SALT LAKE CITY — In early August, a dangerously potent heroin laced with the synthetic opioid fentanyl began showing up in Salt Lake City.

Sometimes referred to as “hulk” because of its green tint, the drug has been responsible for a string of overdoses so powerful that patients often need four or more doses of the overdose-reversal drug naloxone on scene, and in some cases require a naloxone IV drip at the hospital.

“This was alarming,” said Salt Lake Fire Capt. Anthony Burton. “This fentanyl stuff, because it’s such a higher amount than normal, it lasts a little longer. ... Once that reversal agent wears off, they get respiratory suppression again.”

Fentanyl is nothing new. The Centers for Disease Control and Prevention believes the powerful synthetic opioid is behind most of the 31,335 overdose deaths recorded in 2018. But in recent months, Utah Naloxone has documented a rising number of overdoses, likely a result of drugs like “hulk.” In August, the organization reported 175 overdose reversals, a sharp increase from the 125 in July and 99 in June.

“We absolutely saw an increase in the number of overdoses that were being reported,” said Dr. Jen Plumb, medical director for Utah Naloxone.

Data from the Utah Department of Health supports Plumb’s claim, showing a dramatic increase in overdoses that first responders were called to across the Beehive State starting the second week of May.

Then, between July 6-12, Utah’s first responders were called to 275 suspected overdoses, a three-year high. Five weeks later, they responded to 278.

Those figures include all overdoses, not just instances involving opioids. But according to the CDC, the majority of people who overdose do so with opioids.

The recent surge prompted the Salt Lake City Fire Department warn residents of heroin with a “green tint ... linked to multiple overdoses, cardiac arrests” on its social media channels on Aug. 25. On average, the department responded to 151 overdoses and administered naloxone 44 times each month since January. In August, they were dispatched to 164 overdoses, and administered naloxone 52 times.

However, the true number of overdoses in Salt Lake City is likely far higher than what’s actually reported.

Exact figures — whether it’s overdoses, overdose reversals, or doses of naloxone given — are almost impossible to pinpoint. Efforts by groups like Utah Naloxone to train and equip Utahns with the life-saving drug means first responders aren’t called to every overdose. Plus, those struggling with addiction are often hesitant to call 911.

“A lot of the populations we work with in the syringe exchange setting, we’re lucky to get 40% of them calling 911,” said Plumb. Over a one-week stretch in August, her organization reported 62 overdose reversals from the public.

That’s more naloxone than Salt Lake firefighters administered in the entire month alone.

“Something definitely happened here in August. And the bigger picture is that something’s been brewing nationally, this whole year,” Plumb said, pointing to statistics from the National Emergency Medical Services Information System that shows a nationwide uptick in both the amount of opioid-related 911 calls and naloxone distributed by first responders.

In May, the number of incidents that required naloxone spiked, hitting a three-year peak at roughly 7,000 per week. Although numbers began tapering off mid-June, data suggests American first responders are still administering naloxone at rates not seen in recent years.

According to some experts, it’s no coincidence that the spike in overdoses began just weeks after the COVID-19 pandemic prompted most of the country to recede into their homes and cease social interaction.

“The worst fear is that because of social isolation ... people are not being found or treated immediately,” said Dr. Paul Christo, associate professor at the Johns Hopkins University School of Medicine, in an emailed statement.  

”The number of fatalities from opioid-related overdoses could be nearly 30% higher than reported due to missing information or incomplete death records,” he said.

COVID-19 is also compounding an already difficult situation for health care providers, who now have to juggle two public health crises that are far from mutually exclusive. Plumb said whether it’s public health initiatives, data collection, or even how hospitals operate, the opioid crisis has in many ways taken a back seat to the coronavirus.

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“With every public health entity being so focused on COVID, a lot of our other public health reporting is not awesome right now,” said Plumb. “I’m not saying that it shouldn’t have been COVID-focused, obviously, but it’s not easy to have a pandemic within a pandemic,”

According to Christo, COVID-19 restrictions are also impacting drug supply chains. As borders remain closed, certain drugs — whether illegal or legal — are harder to find, which in turn boosts a dangerous domestic black market.

Most of the fentanyl found in heroin is made illegally, according to the CDC, and Burton says manufacturers often intentionally ramp up the drug’s potency, which in turn makes it more deadly.

“Changing some of the groups on the chemical formula changes the way that drug is,” said Burton. “I think we just have drug dealers and drug producers that are getting more and more creative with their product.”

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