OPANA ER insuffalation and Silicosis

[PainGame]

Could an expert comment?

OPANA ER contains silicified microcrystalline cellulose which is bad stuff if I am understanding correctly.

Just to be clear this is NOT microcrystalline cellulose which is in every pill and basically not harmful - it is water soluable.

This is silicified - hence not water soluable.

Inhaling silicates is known to be absolutely horrible.

If someone could clear this up - should there be a harm reduction warning about snorting OPANA ER?

http://en.wikipedia.org/wiki/Silicosis

Can silicified microcrystalline cellulose in OPANA ER cause Silicosis?? If an expert could take a look that would be great - if this is the same as other silicates, if there is enough in there to make a difference, etc. etc.

I tried one for the first time and my lungs are kind of uncomfortable, not sure I would do it again even with the efficacy being 5x-6x that of taking it orally.

 

[raybeez]

Really good question OP.

Silicosis is a type of restrictive lung disease due to chronic inflammation that results in an increase in fibrotic (scar) lung tissue. Fibrotic tissue is non-elastic, hence the development of a 'restrictive' pattern (inability to inhale).

Silicosis is not something that you would develop after one use, and what you are describing could be irritation due to post nasal drip in your large and medium airways containing the presence of non-soluble particulates. I have mixed asthma/small airway disease and find that nasal use of most ER/XR pills irritates my lungs (bronchospasm that is reversible with standard beta 2-agonist asthma inhalers).

There is almost no literature at all associating intranasal use of silica containing medication with the development of silicosis, however inhalation of silica particulates is widely known to cause silicosis in people who work with this material. The lack of info doesn't mean it can't happen; silicated microcrystalline cellulose is a fairly new pilladditive.

There is one single case report that might be relevant - 20 year old woman intentionally used Ajax (95% silica by weight) intranasally for 5 years and developed silicosis.

Initial report: http://www.ncbi.nlm.nih.gov/pubmed/223442
Follow-up report (free full text): http://erj.ersjournals.com/content/9/12/2688.full.pdf

Edit: my mistake, these are actually cases from 2 different patients both of which had intentionally used Ajax intranasally. The first lived 20 years, the second was still alive 7 years post-diagnosis.

For comparison, silicified microcrystalline cellulose found in Opana contains 2% silica by weight. Not sure what % of tota weight this would contribute to the overall composition of Opana though.

 

[PainGame]

That is very interesting and I appreciate the research you have done.

2% by weight would seem to be small. Can you link the document that has all the ingredients by weight/percentage? I would like to look at it as well - it would be nice if we could find a be-all end-all process of extracting the active ingredient without a need of a full laboratory.

A pill weighs about 120-160mg with all the junk they put in it to keep it controlled release (active ingredients being the minority 40mg).

I have found the company behind this stuff - and we really need to know as it is being added to more and more pills and is going to become a concern for everything from Adderal to OPANA ER to possibly even the newer Oxycontin.

In other words - it is spreading to more medications and I think we need to discover if this SILICIFIED MICROCRYSTALLINE CELLULOSE is

a) very harmful when insufallated

b) harmful but in such small quanitity in most pills as to be negligible in effect

c) not harmful

Here is the main manufacturer:

PROSOLV SMCC - SILICIFIED MICROCRYSTALLINE CELLULOSE
PROSOLV - Silicified Microcrystalline Cellulose is a high functionality ingredient because it is multifunctional, requires less complex processing (direct compression), has high inherent functionality and imparts that functionality to the drug formula.

Some traditional ingredients improve compaction performance by reducing density, but the result is decreased flow and content uniformity. PROSOLV imparts both optimum compaction and flow to drug formulations.

http://www.pharmaceutical-technology.com/contractors/drug_delivery/jrs_pharma/

It is essentially a binding/time release agent that is not water soluable so it prevents or hampers IV use. It is going to be appearing in more and more pills.

I am sure the bluelight team can find an answer. Assuming your 2% figure is correct we are talking only about 3-4mg in a pill. That would seem innocuous but you never know, and I don't think anyone wants a five year out surprise that they are going to DIE of an inability to breathe!

