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We are drowning in fraud. Simply defined, fraud is intentional deception, usually for monetary gain. We have become used to robo-calls telling us that we have been subjected to a tax audit and had better call the given number to clear things up. We have learned to dismiss messages from some unfortunate soul supposedly stuck in a foreign country who is in in need of funds to get home. Such scams are annoying, but at least not life threatening. We assume that if we take an aspirin tablet that is indicated to contain mg of acetylsalicylic acid on the label, then that is exactly what we are getting. That assumption is almost certainly correct since selling fake aspirin is not a lucrative business. But buying Kamagra online is a different story. It is produced by a company in India and therein lies a problem. Major pharmaceutical companies such as Pfizer, Merck and Bayer follow exacting manufacturing conditions that ensure their drugs contain the active ingredient in the right dose with their procedures being monitored by government regulatory agencies. The situation is not the same in India where governmental oversight is much more lax. Kamagra may or may not contain sildenafil, and even if it does, the dosage may be suspect. So, better stick to Viagra. If you get it by prescription in Canada or the U. But elsewhere, for example in Mexico, you can walk into a pharmacy and buy Viagra without a prescription. And you will get a bottle with pills that look just like the authentic stuff but may be fake, produced by some clandestine manufacturer in Asia. Still, this is not a life-threatening situation. But what if you are travelling in Africa and develop an infection that requires treatment with antibiotics? Unfortunately, antibiotics are the most commonly counterfeited drugs, mostly sold in low-income nations where proper pharmaceuticals are prohibitively expensive. Now we are looking at a potentially life-threatening situation! Fake antibiotics and fake erectile dysfunction drugs are not the only problem. Fake anti-anxiety drugs like alprazolam Xanax , lorazepam Ativan , and diazepam Valium , as well as attention deficit disorder meds such as methylphenidate Ritalin or amphetamine Adderall are also available on the street and on the internet. The COVID pandemic provided new opportunities for fraudsters who quickly came up with fake versions of hydroxychloroquine. A curious situation since the fakes worked as well as the authentic version, meaning not at all. Illicit drugs are a different case, with counterfeiting being much more prominent. Legitimate generic drugs have also been targeted by counterfeiters. Once the patent on a brand-name prescription drug has expired, it is perfectly legal for a manufacturer to sell a generic version as long as it has the same active ingredient and the same bioavailability as the original. Minor differences in binding agents, fillers and colours are allowed if they have been shown not to interfere with the efficacy. Generic drugs are generally much lower-priced because the manufacturer does not have to recover the cost of the research it took to bring the brand-name drug to market. But generic drugs can be counterfeited just like trade-name drugs, meaning that they may contain no active ingredient, the wrong ingredient or the wrong dose of the right ingredient. There is yet another problem. The Canadian and U. Products are constantly checked for purity and immediate recalls are issued should a problem appear. However, more than half of the generics sold here are imported from India or China where they are produced in licensed plants. Government inspections are spotty, and the lure of taking shortcuts to maximize profits is inviting. This may mean using impure solvents, unclean conditions, improper testing for bioavailability or contamination with foreign materials such as tiny shards of glass once detected in a generic version of Lipitor, the cholesterol-lowering drug. Inspectors from the U. FDA sporadically travel to India to inspect plants producing drugs for the American market. However, these trips are announced in advance allowing the facilities to prepare and put their best face forward. Counterfeiters and sloppy Asian generic drug manufacturers are a big problem, as the brand-name pharmaceutical industry relishes in pointing out. But there are plenty of skeletons in the brand-name closet as well. Companies have been fined for promoting off-label use of drugs, for paying kickbacks to physicians for prescribing certain drugs and for withholding known side effects. In a paper submitted in to the New England Journal of Medicine describing studies on the painkiller Vioxx, Merck researchers failed to disclose some cases of cardiovascular events in the experimental group of which they were aware. Of course, neither the generic nor the brand-name drug industry should be universally impugned because some cases of fraud have come to light. While no drug performs as well as its exuberant television ads proclaim, benefits do outweigh risks when the meds are appropriately prescribed. On the other hand, drug counterfeiters should be vigorously pursued for enticing people play Russian roulette with their pill bottles. Sadly, we will never be able to eliminate counterfeiters. The problem has a long history, evidenced by the appearance of fake cinchona bark to treat malaria back in the 17 th century. As long as the road of deception is paved with money, there will always be fraudsters who will take it. Enter your keywords. Sign-Up Here. The production of counterfeit drugs is a huge global industry, a concern for patients, and a massive headache for regulators. Critical Thinking. Facebook Twitter YouTube Instagram. Accessibility Cookie notice Cookie settings Log in.
