Jamie Landrum has been a police officer for two years in District 3 on the west side of Cincinnati. In late August, the city was hit by 174 overdoses in six days. Landrum says officers were scarce.
鈥淲e were literally going from one heroin overdose, and then being on that one, and hearing someone come over [the radio] and say, 鈥業 have no more officers left,鈥� 鈥� Landrum said. Three more people overdosed soon after that.
Heroin isn鈥檛 new in Cincinnati, but聽聽in overdoses is being blamed on an even more potent drug called carfentanil. It鈥檚 100 times stronger than fentanyl, a more common synthetic opioid that is itself much stronger than heroin. Carfentanil is used to sedate elephants. It can be dangerous to even touch it without gloves.
City and county agencies in the Cincinnati area 鈥� from law enforcement to the county coroner 鈥� are straining to respond to the carfentanil wave.
Carfentanil is part of a shift to synthetic opioids in Cincinnati and around the country. Last year in Hamilton County, Ohio, there were聽聽attributed to fentanyl than to heroin.
Suspected carfentanil cases were first reported in the U.S. in July in Ohio. The rate of overdoses has dropped since that shocking 174 in six days, but not by much. There are currently 20 to 25 overdoses a day, on average, reports Hamilton County鈥檚 heroin task force. Police are calling it the new normal.
About an hour into a recent shift, Officer Landrum gets a call. A man has overdosed at an apartment building on the outskirts of town. His girlfriend found him and called 911.
By the time we get there, there鈥檚 a crowd outside. The man is unconscious in the back of the ambulance, and EMTs have given him three doses of Narcan, an antidote for opioid overdose. For a heroin overdose, one round of Narcan is usually enough.
EMTs clap and shout his name, trying to wake him up, but something鈥檚 wrong. They turn off the music blaring in the ambulance and continue working. After a few minutes, Officer Landrum gives me an update.
鈥淭his is the most I鈥檝e ever seen,鈥� she said. 鈥淗e鈥檚 gotten four Narcans so far, and he鈥檚 still not awake.鈥�
The EMTs decide to take him to the hospital. We follow, not knowing if the man will make it. 鈥淲hatever he got ahold of, it鈥檚 really bad,鈥� Landrum said.
For first responders, the arrival of carfentanil can be summed up with one word: More. More overdoses, more Narcan, more time spent on each call.
And when the efforts to save someone鈥檚 life fail, more work gets passed on to the Hamilton County Coroner鈥檚 Office.
鈥淭he caseload keeps getting larger and larger,鈥� said聽Bob Topmiller, who heads the toxicology section at the coroner鈥檚 office, where they test blood and urine. 鈥淲e may have had a 100- or 150-case backlog a year ago, and it鈥檚 almost doubled.鈥� The time it takes to process a sample has also doubled, from one month to two.
Evidence of the deluge is all over the lab: Equipment spills into the hallways, envelopes cover the intake desk and everyone seems to be busy.
And it鈥檚 more than the number of cases causing the flurry of activity. It鈥檚 the fact that the drug was never meant for people.
鈥淚t鈥檚 what we don鈥檛 know about this drug that scares us,鈥� said聽Dr. Lakshmi Sammarco, the coroner for Hamilton County. 鈥淲e don鈥檛 have any human testing data. We don鈥檛 know what the lethal level really is. There is no therapeutic level 鈥� it鈥檚 not meant for human use.鈥�
That means Sammarco鈥檚 team is using the samples coming in to try to extrapolate some important information, like the lethal dose per kilogram of body weight, or how long carfentanil stays in someone鈥檚 system 鈥� things that could help the people treating the overdoses.
Dr. Lakshmi Sammarco, the coroner for Hamilton County, Ohio, worries about the paucity of information about how carfentanil, an animal drug, affects humans. (Jake Harper/Side Effects Public Media)
Sammarco says this process is part of a pattern they鈥檝e dealt with before, playing catch up with the suppliers as new drugs appear.
鈥淗owever,聽in the spectrum of opiates, this is about max,鈥� she said. 鈥淥ut of all of them, carfentanil really is the most potent.鈥�
For now, Sammarco can only say that there have been eight deaths in which carfentanil might be the cause. Her office is working to test samples dating back to July, when the drug first showed up in Ohio.
At the hospital, Landrum follows the overdose victim into the emergency room. After about half an hour, doctors and nurses stabilize him.
We leave after that. The man didn鈥檛 have any drugs on him, so he wasn鈥檛 charged with any crime. His girlfriend wouldn鈥檛 say where the drugs came from, though she did mention that the two of them had overdosed the week before.
鈥淏elieve it or not, we鈥檒l probably be responding out for her here shortly,鈥� said聽Landrum. Even after close calls, people keep using. Addiction is too strong.
What鈥檚 worse, the danger of carfentanil seems to act as an advertisement: People seem to equate near death with a really good high, and the problems in Cincinnati are attracting customers. Landrum says recently she met a couple from Indianapolis in town to buy drugs. Another officer talked to people from central Kentucky.
So far, the DEA says carfentanil has only been confirmed in Ohio and Kentucky. Other states are starting to test for it, bracing for its arrival.
This story is part of a partnership that includes , and Kaiser Health News.