Wednesday, November 2, 2016

Carfentanil: 5 important facts for Doctors - Update

Carfentanil is marketed under the brand name Wildnil. For years, the drug rested on the shelves of zoologists and veterinarians specializing in large animals. It's a uniquely powerful sedative. There is and never has been any human use for carfentanil.

Carfentanil is being created in clandestine laboratories in China, which has no controls on the drug. Several months ago the Associated Press found a dozen Chinese businesses that said they would export carfentanil for as little as $2,750 per kilogram. One kilogram is sufficient for 50 million doses. The U.S. Department of Defense identified it years ago as a potential weapon in the hands of enemy nations.
In Akron, Ohio, medical examiner Dr. Lisa Kohler has seen over 50 people die from carfentanil since July. Most US emergency doctors had never heard of carfentanil before it showed up in Ohio. It is 10,000 times more potent than morphine, and a grain of it, 20 micrograms, can kill a human. It was aerosolized by Russian special forces in 2002 when Chechen rebels took hostages in a Moscow theater, where it killed over 100 hostages along with the terrorists.

Police in Canada will begin carrying naloxone, not to aid overdose victims, but for officers that come in contact with it. Public health teams across North America are distributing naloxone kits. But there’s one problem; carfentanil is so toxic, naloxone might not work. Police Lieutenant Rick Edwards says his officers are “giving 4–8 doses of naloxone just to get a response.”
1) Fentanyl and carfentanil are being cut into powder cocaine — a drug used by individuals who don’t fit the usual mold of a typical addict.

2) Some first responders are reporting the need to use 10–16 milligrams of naloxone. A typical heroin overdose dosage is 2 milligrams.

3) Doctors can't wait for naloxone to work. In the past people who overdosed on heroin would wake up after a dose of naloxone within minutes. Now those minutes could mean death if Carfentanil is involved. Ventilations are required, and possibly chest compressions as well.

4) Carfentanil causes cardiovascular collapse, (failure of circulation) in addition to hypoventilation (breathing at an abnormally slow rate) and hypoxia, (deficiency in the amount of oxygen reaching tissues) necessitating advanced life support.

5) Residue is dangerous. Personal protective equipment is required around drug paraphernalia.

Russian soldiers carry hostages from the Dubrovka theatre, October 2002
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