EMS: “Gray Death” Hitting the Streets

If you run medicals, chance are you’ve experienced at least one patient who has died from an opioid overdose from heroin in the last three years. This epidemic is not just limited to big cities; it’s affecting middle-class rural and suburban areas, too.

To illustrate the problem in just one state, on May 4, 2017, the governor of Florida declared a public health emergency. In 2015, heroin, fentanyl and oxycodone were directly responsible for the deaths of 3,896 Floridians, according to the state’s website.

Nationally, about 33,000 people died of heroin, fentanyl or oxycodone overdoses in 2015. When compared to the 35,000 who died in automobile crashes and the 15,696 who were murdered in 2015, the opioid epidemic is a national crisis.

The 2016 statistics for opioids has not been compiled yet but it is expected to be much higher.

Last year, U.S. Surgeon General Dr. Vivek Murthy declared a public health crisis of drug and alcohol addiction. In his report, called “Facing Addiction in America,” he noted that one American dies every 19 minutes from a heroin overdose. 

Most of the heroin in the United States comes from Mexico. According to news reports, the Mexican drug dealers have increased the supply of heroin because there is not much of a market anymore for their marijuana after several states legalized it and other states allow medical marijuana.

What makes heroin so attractive to sellers and buyers alike is that it is cheap. A bag of heroin can cost about $10 on the street, and if you buy in bulk, you can even lower that price. It is also attractive to users because a needle isn’t the only way it can be administered; it can be snorted, swallowed or smoked, thus removing the fear of diseases that are transmittable through sharing needles.

The new problem

But just when you thought it couldn’t get any worse, a new and dangerous killer cocktail of heroin, a synthetic opioid called U-47700, and fentanyl carfentanil is hitting the streets. Carfentanil is a drug used to tranquilize large animals. 

This new cocktail of dangerous drugs, which has been identified in many overdose deaths, is called Gray Death. It is called Gray Death because it looks like concrete mix. It comes in either a powder or a hard, chunky material.

As of this writing, Gray Death overdoses have been mainly showing up along the Gulf Coast states, but there have been reported cases in other states, such as Ohio and Kentucky.

As noted, in addition to the animal tranquilizer, one of the ingredients in Gray Death is U-47770. Last year, the U.S. Drug Enforcement Administration (DEA) listed U-47700 as a Schedule 1 controlled substance, which means the drug poses an imminent hazard to public safety and health. Schedule I substances have a high potential for abuse and have no currently accepted medical use. The DEA said U-47770 was associated with 46 deaths in 2015 and 2016, mostly in New York and North Carolina. U-47700 is exported from illegal labs in China, and is also known as “Pink,” "Pinky” or “U4” on the streets.

One of the problems with Gray Death is that those who use it are not sure of the “correct” amount of each component of the cocktail. As we have seen with heroin, if it has already been prepared by the seller, the mixture could be off, resulting in a bad batch hitting a community. In most cases, the buyers are unaware of the ingredients and, because they are addicted, they are only interested in getting their “fix.” Thus, it is reasonable to expect a higher-than-normal number of overdoses as Gray Death proliferates. 

First responders will likely not know whether they are treating a Gray Death OD or an OD from another type of opioid. Patients may be unconscious, have lowered respiration (if breathing at all), and their pupils will be pinpoint. Additionally, they will exhibit confusion and signs of cyanosis from poor circulation. As is the case with heroin, the remedy of choice is Narcan (naxolene).

In sum

This heroin epidemic is not going away anytime soon. As more states legalize marijuana, the cartels in Mexico will continue to push heroin and its other concoctions, like Gray Death, to Americans as their main money-makers. These 9-1-1 calls will strain many EMS systems that are already stretched beyond capacity. Firefighters should make every effort to make sure they recognize a heroin overdose when it presents itself.