With 36 drug deaths so far this year, York County has already matched 2009's total number of overdoses.
There's clearly a drug problem, and one of the major offenders is related to heroin but not as well-known: fentanyl.
The synthetic prescription opioid is being abused more than ever in York County, said Coroner Pam Gay.
"It's concerning because it's so much more potent than morphine," she said, adding fentanyl is some 50 to 100 times more potent than that drug.
So far this year, 10 people have died from fentanyl-related overdoses. In 2011, nobody in York County perished from the drug.
'They stop breathing': Fentanyl is prescribed for moderate to severe pain and used for anesthesia during surgery.
As an opioid, it has a lot of the same pain-relieving effects as morphine and heroin.
It also suppresses the receptors for respiration in the brain, which makes breathing more shallow, Gay said.
"So people basically don't have that urge to breathe, and they stop breathing," she said.
People who abuse the drug get it on the street or from friends, Gay said.
When she's called to overdose scenes, the needle will often still be in the arm of the victim, or he or she will be clutching it, she said.
The same thing happens with heroin overdoses, she said.
A deadly mix: Among the 10 fentanyl-related deaths, six had some sort of connection to heroin, Gay said.
That is to say, it appears the individuals thought they were injecting heroin instead of pure fentanyl or a mix of the two drugs, she said. The U.S. Drug Enforcement Administration has called the mix "killer heroin."
"It's definitely worse when you mix the fentanyl in with the heroin," Gay said, as the drug strengthens the effects of heroin.
The other four fentanyl-related deaths involved users who ingested the drug orally, sometimes with other prescription drugs. "We see fentanyl and oxycodone mixed a lot, and that's really potent," Gay said.
Gay couldn't say why drug dealers cut heroin with fentanyl, but the line of thinking is likely aimed at getting customers to come back for more — not to kill them.
"All these drugs are becoming less expensive, but I don't think they're really out to kill people," she said. "They're out to get them hooked."
The problem: The heroin problem isn't new in urban areas, but suburban areas began to get "hit hard" by it only a year or two ago, said Newberry Township Police Chief John Snyder.
The department covers Newberry Township, Goldsboro, York Haven and Lewisberry and has seen two heroin deaths this year, he said. Both cases involved fentanyl.
"We've seen an increase in heroin all over the place," Snyder said. "It's kind of crazy.'
A hit of heroin costs just $10, he said, whereas OxyContin goes for $80 per 80-mg pill — causing users to switch over because it's much less expensive.
"Right now, heroin's really cheap. Obviously, somebody saw there was a change in the demand for heroin, and now it's becoming more available," he said.
Heroin is the No. 2 drug Snyder sees in the area behind marijuana, he said. He used to deal with heroin cases maybe once a year — now he sees them once a week, he said.
The process: The recent surge in heroin deaths has Newberry Township Police doing everything differently, Snyder said.
Incidents are now being taken more seriously, with officers aiming for charges such as drug delivery resulting in death — a third-degree murder charge, he said.
"Now we're treating everything like a crime scene," he said.
After taking office at the start of the year, Gay created a policy that orders autopsies for all victims of known and suspected heroin overdoses.
Autopsies are invaluable to police, as a lack of one makes conviction in these cases more difficult because prosecutors have to prove beyond a reasonable doubt that the victim died from the drug and not something else, Snyder said.
Recently, police used cellphone technology and some good leads to arrest Denzel "Den" Rymay Outen, 20, of Dauphin County, Snyder said. Outen is charged with drug delivery resulting in death in connection with the death of a 19-year-old Newberry Township woman who died of heroin and fentanyl toxicity.
"I think we're going to have a very, very good case. ... It's our hope that we'll get justice for the family," he said.
If convicted, Outen could face up to 40 years in prison.
"If we start locking these people up for 40 years, maybe people will start paying attention. ... If they kill any more kids here, we're going to come after them," he said.
— Reach Mollie Durkin at firstname.lastname@example.org.