The Pulse

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Substance Use Alerts from Gallus Medical Detox

Gallus Medical Detox Centers, a nationally recognized Center of Excellence for inpatient medical detox, is launching a new substance use alert to inform providers of new and potentially dangerous trends happening across the country. With ten years of experience treating SUD patients, we have a unique front-line perspective in providing the medical assistance needed to help patients overcome addiction. We’re providing “The Pulse” to alert you to the use of new substances, legal and illegal, increasing severity within opioid, benzodiazepine, and stimulant epidemics, and complications brought on by increasing polysubstance use. We hope you find this information informative and useful in our fight against the growing problem of substance use disorders.

Latest Alerts

Flakka

Flakka (alpha-PVP), is a dangerous drug that is similar to the street drug commonly known as bath salts. Flakka is typically white or pink in color and is found in crystal form. DEA has designated it as a Schedule I drug – these drugs are designated as having no medical use, highly prone to substance abuse, dangerous to use, and unable to be used safely even under the care of a physician. Likely to produce the symptoms of physical or psychological dependence if used over a long length of time. 

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Street names: Gravel, The Zombie Drug 
 
How is it used? 
The drug may be eaten, snorted, injected, or vaporized in e-cigarettes. 
 
How does it affect the body? 
Paranoia and hallucinations that may lead to violent aggression and self-injury, overdose, and death have been linked to the use of this drug.  
 
Where do people get it? 
People used to get it online, but it is now illegal. It is bought in lieu of cocaine or amphetamines because it is much cheaper. It also is laced with other drugs such as Marijuana.
 
Most often manufactured in Pakistan and China, but with growing popularity in the younger generation labs are opening in the States. There is little to no oversight in the production of this drug so ingredients vary. Other drugs that might be added to it are Crystal Meth, Ecstasy (MDMA), Methcathinone (MCAT), Mephedrone, and Methylenedioxypyrovalerone (MDPV). Sugar or gelatin may be added to make it taste like candy. 
 
How’s it dangerous? 
Side effects of the drug include: causing people to move like zombies, jerking and contorting in an unnerving and inhuman way. When too much is taken the muscle fibers in their body start to dissolve into the bloodstream. Their bodies start moving uncontrollably. Sometimes, their heads will drop down below their shoulders; other times, their limbs will stiffen and shoot out. It’s like watching a marionette dance as its strings are cut or, perhaps, a glitch in a video game.  
 
Flakka activates the fight-or-flight response in a person’s brain, often turning them irrationally violent. And at the same time, it causes paranoid, delusional fantasies—meaning their brains just come up with reasons to start fighting, flakka rewires the brain chemistry.
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Latest Alerts

Xylazine

Xylazine is a non-opioid sedative and muscle relaxant, commonly used as a large animal anesthetic, and is now being found in the illicit drug market. It is commonly added to opioids because it increases the effects. It is related to Clonidine, an alpha-2 agonist, causing a decrease in heart rate, blood pressure, and sedating effects.

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Other Names: Tranq

 

Where do people get it?

The most common way people are getting it is through the illicit drug market, most recently found in the Philadelphia area.

 

How it is dangerous?

Between 2010 and 2015, xylazine was found in 40 (2%) of 1,854 unintentional overdose deaths for heroin and fentanyl. These statistics increased, in 2019 the percentage rose to 31%. Combining xylazine and opioids (such as fentanyl) increases the risk of overdose fatality, but there isn’t much evidence on the physical side effects.

Naloxone does not appear to be effective against xylazine.

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Latest Alerts

Para-fluorofentanyl and Metonitazene

Para-fluorofentanyl is a schedule I substance that can be found in heroin packets and counterfeit pills, it was invented in the 1960s and has been sold illegally sometimes under the name “China White”. Metonitazene is a benzimidazole-opioid that was developed in the 1950s but was never authorized for medical treatment. This combination is seen more frequently by medical examiners assessing overdose deaths.

