Well, some vendors currently have it in stock, unfortunately just amounts of 5g+ (10g, 20g, 50g, 200g)- what the hell should I do with 5g???
I'd give it a try - or, to be precise, I'd give me a try - well, would also mean to supply some things first, but in the end, I'd challenge my skills. Until now most potent stuff I administered was Sufentanil i.v. - but without anything like Naloxone or such.
When doing Opioids like Carfentanil, Lofentanil, members of the Etorphine-family, this W-18 or even some Enantiomeres of the Ohme-Fentanyl (potency going up to 30.000 by the way with overwhelming affinity), professional method would be: To make sure to have apart from the stuff mentioned here like Naloxone (this is not so important since it's affinity is uncertain to be high enough), muscle-relaxants such as Succinylcholine and a precurariser (Vecuronium, Rocuronium, Alcronium or so) to break off incidental muscular rigidity in thorax-region causing impossibility to breathe or being ventilated manually. Since Naloxone's affinity...., there should be a more potent Antagonist - here we have either Naltrexone, or Nalmefene, or Diprenorphine - at least the last should easily be strong enough to reverse agonism - well, it's a partial agonist itself to the Dynorphine-receptors (kappa) - it's discretionary. Probably Nalmefene is the better choice (but that's just an estimation since I don't know the exact binding-affinity of W-18).
I'd assure a permanent monitoring (at least ECG/SpO2), make sure, that intubation-equipment for manual ventilation is available. But most important: Another competent person who always keeps an eye of me and can come in action if neccessary. Maybe an Ecmo ;-)
The less professional way: I'd make sure to have a sufficient peripheral venous cathether AND Nalmefene, Doxapram and Rocuronium (and Sugammadex, if it was not that fuckin' expensive ^^), a bit Amphetamine, an anestheia bag and a reliale and competent friend who does supervision and can, if necessary, inject some stuff or ventilate me (without intubation) for a short period and in worst case, call for other persons.
I can't understand that discussion regarding a µg-scale. Who needs that?? 10mg is enough, actually 100mg - the agent can be solved in liquid, then can be deluted in a number of steps until the concentration meet ones needs. That's how they do it to produce solution for injection at pharmaceutical companies if I'm not wrong.
And then, there are three ways to administer i.v.: With a syringe (manually), by using a "perfusor" (syringe-pump) or as infusion. Especially the latter one is a very safe method, because it's very slow and you can interrupt it from time to time to receive an impression, to check blood pressure, ECG, SpO2, or whatever and you can approach an amount to define/set up a safe framework. You can countercheck that. After effects came to an end, you can start with direct manual injection.
Unfortunately it is fuckin' hard to find a source for Opioids with a potency of 3000 and more. Except for that W-18. And there at least 5g. Well, I would not bother about having more than needed, but it's expensive ^^
By the way, I know it that way: i.v.: 5mg Morphine ~ 50µg Fentanyl ~ 5-10µg Sufentanil ~ 0,7-1µg Carfentanil ~ 0,8-0,9µg Lofentanil ~ 0,8µg W-18 ~ 0,2-0,6µg particular Ohme-Fentanyl-enent.
But very interesting, that numerous vendors stock that - who, apart from extremely passionate and ambitious opioid-enthusiasts would be interested in dealing with that? Since it could also be used to kill or at least endanger a very large amount of people, the imagination, that incompetent persons could get hold of it, is quite scary :-||
Best regards, Fenta
