Federal, state and local drug investigators are working together on multiple fronts to combat the spread of a deadly batch of heroin that has killed as many as 22 in four counties since Jan. 19 and resulted in nonfatal overdoses throughout Pittsburgh.
Despite authorities' increasing concern, an apparent lull Monday in suspected overdose deaths in Allegheny County provided a glimmer of hope that the worst might have passed. But no one is ready to declare the emergency over.
"What we don't know is, was this a limited amount and has it run its course, or is this just the tip of the iceberg," said Neil A. Capretto, medical director at Gateway Rehabilitation Center.
At least three patients checked themselves into Gateway over the weekend, at least in part because they had become scared for their lives after using the potentially deadly batch of heroin.
"All of them told similar stories," Dr. Capretto said. "Dealers warned them this was stronger and to use it carefully."
As the Pennsylvania State Police, U.S. Drug Enforcement Administration and other law enforcement agencies collaborated on tracking down the drug's supply chain, state and local authorities treated the overdoses as a public-health crisis requiring an education campaign, and street-level detectives tried to ferret out the dealers who sold the bad heroin.
In Pittsburgh, narcotics detectives and others working undercover have been asked to reach out to their informants. Narcotics Cmdr. Linda Rosato-Barone said police were following several leads Monday, but she did not go into detail for fear of jeopardizing the investigation.
"Everybody's helping out," said Detective Tony Marcocci, who is investigating two suspected fatal overdoses in Lower Burrell and Washington Township for the Westmoreland County district attorney's office.
"One of the things that we've tried to do is raise the public awareness about this. There is a killer out there, and we want to try to stop people from using it," Detective Marcocci said. "We are going after the addicts. They can very well supply it to another addict. But ultimately our goal is to go after the source -- the actual dealers -- whether they be in our county or another county."
Detective Marcocci believes the heroin is coming in from outside Pennsylvania.
"The typical pipeline would be from out of state into Allegheny County, and then from Allegheny County it goes to other regional counties," Detective Marcocci said.
Authorities believe that the heroin -- likely laced with the potent painkiller fentanyl -- is being sold throughout Western Pennsylvania under the street names of "Theraflu," "Bud Ice" and "Income Tax," according to Pennsylvania Attorney General Kathleen Kane, who issued a prepared statement that included the 22-death tally.
If lab tests confirm the suspicions of Ms. Kane and local investigators, the number of overdose deaths would exceed the 18 who died in 1988 in the infamous "China White" case, in which 3-methylfentanyl, a more powerful form of fentanyl, was sold as potent heroin.
At least 12 fatalities and dozens of overdoses occurred locally during another national outbreak of heroin laced with fentanyl in 2006 that killed scores of drug users in Detroit, Philadelphia, Chicago, St. Louis and elsewhere.
Although authorities with long memories are well aware of the "China White" cases, they are not quite ready to declare the current situation a similar epidemic.
"Would I call it the same? Not until we confirm exactly what it's made of," Cmdr. Rosato-Barone said.
Laboratory tests are pending on both blood and urine from suspected overdose victims and on heroin found with the deceased.
Authorities cannot conclusively say yet whether fentanyl is involved in all cases, if the three different brand names found on heroin stamp bags contain the same batch of heroin, and whether all 22 suspicious deaths indeed resulted from heroin overdoses.
"China White" echoes loudly today. Detective Marcocci, who has worked narcotics and vice cases for 28 years, drew parallels between then and now.
"The sad reality is I can remember working with an addict, I was working undercover, what she wanted to use was China White. That's just where all the addicts want to go, is to the most powerful stuff. Their belief is it's not going to happen to them," Detective Marcocci said. "That's one of the things that does scare me right now is the media attention to 'Theraflu.' I think a lot of people are going to be looking for it."
The current crisis came to light Friday, when Allegheny County medical examiner Karl Williams and authorities in Westmoreland County issued alerts about deaths in both jurisdictions, as well as at least one suspected overdose death in Rayburn, Armstrong County, on Jan. 19.
At that point, "Theraflu" was the brand name eliciting concern.
But on Monday Dr. Williams reported that "Bud Ice" and "Income Tax" were also potentially connected to the deadly heroin.
Also on Monday, Homestead police announced the discovery of stamp bags of "Bud Ice" when they executed a search warrant Sunday night.
Pittsburgh narcotics Lt. Robert Roth said each of the city's six police precincts had seen at least two overdoses, not all of them fatal.
"The 'Bud Ice' -- we're not positive if that was 'Theraflu' that was just re-stamped or if it's the same batch or whatnot. That would have to be confirmed with the crime lab," Lt. Roth said.
Victims in Pittsburgh range in age from 24 to 50, Lt. Roth said. Six of the city's cases, including two fatalities, involved "Theraflu." Two cases, both nonfatal, involved "Bud Ice." As of Monday evening, Pittsburgh police had not seen any cases involving "Income Tax."
Most of the overdoses, the lieutenant said, involved people who used drugs found in unmarked stamp bags. Often when medics arrive, the victims are unconscious. Sometimes, he said, others have cleaned up the scene, making it harder for detectives to recover evidence.
What makes the heroin so dangerous is its ultrapotent high that entices addicts.
"Conventional wisdom would tell you that this is really bad and it will kill you and to stay away from it," said Barry Fox, a retired Pittsburgh narcotics detective who helped break the "China White" case.
"Unfortunately, there also is dope wisdom which tells them, 'If that can kill you, it must be powerful and really, really good. All I have to do is take it slow.' "
The dealers who manufacture and sell the laced heroin are about one thing, Detective Marcocci said: market share.
Dr. Capretto agreed.
"How do you separate yourself to show you have a more attractive product?" he said. "The way you do that is to have fentanyl-laced heroin."
But the downside is enormous.
"It's not like this comes from an FDA pharmacy," Dr. Capretto said. "You don't know what's in it. We know that the advice not to use heroin in the first place falls on deaf ears for people with addiction.
"If you don't heed that advice and you are going to use, I would recommend using significantly less because if you don't, this could be the last time you shoot up."
Jonathan D. Silver: firstname.lastname@example.org, 412-263-1962 or on Twitter @jsilverpg. Michael A. Fuoco: email@example.com, 412-263-1968. Liz Navratil: firstname.lastname@example.org, 412-263-1438 or on Twitter @LizNavratil. First Published January 27, 2014 11:59 AM