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Other names? None that we know of.

 

Where do people get it?

Illicitly in the streets.

 

How is it dangerous?

Each of these drugs taken alone can lead to respiratory depression, but combining them could cause serious adverse effects. In the Knoxville area, between November 2020 and August 2021, there were 770 recorded unintentional drug overdose deaths. 562 were identified fentanyl only, 188 tested positive for fentanyl and methamphetamine, 48 involved para-fluorofentanyl, and 26 involved metonitazene.

Naloxone still appears to be effective with this dangerous mix, but it’s unclear how many doses will be required with stronger opioids like these.

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Latest Alerts

Isotonitazene

Isotonitazene is a potent synthetic opioid that is derived from etonitazene (an analgesic). Etonitazene is extremely powerful and addictive when it was used in studies on animals and humans, which is why it was never made commercially available. Isotonitazene emerged on the illicit drug market in April 2019. It’s commonly in pill form, but also can be found in powder form as an off-white or yellow color.

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Other names? ISO

Where do people get it?

Initially, it was only available on the dark web, but now can be found illicitly in the streets.

How is it dangerous?

Isotonitazene, like Fentanyl, is being added to other drugs by black market sources to increase potency or create a replica. It’s been found in toxicology reports for hundreds of overdose victims, that specifically test for Isotonitazene. Unfortunately, most standard toxicology reports don’t test for Isotonitazene due to it being new to the market.

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Latest Alerts

Carfentanil

Carfentanil is an opioid agonist developed in 1974 by Janssen Pharmaceuticals and sold under the trade name Wildnil. It is an analog of the synthetic opioid Fentanyl, made as a tranquilizer for wild animals such as elephants, bears, moose, etc, typically delivered with a tranquilizer dart. Wildlife rangers are required to use protective gear when handling such as gloves, face shields, due to the ability to absorb it through the skin and respiratory tract. Veterinarians in the US also use this for the sedation of large animals such as horses.

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Other names:

Drop dead, C.50, serial killer, and grey death (when mixed with other opioids)

 

Where do people get it?

It’s now being sold on the street, and it can be found in various forms: powder, tablets, patches, blotter paper, liquid, and sprays, and can be used nasally, orally, or intravenously. 

 

How is it dangerous?

It is 100 times more potent than Fentanyl, a dose that is smaller than a grain of salt is enough to be fatal. It is odorless and can be yellow, white, pink, or brown in color. Its half-life is long, 7.5 hours, and is very attracted to opioid receptors, resulting in it being difficult to reverse with Narcan, usually requiring several doses of Narcan before being effective.

There is no urine drug screen currently available to test for Carfentanil. It is used in street drugs due to its high potency, ease to obtain, and it being inexpensive. It is unlikely that opioid users are aware the drugs they are obtaining contain Carfentanil.

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Latest Alerts

Ayahuasca

It is a botanical hallucinogen from the Amazon, made from a combination of the Banisteriopsis caapi plant and Psychotria Viridis shrub. It is a traditional psychoactive sacrament that has been used for shamanic ceremonies for centuries and is acclaimed for spiritual and psychotherapeutic benefits. It is now gaining popularity in the US.

 

Other names:

Caapi, yaje, yage

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Where do people get it?

It can be purchased online.

 

How is it dangerous?

Although it is not illegal in the US, one of the active ingredients, DMT (from the Psychotria Viridis shrub) is classified as a Schedule I drug by the DEA. The risks with the use of this plant are psychotic episodes related to serotonin syndrome, which can be life-threatening. Consequences due to long-term use remain unknown. One of the plants used to make Ayahuasca acts as an MAOI, which has many serious drug interactions, especially if taken concomitantly by a multitude of medications, including SSRIs, tricyclic antidepressants, SNRIs, Trazodone, St John’s Wort, Lithium, metoclopramide, and many others.

There have also been fatalities caused by the use of methamphetamines, mescaline, bath salts, or LSD. 

