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Carfentanil – from an animal anesthetic to a deadly illicit drug
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Carfentanil – from an animal anesthetic to a deadly illicit drug
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Journal Article
Carfentanil – from an animal anesthetic to a deadly illicit drug
2021
Overview
•Carfentanil has contributed to an increase in opioids-related intoxications in recent years.•It is often detected in heroin, other street drugs and counterfeit pharmaceuticals.•Detection of carfentanil requires specific and sensitive analytical methods that are not commonly available in hospitals.•There is no particular toxic or lethal blood carfentanil concentration.•Standard naloxone doses may be insufficient to reverse carfentanil-induced respiratory depression.
The use of novel synthetic opioids as recreational drugs has become a public health concern as they are implicated in numerous fatal intoxications across the world. Synthetic opioids have played a major role in the United States opioid crisis and may contribute to a similar opioid epidemic in Europe. The most prominent group of designer opioids consists of fentanyl and its analogues. At present, carfentanil is the most dangerous fentanyl derivative. It was recently detected as an adulterant to other illicit drugs and counterfeit pharmaceuticals, contributing to life-threatening hospital admissions and fatalities. Toxic exposure to carfentanil typically occurs through injection, insufflation or inhalation. Carfentanil produces similar pharmacotoxicological effects to other opioids. However, due to its extraordinary potency, reversing carfentanil-induced severe and recurring respiratory depression requires administration of multiple or higher than standard doses of naloxone. Toxicological reports indicate that carfentanil use is strongly connected to polydrug use. Detection of carfentanil requires specific and sensitive analytical methods that are not commonly available in hospitals. Since abuse of carfentanil is an emerging problem, particularly in the United States, there is an urgent need to develop new techniques for rapid determination of intoxication evoked by this drug as well as new treatment regimens for effective overdose maintenance. This review presents current knowledge on pharmacological activity of carfentanil, prevalence and patterns of use, and analytical methods of its detection. Special emphasis is given to carfentanil-related non-fatal and lethal overdose cases.
