Fentanyl is deadly mix

Laced heroin blamed for boost in fatal overdoses in U.S.

September 03, 2006|By Gail Gibson | Gail Gibson,sun reporter

PHILADELPHIA -- The deaths came in an unexpected spring wave. At the medical examiner's office here, investigators counted 53 fatal overdoses between April and June alone, the lethal toll of heroin mixed with the potent painkiller fentanyl. In Detroit, 12 people died in a 24-hour period. In Chicago, where the same concoction has been linked to nearly 100 deaths this year, some dealers lured addicts by promising a version of the drug so powerful it was intended as a tranquilizer for large animals.

Across the country, at least 300 deaths and hundreds more non-fatal overdoses this year have been blamed on fentanyl, a prescription drug 80 times more powerful than morphine that was cut into heroin to boost the high and sold under brazen street brands as "Drop Dead," "Lethal Injection," and "Get High or Die Trying."

The pace of fentanyl-related deaths has slowed in recent weeks, but the rash of overdoses remains one of the summer's puzzling mysteries - and cities are prepared for the possibility of more deaths.

"We're predicting more than 100 deaths here, and of course, we don't know where it will stop," said William Wingert, chief toxicologist with the Philadelphia medical examiner's office who became alarmed in mid-April when the number of fatal overdose first accelerated.

Many of the victims died so quickly that emergency workers found hypodermic needles still in their arms.

Despite the high-profile bust of a Mexican lab suspected of producing clandestine fentanyl and arrests of key members of an entrenched Chicago drug gang accused of dealing heroin and fentanyl, authorities still cannot say with certainty what sparked the string of overdose deaths from the Midwest to the Mid-Atlantic. Nor can they explain how some cities, including heroin-rich Baltimore, have so far managed to largely escape the threat.

"It's been a big puzzle to put together in a hurry, and it's been critical to do so," said David Murray, a senior policy analyst with the White House Office of National Drug Control Policy, who said fentanyl has gained appeal as a dope additive as the purity of heroin trafficked inside the United States has declined.

"A lot of it depends on how much is still out there. ... In the back of my mind, I think this is an episode that will subside," Murray said. "But on the other hand, what it represents is the new type of drug threat we're increasingly going to be facing."

Few places are as sensitive to that threat as Baltimore, where the heroin-addicted population has been estimated at 60,000 and where public health officials in recent years have praised declines in the number of overdose deaths.

Murray and other law enforcement officials noted that the traditional heroin trafficking route between New York City and Baltimore has dodged, for now, the influx of fentanyl-tainted drugs. But authorities say the city could be vulnerable to the kind of swift pattern of fatal overdoses that appeared in other places this spring and are already monitoring overdose patterns for signs of fentanyl and warning users.

"It may just be a matter of time," said Erin Artigiani, deputy policy director with the Center for Substance Abuse Research at the University of Maryland, College Park, which has studied the unfolding fentanyl scourge. "It may be that the heroin dealers in Baltimore city still have a good enough product that they haven't felt the need to start mixing it in yet."

The first signs of the problem appeared roughly a year ago, when authorities in parts of the Midwest noticed a sudden jump in drug overdoses late last summer and began tracing the problem to fentanyl-tainted heroin.

But the threat was not closely tracked across the country until late this spring, when the numbers of overdoses and deaths spiked and spread to at least eight states, according to data compiled by the National Institute on Drug Abuse and the White House drug office, which reported at a recent conference in Philadelphia that there were 502 deaths across the country linked to fentanyl between April 2005 and July 2006.

In Philadelphia, the sudden rise in overdose deaths rattled heroin users, said Casey Cook, executive director of Prevention Point Philadelphia, which operates the city's needle-exchange program for intravenous drug users.

"There were a lot of overdose deaths, and it really shook people up," Cook said. "My experience, in talking with our clients and people who use our services, is not that anyone was rushing to the fentanyl-laced heroin - it was people who have heroin habits and the only thing they can get, the only thing on the street, was fentanyl-laced."

After a similar spike in overdose numbers in nearby Camden, N.J., the head of that state's poison control center posted a warning on an Internet bulletin board monitored by medical professionals and public health officials across the country.

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