Tox Tuesday: Gray death

May 23, 2017

As if heroin and other opioids weren’t dangerous enough, a new drug known as “gray death” has appeared on the scene in several parts of the United States.

The drug — which gets its name from its cement powder-like appearance — is a cocktail of deadly opioids mixed with heroin or fentanyl, a synthetic opioid. On their own, either of these drugs can take the lives of those who use them. Combined, they have caused at least 50 overdoses in the nation in the past three months.

“To this date, I have no idea what makes it gray,” said forensic chemist Deneen Kilcrease in an article. “Nothing in and of itself should be that color.”

What’s in gray death?

Gray death is made up of some nasty stuff. It usually comprises heroin, fentanyl, carfentanil — which is used to tranquilize enormous elephants — and another synthetic opioid called U-47700.

Fentanyl is about 80 times stronger than morphine, and is used today as an anesthetic for severe pain after surgery. It was first synthesized in the 1950s, and put to medical use the next decade.

Carfentanil is an analog of fentanyl. Just a few granules can kill a human. It was originally synthesized in 1974 as anesthetic for large animals, like elephants. The National Library of Medicine states that its “extreme potency makes it inappropriate for use in humans.” The same source cites it as 100 times stronger than fentanyl and 10,000 times stronger than morphine.

U-47700 was originally created as an alternative to morphine, but failed to gain approval from the U.S. Food and Drug Administration. It’s known on the streets as “pink” or “U4.”

Though the above are the most common substances to be found in the drug, it’s hard to say exactly what makes up gray death. Ingredients can change between batches, as the mix is concocted by different producers.

“You can throw anything in a baggie and call it ‘gray death,’” Dionna Iula, a forensic chemistry expert, told CNN. “It’s going to constantly vary, and it’s going to keep the chemists and the medical examiners on their toes.”

How deadly is gray death?

Just touching the drug is dangerous, as it can be inhaled or absorbed into the bloodstream through the skin.

"A lethal dose is not even visible to the eye," Iula said. "That gives me the chills."

In East Liverpool, Ohio, an officer accidentally overdosed after pulling over two suspected drugged-up drivers. In a panic, the suspects dumped a substance onto the floor of the car. When the officer searched the vehicle, he somehow ingested what is suspected to be a mix of fentanyl and carfentanil.

Though the officer involved is expected to recover after receiving several doses of Narcan, the situation highlights the risk not just for users, but for police and first responders attending to overdose victims.

How do we contain these super-drug cocktails?

Governments struggle to ban synthetic, potent drug mixes because producers overseas continuously hit the markets with new compositions. Chemists in the countries where the drugs are produced can modify a molecule slightly, and end up with a new recipe. Regulations can’t always keep up the pace.

Where do we see this scary stuff?

So far, the drug has not been seen nationwide, but has been causing scares in a few locations. NBC reports that the drug has been tracked down in a few large American cities, including Atlanta, Chicago, Cincinnati and San Diego. Smaller towns affected are Merrillville, Indiana and Lexington, Kentucky. Experts fear that gray death will continue to spread as the opioid crisis worsens across the country.

Category: Toxicology