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CURRENT MERGING TRENDS
Surge in Fentanyl Overdose Deaths
Updated July 9, 2015
A surge in overdose deaths related to fentanyl, an opioid 30 to 50 times more potent
than heroin, has prompted Baltimore health officials to launch a public health campaign
to raise awareness among drug users. Hundreds of people have overdosed on fentanyl
across the nation since 2013, often as a result of using heroin that has been laced with
the much stronger substance. A quarter of drug overdose deaths in Maryland now
involve fentanyl, up from 4 percent in 2013. Opioid overdose can stop a person's
respiration, and fentanyl can have this effect very quickly. Other parts of the country
such as Detroit and surrounding suburbs are also seeing major surges in fentanyl use
and fentanyl-related deaths. In some cases users are unknowingly taking fentanyl in
what they believe to be pure heroin, but a growing number of opioid users are
deliberately taking fentanyl.
Fentanyl and other opioid overdoses can be reversed if the drug naloxone (Narcan) is
administered promptly. In a growing number of states, naloxone is being distributed to
injection drug users and other laypersons to use in the event of overdose. For example,
Baltimore's Staying Alive Drug Overdose Prevention and Response plan issues naloxone and training in its
use.
Increasing Overdoses From Synthetic Cannabinoids (“Spice,” "K2,” etc.) in
Several States
Updated May 8, 2015
Recent surges in hospitalizations and calls to poison control centers linked to
consumption of synthetic cannabinoid products--sold under brand names like “Spice,”
“K2,” "No More Mr. Nice Guy," and others--are being reported in several southern and
northeastern U.S. states and have prompted officials to issue health warnings. After a
surge in synthetic cannabinoid exposures and poison center calls in April and May,
2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs. New York
Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized
following synthetic cannabinoid use in under two weeks in mid April, 2015.
Synthetic cannabinoids are chemically related to THC, the active ingredient in
marijuana, and are sometimes called “synthetic marijuana” or “legal marijuana,” but
actually the effects can be considerably more powerful and more dangerous than
marijuana. Users can experience anxiety and agitation, nausea and vomiting, high
blood pressure, shaking and seizures, hallucinations and paranoia, and they may act
violently.
The Maryland notice lists several chemical compounds in materials from crime labs,
including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand
names above, the New York State health alert lists other common names: Blonde,
Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK47; recent reports have involved products with the names Geeked Up, Ninja, Caution,
Red Giant, and Keisha Kole.
For more information on synthetic cannabinoids, see DrugFacts: K2/Spice ("Synthetic
Marijuana")
"Flakka" (alpha-PVP)
Updated April 6, 2015
Use of a dangerous synthetic cathinone drug called alpha-pyrrolidinopentiophenone (alphaPVP), popularly known as "Flakka," is surging in Florida and is also being reported in
other parts of the country, according to news reports.
Alpha-PVP is chemically similar to other synthetic cathinone drugs popularly called
"bath salts," and takes the form of a white or pink, foul-smelling crystal that can be
eaten, snorted, injected, or vaporized in an e-cigarette or similar device. Vaporizing,
which sends the drug very quickly into the bloodstream, may make it particularly easy
to overdose. Like other drugs of this type, alpha-PVP can cause a condition called
"excited delirium" that involves hyperstimulation, paranoia, and hallucinations that can
lead to violent aggression and self-injury. The drug has been linked to deaths by suicide
as well as heart attack. It can also dangerously raise body temperature and lead to
kidney damage or kidney failure.
U.S. and British Columbia Issue Alerts on Fentanyl
Updated March 18, 2015
The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of
fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100
times more powerful than morphine, is both abused on its own and commonly added to
heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern
for over a decade and have caused numerous overdose deaths among injection drug
users in several U.S. cities.
