Powerful painkiller fentanyl swiftly taking lives
Drug may be mistaken for heroin by those using it
“This is a, ‘Oh my God. How did they even do that level?’ They took a huge dose without knowing it and it circulates for a minute or two and they immediately die.”
The victim lay dead in the hallway of a north side Milwaukee home, looking like life left suddenly, as if by a bullet or knife wound.
The killer, however, was on the kitchen counter: white powder, spoon, needles. Jason Politick’s death Feb. 9 appeared to be another case in the surging body count of heroin fatalities in Milwaukee County.
Less than an hour after Politick’s body was found, paramedics would return to the home. They had missed a second victim, Cristina Orton, who was found slumped over in the bathroom. What could kill two people so quickly? During the autopsies, Milwaukee County Medical Examiner Brian Peterson found the answer: There was no heroin, but instead high doses in Orton and Politick of a more powerful drug, fentanyl.
As drug overdose deaths continue to hit record levels in Milwaukee, fueled by a surge in fatal heroin cases, a troubling trend has emerged of addicts dying from fentanyl.
Four people died from fentanyl in the first five weeks of 2015, medical examiner records show. In all of 2014 there were only four fentanyl-only death cases in Milwaukee County and a total of 19 such deaths since 2009, records show.
Fentanyl, which is used to put patients under
Brian Peterson,
Milwaukee County medical examiner
for surgery and to alleviate severe pain, is 50 times more powerful than street heroin and 100 times stronger than prescription morphine.
“I don’t think they really realize the potency of the fentanyl,” said Tina Virgil, director of the Wisconsin Department of Justice’s Division of Criminal Investigation. “I don’t think people conceptually see it equally as powerful, or stronger than, heroin.”
The painkiller is so potent it can be absorbed through the skin, and the recent uptick in cases prompted the Justice Department to issue an advisory to law enforcement officers, who are urged to wear gloves when they suspect the drug is present.
Before this year, fentanyl deaths in Milwaukee were most often from people abusing fentanyl patches, lozenges and “lollipops” — delivery systems meant to slow the dose of the drug, a review of autopsies shows.
But circumstances around the most recent cases suggest fentanyl may be getting mistaken for heroin by those using it. The result is sudden death. Peterson thinks that’s the case given the high amounts he has seen in victims this year.
“This is a, ‘ Oh my God. How did they even do that level?’ They took a huge dose without knowing it and it circulates for a minute or two and they immediately die,” he said. “If there is word on the street, it may be ‘There is great heroin,’ but they don’t realize ‘great’ will kill them, and very fast.”
Drug deaths hit a record high in 2014, with nearly 250 people dying from overdoses on drugs of all kinds in Milwaukee County. Heroin accounted for 119 and for the first time, heroin deaths were greater than either car crashes and homicides in the county last year.
The surge in drug deaths is traced to the widespread practice of doctors prescribing opioids in the 1990s, according to Peterson and other experts in the field. The easy availability of drugs such as Vicodin, Percocet and oxycodone resulted in illicit sales and use, and high rates of addiction.
“By now we know and are backpedaling against that type of practice,” said Aleksandra Zgierska, an assistant professor at the University of Wisconsin School of Medicine and Public Health specializing in addiction medicine. “We know better the side effects of opioids and that they are not as much a cure of chronic pain. We see the consequences.”
As those practices were tightened, some users have turned to heroin as a cheaper, more available substitute, according to law enforcement.
In this storm of opioid and heroin drug use, fentanyl occupies a special spot. Since its release in the 1990s, fentanyl has been near the top of the food chain of pain drugs, used for surgeries because of its “quick on, quick off” character as a drug, said Robert Hurley, professor and vice chairman for pain medicine in the Department of Anesthesiology at the Medical College of Wisconsin. Its fastacting characteristics make it a good candidate for addiction.
“It would give a fast euphoria and come down quickly and produce addiction,” Hurley said.
Fentanyl also has been used by cancer patients and those who have developed tolerance to weaker pain drugs. That is how it is most often abused, as users try to defeat the slow-release characteristics of the patch or other device.
Zgierska said people using fentanyl illicitly do not have time to respond like they may have with other drugs because of its fast-acting nature.
“There is a moment you feel in control and suddenly a switch comes and you are out,” she said. “There is no time to do anything. The medication just takes over.”
Fentanyl acts on the part of the brain that also controls breathing. It will suppress the rate of breathing when taken under supervision. If the amount is too high, breathing will cease.
First responders can treat a fentanyl overdose with naloxone, also known by its brand name Narcan, just as they would any other opioid overdose, Milwaukee Fire Battalion Chief Steve Riegg said.
Paramedics often don’t know what drug was ingested, but one signal of a fentanyl overdose is if the Narcan has a “much shorter life span,” Riegg said.
“If we give Narcan, and if a patient comes to and they start becoming groggy or unresponsive, then they’re given another dose,” he said.
Because it is a synthetic, fentanyl can be made in underground labs, though its production is complicated. Known as synthetic heroin or China White, this form of fentanyl looks like heroin and is often mixed with drugs, sometimes with deadly results.
Underground lab
Based on evidence at the most recent death scenes, experts suspect the fentanyl that is killing people in Milwaukee could be from an underground lab.
Such a pipeline can have widespread fatal results. In 2005, illicitly made fentanyl produced in a lab in Mexico accounted for nearly 350 deaths in Chicago.
The difference between that crisis and the deaths in Milwaukee is the geography of the deaths here is scattered. In Chicago, there were a large number of deaths tied to one drug shipment to one neighborhood.
If investigators can connect the fatal fentanyl with a dealer, the suspects could face charges under the state’s so-called Len Bias law. The law gives prosecutors the power to issue reckless homicide charges in any fatal overdose involving either a Schedule I or II drug. Bias was a top NBA draft pick who never got to play as a pro because he died of a drug overdose in 1986.
Patricia Daugherty, a Milwaukee County assistant district attorney who exclusively prosecutes such cases, has seen the death toll rise from heroin and other opioids.
“With street drugs, you never know how potent and pure it is,” she said. “It differs every time and can depend on how much they dilute it with a cutting agent.”
She said she prosecuted more Len Bias cases in 2014 than in any other year.
Peterson is concerned and is reaching out to law enforcement and civic leaders to discuss how to tackle drug overdoses, as the community faces numbers that he calls “stunning.”
Orton, 40, the woman found dead in the bathroom last month, got hooked on pain drugs after she had radical weight surgery 14 years ago, according to her mother, Patricia.
Orton, who weighed nearly 400 pounds, traveled to Spain for the surgery.
A portion of her stomach was removed. She lost weight, but was at risk of not getting enough nutrients without a regimen of vitamins. She didn’t follow the vitamin regimen and developed severe pain in her bones and other parts of her body, according to her mother.
She had been prescribed opioids, including fentanyl patches, her mother said. But in the house where she and Politick died suddenly, police found a white powdery substance, two syringes and a spoon with residue from apparently cooking drugs.
Patricia Orton said she couldn’t imagine her daughter shooting drugs, but her addiction had progressed to a desperate level. She said she hopes her death will help someone else get help.
“She was no angel and nobody twisted her arm,” said Orton, 66, who lives in Hancock, west of Oshkosh. “To have her go this way, it’s just such a shame. Any story you can put out there to smarten up young people. They don’t have respect for these drugs. They are fearless. Fearless.”