Mefloquine Stories: Bruce

This Mefloquine Story is from a post made by Canadian veteran Bruce Given. In it he shares a comprehensive history of his life and experiences as someone with chronic quinoline encephalopathy, or quinism. He has joined the ranks of veterans who are advocates for their brothers and sisters in arms and who speak and defend those that cannot do it themselves.

For context I am including the Veteran’s House post that Bruce mentions at the beginning of the post. As usual any editing I have done is to format and not to content. The words written by Bruce are taken directly from the Facebook post.

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This is a follow up to the aforementioned letter in the post from Veterans House Charity. Therefore if you have read it you will understand better as to where & how this summation followed.
I am sharing as it has been suggested that others could benifit from my doing so. So dont shoot the messenger but definately feel free to comment & share your personal experience. Lift & remove the stigma involved.

As I read through the letter posted 23rd December, 2019 I felt a need to personalize my response using it as a guide to relate as to my experience as such with Mefloquine.
I have shared & forwarded the original letter to my personal medical professionals & the veteran community. This needs to be brought forward to any & all concerned from Dr’s to Health Professionals of all sorts including those decision makers within the health system & policy makers like our Members of Parliament.

I am Bruce given. I was administered Mefloquine while on tour in Haiti from March to September 1995. An additional month dosage upon return from the tour made it a 7 straight month for me taking Mefloquine. I experienced symptoms listed on the manufacture’s product monogram black box warning. It still affects me & my family today. The attached letter is asking you to help me in dealing with this Quinism. I retired after a 24 year career with DND & have an infantry background.
The original letter is a lengthy read, however it is hoped that the medical providers providing medical assistance to me & others whether physical or mental treatment will provide a better care and understanding of what it is that I/we are suffering from Quinism & deal with.


I have had the same General practitioner since 2003. I have advised him of my psychological treatments along the route all this time as well including any other treatments. I’m not still convinced that I have convinced him of where it is that I am at because of this neurotoxic drug. I believe this letter is a continued step forward in the right direction to him & others.


Amongst the listed psychological conditions, I also relate to most if not all of them; anxiety, depressed mood, mood swings, agitation, poor frustration tolerance, extremely vivid nightmares, difficulty making decisions, restlessness, confusion, problems with memory and attention, as well as sleep dysfunction.

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I concur with the accompaniment of other non-psychological issues including digestive problems/IBS which was an immediate issue with the Mefloquine (in relation, I just had my 3rd colonoscopy a few weeks ago), dizziness, vertigo, tinnitus & other hearing challenges/hearing aids, vision disturbances/focusing difficulties, sensitivity to noise, sensitivity to light, unsteady gait, migraines/occasionally headaches more so , thermoregulation difficulties/night sweats, swallowing issues/acid re-flux problem, levels of sleep apnea unable to balance the issue with the sleep apnea machine, I can’t keep it on my head long enough to be useful…it’s another thing that sits in a box not being used & not helping with the problem after serious attempts to work with it. I had a quadruple by-pass in 2010 & an additional Stent in 2011. Stress is HUGE!


I’m aware that Mefloquine/Larium did not affect all who took the medication, maybe 10% or so (one is too many & some have taken their life because of it. I also have teetered upon that situation on more than one occasion), & know that it has not affected all in the same manner. The degree to which one may be affected also varies between individuals & the ailments reflecting the poisoning from that drug.


Chronic Issues:


Documentation from DND/DVA confirm that my Chronic Myofacial Pain Syndrome relates to my Neck & Both Shoulder Girdles. This pain is with me all day every & I’m only not in cognizant pain when I’m not conscious. Since my return from that deployment to Haiti I have had to take a digestive pill with each meal for the past 25 years & I gather for the remainder of my lifetime.
Other issues are also chronic & one compounds the other in relation to how my brain & responses to my surroundings/conditions react within myself & to those around me.


Confounding Diagnosis:
I have a diagnosis of PTSD, some of which can be related to OSI from deployments on tour & others in relation to my service in general. I have an infantry background where I believe that exposure to blasts/explosions/transport in armored vehicles etc. which have never been taken into account in relation with Quinism as it hasn’t been a diagnosis as such until recent years. I have never been diagnosed with a TBI as such formally that I can tell. Something that surfaces in this regard are multiples of Mini TBI’s as with the aforementioned of the exposure, use & training in things such as Grenades/Mortars/Karl Gustaf/Heavy Machine Guns/TOW Missiles/Mines & the travel/working relationship to armored vehicles, aircraft whether fixed wing or helicopters. The list of such exposure is huge & varied as was my career.


It’s of interest to note that the screening of past exposure to medications was not apparent to me whether to Mefloquine/Larium or otherwise. I’m not a Dr. & was waiting on medical records. I filed for those medical records through the Library & Archives of Canada (ATIP&PR Section 395 Wellington Street Ottawa, Ontario K1A 0N4) back in October of 2018 & received the disk last week. There were over 700 pages in that documented disk. I found 2 pages that related to my tour in Haiti, (Shy for a lengthy tour I thought) where Mefloquine was mentioned. Bonus as for the acknowledgement where many say they have no records as such, sad. However it is not necessary to prove you have taken Mefloquine if it is on a general record already as to what deployments were issued the drug since 1990 ish. You can still submit to the lawsuit by HSH Lawyers & they will advise you one way or the other. I encourage you to do so.


I have never nor do I personally know anyone who has been part of any study or research into these issues on any national or international scope. I would make myself available for such if able to do so. I have solicited my Dr to look into & advise me of any such studies. If you have been a part of such a thing or know of one up & coming please share that information.


Although I am relating to the veteran side of things, I am also aware that Mefloquine has & is in use with the general population for vacation travel & humanitarian missions around the globe. In the view of vacation travel dosages are of a short-term duration it has been determined that even a single dose of Mefloquine can & does have potential consequences. Be aware! Read & head the warnings labeled. I have been amazed to coincidentally be in contact with professionals outside the military who have taken & can relate to Mefloquine/Larium.

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Courtesy Facebook


Problems with Consistent Primary care & Consistent Medical Records:
I served from 1977 to 2000 in Uniform. An additional time as a civilian employed by DND & a couple of years as a Commissionaire. What I may maintain of my old records is in fact old & prior to my remuster to an Engineering Career. Problems for obtaining any records is a bulk issue with a minimal staff being years behind in fulfilling the request from archives for those records. Still concerned over censorship of those records when I received them.


It has been my fortune to having had a particular Psychological/Psychotherapy Provider who put together much of the associated symptoms which are of medical concerns towards some recovery from those issues. The man was at the end of his varied career that had a huge association with the military, (he practiced on a Base for years), first responders (His son is a Police Officer) & others. With his 40 plus years as a practitioner his knowledge & experience is vast. Thus the advantage of a person educated as such was totally valuable & desirable from a patients perspective. He absolutely helped turn my life around for the better. Thank You Sir!


I’m not sure many providers share in their medical concerns over their psychological treatments with/between other professionals. They are conservative in nature of their profession & limits imposed upon them. That one outstanding Dr. gave me an annual page or two assessment to bring issues to the attention of my General Practitioner which certainly didn’t hurt over the years with either of them. I would like to hear that this is becoming more common place in the way forward for the many rather than the few. I understand there are restrictions & I’m stating responses in a limited manner.


Recommendations for Treatment:
Screening for past use of Quinoline anti-malarial medication use. No recollection of ever having been asked this by any practitioner. The point to note here is that if never having been asked is to be prepared to offer up that detail. Since becoming aware of the details over the recent years many of those blank voids have made more sense now as to how or why certain things transpired as they did then.


What type of screening for TBI is there? Who do we ask in relation to this? What do we need to be believed that this is a potential problem & given the benefit of the doubt to follow through on it? I was shocked to know people in more precarious situations had not been tested either. Brock Blaszczyk told me so just yesterday. He’s famous for having spoke up to the PM at the Town Hall Meeting in Edmonton where the PM said “WE are asking for more than they are able to give”, seriously this should haunt that man forever.


I had an initial assessment for Vestibular issues. This was as it was first sent out that it could be yet another issue to look into & treat the effects as such. I have to say that I was not impressed by the assessment & it’s openness to alternative interpretations. It was far from scientific with instrumentations lacking. Since then I have found that there is a more clinical/scientific measurement of such issues & will be pursuing that avenue. I have also forwarded the original letter in its entirety to them. Following upon that the person seeing/testing & treating me also took Mefloquine for 5 weeks on an African Trip & can relate, wow, the world is shrinking.

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Although I know my mind has some messes within (maybe a lot), I’m not liable to track the situations in a written/diary format. Like all those New Year’s Resolutions we all fall off of after a while this process follows the same relationship to not being able to keep it up over time.


I think I am capable yet to still recall or have some form of documentation to reflect upon for progression in a positive fashion. I’m old school & an old sort of limitations with my own persona to change everything at once or be able to follow up on all I should have/could have/might have done.
I would certainly volunteer for a sleep study. Who does that? Where? How do I get a referral? Perhaps because I was already previously diagnosed with sleep apnea I wouldn’t qualify but there are other sleep issues around those parameters of short & broken sleep, difficulties getting & staying there, night sweats, dreams/nightmares etc.


Referrals to Psychotherapy & Psychology experts is a tough call in so far as who one may be comfortable with is not necessarily the same comfort level with another. I would happily suggest that we all find someone in those professions to be able to find some tools to be able to be more capable to find & work with solutions & tools to deal with the daily/weekly/monthly/yearly issues that hold us back from going forward.


My main point here would be to encourage any & all to link up with a Psychology/Therapist treatment program. The limited number of appointments can be expanded upon by doing the paperwork & substantiating the request. I had intensive therapy with both a Psychiatrist & a Psychologist for some 7 years. I then went without either for another 7 years. At the point of becoming as yet another suicidal statistic I returned to a Psychologist who just happened to save & extend my life & the quality of it. Sadly, he has retired, deservingly, however I have moved on as well & in a better state of mind because of him & the treatments over the years. Regardless if seeing someone at differentiating intervals I think that maintaining some sort of contact with someone as such over the years, if that’s possible, is critical in them being able to professionally make recommendations as to forward progression or what they can view & or gage as a lack thereof.


Having mentioned Substantiation I would like to expand upon where that counts. That is also where our Dr’s have to put more of their emphasis upon the paperwork involved.


Other than checking off the boxes on any particular form a substantiation in the way of a paragraph as opposed to a sentence can convey the requirement to be better understood & assessed as to a necessity rather than a convenience per say to follow through with the request in a positive manner.
I can relate substantiation to this in regards to everything from my dentures, where we as veterans have a 7 year span between replacements as opposed to civilians 5 year span (that extra 2 years is a lot of wear & lack of chewing capability etc.), medications in expanding or reducing quantities (cost measures versus patient needs/improvement), replacement medications which eliminated others, & the ability to see more than one therapist & for more than the limited number of treatments.


Deployment that exposed me to Mefloquine was Haiti in 1995! Known to DND/VAC as UNMIH Op Pivot. Its’s not listed amongst the deployments list in the letter but left open to other deployments from 1992-2007. It was accepted by the Law firm HSH Lawyers & I now have proof from my medical documents that I just received.

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Page 5 is a Neurobehavioral Symptom Inventory (NSI). This is a standard questionnaire amongst the psychological community & I have filled & filed several over the years between different practitioner’s & it’s an ongoing check up on progress or regression. Paperwork is necessary!
Ahead to page 17 it states & I couldn’t agree more that in the absence of medical recognition, veterans, myself included, have experienced considerable frustrations. There have been numerous uplifting moments amongst us that our suspicions to something else being responsible for our conditions not being recognized otherwise are now confirmed. It has filled in several blanks as to what & why we are the way we are.


I knew I came back from Haiti a different person. The problems were much different than the PTSD related conditions of a war-torn country during a war when I had been deployed to Croatia in 92/93 wherein the war was from 1991-1995. I have stated feverishly perhaps that my PTSD symptoms are in fact PTSD & verifiable as such. My emphasis on that does not diminish the renewed emphases on the Mefloquine/Quinism side of things which are also verifiable.


