DRUG COCKTAIL CAUSING OVERDOSES, DEATHS

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. The
county of 2 million typically sees two to three drug deaths a day.

The drug kills by inhibiting respiration, Schmidt said. "It literally
suppresses your natural impulse to breathe," he said.

Before the recent surge, Wayne County saw 20 to 30 fentanyl deaths a
year, Schmidt said. Those cases tended to be severely ill people with
legitimate prescriptions who committed suicide or people who had
stolen the drug, he said.

The fentanyl behind the current problem appears to be manufactured
illegally and mixed with heroin long before it gets to the user, Schmidt said.

In one case, three people found dead in a car last month took
fentanyl not with heroin but with cocaine. Schmidt said he fears that
could indicate a new trend.

Organizations that run needle exchanges and other health programs for
drug users are trying to spread the word. Officials emphasize there
is help for people who have overdosed if they get to an emergency
room immediately.

But to some drug users, the warnings are an advertisement.

"When they hear about people OD'ing somewhere, they want to go there"
to get the more potent drugs, said Larry, the Detroit heroin user.

Like Larry, 37-year-old Latonja said she would do her best to stay
away from the tainted heroin by sticking to dealers she knows.
However, she acknowledged it may be difficult, because users can
never know for sure what they're buying.

"We're not analyzers when we're trying to shoot our dope," said
Latonja, of Detroit, who also asked that her last name not be used.
"We're like, 'OK, it's time to get happy.' "

Drug cocktail problem

WAYNE COUNTY, MICH.:

Fentanyl was found in 63 people who died last year and 70 this year,
through mid-April, in the county that includes Detroit. The county
saw 41 fatal overdoses over seven days ending Friday in which
fentanyl is suspected but not confirmed.

PHILADELPHIA:

Twenty confirmed deaths from heroin mixed with fentanyl since April
17; test results pending for eight suspected cases. In the same
five-week period in 2005, there were seven drug-related deaths of any kind.

CHICAGO:

Thirty fentanyl-linked deaths from September 2005 to March 2006.
Twenty-three suspected cases in April and May.

NEW JERSEY:

Since April, about 10 confirmed fentanyl deaths; 10 to 20 suspected cases.

DELAWARE:

Five suspected drug deaths over two weeks beginning at the end of
April; test results await.