MobiusDick
Bluelighter
Issues I have with labeling deaths opioid overdose
Acetyl fentanyl production by illicit chemists is a logical consequence of the Suspicious Substance List and the full frontal assault on any item that can be used in illicit methamphetamine production; there will likely be more acetyl fentanyl seen on the streets because propionyl chloride & propionic anhydride used to make fentanyl proper, are List 1 Suspicious Substances, requiring DEA notification in any amount; whereas acetic anhydride, which when substituted for the previously mentioned items makes acetyl fentanyl, is a List 2 Suspicious Substance and only requires DEA notification in over 55 gallons.
The name acetyl fentanyl is misleading and would, to a medicinal chemist, imply an additional acetyl group on the fentanyl molecule; whereas, the structure shown should be called desmethyl-fentanyl or nor-fentanyl because there is one less methyl group on the tertiary non-piperidinal nitrogen. I am not trying to be anal-retentive in the naming of this drug, but being on both sides of the fence so to speak, I have heard of and seen naming convention issues in less sophisticated chemists, become issues of small scale poisoning, and while I'm not suggesting that will be the case here, it should be nipped in the bud on general principle.
However, the reason for my post is this: there are gross over-exaggerations in opioid overdose deaths as well as other drug related deaths, for example, Michael Jackson, when multiple drugs are involved. These polydrug deaths, especially when an opioid is combined with a benzodiazepine, any other sedative-hypnotic or alcohol, that skew the data and have a net result ultimately of making it more difficult for pain patients to receive adequate analgesic dosages to relieve chronic pain. Michael Jackson cannot be said to have died of a propofol overdose when he had multiple sub-lethal (if administered alone) benzodiazepines in his system. He died from respiratory depression associated with a polydrug overdose with propofol contributing the major share. In these acetyl fentanyl deaths, without toxicology information in front of me, it is difficult to pick out which drug contributed which amount to the death in question. And even with the toxicology data, without a live patient or other individual, especially when one of the drugs involved is an opioid, it is virtually impossible to accurately view the data. When I was using fentanyl, I would routinely inject 150 mg not 150 mcg from 6-8 times a day. If I had died during this period of drug abuse, any medical examiner in the country would have said I took a lethal amount of fentanyl. And every single one of them would have been wrong. People who have long histories with opioids and other drugs, as well as atypical access, should not be the reason that people in chronic pain do not receive adequate analgesia. The fact still remains, when taken orally, as directed without additional drugs concomitantly, opioids are relatively safe. The usual course of action, especially with IR (as opposed to CR or SR) opioids, is to vomit the dose prior to lethal respiratory depression. Now this doesn't work in the case of parenterally administered opioids, but oral opioids rarely kill by themselves. Alcohol is often enough to push a sublethal oral dose into the lethal range, and it seems rare to find cases where absolutely no alcohol was consumed in the case of many deaths if adolescents or young adults. But let's stop naming polydrug overdose as opioid overdose because the data skew can and usually does, have far reaching implications and consequences.
MobiusDick
Note: very little info is available on this drug. There is not even a wiki stub on it. Here is the structural formula:
Here is the only Bluelight thread with "acetyl fentanyl" in the title:
http://www.bluelight.ru/vb/threads/615138-Need-information-on-Acetyl-Fentanyl-(AcetylFentanyl)
Acetyl fentanyl production by illicit chemists is a logical consequence of the Suspicious Substance List and the full frontal assault on any item that can be used in illicit methamphetamine production; there will likely be more acetyl fentanyl seen on the streets because propionyl chloride & propionic anhydride used to make fentanyl proper, are List 1 Suspicious Substances, requiring DEA notification in any amount; whereas acetic anhydride, which when substituted for the previously mentioned items makes acetyl fentanyl, is a List 2 Suspicious Substance and only requires DEA notification in over 55 gallons.
The name acetyl fentanyl is misleading and would, to a medicinal chemist, imply an additional acetyl group on the fentanyl molecule; whereas, the structure shown should be called desmethyl-fentanyl or nor-fentanyl because there is one less methyl group on the tertiary non-piperidinal nitrogen. I am not trying to be anal-retentive in the naming of this drug, but being on both sides of the fence so to speak, I have heard of and seen naming convention issues in less sophisticated chemists, become issues of small scale poisoning, and while I'm not suggesting that will be the case here, it should be nipped in the bud on general principle.
However, the reason for my post is this: there are gross over-exaggerations in opioid overdose deaths as well as other drug related deaths, for example, Michael Jackson, when multiple drugs are involved. These polydrug deaths, especially when an opioid is combined with a benzodiazepine, any other sedative-hypnotic or alcohol, that skew the data and have a net result ultimately of making it more difficult for pain patients to receive adequate analgesic dosages to relieve chronic pain. Michael Jackson cannot be said to have died of a propofol overdose when he had multiple sub-lethal (if administered alone) benzodiazepines in his system. He died from respiratory depression associated with a polydrug overdose with propofol contributing the major share. In these acetyl fentanyl deaths, without toxicology information in front of me, it is difficult to pick out which drug contributed which amount to the death in question. And even with the toxicology data, without a live patient or other individual, especially when one of the drugs involved is an opioid, it is virtually impossible to accurately view the data. When I was using fentanyl, I would routinely inject 150 mg not 150 mcg from 6-8 times a day. If I had died during this period of drug abuse, any medical examiner in the country would have said I took a lethal amount of fentanyl. And every single one of them would have been wrong. People who have long histories with opioids and other drugs, as well as atypical access, should not be the reason that people in chronic pain do not receive adequate analgesia. The fact still remains, when taken orally, as directed without additional drugs concomitantly, opioids are relatively safe. The usual course of action, especially with IR (as opposed to CR or SR) opioids, is to vomit the dose prior to lethal respiratory depression. Now this doesn't work in the case of parenterally administered opioids, but oral opioids rarely kill by themselves. Alcohol is often enough to push a sublethal oral dose into the lethal range, and it seems rare to find cases where absolutely no alcohol was consumed in the case of many deaths if adolescents or young adults. But let's stop naming polydrug overdose as opioid overdose because the data skew can and usually does, have far reaching implications and consequences.
MobiusDick
