Ohio's Attorney General issued a warning late last week about a new mixture of opiates causing overdoses. Mike DeWine says "gray death" is a mixture of fentanyl, heroin, and the synthetic drug U47700.
However, Hamilton County Coroner Dr. Lakshmi Sammarco says the deadly drug can be any combination of fentanyl, carfentanil, heroin, and various synthetic drugs. And she says it's not new in Hamilton County.
"It's a lot of different drugs," says Sammarco. "One dose or two doses or three doses, etc. of Narcan may not be enough. So is it Narcan-resistant or is it that there's a lot of the opioid still floating around? Narcan's half-life is 18 to 30 minutes, in general, and carfentanil is reported to be, in veterinary literature, 7.7 hours. So, even if you give someone Narcan and they've had carfentanil, they could still overdose when the Narcan wears off."
By The Numbers
Sammarco reports there were 403 overdose deaths in Hamilton County in 2016. Of those, 342 were opiate-related. That compares to 414 overdose deaths in 2015, of which approximately 240 were opiate-related.
Year-to-date, Sammarco says, there have been 221 suspected overdose deaths in Hamilton County.
Borrowing from Utah's anti-opioid campaign, Sammarco is calling this an "opidemic" (opioid epidemic).
Hamilton County Health Commissioner Tim Ingram adds from Jan. 1 to April 30, 2017, 1,400 people have presented to emergency rooms with the chief complaint being a possible overdose. Some of those, he says, could be repeat visits by the same person.
Appealing to the public simply not to do drugs, especially opiates, isn't working, Sammarco says. Speaking during a news conference surrounded by health and law enforcement officials, the group generally agreed more funding is needed for treatment and treatment facilities.
"As we know," says Ingram, "this is a disease of the brain. Certainly, people can clean themselves out, but if the craving hasn't been treated, eventually they go back into usage of opiates."
Ingram says there are some positive signs in terms of increasing treatment and/or rehabilitation. "I'm optimistic that we're starting to see some movement with some of the major (health) systems in town who are linking with different outpatient facilities and so forth. And even the existing institutions that have been doing this business for some years, you're hearing them talk about 'we need to bring physicians in to provide medical-assisted treatment.'"
Ingram says quick response teams, which try to get overdose survivors into treatment, are working well, but he'd like to see a "cultural change" in how healthcare looks at the problem of addiction. He'd like to see more of a hand-off of patients from hospitals to out-patient or in-patient facilities offering medically-assisted treatment and support services.
Hamilton County Heroin Task Force Director Chief Tom Synan says there needs to be more money, more infrastructure to help addicts, and more compassion.
"We're going to need more funding on the back end to get infrastructure. We're going to need innovative programs where we intervene on the street so that firefighter or that police officer, when they Narcan somebody, can get them somewhere where they can get help."
Synan says he'd like to have a program running this year "where we can intervene on the street, take them to treatment, and if we can reduce the numbers by even 10 or 20 percent, it would make a significant difference."
Of course, Sammarco points out, treatment requires some personal responsibility as well.
"We keep talking about a warm hand-off and that's great. These are adults we're talking about who are being discharged from a health care facility and hopefully being provided with follow-ups. We can't make them follow up. They have to make that choice."