Pubdate: Tue, 06 Sep 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
uthor: Jack Healy


CINCINNATI - On the day he almost died, John Hatmaker bought a packet 
of Oreos and some ruby-red Swedish Fish at the corner store for his 
5-year-old son. He was walking home when he spotted a man who used to 
sell him heroin.

Mr. Hatmaker, 29, had overdosed seven times in the four years he had 
been addicted to pain pills and heroin. But he hoped he was past all 
that. He had planned to spend that Saturday afternoon, Aug. 27, 
showing his son the motorcycles and enjoying the music at a prayer 
rally for Hope Over Heroin in this region stricken by soaring rates 
of drug overdoses and opioid deaths.

But first, he decided as he palmed a sample folded into a square of 
paper, he would snort this.

As he crumpled to the sidewalk, Mr. Hatmaker became one of more than 
200 people to overdose in the Cincinnati area in the past two weeks, 
leaving three people dead in what the officials here called an 
unprecedented spike. Similar increases in overdoses have rippled 
recently through Indiana, Kentucky and West Virginia, overwhelming 
ambulance crews and emergency rooms and stunning some antidrug advocates.

Addiction specialists said the sharp increases in overdoses were a 
grim symptom of America's heroin epidemic, and of the growing 
prevalence of powerful synthetic opiates like fentanyl. The 
synthetics are often mixed into batches of heroin, or sprinkled into 
mixtures of caffeine, antihistamines and other fillers.

In Cincinnati, some medical and law enforcement officials said they 
believed the overdoses were largely caused by a synthetic drug called 
carfentanil, an animal tranquilizer used on livestock and elephants 
with no practical uses for humans. Fentanyl can be 50 times stronger 
than heroin, and carfentanil is as much as 100 times more potent than 
fentanyl. Experts said an amount smaller than a snowflake could kill a person.

Dr. Lakshmi Kode Sammarco, the coroner here in Hamilton County, said 
her office had determined that carfentanil was the cause of several 
recent overdose deaths, the first confirmed cases in the county. 
Investigators are now examining deaths back to early July to see if 
carfentanil was the cause.

"We'd never seen it before," Dr. Sammarco said in an interview, while 
toxicologists and drug specialists on the third floor of the 
coroner's office tested blood samples and small bags of white powder. 
"I'm really worried about this."

Officials suspect the carfentanil is being manufactured in China or 
Mexico and is making its way to the Cincinnati area in heroin 
shipments that flow north on Interstates 71 and 75. The drug has 
shown up in Columbus, Ohio, the Gulf Coast of Florida and central 
Kentucky, according to local news reports.

Fentanyl is widely used in hospitals as a fast-acting painkiller, but 
Dr. Sammarco said carfentanil is rare. She said she had to call zoos, 
rural veterinarians, federal law enforcement authorities and a 
licensed manufacturer in Canada to find a sample that her office 
could use to calibrate their drug-testing equipment.

Around Cincinnati, police officers and sheriff's deputies are so 
concerned about the potency of carfentanil and other synthetic 
opioids that they carry overdose-reversing naloxone sprays for 
themselves, in case they accidentally inhale or touch the tiniest flake.

Because of its potency, law enforcement agents have stopped 
field-testing the powders they find at the scenes of overdoses. When 
regional drug enforcement officers in Cincinnati pulled over two men 
on Aug. 26 and found an unknown pink substance, they sent it directly 
to the county coroner's office; it tested positive for heroin, 
fentanyl and carfentanil.

And as ambulance crews and the police rushed to respond to this 
recent wave of overdoses, answering 20 or 30 calls each day, they 
said they sometimes had to give people two, three or five doses of 
naloxone spray to revive them. Usually, one quick spray is enough to 
block a person's opiate receptors and immediately jolt them out of an 
overdose. Some hospitals have had to give overdose patients 
intravenous drips of anti-opioid chemicals.

"Our antidote, our Narcan, is ineffective," Sheriff Jim Neil of 
Hamilton County said, using a trade name for naloxone. "It was meant 
for heroin. It wasn't meant for fentanyl or carfentanil."

Like much of the country, officials here along the Ohio-Kentucky 
border have been straining to cope with the toll of opioid use.

Accidental drug overdose deaths in Hamilton County doubled to 414 
last year from 204 in 2012, according to the county coroner, most of 
those involving fentanyl or heroin.

There were an average of 92 overdose reports each month during the 
first six months of 2016, up from an average of 40 during the last 
half of 2015, according to numbers collected by the Greater 
Cincinnati Fusion Center, a regional law enforcement and public health group.

As deaths mounted, officials formed anti-heroin coalitions and task 
forces. Police officers and addiction experts visited the homes of 
people who had overdosed to try to persuade them into treatment. The 
Cincinnati Enquirer even has a heroin beat reporter.

Nan Franks, the executive director of the Addiction Services Council, 
the Cincinnati affiliate of the National Council on Alcoholism and 
Drug Dependence, said the problem was made worse by scarce bed space 
at the area's lone publicly funded detox center and a constant lack 
of money for treatment services.

Ms. Franks said drugs were so cheap that addicts said they can walk 
through one housing project and get four free samples from dealers.

"People are waiting for treatment," Ms. Franks said. "We need a 
better response to keep them safe."

Five days after Mr. Hatmaker overdosed, a police car pulled up 
outside his home in Norwood, an independent city of 20,000 inside 
Cincinnati. Lt. Tom Fallon, the commander of the county's heroin task 
force, was there to take Mr. Hatmaker to treatment.

As they drove, Mr. Hatmaker thought back to how he had gotten there. 
He said he started selling pain pills in 2012 after being laid off 
from his job at an online retailer's warehouse, then started taking 
them, then turned to heroin. Cycles of withdrawal, jail and treatment 
followed. Some of his friends died or went to prison for selling drugs.

He said he does not remember much from this latest overdose - only 
waking in an ambulance and feeling the pain where medics had pounded 
his chest to keep him alive. The medics who saved him told him he was 
minutes from death, Mr. Hatmaker said.

"I'm tired of this," he said. "I'm tired of overdosing; I'm tired of 
this life. Eventually, you're just going to die."
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