The article provides a great example of the benefits reaped by and importance of having a truly professional and cutting-edge Medical Examiner toxicology laboratory. The detection of new synthetic drug compounds during death investigations is crucial and Dr. McIntyre and his folks work tirelessly to detect and identify these compounds.
February 13, 2015 | San Diego County News Center News Release
Last November, a 24-year-old San Diego County man bought and injected what he thought was heroin. Instead, it was a synthetic drug 10 times more powerful, and he died from the accidental overdose. The drug turned out to be acetylfentanyl, and it was the first time the County Medical Examiner’s Office identified the substance as the cause of a fatal overdose in San Diego.
Additionally, in the past year, medical examiner staff detected five other new synthetic drug compounds during death investigations. None had been seen in local deaths before, and three had never been identified in forensic autopsies anywhere in the United States.
The spate of new substances is worrisome to Iain McIntyre, Ph.D., the medical examiner’s forensic toxicology laboratory manager.
“The last year has been quite surprising — picking up a rash of unusual drugs, new compounds,” McIntyre said. “There are a lot of novel drug compounds being used in San Diego County and these synthetic drugs have dubious purity.”
The United Nations Office on Drugs and Crime calls these synthetic drugs “new psychoactive substances.”
Two of them are bath salt-type stimulants. Two others are psychedelic hallucinogen compounds, one similar to PCP. Two more – including acetylfentanyl – are opioids, similar to heroin.
In the acetylfentanyl case and in another involving a new compound called 5-APB, which is similar to bath salts but chemically based on ecstasy, the drugs were cited as the direct cause of death. In autopsies involving the four other synthetic drugs, the compounds were found to have contributed to the deaths. All the victims ranged in age from their late teens to 20s.
McIntyre said the acetylfentanyl concerns him most because it may be sold in place of heroin and has led to clusters of deaths in other parts of the country. Acetylfentanyl was first identified in a series of deaths in Rhode Island, then in several fatal overdoses in the Carolinas. McIntyre said San Diego toxicologists were the first to measure the fatal toxicity concentration levels. He suspects local hospital emergency room workers have already seen the substance but may not have known it, because users’ symptoms resemble those appearing in heroin overdoses. The treatment is also similar. Acetylfentanyl, however, requires much more antidote as part of treatment because of its increased potency.
McIntyre does not know for certain but he believes the acetylfentanyl may have been purchased locally based on when it is believed the man who died obtained the drug. But many of the other new psychoactive substances are believed to have been purchased online, creating potentially more uncertainty.
“The problem is when you buy these drugs on the Internet, you don’t know exactly what you’re getting, you don’t know if it’s mixed with something that is more toxic than you think you’re taking, and you don’t know the purity of it,” said McIntyre. “So, the drug you buy today on the Internet might be stronger than the one you bought last month. And you get a toxic, fatal reaction to it. The Internet is a game changer with these synthetic, modern abused drugs.”
William Perno, a prevention specialist with the Institute for Public Strategies and a retired San Diego County Sheriff’s deputy, said synthetic drug manufacturers frequently alter drug compounds to stay one step ahead of authorities who ban specific synthetic drug formulas. A manufacturer knows that a product may be out in the market for six months to a year before it’s flagged as a dangerous drug, so they are already working on their next formula, he said.
“This is chemical Russian roulette,” Perno said. “The effects can be death or serious injury after one time use.”
Local drug dealers can be fooled by their drug sources as well. Perno said one North County man, who was a known ecstasy dealer, was actually selling bath salts or methylone, to his own surprise.
The County’s toxicology laboratory identified methylone to be yet another new synthetic substance that caused a death in a 2013 case.
Perno said some recreational drug users think they are smoking all natural herbs, and don’t realize the herbs are sprayed with psychoactive substances because the drugs aren’t identified in the packaging.
For his part, McIntyre said he wants to warn others. The Medical Examiner’s Office has published its findings and methodology on five of the seven drugs in national toxicology and forensic science journals.
Often these new psychoactive substances aren’t even tested for following autopsies in other areas, because not all medical examiners or morgues have a laboratory. In those areas, toxicology tests are conducted at independent contract laboratories.
Additionally, the new psychoactive substances may not even register on some of the routine panels the labs are using for drug testing. The San Diego County Medical Examiner’s Office tests for 12 different categories of commonly abused drugs; other areas may test for only five or six of these.
In San Diego, many of the new psychoactive drugs were initially detected when they triggered a reaction for one of the drugs on the routine screening panel. However, upon subsequent confirmation testing, the sample didn’t contain any of the expected drugs. This tipped off toxicologists to the possibility of another new psychoactive substance, which they then set out to confirm and measure. As it turns out, a number of the newer synthetic drugs produce a positive result on the routine screening tests because their chemical structures are similar.
“As our chief medical examiner, Dr. Glenn Wagner often says, we’re not just the local morgue; we want to be an education source and a research center,” said McIntyre. “I think that the forensic toxicology laboratory is important in that we help educate not only scientists but also the local communities about the dangers of the drugs out there, particularly those that they can get now on the Internet.”