Clean Needles Save Lives

Krokodil Makes its Appearance in the US

The first case of krokodil use in the US has just appeared in Arizona. Another product of our idealistic drug laws, krokodil is made from codeine in a matter similar to illicit methamphetamine production. However even the most rudimentary meth cooks will recrystallize the final product, separating out the toxic solvents and catalysts used in the reaction. Krokodil users inject the final solution straight. While pure desomorphine is probably no more toxic than morphine, the solvents and chemicals used in the reaction cause sores at the site of injection, necrosis of flesh and turns the skin scaly (hence the name "crocodile")...

 A powerful heroin-like drug that rots flesh and bone has made its first reported appearance in the United States, an Arizona health official says.

Known on the street as "krokodil," the caustic homemade opiate is made from over-the-counter codeine-based headache pills mixed with iodine, gasoline, paint thinner or alcohol. When it's injected, the concoction destroys a user's tissue, turning the skin scaly and green like a crocodile. Festering sores, abscesses and blood poisoning are common.

Frank LoVecchio, the co-medical director at the Banner Good Samaritan Poison & Drug Information Center, told KPHO-TV that Arizona health officials have seen two cases during the past week.

"As far as I know, these are the first cases in the United States that are reported," he said. "So we're extremely frightened."

Flesh-rotting 'krokodil' drug emerges in USA

Just more collateral damage caused by the war on drugs.

Ethan Nadelmann: Rise and Fall of the Global Drug Prohibition Regime

The Frozen Addicts: A Cautionary Tale

MPPP is structurally similar to meperidine, in MPPP the ester is the inverted (red arrow) 

This is a cautionary tale for those who dream of home-baking their own drugs. In 1976 a 23-year old graduate student by the name of Barry Kidston began researching opioid drugs that were not scheduled, nor used precursor chemicals watched by the authorities. He came across MPPP, which at the time was an untested, obscure synthetic opioid related to Demerol (meperidine). Relative to Demerol, the ester in MPPP is inverted (red arrow in figure). MPPP is slightly less potent than morphine, and has a shorter duration of action. 

Unfortunately the synthesis is sensitive to both temperature and acidity, if the conditions are not kept perfect a monsterous impurity is formed,  MPTP. MPTP readily crosses into the brain and in uptaken into neurons by the dopamine transporter. It is then converted to the ion MPP+ by the enzyme mono amide oxidase B. From there MPP+ enters the mitochondria where it wrecks absolute havok, setting off a chain reaction that ultimately ends in cell death. The damage done by MPP+ is localized to a region of the brain known as the substantia nigra. Destruction of this brain region results in symptoms of Parkinson's Disease.

Parkinson's usually progresses slowly, symptoms include tremor while at rest, movements are slow, and muscles rigid. In the latter stages patients have reduced facial expressions, inability to move from fixed postures and aphonia (reduced or absent speech). Senses and the intellect are unaffected. For the victims of MPTP induced Parkinson's this must truly have been a traumatic experience; it is must have been terrifying to wake up one day unable to move or speak and then to experience withdrawal on top of this is almost too terrible to imagine. 

Parkinson's Disease in a 23-year-old was unheard of, and Kidston was originally misdiagnosed with catatonic schizophrenia. Treatment for Parkinson's Disease involves administration of the drug L-Dopa,which is converted to dopamine in the body replacing the dopamine usually produced by the cells. It was only after a neurologist administered the drug L-Dopa that Kidston was able to speak again. After telling the doctors about his recent home chemistry work, scientists at the National Institute of Mental Health recovered some samples of Kidston's synthesis from his glassware and discovered the MPTP impurity. 

Drug manufacture should not be attempted without less than a BS degree in chemistry or a related field. A master's degree in organic chemistry is even better. For example I was reading a forum where the synthesis of fentanyl was being discussed. Someone posted a comment asking, what is an SN2 reaction? If you do not know that SN2 refers to a 2nd order nucleophilic substitution, something that is covered in the first semester of a college level organic chemistry course, you have no business trying to synthesize fentanyl. Even Barry Kidston was a graduate student and he made a serious error (if he had access to GC-MS equipment he might have detected the impurity, but since such machines run into the tens of thousands of dollars few clandestine labs are such equipped). 

Unless you are an experienced chemist with a well-equipped laboratory, you should not attempt to synthesize opioids. Instead buy the book Opium for the Masses by Jim Hogshire and try growing your own poppies. Poppy cultivation and opium harvesting is comparatively easy, and not likely to result in devastating errors. 

