Fen­tanyl abuse seen as surg­ing in state, na­tion

Agen­cies ex­am­ine poli­cies for han­dling of po­tent drug

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - SCOTT CAR­ROLL AND ERIC BES­SON

A man in a white pickup pulled up to CHI St. Vin­cent In­fir­mary in Lit­tle Rock the morn­ing of April 11, pushed two limp bod­ies out of the ve­hi­cle and drove away.

Nurses went out­side and found Made­line Tate and a 22-year-old friend ly­ing on the ground. The two were blue in the face and strug­gling to breathe. They were dy­ing.

Nurses found a syringe and a spoon in the friend’s pocket and de­ter­mined he and Tate had over­dosed. They quickly moved Tate, 20, and her friend to the emer­gency room and in­jected them with nalox­one, an anti-opi­oid medicine used to re­verse the ef­fects of an over­dose.

The nor­mally fast-act­ing an­ti­dote took ef­fect slowly. But their heart rates sta­bi­lized and their breath­ing re­turned to nor­mal.

Their lives had been saved.

Tate and her friend later told doc­tors that they had in­jected them­selves with two drugs. The first was heroin.

The sec­ond was fen­tanyl, a syn­thetic painkiller that is 50 to 100 times stronger than mor­phine.

The over­doses, as de­tailed in a po­lice report and re­called by Tate and her fam­ily, were among a ris­ing num­ber across the coun­try in­volv­ing fen­tanyl and its pow­er­ful analogs.

Law en­force­ment en­coun­ters with fen­tanyl spiked from roughly 1,000 in 2013 to 14,400 in 2015, ac­cord­ing to the lat­est report from the Na­tional Foren­sic Lab­o­ra­tory In­for­ma­tion Sys­tem, a pro­gram of the U.S. Drug

En­force­ment Ad­min­is­tra­tion that col­lects in­for­ma­tion from foren­sic labs.

Fen­tanyl is of­ten pre­scribed as a patch or spray to treat chronic pain, but black-mar­ket versions of the drug, man­u­fac­tured in China and Mex­ico, are be­ing used to re­place or am­plify heroin, ac­cord­ing to a DEA report.

“Due to the high po­tency of fen­tanyl and other syn­thetic opi­oids, transna­tional crim­i­nal or­ga­ni­za­tions across the globe are com­pet­ing for the U.S. mar­ket,” the report says.

That mar­ket is eas­ily ac­ces­si­ble. Fen­tanyl can be pur­chased on­line, in a va­ri­ety of forms that in­clude pow­ders, pills and liq­uids, from sellers over­seas.

It’s ac­quired through theft, as well. In Lit­tle Rock, po­lice have fielded nu­mer­ous re­ports of pre­scrip­tion fen­tanyl van­ish­ing from nurs­ing homes, phar­ma­cies and medicine cab­i­nets.

Fen­tanyl is not the scourge in Arkansas that it is in other states — Ken­tucky au­thor­i­ties con­nected it to nearly half the over­dose deaths in the state last year — but the po­tent syn­thetic painkiller is show­ing up more fre­quently in the Nat­u­ral State.

The Arkansas Crime Lab­o­ra­tory iden­ti­fied 56 pos­i­tive sam­ples of fen­tanyl through the first three months of 2017, com­monly as an off-white pow­der or as a com­pound in coun­ter­feit pills, said Felisia Lackey, the lab’s chief foren­sic chemist. That com­pares with 66 pos­i­tive sam­ples in 2016, 85 the pre­vi­ous year and 12 in 2014.

Matt Dur­rett, Washington County pros­e­cut­ing at­tor­ney and pros­e­cu­tor with the re­gion’s drug task force in his district, said the drug doesn’t have a street pres­ence in North­west Arkansas as of yet. They have had some drug thefts in which fen­tanyl patches were among the items stolen, but not many, he said.

There have been no ar­rests in which ac­tual use or sale of the drug have taken place, he said.

Ray Car­son, di­rec­tor of the De­ci­sion Point drug coun­sel­ing pro­gram, which op­er­ates in both Ben­ton and Washington coun­ties, said they have seen a very few cases. Ev­ery case so far in­volved a med­i­cal pro­fes­sional, he said, not­ing they are the only ones with any reg­u­lar ac­cess to the drug.

The rel­a­tively small num­ber of fen­tanyl cases in Arkansas has still been enough to gain the at­ten­tion of hos­pi­tals, am­bu­lance ser­vices and law en­force­ment agen­cies.

Metropoli­tan Emer­gency Med­i­cal Ser­vices of Lit­tle Rock, the largest am­bu­lance ser­vice in the state, and UAMS Med­i­cal Cen­ter, the largest hospi­tal sys­tem in the state, met in June to discuss de­vel­op­ing in­ter­gency guide­lines on treat­ing fen­tanyl over­doses.

