The opioid crisis in the United States garnered more attention recently when a string of heroin overdoses and deaths occurred in Cincinnati. During the span of a single week the city experienced 174 overdoses, an 870 percent increase from the typical 20 overdoses a week. The reason for the spike in overdoses is the presence of carfentanil, a new drug found in heroin being sold in the Midwest and the Appalachians. Nationwide, overdoses from heroin and prescription painkillers result in the deaths of over 28,000 people per year, or approximately 75 people per day.
Carfentanil is a synthetic opioid analgesic and an analogue of fentanyl, a more commonly abused drug. Carfentanil is used in veterinary medicine as an anaesthetic for large animals, such as elephants. The drug is approximately 100,000 times stronger than morphine and 100 times stronger than fentanyl, which is the strongest opioid compound approved for humans. According to the DEA, ingesting a few granules of carfentanil is all it takes to kill someone, and a mere two milligrams is enough to knock out a 2,000 pound elephant. Carfentanil is usually found in the form of a white powder, but officers in Hamilton County have also found samples of pink carfentanil.
According to the DEA, the increasing presence of synthetic compounds like carfentanil and fentanyl in street heroin is related to the general increase in heroin production in Mexico and Columbia. Law enforcement officials in Hamilton County have stated that carfentanil is probably being manufactured in China and transported to South America or Mexico, where it is then smuggled into the United States. The DEA has also stated that there are several companies in China that sell carfentanil online. In June 2016, a kilo of carfentanil was seized in a package from China en route to Calgary by Canadian border officials. The package of carfentanil was marked “printer accessories.”
Individuals who are addicted to prescription painkillers are 40 times more likely than the average person to also be addicted to heroin.
Illicit drug manufacturers may be opting to produce synthetic drugs over natural drugs because synthetic drugs can be produced in a laboratory, whereas natural drugs such as heroin are produced from opium poppies. The U.S. has been experiencing an opioid epidemic for approximately ten years, but the presence of fentanyl and carfentanil in street heroin is a recent phenomenon. Since 1999, overdose deaths in the United States due to opioids have quadrupled. The increase in demand for prescription painkillers such as Vicodin and OxyContin has contributed to an increase in demand for heroin and other similar illicit drugs. From 2002 to 2013, the percentage of heroin-related overdose deaths increased by 286 percent. Similarly, the rate of heroin use among females has risen 100 percent, compared to an increase of 50 percent among males. According to the CDC, individuals who are addicted to prescription painkillers are 40 times more likely than the average person to also be addicted to heroin.
Law enforcement personnel have been encouraged by the DEA to alter how they normally handle drug samples at crime scenes because of the high potency of drugs like fentanyl and carfentanil. Officers are strongly discouraged from performing a field test of suspect drugs because disturbing powdered substances, such as heroin or cocaine that contains one of these powerful synthetic additives, could result in an officer overdosing or dying from the exposure when it is knocked into the air. Instead of performing field tests, officers are encouraged to send all samples to a laboratory. If the officer absolutely must test the substance, the DEA encourages them to wear gloves, use a dust mask, air purifying respirator, or self-contained breathing apparatus to prevent exposure.
The American Association of Zoo Veterinarians told the Associated Press that veterinarians typically wear protective gear, such as a face shield and gloves, before they administer the drug to animals. It is common for veterinarians to shoot darts of carfentanil at large animals.
37 states have passed overdose Good Samaritan laws, providing statutory immunity for possession of a controlled substance in the case of an overdose.
In August 2015, two law enforcement officers in New Jersey were taking samples for a field test of what was revealed to be a mixture of heroin, cocaine, and fentanyl when they were accidentally exposed. In cases of accidental exposure, officers can be administered Naloxone, an overdose-reversing drug, which prevents an accidental overdose by being administered intravenously, intramuscularly, or subcutaneously. Naloxone reverses the effects of an opioid overdose within two to five minutes of administration. However, law enforcement in the Cincinnati area of Hamilton County, have doubled the normal dosage of naloxone that they administer to reverse overdoses. The addition of carfentanil to heroin has required substantially more of the anti-overdose drug to be effective.
The availability of naloxone has been the source of extensive law-making in recent years. In June of 2016, North Carolina became the third state in the country to pass a bill authorizing a “standing prescription order statewide for naloxone.” NC Senate Bill 734 makes naloxone available without a prescription for those at risk of experiencing an overdose and also to friends or family members of individuals who are at risk. In 2013 North Carolina enacted Senate Bill 20, the overdose Good Samaritan Law, which allowed first responders in NC to carry and administer naloxone. Additionally, Tennessee passed a similar standing order law in September 2016 to allow pharmacists to dispense naloxone to the general public without a prescription. Lawmakers have found standing-order statutes necessary because of the extent of the crisis and because naloxone, the drug used to reverse an opioid overdose, is not a controlled substance and does not have a potential for abuse.
A variety of legal interventions have taken place across the nation to reduce the number of deaths due to overdose and to improve access to life-saving anti-overdose drugs. Statutes to limit liability for prescribers, dispensers, and lay administrators of drugs such as naloxone have been enacted in some form in most states. 43 states in the U.S. permit third parties, like friends or family members, to receive a prescription from a doctor for naloxone so the friend or family member can administer the drug to an opioid user during an overdose. Additionally, 37 states have passed overdose Good Samaritan laws, providing statutory immunity for possession of a controlled substance in the case of an overdose. The rationale behind providing liability for possession of a controlled substance is so that bystanders to an overdose can call for help without fear of criminal, civil, or administrative consequences for possession of illicit drugs. However, the development of statutory provisions to deal with the opioid crisis has been incremental. Not every state with laws providing access to naloxone has a contributing Good Samaritan statute.
Large quantities of opioids can result in respiratory depression and death.
In most cases, for immunity to apply, the caller must have a reasonable belief that someone is experiencing an overdose emergency and is reporting that belief in good faith. As of 2016, 47 states and the District of Columbia have enacted laws to provide immunity to medical professionals that proscribe or dispense naloxone and to others who administer naloxone.
According to the CDC, the availability of naloxone is essential to saving lives because, for every overdose death in the U.S., the same person will overdose nine times. For each overdose the drug naloxone plays a significant, if not essential, role in saving an individual’s life. However, for substances like carfentanil and fentanyl, higher doses of naloxone are necessary, and naloxone isn’t always a perfect fix. For some users experiencing an overdose, additional medical interventions like intubation or ventilation support are necessary. Opioids control areas of the brain that regulate respiration, and large quantities of opioids can result in respiratory depression and death. Even with access to naloxone, it is essential for individuals who may be experiencing an overdose to receive medical aid. Signs of an opioid overdose include: reduced pupils, unconsciousness, and respiratory depression.