Feature:
Fentanyl
Death
Toll
Mounts
as
Authorities
Belatedly
Act
5/26/06
A wave of fatal drug overdoses that has killed dozens of people in recent weeks struck Detroit with a vengeance over the weekend, leaving more than 20 people dead after injecting "heroin" that has turned out to mostly or entirely fentanyl, a synthetic opiate 80 times as powerful as morphine. Federal and local authorities are now ringing alarm bells, but with fentanyl-related overdoses occurring at a lower rate for months in Detroit and clusters of deaths breaking out in Atlanta, Chicago, New York, and the Mid-Atlantic seaboard in recent weeks, some are asking what took so long.
Fentanyl mixed with heroin or sold as heroin has been causing overdose deaths in small numbers since last fall, but alarms bells did not begin going off until a couple of weeks ago, when clumps of people started dropping dead in the Chicago and Philadelphia areas. Chicago authorities reported 10 fatal overdoses and dozens of non-fatal ones, while the death toll in the Mid-Atlantic states is near 30 in the past month. In Detroit, although fentanyl-related overdoses killed 106 people between September and April, officials took no action until 23 people died over the weekend. The father of one overdose victim complained that it took a mass outbreak of deaths before authorities responded. Ryan Richter, 18, died in February after taking fentanyl. "He and his friends were experimenting," Randy Richter told the Detroit Free Press. At the time, Richter said, the Wayne County Medical Examiner's Office told him it was aware of the dangers of the lethal fentanyl-heroin mix. "Who is to say how many lives would have been saved if they let this information out then?" Richter asked. This week in Detroit, the authorities got serious. At the request of Michigan health officials, the Centers for Disease Control in Atlanta sent two investigators to look into the overdoses -- the first time the CDC has looked at fentanyl use. The investigators will stay through this week, Wayne County Executive Robert Ficano announced as he warned residents to watch out. "Law enforcement's concern is it's being distributed in the Metro area on the street and it's very point," he warned. The local DEA office has also gotten involved. "Samples are being tested to see if we can determine if it's pharmaceutical grade or from a clandestine laboratory," DEA agent Christopher Hoyt said at a Tuesday press conference. Officials are concerned because they don't know if the wave of fentanyl overdoses is a fluke or a harbinger of the future. "We don't know the extent of the problem," said Robert Corso, DEA special agent in charge in Detroit. Back in the Mid-Atlantic states, law enforcement has responded energetically, seizing thousands of bags of fentanyl-laced dope in the past two weeks. The response in terms of reducing the harm to injection drug users has been less spectacular. "I think it is just incomprehensible that over a hundred people died in such a short period of time and there wasn't a full-scale community alert put out," said Simpson. "If you have bird fall out of a tree dead, you get a big mobilization to see if it had a virus. A damned bird. If somebody gets sick with salmonella, it's a full-blown emergency, but we're talking about a hundred people dead and nothing happened. To not have a state of emergency to save these people's lives is just unconscionable." Drug users are seen as worthless, Simpson said. "It is because of the stigma associated with drug users, they're seen as throwaway people. But they're our brothers and sisters, sons and daughters, and they deserve better. People are still dying here, but once we get a handle on this, we'll go back and try to kick the health department in the ass for their failure to act sooner," he vowed. But for now, at least, public officials are sounding the alarm. In addition to Ficano's press conference, authorities have contacted hospitals, emergency care providers, and the media to put out the warning. And Detroit harm reductionists are hitting the streets, too. "We're trying to get the word out on the street to the people who are at risk," said Simpson. "We are using our needle exchange program to go into areas where the users are and we're putting out flyers and brochures. We've got outreach workers talking to people and giving them information about what they can do and how do deal with overdoses. We don't know where this is coming from and we're trying to get as close to the source as we can," he said. The DEA, the CDC, and state and local authorities may understand that people are dying, Simpson said, but they can't get close to the users. "That's critical because we need a targeted effort to track this thing as close as we can. We're talking to people who have used this stuff or have had ODs around them and trying to find out what is consistent so we can warn people 'If you're cooking up drugs and it does this, then watch out.'" The effort is going state-wide, Simpson said. "We're doing an outreach blitz, if you will. We're having an emergency call to arms to bring outreach workers from across the state to Detroit to inform and train them around OD prevention and identification. We need these outreach workers, because our target audience isn't necessarily paying attention to TV and radio ads." The Detroit effort is getting help from the national Harm Reduction Coalition, which fedexed thousands of informational pamphlets and brochures to the city this week, Simpson said. "I called them because we didn't have any appropriate materials," he recalled, "and we really appreciate them doing that." "These deaths represent the tip of the iceberg," said Harm Reduction Coalition executive director Allan Clear. "Thousands of fatal overdoses occur every year -- but we know that we can reduce overdose deaths by giving drug users the right information, training, and tools." For now, said Simpson, authorities are doing the right thing. "They are doing all the public health things that should be done, but this is horrible. We've lost 125 lives here since September. The city, the county, and the feds should have been all over this six months ago." Legalization would effectively put and end to such outbreaks of overdoses and similar problems -- in a regulated market, users would know what they were getting most of the time. In the meanwhile, the harm reductionists have their work cut out for them saving lives that need not have been so endangered and cleaning up some of the mess created by drug prohibition.
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