This August, at least 96 heroin users overdosed in one devastating, brutal week in just one county in Ohio. It's believed that they were victims not only of their addictions to heroin, but of a synthetic opioid that some dealers are adding to the narcotic to give it an even more powerful – and completely deadly – kick: Carfentanil.
Carfentanil is the most potent commercial opioid in the world, according to the U.S. Drug Enforcement Agency. It is 10,000 times stronger than morphine, and at least 100 times more powerful than its analog, the opioid fentanyl, which was linked to Prince's untimely death. Carfentanil's only officially recognized use is to sedate large zoo animals like moose, buffalo and elephants. It takes just two milligrams of Carfentanil to knock out a 2,000-pound African elephant, and the veterinarians who administer the drug use gloves and face masks to prevent exposure to it, because a dose the size of a grain of salt could kill a person – and may be lethal even when absorbed through the skin. To be clear, Carfentanil is not for human consumption in any way. This does not stop drug dealers from adding a microscopic amount to heroin to give the drug an even more potent high – even though it's often fatal.
"The side effect of Carfentanil is death," says Newtown, Ohio Police Chief Tom Synan, president of the Hamilton County Association of Chiefs of Police and member of the Hamilton County Heroin Coalition taskforce, created in 2015 after a spike in heroin use in the area. "This drug knocks out elephants, that should tell us how dangerous it is," says Synan. "If death is the first side effect, the second is an overdose that you may never come out of." According to his intelligence, Synan believes that Carfentanil could signal a new wave of synthetic opioid use. "What we saw in Cincinnati with the spike [in overdoses] was the literal transition from organic opiates, like heroin, to synthetic opioids like fentanyl and Carfentanil," says Synan.
Hamilton County, which includes Cincinnati, has been particularly hard struck by heroin. It's believed that one person dies from heroin every other day in the county. In 2014, in a county of 800,000 people, 10,000 heroin users moved through its criminal justice system – and those were just the ones who got caught. Thanks in part to dealers who cut fentanyl and Carfentanil into heroin, there were 177 heroin-related deaths in Hamilton County last year – nearly one every other day – according to a recent report from the Heroin Coalition. That number will most likely triple if not quadruple this year, as there were 35 overdoses and six deaths during a three-day span in July, and those 96 overdoses that shook the county during that fateful week in August, which resulted in three more deaths. "Our community is devastated by heroin and fentanyl abuse," Dr. Lakshmi Sammarco, the Hamilton County coroner said in a statement last July. "The fact that there is a new lethal drug that has been found on the streets in Hamilton County is devastating."
After a rash of deaths in the surrounding areas in July, Hamilton County officials issued a public health warning about the drug, urging first responders to take precautions to avoid any contact with the lethal drug, including no longer field testing suspected heroin samples. "It's not worth the risk," says Synan. The DEA has issued a warning about the drug, as well. "When Carfentanil hit the streets, first responders responded to almost 200 overdoses and saved almost everyone's life, which is astonishing," says Synan, who credits the swift action of both the paramedics as well the Heroin Coalition for spreading the word about the dangers of Carfentanil.
According to Synan, the drug seems to mainly be coming from China, where it is illegal, but illicitly manufactured in secret labs before being shipped to the U.S. People order it online and ship it through the U.S. Postal Service, before it eventually makes its way into the local heroin supply. While killing your customer base is a bad business model, according to Synan, dealers cut heroin with Carfentanil because it requires only minuscule amounts – smaller than a grain of salt – to increase the drug's potency. That lets dealers increase their supplies without much additional cost and gives users a nearly lethal bang for their buck. "Users give the dealer a good review – just like you do with Starbucks or McDonald's – telling other users that this dealer has good stuff. Soon customers start to build up. If four or five people die, I still have a hundred or two hundred customers lined up," says Synan.
One reason that Carfentanil-laced heroin is so deadly is that most heroin users have no idea that they are ingesting Carfentanil. (According to Synan, some dealers have no idea they are selling it, either). In its liquid form, it is odorless and colorless and used in such microscopic amounts that even drug labs and medical examiners have a difficult time testing for it. Users may take their standard dose of heroin – not realizing that something far more deadly is in the mix – and overdose as a result.
Overdosing on Carfentil is not the same as overdosing on pure heroin, though. Not only is it incredibly powerful, but it is also incredibly resistant to naloxone, better known as Narcan, the opioid antidote that serves as the last line of defense against a heroin overdose. A typical heroin overdose requires one or two shots to work, but when heroin is laced with Carfentanil, it may require six or more shots to counteract the drug – if it works at all. "What first responders were finding is that it was taking IVs of Narcan in order to just sustain people," says Synan. In short, if you overdose, first responders may not be able to save you – or themselves, which is why the ban on field testing heroin was put into place. "Take this as a dire warning to all if you choose to purchase and use any forms of heroin," said Dr. Sammarco in her statement. "No one knows what other drugs may be mixed in or substituted and you may be literally gambling with your life."
Additionally, while first responders do their best to save overdose victims, Carfentanil is depleting supplies of Narcan across Hamilton County. A Cincinnati city spokesperson told the local Fox affiliate that the cost of the Narcan that's usually administered to users who have overdosed is $32 – and that's starting to add up.
It's not just Hamilton County that's suffering with the effects of Carfentanil, though. From July 5th to 26th, Akron police and paramedics handled 236 heroin overdoses, while, according to the Cincinnati Enquirer, Columbus had 10 overdoses – two fatal – in a nine-hour period. Law enforcement in western Pennsylvania have reported 200 recent overdoses in the region – roughly 20 of them fatal – that may be linked to Carfentanil, and the drug has been blamed for a spike in overdoses in Kentucky, Florida and Canada, according to The Washington Post. As the Carfentanil-related overdoses pile up, law enforcement officers around the country have struggled to find solutions. "You feel like a kid with his finger in the dike, you know?" Joseph Pinjuh, a Department of Justice drug task force chief based in Ohio, told the Associated Press. "We're running out of fingers."
On the local level, Synan and his team are gearing up for whatever comes next. "Drug cartels know their customers better than Avon does," says Synan. "There's going to be another drug out there soon and we're going to have to figure out how to respond to it."