New Drug Threat: Cocaine Laced With Fentanyl Poses Deadly Overdose Risk To Occasional Users

As the raging opioid epidemic continues to sweep across Long Island and the nation, a new warning has been issued for occasional drug users who might find themselves at high risk of overdose — from cocaine laced with deadly fentanyl.

On June 1, the New York City Health Department announced that fentanyl is being increasingly found in cocaine-involved overdose deaths.

Fentanyl, an opioid 50 to 100 times more powerful than morphine, is being mixed in street drugs — often without the buyer’s knowledge, causing an alarming increase in the risk of overdose.

According to statistics provided by the Department of Health, in 2016, 37 percent of overdose deaths involved cocaine and fentanyl without heroin, up from 11 percent in 2015. In 2016, nearly half, or 44 percent, of all overdose deaths involved fentanyl, up from 16 percent in 2015.

“All New Yorkers who use drugs, even if only occasionally, should know their drugs may be mixed with fentanyl,” Health Commissioner Dr. Mary T. Bassett said. “Opioid overdose deaths are preventable. We encourage all New Yorkers who use drugs to take harm reduction measures and equip themselves and their friends and family with naloxone.”

In 2016, more than 1,300 New Yorkers died of a drug overdose, and about 80 percent of those deaths were due to opioids, including prescription painkillers, heroin and fentanyl, the research indicates. More New Yorkers die from drug overdose than homicides, suicides, and motor vehicle crashes combined, the Department of Health said.

Fentanyl "is 40 to 50 times stronger than street level heroin. A very small amount. . .can kill you."

The news comes at the same time that the Drug Enforcement Administration issued a dire warning to police and the public about the dangers of fentanyl exposure.

The DEA released a roll call video this week to all law enforcement nationwide about the dangers of improperly handling even a small amount of fentanyl and its deadly consequences.

Acting DEA Deputy Administrator Jack Riley and two local police detectives from New Jersey appear on the video to urge any law enforcement personnel who come in contact with fentanyl or fentanyl compounds to take the drugs directly to a lab.

“Fentanyl can kill you,” Riley said. “Fentanyl is being sold as heroin in virtually every corner of our country. It’s produced clandestinely in Mexico, and (also) comes directly from China. It is 40 to 50 times stronger than street-level heroin. A very small amount ingested, or absorbed through your skin, can kill you.”

Two New Jersey detectives, recently exposed to a very small amount of fentanyl, appeared on the video.

“I thought that was it. I thought I was dying. It felt like my body was shutting down," one said.

Back on March 18, 2015, the DEA issued a nationwide alert to state that fentanyl, a synthetic opiate painkiller, is being mixed with heroin to increase its potency — but dealers and buyers may not know exactly what they are selling or ingesting. Many users underestimate the potency of fentanyl, experts say.

The dosage of fentanyl is a microgram, one millionth of a gram — similar to just a few granules of table salt, the DEA said.

Fentanyl can be lethal and is deadly at very low doses, the DEA said; fentanyl and its analogues come in several forms including powder, blotter paper, tablets, and spray.

Dangers to law enforcement exist because fentanyl can be absorbed through the skin or accidental inhalation of airborne powder can also occur.

"This is an unprecedented threat"

The DEA is concerned about law enforcement coming in contact with fentanyl on the streets during the course of enforcement, such as a buy-walk, or buy-bust operation, because just touching fentanyl or accidentally inhaling the substance during enforcement activity or field testing the substance can result in absorption through the skin, "one of the biggest dangers with fentanyl," the DEA said.

"The onset of adverse health effects, such as disorientation, coughing, sedation, respiratory distress or cardiac arrest is very rapid and profound, usually occurring within minutes of exposure," a release from the DEA said.

And, the DEA noted, canine units are particularly at risk of immediate death from inhaling fentanyl.

According to the DEA, the current outbreak involves not just fentanyl, but also fentanyl compounds. In the last three years, DEA has seen a resurgence in fentanyl-related seizures. In addition, the release said, the DEA has identified at least 15 other deadly, fentanyl-related compounds. In May, 2016, a traffic stop in Georgia resulted in the seizure of 40 kilograms of fentanyl — initially believed to be bricks of cocaine — wrapped into blocks hidden in buckets and immersed in fluid. The fentanyl from these seizures originated from Mexican drug trafficking organizations, the DEA said.

And, the DEA said, recent seizures of counterfeit or look-a-like hydrocodone or oxycodone tablets have occurred, wherein the tablets actually contain fentanyl.

"This is an unprecedented threat," the DEA said.

Local experts weigh in

Although local experts say the news of cocaine laced with fentanyl is frightening, those individuals Patch interviewed said there have no specific incidents they can point to on Long Island — yet.

That doesn't mean the fentanyl laced-cocaine is not on its way to Long Island, all agreed.

"Historically many of the issues that arise in the city tend to make their way out here," said Anthony Rizzuto, founder and executive director of Families in Support of Treatment. "We know that much of the heroin is transported to Long Island from New York City. That's why I believe there is a good possibility that it can make its way out here. The danger primarily is anything that has fentanyl in it is lethal. Specks of fentanyl can be lethal."

In addition, he said, cocaine is a very addictive stimulant; the combination of a stimulant and depressant puts severe strain on the body. Rizzuto said he's reminded of users who would "speedball", using heroin and cocaine at the same time.

