03-06-18 What can the DEA tell you about changing patterns in use/trafficking of Drugs of Abuse?

                                                 Toxicology Question of the Week

                                                                 March 6, 2018

What can the DEA tell you about changing patterns in use/trafficking of Drugs of Abuse?

Last week I attended the Midyear Meeting for Poison Centers, a meeting that addresses primarily issues of funding/evaluation/functioning of the poison center.  Two DEA agents gave an update on current Drug of Abuse use/trafficking, I’m sharing my notes with you.  I thought some of the new patterns, as well as the reason for them, was quite interesting.  ds

  • Much of the fentanyl is coming from China and Mexico.  It is then combined with heroin in a pill press.  The resultant tablet resembles oxycodone 30 mg tabs, but is much cheaper than actual oxycodone.

  • Cocaine trafficking is increasing from Columbia.  The Columbian government made a peace treaty with the rebels and part of the deal was that government would stop eradicating the coca plants.  (I wish the rebel who negotiated that deal would throw down some pointers or teach a class on the art of the deal) Cocaine exports have increased to the point that traffic is similar to that of the cartel days.  One kg of cocaine will get more money in Europe or Panasia than in the US, so there is currently greater trafficking to other countries than to the US.  A 4-5 year lag occurs from the time of increased production to increased misuse, so more cocaine overdoses are on their way.

  • Methamphetamine is now produced primarily in Mexico rather than locally due to the difficulty obtaining pseudoephedrine.  The price has dropped so purity is increasing.  Purity from 2011 to 2016 increased 90%.

  • DEA Red Flags

In a survey of > 6000 communities, the following were the greatest drug threats:

1)heroin  2)methamphetamine  3)CBD   4)fentanyl   5)marijuana  6)cocaine

  • Much CBD ((cannabidiol)active cannabinoind in cannabis-not psychoactive) is being produced locally and sold over the internet.

  • Marijuana is a Schedule 1 Controlled substance ( federal ), a classification that indicates there is no medically accepted use. 70% of Schedule 1 research is investigating marijuana.  Currently there is no evidence that it alleviates chronic pain or lessens opiate use.

  • Kratom contains active opioid constituents.  In animal studies it is similar to morphine and is being used as a substitute for opioids.  There are many reports of abuse, dependence, and negative outcomes from it use.  It is sold as dried leaves, powder, capsules and tablets.  There have been multiple seizures by the FDA.  Many designer products contain Kratom.

  • Total number of prescriptions written for controlled substances has decreased in the US.  Some states limit the number of days for which controlled substances can be prescribed. 

  • National prescription take back day is April 28.  It occurs twice a year, April and October. One of the keys in determining success is the number of law enforcement officers involved at the local level.   Last October, 456 tons of pills were taken back.  Over the past 8 years 4500 tons have been procured.

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu

Donna Seger, MD

Medical Director

Tennessee Poison Center

www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222

The Question of the Week is available on our website: www.tnpoisoncenter.org