‘THE MOST DANGEROUS DRUG’
Synthetic opioid makes its way into Arkansas
While there have been no confirmed cases of overdoses involving the dangerous synthetic opiate carfentanil in Garland County, emergency medical personnel say it’s possible they have already seen a handful of cases based on treatment protocols.
Jason Gartner, general manager of LifeNet Hot Springs, says paramedics have had to administer unusually high amounts of Narcan, a drug administered in response to opioid overdoses, to some patients, which suggests the possible incorporation of carfentanil.
While opioid abuse is an ongoing problem in Arkansas, the state has seen limited abuse of the deadly synthetic carfentanil, according to Gartner and the head of a local drug treatment facility.
Carfentanil, an analog of the powerful pain-relieving synthetic opiate fentanyl, has seen increased use in the United States, and Casey Bright, CEO of Quapaw House, says the drug has been cited for at least one overdose in the state of Arkansas.
Bright calls carfentanil “the most dangerous drug we’ve had come into our state.”
According to the Drug Enforcement Agency, carfentanil is used as a tranquilizer for elephants and large mammals and can resemble the appearance of
heroin or powdered cocaine. Bright described its appearance as a “concrete-looking substance.”
Carfentanil, according to the DEA, is 10,000 times more powerful than morphine and 100 times more powerful than fentanyl, which is 50 times more powerful than heroin.
Gartner said carfentanil will cause the human body to go into “respiratory depression,” a rapid decrease in breathing. He said the drug will either make its user stop breathing entirely or breathe so slowly that the inhaled oxygen does not reach the brain.
DEA Acting Administrator Chuck Rosenberg has called carfentanil “crazy dangerous.”
“This drug in particular affects all of the opioid receptors and will basically cause you to go into immediate respiratory failure with any type of overdose at all,” Bright said. “If it was to be given, it would be given in a very, very, very small dose because it’s so powerful.”
Bright said carfentanil can be duplicated more easily due to its chemical nature, similar to the way methamphetamine is produced.
“Anybody with any type of knowledge with chemistry whatsoever can make this drug,” Bright said.
Bright said carfentanil is a cheaper option than purchasing heroin, which is highly regulated and sought-after by law enforcement agencies. He said the drug is often cut with heroin for the purpose of making additional, purer heroin.
He said the market for such a drug is found in opioid addicts who have a difficult time “doctor shopping” due to state prescription drug monitoring programs, which are able to indicate if the addict has received a prescribed narcotic within their time allowed.
Bright said because of carfentanil’s purity and instantaneous high, it can become a particularly appealing drug.
“If you’re a heroin addict, you’re gonna think this is, like, the best heroin in the world,” he said. “If I’m a heroin dealer and I can get my hands on this stuff, my drug is gonna be that much stronger and better than any other dealer that’s selling heroin.”
Carfentanil has seen more extensive use in other parts of the United States within the past year. On Sept. 5, 2016, The New York Times reported that medical and law enforcement officials in Cincinnati surmised that more than 200 overdoses in a two-week period in Cincinnati were largely due to the drug. Three of the users died.
Bright said a potential reason treatment for carfentanil has not been seen in Arkansas is because of the drug’s high mortality rate for first-time use. The Times reported that consuming an amount smaller than a snowflake could lead to the user’s death.
Both Bright and Gartner said many users are unaware they are taking carfentanil. Bright said due to the drug’s newness, users will not likely anticipate its effects.
“Especially if you’re taking illicit narcotics, you don’t know what you’re really taking. If you think you’ve bought ‘drug A,’ it may have been mixed with carfentanil,” Gartner said. “We’ve trained our staff to not rely on the patient knowing exactly what they’ve taken. It’s the signs and symptoms they’re exhibiting that we need to react to.”
Bright said the drug’s users will be “lucky” to last a few months if using consistently.
Bright said that, so far, he knows of only one confirmed carfentanil overdose within the state. The user who overdosed was treated at the University of Arkansas for Medical Sciences in Little Rock.
Gartner said Narcan is not nearly as effective in treating carfentanil as other narcotics.
“Normally, when we treat a patient that may have overdosed on a narcotic, we give (Narcan) to counteract,” he said. “They get better really quick; it works really fast. But with carfentanil, that’s not the case. We’ve trained our staff to really be more diligent and not expect the typical improvement as quickly.”
Bright said Arkansas has seen a climb of opioid abuse of all kinds, with heroin and “other opiates and synthetics” comprising 14 percent of all substances reported for the first quarter of 2017. For Garland County, the combined rate of the two categories exceeds that of the state at 20 percent.
Gartner said Garland County should expect to see a similar pattern of carfentanil abuse as the rest of the state has seen with opioids.
“Right now, all the information that we’re getting indicates that we probably should be expecting to see more of it, not less of it,” he said.
For the first quarter of 2017, “other opiates and synthetics” was the fourth-highest reported substance category for the state of Arkansas and the third-most reported in Garland County. Statewide and in the county, that category trailed meth and alcohol as the most-abused reported substances, while “marijuana/ hashish” was third-most reported category statewide.
Bright said meth has remained the most-reported abused substance for some time, with rates of 27 percent for Garland County and 35 percent for Arkansas for the first quarter.
While popular, Bright said meth does not come close to the harmful potential of carfentanil and other opioid synthetics.
“Meth is literally a baby compared to some of these things that are coming out,” he said. “These things are monsters. They’re horrible.”