Lethal New Drug Laced Into Heroin So Strong It's Used as Elephant Sedative

As heroin continues cutting a wide swath of despair and death across Long Island, a new drug, so potent that it's used to sedate elephants, has been identified on the horizon — and it's so lethal that only a few grains can kill.

Carfentanil, which is often seen laced in heroin, is, according to the National Institutes of Health, "an analogue of the popular synthetic opioid analgesic fentanyl, and is one of the most potent opioids known," also the most potent opioid used commercially.

Carfentanil, according to the NIH, was first synthesized in 1974. "It has a quantitative potency approximately 10,000 times that of morphine and 100 times that of fentanyl," the NIH said; it is marketed under the trade name Wildnil as a general anaesthetic agent for large animals. "

Carfentanil is intended for large-animal use only as its extreme potency makes it inappropriate for use in humans," the NIH said.

According to NPR, the United States Drug Enforcement Administration has issued a warning to communities nationwide to be aware of the drug; first responders, EMTs and emergency room staff are told to wear masks and gloves because the drug is so potent it can prove dangerous to those who just inhale it, the report states.

And yet, across the country, carfentanil, believed to be the most powerful commercial opioid, according the NIH, has been found laced in street heroin in states including Ohio, Indiana and Florida.

Two milligrams can sedate a 2,000 lb. elephant

According to Time.com, the drug has contributed to potentially hundreds of overdoses in the past several weeks alone; since the middle of August, about 300 people in four states have overdosed on heroin laced with carfentanil and fentanyl, the report states.

It's so strong that about two milligrams can sedate a 2,000 lb. African elephant, according to CNN.com; in July, officials in Hamilton County, Ohio, issued a public health warning after six deaths and 35 overdoses were reported in three days, the article states.

According to the CNN report, the DEA said most fentanyl type drugs found in the United States are being manufactured in China and brought across the border through Mexico.

Long Island experts concerned: 'We are losing more and more ground in this fight.'

On Long Island, local experts said the reports related to carfentanil are dire and the community should remain aware.

"This is yet another turn for the worse in America's opiate crisis, which has hit Long Island particularly hard," said Dr. Jeffrey Reynolds, president and chief executive officer of the Family and Children's Association in Mineola. "We've gone from pain pills to heroin to heroin laced with fentanyl to heroin laced with carfentanil, which is exponentially more powerful than any other drug we've ever seen before."

Dealers, Reynolds said, "are cutting heroin with synthetic opioids like Fentanyl and carfentanil in order to stretch the supply and boost the high; indeed heroin has become an even bigger business than it was in the past. The overdoses continue to rise and it's clear that we are losing more and more ground in this fight."

While Reynolds said there are some good things happening in the way of new programs and public policy changes, he feels more needs to be done.

"I still feel like we are fighting a vast, raging forest fire with a garden hose," Reynolds said.

Robert Hartmann, president of Mainstream House, a treatment facility in Riverhead, agreed.

"In the haste of making bigger profits, dealers are cutting heroin with other drugs," such as carfentanil and fentanyl, he said. "In their delusion of active addiction, addicts think the stronger the better, so they readily accept the 'poison within the poison.' Now we have two drugs to slow the respiratory system and kill the addict. With growth in the drug's potency, comes growth in our funeral home businesses."

The news is staggering for Suffolk County where statistics were released in April that confirmed what so many devastated families already know to be heartbreakingly true: Suffolk County leads New York State in heroin-related overdose deaths by a wide margin.

Between 2009 and 2013, 337 heroin-related deaths were reported in Suffolk County.

The "New York State Opioid Poisoning, Overdose and Prevention," report prepared for Gov. Andrew Cuomo and the New York State Legislature was unveiled in April.

The report "provides an overview of opioid-related mortality and morbidity and other consequences of heroin and prescription opioid misuse across the state over the last five years," the document states.

