By Steve Johnson
Chattanooga Times/Free Press
HAMILTON COUNTY, Tenn. — Drug overdoses in Hamilton County and the surrounding area have increased by at least 40 percent in the past year, according to data from area hospitals and ambulance services.
Erlanger hospital’s emergency room saw 159 overdose patients in the first nine months of 2016, according to hospital statistics, compared to 113 for the same time period the previous year, an increase of 40.7 percent.
In another less-exact measurement, paramedics and emergency medical technicians in Hamilton County have used more than 45 percent more anti-overdose medical kits so far this year compared to the same period in 2015, 400 versus 273. While the use of Narcan, the anti-overdose drug, does not exactly parallel the number of overdoses, it gives an approximate indication of an increase in cases, said Capt. Ken Wilkerson, director of the Hamilton County Emergency Medical Service.
On a recent day, EMS ambulances answered “five or six calls for overdoses in one 12-hour shift,” said paramedic Ian Stearns, half of a two-person crew in one of two Hamilton County EMS ambulances that operate out of Station 9 on Long Street, about five blocks south of the Chattanooga Choo Choo.
Overdose patients vary, Stearns said, ranging from elderly patients who have mistakenly taken too many painkillers to attempted suicides and addicts abusing heroin and painkillers.
“We’re seeing overdoses go through the roof in the state. We had more overdose deaths in the state last year than we had traffic fatalities,” Tennessee Bureau of Investigation Director Mark Gwyn told the Memphis Rotary Club last month.
What worries some anti-drug officials is the increasing availability of cheap counterfeit painkillers. That is coming at the same time the state has been cracking down on doctors for over-prescribing painkillers. As a result, patients with a legitimate need for medication and those who have been abusing painkillers may have no legal access to the pills.
“If we cut off and eliminate the source of drugs from doctors from pill diversion, they will go to the street,” said Tommy Farmer, director of TBI’s Dangerous Drugs Task Force.
Farmer said counterfeit painkillers are becoming more prevalent. TBI agents confiscated a pill press capable of producing near-perfect copies of the painkiller Percocet and sedative Xanax in a raid in Knoxville last month. But the chemicals used to produce those drugs were not present. Instead, agents seized about a kilogram and a half — more than 3 pounds — of fentanyl, a powerful legal painkiller that is showing up in altered form in counterfeit pills.
Agents seized more than 50 pounds of suspected fentanyl near Jackson in mid-September, Farmer said.
Fentanyl is often used in a patch that patients can attach to their body, so the drug is steadily released over a period of several days.
But it is also showing up in several synthetic forms that are far more powerful than the version used in the patch. For carfentanyl, one of the powerful alternate forms of the drug, an amount about one-third of the size of a grain of sand is sufficient to cause an overdose, Farmer said, making it very difficult for traffickers to produce fake pills with an exact dosage.
“It’s difficult enough for a billion-dollar pharmaceutical company to try to handle this,” he said. “Imagine somebody trying to do it with crude devices such as a blender.”
Because of the difficulty of regulating tiny amounts of the drug, the contents of any given pill may vary considerably, so drug users are playing Russian Roulette, Farmer said.
While data for the Chattanooga area is not available, deaths up Interstate 75 in Knox County from fentanyl grew from five in 2013 to 18 in 2014, 24 last year, and 19 in the first six months of this year.
Opioids such as heroin or fentanyl depress the breathing of anyone using them, so they are very deadly when combined with alcohol or a tranquilizer such as benzodiazepine (Xanax, e.g.), which can have a similar effect.
“By adding benzodiazepine to an opioid, you have increased the chances of an overdose death by 50 percent,” Farmer said. “You complicate that if you have an opioid and a benzodiazepine and a depressant such as alcohol. That’s where you are seeing heightened overdose deaths.”
Fentanyl is also scary for anti-drug agents because it is inexpensive. A gram of fentanyl costs only a few hundred dollars, Farmer said, and can be shipped with little risk of detection. That gram can then be cut into 500,000 doses and sold for about $2 a pill.
“Small amounts are so much more difficult for us to detect,” Farmer said.
Fentanyl is also more resistant to the anti-overdose drug naloxone, usually known by its brand name Narcan, that is carried by most ambulances and, increasingly, by police and firefighters. While Narcan is a true lifesaver, restoring an addict’s breathing in 30 to 60 seconds, it often takes two kits to bring back someone using the more powerful forms of fentanyl, according to paramedic Stearns.
Law enforcement officers are keeping an eye on what is happening north of Chattanooga on Interstate 75, in Knoxville and beyond, to see what may be headed our way. Six weeks ago in Cincinnati, some 200 people overdosed within a two-week period, with many of the overdoses blamed on fentanyl or the more potent carfentanyl.
The TBI’s Farmer said what happens elsewhere along the Interstate 75 corridor usually ends up here.
“When heroin overdoses started again, when fentanyl started again, that is the track it took,” he said. “We were getting it down from Ohio and West Virginia, and it was showing up in Atlanta and all up and down I-75.”
Copyright 2016 the Chattanooga Times/Free Press