I wish that I could say that the damage from MPTP was limited to Barry Kidston, unfortunately it has reared its ugly head again in 1982 in San Jose, California. Apparently these chemists' technique was no better than Kidston's and samples confiscated by authorities were found to be contaminated by MPTP.  

Advice for Opiate Users (Harm Reduction)

If you are buying dope that the dealers claims to be "synthetic heroin" it is possible that the drug is MPPP. MPPP does not have as long a duration as heroin, nor will it appear on a standard drug screen. Moreover mixtures of MPPP-MPTP causes a severe burning at the site of injection, blurred vision, tremors, a metallic taste in the mouth, jerking of the arms and legs followed by tightness and stiffness in the muscles. 

If you think that you have been exposed to MPTP, there are things you can do to prevent the onset of Parkinson's symptoms. It takes 3-4 days for MPTP to do its damage, and it is actually the metabolite MPP+ that does the damage. Taking an MAO-B inhibitor may prevent the conversion of MPTP to MPP+, and thus prevent the onset of symptoms. MPTP can remain in the body for over 2-weeks, so administration of the MAO-B inhibitor may need to continue for several weeks.

Afterword

Thanks to prohibition, opiates are far more expensive than they would be in a free marketplace. It is not surprising then to see people attempting to manufacture their own drugs. Some simply want to self-medicate without having to spend a small fortune doing so, others undoubtedly dream of being like Walter White (Breaking Bad) and running a drug empire. If it were not for prohibition, this would not be an issue. Users would have access to drugs produced by pharmaceutical firms with quality control, and make purchases from pharmacies instead of street corners. 

MPTP induced Parkinson's Disease is another unintended consequence of our War On (the people who use certain) Drugs. During the days of alcohol prohibition, tens of thousands of alcohol users were poisoned by contaminated booze. Opiate users who are poisoned by contaminated drugs are more collateral damage in this futile war. Few people today would suggest that alcohol consumers deserve to contract horrible diseases simply because they choose to consume alcohol (and alcohol is certainly a "hard" drug if the hard/soft distinction is to have any meaning whatsoever).

We are not collateral damage, we are people. It is time to admit that drugs have won the drug war, and  well past time to make peace with drugs.

Further Reading:

Restak, Richard M. (1994) Receptors New York, NY. Bantam Books

MPTP, mitochondrial Complex I, and William Gibson's Necromancer

The Frozen Addicts

The Case of the Frozen Addicts [Book - Amazon Link]

Lee, J.; Ziering, A.; Heineman, S. D.; Berger, L. (1947). "Piperidine Derivatives. Part II. 2-Phenyl- and 2-Phenylalkyl-Piperidines". Journal of Organic Chemistry 12 (6): 885–893. doi:10.1021/jo01170a021

I Need Help...Acquiring Drugs

While this Onion article is meant as a parody, there is truth in this article. Many of the problems caused by opiate dependence could be solved if users could access their drugs in a legal marketplace at reasonable prices. 

I Admit It, I Need Help Acquiring More Drugs
COMMENTARY • Opinion • ISSUE 49•32 • Aug 8, 2013
By Ray Patton

