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Synthetic opioids bring national crisis to streets of Council Bluffs

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The latest drug epidemic to hit the Council Bluffs-Omaha metro area stems from a product that is legal and easily attainable.

It’s also potentially lethal.

Last week, six people were treated at Council Bluffs hospitals after overdosing on a version of fentanyl, a synthetic opioid commonly used as a painkiller, according to local law enforcement and medical experts.

Council Bluffs Police reported on Aug. 1 that three people were found unresponsive in the parking lot of a gas station near North 25th Street, while another unconscious man was found in a house nearby around the same time. All four were found to have used the fentanyl, and they were treated and released.

On Aug. 2, two men were treated at area hospitals for the same reason, police said.

According to the Drug Enforcement Administration, fentanyl is a powerful analgesic, or painkiller, used in medical surgery. In the United States, it is a Schedule II controlled substance because it has a high potential for abuse and may lead to severe physical or psychological dependence, although it is accepted for medical uses, according to the Controlled Substances Act of 1970.

Forensic Chemist Christine Gabig with the Douglas County Forensic Services Division said many synthetic variants of fentanyl have made their way onto the streets in the metro area. Since the substances are not actually fentanyl but a slightly altered version of it, they’re not illegal and can be purchased easily on the internet without a prescription.

“You can order it online and kill yourself right now,” Gabig said. “The goal is to stay ahead of the legislation by messing with the chemical structure of fentanyl to get around the law.”

According to the Centers for Disease Control and Prevention, 91 Americans die every day from opioid overdose, including from prescriptions and heroin. Six out of 10 drug overdose deaths involve opioids. And more than 500,000 people have died from drug overdoses between 2000 and 2015.

The amount of prescription opioids sold in the U.S. has doubled since 1999, while deaths from drugs like oxycodone, hydrocodone and methadone have quadrupled in the same timeframe.

The CDC said fentanyl is estimated to be 50 to 100 times more potent than morphine. Roughly 9,500 people have died from overdoses involving synthetic opioids other than methadone in 2015.

An internet search by The Nonpareil turned up several websites offering fentanyl, ready to ship anywhere. Gabig said those selling synthetic opioids mixed in with heroin or other narcotics are playing off people’s addictions. Gabig’s lab has seen 10 variations of fentanyl since 2015 make appearances in the area.

“If you can make a product that gives a stronger high, people will want it. They’ll put it into heroin and sell it without telling their buyers what they’re getting,” she said.

“And it will kill you.”

Effects and treatment

The emergency rooms at CHI Mercy and Methodist Jennie Edmundson Hospitals in Council Bluffs are no strangers to treating those suffering from overdoses of various opioids, such as heroin.

But fentanyl is different, complicating treatment and frustrating medical providers because patients may not even know they had fentanyl mixed in with other drugs when taking it.

In other words, someone could turn up in an ER with a lethal dose of fentanyl and not even be aware they had been using the substance.

“It’s bad. And there’s no silver bullet to this,” Jennie Edmundson Emergency Services Director Courtney Schmid said.

The hospital has begun instructing staff on how to deal with these cases in the future, because the problem is not likely to fade anytime soon, he said.

Chris Acker, an emergency physician at Mercy, said fentanyl, similarly to other opioids, causes respiratory depression. The body suffers without enough oxygen and closed airways can cause a buildup of carbon dioxide, causing patients to aspirate or stop breathing all together, he said.

What’s worse, fentanyl is incredibly absorptive. Even getting some of the powder on one’s skin is enough to be affected by it, Acker said.

“The biggest issue is those putting it or using it on the street don’t know its strength,” he said. “It’s not regulated and dangerous.”

Jennie Edmundson Medical Director Patrick Costello said the standard response to opioid overdose is to manage the patient’s airway and give them doses of Naloxone, commonly known and sold as Narcan. The medication blocks the effects of opioids to help patients survive overdoses.

But fentanyl binds to brain receptors tighter than heroin, meaning more Narcan is needed for treating its effects, Costello said.

