A wave of drug-induced deaths and overdoses in Pennsylvania has been linked to a trend of mixing heroin with high concentrations of fentanyl.
Last month, the Pennsylvania Department of Health issued a statement to its local medical providers, warning them of this increased toxicity, which has already led to 22 deaths in southwestern Pennsylvania.
"This product is being sold as heroin ... and produces an extremely potent opioid effect including coma and respiratory depression," the statement reads. "(This) can overcome the tolerance of chronic opioid abusers."
Chautauqua County, an area which - by all standards - is already plagued by a substantial heroin presence, may likely be the next target of this deadly mixture.
"It's not out of the realm of possibility," said Joseph Gerace, Chautauqua County sheriff. "They're seeing some (cases) in Buffalo ... so if that's the case, I can make the assumption that it's going to be here. It's only a matter of time."
Michelle Spahn, resident agent in charge of the Drug Enforcement Agency's Buffalo office, acknowledged that fentanyl-laced heroin cases have already cropped up in Buffalo, and that investigations are currently underway to find a source.
"We're not able to tell if the fentanyl (is derived) from pharmaceutical-grade patches or pills ... or if it's clandestinely manufactured, meaning that it's being made in labs in the United States, Canada or Mexico," Spahn said.
Gerace added that heroin mixtures in general are not clinically tested substances.
"A witch doctor could have put them together," he said. "There could be rat poison in them for all we know ... and this is what people are putting into their bodies."
Fentanyl, in particular, is a highly potent synthetic opioid, typically prescribed as an oral tablet or patch, and intended to manage severe pain. According to the DEA, it is 100 times more potent than morphine.
Heroin mixed with fentanyl is therefore attractive to users because of the rapid and extreme "high" that it creates, Spahn said. However, she added, most users are unaware of the purity or dosage of fentanyl added, increasing their risk of overdosing.
"It's all a business," said Rick Huber, executive director of the Mental Health Association. "(Dealers) sell heroin with higher concentrations of fentanyl ... they increase their (clients') tolerance and desire ... and then they lower (the concentration) and increase the demand."
If fentanyl is indeed being used as a silent and strategic tool to increase business, it's having a deadly effect on its so-called "customers," who are quickly finding themselves pawns in a sinister game of supply and demand.
Fentanyl has been mixed with heroin for a long time, according to Huber, but only now have local cases shown such high concentrations.
According to the DEA, an outbreak of fentanyl occurred between April 2005 and March 2007, in which an estimated 1,013 deaths were linked to subsequent overdoses. The majority of deaths were reported in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey and Pennsylvania.
Local law enforcement agencies say they will continue to monitor and aggressively enforce the heroin situation in Jamestown and Chautauqua County, keeping a mindful eye on any new mixtures or threats that might make their way to local streets.