The deadly heroin and opioid epidemic is expected become even deadlier with the increasing prevalence of fentanyl, according to the Drug Enforcement Agency.
Fentanyl is 50 to 100 times more powerful than the related opioid morphine and also substantially more potent than heroin, the DEA states in a handbook on the prescription painkiller.
The DEA’s Philadelphia Division warns fentanyl is on the rise, with seizures more than doubling from 167 kilograms in 2015 to 365 kilograms in 2016. As little as 2 milligrams could be fatal.
It’s laced into heroin and even marijuana and is the primary active ingredient in counterfeit painkillers designed to look like Adderall, Xanax and OxyContin sold on the street.
During the first quarter of 2017, heroin combined with fentanyl was detected in 61 percent of opioids seized for evidence and inspected by the DEA laboratory system.
Heroin laced with fentanyl — and another related opioid, the even deadlier carfentanil — has been blamed for overdose surges in Cincinnati, Ohio, New Haven, Conn., and Western Pennsylvania. Officials haven’t said if an outbreak beginning June 30 in the Williamsport area that sent 51 to the hospital in 48 hours, killing three, involved fentanyl-laced heroin.
Heroin and opioids killed an estimated 280,000 nationwide between 2002 and 2015, according to the National Institute on Drug Abuse. More than 4,800 people died of an overdose in Pennsylvania last year, according to preliminary figures from the state coroners association, and the death toll is expected to grow in 2017.
“The original epidemic was really propagated by prescription drug use leading to addiction to heroin. That’s still a factor,” said Steven Murphy Shope, executive director of Project Bald Eagle, a Lycoming County-based coalition against heroin use and opioid abuse.
“The next chapter is really alarming and could possibly dwarf that. The next chapter is the rise in fentanyl,” he said.
Shope fears counterfeit pills containing fentanyl could catch users off-guard who otherwise suspect they’re consuming non-opioids like stimulants and sedatives.
According to a DEA Drug Threat Assessment, illicit fentanyl is produced in China as a powder or pressed into pills.
It’s then shipped by mail into Canada, Mexico and the U.S. Precursors are also delivered to the countries for processing into fentanyl in clandestine laboratories.
More than 10,000 counterfeit pills containing fentanyl were seized in 2015.
Fentanyl produced legally by pharmaceutical companies and diverted for illegal street sales is much less prevalent, according to the DEA.
Special Agent Patrick Moynihan of the DEA’s Philadelphia office said fentanyl is cheaper to produce than acquiring heroin.
When heroin strengthened by fentanyl or counterfeit pills are distributed to street dealers, Moynihan said they’re often unaware of the fortified potency.
“They think it’s heroin and they’re actually distributing fentanyl. The bottom line is it’s cheaper to get. A lot like their consumers, they don’t know what they’re getting. The one’s who do, it’s profit margin for them,” Moynihan said.
The marketing by Mexican drug cartels of heroin and, by extension fentanyl, shifted in the 2000s compared to past drugs trafficking. Sometime between 2008 and 2010, the DEA said cartels targeted white dealers and users, particularly in the Northeast, in part because of lost marijuana revenue.
Dr. Margaret Jarvis, medical director of Geisinger Marworth Alcohol and Chemical Dependency Treatment Center, said large-scale illegal drug operations are operated by intelligent people with enormous resources.
They’ve shifted the market way from street gangs in metropolitan centers and towards suppliers in upper-class urban areas as well as suburban and rural areas, she said.
“There are enormous amounts of money there to be made. Unfortunately, there’s a very human appetite for these kinds of things,” Jarvis said.
“Particularly in the absence of the availability of great treatment, that appetite goes unchecked,” she said.
The potency of synthetic opioids like fentanyl and carfentanil compared to heroin was displayed in a viral image in May from the Kensington Police Service in Prince Edward Island, a Canadian province northeast of Maine.
It showed three clear vials containing a small amount of heroin, a few dozen white specks of fentanyl and a single grain of carfentanil — all three deadly doses.
First responders and even police dogs are at risk of accidental exposure. An Ohio police officer accidentally overdosed in May after brushing fentanyl powder from his uniform during an arrest.
After the recent overdose surge in Lycoming County, Todd Owens, Mount Carmel police chief and head of the Northumberland County Drug Task Force, advised first responders take measures to protect themselves.
The police chief said his own department stored medical masks, coveralls and heavy-grade gloves in borough cruisers in the event they encounter heroin Owens suspects could be laced with fentanyl or a deadlier chemical compound.
He issued the same advice to neighboring police departments, noting the police officer’s accidental overdose in Ohio.
“That’s why we’re taking the precautions,” Owens said.
Email comments to firstname.lastname@example.org. Follow Scicchitano on Twitter @ericshick11