Maine’s heroin epidemic is becoming increasingly deadly and public safety officials believe the synthetic painkiller fentanyl could be the cause.

Police in Maine recently have seized heroin laced with fentanyl – a painkiller up to 50 times more powerful than heroin that is much more prone to overdose – as well as fentanyl that is being sold as heroin.

Fentanyl is often prescribed to cancer patients in the form of a patch. But the compound showing up in drug busts in Maine and elsewhere is manufactured in clandestine labs. The Associated Press

Because the difference between heroin and fentanyl isn’t easily detectable, addicts are more likely to switch back and forth between the drugs unknowingly, increasing the risk of overdose, according to Dr. Judy Burk.

“If told it’s heroin when in fact it’s fentanyl, the person is at risk for overdosing,” said Burk, who serves on the board of the Northern New England Society of Addiction Medicine.

Fentanyl is often prescribed to cancer patients in the form of a patch that slowly releases the drug through the skin. But the compound showing up in drug busts in Maine and across the country is manufactured in clandestine labs, presumably by the same cartels responsible for smuggling heroin, cocaine and other drugs into the United States. The fentanyl is then smuggled into the country, typically from Mexico.

Dr. Mark Publicker, past president of the Northern New England Society of Addiction Medicine, said fentanyl is not difficult for a good chemist to manufacture, but without quality controls, mild alterations can lead to major swings in potency.

“It has an extremely rapid onset of action, as does heroin, but fentanyl is faster,” Publicker said. “Someone can inject and very rapidly overdose.”

He believes there’s a good chance the recent rash of overdoses may be related to fentanyl.

“It’s going to get someone a brief extreme euphoria, but a rapid drop off,” he said. “The more cycles of this, greater tolerance develops, more drug needs to be taken. There’s less of the euphoric effect and for shorter duration.”

Eventually, “what remains is withdrawal – emotional and physical hell,” he said.

While Maine doesn’t have exact numbers on how many fatal and nonfatal overdoses this year are attributable to fentanyl or fentanyl-laced heroin, the number of overdose deaths involving fentanyl grew from nine in 2011 to 43 in 2014, according to statistics from the Chief Medical Examiner’s Office. During that same period, fatal heroin overdoses in Maine climbed from seven to 57.

The federal Drug Enforcement Agency has been seizing kilos of the synthetic opiate in raids from Buffalo, New York, to California and recently broke up a heroin-fentanyl-cocaine smuggling ring in Lawrence, Massachusetts. At the same time, thousands of people nationally are overdosing from using fentanyl.

“We’ve been seizing multiple-kilo quantities of fentanyl across the United States over the past year or so,” said Agent Matthew Barden, a spokesman for the DEA in Washington. “Because fentanyl is so dangerous – you’re looking at 100 times more potent than morphine, 50 times more potent than heroin … a couple of grains like you would shake out of a shalt shaker and it’s lethal. If you put too much, you’re dead and if you don’t put enough, you don’t get enough of a high.”

PROFIT MOTIVE

The motivation behind the introduction of the illicit fentanyl is profit, police said.

“Think about the cost savings it must make to not have to worry about poppy plants being harvested in some country,” said Cmdr. Scott Pelletier, chief of the Maine Drug Enforcement Agency in southern Maine. “Now they can just produce it in a super lab somewhere with chemicals. The same way they smuggle cocaine and heroin they now smuggle fentanyl. The routes and the customers are the same.”

A kilogram of heroin might cost $20,000, while a kilo of fentanyl costs between $30,000 and $40,000, the DEA’s Barden said. However, because of its potency, fentanyl can be diluted more and still deliver a potent dose.

“Some say you can get as much as 10 kilos just by cutting (1 kilo) of fentanyl,” Barden said.

Dealers, who come to Maine from major cities on the East Coast, may be unaware they are selling tainted heroin, Pelletier said.

“The troubling aspect about it is, the fentanyl we are seizing and buying, people are selling it as heroin,” Pelletier said. “During interviews post arrest, even some of the distributors believe it’s heroin. They don’t even know its actually fentanyl.”

That ignorance extends to users as well and is causing anxiety among them.

“We can’t be certain whether people are getting fentanyl in their heroin or not, unless their urine is tested,” said Caroline Teschke, program manager of Portland’s India Street Clinical Services and Infectious Disease Center. One man who is enrolled in the center’s needle exchange program said his urine recently tested positive for fentanyl and for methadone, but not for the presence of heroin, which he thought he had been using, she said.

“Fentanyl is dangerous for everyone,” she said. “It’s dangerous for experienced users, who think they know what a normal dose is and also for naive users, who often don’t do the right thing by doing tiny increments of testing before shooting up.”

DRUG SUMMIT AUG. 26

Fentanyl is likely to be among the topics discussed at Gov. Paul LePage’s drug summit Aug. 26.

The governor announced the summit shortly after 14 overdoses occurred in Portland over 24 hours this month. Most of those who suffered overdoses were resuscitated by rescue workers, though two died. Police said the spike could be attributable to a “bad batch” of heroin.

It’s unclear how many of those overdoses involved fentanyl.

Dr. Marcella Sorg, a researcher with the Chief Medical Examiner’s Office, is conducting a study into overdose deaths this year and previous years in part to compile that data.

When police seize drugs and need them tested, they send samples to the Department of Health and Human Services Health and Environmental Testing Lab. In 2014, 18 of the samples sent for analysis contained fentanyl and one had acetyl fentanyl, which is the illicit form of the painkiller manufactured in illegal labs. So far this year, 41 samples contained fentanyl and 21 acetyl fentanyl.

The number of people at risk also has been growing.

The number of Mainers seeking treatment for heroin addiction swelled from 1,115 in 2010 to 3,463 last year, according to the Maine Office of Substance Abuse. Nationally, the number of people addicted to heroin has more than doubled in a decade, from 214,000 in 2002 to 517,000 in 2013, according to a study released this year by the Substance Abuse and Mental Health Services Administration.

States and the federal government have recently moved to crack down on fentanyl.

The Maine Legislature this year added fentanyl to the list of illegal drugs like heroin, cocaine and methamphetamine, which increased the penalties for people caught selling or possessing it. Massachusetts Attorney General Maura Healey announced Monday plans to take similar steps. The federal DEA last month approved an emergency rule placing fentanyl on a list of drugs considered at high risk of abuse and addiction.

Fentanyl is so powerful that in its pure form, touching it can be lethal as can breathing airborne particles of it, Barden, the DEA spokesman, said.

‘RUSSIAN ROULETTE’

Some people who say they have used heroin and fentanyl posted concerns about fentanyl on an Internet bulletin board.

One person said that fentanyl quickly increases opiate tolerance, making for a worse withdrawal and greater need to use.

Another said using fentanyl on its own is not enjoyable because it incapacitates users and leaves them craving more when they come down. Mixing in heroin makes it last longer and produces more euphoria.

Barden says the introduction of the synthetic opiate makes an already dangerous lifestyle even more so.

“This is like playing Russian roulette with a two-shot derringer,” he said. “The number of overdose deaths attributable to heroin and fentanyl-laced heroin is just astronomical and we’re not even sure what the true numbers are.”