I attributed some of it to the 3rd world conditions there but not all inclusive as to how that was relative. It was around that same year in 1995/96 when the Gulf War Syndrome was headlining the news. I hadn’t just returned from the same theater of conflict but certainly found I could check off the majority of those symptoms as relatable to me personally. Now I know why! I have only been recognizing these symptoms as related there to what’s now becoming more recognizable as Quinism within the past 3-4 years as the advocacy for such has surfaced & grows.


The personal cost has been huge. Divorced the first time after a 24 year marriage, I lost my wife, my kids, my home, my finances, my security, my self-esteem/self-worth, my mind & my soul. I divorced a second time after a 6 year relationship where adding insult to injury I lost anything I had salvaged from the first marriage & invested in the second. I am married yet a 3rd time just within this last year & there remains plenty of difficulties in maintaining that relationship as well. We are however more cognizant as to why & unified on treating the cause.


I’ve had homicidal thoughts in the past but naturally common sense prevailed & they were only thoughts not actions, suicidal thoughts/idealizations came & went & not sure to ever really be totally dismissed, been homeless during second divorce…one of those couch/garage/basement guests, helpless or so I thought for some time, financially ruined/still deep in lawyers debts & emotionally scarred for all of my remaining days.


It always will be a struggle! There is no cure! There are however coping mechanisms. I faced many demons & have more to deal with yet. Health issues & recovery is an ongoing venture with which I still manage to find a reason to continue & while in public try to remain/maintain a normal image within others perceptions as to what normal is.

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I’ll continue to advocate for those of us suffering & those unable to advocate for themselves. We are #inthistogether#strengthinnumbers#Mefloquine#Quinism & so much more!

Sincerely Bruce Given, Sgt.CD1, Retired

When Is A Secret Not A Secret?

The Next 60 Years Of Major David McBride’s Life Are Riding On The Answer

This is an update on the story of Major David McBride, the Australian Legal Officer who leaked documents to the press, and now faces the prospect of spending the rest of his life in prison. Sometime this spring he will appear in court again to set a trial date, which could be a number of months after that.

Until then McBride, who is representing himself, will be working on his defense against one count of theft of commonwealth property, three counts of breaching the defense act, and one count of unauthorized disclosure of information. Because of the nature of the evidence there will be portions of the trial that will be held in a closed court and only those with Top Secret clearance could be in attendance. This greatly limited his choice of counsel since very few attorneys, if any, would meet the now extremely criteria. Therefore, Major McBride will be appearing pro se, as his own counsel and is preparing to vigourously defend himself against the charges.

In Defence Of David McBride

McBride will be asserting an affirmative defense meaning that while he will be admitting to the underlying offense, there were mitigating circumstances that limit his culpability. This could be more commonly known as a justification defense, and McBride had plenty of justification for his actions. In fact it could be argued that he was legally obliged to do what he did, as I will show next.

Exceptions and Defences

Public Interest Disclosure

2.69 The types of disclosure protected by the proposed public interest disclosure
legislation would include, but not be limited to, ‘serious matters’ related to illegal
activity, corruption, maladministration, breach of public trust, scientific misconduct,
wastage of public funds, dangers to public health or safety, dangers to the environment,
official misconduct
(including breaches of codes of conduct) and adverse action
against a person who makes a public interest disclosure.94 A person making a
disclosure would need to have an honest and reasonable belief, on the basis of
information available to them, that the matter concerns ‘disclosable’ conduct under the
legislation.95

Report on Secrecy Laws and Open Government in Australia (2009)
https://fas.org/irp/world/australia/secrecy.pdf

What David McBride claims to have found is evidence of such ‘serious matters’. Given that he is an experienced attorney and Legal Officer he would have excellent knowledge as to what would constitute a ‘serious matter’, and therefore he could be found to meet the standard of having an ‘honest and reasonable belief’ that the matters were in fact disclosable.

Duty To Disclose

In the course of an officer’s functions and duties
7.16 Secrecy provisions commonly allow information to be disclosed in the
performance of a person’s functions and duties as an employee or officer. For example,
the Aboriginal Land Rights (Northern Territory) Act 1976 (Cth) provides that secrecy
provisions do not extend to a person handling information ‘in the performance of the
person’s functions or duties’ under the Act.17

https://fas.org/irp/world/australia/secrecy.pdf

Having had the honest and reasonable belief that the matter was disclosable, it was David McBrides duty as an officer of the court to disclose. He had also made several prior attempts to take the matter the proper authorities only to be told basically ‘you cannot charge the government’. Left with no other alternative, David McBride took the next logical and reasonable action, which was to leak the documents, as he was still bound by his duty as an officer of the court.

2.72 The Standing Committee also considered that it was necessary to protect a
person making a public interest disclosure to third parties—such as the media, a
Member of Parliament, a trade union or a legal adviser—in certain circumstances. The
Standing Committee stated that: experience has shown that internal processes can sometimes fail and people will seek alternative avenues to make their disclosure. There are cases with implications of the utmost seriousness, when disclosure through third parties has been initially necessary and consequently beneficial.
… A public interest disclosure scheme that does not provide a means for such
matters to be brought to light will lack credibility.98

2.74 The Standing Committee’s final recommendation, however, confined protected public interest disclosures to third parties to very narrow circumstances. A disclosure to a third party external to the public service would only be protected where the matter already had been disclosed internally or to an external authority, but had not been acted on in a reasonable time, and the matter threatened immediate serious harm to public health or safety.100

2.75 The recommendation relating to disclosures to third parties has been criticised as being too limited. Brown, for example, has commented that while it is reasonable to require people to proceed through internal channels or external integrity agencies before disclosing a matter publicly, the requirement that the matter must ‘threaten immediate serious harm to public health and safety’ is too restrictive in that it excludes from protection public interest disclosures to the media regarding major fraud, corruption and major abuses of power. Brown also argues that the recommended provision fails to cover the situation in which the external agency does not adequately address a public interest disclosure, so that ‘even if the Ombudsman had looked at the problem and failed to act, or got it wrong, a public servant who justifiably went public could still be sacked, sued or prosecuted’.101

2.76 In a submission to this Inquiry, Brown stated that the proposed approach fails to contemplate what would occur in circumstances where an official had reason to believe not only that their own agency would not respond appropriately to the disclosure, but that the ability of the relevant external integrity agency to respond appropriately had also been corrupted or compromised.102

2.77 Brown suggested that a better approach would be one that protects publicinterest disclosures to persons outside government: 1) where the matter has been disclosed internally to the agency concerned and to an external integrity agency of government, or to an external integrity agency alone, and has not been acted on in a reasonable time having regard to the nature of the matter; or 2) where a matter is exceptionally serious, and special circumstances exist such as to make the prior disclosure of the matter, internally or to an external integrity agency, either impossible or unreasonable (for example, in some circumstances involving a serious and immediate threat to public health or safety).

Report on Secrecy Laws and Open Government
https://fas.org/irp/world/australia/secrecy.pdf

Even if the ‘immediate threat to public health or safety’ provision remains now, McBride could still make this argument in front of a judge.

National Security

611.            For subparagraph 91.1(1)(b)(ii), the prosecution will need to prove that the information or article dealt with by the defendant concerned Australia’s national security.  Consistent with the definition of national security in section 90.4, this could include information or articles relating to:

·          the defence of Australia (paragraphs 90.4(1)(a) and (e) and 90.4(2)(e))

·          Australia’s border protection (paragraph 90.4(1)(c))

·          activities of Australia’s intelligence agencies, including ASIO (subsection 90.4(2)), and

·          Australia’s relationships with other countries (paragraph 90.4(1)(e)).

We do not know the exact number of documents that are in question, that information has not been released. As to the nature of the documents, McBride says that none of them contained information that would be detrimental to Australia’s national security. If anything the documents contained evidence that would prove the government was complicit in wrongdoing or would otherwise be embarrassing to it. If so they would not be subject to classification and as such the documents should be made public.

Government Approval of Wrongdoing

10.5   Lawful authority

A person is not criminally responsible for an offence if the conduct constituting the offence is justified or excused by or under a law.

          (1)  If intention, knowledge or recklessness is a fault element in relation to a physical element of an offence, that fault element must be attributed to a body corporate (the government) that expressly, tacitly or impliedly authorised or permitted the commission of the offence.

             (2)  The means by which such an authorisation or permission may be established include:

                     (a)  proving that the body corporate’s board of directors (in this case the cabinet) intentionally, knowingly or recklessly carried out the relevant conduct, or expressly, tacitly or impliedly authorised or permitted the commission of the offence; or

                     (b)  proving that a high managerial agent of the body corporate (minister) intentionally, knowingly or recklessly engaged in the relevant conduct, or expressly, tacitly or impliedly authorised or permitted the commission of the offence; or

                     (c)  proving that a corporate culture existed within the body corporate (bureaucracy) that directed, encouraged, tolerated or led to non-compliance with the relevant provision; or

                     (d)  proving that the body corporate (bureaucracy) failed to create and maintain a corporate culture that required compliance with the relevant provision.

             (3)  Paragraph (2)(b) does not apply if the body corporate proves that it exercised due diligence to prevent the conduct, or the authorisation or permission.

What this section basically says is that if the government committed a crime and either explicitly or implicitly condoned such action, any documents relating to such action are exempt from being classified material.

David McBride Acted In Good Faith

He is well versed in International Law, in fact he’s one of Australia’s leading attorneys on the subject. Having analyzed the evidence he came to the conclusion that crimes had been committed, and it was his duty as an officer of the court to report it to the proper authorities. Major McBride did so, taking his case to about half a dozen different agencies over a two year span, including the ANP. In every instance the same thing would happen, the agency would review the evidence and concur with McBride’s findings. All refused to pursue the matter telling him “What do you want us to do? You can’t charge the government.”

As is allowed for in law, McBride then leaked the documents to the press. Only after having exhausted all other available options did he take the “Nuclear Option”. David McBride has no agenda and no personal axes to grind. He did not make those decisions lightly and took the action he did out of a sense of patriotism, not malice.

The extent to which government secrecy in Australia has risen is alarming to say the least. Democracy is being hijacked by the Australian government and the ransom is simply too high a price to pay for Australians. They need to be held to account and made aware that the people are watching what they are doing.

Canada is on a similar path at the moment, watching as our government attempts to subvert our legal rights and uses the law as a weapon against its own citizens rather than as a shield to protect them.

Leaders from democratic nations will be keeping a close eye on what happens in Australia. It will give them an idea as to what they will and won’t be able to get away with. I’ll be watching along with people from around the world as well, and we will all be standing firmly behind David McBride.

http://www5.austlii.edu.au/au/legis/cth/consol_act/cca1995115/sch1.html

National Security Legislation Amendment (Espionage and Foreign Interference) Bill 2018

https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fems%2Fr6022_ems_e4d3fac9-e684-40c4-b573-c000e7a32b03%22

Fentanyl: Weapon of Mass Destruction

Two members of my family are gone because of fentanyl, one of the most toxic substances on the planet.

For my little brother, who left us far too soon. I’ll miss you, Ryan.

December 21, 1975 – September 6, 2019

Loves Labor Lost

Calgary Herald September 29th, 2019

This is the first time that I have written anything since I lost my younger brother almost a month ago. He was 43 when he passed away as the result of an accidental overdose of fentanyl, sometime in the early morning hours of September 6th. Like millions of others, my little brother was addicted to drugs and had been for a long time. So great was the internal anguish that he had felt, that turned to narcotics to ease it.

I don’t want him to be defined by the way he died, but rather for the man that he was. He was not perfect, but he was one of the kindest, most generous people that I knew. He was loyal to his friends and family, and had many long-term friendships, some going back well over 30 years. He touched a lot of lives and will be profoundly missed by those of us he leaves behind.

I have learned that in the days leading up to his death he had been talking about entering a long-term rehab facility. He was so very tired of the life he was living and wanted nothing more than to get better, to heal physically, emotionally, and spiritually. On the day he died, he was supposed to get together with one of his good friends and together they would look online for long-term rehab facilities located outside of town.

Last year, one of my cousins lost his life to an accidental overdose of the fentanyl analog carfentanil, a drug 10,000 times stronger than morphine. It is so dangerous that many first responders have had to be hospitalized after coming into contact with a person having an overdose.

