Fentanyl takes a deadly toll on Vermont

When Eric Bessette tried fentanyl three years ago, he was most struck by the flavor — or lack thereof.

“I clearly remember the stuff had no taste to it,” he recently recalled.

Heroin is often slightly off-white, he said. A dab on the tongue leaves a bitter, medicinal taste. But fentanyl — a synthetic opioid that can be 50 to 100 times more potent than heroin — was pure white, odorless and flavorless.

Bessette was a regular heroin user at the time. His opiate addiction began more than a decade earlier through an all-too-frequent, well-documented route with doctor-prescribed painkillers, though he was into other drugs before that. When his supplier came across some fentanyl, Bessette tried it. To this day, the experience stands out in his memory.

“I had a real close call on that stuff,” he said.

The high was different from heroin. More like anesthesia, the impact, he said, was like putting him to sleep. He remembers coming to and finding himself in the middle of the street on one knee.

“It hits you quicker and stays with you longer,” he said.

Now, Bessette is in recovery. Self-employed, he takes on a variety of odd jobs, like painting and carpentry, in addition to his main gig: foraging for wild ingredients like mushrooms and fiddleheads, and selling them to restaurants. Bessette got into it years ago with two of his brothers after taking an Audubon class. He’s been clean for more than a year and a half. Today, his fentanyl experience is just a memory.

His brother Brian wasn’t so lucky. He died of a fentanyl-fueled overdose in January.

As opiate addiction rates have swelled in Vermont and across the country, fentanyl, initially developed as a pharmaceutical painkiller, has quietly crept into communities with devastating effects. Its potency and stealth quality — users often don’t even know when they are using it — add a dangerous dimension to the epidemic of heroin and painkiller abuse in Vermont and nationally.

Smuggled across the southern border or shipped into the country clandestinely in packages from overseas, the powerful synthetic opioid has infiltrated drug markets across the country — often disguised as other substances. It can be injected, ingested, snorted or absorbed through the skin.

Fentanyl is a factor in rising fatal opiate overdose rates nationwide. In Vermont, where a record number of people died of opiate-related overdoses last year, almost half were linked to fentanyl.

And law enforcement officials expect its frequency to rise.

From Chinese labs, via the U.S. Postal Service

Fentanyl was first developed in 1959 by Belgian chemist Paul Janssen, whose company, Janssen Pharmaceutica, was a leader in the discovery of new medicines through the 20th century.

The potential dangers of fentanyl have been known for decades. There are reports that the U.S. military tried to weaponize it in the form of an aerosol spray, according to the current affairs magazine Maclean’s. Fentanyl is suspected to be an ingredient in a chemical agent the Russian military used in response to a 2002 hostage crisis in a Moscow theater that killed more than 100 people.

Today, fentanyl is used clinically, typically in the form of a patch, to treat pain from conditions including cancer. The drug is a commonly used painkiller for hospice patients dying of terminal illnesses.

But only a very small amount of fentanyl sold on the street today is diverted from medical services. The vast majority comes from illicit laboratories in Mexico and China.

“This is a global problem,” U.S. Drug Enforcement Administration spokesperson Russ Baer said recently.

Frequently, according to Baer, fentanyl enters the U.S. by way of the southwestern border. Sometimes it is smuggled in by itself; other times it is integrated into shipments of heroin or cocaine. Often it flows along the same routes of distribution used for other illicit drugs.

Other times, fentanyl arrives in the country through the U.S. Postal Service.

Law enforcement has intercepted and tracked shipments of manufactured fentanyl, or the chemical components of fentanyl, from overseas, according to Baer.

“You can order it from China with a few clicks on the internet and get a parcel containing 200 to 300 grams within a few days,” Baer said.

Across the country, state and federal law enforcement has found evidence that people are completing the final stages of fentanyl manufacturing in their kitchens with ingredients purchased online. In October, police in Texas arrested a man and several associates accused of manufacturing and distributing fentanyl.

According to a STAT News report, the man allegedly ordered 300 grams of crystallized fentanyl from a Chinese lab for $3,500. He allegedly mixed the fentanyl with methanol and passed the substance to distributors, who completed the final prep stages for converting it into a white powder. Police say the order could have yielded him $500,000 in profit.

