The United States is in the middle of an opioid crisis and synthetic opioids like fentanyl are largely to blame. When a substance is to blame for the overdose deaths of thousands of people per year, it’s hard to imagine another drug in its class that’s even more dangerous and deadly. But carfentanil is an extremely powerful opioid that dwarfs the dangerous overdose potential of fentanyl. Learn more about this drug and how opioid addiction can be treated.

What Is Carfentanil?

Carfentanil is an extremely powerful synthetic opioid that has never been intended for use in humans. While fentanyl has caused a spike in opioid overdose deaths, it does have some medical applications in the treatment of humans. 

It’s effective for use in epidurals because it is fast-acting and can take effect within minutes of going into labor. Other opioids and analgesics take long enough to start working that labor can finish before the painkilling effects begin. However, carfentanil is much more powerful than traditional opioids and even a microdose is too much for a human.

In fact, carfentanil is 100 times more powerful than fentanyl, making it 10,000 times more powerful than morphine.

Carfentanil was first synthesized in 1974 and sold under the brand name Wildnil. Its trade name offers a clue as to its intended use; carfentanil was originally used to sedate and treat pain in large animals like elephants, bison, and moose.

Though it is much more powerful than fentanyl and other opioids, it functions in the same way in the brain and body. Your body and the bodies of many animals have built-in opioid receptors. These receptors are designed to accept binding from naturally-occurring opioid-like neurotransmitters in the brain called endorphins. When endorphins activate opioid receptors, it causes pain relief, relaxation, and calms you down. These natural chemicals are released to mitigate pain and discomfort. In fact, you may have felt these endorphins working if you’ve ever done vigorous exercise. The good feelings you experience after exercise (sometimes called a “runner’s high”) is the work of endorphins.

Opioids work the same way but they are much more powerful. They bind to receptors in nerve cells along the pain trail, from the sight of pain to your spine, and then to your brain. Opioids cause neurons that are sending pain signals to send fewer chemical messages and they also stop receiving neurons from accepting pain messages. The end result is pain relief so effective that it causes euphoria and slows down your nervous system.

However, carfentanil is much more powerful than any other opioid typically used in medicine and recreationally. It dwarfs the potency of fentanyl, a drug the U.S. Centers for Disease Control and Prevention (CDC) say is driving opioid overdose death rates to record highs each year.

Powerful synthetic opioids like fentanyl and carfentanil, are strong, cheap, and easy to make. While fentanyl is sold and used medicinally, the vast majority of illegal synthetic opioids come from clandestine drug labs. According to the Drug Enforcement Administration (DEA), illegal synthetic opioids like carfentanil and fentanyl primarily come from Mexico and China and are trafficked by transnational criminal organizations.

Why Carfentanil Is Used

Since carfentanil is a powerful and cheap opioid, the intent for such an excessively powerful opioid is unknown. Some fear that it could be used as a chemical weapon, especially when large shipments are seized. Still, the drug has been identified in recreational drug cocktails and in overdose cases. It’s effective on the microgram level, which means you can dramatically increase the potency of several bags of heroin or other opioids with just a few grams of carfentanil.

To stretch profits, a dealer might cut their heroin with a cheap inert substance like cornstarch or flour. However, experienced users will notice the difference between heroin with high purity and a batch that’s been cut. Cheap but powerful additives like synthetic opioids can increase the drug’s potency. The dealer can then sell the cheaper product at a higher price. Plus, the drug’s power can trick users into believing it’s more powerful.

However, measuring out non-lethal doses of carfentanil is difficult to do without the proper skill and equipment. If it’s attempted by street-level dealers or anyone without training, the dose is likely to be much too high.

What are the Signs of Carfentanil Addiction?

Carfentanil is overwhelmingly strong and exceedingly deadly. The chance that you encounter it in illicit recreational use and live to feel signs of addiction are very slim. However, if a dealer or manufacturer manages to successfully introduce a dose of carfentanil small enough not to immediately send you into an opioid overdose, the effects will be powerful. 

As with most addictive drugs, high doses of a drug increases your likelihood of developing a dependence or addiction. If you encounter a non-lethal dose of carfentanil, its potency might contribute to an opioid use disorder.

If you have used a powerful synthetic opioid, it’s important to be able to recognize the signs of dependence and addiction. Dependence occurs when your brain and body become tolerant to the opioids you are introducing into your body. To maintain balanced brain chemistry, your system adjusts its natural chemical responses to accommodate the presence of opioids. At this point, you will actually need opioids to feel “normal.” If you suddenly stop using opioids, you will start to feel intense cravings and symptoms of withdrawal.

Most people assume that drug dependence and addiction are the same things. While they are closely related, there is a key difference. Addiction occurs when you continue using drugs despite the negative consequences it is having in your life. Drug use can cause a string of negative effects in multiple areas of a person’s life. It can cause your work or school performance to suffer, job loss, problems at home, medical complications, legal issues, and financial troubles.

If some of these kinds of consequences start to occur, but you still can’t stop using, the nature of your substance use disorder has changed from dependence or abuse to addiction. Addiction is more than just a problem with your brain’s chemical processing and neurological communication, it’s a deeply-rooted problem in your brain’s reward center, also called the limbic system.

