ABUSED, FENTANYL CAN BE A 'DROP DEAD' DRUG

PITTSFIELD — When Carlen Robinson, a local drug treatment and mental
health agency worker, overdosed on the powerful painkiller fentanyl
in 2005, the 32-year-old North Adams woman joined a growing list of
people who have died from a synthetic narcotic that is 80 times more
powerful than morphine.

Dawn M. Cote, the 42-year-old North Adams woman accused of selling
the potent drug to Robinson, was released on personal recognizance
after pleading not guilty to manslaughter and drug distribution
charges in Berkshire Superior Court earlier this month.

But the mere fact that prosecutors are attempting to pin Robinson's
death on Cote — the alleged "drug dealer" in this case — is a first
for Berkshire County, according to some law-enforcement officials,
who are wary of the county's fentanyl problem.

"This is the first time that any of us are aware that this office has
brought these charges," said Berkshire District Attorney David F. Capeless.

'An unusual case'

Holding drug suppliers criminally responsible for overdose deaths is
uncommon — but not unprecedented — in Massachusetts, according to Capeless.

Michael Trudeau, a prosecutor in the office of Cape & Islands
District Attorney Michael O'Keefe, could recall only two such cases
in the past dozen or so years in his jurisdiction, illustrating just
how rarely district attorneys seek the charge.

Trudeau, first assistant district attorney, declined comment on
whether commonwealth prosecutors won convictions in those cases. In
general, manslaughter convictions against drug dealers are rare in
Massachusetts.

Part of the reason prosecutors seldom pursue the charge stems from
the inherent difficulty of overdose investigations, according to Capeless.

"I've been very frustrated that we have had overdose deaths (in the
past), and that we have not been able to hold people accountable,"
Capeless said.

In the case of Robinson's death, however, the information and
evidence gathered by Massachusetts State Police detectives assigned
to the local district attorney's office warranted a manslaughter
charge, according to Capeless, who declined to discuss details of the
investigation.

"This was an unusual case," he said.

Declares her innocence

Cote, the accused, says she is being unfairly targeted for
prosecution. If convicted of manslaughter, she could receive up to 20
years in state prison.

"I am innocent," she said in a brief phone interview with The Eagle
on Friday. "(Robinson) was my best friend. She lived (in the
apartment) directly below me, so obviously I didn't want to hurt her."

Robinson was employed as a direct-care specialist in the
rehabilitation and vocational services department at the Brien Center
for Mental Health and Substance Abuse Services. She worked there from
2000 until the time of her death in November 2005, according to a
spokesman for the Pittsfield-based center, which has satellite
offices throughout the county.

Her death coincided with a nationwide spike in fentanyl-related
overdoses, according to local and national data. Of the 74 fatal drug
overdoses in Berkshire County from 2003 to 2007, 44 involved
prescription medications, according to Capeless.

Of those 44 deaths, eight involved fentanyl, a member of the highly
addictive opioid family. And of those eight fentanyl deaths, five
occurred in 2005 — including Robinson's — with single overdose deaths
occurring in 2003, 2006 and 2007.

Capeless said that two other fentanyl-related deaths, both of which
occurred last year, remain under investigation.

A recent, deadly trend

From 2004 to 2006, a national outbreak of fentanyl-related
fatalities — mainly the result of a deadly cocktail of fentanyl and
heroin — left public health officials from Philadelphia to Detroit
scrambling to get the word out about the lethal mixture.

Heroin addicts, who apparently thought they were just using heroin,
were dropping dead from the fatal cocktail, according to published
Associated Press reports.

In 2005, in Detroit alone, there were more than 100 confirmed cases.
A year earlier, in 2004, more than 100 deaths were reported in
Florida, allegedly from abuse of the fentanyl patch, which is
intended to provide a continuous delivery of pain reliever to a
patient with ongoing pain. Although some fentanyl-related deaths
stemmed from improper use of the patch, others were the direct result
of fentanyl abuse, including ingesting the drug orally and injecting
it like heroin.

On the criminal front, from 2001 to 2006, the federal Drug
Enforcement Administration reported an eighteenfold increase in the
number of fentanyl-related drug cases, from 37 to 1,472 cases.

In the Berkshires, fentanyl has been on the radar of local drug
officials for several years now, according to Massachusetts State
Police Lt. Joseph P. McDyer, coordinator of the Berkshire County Drug
Task Force.

Fentanyl overdoses, while increasingly common here, are nowhere near
epidemic levels, however.

"We don't have an epidemic," said McDyer, "but it does happen."

An end-stage painkiller

The drug is normally used by "people who are on their way out," said
McDyer, citing as an example terminally ill cancer or AIDS patients.

