Amid a statewide surge in overdoses, Baltimore health officials announced a campaign Monday to tell heroin users that the drug they buy on the street could contain the much more potent painkiller fentanyl.
The synthetic opiod, which federal officials say is 30 to 50 times more powerful than heroin, is blamed in the deaths of hundreds of drug users nationwide since 2013. Health, law enforcement and counselors began issuing warnings more than a year ago, but have not been able to stem overdoses.
In Maryland, fentanyl-related deaths now account for nearly a quarter of drug overdose deaths, up from 4 percent two years ago. The percentage now eclipses deaths related to cocaine and alcohol, and is gaining on prescription drugs.
Baltimore has been hit particularly hard. The 39 deaths in the city linked to fentanyl in the first quarter of the year are nearly three times the 14 recorded in the same time last year. They account for more than half of the 73 fentanyl-related deaths in Maryland during the first three months of the year.
"It's unclear why it's happening in Baltimore now, but it is a trend throughout the state and country," said Dr. Leana Wen, the city's health commissioner. "Our goal is to alert the public, alert residents that heroin my be laced with fentanyl."
Baltimore led the state in 2014 with 71 fentanyl-related deaths. Baltimore County was second with 36; Anne Arundel County was third with 23.
One of the most recent victims was Crystal Moulden, a 16-year-old Glen Burnie girl who was found in a Baltimore alley last month. Her family said she was a straight-A student and cheerleader until she began drinking and smoking marijuana. Eventually, she turned to harder drugs, they said.
"It's very concerning, especially when we hear reports about people who don't know what they are using," Wen said. "They think they're using heroin only.
"[Fentanyl] stops their breathing within a minute or so because it's so powerful."
Public health officials say they lack good data on how to effectively warn users about the dangers. Baltimore is using trusted workers from its needle exchange program, in operation for two decades, to spread "lifesaving tips" — rather than a message to quit heroin.
They tell users to avoid drugs that have different colors or textures, warn against using drugs when they're alone, and show them how to use the overdose medication naloxone. They also can steer people to addiction treatment.
"The idea is to keep people alive today so they can make better choices tomorrow," Wen said.
Fentanyl, used by cancer patients and those with chronic pain, is prescribed legally to millions of Americans each year.
It produces euphoric effects similar to those of heroin but is far more powerful, making it particularly dangerous.
Fentanyl overdose deaths surged in 2005 and continued for two years until the U.S. Drug Enforcement Administration shut down a single lab in Mexico. But cases began climbing again in 2014, particularly in the Northeast and California.
Deaths related to fentanyl in Maryland tripled to 185 last year from 58 in 2013, state data shows. Baltimore made up more than a third of the total.
Heroin deaths in general also are rising, with 578 people succumbing last year, up 25 percent from the previous year, and more than double the 2010 total.
"Drug incidents and overdoses related to fentanyl are occurring at an alarming rate throughout the United States and represent a significant threat to public health and safety," DEA Administrator Michele M. Leonhart said in March.
Gov. Larry Hogan has formed a task force on heroin that has been visiting all corners of the state and expects to send recommendations to the governor by year's end.
The Baltimore County Department of Health offers training in the overdose medication. In the last year, 331 people have been certified to use naloxone.
Baltimore City also has been providing such training. That and the new anti-fentanyl campaign are an extension of the Mayor's Heroin Prevention and Treatment Task Force, which is due to issue recommendations next week. Wen said health officials didn't want to wait for the report.
One Baltimore-based addiction specialist said the warnings are a good idea, even if drug users aren't easily dissuaded from risky behavior.
"Although one of the symptoms of addiction is doing things an individual would not usually do without the addiction … the vast majority of overdoses are unintentional," said Dr. Yngvild Olsen, medical director for the Institutes for Behavior Resources/REACH Health Services.
"Most people with addiction do not want to die," she said. "So I think a campaign educating users about the dangers of fentanyl and reaching out to people to assist them in reducing overdose risk — including naloxone and engaging people in treatment — can save lives."
Baltimore Sun Media Group reporter Ben Weathers contributed to this article.