- Courtesy Coroner's Office
- Dr. Leon Kelly
Drug overdoses have always claimed lives in America, but few drugs are considered as dangerous as fentanyl and its sometimes even more deadly analogs. A synthetic opioid, fentanyl is prescribed for chronic pain management for patients suffering from cancer or back pain and is a good alternative for those with allergies to morphine, says Tanya Bolte, manager of pharmacy operations for St. Francis Medical Center.
It's most commonly delivered in a skin patch that releases medication over a period of time, up to 12 hours.
But it's the powder form of the synthetic drug that's the biggest problem. Manufactured illegally in makeshift labs or imported from overseas, it's mixed with heroin and other illegal drugs and then sold on the streets, often without telling the "customer" it's part of the formula.
Bolte says she can't legally purchase powder forms of fentanyl in this country and that illegal overseas manufacturers sometimes change fentanyl's molecular structure, while not altering its pain-killing quality, so that it can bypass laws associated with importation.
El Paso County Deputy Coroner Leon Kelly says fentanyl and its analogs have been on the radar of medical examiners for years and have caused clusters of deaths and hospitalizations in some American cities when used to supplement heroin and other illegal drugs to reduce the cost. Actually, that's a pretty tame way to describe the drug's impact. Synthetic opioids like fentanyl were responsible for at least 20,145 deaths in America in 2016 according to preliminary data from the National Center for Health Statistics, more than heroin's 15,446 deaths, and about a third of the roughly 64,000 drug overdose deaths in the country in 2016. (That last figure, by the way, represents a 22 percent increase over 2015 deaths.)
"We have been fortunate we haven't seen these devastating [deaths] like other communities," Kelly says. "But all we need is one truckload to show up here with a bad batch."
Opioid deaths, whether by suicide or unintentional overdose, have been gaining in numbers locally over recent years. According to the Coroner's Office, in 2013, there were 66. The next year, the number climbed to 93, and in 2015, it rose to 97. In 2016, 120 people died from opioids. Though final numbers are incomplete for 2017 pending toxicology reports and analysis, at least 91 people died from opioids last year, Kelly says.
Police Lt. Mark Comte, who works with the Metro Vice Narcotics and Intelligence unit, describes opioid abuse here as "rising."
"Meth [methamphetamine] is still the drug of choice," he says, "but opioids are quickly catching up. It's kind of a dual use — meth and heroin."
As for fentanyl, Kelly reports his office investigated seven fentanyl-related deaths in 2016 and 2017, but only one involving fentanyl-laced heroin. Three deaths involved fentanyl alone, one involved fentanyl mixed with many other pain medications, another involved fentanyl mixed with methadone, and another involved fentanyl mixed with oxycodone.
"When people use it to commit suicide, you find 12 patches on them," Kelly says, "or you find a patch in their stomach."
Fentanyl is 50 to 100 times more potent than morphine. "If you have skin contact with fentanyl, you can have effects," Kelly says. "Small amounts within seconds get into your bloodstream, and over the course of several minutes you can become comatose."
While there are varying takes in the medical world on the veracity of the claim that touching a tiny amount of fentanyl can kill you — and quite a few urban legends about people dying from an overdose after touching an everyday item with fentanyl on it — the Drug Enforcement Administration notes that fentanyl can be absorbed through the skin as well as inhaled.
Related Tests could shed light on the content of street drugs and save lives as deadly fentanyl hits the streets: A shot in the dark
Now imagine carfentanil, a drug used to sedate elephants and other large mammals, which is up to 100 times more potent than fentanyl. The Drug Enforcement Administration issued a warning in September 2016 to the public and police, noting that law enforcement in the United States had linked the drug to "a significant number of overdose deaths."
"Improper handling of carfentanil, as well as fentanyl and other fentanyl-related compounds, has deadly consequences," the warning said, with then-Acting Administrator Chuck Rosenberg noting it's often disguised as heroin on the streets and is "crazy dangerous."
Comte reports fentanyl is popping up here, but "not in a significant quantity." He adds that carfentanil also is occasionally found on local streets, and even those selling the drug aren't aware what they're selling. "Dealers do not know they're dealing fentanyl or that it's cut with fentanyl," he says.
Testing strips that change colors to show fentanyl is present are being distributed to drug users in Baltimore and other cities (see "A shot in the dark," p. 14) and could be used by first responders as well. So far, apparently no one in the Pikes Peak region is advocating the test strips be handed out to users on the street. Mary Steiner, community program manager with the Coalition for Prevention, Addiction Education, and Recovery, says the coalition hasn't yet taken a stance on street distribution.
"In June 2017," she says via email, "I solicited information from the Colorado Consortium for Prescription Drug Abuse Prevention about carfentanyl [alternate spelling] test kits. At that time, Dr. Rob Valuck, Consortium Director, told me he had not heard of any communities in Colorado distributing them as a harm reduction strategy."
Handing out test strips to drug users probably is unlikely to happen here, considering the El Paso County Public Health board recently rejected grant money to fund a needle exchange program that advocates say cuts down on the spread of disease among intravenous drug users. In rejecting the proposal, some county commissioners alleged needle exchanges enable drug abuse.
Nor are the test strips used by first responders when they encounter unknown powders that could be fentanyl.
Colorado Springs Police Department spokesperson Lt. Howard Black says the CSPD doesn't field test suspected drugs; the department's lab does that, if need be. "We have [a] policy in place dictating the safe handling of suspected opioid analogs," Black says without elaborating.
El Paso County Sheriff's spokesperson Jackie Kirby also reports in an email that deputies don't use testing strips and haven't seen any cases involving fentanyl.
But Mark Mayes, who heads up UCHealth-Memorial Hospital's emergency services line, says Memorial has seen "several cases" of fentanyl-related overdoses at its facilities, though he couldn't say whether the drugs were obtained legally or illegally.
Mayes says via email that emergency department staff were recently trained about the drugs' risks and safe handling.
A spokesperson for AMR, the emergency ambulance company serving the region, reports not having encountered carfentanil so far.
"We haven't seen it," says AMR's Sean Howe. "But if we did run into something like that, it would be a hazmat situation," which would warrant personnel using gloves and other protective equipment.
Dr. Jack Sharon with Penrose-St. Francis Health Services says the Penrose system hasn't seen a significant number of patients in its emergency rooms who had overdosed on fentanyl. Still, emergency personnel are protected from exposure, he notes, because they use gloves when assessing patients who are deemed potential drug users. Any powders suspected of being illegal substances are turned over to police, he says.
Brian Vaughan, spokesperson for the Colorado Springs Fire Department, which serves as first responder to most medical calls, also reports firefighters and medics are trained on the drug's dangers. "I can tell you we are aware of the Carfentanyl ... problem in the country and its deadly capabilities," Vaughan says in an email. "Our Medical Director put out a video for training and awareness approximately one year ago for our frontline personnel."
Most, if not all, police agencies, AMR and the Fire Department are equipped with naloxone, an opiate antidote that reverses an opioid overdose.