Fentanyl, at 50 to 100 times stronger than morphine, is deadly — and poses a definite risk to any who are near it, Rizzuto agrees.

"There are reports of police officers dying from either touching and or inhaling it during their encounters with either addicted individuals or dealers," he said.

He also pointed out the dangers of carfentanil, a drug that's been seen laced with heroin, so potent it's used to sedate elephants, and so deadly that even a tiny amount can kill.

Dr. Jeffrey Reynolds, president and chief executive officer of the Family and Children's Association in Mineola, spoke to the new dangers of cocaine laced with fentanyl this week.

"At this point, we have expect that fentanyl is in everything that's being sold on the street, which is truly a frightening thought. Folks are requiring multiple doses of naloxone and it's easy to imagine instances of naloxone resistance, which means more fatalities," he said.

And that's an urgent call to action, Reynolds said.

"The health alerts now arrive almost daily, but we still haven't done a whole lot to expand treatment availability. To warn users that they could die from a contaminated batch of heroin or cocaine is important, but straight heroin or cocaine can kill you and these folks are mired in addiction so deeply that they can't simply quit using substances without some help. That's where we continue to fall flat and that's why the death rates in 2017 will set new records," Reynolds said.

In order to stem the raging tide, Reynolds believes there's a need for a half dozen facilities just on Long Island, "where users can walk in anytime day or night, say 'I have a problem' and get skilled and professional help no questions asked. Until that happens, we are still battling a raging inferno with a squirt gun."

"Less than a penny can kill"

Christopher Genovese, a former cocaine user and current interventionist with a practice in Garden City, said, throughout the course of his work, he has seen at least two examples in the past two months where cocaine users have overdosed and fentanyl has been found in their systems.

"I'm getting scared," he said.

Fentanyl blends in easily with cocaine, as the color of the powder is similar, he said. And the amount necessary to do lethal harm is staggering, he said.

"Less than a penny can kill," he said.

He said he's especially concerned that those addicted might choose to try and "get their hands on" cocaine laced with fentanyl, thinking it's "the most powerful stuff. Fentanyl could very well be the new fad," he said.

And repercussions for those dealing cocaine laced with fentanyl to unsuspecting users should be severe, he said.

"It's like murder," he said.

The key, Genovese said, is education, so parents and the public knows that even cocaine can now be laced with fentanyl.

Genovese, whose own journey with cocaine and alcohol began in medical school, said the dangers of using even recreational cocaine are terrifying. "It scares the hell out of me that at any given minute I could have died. If this was happening then, I would be dead now."

Today, Genovese is married with a nine month old baby and spends his life helping others. But he's fearful that even with the warnings, those addicted won't stop using. When he was using cocaine, he said, "I wanted to get that package inside me as soon as possible. I wouldn't have cared."

Efforts to stem the tide

Officials are rallying to try and stem the tide of addiction.

In April, New York City Mayor Bill de Blasio and First Lady Chirlane McCray announced HealingNYC, the City’s comprehensive initiative to reduce opioid overdose deaths by 35 percent over five years, a release from the Department of Health reported.

The city is investing $38 million annually to increase naloxone distribution and community-based trainings, expand access to medication assisted treatment, promote judicious opioid prescribing and a range of public safety measures.

Last week, the Health Department held an opioid outreach campaign to raise awareness about the risks associated with fentanyl and provide safety messages directed to people who use drugs, even if only occasionally.

The department also announced the “I Saved a Life” awareness campaign to show New Yorkers that they can help save lives by learning about overdose prevention and by carrying and using naloxone. And a a free mobile app, “Stop OD NYC,” which teaches New Yorkers how to recognize and reverse an overdose with naloxone and links individuals to nearby community-based programs and pharmacies where naloxone is available without a prescription, was launched.

Others are sharing their stories: One Long Island woman spoke to Patch about her journey with deadly fentanyl.

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.

New 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 released, 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: In April 2016, Suffolk County led New York state in heroin overdose deaths.

And despite strides forward, including new tactics and legislation embraced by New York Gov. Andrew Cuomo to provide access to enhanced treatment to those struggling with opioid addiction, Reynolds said the war is far from over.

"While we have made some progress in the last year not two, the reality of the work still yet to be done hit me when a staffer at St. Charles Hospital in Port Jefferson told me that they had 27 patients for 10 detox beds," Reynolds said. "That's not treatment on demand — and until we achieve that reality, we aren't doing everything we can to end the crisis. "

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," he said. "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."

Other experts agree that shining the light of awareness only on the popular new drug of the day can be disastrous.

Kym Laube, executive director of Human Growth and Understanding, or HUGS, an organization focused on providing kids with healthy alternatives, weighed in on fentanyl.

Both Laube and Reynolds sit on a statewide task force to combat heroin convened by Cuomo.

"HUGS, along with other educators and experts, has continued to worry about the singular focus on one substance, as we know the reality of the dangers that presents," Laube said.

"Fentanyl is deadly and dangerous when used non-medically and we are hearing of more overdoses," she said.

However, she added, "I caution that if our focus remains on the singular substance we will continue to remain in crisis. We thought heroin was the worst, now it's fentanyl — leaving one to ask, 'What is next?'"

Instead, Laube feels the focus must be on fighting back against addiction itself.

"If we do not change the culture of addiction, beginning with alcohol and especially underage drinking, we will continue to have the same results, and sadly, continue to lose our loved ones," she said.

Patch file photo.