Page 124 - Journal of Special Operations Medicine - Fall 2017

An Ongoing Series

Carfentanil

A New and Often Unrecognized Threat

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Charles E. Cowles Jr, MD, MBA *; Jason Mitchell, EMT-P ; Joe E. Stepp ; Victor Z. Bewley 4
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ABSTRACT
Law enforcement officers, whether working the streets or on purchased in China with little or no oversight or tracking. In
narcotic detail, and even those who operate in strike teams, response to the recent uptick in lethal overdoses, China added
face a new danger from an old drug: carfentanil. Drug dealers carfentanil to its regulated drug list of the National Narcotics
seeking to increase profits cut this cheap synthetic drug into Control Commission, but large quantities have been sold over
expensive heroin, providing an extreme high. As a potent syn- the past 3 years by 16 major companies and will still be in
thetic opioid narcotic, it is finding its way to the streets of the circulation for a long time.
United States and can pose a threat to life for law enforcement,
first responders, and medical examiners. Like other opioid narcotics, carfentanil binds to the μ recep-
tors, which are located in the central nervous system. Expected
Keywords: carfentanil; law enforcement; narcotics effects of the drug include pupil constriction, loss of cough
and gag reflexes, and respiratory depression, leading to death.
Although most commonly encountered in the powder form re-
sembling cocaine or heroin, carfentanil can also be in the form
Introduction
of tablets, spray, or blotter paper. Routes of drug administra-
First manufactured in 1974 by Janssen Pharmaceutica, carfen- tion include injection, ingestion, inhalation, and transdermal
tanil is a drug used for pain control in and sedation of very absorption. If exposed to a quantity of carfentanil the size of
large animals such as elephants and polar bears. Carfentanil Abraham Lincoln’s eye on a penny, the effects could be lethal.
is marketed under the trade name Wildnil. Carfentanil has To render another perspective, 1kg of carfentanil can be pur-
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10,000 times the strength of morphine and is 100 times as chased overseas for just under $3000 and could cause fatal
potent as the synthetic narcotic fentanyl. Carfentanil’s thera- overdoses in 50 million humans. 3
peutic index is 10,600. 2
Law enforcement agencies in the Southeast Houston, Pasa-
Carfentanil is a Schedule II substance under the U.S. Con- dena, Texas, area have linked drugs confiscated locally to
trolled Substance Act and is available only to those listed on Mexican drug laboratories that receive the precursors to these
a U.S. Drug Enforcement Agency (DEA) approval roster. In drugs in wholesale quantities from China. Each of these drug
other countries, however, this drug can be purchased without laboratories has a “signature cut” of cocaine and heroin, which
regulatory controls. Until 1 March 2017, carfentanil could be frequently contain fentanyl or fentanyl derivatives. From the

*Correspondence to cowlesmd@gmail.com
1 Dr Cowles Jr is an associate professor and assistant clinical director for the Department of Anesthesiology and Perioperative Medicine at the
University of Texas MD Anderson Cancer Center, Houston, Texas. Dr Cowles has been a National Registered Paramedic for the past 26 years
and has over 30 years of prehospital medical experience, including many years as a paramedic for the Beaumont, Texas, Fire Department. In
addition to practicing as a board-certified anesthesiologist, he volunteers as the tactical medical director for the Pasadena, Texas, Police De-
partment and is involved with physician disaster response efforts. Mr Mitchell is regional counterterrorism intelligence police officer for the
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Regional Intelligence Center and has been with the Pasadena, Texas, Police Department for 16 years. He has been licensed by the State of Texas
as a paramedic for 19 years and is a former hazardous materials technician. He has an extensive background in patrol operations, SWAT tactics,
and tactical medicine, serving in Patrol, SWAT, SERT, and Narcotic, and as an adjunct instructor for the Pasadena Police Academy. He has also
served as the health and safety point of contact for all medical-, bloodborne pathogen–, and bioterrorism-related issues for the department. LTC
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(Ret) Stepp has an extensive background in counterterrorism (CT) operations and intelligence. He has several years of experience in Iraq and
Afghanistan during Operation Iraqi Freedom and Operation Enduring Freedom. He is responsible for the day-to-day CT operations of the Re-
gional (Satellite) Intelligence Center located within the Pasadena Police Department and is the Regional CT Intelligence Coordinator. Sgt Bewley
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is a police officer with the Pasadena, Texas, Police Department and is currently a Sergeant over the SWAT team and the Gang Intelligence Unit.
Sgt Bewley has been a police officer for over 18 years and rose through the ranks from the position of a civilian Police Service Officer, where he
served for 3 years as a dispatcher and jailer, to his current supervisory positions; all with the Pasadena, Texas, Police Department. Sgt Bewley
began his SWAT career in 2004 as a Tactical Medic and was promoted to the team’s tactical supervisor in 2012. Sgt. Bewley’s primary duty is
as the supervisor over the Gang Intelligence Unit, which supports other units within the Pasadena Police Department with intelligence gathering
and tactical services as they relate to an organized crime and gang nexus.
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