A Butler County deputy responded this month to a scene where five victims had overdosed unknowingly on suspected fentanyl. There were so many victims, deputies had to use their own patrol cars, as well as a responding ambulance, to get the individuals to the hospital for emergency care.
It’s an incident that only highlights a pandemic-proportion problem law enforcement report they are facing.
“There’s been an increase in the last few years with overdoses. Oftentimes, there’s overdoses that don’t result in death, but also an alarming amount of it does result in death.”
The words of Butler County Sheriff Mark Dobbs echo research published in “Missouri Medicine, the Journal of the Missouri State Medical Association,” which found Missourians are dying of fentanyl poisoning at an unprecedented rate, with dramatic increases in rural and western counties. The publication also highlighted a growing trend to the surge in fentanyl fatalities: Missouri is experiencing a pandemic of counterfeit pills.
“We’ve had cases of fatal overdoses where people were taking what they believe to be (illegal) prescription drugs and sometimes they’re actually counterfeit drugs that contain fentanyl,” Dobbs explained.
Fake pills are often labeled with brand names like alprazolam or oxycodone but may contain only fentanyl at lethal levels. With counterfeit pills being purchased via social media, dealers deliver fentanyl to virtually any town in the state. Seeking an easy and quick high or relief of minor pain and anxiety, the victim takes the pill and experiences an unpredictable level of respiratory depression, sometimes with no possibility of reversing a fatal dose.
“We’ve had actual cases we’ve made where that’s happened, where people have taken what they thought was Oxycontin, and then met their demise because of that,” Dobbs continued.
He stressed the importance of knowing where one’s medications come from.
“I wouldn’t even suggest these days getting an aspirin from an unknown source, because you don’t know what you’re getting, what you’re taking,” he said.
Close to home
Fentanyl is also being mixed with opioids and even methamphetamine. Lt. Derek House of the Butler County Sheriff’s Department saw the aftermath of this firsthand while responding to a scene on Feb. 12. Five overdose victims were discovered in a house on Oakmoore Drive in Poplar Bluff. Their catatonia and respiratory distress — both symptoms of an opioid overdose — were so severe the neighbor who found them thought they were dead.
“They were turning gray, blue, purple... They looked dead when we got there,” House said.
Deputies administered all the Narcan they had and called an ambulance. Only one was available to respond, House recalled, so deputies loaded the remaining victims into their patrol cars and rushed them to the hospital.
“Between the three of us and the one ambulance, we just hauled them out as fast as we could to the hospital. And then luckily, that was enough to save all of them,” he said.
When they regained consciousness, the victims all said they were at a party and had no idea they had consumed fentanyl.
“Everybody was under the impression that they were doing cocaine, when in fact they snorted a bunch of fentanyl,” House explained.
‘A grain of rice’
Fentanyl abuse also “doesn’t necessarily follow cultural or economic boundary lines,” according to Dobbs. And aside from its growing ubiquity, it is dangerous in large part because it is extremely potent.
According to Ohio State University’s Wexner Medical Center, it is 50-100 times stronger than morphine. Lethal doses are measured in micrograms.
“An effective kill dosage can be as small as a grain of rice,” House explained.
It also tends to mix unevenly with other substances, so substances cut with fentanyl can have drastically different effects on different users, he went on.
Dobbs added while many people consume it unknowingly, others deliberately seek out fentanyl when their bodies become accustomed to other opioids.
“Typical heroin doesn’t suffice for them getting high anymore, so they resort to fentanyl,” he said.
Narcan saves victims, responders
The death total would be much higher if not for a record number of naloxone antidote doses — also called Narcan — distributed in the state. In St. Louis, an intense naloxone delivery effort led by the University of Missouri-St. Louis Addiction Science team resulted in a reduction in the number of opioid deaths in St. Louis City, the first such decline in years.
In Butler County, Narcan is now available freely and anonymously through vending machines at the Butler County Health Department, and all first responders now carry it.
Narcan is sprayed up the nasal cavity and blocks the opioid receptors in the brain, temporarily reversing an overdose and buying time for help to arrive. Dobbs has seen it save the lives of victims. It also protects first responders who arrive on scenes where fentanyl particles could be anywhere.
“Even people who use fentanyl have to build up a tolerance to it by using heroin or prescription drugs,” Dobbs said. “Somebody who doesn’t have any kind of tolerance (who) absorbs it either through their skin or inhales a particulate of it... Their body’s totally ill-equipped to handle that, and that can kill you very easily.”
This is why officers carry additional Narcan specifically to administer to each other if necessary.
“We don’t know what our surroundings are going to entail. We don’t know the exact location of those drugs. But we do know that there are people in there that need help. And so that’s our first and foremost objective is to get them out, get them safe, get them somewhere, and then just hope that we haven’t had any type of secondary exposure,” House explained.
Statistics made personal
As the fentanyl epidemic continues, so will the deadly impact on communities.
“Drug overdoses, both fatal and nonfatal, have become an epidemic in Missouri over the past decade. Missouri ranked 32nd among all states and DC for drug overdose death rates in 2020 and is the #1 leading cause of death among adults age 18-44 in Missouri,” stated a report on the Missouri Department of Health and Senior Services website.
Statewide in 2021, MO DHSS reported 1,493 non-heroin overdose deaths, a rise of more than 200 from 2020. In the same period for Butler County, 22 overdose deaths, 12 of which were due to non-heroin opioids.
“There’s not very many people in our county that doesn’t know somebody that has died of a fentanyl overdose,” House said.
Wider regional findings from MO DHSS are available at health.mo.gov/data/opioids/.
This article features content from William V. Stocker, MD; Colin L. Smith, BS; and Elizabeth Connors, MSW from the article, “Missouri’s Fentanyl Poisonings Rise to Record Levels - Part I.”
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