The overdose outbreak that hit Pittsburgh in 2006 sounds a lot like today

http://commons.wikimedia.org/wiki/File:Forget_me_not.jpg

Forget-me-nots. Photo: Wikimedia Commons

From April 4, 2005 to March 28, 2007, the CDC/DEA surveillance system identified 1,013 NPF [nonprescription fentanyl]-related  deaths. The monthly incidence of NPF deaths peaked in June 2006 at 150 cases…

– “Get High or Die Trying in the Summer of 2006”

Last week, Maxim Furek sent us an article he wrote on spike in overdose deaths a few years back caused by a mixture of heroin and fentanyl.  Called “Get High or Die Trying in the Summer of 2006,” it tells a familiar story.  You can read the full article here.

Of course, it’s entirely relevant to the present day: since the middle of last month, 22 people have reportedly died in southwest Pennsylvania (in addition to 37 in Maryland and others elsewhere in the Northeast) from a heroin-fentanyl combination sold under the brand name “Theraflu.”

In response, local and national news sources have dutifully reported the number of overdose deaths and nearly all have marveled that heroin users are in fact attracted to this potentially lethal blend.  Some talk about the lifesaving power of naloxone and Pennsylvania’s need for Good Samaritan laws.  But very few have reported that this phenomenon has repeated itself several times in the last 25 years.

Public officials, too, have issued statements that heroin marked “Theraflu” ought to be avoided, but few have drawn a larger picture of overdose in our region. By and large, they have declined to comment on our region’s history of overdose deaths related to fentanyl, Allegheny County’s “normal” overdose rate (20.5 per 100,000 people, quite above the national average of 13.1 per 100,000)*, or much about what we are doing now to prevent overdose in the future.

It’s striking how many parallels there are between the overdose outbreak in 2006 and the one we are in the midst of, including the failure to look back at previous outbreaks.  Furek’s piece offers some (hopefully) valuable historical perspective.

Furek starts by introducing the heroin that cropped up in New Jersey in 2005. “The names were unassuming enough,” he says.

Echo. Monkey. Flatline. Al Capone –four bizarre names for a street cocktail of deadly heroin. This batch, however, contained a mysterious additive that when combined with heroin’s suppression of the central nervous system, triggered irregular heartbeat, breathing difficulty and horrific feelings of suffocation.

As with the heroin that appeared in our region last month, this heroin had been laced with fentanyl.  And fentanyl, writes Furek,

…can easily paralyze the chest wall and stop a person from breathing (Graham, 2006). Only 125 micrograms of fentanyl, the equivalent of five or six grains of salt, can kill an adult user (Nordqvist, 2006).

The product spread through the Northeast and into the Midwest toward Detroit and Chicago.

As the drug spread across the country the brand names began to change (Fefe. Exorcist. Apollo.) In Pittsburgh it was called Get High or Die Trying (Fuoco, 2006). People died there too.  Pittsburgh authorities compiled the grim facts: Users were predominately white males between the ages of 16 and 56 and crossed all socioeconomic lines.

It was a huge deal. The number of deaths and the wide swath in which they occurred provoked responses from high level officials.  In a statement, Dr. H. Westley Clark, Director of CSAT at SAMHSA, encouraged public health professionals to distribute fact sheets about the “killer drug combination.”

In 2006, Furek reports, prevention efforts were also hindered by the heroin/fentanyl blend’s appeal to heroin users, just as they have been in 2014.

The fentanyl heroin mix provided an opportunity that many hardcore addicts–unable to get high and using only to keep from getting sick–spend a lifetime searching for.

The broad availability of prescription opioids, including fentanyl (even in lollipop and nasal spray form), and the financial opportunities that a fentanyl-heroin blend presented to dealers competing for market share contributed to the overdose deaths in 2006, as it has this year.  Furek quotes pharmacist Michael Palladini:

“The use of fentanyl powder to increase the potency of heroin in a growing and competitive market is a continuing and dangerous practice. The potency of fentanyl can be fatal to opiate-tolerant and opiate-naïve persons alike and, as was seen in Pittsburgh in 2006, alluring to many…”

And at that time, as they have now, some people tried to point out that overdose death is a growing problem generally, quite apart from the dangers of fentanyl-laced heroin.  According to Dr. Stephen Jones, who authored a CDC report on the outbreak in 2008:

“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.”

Finally, the way the media handled the story in 2006 had a lot in common with the reporting we’ve seen this year: there was a surge of breathless reporting on the drug-related deaths but few efforts to analyze the history of the phenomenon.

“It would seem that we have not learned from past mistakes,” Furek writes, of the overdose deaths in 2006.

Over two decades ago another lethal batch of fentanyl-laced heroin made headlines in Pittsburgh. As documented in Top Cops, “The China White Episode,” 18 people died and over 200 overdosed in 1988, after rogue Calgon chemist Thomas Schaefers made up a batch of lethal fentanyl. And in early 1991, over 126 east coast overdose deaths were attributed to chemist George Marquardt, who was manufacturing fentanyl out of his Kansas lab…

In fairness, there have certainly been efforts to look at the larger picture in response to our current outbreak.  Public officials and media outlets have spent time talking about the need for solutions to overdose deaths from heroin cut with fentanyl as well as the growing death rate from opiate overdose in general.  Local news stories have examined the relationship between prescription drug abuse and the rise in heroin use.  National agencies have posted info about states who have enacted Good Samaritan and  naloxone access policies.  The death of Phillip Seymour Hoffman this weekend has lent urgency to the conversation.

Naloxone and Good Samaritan laws

Produced by The Network of Public Health Law, this map has been shared widely in the wake of the overdose outbreak in the Northeast and, especially, Phillip Seymour Hoffman’s death

But it certainly seems notable that no one has spent much time talking about the surge of overdose deaths caused by the same drug that hit our region just a few years ago.  Aren’t there lessons to be learned from it?

 

* This is not a perfect comparison because the Allegheny County overdose death rate is from 2011; the national overdose death rate is from 2009

 

Related

Deaths, overdoses ebbing from fentanyl-laced heroin (July 2006)

Fentanyl Overdose Outbreak Claimed More Than 1,000 Lives (July 2008)

Allegheny Co. Trying to Prevent Further Heroin Overdoses  After Rash of Deaths (January 2014)

Dr. Wilson Compton on Heroin Addiction and Overdose (February 2014)