Carfentanil, an extremely powerful synthetic opioid best known as an elephant tranquilizer, has been linked to two heroin-related deaths in Colorado. But a local expert on addiction who's recently helped treat patients who've used the substance says it could have played a role in even more fatal overdoses, thereby quietly contributing to the shocking rise of heroin deaths in Denver and Colorado as a whole.
"It's being cut into heroin to increase its potency," says Amy Lowe, clinical director of outpatient services for Arapahoe House, Colorado's largest alcohol and drug rehab treatment center; Lowe spoke to us for a September 2016 post that looked at why Spice is popular in a state with legal marijuana. "A lot of people don't know what they're getting, and I would guess that our astounding overdose statistics would include drugs like this one," even if carfentanil isn't specifically cited in the autopsies. After all, carfentanil is relatively new to Colorado, and some coroners may not even be looking for it yet.
Far better known is fentanyl, another synthetic opiate with which carfentanil is frequently associated. Fentanyl has been the object of some notorious thefts by hospital personnel. The most recent case involved surgical tech Rocky Allen, whose needle-swapping led to approximately 3,000 patients at Swedish Medical Center being tested for hepatitis B and C, as well as HIV. Prior to the Allen incident, Rose Medical Center operating-room technician Kristen Parker was given a thirty-year prison sentence for infecting some hospital patients with hepatitis C over her own fenanyl-fueled needle-swapping — and last year, nurse Kim Burgans was arrested for allegedly stealing fentanyl at a hospital in Frisco.
But while fentanyl is a favorite of addicts, it's actually weak in comparison with carfentanil, which is "a hundred times more potent than fentanyl, and a thousand times more potent than morphine," Lowe points out. "Fentanyl is usually prescribed to people with chronic pain conditions, or people who are dying, to use as a dermal patch, while carfentanil actually comes in powder form. And one fragment of carfentanil does fifty times more than what a fentanyl patch would do."
An anti-carfentanil graphic produced by an addiction center in Canada, where the substance has been found since last year.
Plenty of mystery surrounds carfentanil at this point. According to Lowe, "it's likely manufactured in China and it's imported into the U.S., sometimes by drug cartels through Mexico. But there have also been imports by ship," with reports about seizures of carfentanil, often in Canada, beginning to make major news last year. She adds that "there's nothing recorded in the U.S. for it being used on humans for medical reasons. It's not considered a controlled substance in China, however. There, it's used to tranquilize large mammals, like elephants and rhinos."
The effects on people are similar to those produced by other opiates, Lowe notes: "It's sedating and can produce a euphoric feeling. But depending on the quantity taken, it can cause a person to just nod off, pass out."
The likelihood of the latter is high because of carfentanil's strength and relatively low price. "It's not expensive at all, because so little can do so much," Lowe allows. "Manufacturers can afford to sell just a tiny amount at a time, and there's a lot of supply, so it's very inexpensive."
The low cost is only one reason why carfentanil is so appealing to heroin dealers, she continues. "If you're a person selling heroin and you have a limited supply, you can supplement it with this drug — and the buyer might have a stronger effect based on it being added and go back to that dealer. If you get good stuff for less money, it's good from a business angle."
The flip side of that equation is that mixing just a little too much carfentanil into heroin can make a dangerous product even deadlier. Earlier this month, as the Aspen Times reported, the Colorado Bureau of Investigation did tests of pills found at a home in the El Jebel area where two men, 26-year-old Michael Martinez and thirty-year-old Camillo Sanchez, were found dead on March 24. (A third man with Martinez and Sanchez was revived thanks to multiple doses of the anti-overdose medication Narcan.) The pills contained heroin, but they were also cut with carfentanil, prompting the Eagle County Sheriff's Office to put out an alert about the opioid that quotes Chuck Rosenberg, acting administration of the Drug Enforcement Administration.
"Carfentanil is surfacing in more and more communities," Rosenberg said. "We see it on the streets, often disguised as heroin. It is crazy dangerous. Synthetics such as fentanyl and carfentanil can kill you. I hope our first responders — and the public — will read and heed our health and safety warning."
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Eagle County isn't the only place in Colorado where carfentanil has popped up of late, as Lowe knows from personal experience. "In the last two months, we've had two people here who said they were able to purchase it on the Internet," she says.
Assisting people who've used carfentanil in combination with heroin in kicking the habit isn't that much different from treating those addicted to other opioids, Lowe acknowledges — "but the scary thing is the overdose risk. With carfentanil, we're on a different playing field as far as risk is involved.... Overdoses happen a lot when people walk away from drugs and get sober for thirty days or so, usually after they land at an institution, but then go back to using what they had been using before. Then they overdose, because their tolerance drops off in seven to ten days. And carfentanil only adds to that risk."
When Lowe first read about carfentanil last year, she recalls, "I remember being stunned and hoping that it wouldn't come this way. But now it's here."