The drug that killed 18-yearold Evan Schwager in May is among the rarest and strongest in New Hampshire.

The narcotic that claimed his life had remained hidden behind the curtain of a Bedford police investigation until recently, when Hooksett police arrested Montgomery Proulx, the 19- year-old man from Manchester who was wanted for allegedly selling the drug to Schwager. Records in Merrimack District Court identified the lethal drug as fentanyl.

On May 10 at 9:25 a.m., Bedford police and firefighters responded to a medical call at Schwager’s home at 22 Wiggin Road. The West High School student was transported to Catholic Medical Center, where he was pronounced dead.

Michael Zaino, the assistant county attorney involved in the case, said it is the first time in his nearly three years in the Southern New Hampshire area that he has seen fentanyl. Officials at the state level said they had not prosecuted a fentanyl case in at least 15 years.

But the drug is not a new one, according to Dr. Tom Andrew, the state chief medical examiner.

“It’s been around since the ’60s,” he said.

Fentanyl deaths are uncommon in the Granite State. Last year, there were 168 deaths caused by drugs, an all-time state high, Andrew said. Only 10 of those were related to fentanyl. The highest number of fentanylrelated fatalities in the past four years was in 2006, when there were 11 out of a total 138 druginduced deaths.

Of the 7,825 drug cases in 2007, the State Police Forensic Laboratory had only six involving fentanyl and in most of those cases the narcotic had been mixed with another substance, according to Tim Pifer, the director.

Nationwide, however, health and law enforcement officials have seen a spike in fentanyl deaths. Between 2005 and 2007, there were more than 1,000 deaths that resulted from illicit forms of the drug, according to a report from the Centers for Disease Control and Prevention.

Andrew said he hoped more publicity might make would-be abusers of fentanyl think twice. But he expressed little optimism that overall drug behavior would change.

“If it isn’t fentanyl, it’s going to be something else. It’s the human condition,” he said. “The abuse of drugs will always be with us.”

Methadone, not fentanyl, is the drug of choice in New Hampshire and has become the leading cause of drug deaths, according to Andrew. Methadone is in greater supply because it is overprescribed by doctors and is available on the streets, Andrew said, adding that he was expressing his personal opinion.

Fentanyl is obtained either through theft or abuse of prescriptions by patients who needed the drug for pain and became addicted to it, according to state officials. It can also be illegally manufactured and mixed in powder form with heroin, according to Pifer or combined with that drug or cocaine and injected, according to the Wall Street Journal.

About 60 percent of all drug deaths involve combinations of illegal substances, according to Andrew.

According to his death certificate, Schwager succumbed to the toxic effects of fentanyl. Had other drugs contributed to the effect or heightened the potency of fentanyl, they would have been mentioned on the certificate, Andrew said.

State officials said the drug comes in many legal forms. In hospitals, it can be injected. It also can be dispensed as gel through a skin patch and a lollipop, usually for cancer patients. The patches are a recent innovation that allows a slow release of the drug into the body, Andrew said.

Drug users also will wear the patches or rip them open and ingest the gel.

Andrew said fentanyl is 30 to 50 times more powerful than heroin. It is the most potent narcotic Andrew knows and can be dangerous even for lab technicians to handle because it might come into contact with their skin, according to Pifer.

Patients who are prescribed the drug normally have been on other painkillers which have stopped working because their brains have become more resistant to them. Teenagers and twentysomethings who have abused other narcotics such as Vicodin and codeine do not realize that a similar amount of fentanyl can have lethal consequences, Andrew said.

“It’s not a matter of what level of the drug is in the body,” he said. “It’s a matter of how acclimated the person is to receiving the narcotic in the body.”

For someone who has been prescribed the drug, fentanyl fits into nerve receptors in the brain, blocking the sensation of pain. It can lead to death in someone abusing the drug by having a similar effect on the nerves that tells the lungs to keep breathing, depriving the brain of oxygen. Eventually, the heart stops beating.

“It’s a very quiet, silent way to go actually,” Andrew said.

Several prosecutors have said they did not have much experience with the drug. At the state level, Jane Young, the chief of the criminal justice bureau for the New Hampshire Attorney General, said in more than 15 years she has not seen a fentanyl drug case come through the office.