Synthetic opioid W-18 turning up in overdose victims
You may not have heard of the W-18 drug, yet, and unlike other street drugs, it does not have a long list of code names. In fact, it doesn’t appear as though any one is taking W-18 on purpose. It isn’t branded or sold specifically for individual consumption.
Instead, W-18 is turning up in opioids like heroin, cocaine and fentanyl. Similar to other new street drugs, this one was actually discovered by scientists several decades ago, but it was never tested or used on humans. Now it is being detected in overdose victims — way too late.
What Is W-18?
This new drug is essentially a synthetic opioid. The problem is that it contains a variation that makes it extremely dangerous, far more deadly than any other opioids we are familiar with.
Opioids are drugs that come from the opium plant. The grandfather of this class of drugs is opium itself, which was smoked as a recreational drug for centuries dating back to early Asian civilizations. Over time, the opium that comes from the poppy plants grown primarily in Southeast Asia came west.
As the addictive properties of opium were discovered, so was its pain-relieving property. It was harnessed in derivative drugs such as morphine and heroin. What followed decades later were synthetic versions such as oxycodone that we have today.
Opioids are all extremely addictive, but some have tremendous pain-relieving power that was not available before. Doctors prescribe opioid pain relievers for acute and intense pain following surgery or injury. With more prescriptions being written for these strong pain relievers recently, the availability of these substances has increased, as have the cases of addiction.
Some opioid addictions begin with a legitimate prescription for medical purposes, but they become a habit. Others begin when someone wants to tap into the euphoric effect of these drugs for recreational purposes. In recent years, the supply of heroin has forced its price down, and it gives the same high as prescription opioids, so some addicts will switch to getting their high from heroin, which they can buy on the street.
The chemical make-up of heroin, morphine and prescription opioids is very similar. This new drug W-18 is similar but different. It is most likely produced in labs in China, where drug laws are much different than in the U.S. Drug manufacturers in foreign countries often tweak their formula to avoid banned substances on the world market.
Small changes at the molecular level keep these synthetic drugs on the legal side of drug bans without significantly altering the outcome. In the case of W-18, however, the outcome is far more deadly than its predecessors. It has the same effects as other opioid drugs but is thousands of times more potent. Of course, this significantly raises the risk of overdose.
Add to that increased risk of overdose the fact that W-18 is added to other substances or sold by different names, and you have a serious public health threat. Unsuspecting drug users can end up consuming W-18 without even realizing it, compounding the problem.
One of the biggest problems with W-18 is that people are taking it thinking they are getting something else. Any street drugs present a huge health risk, mainly because they are not regulated by the FDA. No one tests these labs in foreign countries or trailer parks and garages to see if they are sticking to an agreed-upon formula.
Street drugs contain whatever the manufacturers decide to put in them. They can change the formula at any time and for any reason because there is no one watching them. Mostly, recipes are changed to accommodate changing drug laws or increase profit margins. These changes are not revealed to customers.
If you end up with a drug that contains W-18, there is no way of knowing it. It does not have a different color or odor from any other opioid. W-18 is just a white powder that could be mixed into any drug you purchase on the street.
Police and border officials do not even have a test for W-18. When they seize drugs, they have to send them to a lab for testing. Scientists are working on developing a field test for W-18, but none is available right now. The lag time between discovering W-18 and identifying it could cost lives.
The Dangers of W-18
The crux of the W-18 story is that there is a new, highly potent opioid drug on the street. It is not the first opioid, and each one seems progressively stronger, so it may be difficult to understand what all the fuss is about. After all, we already know the dangers of drug abuse, and we know the risks of overdosing on opioids, whether they are legally obtained and taken as prescribed or not. W-18, however, presents some increased dangers, including:
It can be too strong to reverse an overdose with Narcan — Public health agencies across the country have recently undertaken a more widespread distribution of naloxone. Previously used by emergency medical personnel, naloxone — also called Narcan — can reverse the effects of an opioid overdose. The immediate administration of this antidote can save lives, so having it available in more places where people might overdose has been determined in the best interest of public health.
