If bodies from overdoses keep rolling through the morgue doors at the rate they did during January and February, Montgomery County could see 100 more drug deaths during 2016 than last year, said Dr. Kent Harshbarger, the county coroner.
More deaths would erase one positive signal. After a record-setting 2014, the county saw a slight drop in overdose deaths in 2015, going from 264 to 259.
If this year’s pace continues, it would also put a dent in the hope that local prevention efforts, including the increased use of naloxone by police, were beginning to turn back the heroin epidemic gripping the region.
Harshbarger is renewing an alarm about fentanyl, the extraordinarily powerful synthetic opioid that is tied to an increasing number of overdose deaths.
Fentanyl was first detected locally at the Miami Valley Regional Crime Lab at the end of 2013 and has since come to overshadow heroin in its sheer lethality in the Miami Valley, across Ohio and across the nation.
“There is a real danger,” Harshbarger said. “What the country is seeing is a stronger fentanyl … One minor error in the dosage of that process gives you a huge increase in the actual concentration you’re ingesting and causing fatalities.”
Of 59 overdose deaths investigated by the office during the year’s first two months, almost 60 percent contained fentanyl; 24 were attributed solely to fentanyl and another 11 contained both fentanyl and heroin. Eleven other cases were found to be heroin working alone and the remaining 13 died of overdoses from other substances.
Positive tests for fentanyl in drug samples taken to the Miami Valley Regional Crime Lab by law enforcement during the first quarter have also shown a dramatic rise. The lab serves about 70 area law enforcement agencies including the Drug Enforcement Administration’s Dayton office.
Through March, the lab saw 347 cases of fentanyl; in all of 2015, there were just 382, according to crime lab statistics.
The increased availability of fentanyl, along with its potency, is seen as the biggest reason for the uptick. The highly lethal drug is synthesized in clandestine labs in Mexico and China and shipped to the United States in packages that are difficult to intercept, say law enforcement. In some cases, the product is manufactured into pills that resemble prescription painkillers.
No let up in sight
The fentanyl scourge became so pronounced in Ohio — with deaths climbing 500 percent between 2013 and 2014 — that the federal Centers for Disease Control and Prevention (CDC) dispatched a special team to the state last October to study the problem.
The six-person EpiAid team studied 2014 data for 14 of the state’s “highest-burden” counties for fentanyl-related mortality. Those counties include Butler, Clark, Miami, Montgomery and Warren counties.
The CDC team’s recently-released report shows the ages of those dying of unintentional fentanyl-related overdoses ranged from 17-71 with an average age of 37.9; 69 percent were male and 89 percent were white.
While Montgomery County saw the slight decline in overdose deaths between 2014 and 2015, deaths in the other area counties continued a frightening climb in 2015 — including a nearly doubling of fentanyl- and heroin-related deaths in Clark County from 28 to 55, and an almost tripling in Greene County to 34. Warren County recorded 44 heroin- and fentanyl-related deaths last year, 15 more than 2014.
Butler County’s numbers reflect the roller-coaster some counties are experiencing in terms of overdose deaths. Martin Schneider, administrator for the coroner’s office, said officials thought a corner had been turned when overdose deaths dropped from 17 in January to 10 in February. Also, just three of the February deaths involved heroin and none involved fentanyl.
That lull was short-lived, however. Schneider said in March, fentanyl was discovered in the bodies of 18 of the 20 overdose victims.
“We were hopeful after a very low February,” Schneider said. “Unfortunately we’re not seeing any sort of a let up in sight right now.”
The overdose numbers would undoubtedly be much higher without the widespread use of naloxone, otherwise known as Narcan, which acts to block the effects of the opioid and has literally brought people back to life.
Last year, Dayton Fire Department medics treated more than 1,000 patients with naloxone and Dayton Police used the antidote drug 167 times, saving nearly as many lives, according to department records.
But as fentanyl comes to America in ever-more-powerful derivatives that can quickly shut down the central nervous system — including respiration — first responders armed with naloxone may be losing the battle against time, Montgomery County Sheriff Phil Plummer said.
“Your life’s in the hands of a dealer,” he said. “If you get a heavy dose of fentanyl, it shuts you down. If you don’t get the naloxone you basically suffocate.”
One of the recommendations from the CDC team was to train people to recognize when multiple doses of naloxone are needed.
Plummer said law enforcement intelligence indicates fentanyl coming to America is no longer exclusively made in clandestine South American labs, but Chinese “superlabs” as well.
The potency of the drug is attracting more users, but it also catches many addicts off-guard, revelance of fentanyl on the street is a sign that those already addicted to heroin may be creating a bigger market for the stronger drug, but the potency often catches others who without tolerance off guard in a deadly way, said Andrea Hoff, director of prevention and early intervention at the Alcohol, Drug Addiction and Mental Health Services board of Montgomery County.
“You have individuals who are addicted and they are seeking a high but they are no longer getting high from the level of heroin,” she said. “Or they don’t know that the fentanyl is laced with the heroin.”
Hoff and Plummer said abuse of opiates often begins first orally taking pain medication, and runs through a succession of increasingly stronger opioids until fentanyl is reached.
“They’ve climbed the ladder to get the next strongest high,” Plummer said.
Staff Writer Cameron Hunter contributed to this report.