The United States is in the midst of an opioid abuse, addiction, and overdose crisis that began with the introduction of powerful prescription pain medications such as Vicodin (hydrocodone/acetaminophen) and OxyContin (oxycodone). Initially touted as “nonaddictive,” these potent narcotics have since become more tightly regulated as their extreme addictive potential has been recognized.
Individuals battling prescription painkiller addiction looked to heroin, a cheaper and easier to obtain opioid, once prescription opioids became harder to get. Derived from the opium poppy plant, heroin is an illegal opiate with no accepted medical use in the United States. When the body processes heroin, the drug is metabolized into morphine.
In 2013, the Drug Enforcement Administration (DEA) reports that another dangerous opioid drug was showing up in drug overdoses – a drug called fentanyl that is 50 to 100 times more potent than morphine. Fentanyl is a synthetic opioid, meaning that it is created in a lab and can be made illicitly.
By 2015, opioid overdose deaths spiked up to over 30,000 fatalities in America. Synthetic opioids accounted for nearly one-third of these deaths.
Carfentanil is an analog of fentanyl that is even more powerful, as the National Institute on Drug Abuse (NIDA) publishes that it is 10,000 times more potent than morphine. With its only legal use in the United States being to sedate large mammals, carfentanil is literally an elephant tranquilizer with no accepted medical use for humans.
As a synthetic analog of fentanyl, carfentanil can also be made in clandestine laboratories. The drug has been manufactured in underground labs in places like China and imported into the United States under the guise of being a “research chemical,” Science magazine reports. In America, the DEA classifies carfentanil as a Schedule II controlled substance, meaning that it has some licit use (for veterinarians) and a high potential for abuse and addiction.
In 2016, the DEA issued a nationwide warning to police and the public regarding the hazards of carfentanil. The drug is 100 times more powerful than even fentanyl and can be lethal in very small doses.
This very dangerous synthetic opioid drug may be passed off as, or laced into, heroin or abused on its own. Individuals often do not even realize that carfentanil is present in the drug being taken. It is extremely addictive and carries a very high risk for a potentially life-threatening overdose.
For humans, there is no safe amount of carfentanil that can be used. The drug can even be absorbed on contact through the skin without intentional ingestion. The New York Times warns that carfentanil can be lethal in doses as small as a piece of dust, as little as 0.02 mg. This means an overdose can occur with even just a tiny amount of the drug overwhelming the central nervous system and causing a person’s respiratory system to shut down.
A carfentanil overdose is an immediate medical emergency. It comes with recognizable symptoms:
Since carfentanil is so extremely potent in even small doses, an overdose can be difficult to reverse. It may take multiple doses of the rescue drug naloxone (Narcan) to overturn the drug’s side effects. Naloxone is an opioid antagonist, which means that it works to kick the carfentanil off the opioid receptors where it binds in the brain, helping to reverse the action of the drug.
As of March 2017, the journal Forensic Chemistry reported that over 400 overdoses and deaths in the United States have been linked to carfentanil. The U.S. Centers for Disease Control and Prevention (CDC) publishes that between July 2015 and June 2017, more than 11 percent of opioid overdose deaths in America involved carfentanil.
Aside from the high risk of overdose, carfentanil abuse has many other hazards. As an opioid drug, it binds to opiate receptors in the brain, filling them and causing a flood of the “feel-good” neurotransmitter dopamine. This is what causes the high.
Opioids also depress the central nervous system. This lowers blood pressure and slows down the heart rate. As a result, anxiety and stress levels are also reduced, and a person is left feeling mellow, relaxed, and often sedated. Inhibitions are lowered, a person will struggle to process thoughts and make rational decisions, impulse control becomes difficult, and a person taking carfentanil will likely be unable to focus or consider the consequences of their actions. This makes them more apt to get into a potentially dangerous situation, take bigger risks, and therefore possibly become injured or get into an accident. Carfentanil also impacts motor control and coordination, which can cause a person to fall down, slur their words, and suffer from blurred vision.
The brain can quickly become dependent on carfentanil with very few uses, meaning that a person may feel that they need the drug in order for their system to feel normal. Drug tolerance builds up with continued exposure to an opioid, requiring the person to take more carfentanil to feel the drug’s effects. In so doing, the risk for overdose increases.
