The use of Narcan in our communities is becoming more common as the opioid crisis grows.
In April, 2018, the U.S. Surgeon General Jerome M. Adams, MD, released a statement in which he encouraged the drug to be distributed within our communities. According to the Centers for Disease Control and Prevention (CDC), more than 191 million opioid prescriptions were dispensed in 2017 in the U.S., when 47,000-plus people died of opioid overdoses. In this post, we explore the opioid crisis by looking into the various types of opioids available, such as carfentanil vs fentanyl, their varying effects, and the myths surrounding fentanyl.
How did the opioid crisis get this bad?
The issue started in the late 1990s when pharmaceutical companies claimed it was not possible to become addicted to prescription opioid medications.
This information led to the use and misuse of the medications before we realized that these medications prove extremely addictive. Should physicians have known the information provided by pharmaceutical companies was untrue? Probably.
Are the pharmaceutical companies solely to blame? No. The increase in fatal overdoses and the crisis-level spread of opioids is specific to the rise of illegally produced fentanyl and other highly potent synthetic opioids such as carfentanil and acrylfentanyl.
Federal legislation and initiatives
To combat the situation, Congress passed the Comprehension Addiction and Recovery Act (CARA) in 2016.
CARA is the most expensive federal legislation to date regarding addiction support, dedicating $80 million to advancing and improving access to treatment and recovery services in the U.S. The legislation also established a three-day limit on the initial prescription of opioids when used for acute pain.
The U.S. Department of Health & Human Services (HHS) said CARA’s five priorities are:
- Improved access to treatment and recovery.
- Promoting the use of opiate-reversing medications.
- Obtaining a better understanding of the problem through public health surveillance.
- Providing research on pain and addiction.
- Promoting better practices in pain treatments.
The National Institutes of Health (NIH) is the U.S.’s leading medical research agency and is committed to finding better ways to prevent misuse, treat opioid disorders and manage patients’ pain. This includes safe and effective non-addictive strategies to manage pain, developing new medications and technologies to treat opioid use disorders, and improved overdose prevention and reversal interventions.
Carfentanil vs Fentanyl vs Acrylfentanyl
The drug was created in Belgium during the 1950s and introduced into medical practice in the 1960s. The Drug Enforcement Agency (DEA) classifies fentanyl as a schedule II synthetic opioid analgesic that is 50 to 100 times more powerful than morphine and is used to treat severe pain post-surgery and chronic pain when the patient has a tolerance to other opioid medications.
Carfentanil, or Narcan-Resistant Fentanyl
While fentanyl is a dangerous drug, a couple more powerful versions have emerged within our communities. In fact, when it comes to carfentanil vs fentanyl, the former is 100 times more potent than the latter and 10,000 times more potent than morphine. Historically veterinarians have used it to sedate large animals, such as elephants. Doses as small as a few grains of salt have proven fatal. Indeed, carfentanil is illegal in most countries.
Acrylfentanyl has no known medical purpose and is believed to be synthesized in China, Canada and Mexico and then smuggled into the U.S.
Researchers have found acrylfentanyl is extremely resistant to Narcan, commonly taking multiple doses to illicit a patient response. Depending on the dose a patient has taken, clinicians may not see any improvement in that patient’s condition. On June 2, 2017, the DEA added Acrylfentanyl to the Schedule I list of dangerous drugs.
Fentanyl myths and hysteria
We have all heard about the anecdotal cases from law enforcement and some prehospital providers that you can overdose when encountering powdered fentanyl or one of the other derivatives. This is completely false. How do we know this is a fentanyl myth?
Christopher Moraff, a journalist and independent researcher, has been gathering heroin and cocaine samples in Philadelphia twice a week since 2017. Moraff says 80% of the samples he collects test positive for the presence of fentanyl. He also noted he never wears personal protective equipment (PPE) when gathering the samples.
What about aerosolized fentanyl? Accidental inhalation is more plausible because fentanyl can enter through the mucous membranes of the mouth and nose. However, fentanyl is extremely difficult to aerosolize, and The New York Times reported that, according to toxicologists, a person would need to spend two hours breathing in an environment to achieve a medical dose in the bloodstream.
Realistically, how many of us are going to be spending longer than a few minutes in this type of environment? Massachusetts has banned all courtroom exhibits that contain fentanyl out of fear that the samples will spontaneously become airborne and cause everyone in the courtroom to overdose.
Do the people who illegally traffic these drugs put on PPE when handling and transporting them? No. I am pretty sure that would be a big red flag when trying to cross a border at any port of entry or when driving past a law enforcement officer.
So, when you’re in the field be safe, wear gloves and don’t give into the hysteria caused by the fentanyl myths out there.