MEMS Ex­ec­u­tive Di­rec­tor Jon Swan­son said there are con­cerns over whether nalox­one, the anti-opi­oid medicine, is strong enough to re­vive some­one who has over­dosed on fen­tanyl or car­fen­tanil, the drug’s more pow­er­ful cousin.

Swan­son said there are also con­cerns for medics and other first re­spon­ders. Tox­i­col­o­gists say ex­po­sure to the small­est amounts of fen­tanyl through in­hala­tion can be deadly. In larger amounts, skin con­tact can be deadly.

“One of the con­cerns that we would have is rec­og­niz­ing the pres­ence of the stuff,” Swan­son said. “It might not be ap­par­ent to us.”

UAMS spokesman Les­lie Young said the hospi­tal has not seen a no­table in­crease in fen­tanyl-re­lated cases but is work­ing to ad­dress safety con­cerns as­so­ci­ated with the drug.

The hospi­tal has posted fliers to warn staff mem­bers about car­fen­tanil and the “sig­nif­i­cant threat of over­dose for any­one com­ing in con­tact with this drug.” The fliers, which show a lump of pow­dered car­fen­tanil, urge staff mem­bers to im­me­di­ately con­tact a su­per­vi­sor, po­lice or the Oc­cu­pa­tional Health and Safety Ad­min­is­tra­tion if they en­counter the drug.

“We’re tak­ing a proac­tive ap­proach in light of news around the coun­try,” Young said.

Lit­tle Rock po­lice are also ex­am­in­ing how to han­dle fen­tanyl en­coun­ters.

Records show that depart­ment com­man­ders have cir­cu­lated DEA train­ing videos on how of­fi­cers can pro­tect them­selves from ex­po­sure to the drug. Po­lice spokesman Lt. Steve McClana­han said the depart­ment is look­ing into equip­ping of­fi­cers with nalox­one, as well.

Ben­ton po­lice and the Pu­laski County sher­iff’s of­fice are among the law en­force­ment agen­cies in cen­tral Arkansas that al­ready carry the over­dose an­ti­dote.

Arkansas Drug Di­rec­tor Kirk Lane, the for­mer Ben­ton po­lice chief, said fen­tanyl is per­haps the strong­est and cheap­est op­tion in a “cir­cle of ad­dic­tion” for many of its users.

He said that cir­cle of­ten be­gins with pre­scrip­tion pain pills, which Arkansas, like many states, has in abun­dance. In 2012, doc­tors in the state wrote 116 painkiller pre­scrip­tions for ev­ery 100 peo­ple, ac­cord­ing to the IMS Health Na­tional Pre­scrip­tion Au­dit. That ranked as the eighth-high­est rate in the na­tion.

In 2015, doc­tors pre­scribed enough hy­drocodone to sup­ply ev­ery Arkansan with 37 pills for the year, ac­cord­ing to an Arkansas Pre­scrip­tion Mon­i­tor­ing Pro­gram report.

Lane said that when some peo­ple build a tol­er­ance to pre­scrip­tion painkillers, it be­comes cheaper to use heroin, which po­lice across cen­tral Arkansas have found more reg­u­larly, and in larger quan­ti­ties, in re­cent years. State Crime Lab data show pos­i­tive heroin tests have in­creased from 82 in 2014 to 159 a year later and 344 in 2016.

Lane said the “cir­cle of ad­dic­tion” then leads to an even stronger, cheaper sub­stance — fen­tanyl.

That’s how it hap­pened for Made­line Tate. Her par­ents, Tom and Hope Hank­ins, said she started abus­ing pre­scrip­tion pills as a teenager and even­tu­ally moved on to harder and cheaper drugs, in­clud­ing meth and heroin.

Tate said that the morn­ing of April 11, the day she was left cling­ing to life out­side CHI St. Vin­cent In­fir­mary, she and the 22-year-old friend had been go­ing through heroin with­drawal.

Af­ter count­less phone calls in search of the drug, they fi­nally found a seller at a house on Colonel Glenn Road in Lit­tle Rock. They bought a bag of heroin and a bag of fen­tanyl, which Tate said she and her friends thought of as “the good stuff.”

“I just knew that if you were sick, it would make you feel bet­ter,” she said.

They com­bined the heroin with small amounts of fen­tanyl and shot up with Tate’s boyfriend in his pickup. Al­most im­me­di­ately, Tate knew some­thing was wrong. Her boyfriend froze up. She looked at her friend in the back­seat and saw he’d also gone stiff.

“And then I started to go out,” Tate said. “Look­ing in the rearview mir­ror, that’s the last thing I re­mem­ber.”

Tate awoke in a hospi­tal bed. Doc­tors told her she was lucky. They said that if her boyfriend had waited just min­utes longer to dump her and the friend out­side the hospi­tal, she would have died.

Tate said in a phone in­ter­view from a drug re­ha­bil­i­ta­tion cen­ter that her fen­tanyl over­dose was a wake-up call.

“We didn’t re­al­ize how strong it re­ally was,” she said.

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