I wanted to know more about the poison that has claimed two members of my family, so as always, I started looking for some answers. The information I found in a very short amount of time sent a chill up my spine. Apart from the effect that fentanyl has had on my life personally, it also has significant international relations ramifications. The People’s Republic of China manufactures most, if not all, of the precursor chemicals used to synthesize fentanyl. You should also consider this; synthesized by scientists in a university laboratory in China, there is now a fentanyl analog so lethal, that one teaspoon would kill about as many people as the Great Plague did in Europe in the 14th century.

Opioid or Opiate?

To make the distinction, opiates are those drugs naturally derived from the flowering opium poppy plant (ie morphine, codeine). Opioids are a much broader category and include any substance, natural or synthetic, which binds to the brain’s opioid receptors.

Fentanyl

Fentanyl will probably be the drug most associated with the opioid crisis, even though that distinction belongs to OxyContin, the Purdue Pharma extended release formulation of oxycodone that has the dubious reputation of starting it.

Although it has gained a great deal of attention 0ver the last decade, fentanyl has been around for a lot longer than that. Dr. Paul Jannsen first synthesized it in 1958 under a patent held by his company, Jannsen Pharmaceutica. It is now owned by conglomerate Johnnson & Johnson, who have lost big dollar law suits brought by women claiming Johnson’s Baby Powder caused their ovarian cancer.

It was a powerful analgesic, some 100x more powerful than morphine, and could also be used for anaesthesia. It would hit the market in the 1960. as an IV anaesthetic with the brand name Sublimaze.

Fentanyl Analogs and Derivatives

A chemical analog is a compound that is structurally similar to another compound on a molecular level, but differs from the original compound to some degree. Not long after Sublimaze was released its popularity would lead to the development of a number of fentanyl analogs and derivatives. among which were Sufentanil, Alfentanil, Lofentanil and Remifentanil.

Sufentanil

The strongest analgesic available for human use, it is 5x the strength of fentanyl and 500x stronger than morphine. It is used in hospitals as an analgesic and as an adjunct to anaesthesia under the brand names Dsuvia and Sufenta.

Alfentanil

Alfentanil has a potency that is approximately 10-25% that of fentanyl. It’s onset of action is 4x that of fentanyl but only lasts one-third as long. It is used as a short acting anaesthetic.

Lofentanil

One of the most potent fentanyl analogs, it is most similar to carfentanil.

Remifentanil

Used in a hospital setting, remifentanil is used for sedation, as an anaesthesia adjunct, and as an analgesic, having the brand name Ultiva. It is twice the strength of fentanyl and 200x more powerful than morphine.

Carfentanil

Carfentanil is used as a sedative for large animals under the brand name Wildnil. At 100x the strength of fentanyl, it is 1000x more potent than morphine. It started to appear on the streets a few years ago with deadly results. The estimated lethal dosage in humans is 50 micrograms. By comparison, a poppy seed weighs approximately 300 micrograms.

Image result for carfentanil lethal dose
Comparison of the lethal doses of heroin, fentanyl, and carfentanil.
Image result for fentanyl lethal dose comparison
A lethal dose of fentanyl for the average adult (2mg)

Ohmefentanyl – The most potent and deadly fentanyl analog

If You Think Fentanyl Is Bad…

https://www.acsh.org/news/2017/01/17/if-you-think-fentanyl-bad-10663

Ohmefentanyl was first synthesized in the early 1970’s by scientists in a lab at the Chinese Academy of Sciences in Guangzhou, China. More than 6,000x stronger than morphine, it is so potent that one ounce of ohmefentanyl is enough to kill 175 MILLION people. That being said it is far more complex to synthesize ohmefentanyl than it is to synthesize fentanyl. The process involves more equipment and additional precursors and solvents and, because it is so toxic, it is extremely hazardous to manufacture and can only be handled safely using protective equipment.

Synthesis and analgesic activity of stereoisomers of cis -fluoro-ohmefentanyl

https://www.academia.edu/8863856/Synthesis_and_analgesic_activity_of_stereoisomers_of_cis-fluoro-ohmefentanyl

Fentanyl Precursor Chemicals

Image result for 4-anilinopiperidine
Pharmaceutical Grade 4-Anilinopiperidine (hydrochloride) for sale online from a Chinese manufacturer. This one is capable of producing 5,000kg of this compound every month.

DEA proposes to control three precursor chemicals used to illicitly manufacture deadly fentanyl

https://www.dea.gov/press-releases/2019/09/17/dea-proposes-control-three-precursor-chemicals-used-illicitly-manufacture

Fentanyl is synthesized using ingredients known as precursors. These precursor chemicals are sold by manufacturers in China, who make tens of thousands of such compounds. These compounds include things such as food additives, veterinary products, pesticides, and the precursor chemicals used to synthesize pharmaceutical drugs, including fentanyl.

The vast majority of the precursors used in the synthesis of fentanyl are sent to Mexico, where most of the illict fentanyl in the US is made. It takes a trained chemist to synthesize fentanyl from scratch, something the Mexican cartels do not have. But, it is easier to make fentanyl using bulk supplies of the precursor chemicals, which is what the cartels do.

On September 17th of this year the DEA announced that it was putting forth a proposal to control three of the precursor chemicals needed to synthesize fentanyl. It’s difficult to say what effect if any this will have since the vast majority of illicit fentanyl is made in Mexico.

The take-home message here is that there are millions of fentanyl analogs that can be made from commercially available chemicals. It is all but certain that many of them will have fentanyl-like properties and that some of these will make even the most powerful analogs today, such as carfentanil and sufentanil, seem like cotton candy. 

Organic Chemistry Can Defeat Any Fentanyl Agreement
By Josh Bloom — December 5, 2018
https://www.acsh.org/news/2018/12/05/organic-chemistry-can-defeat-any-fentanyl-agreement-13645

It just isn’t realistic to think that treaties or international law will end the production and distribution of these precursor compounds. There is simply no easy or effective way of enforcing international agreements amongst sovereign nations. Just look at the current state of international relations.

One way or another these chemicals will continue to be manufactured, the genie cannot be put back into the bottle. The fact also remains that scientists, primarily in The People’s Republic of China, will continue to attempt to synthesize something even stronger.

“NPP is a sensitive products. Why you buy it?” one Yuancheng saleswoman asked me on Skype, before the product was scheduled in China. “I know many people buy it. But I don’t know what it is used for.”

I explained that it was used to make fentanyl.

“I know fentanyl,” she continued, “but why people use it? We Chinese don’t use it.”

It’s highly addictive, I said.

“Yes, I know it is a bad products to person,” the saleswoman admitted, “but I still sell it, so sometimes I feel guilt. NPP is not forbidden in China, so we can sell. I sell it, because I want earn money, earn a living.”

The Brazen Way a Chinese Company Pumped Fentanyl Ingredients Into the U.S. BEN WESTHOFF
https://www.theatlantic.com/health/archive/2019/08/chinese-company-helping-fuel-opioid-epidemic/596254/

While the DEA proposed making regulatory changes in their announcement of September 17th, similar regulatory changes in Canada came in to effect on May 6th, 2019, when they were registered in the Canada Gazette.

Government of Canada changes regulations to help prevent illegal production and trafficking of controlled substances

https://www.canada.ca/en/health-canada/news/2019/05/government-of-canada-changes-regulations-to-help-prevent-illegal-production-and-trafficking-of-controlled-substances.html

Canada Gazette, Part II, Volume 153, Number 10

http://gazette.gc.ca/rp-pr/p2/2019/2019-05-15/html/sor-dors120-eng.html

Weaponizing Fentanyl

Image result for chemical weapons symbols
The international symbols for radiological, biological, and chemical hazards.

With such an extremely high potency, compounds like ohmefentanyl are simply not practical, or safe, for use as an analgesic in human beings. The only logical reason for synthesizing ohmefentanyl would be to use it as a weapon of mass destruction. Granted it would take a huge effort to weaponize it and come up with an effective delivery system, but it is still a distinct possibility.

In May of 2018, the US Environmental Protection Agency (EPA) issued a fact sheet for Federal EPA On Scene Coordinators who respond to any incidents of environmental contamination by fentanyl or its analogs. It is a comprehensive 11 page document, and some of the information contained in it caught my attention. It includes a list of the possible exposure pathways, in other words, the ways that fentanyl could be spread to a population. These include open areas, water/water systems, indoor facilities, and food.

Fact Sheet for OSCs: Version 1.0 05/22/2018 Fentanyl and Fentanyl Analogs

Open Areas: While fentanyl is a solid powder at room temperature, it poses an inhalation or incidental ingestion exposure threat if sufficient powder becomes airborne. Fentanyl can also be dissolved in solvents and fentanyl citrate is soluble in water, which allows exposure in aerosol form. The literature indicates that police officers showed symptoms of opiate exposure after police activities created fentanyl dust/aerosol or when they worked in dusty areas.

Water/Water Systems: Fentanyl in liquid solution creates a possible dermal exposure pathway and is commonly used in many medicinal forms of fentanyl. Literature reviews indicate that aqueous fentanyl may be found as an illicit drug in intravenous form, nasal sprays, eye drops, and vape pen liquids. While fentanyl could enter natural waters or a water system, neither is a likely exposure pathway.

Indoor Facility: Fentanyl could potentially be dispersed as solid particulates or liquid spray (aerosol) inside a building or facility; HVAC systems may be affected. Fentanyl particulates are heavier (less buoyant) than air and will accumulate on lower levels and in utility corridors and/or deposit on surfaces inside a building.

Food: While food is an unlikely exposure pathway, fentanyl can be released as a fine dust or aerosol that may contaminate food.

https://www.epa.gov/sites/production/files/2018-07/documents/fentanyl_fact_sheet_ver_7-26-18.pdf

Before anyone accuses me of giving terrorists and lunatics a great new idea, it is more than likely that someone has already come up with the idea and so have the security agencies that protect us. At least they should have anyway.

It now clearer than ever to me that the only way to eliminate the threat posed by fentanyl and its analogs, aside from banning its production, would be to have it classified as a chemical weapon, and heavily restrict its production and distribution as well as the production and distribution of its precursor chemicals.

The Startling Numbers

This will never happen, it simply isn’t a realistic expectation for a number of reasons. In the meantime, until someone can come up with a workable solution to counter this plague, the number of people killed by fentanyl will continue to rise.

Deaths

Here in Alberta the statistics are alarming to say the least. In 2016 out of 803 drug and alcohol poisoning deaths 43% (347) were attributed to fentanyl or its analogs. In 2017 it had increased to 59% (565/951) and in 2018 fentanyl constituted 63% of overdose deaths (622/985).

Of these overdoses 80% involved fentanyl mixed other drugs. 50% involved methamphetamine, 25% cocaine, and 5% heroin. Drug dealers will add fentanyl to other drugs in order to increase their profitability, and as a means of attracting and retaining customers. What usually results however is that their customers wind up dead.

https://open.alberta.ca/dataset/f4b74c38-88cb-41ed-aa6f-32db93c7c391/resource/c23b895d-1922-4d73-86dc-ce170d0a07b3/download/health-alberta-opioid-response-surveillance-report-2019-q2.pdf

Nationally the number is even higher. In 2016 total number of overdose deaths in Canada was 3023, of which 50% were from fentanyl or its analogs. In 2017 it rose to 67% (4120) and was 73% in 2018 (4588). In the first three months of 2019 it was 79%.

The number of overdose deaths increased sharply as well, up 36% from 2016 to 2017 and up 11% from 2017 to 2018.

https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html#fentanyl

Dollars

Trafficking in fentanyl is a very lucrative business. In fact, it is the most lucrative illicit narcotic currently sold. In 2017, 1 KG of pure fentanyl could be purchased for $4,150. That 1 KG could potentially generate $1,600,000 in revenue for the trafficker, a profit of over 38,000%

By comparison, traffickers will only realize a 1,300% profit off of heroin, or $80,000 in revenue from 1KG of heroin purchased for $6,000.

Fentanyl profitability in the US compared to heroin.

https://www.statista.com/statistics/777882/fentanyl-profitability-in-us-compared-to-heroin/

No Easy Fix

It has been more than a decade since media articles began reporting on what was then called an opioid epidemic, and is now referred to as the “opioid crisis”. In North America, fentanyl has become a threat to public safety unlike any illicit drug before, more than heroin, cocaine, or methamphetamine. It is the most potent and most addictive narcotic there is which also makes it the most dangerous.

