Posts Tagged 'fentanyl'

The weaponization of toxicity

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In a previous post I looked at the use of poison for state-sponsored assassination in the recent past. In the period since the assassination attempt on Khalid Mishal by Israeli agents in 1997 I have not found any other reports of the use of fentanyl for murder. While its lethal effect on people who have used it as a heroin substitute has been notorious, I discovered another even more disturbing application of the drug.

Fentanyl (N-phenyl-N-(1-(2-phenylethyl)4-piperidinyl)propanamide) is a potent synthetic opioid agent widely used for surgical analgesia and sedation. It is 200 times more potent than morphine. In therapeutic use fentanyl is quickly absorbed through the skin and is frequently applied as a skin patch. There has been research into the use of this drug in spray format.

Although prodigiously useful in the operating room, fentanyl has toxic cousins that deliver a lot more than freedom from pain. Nonpharmaceutical fentanyl use can be deadly. According to a 2008 MMWR report 1,013 deaths in six jurisdictions were attributed to fentanyl abuse in a two-year period, making this the largest such epidemic ever reported. Recent data on illicit fentanyl and its analogues indicate that these compounds are becoming increasingly popular on the drug market. The street will sell you a pocketful of sweet dreams with many aliases: China White, Synthetic Heroin, Mexican Brown, Persian White, Apache, China Girl, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango & Cash. All of these potentially lethal hits make morphine look like child’s play.

But beyond its common use as a street drug, fentanyl — or, more accurately, powerful variants of the drug — is being studied by a number of governments for official use as a biochemical weapon. For example, a fentanyl derivative was used to end the Moscow theatre hostage crisis in 2002, in which many hostages died from accidental overdoses of the narcotic. [1,2]

It was this act of terrorism that first brought the issue of incapacitating biochemical weapons to widespread public attention. On October 23, 2002, a group of Chechen terrorists raided the Dubrovka theatre during a performance and took 800 people hostage. The 50-odd hostage takers were well armed and the women among them were wired with high explosives. They demanded the withdrawal of Russian troops from Chechnya and threatened to kill the hostages if their demand was not met. On the morning of October 26, Russian Special Forces troops disseminated a biochemical agent through the ventilation system, putting everyone who remained in the auditorium into a deep sleep. Approximately 30 minutes later, the troops stormed the building, killing the hostage takers and ending the crisis. 125 hostages died from the effects of the gas, and many more were severely injured. Several days later, the Russian Health Minister let it be known that the gas contained a derivative of fentanyl, but he did not reveal the specific nature of the agent used. According to Russian media reports the drug used was the formidable incapacitating agent Kolokol-1, whose active ingredient is secret but could possibly be the extraordinarily potent carfentanil or 3-Methylfentanyl. Sprayed into the air as an anesthetic gas, it takes effect very quickly, within one to three seconds, reportedly rendering its victims unconscious for two to six hours.

The deadly denouement of the Moscow theatre siege is a frightening example of how incapacitating biochemical weapons can be used by the state. The obvious ethical questions aside, it has generated increasing interest on the part of governments in exploring the weaponization of drugs. Indeed, as science and technology continue to advance, our rapidly increasing understanding of human physiological systems indicates that the development of new incapacitating biochemical weapons is not only possible but inevitable.
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In a recent article in International affairs, J.P. Perry Robinson discusses the growing concern over the use of chemical weapons, not so much by terrorists, but by the state for purposes of what it interprets as counterterrorism. [3] Of course, counterinsurgency applications of toxic chemicals have been in use for decades. Major European powers used them in their colonial domains, the Americans in Vietnam. But the re-emergence of biochemical weapons in counterterrorist guise is troubling. Police forces in the UK, for example, are equipped either with Agent CS or with PAVA spray for law enforcement use, and, according to Perry Robinson, the readiness with which the US Marine Corps has taken to Agent OC — a toxic riot control spray produced from ground chili-peppers — seems an indication of a trend. So, perhaps, is the absence of any serious criticism of the Russian government for having authorized the use of a lethal neurotoxin to end the 2002 hostage incident.

Since 1992 proponents of so-called “non-lethal weapons” have been attempting to loosen the constraints imposed by the Chemical Weapons Convention (CWC) on the weaponization of other forms of toxicity, such as riot control agents (RCAs). In a process of creeping legitimization, several countries now appear to be pursuing more lethal forms of incapacitating biochemical weapons.