Just as fentanyl comes into the U.S. in many ways, it turns up on the black market in many forms as well. Often it is laced with other white powder drugs — like heroin — unbeknownst to the drug users, and even to street dealers.

Because fentanyl is more potent, drug organizations can move smaller amounts of it and achieve roughly the same effect they would with larger heroin shipments. If dosed correctly with filler, drug users may not ever know the pill they swallowed or drug they injected was fentanyl, according to officials.

Increasingly, there have been reports of fentanyl pressed into pill form and sold on the street disguised as pharmaceutical painkillers. More recently, fentanyl powder has been found laced with other non-opiates. In May, Rhode Island officials warned that fentanyl was found mixed with cocaine — putting occasional recreational coke users at risk.

New York City officials have also said casual cocaine users may be at risk of fentanyl exposure.

A Vermont law enforcement official said they have not encountered any instances of fentanyl-laced cocaine here but that it is “certainly in the realm of possibility.” Heroin and cocaine mixed together is called a “speedball,” and swapping in fentanyl is possible — but there is a higher danger if the dosing is off, he said.

Over the span of just a couple of years, the synthetic opioid has transitioned from a rarity to omnipresent.

“Fentanyl has hit every corner of our country, from Maine to Marathon,” Baer said.

Including Newport, Vermont.

“Turning a light switch on and off”

On Christmas Eve in 2015, Eric Morin died of acute fentanyl poisoning.

His family was told it was nearly instant.

“The counselor told us it was like turning a light switch on and off,” Morin’s mother, Rachel Coulter, said. “That’s how quick it was.”

“It hits your system, and it’s just, bam,” his older sister, Melissa Zebrowski, added.

Zebrowski said her brother was a cheerful, energetic person with a big heart. A Northeast Kingdom resident, he was an accident-prone kid and a hockey player. When he died, he left behind two teenage children.

Morin’s family members said they believe his substance abuse issues began in high school, when he used marijuana and alcohol. Eventually, he turned to pills and heroin.

His family watched him struggle to overcome his addiction. He sought treatment through several different providers. Two times, Coulter tried to help her son through the symptoms of withdrawal.

“The sweats, the throwing up, the shakes,” she said. “All of it, I watched it, twice.”

In late 2015, he was trying to get clean. He shared the contact information for a drug counselor with his mother. She still has the card.

“Thanksgiving came, and I really thought he was OK,” Coulter said. He celebrated the holiday with his family at his sister’s house, and he seemed happy and healthy, they said.

Then, weeks later, the day before Christmas, Morin died suddenly when he used a dose of heroin laced with fentanyl.

His death left his sister “shattered,” she said.

A couple of weeks later, Zebrowski was watching the news when she saw a report about fentanyl-laced drug packets branded as “Hollywood” heroin that had been linked to several overdose deaths in western Massachusetts.

She called her mother screaming, immediately certain that was what killed her brother.

“That’s what Eric got,” she said. “He was one of the few cases in Vermont that got the Hollywood heroin.”

On the front lines in Vermont

As fatal opiate overdose rates have skyrocketed to record highs, so have fentanyl-related deaths.

In 2016, there were 51 fatal overdoses linked to fentanyl, according to the Vermont Department of Health — a tenfold increase from five years ago, when there were five.

Fentanyl was a factor in almost half of the total 106 opioid-related accidental overdose deaths in Vermont last year — a record number. Many of those fatalities involved multiple substances, according to health officials.

And officials say more fentanyl is on the horizon.

Capt. John Merrigan, who heads the narcotics unit of the Vermont State Police, warned policymakers in Montpelier this year to brace for more cases involving fentanyl.

Police expect to see the drug continue to rise in prominence in Vermont, in part because it makes sense economically. Produced in a lab, fentanyl “eliminates the poppy field, it eliminates the farmers,” he said.

“It takes a whole bunch of your overhead out of the game when you can just do it synthetically in a building,” he said.

Because of its potency, drug distributors can make a smaller amount of fentanyl go as far as a larger quantity of heroin.