W-18 is very much like opioids chemically speaking, but it has some differences. Since it was first discovered in 1982, W-18 was not used or tested on humans, so there is still a lot to learn about the drug. One thing that was figured out pretty quickly was its extreme potency. While this concentrated drug is easier to hide and smuggle into the country, it is much harder to counteract.
More testing is needed, but right now the lack of response to naloxone is one of the ways W-18 is detected in overdose cases. Scientists are not sure that W-18 acts on the same brain receptors that opioids like heroin do and which naloxone is designed to block. With more information about how W-18 acts in the brain, they might be able to develop a similar antidote.
For right now, there is no guarantee that naloxone will reverse a W-18 overdose. Depending on the amount of W-18 consumed and what else it was mixed with, the chances are pretty good that naloxone won’t work. Not having a reliable antidote makes W-18 even more dangerous.
It is impossible to detect in cocaine — There is no way of knowing if the cocaine you buy on the streets of Philadelphia, Alberta, Boston or any other North American city contains W-18. It is essentially an odorless, colorless, white powder with no obvious discernible features.
W-18 is fairly new to the street drug scene, so we can assume it hasn’t made it everywhere yet. But based on the news, we can assume if it isn’t in your city, it is on its way. Drug trends, even when they are detected early, are difficult to stop.
Even if you get the warning before W-18 comes to your area and you want to take precautions, there may be no way to avoid it other than to abstain from street drugs entirely. Knowing the risks of W-18 is certainly important, but if you cannot detect it, how can you avoid it?
It is being added to street drugs and not properly labeled — One of the reasons you cannot detect W-18 in street drugs is that the manufacturers and dealers are not going to tell you it is there. There is no labeling system for street drugs to list the ingredients, so no one is requiring drug dealers to reveal their recipes.
It is one thing to take a risk on a known substance, but when you are blind-sided by something unknown, there is no protection against that. The risks of opioids are fairly well known, the primary one being addiction. Once you are addicted to a substance, it is impossible to overcome that addiction without a conscious effort and professional help.
Despite the dangers of the possible presence of W-18, your addiction is not going to let you suddenly quit your habit. It is in the drug dealers’ best interest to keep you using, and they are not going to cut their profits to try to keep you safe. A drug manufacturer’s motives and yours as an addicted consumer are not really aligned.
It is playing right into the increase in opioid addictions — opioid addictions are on the rise in this country in recent years. From a purely statistical perspective, this is an increased danger. The more people who are abusing opioids, the bigger the market for these drugs.
Manufacturers of street drugs are opportunists. There is an entire worldwide drug market that operates according to the laws of supply and demand, although it is against most other laws. Where there is a demand for a substance, people are going to exploit that demand for their own profit by bringing more of it to market, even if that means tweaking the formula to get through customs.
A larger market for opioids means more sales. More sales of cocaine and heroin, for instance, mean more opportunities for people to mistakenly take W-18 and overdose. Since opioids are rather popular in the illicit drug scene right now, we can count on a lot of W-18 being consumed with possibly disastrous results.
A woman’s 25-year-old son died of a fentanyl overdose. He may have thought he was buying OxyContin, which he was open about using. She complains that there were no warnings out at the time about the dangers of fentanyl being sold on the street as opioids. She complains that despite the dangers associated with W-18, it is still being sold legally. Health care providers who have seen the results of W-18 in emergency rooms agree that warnings need to go out.
This Daily Mail article from the U.K. points out that W-18 is 100 times more powerful than fentanyl and produces a heroin-like high. Despite seizures of W-18 in Canada, the substance is not yet illegal there. The implication is that W-18 is being bought as fentanyl and causing overdose deaths around the world. Labs in China seem to be responsible for producing W-18 and shipping it west via airmail.
