Drug dealers are lacing heroin with the potent painkiller fentanyl, creating a deadly cocktail that is killing unknowing users — sometimes within minutes of use.
The drug combination has killed dozens of people in several states, prompting law enforcement and health officials to issue warnings about its danger.
The Maryland Department of Health and Mental Hygiene said Friday that 37 Marylanders had died since September of overdoses after taking the drug mixture. The deaths accounted for 12 percent of 318 overdose deaths in the past four months.
The deaths have raised concerns because fentanyl, a painkiller used by cancer patients and chronic pain suffers, greatly increases the risk of death from overdose, state health officials said. It is estimated to be 80 times more powerful than morphine and hundreds of times more potent than heroin, according to the Centers for Disease Control and Prevention.
"In a nutshell, fentanyl is very potent," said Dr. Eric Strain, director of the Johns Hopkins Center for Substance Abuse Treatment and Research. "The potency means smaller amounts produce more bang for your buck for an addict."
Most of the users think they are buying regular heroin and shoot up the same amount they normally would, which can prove fatal, said DEA spokesman Edward Marcinko.
"It's very dangerous," said Marcinko, describing it as Russian roulette. "They don't know what they are really putting in their bodies."
A small number of users are told by dealers the drug is stronger, but they don't realize it could kill them, some drug counselors said. The drug's potency is so strong that it can reach the brain within minutes, triggering respiratory failure.
"We sometimes find individuals who have been using heroin and the needle is right there in their arm," said David Fowler, the state's chief medical examiner, who diagnosed the recent deaths. "It can happen unbelievably fast."
Drug agents don't yet know the source of the drug combination. Dealers sometimes create stronger forms of drugs as a marketing tool to get people to buy their product, Marcinko said. They may first try it out with junkies before moving to less frequent users with a lower tolerance, he said.
"We hear about them lacing drugs to see how the junkies like it," Marcinko said. "If it is giving them a different high or bigger rush, they may say, 'Let's try it with the regular customer.'"
Fentanyl-related deaths have been reported in all parts of the state, including Western Maryland, the Eastern Shore and Central Maryland, state health officials said. Areas along the Interstate 95 corridor, including Pennsylvania and Rhode Island, as well as states as far away as Washington, also reported deaths.
In Pennsylvania, Allegheny County medical examiner Karl Williams said this week that laboratory tests showed that both heroin and fentanyl were present in 14 suspected overdose deaths in January and that he anticipated at least one more positive test, according to the Pittsburgh-Post Gazette.
The location of an overdose death does not necessarily indicate where the drug originated, which could help law enforcement stop the flow, Fowler said.
Spikes in overdoses can help drug counselors determine how to target prevention messaging. Overdose increases are often localized to the distribution area, said Bernard J. McBride, president and CEO of Behavioral Health System Baltimore.
"When this kind of information becomes available, we put out our general warnings and hope users will be more cautious about their sources," McBride said.
Word that the fentanyl-laced heroin was taking lives in other states began to reach Maryland officials several months ago, and drug counselors began warning users about it. Workers with the city's "Staying Alive" drug overdose prevention program passed out fliers and taught users about the use of Naloxone, also known as narcan, which can prevent opiate overdose.
"We don't control the drug trade," said Chris Serio-Chapman, community risk reduction services program director for the Baltimore Health Department. "Our job as public health personnel is to get the word out and really just arming our clients with as much information as possible."
Since it started the outreach, users are now asking workers about the drug combination, Serio-Chapman said.
This is not the first fentanyl-laced heroin outbreak to hit Maryland. In 1993, a federal jury convicted nine men of conspiring to distribute heroin and fentanyl, which was blamed for the deaths of 30 people in the state. Defense attorneys argued that their clients didn't know the combination could be fatal. Seven received life without parole, and two others got 24-year terms, with the judge at the time saying they put poison on the streets.
Fowler said he also has seen overdose deaths due to fentanyl mixed with cocaine, but didn't indicate it was a widespread problem.
The outbreaks come as the state has made a priority of reducing overdose deaths, particularly for heroin.
As part of the battle, the General Assembly passed legislation last year that created a statewide program allowing family members of addicts to be prescribed Naloxone and trained in administering it. Emergency responders already give the drug to overdosing patients.
The drug, which advocates say will help save lives in the minutes before an ambulance arrives, helps patients by restarting their breathing.
Deaths by county
Baltimore County 5
Prince George's 5