“After last week, we were running low on Narcan,” Costello said. “And, if this is going to be an ongoing issue, we’re going to need more of it.”

When used illegally, people have mixed fentanyl with other substances — like cocaine or heroin — for a stronger high, but such actions lead to a more lethal concoction, Costello added.

Legality and legislation

As it currently stands in Iowa, the knock-off versions of fentanyl are legal.

Council Bluffs Police Sgt. Robert Christiansen said the drug is usually mailed in after ordering it online.

With the recent string of overdoses, he said it was a good thing victims were around other people or they might not have survived.

“There is no recreational use with this stuff. If you’re messing with it, you’re looking to die,” he said. “It can be absorbed through the skin and make you go to sleep and not wake up.”

The absorbing properties of the drug present a danger to law enforcement and first responders, Christiansen added. Those on scene of an overdose could come into contact with the powdery substance without realizing it and suffer its effects.

“We have to have a protocol now when we suspect fentanyl is present,” he said. “It’s nasty stuff.”

Two lawmakers representing Council Bluffs in the Iowa Legislature — one a Democrat, one a Republican — said action is needed at the state level.

State Sen. Charlie McConkey said the Legislature needs to come together in a bipartisan effort to create measures to combat synthetic versions of drugs. He said tweaking the substance on a chemical level, so it no longer meets the definition of a controlled narcotic, is a complex issue legally.

“We have to have a plan for it,” he said. “We know opioids are over-prescribed as is, but we can help a lot of people out if we put the effort in to crack down on it.”

State Sen. Dan Dawson said that, in his 17 years in law enforcement and as part of the Iowa Division of Criminal Investigation, fentanyl is “probably the nastiest thing” he has dealt with.

He said when the next legislative session begins in January, a proposal will be put together to address the issue of opioid abuse, including synthetic versions.

“We’re trying to get out ahead of the problem before it hits harder here in Iowa,” Dawson said. “The severity and quickness of this stuff endangers the safety of everyone who comes into contact with it.”

Cedar Rapids Police Officer Al Fear told The Cedar Falls-Waterloo Courier in January that opioid abuse will be like cancer in two years: Everyone will know someone who has been affected.

“A lot of people don’t realize the extent of the problem,” Fear told lawmakers and media at the Capitol in Des Moines, according to The Courier. “Just like everyone has their own story about themselves or a family member being affected by cancer. Opioids are going to be the same way.”

The police officer has been assigned to the U.S. Attorney’s Office in Cedar Rapids, which oversees the Northern District of Iowa, including the Waterloo-Cedar Falls area, to help deal with opioid and heroin abuse. The problems in eastern Iowa are on the fringe of a growing opioid problem, he said, with the “eye of the storm” in Ohio and moving westward.

“Unfortunately, it’s only going to get worse,” said Fear, who is spearheading the Eastern Iowa Heroin Initiative.

The group uses prevention, treatment and enforcement to stop the rise of opioids in the area, according to the organization’s website. Fear and the Area Substance Abuse Council provide information through community presentations, town hall meetings and forums, including to area law enforcement.

A path from opioids

Andrew Huff, an anesthesiology doctor at Bluffs Pain Management, said his clinic only prescribes fentanyl in a patch form to help control its use and to steer patients away from possible misuse. The opioid epidemic is very real, he said, but there are people who benefit from the use of opioids.

“It shouldn’t be our primary mode of treating people’s pain,” he said. “Unfortunately, what happened through the 2000s was it was overprescribed. Now it’s created this monster of a problem.”

Some of those addicted to opioids become hooked to avoid withdrawal symptoms and pain brought on by a variety of conditions, he said. Others seek to abuse painkillers to get high or to sell for money.

“We have people come in and try to trick us, saying they have pain just to get medication,” Huff said. “For those in actual need, we focus on injections or other types of therapy and medications that aren’t opioids.”

It’s a balancing act on an issue that is not black or white. Opioids have their place in the medical toolbox, but the issue must be handled with great care, he said.

Huff added that the former ease of getting prescribed opioids has come back to haunt us.

“There were abuses, and now we’re paying for it,” he said.

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