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Class 1 Drugs, Repurposed Rather Than New

Friday, June 30, 2017  
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Student Submission: Class 1 Drugs, Repurposed Rather Than New
Jose B. Fernandez Jr., PharmD Class of 2019
Roger Armen, Phd, Thomas Jefferson University College of Pharmacy

The current opioid epidemic has sparked a great focus by the media and healthcare professionals. The public is inundated with reports of increased use of heroin, however, there are also other substances like W-18, fentanyl, U-47700, K2, and a variety of other compounds that may not have generated as much attention as heroin. With the increased restrictions to obtain prescriptions for opioids and the increase in enforcement to combat marijuana use, other techniques and compounds emerge which create deadlier consequences.

Fentanyl, a synthetic opioid which is 100 times more potent than morphine, was created and is currently used as an anesthetic.1 Recently, its popularity has risen due to counterfeit pills imported from other countries such as China. Laboratories synthesize and package fentanyl into counterfeit prescription pills which can be obtained by purchasing from the internet or the illegal street market.2,3 These pills are not regulated for potency, concentration, and almost always contain unknown additives.

Fentanyl is not the only compound that is illegally transported and marketed in the United States. Another example is K2, commonly referred to as “legal marijuana”. Originally this substance was created to bypass the illegality of marijuana use because it does not contain the same active compound as marijuana. This compound is synthesized in a laboratory, sprayed onto plant material, and then packaged, shipped, and legally sold to use for its euphoric effect. As adverse events occur, efforts are undertaken to identify the substance that caused the adverse event. This process eventually results in individual chemicals being banned, and then the manufacturers synthesize a similar compound and repeat the process using a new molecule. Unfortunately, this cycle continues. Usually these analogues are named JWH-###, for John W. Huffman, PhD, who is one of the original chemists that synthesized about 460 synthetic cannabinoids for research purposes.4 

Just like the vast number of cannabinoids created for research purposes, there are other illicit drugs, such as the synthetic opioids W-18 and U-47700, that are repurposed from research to be utilized for illicit use. W-18 is a chemical that was used for research purposes in the 1980’s and is now commonly mixed with fentanyl and morphine.5 U-47700 has gained publicity as one of the drugs (along with fentanyl) identified as a cause of Prince’s overdose.6 As the chemical synthetic scheme is publically available through peer-reviewed literature, chemists are able to synthesize U-47700 and other research compounds at their own free will and sell it illegally.

The true dangers of these derivatives remain unknown, both to health care professionals and to users themselves. Resources like the DEA Synthetic Designer Drugs News Releases are available to warn the public about the presence of these drugs,7 but if we are uncertain of what they do, how can we help treat our patients? Is the answer that we are simply uninformed and uneducated? We must remember to not only assess this issue from our own perspective as healthcare professionals, but also from that of those who abuse these drugs.

When analyzing our current health systems, the use of these drugs are overlooked while there is emphasis about tobacco and alcohol. Is this due to healthcare providers being uncomfortable to handle a situation if the patient admits using illicit drugs, lack of resources in their area, or no realization that there is an issue present? Lack of education plays a critical role in both the healthcare providers and the users. Many heroin, synthetic cannabinoids, and other opioids overdoses or adverse events may not be directly due to the compound itself.  Commonly an overdose occurs when the patient uses one batch and is unaware that it is a higher concentration than previous batches, which is common in heroin overdose. Or, the patient has a dose of an illicit drug, assuming it is one compound, but it actually contains a different and stronger compound, common with fentanyl fake pills. The impurities, additives, and irregular concentrations may be the actual issues causing all of these problems.

An unknown compound can be one of the most dangerous occurrences in healthcare. During my Introductory Pharmacy Practice Experience (IPPE) at the Youth Emergency Service, we educated the teens that lived at the institution about these illicit drugs. When one teen asked what my preceptor thought the most dangerous drug was, she quickly said K2. My preceptor explained that it is the most dangerous drug in her opinion because we don’t know what it contains, and with each new batch sold, there are new active ingredients and additives unknown to anyone until they are analyzed. These compounds change regularly and it is never stated what is added and at what concentrations. Even if these emerging illicit substances have been studied in the past, such information is usually not readily accessible. With unknown mechanisms of action and effects on the body, drugs interactions and additional harm can be inflicted to patients if they seek help. To combat these issues, healthcare professionals need to be aware of new drug usage, but information about these drugs also needs to be available. It is our responsibility as health care professionals to remain competent and aware of emerging drug patterns in our respective regions.

As a society, we need to change our beliefs about this issue. Healthcare professionals must learn and become aware of these new drugs, as well as, how to properly treat our patients. When we reflect on our own clinical practice, do we feel there is a lack of education regarding this topic for ourselves, among our colleagues, and most certainly our patients? Together by changing the way we view illicit drug use, we can all be more effective advocates for the improved health of our patients.

 

  1. FENTANYL. Drug Enforcement Administration Web site. https://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf. March 2015. Accessed November 14, 2016.
  2. DEA Report: Counterfeit Pills Fueling U.S. Fentanyl and Opioid Crisis. Drug Enforcement Administration Public Affairs Web site. https://www.dea.gov/divisions/hq/2016/hq072216.shtml. July 22,2016. Accessed October 31, 2016.
  3. Drug Fact Sheet K2 or Spice. Drug Enforcement Administration Web site. https://www.dea.gov/druginfo/drug_data_sheets/K2_Spice.pdf. Accessed November 5, 2016.
  4. Walton AG. Why Synthetic Marijuana Is More Toxic To The Brain Than Pot. Forbes Web site. http://www.forbes.com/sites/alicegwalton/2014/08/28/6-reasons-synthetic-marijuana-spice-k2-is-so-toxic-to-the-brain/#43e551c649eb. August 28, 2014. Accessed November 17, 2016.
  5. Kroll D. W-18, The High-Potency Research Chemical Making News: What It Is And What It Isn’t. Forbes Web site. http://www.forbes.com/sites/davidkroll/2016/04/30/w-18-the-high-potency-research-chemical-making-news-what-it-is-and-what-it-isnt/#23ad029b2354. April 30, 2016. Accessed on November 17, 2016.
  6. O’Hara ME. U-47700: Everything You Need to Know About Deadly New Drug. RollingStone Web site. http://www.rollingstone.com/culture/news/u-47700-everything-you-need-to-know-about-deadly-new-drug-w443344. October 4,2016. Accessed October 15, 2016.
  7. Synthetic Designer Drugs News Releases. Drug Enforcement Administration Web site. https://www.dea.gov/pr/top-story/SyntheticDesignerDrugs.shtml. Accessed October 1, 2016.

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