Source | The Dallas Morning News
Lollipop drug for cancer patients can be a fatal high; abuse on rise …
A rare and expensive painkiller sometimes taken in the form of a lollipop contributed to the death of a 20-year-old Southern Methodist University student at his fraternity house earlier this month.
The Dallas County medical examiner has determined that Jacob Stiles, a sophomore economics and psychology major from Naperville, Ill., accidentally overdosed on a toxic mixture of cocaine, alcohol and the synthetic opiate fentanyl.
Fellow students found him unconscious the afternoon of Dec. 2 in his room at the Sigma Alpha Epsilon fraternity house.
In any form, fentanyl can be lethal if taken outside a prescription, experts say.
“People have died with needles in their arms,” said Kurt Klein- schmidt, an associate professor of emergency medicine at UT Southwestern Medical Center and a toxicologist with the North Texas Poison Center.
“What’s really nasty about fentanyl [is] it’s a more potent narcotic than heroin or morphine – up to 100 times,” Dr. Klein- schmidt said. “People can have overdoses and not know what they’ve gotten themselves into.”
Fentanyl has been linked in the last few years to hundreds of overdose deaths around the country, with hot spots arising in states such as Michigan, Florida and Illinois, where Mr. Stiles is from. While no rash of deaths has been reported in North Texas, Dallas police in the last month busted two employees at a doctor’s office on charges of forging prescriptions for $40,000 worth of the lollipops.
The lollipop form is designed for cancer patients who have trouble swallowing, although experts say more abusers prefer fentanyl patches. Some people apply more than one patch, while more hard-core users use a syringe to extract the drug from the patch.
Local, state and federal officials say that abuse of fentanyl is on the rise, but the fact that it is expensive and hard to get have kept it from spreading more quickly. Abuse is relatively rare, mostly because of the high cost – a lollipop might cost $30 to $40 on the street, while a rock of crack cocaine can sell for a few dollars.
Jeffrey Barnard, Dallas County’s chief medical examiner, said Wednesday that he didn’t know what form of the drug Mr. Stiles took or where he got it.
“We have no known history that he was prescribed fentanyl,” Dr. Barnard said. “His family didn’t return our calls, and his doctor in Illinois gave us no information.”
Mr. Stiles’ family could not be reached for comment.
His fraternity threw a large party off campus the night before Mr. Stiles was found unconscious, but SMU police have not released any information about his activities before the overdose or how he may have obtained or taken the drugs. SMU police did not return phone calls.
“We are deeply saddened by this news,” said Jim Caswell, SMU’s vice president for student affairs. He has no information of anyone else caught abusing fentanyl on campus.
“Our time and effort on drug and alcohol programs are geared constantly toward keeping our students well informed,” he said. “We don’t have our heads in the sand that there are drug and alcohol problems among young people.”
Insurer raises red flag
While Dallas police say they’ve not been overrun with cases of fentanyl abuse, the two recent arrests have put them on notice of the drug’s potential for abuse.
About a month ago, a health insurance company alerted Dallas police to some suspiciously large prescription orders billed to their company for Actiq, which is fentanyl in a berry-flavored lozenge attached to a stick.
Known by abusers as “perc-o-pops” or “lollipops,” they can plunge users into a stupor, severely slow breathing and lead to death.
Dallas police eventually traced the large Actiq order – more than 1,000 lollipops – to two workers at a doctor’s office. They were arrested on suspicion of prescription forgery.
Deputy Police Chief Julian Bernal, who heads the narcotics division, declined to name the employees or where they work because others are expected to be arrested and police do not want to tip off their associates.
Chief Bernal said that the employees used some of the lollipops themselves. “We’re still investigating how the rest were either used or distributed,” he said.
He said he had no information that the two are connected to Mr. Stiles. He said that other than the SMU student, he had heard of no local overdose deaths associated with illegal use of fentanyl.
“It’s extremely unusual to come across this product, because it’s very difficult to obtain, even with a prescription,” he said.
100 Detroit-area deaths
Nationally, fentanyl has been tied to hundreds of fatal and nonfatal overdoses on the East Coast and in the Midwest since late 2005, according to the U.S. Department of Justice. In those cases, fentanyl was produced illegally and often mixed with cocaine or, more often, in heroin in a combination known on the street as “magic.”
Detroit has emerged as ground zero of the growing problem. “Since over a year ago, we’ve had over 100 deaths here,” said Mark Greenwald, a researcher at Wayne State University who is studying fentanyl deaths in the Detroit area.
“To my knowledge, virtually all have been among individuals who have been identified as having a heroin abuse history.” And, Dr. Greenwald said, “Almost all of those deaths among heroin abusers are due to fentanyl that they obtained on the street.”
In 2004, there were an estimated 8,000 emergency-room visits for fentanyl overdoses, according to a survey by the federal Substance Abuse and Mental Health Services Administration. But that’s a fraction compared with other painkillers such as hydrocodone (42,491 visits), oxycodone (36,559 visits) and methadone (31,874 visits).
Rare so far in Texas
In Texas, fentanyl-related deaths are rare, according to Jane Carlisle Maxwell, a University of Texas researcher who compiles an annual report, “Substance Abuse Trends in Texas.”
“We’ve been lucky here,” Dr. Maxwell said. “It’s not the largest problem, but people need to be aware of it.”
Texas reported fentanyl-related deaths in the single digits each year from 1998 to 2001. In 2004, the state recorded 32 deaths, with the victims’ average age at 37. Preliminary figures for 2005 indicate 30 deaths, with an average age of 43.
“In comparison to Vicodin and those other drugs, fentanyl’s a pretty small part of the pie,” Dr. Maxwell said.
To date, little is known about fentanyl use among college students, according to Carol Boyd, a researcher at the University of Michigan Substance Abuse Research Center. Studies have found an increase in the last decade of college students abusing prescription pain medicine such as oxycodone, which includes the brand OxyContin, and hydrocodone, or Vicodin, she said.
One study by Dr. Boyd and her Michigan colleagues found that 7 percent of college students reported nonmedical use of prescription pain relievers in the last year. College students who were white, lived in fraternity or sorority houses, were at more competitive colleges and had lower grade-point averages tended to report greater use. The study said results show that prescription drug abuse “represents a problem on college campuses.”
Research also shows that college students who take those drugs for nonmedical uses tended to use alcohol at the same time.
Dr. Caswell said that SMU takes a tough stance when students are caught using illegal drugs.
“We have suspended students on our campus for use of cocaine,” he said. “We have a two-strike approach for marijuana. We work very hard to inform our students about what the consequences are for this behavior. Some students come here with these problems.”
He said that no sanctions are planned for the local Sigma Alpha Epsilon fraternity.
“We believe this is isolated and not a chapter-wide problem,” Dr. Caswell said. “It’s resolved to our satisfaction.”
A spokesman at the SAE national office in Chicago said the office’s inquiry into Mr. Stiles death, conducted in concert with an insurance investigator, is continuing. Preliminarily, they do not believe the chapter is involved.
“If the situation were that it was a chapter-wide activity, there would be that possibility” of reprimand, said Tim Samp, an SAE spokesman in Chicago.
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