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Another View -- Joe Pepe: Carfentanil is a new and deadly threat


Late last month, the casualties of the newest deadly narcotic in New Hampshire arrived in an alarming way at the entrance of Catholic Medical Center’s Emergency Department (ED.) Within 20 minutes, one ambulance and multiple vehicles arrived with seven people who had all overdosed on a powerful opioid drug.

Here’s what it looked like from inside the ED:

Ten overdoses arrived at CMC within 24 hours; seven in the evening hours.

CMC personnel were needed to assist numerous patients from their vehicles in order to bring them into the emergency room.

CMC’s ED was at full capacity at the time the seven patients arrived. Staff began assessing patients using rapid triage.

All seven patients were resuscitated, with one patient requiring 12 milligrams (mgs) of Narcan. The normal dose of Narcan is 2 mgs for an opioid overdose.

All patients survived due to immediate resuscitation practices. This event tested CMC’s ER response to manage multiple resuscitations at one time.

Although we are awaiting toxicology results to be absolutely certain, these overdoses all appear to have been caused by carfentanil — the newest, most powerful, and deadliest drug to infect our communities in this opioid crisis. Carfentanil is most commonly used as a tranquilizer for elephants and other large animals. It is being mixed with other drugs and distributed around the country. It is deadly in even the smallest doses and it is here in New Hampshire.

According to the Drug Enforcement Agency (DEA,) carfentanil is 10,000 times more potent than morphine and 100 times stronger than fentanyl. Think about that for a second: 100 times more powerful than the drug that, until now, has been the source of so much pain and misery in our communities. A dose of carfentanil the size of a couple of grains of salt can be deadly.

Following this incident, CMC met with Manchester fire, EMS services, the city health department, and emergency service representatives from Elliot Hospital to discuss the challenges of managing a sudden influx of multiple overdoses, the need for numerous emergent supplies, the increased demand for Narcan, and the availability of personal protective equipment for all responders.

Doses of Narcan are adjusted based on the individual patient’s response. Carfentanil overdoses require significantly more Narcan than other opioid overdoses. In addition, the health risk posed to our brave EMTs, firefighters and emergency department personnel is extremely high because carfentanil can be absorbed through the skin — putting emergency crews, health-care workers, even bystanders at risk.

The DEA has issued strict warnings to first responders to use extreme caution when approaching an overdose situation. Emergency responders are asked to use protective gear or wait for a hazmat team.

CMC’s emergency department teams followed the DEA warnings when treating the patients who arrived on Tuesday evening suffering from an overdose. The actions of the CMC team saved seven lives that night, despite the fact that their lives were at risk as well.

The carfentanil challenge is particularly frustrating considering recent progress being made in New Hampshire. For example, fewer opioids are being prescribed in New Hampshire now compared to last year. Reports show fewer overdoses and deaths over past six months in Manchester compared to last year. At the same time, there has been impressive progress on the prevention, treatment and recovery fronts, exemplified by the Safe Station program in Manchester.

This is not just a law enforcement problem. This is not just another challenge for EMTs and first responders. This drug is a killer like nothing we’ve seen. It costs very little; it is widely available; it is visually indistinguishable from less deadly substances; and it will take lives.

We are working side by side with local, state and federal officials and agencies along with our first responders to combat this deadly new drug and rid it from our communities.

I urge you to talk to family, friends and loved ones about carfentanil and the immediate and deadly risks it poses to all of us. We must tackle this challenge together and we must do it now.

Dr. Joe Pepe is president and CEO of Catholic Medical Center.


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