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Latest Alerts

Ibogaine

Ibogaine is a substance found in a Western African shrub called iboga. Traditionally, it was used in ceremonies by people of the Bwiti religion. In recent years, it has been utilized as a method of treatment for opiate addiction by alleviating withdrawal symptoms and reducing cravings. However, the FDA has not yet approved it for a treatment for addiction. Ibogaine is a psychoactive alkaloid and is classified as a Schedule I drug in the US. The type of dosage given will dramatically impact the drug’s effect on the body. If only a small amount is used, it acts as a stimulant. However, if given in a larger dose, ibogaine will cause an individual to go into a psychedelic state.

 

Other names:

Iboga

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Where do people get it?

Ibogaine is illegal in the United States, there is only a handful of countries that can do Ibogaine treatments.

 

How is it dangerous?

Some fatalities have occurred in relation to ibogaine usage. The risk of ibogaine-related death is increased in areas where the substance is not regulated or used under the supervision of a physician. The studies that have been conducted regarding ibogaine use have included a small number of participants and were conducted over a short amount of time. So it’s hard to determine if the same results from these studies would apply to the general population. The risks of ibogaine could be amplified if the individual is dependent upon other substances or have health complications. There are still many unknowns about ibogaine, and more research needs to be done in order to understand what the proper dosages are and the risk factors of ibogaine use. 

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Latest Alerts

Fentanyl Laced Street Drugs

Fentanyl is an opiate-based drug that is 50 times more powerful than morphine. Fentanyl analogs like Carfentanil can be up to 10,000 times more powerful. In recent news, there have been fentanyl-related deaths due to other drugs laced with fentanyl, specifically cocaine. It’s showing up across the country, and because of the potency of fentanyl, it’s causing accidental overdoses to people who were not aware.

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How are they dangerous?

There is no regulation with these substances being laced. If you remember our Pulse about Pill Presses, devices that produce counterfeit pills, this is a perfect example of a way these substances could be dangerously laced with street Fentanyl.

Additionally, people who use cocaine or Benzodiazepines (Xanax, Klonopin, etc.) may not be as prepared as folks who use opioids. For example, people who use heroin regularly will have more of a tolerance to opiates, may have Narcan on hand, and be trained on how to use it, than those who use cocaine casually.

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Latest Alerts

Angel Dust

Angel Dust, also known as Phencyclidine or PCP, is a psychedelic drug that causes hallucinations. It is a dissociative drug, which causes the user to see distorted colors, objects, or hear distorted sounds. It was initially developed in the ’50s as an intravenous anesthetic. But it was quickly discontinued due to its neurotoxic side effects. It can be found in tablet form, capsules, powders, which can be taken orally or snorted, and liquid form.

 

Other names:

Boat, hog, love boat, wack, peace pill, dust, rocket fuel.

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How do people get it?

Angel dust is purchased from illicit drug manufacturers and dealers.

 

How is it dangerous?

Angel dust, or PCP, causes the user to feel detached, distant, and estranged. They can feel completely numb, endure acute anxiety, and have extreme hallucinations. PCP is addictive and can lead to dependence. Heavy PCP usage can lead to memory loss, depression, difficulty learning, speaking, erratic, and even aggressive behavior. There is also a high risk of going into a coma when mixed with alcohol and benzodiazepines. 

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Latest Alerts

Benzodiazepines and Rebound Anxiety

Rebound anxiety is the result of consistent sedation from benzodiazepines. It is more common in short to intermediate acting meds like Xanax and Ativan but also occurs in patients taking Klonopin, a long-acting benzodiazepine. Research has proven time and time again that benzodiazepines worsen anxiety when taken daily for more than a month. Commonly people experience diminished effects from benzodiazepines leading to increased tolerance. As people take more medication to decrease anxiety, natural defenses, and coping for anxiety are degraded. Ultimately avoidance of anxiety makes people more vulnerable to distress. While providers prescribing these medications are often intending to alleviate symptoms, long-term patients are set up for failure. Cognitive Behavioral Therapy, Mindfulness, and alternative psychotropic medications are the most effective treatment for anxiety. Relief is slower with these treatments but the benefits and change is more lasting and less harmful.

