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Fentanyl changed dynamic of heroin epidemic


The Herald-Dispatch

CHARLESTON, W.Va. — What is bought and sold on the street as “heroin” has morphed into a much deadlier mix with the widespread use of fentanyl within the past three years.

Congressman Evan Jenkins, R-W.Va., addresses experts during a panel discussion on fentanyl Wednesday at Recovery Point in Charleston.
(Herald-Dispatch photo by Bishop Nash)

The pharmaceutical painkiller, often 50 times more potent than pure heroin, became enemy No. 1 after overdose deaths in West Virginia spiked since 2014, with Appalachia already gripped with deeply rooted addiction problems fueled by prescription drugs and heroin.

When fentanyl entered the scene, often cut with existing drugs to increase potency and profit margin for dealers, it was like throwing gasoline on a fire, U.S. Rep. Evan Jenkins, R-W.Va., told a panel of federal and state experts Wednesday during a roundtable meeting at Recovery Point of Charleston.

The efforts to contain fentanyl come down to understanding the impact of mere milligrams – a fatal dose, said Jenkins, who solicited input from law enforcement and medical, academic and recovery professionals.

West Virginia is the epicenter for the receiving end of the fentanyl supply chain, said Karl Colder, special agent for the Drug Enforcement Administration’s Washington DC Division, which includes the Mountain State. Supplying cities from which the drugs originate tend to change intermittently, including metropolitans within a day’s driving distance like Detroit, Baltimore, Atlanta or Chicago.

Those drug processors and dealers may tend to hail from certain cities, but the vast majority of fentanyl, or the precursors to create it, arrive in the country from China, added Bruce Ohr, associate deputy attorney general with the U.S. Justice Department.

While the United States has traditionally seen its influx of narcotics pour in through its southern border, as was the case with heroin and, to an extent, remains with fentanyl (often arriving in Mexico from China), the rise of China as a drug origin creates its own unique dynamic, particularly in that fentanyl can now be ordered via the internet and mailed directly into the country with little oversight.

“One of the problems is that now highly pure fentanyl is now coming to our communities either to users to people who are then distributing it, maybe pressing it into pills, and then distributing it on,” Ohr told the panel.

The new mission now pushes federal law enforcement to become more cyber-savvy in tracing the source back through the internet, in some cases hopping from one supplier up the ladder eventually to a source supplier in China. So far it’s been an effective method, Ohr said, leading to two major federal indictments against Chinese suppliers stemming from cases this year in Mississippi and North Dakota.

“It’s very difficult for us to stop. It’s not like, ‘Hey, we know who the Sinaloa (Mexican drug cartel) plaza boss is. Let’s go after him.’ It could be multiple people,” Ohr said. “Our guys need to really shift and instead of becoming street agents, they have to become cyberagents.”

Chinese producers stay ahead of the FDA’s drug classifications by creating a new derivative of fentanyl seemingly every month, Ohr added, in an effort to remain on the fringes of legality. When one type of new fentanyl is scheduled as illegal by the FDA and its Chinese equivalent, chemists will tweak the molecules ever so slightly to create a similar product, yet different enough to require new regulations each time before being proclaimed illegal.

“We can’t always be chasing something that’s not illegal, particularly in China,” Ohr said. “They’ve got to make all (fentanyl derivatives) illegal.”

If West Virginia is the epicenter of fentanyl use in the United States, Cabell and Kanawha counties are the center of the epicenter, said Kenny Burner, director of the Appalachian High Intensity Drug Trafficking Areas (HIDTA) program. If left unabated, fentanyl use will eventually leak out of the state’s two bigger cities, Huntington and Charleston, and spread into the outlying rural areas.

Jim Johnson, director of the West Virginia Office of Drug Control Policy, said his office is developing a database profiling demographic and health descriptors from fatal overdoses in the hopes of finding any unseen trend or common denominator among victims. Even with the rise and publicity fentanyl’s killing potential has generated, Johnson added most users are so addicted and hopeless they inject it anyway, knowing they may die, possibly even wishing for the comparatively less deadly heroin of years past.

Although fentanyl dominated discussion, Dr. Brad Henry, president of the West Virginia State Medical Association, added that not enough had been done to subdue the overprescription problem, which drove the majority of current users into addiction. Henry said he hoped West Virginia would soon join 13 other states, including Ohio, in regulating opioid prescriptions to no more than seven days for acute pain.

“There’s no federal limit on a Schedule II product,” Henry noted. “I can write for 10,000 OxyContins today and say I need a prescription.”

Fentanyl was present in 56 percent of the fatal overdoses in Cabell County during 2016, according to data from the Huntington Mayor’s Office of Drug Control Policy, up from 39 percent in 2015. Of the 132 fatal overdoses in Cabell County in 2016, 74 were fentanyl-related. By comparison, 40 of the 102 fatal overdoses were fentanyl-related in 2015.

Follow reporter Bishop Nash on Twitter @BishopNash.

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