Diplomatic agreement with China could help stem opioid deaths in Western Pennsylvania

People fighting the explosion of synthetic opiate deaths hope a diplomatic agreement may at least temporarily stem production of illegal fentanyl.

Last month, China agreed to crack down on illicit exports to the U.S. of four types of fentanyl, the powerful synthetic painkiller that officials blame for many of the overdose deaths in the Alle-Kiski Valley, said David Battiste, assistant special agent in charge with the federal Drug Enforcement Administration in Pittsburgh.

In fact, of the hundreds of drug overdose deaths across the Alle-Kiski Valley's four counties in each of recent years, traces of fentanyl have been found in at least 20 percent of the cases — up to nearly 70 percent — according to figures from OverdoseFreePA.

And Battiste expects that when 2016 Allegheny County drug death statistics are officially released, about 80 per‑cent will include some type of heroin-fentanyl mixture.

Fentanyl is a drug designed to curb extreme pain. It's used in hospitals and even on battlefields.

But the illegal fentanyl has little in common with the legitimate drug when it comes to quality control when it is made.

In this region, 2 milligrams of illegal fentanyl sells for $8 to $10 a packet on the street — a little more than heroin, which sometimes sells for $5 a packet, Battiste said.

But, he said, fentanyl is a popular mix for street drug makers because it's much cheaper to make than heroin.

A lethal substitute

“Things are getting worse,” said Neil Capretto, medical director of Gateway Rehabilitation Center. “People getting treatment are more desperate. Two years ago, only one in 10 addicts had an overdose requiring Narcan. In just the last two to three months, three out of four know someone who has died.”

Most were taking what they thought to be heroin, but many wound up with the much stronger fentanyl.

“You never know what's in a stamp bag,” said Capretto, referring to the small packets in which heroin is commonly sold.

Westmoreland County Coroner Ken Bacha sees it in his cases, which are breaking records every year: “We're seeing so many (fentanyl deaths) without heroin.”

Fentanyl is so powerful, Capretto said, “I'm told some people are (passing) out before the needle is out of their arm.”

From China to Mexico to Valley

Illegal fentanyl sold on A-K Valley streets is mostly shipped from China to Mexican cartels that routinely distribute heroin and fentanyl and other illegal drugs in the United States, according to DEA Special Agent Russ Baer in Washington, D.C.

Some of the fentanyl compounds are shipped directly from China in the mail, he said.

U.S. Postal Inspector spokeswoman Tammy Mayle said she couldn't comment about ongoing investigations.

Already this year, Butler County has recorded drug deaths attributed to all four of the types of fentanyl covered by the Chinese crackdown, according to Butler County Coroner Bill Young. The county has 10 confirmed drug deaths so far.

“Most have been fentanyl without heroin,” Young said.

Young is hopeful that the China agreement will succeed.

“When it starts there, it has to stop there,” he said.

“If the Chinese do this, it would have a major impact,” said Allegheny County Medical Examiner Karl Williams.

State Physician General Dr. Rachel Levine told the Tribune-Review she's hopeful that action in China will make a big difference here.

Illicit fentanyl is found across the state but it appears to be surfacing more in Western Pennsylvania, Levine said.

“The Chinese agreement may have a temporary impact, but (a warm handoff) is needed,” Capretto said.

Levine also is encouraging the establishment of a “warm handoff” of overdose patients — taking them from emergency rooms to treatment facilities immediately to improve chances that drug rehab will succeed.

Mexican trade strong here, too

Capretto worries that the Sinaloa Mexican cartel might restart making fentanyl if the Chinese supply dries up.

The DEA's 2016 National Drug Threat Assessment says the Sinaloa and Los Caballaros Templarious cartels apparently do the most business in Western Pennsylvania. Sinaloa is thought to be shipping increasing amounts fentanyl into this area. The Sinaloa cartel has been led by Joaquin “El Chapo” Guzman, who is in a U.S. federal prison.

Baer agreed that the cartel might reopen a drug plant in Juarez, Mexico, unless Mexican authorities step in. Juarez is controlled by the Juarez cartel.

Smaller amounts worth more, tougher to track

Carfentanyl, which has caused three deaths in the Tri-State, is a related drug used as a painkiller for elephants and is 10,000 times stronger than morphine, according to the DEA.

DEA Special Agent Pat Trainor, based in Philadelphia, said half a gram of carfentanyl — a tiny amount — sells for about $75 in this region.

So just a teaspoon of carfentanyl is worth a minimum of $100,000 on the streets.

The minute amounts needed makes it tougher to bust drug traffickers bringing it into the United STates, Battiste and Trainor said.

It's not like the usually large amounts — pounds of cocaine or marijuana — that are smuggled and much easier to find, Trainor said.

Chuck Biedka is a Tribune-Review staff writer. Reach him at 724-226-4711 or cbiedka@tribweb.com.