Police in Holyoke, Massachusetts are warning about a new heroin mixture that may not respond to naloxone, It allegedly produces violent reactions in its victims. The mixture contains the synthetic cannaboid MDMB-4en-PINACA .
The article is misleading in its assertions about the possible ineffectiveness of Narcan. Narcan may not cure this overdose, but if the person is violent, they do not need Narcan. If they were unresponsive and received Narcan and are now violent, then they responded to the Narcan. Narcan works on opioids, not on cannabinoids. Cannabinoids usually do not cause respiratory depression or respiratory arrest, which is the indication to use Narcan.
Here in Hartford, dealers have been adding PCP, among other substances to the heroin/fentanyl they sell. We have seen people with violent reactions post Narcan that could be due either to their annoyance at being suddenly put into withdrawal or it could be due to other devilish substances that are now unleashed now that the patient is conscious. More typically, the heroin users I have had who overdosed and also had PCP onboard, returned to maintenance breathing, but were often catatonic. One of the users called the drug mind-fuck. Others have complained of racing hearts — we’ve seen heart rates in the 160s-200s, as well as the bizarre behavior associated with PCP and other disassociative and mild altering drugs.
Instead of treating these patients with Narcan, we use Versed or Ativan, benzodiazapines that sedate the patient. We get a lot of experience with this as PCP overdoses, at least in the north end of Hartford, are more prevalent than heroin.
Two points behind all of this.
Naloxone works on opioid overdoses. There has yet to be confirmed evidence of an opioid that does not respond to naloxone.
There are some nasty substances being added to heroin.
What do we do about it?
I think it is time a city in the United States provided medical grade heroin to users in supervised injection sites, and follow how these users do over the course of a year. How many die? How many developed endocarditis or skin abscesses? How many are arrested for violent behavior or other crimes? How many got into rehab?
No only our our fellow Americans dying in unacceptable numbers, they are being poisoned by the additives dealers are adulterating their opioids with.
Medicinal grade heroin has worked in England. We should try it here.