HEROIN-PAINKILLER MIXTURE KILLING DRUG USERS

Sudden Increase In Overdoses Alarms Health Authorities

DETROIT ­ Larry, a 53-yearold heroin addict, has two 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 think they are taking
just heroin.

Officials from New Jersey to Chicago have reported deaths from the
painkiller, 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
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
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, city health officials 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, Ill., which includes Detroit, Medical Examiner Carl
J. Schmidt said he began noticing a rise in fentanyl-related deaths
in September. 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.

It was clear something was amiss when 12 people died of overdoses May
18-19, Schmidt said. There have been 41 drugrelated deaths since May
18, said Teresa Blossom, a spokeswoman for the Detroit-Wayne County
Community Mental Health Agency. The county 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 last month took fentanyl with
cocaine. Schmidt said he fears that could indicate a new trend.

Groups 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.