The latest available data show a decline in opioid-related overdose deaths in Massachusetts from 2016–2017. That’s reason to be optimistic. If this trend continues, the state could make serious strides to reduce the severe effects of the opioid crisis. But there’s also reason to worry. While toxicology analyses indicate a decline in the presence of heroin in opioid-related overdose deaths, fentanyl is on the rise. Even scarier is the emergence of a substance related to, and more potent than, fentanyl: carfentanil. So what is carfentanil?

Carfentanil is a Schedule II substance under the Controlled Substances Act (which includes substances like cocaine, opium, and oxycodone) and is used as an elephant tranquilizer. It’s a synthetic opioid much more powerful than fentanyl. Fentanyl is estimated to be 25–50 times stronger than heroin and 50–100 times stronger than morphine. About 2–3 milligrams of fentanyl can be lethal. That’s roughly the size of 5–7 grains of salt. (See image above.)

Image via DEA

Carfentanil, however, is estimated to be 100 times stronger than fentanyl, or 10,000 times stronger than morphine. As little as .00002 grams can kill a person.

Let that sink in a moment.

According to the Center for Disease Control, carfentanil deaths nearly doubled from 421 in the last half of 2016 to 815 in the first half of 2017. Like fentanyl, which turned up in 89% of toxicology reports among overdose victims in Massachusetts this year, other illicit substances can be laced with carfentanil. For example, a Cincinnati man plead guilty to attempting to murder a witness by selling him heroin cut with carfentanil; in Indianapolis, supposed prescription pills were found to be counterfeit, some of which contained carfentanil.

The arrival of carfentanil in the commonwealth was confirmed by Massachusetts State Police in 2017. At the time, State Police were unaware of any overdose deaths connected with carfentanil. Since then, “The state’s drug lab has detected carfentanil in at least 40 samples of heroin and other opioids seized during arrests” and “as detected in autopsies in at least four overdose cases last year,” as reported in April 2018. The manufacture, possession, and distribution of carfentanil has been explicitly outlawed by the state legislature.

Overdose deaths caused by carfentanil have also been reported in New Hampshire.

On the other side of the continent, harm reduction methods are in development. Scientists in Vancouver, British Columbia have created a paper testing strip that recognizes the presence of fentanyl or carfentanil in a given substance. The hope is this will lead scientists to build “a compact mass spectrometer the size of a small microwave, that could be used in overdose prevention sites, in community health centres [sic] and by mobile harm reduction teams.”

Vancouver, hit extremely hard by the opioid crisis is an international leader in combating it, from offering extreme users clean prescription heroin to the formation of safe injection sites—the idea being you can’t provide treatment people for substance use if they aren’t alive to receive it.

Increased access to naloxone (aka Narcan) has helped reduce opioid-related overdose deaths nationwide. With fentanyl and carfentanil, though, it’s unclear how effective naloxone is. Naloxone reverses the symptoms of overdose in a matter minutes and has been credited with combating overdose deaths. Because of the sheer potency of carfentanil, scientists have seen a resistance to standard doses naloxone, such as an injection or nasal spray, though data remains inconclusive.

The Gándara Center is committed to empowering everyone to learn about naloxone and how to use it. We partnered up with Tapestry Health to hold two Spanish-speaking Narcan training sessions, in Holyoke and Springfield, to provide information and free dosages of Narcan to at-risk populations.

We will continue to work with Tapestry to host more training sessions in the future, and get Narcan in the hands of as many people as possible.