Pubdate: Thu, 31 Aug 2006
Source: Morris Daily Herald (IL)
Copyright: 2006 Morris Daily Herald
Author: Jo Ann Hustis
Bookmark: (Heroin)


Just a little grain of fentanyl ... or two ... or three ... will do it.

The small amount of fentanyl it takes to kill a person can be likened 
to a grain of salt, noted Dr. Ben Johnston, emergency room physician 
at Morris Hospital & Healthcare Centers.

"Imagine one grain of salt and three grains of salt being the 
difference between life and death," he said Tuesday, during a news 
conference by Grundy County Coroner John Callahan in the wake of two 
heroin-related deaths this past week.

A fentanyl death is fast - so quick and relatively painless it is one 
of the drugs of choice for euthanasia, Johnston said.

Roughly 50 to 80 times more potent than morphine, fentanyl is a 
narcotic measured in grains. Fentanyl is used to manage pain during 
surgery and for those with chronic pain who are physically tolerant to opiates.

To make a more marketable product, illegal drug dealers are now 
adding fentanyl to heroin - and sometimes to cocaine and other 
illicit drugs - to give them added punch.

Illicit drug dealers are not scientists, noted Johnston. Neither is 
it is the drug dealers' best interests to kill their clients.

"But what's happening is there are absolutely no controls in regards 
to maintaining a standardized dose of fentanyl when (they are) mixing 
it up," he said.

"This is not being done to any pharmaceutical standards. So, you can 
imagine one grain of salt and three grains of salt is the difference 
between life and death."

Fentanyl is a prescribed drug. Medical supply house burglaries are 
one source for illicit drug dealers. Fentanyl can also be 
manufactured in clandestine labs from several non-prescriptive 
ingredients purchased over-the-counter.

It's not only poor judgment which kills adolescents and teenagers who 
use illicit drugs. The prefrontal cortex - the part of the brain 
where they can figure out that's a really bad idea - is not fully 
developed in adolescents.

"Furthermore, the feeling of 'That can never happen to me' principle, 
combined with a drug which has a certain sex appeal to it and is 
readily available, has poor control and has a sudden onset that's 
very difficult to reverse unless you can get the proper treatment - 
and you've got a quick recipe for death," Johnston noted.

Callahan said the attitude of "It will never happen to me" is 
certainly not very good.

"I think their intent is to get high and all the good things that 
apparently come in their mind along with the high," he said.

"But, death is not a part of it. Death from a drug overdose is purely 
accidental. Young kids compare it to drinking - 'It's not going to 
happen to me, and we're not going to get caught.'"

The average teenager who gets a bad batch of an illicit drug laced 
with fentanyl has only minutes to live from the time it enters his 
system, especially if the substance is inhaled.

This gets the drug into the bloodstream faster than injection.

Inhaling provides tissue concentration, said Johnston.

"Your lungs are about the size of a tennis court if the lung tissue 
was laid out flat. That's a tremendous surface area to absorb things 
relatively rapidly," he noted.

"So, you're talking minutes. It's not like of someone was stumbling 
around with plenty of time. Fentanyl is minutes. It has such a short 
onset it doesn't take long for you to stop breathing.

"If you look at people who are having a hard time dialing 9-1-1 
because they are all excited, imagine the hard time they'd have 
dialing 9-1-1 when they're on fentanyl," he added.

Callahan doubted whether anyone high on fentanyl would have the 
opportunity. Someone else would have to dial the emergency number for 
them. The probability of that being done, however, is almost nil 
because those with the victim do not want authorities to catch them.

The other thing is the anticipated response, or high, the user would 
normally expect to occur. The user would not expect the degree of the 
response on fentanyl, however.

"On a scale of one to 10, and you're expecting a two, so you take the 
stuff and ramp it up to get a two," said Johnston. "And it goes to 
five, six, seven, rapidly up to 10. It doesn't take long, at best."

Sudden death occurs through cardiac or respiratory arrest, severe 
respiratory depression, cardiovascular collapse, or severe 
anaphylactic (allergic) reaction.

Routine toxicology screens for opiates will not detect fentanyl. Some 
labs can test for fentanyl on specific request.

There's little recourse in the emergency room for the victim of a 
fentanyl-laced overdose.

"It depends on whether they're dead or not," said Johnston. "The 
course of treatment is reversal, and see if that brings them out of 
it, and then put them on a ventilator.

"The thing is, eight minutes of lack of oxygen to the brain and 
you're brain-dead," he added. "You're really nothing more than a body."

Death by fentanyl is not gruesome, but is more a seductive thing.

"It's not like dying in a car crash or from someone shooting you," 
Johnston noted. "Fentanyl is given in the emergency room for pain. It 
makes your pain go away - makes you sleep - makes you comfortable. 
The trouble is, it's in such a high dose it kills you."
- ---
MAP posted-by: Beth Wehrman