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Ambulance: Light Weights – Heroin Math 2 (Why We Don’t Get Robbed of our Fentanyl)

Written by RSS Poster Medic Scribe

You carry four 100 mcgs vials of Fentanyl in your controlled substances kit.  How much would those vials be worth on the street?

Let’s do the math.

100 mcgs of Fentanyl is the equivalent of 10 mgs of Morphine.

Morphine is 50% as strong as heroin.

Morphine is the equivalent of 50% pure heroin.

A bag of heroin in Hartford contains 0.1 grams of powder.

0.1 grams of 50% pure heroin is 50 mg of heroin and 50 mgs of filler.

50 mg heroin is the equivalent of 100 mg morphine.

100 mg Morphine is equivalent to 1000mcgs of Fentanyl.

1000 mcgs of Fentanyl is 10 vials of 100 mcg Fentanyl.

A 0.1 mg bag of 50% pure street heroin is the equivalent to 10 vials of 100 mcg Fentanyl.

A bag of heroin costs $5 on the Hartford streets.

Each 100 mcg vial of Fentanyl is worth 50 cents.

Four 100 mcg vials of Fentanyl is worth $2.00.

When was the last time you were held up at gun or knifepoint for your controlled substances by a heroin user?

Ever wonder why 100 mcgs of Fentanyl...

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Ambulance: The dampest squib - Shape of Training outcome

Written by RSS Poster Garth Marenghi
So the Shape of Training Steering Group have published their final report and I think it's fair to say it's a massive improvement on Professor Greenaway's disastrous first draft.  My summary article in the BMJ from 2015 summarises the huge problems with the initial report and the rather dubious political influence upon the review that was taking place off the public record. The most dangerous

Ambulance: Nocebo Effect

Written by RSS Poster Medic Scribe

While headlines of deadly Fentanyl creating Haz Mat scenes and causing first responders to be hospitalized continue to dominate the news, on July 10, 2017 with little fanfare, the US Institute for Occupational Health and Safety removed the statement “skin absorption can be deadly” from its Fentanyl page.

You can read their safety recommendations here:

Fentanyl: Preventing Occupational Exposure to Emergency Responders

A rational article on what is becoming an increasingly hysterical situation was published by STAT.

Are people really falling ill from touching fentanyl? In most cases, scientists say no

Here is an informative passage:

Juurlink said the real culprit in these cases may be a phenomenon known as the nocebo effect, in which the mere suggestion that a substance can be harmful causes people to suffer negative effects after exposure. In medical research, for example, being informed of side effects related to a pill or procedure can bring on real-life symptoms.

“If in a moment of panic, a person sees powder on their skin and...

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Ambulance: Couples

Written by RSS Poster Medic Scribe

The call is for a possible overdose.  A tall attractive young woman in leopard skin pants, and a Ginger from Gilligan’s Island hairdo, meets us at the apartment door.  She is high. Her balance as she sways in front of us is so bad it is making me dizzy just looking at her. “Thank you for coming so quickly,” she says.

“Is he breathing?” I ask.

“Yes, but he won’t wake up. He had his methadone dose upped today and he took some of my benzos. I did CPR on him.”

The apartment has hardwood floors, high ceilings and big windows that look down on the city from the 4th floor of the recently renovated building. I follow her as she stumbles down the hall. “This way.”

A bare-chested bearded man in his thirties lays on the bed, clearly on the nod, but breathing. He has a strong pulse. Some stimulation and he sits up with a jerk to see me, my partner and four firefighters.

“What did you do?” he says to his girlfriend. She begins to cry.  “I saved your life,” she says. “I did CPR on you. 30 and 1. I threw cold water on you....

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Ambulance: An Offer Hard to Refuse: Heroin Math 1 (Pills to Mainlining)

Written by RSS Poster Medic Scribe


People addicted to prescription painkillers who buy their pills on the black market switch to heroin because it is a better economic deal (cheaper and stronger).

The Situation:

When a person’s painkiller prescription runs out or their tolerance outruns their prescription, and the user still needs opioids to keep from being sick, the user turns to the black market and buys painkillers on the street.