It hinges (I would think) on whether or not the silification process actually produces a silica with all its hazardous properties or if it just somehow modifies the microsrystalline cellulose in a way that is not harmful and does not create an actual silica.

Even at low doses chronic use could very closely model that of an old construction worker or insulation installer who breathed in 3mg or so a day and is now 40-50 and dying from this. When you insuffalate that super fine powder it is going to skip your nose and throat as it literally will float in the air and go directly down into the lungs - it is like a very, very, fine dust.

WOW - that lady snorted lines of AJAX!!! She got Silicosis so it is definitely possible. I am leaning towards this probably being okay to do with OPANA ER a couple times a year with no ill effect, but it is frustrating for those of us on a chronic pain regimen as we cannot take it daily this way - I think there would be a decent chance you could get Silicosis. This is just an opinion by the way.

I know I will never insuffalate a pill in the future containing silica until the issue is resolved definitively. I enjoy being alive.

 

[skoat]

Great thread OP.

 

[raybeez]

2% by weight would seem to be small. Can you link the document that has all the ingredients by weight/percentage? I would like to look at it as well - it would be nice if we could find a be-all end-all process of extracting the active ingredient without a need of a full laboratory.

Hi PainGame, the 2% figure is from the website of the company that manufactures PROSOLV SMCC.

a) very harmful when insufallated
b) harmful but in such small quanitity in most pills as to be negligible in effect
c) not harmful

Unfortunately there's absolutely no way to tell Unless there happens to be some intranasal pharmaceuticals (sprays, lubricants, etc) that this is intentionally added to, in which case it implies safety in low quantities. Otherwise nasal use of their product falls outside the scope of it's intended use, so I doubt the company would have any data on this.

It is essentially a binding/time release agent that is not water soluable so it prevents or hampers IV use. It is going to be appearing in more and more pills.

From reading the website, it sounds to me like it's actually being added for two purposes:

a) Makes pills more resistance to crushing
b) What they call "enhanced flowability" which translates to better distribution/movement (thus adsorption) by the GI tract

Assuming your 2% figure is correct we are talking only about 3-4mg in a pill ... It hinges (I would think) on whether or not the silification process actually produces a silica with all its hazardous properties or if it just somehow modifies the microsrystalline cellulose in a way that is not harmful and does not create an actual silica.

Just to clarify, this isn't 2% of the weight of the pill being silica but rather 2% of the total microcystalline cellulose present in the pill. From the website, SILICIFIED MICROCRYSTALLINE CELLULOSE is a mixture of 98% microcrystalline cellulose (MCC) and 2% colloidal silicon dioxide (CSD [colloidal silica]). It would only be 3-4 mg of this was the only non-medical ingredient in the Opana (which it isn't).

Also - in the study you link I do not think they are saying she was snorting LINES of Ajax.

Yes it does The title of the first article is "Silicosis due to intentional inhalation of abrasive scouring powder. Case report with long-term survival and vasculitic sequelae."

Edit: Mistake in the original post -- these are actually two different cases of intentional intranasal Ajax use, both of which caused silicosis.

 

[PainGame]

Hi PainGame, the 2% figure is from the website of the company that manufactures PROSOLV SMCC.



Unfortunately there's absolutely no way to tell Unless there happens to be some intranasal pharmaceuticals (sprays, lubricants, etc) that this is intentionally added to, in which case it implies safety in low quantities. Otherwise nasal use of their product falls outside the scope of it's intended use, so I doubt the company would have any data on this.



From reading the website, it sounds to me like it's actually being added for two purposes:
a) Makes pills more resistance to crushing
b) More "uniform" distribution



Just to clarify, this isn't 2% of the weight of the pill being silica but rather 2% of the total microcystalline cellulose present in the pill. From the website, SILICIFIED MICROCRYSTALLINE CELLULOSE is a mixture of 98% microcrystalline cellulose (MCC) and 2% colloidal silicon dioxide (CSD [colloidal silica]). It would only be 3-4 mg of this was the only non-medical ingredient in the Opana (which it isn't).