Putting an end to this crisis will require action on the part of several governments. There is an ever growing population of opioid addicts who require immediate intervention, but there is currently a critical shortage of treatment facilities. Adding the extra capacity would require taxpayer funding, which would then make it a political issue, and politicians are loathe to spend money on projects from which they will recieve no benefit.

There also needs to be the political will to implement a different strategy to combat the problem. At the moment, efforts are geared more towards harm reduction for addicts. Some jurisdictions have opened safe injection sites, where addicts can do their drugs in a sterile environment and with medical intervention available in the event of an overdose.

There is also a segment of the population who believes that the legalization and regulation of all illicit narcotics is the solution. Many will cite Portugal as an example of success.

Portugal

Portugal in the late 1990’s was dealing with a drug crisis of its own. One percent of its population, 100,000 people, were heroin users and on average more than 350 people a year were dying from a drug overdose. In the early 2000’s, Portugal overhauled its drug laws, decriminalizing small amounts of narcotics for personal use.

The number of overdose deaths has since plummeted, though this is not as a direct result of decriminalization. The Portuguese also recognized that it wasn’t enough to simply decriminalize illicit drugs, they also provided the means for addicts to access treatment, and assisted them as they reintegrated back into society.

If police find you with illicit drugs, you’ll be arrested and taken to a police station where the drugs will be weighed. If the amount is above the strictly enforced threshold limits — designed to be a 10-day supply for personal use, or 25 grams of cannabis, five grams of cannabis resin, two grams of cocaine, or one gram each of ecstasy or heroin — you can be charged as a trafficker. If convicted, jail terms range from one year to 14 years.

If the amount is below the limit, you’ll be sent the following day to the Commission for the Dissuasion of Drug Addiction — even if you’re a tourist. There, you will be interviewed by a psychologist or social worker before appearing before a three-person panel that will offer suggestions aimed at stopping your drug use.

From there, you’re fast-tracked to whatever services you’re willing to accept. If you refuse help, you can be asked to do community service or even, eventually, facing a fine, perhaps even having possessions confiscated and sold to pay the fine.

It’s why Goulão is so quick to point out that Portugal’s success isn’t because of decriminalization. It’s because, in 2001, his country made a commitment to providing whatever its citizens need to be as healthy and as fully engaged in society as possible.

“Decriminalization is not a silver bullet,” he said. “If you decriminalize and do nothing else, things will get worse.

“The most important part was making treatment available to everybody who needed it for free. This was our first goal.”

DAPHNE BRAMHAM 
Daphne Bramham: Decriminalization is no silver bullet, says Portugal’s drug czar
https://vancouversun.com/opinion/columnists/daphne-bramham-decriminalization-is-no-silver-bullet-says-portugals-drug-czar

China: Point of Origin

The precursor chemicals used to synthesize fentanyl and its analogs are manufactured in The People’s Republic of China, and the government places no restrictions on their production or shipping. For the manufacturers the only concern is that they sell their product and make a profit on it, without regard for its end use or the ensuing consequences it may bring. There is also very little likelihood that the Chinese will place any restrictions on the manufacture and distribution of these chemicals, and very little that anyone can do about it. In and of themselves they are not dangerous and do not pose a threat

When I analyze this through the lens of International Relations, I come to some conclusions that many will no doubt disagree with. I may even be labeled as paranoid or a conspiracy theorist, but I will leave it to you to draw your own conclusions.

Strategically speaking it is to China’s benefit that these chemicals be used to synthesize fentanyl. The economic benefit to China is relatively small compared to the strategic benefit. A rapid and dramatic increase in the number of drug addicts within a society will act as a destabilizing force within it, draining resources that could be better used elsewhere.

The Chinese have also lead the way in the synthesis of the most potent and deadly fentanyl analogs, with the potential ability to kill tens of millions of people. There are no conventions banning the research and development of synthetic opioid drugs like there are for chemical weapons or other WMD. Yes, I know that it would be very difficult, and that it would need the proper vehicle for delivery in order to be effective. How are we to know that one hasn’t already been developed, or is being worked on now? Theoretically, they could have already produced enough ohmefentanyl to wipe out half the population of the continental United States. This has the potential to weigh heavily on the global balance of power.

Australia

According to Drug and Alcohol Research Connections, a free, bi-monthly newsletter published jointly by three of Australia’s leading drug and alcohol research centres, a 2017 study found that although the number of fentanyl related overdoses is relatively small compared to North America, the number is growing year after year. It is likely only a matter of time before this crisis is visited upon Australia and other countries across the globe.

A nationwide study of the extent and factors associated with fentanyl use in Australia

http://connections.edu.au/publicationhighlight/nationwide-study-extent-and-factors-associated-fentanyl-use-australia

Share This Information

There are no quick and easy fixes to be found here, and people are going to continue dying in ever growing numbers. Individually there isn’t much that any of us can do either, it is something that must be dealt with on a governmental level and frankly, this gives me little hope that a solution will be found any time soon.

A lot of people will die that didn’t have to, people like my brother, and my heart breaks for the families and loved ones that will be left behind. Share this information with the people you know so that as many people as possible are aware of just how very bad the situation is. It is possible that it might one day save a life, perhaps the life of some one you know and love.

The 11 Year “Pilot Project” That Has Wasted Over $750,000

Tomkins Park public washroom nothing more than city’s “unsafe injection site”.

Over the course of the last month or so I have wandered all over the downtown area taking photos. It has served as a means of helping me deal with the recent loss of my brother, giving me an outlet to focus on creatively.

The other night I went down 17th Avenue, long a trendy spot for bars and restaurants and home to the famous “Red Mile”. It was lit up for the season, and the streets were open following the interminable months of construction that local businesses had to endure. There are a number of new bars and eateries and it is one of THE places to go if you ever visit Calgary. I recommend parking somewhere along the avenue and walking it, since you can’t get the full flavor of the area driving through it.

I started at 14th Street and would make my way towards 4th Street. Tomkins Park is a pleasant green space at 17th Avenue and 14th Street with benches, trees, and a small grandstand. Things that one would expect to see in a public park. At the far east end of the park is a structure that went up in 2008, a new shiny self-cleaning public toilet. It was to be part of a Public Toilet Pilot Program.

It would come at an initial cost of $200,000, something which raised more than a few eyebrows at the time. It would be completely automated, and people would have a time limit to adhere to. Go over the 10 minute mark and lights would flash and it would emit a loud beeping sound. Surely this would keep the nogoodniks out of the shiny new biffy. It was to be modeled after those in some European cities, at a time when Calgary seemed to be going through an identity crisis of sorts.

We would become like the European cities that some in administration wanted us to look like. There was a general consensus that we simply didn’t have enough public toilets. Now, this was also in the days before the streets of San Francisco had turned into the worlds largest toilet, and it’s not like we were hip deep in crap here or anything. But, we asolutely had to have it.

I wanted to take a couple pictures inside since the light on the outside said it was empty, but it was otherwise occupied by someone who was in the process of shooting heroin into their veins. The stench that came out told me I probably wouldn’t have lasted long enough in there to take one picture without wanting to be sick. I didn’t bother to hang around to wait for him to get out.

$50,000 is spent annually to maintain this “public facility”, which let’s face it is more an “unsafe injection site” than a public toilet. Over the course of over a decade taxpayers have forked out nearly three-quarters of a million dollars, and there is no end in sight for this. It’s at the “being looked at” phase within the machinations of the municipal bureaucracy at the moment, so it may well eat up another hundred grand in expenses before a decision is finally rendered.

This city is in desperate need of leadership at this moment because right now there is none. The mayor and many of his council colleagues have hijacked city council’s ability to get anything done. I may not have cared for the policies of previous mayors like Dave Bronconnier or Al Duerr, but they could at least run a council meeting and knew how to work to get things done.

It’s like this; I spoke with a retired widow on a fixed income and this year despite the fact that her property decreased in value she will see a whopping seven and a half percent hike in her property taxes. Not to mention the other increased fees and levies that will be imposed upon her and other Calgarians.

It somehow seems ironic whenever a toilet stands testament to the waste and incompetence of an administration. Maybe instead I’ll have a nice bronze plaque made to commemmorate the latest piece of public art, entitled “Council”.

Here’s your legacy Mayor Nenshi. It isn’t the Olympics you wanted, but at least it’s something.

Failure In Afghanistan Lies At The Feet Of Politicians Not Soldiers

Designating the mission a failure diminishes the sacrifices Canadians made.

In response to Scott Gilmore’s Dec.11, 2019 MacLean’s Magazine Op/Ed

It really comes as no surprise to me that Canada’s military expedition into Afghanistan is being labeled as an abject failure in our press, and for a couple of reasons. First, it’s what is being said in nations around the world. Every country that has sent troops into Afghanistan over the past 18 or so years is calling it a failure, it isn’t just here in Canada.

The second reason has more to do with the way the public percieves things. Joe Average sees it as a waste of time and money, billions were spent and things really aren’t that much different than they were 20 years ago. “What did our troops accomplish in Afghanistan?” is generally the guage by which people will judge the success of this mission, and when they can’t readily see anything it will be labeled a failure.

It is a huge disservice to the 158 Canadian soldiers who gave their lives in Afghanistan. It makes it seem as though these prople died in vain, but they did not. They died while serving their country with honour and for that they are deserving of our greatest respect.

Image result for canada afghanistan

Don’t equate the politicians with the warriors.

When the decision is made to go to war it is typically done by those who will not have to do any of the actual fighting. Politicians leave this to the military which, as well as providing for the self-defense of their nation, is also a means of conducting its foreign policy. The reasons for going to battle are often more political than strategic in nature.

It is the soldier’s job to perform the task assigned to them, and in Afghanistan Canadian troops performed admirably with bravery and honour. They were well trained and, for the most part, they were well led on the ground. They weren’t always so well equipped, something that falls on the shoulders of the bureaucrats and paper officers within the confines of NDHQ in Ottawa. Nevertheless, the Canadians that were there once again proved that, pound for pound, the Canadian soldier is one of the best in the world. Well trained, highly motivated, and most of all, Canadian.

https://thediplomat.com/2017/06/why-is-afghanistan-the-graveyard-of-empires/

At first our mission was clear: hunt down and eliminate Osama Bin Laden. This is something that Canadian troops under the command of then Lt.Col. Pat Stogran came very close to accomplishing in the mountains of Tora Bora. Bin Laden was able to make an escape into Pakistan and we all know how that would ultimately turn out for him.

After that the focus shifted to defeating the Taliban and doing some nation building. Noble ideas, but in the most practical sense quite unrealistic. For centuries foreign armies have marched into Afghanistan and for the most part have had their asses handed to them. For a number of reasons, Afghanistan is a country that is extremely difficult to conquer and hold. For one thing the mountainous terrain provides an excellent defense, inhibiting troop movements and providing the locals with plenty of opportunities to perform ambush attacks.

The tribal nature of a large part of its society, along with the fact that nearly every male over the age of 15 carries an automatic rifle, adds to the quagmire. It can be very difficult to discern friend from foe at times, and allegiances can switch easily and with frequency. They can and will fight amongst themselves but can also unite to fight a common enemy when the need arises.

Wars aren’t like they used to be.

In World War II, victory was attained when the Nazi’s and the Japanese were defeated. Allied forces inflicted such devastation upon these regimes that there was no question that they had lost. By and large the populations of Germany and Japan had accepted this fact whether they liked it or not. It was unequivocal. It was clearly a case of good versus evil that the folks back home were ready to accept.

Things started to change during the Cold War however, when we started going to war with an ideology, communism. It was still a battle of good versus evil, only now it was more nuanced. Western troops had begun to be seen as foreign invaders by many and popular support at home for these conflicts didn’t rise to the levels seen in World War II.

I actually miss the Cold War

Ome day, back in 2003, I can remember sitting around the kitchen table with several of my inlaws discussing the events of the day. As the talk turned to events in the Middle East and the hunt for al Qaeda and its leaders I came to realize something. During the Cold War the world was a very dangerous place, what with the total stockpiles of nuclear arms globally more than enough to blow the world up several times over. There were even times, many unbeknownst to us, when the world very nearly did come to an end.

Yet I found myself feeling safer and more secure then. It was much simpler times. We had the reassurances of MADD and the nuclear weapons of the world were by and large accounted for in the hands of rational actors. Not so today, where non-state actors are the ones that we must now battle.

