ANDERSON — Buying heroin on the street to feed opioid addiction has always been a risky proposition.
But now, with more potent and faster acting synthetic compounds replacing the white powder derived from poppy plants, the risk of overdose and death has increased exponentially, experts say.
And not just for users.
Police, medics, even good Samaritans stopping to help a stranger in need, risk overdose by breathing in airborne powder or having some of it get on their skin while treating a patient.
The latest opioid concoction, known “gray death” because of its concrete-like color is particularly dangerous. It’s a combination of several drugs — heroin, fentanyl, and carfentanil — each of which is more powerful than the other.
Carfentanil is the synthetic opioid currently causing heightened concern.
So far, according to police, emergency medical service experts and Madison County Coroner Marian Dunnichay, carfentanil hasn’t yet appeared in Madison County or been listed as a factor in drug overdose deaths.
But it’s coming.
Originally developed as tranquilizer for large animals such as elephants, carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more powerful than heroin.
What’s particularly worrisome to Todd Cawthorn, deputy chief of the Anderson Fire Department, is the potency of the new drugs, and that they can be absorbed through skin contact and cause an immediate reaction.
Cawthorn oversees the department’s emergency medical service operations.
“Being designed to knock out an elephant ... it won’t have any trouble knocking us down,” he said.
An estimated 2.6 million Americans are addicted to heroin or prescription opioid pain relievers, according to the National Institute on Drug Abuse.
A persistent increase in opioid overdoses tied to the synthetic drug carfentanil have been seen around the country, according to a recent statement issued by the Indiana Department of Homeland Security, Indiana State Department of Health and the Indiana State Police.
“Many people become addicted to opioids from what originally started as legitimate prescribed use, while others became addicted as a result of illicit use,” said Indiana State Police Superintendent Doug Carter.
“But addiction is addiction regardless of the path, and this is not a problem we can — or should try — to arrest our way out of,” he added.
People exposed to fentanyl or carfentanil can become drowsy or disoriented. They may also develop pinpoint pupils or clammy skin. An overdose can also slow a person’s breathing to dangerous levels. Symptoms can occur within minutes of exposure.
An Ohio incident made national headlines when a police officer reportedly overdosed on fentanyl while brushing some of the chemical powder off his uniform with his hands.
The effects of a heroin, fentanyl or carfentanil overdose can be reversed through the use of naloxone, or common brand name Narcan, Cawthorn said.
But the more potent opioids require higher doses of naloxone and, because of the exposure risk to medics and first responders, the Anderson Fire Department is now reserving a supply of the drug to treat firefighters, medics and police if necessary, Cawthorn said.
It’s something that’s never been done before.
According to an alert issued by the federal Drug Enforcement Administration last year, multiple doses of naloxone may be required to reverse the effects of the highly potent synthetic drug.
Another concern is that users and drug dealers often don’t know what they’re buying.
Synthetic opioids are manufactured at clandestine, unregulated factories in China, Mexico and other Central America countries.
“There’s no instruction book for each drug that comes through,” Cawthorn said.
While Madison County Sheriff Scott Mellinger said he’s aware fentanyl is in the county, he doesn’t have a good handle on carfentanil in the county.
What he is certain about, however, is this: “I’m convinced a majority of people here are not recreational users but addicted,” to opioids.
Anderson Police Department spokesman Maj. Joel Sandefur said fentanyl has been a factor in the county since at least 2014.
Again, according to the DEA, many users underestimate the potency of fentanyl.
“The dosage of fentanyl is a microgram, one millionth of a gram — similar to just a few granules of table salt,” the agency said in a 2016 alert. “Fentanyl can be lethal and is deadly at very low doses.”
It also comes in several forms including powder blotter paper, tablets and spray, the agency said.
Citing unpublished data compiled by the National Forensic Laboratory Information System, or NFLIS, an arm of the DEA, the Centers for Disease Control and Prevention (CDC) in 2015 reported a sharp increase in fentanyl seizures from 2012 to 2014.
Reports from forensic laboratories around the country showed 681 seizures in 2012, 945 in 2013, and 4,585 in 2014.
More than 80 percent of drug seizures in 2014 were concentrated in 10 states, the CDC said. Ohio ranked first with 1,245 seizures; Indiana ranked 10th with 133 seizures.
It’s all a matter of simple economics, Sandefur said. Synthetic fentanyl can be manufactured at a lower cost than heroin, which is an agricultural crop. Heroin is added to fentanyl, which gives the drug the bitter taste users expect.
“Economics drives everything,” he said.