Decoding an overdose epidemic

By PHILIP EIL  |  June 21, 2013

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WHEN

Eleven of the acetyl fentanyl OD deaths in Rhode Island occurred between early March and mid April, according to the Department of Health. A twelfth death occurred on May 16. Then two more occurred on May 26.

The autopsies took place at the Rhode Island Medical Examiner’s Office in Providence, the primary destination for the analysis of bodies of local sudden death victims. In early May, representatives from the national Centers for Disease Control and Prevention came to Rhode Island to assist with the analysis and identification of the acetyl fentanyl.

WHERE

Department of Health officials haven’t disclosed the towns where the victims of these overdoses lived, died, or obtained their fatal dose. Recently filed materials by the Rhode Island US Attorney’s office, however, have been much more specific, tracing at least one transaction to the second floor of 620-624 Elm St. in Woonsocket.

This is where, according to an affidavit contained in a criminal complaint filed on June 4, a confidential informant working with the Woonsocket Police Department’s Vice Unit purchased a substance suspected to be heroin from 20-year-old Victor Burgos (“a/k/a/ Fat Boy”). The purchased substance was later positively identified at the Department of Health as “Fentanyl Acetyl Analog, a Schedule II controlled substance,” the affidavit reports.

On May 16, authorities returned to the address with a search warrant and found three bags of a powdery substance, two scales, and “a video console with powdery residue on it.”

Criminal complaints were ultimately issued for both Burgos and a 19-year-old associate, Joshua Rojas, alleging that they worked in tandem to intimidate the confidential informant’s mother. Rojas, according to court documents, confronted the woman to accuse her son of “snitching” and at other times drove by the woman’s house, revving his engine.

Burgos, according to the same complaint, went to the informant’s mother’s house on June 3, knocked on the door, entered the apartment, and reportedly said, “Where the fuck is your son? . . . I am going to spend the rest of my life in jail because of all those overdose deaths. Your son is going down, I promise you I will find him.”

Burgos was eventually indicted on counts of “unlawfully, knowingly and intentionally distribut[ing] a mixture and substance containing a detectable amount of Fentanyl Acetyl analog,” possessing the same substance with intent to distribute it, and threatening a witness with physical force.

“An indictment and a criminal complaint are merely allegations and are not evidence of guilt,” the US Attorney’s office reminds readers in a press release about the cases. “A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.” Burgos’s attorney declined to comment on a pending case; a message left with Rojas’s attorney had not been returned at press time.

Not surprisingly, the ongoing investigations into the sources and movement of acetyl fentanyl makes it more difficult to learn about the overdoses the substance caused.

“I really can’t talk about anything related to that case,” Woonsocket Police Chief Thomas S. Carey told us.

WHY

“Imagine the worst flu you’ve ever had, miserable as you’ve ever been, and it’s gotta be 10 times worse than that,” Dr. Josiah Rich says.

Rich, a professor at Brown Medical School who specializes in addiction and infectious disease treatment at the Miriam Hospital, is describing opiate withdrawal, what he refers to as the most “diabolical” aspect of the disease of addiction.

“It can start with just a runny nose and a little bit of aching, just feeling generally uncomfortable, kinda like a bad cold coming on,” he says. Then your belly starts to ache. Then you’re hit with nausea, vomiting, and dry heaves, accompanied by diarrhea.

“At that point,” Dr. Rich says, “You see a patient in withdrawal and they’re curled up in the fetal position and they just are moaning, ‘Make it stop. Make the pain stop.’ They’re desperate.”

 Lying, cheating, stealing, drinking, drug dealing, sex work — they can all be symptoms of the disease of addiction, Rich says. The brutal withdrawal when an opiate addict stops using, he says, is what really “drives people to do some of the most god-awful things.” When people get the proper treatment, those symptoms generally tend to subside.

After conversations with Dr. Rich and others, it’s reasonable to suspect that the folks who injected acetyl fentanyl were driven more by a fear of the next bout of withdrawal than an itch for recreational thrills.

“Many of my patients say, ‘Doc, I don’t even get high anymore. I’m just trying to feel normal,’ ” Rich says.