 

Other names?

Panic, Panic Attacks, Increased Anxiety, Benzodiazepine Withdrawals

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How do people get it?
Research is clear that taking Benzodiazepines for as little as 2 to 4 weeks can produce increased anxiety. Most people are prescribed these medications from non-psychiatric providers like primary care providers or in emergency departments. People can also buy these types of medications off the street. Recently there has been an uptick in Xanax pills that are pressed with Fentanyl on the streets.    
 
How is it dangerous?
Rebound anxiety and/or panic are a symptom of benzodiazepine withdrawals. In cases where individuals are physically dependent, withdrawals from benzodiazepines can be life threatening. Seizures and respiratory failure are the riskiest effects. Additionally, toxic levels of stress may lead to suicidal thoughts or other risky behaviors in people suffering from rebound anxiety.
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GHB

Gamma Hydroxybutyrate or GHB, also known as the “date rape” drug. It’s a central nervous system depressant and at low doses it can produce effects of euphoria. High doses of this drug can cause blackouts and amnesia. Medically, it’s used to treat sleep disorders like insomnia and narcolepsy. In 1990, the FDA issued an advisory declaring GHB use unsafe and illegal except under FDA approved, physician-supervised protocols. In March 2000, GHB was placed in Schedule I of the Controlled Substances Act. However, the sodium salt of GHB is used as a prescription drug known as Xyrem (sodium oxybate). In 2002, the FDA approved Xyrem for the treatment of narcolepsy. It is a highly regulated prescription medicine classified as a Schedule III controlled substance and requires patient enrollment in a restricted access program.

 

Other names: Scoop, liquid E, liquid X, Georgia Home Boy

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How do people get it?

GHB can be bought on the streets or on the internet.

How is it dangerous?

When GHB is mixed with alcohol it causes faster intoxication, loss of control movements and coordination, vomiting, and more. Withdrawal from GHB can be severe and should be monitored by a medical professional.

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Long Term Benzodiazepine Use for Anxiety

Benzodiazepines are a class of drugs that induce a sedative effects. They work in much the same way as alcohol in how they interact with the Gaba receptor complex. Because of the close similarity of effects benzodiazepines are the Gold Standard for medical detox. 

Other Names: Benzos, downers, candy, chill pills, Z bars

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How do people get it?

Benzodiazepines are most commonly prescribed by doctors and other clinicians treating anxiety. It is widely researched and known that daily use beyond two months worsens anxiety and leads to diminished returns, however, prescribers often continue to prescribe them despite this fact. 

How is it dangerous?

Perhaps the biggest risk is withdrawals from benzodiazepines when someone is severely dependent are life threatening. Physical dependence happens rapidly with this class of drugs and it is notoriously challenging and consequential to quit. Studies have shown that even a month long taper leads to worsening panic attacks, permanent deficits in cognitive functioning, and “significant new somatic symptoms such as malaise, weakness, insomnia, tachycardia, and dizziness, after alprazolam (Xanax) discontinuation.” In short, once people become dependent on this substance, it can be extraordinarily challenging to detox off of it.

Psychiatrically speaking, there is no doubt that the consequences outweigh the benefits. There is no doubt that benzodiazepines will stop a panic attack but long term daily prescriptions would be akin to a doctor recommending you drink alcohol every night to manage that panic or anxiety. The most compelling evidence for these drugs worsening mental health is that they increase risk for suicide 3 fold.

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Cannabis Induced Psychosis

Cannabis concentrates are oils, budder, wax, and dabs that contain unnatural levels of THC (anywhere from 25 – 75%). The THC is typically extracted with a Butane solvent.

Increased concentrations of THC are leading to higher rates of Cannabis Induced Psychosis.

