FENTANYL IS DEADLY MIX

Laced Heroin Blamed For Boost In Fatal Overdoses In U.S.

PHILADELPHIA -- The deaths came in an unexpected spring wave. At the
medical examiner's office here, investigators counted 53 fatal
overdoses between April and June alone, the lethal toll of heroin
mixed with the potent painkiller fentanyl. In Detroit, 12 people died
in a 24-hour period. In Chicago, where the same concoction has been
linked to nearly 100 deaths this year, some dealers lured addicts by
promising a version of the drug so powerful it was intended as a
tranquilizer for large animals.

Across the country, at least 300 deaths and hundreds more non-fatal
overdoses this year have been blamed on fentanyl, a prescription drug
80 times more powerful than morphine that was cut into heroin to
boost the high and sold under brazen street brands as "Drop Dead,"
"Lethal Injection," and "Get High or Die Trying."

The pace of fentanyl-related deaths has slowed in recent weeks, but
the rash of overdoses remains one of the summer's puzzling mysteries
- - and cities are prepared for the possibility of more deaths.

"We're predicting more than 100 deaths here, and of course, we don't
know where it will stop," said William Wingert, chief toxicologist
with the Philadelphia medical examiner's office who became alarmed in
mid-April when the number of fatal overdose first accelerated.

Many of the victims died so quickly that emergency workers found
hypodermic needles still in their arms.

Despite the high-profile bust of a Mexican lab suspected of producing
clandestine fentanyl and arrests of key members of an entrenched
Chicago drug gang accused of dealing heroin and fentanyl, authorities
still cannot say with certainty what sparked the string of overdose
deaths from the Midwest to the Mid-Atlantic. Nor can they explain how
some cities, including heroin-rich Baltimore, have so far managed to
largely escape the threat.

"It's been a big puzzle to put together in a hurry, and it's been
critical to do so," said David Murray, a senior policy analyst with
the White House Office of National Drug Control Policy, who said
fentanyl has gained appeal as a dope additive as the purity of heroin
trafficked inside the United States has declined.

"A lot of it depends on how much is still out there. ... In the back
of my mind, I think this is an episode that will subside," Murray
said. "But on the other hand, what it represents is the new type of
drug threat we're increasingly going to be facing."

Few places are as sensitive to that threat as Baltimore, where the
heroin-addicted population has been estimated at 60,000 and where
public health officials in recent years have praised declines in the
number of overdose deaths.

Murray and other law enforcement officials noted that the traditional
heroin trafficking route between New York City and Baltimore has
dodged, for now, the influx of fentanyl-tainted drugs. But
authorities say the city could be vulnerable to the kind of swift
pattern of fatal overdoses that appeared in other places this spring
and are already monitoring overdose patterns for signs of fentanyl
and warning users.

"It may just be a matter of time," said Erin Artigiani, deputy policy
director with the Center for Substance Abuse Research at the
University of Maryland, College Park, which has studied the unfolding
fentanyl scourge. "It may be that the heroin dealers in Baltimore
city still have a good enough product that they haven't felt the need
to start mixing it in yet."

The first signs of the problem appeared roughly a year ago, when
authorities in parts of the Midwest noticed a sudden jump in drug
overdoses late last summer and began tracing the problem to
fentanyl-tainted heroin.

But the threat was not closely tracked across the country until late
this spring, when the numbers of overdoses and deaths spiked and
spread to at least eight states, according to data compiled by the
National Institute on Drug Abuse and the White House drug office,
which reported at a recent conference in Philadelphia that there were
502 deaths across the country linked to fentanyl between April 2005
and July 2006.

In Philadelphia, the sudden rise in overdose deaths rattled heroin
users, said Casey Cook, executive director of Prevention Point
Philadelphia, which operates the city's needle-exchange program for
intravenous drug users.

"There were a lot of overdose deaths, and it really shook people up,"
Cook said. "My experience, in talking with our clients and people who
use our services, is not that anyone was rushing to the
fentanyl-laced heroin - it was people who have heroin habits and the
only thing they can get, the only thing on the street, was fentanyl-laced."

After a similar spike in overdose numbers in nearby Camden, N.J., the
head of that state's poison control center posted a warning on an
Internet bulletin board monitored by medical professionals and public
health officials across the country.

