PAINKILLER, HEROIN FATAL MIX FOR MANY

DETROIT -- Larry, a 53-year-old heroin addict, has two cardinal
rules: Never shoot up alone, and shoot up only one person at a time.
If one overdoses, "you need someone there to bring you back," he said.

Larry, who asked that his last name not be used because of his habit,
recited his rules after hearing that a mixture of heroin and a
powerful painkiller has been killing users who believe they are
taking heroin alone.

Officials from Philadelphia to Chicago have reported deaths from the
drug, called fentanyl and considered 80 times more powerful than
morphine. In the Detroit area - the apparent hub of the problem with
more than 100 confirmed cases since last fall and as many as 41
possible deaths in the past eight days - officials from the national
Centers for Disease Control and Prevention are investigating and
community organizations are scrambling to get the word out to users.

The CDC says it has no national statistics on fentanyl deaths. But
individual reports from a scattering of states indicate the drug
mixture is widespread.

Philadelphia has had 20 confirmed deaths from heroin mixed with
fentanyl since April 17, and test results are pending in eight
suspected cases, the city health department said.

In New Jersey, where officials first raised the alarm about the drug
in April, there have been about 10 confirmed fentanyl deaths and 10
to 20 suspected cases since last month, according to the state's
poison control center.

In Chicago, 30 people died from fentanyl or fentanyl-laced heroin
from September 2005 to March 2006, said Christopher Hoyt, a spokesman
for the U.S. Drug Enforcement Administration in that city. In
addition, 23 suspected cases were reported in April and May.

"This is a huge, huge problem," said Stephen Marcus, medical director
of the New Jersey Poison Control Center.

In Wayne County, which includes Detroit, Medical Examiner Carl J.
Schmidt said he began noticing a rise in fentanyl-related deaths in
September. In total, medical examiners found 63 people who died in
Wayne County with fentanyl in their blood last year. From the
beginning of 2006 to mid-April, there were 70 such cases.

County officials did not begin treating fentanyl as a crisis until
last week, when the number of overdoses began to soar.

"Sometimes divining what the role of fentanyl is in an individual's
death is more an art than a science," Schmidt said, noting that drug
users often have multiple substances in their blood.

Still, it was clear something was amiss when 12 people died of
overdoses May 18-19, Schmidt said. In total, there have been 41
drug-related deaths since May 18, said Teresa Blossom, a spokeswoman
for the Detroit-Wayne County Community Mental Health Agency.