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A28 SCIENCE
Tuesday 8 January 2019
Growing opioid crisis adds to Puerto Rico’s problems

By DANICA COTO flect the true situation be- for the thinly staffed agen- lacked access to basic around a plastic table near
Associated Press cause the island’s govern- cy struggling with staffing health care for weeks af- an abandoned house and
HUMACAO, Puerto Rico ment is not keeping proper cuts to apply for the new ter the hurricane hit, and injected each other and
(AP) — Jose Carlos Laviena count of deaths and over- grant while also coordi- pharmacies began refill- themselves. One of them
emptied his pockets, took doses. Despite that, the U.S. nating work under earlier ing prescriptions without a stuck a thumb in his mouth
off his shoes and waited to and blew out, making the
die. vein pop on his neck as he
He had just injected him- prepared for the injection.
self with a new type of On the table were dozens
heroin that his dealer was of dirty needles, small wa-
promoting, but the high ter bottles and cookers.
was so strong that Lavi- Program director Rafael
ena thought he had over- Torruella said he noticed
dosed. The 35-year-old was an increase in overdoses
preparing his body for how after Maria hit and his or-
he wanted to be found. ganization began testing
“It’s truly something super heroin cookers for fentanyl.
strong,” he said, referring Now nearly all of them test
to what he believes was positive.
heroin mixed with fentanyl. Laviena was among the
“I felt death at that mo- addicts who approached
ment.” the social workers that day.
Laviena’s near-fatal expe- He dropped off 140 used
rience in an abandoned needles, picked up clean
trailer in southeast Puerto cookers and paused to re-
Rico is one of many signs count his near-death expe-
that the island hasn’t been rience before disappear-
spared from the opioid cri- ing behind an abandoned
sis that has plagued the building. “Hardly anyone
U.S. mainland— a problem In this Dec. 14, 2018 photo, a drug user turns in his used syringes to volunteers from the “Intercambios talks about this problem
Puerto Rico” needle exchange program, in order to get new, clean ones, in an area popular with
that seems to have grown drug users in Humacao, Puerto Rico. in Puerto Rico. It’s like it
as a result of a devastating Associated Press doesn’t exist,” said Torru-
hurricane. ella, who also trains emer-
The government is strug- territory never applied for grants and programs. doctor’s authorization as gency officials on how to
gling to keep up, and a $7.8 million award from “I am extremely worried, a humanitarian move, he save people from an over-
failed to apply for a multi- Congress to help get peo- because this represents said. In addition, mental dose. “Fentanyl is here, and
million dollar U.S. grant that ple into treatment. That an epidemic that has not disorders were exacerbat- we have to do something
advocates say could have money was instead divid- been acknowledged,” ed after Maria, with some about it.”
helped save lives. ed up among U.S. states. said Puerto Rico territorial people waiting up to a But that is proving hard for
More than 600 fentanyl- “It’s ridiculous. There’s a lot Sen. Jose Vargas Vidot, a year for water and power an island mired in a 12-year
related overdoses and 60 of need for that money,” doctor known for his volun- to be reconnected. recession and sharp bud-
deaths were reported in said Carmen Davila, a teer work with drug addicts “There was a boom in get cuts forced by a sort of
Puerto Rico in 2017, largely nurse who helps drug ad- on the island. “In the 30 anxiety disorders and sui- public bankruptcy.
before Hurricane Maria, dicts in rural Puerto Rico. years that I’ve been on the cides,” Vargas said. “All Puerto Rico’s Administra-
up from 200 and eight the She worries the number of streets, I have never seen these things led to fentanyl tion of Services for Mental
previous year. While that’s overdoses will increase, three to four deaths a week and other drugs becoming Health and Addiction con-
much less dire than the and she questioned the in just one neighborhood, much more fashionable.” firmed 40 fentanyl deaths
crisis in some U.S. states, 612 overdoses reported in in just one street ... Every- In addition to locally pro- through March, but 75 sus-
activists and experts say 2017 by the government. thing changed immensely duced fentanyl, authorities pected ones since then
the problem appears to “I’d say it’s three times that after Hurricane Maria.” say a less-controlled ver- have gone untested be-
be expanding rapidly as amount based on the tes- Vargas said the heavy sion of the drug is now be- cause of budget cuts.
use of fentanyl, the opioid timonies of people we’ve presence of law enforce- ing smuggled in from China “Right now we have some
blamed for much of the helped, and that’s a con- ment on the island after and India, then mixed with serious limitations,” said Su-
problem in the U.S., spreads servative estimate.” the Category 4 storm hit heroin, and to a lesser de- zanne Roig, who oversees
more widely here. Julissa Perez, spokeswom- on Sept. 20, 2017, coupled gree cocaine and mari- the agency.
The U.S. Drug Enforcement an for Puerto Rico’s Ad- with a lengthy paralysis of juana. Officials reported a Officials also are worried
Administration and local ministration of Services for all modes of transporta- cluster of fatal overdoses in about legally prescribed
nonprofit groups also say Mental Health and Addic- tion used by smugglers, the western coastal town painkillers. Gov. Ricardo
the official data doesn’t re- tion, said it was too difficult led drug dealers to substi- of Mayaguez, followed by Rossello declared an alert
tute imported heroin with more overdoses at a near- about overdoses in 2017
fentanyl, which was avail- by prison in the northwest and announced the gov-
able at hospitals since it is town of Aguadilla. From ernment would track the
legally produced in Puerto there, activists say, the use use of legal opioids such
Rico. He said he and other of illegal fentanyl and oth- as fentanyl and hydroco-
doctors received anony- er opioids has spread to all done. In the seven months
mous tips that criminals major cities, including the since that began, officials
were threatening hospital capital. recorded about 60 pre-
staff with violence or even In the southeast coastal scriptions per 100 people.
death if they did not hand town of Humacao, a group That’s roughly equal to the
over fentanyl supplies. of heroin and cocaine ad- full-year rate for the U.S.
Meanwhile, many patients dicts recently gathered mainland in 2017.q