The explosion of drug overdoses and deaths in the area this summer has dissipated, indicating fentanyl-laced heroin suspected in the spike is no longer on the streets.
While there's no longer an immediate public-health threat posed by the extra-strong fentanyl-boosted heroin, believed to be responsible for as many as 14 deaths between mid-May and mid-July, there remains a heroin-addiction problem that shows no signs of abating.
"My guess is there's still some [fentanyl-laced heroin] out there, but the good news is it's died down," said Dr. Neil A. Capretto, medical director of Gateway Rehabilitation Center. "But that's the same as saying it's 89 degrees outside and we're finally out of the 90s. It's still a hot day and we still have a bad problem."
Results of toxicology tests on the 14 overdose deaths in Allegheny County won't be known for another month, so authorities can't say with certainty that they involved fentanyl, a painkiller about 80 times stronger than morphine that is used legally as an anesthetic and for acute pain in cancer patients. But Dr. Frederick Fochman, director of the forensic science laboratory division and chief toxicologist of the Allegheny County medical examiner's office, said preliminary toxicology results and tests on residue found in drug packets indicated the presence of fentanyl.
Most of the overdoses occurred in June. The Allegheny County Health Department said there were at least 63 overdoses that month, including nine that were fatal, with 38 of them occurring June 3-5.
A drug cocktail of heroin and fentanyl has been seen here before, but the recent batch, much of it sold in stamp bags labeled "Get High Or Die Trying," "seems to be something to a much greater extent," Dr. Fochman said.
Dr. Capretto agreed: "We've heard on and off since 1999 that there occasionally was fentanyl in the area, but this batch was very potent."
The area wasn't alone in dealing with an outbreak of overdoses from the mixture. From the Midwest to the East Coast, authorities have been trying to get a handle on an extraordinary number of overdoses, and more than an estimated 200 overdose deaths, caused by heroin laced with fentanyl. As it is with fashion or other trends, the Pittsburgh area was a few months behind the outbreaks in Chicago, Detroit and Philadelphia, where addicts began dying in April.
Dealers add fentanyl to diluted or impure heroin for added kick. A dose the size of a few grains of salt can be fatal but, rather than scaring addicts, publicity about its punch drew those looking for a more powerful drug.
"People with addictions want something potent. If a dealer, all of a sudden, says, 'My product here will really lift you to another level,' that's attractive," Dr. Capretto said. "Very few addicts want to die, but they want to get that high, to push the limit of getting close to dying without going over the edge.
"Whenever addicts [hear about overdoses], they think, 'That person went out because they were careless, they used too much. I'll be careful,' " he said. "But that can be a fatal mistake."
Some addicts who heard about the heroin-fentanyl before using it were cautious when they did. One addict, who normally shot up five bags of heroin at a time, injected one from the potent batch, Dr. Capretto said. It knocked him out for 24 hours, scaring him so much that he admitted himself to Gateway. And some addicts were so frightened by the publicized fatal ODs that they, likewise, checked themselves in for rehabilitation, he said.
Of such concern is the outbreak of fentanyl-laced heroin that the White House drug policy office hosted a forum on the combination in Philadelphia on July 28.
"[Drug dealers] have discovered a new way to market their product, much like a soft drink manufacturer might add a twist of lemon to boost sales," Patrick Meehan, U.S. attorney for the Eastern District of Pennsylvania, told those attending. He said current estimates indicated there had been more than 170 deaths and 300 nonfatal overdoses in Pennsylvania, New Jersey and Delaware since April.
In May, Mexican law enforcement authorities seized a fentanyl laboratory in Toluca, Mexico, which they believe was the source of the fentanyl.
Pittsburgh police Cmdr. Maurita Bryant, who heads the narcotics section, said detectives heard from informants that, once federal and local law enforcement here announced they were focused on finding dealers of the drug, "the suppliers put it aside, because it was too hot. It was being cut so it wouldn't be as potent.
"We heard dealers called those [Get High or Die Trying] bags back in and repackaged them with different stamps. We also heard the supply from that particular shipment was gone in the city. Until the investigation is complete and somebody talks, we won't know exactly what happened."
Among those factors was the confiscation by police of 1,131 stamp bags and the arrests of people who had them.
"We believe we got the main source, centered in Hazelwood," Cmdr. Bryant said. "Then it's the matter of trying to find all the subsequent dealers out on the street. The investigation is not over."
Nor is the heroin problem. Dr. Capretto said the area was experiencing an epidemic of addiction to opiates and opioid drugs such as heroin, codeine, morphine, Percocet, Vicodin, Dilaudid and OxyContin, among others. Opioids possess some properties characteristic of opiate narcotics such as heroin and morphine but, unlike them, are not derived from the opium poppy.
"More people than ever are addicted to heroin and opioid medication," he said. "We've had a 600 percent increase in our mission in the last six years.
"What that tells me, from our point of view, is we have an epidemic. From the early '80s to the late '90s, we averaged five teenagers a year [at Gateway]. In the last five years, we've seen 200 to 300 a year."
Heroin use has skyrocketed because drastically increased purity makes it possible to ingest by snorting or smoking instead of injecting, although many end up doing just that in an effort to re-create the initial high, according to Dr. Capretto.
In Allegheny County, drug overdose deaths remained fairly stable between 1998 and 2000 with an average of 105 deaths a year, according to a study by Steven A. Koehler, forensic epidemiologist for the county medical examiner's office. In 2001, there was an increase, with 210 OD deaths, then 228 in 2003, 205 in 2004 and 223 last year. Of the 223 fatal overdoses last year, 77, or 35 percent, were heroin-related; 22, or 10 percent, were opiate related; 10, or 4.5 percent, were morphine related; and 114, or 51 percent, involved other drugs.
"As far as opioids, from what we're seeing and reading nationally, we're worse than average. The opioid problem in our area is certainly more severe than most parts of the country," Dr. Capretto said.
He added that powerful opioid drugs such as OxyContin are prescribed here more than in other areas because of the region's large elderly population and large number of former industrial workers who suffered work-related injuries.
"The heroin/opioid problem is something absolutely everybody should be concerned with," he said.
That problem, unlike the fentanyl-laced heroin, just isn't going away.
Michael A. Fuoco can be reached at firstname.lastname@example.org or 412-263-1968.