New Opioids: Expensive Distractions or Important Additions to Practice?

Heroin Contaminated with Fentanyl Dramatically Enhances Brain Hypoxia and Induces Brain Hypothermia

“…We compared the effects of a control dose of heroin (400 μg/kg) and this dose contaminated with 10% fentanyl, which gives rise to a heroin-fentanyl mixture containing 360 μg/kg of heroin and 40 μg/kg of fentanyl. Both 400 μg/kg of heroin and 40 μg/kg of fentanyl are much lower than the LD50 assessed in rats [15–20 mg/kg (Gable, 2004; Strandberg et al, 2006); 1–3 mg/kg (von Gunten et al, 2010), respectively] and are within the range of consumption of experienced drug users (see erowid.org). No data exists in the literature on the effects of these drugs on brain oxygen levels and brain temperature when taken in combination.…”

“…In addition, fentanyl is more toxic than heroin, with estimates of LD50 from 5- to 20-fold lower than those for heroin [1–3 mg/kg (von Gunten et al, 2010) vs 15–20 mg/kg (Gable, 2004; Strandberg et al, 2006), respectively]. At the 10:1 dose ratio (40 and 400 μg/kg) used in this study, fentanyl and heroin produced relatively similar decreases in NAc oxygen, suggesting that fentanyl is ∼10-fold stronger than heroin in its ability to induce brain hypoxia.…”

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

“…However, TARD formulations tend to be more expensive, posing greater financial burden for underinsured and lower socioeconomic populations 1,19. It has been suggested elsewhere that hospitals, hospices, and nursing homes from inner-city, urban, suburban, and rural areas could engage collectively as a consortium to allow online mail-order purchases of a wider range of medications, including TARD formulations, at reduced costs to these health facilities and to patients and families 14.…”

“…TARD preparations of opioid medications are specially formulated to be difficult to melt or crush so that they cannot be injected or inhaled 1,19. Other formulations become inactivated when melted or crushed, which releases a second drug with significantly greater affinity for the microopioid receptor, thus displacing the opioid from binding to the receptor.…”

“…Despite the enhanced safety and affordability that some TARD medications could provide, there is no evidence that TARD formulations will prevent patients who abuse or divert opioid drugs from seeking to manipulate medical personnel into prescribing excess amounts, or stronger than necessary, drugs 19. Still, TARD formulations may make it more difficult for patients, family members, or friends to abuse them and less worthwhile to divert them.…”