So long as there continues to be a large unmet demand for opioids because we aren't treating people with addiction, the illicit market will find ways to meet that demand - Hakique Virani MD
image by: Dennice Goudie
Carfentanil is the most potent commercial opioid in the world, according to the U.S. Drug Enforcement Agency. It is 10,000 times stronger than morphine, and at least 100 times more powerful than its analog, the opioid fentanyl, which was linked to Prince's untimely death. Carfentanil's only officially recognized use is to sedate large zoo animals like moose, buffalo and elephants. It takes just two milligrams of Carfentanil to knock out a 2,000-pound African elephant, and the veterinarians who administer the drug use gloves and face masks to prevent exposure to it, because a dose the size of a grain of salt could kill a person – and may be lethal even when absorbed through the skin.
To be clear, Carfentanil is not for human consumption in any way. This does not stop drug dealers from adding a microscopic amount to heroin to give the drug an even more potent high – even though it's often fatal.
"The side effect of Carfentanil is death," says Newtown, Ohio Police Chief Tom Synan, president of the Hamilton County Association of Chiefs of Police and member of the Hamilton County Heroin Coalition taskforce, created in 2015 after a spike in heroin use in the area. "This drug knocks out elephants, that should tell us how dangerous it is," says Synan. "If death is the first side effect, the second is an overdose that you may never come out of." According to his intelligence, Synan believes that Carfentanil could signal a new wave of synthetic opioid use. "What we saw in Cincinnati with the spike [in overdoses] was the literal transition from organic opiates, like heroin, to synthetic opioids like fentanyl and Carfentanil," says Synan...
According to Synan, the drug seems to mainly be coming from China, where it is illegal, but illicitly manufactured in secret labs before being shipped to the U.S. People order it online and ship it through the U.S. Postal Service, before it eventually makes its way into the local heroin supply. While killing your customer base is a bad business model, according to Synan, dealers cut heroin with Carfentanil because it requires only minuscule amounts – smaller than a grain of salt – to increase the drug's potency. That lets dealers increase their supplies without much additional cost and gives users a nearly lethal bang for their buck. "Users give the dealer a good review – just like you do with Starbucks or McDonald's – telling other users that this dealer has good stuff. Soon customers start to build up. If four or five people die, I still have a hundred or two hundred customers lined up," says Synan.
One reason that Carfentanil-laced heroin is so deadly is that most heroin users have no idea that they are ingesting Carfentanil. (According to Synan, some dealers have no idea they are selling it, either). In its liquid form, it is odorless and colorless and used in such microscopic amounts that even drug labs and medical examiners have a difficult time testing for it. Users may take their standard dose of heroin – not realizing that something far more deadly is in the mix – and overdose as a result.
Overdosing on Carfentil is not the same as overdosing on pure heroin, though. Not only is it incredibly powerful, but it is also incredibly resistant to naloxone, better known as Narcan, the opioid antidote that serves as the last line of defense against a heroin overdose. A typical heroin overdose requires one or two shots to work, but when heroin is laced with Carfentanil, it may require six or more shots to counteract the drug – if it works at all. "What first responders were finding is that it was taking IVs of Narcan in order to just sustain people," says Synan.
In short, if you overdose, first responders may not be able to save you – or themselves, which is why the ban on field testing heroin was put into place. "Take this as a dire warning to all if you choose to purchase and use any forms of heroin," said Dr. Sammarco in her statement. "No one knows what other drugs may be mixed in or substituted and you may be literally gambling with your life."
On the local level, Synan and his team are gearing up for whatever comes next. "Drug cartels know their customers better than Avon does," says Synan. "There's going to be another drug out there soon and we're going to have to figure out how to respond to it."
Source: Melissa Locker, Excerpt from Heroin Epidemic's New Terror: Carfentanil, Rolling Stone, September 8, 2016.