KELLY MCEVERS, HOST:
One of the scariest things about today's opioid epidemic for public health workers, police and users is the makeup of the opioids themselves and how that's constantly changing. Pills that are sold illegally don't come with a list of ingredients, at least one that can be believed. And without clear identification, it's hard to treat overdoses and prosecute dealers.
Max Blau has been reporting on this for STAT News. He's with us from Atlanta. Welcome to the show.
MAX BLAU: Thanks for having me.
MCEVERS: So first just explain this idea that we don't really know what's in a drug. Like, how much can one dose of an opioid differ from another?
BLAU: When we're talking about opioids, I think the first thing we need to realize is that there are different types. There are the ones a doctor may prescribe you. There is heroin. And then there are these other class you may have heard of called synthetic opioids. They're known as fentanyl, carfentanil. And it's a very small amount of synthetic opioids that it takes to kill someone. And oftentimes when people are buying drugs on the street, the person buying the drug doesn't always know exactly what they're getting.
MCEVERS: Right. And it's one of the reasons we see so many overdoses - is people just don't know the quantity that they're taking. You also, though, talk about this situation as a cat-and-mouse game between opioid dealers and law enforcement. Can you explain that?
BLAU: So what you're seeing in some states as certain kinds of synthetic opioids are banned - that manufacturers of drugs are actually finding slightly different variants of synthetic opioid that is then manufactured and is technically legal. Oftentimes some of these are just lab formulations that were created in, like, the '60s and '70s and never made it actually out into the world. People who are working in kitchens or other, like, homemade labs have been able to find them and create slightly different opioids that are legal only because there's never been a reason not to make them illegal.
MCEVERS: Right, so you're, like, oh, right, if I got caught with - selling this particular formulation and it's been determined illegal, I'll just make a slightly different variation of it and I'll be fine.
BLAU: And of course with that, there is, you know - none of these have been ever approved as a drug, rather, for either use in animals or humans, so...
MCEVERS: Give us a sense of the time pressure here. I mean once first responders, you know, seize pills, how long does it take for them to identify what they actually are?
BLAU: One of the things that's really been, you know, hard for towns like Cincinnati or Macon or other ones that have seen these clusters of overdoses where dozens of people are suddenly going to the hospital or even dying within a matter of days or by the end of a weekend - one of the things that is a struggle is, how do you get those drugs tested as fast as possible? And often what would happen if it was just maybe one person overdosing or one drug that was seized is that it would go to a crime lab, and it would be at the bottom of the pile. And there would be a bunch of other cases ahead of that that would have to get processed, and sometimes, it could take weeks or a month to actually identify what that drug was.
MCEVERS: You have also written that crime lab chemists are partnering with public health officials now to combat this epidemic. Can you give us an example of where this is working?
BLAU: This has happened in Baltimore. The fire department there is the group that responds to overdoses. And when there is a uptick that is higher than usual in Baltimore, they alert the public health commissioner, who has this belief that, you know, instead of waiting months or even a year for final data to come out on the public health side, by having imperfect data sooner about where overdoses are, she can send outreach workers there to a neighborhood or a block where overdoses are happening and get either people trained on how to use Naloxone - just everyday residents - or to have health workers on hand in case there are more overdoses on the way.
MCEVERS: Why isn't this being done more often and in more places?
BLAU: I think part of the issue is that fentanyl is - hasn't hit the entire country to the same degree at the same time. So I think a lot of it is drugs come to a place, and only after the fact are our public health and law enforcement officials handling the issue - so yeah.
MCEVERS: Max Blau is the southern correspondent for STAT News. Thank you so much.
BLAU: Thanks for having me. Transcript provided by NPR, Copyright NPR.