N.M. Gets Hit with Fentanyl Overdoses
July 07—SANTA FE, N.M.—Fentanyl, a powerful synthetic opioid, has been wreaking havoc on the East Coast and Midwest in recent years. A couple of Santa Fe narcotics detectives say the dangerous drug now has reached the City Different.
And most users may not even be aware that they're consuming fentanyl, a drug first made in the 1960s that is exponentially more potent than morphine and used legitimately to treat severe pain.
"For the longest time, we thought it would take a lot longer to reach New Mexico," Santa Fe Police Department Detective Michael McCluskey said of fentanyl abuse. "We thought there was no way people were going to do that, and it rocked this community."
He added: "It mixes too well with heroin, so I don't see it going away any time soon."
SFPD Sgt. Matt Champlin said the first laboratory-confirmed case of fentanyl locally occurred in the middle of last year and the first overdose death came a few months later. He said the person who died thought it was just heroin.
Twenty New Mexicans were killed by the drug in 2016, according to the Department of Health, including one in Santa Fe County and another in San Miguel County.
Champlin said drug dealers are taking heroin and adding a malleable powder, like brown sugar, as filler and then adding fentanyl to increase potency.
"Most people don't have any idea what fentanyl is," Champlin said. "To a user, it's just good heroin, but they don't understand that what's actually happening is the dealer is cutting it with fentanyl or adding fentanyl to it so they can quadruple their profits."
Fentanyl is used to treat severe pain and is 50 to 100 times stronger than morphine, according to the Drug Enforcement Administration. Dr. Michael Landen, an epidemiologist with the DOH, said the drug is often prescribed in patch form so that it is absorbed slowly over time.
Of the ingredients used to make illicit fentanyl, 90 percent come from China and then go to Mexico or directly to the U.S., Champlin said.
Ninety to 95 percent of heroin comes from Mexico, where it is cut with another substance, and it gets cut several more times before it reaches the common user, Champlin said. "By the time it hits the street (in Santa Fe), it may have been through 10 hands," he said.
Since fentanyl is much more potent than traditional opioids, "criminal organizations can use one kilogram of fentanyl to produce approximately 1 million counterfeit (1 millogram) pills, resulting in potentially 10-20 million dollars in revenue," says a DEA pamphlet titled "Fentanyl: A Briefing Guide for First Responders."
The potency makes the drug deadly, as an amount equal to five to seven grains of table salt can be fatal.
"As a matter of reference, it has been determined that it would only take 2-3 milligrams of fentanyl to induce respiratory depression, arrest and possible death," the DEA says.
Since a lot of users don't know that fentanyl is in their heroin, they take the same doses they usually do and suffer the consequences. "They hear on the street that they got this heroin from this dealer that's really good stuff, and that good stuff turns out to be fentanyl," Detective McCluskey said. "They use their usual amount and overdose because it has fentanyl in it."
In Santa Fe, Champlin said, people have referred to fentanyl as "kill-kill."
"Think about it, you're doing a drug called 'kill-kill,' " he said. "It kind of pre-empts you on what's possible to come."
Naloxone, which is typically known by the brand name Narcan, is currently being used by all law enforcement agencies in the state to reverse opioid overdoses and is known to be quite effective. Champlin described a naloxone overdose reversal as an "immediate shock to life."
But fentanyl's potency means several doses of naloxone may have to be administered to reverse an overdose.
The DEA recommends applying naloxone every two to three minutes until the victim has been breathing independently for at least 15 minutes or until medics arrive.
"I've heard stories, even here in Santa Fe, where they hit people eight, nine, 10 times with Narcan and there's no reaction out of it," Champlin said. "They're too far gone. Their respiratory system is depressed. For them to hit them nine or 10 times with it and not get a response speaks volumes to how strong it is."
The DOH's Landen says Narcan should work on fentanyl. "Narcan is really our only approach to reversing drug overdoses," he said. "With fentanyl, you may need repeated doses of Narcan and I'm not aware of a situation where it hasn't worked. There's no indication that Narcan isn't effective at reversing fentanyl."
The drug is also very dangerous for law enforcement and other first responders. Since fentanyl can be inhaled through the nose or mouth, or absorbed through the skin, "any substance suspected to contain fentanyl should be treated with extreme caution as exposure to a small amount can lead to significant health-related complications, respiratory depression, or death," the DEA guide says.
The guide recommends that anyone processing a scene with suspected fentanyl wear chemical-resistant suits, nitrile gloves, dust masks and even suits with a self-contained breathing apparatus, depending on the level of possible fentanyl contamination. Champlin said the SFPD immediately started conducting the appropriate training when the DEA warned that fentanyl was starting to show up in Santa Fe.
Champlin said there are confirmed reports of officers in other parts of the country getting fentanyl on their uniforms and having it soak into the skin, resulting in respiratory distress.
The rise of a strong opioid like fentanyl has also pushed the spread of uppers like meth. Eleven of the 20 fentanyl overdose victims in New Mexico last year also had meth in their system, according to the DOH.
Champlin said people here use meth to balance the effects of fentanyl, but that's not very smart. "That is not going to work to take methamphetamine to reverse the effects of fentanyl. It's the street logic. One's an upper and one's a downer."
McCluskey said an uptick in meth use by known heroin users tipped off officers that something was different. "We started seeing the rise in meth when we started seeing people that we knew to be heroin addicts who had never used meth were carrying the meth with them with the heroin, and that's how we found out fentanyl was making its mark on the city," McCluskey said. "Clearly, this heroin isn't pure heroin like they say on the streets. It's cut with something much stronger.
"It's almost like they're using meth as their own Narcan."
Heroin is still the top drug in Santa Fe, Champlin and McCluskey say, and the detectives believe the problem is only going to get worse. There were 33.9 drug overdose deaths per every 100,000 residents in Santa Fe County in 2015, up from a rate of 31 per every 100,000 residents in 2014, according to DOH data. Landen said the department plans on releasing 2016 overdose statistics soon.
"I think fentanyl kind of gave new life to heroin," Champlin said. "It's unfortunate, especially in this community."
Albuquerque Journal, N.M.