Fentanyl deaths up 1,000% since 2013, so much so that even heroin's supply is dwarfed

Terry DeMio | Cincinnati Enquirer

Show Caption Hide Caption Hamilton County sees spike in fentanyl deaths The Hamilton County coroner says they there is a downward spiral in the number of heroin overdose deaths, but a huge increase in the number of deaths related to fentanyl and fentanyl mixtures.

The powerhouse opioid fentanyl has drenched the drug supply in Greater Cincinnati, dwarfing the presence of heroin sold on the streets.

More than 90 percent of drugs analyzed at the Hamilton County crime lab through May 3 this year have had the synthetic opiate in them.

Fentanyl crept into the drug stream around 2012. By 2013, fentanyl-related deaths amounted to 24. Last year? 324.

That's more than a 1,000 percent increase.

Fentanyl is king, says Newtown Police Chief Tom Synan, co-chair of drug interdiction for the Hamilton County Heroin Coalition.

"Its power is immediate and death can be immediate, unlike anything we have seen from any other drug," Synan said. "Fentanyl and similar synthetic opiates have produced overdoses and deaths in not only unprecedented numbers but previously unimaginable."

"It is no longer a heroin epidemic but a synthetic-opiate epidemic," said Synan.

That's the case nationwide, said Synan, who takes part in a monthly national call about the opioid epidemic.

The Journal of the American Medical Association (JAMA) published a research letter that stated that nearly half of opioid-related deaths in 2016 involved fentanyl.

Greater Cincinnati is an epicenter of the nation's opioid epidemic, and fentanyl-related deaths have raced way beyond half of opioid overdose deaths.

Dr. Lakshmi Sammarco, Hamilton County coroner, said fentanyl or a combination of drugs including it was at fault in about 85 percent of the opioid overdose deaths her office saw last year.

"It's the small amounts of the extremely deadly substances that are killing people," she said, calling the uptick in fentanyl over the last few years "huge."

It could get worse.

The drug's chemical bonds can be altered to create additional types, or analogues, of fentanyl, with some of them more powerful than their predecessors. Sammarco's drug analysts have identified nine of these so far.

When it first appeared in the region's drug supply, narcotics agents said fentanyl was slipped into heroin, coaxing unwitting heroin users into an overdose danger they hadn't experienced before.

Fentanyl gets a following

That still happens.

But now, more people who once sought heroin are asking dealers, or "dope boys" as they're often called, explicitly for fentanyl.

It is not a death wish, explained Derek List, of Taylor Mill, who has been in recovery for 15 months.

“I know people who think, ‘If it kills me, it kills me. But my mission today is to get as close to the borderline of consciousness and death as possible,' " said List.

"The fentanyl’s the one that does it."

"Even when I was using, if I found out a friend fell out ... I'd find out who he was going to (to buy drugs) and he’s the next one I want to go to," List said. "You think, 'I’m going to do a little bit less than I normally do, and hopefully it gives me what I want.' "

"Nine times out of 10 it's not about trying to die," said List, 28. "It's about trying to get high."

That's because people who use opioids build a tolerance and eventually need the drug just to quell withdrawal symptoms.

Dr. Mina "Mike" Kalfas, of Northern Kentucky, who treats more than 300 people for addiction, wouldn't put a number to it but said he's seeing patients who volunteer that the drug they seek is fentanyl.

"It's starting to happen more and more," Kalfas said. "These folks are using just to be normal. Death doesn't scare them. The emptiness does. Withdrawal does."

Fentanyl's promise of an intense high, Kalfas said, "might be 'just potent enough" to make them feel something.

"So they seek it."

That same reasoning convinced some former prescription painkiller users to switch to heroin, Kalfas said. "It's basically the same. Just the next rung on the ladder. Until something even more potent and deadly comes along."

Fentanyl: a windfall for dealers

From the sellers' point of view, fentanyl is a boon, narcotics agents say.

It's easy to manufacture. Easy to get. And highly profitable.

There is no cultivation of land for poppy plants, no growing period or complicated manufacturing process. No difficult transport.

This is not your grandfather's pain medication, though fentanyl has been long an analgesic in the United States used for, among other patients, people with cancer pain. The fentanyl that's bombarding the United States is not the prescription variety.

Sammarco recalled a few early cases in which remnants of fentanyl patches would be found in the mouth of someone who'd overdosed. That was rare.

It became clear through federal narcotics agents' work that this drug that was sold on the streets was not diverted prescription fentanyl.

Most of it is, and was, made imprecisely by rogue chemists in clandestine labs overseas, often in China, according to the U.S. Drug Enforcement Administration.

And with such a small amount per dose needed for a traditional heroin user to get an intense euphoria, fentanyl is easy to transport. It's sold over the Dark Web and sometimes transported illegally through the U.S. Postal Service.

"It's just everywhere," said Tom Fallon, investigative commander of the Hamilton County Heroin Task Force.

There's social-media talk that drug cartels are trying to kill their customers, but drug agents say fentanyl trafficking, like that of any drug, is strictly a business.

"Drug dealers are selling drugs to make money," Fallon said.

"Their rate of return from investment and profit is astronomical," said Mauricio Jiminez, assistant Special Agent in Charge of the Columbus District DEA office, which serves Cincinnati, Dayton and Columbus.

The cost of the drug on the street is about $10 to $20 a dose and, depending on a user's tolerance, just a few grains of fentanyl can be lethal.

A DEA fact sheet notes: "Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier," prepare small doses "and sell it for millions of dollars in profit."

All drug users need to beware

Recreational cocaine users and drug users addicted to methamphetamine shouldn't feel free of the fentanyl threat.

The synthetic opiate has been, increasingly, dropped into stimulant drugs as well as heroin and other opioids. Sammarco first noted cocaine-fentanyl related cases in Hamilton County a year ago.

It has been disguised as typical prescription painkillers, including Percocet. The pills are made by pressing fentanyl powder into molds that have the same markings as the pharmacy-purchased medications have. Jiminez said that's been seen in Ohio, but powder makes up the vast majority of the fentanyl here.

Even so, he cautioned, "These organizations are putting fentanyl in anything they can."

Sammarco's mantra has become simple: No street drug is safe. "It's like playing Russian roulette," she added.

Hamilton County Crime Laboratory handles the drug submissions of about 50 law enforcement agencies in the region.

Across the United States, the DEA's National Forensic Laboratory Information System reports show the fentanyl supply growing and heroin decreasing. Heroin's still more plentiful and, unlike fentanyl, is a top-reported drug at labs, but it's less common than it used to be.

"The introduction of synthetic opiates like fentanyl has killed tens of thousands of Americans and should be seen as the country's most pressing health, national security issue and social crisis we face right now," Synan said.

Even police and emergency medical personnel have been warned of the dangers of the drug.

Sammarco's crime-lab analysts cover themselves from head to toe before handling drugs. "They have to treat every substance like it's a lethal substance," she said.

"There is nothing that worries me more than synthetic opiates," said Synan. "And what will be the next, more powerful synthetic that hits the street."

More opioid epidemic stories from The Enquirer:

Hamilton County sees 31-percent jump in OD deaths in 2017

Lethal fentanyl reaches recreational cocaine users

Couple charged in Dark Web fentanyl operation sent to treatment

DEA to cops: Fentanyl can kill you, too

Butler County sees 4 out of 5 OD deaths from fentanyl

Seven days of heroin: This is what an epidemic looks like