In Hartford, the going rate for oxycodone is $1 per milligram.  A 30 mg oxycodone costs $30.  The same person who sells them oxycodone often also sells heroin.  Heroin in Hartford goes for $5 a bag.

For $30 you can buy 6 bags of heroin.  (This is without any discount.)

If the strengths were equally priced, a 30 milligram oxycodone would be the equivalent of six bags of heroin.

It is not.  Heroin is not only cheaper than oxycodone, it is stronger.

Let’s do some math.

The Math/Assumptions

An oxycodone 30 mg is the equivalent of 15 mg morphine IV.  (1)

Heroin is at least...

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Ambulance: Fact or Fiction

Written by RSS Poster Medic Scribe

Great article on

Medical commentary on the issue of danger to first responders of transdermal fentanyl exposure.

Dr. Tan, discussing transdermal fentanyl exposure, agrees that exposure as would be typically encountered by first responders is an extremely low risk.

“It is not zero risk and certainly not impossible, but extremely low,” he said.

Fact or fiction: Transdermal fentanyl exposure

Ambulance: Falsehood Flies

Written by RSS Poster Medic Scribe

“Falsehood flies, and truth comes limping after it, so that when men come to be undeceived, it is too late; the jest is over, and the tale hath had its effect.” – Jonathan Swift

This quote came to me from a respected toxicologist after reading some news accounts of public safety response to possible fentanyl overdose scenes.

The falsehood that just touching fentanyl can kill you has persisted despite the recently published position paper by The American College of Medical Toxicology and the American Academy of Clinical Toxicology that it is not so.

ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders

On July 26, the Los Angeles Times, in a story about a drug overdose scene, 1 dead, 2 others hospitalized after authorities find white powder in Santa Ana apartment, reported: “A small dose of the odorless white power can be fatal.  In some cases, just touching the powder could trigger an overdose like it did this year in Ohio.”  They go on and talk about the...

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Ambulance: 10 Year Old Boy

Written by RSS Poster Medic Scribe

Jeanmarie Perrone MD, an emergency physician and medical toxicologist, answers questions from a reporter about the death of a 10-year- old boy in Miami and the dangers of fentanyl exposure.  Hers is a voice of reason in an understandable climate of hysteria.

Miami Boy’s Death Shows Powerful Opioid’s Chilling Potential

The case is tragic.  A 10-year-old boy walking home from the pool somehow encounters fentanyl and on arrival at home, vomits, collapses and dies, and later tests positive for fentanyl and heroin.

Miami chief: no leads, suspects in young boy’s opioid death

Who knows what the final details of the case will be, but the facts of fentanyl exposure remain the same.  Dermal contact is highly unlikely to cause an overdose.  Injection, inhalation or ingestion are the areas of concern.

CDC: Protecting Workers at Risk

The boy did live in a neighborhood known as “ground zero” of the area’s opioid epidemic.  Could he have found heroin/fentanyl on his way home, and either touched the whitish powder (heroin is often cut...

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Ambulance: Breathtaking incompetence - a monumental shambles in their hands

Written by RSS Poster Garth Marenghi
I've been reading Rachel Clarke's book over the last few evenings and this is what has inspired me to ramble on the blog today.  The mixture of humanity, sharp analysis and reasoned argument makes Rachel's excellent book absolutely essential for anyone interested in medicine, the NHS or healthcare.  The way in which the government have ignored precisely this kind of incisive intelligence sums

Ambulance: Medical Statement on Fentanyl Exposure

Written by RSS Poster Medic Scribe

The American College of Medical Toxicology and the American Academy of Clinical Toxicology have issued a joint statement on Preventing Occupational Fentanyl and Fentanyl Analog Exposure to First Responders that states “the risk of clinically significant exposure to emergency responders is extremely low.”

The statement addresses reports of responders suffering overdose from handling or being in proximity to these opioids. Hopefully, this joint statement will help reduce some of the concern and hysteria caused by these stories, and prevent unnecessary delays in treating critical patients without endangering responders.

The statement reads:

“To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity.  Reports of emergency responders developing symptoms after contact with these substances have described nonspecific findings such as...

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