What is carfentanil?
The drug carfentanil (4-carbomethoxyfentanyl) is an analogue of the synthetic opioid fentanyl. It was first synthesized in 1974 by Janssen Pharmaceutical, and was sold under the trade name of Wildnil®. Carfentanil has no distinguishable odor and comes in many forms, including powder, tablets, patches, blotted paper, liquid, and sprays. Carfentanil can be administered orally, nasally, or intravenously. Although known to resemble powdered cocaine or heroin, this drug has also been seized as a pale yellow, pink, or brown powder. Common street names of carfentanil include “drop dead”, “C.50”, “serial killer”, and when mixed in combination with other opioid/opioid-like drugs, “grey death”.
Carfentanil acts as an agonist on the mu-opioid receptors in the central nervous system. This causes effects similar to other opioids, such as analgesia and extreme sedation. It also suppresses the respiratory system, depresses the cough reflex, and constricts pupils.
What is it used for?
Traditionally, carfentanil is used by veterinarians to tranquilize and sedate farm animals, or large wild animals in need of care (e.g., deer and moose). Wildlife rangers also use combinations of drugs (including carfentanil) for sedating wild bison. Because it is so potent, veterinarians who use carfentanil wear protective gear, such as gloves and face shields, when administering the drug. In the United States, veterinarians must have a Drug Enforcement Agency (DEA) number, and be on the approved user’s list.
Why is it so dangerous?
Carfentanil is one of the most toxic opioids currently known, with studies showing it to be 10,000 times more potent than morphine, 4,000 times more potent than heroin, and 100 times more potent than fentanyl. In humans, a dose as small as 1 microgram is enough to elicit a response to the drug and about 20 micrograms, which is less than a grain of salt, is enough to be fatal. Like fentanyl, carfentanil can be absorbed through accidental inhalation of airborne powder, which makes its exposure and handling dangerous.
There are reports of drug dealers adding carfentanil to traditional drugs because it is cheaper, more potent, and easier to obtain than heroin or cocaine. It is unlikely that drug users are aware that they are receiving drugs laced with carfentanil, and may be more likely to overdose when taking their usual dose.
Fatalities and treatment
Between January and November 2017, the number of accidental drug poisoning deaths related to carfentanil in Alberta had risen by 330% (29 in 2016 to 125 in 2017). Edmonton and Calgary zone reported the highest number of carfentanil-related deaths in Alberta, with the majority of new cases occurring within the Calgary zone.
Naloxone has been used to reverse carfentanil overdoses; however, greater than normal doses are required to revive those who have overdosed. In response to the current opioid crisis in Alberta, overdose reversal kits containing naloxone are publicly available at some pharmacies, walk-in clinics, and emergency services.
Carfentanil is a controlled schedule I drug in Canada. Unauthorized possession of a schedule I drug may result in a maximum of six months jail time and a $1000 fine, if treated as a summary conviction offence. If treated as an indictable offence, the maximum penalty is seven years jail time. Those charged with trafficking also face lifetime imprisonment, with a mandatory one-year jail sentence for trafficking a Schedule I drug under 1 kg.
In an attempt to help decrease the availability of carfentanil, fentanyl, W-18, and other potent opioids, provincial legislation was passed in 2017 to restrict access to pill press machines. Illegally possessing a pill press machine can result in fines ranging from $50,000 to $375,000 and possible jail time from six months to one year.
What is Carfentanil and Why is it so Deadly?
It’s been responsible for scores of Emergency Room visits and hospital admissions. Far too many families have already said goodbye to a loved one due to a drug overdose.
As prescription painkiller abuse has increased over the past several years, use of heroin has also been on the rise. The National Institute on Drug Abuse reports that heroin use was 19 times higher among people who had used pain medications non-medically than those who had not. A 2013 study of the general population found that the majority of heroin users (80 percent) used prescription opioid medications before switching to the illicit drug.
“Crazy Dangerous” According to DEA
Carfentanil is a drug that is so toxic it leaves other opioids far behind. It’s been described as “crazy dangerous” by DEA Acting Administrator Chuck Rosenberg and it’s on the streets of major cities in both the U.S. and Canada. What is this drug and what makes it so deadly?
In order to understand what carfentanil is, we need to go back to 1974. Carfentanil was developed that year as an animal tranquilizer. It wasn’t approved for use in humans because of its strength.
Zookeepers and veterinarians use carfentanil to sedate large mammals, such as horses and elephants. This is the drug’s only legitimate use.
Relationship Between Fentanyl and Carfentanil
Carfentanil’s chemical makeup is similar to fentanyl, which is another powerful opioid medication. Fentanyl is available by prescription to treat severe pain and is used in hospitals as an anesthetic. It’s 50-100 times more powerful than morphine, and is generally only given to patients who are already taking similar types of pain medication.
Fentanyl is being mixed with heroin to increase the latter drug’s potency. Drug dealers will “cut” their supply with any number of ingredients to divide it up and increase their profit. Customers have no way of knowing what a particular batch has been cut with; it could be something relatively benign, such as baking soda or baby powder, or it could be something potentially lethal, like fentanyl or even carfentantil.
Carfentanil looks like powdered heroin but is 100 times more powerful that fentanyl. Other than a powder, carfentanil is available in a tablet, blotter paper, and spray form. It can be absorbed directly through the skin or inhaled. It is so potent that one dose of carfentanil is 1 microgram (one millionth of a gram), which is about the size of a few grains of salt. Anyone coming into contact with that amount of the drug needs immediate medical attention.
Signs of Carfentanil Exposure
Carfentanil is a drug that works very quickly. If a loved one has been exposed, signs of exposure will become evident within a few minutes.
- Clammy skin
- Pinpoint pupils
- Respiratory depression
Call your local emergency number to have medical help dispatched to your location immediately. If you suspect the carfentanil has been inhaled, move the person into fresh air. In a situation where the drug has been ingested and the person is conscious, wash out their mouth with cool water.
If naloxone is available, administer a dose as directed. The drug is used to counteract the effects of opioids. More than one dose may be needed in the case of carfentanil, and naloxone can be administered at two-three minute intervals until the person is breathing on their own for 15 minutes or paramedics have arrived.
Find Help for Prescription Drug Addiction
The best way to avoid a problem with carfentanil exposure is prevention. The journey to addiction doesn’t happen overnight; it’s a slope that develops over time for people. Be alert for the following signs of prescription drug addiction.
- Taking more than the amount prescribed by their doctor
- Running out of their pain medication “early”
- Seeing more than one doctor to get pain medication (“Doctor shopping”)
- Complaining of having prescriptions lost or stolen to get more medication
- Taking prescription drugs that weren’t originally prescribed for them
Waiting to get help for your loved one only gives the addiction time to become deeply embedded. At Summit BHC, we can offer caring, personalized treatment in a supportive atmosphere.
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