Suspected Novel Psychoactive Substance Outbreak in Northwest Tennessee — Fatal Opioid Overdose Risk Increases Thanks to Coronavirus

I live in Northwest Tennessee, also known as Region 6N by the state (at least as far as Regional Overdose Prevention Specialist jurisdiction is concerned), a nine-county region home to about 254,000 people. 2014 — that’s when I moved here. It’s also when I picked up opioids as my drug of choice. I’ve been using illicit opioids, both heroin and diverted prescription opioids, regularly since then.

Although now I’m “in recovery,” I’m still in touch with people who use opioids around here. I give out syringes, naloxone, fentanyl test strips, and the like. I educate people about safe drug use practices. I inform law enforcement and members of the public about relevant issues and the gospel of harm reduction.

I read countless articles and social media posts about how the novel coronavirus pandemic would disrupt the drug trade. Nothing, really, changed around here. Until now.

A week-and-a-half ago, I came across a report of some strong heroin. People I know claim this stout stuff acts like normal heroin, but another (often strong) wave kicks in anywhere from a few minutes to over an hour later — even if they inject it intravenously.

I came across this same stuff again just five days after my first encounter with it. People around me say they’ve had this stuff before, maybe even as far back as a few months or years ago. But it’s in supply now. If you’re buying opioids, whether it be heroin, diverted prescription opioids, or counterfeit opioid painkiller tablets, there’s a chance you come across this stuff.

I know it’s in Jackson, too, which isn’t technically in Northwest Tennessee — it’s central West Tennessee.

I was told by a regional medical/public health official there were nine fatal overdoses in Northwest TN in the past month. I was also told by a fellow opioid user that there were three fatal overdoses on Mother’s Day weekend alone. I don’t know if these three are included in the nine since the second report came from an unofficial, anecdotal source.

Unfortunately, I don’t know what’s in this heroin. It could also be in counterfeit pain pills around here, if not elsewhere, but I don’t know. I haven’t heard reports of this stuff in Knoxville, Nashville, or North Carolina from sources in these areas.

I think a novel psychoactive substance (NPS) is being cut into heroin because of supply chain issues thanks to the novel coronavirus pandemic. But we don’t know what that NPS is yet. It could be a fentanyl analogue. It could be something like U-47700. But I don’t know. It’s definitely an opioid, that’s for sure.

My purpose in writing this is to sound the alarm and tell people who use drugs, specifically opioids, to be careful. But how, exactly, can you be careful while using this drug — whatever the hell it is?

Advice for Using Opioids During This Time

These tips are gathered from real-world experience with harm reduction in mind. The following tips aren’t necessarily true for all opioids — again, they’re written with this batch of whatever-the-fuck-it-is in mind.

Take It Super Duper Slow

Like I said, this stuff takes anywhere from a few minutes to over an hour to fully kick in. You should always use test doses (called test shots if you’re injecting), but especially with what’s going around right now. Although it’s tempting to use a larger dose at first or even a few minutes after doing a test shot, refrain yourself from dosing again for at least an hour, if not longer.

I know this is difficult. Plus, it’s not practical to assume everyone will take this precaution. A test dose might not be enough to bring someone out of hellish opioid withdrawal. Also, being careful isn’t always synonymous with having fun — I understand the rush this stuff brings is nothing short of sensational.

Cook It First

You can’t do this unless you inject — well, you can, but most snorters don’t want to dissolve their drugs in water; plus, most people aren’t willing to boof, or rectally administer, opioids, even though it’s the next-best route of administration after injecting with roughly 60% bioavailability — but “cooking” your dope refers to heating it up wth a lighter just to the point of boiling (some prefer to heat it to a boil, some don’t) once you dissolve the drugs into water.

Rumor has it that cooking this stuff makes it potentially safer by helping the other active drug(s) kick in faster. If possible, even if you only snort or boof, cook your opioids before using them (I wouldn’t cook pills, but, then again, I wouldn’t recommend injecting or otherwise using pharmaceuticals other than directed, which is usually orally). Here’s how to do just that:

1. Dissolve some of your drugs (this is possible with other water-soluble drugs, not just opioids) in water. I recommend using less than one milliliter of water, as well as using metal “cookers” as shown below. A metal spoon will work just fine, too.
2. Mix the drugs until they dissolve. Sometimes, like with black tar heroin, they might not dissolve without heat. Here in Northwest Tennessee, though, powdered heroin that readily dissolves in water is the norm.
3. Hold a lighter under the cooker just until it boils. The boiling point is reached as soon as you begin seeing bubbles form. You should see black scum forming at the top of the solution. These are likely impurities, if not one or more of the novel psychoactive substances (or one or more of their byproducts), that you don’t want to be consuming anyway. Keep in mind you want to avoid boiling because opioids could be destroyed. Nobody wants that. At least not me.
4. Use cotton or a wheel filter (good luck finding those; they are available online, just kinda pricey) to draw the solution into a hypodermic syringe or an oral syringe — hell, a turkey baster, if you can’t get either of those. You can get oral syringes from pharmacies without prescriptions. Go ask any pharmacy (I’ve had success at Walmart) for an oral syringe, they’ll usually give one to you for free. You can buy hypodermic syringes online from medical/diabetes supply shops without syringes — I’d recommend pharmacies, but most here aren’t willing to sell needles without prescriptions.
5. Most people don’t store injection drug solutions for long, as they usually cook just enough for one dose. If you do decide to store an opioid solution, I recommend keeping it in a refrigerator.

Know How to Spot It

Check out these pictures an anonymous source took of this batch. These were taken just a few days ago, around Wednesday, June 10th.

Remember how I said the color of the uncooked solution is often darker? Here’s what that solution looks like before being heated. Note the color of the solution is darker than after it’s been heated.

Although the cooked solution is visible in the first picture above, here’s what the cooked, filtered solution looks like. There doesn’t seem to be much difference in the filtered and unfiltered solution after it’s cooked.

But what does the dope itself look like?

Here’s what the stuff looks like outside of plastic.

This stuff is said to taste just like any other batch of heroin and wasn’t sweet like fentanyl-cut batches sometimes are. Keep in mind that you can’t reasonably identify drugs just by their appearance, though it is important to know what this stuff could look like and how it might behave.

If you come across any opioids that share some or all of these chracteristics, contact me and/or other drug-involved persons, ranging from dealers, fellow users, family members, prevention coalitions, law enforcement agencies (reporting the presence of drug trends to law enforcement ain’t snitchin’), syringe services programs, medication-assisted treatment program administrators and physicians, addiction treatment providers. Don’t do anything that might incriminate you, but there are plenty of ways to go about sharing drug reports without getting yourself or others in trouble.

Getting Naloxone

If you live in Northwest Tennessee and need naloxone (Narcan), contact Region 6N Regional Overdose Prevention Specialist (ROPS) Melesa Lassiter at (731) 819-7603 or melesa@martinhousing.org. You can also contact Martin Housing Authority if you’re around Martin at (731) 587-3186 or the Weakley County Prevention Coalition at (731) 514-7951 or weakleyprevention@gmail.com.

If you live elsewhere in Tennessee, use this to find your region’s ROPS, along with their phone numbers and emails.