Longview teen's death exposes dangers of fentanyl patches

-tdn.com

06/04/2008- Late in the evening of March 12, 19-year-old Cody Norton left the Longview apartment he shared with his mom, Stephanie Rexford.

She returned home from her graveyard shift at about 8 a.m. and found Cody asleep. Thinking he had dozed off in the couch while watching TV, and exhausted herself, she went to sleep. When she woke, she found her son still on the couch, deceased. She called 911 at 2:49 p.m.

Although Rexford can’t be sure, she and others have been told her son may have gone out earlier that night and bought a patch of fentanyl, a powerful narcotic for which he had no prescription.

“I’ve heard from different people that in a time frame around 11 to midnight he may have gone out and purchased (a patch),” Rexford said a few days later. “(A friend) called me and she found out that Cody was dead, and she said that she thought that it might have been a drug overdose because she had heard that he was using fentanyl patches. And I asked her, ‘What is a fentanyl patch?’ ”

A toxicology report released last week found that fentanyl intoxication caused Norton’s death, Cowlitz County Coroner Tim Davidson said.

Coming just a year after a local high school senior nearly died from using two of the patches, the death is another tragic local example of the national rise in prescription drug abuse, and of fentanyl in particular.

Norton’s body did not have a patch on it at the time of death, his mom reported, suggesting Norton may have used street methods to ingest a patch’s contents in a single, lethal dose.

“This (expletive) needs to stop,” Rexford said.

‘The most powerful narcotic on the planet’

According to the most recent published estimates by the Drug Abuse Warning Network, there were 9,160 emergency room visits involving fentanyl across the U.S. in 2005. While that’s a relatively small number, the Department of Health and Human Services and Johnson & Johnson report fentanyl-related emergency room visits rose sharply, from 576 in 2000 to 8,000 by 2004.

Fentanyl is a Schedule II controlled substance, the highest level of control for drugs with a recognized medical use, according to Medicine.org.

According to the National Institute on Drug Abuse, fentanyl patches are typically prescribed to patients suffering from chronic, severe pain who already have high opiate tolerance. Numerous companies market the patches, a transdermal delivery system that provides relief over a two- or three-day period.

Two companies, Activis and PriCara, recalled patches this year because of concerns the patches could leak, releasing too high a concentration of the drug to be absorbed through skin.

“It’s the most powerful narcotic on the planet,” said Jim LeFever, outpatient programs manager at Drug Abuse Prevention Center in Longview. “It’s 150 times more powerful than morphine. Most other medications are measured in grams. This is measured in micrograms.”

“They become like the next level up” for users looking for a more powerful high, said Brian McCrady, Coordinator of the Cowlitz Substance Abuse Coalition. “I hadn’t even heard about these patches until the overdose we had last year,” he said. “I was just kind of like, ‘wow.’ ”

In December 2006 a Kelso High School senior traded some Prozac pills for two fentanyl patches. He nearly died after slapping them on his back.

LaFever said users often extract the patch’s contents and ingest it all at once.

“What people that abuse them do is they put them in the freezer and freeze the patch, and that makes the fentanyl readily available because it’s frozen.”

McCrady said Oxycodone pills now sell for $60 to $80 on the street, and the more powerful patches likely sell for an even higher price.

Some younger or first-time users might mistakenly assume they’re safe because they’re patches.

“It’s scary, it is, it’s just really scary to think of kids putting this on their arms and not even having a clue as to what the effects might be,” McCrady said.

Rexford said there was no patch on Norton’s body, suggesting he probably ingested a full dose at once. Since the patches come in strengths ranging from 25 to 100 milligrams, it’s unknown how much Norton ingested.

A friend of Norton’s, Rene Smith, said she was aware Cody had been using fentanyl patches, but she declined further comment.

Longview police took evidence from a Coke bottle with a “clear liquid” inside at the apartment. As of last week they had not analyzed its contents, because they had not yet received notification of the cause of death from the coroner’s office, said Detective Terry Reece. That analysis will take place as soon as notification is received, and Longview police are continuing to investigate, Reece said.

“I have talked to some friends of the deceased,” Reece said. “The only thing I was told was they can get sharp tweezers or some kind of instrument, and pick the patch open and get to the fentanyl that way.”

“I don’t know if they drink it, snort it, or ingest it.”

Instructor Jack Smith of Cowlitz 2 Fire & Rescue, who teaches and has taught firefighting to many friends of Norton — a former fire cadet — said some of the young people he spoke with knew how to manipulate the patches.

“One of the kids said that you can put it on your tongue to get it in your system right away,” Smith said.

A well-liked youth

By all accounts, Norton was a popular, likeable young man with a lot to live for. The Kelso High graduate worked in the state Department of Natural Resources’ wild land firefighting program in 2007. He liked to hang out at Cowlitz 2 Fire & Rescue’s Columbia Heights fire station.

He was physically healthy and not on prescription medication, his mother said. She knew of no history of drug abuse by her son besides occasional marijuana use.

“The (fire) department had quite an investment in him, and it was big surprise to all of us,” Jack Smith said. “It shook up a lot of the kids, because everybody was friends with Cody.”

“These are good kids, they’re not mainstream drug addicts, so (patches) are reaching a lot of kids,” Smith said.

Jodie Underwood, spokeswoman for the Seattle office of the U.S. Drug Enforcement Administration, said in some cases fentanyl patches are being “diverted” from nursing homes or long-term-care facilities.

“We’re aware that it’s happening, but we don’t have the information to provide to you,” she said.

Castle Rock Police Chief Bob Heuer said the patches have “been on the radar of all the (local police) chiefs and prosecutors.” He said prescription drug abuse of all sorts is a top priority for local law enforcement.

“It kind of ties in with prescription overdoses, and it’s a real concern with us. We’ve discussed having a community forum, having a task force to address it.”

For Rexford, only time will dull the pain of her son’s death.

“A lot of my mourning is to figure it out,” she said. “This is not something that I would wish on any parent. ... This is just as bad as heroin or anything else, simply because they can hide it, and they’re able to get a hold of it. That’s the worst thing, is they’re able to get a hold of something that’s supposed to help people and not harm them.”

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