Emergency crews from the Lexington Division of Fire responded to four calls last month about individuals who overdosed on heroin. Firefighters were able to save three of the four by giving them a shot of Naloxone, also known as Narcan, an antidote that can reverse the effects of opiate drug overdoses. The fourth person died, said Public Safety Commissioner Clay Mason.
More often firefighters are responding to calls about overdoses, and Narcan shots are being administered — and saving lives.
Last year, Lexington Division of Fire Battalion Chief Brian Wood said the department administered 843 Narcan shots, which are used to reverse an overdose. The department operates on an unconscious/unknown protocol allowing emergency crews to give the shot to those who are passed out. The number of heroin related cases were unknown, but Woods thinks at least 90 percent of the 843 shots were heroin-related.
Still, Lexington's battle with heroin overdoses persists, and officials are concerned about the potency that is on Lexington streets.
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"We picked up some young adults in affluent neighbors and others in the street," Wood said. "It appears that (heroin) may be more fatal ... You don't know what you're taking."
Wood said dealers have started to lace the drug with fentanyl, a powerful synthetic opiate. He said he has not seen the enhanced heroin in Lexington, but doesn't doubt it has made a toe-hold in the city.
The Associated Press reported last month that 80 people had died across the country in recent weeks after injecting heroin laced with fentanyl, a narcotic that is typically administered to people in chronic pain, including end-stage cancer patients.
Fentanyl is also used as an anesthetic. It is considered 80 times more powerful than morphine and can kill by inhibiting breathing.
Fayette County Coroner Gary Ginn said his office tests for fentanyl among other abusive drugs. But, so far, he has only seen the drug in prescription medicine.
"When you have something that's unknown it's like Russian roulette," Ginn said. "When someone buys (heroin) they don't know the purity of it. They don't know if it's been mixed with something; they have no idea. But with pills, especially prescription, they know exactly what they're taking. It's in dosages."
Mason agreed: He said when heroin users buy the drug, many are unaware of how pure it is, because it changes from dealer to dealer.
Mason said the city is dealing with a purity count between 50 and 60. The purer it is, the stronger — and more deadly — it is.
The city finished 2013 with 44 heroin related deaths, according to statistics from Ginn.
There have been three heroin overdose deaths in the first two months of 2014. That's a slower pace than last year when there were nine heroin-related deaths this same time of year. But Ginn said they are awaiting testing results for eight to 10 deaths that could also be heroin-related.
In the first six months of 2013, there were 28 heroin overdose deaths in Lexington, six more than in all of 2012 and more than five times as many as two years ago.
Mason said much of the city's heroin is being transported down the I-75 corridor, but he's unsure of where the drugs are coming from before they hit the highway.
"It's something that's not going away," he said of heroin overdoses. "We're seeing volumes of heroin coming into the community."
The resurgence of the dangerous street drug, which rose to prominence in the 1970s, began significantly increasing in Fayette County in 2012. But overdose deaths have been noticed since 2007.
There were no heroin deaths in Lexington from 2002 to 2006, and there was one in 2007, according to figures from officials. There were one to five heroin overdose deaths each year until 2012, when there were 22.
The excessive usage of heroin in the city came after Kentucky's ability to crack down on the abuse of painkillers with House Bill 1 that was passed a few years ago. The bill placed greater restrictions on access to prescription opioid medicines. When the pills became harder to get and therefore more expensive on the street, addicts turned to heroin as their drug of choice, officials have said.
The vast majority of people who were addicted to prescription drugs are now looking for opiates.
"With any type of addiction, they're going to do what they can do to get that high," said Kentucky State Police spokesman Paul Blanton. He praised legislators for tougher laws governing prescription pills but said, "the people with the illegal prescription pills are also selling the heroin."
Blanton said for years the problem for addicts was the availability of prescription pills, and now pills are harder to buy, so they're switching over to heroin.
Heroin, which is generally snorted, smoked or injected, comes in three different colors — black, white and beige — and is cheaper than prescription pills. Mason said Lexington has seen the use of white powder — the purest form.
A single 80 milligram pill of the painkiller Oxycontin can sell for $80 to $100. With heroin, dealers sell one-tenth of a gram, Mason said. A bag generally costs $9 or $10.
As heroin passes through drug dealers on the street, they "cut it" — crushing up an additive, like vitamins, and mixing it with the heroin to dilute it. This makes the product weaker and gives the dealer more to sell.
About a week ago the Kentucky Injury Prevention and Research Center at the University of Kentucky of Public Health released a report that showed a decrease in prescription pill overdoses and emergency room visits but a huge increase in heroin overdoses from 2011 to 2012. There were 1,031 overdose deaths in 2012 and 6,496 overdose emergency visits compared to 1,022 and 6,492 in 2011. Pharmaceutical opioids remained the primary cause of overdose deaths.
The same report attributed benzodiazepines for the primary cause for emergency department visits and hospitalizations in 2012, but decreased from 939 in 2011 to 856 in 2012. Heroin overdoses skyrocketed in 2012 with 129, up from the 42 heroin-related deaths recorded in 2011.
Last year, officials formed a task force to devise a strategy to overcome the punishing blows that heroin has laid on the city. Then, the task force reported heroin-related arrests were up 57 percent over all of 2012. There were 160 arrests from Jan. 1 through July 11, 2013, compared to 102 for 2012 and 8 in 2011.
Mason said the task force hopes to update the city on its recent findings next month.
Lexington police spokeswoman Sherelle Roberts said police have teamed up with the community, Drug Free Lex and other organizations to fight the heroin epidemic.
"I think what we're doing different is the education we're doing on heroin," she said.