Synthetic opioids are evolving so fast, even Michigan’s forensic scientists are caught in a game of cat and mouse: As soon as a new synthetic gets identified, another one pops up.
First it was fentanyl, which can be lethal even in very small doses – far smaller than a lethal dose of heroin. Then it was carfentanil, which made headlines for being even more powerful than fentanyl. And new variations on these synthetics keep turning up in crimes scenes and autopsies.
Wayne County Medical Examiner Carl Schmidt says at least with carfentanil, they knew what they were dealing with.
“But when you get these synthetic fentanyls, who come from who knows where, you don’t know what their potency is,” he says. “But so far they’ve proven to be more potent than just plain old fentanyl.”
In fact those synthetic opioids may be so lethal, they could be killing people even before first responders can administer Narcan (that’s the anti-overdose drug that’s used in heroin and other opioid cases.) Schmidt says when a heroin user dies, Narcan is far more likely to be detected, compared with a death involving a synthetic fentanyl.
“Because carfentanil killed them so quickly, that they were beyond help by the time EMS services or the police came around with Narcan,” he says.
Fentanyl and other kinds of synthetic opioids are quickly becoming the deadliest drugs in some areas of Michigan. Of 849 drug-related deaths in Wayne County last year, fentanyl was detected in more than half those deaths, way up from 2015. Some 70% of those who fatally overdose are white, and the vast majority are men.
“The average drug death in southeast Michigan is a 42-year-old white male,” Schmidt says. But he doesn’t like the term "overdose." “It doesn’t describe what actually happens. We’ve seen people with very low fentanyl concentrations [die.] That’s a naïve user. They get exposed to a drug on the street, they’ve never been exposed to it before, and they succumb to it right away.”
Last year, the eight Michigan State Police forensic labs across the state began sending every report involving fentanyl or another synthetic opioid to the Michigan Intelligence Operations Center. Those labs see different compounds turn up depending on their geographic area, says Elaine Dougherty of the Michigan State Police Crime Laboratory in Bridgeport, speaking at a conference on synthetic opioids Monday.
“Some labs have a 6 to 8 week backlog [of compounds to test] and other labs have an almost one-year backlog,” Dougherty says. Still, a few patterns are emerging: an increase in fentanyl overall, a surge in carfentanil more than a year ago that’s been dropping off in the last several months, and an overall explosion of extremely complex compounds.
Instead of pure carfentanil, Dougherty says, a single substance found at a crime scene can contain a wide mix of synthetics and designer drugs like acetyl fentanyl, furanylfentanyl, and U-51754, not to mention blends of heroin, Xanax or cocaine.
That typically makes it tough to identify a common source, Dougherty says. “[I was] hoping to see more common source mixtures [among the state police lab reports,] but it was just a hodgepodge … you wonder if someone’s putting something in that mixture [of opioids before selling it] or is it just a totally different source?”
That’s why Carl Schmidt, the Wayne County medical examiner, says we should be thinking about opioid use as an infectious disease. If 849 people in Wayne County died of the flu last year, he says, wouldn’t we be pouring resources into figuring out what strain of the flu was killing them?
“You can’t understand what you don’t see,” he says. “A [synthetic opioid] drug may not be part of the drug screen, because you only find what you screen for. Many communities don’t know what their drug use patterns are,” Schmidt says, because their county medical examiners or forensic labs just don’t have enough resources.