"We've had a high incidence of fentanyl abuse," McDyer said. "It's a
painkiller — it's like heroin — that basically suppresses your whole system."

In general, people who tend to abuse Oxycontin or heroin also tend to
abuse fentanyl, McDyer said. But fentanyl is far more potent than
heroin, he said, and its abuse can lead to heart failure and death.

Opioids such as fentanyl, which are typically used for pain relief,
can consist of natural, manmade or semisynthetic substances. Common
opioids include heroin, morphine, oxycodone and methadone, among
numerous other varieties.

But fentanyl, released in the 1960s but made available in
time-release patch form in the early 1990s, is among the most
powerful class of opioids, and its abuse has been on the rise since
then, according to local and national data.

With a potency level that is more than 80 times the strength of
morphine, fentanyl is used to treat severe or chronic pain. The patch
— a prescription-only product — is generally intended for cancer
patients, the terminally ill or for those suffering from chronic
pain, and its delivery system is designed to dispense the drug slowly
through the skin.

Common street names for the drug include Apache, China Girl, China
White, Goodfella, Murder 8 and TNT.

'Chew one, drop dead'

According to McDyer, addicts typically will tear open a fentanyl
patch and suck on the gel form of the drug contained inside the device.

"They'll go and chew on one, and they'll drop dead," he said.
"They're playing with fire. It's such a dangerous drug."

"The biggest problem in Berkshire County is the abuse of prescription
drugs," not the abuse of common street drugs such as cocaine or
marijuana, he said.

Dr. Jennifer Michaels, a psychiatrist and substance-abuse expert who
is also medical director for the Brien Center on East Street, said
that fentanyl, when used therapeutically as prescribed by a medical
doctor, can be quite effective in pain management. However, when the
drug is used "recreationally to get high," the results are often
deadly, she said.

Easily addictive

Fentanyl has "a very low threshold for addiction," she explained,
which means that people can become addicted to the drug quickly and easily.

Michaels said that, when a person sucks or chews on the patch, the
experience is "a rapid delivery" of fentanyl, which can overwhelm the
body's system.

"Think of it this way: If a patch is meant to last for 24 hours, and
you're taking a 24-hour medication in literally minutes, there's a
risk of overdosing and dying," she said.

The effects of the drug, when deliberately misused to get high, can
include feelings of intense euphoria. But the effects also can lead
to respiratory depression, coma or death, according to Michaels, who
said she rarely encounters individuals who are exclusively addicted
to fentanyl.

Fentanyl historically has been misused by people who work in the
health care field, according to the Drug Enforcement Administration,
primarily because the general public has limited access to the
controlled substance.

Lorraine Robinson, Carlen Robinson's mother, declined to discuss her
daughter's death until after the case has been resolved. The district
attorney declined to speculate on when the manslaughter case might go to trial.

"Right now, the family, we don't really have anything to say at this
time," Robinson said in a phone message to The Eagle. "But there is a
story to be told after all is said and done in court."

Carlen Robinson's sister, Kristen Gordon, the principal of C.T.
Plunkett Elementary School in Adams, said she misses her sister
"every single hour of every single day."

In September, the school officially dedicated a section of its garden
to Carlen Robinson, now known as "Carlen's Corner."

Fentanyl at a glance ...

Fentanyl, a powerful synthetic pain-relief medication, was introduced
in the 1960s, but it was not until the early 1990s that it became
available in patch form. Among the king of painkillers, this narcotic
is more than 80 times more powerful than morphine. Abuse and misuse
of fentanyl, particularly in patch form, is on the rise.

Facts

# Misuse of fentanyl patches is killing people, according to the
federal government, which last month issued its second warning in two
years about the powerful narcotic.

# In 2005, the Food and Drug Administration announced that it was
investigating 120 fentanyl-related deaths.

# The introduction of heat sources, such as heating pads, saunas or
hot baths, while wearing a fentanyl patch can increase the drug's
absorption and lead to an overdose.

# Abuse of fentanyl patches, including sucking or chewing on the
time-release devices, can cause a deadly overdose.

# Nationwide emergency-room visits by people misusing fentanyl, a
member of the opioid drug family, rose nearly fourteenfold to 8,000
between 2000 and 2004.

SOURCES: The U.S. Department of Health and Human Services; the U.S.
Drug Enforcement Administration; The Associated Press.

On the Web

# The Food & Drug Administration's safety warnings regarding the use
of fentanyl transdermal patches:

www.fda.gov/CDER/drug/advisory/fentanyl_2007.htm

# The American Society of Health-System Pharmacists' Web site on fentanyl:

www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601202.html