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ST. LOUIS • Emergency responders are facing a flood of people overdosing on synthetic drugs, a problem that has “exploded” in recent years, medical experts testified Friday in a sentencing hearing for two traffickers.

A recent two-week period saw 100 emergency room admissions at St. Louis University Hospital, said Dr. Laurie Byrne, head of the Division of Emergency Medicine there.

“It was … crazy. They kept coming and coming and coming,” she said.

Some were comatose. Some were paranoid or very agitated. One had to be restrained and sedated. One was stabbed. Another fell down steps. In one case, the person had overdosed on other medications, too, and it wasn’t clear if he was trying to commit suicide or just didn’t know what he was doing, she said.

The outbreak is “overwhelming” the department, Byrne told U.S. District Judge John A. Ross in a daylong hearing in court downtown.

Ross handed down prison terms of 12½ years each to Anwer Rao and Michael Lentsch, both 36 and from O’Fallon, Ill.

They pleaded guilty last fall to drug conspiracy and other charges, admitting they tried to get around drug laws by making or reselling synthetic cannabinoids, like K2, also known as “spice,” and cathinones, more commonly known as bath salts. Officials said that despite labels warning “Not for Human Consumption” the two knew customers were smoking or otherwise taking the drugs to get high.

They sold the drugs via a website and out of a series of locations in Missouri and Illinois under the brand names “Cloud 9 DEEW” (weed spelled backward), “Mad Hatter,” “Optima,” “Crazy Eyes,” and “Primo.”

Their organization was taken down by a July 2012 raid by police and federal agents, who seized drugs and manufacturing equipment. Rao, Lentsch and 26 others were indicted in 2014.

Byrne said there is no easy way of testing for these drugs, and no antidote, making it “really, really challenging for medical providers.”

Doctors can only treat the symptoms and wait for the drug to wear off.

The symptoms can include seizures, aggression, paranoia, nausea and even organ failure and death, said Dr. Jordan Trecki, a pharmacologist with the Drug Enforcement Administration, in response to questioning by Assistant U.S. Attorney Jim Delworth.

Byrne said the homeless in St. Louis were being hit particularly hard. Someone, she said, is “pushing the K2 on them and making it cheap.” Many buy a single hit from someone who bought a larger package of three grams for around $30.

Police and emergency responders have also seen a spike. Between Jan. 25 and Feb. 3, there were 18 “medical emergencies” related to K2 in the city police downtown Fourth District alone, a court document shows.

Not a new problem

The DEA and others have been tracking overdose outbreaks for years — including one in 2015 that resulted in more 2,500 overdoses and nearly three dozen deaths in 12 states. It put such a strain on resources that it was declared a public health emergency, he said.

But officials have been playing a cat-and-mouse game since the early 2000s, as they detect and outlaw synthetic versions of THC, the psychoactive ingredient in marijuana, and bath salts, which can mimic the effects of methamphetamines or cocaine.

Each time a new drug formula is outlawed, manufacturers tweak it, and the pharmacological effects are unchanged, Trecki said, and the new drug goes back on the market. Makers often try to make the sale legal by printing packages with “Not for Human Consumption” or “DEA Compliant,” he said.

But Trecki said anything intended for human consumption that mimics the effects of a controlled substance is also illegal under federal law.

Because the drugs are typically obtained from China and produced using equipment better suited to the construction trade — portable cement mixers and paint sprayers — the quality varies and users can get doses of different strengths from the same bag, he said.

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Officials said Rao and Lentsch were connected to others in Arizona — and an Indiana drug conspiracy that the Indianapolis Star reported to include two deputies, a teacher and a minister.

The two defendants admitted selling the equivalent of 90,000 kilograms of marijuana. As part of their pleas, they agreed to forfeit real estate in Illinois and Missouri, including five downtown St. Louis loft apartments, and more than $5 million.

In exchange for their pleas, prosecutors agreed to ask for no more than the 150-month terms they received.

Rao’s lawyer, Thomas Keefe III, and Lentsch’s lawyer, John Stobbs, sought less, arguing that their clients had clean records, conducted their business openly, paid taxes and even sought the advice of a Florida attorney who told them their business would be legal in that state.

Lentsch “dodged a bullet because but for the plea agreement, he would have received a significantly higher sentencing,” Stobbs said after the hearing.

Several co-defendants have pleaded guilty and others await trial, prosecutors said.

Police raided a market near North Jefferson Avenue and Dr. Martin Luther King Drive in St. Louis this month, seizing a gun, a surveillance system and suspected drugs.

Byrne said that may explain a decrease in overdoses recently.

But she said her patients say they are still buying their “Green Giant” and “24K Monkey” from a downtown shop.

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