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Other Names: Wax, dabs, honey oil, black glass

 

How do people get it?

It is extracted from marijuana.

 

How is it dangerous?

It is a common misconception that cannabis does not cause withdrawal. It is true that in the vast majority of the people that use cannabis will have little to no issue stopping. However, for those using concentrates multiple times per day there can be many uncomfortable withdrawal symptoms. At Gallus we have treated patients using 1000mg or more per day (standard dose is 5 to 10mg). At that level of use people can experience hyperemesis (uncontrollable vomiting), hypertension, psychosis, irritability, trouble sleeping, difficulty concentrating, trouble regulating body temperature, etc. The psychosis and metal health disturbance can become quite significant and treatment usually involves short term use of sedatives or antipsychotics to stabilize patients. Those experiencing hyperemesis may also require IV fluids.

In addition to concentrates, casual marijuana users also risk acute mental health episodes when using edibles. Because edibles act more slowly than smoking cannabis, people have been found to eat copious amounts when “I can’t feel anything.” A 5 to 10mg dose is enough to produce the desired high and when users ingest 5 or 10 times that dose paranoia, psychosis, and hypertension can lead to emergency room visits.

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Soma

Soma is a muscle relaxer, and its generic name is carisoprodol. It’s used to treat muscle pain, and usually used with rest and physical therapy. It typically is prescribed in 350mg pills and a typical prescription is one pill 3-4 times per day.

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How do people get it?

It’s prescribed for muscle pain and relaxation.

 

How is it dangerous?

There are risks for withdrawals from the substance and at high doses there is a risk of withdrawal seizures. Similarly to Benzodiazepines, Soma is a schedule IV substance by the Federal government. This designates it as low risk of abuse and that it does have verifiable medical benefits. When combined with opiates or benzodiazepines there is an increased risk for abuse. There has been a rise in use and abuse of Soma over the past decade.

“Moreover, while the number of reports regarding carisoprodol abuse continues to increase, there has been little progress in the treatment of carisoprodol dependence and withdrawal. At present, treatment consists of brief courses with benzodiazepines or phenobarbital to combat anxiety and insomnia. Furthermore, treatment of carisoprodol overdose is complicated as it is often characterized by agitation and seizures, and the administration of anticonvulsants and sedatives exacerbates CNS depression, leaving supportive therapy as a preferred course of action.”

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Kratom

According to the National Institute on Drug Abuse, kratom is a tropical tree native to Southeast Asia and its leaves contain compounds that can have stimulant and opium-like effects. Traditionally, kratom leaves have been used by Thai and Malaysian natives for centuries. It’s a member of the coffee family, and it’s been utilized to enhance work productivity, cultural ceremonies, and for medicinal purposes.

Other names? Biak, ketum, kakuam, ithang, thom.

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How do people get it?

Kratom, as of recently, is illegal in Thailand, but currently legal in the United States except Wisconsin, Arkansas, Indiana, Alabama, Vermont, and Rhode Island. It can be ordered on the internet and bought in smoke shops. It’s sold in pill, capsule, gum, or extract form.

How is it dangerous?

Kratom causes effects similar to opioids and stimulants. The compounds mitragynine and 7-a-hydroxymitragynine found in kratom leaves interact with opioid receptors in the brain, which produces sedation, pleasure, and decreased pain. Mitragynine also interacts with other receptors in the brain to create stimulant-like effects. When taken in small amounts, users of kratom report increased energy, sociability, and alertness. But Kratom can cause uncomfortable and potentially dangerous side effects. 

There are now some products out there that are adulterating the substance by adding the ingredient 7-hydroxymitragynine, which increases side effects. “We have found multiple packaged commercial Kratom products to contain artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for M. speciosa’s concerning mechanistic and side effect profile [2022]. The amount of 7-hydroxymitragynine exceeded that found in naturally occurring material by up to 500%.”

