More deadly doses of heroin flood market

By Elisha Sauers, Capital Gazette

Blue Magic, a name given to some heroin, started circulating in the area last summer.

Charles "Buck" Hedrick, who manages a U.S. Drug Enforcement Administration intelligence program in Baltimore, said drug dealers didn't know what was in it, but knew it was powerful: Some of their customers were dying.

As a marketing strategy, dealers labeled the drugs with a blue marker so customers could recognize the extra-strength dope. And when it started getting a bad rap, sellers repackaged it with different names.

Blue Magic turned out to contain fentanyl, an opiate stronger than morphine typically administered to patients in extreme pain or recovering from surgery.

"People in your county died because of that drug," said Hedrick, speaking to about 200 health professionals at the Anne Arundel County Opioid Misuse and Overdose Symposium in April.

Throughout the state, overdose deaths involving fentanyl, a painkiller 30 to 50 times more potent than heroin, are spiking. Last year there were 185 fentanyl-related deaths, up from 58 in 2013.

Last year Baltimore City led jurisdictions with 71 fentanyl-related deaths, followed by Baltimore County with 36. Anne Arundel County was third in Maryland with 23.

Statewide data showing a higher rate of fentanyl-related deaths between January and March spurred health officials to launch new campaigns; they're telling heroin users that what's on the street could have traces of a more lethal drug.

In the county, health officials have included discussions of fentanyl in their heroin warnings at middle and high schools. Since County Executive Steve Schuh declared heroin a public health emergency in January, local officials have promised to focus on the problem.

They're trying to prevent teens from becoming the latest victims.

Crystal Moulden, a 16-year-old from Glen Burnie, didn't survive her overdose involving fentanyl. Police found her on June 17 in a Baltimore alley and couldn't revive her.

"It's a buyer beware with heroin and fentanyl mixed in," said Dr. Jinlene Chan, county health officer. "There's no standardization."

Origins

A small portion of the heroin sold in Maryland comes from Southwest Asia. The drugs are shipped on boats to West Africa. Then "couriers" swallow the drug, double-wrapped in condoms, and fly to the United States, officials say.

But the majority of heroin in the state — perhaps seven out of 10 doses, Hedrick said — comes from poppies grown along the Andes Mountains in South America.

The drugs, he said, are processed in clandestine laboratories, usually in Mexico, and driven over the border.

The fentanyl often comes to Mexico from China.

Federal officials say heroin "chemists" add other white substances — drywall, baby laxatives, powdered milk or flour — to stretch their supply. But to ensure it still gets people high, they'll add fentanyl.

In 2005 the DEA dismantled a large lab in Toluca, Mexico, that was mixing fentanyl with heroin. Those drugs killed 1,000 people in different parts of the United States, according to the agency.

"When he was mixing this heroin in a lab, you see the fancy equipment he had," Hedrick said. "Sometimes he put the heroin on the table and mixed the fentanyl in with a kitchen spoon."

Those imprecise methods make it easy for parts of the supply to become "hot spots" — the term experts use to describe high concentrations of fentanyl found in heroin production.

This spring the DEA issued a nationwide alert on fentanyl as a public health threat. National forensics monitoring data showed that the amount of fentanyl evidence submitted by local and state labs in 2014, compared to the prior year, had tripled.

Anne Arundel County police lab submissions followed the same pattern. In all of 2012 and 2013, officers seized just one sample that tested positive for fentanyl. There were 43 last year and 20 more so far this year.

Federal officials said the recent outbreak includes not just fentanyl but other derivative chemicals with similar molecular structures. And compared to the fentanyl outbreak 10 years ago, it's spreading farther geographically.

The DEA has urged police who deal with drug evidence to be cautious, as fentanyl can be inhaled or absorbed through skin contact. Amounts as small as 0.25 milligrams can be fatal, according to the agency.

County police are trained to wear gloves while handling drug evidence. Lt. T.J. Smith, a police spokesman, said they cannot tell what chemicals have been cut into a drug just by looking at it.

"This is not TV. We're not going to dab it on our gum to see if it is what it really is," Smith said. "We know how dangerous it can be … it's just another level of what our officers have to deal with."

Trends

From her office at the University of Maryland in College Park, Erin Artigiani is monitoring the emerging fentanyl trend.

She's an investigator for the National Drug Early Warning System, which helps health experts, researchers and residents respond quickly to outbreaks of illicit drugs.

While she has seen fentanyl surge in Maryland, her collaborators in 12 different areas nationwide are seeing similar patterns.

"Users are generally unaware of what they're getting," Artigiani said. "And it's something that's being done as sort of a marketing tool to increase the potency of lower-quality heroin."

Then there is the other trend she is watching: street opiates manufactured to look like prescription pills.

For example, Percocet lookalikes in Cincinnati were actually a cocktail of heroin, Oxycodone and fentanyl. In Seattle, Vicodin knockoffs tested as heroin, and in New Jersey, heroin has been disguised as Oxycodone pills.

"It could be that when faced with a decrease in the availability of pills, dealers tried to develop a cheaper alternative," Artigiani said. "Another suggestion I have heard is that there is less stigma attached to pills than to heroin."

But officials worry that even if they warn heroin addicts about the more deadly drugs on the streets, it might not stop them. In fact, it could entice them. Opiate addictions erode people's judgment.

"You might think that dying would be an incentive not to buy a product," Hedrick said. "Actually for an abuser, they will buy the heroin that just killed their friend."