The report indicates that 337 people died from heroin overdoses in Suffolk County during a five-year period, more than in the Bronx, which recorded slightly over 200 such deaths, the second-highest rate in the same period. There were 128 heroin-related deaths in Nassau County.

The report also indicates that Suffolk County is plagued by cheap heroin coming into the United States, lawmakers said, with hospitals and outpatient treatment facilities swamped by an ever-escalating number of cases and Narcan saves rising dramatically.

According to the report, opioid-related emergency department visits increased 73 percent from 2010 to 2014. The number of heroin-related deaths increased in 2013 to 637, and opioid analgesics related deaths rose to 952, increases of 163 percent and 30 percent from 2009, respectively, the report states.

In 2013, an average of two New Yorkers a day died of heroin-related overdoses, the report said. More than four times as many men died of one of these overdoses compared to women; whites died of heroin-related overdoses at a rate of nearly twice that of blacks, and almost 1.35 times that of Hispanics.

"The upward trend in heroin-related overdose fatalities among younger New Yorkers is particularly alarming," the report states. "Half the people who died were under age 35."

Waging the war against heroin

“These numbers are absolutely devastating, but shouldn’t be a surprise to anyone," Reynolds said.

"Treatment professionals and bereaved families have, for more than a decade now, been warning about the worsening crisis. There are still gaps in school-based prevention, waiting lists for treatment slots, insurance company barriers to care and too few resources designed to support those who do find a path to recovery."

Although Narcan saves are reported daily, Reynolds said education is critical: "The widespread distribution of naloxone has prevented many overdose fatalities, but too often, I’m seeing folks revived, brought to an emergency room only to be discharged within an hour and dead of a subsequent overdose within 24 hours. This is a huge missed opportunity and we need to make sure that those who are revived are properly counseled, their families are supported and we help them find a path into treatment."

In June, Cuomo signed legislation to combat the heroin and opioid crisis that's claiming countless lives.

The comprehensive package of bills was passed as part of the 2016 legislative session and "marks a major step forward in the fight to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York," a release from Cuomo's office said.

Included in the legislation are several best practices and recommendations identified by members of Cuomo's new heroin and opioid task force, launched in May.

The new legislation includes initiatives to address heroin and opioid abuse statewide such as:

• measures to increase access to life-saving over-dose reversal medication
• regulations to limit opioid prescriptions from 30 to seven days
• ongoing prevention education for all physicians and prescribers.

The legislation aims to remove "burdensome" barriers to access for inpatient treatment and medication.
Specifically, the legislation will put an end to prior insurance authorization to allow for immediate access to inpatient treatment as long as that treatment is needed.

In addition, the legislation establishes that utilization review by insurers can begin only after the first 14 days of treatment, ensuring that every patient receives at least two weeks of uninterrupted, covered care before the insurance company becomes involved.

An ongoing battle

Since 2014, Cuomo has implemented a series of reforms aimed at fighting back against heroin and opioid addiction, including signing the "Combat Heroin" legislation; expanding insurance coverage for substance use disorder treatment; increasing access and enhancing treatment capacity across the state, including a major expansion of opioid treatment services; implementing new and expanded recovery services; and launching a public awareness and prevention campaign to inform New Yorkers about the dangers of opioid use.

In March, new regulations took effect that require all prescriptions to be transmitted electronically from the prescriber directly to the pharmacy. The measure is part of New York’s comprehensive I-STOP law, first implemented in 2012, designed to reign in prescription drug abuse across the state, Cuomo said.

As overdose is now the leading cause of accidental death in New York, with Suffolk County reporting the highest number of heroin overdoses, the state has led an effort to make naloxone, or Narcan, available without a prescription at approved pharmacies.

Also, New York has trained thousands of first responders and community members to recognize and respond to overdoses with Narcan.

As a result, Cuomo said, more than 3,500 overdose reversals have been documented, with over 1,500 lives saved in 2015.