HEROIN DEATHS UP, SAYS STUDY

Greater Availability, Potency Of Drug May Explain 42% Increase

The first thing you notice after the flood of heroin hits your
bloodstream is that your breathing slows. In a few minutes, organs
starved for oxygen begin breaking down.

As they do, your blood vessels start leaking. Air blends with blood,
creating a frothy mix that fills your lungs and oozes from your
mouth. After you die, the medical examiner who performs your autopsy
will refer to it as a "foam cone."

That scene is becoming more common in the Twin Cities, according to
an alarming report to be released today by the Hazelden Foundation.
Opiate-related overdose deaths were up 42 percent in the metro area
last year compared with 2004.

Police, emergency room personnel, medical examiners and those who
provide substance-abuse treatment have noted the increase.

"Something changed in the Twin Cities in the year 2000 as it relates
to heroin availability," said Carol Falkowski, director of research
communications for Hazelden and the report's author.

"Prior to that, we weren't a prime market for heroin. Beginning in
2000, heroin availability increased, and now, six years later, we're
starting to see the long-term effects of that."

According to statistics from the medical examiners' offices in
Hennepin and Ramsey counties, there were 102 opiate-related
accidental overdose deaths in the five-county Twin Cities area last
year. In 2000, there were 58.

There are two theories behind the increase. One is that heroin use is
on the rise, particularly in young adults. Another is that purer -
and more potent - heroin is reaching the Twin Cities, Falkowski said.

"It could be attributed in part to an unusually pure batch of street
heroin that can result in overdose deaths for both experienced and
novice users, or it could reflect new, inexperienced users who don't
know the dose amount that they can tolerate, or some combination of
the both of those," she said.

Dr. Kathryn Berg, Hennepin County's chief assistant medical examiner,
said her office has seen the effects of the increase.

"The heroin available to these people was more pure than what they'd
seen in awhile," she said.

"The person who uses this drug probably would unknowingly be taking
what they thought was a safe amount for themselves, but in effect
they were taking more."

The Hazelden Foundation, based in Center City, is one of the nation's
oldest private drug- and alcohol-treatment facilities. The nonprofit
organization also collects and analyzes data on drug-use trends and
publishes a report twice a year that looks at overdose deaths,
treatment-program admissions, drug-related emergency-room visits,
drug seizures and other information.

The report to be released today also found that cocaine-related
overdose deaths went up, from 49 in 2004 to 62 last year. Fatal
overdoses from methamphetamine declined over the same period, from 20 to 14.

But it was the increase in opiate-related overdose deaths that has
experts concerned. The opiates include heroin, methadone, oxycodone
and a relatively new narcotic, fentanyl.

"It is such a marked increase that at a minimum, it is something we
should watch in the future, and especially in light of some deaths
and outbreaks of heroin-related deaths in other parts of the
country," Falkowski said.

She was referring to a recent spate of fatalities in Detroit,
Chicago, Philadelphia and Camden, N.J., resulting from drug users who
took a potent mix of heroin and fentanyl.

Fentanyl is a synthetic opiate developed to ease the excruciating
pain often felt by terminal cancer patients. Most of the fentanyl
sold on the street is not pharmaceutical grade; rather, it is cooked
up in clandestine labs, probably in Mexico, law enforcement
authorities believe. Once the drug makes it to the retail level, it
is mixed with heroin and often sold as heroin.

One of the drug's street names is "Death Bags."

Todd Axtell, who heads the St. Paul police narcotics unit, said he
suspects fentanyl may have contributed to some of the overdose deaths locally.

"That's a concern to us," he said. "We're trying to address the
supply of that drug into St. Paul and the metro area."

He said the new drug is showing up on the streets at a time when more
young people are experimenting with heroin.

"The issues that we're hearing is that if that's not mixed the right
way, that can be fatal," he said of the heroin-fentanyl combo. "It's
not just the amount of heroin coming in; that really hasn't increased
a whole lot. What we've seen on the street is that more people seem
to be using it right now, and a lot of younger people are using it."

Proving fentanyl's role in an overdose death can be difficult from a
forensic examination, though, said Berg. Like heroin, once it enters
the body, it metabolizes rapidly into morphine. Proving its existence
often depends on evidence found at the scene of the overdose or
witness statements.