Pubdate: Thu, 31 Mar 2016
Source: Sacramento News & Review (CA)
Copyright: 2016 Chico Community Publishing, Inc.
Contact:  http://newsreview.com/sacto/
Details: http://www.mapinc.org/media/540
Author: Raheem F. Hosseini

DOCTORED PAIN PILLS PROVIDE NEW TWIST IN SACRAMENTO'S OPIOID EPIDEMIC

28 Overdoses Linked to Fentanyl-Fueled Pills

It's the development that public health officials and medical 
providers dreaded, but with a twist: With the nation gripped by a 
metastasizing opioid epidemic, 12 overdoses flooded Sacramento County 
emergency rooms in a two-day span last week.

The suspected culprit is a synthetic palliative drug named fentanyl, 
which is 80 times stronger than morphine and hundreds of times more 
powerful than heroin, and is increasingly laced with the latter, say 
harm-reduction specialists. But instead of people coming in 
blue-faced and unresponsive from fentanyl-laced black tar heroin, 
this was believed to be something relatively new: fentanyl doctored 
to look like Norco pain pills and packing a devastating punch.

"This is the first time I've heard of anything like this," said 
county spokeswoman Laura McCasland, who has worked with the public 
health sector since 2004.

"Fentanyl has been on the radar. The pill form, especially masked as 
Norcos, we haven't heard of as much," added Melinda Ruger, executive 
director of Harm Reduction Services in Oak Park, which provides 
addiction services to users around the region, including clean 
syringes and the overdose-reversing antidote Narcan. "That's pretty 
new to us. Whereas hearing about it in the black tar, we've heard of 
that for a while."

On Tuesday, county officials raised the number of suspected overdoses 
to 28 victims, six of whom have died, though McCasland cautioned that 
the official causes of death pended toxicology exams. "The 
information is still coming in," she said.

But officials do know a few things.

The first overdose was diagnosed March 24, McCasland says. The county 
was alerted a day later by the California Poison Control Center. The 
sheriff's department was notified late that Friday afternoon, 
according to spokesman Sgt. Tony Turnbull. He said an investigator 
has interviewed Public Health Officer Dr. Olivia Kasirye, but that 
the investigation remains in the early stages.

"It will take time to compile information from all parties involved," 
he emailed on Monday. "It is too early to tell the source of the bad supply."

Whether the overdoses originated from one bad batch or several 
sources isn't known. Officials also haven't determined whether any of 
the tablets contained Norco.

At least some recovered pills tested positive for fentanyl, a 
fast-acting synthetic opiate that is odorless and commonly 
administered for end-of-life pain management. "These were not 
prescribed pills," McCasland said, noting that the tablets look to 
have been procured from strangers, friends and neighbors of the victims.

Victims included men and women, with their ages ranging between 24 
and 59. "It's pretty scary how many people from how many age groups 
were affected," McCasland said. "We're looking at a very wide 
population from all walks of life."

That makes it trickier to target outreach efforts, she added, one of 
the goals of the county's new Opioid Task Force, which started 
meeting in February and convened last week. The task force operates 
under the county's Department of Health and Human Services. Its 
stakeholders include harm-reduction specialists, law enforcement, 
school officials and behavioral health providers, among others. 
"Many, many organizations have asked to be part of this," McCasland said.

Ruger is a member as well, and sits on its overdose prevention 
subcommittee. Since February 2014, HRS has provided its clients with 
free doses of Narcan, an opioid antidote that has reversed 139 
overdoses in less than two years.

According to her organization's tracking, the largest proportion of 
opiate users first tried the drugs by ingesting them, and between the 
ages of 14 and 17.

Opioid-related deaths in Sacramento County rose 83 percent between 
2011 and 2013, according to the California Department of Health.

But Ruger and her outreach workers are seeing an even quicker spread 
of opioid use in neighboring suburbs without programs like hers. "The 
greatest areas of growth that we're seeing is Rocklin, Roseville 
[and] El Dorado County," she said. "That's where we're seeing the 
steady increase."
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MAP posted-by: Jay Bergstrom