Deadly Fentanyl, Synthetic Drugs Proposed For State's Controlled Substance List: Cuomo

As war on the deadly opioid epidemic rages across Long Island, on Thursday, Suffolk County Police Commissioner Timothy D. Sini joined Governor Andrew Cuomo, who announced a proposal to add chemical variations or derivatives of synthetic drugs, including fentanyl, to New York State's controlled substance list.

The measure, Cuomo said, will help to increase law enforcement's ability to target and arrest the drug dealers who manufacture and sell different forms of fentanyl and other synthetic drugs.

"In Suffolk County, we are experiencing over 300 fatal opioid-related overdoses each year for the past several years, with fentanyl being the number one killer in 2016 and 2017," Sini said. "By increasing the number of synthetic drugs listed in New York State's controlled substance schedules, law enforcement will able to further prosecute the drug dealers who are poisoning our communities."

Sini thanked Cuomo for providing another "necessary tool" in the opioid epidemic battle.

The legislation, which adds 11 fentanyl analogs to New York State's controlled substance schedule, affords law enforcement the ability to help target dealers who manufacture and sell, Cuomo said.

In addition, Cuomo is directing the New York State Department of Financial Services to take immediate action to advise insurers against placing arbitrary limits on the number of naloxone doses covered by an insurance plan," a release from Cuomo's office said.

Fentanyl can be up to 50 times more powerful than heroin and it can take multiple doses of naloxone to reverse a fentanyl overdose,; the new measure will ensure access to adequate doses of overdose reversal medication and save lives, he said.

"Drug dealers and trafficking organizations are flooding our streets with addictive, deadly drugs that devastate families and destroy lives in communities across our state, and we must take bold action to close loopholes and hold these criminals responsible," Cuomo said. "I'm calling on the segislature to ban these new types of fentanyl and equip law enforcement with tools to go after these dangerous dealers to stop this scourge on our communities, and help build a safer, stronger New York for all."

Fentanyl deaths increased 160 percent statewide between 2015 and 2016

According to data provided by Cuomo's office, in New York State, overdose deaths involving opioids increased nearly 35 percent between 2015 and 2016. However, fentanyl-related deaths increased at a much higher rate— nearly 160 percent statewide. Fentanyl-related deaths in New York City increased by more than 310 percent, while fentanyl-related deaths in counties outside of New York City increased by more than 110 percent, the data indicated.

Fentanyl analogs have been increasingly found in heroin and cocaine sold in New York State, Cuomo said.

Fentanyl in the size of the head of a pin can be fatal

Pressed into pill form to resemble name-brand prescription opioids, fentanyl analogs vary in potency, but can be 100 times stronger than morphine. Just 3 milligrams of fentanyl can be fatal, compared to 30 milligrams of heroin. Heroin and cocaine containing deadly concentrations of these synthetic opioids have been increasingly present in communities throughout New York State, Cuomo said.

The 11 substances meant to be added to the state's controlled substance list are already listed on the federal schedule of controlled substances.

Just a small amount of the deadly drug can be lethal, Cuomo said: Just .25 milligrams of fentanyl, or about the size of a head of a pin, can potentially result in death.

And, in the past three years, deaths from synthetic drugs such as fentanyl have increased by more than 500 percent, Cuomo said.

Meanwhile, locally on Long Island, overdose deaths involving opioids increased 27 percent between 2015 and 2016, Cuomo's release said.

A preliminary analysis conducted by the Department of Health identified more than 480 opioid-related deaths among residents across the region in 2016. However, fentanyl-related deaths among residents in Long Island increased at a much higher rate — nearly 175 percent, he said.

Fentanyl is used medically as a painkiller, an anesthetic, and in palliative care. Fentanyl's listing as a Schedule II controlled substance, available by prescription only, makes it a felony to sell on the street and a crime to use the opiate without a prescription, Cuomo explained.

As a result, "underground labs have tweaked" the molecular structure of fentanyl to create new, unregulated chemicals referred to as fentanyl analogs. These "deadly cousins" are chemically similar to fentanyl — and often many times more potent — but are not listed on New York State's schedule of controlled substances, and not subject to the same criminal penalties, the release said.

"I'm calling on the Legislature to ban these new types of fentanyl and equip law enforcement with tools to go after these dangerous dealers to stop this scourge on our communities, and help build a safer, stronger New York for all," Cuomo said.

Local lawmakers applauded the proposal.

"The scourge of opioid addiction is destroying lives and devastating communities across Long Island and all across the country," Suffolk County Executive Steve Bellone said. "Meanwhile, a new synthetic drug, fentanyl, has exacerbated the epidemic and increased the death toll. I applaud Governor Cuomo for taking new action to stop the spread of fentanyl and protect our communities."

