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In Minnesotans' opioid abuse, fentanyl is a new factor. A killing factor.
Saint Paul Pioneer Press - 12/10/2017
Dec. 10--Jason Roberts knows he's lucky to be alive.
A longtime heroin addict, Roberts overdosed twice on drugs laced with the man-made opioid fentanyl. He's convinced he'd be dead today if he hadn't been arrested for aggravated robbery in 2015 and entered an addiction recovery program.
"It's a plague," Roberts said of fentanyl, which is 50 times more powerful than other pharmaceutical opioids like morphine and is highly addictive.
"It's going to be death, one way or another. Either your soul or your body will die. It's going to kill you," he said.
Fentanyl killed 20,000 people across the United States in 2016 and was responsible for one out of every three drug overdose deaths, according to a recent report by the Centers for Disease Control and Prevention.
And it's here in Minnesota. Fentanyl played a role in 87 of the state's 395 opioid-related deaths in 2016, or 22 percent, according to data from the state Department of Health. That's more than twice as many fatalities as the year before.
But it is not a complete picture of the drug's toll because fentanyl is often combined with other substances and is not always listed on death certificates. The drug's most famous Minnesota victim was the musician Prince, who overdosed on pills containing fentanyl in 2016.
Carol Falkowski, an addiction specialist who has worked in state government and with recovery programs, said fentanyl presents a danger to all types of Minnesotans.
"Fentanyl is an absolute game-changer in the drug-abuse scene today, and there is no sign of it slowing down or abating," Falkowski said. "(Minnesotans) tend to think we are immune from deep-seated societal problems. What is going on in the rest of the country is taking hold here."
A HIDDEN DANGER
Fentanyl originated as a pharmaceutical for treating extreme pain, but it has become increasingly popular on the black market across the U.S. because it can be manufactured cheaply overseas and is extraordinarily powerful, Minnesota health and law enforcement officials say.
It is typically combined with other illicit drugs, such as heroin, cocaine or methamphetamine, in order to make those drugs more potent and valuable on the street.
Addicts don't always know they are taking drugs laced with fentanyl, which can be lethal even in small doses.
St. Paul Police Cmdr. Ken Sass, who leads the department's narcotics unit, said officers are on high alert about fentanyl because they don't have a way to field test for the drug. So illicit powders police seize that are identified as heroin, cocaine or methamphetamine may also include dangerous amounts of fentanyl without officers realizing it.
"If we are doing a heroin case, we know to be more alert," Sass said. "If officers on the street come across a powder, we're telling them to ask the person what it is and treat it with more caution."
The state Bureau of Criminal Apprehension can test for fentanyl, but that isn't typically necessary if officers already have used a field test to determine a substance is a narcotic. Law enforcement is increasingly more likely to look for fentanyl in toxicology reports after a fatal overdose.
Pete Orput, Washington County attorney, is increasingly concerned about the growing number of counterfeit pills on the black market. Dealers are passing off pills containing fentanyl as prescription opioids like hydrocodone and oxycodone.
"It fools people," Orput said. "Even a junkie thinks, 'If it's a pill, I know what I'm getting.' There's too many fakes out there, and if you're wrong it will kill you."
While some addicts are unaware the drugs they are taking are laced with fentanyl, others seek it out even though the potency can vary wildly from batch to batch.
"That's why you see a spike in deaths," Sass said. "Addicts will tell you they seek out those hot loads."
That's what Roberts did when he was an addict because he knew higher-potency drugs would satisfy his cravings.
"The stuff was so strong," Roberts said. "They used to call it 'Get high or die trying.' "
Roberts, who now lives in Golden Valley, finished a court-ordered recovery program provided by the Salvation Army in 2015 and now works for the organization as a dispatch manager.
Growth of Twin Cities opioid deaths 2000-2016
The darker the color, the greater the percentage increase in opioid fatalities. Click on a county to see how many residents died from overdoses of different drugs.
SPIKE IN OVERDOSES
Fentanyl has roughly two dozen analogs that differ slightly in chemical composition and can make it hard for public safety officials to identify.
Minnesota has statewide data on fentanyl-related overdoses going back only to 2012, when the drug was listed on 27 death certificates. That same year, 14 other Minnesotans died from synthetic opioids, but it is unclear if fentanyl was a factor.
However, as opioid overdoses have skyrocketed, law enforcement and public health officials fear fentanyl may be playing an increasing role.
"It really is hard to imagine the far-reaching effects of fentanyl," Falkowski said. "It is a contaminant ... a fatal poison in the illegal drug supply."
Data from the state Department of Health shows opioid-related deaths jumped from 54 in 2000 to 395 in 2016, an increase of more than 600 percent.
No area of the state has been immune to the crisis. Greater Minnesota saw the largest percent increase, with opioid overdoses growing a staggering 1,154 percent since 2000. The metro area had the most deaths, recording 2,337 fatalities from opioids in the past 17 years.
In Dakota, Washington and Ramsey counties, opioid deaths increased 1,000 percent or more. In 2000, just a few residents were killed by opioids; last year it was dozens.
HOW DO WE RESPOND?
Law enforcement and public health officials have realized Minnesota will not escape the opioid crisis that has devastated other states and have responded with a flurry of prevention and education campaigns along with legal actions.
Public safety officials say they are routinely talking to students and community groups about the danger of opioids. They are especially focused on prescription drugs which are often the gateway to more serious addictions.
"This is not a fad, it is not just a trend, it's the future," said St. Paul police commander Sass. He noted that St. Paul police have held opioid symposiums for the public, where they show "Chasing the Dragon," an FBI-produced film about the life of an opioid addict, and take questions from the audience.
Minnesota's county attorneys are increasingly filing criminal charges against dealers who supply drugs that cause fatal overdoses. Ramsey County has filed three such cases, and in two of them the victims had traces of fentanyl in their system.
Orput, the Washington County attorney, said the Minnesota County Attorneys Association plans to lobby the Legislature to update how fentanyl is legally defined to include the different versions arising.
"We play cat-and-mouse with the chemists, and I'm willing to keep playing," he said.
Orput is also one of a group of county attorneys who last week announced lawsuits against the manufacturers and distributors of prescription opioids such as Oxycontin. Their lawsuits allege that deceptive marketing practices led doctors to believe the pills were a non-addictive way to manage pain.
But when patients' prescriptions ran out they turned to illicit drugs, which can be even more dangerous because they don't know what they are getting.
In Washington, Minnesota Sen. Amy Klobuchar is a sponsor of the bipartisan Synthetics Trafficking and Overdose Prevention, or STOP Act, legislation that would tighten oversight of packages shipped from overseas, where much of the illicit fentanyl in the U.S. originates.
"I figure if Target can find a pair of shoes with a (barcode), we should be able to track opioid packages," Klobuchar said in an interview earlier this year.
Finally, state officials and addicts alike are pushing for wider availability of naloxone, the opioid antidote sold under the brand name Narcan. Many first responders across the Twin Cities carry nalaxone and use it routinely to revive addicts from what might otherwise be fatal overdoses.
Roberts was one of them. He overdosed in the bathroom of a North Minneapolis fast-food restaurant and woke up in the hospital. Narcan saved his life.
Roberts says making it easier for addicts to get naloxone would lower the death toll.
"Every junkie has a kit," Roberts said, referring to the collection of syringes, tourniquets and other paraphernalia they use to get high. "Narcan should be in there, too."
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