SALT LAKE CITY — They were panicky, confused. Some slurred their speech. Others had hallucinations. Convulsions. Seizures.
All said they had recently ingested cannabidiol oil that they’d bought at local smoke shops, though that didn’t make sense to the nurses and pharmacists answering the phones late last year at the Utah Poison Control Center. CBD oil is a nonpsychoactive component of the marijuana plant. Federal law technically bars smoke shops from selling it, but the law is widely disregarded, and CBD oil isn’t known to be dangerous. What these callers described sounded dangerous.
Next, the substance was sent to the Utah State Crime Lab, where tests revealed it wasn’t CBD oil at all, but a previously unseen type of synthetic cannabinoid, similar to drugs known widely as spice. The Department of Public Safety then warned smoke shop owners, health workers, police officers and the wider public: Steer clear of purported CBD oils. And on Tuesday, the Legislature passed a bill sponsored by Cedar City Republican Sen. Evan Vickers to order the state's Department of Agriculture to make sure any product labeled CBD oil is actually what it claims to be.
The speed of that systemic reaction, going from unprecedented problem to a possible solution in just a few months, is owed partly to the timing of Utah’s annual legislative session. But officials say it’s also due to a new framework for sharing information, built using state law enforcement resources that were originally meant to combat terrorism, not drug use.
The Sandy-based Statewide Information and Analysis Center opened in 2007 as part of a nationwide network of so-called “fusion centers,” established with support from the Department of Homeland Security to gather and share intelligence after the Sept. 11, 2001, attacks. Utah and a growing number of states have since realized another use for them, though: gathering and sharing intelligence about illicit drugs.
By piecing together the vast quantity of available data collected each day about overdoses and drug seizures, fusion centers have been able to spot emerging threats that the data collectors might miss as they await monthly or even annual updates from their partners.
The value of such insights is increasing as people abuse more and more types or variants of drugs — some of them acquired through online cryptocurrency transactions that are more familiar to drug-seeking teenagers than many in law enforcement. Fentanyl and other opioids are so potent they can endanger first responders and investigators who unwittingly breathe them in, while the risks of new synthetic drugs like last year’s CBD oil impostor may not be fully understood until they’re seen at poison control centers, emergency rooms and coroner’s offices.
By making quick sense of it all, fusion centers like Utah's can reduce the severity of overdose events — or even prevent them altogether.
It’s never TMI for a DMI
New Jersey has an immense supply of highly pure white powder heroin, brought in by sea, air, rail and roads. The state's opioid trends are also among the nation’s most alarming.
While fatal heroin overdoses more than doubled in Utah between 2011 and 2016, according to a recent Kaiser Family Foundation study, they increased by 650 percent in New Jersey. Over that time, that state also saw a 22-fold increase in overdose deaths involving synthetic opioids like fentanyl.
Yet, Juan Colon felt in the early days of the opioid epidemic, there was little real-time understanding of the crisis — where it was peaking, which batches were to blame and how to respond. So, Colon, who recently retired as a major with the New Jersey State Police, sowed the seeds for the nation’s first Drug Monitoring Initiative.
The spark came to him years earlier, during a statewide assessment of phencyclidine, also known as PCP, angel dust, embalming fluid ... and a half-dozen other names that local police departments were using in their records, thereby muddying the overall picture of PCP use in the state.
Around 2009, Colon began to solicit as much information about drug overdoses as he could get his hands on — police seizures, crime lab analyses, coroner’s reports, emergency responses and injections of overdose-reversal drugs. He reached out to crime labs, medical examiners, nearly 500 police departments and more than 200 EMS providers. Some had concerns. Some said no. But Colon persisted.
“OK, give me your email, and we’re going to share whatever we have with you, anyway,” he said he would tell them.
Whereas previously his department had waited years to receive some reports, long after trends had passed, now it had weekly and even daily updates. Doubters became devotees.
But it wasn’t until 2013 that Colon received the state’s blessing and the Drug Monitoring Initiative was formally established at the Regional Operations and Intelligence Center. By then, the data had already begun to demonstrate where heroin use was concentrated and how it was concentrated by age, gender and race. It also revealed previously invisible drug problems in rural areas, from where residents flocked to New Jersey’s urban centers to find their fix.
Unlike the black tar heroin found in Utah and throughout the Western region, white powder heroin is easily mixed with fentanyl and other opioids that can increase its potency and reduce costs for producers. Fentanyl is 50 to 100 times as potent as morphine and can cause respiratory problems even in minute quantities. Illegal drug manufacturers would be hard-pressed to guarantee, even if they wanted to, that a given dose containing fentanyl would not kill a user.
In early 2014, Colon saw a crime lab analysis of a powder that had been thought to be heroin but in fact only included fentanyl among active ingredients. When he asked the lab how frequently fentanyl was being mixed in with heroin, lab workers told him they stopped testing a sample once they identified heroin or another Schedule I drug. Colon instructed them that from then on, they should test each sample for all substances. Soon they saw that fentanyl was more prevalent than anybody had realized.
“Once we started getting the results, it opened our eyes,” he said.