The limbic system is designed to identify activities that trigger positive feelings. It typically works by learning the activities that cause good feelings like eating and sleeping and encouraging you to repeat them. However, drugs like carfentanil that cause powerfully euphoric effects can trick the limbic system into believing that opioid use is one of the activities that are necessary for your survival. As a result, it triggers cravings and impulses to use and continue using.

This causes deep psychological symptoms that you may be able to identify in yourself or a loved one such as:

  • Anxiety
  • Irritability or agitation
  • Depression
  • Isolationism
  •  Drug seeking behavior
  • Withdrawing from normal activities

However, there are also a number of physical signs to consider if you’ve used opioids and you are worried that you may have become addicted, including

  • High blood pressure
  • Bloody noses
  • Sneezing
  • Coughing
  • Watery eyes
  • Dehydration
  • Fatigue
  • Confusion
  • Insomnia
  • Sweating
  • Excessive yawning
  • Dilated pupils
  • Nausea
  • Vomiting

What is Involved in Carfentanil Addiction Treatment?

The deep-rooted nature of the disease of addiction is what causes you to keep using even when you’ve experienced negative consequences. Addiction is complicated and chronic. Unlike its portrayal in some movies and TV shows, addiction usually takes more than one night of withdrawal and detox to overcome. However, it is a treatable disease and there are a variety of addiction treatment methodologies that are supported by research and proven to produce results.

To be effective, addiction treatment needs to be tailored to your individual needs and it needs to address more than one type of need. Addiction can affect your work, social life, physical and mental health, and other aspects of your life so addiction treatment should treat your medical, psychological, sociological, vocational, and legal needs.

Depending on your needs, you should be placed somewhere on the continuum of care to receive treatment that’s ideal for you. This continuum involves the following levels of care:

  • Detox. Medical detox, or medically managed intensive inpatient services, is 24 hours of medical care every day. Detox typically lasts for a week but in specific cases, it can last anywhere from a few days to up to two weeks. Detox is important for addressing medical needs like dangerous withdrawal symptoms but it can also help manage other mental health needs or co-occurring medical needs.
  • Inpatient. If you no longer need medically managed services but you do need monitoring for medical issues or other complication, inpatient services provide 24/7 medical monitoring while you pursue treatment therapies.
  • Intensive outpatient (IOP).  You attend nine or more hours of treatment per week while you live independently or in a sober living environment. IOP helps you continue your recovery program, relapse prevention, strategies, and behavioral therapies while you gain a little more independence and flexibility.
  • Outpatient. The lowest level of care involves less than nine hours of clinical services but till offer you plenty of support. Outpatient services are an important transition point between treatment and aftercare.

How Dangerous is Carfentanil?

Carfentanil’s danger comes from its sheer power. Its potency is a clear reminder that it is a substance not meant for humans. For the average person, a lethal dose of carfentanil is around 0.02 milligrams. To put that in perspective, an amount of carfentanil that weighs the same as a single grain of salt is enough to kill three people. A dose of carfentanil that is equal in size to a common effective dose of morphine (10 milligrams) could kill a 15,000-pound elephant. Doses that small are incredibly difficult to measure out successfully and if you, a dealer or manufacturer tries to “eye-ball” it, it’s likely that you are going to overdose.

Since the drug is potent in such tiny amounts, a significant number of effective doses can be transported in very small packages like iPhone boxes. This and the fact it is cheap and easy to manufacture makes carfentanil an option to dealers who want to stretch their heroin profits.

During an opioid overdose, your nervous system will begin to slow down dramatically. You may lose consciousness and your breathing will begin to slow as well. As your breaths become shorter, shallower, and farther between, you will start to experience the effects of oxygen deprivation like hypoxia, brain damage, tachycardia, and low blood pressure. In high doses, you may stop breathing altogether. 

The lack of oxygen can lead to coma or death without medical attention. Opioid overdose can be reversed with an opioid receptor antagonist called naloxone that pushes the opioid off the receptor and blocks it from binding. Naloxone, sold as Narcan, is carried by first responders and police and can be purchased over the counter in some states.

Carfentanil has been found in heroin and in drug mixtures. Grey Death is the street name for a drug cocktail that has been found to contain a variety of opioids including carfentanil. However, carfentanil is incredibly difficult to distinguish from heroin. Users often overdose on carfentanil or other synthetic opioids thinking they were using only heroin.

Synthetic drugs like fentanyl and carfentanil may have high transdermal bioavailability, which means they can be effectively absorbed into the bloodstream through the skin. Stories have emerged of first responders coming into contact with powerful opioids and experiencing overdose symptoms. However, there is little evidence to suggest that incidental contact with the drugs can cause significant effects.

High transdermal bioavailability comes with medical patches that are designed for prolonged exposure. However, carfentanil is strong enough that airborne powder can have an effect if it’s inhaled. First responders and other handlers should always wear gloves when encountering powdered substances.

Carfentanil Abuse Statistics

  • In 2017, Canadian authorities seized 42 kilograms of carfentanil, enough for a lethal dose for everyone in the country.
  • Less than one ounce of carfentanil is produced in the U.S. annually. It is the total annual supply needed for zoos and large animal veterinarians.
  • A single microgram of carfentanil is enough to be effective in humans. For comparison, a snowflake is 3,000 micrograms.
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