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Lake Zurich Man Died from Fentanyl Analog — System Had Drug Never Detected in Cook County Investigations

Sat December 10 2016 3:31 am  http://www.arlingtoncardinal.com/?p=81173
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A 35-year-old Lake Zurich man is one of the first people known to die of an overdose due to a specific fentanyl analog. Also, a 46-year-old man is the first to die with Carfentanil detected in a victim’s body system. The Lake Zurich resident was one of two recent deaths attributed to extremely powerful opioids never before seen in Cook County. The Chicago man’s toxicology testing discovered the drug Carfentanil — a fentanyl analog that is 10,000 times more potent than morphine, and is used by veterinarians to immobilize large animals (i.e., elephant tranquilizer).

The Lake Zurich man apparently did not die in Lake Zurich because all of Lake Zurich is in Lake County. Neither of the men were identified nor were details of their deaths explained. The medical examiner’s office said their deaths this past summer 2016 resulted from a lethal combination of fentanyl analogues — not the controlled narcotics or pharmaceutical-grade drugs prescribed by medical professionals for severe pain. Toxicology test results can take up to 90 days to obtain.

The medical examiner’s office has confirmed a 35-year-old Lake Zurich man died June 8, 2016 from a 3-Methylfentanyl overdose — a fentanyl analog that is 400 times more potent than morphine, and four times more potent than fentanyl.

Also, the medical examiner’s office toxicology testing on the other man — a 46-year old Chicago resident who died September 10, 2016 — found he had the highly potent fentanyl analog carfentanil in his system — again, 10,000 times more potent than morphine. Carfentanil is also known as carfentanyl of 4-carbomethoxyfentanyl.

The cases are the first overdose deaths in Cook County from those specific fentanyl analogues. The Cook County medical examiner’s office also reported that 2016 has seen a marked increase in deaths from fentanyl and other fentanyl analogues and that the number of deaths attributed to a powerful opioid have increased nearly five times from 2014 to 2015.

In 2015, the medical examiner’s office found 102 deaths were caused, at least partially, by fentanyl or fentanyl analogues, following only 20 deaths attributed to fentanyl in 2014.

Comparing 2015 to 2016, deaths attributed to fentanyl and other fentanyl analogues have increased almost four times — from 102 to 380. The year’s toxicology testing is far from over, even though it’s December because toxicology test takes 90 days to complete.

“Fentanyl and fentanyl analogues, like carfentanil, are very powerful drugs that are likely to be lethal. Just one dose can easily stop a person from breathing, causing immediate death.”

— Dr. Ponni Arunkumar, Cook County’s chief medical examiner

The medical examiner’s office routinely began testing for fentanyl in June 2015 after national trends showed an alarming increase in fentanyl use. Previously, the medical examiner’s office tested for fentanyl at the discretion of the pathologist.

“Carfentanil is an elephant tranquilizer. It is not a drug that humans should be ingesting. These high-potency opioids and opioid analogs are thousands of times stronger than street opioids like heroin and are far more likely to cause death.”

— Dr. Steve Aks, emergency medicine physician and toxicologist at Cook County Health & Hospitals System’s Stroger Hospital

According to the FDA, one form of the opioid — carfentanil citrate or WILDNIL — is indicated for use as an immobilizing agent in free-ranging or confined members of the family Cervidae (deer, elk, moose). In a study of 92 free-ranging moose, the average time to immobilize a moose was 5 minutes with at least 3 mg of WILDIL. The dosage of the Carfentanil was as little at 0.006 to 0.014 mg/kg. Six of the moose died in the study. Immobilization was otherwise reversed with diprenorphine of about 20 to 40 mg per moose.

The most common fentanyl analogues detected in Cook County include furanyl fentanyl and a precursor/metabolite of fentanyl called despropionyl fentanyl or 4-ANPP, according to the medical examiner’s office.

Toxicology tests historically have showed that overdose victims’ bodies had fentanyl alone, or fentanyl with heroin — or combined with other drugs, such as cocaine.

Fentanyl analogs are also known to have killed hundreds of people throughout Europe and the former Soviet republics. Use began in Estonia in the early 2000s during a heroin shortage, and novel derivatives continue to be discovered by researchers. Estonia has the highest death rate from drug overdoses in Europe. The slang term for fentanyl analogues is China white, Persian white or Afghan — misnomers intended to be intriguing cover for a killer powder synthesized in clandestine labs nearby in Russia. Another slang name for fentanyl analogues is flatline.

Fentanyl and analogues are in the lists of Schedule I and Schedule II drugs as defined by the United States Controlled Substances Act. Schedule II drugs have currently accepted medical use in treatment in the United States. Schedule I drugs have no currently accepted medical use in treatment in the United States, and have no accepted safety for use of the drug or other substance under medical supervision.

See also …

Time Why Europe’s Healthiest Economy Has Its Worst Drug Problem
FDA Summary [PDF]




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