OD crisis: Flying blind in search of killer heroin's source

An overdose crisis in Cincinnati for the past six days has left police and emergency responders drained, and for now, without clues. It has also underscored that the region does not have the resources to treat all of the addicted.

Police are asking for the public's help in identifying the source of purported heroin sold to people in Cincinnati, mostly on the West Side, that caused scores of overdoses, including at least three deaths.

"We're working very closely to find the source dealer," said Newtown Police Chief Tom Synan, who heads the law enforcement task force for the Hamilton County Heroin Coalition. He said local, state and federal authorities are combining their forces to investigate the source or sources. "We don't have anything solid to go off of."

With an estimated 78 overdoses Tuesday and Wednesday alone, and an estimated 174 overdose cases in emergency rooms in less than a week, officials are scrambling to attack a heroin crisis of a magnitude they've never had before.

Region continues to grapple with spike in overdoses

"This is unprecedented to see as many alerts as we've seen in the last six days," said Hamilton County Health Commissioner Tim Ingram. He was referring to a surveillance system that alerts the public health department when an unusual number of drug-related emergency-room encounters occur.

Cincinnati typically sees an average of four overdose runs per day, according to a city memo from City Manager Harry Black.

"It's unlike anything we've seen before," said Hamilton County Commissioner Dennis Deters, who called the outbreak a public health emergency.

Numbers of overdose runs are sketchy for now, officials said, because there are several agencies reporting, and the surveillance system does not pinpoint specifics but alerts when there's a breach of a threshold.

There are no samples of the drugs to test yet, according to Synan and Cincinnati Police Lt. Col. Mike John. The victims could have injected heroin mixed with the potent painkiller fentanyl or the mega-potent animal opioid carfentanil.

Carfentanil, an analgesic for large animals including elephants, was discovered in July in the region's heroin stream. Black said in the memo Carfentanil is believed to be the cause of the overdose spike the city is seeing now. Officials in Akron and Columbus have reported carfentanil in heroin found in their cities as well; both locations have suffered from bouts of overdoses.

Hospitals in the region are not equipped to test blood for the animal opioid, which is rare and only in July surfaced in Greater Cincinnati's street heroin.

Can you test for carfentanil?

"Yes," said Dr. Shawn Ryan,  a certified addiction expert and founder of BrightView Health, an outpatient addiction medicine practice with offices in Norwood and Colerain Township. But the drug is so rare and so new to the region, no local hospitals would have such tests available, he said.

Mercy Health and the University of Cincinnati Medical Center officials said such tests are not available there.

"We can’t confirm in the short term if someone’s had fentanyl, carfentanil or heroin – the tests flag only as positive or negative for opiates," said Nanette Bentley, spokeswoman for Mercy Health. Tests could be ordered, but results could take days to weeks to come back, she said.

Deters announced Thursday in a news conference that he'll ask his fellow county commissioners to come up with funding for treatment that would come with an expanded Heroin and Opiates Response Team. Sheriff Jim Neil has thrown his support behind the move, and the two said that it's a direct response to the crisis facing Greater Cincinnati.

The teams would consist of a law enforcement officer, emergency responder and treatment specialist who would approach people who've overdosed and offer them treatment. Already, Colerain Township and Norwood have such response teams, and Deters said the drop in overdoses in Colerain has been 35 percent since the work began a year ago. Norwood's started in July.

Addiction Services Council provides the treatment specialist partners for the Colerain and Norwood response teams and is ready to provide the method to a broader number of communities.

Deters said the cost of an expansion of the response teams is still being developed, but he would ask support for county funding for treatment based upon the number of cities, townships and villages that establish a team.

Addiction experts across the nation, as well as in Greater Cincinnati and Northern Kentucky, say that it's urgent to get to overdose survivors as quickly as possible to steer them into treatment. But that doesn't mean enough treatment is available.

Nan Franks, a facilitator for the Addiction Services Council of Cincinnati, said that she is fully supportive of the effort to get the response teams in place.

City Council wallows in mud amid 'heroin hell'

"People overwhelmingly want help, but we have to have a place to take them," Franks said.

If all of those who need addiction treatment were to seek it at once, she said, there wouldn't be enough help."The treatment system would not be able to absorb the flood."

There's no telling whether carfentanil is the drug that was sold to the overdose victims, but investigators believe it's a possibility.

If that's a question, the drug could be identified by Drug Enforcement Administration lab tests, however, said Melvin Patterson, a DEA spokesman in Washington, D.C.

The DEA has been on alert for the animal opioid since its appearance in U.S. and at the Canadian border.

There's little doubt that the carfentanil that's showing up in street drugs is from overseas, just as fentanyl is manufactured and brought across the U.S. borders, Patterson said.

"It's such a restricted drug there's only a handful of places in the United States that can have it," he said.

He said the DEA is working with Chinese counterparts who want to stop the illegal shipments. The drug is sometimes manufactured in China, delivered to Mexico, shipped to Canada and then to Ohio, Patterson said. There also have been reports of it going directly to Canada, and being intercepted by Mexican drug organizations, he said.

John, who is CPD's special services commander, said the week of overdoses has taken a toll on his force.

"It's been exhausting," John said. "They're running from one run to another. It's been very taxing on the officers and the fire department."

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