Overseas Opioids

I saw this article on the front page of the Wall Street Journal last week - This is U-47700, Once a Lab Experiment, Now a Killer Opioid. The title is arguably eye-catching for someone with my perspective on life, but as I read the article my anxiety grew as I became fully aware of the ongoing cat-and-mouse game to feed the addictions of the U.S.

The article is an easy read but I will summarize for you:

• The synthetic opioid U-47700 was created in 1973 in an effort by Upjohn Co. in Kalamazoo MI to "create a drug with the pain-relieving power of morphine but without the risk." During lab tests on mice, they estimated it to be 7.5 times more potent than morphine. They also found out that it caused tolerance and dependence and included all of the usual opioid side-effects. So research was stopped, with no human trials. But not before it was patented. These mid-1970's research projects to find the perfect analgesic left behind "copious patents and scientific papers which can serve as recipes for today's enterprising chemists."
• There have been 125 confirmed overdose deaths from U-47700, the first in May 2015, spanning at least 31 states from Alaska to Utah to Florida. That number does not include non-fatal overdoses nor those that use it without overdosing. This article includes two personal stories as recounted by the parents. Sad.
• U-47700 can be purchased online, primarily from Chinese labs, who label them as "research chemicals" and "not for human consumption" (likely to try and circumvent questions of legality). The recent cost from one Chinese online vendor was $129 per gram or $290 for 10 grams. One user estimated he "would have to spend 15 times as much to get the same high from oxycodone."
• The DEA added U-47700 to the list of Schedule I drugs on September 7. But that was obviously in response to the growing trend of use and deaths and in hopes of preventing more.

So, after hard work in trying to identify the substance, trace its origins, and go thru the rigor of validating the lack of medical purpose and the significant abuse risk, the DEA was able to fast-track making U-47700 an illegal drug. It was reactive, but (in relative terms) very quick. Kudos to them.

Here's the scary part ...

The United Nations Commission on Narcotic Drugs estimates that "new psychoactive substances" - a broad list that includes synthetic opioids - are emerging globally at an average rate of one a week

It's hard to keep track of what's killing people

The bad guys, I hate to say it, are smart. They always seem to be a step ahead of the regulators

If the DEA doesn't think there are entire communities analyzing and making and testing new chemical structures every day, then they have no idea how our world works

The battle for lives is asymmetrical. Not just legitimately prescribed opioids, or prescription opioids used non-medically (the user was not the one for whom the prescription was written), or the concurrent rise in the use of heroin. But synthetic opioids taken out of 1970's mothballs and sold openly from across the Pacific Ocean.

Our country is doing a good job ... now, finally ... of the first rule of holes - stop digging - to change prescribing behavior and reduce the supply. That's through new legislative mandates and Work Comp drug formularies and treatment guidelines and Federal/State/local leadership and prescriber education and DEA take-back days and PDMP access and a number of other tactics. There can be no doubt that anybody who pays attention in the U.S. now knows the dangers of opioids. As far as I'm concerned, ignorance is not an excuse.

The next step is to clean up the mess. And that will be our country's focus (and our industry's focus) for the next several years. That entails helping people who are dependent or addicted to these drugs find other ways to manage their physical, emotional and/or psychological chronic pain.

But the pathway is tougher when it's a moving target. I'm hopeful the U.S. is working with China (and Mexico, which is a large gateway for fentanyl, another issue for another day) to proactively stop these "chemists" from creating evermore deadly drugs. We will have to count on the DEA, FBI and other Federal and State agencies for the macro solution. The rest of us are responsible for the micro solution - individuals, with their own unique stories and opportunities, that need help.

#TurnTheTide