Just when we thought America was getting a handle on skyrocketing drug overdose deaths, along comes a new opioid that is killing people at a shocking pace. The drug is called carfentanil, a derivative of the synthetic opioid fentanyl. Carfentanil was developed for use as an elephant tranquilizer.

Carfentanil is said to be 100 times as strong as fentanyl, which itself is considered to be 100 times as strong as heroin. The alarm was sounded on carfentanil in 2021 when the journal Forensic Science International first reported on autopsies indicating the presence of the drug. “Detection of carfentanil requires specific and sensitive analytical methods that are not commonly available in hospitals,” write the authors.

The potent drug is the cause of life-threatening hospitalizations and fatalities, in Europe and throughout the U.S. One reason carfentanil is so deadly is that its effects are difficult to reverse with naloxone. According to researchers:

[D]ue to its extraordinary potency, reversing carfentanil-induced severe and recurring respiratory depression requires administration of multiple or higher than standard doses of naloxone.

According to investigative health reporter, Maiya Focht, overdose deaths involving carfentanil have increased sevenfold in the past year. Focht cites a recently published alert from the Centers for Disease Control (CDC). In an article for Business and America, Focht says of carfentanil’s toxicity:

As little as 2 milligrams, about one 50th of a pinch of salt, of the drug can be lethal — slowing breathing to dangerous levels, leading to brain damage or death.

The CDC suspects that the supply of the drug is being manufactured rather than stolen from legal repositories, due to the large quantities now invading the market. More than 70% of the overdose deaths from 2021-2023 were due to illegally manufactured fentanyls, according to the CDC. It’s discouraging that carfentanil deaths are increasing at the same time as fentanyl-related deaths are slowing.

Carfentanil-related deaths are highest in Florida and West Virginia, with each state reporting over 20 deaths since 2021. They are followed by a circle of midwestern states, including Kentucky, Indiana, Michigan, and Ohio. Kentucky Today reports that carfentanil is turning up in urine drug testing (UDT) at an alarming rate:

The analysis of more than 158,000 fentanyl-positive UDT specimens also showed that carfentanil use is associated with significantly higher rates of other drug use, including methamphetamine, xylazine, cocaine, benzodiazepines, and other fentanyl analogues.

This corroborates the 2021 report in Forensic Science International which found that “carfentanil use is strongly connected to polydrug use.” Polysubstance abuse is a growing problem in the U.S. and is behind the “third wave” of overdose deaths. For the time being, the best recommendation for treating a carfentanil overdose is a generous amount of naloxone — enough to wake up an elephant.

Written by Steve O’Keefe. First published December 10, 2024.

Sources:

“Urgent CDC warning as new drug carfentanil 100 times more deadly than fentanyl kills hundreds in 37 states,” Business and America, December 5, 2024.

“Carfentanil — from an animal anesthetic to a deadly illicit drug,” Forensic Science International, March 2021.

“Dangerous carfentanil surges in 21 states, including Kentucky,” Kentucky Today, October 8, 2024.

Image courtesy of CDC, used under Fair Use: Commentary.