After Four Fatal Overdoses, Nantucket Physician Warns Of Fentanyl "Tsunami"

Few people on Nantucket have a better sense of what’s happening in the island’s drug scene than Dr. Tim Lepore. He treats people who are addicted to opiates in his clinic. He cares for patients who end up in the emergency department at Nantucket Cottage Hospital. And as the island’s medical examiner, he responds when an overdose victim is found dead.

And what’s been evolving over the past two years on Nantucket is downright frightening, Lepore said. Since April of 2021, at least four people on Nantucket have died from fentanyl overdoses. And numerous others have come precariously close to joining them, having overdosed but survived after being administered Narcan.

“With opiates, there’s been a sea change and fentanyl is in everything,” Lepore said. “I’ve seen on Nantucket marijuana contaminated with fentanyl. I’ve seen Xanax pills - counterfeit pills - with fentanyl in there. Just within the last two weeks we’ve had a couple guys who thought they were getting cocaine and it was laced with fentanyl and they nearly died. On Nantucket. A near-miss overdose.”

While Nantucket has fared better than other cities and towns, Lepore said he fears what is on the horizon.

“This is the tsunami warning going off,” Lepore said. “We’ve seen the first couple little waves, but there’s more coming. We are flooded with it. People just don’t know what they’re getting. It’s the wild west.”

Through his non-profit Addiction Solutions of Nantucket, Lepore offers medication-assisted treatment and counseling to at least a dozen island residents - sometimes as many as 20 - on a weekly basis. Through his sessions with those patients, along with his work at the hospital and in the community as medical examiner, what Lepore has witnessed is leading him to sound an alarm with anyone who will listen.

Yes, he acknowledges, Nantucket has had a drug and alcohol problem for years. But what is happening now, Lepore said, is different.

“Years ago, if you saw a Percocet pill it was a Percocet pill. It wasn’t laced, and that’s the difference,” Lepore said. “The island is full of people that are using and it is dangerous because you don’t know what you’re getting. Then you throw in the kicker: xylazine. It’s another drug being added to fentanyl and the other drugs to prolong the high. The trouble is it’s an animal tranquilizer but in humans it has no particular use and it causes gaping wounds and sores. The cases I've seen here personally, there was someone losing toes. It cuts down the blood supply. They came through the emergency department and then had to go to Boston.”

A common animal tranquilizer, xylazine is often used on horses and cattle, but the powerful sedative has now crept into the illicit drug trade. Last month, the federal Drug Enforcement Administration issued an alert in which it disclosed that xylazine had been detected in nearly a quarter of the confiscated fentanyl samples in 2022.

Since April 2021, when a 20-year-old Nantucket woman died of a fentanyl overdose in an apartment off Old South Road, there have been three other fatal overdoses, according to Lepore. Last October, the body of a 24-year-old man was discovered in the state forest off Lovers Lane, and the following month, a 26-year-old man was found dead in a home on Fifth Way. Those incidents were followed by another suspected overdose death in February 2023 at a property off Old South Road.

But Nantucket Police Department chief Bill Pittman said he did not view the three most recent suspected overdoses over the span of four months as a cluster or connected in any way.

“I’m not sure about a cluster,” Pittman said. “Other than proximity in time, there does not seem to be any direct relationship between them. Given the amount of fentanyl that is pouring into the country and the significant number of deaths being reported in many East Coast jurisdictions I’m not sure that I would consider these deaths out of the ordinary.”

Indeed, the country has seen a significant increase in the number of people dying from suspected opioid overdoses, particularly from fentanyl. According to the DEA, fentanyl is involved in more deaths of Americans under 50 than any other cause of death, including heart disease, cancer, homicide, suicide, and other accidents. Of the 107,375 people in the United States who died of drug overdoses and drug poisonings in the 12-month period ending in January 2022, approximately 67 percent of those deaths involved synthetic opioids like fentanyl.

Given those numbers and what he’s witnessed already on Nantucket, what is Lepore’s message to the community?

“This is something people have to realize: you can’t trust your drug dealer and you don’t know what you’re getting,” Lepore said. “You’re taking a big chance, and you could end up dead.”

On Nantucket, Narcan is available at the following locations:

• Dan’s Pharmacy, 110 Pleasant Street
• Fairwinds: Nantucket's Counseling Center, 20 Vesper Lane, Unit L-1 in Gouin Village.
• Health Imperatives, 20 Vesper Lane, Unit L-3 in Gouin Village.
• Nantucket Cottage Hospital (at the emergency department and the Cottage Pharmacy)
• Nantucket Pharmacy, 45 Main Street

To contact Dr. Lepore’s Addiction Solutions, call (508) 680-4013.