The process has been one of not only “public diplomacy” and other more hidden pressures for exemption, but also one of national legislation. In the United States the “Ensign Amendment” of the 2006 National Defense Authorization Act asserts that “riot control agents are not chemical weapons.” No other state that is party to the CWC has adopted such a position, nor even commented publicly on what the United States has done. At the same time, the failure to amend the the 1993 Chemical Weapons Convention to prohibit the growing acceptance of RCAs demonstrates the varying levels of ignorance, incompetence, heedlessness, short-termism and conflicting political interests among the world’s governments. A situation in which some types of toxic weapon are tolerated but others are not is certain to be unstable.

Let us hope that saner views will prevail now that the Bush years are over. Otherwise a toxic chemical attack could be coming to a theatre near you.

References

1. Geoghegan J, Tong JL. Chemical warfare agents. Continuing Education in Anaesthesia, Critical Care and Pain. 2006 1 Dec ;6(6):230-234

2. Pearson A. Incapacitating biochemical weapons: science, technology, and policy for the 21st century. Nonproliferation review. 2006 July;13(2):151-188.

3. Perry Robinson JP. Difficulties facing the Chemical Weapons Convention. International affairs. 2008;84(2):223-239.

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The pellet with the poison’s in the vessel with the pestle

I was doing a literature search on some toxins when I got to thinking about how poisons get into the body, and in cases where that doesn’t happen accidentally, how various poisoners have achieved their nefarious ends. There is an old mnemonic: Stick it, Sniff it, Suck it, Soak it. An effective trick for remembering the four pathways into the body used by medications and toxins alike: injection, inhalation, ingestion, and absorption.

poisonvial

The Vessel with the Pestle

As with so much else, Shakespeare is a fecund source of toxic text. The Bastard in King John boasts that he can offer “sweet, sweet, sweet poison for the age’s tooth.” Take Hamlet, for example, with at least five nasty poisonings by my count – six if we include the knavish piece of work by Gonzago in the play within the play – not to mention the other on-stage and off-stage deaths by dagger, drowning, and execution. No “sniff it” murders, but stick, suck and soak get the full Shakespearean treatment. I’m not aware of any inhalations of poison in the Bard’s works, although in Timon of Athens there is an unsettling prefiguration of air pollution:

… a planetary plague, when Jove
Will o’er some high-viced city hang his poison
In the sick air.

macbeth-witchesAnd the witches’ brew in Macbeth must have issued the most mephitic and pestilential of odours, enough, as my uncle used to say, to knock a buzzard off a shyte wagon:

Round about the cauldron go;
In the poison’d entrails throw …
Pour in sow’s blood, that hath eaten
Her nine farrow; grease that’s sweaten
From the murderer’s gibbet throw
Into the flame.

But other dramatists of the time made sure that all four of poison’s pathways were well covered. In the spectacularly gory final scene of Thomas Middleton’s Women Beware Women (think Romeo and Juliet meets Pulp Fiction) Livia dies of inhaling poisoned smoke; the Duke expires messily from the revenge tragedy standard, poison meant for another; and Bianca, who has been raped by the Duke and forced to become his mistress, commits suicide by kissing the Duke’s poisoned lips. Not to be outdone by Hamlet, Middleton also adds a couple of other fearsome killings: Isabella is murdered by flaming gold and an anguished Hippoloto impales himself upon a sword.

On a lighter note, those of a certain age may remember LMAOing at the jousting scene in Danny Kaye’s 1955 film, The Court Jester. A bumbling commoner ends up encased in armour and set up to fight in a joust to defeat an evil conspiracy against the king. Before the tournament begins he is warned to be careful of the ritual libation offered to the combatants. A witch who is trying to be helpful has poisoned one of the drinks. As she puts it, “The pellet with the poison’s in the vessel with the pestle; the chalice from the palace has the brew that is true.” Hilarity ensues as Danny struggles to remember these zany instructions. Just when he thinks he’s got it, he’s told that everything has changed because the vessel with the pestle has been broken and replaced with the flagon with the dragon. Now the pellet with the poison’s in the chalice from the palace; the flagon with the dragon has the brew that is true. Oh my! But never fear. The drinks get safely spilled, the jester wins the tournament, and he becomes the unlikely hero of the day.

gertrudeThe Chalice from the Palace

Hamlet is the classic instance of the poison-meant-for-another plot device. Shakespeare liked this so much that he used it three times in the same scene as Gertrude, joined later by Claudius and Laertes, drops dead with bulging eyes and a strangled WTF. “No, no, the drink, the drink! O my dear Hamlet! / The drink, the drink! I am poisoned.” To be followed, of course, by Hamlet himself. “The point! envenom’d too!” (An example of Stick it.) But at least in Hamlet’s case the poison was actually meant for him. For my money, however, the Ghost’s blood-curdling description of his death by poisoning in the ear is a high point of the play:

