DRUG MIX AT HEART OF HEROIN OVERDOSES

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 fall 2005 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.

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.

"This is a huge, huge problem," said Stephen 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 2006, said Christopher Hoyt, a
spokesman for the U.S. Drug Enforcement Administration in that city.
Another 23 suspected cases were reported in April and May.

The drug kills by inhibiting respiration, said Carl J. Schmidt, the
medical examiner for Wayne County, Mich., which includes Detroit. "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, 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. "Is your friend turning
blue?" reads one flier that describes what to do in an emergency.

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

But to some drug users, the warnings are in fact 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.