In our centers, we are seeing that Kratom is not coming off patient’s receptors quickly. This causes the risk of increased precipitated withdrawal when starting Buprenorphine to ease withdrawal symptoms. We are having to allow more time between the patient’s last Kratom use and beginning a Buprenorphine taper, which extends the patients length of stay in detox. The withdrawal symptoms from Kratom have also increased in severity from what we used to see.

“We have cared for patients in severe withdrawals from Kratom and are seeing an uptick in cases. This is likely due to the way they are altering Kratom with presumably more potent intoxicating additives. The withdrawals we observe from Kratom are identical to what you would experience withdrawing from Heroin or other prescription opiates.” Steve Carleton LCSW, CACIII

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Nitrous Oxide

Medical nitrous oxide is used for sedation and pain relief and is classified as a dissociative anesthetic. It is also used as a propellant for whipped cream and in the automotive industry to enhance engine performance. Sold as cartridges that can be discharged into another object such as a balloon or directly into the mouth and inhaled. They provide a brief, rapid euphoric high and feeling of floating or excitement. They also can cause sudden death do to profound hypoxia.

Other names: Whippits, NOS, nangs, hippy crack, buzz bomb, balloons or laughing gas

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Where do people get them?

It can be purchased on Amazon and restaurant supply stores.

 

How are they dangerous?

When used frequently or long term, they can cause memory loss, vitamin B12 deficiency (causing brain, spinal cord, and nerve damage), incontinence, depression, dependence, psychosis, as well as other side effects. When inhaling directly from tanks or whippets, it can cause frostbite to the nose, lips and throat, including the vocal cords. Because of the high pressure, it can also cause ruptures in the lung tissue when inhaled directly from the containers. The neurological symptoms can be severe, resembling Guillain-Barre Syndrome, affecting the ability to walk and causing profound weakness of the extremities. Abstinence and supplementation with injectable B12 is the only treatment for the neurological side effects and can sometimes take months to completely reverse the damage, sometimes the damage is not completely reversible.

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Gabapentin

Gabapentin, approved in 2004, was originally prescribed for neuropathic pain, it is now also prescribed for a variety of things, including mood disorders, anxiety, and seizure disorders. 

Other names: Gabbies

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Where do people get them?

They are prescribed, also sold from drug dealers.

 

How are they dangerous?

Gabapentin is now a prevalent drug of abuse, causing euphoria, improved sociability, relaxation, and a sense of calm. Evidence supports that patients with opioid use disorder are at higher risk of abusing Gabapentin. The withdrawal symptoms include mental status changes, chest pain, high blood pressure, restlessness, agitation, anxiety, insomnia, and seizures.

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M-30's

M-30 is the common, or street name, for oxycodone IR 30 mg pills, called that because the pill has a ‘30’ on one side and an ‘M’ on the other. These have long been very popular with opiate users.

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Where do people get them?

Off the street, purchased online or through friends.

How are they dangerous?

Several years ago, dealers started to press pills to look identical to the pharmaceutical M-30s, but they actually made them with Fentanyl, due to the cheaper cost and easier availability of Fentanyl vs pharmaceutical oxycodone. This caused a huge spike in overdose deaths, because people did not know they were getting Fentanyl. Now, at least in most metropolitan areas, most opiate addicts know they are getting Fentanyl when they buy M-30’s off the street.

Now we assume anyone buying M-30s that aren’t prescribed is actually getting Fentanyl. At Gallus we did a review of all of our opiate admissions from November through the end of February, 88% were positive for Fentanyl – that accounted for 100% of the Colorado opiate admissions, and only 2 of the Scottsdale admissions were actually getting oxycodone – they were purchased from friends who were selling their prescriptions. Prior to a few years ago, we never saw Fentanyl unless it was prescribed.