It is worth remembering that many of the conflicts we are fighting, and to come, will not be fought against other nations, but against groups like the Taliban, the Islamic State, and al Qaeda. It is not as easy to define the victories and the defeats as when you fight against a national army.

So before anybody begins to declare victory or defeat in this age, they had better keep this in mind before making their pronouncements. Just saying.

Fentanil: arma di distruzione di massa

Due membri della mia famiglia se ne sono andati a causa del fentanil, una delle sostanze più tossiche del pianeta.

Per il mio fratellino, che ci ha lasciato troppo presto. Mi mancherai, Ryan.

21 dicembre 1975 – 6 settembre 2019

Ama il lavoro perduto

Fentanil è responsabile della percentuale record di decessi da oppiacei dell’Alberta, secondo un rapporto.

Calgary Herald September 29th, 2019

Questa è la prima volta che scrivo qualcosa da quando ho perso mio fratello minore quasi un mese fa. Aveva 43 anni quando è deceduto a causa di un sovradosaggio accidentale di fentanil, a volte nelle prime ore del mattino del 6 settembre. Come milioni di altri, il mio fratellino era dipendente dalle droghe ed era stato per molto tempo. Era così grande l’angoscia interna che aveva provato, che si era rivolta ai narcotici per alleviarlo.

Non voglio che sia definito dal modo in cui è morto, ma piuttosto per l’uomo che era. Non era perfetto, ma era una delle persone più gentili e generose che io conoscessi. Era fedele ai suoi amici e alla sua famiglia e aveva molte amicizie a lungo termine, alcune risalenti a oltre 30 anni fa. Ha toccato molte vite e ci mancherà profondamente da quelli di noi che si lascia alle spalle.

Ho imparato che nei giorni precedenti la sua morte aveva parlato di entrare in una struttura di riabilitazione a lungo termine. Era così stanco della vita che stava vivendo e non voleva altro che guarire, guarire fisicamente, emotivamente e spiritualmente. Il giorno della sua morte, avrebbe dovuto incontrarsi con uno dei suoi buoni amici e insieme avrebbero cercato online strutture di riabilitazione a lungo termine situate fuori città.

L’anno scorso, uno dei miei cugini si è tolto la vita con un sovradosaggio di carfentanil analogo di fentanil, un farmaco 10.000 volte più forte della morfina. È così pericoloso che molti primi soccorritori hanno dovuto essere ricoverati in ospedale dopo essere entrati in contatto con una persona che aveva un sovradosaggio.

Volevo saperne di più sul veleno che ha provocato due membri della mia famiglia, quindi come sempre ho iniziato a cercare alcune risposte. Le informazioni che ho trovato in brevissimo tempo mi hanno raffreddato la schiena. A parte l’effetto che il fentanil ha avuto sulla mia vita personalmente, ha anche importanti implicazioni nelle relazioni internazionali. La Repubblica popolare cinese produce la maggior parte, se non tutte, delle sostanze chimiche precursori utilizzate per sintetizzare il fentanil. Dovresti anche considerare questo; sintetizzato dagli scienziati in un laboratorio universitario in Cina, ora esiste un analogo del fentanil così letale, che un cucchiaino ucciderebbe circa quante persone ha fatto la Grande Peste in Europa nel 14 ° secolo.

Oppioidi o oppiacei?

Per fare la distinzione, gli oppiacei sono quei farmaci naturalmente derivati dalla fioritura della pianta di papavero da oppio (cioè morfina, codeina). Gli oppioidi sono una categoria molto più ampia e comprendono qualsiasi sostanza, naturale o sintetica, che si lega ai recettori degli oppioidi del cervello.

Fentanyl

Il fentanil sarà probabilmente il farmaco più associato alla crisi degli oppioidi, anche se questa distinzione appartiene a OxyContin, la formulazione a rilascio prolungato di ossicodone di Purdue Pharma che ha la dubbia reputazione di avviarlo.

Sebbene abbia guadagnato molta attenzione negli ultimi dieci anni, il fentanil è in circolazione da molto più tempo. Il Dr. Paul Jannsen lo sintetizzò per la prima volta nel 1958 con un brevetto detenuto dalla sua società, Jannsen Pharmaceutica. Ora è di proprietà del conglomerato Johnnson & Johnson, che ha perso ingenti cause legali promosse da donne che affermano che la polvere per bambini di Johnson ha causato il loro cancro alle ovaie.

Era un potente analgesico, circa 100 volte più potente della morfina e poteva anche essere usato per l’anestesia. Sarebbe arrivato sul mercato nel 1960. come anestetico IV con il marchio Sublimaze.

Fentanil Analoghi e derivati

Un analogo chimico è un composto che è strutturalmente simile a un altro composto a livello molecolare, ma differisce dal composto originale in una certa misura. Non molto tempo dopo il rilascio di Sublimaze, la sua popolarità avrebbe portato allo sviluppo di numerosi analoghi e derivati del fentanil. tra cui Sufentanil, Alfentanil, Lofentanil e Remifentanil.

Sufentanil

L’analgesico più potente disponibile per l’uso umano, è 5 volte più forte del fentanil e 500 volte più forte della morfina. È usato negli ospedali come analgesico e in aggiunta all’anestesia con i marchi Dsuvia e Sufenta.

Alfentanil

Alfentanil ha una potenza che è circa il 10-25% di quella del fentanil. L’inizio dell’azione è 4 volte quello del fentanil ma dura solo un terzo del tempo. È usato come anestetico a breve durata d’azione.

Lofentanil

Uno dei più potenti analoghi del fentanil, è molto simile al carfentanil.

Remifentanil

Utilizzato in ambito ospedaliero, remifentanil viene utilizzato per la sedazione, come aggiunta di anestesia e come analgesico, con il marchio Ultiva. È due volte più potente del fentanil e 200 volte più potente della morfina.

Carfentanil

Carfentanil è usato come sedativo per animali di grossa taglia con il marchio Wildnil. A 100 volte la forza del fentanil, è 1000 volte più potente della morfina. Ha iniziato ad apparire per strada alcuni anni fa con risultati mortali. Il dosaggio letale stimato nell’uomo è di 50 microgrammi. In confronto, un seme di papavero pesa circa 300 microgrammi.

Image result for carfentanil lethal dose
Confronto delle dosi letali di eroina, fentanil e carfentanil.
Image result for fentanyl lethal dose comparison
Una dose letale di fentanil per l’adulto medio (2 mg)

Ohmefentanil – L’analogo fentanil più potente e mortale

L’Omefentanil fu sintetizzato per la prima volta nei primi anni ’70 dagli scienziati in un laboratorio dell’Accademia cinese delle scienze di Guangzhou, in Cina. Più di 6000 volte più forte della morfina, è così potente che un’oncia di ohmefentanil è sufficiente per uccidere 175 MILIONI di persone. Detto questo, è molto più complesso sintetizzare ohmefentanil che sintetizzare il fentanil. Il processo coinvolge più apparecchiature, precursori e solventi aggiuntivi e, poiché è così tossico, è estremamente pericoloso da produrre e può essere manipolato in sicurezza solo utilizzando dispositivi di protezione.

Sintesi e attività analgesica degli stereoisomeri del cis -fluoro-ohmefentanil

https://www.academia.edu/8863856/Synthesis_and_analgesic_activity_of_stereoisomers_of_cis-fluoro-ohmefentanyl

Prodotti chimici precursori del fentanil

Image result for 4-anilinopiperidine
Grado farmaceutico 4-Anilinopiperidina (cloridrato) in vendita online da un produttore cinese. Questo è in grado di produrre 5.000 kg di questo composto ogni mese.

La DEA propone di controllare tre precursori chimici usati per produrre illecitamente fentanil letale

https://www.dea.gov/press-releases/2019/09/17/dea-proposes-control-three-precursor-chemicals-used-illicitly-manufacture

Il fentanil viene sintetizzato utilizzando ingredienti noti come precursori. Questi prodotti chimici precursori sono venduti dai produttori cinesi, che producono decine di migliaia di tali composti. Questi composti includono elementi come additivi alimentari, prodotti veterinari, pesticidi e precursori chimici usati per sintetizzare farmaci, incluso il fentanil.

La stragrande maggioranza dei precursori utilizzati nella sintesi del fentanil viene inviata in Messico, dove viene prodotta la maggior parte del flicanil illict negli Stati Uniti. Ci vuole un chimico esperto per sintetizzare il fentanil da zero, qualcosa che i cartelli messicani non hanno. Tuttavia, è più facile produrre il fentanil usando grandi quantità di prodotti chimici precursori, che è ciò che fanno i cartelli.

Il 17 settembre di quest’anno, la DEA ha annunciato che stava presentando una proposta per controllare tre dei precursori chimici necessari per sintetizzare il fentanil. È difficile dire quale effetto avrà questo dato che la stragrande maggioranza del fentanil illecito è prodotta in Messico.

Il messaggio da portare a casa qui è che ci sono milioni di analoghi del fentanil che possono essere fatti da sostanze chimiche disponibili in commercio. È quasi certo che molti di loro avranno proprietà simili al fentanil e che alcuni di questi faranno sembrare persino gli zucchero filati anche gli analoghi più potenti oggi, come il carfentanil e il sufentanil.

La chimica organica può sconfiggere qualsiasi accordo di fentanil
Di Josh Bloom – 5 dicembre 2018
https://www.acsh.org/news/2018/12/05/organic-chemistry-can-defeat-any-fentanyl-agreement-13645

Non è realistico pensare che i trattati o il diritto internazionale porranno fine alla produzione e alla distribuzione di questi composti precursori. Semplicemente non esiste un modo semplice o efficace per far rispettare gli accordi internazionali tra le nazioni sovrane. Guarda lo stato attuale delle relazioni internazionali.

In un modo o nell’altro questi prodotti chimici continueranno a essere prodotti, il genio non può essere rimesso nella bottiglia. Resta anche il fatto che gli scienziati, principalmente nella Repubblica popolare cinese, continueranno a tentare di sintetizzare qualcosa di ancora più forte.

“La NPP è un prodotto sensibile. Perché lo compri? ”Mi ha chiesto una commessa Yuancheng su Skype, prima che il prodotto fosse programmato in Cina. “So che molte persone lo acquistano. Ma non so a cosa serve. “

Ho spiegato che era usato per fare il fentanil.

“Conosco il fentanil”, ha continuato, “ma perché la gente lo usa? Noi cinesi non lo usiamo. ”

È molto avvincente, ho detto.

“Sì, lo so che è un brutto prodotto per persona”, ha ammesso la commessa, “ma lo vendo ancora, quindi a volte mi sento in colpa. La centrale nucleare non è vietata in Cina, quindi possiamo vendere. Lo vendo, perché voglio guadagnare soldi, guadagnarmi da vivere. ”

il modo sfacciato che un’azienda cinese ha pompato ingredienti di fentanil negli Stati Uniti
https://www.theatlantic.com/health/archive/2019/08/chinese-company-helping-fuel-opioid-epidemic/596254/

Mentre la DEA ha proposto di apportare modifiche normative nel loro annuncio del 17 settembre, simili modifiche normative in Canada sono entrate in vigore il 6 maggio 2019, quando sono state registrate nella Gazzetta ufficiale del Canada.

Il governo del Canada modifica le normative per aiutare a prevenire la produzione illegale e il traffico di sostanze controllate

https://www.canada.ca/en/health-canada/news/2019/05/government-of-canada-changes-regulations-to-help-prevent-illegal-production-and-trafficking-of-controlled-substances.html

Gazette canadese, parte II, volume 153, numero 10

http://gazette.gc.ca/rp-pr/p2/2019/2019-05-15/html/sor-dors120-eng.html

Fentanil Armonizzante

Image result for chemical weapons symbols

Con una potenza così elevata, composti come l’omeme-fentanil non sono semplicemente pratici o sicuri per l’uso come analgesici negli esseri umani. L’unica ragione logica per sintetizzare ohmefentanil sarebbe usarlo come arma di distruzione di massa. Concesso, ci vorrebbe uno sforzo enorme per armarlo e trovare un sistema di consegna efficace, ma è ancora una possibilità distinta.

