance appears to be some type of synthetic cannabis, but authorities are not sure. Some of the victims were unconscious and in respiratory distress.

At first, the drug [naloxone] — used to treat narcotic overdoses — appeared not to work. ‘Narcan was not effective here at the scene,’ said Alston. ‘However higher concentrations of it in the emergency room proved effective.’

He says one of the victims still had some of the drug, which has been sent off to a lab for testing.”

That piece of information – that high doses of naloxone seemed to reverse the effect of the mystery drug – strongly suggests a chemical with a very strong attraction to the mu opioid receptor at work in Fentanyl Park, Connecticut.

So there are a couple of things to discuss here – What is synthetic marijuana and what is fentanyl?

Synthetic marijuana (examples include K2 and Spice, among others – I have samples of Green Goblin, White Tiger and Geeked Up that I’ve taken off the streets of North Philly) is a series of chemicals that are whipped up in someone’s bathtub, applied (usually soaked) into some kind of vegetable material and smoked.

Geeked Up Synthetic Marijuana (Back)

Geeked Up Synthetic Marijuana (Front)

White Tiger Synthetic Marijuana

The most familiar series of chemicals that are often found when synthetic marijuana is analyzed is the JWH series of chemicals after John William Huffman, a chemist at Clemson University, who in 1984, synthesized a series of about 400 chemicals that had varying effects on endocannabinoid physiology. JWH eventually abandoned the effort, but in the early years of this century some of his chemicals began appearing in German nightclubs. Producers of synthetic marijuana products might use one of the JWH chemicals to create their product, or they might begin with a JWH chemical and alter it somehow or they might just throw together any old chemicals they find in their garage. That’s part of the challenge of synthetic marijuana – you never know exactly what you are dealing with. Since the ingredients are a complete crap-shoot, the symptoms of use and overdose are a grab-bag of just about every different type of crazy you can think of. Everything from falling asleep, to biting off your thumbs and tongue and jumping out of a 9th story window (my patient about 6 months ago).

Synthetic marijuana is a chemical applied to some kind of vegetable or plant material.

First made by Paul Janssen of Janssen Pharmaceuticals in 1960 and approved for medical use in the United States in 1968, fentanyl is a highly powerful opioid receptor agonist (stimulant). As of 2017, fentanyl was the most widely used synthetic opioid in medicine. It has a rapid onset and effects generally last less than an hour or two unless it is applied as a transdermal patch. Medically, fentanyl is used by injection, as a transdermal patch as a nasal spray or swallowed orally in a lollipop formulation. Unlike synthetic marijuana, fentanyl is a pure opioid and the effects are very predictable. Death from fentanyl overdose occurs from respiratory depression and was the agent responsible for the deaths of Prince and Tom Petty. A little bit of fentanyl added to something like synthetic marijuana is a potentially lethal combination. Because it is so potent, its very difficult to dilute or cut the pure drug to a safe concentration and it can be smoked, snorted, injected or applied to the mucous membranes or swallowed.

Whatever the mystery drug of Fentanyl Park, Connecticut really is may never be known.