As any longtime drug user can attest, there comes a time in your life when you have to admit that you have a problem. A time when things get so bad that the only thing left to do is open your eyes and admit you need help. It’s about acceptance, about acknowledging that something is wrong and that you can’t fix it alone. And for me, that moment of acceptance happens now. So here it is: I admit that I am a serious drug abuser and that I need help acquiring more drugs.
I have a problem, and my problem is that I don’t have any drugs right now and I need you to help me find more drugs.
This is not an easy thing for me to admit, as you can imagine. Hell, it took me a long time before I could even admit to myself that I have a problem obtaining illicit drugs. And then once I did finally admit this to myself, I felt a great deal of shame about my drug-acquiring problem, and I spent many long, sleepless nights wondering, “Damn it, why can’t I beat this thing? Why can’t I just find a dude in the park who’s willing to give me a solid discount on some rock or blow, no hassle?”
That’s when I realized I couldn’t do this alone, and that I don’t have to do this alone. On the contrary, I have to be able to trust in the kindness, understanding, and generosity of loved ones to guide me through this challenging, drugless time by helping me secure a new connection and maybe lending me a little extra scratch if they have any. Whatever they can spare.
And the thing I’ve come to accept is that it’s okay to ask for help, ya know? There’s no shame in it. It’s okay to turn to a close friend or family member and say to them, from the bottom of your heart, “Yo, your neighbor likes to party, right? Can you call him up and see who his delivery guy is? Come on, man, I really need this. I’ll make it up to you, I fucking swear.” Once you take that first crucial step toward accepting help for your drug-finding—as difficult as it is for someone who’s completed hundreds if not thousands of drug transactions before with no assistance whatsoever—then you’re on the road to being a regular user again, enjoying a normal life of hard drug abuse.
Now, it goes without saying that acquiring more drugs isn’t going to be easy, and I know that. I know I’ve got a tough road ahead of me, as does my family, and especially my friends, whose help I’m going to need every day if I’m ever going to find another dealer and pay upfront for my shit so I don’t start owing people and getting a bad rap on the street. It’s humbling, sure, but with patience and the support of others, I can make it out the other side of this struggle.
Preferably sooner rather than later, too, because if I don’t score in the next few hours I’m going to be crawling up the fucking walls.
And for those who doubt me, let me promise you this: I am deeply, deeply committed to finding more drugs. I’m not just going through the motions here to please others. This is not an empty promise. This is something that I desperately want to do for myself so that I can get high constantly each and every day. Hell, just hearing myself make that promise to exploit close relations for drugs makes me truly believe I can conquer this thing. This not-having-drugs thing.
And when you think about it, I’ve already come a long way. A week ago I never would have admitted that I needed anyone’s help finding drugs. At that point I would have just probably stolen from a sibling or old college buddy and lied about it. But now I’m coming right out and saying, “Hey, buy me drugs, I need them real fucking bad, okay? What kind of monster are you? If I don’t get a hit I’ll die, man. Do you want me to die?” That’s a huge step. And you know what? I’m proud of myself. I’ve really come a long way.
So, that being said, may I please have $50 and a ride to the Safeway parking lot on Brentwood? I really need your help.

Charging Dealers with Murder Following an Overdose Death

Drug selling and buying are considered consensual crimes.  Two people come to an agreement about quantity and price and make an exchange. There is no victim. A merchant who deals in tobacco or alcohol does not belong in a different logical category than a merchant of cocaine, cannabis or opiates. With alcohol or tobacco, after the purchase the responsibility to then use the substance lies with the purchaser, not the seller. If the individual chooses to use the drug in an irresponsible manner, such as operating machinery while intoxicated or otherwise putting others in harm's way, the consequences should lie with the individual. We don't hold liquor stores responsible for drunk drivers or cases of alcohol poisoning, neither should heroin sellers be responsible for overdoses resulting from use of their product.

Similarly the individual should educate themselves about the pharmacological effects of the drug prior to consumption. Just as one should not attempt to drive a car without first learning how to operate an automobile, one should not use drugs without first becoming familiar with their effects. Of course society has put in place regulations on the operating of automobiles, since they can be dangerous in the wrong hands. Unfortunately with illicit drugs it is a free-for-all. Far from drug control, the current system is completely uncontrolled. There are no age restrictions or any prerequisites at all in the illicit drug marketplace outside of cold hard cash. On the supply side there is no standards or quality control. The drug purchased may be something else entirely, or an inert substance. Substances oft injected are not sterile.

Accidental drug overdoses are often tragic, and probably largely avoidable if our drug policies were guided by science instead of hysteria. Nevertheless the drug war machine rolls on, and the bodies continue to stack up. As the crackdown on prescription opioids continues, heroin has been strong comeback, and with it an increase in overdoses.

To respond to the increase in overdoses law enforcement has been moving to charge dealers with additional penalties when a particular sale results in death. The additional penalties are substantial, not that the penalties for selling heroin are anything to laugh at.    

Dealers now being charged in drug overdose deaths

TOMS RIVER, N.J. (AP) — With the number of heroin overdoses skyrocketing nationwide, a growing number of law enforcement agencies are dusting off strict, rarely used drug laws, changing investigatory techniques and relying on technology to prosecute drug dealers for causing overdose deaths.

The aggressive change in tactics comes as more people turn to heroin because of crackdowns on powerful prescription opiate painkillers that make them more expensive and inaccessible. The popular prescription drug OxyContin has also been reformulated to make it difficult to crush and snort, making it less desirable on the street, law enforcement officials said.

Nationwide, the number of people who said they have used heroin in the past year skyrocketed by 66 percent between 2007 and 2011, according to the Substance Abuse and Mental Health Services Administration. The number of people who died of overdoses and had heroin present in their system jumped 55 percent from 2000 to 2010, according to the Centers for Disease Control and Prevention.

