Carfentanil or carfentanyl, formerly sold under the brand name Wildnil, is an extremely potent opioid analgesic formerly used in veterinary medicine to anesthetize large animals such as elephants and rhinoceroses. It is a structural analogue of the synthetic opioid analgesic fentanyl. It is typically administered in this context by tranquilizer dart. It acts as an ultrapotent and highly selective agonist of the μ-opioid receptor. It was introduced into veterinary medicine in 1986. Commercial production of Wildnil ceased in 2003; the drug is now available only in compounded form and not available for veterinary use due to human abuse. Since then, etorphine has become the standard tranquilizing agent for large mammals, with diprenorphine as the preferred reversal agent. Diprenorphine was also used previously to reverse the effects of carfentanil.
Clinical use
Carfentanil has been used at doses of less than 7 μg as a radiotracer for positron emission tomography imaging of the μ-opioid receptor in the brain in humans. It showed affinity values (K<sub>i</sub>) of 0.051 nM for the μ-opioid receptor, 4.7 nM for the δ-opioid receptor, and 13 nM for the κ-opioid receptor in rat brain.
Pharmacokinetics
A lipophilic chemical that can easily cross the blood–brain barrier, carfentanil has a very rapid onset of action and is longer acting than fentanyl.
History
The first reported case of carfentanil overdose in a person was in 1986 when a veterinarian accidentally splashed 1.5 mg carfentanil citrate into his eyes and mouth. Sedation occurred within 2 minutes and naltrexone was administered. The veterinarian was hospitalised but made a full recovery within a day. In 2017, a Milwaukee, Wisconsin man died from a Carfentanil overdose, likely taken unknowingly with another illegal drug such as heroin or cocaine. Carfentanil is most often taken with heroin or by users who believe they are taking heroin.
Around 2016, the United States and Canada reported a dramatic increase in shipment of carfentanil and other strong opioid drugs to customers in North America from Chinese chemical supply firms. In June 2016, the Royal Canadian Mounted Police seized one kilogram of carfentanil shipped from China in a box labeled "printer accessories". According to the Canada Border Services Agency, the shipment contained 50 million potentially lethal doses of the drug, in containers labeled as toner cartridges for HP LaserJet printers.
Carfentanil was not a controlled substance in China until 1 March 2017, and until then was manufactured legally and sold openly over the Internet, being actively marketed by several Chinese chemical companies. Researchers had previously surmised from the available evidence that the Moscow emergency services had not been informed of the use of the agent, despite being instructed to bring opioid antagonists to the scene. Unaware that hundreds of patients had been exposed to high doses of strong opioids, the emergency workers failed to bring sufficient quantities of naloxone and naltrexone to counteract the effects of carfentanil and remifentanil. One hundred and twenty-five people exposed to the aerosol are confirmed to have died from respiratory failure during the incident.
Potential as a chemical weapon
The toxicity of carfentanil in humans and its ready commercial availability has raised concerns over its potential use as a chemical weapon of mass destruction by rogue nations and terrorist groups. The toxicity of carfentanil has been compared to that of nerve gas.
- In Germany, carfentanil and its stereoisomers and salts are controlled by the Betäubungsmittelgesetz as a Anlage I substance and can only be used with the special permission of the authorities.
- Carfentanil is classified as Schedule II under the Controlled Substances Act in the United States with a DEA ACSCN of 9743 and a 2016 annual aggregate manufacturing quota of 19 grams (less than 0.7 oz.). Carfentanil requires approval from the Drug Enforcement Agency for veterinary use.
- Carfentanil has been specifically controlled as a Class A drug in the United Kingdom since 1986.
See also
- Opioid potency comparison