Sini added that Cuomo's measure "will equip law enforcement to go after the dealers and manufacturers of this deadly substance and ensure our officers are empowered to stop the spread of fentanyl."

One woman's fentanyl story

Joann Piche, a well-coiffed professional, a psychotherapist who lives in Aquebogue and has an office in Westhampton Beach, has spoken to Patch in past months about the grip of fentanyl

She's a well-respected, successful member of the community — and no one would ever guess, at first glance, that for seven years, she was caught in the nightmarish grip of fentanyl, a drug that's now outpacing heroin as the deadliest drug on Long Island.

Fentanyl, according to the National Institutes of Health, National Institute on Drug Abuse, is a "powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent." Fentanyl, often used for surgery, is typically used to treat patients with severe pain or to manage pain after surgery, or to treat patients with chronic pain.

The drug received a flurry of attention in 2016 when a toxicology report from the Midwest Medical Examiner's Office determined that Prince died from fentanyl toxicity.

Statistics on Long Island indicate that fentanyl has taken the lead over heroin in deaths: According to a New York Times report, fentanyl took the lives of at least 220 in 2016, according to medical examiners' records.

In Suffolk County, according to statistics, of 240 total opioid deaths, 130 contained fentanyl, while deaths linked to heroin numbered 94. Deaths tied to a combination of heroin and fentanyl totaled 45, according to statistics provided by the Suffolk County Medical Examiner's Office.

According to Suffolk County Medical Examiner Dr. Michael J. Caplan, fentanyl has outpaced heroin as the drug most often found in fatal opioid overdoses in Suffolk County, Vanessa Baird-Streeter, assistant deputy county executive for public information in Suffolk County Executive Steve Bellone's office, told Patch.

It's not the first time Suffolk County has been in the spotlight for an escalating opioid crisis: Suffolk County also made headlines for leading New York state in heroin overdose deaths.

But for Piche, fentanyl statistics reflect a sad reality she fought against for seven long years.

For Piche, who was prescribed a fentanyl transdermal patch in 1998 for a chronic medical condition that requires pain management, the reliance upon the drug was never about getting high.

"I don't want to be misunderstood," she said. "The problem with the medication is that the withdrawal symptoms were agonizing and immediate. There was no 'high' involved for me. I was not a drug-seeking drug addict. I was prescribed this patch by a pain management physician."

In order to avoid the horror of withdrawal, Piche found herself carefully orchestrating her life so that she was scheduling her entire life around the drug, careful to be at her doctor's office exactly every 30 days as required, to receive her new prescription and make sure she had a new patch on before the old was removed.

"This medication is so potent and so addictive, even when you use it for the first time, your body experiences withdrawal immediately," she said. Withdrawal so excruciating that the symptoms were unbearable, she said, and included flu-like symptoms and vomiting.

And it was a dance with danger that she'd never even been warned to avoid.

"I was a young mother at the time," she said. "Nobody told me not to drive. Nobody told me anything about this medication; the transdermal patch was fairly very new at the time. No one ever said it was highly addictive. No one told me anything."

Her son, now 21, was only 3 or 4 years old when her long battle with fentanyl began, Piche said.

"I was sleeping all the time; it causes you to become even more debilitated," she said. "I was prescribed pain management medication in order to function and not be hospitalized, yet it was so potent that I was sleeping all the time and becoming more disabled because of it."

And even though she is a small woman, maybe 110 pounds at the time, she was able to take high dosages because she'd built up such a high tolerance to narcotics, she said.

Fentanyl, she said, "really changed my life; it took over."

After seven long years, Piche reached a point where she knew she had to wean herself off the medication. "It was really controlling my life. I had a moment of clarity, and I just said, 'I’m not living my life as fully as I would like to.'"

And so, she let go, weaning herself off fentanyl, going back to school and earning a master's degree in social work.

Experts speak out

Fentanyl's rise in popularity isn't a surprise, said Jeffrey Reynolds, president and chief executive officer of the Family and Children's Association in Mineola.

"Fentanyl has become a major deal in Long Island and elsewhere, which frankly, isn't a shock. We all saw this coming a few years ago, and now many of the skyrocketing overdoses are attributable to drug combinations that include fentanyl," Reynolds said.

Fentanyl's allure lies in its potency, Reynolds said.

"The drug has become so popular precisely because it is so powerful. It's showing up in heroin but also in counterfeit Percocet, OxyContin and Vicodin," said Reynolds. "Heroin dealers will add some to batches as they look for a steady stream of customers in search of the most potent heroin. Of course, by the time the heroin travels through hundreds of hands, nobody can be sure what or how much of anything has been added to that bag."

He added, "There are literally thousands of heavily addicted folks in our region searching for the best and most cost-effective solution they can find, and the stakes continually get higher."

Photo, video of Governor Andrew Cuomo's press event courtesy of Cuomo's office.