Terry DeMio

The Cincinnati Enquirer

CINCINNATI — An overdose crisis in the past week has left police and emergency responders here drained and without clues.

It has also underscored that this region does not have resources to treat all of people addicted to opioids, including heroin.

Police are asking for the public's help in identifying the source of heroin sold here that caused scores of overdoses, including at least three deaths. More than 200 people in four states have been victims of what law enforcement officials are calling a supercharged form of the sedative, and one additional person died in Indiana.

"We're working very closely to find the source dealer," said Police Chief Tom Synan of Newtown, Ohio, who heads the law enforcement task force for the Hamilton County Heroin Coalition. He said local, state and federal authorities are combining their forces to investigate the source or sources. "We don't have anything solid to go off of."

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The toll here has risen to an estimated 78 overdoses Tuesday and Wednesday alone and an estimated 174 overdose cases in emergency rooms in less than a week.

In other states just this week:

New Jersey. 29 people overdosed between Tuesday and Thursday in Camden on free samples of heroin marketed with a Batman stamp.

29 people overdosed between Tuesday and Thursday in Camden on free samples of heroin marketed with a Batman stamp. Indiana. 13 people overdosed Tuesday in Jennings County, about 60 miles north of Louisville. That includes fatality.

13 people overdosed Tuesday in Jennings County, about 60 miles north of Louisville. That includes fatality. Kentucky. 12 people overdosed Wednesday in Montgomery County, about 100 miles east of Louisville.

A similar cluster of overdoses occurred Aug. 15 in Huntington, W.Va., where 27 people overdosed within five hours, one fatally.

"This is unprecedented to see as many alerts as we've seen in the last six days," said Tim Ingram, health commissioner for Hamilton County where Cincinnati is the largest city. A surveillance system alerts the public health department when an unusual number of drug-related emergency-room encounters occur.

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Deaths have not spiked along with the overdose reports because police officers or emergency medical technicians are immediately administering naloxone, sometimes in more than one dose, to bring heroin users back to consciousness and start them breathing.

Cincinnati typically sees an average of four overdoses a day, according to a memo from City Manager Harry Black.

"It's unlike anything we've seen before," said Hamilton County Commissioner Dennis Deters, who called the outbreak a public health emergency.

The number of overdoses reported this week in the Cincinnati area has grown because several more agencies have added cases, officials said. The surveillance system does not give specifics but alerts on a breach of a threshold.

No samples of the Cincinnati-area drugs are available to test yet, according to Synan and Cincinnati Police Lt. Col. Mike John. The victims could have injected heroin mixed with the potent painkiller fentanyl or the mega-potent animal opioid carfentanil.

Carfentanil, an analgesic for large animals including elephants, was discovered in July in the region's heroin stream. In the memo, Black said carfentanil is believed to be the cause of the overdose spike the city is seeing now.

When an officer doesn't know if a person has overdosed on heroin, it's OK to hit them with a dose or two of naloxone, said Dr. Erik Kochert, program director in York Hospital's emergency room. Police in the Pennsylvania county of almost 450,000 already have administered the opioid antidote almost 250 times this year.

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Even if the patient didn't overdose, naloxone won't cause any harm. It would just make a person wake up and experience withdrawal, Kochert said, which is better than not breathing.

Officials in Akron and Columbus have reported carfentanil in heroin found in their cities as well. Both locations have suffered from bouts of overdoses.

Hospitals in the region are not equipped to test blood for the animal opioid, which is rare and only in July surfaced in Greater Cincinnati's street heroin.

Can doctors test for carfentanil?

"Yes," said Dr. Shawn Ryan, a certified addiction expert and founder of BrightView Health, an outpatient addiction medicine practice with offices in Norwood and Colerain Township in suburban Cincinnati.

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But the drug is so rare and so new to the region, no local hospitals would have such tests available, he said.

"We can’t confirm in the short term if someone’s had fentanyl, carfentanil or heroin. The tests flag only as positive or negative for opiates," said Nanette Bentley, spokeswoman for Cincinnati's Mercy Health. Tests could be ordered, but results could take days to weeks to come back.

Deters announced Thursday in a news conference that he will ask his fellow county commissioners to come up with money for treatment to expand the Heroin and Opiates Response Team. Sheriff Jim Neil has thrown his support behind the move, and the two said that it's a direct response to the overdose crisis.

The teams would consist of a law enforcement officer, emergency responder and treatment specialist who would approach people who've overdosed and offer them treatment.

Colerain Township and Norwood already have such response teams, and Deters said the drop in overdoses in Colerain Township has been 35% since the work began a year ago. Norwood's started in July.

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Cost of an expansion of the response teams is still being determined, he said.

Addiction experts across the nation consider it urgent to get to overdose survivors as quickly as possible to steer them into treatment. But that doesn't mean enough treatment is available.

"People overwhelmingly want help, but we have to have a place to take them," said Nan Franks, a facilitator for the Addiction Services Council of Cincinnati.

If all of those who need addiction treatment were to seek it at once, enough help wouldn't be available, she said.

The federal Drug Enforcement Administration has been on alert for carfentanil since its appearance in U.S. and at the Canadian border, said Melvin Patterson, a DEA spokesman in Washington. Officials have little doubt that the carfentanil that's showing up in street drugs is from overseas, just as fentanyl is manufactured and brought across the U.S. borders.

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"It's such a restricted drug, there's only a handful of places in the United States that can have it," he said.

Patterson's agency is working with Chinese counterparts who want to stop the illegal shipments, he said. The drug sometimes is manufactured in China, delivered to Mexico, shipped to Canada and then to the United States.

He has heard some reports of it going directly to Canada and being intercepted by Mexican drug organizations, he said.

John, who is the Cincinnati Police Department's special services commander, said the week of overdoses has taken a toll on his force.

"It's been exhausting," John said. "They're running from one run to another."

Contributing: (Cherry Hill, N.J.) Courier-Post; Justin Sayers, The (Louisville) Courier-Journal; Vic Ryckaert and Shari Rudavsky, The Indianapolis Star; Mark Walters, York (Pa.) Daily Record. Follow Terry DeMio on Twitter: @tdemio