PATHOLOGY TRIPLE TONIGHT with @mrs_angemi and @jmgardnermd!! Image: human lung under polarized light, 400X. Photo by @deathunderglass. As you may have heard, the death of the late entertainer Prince has been attributed to a fentanyl overdose. Fentanyl is a synthetic painkiller that is 80-100 times more potent than morphine. Fentanyl isn't new - it was invented in 1958 - but a recent rash of recreational use has led to a spike in opiate overdoses.
I practice forensic pathology in an area that has one of the most pervasive opiate and opioid problems in the country. From an operational perspective, the number of overdoses is problematic in unexpected ways; for instance, we not infrequently run out of room for bodies in the mortuary cooler. It's a little like Groundhog Day at the morgue, because it's as if we cut the same case, over and over - that of a young person with no natural disease who might have lived another 60 years, were it not for their addiction.
There has been a trend over the past 20 years that began with abuse of prescription painkillers like Oxycontin, Percocet, and Vicodin. As regulations tightened, prescription drugs became expensive and hard to get. So, users switched to heroin because it binds to the same opiate receptor. Most addicts begin with oral ingestion of pills, then crush pills and snort them (to get around the time-release mechanism), and end up injecting crushed tablets. So from there, it's a short hop to intravenous use of heroin. Painkillers contain many other ingredients than the painkiller itself - like colorants, binding agents, and coatings - and heroin is often cut with bulking agents. NONE of these added substances are designed to pass through your bloodstream and so they often become lodged in the walls of the blood vessels of the lungs. If I turn the light down on my microscope and use a polarizer, they light up like stars in the sky, as in the image above - beautiful, but deadly.
Many addicts are now intentionally or inadvertently buying heroin adulterated or completely replaced by fentanyl or its rarer analogs like acetyl fentanyl or methyl fentanyl.
#forensic #pathology #opiates