Carfentanil Poses New Threat of Epidemic in Local Communities

By: Gabrielle Flavoni, PharmD Candidate c/o 2018

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Drug diversion has always been a golden target for our nation’s law enforcement agents, and a new level of overdose epidemic is taking center stage. Last month, the U.S. Drug Enforcement Agency (DEA) issued a public health warning regarding a synthetic opioid known as carfentanil. Carfentanil is a schedule I drug that has primarily been used in mammals, and has not been approved for human use.¹ As a general tranquilizing agent in veterinary medicine for large animals, it has a dangerous potential to cause fatal overdoses or severe detrimental effects to any human ingesting it for any reason. Human research has not been conducted, and there is no current evidence indicating the safe dosage, use, or ingestion of it. In fact, this potent analog of fentanyl, a widely used opioid, has a potency 10,000 times stronger than morphine.² When used properly and in safe doses, the drug poses no threat. However, when abused, carfentanil has the potential to be lethal.³

Abuse of fentanyl-based opioids stems back from as early as the 1970’s and has only grown since then. Currently, there are over 12 different analogs of fentanyl on the market. Many of these are abused on a regular basis, both by patients being treated with them for analgesia as well as for recreational use.² Fentanyl-based drugs have a similar biologic effect to Heroin when they are abused. However, the only overwhelming difference is how drugs like carfentanil are marginally more potent. According to the National Institute of Drug Abuse, fentanyl analogs bind to opioid receptors in the brain, which affects pain levels and emotions.⁴ When the drug is ingested, a euphoric effect takes place and the patient gets a “high” to relieve them of pain. This class of drugs has proven to be troublesome in terms of addictive behavior, and has become a source of recreational drug use. Carfentanil has recently taken the spotlight in this issue.

The drug has become increasingly popular in many communities throughout the U.S. At the end of September, the DEA raised a red flag to authorities regarding the use of the drug and the rising trend of overdose-related-deaths due to the mishandling and improper use of the drug.³ Chuck Rosenberg, a DEA administrator, even commented that in some areas of the country, carfentanil has been sold in communities disguised as heroin. It has been found within the community as powders, blotter papers, tablets, and sprays, which sometimes makes it difficult to identify.¹ With such a wide range of dosage forms, people must stay vigilant and knowledgeable when handling foreign substances.

Further study of the drug has also shown that dermal exposure to the drug or inhalation of any powders may lead to absorption into the body.¹ The DEA has issued heavy warnings to first responders to practice extreme caution while handling any unknown substances. The risk of absorbing unknown amounts of carfentanil can lead to toxicities and overdosing without even orally ingesting the opioid. They have also been advised that if they suspect that they have been exposed to it at all, that they shall be immediately transported to an emergency medical facility for treatment.

What will come of this upcoming threat is still unclear, but health care professionals and federal law enforcement alike will remain vigilant in limiting the abuse from spreading further.

SOURCES:

1. DEA Issues Carfentanil Warning to Police and Public. United States Drug Enforcement Administration. https://www.dea.gov/divisions/hq/2016/hq092216.shtml. Published 09/22/16. Accessed 10/25/2016.
2. Opioids. LexiComp. http://online.lexi.com.jerome.stjohns.edu:81/lco/action/doc/retrieve/docid/lexier/1116780. Published 09/22/2016. Accessed 10/25/16.
3. Drug Fact Sheets; Fentanyl. United States Drug Enforcement Administration. https://www.dea.gov/druginfo/concern_fentanyl.shtml. Accessed 10/25/16.
4. DrugFacts – Fentanyl. National Institute of Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/fentanyl. Published 06/01/16. Accessed 10/25/16.