Fentanyl-cocaine combo taking lives in Western Pa.
A deadly blend of cocaine and the powerful opioid fentanyl is appearing on Western Pennsylvania streets and autopsy tables, according to police, coroners and other experts.
The combination is a modern “speedball,” with stimulant and depressant drugs like the stuff that killed actor John Belushi in 1982 and thousands of others, said a UPMC addiction medicine specialist, Dr. Antoine Douaihy.
The mix killed a Cowanshannock Township man in his 30s in January, for example, Armstrong County Coroner Brian K. Myers said.
Westmoreland County Deputy Coroner Joshua C. Zappone said the two drugs increasingly were present in deaths investigated over the past two years.
Eleven people died with cocaine in their systems in 2015, and there were only two cases in which fentanyl also was present, Zappone said.
By 2017, autopsies showed 48 people with cocaine in their system — and 40 of them also had taken in fentanyl.
“The amount of cocaine-related deaths dramatically began to increase in 2016, and most likely due to the start of fentanyl being mixed with it,” Zappone said.
People have used cocaine for decades in Westmoreland County, Zappone said, “and there were never the amount of deaths that we have seen in the last two years.”
The problem has become so serious, Douaihy said, that doctors tell cocaine users to carry naloxone, a prescription treatment for opioid overdoses commonly sold under the brand name Narcan.
Fentanyl powder can't be detected in powdered cocaine just by looking at it, he said.
“This is a matter of life and death,” Douaihy said.
‘Speedballing on steroids'
Dr. Tony Campbell of the Substance Abuse and Mental Health Services Administration, part of the federal Health and Human Services department, called the cocaine and fentanyl mix “speedballing on steroids.”
“The cocaine gives a high, and then it wears off, and users have nothing there but fentanyl,” Campbell said. Unless they are treated, they stop breathing and die.
Two types of people appear to be using the drug mix: Those with a tolerance for opioids who need to get high and are willing to risk overdosing; and those who shun fentanyl but don't know it's in the cocaine they bought, experts say.
Dr. Neil Capretto, a Vandergrift native and medical director of the Gateway Rehabilitation Center addiction recovery network, said opioid addicts who are tolerant to the drugs still may take them so they don't get sick, “but with high dosages, they nod off or fall asleep.”
Adding a stimulant such as cocaine releases the internal body chemical dopamine, which “can be pleasurable, and they can stay awake” longer, Capretto said.
But when the cocaine wears off, the body must deal with the fentanyl — 100 times more potent than morphine, and 50 times more potent than heroin.
The cocaine causes a heart attack or stroke, or the painkiller stops the person's breathing, he said.
The U.S. Drug Enforcement Agency in January published a report warning about the risk of mixing of cocaine and fentanyl.
Fentanyl surpasses coke as killer
Cocaine, as a powder or in small crystals known as crack, was the leading killer drug in Pennsylvania until 2002.
After that year, heroin and then synthetic opioids such as fentanyl jumped to the top of the list.
Cocaine didn't disappear, though, and since 2016 there is evidence that drug traffickers have been pushing more and more of it, DEA Special Agent Patrick J. Trainor said.
“In 2013, fentanyl didn't even make the list” of drugs killing people in Allegheny County, county Medical Examiner Dr. Karl Williams said.
According to the website OverdoseFreePA and county data, only 3 percent of Allegheny County coroner's cases in 2013 involved fentanyl.
The figure jumped to 21 percent the following year, and to 65 percent in 2015.
In 2016, almost 70 percent of cases involved fentanyl, and by 2017 the number jumped again to almost 80 percent.
“Either cocaine or fentanyl has a good chance of killing you,” Williams said. “You would have to ask the junkies why they choose (the mix). But more likely is they never really know what they are getting from their dealer.”
Dr. Michael J. Lynch, medical director of the Pittsburgh Poison Center, said area emergency rooms treat opioid or cocaine overdoses based on a patient's symptoms.
Sometimes, cocaine is laced with fentanyl and users are unaware of it, he said.
“We have seen some cases where people thought they were only using cocaine and they wound up being treated for opioid overdose symptoms.
“One man was adamant that he'd only used cocaine” but he had an opioid OD, Lynch said.
The man was treated with Narcan and survived.
Other deadly drugs lurk
Other drug threats haven't disappeared.
“We're unfortunately seeing an increase in cocaine and crystal methamphetamine trafficking, especially in rural Pennsylvania, and we are stepping up our efforts,” state Attorney General Josh Shapiro said. Crystal meth also is a stimulant.
Allegheny County police Lt. Jeffrey W. Korczyk said narcotics and pills are still the most misused drugs in the county.
The crack form of cocaine “is making a comeback, and crack with fentanyl is out there,” said VonZell Wade, co-founder of Lost Dreams Awakening, a drug recovery center in New Kensington.
Wade also is clinical director of Spirit Life Inc., an inpatient drug rehabilitation center with a 14-bed detoxification unit and a 30-bed rehabilitation facility.
Westmoreland County Detective Tony Marcocci said cocaine and crystal meth sales appear to have increased in the past year.
Armstrong County Detective Frank Pitzer also said there is an “incredible increase” in cocaine being sold there.