It was a grim Thanksgiving holiday weekend for police and families in Harford County, as five people died from heroin overdoses between last Wednesday and Sunday.
While that number may be staggering, local police say it could get to the point where there are multiple fatal overdoses in a period of hours.
It's not a matter of if, but when, carfentanil, a relatively new synthetic opioid, makes its way into the heroin addicts in Harford County use, both law enforcement and county public health officials have acknowledged.
When it does, police expect carfentanil to have deadly impact immediately, drastically increasing the number of fatal overdoses. All the states surrounding Maryland have seen the synthetic opioid that's 10,000 times more potent than morphine and 100 times more potent than fentanyl, another synthetic opioid which has killed many people.
"We fully expect to see it here in Maryland and here in Harford County. It's a matter of time, we're not going to be immune," Capt. Lee Dunbar, of the Harford County Task Force, said. "It will drastically increase our fatality rate."
Instead of five fatal overdoses in days, he said, Harford could see five fatal overdoses in a matter of hours.
The five fatal overdoses since last Wednesday bring to 48 the total this year, an average of about one per week. If that pace continues through the rest of the year, Harford will record 53 fatal overdoses in 2016, only one less than double the number of fatal overdoses – 27 - in 2015.
There have been 198 non-fatal overdoses (246 total) so far this year compared with 174 (201 total) all of last year, based on calls investigated by the Sheriff's Office and other police agencies in the county.
Dunbar attributes the drastic increase in overdoses this year over last year to the increase in the use of fentanyl mixed with heroin, though users may not be aware it's in their drug.
Each of the recent fatal overdoses were independent of each other, Dunbar said. Two of the five victims were from out-of-state, he said, one in Harford spending the holidays with family and one in the county for work.
One overdose occurred in the bathroom of a large national retail establishment, one was in a hotel and the others were in residences, Dunbar said.
It just goes to show, he said, that there is no rhyme nor reason to who is abusing heroin or why.
"You can't explain it. It's hard to explain. There's causes and they vary," Dunbar said.
Narcotics investigators have interviewed more than 400 people in the last two years and they've only found one common theme.
"A lot of people felt like they have no one to talk to," Dunbar said. "We try to stress that to high schools, when we go to Harford Community College, we stress to students to find somebody, even if it's not a parent, find a school counselor, a friend, reach out to somebody and not internalize it. Even if you think your child is doing fine, reach out and ask a simple question, how are you doing, how are things going."
Heroin addicts have said they started using drugs because of depression issues, undue stress from parents or friends at school to be better at sports, more popular, to dress better, to fit in more. Others refer to specific incidents, he said, like the loss of a loved one or a friend or parents divorcing.
"They range on why they started using," Dunbar said. "Everybody wants to look for a specific cause on why a young person or adult decides to stick a needle in their arm or snort cocaine, with all the education they have."
"It we could find that one reason or causation, that would be great, then we could target that issue and deal with it," he added.
Most of the users didn't start out using heroin, they were led to it from other drugs.
"In more than 90 percent, they started out with marijuana because it was readily accessible, relatively safe and it helps relieve anxiety or depression, or it makes whatever bad feelings go away," Dunbar said. "When that didn't work, a lot progress to pills, when they're available. And now a lot of them progress from marijuana to heroin."
Regardless of who starts using it, they'll become addicted, he said.
The Harford heroin victims are often more affluent, more males than females and more whites than blacks, police say. They're college graduates, students, kids on the high school equestrian team, the honor roll.
"There's no rhyme or reason. We track all the data, we look at it, but a lot of times it doesn't make sense," Dunbar said.
It's not like a burglary or other types of crimes where investigators can determine patterns.
"When it comes to heroin victims, it's very hard to do," he said.
From a law enforcement standpoint, it's "extremely frustrating and it's sad when you think about the loss of life. A lot had very promising futures, they're from all walks of life," Dunbar said.
It's also frustrating as a parent, he said, "because you have to go tell these parents their child is deceased."
Many times, the victims have been estranged from their families for years.
"And we have to tell them their child has died of a heroin overdose," he said. "It's sad. They're heartbroken, but sometimes relieved, because their children have been in a living hell for many years."
At the semi-annual Harford County Board of Health meeting on Oct. 18, County Health Officer Susan Kelly discussed the heroin epidemic in detail, zeroing in the increased use of fentanyl, which she called "extremely alarming."
Kelly said fentanyl gives "a greater high" and may be a drug of choice for some users; "although in many cases, the people who are using may not realize the heroin they are using is laced with fentanyl."
She also said fentanyl is 15 to 100 times more potent than morphine.
According to statistics cited by Kelly, fentanyl-involved deaths in Harford County have risen from one in 2013 and two in 2014 to 16 last year and 15 through the end of June this year. By 'involved" she said she meant heroin could also be involved, "but fentanyl was part of the mix"
"At that rate, we are going to far exceed that number," she said referring to last year.
Statewide, she noted, 18 fentanyl-related deaths were recorded in the first six months of 2013, 114 in the same period of 2014 and 121 in 2015 and 466 through the first six months of this year – the latter figure being preliminary.
County Councilman Curtis Beulah said he had been doing research about carfentanil, which Kelly said "is 10,000 times more potent than morphine and 100 times more potent than fentanyl." The County Council also sits as the Board of Health.
The night Kelly spoke, she said she was not aware of any reported carfentanil deaths in Maryland, but there had been some reported in surrounding states and some in states out West, "and apparently this is just extremely powerful, and I have been told that even when DEA officials have it [carfentanil] in a plastic bag and are trying to compress it to get the air out, it actually has caused overdoses because it is so powerful."
She also said she learned that overdose victims, who might normally need one or two doses of naloxone to be revived, may need six or more, if they have ingested carfentanil.
"It is extremely powerful, it is extremely lethal and it is of great concern," she said.
Beulah said it was his understanding dealers "can buy [carfentanil] online from China," and Kelly said he was correct.
He also said he understands carfentanil is used primarily "as a tranquilizer for large animals" and is potent enough that "a gram can kill 100 people." Kelly, however, said she was not able to speak to those claims.
Kelly said carfentanil is considered "a legitimate opioid used for pain, hospitals use it for pain, but not in the way it's being used, manipulated with people who have a substance use disorder."
"It just a matter of time before it gets here," Beulah said.
With fentanyl and carfentanil readily available over the Internet, which she called "disturbing," Kelly said it seems the drug dealers "are one step ahead of law enforcement and public health, and I'm hoping we'll soon be able to close that gap."
Kelly said they have a number of programs to help people who are addicted kick the habit, and she said they also have an overdose fatality team that reviews each drug-related death.
"What we are finding across-the-board is the overall increase and the overall spike and that is of what is of concern to all of us," she said of the heroin-related fatalities in the county.
Aegis staff member Allan Vought contributed to this report.