Drug cartels turn to a synthetic opioid 100 times stronger than fentanyl, 'killing hundreds of unsuspecting drug users'

The chemical makeup of carfentanil. The drug is legally used to  
anesthetize large animals such as elephants and rhinoceroses. 

Carfentanil is a deadly "weapons-grade" synthetic opioid that illicit drug makers are adding to other drugs as a potent substitute for fentanyl. The drug, which authorities say is "10,000 times more potent than morphine and 100 times stronger than fentanyl, has seen a drastic resurgence across the U.S., killing hundreds of unsuspecting drug users," report Hallie Golden and Jim Mustian of The Associated Press.

Carfentanil's presence in illegal drugs sold in the U.S. has surged since the Chinese government's more recent "crackdown on the sale of precursors used to make fentanyl," AP reports. "Those regulations are likely prompting traffickers in Mexico to use carfentanil to boost the potency of a weakened version of fentanyl."

The sheer potency of carfentanil is what makes it so dangerous for anyone who takes drugs not prescribed by their doctor. Frank Tarentino, the U.S. Drug Enforcement Administration chief of operations for its northeast region, which stretches from Maine to Virginia, told AP, "You’re talking about not even a grain of salt that could be potentially lethal. This presents an extremely frightening proposition."

While some Mexican drug cartels may be making carfentanil in their own labs, others are purchasing it from darknet marketplaces. Regardless of where it originates, it's making its way onto American streets. Golden and Mustian write, "In 2025, DEA labs identified carfentanil 1,400 times in U.S. drug seizures, compared with 145 in 2023 and only 54 in 2022."

Russia used an aerosol form of carfentanil as a chemical weapon to subdue Chechen separatists in 2002, AP reports. It is legally used to anesthetize large animals, such as elephants.

Michael King Jr., founder of the Opioid Awareness Foundation, told AP, “It’s like a biological weapon. If the world thinks we had a problem with fentanyl, that’s minute compared to what we’re going to be dealing with with carfentanil.”

Syringe exchange programs meant to slow HIV's alarming spread in West Virginia limited by political resistance

Photo by R. Konkathi, Unsplash

Despite federal recommendations and community efforts to stem HIV infections among opioid or methamphetamine users in central Appalachia, the disease continues to spread. Harm-reduction advocates and medical providers cite resistance to syringe exchange programs as the primary obstacle, reports Taylor Sisk of KFF Health News. "The situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use."

In 2021, West Virginia's HIV outbreak was particularly concerning to officials from the Centers for Disease Control and Prevention. Sisk writes, "The CDC’s HIV intervention chief called it 'the most concerning HIV outbreak in the United States and warned that the number of reported diagnoses could be just 'the tip of the iceberg.'" 

Rural areas without substance disorder treatment or disease education present a ripe breeding ground where HIV can spread undetected. Ryan White HIV/AIDS Program Director Christine Teague "is concerned for West Virginia’s rural counties, most of which don’t have a syringe service program," Sisk adds. "Tasha Withrow, a harm reduction advocate in rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that with little testing and heightened stigma in a rural community, it’s difficult to know."

Robin Pollini, a West Virginia University epidemiologist who conducts community-based research on injection drug use, told Sisk, “You would think that in a state that had the worst HIV outbreak in the country, we would have a statewide testing strategy." Sisk reports, "Teague would like every rural county to have a mobile unit. . . offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more."

While disease prevention through syringe exchange programs is well documented, the CDC's health warnings and recommendations for improved access to syringe exchanges have been largely ignored. Sisk reports, "In April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID."

Opioid settlement payments to state and local governments can now be tracked with this online tool

KFF Health News tool, from BrownGreer data

Beginning in 2022, state and local governments started receiving opioid settlement funds from companies that made, sold or distributed prescription opioids. Tracking the flow of opioid money into communities can now be done using a new online database from KFF Health News, report Aneri Pattani, Lydia Zuraw and Holly K. Hacker. "Determining how much money has arrived is the first step in assessing whether the settlements will make a dent in the nation’s addiction crisis."

The database reflects only the largest settlement so far, $26 billion to be paid by pharmaceutical distributors AmerisourceBergen (now called Cencora), Cardinal Health and McKesson, as well as opioid manufacturer Janssen (now known as Johnson & Johnson Innovative Medicine). The $26 billion will be paid over two decades, KFF News reports. "As of late February 2024, more than $4.3 billion had landed in government coffers."

This first piece does not include settlements with other drug manufacturers and retailers, such as Walmart, Walgreens and CVS. Data from these companies will be added in July, according to BrownGreer, the settlement firm that gets the money and makes the payments. It is not handling some additional settlements, such as the agreement between Kentucky and four Midwestern states with regional supermarket chain Meijer.

Other settlements, including with OxyContin manufacturer Purdue Pharma, are pending.

