As if the narcotics we have out there now aren’t bad enough to deal with, a potent opioid that hasn’t been seen since the 1970s is making a strong comeback – and it’s killing our patients.
The drug, U-47700, was an opioid analgesic developed in the early 70s by a team at the Upjohn Pharmaceutical company, and was never intended as a medicine or for use on humans. According to records released by the Florida State Office of the Attorney General, it was created for research purposes, and became the lead compound in several other kappa opioid ligands. They were looking for a synthetic alternative to morphine that would have the same pain killing effects, but none of the addictive properties.
It was supposed to stay on a laboratory shelf, but apparently made its way out onto the streets. Called “pinky” by users, U-47700 comes in a yellowish-pink powder that can be snorted, injected, used rectally, taken orally – it even comes in an intranasal spray. There are still sites on the Internet you can purchase it from; if you can Google it, you can find it. And it’s cheap on the streets: about $40 per gram – and up until just recently, it was perfectly legal.
U-47700 has eight times the binding affinity for μ-opioid receptors than morphine; this is not a mild sedative. The problem is this: it is being mixed with other opioids such as heroin, fentanyl and oxycodone, and benzodiazepines like alprazolam, clonazepam and diazepam to be used recreationally. The resulting cases of poly-drug overdoses are stacking up.
Sweden and Finland made U-47700 illegal in January of this year after a rash of overdose deaths. And in May after similar circumstances, Ohio Governor John Kasich signed an emergency order to make it illegal. Wyoming and Kansas quickly followed suit. The U.S. Drug Enforcement Administration also signed an emergency order on Sept. 7, declaring this powerful opioid a Schedule I narcotic under the Controlled Substances Act.
In answer to several deaths across the Florida panhandle, central Florida and Pinellas and Bay counties – eight within the last week alone – State Attorney General Pam Bondi, along with the sheriffs of several counties, on Sept. 27 also signed an emergency order, making it illegal. She has also ordered medical examiners across the state to reopen drug overdose cases to test for U-47700 as the culprit.
“Pinky” acts like other typical opioid agonists in its clinical presentation:
- Strong analgesic effects
- Heavy sedation, unresponsiveness
- Itchy skin/open sores on arms and legs
- Respiratory depression to the point of death
- Withdrawal arrhythmias
No one knows really why U-47700 disappeared for so long, and how it came back in these recent months with such a vengeance. The Centers for Disease Control and Prevention state it is being manufactured in China but it’s here, it’s a problem, and now it’s our problem as EMS professionals. Remember to stay vigilant with any overdose patient, and have a high index of suspicion that you may be dealing with a poly-substance situation. Obviously, airway management will be key here – and the use of naloxone (as per your medical direction’s protocols).
But Narcan may not be enough to do the trick with these patients, if what the reports are saying is true. Mixing U-47700 with other drugs does nothing but create a hydra-monster that we may not be able to manage. It’s no secret that Americans have a love affair with opioids, especially prescription narcotics. At the end of April, several news agencies reported that 80% of the world’s opioid production was consumed in the United States. Considering that we make up only about 5% of the earth’s population, that’s a frightening statistic. And consider this: more than 99% of the hydrocodone (Vicodin, Norco) manufactured in the world is being used by Americans.
Over 300 million pain prescriptions were written in 2015, a $24 billion big pharmaceutical market. Prescription opioids like hydrocodone, fentanyl, morphine, oxycodone, kill more people in the U.S. than every other drug combined. I think it is pretty safe to say that we are in a pandemic-level crisis with opioid consumption.
As we are all aware, heroin use has also skyrocketed in recent years. These trend lines between illegal opioid use and abuse of legally obtained prescribed opioids are definitely intertwined. So, stay watchful and spread the word.
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.
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