Yes it does The title of the first article is "Silicosis due to intentional inhalation of abrasive scouring powder. Case report with long-term survival and vasculitic sequelae."

Yeah I had just corrected my post before you posted this - the crazy lady snorted AJAX! So in theory this silicated microcystalline cellulose could be as high as 100mg or so per pill - something I would be very wary of.

---edit----

Here is another study, it is not relevant to intentional insuffaltion directly but explains a lot more about what this stuff is: http://www.polimery.am.wroc.pl/2007/202a.pdf The study seems to show it is being used as the major binding agent so there may be quite a bit of it inside the pill.

 

[raybeez]

Yeah I had just corrected my post before you posted this - the crazy lady snorted AJAX!

2 crazy ladies actually see above edits

So in theory this silicated microcystalline cellulose could be as high as 100mg or so per pill - something I would be very wary of.

Right, of which only 2% is silica, so maximum 2 mg / pill (but I'm guessing less).

Also of interest, I looked up the air levels of silica above which silicosis is thought to occur (in mines, work places, with daily exposure over 10-20 years) and it's 10 mg per cubic meter (1000 L of air).

Normal lung volume (vital capacity) is ~4.5 L in a healthy adult male and ~3.5 L in a female. This translates to 0.045 and 0.035 mg max daily safe lung exposure (over 10-20 years) for a total cumulative exposure of 125-165 mg (female-male range over 10 years).

Not sure how much of the intranasal dose would actually get into the lungs though (vs being swallowed). It would be much higher in smokers though.

 

[PainGame]

2 crazy ladies actually see above edits



Right, of which only 2% is silica, so maximum 2 mg / pill (but I'm guessing less).

Also of interest, I looked up the air levels of silica above which silicosis is thought to occur (in mines, work places, with daily exposure over 10-20 years) and it's 10 mg per cubic meter (1000 L of air).

Normal lung volume (vital capacity) is ~4.5 L in a healthy adult male and ~3.5 L in a female. This translates to 0.045 and 0.035 mg max daily safe lung exposure (over 10-20 years) for a total cumulative exposure of 125-165 mg (female-male range over 10 years).

Not sure how much of the intranasal dose would actually get into the lungs though (vs being swallowed). It would be much higher in smokers though.

I think you just proved snorting these is NOT safe. Lets say .5mg per pill. Thats an extremely low estimate and it is way above the range for developing the disease. Snorting 100 pills would almost guarantee you develop the disease.

That may sound like alot but people get 60-90 of these scripted a month.

So sad! I think the only way is going to be through the rather complex ethyl alcohol evaporation method and then snorting the left behind product. However it is such a small amount I wonder if a chemist type could chime on on wether the alcohol evaporation will remove silica or not?

 

[raybeez]

I think you just proved snorting these is NOT safe. Lets say .5mg per pill. Thats an extremely low estimate and it is way above the range for developing the disease. Snorting 100 pills would almost guarantee you develop the disease.

That may sound like alot but people get 60-90 of these scripted a month.

So sad! I think the only way is going to be through the rather complex ethyl alcohol evaporation method and then snorting the left behind product. However it is such a small amount I wonder if a chemist type could chime on on wether the alcohol evaporation will remove silica or not?

Edit: Okay this math is more sound and corrected for microcrystaline silica (smaller particulate size).

Given a lung tidal volume of 500 ml, an average RR of 15/min, you get 4600 L air circulated in the lungs per 10 hours. Given a microcrystaline silica exposure of limit of 0.1 mg/1000L the maximum safe daily exposure is 0.46 mg per day (roughly 10x higher than what I calculated previously).

Assuming the SMC constitutes 100% of the inert filers in the pill, you'd get ~2mg silica/pill or 4x the safe daily exposure limit. Assuming SMC constitutes 25% of the inert fillers you get ~0.5 mg silica/pill which puts you just above the safe daily exposure limit.

