July 25, 2008

Painkiller Overdoses Kill More Than 1,000

More than 1,000 people died during the span of two years from an illegal version of the painkiller fentanyl, the government reported Thursday in its first national tally of those deaths.

The U.S. Centers for Disease Control and Prevention said some of the fentanyl came from Mexico, and was then illegally sold by drug dealers on U.S. streets, sometimes mixed with cocaine and heroin.

The CDC report said the Chicago area had the most deaths with 349, followed by Philadelphia with 269, the Detroit area with 230. Other deaths were reported in St. Louis, Missouri, and the states of Delaware and New Jersey.

Emergency medical personnel reported finding some victims with the needle still in their arms. They couldn't complete the injection because the drug was so powerful, said retired CDC public health service officer Dr. Stephen Jones.

"I think this is an extraordinary episode of fatal drug overdoses. But it's got to be recognized as part of the bigger problem of the increasing numbers of drug overdose deaths in the United States," said Jones.

However, health officials say the spike of overdoses seems to have ended, pointing to law enforcement's shutdown of a fentanyl operation in Mexico in 2006.

The wave of fentanyl overdoses first came to light in Chicago in 2005, and by 2006 more clusters were identified in Philadelphia, Detroit and other cities.

Local newspapers reported hundreds of deaths from the drug. Thursday's report from the Centers for Disease Control and Prevention puts the toll at 1,013 deaths from early April 2005 through late March 2007.

"This was really an epidemic," said Dr. Steven Marcus, the executive director of New Jersey's poison control center and a co-author of the new report.

The CDC found the number of deaths from drug overdoses and other cases of unintentional drug poisonings jumped from 11,155 in 1999 to 22,448 in 2005. The study noted powerful painkilling drugs played an important role.

Dr. Jones said, some deaths from illegal fentanyl still occur, but the worst of the outbreak seems to have ended after law enforcement closed down a fentanyl-making operation in Toluca, Mexico, in May 2006.

"It almost disappeared entirely. The shutting down of the Toluca facility was probably a major factor," said Jones.

The new report is being published this week in a CDC's Morbidity and Mortality Weekly Report.

Fentanyl is a prescription painkiller that doctors prescribe for cancer patients. It is administered through a patch, but it's also a powerful, euphoria-inducing narcotic, 30 to 50 times more potent than heroin.

Illegally made versions of the drug are sold as a powder, and sometimes used as a heroin replacement. Experts say it's possible some heroin addicts are unaware fentanyl is part of their injection.

The report found, "One gram of pure fentanyl can be cut into approximately 7,000 doses for street sale. Manufacture of (fentanyl) requires minimal technical knowledge, and recipes for making (fentanyl) are available on the Internet".

Smaller outbreaks of fentanyl-associated deaths in addicts have been reported before, including the "China White" outbreak of the 1980s.

Law enforcement found the latest outbreak in Chicago. Patients said drug dealers trying to attract more customers gave them free heroin in orange and pink plastic bags.

The Chicago cases are summarized in the July issue of Clinical Toxicology.

Marcus said, it took a cluster of overdoses seen in Camden, N.J., emergency rooms in April 2006 before federal officials were notified of the problem.

The resulting investigation was unusual, because some health officials have been reluctant to spend time and energy investigating deaths related to illicit drugs, Marcus said.

"The response when I deal with public health officials is; 'Drug abuse is a dangerous habit, and drug abusers know it's a dangerous habit, so why are we making a big deal out of it?'" he said.

The report noted deaths due to illegally made fentanyl from those due to illicit use of the pharmaceutical product.

Medical examiners cannot tell the difference from an autopsy, so investigators relied on drugs found at the scene and other information to separate the two categories.

Investigators did not count cases in every city. The tally covers only two states - New Jersey and Delaware - and the cities of Chicago, Detroit, Philadelphia and St. Louis.

"It's an incomplete picture," Jones said.

National health statistics show the death rate from unintentional drug poisonings roughly doubled from 1999 to 2005.


On the Net: