Paul Davis: ‘Gray Death’ — Carfentanil, fentanyl’s more deadly cousin
Carfentanil, a deadly synthetic opioid drug, is not new to the Philadelphia area.
Deaths from the drug were first reported in this area back in 2017, and the threat is growing. The Philadelphia Department of Health issued an advisory health alert in March of last year.
“In response to identification of N-Desethyl Isotonitazene in Philadelphia’s drug checking services of ‘dope’ (illicit heroin/fentanyl) in December of 2022, the Medical Examiner’s Office partnered with the Division of Substance Use Prevention and Harm Reduction (SUPHR) to pilot enhanced nitazene surveillance among drug overdose decedents. To date, four distinct nitazene analogs (N-Pyrrolidino Etonitazene, N-Desethyl Isotonitazene, metonitazene, and protonitazene) have been detected in decedent toxicology with potency ranging from equipotent to 20 times more potent than fentanyl. Concurrent drug checking has identified two higher potency nitazenes (N-Pyrrolidino Etonitazene and N-Desethyl Isotonitazene) as well as carfentanil, a fentanyl analog 100 times more potent than fentanyl, in several samples from the illicit drug supply in Philadelphia…
A dope sample collected in January 2024 contained carfentanil. The sample with carfentanil tested positive for fentanyl, para-fluorofentanyl, xylazine, and 4-ANPP. Carfentanil is a synthetic opioid estimated to be 100 times more potent than fentanyl and has not been identified in Philadelphia since June 2017, when carfentanil was found in blood samples of two people who died of unintentional overdoses.
As more potent opioids, smaller amounts of dope can lead to unintentional overdose, especially among people with low opioid tolerance. It is important to note that to date, these novel substances have only been identified in “dope,” though caution among persons who use any substances is critical to limit adverse events. Both nitazene analog and carfentanil overdoses can be reversed with naloxone (e.g., NarcanTM, ReViveTM), and rescue breathing may be necessary in instances in which someone also has ingested non-opioid sedatives like xylazine or benzodiazepines. Additional doses of naloxone doses may be necessary, and the number of naloxone doses has not been shown to impact mortality among people who have overdosed. Nitazene test strips are not widely available.
Due to smaller amounts typically present in these samples, fentanyl test strips may be unable to detect the presence of carfentanil, therefore education and access to naloxone is imperative. For people with opioid use disorder, withdrawal from nitazene analogs and many novel synthetic opioids has not been characterized in the literature. Anecdotal experiences from people who use drugs in Philadelphia suggest that the onset of withdrawal from nitazene analogs occurs more quickly and with more severity.
Providers treating people using illicit opioids should be aggressive with management of pain and withdrawal symptoms. The illicit drug supply is ever-changing and increasingly dangerous. Novel synthetic opioids in Philadelphia have been first identified through drug checking, and increased drug checking can aid detection and response to emerging substances. Providers (doctors, nurses, social workers, case managers, and peer specialists) should talk to and listen to their patients about their substance use. Providers can discuss the volatility of the illicit drug supply, encourage safer use practices, and ask patients with substance use disorder and history of substance use about their openness to treatment.”
A retired Philadelphia detective who worked primarily in the Kensington area told me that he heard about the drug from his street informants back when he worked narcotics. They told him that carfentanil, called by street dealers and drug users as the “Gray Death,” was a powerful drug. The former detective told me that carfentanil, a drug developed as a tranquilizer for large animals, was deadlier than even fentanyl.
“I’m worried that carfentanil will take hold in places like Kensington, where the addicts are craving a more powerful drug,” the veteran detective told me. “The junkies appear unconcerned about the possible side effects of the drug, such as an overdose death.”
He also worried about police officers and other first responders who come into contact with carfentanil.
“The carfentanil in powder form can be unintentionally inhaled, causing the cops or rescue people to die from an overdose.”
The former narcotics detective directed me to a recent DEA report on carfentanil.
On May 14, the DEA issued a report called “Carfentanil: A Synthetic Opioid Unlike Any Other.”
“Over the past two decades, synthetic opioids have increased the threat of the ongoing opioid epidemic. Nearly 70 percent of all drug poisonings and overdose deaths in 2023 involved synthetic opioids, primarily fentanyl. Also, among these substances is carfentanil, which stands out — at this time — as one of the deadliest fentanyl analogues. This white, powdery drug closely resembles other substances like fentanyl or cocaine, but its danger far exceeds that of nearly any other opioid on the street,” the DEA report noted.
“Carfentanil is a chilling reminder of how the opioid epidemic continues to evolve and introduces new threats at an alarming pace.
The former Philadelphia detective who spoke to me was angry.
“The drug producers and the drug traffickers know full well that carfentanil is a deadly drug,” he said. “But they don’t care. These evil bastards only care about making money, even if their product kills many poor drug addicts.”
Paul Davis, a Philadelphia writer and frequent contributor to Broad + Liberty, also contributes to Counterterrorism magazine and writes the “On Crime” column for the Washington Times. He can be reached at pauldavisoncrime.com.
