Is W-18 Too Powerful for Naloxone?

Over the last few years there have been a number of deadly cases of heroin laced with fentanyl overdoses. Fentanyl is a powerful opioid analgesic, typically used in a hospital setting for either surgery or the most severe pain. The drug is roughly 80 to 100 times more powerful than morphine and around 40 to 50 times more potent than pharmaceutical grade heroin, according to the Centers for Disease Control and Prevention (CDC). With potency like this, it is easy to see that mixing fentanyl and heroin together is a sure recipe for disaster.

Fentanyl is now being produced in clandestine labs in China, shipped to Mexico and mixed with inferior grades of heroin to increase potency. Heroin users in the United States are often times unaware of the deadly admixture when they use, so they do not adjust their dosage accordingly—overdose often ensues. You might find yourself wondering if there could be a more deadly amalgamation. The answer to that question, unfortunately, is yes.

A drug that could be as many as 10,000 times more potent than morphine is possibly being mixed with heroin in the Philadelphia area, The Philadelphia Inquirer reports. The drug, known as W-18, may be too powerful for the opioid overdose drug naloxone to reverse. The Drug Enforcement Administration (DEA) has released a bulletin warning of the dangers associated with mixing W-18 with other drugs, such as heroin. The agency pointed out that a microscopic dose of W-18 could be fatal.

Recently, anesthesiologist Anita Gupta, who works as a pharmacist and pain specialist at Drexel University College of Medicine, began seeing cases of overdose where patients didn’t have the typical response when naloxone was administered. Gupta’s suspicion for the atypical response was the presence of W-18.

“The symptoms were worse than we were used to seeing,” said Gupta. “We were getting patients with symptoms of near-death, and often required multiple doses of the antidote naloxone.”

Two Types of Alcoholics

Drugs and alcohol take their toll on the human brain, which can be measured through a number of scanning techniques. When compared to the brains of people who have not had a substance use disorder, clear differences can be seen. That being said, the brain of one alcohol user may look different than another, and new research may have found that there are two types of alcoholics. Researchers from the University of Eastern Finland found that while all alcoholics share similar brain changes, some alterations are exclusive to one type of alcoholic but not another, PsychCentral reports. The findings are published in the journal Alcohol and Alcoholism.

There are two types of alcoholics, anxiety-prone (Type I) and impulsive (Type II) based on Cloninger’s typology, according to the article. The researchers looked at post-mortem brains from both types of alcoholics and a control group.

“From the viewpoint of the study setting, this division was made in order to highlight the wide spectrum of people suffering from alcohol dependence. The reality, of course, is far more diverse, and not every alcoholic fits into one of these categories,” said Olli Kärkkäinen, M.Sc. (Pharm).

Typically, Type I alcoholics are more prone to anxiety and are more likely to become dependent on alcohol later in life, the article reports. On the other hand, Type II alcoholics usually become dependent on alcohol when they are younger and show greater impulsivity and antisocial behavior. In Type I alcoholic brains, the researchers found:

• Changes in the endocannabinoid system, which modulates stress responses.
• Increased Docosahexaenoylethanolamide levels in the amygdala, possibly linked to their anxiety prone nature.

With Type II alcoholic brains, the researchers found elevated levels of AMPA receptors in the anterior cingulate cortex, according to the article. That part of the brain has a hand in learning and the regulation of behavior, which could explain the impulsive nature of Type II alcoholics.

“These findings enhance our understanding of changes in the brain that make people prone to alcoholism and that are caused by long-term use. Such information is useful for developing new drug therapies for alcoholism, and for targeting existing treatments at patients who will benefit the most,” said Kärkkäinen, the study findings were part of his doctoral thesis.