100 times more potent than fentanyl

Erie County, NY – The Erie County Medical Examiner’s Office has confirmed the first Erie County opioid-related overdose death linked to carfentanil, a synthetic opioid that is about 10,000 times more potent than morphine and 100 times more potent than fentanyl. The death occurred in September, and toxicology tests for that case confirmed the presence of multiple substances, including carfentanil, cocaine, fentanyl and other fentanyl analogs.

“Carfentanil’s effects hit faster and last longer than fentanyl. The discovery of this toxic and incredibly dangerous drug signals another phase in the opioid epidemic,” said Commissioner of Health Dr. Gale Burstein. “Now that we know that carfentanil has made its way into the local illicit drug supply, we need to reinforce the risks for people who use any illicit drugs, including drugs not marketed as opioids, such as cocaine, and emphasize the support, resources and harm reduction tactics available for people to avoid injury and death.”

Although carfentanil does have some limited clinical uses, veterinarians generally use it to anesthetize large animals like elephants for surgery or medical treatment. Carfentanil that is diverted, stolen or manufactured overseas is added to cocaine, methamphetamine, heroin and other illicit drugs as a cheap, easy to obtain filler substance.

“Our Medical Examiner’s Office investigated 371 confirmed or suspected opioid-related overdose deaths in 2023, with another month left this year. That is already 20% higher than the total in 2022, which was our highest total ever and the year is not over yet,” Dr. Burstein explained. “Given the volume of opioid-related overdose deaths in 2023, it is possible that toxicology testing will confirm carfentanil in other cases.”

Narcan (naloxone) will work to reverse the effects of carfentanil exposure. However, because of its extreme potency, higher doses or more doses of naloxone may be required to get a person breathing again.

Fentanyl test strips are available for people who use drugs to test for the presence of fentanyl. No test is 100% accurate. Fentanyl test strips do not indicate which type of fentanyl or fentanyl-analog, like carfentanil, is present, nor do they indicate the concentration or potency. People who use any drugs, especially people who use cocaine, should expect that their drugs contain opioids that could cause an overdose – now possibly including carfentanil – stop them from breathing, and lead to death. Cocaine contaminated with fentanyl has contributed to about 75% – three out of four – opioid-related overdose deaths in 2023.

The Erie County Department of Health (ECDOH) offers harm reduction supplies and peer support – call (716) 858-7695. Other ways to reduce the risk of harm from drug use:

  • Carry Narcan, and know how and when to use it. Text (716) 225-5473 to have Narcan and fentanyl test strips mailed to you for free.
  • Never use alone. Have Narcan and a friend with you who is not using drugs, or contact a service like Never Use Alone (neverusealone.com)
  • Test your drugs for fentanyl even if you think it is cocaine or another substance that is not an opioid. Free test strips available from the Erie County Department of Health. Call (716) 858-7695.
  • Seek support. ECDOH has peer navigators and a family coordinator; call (716) 858-7695. The Buffalo & Erie County Addictions Hotline is available 24/7 with referrals for individuals and their families. Call (716) 831-7007.
  • Seek treatment. Local hospital emergency departments can connect patients to immediate medication assisted treatment. Ask for MATTERS Network.