Deadly new drugs emerge in North Carolina's opioid crisis

Phyllis Crawford was sitting in her gazebo enjoying the spring warmth when an Asheville police department patrol car stopped in front of her house. That was strange, she thought. She lives in Haywood County.

The officer walked into her backyard, removed his hat, and from his expression she knew what was wrong. She hadn't heard from her son, Lucas, for two days, and she had been afraid he was using drugs again.

"My heart stopped when I saw the officer," Crawford recalled.

The detective told her Lucas had been found dead in his car the night before near Asheville-Buncombe Technical Community College. He didn't have many details, other than her son had most likely died of a heroin overdose.

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“I collapsed to the ground and just started screaming,” Crawford said. “I wouldn’t wish that kind of loss on my worst enemy.”

Months later, the toxicology report mailed to her home would show medical examiners found no traces of heroin in the 34-year-old's body. What the toxicologist did find were multiple strains of fentanyl mixed with other substances.

Similar mixes have been blamed for an increasing number of deaths in North Carolina's opioid crises. In some case, those mixtures have replaced the use of heroin and include opioids potent enough to kill in even tiny doses.

Crawford suspects her son may have unknowingly ingested Carfentanil, a strain of fentanyl most commonly used as an animal tranquilizer. She doesn't think she will ever know what ultimately killed him.

North Carolina has recorded 33 drug deaths involving Carfentanil, according to Dr. Ruth Winecker of the office of the Chief Medical Examiner at the North Carolina Department of Health and Human Services. One case was recorded in Buncombe County, but Winecker couldn't confirm if it was Crawford due to privacy laws.

"I was told there were traces of some kind of tranquilizer that is used on big animals like elephants and that he died from the toxicity from all of the things that were mixed together," Crawford said.

Carfentanil was first synthesized overseas in 1974, said Dr. Craig Martin, Chief Medical Officer at Vaya Health. It was designed for veterinarians to use on large animals and was never meant for humans.

"Since then, it has been given the nickname 'the elephant tranquilizer'," Martin said. "It is 10,000 times more potent than morphine."

Carfentanil's growing popularity in the U.S. started about a year ago, mainly in Ohio and Florida, when people realized that Carfentanil was being used to give addicts a bigger kick in their heroine doses, Martin said. 

Today, Martin said the drug travels from manufacturers in Mexico and China to drug dealers in the U.S., where fentanyl and Carfentanil are being mixed in with heroin and other pills.

Winecker's team discovered the first case of fentanyl analogs in North Carolina in 2014. Analogs are similar to fentanyl, except with slight chemical changes, according to the North Carolina Department of Health and Human Services.

"Today, there are 10 different fentanyl analogs in North Carolina and they are a big problem, especially Carfentanil," Winecker said. "It is 100 times more potent than even your most basic fentanyl."

Winecker added that although her office typically sees a cyclical drug use and abuse cycle, she has never seen the drug crisis as intensified as it is now.

More than 12,000 North Carolinians have died from opioid-related overdoses over the last 17 years, the majority of which were unintentional, according to the North Carolina Department of Health and Human Services.

"That means we are losing four people a day," Martin said.

Multiple statewide reports document that fentanyl-related overdoses and deaths are steadily on the rise, and will continue to increase.

The North Carolina Opioid Action Plan showed a spike in fentanyl cases.

The percent of opioid deaths involving heroin, fentanyl and related analogs caused more than half of the opioid deaths in 2016 - 58.4 percent, according to the action plan. In 2010, they only accounted for about 15 percent of deaths.

By 2021, it is expected that heroin or fentanyl will make up close to 90 percent of opioid deaths, if the epidemic is not fully addressed.

Fentanyl is a synthetic opioid created to treat patients in severe pain, like cancer patients, people living with chronic pain or people who have just undergone surgery, according to the National Institute on Drug Abuse.

"So fentanyl is legal if it prescribed and used appropriately," Martin said. "Carfentanil is legal too, but only when it is being used by a veterinarian."