My conclusion: Daily nasal use of Opana pills will probably put you at low-medium risk for the development of silicosis. Less regular use probably won't.

 

[PainGame]

Edit: Okay this math is more sound and corrected for microcrystaline silica (smaller particulate size).

Given a lung tidal volume of 500 ml, an average RR of 15/min, you get 4600 L air circulated in the lungs per 10 hours. Given a microcrystaline silica exposure of limit of 0.1 mg/1000L the maximum safe daily exposure is 0.46 mg per day (roughly 10x higher than what I calculated previously).

Assuming the SMC constitutes 100% of the inert filers in the pill, you'd get ~2mg silica/pill or 4x the safe daily exposure limit. Assuming SMC constitutes 25% of the inert fillers you get ~0.5 mg silica/pill which puts you just above the safe daily exposure limit.

My conclusion: Daily nasal use of Opana pills will probably put you at low-medium risk for the development of silicosis. Less regular use probably won't.

Agreed!

This is very serious though, as anyone who has now looked at Silicosis understands that the most common outcome is death - like being unable to breathe and slowly dying of strangulation.

This would be absolutely horrible and what is crazy is the disease takes 5-10 years to appear AFTER you have snorted the pills - so if you have snorted say 200 OPANA ER in the last two years, there is a very good chance you are going to have a horrible horrible thing start to happen to you in 5-10 years.

How many people have signed their death warrant already but don't know it?

This is a brand new additive that has only been around recently and is just now going into pills - there is going to be a media firestorm in 10 years as college kids start developing Silicosis and it will be pulled from products.

We need a moderator to put this in some kind of place where people will see it.

All over the net people are saying "SNORT OPANA it is the ONLY WAY!!"

There is ZERO awareness of how dangerous that could be if you get even a small habit!!!

People snort heroin daily and snorting OPANA ER is almost an identical rush and feeling, and I am SURE there are people out there RIGHT NOW snorting it daily who WOULD NOT if they knew they would probably die from it in ten years.

This information about the possible DEATH risk of snorting as little as one bottle full of OPANA ER needs to be put somewhere people will see it, I don't know if they sticky or have a Opiate FAQ or whatever - but seriously Bluelight might save some lives.

ALSO - PEOPLE NEED TO UNDERSTAND THIS ONLY APPLIES TO THE OPANA ER - OPANA IR does NOT have SILICA and is safe for snorting.

SO -

Extended Release - Don't snort ever or only snort once every 2-3 months.

Instant Release - Snort ALL YOU WANT!!!

This info needs to be shared among the community - as it also applies to more pills now too and people need to be aware that MANY pills are going to have this ingredient.

In fact I may start a master project of identifying popularly snorted pills that have this silica in it - it would save lives.

I think this is a project I will start tonight after work.

 

[cdin]

good idea

yeah, please please do that. i was just thinking about all the mountains of ocs, klonopins, adderalls etc. that ive snorted over the years and what this development could possibly mean for seriously modifying my behavior in this area. I already have fucked up lungs from smoking 30 cigarettes a day, the last thing i need is a case of silicosis on top of copd

 

[raybeez]

Hey I thought of an easy way to remove the silica.

According to the PROSOLV website, the average size of their silica particles is 60 micrometers (microns) and the MSDS says it is insoluble in water whereas oxymorphone is extremely soluble (1 gram per 4 ml).

Remove any outer coatings, crush and cut into as fine as a powder as possible. Place it in something the shape of a test tube, add 4 ml of water, agitate it a bunch, and then allow the insoluble particles to settle to the bottom (an hour is probably good).

Get yourself a micron wheel filter that attaches to the end of a syringe. Avoid the really small sizes (0.45 and less) -- these are for filtering bacteria/viruses for IV prep. Probably go for a 0.8 - 1.0 micron filter as larger sizes are more resistant to clogging. Pass the liquid through the micron filter, and it will capture the silica as the silica will be ~60x bigger than the pore size.

