Pubdate: Thu, 15 Jun 2006
Source: New York Times (NY)
Copyright: 2006 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Kirk Johnson
Cited: Chicago Recovery Alliance http://www.anypositivechange.org
Bookmark: http://www.mapinc.org/topics/fentanyl
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)
Bookmark: http://www.mapinc.org/topics/naloxone
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

OFFICIALS SEEKING SOURCE OF LETHAL HEROIN MIXTURE

CHICAGO - The police and health authorities are struggling to track 
down the source of a doctored, intensely powerful heroin that has 
killed at least 130 people in and around Chicago and Detroit and sent 
hundreds more to hospitals in cities from St. Louis to Philadelphia.

In the labyrinthine and often paranoid world of illicit drugs, tales 
of killer heroin have come and gone before. But this time is 
different, law enforcement and health officials say.

The pattern of cases is broader, involving many markets at once, 
suggesting, they say, a larger and more sophisticated distribution 
network. The additive has been traced to laboratories in Mexico, 
which has traditionally supplied much of the Midwest heroin, raising 
fears that other hybrid pharmaceutical street drugs might emerge.

"The biggest new thing is the high mortality rate," said Dr. Carl 
Schmidt, the chief medical examiner for Wayne County, Mich., which 
includes Detroit and suburbs. The county has had more than 70 deaths 
since September related to the altered heroin mixture, Dr. Schmidt 
said, including those of three people found together in a car in 
April. The three were overcome so quickly that no one could get out 
to summon help.

The additive, called fentanyl, was developed as a commercial 
painkiller in the 1960's and surfaced as street-drug compound in the 
mid-80's on the West Coast, where it killed perhaps 100 people over 
as many as eight years. It made waves again in the early 90's in the 
New York metropolitan region, where it killed dozens of people who 
bought fentanyl-laced heroin under the street brand Tango and Cash.

Fentanyl, which is 50 to 100 times more powerful than morphine, is 
not a contaminant or filler, drug experts say, but rather a 
deliberately introduced enhancement intended to improve the product. 
It kills by shutting down a victim's respiratory system when too much 
is taken, an easy mistake because of the potency.

Much has changed in the drug world since fentanyl first became a 
killer. In many parts of the country, the use of synthetic, 
laboratory-produced drugs like methamphetamine, or meth, has surged. 
A sharp increase in prescriptions for narcotics, depressants and 
stimulants has also contributed to an increase in drugs diverted for 
illicit use and has created drug users familiar with pharmaceuticals, 
according to a report this year by the National Drug Intelligence 
Center, a unit of the Justice Department.

And a national crackdown on illegal drug laboratories in the United 
States has recently pushed more meth production to Mexico, where 
local police officers and federal Drug Enforcement Administration 
officials say they think Chicago's fentanyl was produced.

The Chicago police superintendent, Philip J. Cline, said in an 
interview that his officers working with the D.E.A. were looking for 
connections among clusters of overdose cases and then trying to track 
back from there through undercover purchases, arrests and laboratory 
tests to understand the pipeline.

"Everybody is looking for a signature," Superintendent Cline said. 
"Is it the same here as in Philly? We're not sure on that yet."

Superintendent Cline said city officials had been frustrated because 
warnings appeared to have partly backfired. Drug dealers were even 
seen waving the fliers the city distributed this year, advertising 
that they were selling the very thing the police were so worried about.

"The biggest problem is that we have willing victims," he said.

One former heroin user, Justin Sorci, said the wave of deaths had 
given him a mission, to warn people he knows are still using.

"The thinking of an addict is that 'I won't be the one,' " said Mr. 
Sorci, 27, who went on Wednesday morning to a mobile treatment van on 
the North Side of Chicago to receive the methadone tablets that blunt 
his craving for heroin. "People who are still out there -- I'm 
warning them to be careful."

Fentanyl's re-emergence has revived old fears among some experts that 
underworld chemists could one day learn to manipulate opiate 
molecules to produce superdrugs of devastating malevolence -- more 
addictive or corrosive to society than heroin, alcohol or cocaine at 
their worst. Others say the wave of deaths proves that such a formula 
has not been perfected, since the fentanyl makers are killing off 
their own customers.

But people who study the market say more laboratory-produced drugs, 
of whatever quality, are probably inevitable because the process is 
cheaper than harvesting and transporting agricultural drugs and can 
be done anywhere.

"It is becoming easier to manufacture mind-altering substances, and 
the Internet has spread that knowledge all over the world," said 
Martin Y. Iguchi, a professor of public health at the University of 
California, Los Angeles, who was running a drug treatment clinic in 
New Jersey when the Tango and Cash cases unfolded in the 90's. 
"That's got to have an impact longer term."

But drug treatment workers and addicts have a tool against overdoses 
that was not widely available in the past, an injectable medicine 
called naloxone or narcan that can reverse respiratory failure.

The Chicago Recovery Alliance, a group that works to improve the 
health of intravenous drug users and runs the methadone van where Mr. 
Sorci stopped, pioneered the effort to get naloxone into the hands of 
the city's drug users in 1999. Baltimore, San Francisco and other 
cities now have anti-overdose programs using the medication, as well.

The group's medical director, Dr. Sarz Maxwell, said she knew of at 
least five people in Chicago who had stopped breathing after using 
heroin-fentanyl and were saved by friends.

"We even heard of a couple of complete strangers who found somebody, 
had naloxone and saved a life," Dr. Maxwell said.

One heroin user, Sean H., 20, who was visiting the treatment van and 
spoke only on the condition that his last name not be used, said a 
friend died six weeks ago from a fentanyl-related overdose. The man, 
24, specifically sought out fentanyl, Sean said, and had just 
recovered from one overdose. His body was found on a train.

Sean says he and his brother, who also uses heroin, are more careful 
now and always have naloxone on hand when they take drugs, though he 
thinks that none of the heroin they have taken has contained the 
additive. But the talk about the intensity of the fentanyl experience 
has intrigued him, he said.

"From an addict's point of view," he said, "that intensity is what you want." 
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