Cocaine with Fentanyl

(Image from InspireMalibu)

When they can’t get a hold of their local dealer, the two young men come in to Hartford from the suburbs to buy cocaine. Bart boasted to a younger friend Milton that he could get any drug he wanted on Park Street. “Well, let’s do it,” Milton said.

It is true that Bart knows where to buy drugs.  What he hasn’t told Milton is that when he used to do heroin, he met a friend named Mark who would do the buying for him. And since he got out of rehab, he has only been using percocet.  He doesn’t inject anymore because his veins are hard to find because of his chubby arms.  Only Mark could hit his veins and Mark has been no where to be found, which is a good thing as Bart can handle the Percocets better than he could heroin. Bart has also never purchased cocaine in Hartford, though he knows the same guys who sell heroin have coke. Bart sticks with his boast.  “Sure, let’s do it.”

They park Milton’s car on Zion Street. They get out and start toward Park. “You sure, you know what you’re doing?” Milton asks.

“Yeah, yeah, put your hoodie up. They got cameras all over the city.”

They walk into the November wind, hoodies up, hands in pockets.

The first guy standing outside the bodega says, “Yo, what are you looking for?”

“Coke,” Bart says.

“How much you want?” the man says.

They haggle briefly on the price. Bart gives the man what he asks for. He palms the cash and gives it to the man in a handshake that moves into an awkward embrace. The man nods to a young man sitting on a nearby stoop, who saunters over and shakes with Bart, slipping him the envelope.

“I told you, yo,” Bart says to Milton when they get back in the car.

“Cool,” Milton says.

Bart looks at the bag then. It is a glassine envelope like they sell heroin in, but inside the envelope is a small ziplock bag full of white powder. “Look at all that,” he says. “I told you it cheaper in the city.”

“Let’s go to Jeanna’s,” Milton says.

There is a girl Milton knows from the magnet school who has an apartment now on Sigourney Street.

“This isn’t enough for three,” Bart says.

“She parties, but she doesn’t do drugs. She’s cool, though.”

They ride over to her place, after buying a six pack of Modelo at the corner store for Jeanna. She buzzes them in, and she gives Milton a kiss as he squeezes her bottom. They make introductions, and then with Cardi B on the sound system, Jenna fetches them a paper plate. Bart spreads the powder into four lines, and hands Milton a broken off bic pen. “No, you do the honors,” Milton says. “You’re the man.”

Bart feels really good about the compliment. He leans over and the pen in his nose and the other nostril clogged off with his thumb, he inhales a line, and then hands it to Milton. The feeling is odd. There is a rush, and it is not the typical warp speed thrill. It is good and familiar, but not right. It is powerful and warm, but not what Bart was expecting. He feels faint, and starts to give himself up to the feeling.  he looks at Miltons and sees something is wrong.

Milton falls face forward, and hits the floor hard.  The girl screams.  Shit!  

Bart checks Milton’s chest. Oh, God.  Oh God.  Milton is gurgling and he vomits. Bart rolls him on his side, and shouts call 911!  The girl is crying. “Now! Now!” he says.

***

We arrive after the police and fire department.  A young bearded boy, who looks familiar to me, sits against the door in the hallway crying, and looking scared. A police officer stands over him. “Is this the OD?” I ask.

The officer shakes his head and nods into the apartment. On the living room floor a young man lays on his back, his arms outstretched. He is very pale. A firefighter stands over him trying to assemble an ambu-bag while another firefighter attaches the hose to the oxygen tank in his blue house bag. I see a discarded vial of narcan by the boy’s head. I look at him carefully. He looks dead. “Is he breathing?”

Just then, I see his Adam’s apple move with one agonal breath.

The FD starts bagging him. I attach the ETCO2.  It is 100.

“Any paraphernalia?” I ask.

“They all deny drug use.”

I see a girl crying on the coach.

“What did he use?” I ask her.

“I don’t know. I just had a beer. He just fell over and his friend told me to call 911.”

His blood pressure is good, his heart is going at 112. Pupils are pinpoint.

I go out into the hall, and ask the kid. “What did he use?”

“I can’t answer that.”

“We’re just trying to help him.”

“I, I , think I need to consult with my lawyer.”

“You’re not in trouble. He’s not under arrest, is he?”

The officer shakes his head.

The boy avoids my eyes.

I go back in the room and see the boy’s end tidal is down to 50. I give him a sternal rub, but he doesn’t respond. The ETCO2 is now in the 40’s. I tell them to stop bagging. His respiratory rate is now 16. SAT is 100. ETCO2 – 42. He is stable.

I go back outside. “Your friend is fine. He responded to narcan. What did the bag look like you bought?”

“You can tell us,” the cop says. “You’re not under arrest. Its just to help your friend.”

The boy looks uncertain.

“You are going to be in trouble if you don’t help,” the cop says.

“It was a clear bag,” the boy says. “We just bought cocaine. He wanted to do some. It was his idea.”

“Cocaine, huh,” I say. “Seems there was probably some fentanyl in it.”

“It felt like percocet,” the boy says.

“How do you know that?”

“I use prescription pain meds,” he says.

“Does you friend do pills, too?”

“No, just cocaine, and he smokes pot.  We both do, a little.” 

“Maybe because he doesn’t use pills is why he went out and you didn’t. Be careful what you buy these days.”

The friend finally arouses, but he is too groggy to walk. We stair chair him down the three flights and take him to the hospital.  

“What happened,” the boy says, in the ambulance. “Was I in a car accident?”

***

This isn’t the first time someone in Hartford has bought what they thought was cocaine, but it ended up either being heroin/fentanyl or cocaine laced with heroin/fentanyl.

It is almost impossible to tell white heroin, fentanyl and cocaine apart by sight.

What happened to the boys? Did the dealer think Bart said dope instead of coke? Did he sell him coke that he had spiked with a little fentanyl? Did someone higher up the chain do the same?  Or maybe it was contamination at the drug packaging site? Did they neglect to clean the grinder and the scale they used for fentanyl before they started in with their cocaine packaging?  A little cross-contamination?

There has been a lot of speculation about this issue. Here are two good articles about it.

How Fentanyl Is Contaminating America’s Cocaine Supply

Cocaine Deaths Are Rising At An Alarming Rate, And It’s Because Of Fentanyl

A friend of mine in harm reduction thinks it is accidental contamination. He says it doesn’t make sense a dealer would add fentanyl to the cocaine, which might kill his customer if they are opioid naive.

Deliberate or intentional, these overdoses are increasing. Not just in Hartford, but across the country.  Anyone buying or using cocaine these days needs to be careful. Have naloxone available just in case.  Don’t use alone.  Do just a little at a time.  Call 911 if someone overdoses.

 

 

 

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