Carfentanil, the ultra-deadly relative of the opioid drug fentanyl that has been implicated in many fatal overdoses, is the suspected culprit in the death of a middle-aged man in West Philadelphia two weeks ago, authorities said.
If confirmed by toxicology tests, it would be the second deadly appearance in the city of a drug so dangerous that law enforcement officers in South Jersey and elsewhere have overdosed during busts involving synthetic opioids in its class.
The fentanyl relative, used to sedate elephants and other large animals, has been linked to a small but growing number of fatalities around the country over the last year or so, including six in Western Pennsylvania since November. None have been reported in New Jersey.
A kilogram of carfentanil shipped from China — seized in Vancouver by Royal Canadian Mounted Police in hazmat suits sealed with yellow tape, carrying oxygen tanks on their backs for breathing — was enough of the drug to wipe out the nation's entire population of 36 million, the Canada Border Services Agency reported last June.
This month's Philadelphia case involved a 56-year-old man found on June 8, according to the Drug Enforcement Administration. Preliminary test results found multiple drugs, including carfentanil, in his blood. The Philadelphia Medical Examiner's Office said final toxicology results were still pending.
The city's first carfentanil-related fatality was a 59-year-old man found dead on Dec. 21 in South Philadelphia, the Medical Examiner's Office said. He tested positive for carfentanil but negative for heroin, fentanyl, and cocaine, all drugs that often are used in combination.
"At this point, the two cases appear pretty dissimilar in terms of time, location, and toxicologic profile," James Garrow, a spokesman for the medical examiner, said in an email. "We cannot call this a pattern. Based upon reports from other cities that they're seeing more carfentanil-related deaths, we expect it's possible that we'll see more in the future, but obviously can't say for sure."
Philadelphia police had no information about either case. The department is reviewing internal guidelines for dealing with unknown substances. Officers are instructed to take precautions such as wearing gloves and sometimes masks, and ensure that "two officers are always present for handling and processing of drugs, so that the second officer can observe the one handling the drugs for safety reasons," said Capt. Sekou Kinebrew, a police spokesman.
Like surgeons who could be exposed at any time to highly infectious blood-borne diseases with a scalpel slip or needle stick, police need to take precautions in every case, Kinebrew said. "Unfortunately there's no stamp that says, 'This is carfentanil.' "
Fentanyl itself is up to 50 times stronger than heroin and 50 to 100 times more potent than morphine. Carfentanil is 10,000 times more powerful than morphine. The DEA says there are now at least a half-dozen fentanyl-related substances available on the illicit drug market, from carfentanil to 3-methylfentanyl and acetyl-fentanyl, and the specific type would not be identified until toxicology tests come back many weeks after an autopsy. Police would almost never know exactly what they were seizing or the extent of the danger.
Daniel Kallen, an investigator with the Atlantic County Prosecutor's Office, had just sealed a bag of powder for evidence in 2015 when "a bunch of it poofed up into the air," he recalls in a video that the DEA released two weeks ago with precautions for first responders around the country. "You actually felt like you were dying. You couldn't breathe," Kallen said. "It was so quick and such a small amount that we didn't even have time to think."
Another investigator in the 2015 case, Eric Price, described the feeling as "your body is completely shutting down." The powder was later identified as a mix of fentanyl, heroin, and cocaine. Both men are fine, the DEA's acting administrator, Chuck Rosenberg, says in the video.
An accompanying 21-page guide — more than half of it devoted to safety for first responders — warns that fentanyl residue could be present on other kinds of evidence such as currency and cellphones. As little as two or three milligrams of fentanyl — an amount that would look like about five to seven grains of table salt — can induce respiratory arrest, which can lead to death, according to the guide. Carfentanil would be 100 times stronger than fentanyl.
The Pennsylvania Department of Health issued an advisory on the same day as the DEA report that urged first responders to "use caution and utilize appropriate personal protective equipment when handling carfentanil due to the drug's ability to be absorbed through the skin."
A police officer in East Liverpool, Ohio, overdosed three weeks earlier after brushing a bit of white powder that was suspected to be fentanyl or some relative of the drug from his shirt after a field test, authorities said. Several doses of the opioid overdose-reversal medication naloxone were required to revive him.
Susan M. Shanaman, a spokeswoman for the Pennsylvania State Coroners Association, said toxicology tests have confirmed the presence of carfentanil in drug overdose deaths in two Beaver County cases and one each in Bedford, Butler, Fayette, and Westmoreland Counties. This month's Philadelphia death, if toxicology tests confirm a preliminary screening, would bring the total to eight.
But coroners do not test for carfentanil in every drug death, and there have been concerns in the past that the quantity needed to kill is so tiny that some screenings might not pick it up. Testing in the first Philadelphia case, in December, confirmed carfentanil but was negative for the drugs that typically are found with it.
Most deaths around the country in which carfentanil has been detected were individual cases, rather than coming in clusters, as might be expected if a dealer had added the drug to a supply of heroin or fentanyl and sold it on the street. Thirty-five of the 907 overdose deaths in Philadelphia last year, for example, came during five days in December and most of them involved fentanyl.
Patrick Trainor, a special agent and spokesman for the DEA's Philadelphia division, suggested that the pattern "might be from orders coming off the dark web" rather than purchased on the street.
Overdose deaths overall have increased sharply nationwide in the last two years, due largely to fentanyl, which was found in more than half of Pennsylvania's overdose fatalities last year.
There were 4,642 accidental drug deaths statewide in 2016, the DEA's Philadelphia Division reported this month, up 37 percent from the previous year, based on county coroners' reports that the agency collected.
The Pennsylvania Coroners Association, which includes suicides and may be slightly more up to date, said its own preliminary tally had reached 4,812 and was likely to increase due to toxicology tests that were still pending.