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When the team of paramedics in the American state of Indiana found Michael Purvis, had to apply four doses of naxolona so that he could go back to breathe.

It is the double of what is usually fit for naxolona - medicine that counteracts the effects of opiates such as heroin - even in severe cases of overdose.

Similar stories were reported in Ohio and Kentucky, where, as well as in Indiana, there was an increase in the number of overdoses.

In just six days last week, the three states recorded 174 medical care of any kind. They used to be 25 weekly cases. This increase is due, according to local governments, the fact that users are using a new combination of drugs.

Since July, the authorities of the city of Cincinnati, Ohio, have noted that heroin is being mixed with carfentanil, a synthetic opiate. Also suspect that users are using together other similar opiácio, fentanyl, a powerful painkiller.

The American agency drug, describes the carfentanil as a numbing 10 000 times more powerful than morphine and "used in veterinary practice to immobilize large animals." Therefore, it is known as a "elephant tranquilizer".

Since fentanyl is 100 times weaker than the carfentanil, but an overdose it is potentially lethal.

The emergency services registered 174 cases of overdose in six days when the normal in a week is the record of 25 cases

Already fentanyl is a hundred times weaker than carfentanil, but an overdose of it is potentially lethal.

Emergency services reported 174 overdose cases in six days when normal in a week is 25 cases record

Coincidences

the average of 25 cases of overdose a week is "normal", according to Thomas Synan, the Coalition for the Drugs of the county of Hamilton, Ohio.

And although it is not possible to prove that in all 174 recent cases was mixing with carfentanil, the authorities have found similarities between those who suffered overdoses that lead them to believe that this is the case.

One is that poisonings are much stronger than normal.

Now the cases are being analyzed for common standards, including in places where victims of overdoses were found.

The naloxone is one of the most important pharmaceutical tools to reverse an overdose, but those occurring after the use of the mixture of heroin and other synthetic opiates are stronger and need more doses

Synan told the BBC that most of them are in the Cincinnati area, in the triangle between States Ohio, Kentucky and Indiana.

The spokesman for the Indiana State Police, Stephen wheeles, believes it is a "consignment" of the drug that came to Cincinnati and from there was distributed to other places.

"Consumers expect and as soon as it arrives, start using (drugs)," wheeles told a news conference, according to local newspaper The Republic.

And the cases multiply in the region. In Jennings County, there were ten records overdose around 18h last Thursday, including three children under 18 years.

Last week, six deaths were recorded in Ohio and one in Indiana, but there may be more undetected deaths.

Oxycodone, fentanyl and carfentanil are some of the synthetic drugs that were mixed with heroin to increase its effects

Reports of the use of this combination of drugs have appeared in Pennsylvania, West Virginia and Florida.

Traffic

Returning to the case of Michael Purvis, he not only was a victim of an overdose.

Purvis was also arrested on suspicion of "selling a controlled substance," he told BBC spokesman of the police of the city of Seymour, Indiana.

heroin users usually do not know what the other substances mixed with the drug, and some cases, traffickers have used to rat poison

He admitted he supplied heroin to two women, and it is believed that Purvis may be involved with the distribution of the drug mixed with carfentanil or fentanyl.

According to Thomas Synan, users never know what heroin is adulterated and just feel after consumption, the strongest effects and consequences of mixing with carfentanil.

"Publicize this information (the dangers of consumption)," Seymour police said on his Facebook page. "If you know someone who can get in touch with that heroin, please warn him. You may be saving his life."