LOUISVILLE, Ky. (AP) - By BETH WARREN
A deadly mystery drug sickened hundreds of people in the summer of 2016, ripping a destructive path down Interstate 71 from Cincinnati to Louisville.
Many collapsed, struggling to breathe. Doctors sprinted outside emergency rooms to cars, yanking out those left motionless and blue. They had mere minutes to prevent brain damage or death.
"It was almost like you get a forecast that a hurricane is coming on the East Coast," said Tom Synan, police chief in Newtown, Ohio, about 20 minutes east of downtown Cincinnati. "You start prepping, but you can't know how bad it's going to be until it hits."
The veteran lawman, doctors and medical examiners were baffled as even longtime heroin and cocaine users were near death from this batch of drugs.
"I'm scared of whatever is used to cut this heroin," Dr. Robert Couch, with Louisville's Norton Hospital, told reporters at a late-night news conference Aug. 30, 2016, declaring a public emergency.
The culprit would soon have a name - carfentanil, an elephant tranquilizer - thanks to a team of pioneering scientists at the Drug Enforcement Administration's secret lab in Northern Virginia. Here, chemists at the Special Testing and Research Laboratory recently granted rare access to the Courier Journal and USA TODAY Network for a behind-the-scenes look at their critical work.
They also revealed how they helped solve the mystery of carfentanil and tracked the spread of the drug, the most lethal variation of America's No. 1 killer - fentanyl.
The lab's location is kept secret. DEA scientists don't even publicly disclose what city they're in. And even if you drove past the dull gray, one-story building with metal siding, you'd never know the important work going on inside. That's by design.
There's no sign, and the building blends in with others nearby in an industrial park.
A security guard, a gate and tall chain-link fence make it look more like a small correctional facility or a warehouse with valuables worth guarding closely.
Inside, a second guard provides another layer of security. The halls are long and sterile with gray faux tile flooring and unadorned white walls. It resembles a hospital corridor, except for a large clue - a mobile whiteboard in the hall with a diagram of a compound's chemical structure.
Inside the lab, a large room houses the usual beakers, test tubes and flasks, as well as rare groundbreaking equipment - including a $500,000 isotope ratio mass spectrometer - used to track the origin of illegal drugs. Here, from their work tables, specially trained scientists covertly help fight the nation's worst ever drug epidemic.
Decoding the mystery drug
During the 2016 overdose outbreak, many united in the rush to save lives - from doctors and researchers to police.
A Cincinnati investigator learned from a source that the illnesses might be blamed on a new street drug called carfentanil, a danger many officers and doctors hadn't heard of.
In six days, at least three people died and more than 170 others overdosed in Hamilton County, Ohio, the bulk of them in Cincinnati. In Louisville, two dozen men and women nearly died in a single day - Aug. 30, 2016 - from the mystery drug. And like a contagion, the destruction continued to spread to Georgia and Florida and eventually across the country.
Carfentanil, 100 times more potent than fentanyl, was never meant for humans, so labs in Ohio didn't have a known sample to use for comparison.
"How can you plan for it if you don't know what you're fighting?" said Synan, who helps prepare for such emergencies as part of the Hamilton County Heroin Coalition, which includes the DEA and other federal, local and state agencies as well as public and private health officials. They turned to the DEA's elite team.
Getting an answer took a lot of hustle.
Nearly a year earlier, a lab on the Pacific Coast tested a sample from a drug seizure that didn't match any known drug. Officials there also heard it might be carfentanil, so the DEA's research lab wanted to get a sample that had been confirmed as the animal tranquilizer to use for comparisons. But they hit a snag.
At the time, the only lab with the drug was owned by a private company that supplied zoos.
Since carfentanil is used to tranquilize large animals and is heavily regulated, it was difficult for lab officials to get it for research purposes.
"It took us over nine months to be able to acquire that standard, that reference material," said Jill Head, supervisory chemist at the DEA lab.
The DEA got the carfentanil just a few months before the mass overdoses in the summer of 2016. So it was quickly able to ship samples to the Ohio lab. Some called it tainted heroin, and by knowing what was in it, health officials could alert users and the public. And police, ambulance crews and emergency rooms could stock up on extra doses of naloxone - an opioid antidote - since carfentanil can require two or three times more naloxone to bring a patient back to life compared with heroin.
