'We have found it in everything': Fentanyl linked to more overdose deaths in the suburbs

DuPage County Coroner Richard Jorgensen began noticing an ominous shift in the opioid crisis in 2015.

Heroin mixed with fentanyl - a far more lethal synthetic opioid - killed seven people that year.

"Prior to 2015, we almost had no fentanyl found in our overdoses. It was all heroin," Jorgensen said.

Illicit fentanyl and its analogues have since flooded the street drug supply, contributing to a continued rise in overdose deaths across the region.

"Fentanyl is cheap to put in drugs, and it has that opioid hook, that addictive hook," said Laura Fry, executive director of Live4Lali, an Arlington Heights-based overdose prevention group.

As the crisis evolves, suburban coroners say fatal overdoses are increasingly tied to a toxic cocktail of substances. Some experts have warned of a new phase of the opioid epidemic involving the use of cocaine and other stimulants alongside opioids.

In DuPage, 137 people died from overdoses in 2021. More than 60% - 83 - were linked to fentanyl. Only one person died from heroin alone, compared with 13 in 2019.

"Now, we see one or two different fentanyls, some heroin, some cocaine, some Valium," Jorgensen said of multi-drug overdoses.

In response to the influx of lab-made fentanyl, Live4Lali has distributed tens of thousands of fentanyl test strips every year to try to find where it's lurking. Advocates try to reach both people with substance use disorders and the casual user who may not know it's in what they're using.

"I have personally tested cocaine and found fentanyl. Percocet 30s that were sold up here near our office in Arlington Heights, I tested them, and they were positive for fentanyl," Fry said. "We found it in LSD. We found it in MDMA and Molly and crack, which is really weird to find it in crack. But we have found it in everything."

'So disheartening'

In Will County, 147 people died from overdoses last year, an increase of nearly 18% from 2020.

"It's out of control. Almost every overdose that I have, most of them, are fentanyl-related," Coroner Laurie Summers said.

Over three straight days in July, fentanyl-related overdoses claimed the lives of four county residents. Opioids accounted for all but seven of the overdose deaths recorded in 2021, Summers said.

"It scares the hell out of me. I don't know what else to say," Summers said. "It's so disheartening to continually sign these cases out."

The Cook County medical examiner's office has, so far, confirmed more than 1,600 opioid-related deaths in 2021, according to preliminary data. With hundreds of deaths still pending review, the final count will likely surpass 2,100, officials said.

DuPage saw 102 opioid-related overdose deaths last year, only 10 fewer than the record high set in 2020. Still, the overall number of overdoses, with or without opioids, eclipsed the previous year's total.

"The majority of our toxicology reports will show certainly five drugs, very commonly 10 drugs and even up to 15 different drugs in the person's system," Jorgensen said.

Sixteen people died from a combination of fentanyl and cocaine. There were 29 deaths caused by fentanyl alone. Seventeen were due to heroin, fentanyl and "a bunch of other drugs," the coroner said.

"It's just all over the place," Jorgensen said.

He's aware of some 50 to 60 illicit types of fentanyl, and their potency varies.

"There's a kind of fentanyl called carfentanil, which we've had a couple of cases out here in DuPage, and that is 100 times stronger than fentanyl, which means that it's 10,000 times stronger than morphine," Jorgensen said. "And it is terrifyingly dangerous."

There also could be a hidden danger: Users might have no idea they're taking fentanyl-laced substances.

"And that puts you at significantly increased risk for overdose," said Dr. Juleigh Nowinski-Konchak, an addiction medicine specialist for Cook County Health.

Live4Lali provides test strips that can detect fentanyl in drug samples. The nonprofit group offers a delivery service for safe use supplies, including naloxone, the lifesaving opioid overdose antidote, to anyone in suburban Cook, DuPage, Lake and McHenry counties.

"We have to mail out three times a week we've got so many requests, and a lot of it is for fentanyl test strips and Narcan," Fry said.

'Test, test, test'

The number of deaths from cocaine-only overdoses in DuPage also went up, from six in 2020 to nine last year. Cocaine deaths increased nationwide during the first year of the pandemic, according to the Centers for Disease Control and Prevention.

"If you look over 20, 30 years, you see trends like this where opioids or downers will rise up, and the stimulants will fall, and then it will reverse," Fry said.

Live4Lali also distributes safe use supplies and syringe disposals out of a purple van that makes weekly stops in McHenry, Waukegan, West Chicago and Woodstock. The organization just secured a grant to bring the truck to Cook County suburbs.

"We're seeing a lot of rock cocaine or crack use, and powdered cocaine is making a big comeback," Fry said.

Her team looks at overdose data and arrest records to target their outreach. If they hear of a sudden spike in overdoses, advocates will load up backpacks and fan out on foot to hot spots. Their message?

"Test, test, test, and always carry Narcan," Fry said.

Harm reduction strategies and more accessible, evidence-based treatment options are key to addressing the crisis, Nowinski-Konchak said. Medications for opioid use disorder are available at all Cook County Health centers.

"We have to prepare and be comfortable talking about how you can reduce your risk of overdose should you have a return to use," Nowinski-Konchak said. "And that means making sure that naloxone is in the hands of all of our patients and making sure that they know that a family member or friend knows how to use it."

When people come to the Live4Lali truck for naloxone or fentanyl test strips, Fry said, it also creates a connection, a sense of trust with social workers and other specialists.

"Then they know that we don't judge them. We meet them where they're at," she said. "And when they want to make a change, they know who to come to."

Those relationships were disrupted during the worst of the pandemic. Many experts attributed a COVID-era surge in overdose deaths to forced isolation, economic hardships and emotional trauma.

As the pandemic recedes, Live4Lali plans to gradually open up peer support meetings that went online.

"What can we be doing better? We're not reaching enough people. That spins in my head all the time," Fry said. "How can we reach more people?"

Overdose deaths

<b>Cook County</b>2021: 1,602 opioid-related overdose deaths, according to preliminary data (717 cases still pending review)

2020: 1,840 opioid-related deaths

<b>DuPage County</b>2021: 102 opioid-related, 137 total overdose deaths

2020: 112 opioid-related, 130 total

<b>Kane County </b>2021: 68 opioid-related (doesn't include pending cases), 90 total so far

2020: 64 opioid-related, 85 total

<b>Lake County</b>2021: 93 opioid-related, 127 total

2020: 100 opioid-related deaths, 124 total

<b>McHenry County </b>2021: 38 opioid-related deaths, 42 total (two pending cases)

2020: 47 opioid-related, 51 total

<b>Will County</b>2021: 140 opioid-related, 147 total

2020: 125 total

Source: County coroners, Cook County health department