So far, 41 fatal overdoses linked to synthetic forms of fentanyl

As deaths from overdoses continue to plague Manatee County, one growing menace is fentanyl in its synthetic forms, according to those on the frontlines of the drug abuse epidemic.

So far this year, synthetic fentanyl variations, or analogs, have been found in 41 fatal overdoses by the 12th District Medical Examiner’s Office, which serves Manatee, Sarasota and DeSoto counties.

“The analogs are a really big problem,” said Chief Medical Examiner Dr. Russell Vega, who gave a presentation Saturday on current trends in intravenous drug use to the local group No Longer Silent, which works to bring awareness to the overdose crisis in Manatee County.

Early this summer, as the district saw a second spike in overdose deaths, law enforcement officials first discovered that drug dealers were cutting some heroin supplies with carfentanil — a synthetic form of fentanyl that is 10,000 times more powerful than morphine and is used as a tranquilizer to subdue large, exotic animals such as rhinos, elephants and hippos.

A challenge at the time for the Medical Examiner’s Office was that the toxicology lab it uses had not yet developed an analytical tool to identify cartenfentanil to determine if the drug is present in a victim’s body or blood. But because of the potency of the drug, it became a high priority.

By late August, Vega had been notified that examiners could finally begin testing for it after the creation of an analytical tool.

As of two weeks ago, Vega was finally able to gather some statistics on deaths in which synthetic fentanyl analogs were found. Those results were:

▪  Carfentanil: 35 deaths.

▪  Acetylfentanyl: 5 deaths.

▪  Furanylfentanyl: 1 death

Meanwhile, fentanyl has been found present in 26 deaths so far this year, according to Vega.

And most of the cases, he said, are from Manatee County.

Group member Gordon Stanhope asked one question that remains unanswered: Why Manatee County?

Law enforcement officials have yet to determine why Manatee County has become the epicenter of the epidemic with more deaths per capita where heroin, fentanyl, morphine or cocaine were found in 2015.

Lisa Carter, whose son died in May 2014 from a heroin overdose, was among those gathered at Saturday’s meeting.

“He’s one of the statistics,” Carter said after the meeting, referring to Vega’s presentation.

She and others who attend No Longer Silent meetings are hoping that increasing awareness and education about the epidemic will foster new solutions to help control the problem.

“It’s a ever-growing epidemic, it’s not stopping,” Carter said. “Something is not working.”

Testing remains challenge

For the toxicology and crime labs, testing remains a challenge as drugs dealers are creating fentanyl and the synthetic variations in laboratories of their own.

Like with designer drugs, the molecules are tweaked slightly, making them undetectable and nearly impossible for toxicology and crime labs to keep up.

“That is what is going on right now,” Vega said Saturday.

Synthetic analogs aren’t easily detected during clinical testing when overdose patients are taken to hospitals, he said. One reason is because of the minute doses taken of the highly potent compounds. Another reason is that with carfentanil, death occurs so rapidly that there is no time for the body to metabolize or excrete the analogs into the urine.

Examples of fentanyl analogs include numerous variants, such as: carfentanil; alfentanil; butyryl fentanyl; acetyl fentanyl; furanylfentanyl; sufentanil; and beta-hydroxythiofentanyl

Cocaine never left

Despite the rise of popularity of opioid drug use that has led to the current heroin and fentanyl epidemic, cocaine never went away.

“We are seeing more and more opioids mixed with cocaine, especially carfentanil,” Vega said during Saturday’s presentation.

The current trend, however, is moving toward more intravenous use for cocaine users.

But while opioids are a depressant, cocaine is a stimulant, so they have different effects on the body.

“I can’t help but wonder if cocaine is being added as some sort of insurance policy,” Vega said adding that perhaps drug dealers naively thought it could reverse some of the lethal affects.

That is not the case, however, he said.

This story was originally published November 19, 2016 at 8:41 PM with the headline "So far, 41 fatal overdoses linked to synthetic forms of fentanyl."