Pubdate: Mon, 26 Jun 2006 Source: Star-Ledger (Newark, NJ) Copyright: 2006 Newark Morning Ledger Co Contact: http://www.nj.com/starledger/ Details: http://www.mapinc.org/media/424 Author: Amy Ellis Nutt Bookmark: http://www.mapinc.org/heroin.htm (Heroin) AN ULTRA-LETHAL DRUG SPREADS THROUGH JERSEY Authorities Alarmed As The Toll Of Fentanyl-Laced Heroin Soars Drug dealing in Camden, where daily life is a brutal business, rarely registers a yawn. But the drug that killed three young men and hospitalized 42 others in South Jersey last weekend has shattered the usual indifference. The killer cocktail: heroin laced with fentanyl, a synthetic opiate that is 80 to 100 times more potent than morphine. Ten and $20 bags of the substance are easy to come by on the streets of North Camden. Dealers market the high-octane heroin under names such as "Flatline," "Knockout" and "Get High or Die." And the advertising is proving all too genuine, with hundreds of deaths reported across the country since 2005. While the South Jersey-Philadelphia region has recorded 70 fentanyl-related fatalities in the past year, there is evidence the epidemic has slowly snaked its way along New Jersey's coast since January. From Camden to Ocean to Monmouth to Middlesex to Bergen to Hudson and finally to Passaic, victims of fentanyl-adulterated heroin (and occasionally cocaine) have ended up in county morgues. "What a lot of people don't know is that 125 micrograms -- that's about four grains of salt -- is enough to create an overdose effect," said Jerry Daley, director of a Camden-Philadelphia drug trafficking program, operated out of the White House's Office of National Drug Control Policy. "And (when mixed into heroin or cocaine) it's not readily visible to the eye, taste or smell." While fentanyl has been legally used for decades in anesthesia and pain management (New Brunswick's Johnson & Johnson patented the Duragesic transdermal patch 16 years ago), the fentanyl found in the tainted heroin, say drug and law enforcement officials, is manufactured illegally. A Rapid Death The narcotic is a quick killer that users can smoke, snort or inject. Earlier this year, a victim was found in a fast-food restaurant in St. Louis, the syringe still in his arm. In Michigan, a dozen people in one room were found passed out, overdosed on fentanyl-tainted heroin. And last Sunday, at Camden County's Riviera Motor Inn, the body of 30-year-old James MacDonald was found in a standing position inside his motel room, bent over at the waist and leaning against the door. A bag filled with powder labeled "Chemistry" was discovered nearby. "With an overdose of fentanyl -- and it doesn't take much -- you just stop breathing," said Steve Marcus, executive director of the New Jersey Poison Information and Education System. "It also has a funny habit of tightening the muscles in the chest so you can't breathe -- like drowning. It's not a nice high. Either you pass out, you get muscle contractions in your chest, or you die." Tim Ogden, an agent in the U.S. Drug Enforcement Administration, last week told a gathering of officials from a dozen states, including New Jersey, that the problem of fentanyl abuse has not yet been adequately addressed. "In my almost 30 years of law enforcement experience, I haven't seen a threat that concerns me this much," he said. Menace Spreads Sporadic, but localized, clusters of fentanyl-related deaths have been reported since the late 1970s. What alarms law enforcement and public health experts now is that the tainted heroin seems to be spreading all across the country. In Detroit, 33 people died in just one week in May. In Cook County, Chicago, 55 have died since the beginning of the year. Delaware, Maryland, Missouri, Ohio, Pennsylvania -- all have confirmed fentanyl-related deaths. With more than 250 victims nationwide, even the Centers for Disease Control and Prevention is now investigating what it calls an "outbreak." In late May, when a team was sent to Detroit to gather information, Bernadette Burden, a CDC spokeswoman, told reporters, "This is new territory for CDC investigators." A Lack Of Interest Public awareness of the problem, however, is practically nonexistent. "It struck me as amazing, the lack of interest," said Marcus, who also is a professor of Preventive Medicine and Community Health at UMDNJ. "In general, people out there have an attitude of, well, drug addicts know what they're doing is dangerous ... but there are people out there dying who shouldn't be." Compounding the problem, says Marcus, is the difficulty in getting accurate statistics. For example, medical examiners in Chicago and Detroit began testing for minute levels of fentanyl (hard to detect through standard toxicology tests), only when the deaths started mounting. "There is nobody, to my knowledge, putting this together, either in the state or in the nation," said Marcus. "And we're not exactly being proactive in New Jersey." That may be changing. On Tuesday, officials from Philadelphia and Camden County, the U.S. Drug Enforcement Agency, the FBI and Philadelphia's behavioral health department agreed to coordinate their investigations into fentanyl-related deaths. North Jersey, however, is just starting to take notice. "A doctor in the ER at University Hospital told me two weeks ago that he saw eight drug overdoses in just one weekend," Marcus said. "He couldn't be sure that it was the tainted heroin, but it was an unusually large number of overdoses that had to be treated with an antidote." Newark health officials were alarmed enough to call a meeting about fentanyl earlier this month with representatives from law enforcement, emergency medicine and substance abuse programs. Seeking The Source The source of the drug continues to baffle experts. Since 2000, five illicit fentanyl labs have been taken, four of them in California and one in suburban Newton Square, Pennsylvania, according to the National Drug Intelligence Center. Last week, agents from the DEA and the Chicago Police Department arrested 29 alleged members of a street gang suspected of trafficking fentanyl-laced heroin. In May, agents from the Mexican Federal Investigative Agency and the Organized Crime Division of the Mexican Attorney General's Office raided a lab in Toluca, Mexico. U.S. officials believe it was a main source of the fentanyl-laced heroin that found its way to the streets of Camden, Chicago and Detroit. As to whether that lab was the source of the lethal drugs that hospitalized dozens and killed three in Camden County last weekend, Daley demurs. "To my knowledge there is no way of confirming, right now, that the product on the street is related to Toluca, but it's believed some had already been shipped out before the lab was broken up." The symptoms of overdose survivors provide a clue. "There are similarities between them -- respiratory distress, seizures and then they pass out," said Bill Shralow, spokesman for the Camden County prosecutor's office. "We have heroin overdoses once or twice a week here, but when you have dozens in just a couple of days and three deaths, it looks more and more like what we saw a few months ago." In response to the rash of overdoses, Camden police on Monday arrested 39 people trying to buy heroin in the city. Twenty-four hours later, 51 more were arrested, caught in the exact same location. "Remarkably, even the most recent heroin-related fatalities have not stopped people from coming to Camden to buy drugs," said acting Camden County Prosecutor James P. Lynch. Several of the residents at the Riviera Motor Inn, just a few miles from Camden City, admit that there is a steady stream of users and dealers in the area. Maintenance man Hector Flores, who found the body, knew MacDonald only in passing. "He seemed like an ordinary guy, a nice guy" said Flores. "I felt bad. I mean, he was somebody's dad, somebody's brother. ... It was a wasted life." - --- MAP posted-by: Beth Wehrman