Nel maggio del 2018, la US Environmental Protection Agency (EPA) ha pubblicato una scheda informativa per i coordinatori federali EPA On Scene che rispondono a qualsiasi incidente di contaminazione ambientale da parte del fentanil o dei suoi analoghi. È un documento completo di 11 pagine e alcune delle informazioni in esso contenute hanno attirato la mia attenzione. Include un elenco dei possibili percorsi di esposizione, in altre parole, i modi in cui il fentanil potrebbe essere diffuso a una popolazione. Questi includono aree aperte, sistemi acqua / acqua, strutture interne e cibo.

Scheda informativa per OSC: versione 1.0 22/05/2018 Analoghi di Fentanyl e Fentanyl

Aree aperte: sebbene il fentanil sia una polvere solida a temperatura ambiente, rappresenta una minaccia di esposizione per inalazione o ingestione accidentale se una polvere sufficiente viene dispersa nell’aria. Il fentanil può anche essere disciolto in solventi e il fentanil citrato è solubile in acqua, il che consente l’esposizione in forma di aerosol. La letteratura indica che gli agenti di polizia hanno mostrato sintomi di esposizione agli oppiacei dopo che le attività di polizia hanno creato polvere di fentanil / aerosol o quando hanno lavorato in aree polverose.

Sistemi acqua / acqua: il fentanil in soluzione liquida crea una possibile via di esposizione cutanea ed è comunemente usato in molte forme medicinali di fentanil. Le revisioni della letteratura indicano che il fentanil acquoso può essere trovato come una droga illecita in forma endovenosa, spray nasali, colliri e liquidi per penne a vaporizzazione. Mentre il fentanil potrebbe penetrare in acque naturali o in un sistema idrico, non esiste neppure una via di esposizione probabile.

Struttura interna: il fentanil potrebbe potenzialmente essere disperso come particelle solide o spray liquido (aerosol) all’interno di un edificio o di una struttura; I sistemi HVAC potrebbero essere interessati. I particolati di fentanil sono più pesanti (meno galleggianti) dell’aria e si accumulano su livelli inferiori e in corridoi di servizio e / o depositi su superfici all’interno di un edificio.

Cibo: mentre il cibo è una via di esposizione improbabile, il fentanil può essere rilasciato come polvere fine o aerosol che può contaminare il cibo.

https://www.epa.gov/sites/production/files/2018-07/documents/fentanyl_fact_sheet_ver_7-26-18.pdf

Prima che qualcuno mi accusi di dare a terroristi e pazzi una nuova grande idea, è più che probabile che qualcuno abbia già avuto l’idea e così anche le agenzie di sicurezza che ci proteggono. Almeno dovrebbero avere comunque.

Ora più chiaro che mai per me che l’unico modo per eliminare la minaccia rappresentata dal fentanil e dai suoi analoghi, oltre a vietarne la produzione, sarebbe quello di classificarlo come arma chimica e limitare pesantemente la sua produzione e distribuzione, nonché il produzione e distribuzione dei suoi precursori chimici.

Questo non accadrà mai, semplicemente non è un’aspettativa realistica per una serie di motivi. Nel frattempo, finché qualcuno non riuscirà a trovare una soluzione praticabile per contrastare questa piaga, il numero di persone uccise dal fentanil continuerà ad aumentare.

I numeri sorprendenti

Morti

Qui in Alberta le statistiche sono a dir poco allarmanti. Nel 2016 su 803 decessi per avvelenamento da alcol e droghe il 43% (347) è stato attribuito al fentanil o ai suoi analoghi. Nel 2017 è aumentato al 59% (565/951) e nel 2018 il fentanil ha rappresentato il 63% dei decessi per overdose (622/985).

Di queste overdose l’80% ha coinvolto fentanil con altri farmaci. Il 50% ha coinvolto metanfetamina, 25% di cocaina e 5% di eroina. I trafficanti di droga aggiungeranno il fentanil ad altri farmaci al fine di aumentarne la redditività e come mezzo per attrarre e fidelizzare i clienti. Ciò che di solito risulta tuttavia che i loro clienti finiscono morti.

https://open.alberta.ca/dataset/f4b74c38-88cb-41ed-aa6f-32db93c7c391/resource/c23b895d-1922-4d73-86dc-ce170d0a07b3/download/health-alberta-opioid-response-surveillance-report-2019-q2.pdf

A livello nazionale il numero è ancora più alto. Nel 2016 il numero totale di decessi per overdose in Canada è stato di 3023, di cui il 50% da fentanil o suoi analoghi. Nel 2017 è salito al 67% (4120) e al 73% nel 2018 (4588). Nei primi tre mesi del 2019 era del 79%.

Anche il numero di decessi per overdose è aumentato drasticamente, in crescita del 36% dal 2016 al 2017 e dell’11% dal 2017 al 2018.

https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html#fentanyl

I soldi

La tratta di fentanil è un affare molto redditizio. In realtà, è il narcotico illecito più redditizio attualmente venduto. Nel 2017, 1 KG di fentanil puro potrebbe essere acquistato per $ 4.150. Che 1 KG potrebbe potenzialmente generare $ 1.600.000 di entrate per il trafficante, un profitto di oltre il 38.000%

In confronto, i trafficanti realizzeranno solo un profitto del 1.300% sull’eroina, o $ 80.000 di entrate da 1 kg di eroina acquistata per $ 6.000.

Redditività del fentanil negli Stati Uniti rispetto all’eroina.

https://www.statista.com/statistics/777882/fentanyl-profitability-in-us-compared-to-heroin/

Nessuna soluzione semplice

È passato più di un decennio da quando gli articoli dei media hanno iniziato a riferire su quella che allora era chiamata un’epidemia di oppioidi, e ora viene definita “crisi degli oppiacei”. In Nord America, il fentanil è diventato una minaccia per la sicurezza pubblica a differenza di qualsiasi droga illecita prima, più dell’eroina, della cocaina o della metanfetamina. È il narcotico più potente e avvincente che esiste e che lo rende anche il più pericoloso.

Porre fine a questa crisi richiederà un’azione da parte di diversi governi. C’è una popolazione sempre crescente di tossicodipendenti da oppiacei che richiedono un intervento immediato, ma al momento vi è una carenza critica di strutture terapeutiche. L’aggiunta della capacità aggiuntiva richiederebbe il finanziamento dei contribuenti, il che lo renderebbe una questione politica, ei politici detestano spendere soldi per progetti dai quali non riceveranno alcun beneficio.

È inoltre necessaria la volontà politica di attuare una strategia diversa per combattere il problema. Al momento, gli sforzi sono maggiormente orientati verso la riduzione del danno per i tossicodipendenti. Alcune giurisdizioni hanno aperto siti di iniezione sicuri, in cui i tossicodipendenti possono fare i loro farmaci in un ambiente sterile e con interventi medici disponibili in caso di sovradosaggio.

C’è anche un segmento della popolazione che ritiene che la soluzione sia la legalizzazione e la regolamentazione di tutti i narcotici illeciti. Molti citeranno il Portogallo come esempio di successo.

Portogallo

Il Portogallo alla fine degli anni ’90 stava affrontando una crisi della droga. L’uno per cento della sua popolazione, 100.000 persone, erano consumatori di eroina e in media più di 350 persone all’anno morivano per overdose. All’inizio degli anni 2000, il Portogallo ha rivisto le sue leggi sulla droga, depenalizzando piccole quantità di stupefacenti per uso personale.

Il numero di decessi per overdose è precipitato, sebbene ciò non sia il risultato diretto della depenalizzazione. I portoghesi hanno anche riconosciuto che non era abbastanza per depenalizzare semplicemente le droghe illecite, hanno anche fornito i mezzi per accedere ai trattamenti ai tossicodipendenti e li hanno aiutati a reintegrarsi nella società.

Se la polizia ti trova con droghe illecite, verrai arrestato e portato in una stazione di polizia dove verranno pesate le droghe. Se la quantità supera i limiti di soglia rigorosamente imposti – progettati per essere una scorta per 10 giorni per uso personale, o 25 grammi di cannabis, cinque grammi di resina di cannabis, due grammi di cocaina o un grammo ciascuno di estasi o eroina – tu può essere addebitato come trafficante. Se condannati, i termini del carcere vanno da un anno a 14 anni.

Se l’importo è inferiore al limite, verrai inviato il giorno seguente alla Commissione per la dissuasione dalla tossicodipendenza, anche se sei un turista. Lì, sarai intervistato da uno psicologo o un assistente sociale prima di comparire davanti a un panel di tre persone che offrirà suggerimenti volti a fermare il consumo di droghe.

Da lì, segui rapidamente tutti i servizi che sei disposto ad accettare. Se rifiuti aiuto, ti può essere chiesto di fare un servizio alla comunità o addirittura, eventualmente, di fronte a una multa, forse anche avere beni confiscati e venduti per pagare la multa.

Ecco perché Goulão è così veloce nel sottolineare che il successo del Portogallo non è dovuto alla depenalizzazione. È perché, nel 2001, il suo paese si è impegnato a fornire tutto ciò di cui i suoi cittadini hanno bisogno per essere il più sani e pienamente impegnati nella società possibile.

“La depenalizzazione non è un proiettile d’argento”, ha detto. “Se depenalizzi e non fai nient’altro, le cose peggioreranno.

“La parte più importante è stata rendere il trattamento disponibile a tutti coloro che ne avevano bisogno gratuitamente. Questo è stato il nostro primo obiettivo. ”

Daphne Bramham: la depenalizzazione non è un proiettile d’argento, afferma lo zar della droga del Portogallo
https://vancouversun.com/opinion/columnists/daphne-bramham-decriminalization-is-no-silver-bullet-says-portugals-drug-czar

Cina: punto di origine

I prodotti chimici precursori utilizzati per sintetizzare il fentanil e i suoi analoghi sono prodotti nella Repubblica popolare cinese e il governo non pone restrizioni alla loro produzione o spedizione. Per i produttori l’unica preoccupazione è che vendano il loro prodotto e ne traggano un profitto, indipendentemente dal suo uso finale o dalle conseguenze che ne possono derivare. C’è anche una probabilità molto bassa che i cinesi impongano restrizioni alla produzione e alla distribuzione di questi prodotti chimici, e molto poco che chiunque può fare al riguardo. Di per sé non sono pericolosi e non rappresentano una minaccia

Quando analizzerò questo attraverso l’obiettivo delle relazioni internazionali, giungerò ad alcune conclusioni con cui molti saranno sicuramente in disaccordo. Potrei anche essere etichettato come paranoico o teorico della cospirazione, ma lascerò a te trarre le tue conclusioni.

In termini strategici, è un vantaggio per la Cina che queste sostanze chimiche vengano utilizzate per sintetizzare il fentanil. Il vantaggio economico per la Cina è relativamente ridotto rispetto al vantaggio strategico. Un rapido e drammatico aumento del numero di tossicodipendenti all’interno di una società fungerà da forza destabilizzante al suo interno, drenando risorse che potrebbero essere meglio utilizzate altrove.

I cinesi hanno anche aperto la strada alla sintesi degli analoghi fentanil più potenti e mortali, con la potenziale capacità di uccidere decine di milioni di persone. Non ci sono convenzioni che vietano la ricerca e lo sviluppo di droghe sintetiche da oppiacei come quelle per armi chimiche o altre armi di distruzione di massa. Sì, so che sarebbe molto difficile e che per essere efficace avrebbe bisogno del veicolo adeguato per la consegna. Come possiamo sapere che uno non è già stato sviluppato o su cui si sta lavorando ora? Teoricamente, avrebbero già potuto produrre abbastanza ohmefentanil da spazzare via metà della popolazione degli Stati Uniti continentali. Ciò ha il potenziale per pesare pesantemente sull’equilibrio globale del potere.

Condividi queste informazioni

Non ci sono soluzioni rapide e facili da trovare qui e le persone continueranno a morire in numero sempre crescente. Individualmente non c’è molto che nessuno di noi possa fare, è qualcosa che deve essere affrontato a livello governativo e, francamente, questo mi dà poche speranze che una soluzione venga trovata presto.

Molte persone moriranno che non dovevano, persone come mio fratello, e il mio cuore si spezza per le famiglie e le persone care che rimarranno indietro. Condividi queste informazioni con le persone che conosci in modo che il maggior numero possibile di persone sia consapevole di quanto sia grave la situazione. È possibile che un giorno possa salvare una vita, forse la vita di qualcuno che conosci e ami.

