In the past 3 years, the quantity of synthetic opioids smuggled into the United States has increased. Synthetic opioids are primarily fentanyl analogues. Law enforcement believes that these drugs are arriving form Mexico and China due to the reduced costs of synthesis compared to traditional opiate (heroin) manufacturing. Most alarming is the increase in the number of opioid overdose related deaths in 2015 specifically due to a fentanyl analogue named Carfenatnil.
Carfentanil is approximately 100 times more potent than fentanyl and 10,000 times more potent than morphine. It was originally synthesized for veterinary use in order to sedate elephants and other large animals. However, it is being detected in increasing quantities mixed with heroin and other opiates purchased illegally. According to the DEA, Carfentanil is found in multiple forms such as: powder, blotted paper, tablets, and sprays. The CDC warns that Carfentanil has been sold in counterfeit tablets masquerading as oxycodone, xanax, and norco.
Why the concern? Unlike traditional opiates of abuse, carfentanil poses a significant risk to law enforcement and EMS personnel as well as healthcare workers. The substance can be absorbed through the skin or inhaled by those rendering aid to victims, and even the smallest quantity can lead to an unintentional overdose. Additionally, due to the potency of the drug, Carfentanil requires much larger doses of narcan (naloxone) for reversal. The DEA has advised law enforcement to skip traditional field testing of suspected heroin and use special precautions when handling powdered substances. In order to reduce potential exposure, the DEA has also urged that specimens be taken from crime scenes directly to a lab for processing, bypassing the traditional chain of custody.
As an example of the real threat to first responders, the DEA has released a video (link) of two officers accidentally exposed to a small amount of fentanyl bagged at a crime scene. The DEA face sheet detailing their recommendations can be found here (link). Additional information from the CDC is also avaialble here (link).
The CDC’s 2015 data shows fentanyl related seizures by state, representing a steadily increasing trend for the past 3 years.
Unlike other substances, Carfentanil poses a very real and direct threat not only to unsuspecting addicts, but also to all of us involved in caring for them. As the drug spreads throughout the US, the DEA is recommending that law enforcement begin carrying naloxone. However, all of us working the front lines in EMS and emergency departments across the country need to increase our awareness and vigilance of this growing crisis.