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.