'Bodies can't take it': Fentanyl involved in nearly half of drug overdose deaths

Shari Rudavsky | IndyStar

Show Caption Hide Caption What is fentanyl? Quick facts on the killer opioid Fentanyl, a synthetic opioid, is quickly becoming the most dangerous drug in America. Here are the basics.

When Niki Rasmussen fatally overdosed last August in Columbus, her brother wasn't surprised the opioid found in her system and in the plastic baggy next to her body was pure fentanyl. Niki always had a penchant for fentanyl, he told his grieving parents.

For years, Niki's father, Daniel Rasmussen, had feared the call that eventually came, informing them of Niki's death and changing their lives forever.

“You don’t talk to a 50-year-old with fentanyl addiction,” Daniel Rasmussen said. “Bodies can’t take it. It’s terminal. It’s just a matter of when.”

Niki, who died at the age of 31, is far from the only person felled by fentanyl. Increasing illicit use of the drug is being implicated in more and more deadly overdoses, either on its own or in conjunction with other drugs.

In many cases, the person taking the drug may think they're taking heroin alone, not knowing it includes fentanyl, which is 50 times more potent. And the abuse of fentanyl is rapidly outpacing heroin.

A report in May in the Journal of the American Medical Association found that of the 42,249 opioid-related overdose deaths in the United States in 2016, nearly 46 percent involved fentanyl, while heroin played a role in 37 percent. Just six years earlier, fentanyl appeared in only 14 percent of opioid-related deaths.

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Fentanyl has traveled a similar trajectory in Indianapolis, research conducted by an IUPUI sociologist shows. Before about 2013, fewer than 15 percent of fatal overdose cases involved fentanyl, according to data from the Marion County Coroner’s Office. After that year, rates rose exponentially nearly reaching 50 percent by 2017, said Brad Ray, assistant professor at IUPUI’s School of Public and Environmental Affairs.

“We found fentanyl present in 47 percent of cases. That’s nearly half of every single person that dies of a drug overdose,” Ray said. “That’s far outpaced heroin.”

The Indianapolis study also found that over time, fentanyl showed up more on its own, rather than along with opioids. But the national research has found that fentanyl is also frequently involved in overdose deaths with non-opioid drugs such as cocaine and benzodiazepine.

Researchers have no way of knowing whether those who take drugs that include fentanyl know it's among the ingredients. They do not know whether those who purchase it on the street are seeking that drug or if they’re just looking for a high without worrying what substance will provide it.

“The true answer to that is we have no clue. It is sometimes a little frustrating to me to hear folks say, ‘Oh yes everybody’s looking for this stuff and they want it,'” Ray said. “These are not folks that are going to the liquor store and deciding if they want a Pinot Noir or IPA. … They are addicted to drugs, and they’re not picky in the drugs they use.”

Addiction experts do know that people with substance use disorders will seek out increasingly more potent drugs to use as their bodies acclimate; this syndrome is known as "chasing the dragon."

Fentanyl and its variants fit that bill. Paramedics who respond to cases involving such powerful drugs report needing to administer multiple doses of the drug that can reverse the opioid’s effects, a hint that fentanyl may have been part of the victim’s drug cocktail.

'Things were askew'

Niki, however, never had that chance for revival. She took that fatal overdose alone in her apartment, only her dog, Patton, by her side. The Pitbull lab mix sat there for hours before Niki’s roommate returned home, noticed her light on in her room, and entered to find her body.

When Daniel Rasmussen’s cell phone rang in the middle of the night in his south side home, he noticed the caller was “My Niki” and wondered what she was doing up at that hour. It rang once and then stopped, but within seconds his phone rang again. This time the coroner was on the other side.

For nearly a decade, her parents had dreaded that this call would come one day as Niki had slipped in and out of drug use. But for the most part, she had stayed sober for the past five years.

Still, the relationship between her and her parents had long been fragile.

Recalled her mother, Julie: "We never really got to know our daughter as an adult because of her addiction and the lifestyle it created even when she was clean."

Niki grew up in a household where alcohol was not allowed. It was “standard Christian practice,” as her father, pastor of the Center United Methodist Church on the south side said.

Although Niki brought her beautiful voice to church every Christmas Eve to perform a stunning rendition of “O Holy Night,” she embraced the role of the rebellious “preacher’s kid,” Daniel said.

After graduating from Perry Meridian High School in 2004, Niki went to the University of Indianapolis. When her first year ended and she moved into an apartment on her own, that's when things “started to go haywire,” Daniel said.

