FENTANYL PUTS FEAR IN CORONER

Illegal Drug Use

The Painkiller Is Suspected In Several Recent Deaths. Dr. John
Consalvo Sees The Situation Getting Worse.

"If history is any predictor of the future, that trend will continue.
As long as drugs are available people are going to take them." Dr.
John Consalvo Luzerne County coroner

The drug isn't new, and it's actually legal for certain patients, but
the latest ways to abuse the painkiller fentanyl - combined with the
unawareness of users - has killed more than 100 people throughout the country.

And, it is indicated in at least five overdose deaths in Luzerne County.

Drug overdoses are suspected in six deaths in the county in the past
week, at least two of which are thought to be fentanyl-related. And,
a spate of three fentanyl-related overdose deaths in two months
alarmed county Coroner Dr. John Consalvo enough in May to ask the
U.S. Drug Enforcement Administration to remove the drug from the market.

Until then, he expects the situation to worsen. "If history is any
predictor of the future, that trend will continue. As long as drugs
are available people are going to take them."

Spreading out of the West, fentanyl-laced heroin has pervaded the
national drug trade and is killing unsuspecting users who take their
usual dose and unwittingly consume much more than expected, authorities say.

Since mid-April, 50 fatal overdoses in Philadelphia have been
attributed to the drug combination, according to Jerry Daley, the
executive director of the Philadelphia/Camden High Intensity Drug
Trafficking Area program.

The fentanyl trouble doesn't end there. The drug's time-released,
dermal patch form is prescribed to sufferers of severe chronic pain
for long-term relief, but abusers chew on the patches, releasing in
minutes a dosage meant for 24 hours or more.

"Usually they don't even get through (the patch). We find it in their
mouth," said Consalvo, adding that it's the only drug in a patch form
that he has seen cause deaths.

When he first noticed the practice in his former role as the head of
the emergency department at the former Mercy Hospital in
Wilkes-Barre, he wasn't as concerned.

"I was amused by it. ... I was thinking, 'That's pretty innovative
behavior.' I mean, I would never think to chew it. I can't imagine
they taste very good. Opiates have a very bitter taste as it is and
then there's the adhesive and the plastic."

But the recent fentanyl-related deaths have changed his attitude.
Patches were found in the mouths in two of the five victims and
fentanyl was found in the blood of two others, he said. The final
death seems linked to the laced heroin.

Consalvo said the main problem is that abusers either don't know the
heroin is laced with fentanyl or don't realize the strength of the
drug. Estimates vary, but the opiate is perhaps 100 times more potent
than morphine, and a 125 microgram dose, roughly equivalent to five
grains of salt, is enough to kill an adult.

Consalvo thinks the patch-chewing deaths were accidents in which
users theorized a 24-hour dose would simply produce "a great big
high" rather than death.

Law enforcement officers are trying to fight the problem, but there's
a hitch: They don't know where the heroin/fentanyl cocktail, which
originated in California, is being made.

It's not local, said Daley, who heads the federal Philadelphia-area
drug trafficking agency. And though Philadelphia and New York City
are usually the main sources of Northeast Pennsylvania's heroin,
there is no evidence it's being transported from Philadelphia, and
there haven't been any fentanyl-related deaths reported in New York, he said.

Counter to common logic, which might dictate staying away from
potentially deadly risks, addicts flock to killer drug batches, said
Ed Pane, the president and chief executive officer of Serento
Gardens, a Hazleton drug and alcohol rehabilitation center.

The situation is analogous, he said, to cigarette smokers who know
the cancer risks but don't believe they will be afflicted.

"If someone dies, the message isn't 'stay way.' The message is 'this
is really, really good stuff.' ... A drug addict is in a world of
insanity, doing the very things that logic would say could kill you.
It's not even an awareness that (the addicts are) acting stupid. It's
a different set of rules."

A handful of addicts with fentanyl stories have come into his center,
Pane said, and he anticipates their numbers will increase.

Given its potency, fentanyl could continue to be cut into heroin for
some time, he said, because it can be illegally made, and it has a
higher profitability, gram for gram, than heroin.

"In my career, and it's a long one, I have never seen anything quite
like this," he said of the national wave of deaths linked to the
fentanyl-laced heroin. "It's a crescendo. It's building and building."

While the deaths are alarming, the nonfatal overdoses haven't seemed
to change. Ted Cross, the operations manager of the emergency
department at Geisinger Wyoming Valley Medical Center, said he hasn't
noticed a particular increase in patients admitted for overdoses.
There's a cyclical increase in overdoses sometimes, he said.

"They'll come in two or three at a time. ... Then we know there's a
change in the chemical makeup of the heroin on the street," he said.

The last of these happened within the past couple of months, he said,
but there isn't one now.

That doesn't mean the problem doesn't exist, though, so even if the
publicity only acts as advertisements for users, Consalvo wants to
continue raising awareness.

"There are recreational users who don't shoot up all the time and
they're the most susceptible. They're they ones who gotta be aware,"
he said. "I think the main thing to do is to continue putting out
warnings about it. Those of us who are of sane mind can't stand by
and watch that happen."