"It's still more considered a problem of law enforcement than of
public health, and that to me is a little surprising," Steven Marcus,
director of the New Jersey Poison Control Center, said in a recent
interview. "People say, 'Hey, taking drugs is risky, and the drug
users know it, and they take their chances, and they get what they
deserve.' They don't think about these people as being truly addicts,
and that's an illness. We in the United States have not really accepted that."

Marcus said that shortly after he posted his Internet warning, he got
a call from Maryland's Eastern Shore, where authorities in Wicomico
County on April 20 had discovered six apparent heroin overdoses and
one fatality - users that all ended up testing positive for pure
fentanyl, according to state police investigators.

That was the worst day for Maryland as the fentanyl scare crossed the
country. Including that one death on April 20, state officials this
year have recorded five fentanyl-linked overdose deaths and are
investigating three more possible deaths, said Artigiani, with the
substance abuse research center.

Two of the Maryland deaths, one on April 26 and one on May 1,
occurred in Baltimore. Of the other deaths, one occurred April 25 in
Howard County and one on May 12 in Somerset County.

David Fowler, the acting state medical examiner, said he was
prohibited from releasing any identifying information about the
victims. But he said the issue is one that he and Baltimore City
Health Commissioner Joshua Sharfstein are following closely, and they
are prepared to swiftly alert drug users as well as police and
emergency workers if faced with a bigger problem.

"I've talked to some people who are addicted to heroin about this,
and they say they can distinguish heroin from other places,"
Sharfstein said. Maj. John F. Hess, commanding officer of the
Baltimore Police Department's organized crime division, said officers
had detected almost no fentanyl in city heroin seizures until late
June, when a half kilogram of heroin seized in Southeast Baltimore
tested positive for added fentanyl.

Advertisement Click here to find out more! "Is it here? Yes. Is there
probably more? More than likely," Hess said. But, he added, "we
haven't had that same problem - knock of wood - we're not in the
position of Chicago, Philadelphia, Camden, N.J., and some of the others."

Baltimore was not as lucky in a case from the early 1990s that has
sharp parallels to the current outbreak of fentanyl-related deaths
and which some federal investigators acknowledge could be instructive
as they work to solve this year's pattern of deaths.

A potent mix of heroin and fentanyl that was sold on the street under
the names "China White" and "Tango & Cash" was blamed for the deaths
of 30 people in Baltimore in 1992. The same mix was linked to at
least 126 deaths across the East Coast between 1991 and 1993, when
investigators with the U.S. Drug Enforcement Administration
eventually traced the source of the fentanyl to the unlikeliest of
places - a clandestine lab in Kansas, operated by a high school
dropout named George Marquardt who later said in a jailhouse
interview that he thought he was responsible for the deaths of as
many as 300 drug users.

"The deaths were considered good advertising by the people that
distributed the product," Marquardt said in a 1994 interview on the
ABC news program Day One. "When someone dies of a drug overdose,
people immediately get enthusiastic about it - 'Well, we want to get
some of that stuff' - and they go looking for it."

Authorities said that the fentanyl produced by Marquardt, who is in
federal prison until 2014, reached the streets through a drug
distribution pipeline that stretched east through Chicago, Pittsburgh
and ran along the East Coast. A similar pattern likely is in play in
the recent rash of fentanyl deaths, with clandestine fentanyl coming
into the country from Mexico and moving north to Chicago.

Joseph T. Rannazzisi, chief of the Drug Enforcement Administration's
office of diversion control, told officials at the Philadelphia
conference that his agency was waiting for chemical testing results
that could indicate whether the clandestine lab raided earlier this
summer in Toluca, Mexico, is responsible for the outbreak of fentanyl
deaths in the United States. If that was the source, he said, "it's
in the trafficking system - there are sophisticated trafficking
routes already established."

Baltimore might have been spared only because its traditional heroin
pipeline from New York City has been largely untouched by fentanyl,
some investigators and drug researchers suspect.

Maryland State Police Sgt. Alan McLeod, who heads a multi-agency drug
task force for Wicomico County, said the fentanyl linked to the
overdoses on the Eastern Shore this spring likely came from
Philadelphia, New Jersey or Delaware. The recent quiet, he said,
might mean only that the supply of fentanyl-tainted heroin that
reached the shore earlier this year sold out.

"I'd be naive to say, 'Oh yeah, they stopped using it,' because
that's not the way it is in the real world," McLeod said.