A rash of drug overdose deaths in small towns and cities across the country has caused authorities and public health officials to raise the alarm about a potent synthetic painkiller potentially raising the stakes amid the nation's ongoing opiate crisis: Fentanyl.

Alarming numbers of overdose deaths in Orleans and Jefferson parishes linked to fentanyl -- a synthetic opiate painkiller increasingly popular on the black market -- led federal Drug Enforcement Agency officials to warn the public at a briefing in New Orleans in August. At that point, coroners in those two parishes were already reporting almost twice as many deaths linked to fentanyl as in all of the previous year.

But so far, the Baton Rouge area has been largely spared the dramatic jump in deaths tied to the drug, which law enforcement agents say is usually manufactured abroad and smuggled into the country.

Overdose deaths attributed to the drug, used either alone or mixed with other narcotics, have risen from four in 2015 to five so far this year, said Dr. William "Beau" Clark, the East Baton Rouge Parish coroner. Although Clark says he's very concerned by those numbers -- and by the alarming frequency of heroin and other overdoses, which are now the leading cause of accidental death in the parish -- the deadly rise in fentanyl use elsewhere has reached crisis pitch. In West Virginia, where the state saw fentanyl-linked deaths triple between 2014 and 2015, the small city of Huntington grabbed national headlines when authorities there reported 26 fentanyl-related overdoses in less than 24 hours in August.

What makes fentanyl particularly dangerous is its incredible potency, which in its purest forms can be 50 to 100 times stronger than morphine, according to the Centers for Disease Control and Prevention. Frequently mixed with other drugs and diluted to varying degrees before being sold, fentanyl's powerful concentration makes it especially difficult for drug users to gauge the dosage.

"Just two milligrams of fentanyl can kill most people," said Brad Byerley, the DEA special agent in charge of the Baton Rouge field office.

When prescribed by a doctor, fentanyl is one of the most commonly used synthetic opiates, often dispenses in the form of transdermal patches or lozenges. But a black market for the drug -- much of which is manufactured abroad and smuggled into the country through Mexico -- has boomed in recent years as a wider wave of prescription drug and heroin use has gripped the country.

The divergent trends in overdose deaths -- often an indicator of the drug supply in the area more generally -- between Baton Rouge and the New Orleans area is puzzling, in particular since the two cities sit just 70 miles apart on Interstate 10, said DEA Special Agent Debbie Webber, a spokeswoman with the agency's New Orleans office.

"Normally, both of our cities are getting the supplies coming from Mexico via Houston," Webber said. "As far as we're seeing, most of the fentanyl is coming in from Mexico. The traditional route it comes to New Orleans is through Houston and comes right through Baton Rouge."

Just why Baton Rouge has thus far been spared the alarming jumps in fatal overdoses seen elsewhere remains unclear. Local police and sheriff's deputies say they continue to see alarming quantities of heroin but haven't encountered much fentanyl on the streets around Baton Rouge. But Byerley said his agents are currently working fentanyl cases throughout the capital region.

"It's here, we're seeing it," said Byerley. "We've been so lucky we haven't seen more deaths."

Logan Kinamore, the executive director of No Overdose Baton Rouge, a public health advocacy group that pushes overdose prevention policies, said drug users and public health workers in New Orleans noticed a shipment of fentanyl-laced heroin that hit the streets there around Christmas of last year. Kinamore said it appeared that shipment came from somewhere in the northeast after increased enforcement along I-10 and bypassed Baton Rouge.

Kinamore said word quickly spread among drug users to take extra precautions: Avoiding injecting alone and seeking out supplies of Naloxone, a highly effective opiate antidote also known by the brand name Narcan.

 

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As fentanyl has become far more widespread, law enforcement officers are also taking additional precautions, Byerley said. Fentanyl's extreme potency means small amounts inhaled accidentally can cause issue. And unlike most other opiates, the drug is designed to be absorbed through the skin, something that raises additional risks for agents working on the streets or technicians in police labs.

At least 11 police officers in Hartford, Connecticut, became ill in September and were hospitalized after breathing in the drug during a SWAT raid, according to the Hartford Courant newspaper. The Wall Street Journal, in a front-page story on the drug's devastating effect on small communities in Wisconsin, noted that state crime labs in that state had begun stocking supplies of Naloxone.

"You have a lot of law enforcement officers nationally whose lives have been endangered buying it undercover or going into labs where people are using this stuff," Byerley said.

Follow Bryn Stole on Twitter, @BrynStole.