“It’s just cost-effective and just makes sense to move fentanyl instead of heroin because you have to move less of it to have the same street result,” Merrigan said.

The rise in prominence of fentanyl has added a rash of complications to the already significant challenge of responding to the opiate addiction crisis.

For one, the potency of the substance makes it difficult to respond to overdoses in time to administer lifesaving measures.

When an overdose patient arrives at the emergency department of Rutland Regional Medical Center, it is typically not clear what substance or mixture of substances caused the overdose, according to the department’s medical director, Dr. Todd Gregory.

Typically, medical staff begins treatment by administering naloxone, the opiate overdose reversal drug.

However, according to Gregory, not many of the patients who come into the ER because of an overdose are on fentanyl.

“The problem with fentanyl is that it’s so potent that a lot of times we don’t see those patients at all,” Gregory said. “By the time they are discovered, they’ve died.”

The more potent drug sometimes requires multiple doses of naloxone to reverse an overdose, according to professionals.

Once the naloxone has kicked in, the patient is not in the clear.

Naloxone’s half-life is shorter than that of fentanyl. Someone who has taken a particularly potent dose of fentanyl could potentially overdose again from the initial batch once the naloxone wears off, according to Gregory.

The rise in the prominence of fentanyl also has implications for law enforcement and first responders.

The drug is so potent that accidental exposure is a concern.

Touching a small grain of some types of fentanyl can cause people to overdose, according to Merrigan.

In other parts of the country, there have been instances of police officers and first responders overdosing because they were exposed to the drug in the course of treating patients. Just last month, an Ohio police officer passed out within minutes of exposure to fentanyl and was revived with naloxone.

Merrigan said this spring that he was not aware of any instances in Vermont where officers have overdosed from accidental exposure. However, he led an effort to rework the state’s drug field-testing policy to try to make it safer given the concerns.

Defender General Matt Valerio noted that fentanyl is not new. In the 1990s, he said, there were instances of fentanyl, a depressant, mixed into cocaine, a stimulant. Back then, the fentanyl was typically diverted from the medical system, and cases were not as common as they are now.

Valerio believes most local drug suppliers do not know that the substances they are selling contain fentanyl. The decisions to cut fentanyl into heroin or crack tend to happen much higher up the supply chain, he said, and it is “highly unlikely” that street dealers are aware.

“The only way they find out is when people start dropping dead and they start to wonder,” he said.

The dramatic increase in the prominence of the powerful opioid has driven policymakers across the country to pursue legal changes to crack down on the drug. Here in Vermont, lawmakers passed a bill creating new criminal penalties for knowingly distributing and trafficking fentanyl. That measure, H.503, is with Gov. Phil Scott for his review now.

Under current law, crimes related to the substance are typically prosecuted under other laws because the drug is frequently mixed with other illegal products.

As the bill worked its way through the Legislature, Valerio guided lawmakers to write the law to try to make sure that low-level dealers who unknowingly peddle fentanyl-laced drugs aren’t caught under the new crime. But he acknowledged that fentanyl is an extraordinary substance.

“I’m not one to be interested in people being punished for their drug use,” Valerio said. “But fentanyl is really, really dangerous.”

“There’s nobody in this world that needs a medication like that”

It had been years since Eric Bessette used fentanyl when he got the news in January that the powerful opioid had killed his eldest brother.

Bessette is convinced his brother had no idea he was using fentanyl. He was relatively new to using heroin, Bessette said.

Dealers, Bessette said, have a moral obligation to inform their customers if the product they’re hawking has fentanyl in it.

“If you know that it’s fentanyl and you’re not telling anybody, you’re not advising people you sell to, that’s wrong. That’s just wrong,” he said.

He sees fentanyl as a problem flowing into Vermont from outside sources.

“I have no sympathy for the people who come up here and get caught,” Bessette said.
“More power to the police.”

In Bessette’s view, the only way to stop the devastation from fentanyl is to stem the flow from the source. His feelings are so strong about it that he sees no use for the drug, illegal or legally prescribed, because of the devastating effects if diverted.

“There’s nobody in this world that needs a medication like that,” Bessette said. “That substance doesn’t need to be in America, whatsoever.”

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