Pennsylvania might be the latest state to grapple with the mortal scourge of heroin combined with the painkiller fentanyl, but it is hardly the only one.
Over the past year Maryland, New York and Ohio have all experienced outbreaks of overdoses from the often-fatal mixture.
On Friday, Maryland's office of the chief medical examiner issued a statement warning of the illicit drug combination and blaming it for at least 37 deaths statewide since September.
In western New York, which experienced a wave of fentanyl-laced heroin deaths over the summer, the mixture is showing up again.
"Going back to last year, we were also observing for a period of time a spike in heroin-fentanyl overdoses," William J. Hochul Jr., U.S. attorney for the Western District of New York, said Friday. "In Buffalo, we've had a recent spike in overdoses as well."
And stamp bags marked "Theraflu," a brand linked by lab results in Allegheny County to fatal overdoses from heroin and fentanyl, have recently appeared in small quantities on the streets of Paterson, N.J., about 20 miles outside New York City.
"We've seen a little bit of the 'Theraflu,' but minimal, basically on buyers," Paterson police narcotics Capt. Troy Oswald said Friday.
Pennsylvania State Police recently alerted law enforcement in the commonwealth about a possible connection between Paterson and tainted heroin in Western Pennsylvania.
Capt. Oswald confirmed that authorities from Pennsylvania -- he was unsure which agency -- had consulted a supervisor in his squad.
"People from your area have contacted us about different stamps," he said.
State police would not discuss the bulletin -- which was distributed as part of their efforts to track down the source of a drug that has killed as many as 23 people in Allegheny, Armstrong, Butler and Westmoreland counties -- based on new data released Friday by the Allegheny County medical examiner's office.
The state attorney general's office believes that seven overdose deaths involving the deadly mixture have occurred in Armstrong, Butler and Westmoreland counties.
There have been 14 deaths in Allegheny County in which victims tested positive for both heroin and fentanyl.
Of those, nine overdoses happened in Pittsburgh. The other five happened in Aspinwall, Castle Shannon, Coraopolis, Penn Hills and Tarentum.
Lab results are pending for another two potential overdoses in the city.
The deaths began Jan. 16 and came in at a rate of nearly one a day until Jan. 23, when there were four fatal overdoses.
One occurred the next day, followed by three on Jan. 25. The most recent ones were Monday and Thursday.
Victims ranged in age from 25 to 50.
There were 16 distinct stamp bags found at the scenes. "Theraflu" was the only brand with residue that tested positive for both heroin and fentanyl.
Another brand, "Magic City," tested positive for heroin on the bag only; a spoon had both heroin and fentanyl.
Medical examiner Karl Williams confirmed Friday that heroin labeled "Bud Ice" and seized Sunday from a Homestead residence contained fentanyl.
Test results were not available on a large batch of heroin seized Friday morning in McKees Rocks.
Two men -- Andre Woods, 45, and Damany Hayes, 30 -- were charged with drug offenses after police working with the District Attorney Narcotics Enforcement Team served a search warrant and seized about 350 stamp bags and roughly 70 grams of suspected raw heroin from a home in the 300 block of Shingiss Street.
That amount, DA's spokesman Mike Manko said, is enough to package into 10,000 bags.
Police were alerted to the drug operation earlier this week after interviewing a person who had overdosed after taking heroin marked "Theraflu."
Detectives set up undercover drug purchases, leading to the execution of the search warrant.
Police also recovered two weapons, a small amount of cash and suspected marijuana.
Also Friday, U.S. Sen. Bob Casey, D-Pa., released a letter he had sent to the head of the federal Drug Enforcement Administration for increased assistance.
"According to the Substance Abuse and Mental Health Services Administration, Pennsylvania has the third-highest rate of heroin abuse in the country, and heroin abuse in Western Pennsylvania is on the rise," Mr. Casey wrote.
"With reports that the fentanyl-mixed heroin likely came from outside of Pennsylvania, the federal nexus to this issue is clear," the letter continued.
"I respectfully request that the DEA provide significant support to state and local law enforcement in identifying and eliminating the source of the heroin, and bringing charges against the producers and sellers responsible for twenty-two senseless deaths."
Pittsburgh police, meanwhile, would release no new information about their efforts.
"We are working closely with local, federal, state and county law enforcement agencies and will continue to investigate all overdose incidents and deaths," acting Chief Regina McDonald said in a statement.
"Narcotics detectives and other plainclothes detectives will continue to target neighborhoods throughout the city."
Jonathan D. Silver: firstname.lastname@example.org, 412-263-1962 or on Twitter @jsilverpg. First Published January 31, 2014 11:50 AM