A powerful drug that's sometimes laced with heroin is driving West Virginia overdose deaths to record levels.
Fatal overdoses related to fentanyl, an opioid that's 100 times stronger than prescription morphine, nearly tripled last year compared to 2014.
"The number of deaths has gone to alarmingly high levels," said Dr. Rahul Gupta, commissioner of West Virginia's Bureau of Public Health. "With fentanyl, people are going into overdose and dying more quickly."
West Virginia has the highest drug overdose death rate in the nation. At last count, 643 people had died of drug overdoses in West Virginia in 2015, the most drug deaths since 2011, when 656 fatalities were recorded, according to data released by the state Health Statistics Center last week.
Last year's overdose deaths could still eclipse the 2011 total, as death reports from December continue to trickle in.
"The numbers are only going to get higher," Gupta said.
While overdose deaths caused by prescription painkillers like Lortab, Vicodin and Oxycontin are decreasing in West Virginia, heroin- and fentanyl-related deaths are surging.
Overdoses caused by fentanyl - also known by its street name "China White" - increased from 55 deaths in 2014 to 154 deaths in West Virginia last year.
Kanawha and Cabell counties had the most fentanyl-related deaths with 33 each. Berkeley County reported 15 fentanyl-related fatalities last year, the third-highest number among counties.
Hospitals use fentanyl to put patients under for surgery. Doctors also prescribe the drug to alleviate severe pain. In the past, addicts abused fentanyl lozenges or patches intended to be applied to a patient's skin. The delivery systems aimed to slow the dose of the drug.
Now, fast-acting fentanyl is showing up in West Virginia and numerous other states in a powder form, manufactured in underground labs by Mexican drug cartels.
"Because it's produced in clandestine labs, there are no control measures," Gupta said. "Each batch may have a different potency. It can be really unpredictable when it gets in the body."
White-powdered fentanyl is sold on the street for the same price of heroin - and often mistaken for heroin by those abusing it. The two drugs also are often mixed together.
"They want it mixed because it's a better high," said Chad Napier, prevention coordinator for Appalachian High-Intensity Drug Trafficking Areas. "Fentanyl is really dangerous. It's a lot more dangerous than regular heroin."
Fentanyl depresses a person's respiratory system and neurological functions rapidly, Gupta said, so people using fentanyl illegally don't have time to respond before they're knocked out.
Fentanyl is 50 times more powerful than street heroin.
"With fentanyl, it really acts quickly," Gupta said. "It's a race against time to begin with, and when somebody's dying because of an extremely potent substance, they're going to be on the losing end of that race."
Heroin-related overdose deaths also are climbing in the Mountain State.
So far, counties have reported 181 heroin deaths from last year, up from 165 in 2014. That's a six-fold increase from 2010.
Cabell County had the highest number of heroin-related overdoses last year with 50, followed by Kanawha County with 31, and Berkeley County with 15.
The Health Statistics Center compiles its drug overdose data from death certificates certified by the Office of the Chief Medical Examiner. The overwhelming majority of overdose deaths involve combinations of multiple drugs.
West Virginia's crackdown on prescription pankillers - spearheaded by Gov. Earl Ray Tomblin - seems to be helping to reduce overdose deaths caused by drugs such as hydrocodone and oxycodone. In recent months, state regulators have shut down rogue pain clinics that churned out suspect prescriptions for large quantities of pills. The federal government also mandated stricter rules for prescribing painkillers.
Last year, 163 West Virginians died from oxycodone-related overdoses, down from 199 in 2014. Overdoses caused by hydrocodone products like Lortab and Vicodin declined from 133 deaths two years ago to 104 deaths last year.
Early this week, Tomblin is expected to sign into law a measure (SB 431) that will allow pharmacists and pharmacy technicians to dispense an overdose-reversing drug to people without a prescription. First responders in West Virginia already are using naloxone - also known by its brand name Narcan - to treat heroin and fentanyl overdoses.
Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.