Frank Lucas Dies at 88; Drug Kingpin Depicted in ‘American Gangster’
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The slightest exposure can trigger an overdose. The belief that simply coming into contact with fentanyl can kill you is widespread within law enforcement. But is it true? In , Dr. Opioids act on specific receptors in our body, which results in pain relief. Opium has been used by humanity for millennia: it is the milky fluid from the opium poppy. In , a specific opioid from this latex was extracted. Named morphine, it would be adopted for pain relief and as a general anesthetic a few decades later. But what Janssen wanted was to create in the laboratory the most potent and fast-acting pain reliever. He succeeded by synthesizing fentanyl, which would be approved for use in Europe in and in the United States in To this day, fentanyl is the most widely used synthetic opioid in medicine. When fentanyl binds to certain opioid receptors in our body, the effect is euphoria, drowsiness, relaxation, and pain and anxiety relief. This has led to its abuse by some healthcare workers, especially anesthesiologists and surgeons who have easy access to it. But in , fentanyl became the fountainhead of the third wave of the opioid crisis , which had begun in with a rise in prescription opioid overdose deaths and continued in with a second wave caused by heroin overdoses. Deaths from fentanyl were not new in Heroin and cocaine had been adulterated with fentanyl before, causing limited outbreaks of overdose deaths. Around , however, the dam burst. Fentanyl-laced heroin and cocaine became more and more available, as well as counterfeit opioid pills made to resemble Xanax and OxyContin but containing the much more potent fentanyl. A clampdown by China in on the illicit manufacturing of the drug changed the production landscape but not the outcome: chemical precursors used in the synthesis of fentanyl and of other legal pharmaceuticals are now made in China and shipped to Mexico, where powerful drug cartels recruit chemistry students and graduates from local universities to finish the synthesis of fentanyl, before moving the product across the border. As an aside, a review article points out that most cases of fentanyl misuse in North America and Eastern Europe implicate illicitly manufactured fentanyl, whereas a substantial percentage of abused fentanyl in Western Europe and Australia comes from legal fentanyl made for medical use being diverted. Accidental deaths from fentanyl often arise because the person did not know they were consuming the powerful opioid. Early studies showed fentanyl to be roughly 50 to times more potent than morphine and 30 to 50 times more potent than heroin, meaning that a much lower dose of fentanyl is needed to create the same response. Sixteen-year-old Cooper Davis from Shawnee, Kansas took half of a pill said to contain oxycodone, a pill he got from a drug dealer he found through Snapchat, and died from accidentally overdosing on its fentanyl. His mother pushed back against the use of this word, overdose. These tragedies are now more common, with deaths from accidental overdoses or poisonings skyrocketing in recent years. Minor players include similar molecules which were developed over the decades to create better anesthetic agents but were put aside due to undesirable side effects. A molecule like carfentanyl, which looks like fentanyl but has a specific chemical group added to it, was synthesized back in to be used in large animals as an anesthetic. It is times as potent as fentanyl and has made its way into the heroin supply in the United States. To this long list of fentanyl analogs, we can add synthetic opioids not based on the fentanyl backbone, with unremarkable names like U and AH This fear, though, is misplaced and can have dire consequences for the people in need of medical attention. It started in Montreal. In April , police conducted seven raids around Montreal and seized drug-making equipment and synthetic drugs, including a fentanyl derivative called desmethyl fentanyl. The clandestine labs making these drugs contained many chemicals, and the Montreal Gazette reported at the time that four police officers became ill from handling some of these drugs. One was hospitalized with heart problems, while three other cops, who were wearing masks and gloves, developed rashes on their arms. The link between touching fentanyl and getting sick was born. But what really cemented the fear that merely touching fentanyl or one of its analogs causes instant harm was a case in Ohio four years later. A man who had just been released from jail on bond was driving and was pulled over by a police officer, who was joined by Chris Green, a local off-duty cop who happened to be nearby. The two officers found drugs in the car and the man admitted that the powder in his vehicle might include fentanyl. Green noticed some powder on his shirt and brushed it off with his naked hand. An hour or so later, Green was sweaty, barely coherent, and not feeling well. He was taken to the hospital, where he was treated for an overdose. The man he had arrested was charged with drug trafficking and