California prosecutors charge fentanyl suppliers with murder. The legally unsettled approach is catching on.

Prosecutors in California are forging a path to make fentanyl dealers accountable for their part in overdose deaths by filing homicide charges against them. In Riverside County, California, county district attorney Mike Hestrin "has charged 34 suspected fentanyl suppliers with murder and is said to be the first prosecutor in California to achieve a guilty verdict from a jury in a fentanyl-related homicide trial," reports Michael Corkery of The New York Times. Some critics fault the prosecution of street dealers "as a misguided return to the aggressive approaches of the 1990s, which failed to curb drug use and swelled state prison populations."

But even in boldly liberal parts of the state, murder investigations of fentanyl overdoses are being used to discourage fentanyl sales and provide some level of justice for families. Corkery writes, "Some other counties — like San Diego and Placer, near Sacramento — that have also brought murder charges against fentanyl suppliers have sizable numbers of conservative-minded voters who tend to favor more punitive approaches to crime." Even in San Francisco, the district attorney's office is planning to prosecute fentanyl dealers for overdose deaths.

While prosecutors pursue murder charges against fentanyl dealers, their cases are on murky legal ground. "Prosecutors have been working around the fact that California does not have a law that specifically allows fentanyl deaths to be charged as murders," Corkery explains. 

Defense attorneys have responded to the prosecutions as "overbroad and unconstitutional," Corkery reports. But their complaints are being drowned out. "Parents whose children died from fentanyl are a driving force behind new laws and stepped-up prosecutions just as the parents of drunken-driving victims swayed the nation to crack down on alcohol-fueled traffic deaths decades ago."

To read more on how California prosecutors are using the Watson murder rule to prosecute fentanyl suppliers, click here. 

Drug Enforcement Administration statistics draw a startling picture of fentanyl's lethal power: It is the leading cause of death for Americans ages 18 to 45, and it's responsible for nearly 70 percent of the United States' 107,000+ drug overdose deaths in the past year. A educational warning video is shared below.

Overdose-prevention programs in remote Maine work to stem drug-related problems and deaths

Naloxone is part of harm-reduction strategies.
(Photo by NEXT Distro, Unsplash)

Access to drug overdose prevention and addiction treatment in rural America can be almost non-existent. In Washington County, Maine, a remote area ravaged by drug use and overdose deaths, there was little help for substance-related issues. But a non-profit with federal dollars from the Substance Abuse and Mental Health Services Administration is working to change the county's number of drug-related medical problems and deaths, reports Taylor Sisk of The Daily Yonder. "In 2022, SAMSA awarded $30 million to 25 grantees to support community-based overdose-prevention programs, syringe services programs, and other harm reduction services. . . .MaineHealth received $1.2 million for a statewide overdose- and infection-prevention initiative."

Washington County, ME
(Wikipedia map)

Because Maine is small -- California is five times its size -- fewer people may know the extent of the state's drug problems. "Maine is the most rural state in the country with one of the highest drug-overdose rates. . . . It has one of the highest rates of acute hepatitis B. And it has the highest rate of hepatitis C, largely attributed to injection drug use," Sisk writes. "Washington County is the nation's easternmost county – the last stop on the line. It has a Walmart in Calais, the county's largest town, pop. 3,032. But if you live in Machias, the second largest town, pop. 2,062, it's an hour's drive. You're more likely to rely on the Family Dollar for your essentials. There's no bus service and one taxi company. . . . It has the highest poverty rate in the state."

In 2022, MaineHealth "launched Project DHARMA – Distribution of Harm Reduction Access in Rural Maine Areas – a collaboration with community-based organizations, including syringe services programs. Washington County became a beneficiary," Sisk reports. Harm reduction care "embraces a set of evidence-based strategies for reducing the negative consequences of drug use to keep people alive and as healthy as possible until such time as they should be ready to seek treatment."

Kinna Thakarar is an infectious disease and addiction medicine physician for MaineHealth and Project DHARMA's lead researcher. She told Sisk, "The services Project DHARMA is funding are evidence-based. Among the supplies and services syringe services programs typically provide in addition to clean syringes are saline, Band-Aids, condoms, information, and referrals. . . . They provide naloxone, a medication that quickly reverses the effects of an opioid overdose, and offer fentanyl test strips, an increasingly urgent need."

"Another critical service this grant will fund is one advocates have fought hard to launch: drug testing using handheld spectrometers. Outreach workers will test drugs to determine their contents; the drugs will then be sent to Colby College for confirmation. Other academic partners are providing technical assistance," Sisk writes. "But gaining permission to do so wasn’t easy. It required passing legislation 'so that none of us would get arrested in doing this evidence-based public health work,' Thakarar said. The passage of L.D. 1745, signed into law this summer, allows select individuals to possess 'nominal amounts' of illicit or controlled substances for the purposes of drug testing."