Pubdate: Sun, 03 Sep 2006
Source: Baltimore Sun (MD)
Copyright: 2006 The Baltimore Sun, a Times Mirror Newspaper.
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Gail Gibson
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)

FENTANYL IS DEADLY MIX

Laced Heroin Blamed For Boost In Fatal Overdoses In U.S.

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.

"It's still more considered a problem of law enforcement than of 
public health, and that to me is a little surprising," Steven Marcus, 
director of the New Jersey Poison Control Center, said in a recent 
interview. "People say, 'Hey, taking drugs is risky, and the drug 
users know it, and they take their chances, and they get what they 
deserve.' They don't think about these people as being truly addicts, 
and that's an illness. We in the United States have not really accepted that."

Marcus said that shortly after he posted his Internet warning, he got 
a call from Maryland's Eastern Shore, where authorities in Wicomico 
County on April 20 had discovered six apparent heroin overdoses and 
one fatality - users that all ended up testing positive for pure 
fentanyl, according to state police investigators.

That was the worst day for Maryland as the fentanyl scare crossed the 
country. Including that one death on April 20, state officials this 
year have recorded five fentanyl-linked overdose deaths and are 
investigating three more possible deaths, said Artigiani, with the 
substance abuse research center.

Two of the Maryland deaths, one on April 26 and one on May 1, 
occurred in Baltimore. Of the other deaths, one occurred April 25 in 
Howard County and one on May 12 in Somerset County.

David Fowler, the acting state medical examiner, said he was 
prohibited from releasing any identifying information about the 
victims. But he said the issue is one that he and Baltimore City 
Health Commissioner Joshua Sharfstein are following closely, and they 
are prepared to swiftly alert drug users as well as police and 
emergency workers if faced with a bigger problem.

"I've talked to some people who are addicted to heroin about this, 
and they say they can distinguish heroin from other places," 
Sharfstein said. Maj. John F. Hess, commanding officer of the 
Baltimore Police Department's organized crime division, said officers 
had detected almost no fentanyl in city heroin seizures until late 
June, when a half kilogram of heroin seized in Southeast Baltimore 
tested positive for added fentanyl.

Advertisement Click here to find out more! "Is it here? Yes. Is there 
probably more? More than likely," Hess said. But, he added, "we 
haven't had that same problem - knock of wood - we're not in the 
position of Chicago, Philadelphia, Camden, N.J., and some of the others."

Baltimore was not as lucky in a case from the early 1990s that has 
sharp parallels to the current outbreak of fentanyl-related deaths 
and which some federal investigators acknowledge could be instructive 
as they work to solve this year's pattern of deaths.

A potent mix of heroin and fentanyl that was sold on the street under 
the names "China White" and "Tango & Cash" was blamed for the deaths 
of 30 people in Baltimore in 1992. The same mix was linked to at 
least 126 deaths across the East Coast between 1991 and 1993, when 
investigators with the U.S. Drug Enforcement Administration 
eventually traced the source of the fentanyl to the unlikeliest of 
places - a clandestine lab in Kansas, operated by a high school 
dropout named George Marquardt who later said in a jailhouse 
interview that he thought he was responsible for the deaths of as 
many as 300 drug users.

"The deaths were considered good advertising by the people that 
distributed the product," Marquardt said in a 1994 interview on the 
ABC news program Day One. "When someone dies of a drug overdose, 
people immediately get enthusiastic about it - 'Well, we want to get 
some of that stuff' - and they go looking for it."

Authorities said that the fentanyl produced by Marquardt, who is in 
federal prison until 2014, reached the streets through a drug 
distribution pipeline that stretched east through Chicago, Pittsburgh 
and ran along the East Coast. A similar pattern likely is in play in 
the recent rash of fentanyl deaths, with clandestine fentanyl coming 
into the country from Mexico and moving north to Chicago.

Joseph T. Rannazzisi, chief of the Drug Enforcement Administration's 
office of diversion control, told officials at the Philadelphia 
conference that his agency was waiting for chemical testing results 
that could indicate whether the clandestine lab raided earlier this 
summer in Toluca, Mexico, is responsible for the outbreak of fentanyl 
deaths in the United States. If that was the source, he said, "it's 
in the trafficking system - there are sophisticated trafficking 
routes already established."

Baltimore might have been spared only because its traditional heroin 
pipeline from New York City has been largely untouched by fentanyl, 
some investigators and drug researchers suspect.

Maryland State Police Sgt. Alan McLeod, who heads a multi-agency drug 
task force for Wicomico County, said the fentanyl linked to the 
overdoses on the Eastern Shore this spring likely came from 
Philadelphia, New Jersey or Delaware. The recent quiet, he said, 
might mean only that the supply of fentanyl-tainted heroin that 
reached the shore earlier this year sold out.

"I'd be naive to say, 'Oh yeah, they stopped using it,' because 
that's not the way it is in the real world," McLeod said.
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MAP posted-by: Beth Wehrman