Health and law enforcement officials around the state are bracing for an uptick in drug overdoses as a deadly synthetic opioid only meant for use in large animals has hit Maryland streets.
The drug, carfentanil, already has been linked to two overdose deaths in Anne Arundel County and one in Frederick County. The drug is so potent it was never meant for use in humans and is normally used as a tranquilizer for elephants, hippos and other large animals.
It is 10,000 times more potent than morphine and 5,000 times more potent than heroin, according to the U.S. Drug Enforcement Administration.
Health and police departments throughout the state have issued special alerts about carfentanil, while clinics and others who work with addicts are taking extra efforts to warn them about the danger of the drug.
"Usually when there's one or two cases, there's going to be several more right behind it," said Steven Bell, a spokesman for the U.S. Drug Enforcement Administration.
Police departments also are warning officers about handling the drug because it can be absorbed through the skin. In Anne Arundel County for instance, officers are wearing gloves, as well as eye and mouth protection, when handling suspected drugs.
Carfentanil is so strong that naloxone, which is used to resuscitate someone who has overdosed on opioids is not as effective. It may take several doses of naloxone to bring somebody back from the brink of death after taking carfentanil.
Gov. Larry Hogan, who two months ago declared a state of emergency in response to the rapidly escalating opioid crisis, said carfentanil is just the latest in newer, deadlier drugs being sold to users or laced into other drugs without their knowledge.
"It is imperative that we raise awareness of just how deadly these drugs are," Hogan said in a Facebook post Monday.
There were 1,468 fatal drug overdoses statewide from January to September 2016, the latest data available. The numbers of deaths exceeded the 1,259 deaths for all of 2015. Drug overdoses, mostly from opioids, kill far more Marylanders than car crashes and homicides.
Police and health officials have been preparing for months for carfentanil to reach Maryland, saying it was only a matter of time. The DEA first put out warnings in September about the drug, which has gripped the Midwest. The Maryland Department of Health and Mental Hygiene confirmed the three local deaths late Friday.
Carfentanil overdoses began appearing last summer and the drug has been found in Michigan, Kentucky and Ohio before spreading east.
A 56-year-old man died in the city of Frederick on April 7, said Lt. Clark Pennington, commander of the criminal investigations division of the Frederick Police Department. The department is looking for connections between the man and any drug dealers who could be selling the more potent drug.
The deaths in Anne Arundel County occurred in Pasadena and Linthicum in the first two weeks of April, said Lt. Ryan Frashure, a spokesman for the Anne Arundel County Police Department. He did not provide any other details about the people who died.
Detectives from the heroin task force are investigating the deaths to see if they are linked and to determine the source of the drugs, Frashure said.
The department has not changed the way it is responding and investigating opioid overdoses, but is taking extra efforts to make people aware of the dangers of carfentanil, warning drug users about the high risk of overdose and death, Frashure said.
He added that the department hopes this doesn't become a trend in the county.
The Anne Arundel County Department of Health put out a special alert to drug treatment centers and other community groups over the weekend.
"There is a concern that depending on the penetration of this drug within Maryland it could really impact the fatalities because of how toxic it is," said Dr. Jinlene Chan, the county's health officer.
Carfentanil appears much like heroin, as an off-white powder. But a single grain, comparable to a grain of salt, could produce a high or even prove deadly for an adult, Bell said. Doses are so small police have needed a specialized instrument called a mass spectrometer to detect the drug. Some dealers are mixing it in with heroin unbeknownst to users.
"We are extremely concerned that carfentanil and other synthetic drugs like it can be fatal in extremely small doses and can be mixed in with other drugs without people knowing it," said Baltimore Health Commissioner Dr. Leana Wen.
Addiction specialists and health departments have beefed up outreach efforts in response.
At Health Care For the Homeless, addiction counselors are warning clients about the new drug now that it has appeared in Maryland.
"One of our major messages to clients is you don't know what is being cut into the heroin," said Dr. Nilesh Kalyanaraman, the group's chief health officer. "You need to be careful because your chances of overdosing are higher depending on what they put into it."
Carfentanil is similar to, but much more powerful than fentanyl, another synthetic opioid that can be toxic and has contributed to the rapid increase in overdoses. The main difference between the drugs is the potency and there are more legal uses for fentanyl, said Dr. Amanda Latimore, director of social epidemiology and evaluation at Behavioral Health System Baltimore, which manages the city's mental health and substance abuse programs.
Latimore said carfentanil ultimately may not have as much of a presence because there are fewer legal uses compared to fentanyl.
In the United States, the drug is only legal for veterinary or wildlife management use; authorities believe it is being imported illegally from Chinese sources.
Behavioral Health System Baltimore has not yet started warning about carfentanil but will start soon, Latimore said. The agency wants to make sure the message is done in a way that will prevent some addicts from seeking out the new drug because they crave a more potent high.
The organization currently sends out overdose alerts to drug treatment providers in the city to let them know when there is a spike of overdoses in certain neighborhoods. Those alerts soon will include information about carfentanil.
A naloxone outreach team run by Behavioral Health System Baltimore, which gives out kits that includes the anti-overdose drug, also is going to increase the number of doses they include in the packages from 2 to 4.
"We knew that carfentanil was imminent and we need to keep our eye on it," Latimore said.
Baltimore Sun reporters Tim Prudente and Meredith Newman contributed to this article.