Officials: New opioid could be naloxone-resistant

A DEA special agent said that acrylfentanyl has shown some possibility of being resistant to naloxone


By Jonathan Greene
Richmond Register

RICHMOND, Ky. — As overdoses continue to rise in Kentucky and across the country, a new opioid has hit the streets that could potentially be Narcan-resistant.

Naloxone, better known as Narcan, is an opioid antidote. However, Special Agent Patrick Trainor of the Drug Enforcement Agency recently told CNHI News that acrylfentanyl “has shown some possibility of being resistant” to Narcan.

The state Medical Examiner’s Office has seen three confirmed cases so far in which acrylfentanyl was a factor in the death, according to Mike Wynn, spokesperson for the Justice and Public Safety Cabinet.

Local officials said they have not see any cases yet, however, they noted Madison County has not been immune to other drugs previously.

Madison County EMS Director Carlos Coyle said, in the first three months of 2017, EMS paramedics had administered 144 doses of Narcan to 97 patients. Those numbers were up from 107 doses to 67 patients in the first quarter of 2016.

“The (individuals) we see where Narcan is administered are barely breathing or not breathing at all when we get there,” Coyle said. “If it is a drug we aren’t able to reverse, a lot of these people would be dead.”

Madison County EMS administered 443 doses to 291 patients in 2016, Coyle said.

It was the fourth highest total of Narcan doses administered by EMS in the state behind only Kenton, Fayette and Campbell counties, according to data from the Kentucky Ambulance Providers Association (KAPA).

Madison County also had the sixth most overdose deaths in the state, according to the 2015 Overdose Fatality Report. There were 31 overdose deaths — eight more than 2014. The 2016 report will be released this summer.

Fatal overdoses in Kentucky for 2015 totaled 1,248, compared to 1,071 in the previous year, according to the report.

Overdose deaths could skyrocket if opioids become Narcan-resistant.

KAPA data noted 8,569 doses of Narcan were administered across the Commonwealth in 2016 from reporting agencies.

“If opioids such as acrylfentanyl become Narcan-resistant, I assure you it will increase the deaths in Madison County drastically,” said Madison County Coroner Jimmy Cornelison. “None of these drugs are measured out and (drug users) never know what they are getting. This is just Russian roulette.”

Coyle said it could also strain first responders even more, along with health care providers. He recalled an overdose spike the county experienced in February when EMS responded to five overdoses in a 90-minute period stretching its resources.

“I really hope we don’t see it,” Coyle said of acrylfentanyl.

Because acrylfentanyl is so new to the United States, the DEA has not yet included it on its list of scheduled drugs, Trainor told CNHI.

“We’ve seen a similar thing with a lot of these synthetic drugs,” he said, “where we schedule something, all the chemist has to do is change one compound and it's a totally different drug.”

The DEA is currently evaluating the possibility of scheduling acrylfentanyl on an emergency basis, according to Trainor.

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine, and it is causing an increasing number of overdose deaths in the United States, according to the Centers for Disease Control and Prevention.

Fentanyl has a large number of synthetic analogues, “all of which are very concerning to us,” Trainor said.

An analogue is a drug whose chemical structure is substantially similar to the chemical structure of another drug or that has effects that are similar to those of another drug when used.

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McClatchy-Tribune News Service

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