Since carfentanil is so powerful in such small amounts, it doesn’t take much to cause physical dependence, drug tolerance, and then addiction. Addiction is a long-term side effect of repeated and chronic opioid use that becomes compulsive.
Carfentanil often resembles drugs like heroin and cocaine. It may be difficult to differentiate it from these other drugs, even for someone who is familiar with these illicit substances. It is a white powder that is odorless, and it was previously marketed as Wildnil for veterinary use. On the street, it is called “serial killer” and “drop dead.”
It does pack a much bigger punch than the drugs it is often laced into or used to cut, so a person taking carfentanil is likely to suffer intense side effects from the drug rather quickly after ingestion. It is regularly taken unintentionally; however, individuals struggling with addiction to other opioids may seek the more potent carfentanil out for a stronger high.
Carfentanil may be mixed in with other drugs or taken on its own, either by smoking, injecting, snorting, or swallowing the drug. Someone under the influence of carfentanil may seem extremely drunk. They may also fall asleep or go “on the nod” and be nearly catatonic. Someone taking carfentanil may act in ways that are out of character and unpredictable.
Carfentanil can be abused in a multitude of ways and often in combination with other drugs. Mixing it with additional substances, especially other central nervous system depressants like another opioid, alcohol, or a benzodiazepine drug, elevates all of the possible risk factors and odds for a potentially life-threatening overdose.
The manner in which carfentanil is abused can also impact the possible short-term and long-term side effects of the drug as well as influence how to recognize its abuse. For example, snorting carfentanil may be evident by a chronic runny nose, regular nosebleeds, and damage to sinus and nasal passages. When the drug is injected, scarring at the injection site, skin infections, the contraction of a blood-borne infectious disease like hepatitis or HIV/AIDS, and infections of the lining of the heart are possible. Smoking carfentanil can impact the respiratory system, leading to coughing as well as possible infections or diseases of the lungs and respiratory tract. Smoking the drug may be evident by burns on the face or hands. Gastrointestinal issues, including stomach ulcers, can be the result of ingesting carfentanil.
Drug dependence and tolerance develop with regular use of carfentanil and can be signs of addiction. One of the ways to recognize physical dependence is by the presence of withdrawal symptoms when the drug wears off.
Since carfentanil is so deadly, it’s rare that people regularly abuse the drug. Instead, it’s more likely that they abuse carfentanil as part of an ongoing opioid addiction, so an overall dependence on other opioid drugs generally precedes carfentanil abuse.
Opioid withdrawal can be intense and uncomfortable, indicated by symptoms that are physically similar to a really bad case of the flu, including chills and sweating, irregular heart rate, nausea and vomiting, diarrhea, tremors, yawning, muscle tension, body aches, runny nose, watery eyes, stomach cramps, loss of appetite, and insomnia. Emotionally, a person struggling with opioid withdrawal often suffers from significant drug cravings, depression, anxiety, restlessness, irritability, mental confusion, and trouble thinking clearly.
As a chronic brain disease, addiction has both physical and emotional ramifications. Someone battling addiction will not be able to control how often they take the drug and how much of it they take each time, often using more of it for longer periods of time than they intended initially. It can become difficult for a person to stop taking the drug, even if they want to, and they may make several unsuccessful attempts to stop using it.
Social circles change to accommodate the drug use. Family, school, and work obligations will go unfulfilled, often resulting in poor performance and strain in these areas. Interpersonal relationships often take a hit. Individuals will continue to take carfentanil even when they know it will have negative social, emotional, and/or physical side effects.
As a powerful opioid drug, carfentanil abuse generally comes with physical drug dependence. As such, a specialized addiction treatment program that includes or begins with a medical detox program is optimal.
Medical detox can minimize withdrawal symptoms and manage drug cravings. During medical detox, a person can be closely monitored around the clock while trained professionals ensure that vital signs remain stable and emotional support is in place.
Methadone is an opioid agonist itself; however, it is a long-acting opioid that can be given once daily in federally regulated clinics to offset the severity of opioid withdrawal.
Another partial opioid agonist, buprenorphine is also long-acting and has a ceiling effect, which means it is less likely to produce a euphoric high. Therefore, it has a reduced abuse potential.
