The U.S. Is Worried About Fentanyl as a Chemical Weapon

The US has approved a naloxone injector to combat fentanyl as a chemical weapon.

Plus: The overdose dangers of common prescription meds for teens, and a new way to test for alcoholism risk

By Mark Mravic

Among the many tragedies emerging from Russia’s criminal invasion of Ukraine is that we all have to start thinking again about the unthinkable. Indeed, the U.S. and its allies may soon be rolling out a newly approved countermeasure against the use of fentanyl—now the chief culprit in the opioid crisis—as a chemical weapon.

Also this week, insight into fatal overdoses involving prescription drugs among young people, and a new genetic tool to evaluate the risk for alcoholism.

From the FDA:
Countering Fentanyl’s Chemical Weapons Threat

The horror stories around fentanyl continue to grow. Some are exaggerated, but others appear all too real. Now we can add the fear that variants of the powerful opioid could be used as chemical weapons—a threat the U.S. military is taking seriously. Earlier this month the Food and Drug Administration (FDA) approved a 10mg naloxone injector, created by the pharmaceutical company Kaléo in conjunction with the U.S. Defense Department’s Chemical and Biological Weapons Defense program, for emergency treatment in cases where high-potency opioids are suspected to have been dispersed on the battlefield. Kaléo CEO Ron Gunn said the company is working with the Defense Department “to support the inquiries from NATO forces and other allied nations for immediate access” to its naloxone injector.

The prospect of fentanyl as a chemical weapon isn’t as far-fetched as it sounds. In fact, there is a documented case in which the drug has been deployed in a mass assault. In 2002, Chechen terrorists took over a Moscow theater and seized more than 800 hostages. After negotiations failed, Russian security forces pumped aerosolized carfentanil into the theater, incapacitating everyone inside. The terrorists were killed—and so were some 130 hostages. After-action reports suggest many of the hostages could have been saved if the Russian forces had told medical personnel what the victims had been exposed to.

“These synthetic opioids, such as fentanyl and carfentanyl, can pose a devastating threat to our service members.”

—Col. Ryan R. Eckmeier

The incident revealed that Russia had continued its research into fentanyl as a potential weapon after the U.S. had ended a similar program, and in fact had actually made a usable version. While the 1997 Chemical Weapons Convention (CWC) doesn’t specifically mention fentanyl, its application in war would still be considered a violation of the treaty. However, the CWC has an exemption for law enforcement uses of chemical agents—tear gas, for instance, is banned in war but can be deployed by police. That raises the risk, as one WMD expert put it, “for CWC members to exploit the law enforcement exemption as cover to prepare for the use of chemical weapons in warfare.”

The U.S., along with Australia and Switzerland, has pushed for the CWC to close the law enforcement loophole for aerosolized agents that act on the central nervous system—an intentional reference to opioids—to prevent their use against either soldiers or civilians. “These synthetic opioids, such as fentanyl and carfentanyl, can pose a devastating threat to our service members,” said Col. Ryan R. Eckmeier, defense department project manager. ”Access to a point of injury countermeasure such as the Naloxone Auto-injector 10 mg is a major step forward to protect and maintain readiness of the Joint Force.”

From Pediatrics:
Teen Overdoses on Prescription Mental Health Meds

Greta Bushnell

A significant number of young people who overdosed on a benzodiazepine (a sedative, like Xanax) or a psychostimulant (like Adderall) had recently been prescribed the drug. That’s the troubling news from a new study out of Rutgers University that analyzed three-year data from 1,629 overdose deaths involving benzos or stimulants among Americans aged 15 to 24. Researchers found that 29% of young people who fatally overdosed on a benzodiazepine from 2016 to 2018 had a doctor-written prescription in the previous month, and 42% had been prescribed the drug in the previous six months. For psychostimulants, the one-month figure was 25%, the six-month numbwe 39%. Researchers say doctors treating young people for ADHD, anxiety and other disorders should closely weigh the benefits and risks of prescription medications.

“These findings highlight the need for physicians to assess youth for self-injury risk who are prescribed BZDs and stimulants, as well as the need for varying efforts to prevent intentional and unintentional overdoses,” said Greta Bushnell, PhD, a corresponding author of the study. She also drew attention to the need for discussion around polysubstance use, since many overdoses involve benzodiazepines or psychostimulants in combination with alcohol, opioids or other substances.

From Alcoholism: Clinical and Experimental Research:
A Genetic Measure for Alcoholism Risk

Family history has long been helpful in determining whether someone is at risk for alcohol use disorder (AUD). But in some cases when patients are being evaluated for AUD, family history is either unavailable or unreliable. Genetic information is helpful as well, but individual genetic factors may have just a small effect on AUD. Researchers at Indiana University believe they’ve found a way of overcoming those hurdles with a method that takes into account a range of genetic traits to calculate a person’s “polygenic risk score“ (PRS) for alcohol misuse.

“While family history reflects at least part of the genetic risk for AUD, PRS provides complementary information, and together they improve the ability to evaluate risk.”

—from the Polygenic Risk Factor study

In a recent study, the Indiana researchers analyzed genetic information of more than 3,000 people who met the diagnosis for alcohol disorder or dependence and determined a PRS score for each subject. They found that on the whole, participants with AUD had higher scores than control subjects, and that the higher the score, the greater the severity of the disorder. Subjects in the top 10% of the score range were twice as likely to have AUD as other participants. “While family history reflects at least part of the genetic risk for AUD,” the researchers note, “PRS provides complementary information, and together they improve the ability to evaluate risk.” The authors suggest that evaluating people for their polygenic risk score before the onset of AUD can allow for “targeted interventions that enable individuals to make informed decisions about their alcohol use.”

Top photo: Pablo Stanic