Doctored pain pills provide new twist in Sacramento’s opioid epidemic

It’s the development that public health officials and medical providers dreaded, but with a twist: With the nation gripped by a metastasizing opioid epidemic, 12 overdoses flooded Sacramento County emergency rooms in a two-day span last week.

The suspected culprit is a synthetic palliative drug named fentanyl, which is 80 times stronger than morphine and hundreds of times more powerful than heroin, and is increasingly laced with the latter, say harm-reduction specialists. But instead of people coming in blue-faced and unresponsive from fentanyl-laced black tar heroin, this was believed to be something relatively new: fentanyl doctored to look like Norco pain pills and packing a devastating punch.

“This is the first time I’ve heard of anything like this,” said county spokeswoman Laura McCasland, who has worked with the public health sector since 2004.

“Fentanyl has been on the radar. The pill form, especially masked as Norcos, we haven’t heard of as much,” added Melinda Ruger, executive director of Harm Reduction Services in Oak Park, which provides addiction services to users around the region, including clean syringes and the overdose-reversing antidote Narcan. “That’s pretty new to us. Whereas hearing about it in the black tar, we’ve heard of that for a while.”

On Tuesday, county officials raised the number of suspected overdoses to 28 victims, six of whom have died, though McCasland cautioned that the official causes of death pended toxicology exams. “The information is still coming in,” she said.

But officials do know a few things.

The first overdose was diagnosed March 24, McCasland says. The county was alerted a day later by the California Poison Control Center. The sheriff’s department was notified late that Friday afternoon, according to spokesman Sgt. Tony Turnbull. He said an investigator has interviewed Public Health Officer Dr. Olivia Kasirye, but that the investigation remains in the early stages.

“It will take time to compile information from all parties involved,” he emailed on Monday. “It is too early to tell the source of the bad supply.”

Whether the overdoses originated from one bad batch or several sources isn’t known. Officials also haven’t determined whether any of the tablets contained Norco.

At least some recovered pills tested positive for fentanyl, a fast-acting synthetic opiate that is odorless and commonly administered for end-of-life pain management. “These were not prescribed pills,” McCasland said, noting that the tablets look to have been procured from strangers, friends and neighbors of the victims.

Victims included men and women, with their ages ranging between 24 and 59. “It’s pretty scary how many people from how many age groups were affected,” McCasland said. “We’re looking at a very wide population from all walks of life.”

That makes it trickier to target outreach efforts, she added, one of the goals of the county’s new Opioid Task Force, which started meeting in February and convened last week. The task force operates under the county’s Department of Health and Human Services. Its stakeholders include harm-reduction specialists, law enforcement, school officials and behavioral health providers, among others. “Many, many organizations have asked to be part of this,” McCasland said.

Ruger is a member as well, and sits on its overdose prevention subcommittee. Since February 2014, HRS has provided its clients with free doses of Narcan, an opioid antidote that has reversed 139 overdoses in less than two years.

According to her organization’s tracking, the largest proportion of opiate users first tried the drugs by ingesting them, and between the ages of 14 and 17.

Opioid-related deaths in Sacramento County rose 83 percent between 2011 and 2013, according to the California Department of Health.

But Ruger and her outreach workers are seeing an even quicker spread of opioid use in neighboring suburbs without programs like hers. “The greatest areas of growth that we’re seeing is Rocklin, Roseville [and] El Dorado County,” she said. “That’s where we’re seeing the steady increase.”