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00000174-c556-d691-a376-cdd69e980000Day after day, week after week, the headlines in Northeast Ohio and across much of the country contain news of tragic loss: lives lost to opioids. It’s a problem that knows no bounds: geography, race, gender, level of education or income.The problem took on new urgency this summer as the powerful elephant sedative, Carfentanil, began hitting the streets. First responders armed with their only weapon, the overdose antidote Naloxone, have struggled to keep up with what’s become an overwhelming problem. It’s an issue that’s straining public and social resources. What has become clear is that business as usual is not going to fix the problem.WKSU news has been covering the unfolding crisis. Tuesdays during Morning Edition, the WKSU news team digs even deeper. WKSU reporters will examine what’s led us here and what might be done to turn the tide. Support for Opioids: Turning the Tide in the Crisis comes from Wayne Savings Community Bank, Kent State University Office of Continuing and Distance Education, Hometown Grocery Delivery, Mercy Medical Center, AxessPointe Community Health Center, Community Support Services, Inc., Medina County District Library and Hudson Community First.00000174-c556-d691-a376-cdd69e980001

The Emergence of the Elephant Tranquilizer Carfentanil Marked a Shift in the Opioid Supply

Last year was a record year for fatal overdoses in Ohio. And a big part of that spike was the sudden appearance of the deadly opioid carfentanil.

In this preview of our new series, "Opioids: Turning the Tide in the Crisis," WKSU’s Jeff St.Clair reports the easy availability of powerful synthetics has marked a turning point in the ongoing epidemic.

UPDATE FEB. 16, 2017:  China now regulates sales of carfentanil.

Akron narcotics detective Brian Callahan recalls the day it all started.

Just before July 4th, “a dispatch call went out of an overdose on Copley Road.”

Callahan was one of the first to arrive.

“And I remember looking inside the apartment and I saw three people laying motionless on the floor.  Little did I know there was a fourth motionless [person] struggling for life in the bathroom.”

It was the beginning of a wave of overdoses that swept through Akron. 

Police responded to 236 overdoses over three weeks in July; at least 14 of them were fatal.

The cause?
Carfentanil, a synthetic opioid used to anesthetize elephants, had somehow landed in Akron.

Lt. Dave Garro is head of Akron’s narcotics division. 

Lt. Dave Garro is head of the Akron Police Department's narcotics unit. He says dealers are now exclusively selling synthetic opioids like fentanyl and carfentanil because of their easy availability, cheaper costs, and higher potency.

He says carfentanil is 5,000 times stronger than heroin, “and a dose the size of a poppy seed will kill you.”

Addicts in Akron began toying with a potent poison and Garro says police were suddenly exposed to a new level of risk.

"That was the game changer.”

Touching carfentanil, or even breathing airborne particles can knock out a grown man.

First responders need to administer multiple doses of the anti-overdose drug Narcan to revive carfentanil victims. 

It doesn’t always work.

A Deadly Turn in the Heroin Crisis
Summit County Medical Examiner Lisa Kohler says the summer spike was so bad she brought in a refrigerated truck to house bodies awaiting exams.

"And since that weekend, we’ve had at least 75 cases and it continues to show up.”

She doesn’t believe it’s a temporary blip.

"My fear is that the carfentanil is here to stay," says Kohler.  

"It could be a test market." U.S. DEA agent Keith Martin

From July to November, 343 of the 407 seizures of illicit carfentanil nationwide have been in Ohio, according to the Associated Press. The Buckeye State is now the epicenter of the next phase in the war on drugs.

Why Ohio?
U.S. Attorney Carole Rendon says the answer to that question is simply demand.

U.S. Attorney Carole Rendon blames Ohio's ongoing heroin crisis on the overuse of prescription pain killers. She says most of the synthetic opioids sold by dealers are now coming directly from China.

“We have a historical problem in Ohio with the over prescription of pain medication,” says Rendon.

She says between illegal pill mills and aggressive pain management by doctors over the past decade, Ohio has created a population of people addicted to opioids.

“That’s the foundation that has caused our state, and particularly our district, to be Ground Zero for this crisis as it has morphed into heroin and fentanyl and now carfentanil.” 

And Rendon says that ready market made Ohio attractive to sellers.

“Historically drug dealers go where the customers are.”

It makes sense to Keith Martin, resident agent-in-charge of the U.S. Drug Enforcement Administration’s Cleveland office. 

“The thought has crossed my mind that it could be a test market,” says Martin.

He says dealers are experimenting with readily available synthetic opioids like fentanyl and its powerful cousin carfentanil.

Trafficking in the 21st Century
Instead of needing a network of poppy growers in Afghanistan, Mexican middle-men, and risk-taking traffickers, Martin says today’s dealer can simply order a kilo of synthetic opioid over the internet --shipped directly from China.

“That actually keeps me up at night, believe it or night.”

Martin says it’s a nightmare scenario, because unlike other opioids, carfentanil is under no restrictions for export from China.

He says the DEA is working to change that, and he tries to remain upbeat despite the worsening ties with Beijing following Donald Trump’s election.  

“I do believe we’re going to make progress with working with the Chinese to make carfentanil illegal with the incoming administration,” says Martin.

New Economics of Opioids
Meanwhile, Lt. Garro of Akron's narcotics division says carfentanil is a dealer’s dream.

It costs one tenth as much as heroin, and because it goes much further, reaps more profit.

Users of synthetic opioids are more likely to snort the drug than inject it, according to Akron narcotics detective Brian Callahan. He says synthetics like fentanyl have entirely replaced heroin on the streets of Akron.

“The drug dealers aren’t dumb. Economics suggest go with the low overhead and the high markup,” says Garro.

For detective Callahan, the rise of synthetic opioids has fundamentally changed the policing of narcotics.

He says drugs used to be funneled through major hubs like Miami, Chicago, New York and Los Angeles. "Now there are no source cities anymore; everything’s just parcels coming from anywhere.”

He says the cruel reality of heroin addiction means that whoever sells the strongest drugs gets the most customers,“even if it kills them.”

Click here for more on understanding the epidemic

Jeff is your average chemist turned radio host and reporter. He currently hosts middays on WKSU and has reported extensively on science, politics, business, and the environment.