Her parents don’t know exactly when she started using drugs, but they suspect it was when she was in her early 20s. Still, they didn’t want to pry.

"We knew things were askew,” Daniel said. “We would never just drop in on her apartment. We just figured she was going through a part of her life when she would do what she was going to do and we would be part of it.”

In retrospect, Daniel thinks his daughter’s first exposure to fentanyl likely came after she had already started using other painkillers. If she found herself in need of a fix and with no means to get it, he said, she helped herself to fentanyl patches she took from a family member who was legally prescribed the medicine.

Niki's struggle

But Daniel and his wife had no idea the extent of Niki’s drug use until she moved in with them about seven years ago, a few months before she was planning to get married.

She told them the plan was to spend some quality time with her parents.Then one April night Daniel arrived home to find her in convulsions, vomiting all over the house.

“I have unfortunately been around possession, demonically speaking, and it looked like that,” he said. “She was going from the couch to the floor to the bed. She must have thrown up 15 places.”

He had no idea what was wrong until his wife went upstairs to change the sheets on her soiled bed and discovered a bottle of methadone. The couple confronted Niki, who admitted that she had been using heroin in the past and was trying to shed the habit before her wedding.

Her physician had given her a prescription for methadone, and she had been self-medicating, she confessed. Now she was in full-on withdrawal.

That night they called three hospitals, all of which said they could not help a person in withdrawal. They wound up at Community Hospital North, and the next day she was admitted to Fairbanks Hospital for rehab.

Her fiancé, who knew she struggled with drugs but did not know that she used heroin, called off the wedding. Over the next few months, she went in and out of four different rehab programs.

In August of that year, she disappeared completely. Every so often she would text her parents. That year was a rough one. She spent time on the streets, entered an abusive relationship, and continued to use drugs.

A year later, she stopped cold turkey and moved to Brown County and then Columbus. For the next five years, aside from one relapse, she stayed away from drugs as far as her parents knew. During that time, she became pregnant.

Her parents offered to let her and the child live with them but made it clear they expected her to raise her child. After much soul-searching, she decided to give the child up for adoption.

“She wanted to be a good mother. She knew she couldn’t be,” Daniel said. “The most selfless thing my daughter ever did was give up that girl for adoption.”

The power of fentanyl

During the last five years of Niki’s life, fentanyl became increasingly popular in Indiana and across the country, either on its own or mixed with heroin. In just one year – from 2014 to 2015 — reports on fentanyl from federal, state and local forensic laboratories jumped from nearly 5,400 to more than 14,600, according to the National Forensic Laboratory Information System.

Often drug testing does not include the more costly analysis that looks not only for the presence of an opioid but also tries to identify what specific opioid is present.

Fentanyl is about 100 times more potent than morphine and 50 times more powerful than heroin, according to the Drug Enforcement Agency. This means multiple doses of naloxone may be required to reverse the overdose of a person who has used a drug that contains fentanyl.

Recently, Jeffrey Yanis, director of the Drug Treatment and Re-entry Courts for Marion County, has noticed more overdoses. While the courts currently do not test for fentanyl, Yanis said he suspects fentanyl is at play.

“Fentanyl is a lot stronger. Things don’t usually go well,” he said. “A part of why we see a lot of these overdoses is people think they’re using heroin, and it’s laced with fentanyl.”

California and New York are handing out test strips to drug users so they can ascertain whether the product they bought contains dangerously powerful fentanyl, which might mean they would use less of the drug to avoid overdosing.

But that is not yet being done in Marion County, IUPUI’s Ray said.

To this day, the Rasmussens don’t know what drew Niki back to the needle.

They had hoped she had finally conquered the addiction but piecing together the last few days of her life, Daniel said, they think she shot up about 48 hours before that last, final high. The manager of the fast food restaurant where Niki worked later told the Rasmussens on Thursday night she had found Niki asleep in her car in the parking lot and had shaken her awake.

Her first words, when she came to, said Niki’s colleague: "I don’t know if I want to live or die."

Hearing those words, Daniel thinks he knows what his daughter was trying to say.

“I believe that was not as much a suicide threat, as 'I know what I have just done, and I don’t want to live like this,” he said.

Two days later, she was dead.

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.

IndyStar’s “State of Addiction: Confronting Indiana's Opioid Crisis” series is made possible through the support of the Richard M. Fairbanks Foundation, a nonprofit foundation working to advance the vitality of Indianapolis and the well-being of its people.