DRUG EXPERTS ADVISE EXTRA PRECAUTIONS IN HEROIN USE

The deaths of three heroin users and the emergency treatment of 35
more have prompted an overdose prevention expert to offer this
advice: If you're going to use, have someone nearby in case you need help.

Alice Bell, overdose prevention project coordinator at Prevention
Point Pittsburgh, the region's only needle exchange program, said
there had been talk about drug users in other cities overdosing on a
powerful combination of heroin and a narcotic painkiller called fentanyl.

Prevention Point staff had begun to inform its needle exchangers
about the potential problem, but until two days ago no one had seen it here.

This could be it, Ms. Bell recalled thinking, when she heard news
media reports of an unusually high number of overdoses. It's not yet
certain that the fentanyl and heroin combination has arrived on local streets.

"What we know is that there's unusually strong heroin on the streets
in various cities, including now in Pittsburgh," she said.

In a June 2 letter, the U.S. Department of Health and Human Services
warned public health workers that fentanyl was being added to heroin
or cocaine and sold to drug users.

"In just one week, an estimated 33 individuals in the Detroit area
are reported to have died after using this fatal mix of drugs," the
letter says. "The same drug combination may have been responsible for
over 100 deaths in the same region since last September."

Philadelphia, St. Louis and Chicago have all had clusters of
drug-related deaths.

Fentanyl amplifies the potency of heroin and cocaine, the HHS letter
says. Routine toxicology tests will not detect it.

Dr. Daniel Brooks, chief of the medical toxicology division at UPMC
Presbyterian, said that heroin usually contains fillers to make it
less potent and more economical for dealers. It's possible that the
recent overdoses are the result of street drug that is "cut too
rich," as he put it.

Opioids such as heroin and fentanyl can kill because they depress the
respiratory and central nervous systems, Dr. Brooks explained. The
unconscious user loses protective airway reflexes.

Dr. Brooks was told by an overdose patient yesterday that the heroin
he had used came from Philadelphia, cost about the same as it usually
did, and he had used half his usual dose. But it still turned out to
be too much.

More information needs to be collected to better understand the
impact of the fentanyl and heroin combination, said Dr. Sharon
Stancliff, medical director for the Harm Reduction Coalition in New York.

A typical heroin overdose takes a couple of hours "because people
slowly nod off and essentially forget to breathe," she explained. "I
can't tell you if that's what happens with fentanyl."

Doctors use a drug called naloxone, or Narcan, to reverse opioid
overdoses. It's not known if more Narcan is needed for a fentanyl
overdose, or if the treatment window is briefer, Dr. Stancliff said.

And it may not be obvious when heroin has been laced with fentanyl,
Ms. Bell noted. Dealers may not know, or tell the buyer, and a stamp
on a bag is not a reliable indicator.

So "it's really important for people to avoid using alone, if at all
possible," Ms. Bell said. Also, "it's important for people to know
what to do if you're with someone who overdoses, which means learning
how to do rescue breathing and getting Narcan."

Since July 2005, Prevention Point's education program has included
training in the use of Narcan, and physician volunteers have written
about 65 prescriptions for it, Ms. Bell said.

Since then, "we have firsthand reports of 17 overdose reversals from
people who have participated in the program," she said.

It's not surprising to Dr. Neil Capretto, medical director of Gateway
Rehabilitation Center, that a person who had just been treated for an
overdose might be back in the emergency room the next day with the
same problem.

After Narcan treatment, "he's going to be sick and going through all
these terrible physical withdrawal symptoms," Dr. Capretto said. "And
the only way to counteract that is to use."

Ideally, overdose patients could immediately get into long-term,
intensive treatment programs, but the demand far exceeds availability, he said.

There are more people using heroin in Western Pennsylvania than ever
before, said Dr. Capretto, adding that if he had loved ones who were
heroin addicts, he'd keep Narcan on hand.

For more information about Prevention Point's program, call 412-247-3404.