As if the opioid epidemic isn’t grave enough in Ohio, now there’s an added threat: carfentanil illegally manufactured to resemble OxyContin® painkiller tablets. The Cuyahoga County Medical Examiner’s Office detected this powerful animal sedative in the tablets last week in Northeast Ohio. The Office received the fake pills from the Cleveland Police Department and issued a statement shortly afterward to warn residents. Cuyahoga medical examiner, Dr. Thomas Gibson, assured citizens that “the supply of [legitimate OxyContin] tablets dispensed legally from a pharmacy will not be affected by this.”

The counterfeit substance presents a very serious risk only to those who buy OxyContin (or what they think is OxyContin) on the streets or any other place without a prescription, including online sources. The differing potency levels of these two drugs are what make the imitation so dangerous. Carfentanil is 5,000 times more powerful than the oxycodone found in prescription OxyContin pills, so mistaking it for a legal drug could lead to more overdose deaths. The effects of carfentanil on humans are very serious and potentially fatal, even if only a small amount is ingested. Medical examiners, news stations and other sources have issued many warnings in response to this new threat to Ohio.

Carfentanil: From the Lab to the Streets

Carfentanil is a powerful tranquilizer commonly used by zoologists and veterinarians for elephants and other large animals. It’s comparable to fentanyl (a synthetic analgesic) and is 10,000 times more powerful than morphine. This highly potent drug was first developed in 1974 by a team of chemists at Janssen Pharmaceutic as an odorless, white powder. Although there is currently no approved human use for the sedative, it’s now sold on the streets disguised as or cut with other illicit drugs. Some dealers cut carfentanil with other drugs like cocaine and heroin to increase its potency — making it more appealing to users — and increase their supply of the drug to boost profit margins.

The Drug Enforcement Administration (DEA) states that illegal carfentanil is imported directly from China or produced in Mexico and trafficked into the United States. It can even be purchased online from China, according to DEA spokesman Russ Baer. The powerful sedative began showing up in the Cincinnati area in July 2016, according to Tim Synan, director of the Hamilton County Heroin Coalition Task Force in Southwest Ohio. After the inevitable spike in overdoses that ensued, it didn’t take long for news of the drug to show up in headlines. “Instead of having four or five overdoses in a day, you’re having these 20, 30, 40, maybe even 50 overdoses in a day,” he told NPR. In Cuyahoga County, there were at least 58 fatalities as a result of carfentanil ingestion in 2016.

Cases of carfentanil disguised as OxyContin tablets are fairly new to Ohio, but they’ve been occurring in other areas, both in the U.S. and Canada, for the past couple of years. There have also been reports of other counterfeit opioids as well:

  • Cincinnati, Ohio: Eight deaths in early July 2016 were blamed on heroin laced with carfentanil.
  • Alberta, Canada: In December 2016, tablets that looked like green OxyContin 80 mg prescription pills were seized in Edmonton. They were later found to be carfentanil, according to Global News.
  • California-Mexico Border: In April 2016, Pain News Network reported that an alleged smuggler was caught at the border with more than 1,000 fake oxycodone pills made with fentanyl.
  • Wayne County, Michigan: Michigan Radio stated that public officials in Wayne County linked at least 19 deaths in July 2016 to carfentanil-laced heroin.
  • Saskatchewan, Canada: In January 2015, CBC News reported that the death of a 19-year-old man in Saskatoon was linked to fentanyl pills that were manufactured to resemble OxyContin pills.

Carfentanil’s Effects in Humans

Because carfentanil is intended to sedate animals as large as 10 tons (African elephants), its high potency level was a top priority for chemists. Safely sedating a young, 2,000-pound African elephant would require only about 2 mg of carfentanil. For a human, however, ingesting just 1 mg (which would be about the size of Abraham’s Lincoln’s nose on a penny) would kill him or her. This high potency level is why this drug is not approved for people. However, if a person does ingest carfentanil, its effects would be very rapid, making overdose difficult to stop and hard to treat. The sedative also takes several hours to metabolize in the human body, resulting in a longer-lasting high.

A carfentanil overdose can occur within minutes of exposure. Some of the initial overdose symptoms include:

  • Disorientation or lethargy
  • Shallow or no breathing
  • Cold and clammy skin
  • Pinpoint pupils
  • Nausea and vomiting
  • Heart failure
  • Sedation
  • Extreme drowsiness
  • Weak or absent pulse

With any opioid overdose, brain damage can occur within just a few minutes because of a lack of oxygen to the brain. The chances of revival after a carfentanil overdose are lower than those of other opioids, but ingestion is commonly treated with naloxone, an antidote designed to block the effects of opioids. This antidote — administered intranasally (Narcan®) or via an injection — is often used to revive heroin and fentanyl overdoses, as manifested by respiratory or central nervous system depression.

Naloxone must be administered as soon as possible after an overdose, and emergency medical assistance should be sought after the first dose, which takes about five minutes to become effective. Several doses may be needed to reverse overdose symptoms. Although this antidote has been proven to be effective for human-approved opioids, there is no guarantee that it will work with overdoses involving an animal sedative like carfentanil.

Preventing the Problem

The primary way to prevent ingesting counterfeit OxyContin that contains carfentanil is to simply not purchase it from any place other than a licensed, brick-and-mortar pharmacy, and only with a valid prescription. Never buy drugs from the streets or from an online source, even if it seems like a reliable website and even if you have a prescription. The risks are far too great. If you have any questions or concerns about your opioid prescription, always consult your doctor. If you’re a parent or other guardian, be sure to educate your children on the dangers of opioids. Tell them to never take pills or powder from a stranger or even from a friend if the substance is unknown.

If you’re currently struggling with an opioid addiction, The Recovery Village Columbus can help. Specialists are available 24 hours a day, seven days a week to speak with you. Whether you just need a listening ear, or you’re ready to enroll in a treatment program, all calls are completely confidential and toll-free. In addition to our Ohio location, there are locations in Florida, Colorado, Ohio and Washington — all of which offer individualized treatment programs and supplemental recreational amenities. Call today. There’s always someone available to listen.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.