Fentanyl, and the Deadlier Carfentanil, Now Outpacing Heroin Sales in Many Areas

The Ohio Substance Abuse Monitoring Network

Fentanyl

The OSAM Network first picked up on fentanyl as a substitute for heroin in January 2003 when a female heroin-user reported that the “china white” (white powdered heroin) sold in Columbus during the summer of 2002 was fentanyl from New York City. At that time, no other drug users or treatment providers mentioned fentanyl being sold as heroin. OSAM’s first mention of fentanyl-heroin mixtures occurred in January 2004 when participants in Cleveland indicated that some dealers were adulterating heroin with fentanyl. Since June 2014, when, for the first time, every OSAM region reported on the availability of fentanyl and heroin-fentanyl mixtures, the OSAM Network has continued to track increases in the use of fentanyl statewide.

Today, fentanyl is the leading opioid of abuse in many areas of Ohio, and its availability and use are also outpacing heroin in many places.

Participants discussed: “Let’s keep in mind, heroin isn’t heroin anymore, it’s fentanyl; It’s almost impossible to get heroin, lately, ‘cause they are pushing this stuff (fentanyl); It’s less and less heroin and more fentanyl; The white heroin you get in Ashtabula is not heroin, it’s fentanyl; There’s no such thing as pure heroin; It’s very potent, but it’s not heroin; Are we talking about heroin or fentanyl? There is so much fentanyl on the streets today. It’s pretty much what people are dying from … they aren’t dying from heroin. I remember when I first started using heroin, no one was dying. When fentanyl hit the streets … there’s bodies every day.” Corroborating data indicates that fentanyl has become more available than other opioids for illicit use in many places. A query of the National Forensic Laboratory Information System (NFLIS) by each of the eight OSAM regions for January to June 2016 found that the numbers of cases for fentanyl are increasingly higher than for all other opioids for the Cincinnati, Cleveland and Dayton regions.

Carfentanil

The U.S. Drug Enforcement Administration (DEA) issued a carfentanil warning in September 2016 to the general public, as well as to law enforcement agencies across the country. The DEA cautioned that carfentanil, a synthetic opioid 10,000 times more potent than morphine and 100 times more potent than fentanyl, could be lethal at the 2-milligram range.1 Carfentanil (aka “elephant tranquiliz-er”) is primarily produced in China as a large-animal anesthetic to be used in veterinary medicine; it is brought to this country from China via the U.S. mail service. However, the DEA has worked closely with the Chinese government to ban the manufacture and sale of carfentanil in China, as well as ban furanyl fentanyl, acrylfentanyl and valeryl fentanyl, effective March 1, 2017 (http://www.cnn.com/2017/02/16/ health/fentanyl-china-ban-opioids). (Ohio’s Bureau of Criminal Investigation (BCI) crime labs reported having processed an increased number of fentanyl analogs during the past six months, including furanyl fentanyl.)

Carfentanil was first detected in Ohio in July 2016. During the most recent reporting cycle of July to December 2016, participants in six of OSAM’s eight regions reported on the presence of carfentanil in their communities: Akron-Canton, Athens, Cincinnati, Cleveland, Columbus and Youngstown. Participants discussed: “The heroin is cut with fentanyl and carfentanil; Everyone wants it if it’s cut with fentanyl because it is stronger … and it’s even better ‘dope’ (heroin) if it’s mixed with carfentanil; If somebody overdoses and dies, they (users) want to know who provided that dope because it was obviously good; I never worry about overdosing. I overdosed one time … it took me six shots of Narcan® (naloxone, medication to reverse opioid overdose) … to get back; People are overdosing because of the fentanyl and carfentanil.” In discussing the current quality of heroin, participants explained: “The quality isn’t based on heroin anymore. It’s based on if there’s fentanyl in it; If you’re talking about straight fentanyl, I mean it’s a ‘10’ … it’s quality; Any quality of heroin that’s mixed with fentanyl or carfentanil … it’s going to be top notch.” In discussion of carfentanil potency, a law enforcement officer in Akron-Canton stated, “It’s hard to tell what we buy. We’re not supposed to field test … we don’t field test anything that has to do with heroin … we always send it to the lab.” A Cincinnati officer observed, “We are seeing many cases of heroin laced with fentanyl and carfentanil.” Due to the danger of exposure to carfentanil, officers minimize the handling of dangerous substances by sending all suspected heroin seizures to their crime lab for testing. In addition to carrying Narcan® as first aid to those overdosing, officers now carry Narcan® in case they are exposed to carfentanil.

NFLIS data confirms the presence of carfentanil in Ohio communities starting in July 2016 (no carfentanil cases were found in NFLIS prior to this date). For July to October 2016 (most current available data), there were 347 carfentanil cases recorded. Carfentanil seems to be highly concentrated in the northeast area of the state with 237 cases (68.3% of all cases), forming a contiguous geographical area surrounding Cleveland and Akron; 86 cases were from Summit County (home of Akron) and 67 cases were from Cuyahoga County (home of Cleveland). In the southwest area of Ohio, carfentanil seems to be highly concentrated in OSAM’s Cincinnati region where 81 cases were logged (Hamilton County, home of Cincinnati, accounted for 77 cases). All other OSAM regions had between 3 – 11 cases with the exception of OSAM’s Athens region (southeast Ohio) where no carfentanil cases were found.

Ohio may be ground zero for carfentanil. According to the DEA’s Special Testing and Research Laboratory Synthetic Drug Threats in the United States 2017 Update, 451 carfentanil cases, submitted from 22 participating laboratories, were confirmed for the reporting period of July to October 2016. Of these 451 carfentanil identifications from throughout the U.S., 83% were in Ohio.2

Media outlets reported on law enforcement seizures and arrests related to carfentanil throughout Ohio. One news source reported that from July to October 2016, there were approximately 645 drug overdoses in Summit County; the Summit County Medical Examiner’s Office confirmed 73 drug-related overdose deaths were from carfentanil (www.ohio.com, Nov. 3, 2016).

1 U. S. Drug Enforcement Administration. DEA Issues Carfentanil Warning to Police and Public. Retrieved from https://www.dea.gov/divisions/hq/2016/hq092216.shtml. 2 Head, Jill, Special Testing and Research Laboratory, U.S. Drug Enforcement Administration. Synthetic Drug Threats in the United States: 2017 Update. Retrieved from https:// ndews.umd.edu/sites/ndews.umd.edu/files/ndews-webinar-feb-15-2017-synthetic-drug-threats-jill-m-head-dea.pdf.