possession, yes, but also with assault on a peace officer because he had exposed Green to fentanyl. The belief that simply touching fentanyl will cause physical harm is very common among law enforcement officers. It is reinforced by media coverage, which often repeats this presumption with no pushback. Ryan Marino. He is also one of a handful of experts frequently pushing back against opioid myths through the website WTFentanyl. This is simply not happening. You may be skeptical if you know that fentanyl patches exist, in which the opioid is allowed to seep through the skin and provide relief to patients dealing with chronic pain. But these transdermal patches were the fruit of significant investments to devise a technology that would allow fentanyl to be absorbed through the skin. Even with this patented delivery system, a patient will start to benefit from the fentanyl only three to 13 hours later. The effect is far from instantaneous. In fact, you can witness Chad Sabora on Facebook showing that a heroin powder tests positive for fentanyl and then holding it in his left hand for an extended period of time. But what about the danger of accidentally inhaling fentanyl while conducting a drug bust? The closest thing might have been the Moscow theatre hostage crisis of , in which Chechen terrorists occupied a theatre. The Russian Federation responded by pumping in a gas that killed of the more than hostages, as well as at least 33 terrorists. The Russian government did not initially reveal the composition of the gas. An analysis by a British laboratory of the clothing worn by two British survivors and the urine from a third revealed the presence of carfentanyl and remifentanil. Even if those were indeed the gases used to subdue the terrorists, it is clear that this situation bears little resemblance to first responders arriving at the scene of a fentanyl overdose, or even to police officers raiding a fentanyl laboratory. First responders who believe they are overdosing on fentanyl from simply touching it in fact exhibit the exact opposite of the symptoms we would expect. While fentanyl makes you euphoric and slows down your breathing, cops start breathing faster, sweat a lot, and become anxious. The symptoms seem most consistent with a panic attack or anxiety or a fear reaction. You would have lost consciousness and barely been breathing. This panic over accidentally touching fentanyl is causing actual harm. If someone looks like they are overdosing on an opioid like fentanyl, the best thing to do after calling emergency medical services is to administer naloxone, which competitively binds to the same receptors as opioids do without activating them. Naloxone nasal spray is available without a prescription at most Canadian pharmacies and many American drugstores. Naloxone can take a few minutes to kick in and more than one dose may be needed. Also, its effect wears off after 20 to 90 minutes , making medical attention necessary regardless. Naloxone will not cause harm, even in someone who is not actually overdosing on an opioid, except in one situation: if the person has been using opioids daily for a long time and is dependent on them, receiving naloxone will cause drug withdrawal symptoms. Marino told me. And if you are a first responder and your partner has a panic attack after accidentally touching a white powder at the scene, having them seek medical attention may be necessary, but simply calming them down can work wonders. That would be productive rather than just giving Narcan over and over again and adding to the panic. Blue Bloods may have fueled the fear over accidental fentanyl poisoning, but another cop show took a different approach. Just wash your hands. Take-home message: - There are no verified cases of poisoning from a casual fentanyl exposure - First responders who accidentally touch what they believe to be fentanyl and start hyperventilating exhibit symptoms that are the exact opposite of what fentanyl poisoning would look like. Their symptoms are more consistent with a panic attack - The myth that simply touching fentanyl can kill you causes harm: it delays first responders from helping people who are overdosing, it drives cops to buy unnecessary and expensive protective equipment, and it leads to people receiving harsher sentences for the imaginary crime of exposing a cop to fentanyl. Enter your keywords. Sign-Up Here. Fears around fentanyl are making people think they are accidentally overdosing on it. Only problem is, their symptoms are the wrong ones. Jonathan Jarry M. Critical Thinking. Where fentanyl comes from In , Dr. Touching a raw nerve It started in Montreal. Their symptoms are more consistent with a panic attack - The myth that simply touching fentanyl can kill you causes harm: it delays first responders from helping people who are overdosing, it drives cops to buy unnecessary and expensive protective equipment, and it leads to people receiving harsher sentences for the imaginary crime of exposing a cop to fentanyl CrackedScience. Facebook Twitter YouTube Instagram. Accessibility Cookie notice Cookie settings Log in.
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