By Dani McClain
Milwaukee Journal Sentinel (Wisconsin)
Copyright 2006 Journal Sentinel Inc.
A wave of overdose deaths among injection drug users in Chicago, Detroit and St. Louis has prompted Milwaukee County Medical Examiner Jeffrey Jentzen to investigate whether painkiller-laced heroin has made its way to the Milwaukee area.
Jentzen will revisit the county’s six heroin-related deaths that have occurred this year, said Eileen Weller, administrative manager of the medical examiner’s office. A new round of tests will screen specifically for fentanyl, a powerful prescription painkiller that has contributed to almost 100 fatal overdoses in the Midwest this year.
Kelly McAndrews, the medical examiner for Washington County, said she has similar questions concerning the death of 28-year-old April Krueger, a Jackson resident who died six weeks ago. McAndrews said Krueger most likely died from a heroin overdose. The results of the toxicology report are not yet available, but McAndrews said she ordered tests that would show the presence of the painkiller.
Milligram per milligram, fentanyl is 80 to 100 times more potent than morphine. When used appropriately, the drug is administered either intravenously, in a patch that passes it through the skin and into the bloodstream, or in a lozenge that dissolves in the mouth. But batches of heroin doctored with the drug have been increasingly common in the Northeast and Midwest in the past year.
Jentzen and McAndrews might be ahead of the curve in investigating the illicit presence of fentanyl in the area.
Emergency room doctors at Aurora St. Luke’s Medical Center and Froedtert Memorial Lutheran Hospital report no evidence of heroin laced with the prescription drug, said Aurora spokesman Steve Pinzer and Froedtert spokeswoman Kim Wick.
Over the past two weeks, the Milwaukee Health Department has surveyed metropolitan-area hospitals and found no significant increase in heroin overdose, according to a written statement from Geoffrey R. Swain, the department’s associate medical director.
Fentanyl has posed no particular law enforcement problem, said Anne E. Schwartz, Milwaukee Police Department spokeswoman.
“It has not made its way up here, thank goodness,” Schwartz said.
She said police have not prepared for the threat, as there is no guarantee that heroin cut with fentanyl will come to the city. Schwartz likened Milwaukee’s apparent exclusion from the trend to the relatively small numbers of methamphetamine abuse reported in the area.
Heroin abuse on rise
But heroin abuse has been on the rise in Milwaukee and some surrounding counties in the past several years and is increasingly popular among people in their 20s and teens, said Erick Slamka, director of the Milwaukee High Intensity Drug Trafficking Area.
In early April, nine people from the Kenosha area had heroin-related overdoses over the span of three days. No fatalities resulted, and Lt. Ron Bartholomew of the Kenosha Police Department said that none of those cases was attributed to fentanyl.
Later that month, 31-year-old Eric Laitinen and 33-year-old Salvatore Victoria died in Kenosha of overdoses from unspecified drugs, according to Bartholomew. These cases are still under investigation and the medical examiner’s office has not released the results of the toxicology tests.
Last fall, 17-year-old Cedarburg resident Angela Raettig and 21-year-old Matthew Kobiske of Grafton both died of overdoses.
These deaths were unrelated to fentanyl, said Ozaukee County Coroner John Holicek. He acknowledged that his office had not administered specialized testing to check for the drug. The prescription painkiller does not show up in the normal opiate screening used when heroin overdose is suspected.
Fear of charges
The key to preventing overdose deaths is providing injection drug users with the resources they need to save their own lives, said Scott Stokes, director of prevention services at the AIDS Resource Center of Wisconsin.
In the past month, the organization has been warning heroin users about fentanyl’s potential arrival in Milwaukee, as well as teaching CPR and offering tips on how to call 911 without alerting police of illegal drug use.
Stokes said that 85% of overdoses are witnessed, but fear of facing criminal charges keeps many users from helping friends who have lost consciousness.
“Actual users have the most chance of saving people’s lives,” said Stokes, whose new project provides heroin users with pre-filled syringes of naloxone, a drug that quickly reverses the effects of an overdose. Paramedics carry the drug but sometimes arrive too late to administer it effectively.
Even when the heroin contains fentanyl, naloxone can save lives, said Stokes.
Randy Brown, a Madison physician, serves as the project’s medical director and writes naloxone prescriptions for those who have gone through Stokes’ training.
Stokes said there have been 20 resuscitations from overdose since the AIDS Resource Center of Wisconsin piloted the project in Madison six months ago. He plans to train 60 to 80 Milwaukee users by July 1 on how to use naloxone and is developing similar plans for the Kenosha and Racine areas.