Rather than going after lower-level users of heroin, prosecutors are looking to take out dealers and members of the supply chain by connecting them and the drugs they sold to overdose deaths and charging them with laws that carry stiff penalties.

"We're going to be ruthless," said prosecutor Joseph Coronato of Ocean County, N.J., where 75 overdose deaths have occurred this year. "We're looking for long-term prison sentences."

Coronato and other New Jersey prosecutors are employing the state's little-used "strict liability for drug death" statute, a first-degree crime that holds dealers and producers responsible for a user's death and has a 20-year maximum sentence.

He and other prosecutors nationwide are changing the way they investigate overdoses, which were once looked upon as accidents. Detectives are being immediately dispatched when word of an overdose comes in. Paramedics are being told to treat overdoses like crimes. And coroners are being asked to order autopsies and preserve forensic evidence, as proving that a death was caused solely by heroin can be difficult when other opiates, drugs or alcohol are present in a person's system.

"When you go to an overdose death, treat it like a crime scene. Don't treat it like an accident," said Kerry Harvey, the U.S. attorney for eastern Kentucky. He has started prosecuting people who sold both prescription opiates and heroin under a federal law that prohibits the distribution of illicit substances and allows additional penalties for a death.

Technology is another boon to such cases. Prosecutors said cellphones have been instrumental in helping gather enough evidence because people leave behind a trail of text messages and calls.

"People text their dealer and say, 'Get me some horse,'" said Hennepin County, Minn., attorney Mike Freeman, using slang for heroin. "They text back and say, 'Meet me at McDonald's, I have some really good horse.' The guy is dead three hours later."

[...]

Some wonder whether the enforcement efforts are actually going to curtail drug sales. Douglas Husak, a lawyer and professor of philosophy at Rutgers University, said he doesn't think the stricter enforcement will stop people from dealing heroin.

"Heroin distributors are not murderers, and they're not murderers when their customers die from an overdose," said Husak, who has called for decriminalizing drugs.

In New Jersey, officials say heroin has become a scourge across the entire state, prompting Gov. Chris Christie to create a task force on heroin and other opiates. Forty-five percent of the primary drug treatment admissions in 2011 were for heroin, according to the White House Office of National Drug Control Policy.

Mariann Farino's son Raymond died of a heroin overdose in January. Coronato's office charged the man they say sold her son heroin in June.

"Did he stick the needle in my son's arm? No. Did he sell him stuff that was crazy? Yes," she said. "Should he be held partially responsible? Yes."

Ocean County Prosecutor Joseph D. Coronato with packets of confiscated heroin

So let’s put aside the morality or logic of holding dealers responsible for overdoses, there are some very good reasons why this is a bad idea. For one it is doubtful that there will be any deterrent effect from the increase in penalties. The penalty for selling heroin or other opiates is already severe enough to deter most people who might enter the market if prohibition was repealed. There is a point of diminishing returns where additional penalties will have no further deterrent effect. Dealers do not operate on a daily basis expecting to be caught, nor do they expect their clientele to die from their product (it would be bad business to kill your repeat customers). 
Many dealers are dealers in name only. Often they are addicts who support their habit in part by acquiring drugs for others, plus a modest fee. Such people are driven by forces more powerful than criminal law can hope to influence.

How much will the increased penalties cost taxpayers? An added 10 years to a sentence can run into the hundreds of thousands of dollars. As in all aspects of the drug war, this will undoubtedly fall heaviest on the poor and minority communities, exacerbating the already unconscionable racial bias in the US prison system.

Treating overdoses as crime scenes is likely to make the problem of fatal overdoses more likely. Since the increased penalties will have little to no deterrent effect, we can expect the frequency of overdoses to remain unchanged. However people will be less likely to call for help if they are aware that they will be criminally liable, especially if they sold the drugs themselves. This is where "Good Samaritan" laws come into play, where immunity is given in cases of overdoses. Specifics differ and some laws do not grant immunity for selling or for those on probation or in drug court.

What is more important, saving lives or punishing people for using opiates? History has taught us that we cannot do both. Short of a complete repeal of opiate prohibition, methadone, buprenorphine and heroin maintenance has a proven track record of saving lives, improving the health of addicts and the community in general. Naloxone access should be dramatically expanded to get OD kits in the hands of opiate users, and should also be available over-the-counter (OTC). If we are truly serious about ending the "epidemic" of opioid overdoses, this is the way forward (opiates are not infectious particles, this is a metaphorical epidemic).

Mario in Trouble With the Police

Not specifically opiate related, but good artwork nonetheless.