Heroin is not the only drug that can be laced with fentanyl, however. Officials in
Vancouver, British Columbia, Canada, recently issued public warnings about a wide
range of fentanyl-laced drugs causing overdose deaths among users. They warn that
fentanyl is now being concealed in non-injection drugs, including oxycodone and
various "party drugs" in powder or pill form, as well as in marijuana (although no
deaths have been confirmed from fentanyl-laced marijuana). Because of this new
threat, British Columbia officials are urging all recreational drug users to "know their
source."
HIV Outbreak in Indiana Linked to Abuse of Opana
Posted February 27, 2015
Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases
in the southeastern portion of the state that are linked to injection drug abuse of the
powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection
equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in
southeastern Indiana were transmitted sexually.
Officials advise that people in southeastern Indiana who have engaged in needle
sharing or unprotected sex should get tested for HIV and then re-tested after 2-3
months, as HIV may not appear on tests immediately when the virus is contracted. To
reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles,
and having unprotected sex or sex with commercial sex workers.
Warning from Europe: "Superman" pills
Posted January 16, 2015
An alert was recently issued in The Netherlands warning about pills with a distinctive
Superman logo, sold as MDMA (also called ecstasy or Molly) but actually containing a
lethal dose of another substance, PMMA (paramethoxymethylamphetamine). These pills
have not been reported in the U.S., but four people in the UK are thought to have died
after taking these pills.
New Synthetic Cannabinoids—“Cloud 9,” “Mojo,” etc.
Posted November 13, 2014
Makers of designer drugs that are chemically similar to marijuana’s active ingredient
THC—called synthetic cannabinoids or colloquially “synthetic marijuana” or “synthetic
pot”—are constantly creating new products to evade legal bans on older compounds.
Despite the similarity on the molecular level, these drugs are much more dangerous
than marijuana, and have resulted in very serious health consequences including
overdoses and aggressive or suicidal behavior in users.
Some new compounds have recently emerged that are sending many users to the
hospital in cities around the country. They include:

AB-PINACA, AB-FUBINACA (sold as “Cloud 9,” “Relax,” or “Crown”) is sold as a
liquid in eyedropper bottles and often used with vaporizing devices—e-cigarettes or
“hookah pens.” Numerous hospitalizations in Michigan prompted the Macomb
County Health Department to issue an emergency warning and ban on the sale of
these drugs, which are reported to cause hallucinations, aggressive behavior, racing
heartbeat, drowsiness, and vomiting.

MAB-CHMINACA, ADB-CHMINACA (sold as “Mojo,” “Spice,” “K2,” and “Scooby
Snax”) resulted in over 150 hospital visits in Baton Rouge and Lafayette, LA in
October, prompting the governor to ban the drug in that state. It is reported to
cause severe agitation, anxiety, and paranoia; raised heartbeat and blood pressure;
nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations
and psychotic episodes, including suicidal fixations and other harmful thoughts.
Read more about "K2" and "Spice" synthetic cannabinnoids
Caffeine Powder
Posted July 23, 2014
The death of an Ohio high school senior caused by an overdose of powdered caffeine
has prompted the FDA to issue a safety advisory about caffeine powders. Bulk bags of pure
caffeine powder are readily available online, and these products may be attractive to
young people looking for added caffeine stimulation or for help losing weight, but they
are extremely dangerous. Just a teaspoon of pure caffeine powder is equivalent to
about 25 cups of coffee—a lethal amount. Besides death, severe caffeine overdose can
cause fast and erratic heartbeat, seizures, vomiting, diarrhea, and disorientation—
symptoms much more extreme than those of drinking too much coffee or tea or
consuming too many sodas or energy drinks.
Although caffeine is generally safe at the dosages contained in popular beverages,
caffeine powder is so potent that safe amounts cannot be measured with ordinary
kitchen measuring tools, making it very easy to overdose on them even when users are
aware of their potency. The FDA thus recommends that consumers avoid caffeine
powder altogether, and wishes to alert parents to the existence of these products and
their hazards