The rising deaths from fentanyl and Carfentanil are not necessarily due to people seeking a stronger dose - the majority of the time addicts do not know they are ingesting fentanyl when they buy it from a dealer because it is so hard to detect, Martin said.

But because it is cheaper and more convenient for drug dealers to sell on the streets, fentanyl and its analogs, like Carfentanil, have become the drug of choice, said Dr. Don Teater, a family physician in Western North Carolina who specializes in opioids.

"It is going to be a problem in the future," Teater said. "Instead of transporting kilos of drugs, people can now transport micro-grams of, say, fentanyl, and that is important to drug dealers - whatever is cheapest."

Teater said that over the past year he has talked to opioid experts that believe that doctors won't be dealing with heroin as much, it will be solely fentanyl and its derivatives. 

"Carfentanil is so powerful and you can't dilute it down enough to be safe in humans, so one mistake will kill a bunch of people," Teater said.

The widespread epidemic of fentanyl overdose cases has caught the attention of Buncombe County District Attorney Todd Williams, local law enforcement and firefighters.

In the past month, there have been four meetings on the opioid problem plaguing Buncombe.

Williams also addressed the growing threat of Cafentanil during the latest meeting, where he unveiled new strategies to tackle the opioid crisis with a diversion plan to be released in the coming weeks. 

“Carfentanil was used as an aerosol agent by Russian President Vladimir Putin in 2002 to gas terrorists – and our community is now using it regularly," Williams said.

Williams emphasized a group approach to overcoming the opioid crisis, with treatment as the primary focus.

Over the years as a clinical psychiatrist, Martin has witnessed the changing trend of drug addiction and sees the fentanyl epidemic as nothing short of tragic.

"These are people who are interested in making money at the expense of human life," Martin said. "Drug dealers and manufacturers are taking advantage of someone with serious dependency issues."

Without care

Robert Ivey, Lucas Crawford's childhood friend, barely survived the seemingly endless cycle of addiction that started with cigarettes and marijuana when he was 14 and living in Haywood County.

Ivey, now 35 and living in Florida, said he experimented with all types of drugs, including heroin. But near the end his drug of choice was mainly alcohol.

When he heard that Lucas had died from a mixture of fentanyl, and possibly the elephant tranquilizer, Ivey said he drove to a bar and almost ended his nearly 18-month sobriety stretch - the longest he had been sober since he was 14.

He struggled with the idea of losing Lucas, who he said was always careful with what he ingested despite being an addict. To Ivey, his death didn't make sense.

Ivey said he believes Lucas was not looking for fentanyl that night, but got the last batch at the bottom of a heroin bag, which he said is always the strongest. 

"There are junkies sitting in a basement combining whatever they want, so if you get a hot spot, which is the last bag or two from a shipment, a lot of that has settled to the bottom," Ivey said. "So the person buying it takes what we call a hot shot and that just drops you, sometimes drops you dead."

Martin and Teater both said that the majority of the time users are not seeking out fentanly or its derivatives, especially Cafentanil.

Crawford said she was shocked when she saw the toxicology report with no traces of heroin.

The report showed that at the time of his death, Lucas had cocaine, fentanyl, methoxyacetyl-fentanyl, methadone and another fentanly derivative, U-47700, in his system. The cause of death was due to mixed drug toxicity.

Crawford knows in her heart that her son did not want to inject fentanyl - she said as a mother that's its own form of murder.

"We are losing our people to drug dealers," Crawford said.

Over the years, Crawford said Lucas had been working towards staying sober but had always struggled.

He tried to stay in rehab six different times but those efforts failed when he ran short on money, or could not leave work to make it to classes or support groups, Crawford said.

When he died, Lucas was a student at A-B Tech and was a father of two children, a son and a daughter. He received a diploma posthumously from the school earlier this summer.

"He was such a likable person and he had so much potential, it is a shame," Crawford said. "I have to believe that Lucas is much better off. I have to tell myself every day that he didn’t want to live like that anymore."

She added, "What we miss most is his smile, he had the most beautiful smile."