Battling an Epidemic - Part One: Fentanyl, similar powerful opioids are on the rise in Iowa
A Catastrophic Mixture
IOWA CITY — In autumn 2016, Rod Courtney had a long conversation with his son, Chad.
Chad was on his way home from a 28-day drug treatment program. He was an artistic guy who loved to write music and poetry and in high school dreamed of becoming an Eagle Scout.
But as a teenager Chad started experimenting with alcohol and marijuana. As he grew older, he was in and out of treatment and in and out of prison for multiple drunken driving convictions and parole violations.
But on that day in 2016, Chad told his dad he was focused on getting better.
"He said, 'Dad, I just want to get clean and do what's right and make a difference and help other people," recalls Rod Courtney, a parole and probation officer with the 6th Judicial District.
A month later, Chad was dead.
A few years earlier, Chad had been working a construction job. He injured his shoulder and was placed on an opiate-based medication. Given opiate's addictive nature and Chad's history, his dad asked him if that was a good idea. Chad told his father he could handle it.
"That was ... the beginning of the end for Chad," Courtney recalled.
What followed was an "almost textbook" transition from medication to harder drugs. Chad's prescription ran out and he began to doctor-shop, trying to find one who would write him a prescription for more painkillers.
When that didn't work, he got medications on the street. And when those options dried up, Chad turned to heroin.
"He probably used heroin earlier" in his life, Courtney said. "The last two years (before he died), that was the focus of his substance use disorder."
From there, Chad's heroin abuse "grew and grew and blossomed," until he was using just to avoid withdrawal symptoms, his father said. He held down temporary jobs and was able to hide his abuse from his wife and two daughters.
That changed Nov. 1, 2016. Chad, 38, bought what he thought was heroin and — while his dinner waited at his table in his Iowa City home — he shot up at a fast-food restaurant in Iowa City and overdosed. 911 was called and first responders administered Narcan — a drug that combats the effects of opioids — and Chad was taken to the University of Iowa Hospitals and Clinics, where he died.
"The autopsy later showed what Chad had used that evening was indeed not heroin, it was fentanyl," Courtney said. "It was 100 percent fentanyl. It wasn't cut. My belief is he did not know when he dosed that day."
More fentanyl than heroin
An opioid such as heroin or morphine, fentanyl is a painkiller 100 times stronger than heroin and, thus, considerably more lethal. Drug dealers will cut — or mix — fentanyl with heroin to make it more potent and attractive to users chasing a high.
Statistics from the Iowa Division of Criminal Investigation crime lab, fentanyl and fentanyl analogues increasingly are more common in Iowa. And data from local medical examiners show that people in the this part of the state are dying from these substances.
"We're actually seeing a lot more fentanyl lately than heroin," said Al Fear, a Cedar Rapids police officer assigned to the Eastern Iowa Heroin Initiative, a federally funded opioid task force.
"If you look at the stats from the crime lab in Des Moines, over the last three years ..., it's really morphed into this catastrophic mixture of all these different drugs."
"The battle against this is becoming more and more difficult because they're adding more and more mixtures of different substances to create more potency and causing more damage, more deaths."
According to DCI crime lab statistics, since 2015:
• The total number of heroin cases submitted to the lab have increased from 175 to 306 in 2017
• The number of heroin-fentanyl mixture cases have increased from 21 to 120.
• Fentanyl-only cases have jumped from one case involving fentanyl reside and two cases involving fentanyl patches in 2015 to 24 fentanyl only cases in 2017.
• There were no cases of fentanyl being mixed with other substances in 2015, but in 2017 there were 85 such cases.
In 2017, the crime lab analyzed a multitude of other cases involving fentanyl analogues, including acryl fentanyl, acetyl fentanyl and cyclopropyl fentanyl. There also were three cases of pure carfentanil and two cases of carfentanil in a mixture.
"Ten years ago, we didn't see very many heroin cases at all," said Bruce Reeve, the DCI lab administrator. "Just in general, we’re seeing a lot more cases. Not nearly as methamphetamine, but they definitely have been on the uptick. That’s concerning."
'No quality control'
Known as "the elephant tranquilizer," carfentanil is 10,000 times more potent than heroin, Fear said.
"If you look at a standard penny, you put enough carfentanil to fill the ear of Lincoln, that's enough to be lethal," he said.
Citing information from the Drug Enforcement Administration, Cedar Rapids police Sgt. Robert Collins, who oversees the department's narcotics unit, said fentanyl found in heroin and used illegally is being synthesized in China and smuggled into the United States. The risk to heroin users is when they buy a dose from their dealer, they don't know what they're getting — heroin, a heroin-fentanyl mixture or, as in Chad's case, pure fentanyl.
"There's no quality control, so to speak," Collins said. "Not like alcohol."
