An extremely powerful drug used as an elephant tranquilizer has quickly become a new killer in the nation’s opioid epidemic, and New England authorities and health workers are bracing for its arrival.
The drug, carfentanil, is a synthetic opioid that is 10,000 times stronger than morphine and 100 times more potent than fentanyl, another deadly synthetic opioid. The emergence of a new, even more powerful drug would present a fresh challenge to local officials already battling a raging crisis.
So far, carfentanil’s reach has been confined primarily to the Midwest, particularly Ohio, but New England officials said the aggressive demand for illicit opioids means carfentanil could surface here soon.
“I’m afraid that these things tend to spread,” said Dr. Marc Larochelle, a physician and researcher at Boston Medical Center.
The Drug Enforcement Administration has issued a nationwide alert about the drug, which its acting chief called “crazy dangerous.” In Massachusetts, State Police have warned their crime lab staff about how to handle carfentanil during analysis. Even inhaling the drug or absorbing it through a cut can be fatal.
“The lab is taking all necessary steps to prepare for possible future testing of carfentanil,” said Felix Browne, spokesman for the state Executive Office of Public Safety and Security.
Adding to their unease, law enforcement and health workers said they know little about carfentanil. The drug has never been clinically tested on humans, and the minimum dose needed to kill someone is unknown.
Law enforcement and health officials believe most users do not know they are ingesting carfentanil, which apparently is often mistakenly thought to be heroin or a mixture of heroin and fentanyl, a weaker but still lethal synthetic opioid.
“It’s quite horrifying,” said Colleen LaBelle, who directs an addiction-treatment program across Massachusetts. Confirmed and suspected opioid deaths in the state rose 68 percent between 2013 and 2015, from 911 fatalities to 1,526.
Carfentanil threatens to drive those numbers higher, and its strength means that naloxone might not reverse an overdose. Instead of a single 2-milligram dose of naloxone, an anti-overdose drug often marketed as Narcan, six or more doses might be needed to prevent death, medical workers said.
Carfentanil is believed to have driven part of a staggering cluster of 175 opioid overdoses in Hamilton County, Ohio, over six days in late August, officials there said.
“There are a lot of people around the country looking at us as ground zero. This is uncharted territory for us,” said Dr. Lakshmi Sammarco, the Hamilton County coroner, whose jurisdiction includes Cincinnati. “To our knowledge, this is the most potent synthetic opioid that has been made.”
If carfentanil’s trade route is similar to that of fentanyl, the path stretches from Chinese manufacturers to Mexican processors to smugglers who supply dealers in the United States, law enforcement officials said.
The drug also is being mailed into the country, authorities said. Carfentanil can resemble heroin and fentanyl, which means that desperate addicts often are unaware of the exponentially heightened danger.
“There’s no quality control, so when it gets here the distributors don’t know what they have and the user has no idea,” said Timothy Desmond, a special agent with the New England division of the DEA. “That’s where it’s a game of Russian roulette.”
First responders in Hamilton County are seeing the outcome of that game of chance. Since July, opioid overdoses there — fatal and nonfatal — have surged to an average of 25 to 30 a week, said police Lieutenant Tom Fallon, investigative commander of the Hamilton County Heroin Task Force.
“We’re seeing carfentanil in small seizures, large seizures, and we’re seeing it tied to many, many overdose deaths,” Fallon said. “This is like nothing we’ve ever seen. It hit like a Mack truck. It took a problem that was described as an epidemic and made it much, much worse.”
Containing that impact to Ohio and neighboring Appalachian areas where the drug has been reported — including Kentucky, West Virginia, and western Pennsylvania — will be difficult if not impossible.
“We hope it doesn’t make its way to New England, but unfortunately the demand for opioids is so great here,” Desmond said.
Sammarco echoed the sense that carfentanil will spread. “If you look at cartel transportation and distribution services, they tend to go into the Midwest and spread to the coast,” she said.
Hamilton County officials are baffled by the marketing strategy behind such a lethal drug. “It doesn’t really make sense that you would want to kill your customers,” Fallon said.
Still, Sammarco added, “there’s a certain group of addicts that are looking for the biggest, baddest, worst, most extreme high that they can get. How close can they get to dying without actually dying?”
Law enforcement officials also are concerned that carfentanil will harm first responders. The DEA has warned police not to conduct field tests on seized drugs that might contain carfentanil. Instead, the agency urged officers to secure their samples and deliver them only to colleagues with training and equipment to handle the drug.
In Massachusetts, the State Police crime lab “has reminded all involved of the need to wear appropriate personal protection equipment during all aspects of sample analysis and evidence intake,” said Browne, the state public safety spokesman.
For now, police and health workers in New England are keeping a wary watch on the front line of the opioid scourge.
“People sometimes are seeking drugs that can give them a more rapid and intense high,” said Larochelle, the Boston Medical Center physician. “What we need as a community is to get out in front.”
Brian MacQuarrie can be reached at firstname.lastname@example.org.