CONTEXT

There’s no easy way to measure the number of IV drug users in the state of Rhode Island, Director of Health Dr. Michael Fine tells us.

“Just like trying to count the number of people who are undocumented,” he says, “the reason that we can’t count them is that they’re undocumented. Very few IV drug users are advertising that they’re doing IV drugs.” Anecdotally, he has heard the number estimated at 10,000, he says.

The number of Rhode Islanders who die each year from overdoses is slightly easier to quantify. “We lose 100 to 200 people a year,” Fine said in a recent interview with WPRO 630. “That’s two Station nightclub fires a year, or an airline going down.”

On the prescription drug front, Rhode Island ranked seventh in the country in country for its 17.2-per-100,000-people rate of fatal overdoses, according to a 2011 Rhode Island Public Health Association report. But Department of Health Officials are quick to remind us that acetyl fentanyl is not FDA-approved, commercially available, or physician-prescribed.

“Doing IV drugs is always incredibly dangerous, but right now, it’s way more dangerous,” Fine says. “This is a good time to get into treatment.”

IN TREATMENT

There are stacks of brightly-colored flyers on the floor of Jim Gillen’s office on a recent afternoon (before the two latest ODs were announced). One bright red packet is marked “The Brain’s Response to Opiates.”

“If you’ve ever seen The Wizard of Oz,” the cover reads, “then you’ve seen the poppy-plant the source of a type of drug called opiates. When Dorothy lies down in a field of poppies, she falls into a deep sleep.”

Gillen is the associate director of Recovery Services at the Anchor Community Center on Main Street, in Pawtucket — right in the heart, you might say, of “northern Rhode Island.”

“I’m sure, between the three of us, we don’t know all 12 people that died?” he says. Also in the room are Larry Threadgill, a former addict who now works at the center, and another recovered man who used drugs for 25 years. We’ll call “Tim.” (For reasons relating to his job, he asked we not share his name.)

Fatal overdoses, for this crowd, are unfortunately not news.

“I didn’t even have to read it,” Tim says. “I looked at the thing, I saw ‘12 Dead.’ Like, I already know.” On average, he says, he loses about one friend or acquaintance per month.

The men spend a few minutes talking about friends, family members and acquaintances who died within the time frame that the Department of Health indicated for the acetyl fentanyl deaths. One, Threadgill’s cousin, died in a bathroom in Providence, shortly after being let of out jail. Another had been fighting addiction for most of her life. Her mother was an addict, as well.

But rather than reverse-engineering details of the story, Threadgill — who, himself, survived six overdoses before successfully finding treatment — wants to tell people about the systemic changes society needs.

“When are we gonna . . . accept the fact that alcohol and drug addiction is a disease?” he says. When are we going to start classifying addiction it like diabetes or tuberculosis? “Because it’s the same thing,” he says. “And it needs the same kind of treatment.” Addiction is the only disease we’re condemned for, he says.

Tim remembers using fentanyl during his time on the streets of Providence.

He once injected it with a circle of friends in a house in the city’s west end, he says. One by one, he saw each of them nod out after shooting it, yet he still lined up to take his hit. Another time, he shot up and blacked out almost immediately, falling unconscious on the side of a tractor-trailer on Cranston St. for more than 12 hours. He doesn’t remember the events of the days that followed. He still has the scar from where his cigarette burned his hand.

Nobody wants to live this kind of life, he says. The most recent victims, “they didn’t wake up one day and say, ‘Look, this is what I’m gonna do. For the rest of my life.’ That’s absurd.”

Fentanyl, specifically, he says, was something he would turn to when he was short on his usual supply.

“You scrape it off the [pharmaceutical] patch, you put it in the oven and it kinda just dries out,” he says, “And then you sell it, because it works similar.”

“If your supply is cut off and you have that demand,” he adds, “you fit that demand with whatever’s necessary.”

CORRECTION: An earlier version of this article misstated the date of the two most recent deaths attributed to acetyl fentayl by the Rhode Island Department of Health. It was May 26, not May 24.

Philip Eil can be reached at peil@phx.com. Follow him on Twitter @phileil.

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