CINCINNATI – Police can't be sure they will ever know what's in the deadly mix of heroin that has caused 88 overdoses here from Tuesday through Thursday.
That's because they haven't found any unused drug they can tag and send to the lab.
The head of the Hamilton County Heroin Task Force, Newtown Police Chief Tom Synan, said Thursday he was not aware of any physical evidence so far that can be tested. It's not that police haven't looked hard for it. There just hasn't been any extra heroin to collect.
Synan has speculated that the drug that has killed three people here this week is laced with a narcotic -- possibly fentanyl (surgical anesthetic) or carfentanil (animal tranquilizer). Both give a more powerful high and both are exceedingly dangerous, but carfentanil wins the prize. It is used on elephants and other large animals and is said to be 100 times stronger than fentanyl and 10,000 times more potent than morphine.
Butler County Coroner Dr. Lisa Mannix, who has been fighting the heroin war on the Tri-State's northern front, is keeping a nervous watch on what's happening in Cincinnati and hoping the unusual outbreak doesn't spread to Hamilton or Middletown.
"We started seeing some of that (carfentanil) in July ... it may be responsible for the spikes that we're seeing now, but the answer to that is probably weeks or months away," she said.
Mannix said her experience with carfentanil suggests it might not be the problem in Cincinnati this week. If it were, there should have been far more than three deaths among the 80 overdoses, she said.
Two negating factors could be the very fast response of Cincinnati first responders and the administration of life-saving Narcan by IV.
The president of Sojourner Recovery Services in Hamilton is hoping that carfentanil hasn't taken root in Southwest Ohio.
"I think since carfentanil hit the black market in the region, it's been something that we've all been saying, 'God, I hope it never happens here,'" said Scott Gehring.
"If you're seeing that much happening in Cincinnati, very clearly there's a dealer somewhere that is making bad cuts and I think that is a threat to all of us."
Fentanyl is already entrenched here, Hamilton County Coroner Dr, Lakshmi Sammarco said. Hamilton County led the state in fentanyl deaths last year with 195. And yet, addicts aren't afraid of it - they want more of it.
"Some of the addicts we've talked to actually said that they hope they are getting fentanyl when they buy the heroin...because it is such an intense high," Sammarco said.
Synan said dealers know they're distributing a deadly mix and they're doing it on purpose.
"These people are intentionally putting in drugs they know can kill someone," said Synan. "The benefit for them is if the user survives it is such a powerful high for them, they tend to come back ... If one or two people dies, they could care less. They know the supply is so big right now that if you lose some customers in their eyes there's always more in line."
Mannix understands the frustration of police in Cincinnati, not knowing what they're dealing with. She said it's like trying to hit "a moving target."
"If a batch of drug, whatever it is - bad heroin, carfentanil, whatever - comes in and is distributed and consumed so quickly, how do you trace that? What do you do with that before the next batch comes?" Mannix said.
Police have been furiously trying to find something related to all of these overdoses. If they do find something, it will be fastracked to the Hamilton County Coroner's Office.
Butler County has seen a surge in overdoses past two years. In 2014, drug overdoses took over as the leading cause of deaths investigated by the coroner's office, Mannix said. There were 137 drug overdoses in the county and 75 percent were caused by heroin.
The surge continued in 2015 with 136 drug overdoses in the first nine months and 79 percent attributed to heroin.