DRUG COCKTAIL CAUSING OVERDOSES FROM PHILADELPHIA TO CHICAGO

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 up to 33 possible
deaths 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.

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.

"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 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.

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. In total, over the week beginning
May 18, there were 33 drug-related deaths, 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.

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.

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.

Detroit police spokesman James Tate said the department is following
up on several leads about where the fentanyl is originating. So far,
however, there is no indication that it is being manufactured locally, he said.

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.

"Treatment is available, and treatment works," said Michele Reid,
medical director of the Detroit-Wayne County Community Mental Health
Agency and chairwoman of the newly created Wayne County fentanyl work group.

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.

That's what New Jersey officials found last month. "The drug addicts
were actually looking for the drug, so what we did was actually
counterproductive," said Marcus, the poison control director.

Like Larry, 37-year-old Latonja, of Detroit, 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, since users can
never know for sure what they're buying.

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

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