A DEADLY HEROIN MIXTURE IS CLAIMING DOZENS OF LIVES

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

Larry, who spoke on the condition that his last name not be used
because of his illegal habit, recited his rules after hearing that a
mix of heroin and a powerful painkiller was killing users who thought
they were taking pure heroin.

Officials from Philadelphia to Chicago have reported deaths from the
painkiller, which is called fentanyl and is 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 about two dozen suspected
ones in the last week, officials from the federal Centers for Disease
Control and Prevention are investigating, and community organizations
are scrambling to get the word out.

The disease control centers have no national statistics on fentanyl
deaths and have been asked to investigate only in Michigan. But
reports from a scattering of states indicate the problem is widespread.

In Philadelphia, there have been 20 confirmed deaths from heroin
mixed with fentanyl since April 17, and test results are pending for
eight other cases, according to the Health Department.

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.

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

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

In Wayne County, Mich., which includes Detroit, the medical examiner,
Dr. Carl J. Schmidt, said he began noticing a rise in
fentanyl-related deaths in September. But county officials did not
begin treating fentanyl as a crisis until last week, when the number
of overdoses began to soar.

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

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

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

Officials emphasize that there is help for people who have overdosed
if they get to an emergency room immediately.