Fentanil: Oružje za masovno uništenje

Dva člana moje obitelji su otišli zbog fentanila, jedne od najotrovnijih tvari na planeti.

Za mog malog brata koji nas je prerano napustio. Nedostajat ćeš mi, Ryan.

Voli izgubljeni rad

Ovo je prvi put da sam išta napisao otkako sam izgubio mlađeg brata prije gotovo mjesec dana. Imao je 43 godine kada je preminuo kao posljedica slučajnog predoziranja fentanila, negdje u ranim jutarnjim satima 6. rujna. Kao i milijuni drugih, i moj je mali brat bio ovisnik o drogama i dugo je bio. Toliko je velika bila unutarnja tjeskoba koju je osjećao, da se okrenuo narkoticima da bi ga olakšao.

Ne želim da on definira način na koji je umro, već za čovjeka koji je on bio. Nije bio savršen, ali bio je jedan od najslađih, najdarovitijih ljudi koje sam poznavao. Bio je odan svojim prijateljima i obitelji i imao je mnogo dugoročnih prijateljstava, a neka su se vratila i preko 30 godina. Dotaknuo je puno života i duboko će ga propustiti oni koji nas ostavi.

Saznao sam da je u danima koji su vodili do njegove smrti govorio o ulasku u dugoročno saniranje. Toliko se umorio od života koji je živio i nije želio ništa više od ozdravljenja, fizičkog, emocionalnog i duhovnog liječenja. Na dan kad je umro, trebao se okupiti s jednim svojim dobrim prijateljima, a zajedno će tražiti internetske sadržaje za dugotrajne rehabilitacije koji se nalaze izvan grada.

Prošle godine jedan moj rođak oduzeo je vlastiti život predoziranjem fentanil analognim karfentanilom, lijekom 10.000 puta jačim od morfija. Toliko je opasno da su nakon dolaska u kontakt s osobom predoziranja morali biti hospitalizirani mnogi prvi liječnici.

Željela sam znati više o otrovu koji je tvrdio dva člana moje obitelji, pa sam, kao i uvijek, počeo tražiti neke odgovore. Podaci koje sam pronašao u vrlo kratkom vremenu poslali su mi hladnu kralježnicu. Osim učinka koji je fentanil imao na moj osobni život, on ima i značajne posljedice u međunarodnim odnosima. Narodna Republika Kina proizvodi većinu, ako ne i sve, kemikalija prethodnika koji se koriste za sintezu fentanila. To biste trebali uzeti u obzir i; sintetizirali su ga znanstvenici u sveučilišnom laboratoriju u Kini, sada je analog fentanila toliko smrtonosan da bi jedna žličica ubila oko toliko ljudi koliko je Velika kuga učinila u Europi u 14. stoljeću.

Opioid ili opijat?

Da bismo ih razlikovali, opijati su oni lijekovi koji su prirodno izvedeni iz cvjetajuće biljke opijumskog maka (tj. Morfij, kodein). Opioidi su mnogo šira kategorija i uključuju bilo koju supstancu, prirodnu ili sintetsku, koja se veže na opioidne receptore mozga.

Fentanil

Fentanil će vjerojatno biti lijek koji je najviše povezan s opioidnom krizom, iako to razlikovanje pripada OxyContinu, formulaciji produženog otpuštanja oksikodona, Purdue Pharma, koja ima sumnjivu reputaciju.

Iako je stekao veliku pažnju 0 u posljednjem desetljeću, fentanil je već duže vrijeme od toga. Dr. Paul Jannsen prvi ga je sintetizirao 1958. godine pod patentom njegove tvrtke Jannsen Pharmaceutica. Sada je u vlasništvu konglomerata Johnnson & Johnson, koji su izgubili tužbe protiv velikih dolara koje su pokrenule žene koje tvrde da je Johnsonov prašak za bebe uzrokovao rak jajnika.

Bio je moćan analgetik, nekih 100x snažniji od morfija, a mogao se koristiti i za anesteziju. Na tržište će se pojaviti 1960. godine kao IV anestetik s robnom markom Sublimaze.

Fentanil analozi i derivati

Kemijski analog je spoj koji je strukturno sličan drugom spoju na molekularnoj razini, ali se u određenoj mjeri razlikuje od izvornog spoja. Ubrzo nakon izdavanja Sublimaze njegova će popularnost dovesti do razvoja brojnih analoga i derivata fentanila. među kojima su bili Sufentanil, Alfentanil, Lofentanil i Remifentanil.

Sufentanil

Najjači analgetik dostupan za ljudsku upotrebu, on je 5 puta jači od fentanila i 500x jači od morfija. Koristi se u bolnicama kao analgetik i kao dodatak anesteziji pod robnim markama Dsuvia i Sufenta.

Alfentanila

Alfentanil ima jačinu koja je otprilike 10-25% od fentanila. Dejstvo je četiri puta veće od fentanila, ali traje samo jednu trećinu. Koristi se kao kratko djelujući anestetik.

Lofentanil

Jedan od najsnažnijih analoga fentanila, najsličniji je karfentanilu.

Remifentanil

Remifentanil se koristi u bolničkim uvjetima. Koristi se za sedaciju, kao anestezijski dodatak i kao analgetik, koji ima robnu marku Ultiva. Dvostruko je jača fentanila i 200x je snažnija od morfija.

Karfentanil

Karfentanil se koristi kao sedativ za velike životinje pod robnom markom Wildnil. Pri 100x jačini fentanila, 1000 puta je jači od morfija. Počeo se pojavljivati na ulicama prije nekoliko godina sa smrtonosnim rezultatima. Procijenjena smrtonosna doza za ljude je 50 mikrograma. Za usporedbu, sjeme maka teži otprilike 300 mikrograma.

Image result for carfentanil lethal dose
Usporedba smrtonosnih doza heroina, fentanila i karfentanila.
Image result for fentanyl lethal dose comparison
Smrtonosna doza fentanila za prosječnu odraslu osobu (2mg)

Ohmefentanil – najsnažniji i najsmrtonosniji analog fentanila

Ako mislite da je fentanil loš …

https://www.acsh.org/news/2017/01/17/if-you-think-fentanyl-bad-10663

Ohmefentanil prvi su sintetizirali početkom 1970-ih znanstvenici u laboratoriju na Kineskoj akademiji znanosti u Guangzhouu, Kina. Više od 6.000x jače od morfija, toliko je snažno da je jedna unce ohmefentanila dovoljna da ubije 175 milijuna ljudi. Rečeno je da je sintetizacija ohmefentanila mnogo složenija nego sinteza fentanila. Postupak uključuje više opreme i dodatnih prekursora i otapala, a budući da je tako toksičan, izuzetno je opasan za proizvodnju i njime se može sigurno rukovati samo zaštitnom opremom.

Sinteza i analgetska aktivnost stereoizomera cis-fluoro-ohmefentanila

https://www.academia.edu/8863856/Synthesis_and_analgesic_activity_of_stereoisomers_of_cis-fluoro-ohmefentanyl

Kemikalije prekursora Fentanila

Image result for 4-anilinopiperidine
Prodaje se farmaceutski stupanj 4-anilinopiperidin (hidroklorid) na mreži od kineskog proizvođača. Ovaj je sposoban proizvesti 5000 kg ovog spoja svaki mjesec.

DEA predlaže kontrolu tri kemikalije prethodnika koji se koriste za nelegalnu proizvodnju smrtonosnog fentanila

https://www.dea.gov/press-releases/2019/09/17/dea-proposes-control-three-precursor-chemicals-used-illicitly-manufacture

Fentanil se sintetizira korištenjem sastojaka poznatih kao prekursori. Te kemikalije prethodnika prodaju proizvođači u Kini, koji čine desetke tisuća takvih spojeva. Ti spojevi uključuju stvari poput aditiva u hrani, veterinarskih proizvoda, pesticida i kemikalija prekursora koji se koriste za sintezu farmaceutskih lijekova, uključujući fentanil.

Ogromna većina prekursora koji se koriste u sintezi fentanila šalje se u Meksiko, gdje se proizvodi većina nevidljivog fentanila u SAD-u. Potreban je obučeni kemičar da sintetizira fentanil ispočetka, što meksički karteli nemaju. Ali, lakše je napraviti fentanil upotrebom velikih količina opskrbljenih kemikalija, a to je ono što čine karteli.

Dana 17. rujna ove godine DEA je objavila da daje prijedlog za kontrolu tri kemikalije prekursora potrebne za sintezu fentanila. Teško je reći kakav će učinak imati bilo koji takav učinak jer je velika većina nezakonitog fentanila proizvedena u Meksiku.

Poruka “kod kuće” je da postoje milijuni analoga fentanila koji se mogu proizvesti od komercijalno dostupnih kemikalija. Sasvim je izvjesno da će mnogi od njih imati svojstva slična fentanilu i da će neki od njih napraviti čak i danas najsnažniji analozi, poput karfentanila i sufentanila, poput bombon bombona.

Organska kemija može pobijediti bilo koji sporazum o fentanilu
Autor Josh Bloom – 5. prosinca 2018
https://www.acsh.org/news/2018/12/05/organic-chemistry-can-defeat-any-fentanyl-agreement-13645

Jednostavno nije realno misliti da će ugovori ili međunarodno pravo prekinuti proizvodnju i distribuciju ovih spojeva prethodnika. Jednostavno, ne postoji jednostavan ili učinkovit način provođenja međunarodnih sporazuma među suverenim državama. Pogledajte samo trenutno stanje međunarodnih odnosa.

Na ovaj ili onaj način ove kemikalije će se i dalje proizvoditi, džin se ne može vratiti u bocu. Činjenica je i da će znanstvenici, prije svega u Narodnoj Republici Kini, pokušavati sintetizirati nešto još jače.

„Nuklearna elektrana je osjetljiv proizvod. Zašto ga kupujete? “, Jedna prodavačica Yuancheng-a pitala me na Skypeu, prije nego što je proizvod bio zakazan u Kini. „Znam da ga mnogi kupuju. Ali ne znam za što se koristi. “

Objasnio sam da se koristio za izradu fentanila.

“Znam fentanil”, nastavila je, “ali zašto ga ljudi koriste? Kinezi ga ne koristimo. “

To je vrlo zarazno, rekao sam.

“Da, znam da su ljudi loši proizvodi”, priznala je prodavačica, “ali ja to i dalje prodajem, pa ponekad osjećam krivnju. NPP nije zabranjena u Kini, pa je možemo prodati. Prodajem ga, jer želim zaraditi, zaraditi za život. “

Na hrabar način kineska tvrtka izbacila je sastojke fentanila u Sjedinjene Države.
BEN WESTHOFF
https://www.theatlantic.com/health/archive/2019/08/chinese-company-helping-fuel-opioid-epidemic/596254/

Dok je DEA u svojoj najavi za 17. rujna predložila uvođenje regulatornih promjena, slične regulatorne promjene u Kanadi stupile su na snagu 6. svibnja 2019. godine, kada su bile registrirane u Kanadskom glasniku.

Vlada Kanade mijenja propise radi sprečavanja ilegalne proizvodnje i prometa kontroliranih tvari

https://www.canada.ca/en/health-canada/news/2019/05/government-of-canada-changes-regulations-to-help-prevent-illegal-production-and-trafficking-of-controlled-substances.html

Kanatski glasnik, II dio, svezak 153, broj 10

http://gazette.gc.ca/rp-pr/p2/2019/2019-05-15/html/sor-dors120-eng.html

Oružje fentanila

Image result for chemical weapons symbols

Sa tako izuzetno jakom potencijalom, spojevi poput ohmefentanila jednostavno nisu praktični ili sigurni za upotrebu kao analgetik kod ljudi. Jedini logični razlog za sintezu ohmefentanila bio bi korištenje kao oružje za masovno uništenje. Omogućeno je da će trebati ogroman napor da se to naoruža i osmisli učinkovit sustav isporuke, ali to je još uvijek posebna mogućnost.

U svibnju 2018. godine, američka Agencija za zaštitu okoliša (EPA) izdala je informativni list za koordinatore scenarija Federalne agencije za zaštitu okoliša koji reagiraju na bilo kakve incidente onečišćenja okoliša fentanilom ili njegovim analogima. To je opsežan dokument od 11 stranica i neke od informacija sadržanih u njemu privukle su mi pažnju. Sadrži popis mogućih putova izloženosti, drugim riječima, načina na koji bi se fentanil mogao širiti na populaciju. Uključuju otvorene površine, vodoopskrbni sustav, zatvorene prostore i hranu.