It took Canadian officials three months to detect the presence of W-18 in the country. They thought it was meth, fentanyl or some other opioid already known to them. When the substance was tested and discovered to be W-18, a warning went out to emergency room doctors and was subsequently leaked to the press. The substance was seized from a lab and assumed to be some random white power, which is why it took so long to analyze. A professor at the University of Alberta explained that W-18 is the result of some mutation of a synthetic opioid designed to get around drug restrictions.
In Philadelphia, doctors were alerted to a problem when overdose patients did not respond to typical antidote drugs. Some patients required multiple doses of naloxone to bring them out of near-death overdoses. According to the Drug Enforcement Agency, the tiniest amount of W-18 can cause an overdose, and people in Philadelphia seemed to be taking it without even realizing what it was. Narcan can reverse an opioid overdose, but W-18 is too strong for Narcan. The presence of W-18 on the streets of Philadelphia plays into the increase in opioid addictions since 2000 by adding an unexpected deadly twist.
Officials report that the spread of W-18 in New England could predict an increase in heroin overdoses in Connecticut shortly. Based on the news from Massachusetts and other neighboring states, Connecticut is preparing for the results of unsuspecting drug users getting heroin cut with W-18. This concern comes just one year after an increase in drug overdoses from fentanyl. Despite the circulation of heroin cut with W-18 in the Northeast, the DEA has not enacted an official ban yet.
There is great concern that the measures put in place to protect against fentanyl overdoses last year will not work on W-18. Fentanyl caused 274 deaths in Alberta in 2015, and W-18 could be even worse. Although W-18 is very similar to an opioid, there is not enough information about the specific pharmacology of this new drug to predict if it will bind to the same receptors in the brain as heroin. It is that binding process that Narcan disrupts in order to reverse an overdose. If naloxone doesn’t work, there are no other tools right now to treat W-18 overdoses.
A drug dealer smuggling fentanyl into the country from China was also found in possession of W-18. This drug seizure was one of the first in the United States. Before that, authorities could only confirm the presence of W-18 in Canada. The drug dealer could not be prosecuted for the W-18 because it is not an illegal substance in this country. It takes time for the law to catch up to analog drugs, ones that are created by making small changes to the molecular structure avoiding banned substances. Broward County officials consider the presence of W-18 in Florida a sign that the opioid problem, specifically fentanyl, is escalating. This discovery of pure W-18 in Florida suggests that it is being added to drugs here in the U.S. as opposed to them coming in from other countries with the W-18 already mixed in.
The first death involving W-18 in Alberta was confirmed through toxicology testing. W-18, fentanyl and heroin were all found in the victim. The test used to detect W-18 was only recently developed, but it will now be used to go back and test other overdose victims. Some of the deaths attributed to fentanyl may now be determined to be connected to W-18.
Deaths by Fentanyl or W-18
Because there is some confusion about what actually goes into street drugs, the mix-up between fentanyl and W-18 is causing overdoses. Some of these more recent fentanyl deaths may be attributed to W-18.
158 deaths were attributed to fentanyl in New Hampshire, compared with 32 heroin deaths in the same time period
Canadian overdose deaths related to fentanyl between 2009 and 2014 are estimated at 655
In 2015, deaths from fentanyl overdose in Massachusetts numbered 336
Health officials are concerned that W-18 will start a new deadly trend with other opioids.
How to Stay Safe From W-18
The W-18 crisis has public health officials scrambling to identify this substance, detect it and counteract it in an emergency. Law enforcement is out there tracking W-18 to find out where it is coming from and what routes are spreading it. Until changes in the drug laws catch up to this new analog, W-18 possession is not actionable. The good news, however, is that it tends to turn up with heroin or other banned substances.
While W-18 continues to spread across the continent, the only way to be truly safe is to avoid illicit drugs, especially the white powdered ones or pills that could be made with a combination of powdered substances. Street drugs are inherently dangerous, but with W-18 out there and invisible, they are especially deadly.
If you or someone you love is addicted to opioids, consider getting help to overcome your addiction. This new threat on the street might be the incentive you need to give up drugs and develop a healthy lifestyle. Addiction is a powerful force that can develop before you realize, but with the right help and support, it can be overcome.