Investigators are racing to find the source of a synthetic narcotic called fentanyl that is sometimes mixed with heroin and is believed by health authorities to be responsible for scores of US overdose deaths in recent months.
The authorities are investigating whether fentanyl, which is up to 50 times more potent than heroin, might have been combined with the heroin believed to have killed Philip Seymour Hoffman.
The Oscar-winning actor was found dead in his Manhattan apartment on Sunday, with a syringe stuck in his arm. New York City police sources familiar with the case said 50 small bags of what appeared to be heroin were found in his home.
An autopsy of the actor's body was performed on Monday and the results could be made available as soon as Wednesday, officials said. "It takes a very small amount of fentanyl to kill. A few grains of powder by itself is probably enough," said Dr. Melinda Campopiano, medical officer for the US Substance Abuse and Mental Health Services Administration. "The heroin is probably incidental at that point."
Many addicts like the additional "pop" that fentanyl seems to give their heroin high, even though they are usually unaware of the drug's presence and added danger, according to experts.
The full extent of the current fentanyl scourge remains a mystery, according to health and law enforcement officials. No national surveillance system tracks these drug overdoses and many states and counties do not routinely test for the chemical. "The states have the capability in terms of lab capacity, but it's a matter how public health resources are allocated,"said Dr. Matthew Lozier, epidemic intelligence officer for the US Centers for Disease Control and Prevention.
With spotty current testing and confirmation, Lozier said some states could have undocumented cases of fentanyl deaths.
Fentanyl is widely used in a number of approved prescription drugs to treat intense cancer pain, including skin patches sold by Johnson & Johnson and generic drugmakers, as well as lozenges and under-the-tongue tablets. It is also available in vials for use in anaesthesia.
The spotlight on fentanyl became bad news for Galena Biopharma Inc, whose shares plunged 20 per cent on Monday after a fund manager for Bronte Capital, in a blog, harshly criticised Galena's website for offering free samples of its fentanyl drug. The stock remained in the doldrums on Tuesday. Company officials could not immediately be reached for comment.
The tiny Oregon biotechnology company in October introduced its tablets, called Abstral, which dissolve under the tongue, as an approved US treatment for intense cancer pain. Although the website offered the first month of treatment free, the controlled drug is only available to patients enrolled in a restricted-access programme.
What remains unclear to investigators is whether the fentanyl believed responsible for the recent spate of US heroin overdose deaths is coming from a single source, or multiple sources. It is also unknown if it is being diverted from legitimate pharmaceutical labs or made illicitly with recipes available on the internet.
But Campopiano said "no legitimate pharmaceutical manufacturer in the United States has reported fentanyl missing."
The recent deaths have been clustered mostly in cities on the East Coast, stretching from Rhode Island to Maryland. "We are still determining" the source of the fentanyl believed to be responsible for the Northeast US overdose deaths, said Dawn Dearden, a spokeswoman for the US Drug Enforcement Administration.
Between 2005 and 2007 more than 1,000 people were reported to have overdosed after using heroin laced with fentanyl later traced to illegal factories in Mexico, according to the US Centers for Disease Control and Prevention.
Campopiano said previous outbreaks of fentanyl-related deaths tended not to travel west of the Mississippi River. "Heroin there is brown or black, so it's hard to mix in white fentanyl powder without being noticed," she said.
On Friday, officials in Long Island's Nassau County, a New York suburb that is one of the nation's wealthiest, issued a"contaminated heroin alert" following five overdose deaths. One was attributed to pure fentanyl powder marketed as heroin, while the other four were a combination of the two illicit drugs.
Those fatalities followed 22 overdose deaths in one week last month in Pennsylvania, all believed to be caused by fentanyl-laced heroin. A dozen more in Rhode Island last spring involved a similar chemical called acetyl fentanyl.