Heroin Is Being Laced With a Terrifying New Substance: What to Know About Carfentanil

A drug so powerful that it’s used to sedate elephants is finding a new, illicit use laced into heroin, potentially contributing to hundreds of overdoses in the last several weeks.

The drug, called Carfentanil, is a synthetic opioid so strong that just a few granules the size of grains of table salt can be lethal. Since mid-August, roughly 300 people in at least four states have overdosed on heroin linked to Carfentanil and the less powerful compound fentanyl.

One of the hardest-hit spots was Hamilton County, home to Cincinnati, where on a single day in late August there were 48 heroin overdoses and two deaths. From Aug. 15 to Sept. 4, the Drug Enforcement Administration has recorded 208 overdoses, and local officials say at least eight deaths in the Cincinnati area have been linked to Carfentanil.

“The last 10 days have been unprecedented,” says Dennis Deters, a Hamilton County commissioner and chairman of the county’s heroin coalition.

Cuyahoga County, which includes Cleveland, saw 52 overdose deaths in August with at least two from Carfentanil, the most fatalities related to heroin and fentanyl the county has ever seen. In Akron, authorities have reported more than 100 overdoses this year and 24 on last Friday alone. And officials in Indiana, West Virginia and Kentucky have seen similar overdose spikes in the last month. The problem was highlighted in a graphic photo released by police in East Liverpool, Ohio, of an overdosed couple unresponsive in their car while a 4-year-old boy sat in the back.

The outbreak across the Midwest and the Appalachian region has raised a number of questions about the troubling synthetic, how it has made its way into the U.S., and what’s being done to stop it.

What is Carfentanil?

Carfentanil is an incredibly powerful synthetic opioid normally used as a sedative for animals like elephants. It’s in the same drug class as other opioids such as heroin, fentanyl, and prescription drugs like Oxycodone but has been showing up mixed in with doses of heroin in Ohio, West Virginia, Indiana, Kentucky and Florida, creating a more potent and potentially deadly high for users.

How powerful is it?

The DEA says it’s 100 times deadlier than fentanyl, which itself is 30 to 50 times more lethal than heroin. DEA spokesperson Russ Baer says it only takes a few ingested granules to kill someone. Officers and health officials have had to take extra precautions to protect themselves from accidentally ingesting the substance when responding to overdose victims over fears that they could overdose themselves.

Why is it showing up in heroin?

“You don’t have to worry about growing poppy fields and converting the poppy resin into morphine and into heroin,” Baer says. Carfentanil, on the other hand, can be manufactured inexpensively in a lab and cut into heroin, making it more potent and addictive.

How many people is it affecting?

Hamilton County, which appears to be the epicenter of the latest outbreak, saw 200 overdoses in one week in August. In Jennings County in Indiana, more than a dozen were treated for heroin overdoses in late August. Police in Huntington, W. Va., say they responded to 26 overdoses within four hours on Aug. 15. In Louisville, 24 people experienced overdoses in a single day. Overall the DEA estimates there have been about 300 fentanyl-related overdoses in the last few weeks in Ohio, West Virginia, Kentucky and Indiana.

Where is it coming from?

Probably China by way of South America or Mexico. Tom Synan, police chief of the Newtown Police Department and director of the Hamilton County Heroin Coalition, says evidence points to Carfentanil likely being manufactured in China, ordered online, and shipped to drug traffickers in Mexico or South America. Mexican labs, he says, could also be manufacturing it.

“We’re talking about clandestinely manufactured,” Baer says. “Somebody’s making this stuff in secret laboratories.”

Why is this happening now?

Prescription pain addiction has been a problem in economically depressed areas across the Rust Belt and Appalachian states for at least a decade. Over the last several years, so-called “pill mills”—doctors who readily offered painkillers to drug addicts—have been shuttered, especially in Ohio. But addiction remained, forcing people to the black market to obtain heroin, which produces a similar high to that of pain pills like Oxycodone or Oxycontin.

In the last year, health officials have seen a shift away from organic drugs to fentanyl-related synthetics that are more addictive and more powerful. Carfentanil, meanwhile, has shown up on the streets just within the last few months. Local officials say Carfentanil appeared in the Akron and Columbus areas in July.

“We expected it to head our way,” says Synan, the Newtown police chief. “We know when one place spikes, there’s a potential it’ll spike in other places. That put us on high alert.”

Read more: Heroin Use in U.S. Reaches Epidemic Levels

DEA officials say they’ve also seen an increase in heroin production from Mexico and countries in South America like Colombia.“They’re exploiting America’s addiction and flooding the market,” Baer says.

How are officials responding?

In Hamilton County, police officers have doubled the dosage of Naloxone, a medication that reverses the effects of an opioid overdose, from 2 mg to 4 mg. Synan of the Newtown Police Department says his officers are stepping up efforts to locate dealers while working with prosecutors to charge drug offenders to the fullest extent of the law. Meanwhile, local officials are trying to get those who have overdosed into treatment.

“We can’t just say it’s a crime and lock them up,” Deters says. “You have to engage hospitals and addiction treatment centers and try to get people out of this cycle.”

But that will likely be extraordinarily difficult for local officials, who say they’ve never seen anything like the latest outbreak. “It’s so widespread and so abundant right now with so many users,” Synan says. “There has been nothing like this.”