Carfentanil, a sedative for large animals, was the cause of at least eight overdose deaths in Hamilton County, Ohio, coroner Dr. Lakshmi Kode Sammarco said Tuesday.
Sammarco added that they are waiting on blood and urine tests from five more overdose deaths which she is confident “will also be due to carfentanil.”
The most potent opioid commercially available
Carfentanil is the most potent opioid used commercially, 10,000 times stronger than morphine. It is a version or analogue of fentanyl, the painkiller that most recently made headlines as the cause of the the accidental overdose death of pop star Prince.
Carfentanil is a synthetic opioid and can slow breathing significantly. It’s not approved for human use, but is used commercially to sedate large animals, such as elephants. As little as 2 milligrams can knock out an African elephant weighing nearly 2,000-pounds.
According to the Drug Enforcement Administration, users might not know they are even taking the drug, as dealers have been cutting heroin with fentanyl to give it a boost and stretch their supply. Dealers are also using it to make counterfeit pills. Between 2013-2014, there were 700 fentanyl-related deaths. Officials believe it is helping fuel the opioid and heroin crisis.
Ohio has been one of the places hardest hit by the epidemic. According to the Centers for Disease Control and Prevention, in 2014, it had the second-largest number of opioid-related deaths in the country and the fifth-highest rate of overdose.
Between 2013 and 2014, Ohio’s fentanyl submissions to DEA labs by law enforcement increased by 1,043%, while fentanyl-related deaths increased by 526%. In the same time period, prescriptions for fentanyl actually dropped by 7% in the state.
However, Hamilton County Sheriff Jim Neil said they are increasingly seeing just fentanyl or carfentanil cut with heroin. “It’s not heroin cut with anything else anymore, it’s synthetic (opioids) cut with heroin,” he said.
In July, Hamilton County officials issued a public health warning about the drug after seeing 35 overdoses, including six deaths, in a three-day period.
Drug difficult to track
The DEA does not track carfentanil cases separately. Most states flag a handful of fentanyl analogues in postmortem testing, but very few labs across the country are equipped to test for it or have any reference materials to help identify it.
In fact, according to Sammarco, the county was unable to test for carfentanil in her lab until just last week because Hamilton County was unable to get a sample of the drug to compare to the overdosed samples. Sammarco was finally able to gain access to the drug last Tuesday after working with Ohio Senator Rob Portman’s office.
Sammarco said that the area has been so devastated by overdoses, their toxicology lab is 290 cases behind.
Hamilton County Heroin Task Force Director Tom Synan Jr. said it was time for Governor John Kasich to declare a public health emergency to deal with the epidemic.
“We need to realize funding immediately that goes into treatment…We need action, and that action needs to be coming into treatment centers,” said Synan.
Sammarco agreed that treatment is key to ending the epidemic.
“These people have a disease and need to be treated, and you have to have empathy for that,” said Sammarco. “This has to be a community-wide response, raise the awareness with everybody.”