Otvorena područja: Iako je fentanil čvrsti prah na sobnoj temperaturi, on predstavlja inhalaciju ili prijetnju slučajnim izlaganjem ako se dovoljno praha unese u zrak. Fentanil se također može otopiti u otapalima, a fentanil citrat je topiv u vodi, što omogućava izlaganje u aerosolnom obliku. U literaturi se vidi da su policajci pokazali simptome izloženosti opijatima nakon policijskih aktivnosti koje su stvarale fentanil prašinu / aerosol ili kada su radile u prašnjavim područjima.

Voda / Vodeni sustavi: Fentanil u tekućoj otopini stvara mogući put dermalne izloženosti i obično se koristi u mnogim ljekovitim oblicima fentanila. Literaturni pregledi pokazuju da se vodeni fentanil može naći kao ilegalna droga u intravenoznom obliku, sprejevi za nos, kapi za oči i tekućine s vape olovkom. Iako fentanil može ući u prirodne vode ili vodeni sustav, nije vjerojatni put izloženosti.

Unutarnji pogon: Fentanil se potencijalno može dispergirati u obliku krutih čestica ili tekućeg spreja (aerosola) unutar zgrade ili objekta; Može utjecati na sustave klimatizacije. Čestice iz fentanila su teže (manje plutajuće) od zraka i skupit će se na nižim razinama, u komunalnim hodnicima i / ili taložiti na površinama unutar zgrade.

Voda / Vodeni sustavi: Fentanil u tekućoj otopini stvara mogući put dermalne izloženosti i obično se koristi u mnogim ljekovitim oblicima fentanila. Literaturni pregledi pokazuju da se vodeni fentanil može naći kao ilegalna droga u intravenoznom obliku, sprejevi za nos, kapi za oči i tekućine s vape olovkom. Iako fentanil može ući u prirodne vode ili vodeni sustav, nije vjerojatni put izloženosti.

Unutarnji pogon: Fentanil se potencijalno može dispergirati u obliku krutih čestica ili tekućeg spreja (aerosola) unutar zgrade ili objekta; Može utjecati na sustave klimatizacije. Čestice iz fentanila su teže (manje plutajuće) od zraka i skupit će se na nižim razinama, u komunalnim hodnicima i / ili taložiti na površinama unutar zgrade.

Hrana: Iako je hrana malo vjerodostojna izloženost, fentanil se može osloboditi u obliku sitne prašine ili aerosola koji može kontaminirati hranu.

List s podacima za OSC-ove: Verzija 1.0 22.05.2018. Fentanil i Fentanil Analogi
https://www.epa.gov/sites/production/files/2018-07/documents/fentanyl_fact_sheet_ver_7-26-18.pdf

Prije nego što me itko optuži za davanje terorista i ludaka sjajnoj novoj ideji, više je nego vjerovatno da je netko već smislio tu ideju, pa tako i sigurnosne agencije koje nas štite. Barem bi ih svejedno trebali imati.

Sada mi je jasnije nego ikad prije da je jedini način da se eliminira prijetnja fentanila i njegovih analoga, osim zabrane njegove proizvodnje, taj da ga svrstamo u kemijsko oružje i ozbiljno ograniči njegovu proizvodnju i distribuciju kao i proizvodnja i distribucija kemikalija prethodnika.

Zapanjujući brojevi

To se nikada neće dogoditi, jednostavno nije realno očekivanje iz više razloga. U međuvremenu, sve dok netko ne nađe djelotvorno rješenje za suzbijanje ove kuge, broj ljudi ubijenih fentanilom nastavit će rasti.

Broj umrlih

Ovdje u Alberti statistika je najmanje alarmantna. U 2016. od 803 smrtnih slučajeva od trovanja drogama i alkoholom 43% (347) pripisalo se fentanilu ili njegovim analogima. U 2017. godini povećao se na 59% (565/951), a u 2018. godini fentanil predstavlja 63% smrti od predoziranja (622/985).

Od ovih predoziranja 80% je uključivalo druge lijekove koji su miješali fentanil. 50% je uključivalo metamfetamin, 25% kokain i 5% heroin. Trgovci narkoticima dodavat će fentanil drugim lijekovima kako bi povećali svoju profitabilnost i kao sredstvo za privlačenje i zadržavanje kupaca. Ono što obično rezultira je da njihovi kupci ostanu mrtvi.

https://open.alberta.ca/dataset/f4b74c38-88cb-41ed-aa6f-32db93c7c391/resource/c23b895d-1922-4d73-86dc-ce170d0a07b3/download/health-alberta-opioid-response-surveillance-report-2019-q2.pdf

U nacionalnom broju je još veći. U 2016. godini ukupan broj smrtnih slučajeva predoziranja u Kanadi bio je 3023, od čega je 50% bilo fentanila ili njegovih analoga. U 2017. godini porasla je na 67% (4120), a u 2018. godini iznosila je 73% (4588). U prva tri mjeseca 2019. godine bio je 79%.

Također je naglo porastao broj smrtnih slučajeva predoziranja, što je za 36% više od 2016. do 2017. i za 11% više od 2017. do 2018. godine.

https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html#fentanyl

Novac

Trgovina fentanilom vrlo je unosan posao. U stvari, riječ je o najslavnijem ilegalnom narkotiku koji se trenutno prodaje. U 2017. godini 1 kg čistog fentanila moglo se kupiti za 4.150 dolara. Ta 1 KG potencijalno bi mogla donijeti 1.600.000 USD prihoda prometnika, dobit od preko 38.000%

Za usporedbu, trgovci ljudima ostvarit će samo 1300% profita od heroina, odnosno 80.000 dolara prihoda od 1KG heroina kupljenog za 6000 dolara.

Profitabilnost fentanila u SAD-u u usporedbi s heroinom.

https://www.statista.com/statistics/777882/fentanyl-profitability-in-us-compared-to-heroin/

Nema jednostavnog popravljanja

Prošlo je više od desetljeća od kada su u medijima počeli izvještavati o tadašnjoj epidemiji opioida, a danas se naziva “opioidna kriza”. U Sjevernoj Americi fentanil je postao prijetnja javnoj sigurnosti za razliku od bilo koje ilegalne droge prije, više od heroina, kokaina ili metamfetamina. To je najsnažniji i najzaostaliji narkotik što ga čini i najopasnijim.

Za zaustavljanje ove krize zatražit će se djelovanje nekoliko vlada. Sve je veća populacija ovisnika o opioidima koji zahtijevaju trenutnu intervenciju, ali trenutno postoji kritični nedostatak ustanova za liječenje. Dodavanje dodatnih kapaciteta zahtijevalo bi financiranje poreznih obveznika, što bi ga tada postalo političkim problemom, a političari se nerado troše novac na projekte od kojih neće ostvariti nikakvu korist.

Također treba postojati politička volja za provedbu drugačije strategije za borbu protiv problema. Trenutno su napori usmjereni više na smanjenje štete ovisnika. Neke su jurisdikcije otvorile sigurna mjesta ubrizgavanja, gdje ovisnici mogu drogirati u sterilnom okruženju i uz dostupnu medicinsku intervenciju u slučaju predoziranja.

Postoji i segment stanovništva koji vjeruje da je legalizacija i regulacija svih ilegalnih opojnih droga rješenje. Mnogi će kao primjer uspjeha navesti Portugal.

Portugal

Portugal se krajem devedesetih suočio sa krizom lijekova. Jedan posto njezine populacije, 100.000 ljudi, bili su korisnici heroina, a prosječno više od 350 ljudi godišnje umire od predoziranja drogom. Početkom 2000-ih, Portugal je popravio svoje zakone o drogama, dekriminalizirajući male količine narkotika za osobnu upotrebu.

Broj smrtnih slučajeva predoziranja od tada je opao, iako to nije izravni rezultat dekriminalizacije. Portugalci su također prepoznali da nije dovoljno jednostavno dekriminalizirati neovlaštene droge, osigurali su i ovisnicima sredstva za pristup liječenju i pomagali im kako se ponovo integrirali u društvo.

Ako je iznos ispod ograničenja, bit ćete poslani sljedećeg dana Komisiji za suzbijanje ovisnosti o drogama – čak i ako ste turist. Tamo će vas intervjuirati psiholog ili socijalni radnik prije nego što se pojavite pred panelom za tri osobe koji će ponuditi prijedloge za zaustavljanje vaše uporabe droga.

Odatle ćete brzo pratiti sve usluge koje želite prihvatiti. Ako odbijete pomoć, od vas se može zatražiti da rade u zajednici ili čak, na kraju, suočite se s novčanom kaznom, možda čak i da vam se imovina oduzme i proda za plaćanje novčane kazne.

To je razlog zašto Goulão tako brzo ističe da uspjeh Portugala nije zbog dekriminalizacije. To je zato što se njegova država 2001. godine obvezala pružiti sve što svojim građanima treba biti što zdravija i što potpunije uključena u društvo.

“Dekriminalizacija nije srebrni metak”, rekao je. “Ako dekriminalizirate i ne učinite ništa drugo, stvari će se pogoršati.

DAPHNE BRAMHAM
Daphne Bramham: Dekriminalizacija nije srebrni metak, kaže portugalski car droga
https://vancouversun.com/opinion/columnists/daphne-bramham-decriminalization-is-no-silver-bullet-says-portugals-drug-czar

Kina: mjesto porijekla

Kemikalije prethodnice koje se koriste za sintezu fentanila i njegovih analoga proizvode se u Narodnoj Republici Kini, a vlada ne ograničava njihovu proizvodnju ili otpremu. Proizvođače je briga samo što oni prodaju svoj proizvod i na njemu ostvaruju zaradu, bez obzira na njegovu krajnju upotrebu ili posljedice koje on može donijeti. Također je vrlo mala vjerojatnost da će Kinezi postaviti bilo kakva ograničenja u proizvodnji i distribuciji tih kemikalija, i vrlo malo da ih bilo tko može učiniti. Sama po sebi nisu opasna i ne predstavljaju prijetnju

Kad to analiziram kroz leće međunarodnih odnosa, dolazim do nekih zaključaka s kojima se mnogi nesumnjivo ne slažu. Možda ću biti označen kao paranoičan ili teoretičar zavjere, ali prepustit ću vam to da izvučete vlastite zaključke.

Strateški gledano je na korist Kine da se te kemikalije koriste za sintezu fentanila. Ekonomska korist za Kinu relativno je mala u odnosu na stratešku. Brz i dramatičan porast broja ovisnika o drogama u društvu djelovat će kao destabilizirajući sila u njemu, dovodeći resurse koji bi se mogli bolje upotrijebiti na drugom mjestu.

Kinezi su također predvodili u sintezi najsnažnijih i najsmrtonosnijih analoga fentanila, s potencijalnom sposobnošću ubijanja desetaka milijuna ljudi. Ne postoje konvencije koje zabranjuju istraživanje i razvoj sintetičkih opioidnih droga poput kemijskog oružja ili drugih oružja protiv oružja. Da, znam da bi bilo vrlo teško i da će mu biti potrebno odgovarajuće vozilo za dostavu da bi bilo učinkovito. Kako znati da jedan još nije razvijen ili se na njemu već radi? Teoretski, oni su već mogli proizvesti dovoljno ohmefentanila kako bi izbrisali polovicu stanovništva kontinentalne države. To ima potencijal da se uvelike odmjeri na globalnoj ravnoteži snaga.

Podijelite ove informacije

Ovdje se ne mogu naći brzi i jednostavni popravci, a ljudi će i dalje umirati u sve većem broju. Pojedinačno ne može itko i drugi učiniti, to je nešto s čime se moramo baviti na državnoj razini i iskreno, to mi daje malo nade da će rješenje uskoro biti pronađeno.

Umrijet će mnogo ljudi koji to nisu morali, ljudi poput moga brata, a moje srce će se slomiti za obitelji i voljene koji će ostati. Podijelite ove informacije s osobama koje poznajete kako bi što veći broj ljudi bio svjestan koliko je situacija vrlo loša. Moguće je da bi vam jednog dana mogao spasiti život, možda i život nekoga koga poznajete i volite.



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