In 2015, more Americans died from an opioid overdose than any other year on record, the Centers for Disease Control and Prevention (CDC) publishes. More than 33,000 people were killed as a result of an opioid overdose in the United States in 2015, including from both illicit opioids like heroin and prescription painkillers like oxycodone, fentanyl, and hydrocodone.
The Drug Enforcement Administration (DEA) has issued a warning to the public about the dangers of the extremely potent opioid carfentanil, a synthetic opioid that is technically classified as a Schedule II controlled substance. Carfentanil is primarily used as an elephant tranquilizer within the United States and is not intended for human consumption. The U.S. National Library of Medicine (NLM) publishes that carfentanil is commercially marketed as Wildnil, a general anesthetic designed for use in large animals. It is also the most potent commercial opioid on the market.
Carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which is already 50 times more powerful than heroin. Fentanyl is lethal in doses as small as two milligrams, so it is postulated that carfentanil may be deadly in amounts less than half that size. It can even be absorbed through the skin, making unintentional contact and overdose possible as well, the DEA warns.
Carfentanil may be illicitly marketed for recreational use in the form of tablets, spray, powder, or blotter paper, which may be smoked, ingested, inhaled, snorted, or injected. The high associated with the drug is intense and has a rapid onset.
The carfentanil outbreak for recreational human use seems to have began in Ohio, where opioid overdoses (many of which were linked to the dangerous drug) surged in the summer of 2016, NPR reports. The drug was believed to be being manufactured in China and then mailed over into the United States. Carfentanil exposure and reports have since spread into other states.
The National Institute on Drug Abuse (NIDA) warns that carfentanil, and other fentanyl analogues, may be being added to street drugs like heroin without the knowledge of the consumer, making it even more potentially hazardous since people do not know what they are taking. Carfentanil is a powerful and dangerous drug that is not intended to be used in humans due to the immense risk associated with its potency.
Overdose and Dangers of Carfentanil
In just half of 2016, the Akron County medical examiner reported 140 overdose deaths in which carfentanil was involved, The New York Times publishes. Carfentanil may be lethal in as small of a dose as a few grains of salt, and it is considered the deadliest of all of the fentanyl analogue drugs.
Symptoms of exposure to carfentanil include:
- Pinpoint pupils
- Clammy skin
- Cold to the touch
- Slow pulse and heart rate
- Bluish tinge to the nails, lips, and skin
- Trouble breathing or stopping breathing altogether
A carfentanil overdose may be more difficult to reverse than a typical opioid overdose, which can generally be managed with a dose of the opioid reversal drug naloxone (Narcan). It may take multiple doses of the opioid antagonist in order to overturn a carfentanil overdose, and NBC News warns that even then the antidote may not be strong enough. Brain damage, coma, and death may result from a carfentanil overdose. Depending on how fast the reversal drug is administered and how much carfentanil was taken, overdose may or may not be able to be treated, and effects may be permanent and potentially fatal. When carfentanil is mixed with other drugs, its effects and dangers are multiplied.
Other than the extremely high risk for overdose when taking carfentanil, either knowingly or not, long-term side effects of the drug also include respiratory issues and problems related to how the drug was taken. For example, ingesting carfentanil may lead to gastrointestinal issues, such as stomach ulcers or blockages of the intestines. Injecting the drug increases the potential risk for developing an infectious disease like hepatitis or HIV/AIDS as well as for suffering from collapsed veins, skin abscesses and infections, and infections in the lining of the heart. Smoking, snorting, or inhaling the drug regularly can cause chronic nosebleeds or runny nose, coughing, respiratory infections, and damage to the sinus cavity, nose, and sense of smell. Cardiac and cardiovascular functions can also be compromised from long-term opioid abuse.
Another side effect of abusing an opioid, especially one as potent as carfentanil, is physical dependence. Opioid drugs block pain sensations in the brain and bind to opioid receptors, creating a flood of dopamine – one of the brain’s chemical messengers involved in how a person feels pleasure. This creates the euphoric rush that individuals may be keen to recreate. With repeated use, the brain stops making dopamine at normal rates and begins to rely on carfentanil instead. Balance in brain chemistry is compromised, and physical dependence is established. It may be easy to then lose the ability to control how often a person takes carfentanil, and compulsive drug use defines addiction.
Treatment for Carfentanil Addiction
Around 2.5 million American adults are estimated to suffer from opioid addiction involving both illicit and prescription opioids, the American Society of Addiction Medicine (ASAM) reports based on 2015 numbers. Close to 5 million adults in the United States were considered to be currently using an opioid drug (either heroin or a prescription painkiller) at the time of the 2014 National Survey on Drug Use and Health (NSDUH).
Opioid drugs are deemed highly addictive, and the higher the potency, the greater the risk. Since carfentanil is one of the most potent opioids on the market, it may be one of the most addictive drugs. Preventative measures and public education as to the dangers of carfentanil are the first line of defense against the risks of this powerful drug.
Carfentanil abuse and addiction should be treated with a specialized program that helps to manage both the physical and psychological aspects of the disease that is addiction. Physical dependence must be managed first before the behavioral, social, and emotional components are addressed.
Prescription Drug Categories
A medical detox program is necessary due to the severe dependence caused by this drug. Medical professionals can manage the withdrawal side effects that occur when carfentanil processes out of the body. Withdrawal from an opioid drug can be both physically and emotionally intense, as it can feel like the worst possible case of the flu coupled with insomnia, depression, anxiety, irritability, and cognitive difficulties. Medical detox helps to smooth out withdrawal by providing medical management and 24/7 care. Medications are often a big part of medical detox from opioid drugs. Carfentanil may be replaced with a longer-acting opioid drug like methadone or buprenorphine, which can then be slowly tapered off via a controlled schedule instead of stopped suddenly.
After physical stabilization through detox, the person should then enter into a residential or outpatient addiction treatment program that can offer life skills trainings, counseling, behavioral therapy sessions, educational programs, relapse prevention tools, support group meetings, and holistic methods in order to promote and enhance recovery. Co-occurring mental health and medical concerns can also be attended to with an integrated and comprehensive addiction treatment program.
Addiction and recovery are highly personal, and each person will benefit from a program that is specifically tailored to their unique set of circumstances.