Ultra-potent “elephant tranquilizer” appears to be driving new surge in overdose death in Ohio

Carfentanil is back and is killing significant numbers of Ohioans again.

Carfentanil was found in nearly 10% of all illegal drugs (excluding marijuana) confiscated in April, a Harm Reduction Ohio analysis of state crime lab data found. That’s the highest level of carfentnail found since January 2018 and a sharp jump from just a six months ago when the drug appeared to have nearly vanished from Ohio.

Harm Reduction Ohio reported on April 15 that a surge in overdose deaths in Ohio appeared to have started at the end of last year. The increase in deaths appeared to reverse a steady decline in overdose deaths that started in the summer of 2017 and had reduced overdose deaths by 25%. However, we reported that it was unclear what had cause overdose deaths to begin climbing again.

On April 21, we reported that carfentanil night be the cause. However, the data set provided by the Bureau of Criminal Investigation, which operates four state crime labs, was missing some data to know for sure. BCI provided a complete data set last week and the bad news was worse than we expected.

Source: Harm Reduction Ohio analysis of Ohio Bureau of Criminal Investigations crime lab data.

Ohio’s deadly tradition. The danger of carfentanil’s return to Ohio cannot be overstated. The explosion of carfentanil in Ohio’s drug supply in the last half of 2016 and first half of 2017 was the primary cause of  our state’s historic surge in overdose deaths.

Ohio had 21 times the carfentanil overdose death rate of other states, the Centers for Disease Control and Prevention found. Carfentanil cause nearly 2,000 deaths in Ohio over two years, the CDC found.

For reasons unknown, carfentanil was an Ohio thing. No other state in the nation had even a fraction of the number of carfentanil deaths as Ohio.

A Harm Reduction Ohio analysis of results from Ohio Bureau of Criminal Investigations drug-testing labs found that carfentanil went from non-existent in Ohio in 2016 to being nearly omnipresent a year later —  found in more than half of all confiscated drugs (excluding marijuana) confiscated in Ohio in June 2017.

Then, for reasons as unexplained as why it hit Ohio so hard and fast, carfentanil nearly vanished. As recently as November, it was found in found in only 0.2% of confiscated drugs in Ohio.

Source: Harm Reduction Ohio analysis of Ohio Bureau of Criminal Investigations crime lab data

Carfentanil is the most powerful and dangerous fentanyl analog. It’s active in humans in a dose as small as one microgram. It is estimated to be 10,000 times more powerful by weight than morphine. It can never be used safely in the illegal markets. Unlike fentanyl, which could be mixed safely in illegal markets if dilution was done in a liquid using a rotary evaporator, carfentanil can never be diluted to consistently survivable levels. Proper dilution of this microgram drug requires facilities and skill  found only in a professional pharmaceutical factory.

Drug checking. Fentanyl test strips pick up carfentanil when it’s in a drug. However, the strips don’t distinguish between carfentanil, fentanyl and other fentanyl analogs.

A couple harm reduction groups have bought $60,000 portable machines that can identify carfentanil in most situations when operated properly. (Not always easy to do.) The high-pressure mass spectrometry MX908 is probably the best.

Until then, public health officials should consider allowing — indeed, encouraging — drugs to be tested for safety on the many gas chromatography–mass spectrometry machines that exist. Testing drugs for safety is now criminalized, a deadly health policy mistake. In reality, a gas chromatography machine costs just $20,000 or so and can do the job with great accuracy without paying the $200,000 that a mass spectrometry instrument adds.

 — Dennis Cauchon, President, Harm Reduction Ohio


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