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. - --- MAP posted-by: Beth Wehrman