In a troubling development, the Centers for Disease Control and Prevention (CDC) has sounded an alarm over the dramatic rise in deaths linked to carfentanil, a synthetic opioid that is 100 times more potent than fentanyl and 10,000 times stronger than morphine. This alarming trend has been observed across 37 states in the U.S., highlighting the escalating severity of the opioid crisis. Carfentanil, initially synthesized in the 1970s under the name Wildnil, was originally intended as a tranquilizer for large animals such as elephants. However, it has found its way into the illegal drug trade, posing a significant threat to human life.
The potency of carfentanil means that even a minuscule amount can lead to an overdose and potentially fatal outcomes. The CDC's recent findings indicate an increase of more than 720% in carfentanil-related deaths from the first half of 2023 to the first half of 2024. This surge underscores the growing presence of this dangerous substance in illicit drug markets. Dr. Calello and her colleagues have expressed concern about this trend, pointing out that "carfentanil becomes a more common component of the illicit drug supply, opioid overdose deaths will increase and some of the progress which has been made will be undone."
The U.S. has long struggled with an opioid crisis, with thousands of overdose deaths recorded annually. While carfentanil-related fatalities were previously considered rare, they are becoming increasingly prevalent. This rise parallels historical patterns observed during the 2016–2017 carfentanil outbreak, when precursor chemicals from China led to localized surges in overdose deaths.
“During the 2016–2017 carfentanil outbreak, precursor chemicals from China fueled localized surges in overdose deaths,” – he
After China regulated fentanyl in 2018, there was a temporary decline in carfentanil-related deaths. However, the current outbreak is more widespread, making it challenging to control supply and mitigate its impact on the opioid crisis.
“After China regulated fentanyl in 2018, carfentanil-related deaths declined. The current outbreak appears more widespread, affecting 37 states, which poses greater challenges for controlling the supply and mitigating its impact on the opioid crisis.” – he
Carfentanil's extreme potency makes exposure particularly difficult to treat. The rapid onset of its effects in the body can lead to severe respiratory distress, cognitive difficulties, and respiratory arrest. A person can experience a reaction after being exposed to just one microgram of carfentanil. This raises significant concerns about its use as an adulterant in other drugs.
“The potential mixing of carfentanil into fentanyl products as an adulterant raises concern that its presence might be unknown to persons using drugs, reminiscent of the way that fentanyl was first introduced as an adulterant of heroin,” – the report
The impact of carfentanil is particularly concerning in eight states—New York, Maryland, Florida, Illinois, Michigan, Ohio, West Virginia, and Kentucky—each reporting over 20 carfentanil-related deaths. The CDC's data also indicates that nearly 87% of individuals who died from carfentanil between July 2023 and June 2024 had illegally manufactured fentanyl in their systems.
The presence of carfentanil as a contaminant or adulterant in the drug supply means users often unknowingly expose themselves to this lethal substance.
“It is a contaminant or adulterant in the drug supply, meaning the person who is using it is not anticipating to be exposed to it,” – Calello
Treating overdoses involving carfentanil presents additional challenges due to the drug's potency. Jalal notes that multiple doses of antidotes like naloxone may be necessary in rapid succession to counteract its effects, reducing the chances of successful reversal.
“Due to the drug's extreme potency, multiple doses may be required in rapid succession, which reduces the likelihood of successful reversal,” – Jalal
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