Pubdate: Sun, 16 Jul 2006
Source: Boston Globe (MA)
Copyright: 2006 Globe Newspaper Company
Contact:  http://www.boston.com/globe/
Details: http://www.mapinc.org/media/52
Author: Suzanne Smalley, Globe Staff
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

OPIATE FENTANYL GAINING FOOTHOLD

Region's Overdose Rate On The Rise

A deadly synthetic opiate estimated to be about 50 times more potent 
than heroin is increasingly showing up in Boston, according to 
statistics obtained by the Globe.

Fentanyl, which is produced illegally in labs in Mexico and the 
United States, killed a dozen people in the state during the first 
five months of the year, according to the state medical examiner, 
Mark Flomenbaum.

 From 2000 to 2003, Flomenbaum said, typically one person per month 
died in the state because they overdosed on fentanyl, which 
specialists say stops a user's breathing quickly when taken in 
excess. By 2004 and 2005, the number of fentanyl deaths per month 
ticked upward to about two to three per month, though in October 2005 
and September 2004 it caused six deaths each month, he said.

Flomenbaum provided the data in response to a public information 
request from the Globe.

Recent victims include a man in his 60s who overdosed on fentanyl in 
a Boston homeless shelter in February; a woman in her 40s found dead 
in Medford in March with fentanyl and cocaine in her system; and a 
Somerville man in his mid-40s who died the same month, also of a 
fentanyl and cocaine overdose.

"Fentanyl is slowly slipping into our cause of death," Flomenbaum 
said. "I'm going to watch it now."

Dr. George Behonick, director of forensic toxicology at the UMass 
Memorial Medical Center in Worcester, also said he is concerned that 
fentanyl is taking a hold in Massachusetts.

Doctors use fentanyl to control acute and chronic pain, but 
authorities have seized four illegal fentanyl labs in California and 
Pennsylvania since December 2003. Fentanyl causes a euphoric high, 
but because the standard medical dose of fentanyl is 45 micrograms -- 
a grain of salt is about 60 micrograms -- a small miscalculation when 
diluting the drug can easily lead to an overdose, authorities say. 
Heavy sweating, disorientation, and in the worst cases, respiratory 
shutdown, follow.

Fentanyl has been linked to hundreds of fatal and non fatal overdoses 
across the Midwest, Northeast, and mid-Atlantic since late 2005, 
according to a US Department of Justice bulletin. In Chicago, at 
least 64 people died of drug overdoses caused by fentanyl between 
November and May. In Wayne County, Mich. , where Detroit is located, 
fentanyl showed up in 94 dead bodies in the first five months of the year.

Because of the unusually large number of heroin addicts in 
Massachusetts, local and state authorities yesterday expressed 
concern about the medical examiner's statistics and said they are 
stepping up efforts to monitor the drug .

John Auerbach, the head of the city's Public Health Commission, said 
he has alerted substance abuse counselors, emergency room doctors, 
and needle exchange workers, who will hand out an educational flier 
to addicts about fentanyl.

Auerbach also said he has asked the medical examiner to inform him 
whether fentanyl is present in any of three people found dead in 
public in the past two weeks . None had gunshot or stab wounds, 
police have said, but toxicology tests are pending.

In 1965, Janssen Pharmaceutical patented the original synthesis for 
fentanyl, according to a Drug Enforcement Administration bulletin 
issued in May.

Heroin and cocaine users can inject or snort fentanyl in pure powder 
form. But specialists also said many recreational drug users are 
unaware of the risks posed by fentanyl, which can be substituted for 
heroin and cocaine, or combined with heroin and cocaine, without a 
user knowing.

 From Sept. 6 through May 9 , 23 autopsies in the state showed 
cocaine and fentanyl together, according to Behonick .

Behonick, who is in charge of forensic toxicology analysis for the 
state medical examiner's office, said that from Sept. 27 through June 
27, 33 autopsies showed fentanyl and opiates in combination.

"Twenty-three cases with cocaine and fentanyl is, at least in my 
mind, pretty significant because that's somewhat of an unusual 
combination," Behonick said. "Fentanyl is not something you should 
just see routinely."

All but six of the 56 fentanyl cases involved patients from Boston, 
Behonick said.

Behonick said the concentrations of fentanyl he detected in the 
autopsies were alarming in some cases and, for the most part, well 
beyond what would be prescribed by doctors.

He said the high concentrations and the mixture with cocaine or 
heroin suggest drug abuse.

Behonick said comparison data were not available because he just 
started testing for fentanyl late last summer.

It is unusual for a state medical examiner's office to test for 
fentanyl, specialists said. Behonick said he began screening for it 
because "it's lethal and it's abusable."

Despite evidence of fentanyl abuse showing up in autopsies of people 
from Boston, police say they have not seen an upswing.

"I've spoken to all of my officers for the drug control unit who 
continue to make heroin arrests in the city, but have not uncovered a 
trend of this fentanyl mix and have not gathered any intelligence 
from their sources to that effect," said Deputy Superintendent Paul 
Fitzgerald, who supervises the drug control unit. " We'll continue to 
watch for it."
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MAP posted-by: Beth Wehrman