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Dangers of Pill Presses

Pill presses are devices that produce counterfeit pills. Pressed pills are commonly produced with fentanyl because it’s cheaply imported. The biggest risk and danger is that people are not getting what they think they are getting. It is common that people are seeking benzodiazepines, MDMA, or other prescription opiates but it’s more often than not Fentanyl. When substances are mixed and pressed with these devices they are not balanced effectively. The pills end up with varied strength, resulting in higher risk for overdose and death.

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​Where do people get them?

The internet.

 

How are they dangerous?

There is a risk of hot shots, dealers at times will intentionally press pills with higher potency leading to overdose. When people seeking drugs hear about an overdose there is often an assumption that the supplier has higher quality product which leads to an uptick in sales for the supplier. Another concern is that there is no manufacturing control or protocol when making these counterfeit products. Pharmacies and legal drug manufactures ensure that when drugs are mixed they are balanced and there is a guarantee of consistency that pills of the same variety are identical. The strength of illegally manufactured drugs sold on the street can be extremely varied leading to risk of overdose. Finally, this growing trend is dangerous because people are completely unaware that they are buying Fentanyl when seeking out drugs. The might be searching for sedatives, stimulants, or some other type of opiate and end up with Fentanyl. 

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Mephentermine

Mephentermine was originally approved by the FDA in 1951 as a vasopressor (used to increase blood pressure) and a nasal decongestant. It’s banned in the United States, but still used in other countries. It is structurally similar to methamphetamine. It’s prohibited by the World Anti-Doping Agency – used by young athletes for its stimulant effect and improved physical performance.

Other Names?
None found.
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How do people get it?

Online from other countries.

How is it dangerous?

It can cause psychotic symptoms with misuse, and chronic psychosis with dependency; cardiac disorders and rhythm disturbances. It can also cause hallucinations, seizures, slow heart rate, confusion, irritability. Fatal side effects include severe heart block, cerebral (brain) hemorrhage, pulmonary edema (fluid in the lungs), and fatal heart rhythm disturbances. This is not super commonly seen in the US, but Brazil and India are experiencing a huge increase in issues from this drug. ​

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Phenibut

A central nervous system depressant with anxiolytic properties. A GABA-b receptor agonist similar to Baclofen and GHB. With higher doses is a GABA-agonist, much like benzos. Developed in the Soviet Union in the 1960’s and currently the only area of the world that uses it for medical purposes. Not approved for medical use in the US. Used for insomnia, anxiety, and as a nootropic for focus and concentration.

Other names? Fenibut, Anvifen, Noofen

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How do people get it?

GNC, and health or nutritional supplement store, online.

 

How is it dangerous?

Very – intoxication has been known to cause decreased level of conscious, stupor, decreased muscle tone, decreased respiratory drive temperature dysregulation and high or low blood pressure; also can cause severe agitation, hallucinations, seizures and delirium, to the point of requiring so much sedation that the person gets intubated and put on mechanical ventilation. Withdrawal is very dangerous, commonly ending up in the ICU on mechanical ventilation due to severe agitation, seizures, unstable heart rate and blood pressure.

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2c-b

2c-b is classified as a novel psychoactive drug from the phenethylamine class of drugs, similar to mescaline. Its effects vary depending on dosage, but is classified as a stimulant and hallucinogenic. It is a club drug, commonly found as an adulterant in MDMA or Ecstasy. It can also be taken alone. It comes in powder or tablet form and can be snorted, taken by mouth, or taken rectally. It causes feelings of pleasure, hallucinations. Side effects can include tremors, muscle spasms, diarrhea of other GI distress, tachycardia, hypertension, and elevated body temperature.

Other names: Nexus, Bees, Tu Si

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Where do people get it?
 
It can be purchased on the internet, but more commonly mixed in other drugs or bought off the street.
 
How is it dangerous?
 
