Deadly Drug Combo Has Not Hit Locally, Yet

By John Voket

It has been almost a month since the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an action alert to substance abuse treatment and prevention professionals about a new combination of street drugs with a potentially lethal effect. But to date, local emergency physicians have not seen any sign that the potentially deadly concoction has reached the greater Danbury area.

Dr David Charash, DO, has seen the worst effects of all types of substance abuse in his 11 years at Danbury Hospital’s emergency room, and plenty more before that in his tenure at urban Detroit’s Henry Ford Hospital. In fact, he is considered a specialist in terms of drug overdoses and toxicology, and presents nearly three dozen talks annually on the subjects to audiences of all ages and professions.

While Dr Charash has certainly heard about drug dealers and users adding fentanyl, a powerful narcotic analgesic, to heroin or cocaine being sold on the streets, he and fellow physicians in Danbury recently confirmed they have seen no incidents involving the drugs in this manner.

According to the SAMHSA release, the drug combination is believed to be the cause of clusters of drug-related deaths and even greater numbers of overdoses in East Coast and Midwest cities in the past few months.

In just one week in May, an estimated 33 individuals in the Detroit area are reported to have died after using this fatal drug mix. The same drug combination may have been responsible for more than 100 deaths in Philadelphia/Camden, Chicago, St Louis, and Detroit since last September.

“While my colleagues haven’t seen it yet, it’s important for people to realize the increased lethality the drug has when combined with cocaine or heroin,” he said.

The alert was issued by SAMHSA’s Center for Substance Abuse Treatment Director H. Westley Clark, MD, JD, MPH, to substance abuse professional organizations, treatment providers, state substance abuse authorities, and recovery community-related organizations and individuals. It highlights the growing concern about the potentially fatal effects of this street drug combination and encloses a brief fact sheet about preventing as well as detecting and treating overdoses.

“Individuals involved in the public health need to be aware of this new dangerous drug combination,” Dr Clark said. “They need to be prepared to alert patients, clients, and others to help save lives. After all, fentanyl is 50–100 times more powerful than morphine. When mixed with cocaine or heroin, the results can be lethal.”

According to Dr Charash, the problem with fentanyl is it will not show up in routine drug tests or screens, so it is difficult to determine without extensive chemical analysis if a person is using the drug.

“Even though it’s quite potent, it’s unfortunately undetectable in virtually any conventional drug screening,” he told The Bee recently.

Dr Charash said fentanyl is a potent narcotic used for pain control, and can be applied intravenously, in pill form, or in time release patches.

“While one would need a prescription to obtain it, people have been known to obtain quantities of it by ‘doctor shopping’ with a legitimate pain issue,” he said. “Once they get it, they either sell it or cook it up themselves and add it to other drugs.”

The SAMHSA alert encourages recipients not only to advise their networks of patients and colleagues, but also to join local health authorities to bring information about the drugs to first responders, emergency room personnel, street substance abuse workers, drug treatment facilities, local health care providers, the recovery community, and the public at large.

When used illegally, particularly in combination with a drug such as heroin or cocaine, or when used in excessive amounts, fentanyl can result in irregular heart beat, the inability to breathe, and death. In some cases, heroin or cocaine users are aware they are purchasing this dangerous combination of drugs; in other cases, the buyer is not aware that he or she is purchasing this potentially lethal drug combination.

Dr Charash said the worst aspect of the mixture involving fentanyl is the advanced symptoms of overdose cannot be readily countered by other drugs. He said a pure heroin overdose can be treated with a drug called Narcann, which has saved many lives, but once the fentanyl combination takes hold, especially in conjunction with cocaine, there is little that can be done to stop the chemical reactions in the body.

“Make no mistake, this is a serious medication for chronic or acute pain and surgical procedures,” DR Charash said. “It is dangerous and highly addictive, especially if taken unchecked or outside the realm of a doctor’s care.”

The SAMHSA alert advises local vigilance for the possible introduction of this potent drug mixture into circulation on the street and emphasizes the importance of education, particularly on the street.