CDC Health Advisories have been issued due to nonpharmaceutical fentanyl(NPF). NPFs are playing an increasing role in overdose deaths. NPFs often contain carfentanil or other fentalyn analogs. While fentanyl is 50-100x more potent than morphine, carfentail is 50-100x more potent than fentanyl.
Therapeutic indexs changes may play a role in overdose. The maintenance dose of heroin or illicit prescription use is near the lethal dose. When fentalyn or an analog is takne in similar amountss, overdose is likely.
NPFs are being discovered not just in illicit opioids, but in cocain, MDMA and Meth.