While buprenorphine is a partial opioid agonist, naloxone is an antagonist. Combination medications can, therefore, act as abuse-deterrents during opioid addiction treatment. The naloxone component will remain dormant unless the medication is altered and abused, at which point, it will precipitate withdrawal.
Recently approved by the FDA, as published by NIDA, lofexidine is a new medication designed to reduce opioid withdrawal symptoms.
Sleep aids, mood stabilizers, gastrointestinal medications, and nonsteroidal painkillers can all be helpful during opioid withdrawal to target specific symptoms.
There are also several medications that can be used off-label to treat the side effects of opioid withdrawal. Clonidine, which is technically a blood-pressure medication, can be helpful with drug cravings and stabilization of the heightened activity of the central nervous system that occurs during carfentanil withdrawal.
Medical detox for opioids typically lasts between five and seven days on average. A medical detox program can help a person to become physically stable before entering into a specialized opioid abuse and addiction treatment program.
Following detox, supportive and therapeutic methods are used. Behavioral therapies, such as cognitive-behavioral therapy, can help individuals to learn healthy coping mechanisms, provide tools for minimizing relapse, and build important life skills.
Addiction damages the reward system in the brain, which can take time to reset. During withdrawal and after stopping use of the drug, a person often has difficulties feeling pleasure and suffers from mood swings and sleep difficulties. Behavioral therapies can help a person to learn new strategies for finding happiness and regulating emotions.
Set sleep schedules and structured days can help to regulate the brain and body, and balanced nutrition can also be beneficial to healing. Support groups, such as the 12-step program Narcotics Anonymous (NA), are often recommended during an addiction treatment program. Participation can continue after treatment, providing a healthy sober outlet in ongoing recovery
There are also various alternative and adjunctive treatment methods that can be offered as part of an addiction treatment program.
Addiction treatment can be offered in a variety of settings, including on an inpatient and outpatient basis. Inpatient treatment models provide the highest level of care, as a person will remain on site for the duration of the program, receiving attention and supervision 24 hours a day.
Each person is different, and treatment models reflect individual needs. NIDA recommends that a person remains in a treatment program for at least 90 days to allow their brain time to heal and form new habits.
After completing an addiction treatment program, there are transitional options that can work as a good next step. A sober living environment can provide a safe place to practice new skills and healthy habits before reintegrating back into society and regular home life.
Fentanyl: A Briefing Guide for First Responders. (June 2017). Drug Enforcement Administration from https://www.dea.gov/druginfo/Fentanyl_BriefingGuideforFirstResponders_June2017.pdf
Emerging Trends and Alerts. (September 2016). National Institute on Drug Abuse from https://www.drugabuse.gov/drugs-abuse/emerging-trends-alerts
Underground Labs in China Are Devising Potent New Opiates Faster Than Authorities Can Respond. (March 2017). Science from http://www.sciencemag.org/news/2017/03/underground-labs-china-are-devising-potent-new-opiates-faster-authorities-can-respond
DEA Issues Carfentanil Warning to Police and Public.(September 2016). Drug Enforcement Administration from https://www.dea.gov/divisions/hq/2016/hq092216.shtml
Ordering Five Million Deaths Online. (April 2018). The New York Times from https://www.nytimes.com/2018/04/04/opinion/carfentanil-fentanyl-opioid-crisis.html
Analysis of Illicit Carfentanil: Emergence of the Death Dragon. (March 2017). Forensic Chemistry from https://www.sciencedirect.com/science/article/pii/S2468170916300996
Morbidity and Mortality Weekly Report (MMWR). (July 2018). Centers for Disease Control and Prevention from https://www.cdc.gov/mmwr/volumes/67/wr/mm6727a4.htm
Key Substance Use and Mental Health Indicators in the United States: Results From the 2016 National Survey on Drug Use and Health. (September 2017). Substance Abuse and Mental Health Services Administration from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#sud3
FDA Approves First Medication to Reduce Opioid Withdrawal Symptoms. (May 2018). National Institute on Drug Abuse from https://www.drugabuse.gov/news-events/news-releases/2018/05/fda-approves-first-medication-to-reduce-opioid-withdrawal-symptoms
Narcotics Anonymous. (2018). Narcotics Anonymous from https://www.na.org/
How Long Does Drug Addiction Treatment Usually Last? (January 2018). National Institute on Drug Abuse from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment