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How Did a Deadly Animal Sedative End Up in Ohio's Opiate Supply Chain? 

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Carfentanil.

Before this summer, the word meant absolutely nothing to most Ohioans, unless you happened to work at a zoo. Even there, though, it's not exactly an everyday term.

But then a flash flood of headlines rolled in and suddenly the general public was very well aware of what carfentanil is: an opiate used to knock out elephants during surgery. They knew that because the heroin crisis has gotten worse. An entire generation of addicts is dying in American bedrooms and bathrooms and cars, in fast food restaurants and bars.

In July 2016, Akron alone saw 236 overdoses in three weeks. The numbers were shocking, which is saying something — Cuyahoga County, Summit County, Ohio and America at large are subjected to numbing and record-setting overdose stats every month at this point. But an abrupt spike of 200 was unheard of in Akron.

Something was different.

That difference was highlighted publicly when Akron police chief James Nice announced that carfentanil was suspected in some cases. The word blindsided observers. Long used as a sedative for large animals like elephants and rhinoceroses, carfentanil had somehow seeped into the heroin supply.

click to enlarge The pink substance is heroin and carfentanil, seized by the Hamilton County Sheriff’s office in August.
  • The pink substance is heroin and carfentanil, seized by the Hamilton County Sheriff’s office in August.

The opiate problem is becoming worse with each passing day. The introduction of the powerful prescription painkiller fentanyl into the heroin chain had a lot to do with that. But that process unfolded slowly over decades. The potency in 2016 is advancing tenfold, thanks to tiers of American drug dealers "stepping on" their product and cutting a buffet of chemical analogs of fentanyl, like carfentanil, into the supply.

And so we come to the next wave of the opiate overdose crisis. This summer introduced addicts and the general public alike to carfentanil, the most powerful commercial opiate in the world. (It's prohibited from use in war under the Chemical Weapons Convention.) And it's killing Americans in droves.

***

Carfentanil, marketed under the brand name Wildnil, has a long and mostly niche history in the annals of American pharmaceuticals. For years, the drug rested on the shelves of zoologists and veterinarians specializing in large animals. It's a uniquely powerful sedative.

"There's no human use for carfentanil," Keith Martin says. "None."

Martin is the resident agent in charge of the Cleveland office of the Drug Enforcement Agency. His office has been closely tracking the movement of carfentanil in Ohio.

"And even when they use carfentanil for [sedating large animals], it's used in small doses," Martin says. "And it's not always guaranteed that they'll be able to bring that animal back to life. For someone to be putting into their body or their system carfentanil, knowing that it can possibly kill a large animal — I mean, it's almost like playing Russian roulette."

Carfentanil is 100 times more powerful that fentanyl, which itself is 80 times more powerful than heroin. That comparison can be found in any number of news articles, but it's hard to grasp what that even means. In very simple terms: When it comes to carfentanil, all it takes is a snowflake-sized amount to kill a human, even through seemingly benign skin contact. Unwitting heroin addicts, duped by dealers with dollar signs in their eyes, are shooting this stuff into their veins. (Animal clinicians and, now, first responders must wear protective gloves and masks when dealing with the stuff.)

The U.S. Department of Defense has long identified the drug as a potential weapon in the hands of enemy nations. Lately, the U.S. has grown concerned that ISIS operatives could begin using the drug in various biological attacks. It's a grave and known concern. In 2002, Russian special forces deployed gaseous carfentanil in a counterattack at a Moscow theater; there, some 40 Chechen terrorists had taken 850 hostages. The opiate killed all of the attackers, along with 133 hostages. (Naloxone was used to save some hostages.) The U.S. later deemed the actions justifiable.

But when it comes to American addictions, the drug falls in line with a trend toward synthetic opioids — a different beast altogether than Oxycontin and Vicodin prescriptions, which, through government regulations and public stigma, are on the decline nationally.

For the most part, carfentanil is being created in clandestine laboratories in China, where oversight remains far more lax than in the States. The drug can be purchased online via the "dark web" on the encrypted Tor network and shipped right to one's doorstep here in the U.S. (Go ahead and Google it. See for yourself how easy it is to find.) The drug is a Schedule II controlled substance, according to the DEA's oversight, and remains illegal to possess outside of properly outfitted animal clinics, such as the zoological medicine department at the Cleveland Metroparks Zoo.

click to enlarge An amount of carfentanil equal in mass to a grain of salt can kill a human.
  • An amount of carfentanil equal in mass to a grain of salt can kill a human.

Because the drug is coming in through the mail, like an Amazon Prime order, the standard investigations that end with indictments against a ring of regional dealers don't really work in this new climate. Still, investigators say that cartels play a role. The manufacturers in China may not be directly in cahoots with them, but Mexican cartels long familiar with the opiate business are getting their hands on these uniquely powerful synthetics and introducing them into the supply.

The U.S. and China continue to discuss the matter of rising overdose deaths and border seizures — the DEA maintains an office in Beijing where agents work to clamp down on clandestine manufacturers — though it's unclear how far along those talks have progressed. China has not yet scheduled the control of the drug. This year, the Associated Press took a close look and identified 12 Chinese businesses that said they would export carfentanil to the United States, Canada, the United Kingdom, France, Germany, Belgium and Australia for as little as $2,750 per kilogram.

As part of that investigation, the AP contacted business owners in China. "We can supply carfentanil ... for sure," a saleswoman from Jilin Tely Import and Export Co. wrote to reporters in a September email. "And it's one of our hot sales product."

***

It's debatable when, precisely, the synthetic opioid wave began in the U.S., but by 2014 the problem was certainly clear. In Ohio, according to the Centers for Disease Control and Prevention, fentanyl-related deaths rose 526 percent, from 84 to 526, between 2013 and 2014.

Martin points out that, naturally, money has driven this trend. The profit margin on fentanyl and carfetanil (and other analogs, like acetyl fentanyl and U-47700) is dramatic. Only a small amount is needed; you can smuggle in a brick of carfentanil and have enough supply to cut a mountain of heroin. The drug that you're selling becomes stronger, and there's more to go around. More money.

click to enlarge Hamilton County coroner Lakshmi Sammarco
  • Hamilton County coroner Lakshmi Sammarco

And while the first wave of opiate addiction, via legally prescribed painkillers, filled hospital waiting rooms to the brim, this second wave has driven patients to the streets. That, combined with the profit motive, has prompted the flash flood of fentanyl- and carfentanil-laced heroin. Demand soars, and supply follows. Ohio, once ground zero for opiate prescriptions in the late 20th century, has become the "test tube" for high-powered synthetic opiates, according to a theory pushed by Hamilton County coroner Lakshmi Sammarco.

"The very intense and focused spike brought up a lot of fears ... that our community was being used as a test tube," she said. "What are [the dealers] learning from it? Are they looking to see how many people it's going to kill or how quickly our first responders can respond? And how many customers is that going to generate for them?"

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