Pubdate: Thu, 21 Dec 2006
Source: Dallas Morning News (TX)
painkiller blamed in SMU student's death
Copyright: 2006 The Dallas Morning News
Contact:  http://www.dallasnews.com/
Details: http://www.mapinc.org/media/117
Author: Jason Trahan, Holly Hacker The Dallas Morning News

POTENT PAINKILLER BLAMED IN SMU STUDENT'S DEATH

Lollipop Drug for Cancer Patients Can Be a Fatal High; Abuse on Rise

A rare and expensive painkiller sometimes taken in the form of a 
lollipop contributed to the death of a 20-year-old Southern Methodist 
University student at his fraternity house earlier this month.

The Dallas County medical examiner has determined that Jacob Stiles, 
a sophomore economics and psychology major from Naperville, Ill., 
accidentally overdosed on a toxic mixture of cocaine, alcohol and the 
synthetic opiate fentanyl.

Fellow students found him unconscious the afternoon of Dec. 2 in his 
room at the Sigma Alpha Epsilon fraternity house.

In any form, fentanyl can be lethal if taken outside a prescription, 
experts say. "People have died with needles in their arms," said Kurt 
Klein-schmidt, an associate professor of emergency medicine at UT 
Southwestern Medical Center and a toxicologist with the North Texas 
Poison Center. "What's really nasty about fentanyl [is] it's a more 
potent narcotic than heroin or morphine - up to 100 times," Dr. 
Klein- schmidt said. "People can have overdoses and not know what 
they've gotten themselves into." Fentanyl has been linked in the last 
few years to hundreds of overdose deaths around the country, with hot 
spots arising in states such as Michigan, Florida and Illinois, where 
Mr. Stiles is from. While no rash of deaths has been reported in 
North Texas, Dallas police in the last month busted two employees at 
a doctor's office on charges of forging prescriptions for $40,000 
worth of the lollipops.

The lollipop form is designed for cancer patients who have trouble 
swallowing, although experts say more abusers prefer fentanyl 
patches. Some people apply more than one patch, while more hard-core 
users use a syringe to extract the drug from the patch.

Local, state and federal officials say that abuse of fentanyl is on 
the rise, but the fact that it is expensive and hard to get have kept 
it from spreading more quickly. Abuse is relatively rare, mostly 
because of the high cost - a lollipop might cost $30 to $40 on the 
street, while a rock of crack cocaine can sell for a few dollars.

Jeffrey Barnard, Dallas County's chief medical examiner, said 
Wednesday that he didn't know what form of the drug Mr. Stiles took 
or where he got it. "We have no known history that he was prescribed 
fentanyl," Dr. Barnard said. "His family didn't return our calls, and 
his doctor in Illinois gave us no information."

Mr. Stiles' family could not be reached for comment. His fraternity 
threw a large party off campus the night before Mr. Stiles was found 
unconscious, but SMU police have not released any information about 
his activities before the overdose or how he may have obtained or 
taken the drugs. SMU police did not return phone calls. "We are 
deeply saddened by this news," said Jim Caswell, SMU's vice president 
for student affairs. He has no information of anyone else caught 
abusing fentanyl on campus.

"Our time and effort on drug and alcohol programs are geared 
constantly toward keeping our students well informed," he said. "We 
don't have our heads in the sand that there are drug and alcohol 
problems among young people." Insurer raises red flag While Dallas 
police say they've not been overrun with cases of fentanyl abuse, the 
two recent arrests have put them on notice of the drug's potential for abuse.

About a month ago, a health insurance company alerted Dallas police 
to some suspiciously large prescription orders billed to their 
company for Actiq, which is fentanyl in a berry-flavored lozenge 
attached to a stick. Known by abusers as "perc-o-pops" or 
"lollipops," they can plunge users into a stupor, severely slow 
breathing and lead to death. Dallas police eventually traced the 
large Actiq order - more than 1,000 lollipops - to two workers at a 
doctor's office. They were arrested on suspicion of prescription forgery.

Deputy Police Chief Julian Bernal, who heads the narcotics division, 
declined to name the employees or where they work because others are 
expected to be arrested and police do not want to tip off their 
associates. Chief Bernal said that the employees used some of the 
lollipops themselves. "We're still investigating how the rest were 
either used or distributed," he said. He said he had no information 
that the two are connected to Mr. Stiles. He said that other than the 
SMU student, he had heard of no local overdose deaths associated with 
illegal use of fentanyl.