And that's a "big part" of why opioid users are overdosing, Collins said. According to the Linn County Medical Examiner's Office, there were 28 fatal overdoses in 2017, 19 of which involved opioids. Of those, six involved fentanyl or a fentanyl analogue.
There were 13 opioid-related deaths in Johnson County in 2017, according to the Johnson County Medical Examiner's Office. Fentanyl was present in four deaths, while acrylfentanyl was present in one death.
Statewide, opioids caused 99 overdose deaths in 2017, according to provisional data from the Iowa Department of Public Health. Heroin was the cause of 30 of those deaths.
In addition, there were 202 deaths last year in which opioids were a contributing factor, 59 of which were heroin-related.
The 202 opioid-related deaths is a record in Iowa. In 2000, there were fewer than 50.
"It's concern because what we've seen nationally (with the opioid epidemic), we're now seeing in Iowa," said Dale Woolery, associate director of the Governor's Office of Drug Control Policy.
Over the edge
While the potency and lethality of street opioids continues to grow, that does not appear to be deterring users. Rather, a powerful — even deadly — mix actually can be attractive to opioid addicts, Fear said.
"They're looking for the drug that takes them closest to the edge," he said. "Once they get the high they're looking for, your body will never allow you to reach that high again."
"However, if a drug dealer makes something that's more potent, it will take them over the edge. More than likely, it will push them over the edge to death."
"For a drug dealer, the more potent, the better the sales," Fear added. "They have the claim they have the best stuff on the street because it's the most potent."
Heroin continues to be an enforcement priority for police in the Corridor. According to statistics provided by the Cedar Rapids Police Department, there were 41 heroin-related arrests in 2017, up from 31 the year before. But Collins — the Cedar Rapids police sergeant — said heroin can lead to other crimes such as prostitution, burglaries and violence.
"Because of all that, we're going to put a lot of focus on it," Collins said.
Among the cases in 2017, two people were charged with state-level heroin delivery charges and three were charged with federal heroin delivery charges. One of those cases involved Cordero Seals, a Cedar Rapids heroin and fentanyl dealer who was sentenced to 30 years in federal prison for distributing fentanyl-laced heroin that caused a non-fatal overdose in April 2017.
While the Iowa City Police Department doesn't have heroin-specific arrest totals, Iowa City Police Lt. Zach Diersen, head of the department's investigations unit and a former street crimes detective, is confident heroin is on the rise in the city.
"Over the course of the last four to five years, we've seen more heroin than I've ever seen in my career," he said. "When I first came to Iowa City (in 2002), I spent a lot of my career working on street crimes. When I first came here, if we saw heroin once or twice a year, that was a big deal."
"Maybe we'd seize half a gram or it or a gram of it a year. A couple of grams would be a big deal."
Compare that to recent seizure totals from the Johnson County Drug Task Force, which typically handles heroin cases in the county. Diersen said there were 142.86 grams of heroin seized in 2015, the result of taking down "a pretty good kingpin." In 2016, there were only 41 grams of heroin seized. But last year, task force officers seized 101.39 grams of heroin.
"It's been ramping up," Diersen said.
When you're the parent of someone with a substance abuse disorder, you spend a lot of time fighting that disease, Courtney said.
"When Chad died, ... I couldn't leave the fight," he said.
In early 2017, just month's after Chad's death, Rod and his wife, Debbie, attended their first meeting of CRUSH — Community Resources United to Stop Heroin. Founded by Fear and with chapters in Linn, Johnson, Black Hawk, Dubuque and Clinton counties — and more on the way — CRUSH is a community-based organization for victims of opioid addiction with a mission to educate communities about the opioid crisis.
Not long after attending his first meeting, Courtney became the coordinator and facilitator for the CRUSH groups in Linn and Johnson counties. When he retires in August, Courtney said CRUSH will become his "semiretirement gig."
Courtney said CRUSH has given him "purpose." He thinks back to Chad and their last long conversation about making a difference.
"I really see my involvement in CRUSH as doing that with Chad," he said. "He is making a difference today and has made a difference."
Where to go for help
Need help or support? CRUSH meetings in are held in Linn County from 6-7:30 p.m. on the first and third Wednesday of each month at Mission of Hope, 1700 B Ave., NE in Cedar Rapids.
Johnson County CRUSH meetings take place from 6-7:30 p.m. on the third Monday of the month at Prelude Behavioral Services, 430 Southgate Ave., Iowa City.
• Heroin — A highly addictive narcotic derived from morphine.
• Fentanyl — A synthetic opioid analgesic similar to — but 50 to 100 times more potent than — morphine. It is used to treat severe or chronic pain. It can be mixed with or substituted for heroin.
• Carfentanil — A fentanyl analogue 10,000 times more powerful than morphine and 100 times more potent than heroin and used to tranquilize large animals. It can be mixed with heroin.
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