Sleeping within my orchard,
My custom always of the afternoon,
Upon my secure hour thy uncle stole,
With juice of cursed hebenon in a vial,
And in the porches of my ears did pour
The leperous distilment.

poisoned-chaliceIf you go to PubMed, you will look for hebenon in vain. Numerous theories about its meaning have been proposed. There is a useful review in Liberman and Mitchell’s An analytic dictionary of English etymology. Shakespeare may have borrowed the term from his contemporary Christopher Marlowe, who liked poison scenes too. In his Jew of Malta Marlowe writes of “the blood of Hydra, Lerna’s bane, / The juice of hebon, and Cocytus breath, / And all the poisons of the Stygian pool.”

Why am I prattling on about poison in this way, you may ask. It’s because of one of those odd coincidences that, while investigating the toxic effects of fentanyl and its derivatives, I found an article in the London Review of Books that mentioned the use of “levofentanyl” as the poison of choice in a failed attempt by Mossad agents to assassinate a leading figure in Hamas. This was to be a “soak it” murder, achieved by spraying the poison into the ear of the victim. Like the Ghost’s leperous distilment. Although familiar with fentanyl as a synthetic primary μ-opioid agonist commonly used to treat post-operative and chronic breakthrough pain, I had never heard of levofentanyl.

killkhalidPaul McGeough’s new book, Kill Khalid: The Failed Mossad Assassination of Khalid Mishal and the Rise of Hamas, raises the disturbing issue of the use of poison (or should I use the term biochemical weapons?) by the state to carry out covert murders. Here, in vivid detail, is a description of a plot to liquidate an undesirable in an unpleasant and undetectable way. It was a devious plan approved by the then and once again Israeli Prime Minister, Benjamin Netanyahu.

“Mishal’s murder had to be discreet and, if possible, invisible. The attack would take a matter of seconds – so quick he wouldn’t know it was happening. One agent would shake a can of Coke and pop it open to distract Mishal while another would spray levofentanyl, a chemically modified painkiller, in his ear. He would feel as if he’d been bitten by an insect; 48 hours later the drug would kill him, leaving no trace. Mossad agents rehearsed the assassination using water instead of poison on unsuspecting pedestrians in Tel Aviv. Netanyahu liked what he saw, and gave Yatom [the head of Mossad] the go-ahead.”

But it was Mishal’s luck that the murder attempt was botched. Reading McGeough’s account one wants to laugh as much as one feels like throwing up. Subsequent events also did not go well for Israel. Things unravelled quickly. King Hussein and Bill Clinton got involved, bottoms had to be kissed, Mossadl had to provide the antidote to their poison, Mishal survived, and he went on to become a Hamas hero.

My professional interest was sparked by the nature of the poison used in the attempted murder of Mishal. A contemporary account in Salon (Newsreal: Bibi the bungler by Jonathan Broder) calls it a “lethal nerve toxin.” When I read McGeough’s account I had never heard of “levofentanyl.” A search on this term produces no results in PubMed and other major drug databases. I’m very curious about the nature of Mossad’s version of hebenon and its power to kill. Obviously I have some work to do, since this kind of information is not too readily available in the standard sources. I hope to post about this again in the near future.

umbrellab&wThe Flagon with the Dragon

For no better reasons than those of prurient curiosity, I investigated some recent politically-motivated poisonings. From the cold war period there is the notorious 1978 murder of the defector journalist Georgi Markov. While strolling on London’s Waterloo Bridge, he was stabbed in the calf by an umbrella, a coup de parapluie administered by the Bulgarian secret police. Death came by means of a tiny pellet containing ricin, a deadly toxin with no known antidote. In this case the pellet with the poison was in the brolly full of folly carried by the creepy crawly.

Ukrainian presidential candidate Victor Yushchenko was poisoned during the 2004 campaign, possibly by enemies in his own government. Dioxin seems to have been the cause of a sudden illness that nearly killed him and left his face greatly disfigured: jaundiced, bloated, and pockmarked. Yushchenko survived and went on to win the election. Cynics continue to question the circumstances of his case, but it is possible that the pellet with the poison was in the container of a retainer.

More recently, in 2006 former KGB agent Alexander Litvinenko suddenly fell ill and was hospitalized in what was established as a case of poisoning by radioactive polonium-210. The pellet with the poison was in the brew that glowed blue. He died an agonizing and well publicized death three weeks later.

These three other famous poisonings have been given much more attention in the Western media than the Mossad’s cock-up in Amman. But then, it is easier to speak critically of current and former enemies (those shady Eastern Europeans) than of our supposed allies.

poisoned-cup


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