"It's extremely unusual to come across this product, because it's 
very difficult to obtain, even with a prescription," he said. 100 
Detroit-area deaths Nationally, fentanyl has been tied to hundreds of 
fatal and nonfatal overdoses on the East Coast and in the Midwest 
since late 2005, according to the U.S. Department of Justice. In 
those cases, fentanyl was produced illegally and often mixed with 
cocaine or, more often, in heroin in a combination known on the 
street as "magic."

Detroit has emerged as ground zero of the growing problem. "Since 
over a year ago, we've had over 100 deaths here," said Mark 
Greenwald, a researcher at Wayne State University who is studying 
fentanyl deaths in the Detroit area. "To my knowledge, virtually all 
have been among individuals who have been identified as having a 
heroin abuse history." And, Dr. Greenwald said, "Almost all of those 
deaths among heroin abusers are due to fentanyl that they obtained on 
the street."

In 2004, there were an estimated 8,000 emergency-room visits for 
fentanyl overdoses, according to a survey by the federal Substance 
Abuse and Mental Health Services Administration. But that's a 
fraction compared with other painkillers such as hydrocodone (42,491 
visits), oxycodone (36,559 visits) and methadone (31,874 visits).

Rare so far in Texas In Texas, fentanyl-related deaths are rare, 
according to Jane Carlisle Maxwell, a University of Texas researcher 
who compiles an annual report, "Substance Abuse Trends in Texas."

"We've been lucky here," Dr. Maxwell said. "It's not the largest 
problem, but people need to be aware of it."

Texas reported fentanyl-related deaths in the single digits each year 
from 1998 to 2001. In 2004, the state recorded 32 deaths, with the 
victims' average age at 37. Preliminary figures for 2005 indicate 30 
deaths, with an average age of 43.

"In comparison to Vicodin and those other drugs, fentanyl's a pretty 
small part of the pie," Dr. Maxwell said.

To date, little is known about fentanyl use among college students, 
according to Carol Boyd, a researcher at the University of Michigan 
Substance Abuse Research Center. Studies have found an increase in 
the last decade of college students abusing prescription pain 
medicine such as oxycodone, which includes the brand OxyContin, and 
hydrocodone, or Vicodin, she said. One study by Dr. Boyd and her 
Michigan colleagues found that 7 percent of college students reported 
nonmedical use of prescription pain relievers in the last year. 
College students who were white, lived in fraternity or sorority 
houses, were at more competitive colleges and had lower grade-point 
averages tended to report greater use. The study said results show 
that prescription drug abuse "represents a problem on college 
campuses." Research also shows that college students who take those 
drugs for nonmedical uses tended to use alcohol at the same time. Dr. 
Caswell said that SMU takes a tough stance when students are caught 
using illegal drugs.

"We have suspended students on our campus for use of cocaine," he 
said. "We have a two-strike approach for marijuana. We work very hard 
to inform our students about what the consequences are for this 
behavior. Some students come here with these problems."

He said that no sanctions are planned for the local Sigma Alpha 
Epsilon fraternity.

"We believe this is isolated and not a chapter-wide problem," Dr. 
Caswell said. "It's resolved to our satisfaction."

A spokesman at the SAE national office in Chicago said the office's 
inquiry into Mr. Stiles death, conducted in concert with an insurance 
investigator, is continuing. Preliminarily, they do not believe the 
chapter is involved. "If the situation were that it was a 
chapter-wide activity, there would be that possibility" of reprimand, 
said Tim Samp, an SAE spokesman in Chicago.

FENTANYL: MORE POTENT THAN MORPHINE AND HIGHLY ADDICTIVE

What Is Fentanyl?

A man-made opiate designed as a painkiller. It can be 80 to 100 times 
more potent than morphine.

How is it taken? The drug comes in the form of a lollipop (for 
patients who have trouble swallowing) or a patch or can be injected. 
Who is it prescribed for? The lollipop form is designed specifically 
for cancer patients with a high tolerance for morphine. Doctors must 
be extremely vigilant about dosage and reaction because of its 
toxicity and addictive properties.

How is it abused? People most often obtain it through forged 
prescriptions or buy it or steal it from people with legitimate 
prescriptions. Taken in any of its forms, it is highly addictive and 
can lower blood pressure and slow breathing to dangerous levels. The 
high it offers is similar to heroin. Combined with heroin, it has the 
street name "magic." Taken with other drugs, it can be fatal.
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