One word uttered by a suspected drug dealer inside his South Louisville home sent narcotics detectives scrambling out the door to call for reinforcements:
Fentanyl.
The suspect cautioned that he mixed his heroin stash with the stealth and deadly drug, which has caused some U.S. police officers — and a police dog — to overdose after breathing in or having their skin exposed to even a small amount of its fine powder.
A few years ago, many residents, drug users, and even some police officers hadn't heard the word. Now fentanyl is blamed for causing or contributing to nearly 43 percent of the county's 325 fatal drug overdoses last year — and taking more lives than homicides.
Fentanyl-related deaths spiked to 139 from 26 between 2015 and 2016. That's five times more victims, according to Jefferson County coroner's data. Deaths blamed on all drugs also climbed by nearly 48 percent, from 220 to 325, mirroring similar spikes across the nation.
Fentanyl, a synthetic opioid, is legally used to ease the severe pain for amputees and advanced cancer patients but is increasingly hidden in batches of heroin or other drugs. It can be up to 50 times more potent than heroin, according to officer safety alerts by the U.S. Drug Enforcement Administration. And, the DEA cautioned, a dose as small as two milligrams — about the size of Abraham Lincoln's cheek on a penny — can be lethal.
Officers and users can't detect it. And sometimes dealers don't even know it's in the shipment they bought from their suppliers, police say.
"I'm scared of it," said Louisville Metro Police Lt. J.T. Duncan, a narcotics unit supervisor. "You never know what you're going to get."
► READ MORE: 5 things to know about trendy street drug fentanyl
And predictions for 2017 are bleak.
Jim Scott, resident agent-in-charge of the DEA's Louisville Division, expects to see overdoses from fentanyl rise this year.
It's cheaper than heroin and delivers a more powerful high, appealing to manufacturers and traffickers. It's often made in China and shipped to Canada or Mexico and then hauled into the United States, but it also has been sent directly from China, Scott said.
Manufacturers are making more of it and adding it to a wider variety of products — such as counterfeit prescription pills, cocaine, and methamphetamine — to expand the customer base beyond heroin users.
"There are some who will not touch heroin because of the stigma," Louisville Metro Police narcotics Sgt. Tom Schardein said.
They could end up unwittingly taking a pill containing fentanyl. The DEA issued a warning on its website calling its pressed pill form, which mimics the appearance of oxycodone and other prescription pills, "a global threat" amid the nation's largest "fentanyl crisis" in a decade.
The FBI and Centers for Disease Control and Prevention also issued fentanyl alerts, noting last year's overdose spikes across the nation.
► READ MORE: Dangerous cancer drug on the rise in Louisville
"It's troubling," the police sergeant said. "We’re talking to people now who were actually trying to find the fentanyl. We’re told the high is quicker and slightly longer.”
More than two dozen people already have overdosed this year in Jefferson County. Of the eight whose toxicology reports are concluded, seven had consumed fentanyl, Scott said.
Fentanyl comes in many forms other than pills or powder, police said. Some addicts steal cancer patients' patches and chew them or rip them open and scrape off the fentanyl. There's also a spray and a lozenge on a stick that resembles a lollipop.
The scope of the fentanyl crisis is difficult to quantify.
Some reports point to fentanyl as the commonwealth's new No. 1 killer, overtaking heroin. But some deaths blamed on morphine were likely caused by heroin that metabolized in the victim's body over time, so heroin's exact death toll is unknown.
Last year, fentanyl surpassed the known number of heroin-related deaths in Kentucky — with 28 percent of all fatal overdoses linked to heroin, compared to 34 percent to fentanyl, according to a 2015 fatality report by the Kentucky Office of Drug Control Policy. And fentanyl overtook the confirmed number of heroin-related deaths in Jefferson County, which totaled 99 last year, according to coroner records.
Final numbers for 2016 aren't available, but fentanyl again is expected to be the top known culprit in the statewide death toll, said Van Ingram, the office's executive director.
The extent of non-fatal overdoses blamed on fentanyl also is unknown.
Hospitals don't routinely test for fentanyl or heroin and instead use life-saving measures for opioids in general.
Dr. Robert Couch, medical director for Emergency Services at Norton Audubon Hospital, said opioid overdoses in the last five years grew from "an occasional event to an everyday event" with doctors sometimes fighting to save two or three overdose patients simultaneously.
He called a late night news conference Aug. 30 to declare a public health emergency after nine overdose patients in a single night were rushed into Norton, amid clusters of regional and national overdoses.
"I'm scared of whatever is used to cut this heroin," he told reporters.
► READ MORE: Beshear plan targets fentanyl ‘dealers of death’
A few days before the doctor's public alert, a 31-year-old female died from what toxicology reports later showed was a mix of heroin and fentanyl, and a 30-year-old man died of cocaine and fentanyl, according to data from the Jefferson County Coroner's Office.
Couch described why fentanyl doses are so deadly: "They make people stop breathing, They get sleepy, lose consciousness and ... once they stop breathing, there's very little time to save them."
Irreversible brain damage occurs in four to six minutes. Death follows.
"Sometimes someone wants to experiment and it only takes one pill to die," Couch said. "If it’s fentanyl, it’s Russian roulette."
