DRUG COCKTAIL CAUSES OVERDOSES NATIONWIDE

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

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

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 about two dozen
suspected ones in the last week - officials from the national Centers
for Disease Control and Prevention are investigating, and community
organizations are scrambling to get the word out to users.

Widespread use

The CDC says it has no national statistics on fentanyl deaths and has
only been asked to investigate in Michigan. But individual reports
from a scattering of states indicate the drug is widespread.

In Philadelphia, there have been 20 confirmed deaths from heroin
mixed with fentanyl since April 17, and test results are pending for
another 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
another 10 to 20 suspected cases since last month, according to the
state's poison control center.

In Chicago, 30 people have died from fentanyl or fentanyl-laced
heroin from September 2005 to March 2006, said Christopher Hoyt with
the U.S. Drug Enforcement Administration in that city. Another 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
Schmidt said he began noticing an uptick in fentanyl-related deaths
in September. In total, medical examiners found 63 people in Wayne
County with fentanyl in their blood when they died last year. From
the beginning of 2006 to mid-April, there were 70 such cases.

Crisis mode

But 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. Over the next four days, there
were 15 more fatal overdoses, Schmidt said. The county of 2 million
typically sees two to three drug deaths a day.

Fentanyl is a suspected culprit in most of the recent deaths, though
that won't be confirmed until after the toxicology results come back
in four to six weeks.

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 for fentanyl patches who committed suicide
by putting on many patches at once or the occasional person who had
stolen the drug, he said.

Associated Press writers Maryclaire Dale in Philadelphia, Geoff
Mulvihill in Mount Laurel, N.J., and Michael Tarm in Chicago
contributed to this report.