Heroin overdoses are up in Madison. Way, way up.
Last month, an opioid antidote, Narcan, was used 42 times to revive drug users who had overdosed, according to the Madison Fire Department. This compared to just 11 times in May of last year.
While that increase is alarming, it pales in comparison to the month before. In April 2015, Narcan was used 14 times to correct an opioid overdose, but in April of this year, drug users overdosed and were revived 70 times.
“These are just the cases that we know of,” says Ché Stedman, medical affairs division chief for the Madison Fire Department. His department’s data includes only overdoses where paramedics or someone else reported using an opioid antidote.
“It’s very likely — because there’s so much more Narcan out there now — that someone overdoses at home, [someone gives them] Narcan, and they never call us about it,” he adds. “So, we have no idea how many more of those there are.”
The suspected cause of the increase in opiate (naturally occurring substances) or opioid (synthetically manufactured drugs) overdoses likely isn’t an influx of new, inexperienced users or a larger-than-normal quantity of drugs coming into the area.
Instead, authorities say, it’s an incredibly more potent opioid being mixed in with the heroin. Fentanyl, a fast-acting pain relief narcotic, became headline news last week when it was reported as the cause of Prince’s death in April. Authorities believe this drug is now circulating in Madison, causing the spike in overdoses.
“The [drug] user pool is pretty steady, and their needs are pretty steady, so there’s something in the supply that’s causing this,” says Madison Police Lt. Jason Freedman, commander of the Dane County Narcotics Task Force. “What we believe is happening is that fentanyl or something akin to fentanyl is being introduced with more regularity and in a higher quantity with standard heroin.”
Freedman says fentanyl’s strength is its selling point with addicts. “The addicts will seek out the most potent source because, frankly, that’s more bang for the buck — it’s almost rational,” Freedman says. “If I know my buddy got something that’s super, super potent, I’m going to seek that out even if I know it’s more dangerous.”
For about four years, paramedics have used fentanyl as a “go-to pain med,” says Stedman. “We typically use it in pre-hospital [emergency situations] as a good pain control for our trauma patients.”
“It’s been used more predominantly in recent years because it doesn’t mess with people’s vital signs like morphine does,” Stedman adds. “It’s preferred because it’s a cleaner drug.”
But it’s also much stronger, making it riskier to take recreationally. In October, the Centers for Disease Control warned public health agencies about an outbreak of fentanyl-laced heroin, stating it is “50-100 times more potent than morphine.”
While local authorities believe fentanyl is causing the spike in overdoses, they aren’t positive. Those who overdose on fentanyl typically need more Narcan to be revived.
“We can make a pretty reliable guess that these patients that we’re giving two to three times more Narcan to is that it’s likely because it’s fentanyl-laced heroin,” Stedman says. “But, we never know for sure.”
Carolyn Fath
Although overdoses are up, deaths are down, possibly due to increased availability of the antidote Narcan.
Freedman agrees that fentanyl-laced heroin is circulating in Madison. “If it looks like a duck, walks like a duck and sounds like a duck, it’s probably a duck,” he says.
The introduction of fentanyl-laced heroin to the already-ongoing opiate epidemic “is only driving things faster that are already going way too fast,” Freedman adds.
Other signals suggest a surge in fentanyl-laced heroin across the country. According to the federal Drug Enforcement Agency, fentanyl drug seizures have spiked. In 2012, fentanyl was confiscated 618 times, while just two years later, authorities seized it 4,585 times. About 80% of the drug was found in 10 states, including Ohio and Indiana in the Midwest.
Authorities suspect that fentanyl-laced heroin is being manufactured en masse by the drug cartels. “The vast majority of our heroin is coming from Chicago, and the vast majority of their heroin is coming from Mexico,” Freedman says. “So, the logical conclusion is that somewhere south of the border, at the point of manufacture, by the time it comes into the United States, it’s already been [mixed with fentanyl].”
Melissa Heinz, a supervisor with Public Health Madison & Dane County, says fentanyl is likely here to stay. “I think fentanyl in the heroin drug supply is the new normal,” she says. “I can’t imagine a reason why traffickers would move away from something that is so fabulously successful.”
This increases the need for prevention, treatment opportunities and Narcan availability, says Heinz, adding that “friends and family members should be prepared for the possibility [of an overdose] with an overdose response plan.”
Outreach groups, like the AIDS Resource Center of Wisconsin, work to provide such a plan. The center, which runs a needle exchange program to prevent the spread of communicable diseases, warns addicts about the potency of unknown narcotics.
“[We tell addicts] that if they’re purchasing the heroin from someone other than your usual source, do not do the same amount that you normally do from your regular source because of the purity issue,” says the center’s Scott Stokes.
He adds that the country has seen fentanyl before. “When we started the preventing fatal opiate overdose program, it was late 2005, and it was because there was a batch of heroin that was laced with fentanyl and there were 200 overdose deaths in the Midwest alone over the course of a weekend,” Stokes says.
Since 2006, ARCW’s fatal opiate overdose prevention program has trained more than 9,000 people how to administer naloxone — the drug in Narcan. The program is free, and those trained receive five doses of naloxone. Statewide, graduates of the program are credited with reviving 4,000 people who’ve overdosed since the program began, including 1,038 last year.
In Madison, naloxone is available for purchase at local pharmacies without a prescription. It ranges in price from $40 to $140, depending on the dosage and delivery device. It’s most commonly available as an injection but can also be given as a nasal spray, which is less effective.
Although overdoses might be on the rise, deaths associated with heroin are down locally. Fentanyl has been listed as a contributing factor in a handful of them, according to Barry Irmen, director of operations for the Dane County Medical Examiner’s Office.
In 2013, there were 40 deaths attributed to heroin. With four of those, fentanyl was considered as a possible factor. In 2015 and 2014, 26 and 29 deaths respectively were caused by heroin, with fentanyl a factor only in one case each year. So far this year, there have been six deaths caused by heroin; in two of those fentanyl was found in the deceased’s system.
Stedman fears there could be more because heroin use ramps up during summer.
“The highest months have always been July and August, and those [historically] have only been about 25 or 27 [opioid overdoses],” he says. “So, what we’re afraid of right now is that if July is usually our highest month and we’re already at 70 in April, what is that going to mean for July of 2016?”
