There is a time each week when one can walk into a government building in Allegheny County, Pennsylvania, and hear something other than the typical line on illicit drug use. Prevention Point Pittsburgh holds hours every Sunday in an otherwise dark and empty health department building next to an Arby's. Here, intravenous drug users can get clean needles, be prescribed the overdose-reversal drug Narcan, and learn what to do if they're around someone who OD's (everything from CPR to how to administer one of those syringes of Narcan). The nonprofit gets funding from the state and county but has to seek private donations to buy the needles. The idea is not to prevent drug use per se (though they do have case workers who will help with that) but to prevent deaths from drug use.
Alice Bell, the group's project coordinator, says Prevention Point's clientele has been shaken by the recent spate of overdoses from a batch of fentanyl-laced heroin. "Some people are scared," she says. "Some people say they know someone who has died from it. Others are looking for it. If you can get a batch that is a lot stronger, you can stay high for a lot cheaper."
The heroin that has hit Allegheny County—a rusted-out patch of former mill towns with Pittsburgh at its epicenter—in the last two weeks is, if anything, stronger than average. On the last Friday of January, the county medical examiner's office saw three overdose deaths in 24 hours. Four more came the following Saturday. Investigators linked them to a particularly potent batch of horse mixed with fentanyl, a painkiller 100 times more potent than morphine that's used in operating rooms and war zones. Right now, the state attorney general's officer thinks it's bootleg fentanyl cooked up somewhere out of state. It has been sold out of bags marked "Theraflu" and has also gone under the street names "Bud Ice" and (inexplicably) "Income Tax." As the fatalities have continued and overdoses in neighboring counties have been linked to the stuff, the death toll from the Theraflu mix stands at 22.
An image of "Theraflu" baggies released by the Allegheny County Medical Examiner.
Dr. Neil Capretto, medical director of Gateway Rehab, a regional chain of recovery centers, says he has encountered patients who have survived the combo. "I talked to one who was a real heavy heroin user. He typically did 25 [stamp-sized] bags a day, seven to ten at a time. His dealer told him, 'This stuff is potent. Do less than usual.' He cooked up two bags and went unconscious before he could take the needle out of his arm." Luckily, the guy's mother found him and called 911. Capretto says a few others have checked into Gateway after "near-death experiences."
Bell recounts a story from one of Prevention Point's regulars, who claims that he and his friends scored some Theraflu. Three friends all shot it into their arms and were unconscious instantly. "He said he could hear the sound of one of them hitting the floor, like a knock on a door," says Bell. None OD'ed.
There has been the expected clampdown on dealers across the area, some of whom were selling Theraflu and some of whom were not. In one of the colorful busts, police collared an employee of a city McDonald's who was allegedly selling heroin through the drive-through. "I'd like to order a toy" was apparently code to get a Happy Meal box containing a stamp. Yet the 26-year-old employee, who was still wearing her Mickey D's uniform in her mug shot, wasn't selling Theraflu but a less potent batch. A source said it went under the street name "Night, Night, Nigger."
Shantia Dennis, 26, accused of selling heroin through a McDonald's drive-through. Photo courtesy Office of the Allegheny County District Attorney
Drug overdoses are on the rise all over the US but are particularly skyrocketing in Allegheny County. Nationwide, they tripled from 1990 to 2008, according to the CDC, but nearly quintupled in this bit of urban Appalachia. According to figures from the county health department, drug overdoses in Allegheny County averaged 58 per year across the 80s, broke past the 100 mark in 1998, and then hit the 200 mark in 2002. They hurdled to 288 in 2012.
Just as is the case all over, there is a trend of users going from prescription painkillers to heroin. "It's pretty rare that someone starts by injecting," says Point Prevention executive director Renee Cox. "Most of our clients start with something like a car accident and then get a prescription for a painkiller, and then they become addicted to opioids." When the doctor stops croaking up prescriptions, they start seeking H.
Or they could go that route because it's cheaper. "You stay high every day for about a fifth of the cost [of prescription painkillers] if you do the new heroin," says Capretto, Gateway's medical director. And as the drug became a lo-fi replacement for white-market drugs like Percocet and Oxycontin, it made the predictable and cliché inroads into Pittsburgh's suburbs. "My patients are increasingly people from nice homes whose moms went to all their baseball games," says Capretto.
And it's not a coincidence that the Pittsburgh region is slurping down narcotics at a rate higher than our pill-head nation at large, says Capretto, who has treated addition in the region for 30 years. "We were a major marketing area for the first round of prescription painkillers in the 1990s," he says. "Believe me; I got all the advertising—Big Pharma is smart. They know their demographics and knew we had a higher population of people who would need these products." At the time, western Pennsylvania had an older populace, many of whom destroyed their bodies in steel mills and lumber yards. "They didn't market this stuff to San Diego as aggressively," says Capretto.
Every decade or so in Pittsburgh, someone tries to up their game, and a particularly dangerous street opioid like Theraflu leads to a body count and and a few days of headlines. In 1988—in a case that anticipated Breaking Bad—an industrial chemist cooked up a batch of "China White" heroin and partnered with a junky to distribute it. Eighteen people OD'ed on it. In 2006, another batch of fentanyl-laced smack, sold under the street name "Get High or Die Trying" was linked to nine deaths.
Even when there is not a particularly dangerous product out there, overdoses are a frequent crisis for emergency rooms, one that Pennsylvania has not yet responded to by implementing a Good Samaritan law to shield anyone who calls 911 about an OD from a possession charge or by making drugs like Narcan more available. (It currently can only be prescribed to users, not friends or parents, apparently leaving them with the task of injecting it themselves as they overdose.)
"It causes a lot of talk when there are 22 deaths in a week," says Point Prevention Pittsburgh's Bell, "but [Allegheny County] deals with four or five in a typical week. That is status quo. That should be enough for us to talk about how we are treating users."
[Editors note: No, this was not the smack that killed Philip Seymour Hoffman.]