Proponents of the Controlled Substances Act like to characterize fentanyl analogs as more potent and thus more deadly than fentanyl—if you want to keep the public afraid of drugs, each new one has to be scarier than whatever came before. But for the most part fentanyl analogs are sometimes a bit more potent than fentanyl and sometimes a bit less, which is a boring explanation with no shock value. For that you’d want to focus on the highest-potency analog identified so far, which is why everyone likes talking about carfentanil.
On December 5, researchers with the Centers for Disease Control and Prevention published an analysis of overdose mortality data between 2021 and 2024.
“Carfentanil, a fentanyl analog 100 times more potent than fentanyl, has reemerged in the US drug supply,” the authors wrote. “[R]ecent sharp increases in overdose deaths with carfentanil detected, although rare, highlight the ever-changing illegal drug supply and threaten progress in reducing overdose deaths.”
Carfentanil was detected in 513 overdose deaths in the United States since 2021, with a sharper increase that’s more recent. The data show that in the first half of 2023, there were 29 overdose deaths involving carfentanil. In the first half of 2024, there were 238. Between January 2023 and June 2024, 37 states reported at least one overdose death where carfentanil was detected.
One of the most important things to know when reading any coverage of overdose mortality data is that a substance “-involved” or “-related” to a death did not necessarily cause the death, or even contribute to it. Often those terms just mean that a post-mortem toxicology screen detected that substance in the person’s system, but this distinction is rarely intact by the time the information gets packaged into a headline.
Urgent CDC warning as new drug carfentanil 100 times more deadly than fentanyl kills hundreds in 37 states https://t.co/N5GBUNmkT7 pic.twitter.com/W7TTd5MNWr
— Daily Mail Online (@MailOnline) December 5, 2024
Carfentanil has been identified in the drug supply off and on since 2016, but mostly off. Over the course of 2024 several states have reported identifying it, both through autopsy reports and public health drug-checking.
Because of its potency, it’s easier to imply that even trace amounts are fatal, and that its presence in the supply will represent exponentially more deaths. Drug-checking experts told Filter that carfentanil’s potency doesn’t automatically mean that any amount is fatal. The does seem to be an uptick in detection but not really in a way that’s more notable than any other feature of the changing supply. It’s also important to remember that drug-checking results will always skew toward the drugs that people are trying to find.
In 2023, overdose deaths began to drop for the first time since 2018. The CDC authors note that we seem to still be on that trajectory in 2024.
“However, recent reemergence of carfentanil,” they wrote, “might threaten this progress.”
Except there’s no evidence of that. The data show that the number of overdose deaths involving carfentanil is increasing, compared to recent years. That is not the same thing as carfentanil increasing the number of overdose deaths—which it isn’t. If it were, the number of overdose deaths would be going up, not down.
The more specific drug war agenda carfentanil serves is pushing standard-dose naloxone out of the picture.
The fixation with carfentanil serves the broader drug-war agenda of justifying more funding and harsher enforcement by telling the public that whatever drug is out there right now is a bigger threat than they’ve ever faced before. The DEA has been seeding the concept more recently, too, telling reporters that “we’re seeing a little bit of a national trend … but we can’t get into specifics about where it happened, specifically when it happened.”
But the more specific drug-war agenda carfentanil serves is pushing out the overdose antidote that works—standard-dose naloxone—in favor of higher doses, longer-acting formulations or other opioid antagonists that are not naloxone.
“[G]iven carfentanil’s high potency,” the CDC report states, “more doses of naloxone and faster overdose response might be required to prevent death.” The study it cites debunks the myth that higher-potency opioids require higher doses of naloxone—but claims that carfentanil is so high-potency that it’s the exception. It’s not.
The reason that naloxone is effective regardless of opioid potency is that it doesn’t act on the opioids themselves, just the receptors they sit on. No opioid is potent enough to change that.
Image via Maryland Department of Health
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