Tox Tuesday: Carfentanil

August 16, 2016

Typically used to sedate elephants and other extremely large animals, carfentanil is one of the latest and most deadly opioids suspected in a new rash of overdoses around the country. Recent reports have also found the drug mixed with or disguised as heroin, and seized in several states including Ohio, Kentucky, Pennsylvania and Florida.

Formerly known under the commercial name wildnil, carfentanil is described as an analog of the synthetic opioid analgesic fentanyl, and was first synthesized in the early 1970s for rapid immobilization and chemical capture of wildlife and exotic animals for examination, assessment, and procedures. It’s reported to have a quantitative potency approximately 10,000 times that of morphine and 100 times that of fentanyl, with activity in humans starting at about 1 microgram.

One article explains that it is so powerful zoo veterinarians typically wear a face shield, gloves and other protective gear — "just a little bit short of a hazmat suit" — when preparing the medicine to sedate animals because even one drop splattered into a person's eye or nose could be fatal. “Our veterinarians handle it almost like uranium,” Dr. Rob Hilsenroth, executive director of the American Association of Zoo Veterinarians said. “This blows my mind that people are playing with such a dangerous drug.”

This isn’t the first drug for animals that has found its way onto the street. In the 1990s, a cat anesthetic known as ketamine became a popular date rape drug. In one case, Hilsenroth said in the article, a dealer using a stolen DEA license number for a veterinarian in Africa managed to order thousands of vials of the drug and sell it in New York City.

Small animal hospitals have also been burglarized for their drugs over the years, and now they are required to keep animal medicine in a locked safe. “People have been looking for all different ways to get this stuff,” Hilsenroth added.

Investigators are not completely sure where carfentanil is coming from and explained it could be stolen from a legitimate source, imported from abroad, or concocted by someone in a kitchen or laboratory. It was also recently discovered that some Chinese companies sell carfentanil online, but as of now, the U.S. Drug Enforcement Administration (DEA) said it hasn't shown up in the U.S. drug supply.

Regardless, these new cases of abuse come as law enforcement officials continue to deal with the dramatic rise of opioid related overdoses and deaths including the use and abuse of heroin and other extremely potent painkillers.

According to reports, an Ohio man was recently charged with murder in Columbus for selling carfentanil that led to two deaths and nine other overdoses within a few hours. Some of the survivors said they thought they were only taking heroin. In addition, in early July, Akron had 91 heroin overdoses in nine days, eight of which were blamed on heroin laced with carfentanil.

According to The Journal of Emergency Medicine, carfentanil is a highly water-soluble, clear liquid with no distinguishable odor, making it impossible for a person using it illicitly to detect it. Furthermore, because this drug is being laced with heroin, users experience the drug’s effects very quickly, which can overwhelm the body’s systems. The DEA speaks of fentanyl analogues in the article and states that they “are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted.”

The signs and symptoms of exposure are consistent with opioid toxicity and include pinpoint pupils, respiratory depression, and depressed mental status, another article explains. Other symptoms include dizziness, lethargy, sedation, nausea, vomiting, shallow or absent breathing, cold clammy skin, weak pulse, loss of consciousness, and cardiovascular collapse.

In some suspected carfentanil cases, emergency responders have had to administer multiple doses of the overdose antidote naloxone — often known by the brand name Narcan — to save people, but, health officials explain even the antidote might not be enough. Dr. Lakshmi Sammarco, the Hamilton County coroner in Cincinnati, publicly warned users during a recent news conference: "Narcan may not save you on this one."

In addition, the potent drug can be absorbed through the skin, which provides yet another concern for health officials. While emergency medical crews use gloves when assisting with a heroin overdose, police officers may not have them and bystanders who want to help will not either.

Because of this, investigators are taking the risks very seriously. In a bulletin to law enforcement agencies, Ohio Attorney General Mike DeWine said he is discouraging police from field-testing suspected heroin or fentanyl for fear that it contains carfentanil or other potentially harmful synthetic opioids. Instead, the office has recommended sending samples straight to a lab for testing.

“What we do know is that this drug is in a category all its own,” Hilsenroth said. “What is the world coming to?” he asked.

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Category: Toxicology