Carfentanil is an opiate ten thousand times more powerful than morphine, and it has been killing addicts and confounding first responders across the country since last summer.
The drug was never intended to be consumed by humans. But it has been used to kill and immobilize humans — including by Russian Special Forces, who reportedly used it in aerosol form to end a hostage situation in 2002. Tragically, the gas ended up killing more than 100 hostages.
“Carfentanil is a synthetic opioid. It's of a drug class similar to fentanyl and other fentanyl analogs,” explained Terry Boos, of the Drug Enforcement Agency.
The only legitimate use for the drugs is as a tranquilizer for very large animals, like elephants or hippos, Boos said. So there’s no medical literature to consult for the effects on humans. That knowledge is being gained the hard way — by first responders.
“During the month of July , paramedics in Akron [Ohio] registered more than 230 drug overdoses, with 14 of those being fatal,” DEA spokesman Russ Baer said. All were linked to carfentanil. Since then, DEA has seen the drug pop up in Florida, Georgia, Rhode Island, Indiana, Pennsylvania, Kentucky, West Virginia, New Jersey, and Illinois.
"We're still tracking the presence and the proliferation of carfentanil,” Baer said.
When the drug first appeared in Ohio, authorities had no idea what they were dealing with.
“In Cincinnati, it took several days to get a sample ... to be able to check it, and sure enough many of the overdoses that had occurred in a spike were related to this carfentanil,” Ohio Sen. Rob Portman says.
The DEA rushed to bring toxicology labs across the country up to speed. It’s important for first responders to be able to recognize a carfentanil overdose. They might, for instance, require multiple doses of the anti-overdose drug Naloxone. And since even the tiniest amount of carfentanil can kill, first responders who might encounter the drug need to take extra precautions.
That includes agents screening packages from overseas.
“It normally comes in — we're told — by the U.S. mail system, usually from China,” Portman explained. “Some laboratory in China producing it, and then shipping it to the United States by mail.”
The illicit sellers in China avoid private carriers like FedEx or UPS because they require tracking information from the sender, according to Portman. “With the U.S. mail system, that's not required. So China has an arrangement with the U.S. mail system where they send it through without that information,” he said.
Portman is a co-sponsor of the Synthetics Trafficking and Overdose Prevention Act, or STOP.
Juliette Kayyem is a senior advisor to Americans for Screening All Packages, an advocacy group that backs the STOP act. She says the new law would require the U.S. Postal Service to track senders the same way private shippers do.
“The sender is required to give you a valid name, address, content size of the package, who they're sending it to in the United States," Kayyem says.
Supporters say that even if illicit drug sellers put in false information, when the data from all the packages gets crunched, algorithms can still identify suspicious packages so screeners know which ones to scrutinize out of the millions the postal service handles.
The STOP Act stalled in the Senate last year, but Sen. Portman reintroduced the legislation last month and is hopeful it can pass with bipartisan support.
In the meantime, the Chinese government has taken action of its own. Largely at the request of the U.S., this month, China banned the export of carfentanil along with three other opioids.
Baer, of the DEA, says a similar ban in 2015 helped get the drug known as “flakka,” or alpha-PVP, off the streets here.
“Once China scheduled, alpha PVP ... virtually fell off the radar, and we've not seen any extent of flakka being in the distribution chain. So we've seen what the scheduling actions in China can do,” Baer said.
While Fentanyl and its analogs remain a deadly problem, he said, the percentage of overdoses associated with carfentanil has been on the decline in recent weeks, and he’s hopeful China’s new ban on sales will help keep the deadly opioid out.