The Hoquiam Police Department announced Wednesday morning it had served a warrant and made an arrest in Hoquiam following an investigation into suspected fentanyl sales.

Fentanyl, a synthetic drug more powerful than heroin, has been a scourge nationwide for years, with minuscule amounts capable of triggering a fatal overdose as the narcotic slams the body’s ability to even draw breath.

But even as members of the county’s drug task force were serving the warrant, the last several months have seen a small but increasing number of seizures of carfentanil, an even more powerful opioid.

“We’ve had at least four in a single 72 hour period,” said Capt. Larissa Rohr of the Hoquiam Fire Department in an interview. “Aberdeen is starting to get calls as well.”

A growing problem

While fentanyl has been a lethal issue for years, carfentanil’s hugely increased potency makes it even more dangerous.

“Carfentanil was originally used to tranquilize large animals,” Rohr said. “We heard about it years ago.”

While its use as a narcotic had been documented elsewhere nationwide, it wasn’t until recently that the opioid appeared in Grays Harbor.

“In the past couple months we’ve definitely seen more overdoses and people needing more Narcan,” said fire service specialist Mitch Housden of the Aberdeen Fire Department.

Carfentanil is roughly 100 times more potent than fentanyl, which is itself 50 times more potent than heroin.

This means overdose victims require far more naloxone, the drug commonly distributed as Narcan, to save overdose victims compared to other, less powerful opioids.

“We had an incident two weeks ago. Our officers had to administer 10 milligrams of Narcan to get a patient to breathe again,” said Lt. Jeff Salstrom of the Hoquiam Police Department. “It is here and it’s having an effect on people.”

For comparison, the nasal Narcan injectors typically contain 4 milligrams of the naloxone, which was generally enough before the advent of carfentanil, Rohr said. Narcan costs HFD about $40 for a 2 milligram vial, Rohr said. In recent weeks, police and fire department personnel have found themselves using 14-16 milligrams of the opioid antagonist in a single day, sometimes as much as 10 milligrams on a single patient, in an effort to keep them alive.

“We’re using significantly more Narcan. Our initial dose when it was heroin was 4 milligrams to wake them up,” Rohr said. “Now we’re going up to 10 milligrams to increase the respiratory drive and wake them.”

A significant issue with treating patients who have overdosed on opioids is a trend in some victims of removing themselves from care as soon as they’re resuscitated, said firefighter/paramedic Sean Koehnen. The Narcan will wear off, but there’s still enough narcotics in the patient’s system to trigger a relapse of symptoms after they’ve fled care.

“The duration of action is far longer for fentanyl,” Koehnen said in an interview. “You may be running out of there, but there may be enough residual fentanyl to bind back on to your system when the Narcan wears off.”

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Action/reaction

While emergency medical personnel do their best to save overdose victims, members of the Grays Harbor Drug Task Force, which includes personnel from HPD, APD and the Grays Harbor Sheriff’s Office seek to interdict the flow of opioids and other illegal drugs into the county.

“We’ve been finding fentanyl for a couple years, but carfentanil is scarier,” said Sgt. Darren King, supervisor for the drug task force.

Fentanyl and now carfentanil come from China via Mexico, King said, before winding up in the homes and hands of users in places like Grays Harbor County. While the incidents of carfentanil so far have been low, King said he suspects the rates will increase, despite the appalling risk.

“The users know and the sellers know, it could kill you. Everyone knows that now. Every pill you buy on the street is suspect; it could kill you,” King said. “I would say right now, it’s very small. It’s just starting to appear. We’re going to see more appear, I’m sure.”

The frequency will likely increase as availability opens up in the byzantine and nefarious supply chains used to supply the population with illegal narcotics, King said.

“All the drugs, a lot of them are from the same suppliers out of town. It’s all linked,” King said. “It’s like a new item to sell.”

Part of the task force’s job is to educate the public on the threat posed by the drugs, as well as to helping those addicted, King said. Even a microscopic amount of the illegal narcotics, wiped on a mucous membrane by a careless gesture, can cause a fatal overdose.

“Since fentanyl came out, we’ve been really careful. We all carry Narcan and glove up,” King said. “Everyone’s aware of what happens. We’ve seen the safety videos.”

Members of the public can get doses of Narcan for free from local pharmacies and from the Moore Wright Group, Rohr said. Members of the public with friends or family members who have a history of abusing opioids or are commonly around such activity are encouraged to keep Narcan nearby, Salstrom said.

The cities of Hoquiam and Aberdeen are also working toward a number of programs for lowering the risk of overdose deaths and combating the cycle of opioid addiction, Salstrom said.

“We can’t forget the people that are addicted,” King said.

Contact reporter Michael S. Lockett at 757-621-1197 or mlockett@thedailyworld.com.

In the case of a suspect opioid overdose

1. Call 911 immediately

2. Administer Narcan if available

3. Try to keep the person awake and breathing

4. Lay the person on their side to prevent choking

5. Stay with the person until emergency assistance arrives