JUST A FEW GRAINS BETWEEN LIFE AND DEATH

Just a little grain of fentanyl ... or two ... or three ... will do it.

The small amount of fentanyl it takes to kill a person can be likened
to a grain of salt, noted Dr. Ben Johnston, emergency room physician
at Morris Hospital & Healthcare Centers.

"Imagine one grain of salt and three grains of salt being the
difference between life and death," he said Tuesday, during a news
conference by Grundy County Coroner John Callahan in the wake of two
heroin-related deaths this past week.

A fentanyl death is fast - so quick and relatively painless it is one
of the drugs of choice for euthanasia, Johnston said.

Roughly 50 to 80 times more potent than morphine, fentanyl is a
narcotic measured in grains. Fentanyl is used to manage pain during
surgery and for those with chronic pain who are physically tolerant to opiates.

To make a more marketable product, illegal drug dealers are now
adding fentanyl to heroin - and sometimes to cocaine and other
illicit drugs - to give them added punch.

Illicit drug dealers are not scientists, noted Johnston. Neither is
it is the drug dealers' best interests to kill their clients.

"But what's happening is there are absolutely no controls in regards
to maintaining a standardized dose of fentanyl when (they are) mixing
it up," he said.

"This is not being done to any pharmaceutical standards. So, you can
imagine one grain of salt and three grains of salt is the difference
between life and death."

Fentanyl is a prescribed drug. Medical supply house burglaries are
one source for illicit drug dealers. Fentanyl can also be
manufactured in clandestine labs from several non-prescriptive
ingredients purchased over-the-counter.

It's not only poor judgment which kills adolescents and teenagers who
use illicit drugs. The prefrontal cortex - the part of the brain
where they can figure out that's a really bad idea - is not fully
developed in adolescents.

"Furthermore, the feeling of 'That can never happen to me' principle,
combined with a drug which has a certain sex appeal to it and is
readily available, has poor control and has a sudden onset that's
very difficult to reverse unless you can get the proper treatment -
and you've got a quick recipe for death," Johnston noted.

Callahan said the attitude of "It will never happen to me" is
certainly not very good.

"I think their intent is to get high and all the good things that
apparently come in their mind along with the high," he said.

"But, death is not a part of it. Death from a drug overdose is purely
accidental. Young kids compare it to drinking - 'It's not going to
happen to me, and we're not going to get caught.'"

The average teenager who gets a bad batch of an illicit drug laced
with fentanyl has only minutes to live from the time it enters his
system, especially if the substance is inhaled.

This gets the drug into the bloodstream faster than injection.

Inhaling provides tissue concentration, said Johnston.

"Your lungs are about the size of a tennis court if the lung tissue
was laid out flat. That's a tremendous surface area to absorb things
relatively rapidly," he noted.

"So, you're talking minutes. It's not like of someone was stumbling
around with plenty of time. Fentanyl is minutes. It has such a short
onset it doesn't take long for you to stop breathing.

"If you look at people who are having a hard time dialing 9-1-1
because they are all excited, imagine the hard time they'd have
dialing 9-1-1 when they're on fentanyl," he added.

Callahan doubted whether anyone high on fentanyl would have the
opportunity. Someone else would have to dial the emergency number for
them. The probability of that being done, however, is almost nil
because those with the victim do not want authorities to catch them.

The other thing is the anticipated response, or high, the user would
normally expect to occur. The user would not expect the degree of the
response on fentanyl, however.

"On a scale of one to 10, and you're expecting a two, so you take the
stuff and ramp it up to get a two," said Johnston. "And it goes to
five, six, seven, rapidly up to 10. It doesn't take long, at best."

Sudden death occurs through cardiac or respiratory arrest, severe
respiratory depression, cardiovascular collapse, or severe
anaphylactic (allergic) reaction.

Routine toxicology screens for opiates will not detect fentanyl. Some
labs can test for fentanyl on specific request.

There's little recourse in the emergency room for the victim of a
fentanyl-laced overdose.

"It depends on whether they're dead or not," said Johnston. "The
course of treatment is reversal, and see if that brings them out of
it, and then put them on a ventilator.

"The thing is, eight minutes of lack of oxygen to the brain and
you're brain-dead," he added. "You're really nothing more than a body."

Death by fentanyl is not gruesome, but is more a seductive thing.

"It's not like dying in a car crash or from someone shooting you,"
Johnston noted. "Fentanyl is given in the emergency room for pain. It
makes your pain go away - makes you sleep - makes you comfortable.
The trouble is, it's in such a high dose it kills you."