From July through December of 2016, nearly 400 overdose deaths in Ohio involved carfentanil, according to the U.S. Centers for Disease Control and Prevention. That year, Florida linked the drug to 500 deaths. Without quick action and widespread access to the antidote, thousands could have died, Synan said.
"We could see, just looking at a map and watching it spread in either direction along the highway, all the cities that border (Interstate) Highway 71," linking Ohio and Kentucky, Head said.
"Over the period of a couple of months, it spread throughout Ohio and then to neighboring states, then to Florida, the Northeast and then eventually it spread throughout the entire United States."
Carfentanil remains a threat nationwide.In February, more than two years since the big wave of overdoses, the elephant tranquilizer caused small rashes of overdoses in Cleveland and Columbus. This time, Ohio officials quickly identified the cause, thanks to the DEA lab's standard.
The lab has shared samples of carfentanil and other drugs with labs across the country, which has helped communities identify emerging drug threats.
While carfentanil has been linked to overdose outbreaks,fentanyl - a synthetic opioid - is now killing more Americans than any other drug.
Last year, fentanyl, up to 50 times stronger than heroin, killed more than 760 men and women in Kentucky. That propelled the commonwealth to a No. 5 ranking for overdose deaths, behind West Virginia, Ohio, Pennsylvania and Washington, D.C., according to a CDC report released in November.
The special DEA lab, one of the agency's nine labs, also works to trace the origins of fentanyl and other illicit drugs. Based on chemical markers - partially impacted by the type of soil - they're often able to decipher whether cocaine came from Colombia versus Peru. They're now able to detect 16 distinct growing regions in Colombia, two in Peru and one in Bolivia. They share this information with field agents who are working to trace drug pipelines and uncover growers and traffickers.
They also try to figure out how synthetics - such as methamphetamines, fentanyl and carfentanil - are made, which is more difficult because they are manmade.
While chemists conduct their sleuthing in secure labs, their work also can be dangerous.
During a recent Tuesday, a chemist donned thick safety glasses,turquoise latex gloves and a heavy lab coat to avoid exposure to fentanyl.
The pills she placed inside a vial looked harmless, but they represent an emerging new danger: fentanyl pressed into pills that are dyed a variety of colors and stamped to resemble much safer legitimate pharmaceuticals.
The chemist picked up light blue pills and flipped them over, revealing an "M'' on one side and "30" on the other, mimicking 30 mg oxycodone pain pills.
She then inventoried vials of fine powder, acetyl fentanyl and other fentanyl variations before securing them in plastic evidence baggies.
The DEA has broadcast alerts cautioning police across the country to stop field testing anything that contains fentanyl or a related substance, calling the fentanyl crisis a "global threat." These tests are performed in DEA labs within reach of oxygen tanks and fire extinguishers.
While recently testing pills believed to contain fentanyl, a chemist put on a face mask that covered her mouth and nose before stepping inside a large gray enclosure with air vents. She used a glass pestle, which is a small and club-shaped tool, to crush powder for analysis inside a small bowl.
Outside the fume hood, red block letters caution: "FLAMMABLE: KEEP FIRE AWAY." Inside, a fire extinguisher is at the ready. So are doses of naloxone, just in case.
The lab has identified about three dozen fentanyl derivatives. All can be deadly if their fine powders are inhaled, posing a risk for police and researchers. For drug users, an amount of fentanyl as tiny as 2 milligrams - about the size of Abraham Lincoln's cheek on a penny - can be lethal. With carfentanil, the size of a few grains of salt can kill.
The lab's work helped U.S. lawmakers add more drugs to the controlled-substance list and armed agents and State Department officials with a list of poisons so they could lobby China to regulate those ingredients.
At the DEA lab, a team of scientists also are studying today's crystal meth, a drug that has continued to spread across the country in the shadows of heroin and fentanyl.
"Everything we're seeing is high purity, 96 percent or greater," said Jaclyn Brown, a senior forensic chemist. "The majority of what we're seeing comes from Mexico."
Chemists from law enforcement agencies in Mexico have come to the DEA's Northern Virginia lab to learn the best ways to test drugs and spot drug trends.
"They're like you and me," Brown said. "They want what's best for their neighborhoods, their cities and their country."
Information from: Courier Journal, http://www.courier-journal.com