It can cause serotonin syndrome, leading to severe cerebral edema (brain swelling), seizures, and long term neurological damage.
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Tianeptine

An atypical antidepressant and neurorestorative agent. It is also a mu-opioid receptor agonist, which at high doses works just like any other opioid. It has a long half life and is very addictive. It is not FDA approved in the US. It was scheduled in Michigan as a schedule 2 narcotic, and Alabama is currently working through doing the same thing. The CDC has identified it as an emerging public health risk, as its use is becoming popular, and there are being more and more deaths reported as being directly related to Tianeptine. Particularly when also being taken with Phenibut. Appears to be very hepatotoxic (liver toxic) at higher doses, but not well studied. It can be reversed by Naloxone, but is not always recognized as an opioid overdose. Interestingly enough, it wasn’t until recently it has been seen as an addictive substance, in fact there are many research articles from 2017 and prior that state it is not addictive and works well as an antidepressant.

Other names: Tia, ZaZa Reds, ZaZa Whites

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Where do people get it?
 
Gas stations, online.
 
How is it dangerous?
 
It has a long half-life, not detectable in normal urine drug screens, and from anecdotal reports does not always respond well to Sub.
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Fentanyl

It’s a synthetic opioid pain reliever that is 80 – 100 times more powerful than morphine. There is pharmaceutical fentanyl and illicitly manufactured fentanyl. Pharmaceutical fentanyl is used to treat severe pain, most commonly advanced cancer symptoms. Illicitly manufactured fentanyl is placed in eye droppers or nasal sprays, made into pills, dropped onto blotter paper and made into a powder. Chemically-similar analogs of fentanyl are also being created, and these include carfentanil, acetylfentanyl, butyrfentanyl, and furanyl fentanyl.

 

Other names: Apace, China Girl, China Town, Dance Fever, Goodfellas

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Where do people get it?

Online and through illegal drug markets. Many people purchase heroin, not knowing it is mixed with fentanyl, resulting in overdose deaths. Counterfeit OxyIR 30mg tabs (M-30s) bought off the street are usually Fentanyl pressed into a pill and made to look like OxyIRs.

How is it dangerous?

It has a heroin-like effect and is highly addictive. Heroin or cocaine have the highest likelihood of being mixed with fentanyl. Fentanyl has become a popular additive due to its easiness in creating a high, making it a cheaper option. Fentanyl has a long half-life, causing many patients to have precipitated withdrawal when being switched over to substances too soon. As a company (both our Colorado and Arizona centers) we are seeing 88% of our opiate patients testing positive for Fentanyl, and many patients are unaware they were being given fentanyl.

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Clonazolam

It’s a triazolobenzodiazepine, it was prescribed for veterinary practices in some regions of Africa, but is now sold online as a designer drug. It’s considered Schedule 1 in Virginia and Louisiana, but in all the other states it’s classified as research. It has similar effects as a benzodiazepine but is much much stronger. It is also sold in blotters.

Other names? Clam, c-lam

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Where do people get it?

It’s not prescribed in the U.S. People are buying it online.

How it is dangerous?

It’s highly addictive, and when taken it can cause a large increase in seizures. The effects last longer than 24 hours. Research shows that people think they’re buying valium or Xanax but it’s Clonazolam. Gallus’ experience has been that the withdrawal is much longer and has significantly more detox symptoms than regular benzos.

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U-47700

A synthetic opioid 7.5-8 times more potent than Morphine. In 2016, DEA classified it as a Schedule 1 narcotic. It has had no medical use in the United States. Originally developed by the pharmaceutical company Upjohn in the 1970s. It started emerging in 2014.

Other Names: Pink, pinky, pink heroin

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Where Do People Get It?It’s sold on the internet as a research chemical, it’s also sold on the street. It’s often pressed into pills and made to look like prescription Oxy IR, often combined with Heroin or Fentanyl.

How It Is Dangerous?Research suggests it has enhanced brain penetration, it’s more attracted to lipids than Morphine, which makes for longer half-life (researchers think around 6.5 hours). There have been many overdose fatalities, contributed to Prince’s overdose and subsequent death. It’s unable to be detected on most UDS screens, but Lab Corp does have a test for it.

danger scale from one to six with six crossed off