Colon’s team also began to track and map the distinct dealer brands that were stamped onto the waxy, transparent paper folds that white powder heroin is sold in (black tar heroin, by comparison, is balled up and tied in tiny, indistinguishable and unstampable balloon scraps). When there was a spike in overdoses related to, say, “Bud Ice” or “Blue Magic,” the fusion center issued targeted geographic alerts.
In early 2015, upon hearing that six people died using “Power Hour,” “Taliban” and “Strike Dead” and that some had not responded to opioid overdose-reversal drugs, they issued an all-points buyer beware that those brands contained an unusual cocktail of compounds that in some cases didn’t include any heroin.
New Jersey announced in February that it plans to ratchet up those information efforts by rolling out a real-time dashboard that will combine the monitoring initiative data with information from Consumer Affairs’ prescription drug monitoring program, so that street-level activity and prescription abuse aren't treated as though they are separate narratives.
“The intangible is, ‘OK, what did you prevent?’ And it’s hard to measure what you prevented," Colon said. "But we have such a better understanding of what’s going on in the state."
Predict and prevent
Utah became one of the earliest adopters of New Jersey’s increasingly popular model when Public Safety Commissioner Keith Squires heard a half-hour presentation from the Regional Operations and Intelligence Center while on a 2015 family vacation to the Garden State.
Squires said there had been several times he learned about drug-related incidents in newspapers, on TV or in multiagency meetings and thought to himself that his department might have done something if it had known sooner.
“We really, a lot of the times, get wrapped up in what’s taking place in our area of responsibility, or our jurisdiction — this individual, this group, this criminal activity,” Squires said. “But we have not been very good at sharing information.”
The job of coordinating between public safety and its many partners in Utah’s version of the Drug Monitoring Initiative falls to Stephen Gilley, a retired U.S. Air Force special agent who works as an intelligence analyst at the Sandy fusion center.
Gilley started by working backward. After he negotiated memorandums of understanding to swap stats with federal, state and local partners, they collaborated on a historical review of drug data for a five-year period beginning in 2014. With that baseline established, Gilley began to distribute regular reports about fatal overdoses, hospitalizations, emergency room visits, poison control contacts, treatment admissions, submissions to the state crime lab, drug seizures and more.
None of it was new, per se. But “Steve will put out these reports, and we’re able to see it all concisely in one place,” said Sherrie Pace, outreach coordinator at the Utah Poison Control Center.
Utah’s illegal drug profile is fairly different from New Jersey’s. Black tar heroin isn’t so easily mixed with fentanyl and related opioids, so that’s less of a concern, nor does it come in branded packaging that can be tracked and mapped. But between the rise in opioid use, illicit pills, spice variants and bulk orders of online powders, the drug use landscape is as newly alien here as it once was in New Jersey.
After September 2016 reports of two fatal overdoses involving the synthetic opioid U-47700, or “pink,” drug monitoring reports went out to local law enforcement and emergency room staff, urging them to be on the lookout.
“We had seen (U-47700) in the East, on several overdoses and fatal overdoses, but this was kind of the first time we’d seen it here in Utah, and it was because of the relationships we’d built with this program that we were able to do that,” Gilley said.
Within days, two 13-year-old Park City boys, Grant Seaver and Ryan Ainsworth, were found dead from U-47700 overdoses. Although the new initiative hadn’t prevented the tragedy, the information helped responders quickly grasp what they were dealing with, and another recent monitoring report on dark web purchases guided local investigators who were searching the electronic devices of local teens for evidence.
Also in 2016 — before a large illicit fentanyl pill-pressing operation was discovered in the Cottonwood Heights home of alleged online drug kingpin Aaron Shamo — the monitoring initiative briefed the community about the dangers of not only purposely ingesting fentanyl and its analogs, but of accidental exposure.
Jennifer McNair, senior forensic scientist manager at the state crime lab, said lab workers wear a coat, safety glasses, gloves, hoods and sometimes face masks to handle fentanyl, and by rule they never handle it alone.
“We don’t see (those drugs) to the extent that the Northeast does, or the Eastern part of the United States,” McNair said, though the most recently released state data showed that fentanyl-related overdoses in Utah have increased by a smaller factor and jumped from 24 in 2015 to 41 in 2016. “However, these substances are so dangerous that one exposure in a massive amount can kill someone.”
The ultimate goal for the Drug Monitoring Initiative, said Department of Public Safety Col. Brian Redd, is to not only become more nimble and reactive, but to eventually collect and analyze data at such a sophisticated level that it can stop crises before they start.
It recently thought it had one such opportunity, amid the ongoing crackdown on lawbreaking around Salt Lake City’s downtown homeless shelter.Comment on this story
When the fusion center learned people had overdosed after using what they thought was spice — and that they had been revived somehow by overdose-reversal drugs that are only meant to work for opioids — it told first responders and residents “to just be careful,” Redd said. Officials still aren’t sure what happened. They don’t believe the spice was laced with fentanyl. But as the list of available drugs and compounds continues to expand and habits keep shifting, such things can happen, he said.
“I think what we hope in the future — and I don’t know if it’s going to take legislation, it’s going to take more collaboration or it’s just more effort — but we want to be more predictive in our response to these threats.”