Penn. County Sees Spike in Synthetic Fentanyl Overdose Deaths

Tribune-Review, Greensburg, Pa.

Oct. 29—As opioid-related overdose deaths continue to mount, Westmoreland County Coroner Ken Bacha said he has noticed a troubling trend in recent months—an astronomical spike in the level of synthetic fentanyl involved in fatal cases.

One victim last month had 170 nanograms of fentanyl per milliliter of blood in toxicology test results, he said. That's more than 20 times the average of 8 nanograms typically found by NMS Labs, which performs the coroner's toxicology tests. A very small amount of fentanyl—as little as 2 or 3 nanograms per milliliter of blood—can be deadly, according to Bacha and the Drug Enforcement Administration. It also depends on other drugs a person may have used, he said.

"You could have a tanker truck of Narcan (naloxone), and it wasn't going to save them," Bacha said, referring to the opioid overdose reversal drug first responders carry.

The number of fentanyl-related deaths surpassed heroin-related deaths for the first time in Westmoreland and Allegheny counties last year .

Of the 174 drug overdose deaths investigated by the Westmoreland County Coroner's Office in 2016, fentanyl was present in 109 cases, heroin in 94. In 2015, there were 124 overdose deaths in the county; fentanyl was involved in 24 and heroin in 56. Both drugs were present in some cases.

In Allegheny County last year, 650 people died of drug overdoses, with fentanyl present in 412, heroin in 330. That's a shift from 2015, when 424 died and fentanyl was found in 126 cases, heroin in 284 cases.

The synthetic opioid was developed as a painkiller and anesthetic for pharmaceutical uses, but it has become an attractive substance to manufacture illicitly in laboratories. New forms—which can be made by tweaking the molecular structure—regularly pop up in heroin stamp bags and toxicology reports.

Fentanyl is many times stronger than heroin, said Dr. Karen Hacker, director of the Allegheny County Health Department. "The problem is it looks basically the same as heroin."

Investigations into five Westmoreland overdose deaths in recent months uncovered the use of carfentanil, a potent elephant tranquilizer, Bacha said, and a toxicology report this week showed that the blood of an overdose victim contained four different types of fentanyl. Allegheny County Medical Examiner Dr. Karl Williams said his office has seen nine carfentanil cases so far in 2017, compared to none in 2016.

It's clear to law enforcement that dealers oftentimes sell "heroin" that doesn't even contain that drug or which includes a drug mixture. The evidence is sky-high levels of fentanyl and their analogs—"well beyond survivability," Bacha said—found in victims' bloodstreams.

"They don't know what they're getting in the bag," Bacha said.

Fentanyl is 50 times more potent than heroin, the Centers for Disease Control and Prevention reports.

More than 52,000 people died from overdoses across the country in 2015, a figure that grew to about 64,000 last year, the New York Times reported.

Overdose deaths involving fentanyl and other synthetic opioids aside from methadone climbed to 9,500 nationwide in 2015—a one-year increase of 72 percent, according to the CDC.

"The explosion of fentanyl we have seen across the region is quite troubling," said Patrick Trainor, special agent with the Drug Enforcement Administration. "We see bags of what are sold as purported heroin that contain absolutely no heroin at all."

The pace is on track to continue for 2017.

Greensburg police officers now assume a stamp bag of heroin contains fentanyl, Capt. Bob Stafford said.

"It's mixed with heroin, but you don't get much that's just heroin anymore," he said. "Everything seems to have fentanyl in it now."

Last year, police departments across the country began taking precautions—such as wearing gloves and not field-testing stamp bags—when handling suspected drugs after an advisory from the Drug Enforcement Administration. In Greensburg, officers began taking those precautions last year in the event they came in contact with fentanyl, but now they just assume that whatever they are touching has the deadly opioid in it, said Stafford.

DEA investigators use victims' toxicology reports to learn about new forms of the synthetic opiate, such as butyryl fentanyl and 3-methylfentanyl, and where they are found. Even drug dealers who are arrested with what they believe is heroin, it's actually fentanyl, Trainor said.

"This is a very, very dangerous time to be someone who is struggling with substance abuse," he said.