Using a syringe without a needle, suck up as much liquid as you can without disturbing the powder. You can re-extract the powder with a second 4ml of water if you want. Do NOT pass any visible insoluble powder through the wheel syringe as it will clog instantly. Most wheel filters can accommodate 25 ml of liquid before the pores start to break... so make sure to not use the same one too many times.

Evaporate the filtered liquid gently and the resulting powder will be free of most fillers and more importantly, silica free.

(note: the silica is colloidal so it won't settle to the bottom with the rest of the powder and will stay in suspension in the water... hence the need to wheel filter to remove it)

 

[fastandbulbous]

^ what the man says!

 

[syndeusys]

I've been an oral user for most of my time but recently have developed a liking to intranasal administration and am fairly naive about the specifics surrounding it and harm reduction. Do we have any other ingredients that are "suspect" or known to be harmful via an intranasal/intravenous ROA. I tried using the search and couldn't turn much up on harmful particulates. I do have a decent amount of time on my hands and given ingredients I can go over many different manufacturer's tablet composition in order to help get a more effective safety profile for each. I just need to know the dangerous ones to look for. I suppose in the interim I'll head back over to oral for the time being and thanks to whoever throws a link/list my way gimme a month or so and I'll do my best to reciprocate with that safety data.

 

[Captain.Heroin]

If the particles are > 50 um, then compacted cotton will filter it out.

 

[arthunter888]

Does anyone know what must occur for you to risk illness from the silicates? Since they are in pills, they must be safe when swallowed? Are they risky when absorbed by the nasal membrane/sinus?

Or MUST the silicates be inhaled in order to cause problems? (this can happen when snorting too strongly -- down the throat causing a small cough)

 

[raybeez]

Does anyone know what must occur for you to risk illness from the silicates? Since they are in pills, they must be safe when swallowed? Are they risky when absorbed by the nasal membrane/sinus?

Or MUST the silicates be inhaled in order to cause problems? (this can happen when snorting too strongly -- down the throat causing a small cough)

If you carefully go back and read through this post you'll see the entire thread is a discussion about intranasal use (snorting).

Yes snorting does cause the powder to go into your lungs, and therefore DOES cause a risk of silicosis. This is why in the first few posts we are talking about two women who got silicosis by intentionally snorting silica scouring powder

Oral use is 100% safe. If it wasn't safe, the FDA wouldn't be adding it to pills.

Edit: Even those "DO NOT EAT" silica packages that come inside of new bottles of pills or a box of shoes are 100% non-toxic and at best cause GI upset.

 

[arthunter888]

I'm mainly curious about snorting. I can't really feel anything going into my lungs, does this happen automatically when you snort, or is it the result of too much force?

 

[PainGame]

I'm mainly curious about snorting. I can't really feel anything going into my lungs, does this happen automatically when you snort, or is it the result of too much force?

This is going to be a disaster caused by this because people are doing this all over the country and are clueless. Wait for the news stories to start in ten-fifteen years about kids, then in there 30s dying like flys all over the country. It will take them a long time to put it together because everyone will lie about their previous drug use, and Doctors will probably think they are being exposed to silica some other way.

Finally though it will happen enough among addict populations that people will figure out it was from pills.

I wonder how many will die? 100,000?

Yes it goes into your lungs - the silicates are almost lighter than air like a very fine baby powder that will float back into your lungs ANYTIME you snort plain crushed OPANA.

The only way is to do an extremely complex extraction of the oxymorphone from the pill entirely or to somehow put something in your throat when you snort to collect the dust. i have no idea how you would do this and not gag as it would need to block your airway.

 

[kakti]

Crushing the pill as fine as possible is a very bad idea; the smaller the silica molecules the more dangerous they are. It's said that the larger the silica "chunks" the better off you are, and the finer the dust the more likely it is to bounce around or tear long strips of your lungs. And we have no idea exactly what size the silica particles are after chopping up. The micron bags could be letting them right through for all we know.

I think media outlets need to be contacted about this asap...