Fentanyl's potency stirs terror concern; deadly drug is ‘significant threat to national security,’ ex-CIA chief says

It would take only 118 pounds of fentanyl to kill 25 million people.

That's how much of the powerful opioid painkiller Nebraska State Trooper Sam Mortensen found in April when he stopped a truck marked "U.S. Mail" swerving onto the shoulder along Interstate 80.

He rolled up the trailer door and found an empty hold. But just below a refrigeration unit, behind a plastic panel secured with mismatched bolts, Mortensen found 42 brick-shaped packages, weighing 118 pounds, full of fentanyl. The drug is so potent that even the equivalent of a few grains of salt can be lethal.

"Is that even believable? Can you even imagine?" President Donald Trump said in October when Mortensen was honored at the White House for making one of the largest fentanyl seizures in U.S. history. The truck's two drivers were arrested.

Fentanyl has emerged as the most dangerous of a group of drugs blamed for creating a U.S. public health crisis. American deaths linked to fentanyl grew more than 50 percent to 29,406 last year, from 19,413 in 2016, according to the National Institute on Drug Abuse. Relatively easy to manufacture, the drug is turning up more on the streets as dealers strive to meet high demand for opioids in the U.S.

"There's never been a drug like fentanyl before," said Josh Bloom, senior director of chemical and pharmaceutical research at the American Council on Science and Health. "For street drugs, this absolutely destroys anything else in terms of lethality and danger."

Fentanyl is 50 times more potent than heroin, with which it is often mixed. In its strongest form, called carfentanil, it is used legally as an elephant tranquilizer. Law enforcement officers and first responders have been warned to handle fentanyl with extreme caution; some have fallen seriously ill after getting it on their skin or clothing.

The fatal potential of even glancing contact with fentanyl is a major reason why national security experts are becoming alarmed at the prospect of it being used to sow terror. The drug is "a significant threat to national security," Michael Morell, the former acting director of the Central Intelligence Agency under President Barack Obama, wrote last year. "It is a weapon of mass destruction."

Containing a fentanyl attack would be difficult for police and emergency medical officials. Overdoses of the drug are hard to reverse with existing formulations of antidotes such as the Narcan nasal spray.

Narcan is carried by many police officers and paramedics, especially in areas hard-hit by the opioid epidemic. But people incapacitated by fentanyl frequently require multiple doses.

Last year, police officer Chris Green made a traffic stop in East Liverpool, Ohio, and ended up with fentanyl powder on his shirt. After another officer pointed it out back at the station, Green brushed it off with his hand. Soon, paramedics were rushing him to the hospital.

"He realizes something ain't right," said Police Chief John Lane. "He gets lightheaded."

Green survived after being given four doses of Narcan. Though skin contact with fentanyl isn't typically deadly, Green had used sanitizer on his hands, which hastened the absorption of the fentanyl through his skin.

The U.S. Biomedical Advanced Research and Development Authority has the task of developing medical countermeasures. In September, it penned a potential $4.6 million contract with Opiant Pharmaceuticals Inc. to produce a reliable single-dose fentanyl antidote.

"Fentanyl-based drugs have been used in conflicts in other countries, so we know it's possible, and we need to be ready to save lives and protect Americans from potential health security threats," said Biomedical Advanced Research and Development Authority Director Rick Bright. He said repeat doses of naloxone, as Narcan is known generically, could be difficult to administer in a terror attack.

Opiant, based in Santa Monica, Calif., plans to test a nasal-spray version of a drug called nalmefene with the goal of counteracting fentanyl in one shot. In addition to the Biomedical Advanced Research and Development Authority deal, Opiant scored a $7.4 million grant from the National Institute on Drug Abuse earlier this year to develop the new antidote. It is aiming to file for Food and Drug Administration approval in 2020.

"Nalmefene is five times more potent than naloxone," said Roger Crystal, chief executive officer of Opiant. "It's fighting fire with fire."

The FDA approved injectable nalmefene, called Revex, in 1995, but Baxter International Inc. discontinued it in 2008. Crystal said the market has room for Narcan and nalmefene, but the more potent of the two will become dominant, especially with fentanyl becoming a central concern of drug enforcement. He thinks fentanyl production, currently focused in China, will increase in the U.S. as officials crack down on shipments at the border.

China agreed at a trade summit with the U.S. this month to regulate fentanyl as a controlled substance.

A Section on 12/16/2018

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