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The opioid crisis in Massachusetts 4.1

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An update on the public safety response to the opioid crisis in Massachusetts.

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The opioid crisis in Massachusetts 4.1

  1. 1. OPIOID CRISIS IN MASSACHUSETTS David DiGregorio, Director MA DFS Hazardous Materials Emergency Response Division
  2. 2. OPIOIDS Highly addictive drugs that provide “pain relief” both physically and emotionally. • Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. • Other medical uses include suppression of diarrhea, treating opioid use disorder, reversing opioid overdose, suppressing cough, and suppressing opioid induced constipation. • Extremely potent opioids such as carfentanil are only approved for veterinary use. • Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. -Wikipedia
  3. 3. • The naturally occurring opiates are those which are found in the opium resin of the opium poppy. Although there are over 25 different alkaloids present in opium, morphine and codeine are the only two that are used as narcotic opiate analgesics. • All other opioid analgesic medications are either semi- or fully-synthetic and are not found in nature. The semi-synthetic opioids such as hydrocodone, hydromorphone, oxycodone, and oxymorphone are derived from the naturally occurring opiates and opium alkaloids
  4. 4. • Although we have recently seen a slight drop in opioid deaths in Massachusetts during the first 9 months of 2017, fentanyl-related opioid deaths have skyrocketed.
  5. 5. • Although the recent decrease in opioid deaths in 2017 is promising, the recent spike in fentanyl deaths is alarming. • In 2014, fentanyl-related opioid deaths were at approximately 10%. • In 2016, fentanyl-related opioid deaths have risen to over 80%.-MA Governor Charlie Baker
  6. 6. ANALOGS • A fentanyl analog is a drug that has been designed to mimic the pharmacological effects of the original drug. • Some manufacturers create new fentanyl analogs to avoid classification as illegal, policy restrictions on manufacturing, and/or detection in standard drug tests. • New fentanyl analogs are being made regularly.
  7. 7. • William R Brownfield, Assistant Secretary for the Office of National Drug Control Policy warned that “Massachusetts is a preview of coming attractions” with 900 opioid overdose deaths that involved fentanyl in 2015, and 1500 opioid overdose deaths that involved fentanyl in 2016.
  8. 8. • One kilogram of fentanyl is equal to 80- 100 kilograms of heroin
  9. 9. • A lethal dose of fentanyl as compared to a penny -DEA
  10. 10. WHY FENTANYL? Concentrated Synthetic Versatile • It’s concentrated, making it hard to find and easy to transport. • It is a synthetic drug and can be made anywhere. • It’s versatile • Can add it to heroin for an extra kick. • It can be made into pills. • Users can snort it, shoot it, eat it and even wear it
  11. 11. WHY FENTANYL? • Fentanyl sales are much more lucrative than heroin. A kilogram of heroin is purchased for approximately $6,000 and sold for appropriately $80,000. • A kilogram of fentanyl is purchased for approximately $6,000 and sold for approximately $1.6 million. • The reason for this vast difference in pricing is that the potency of fentanyl is so great, that it is cut into heroin and other drugs, to expand their volume.
  12. 12. WHY FENTANYL? • Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier, transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit. • If a particular batch has 1.5 milligrams of fentanyl per pill, approximately 666,666 counterfeit pills can be manufactured from 1 kilogram of pure fentanyl.
  13. 13. • Fentanyl can be purchased in its pure form or can be manufactured using a few key ingredients. MANUFACTURING FENTANYL
  14. 14. • DEA reports 3,911 law enforcement reports concerning fentanyl in Massachusetts in 2016. • The state ranked second only to Ohio, which had 7,971 -- and ahead of Pennsylvania's 2,355. FENTANYL IN MASSACHUSETTS
  15. 15. • The United States is not alone in fighting the fentanyl epidemic. Canada is seeing marked increases in fentanyl seizures.
  16. 16. • Fentanyl is often mixed with other drugs, predominantly heroin.
  17. 17. CARFENTANIL IN THE COMMONWEALTH ‘Extremely Dangerous’ Opioid Carfentanil Is Now In Massachusetts, Police Say (June 7, 2017 4:43 PM CBS Boston)
  18. 18. • A slight change in the functional group of fentanyl can result in significant increases in strength and intensity of the new drug. • Carfentanil is an analog of fentanyl and has been found in Massachusetts several times. • A unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine.
  19. 19. • The sale of fentanyl and carfentanil is extremely profitable. • Investigations and arrests involve local dealers as well as large, intricate drug cartels both nationally and internationally.
  20. 20. • In addition to fentanyl seizures, Massachusetts ranks amongst the highest in overdose deaths per 100,000 population.
  21. 21. • Fentanyl “recipes” can easily be found on the internet. • More sophisticated information and sources for purchasing can be found on the “dark web”, a series of internet sites which can be extremely difficult to monitor by law enforcement.
  22. 22. “The whole reaction takes place under mild conditions and at room temperature by performing three successive one pot reactions, separation and purification of the intermediates were excluded, thereby increasing the overall yield. This method can also be used for the synthesis of fentanyl analogues.” • To date, the synthesis of illicit fentanyl has not been discovered in Massachusetts, although the potential is there to make fentanyl or fentanyl analogs rather than having to purchase them from foreign sources.
  23. 23. LAB AND ANALYSIS CHALLENGES
  24. 24. State Public Health Lab Jamaica Plain State Police Crime Lab Maynard • The first responder community works closely with the MA State Public Health Laboratory and the MA State Police Crime Lab for analysis of products found in the field. Policies and protocols with regard to fentanyl and its analogs are currently being reviewed.
  25. 25. WHITE POWDER CALLS • DFS Hazmat has responded to approximately 30 white powder calls since January 2017. • Often, these calls are identified as benign substances such as boric acid, lactose, sucrose, etc. or drugs (cocaine, heroin)
  26. 26. WHITE POWDER CALLS • Initially, most fentanyl and its analogs were being mixed with other drugs. More recently, DEA reports that most fentanyl is being mixed with these benign substances and passes off as heroin or cocaine.
  27. 27. WHITE POWDER CALLS • Although we have the correct technology, currently we are extremely limited in our ability to identify fentanyl or its analogs due to limitations of our libraries within these devices. • Recently, current field technology has shown promising results in detecting and identifying fentanyl and its analogs in low concentrations
  28. 28. WEAPONIZING OPIOIDS Global News, Canada 2016
  29. 29. DANVERS JANUARY 10, 2017
  30. 30. WEST BRIDGEWATER MARCH 24, 2017
  31. 31. DANVERS MAY 19, 2017
  32. 32. BROCKTON JUNE 7, 2017
  33. 33. LAWRENCE JULY 17, 2017
  34. 34. CHELSEA AUGUST 4, 2017
  35. 35. NORTHAMPTON OCTOBER 17, 2017
  36. 36. HOLYOKE NOVEMBER 16, 2017
  37. 37. LYNN NOVEMBER 18, 2017
  38. 38. OPIOID CRISIS IN MASSACHUSETTS David DiGregorio, Director MA DFS Hazardous Materials Emergency Response Division

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