Carfentanil

Carfentanil, also Carfentanyl, is an analogue of the popular opioid Fentanyl, and is one of the most potent opioids known (and the most potent opioid used commercially). It has a quantitative potency approximately 10,000 times that of morphine and 100 times that of fentanyl (activity in humans starting at about 1 µg). It is marketed under the trade name Wildnil as a tranquilizer for large animals. Carfentanyl is intended for animal use only as its extreme potency makes it inappropriate for use in humans. more...

It is thought (Wax et al 2003) that in the 2002 Moscow theater hostage crisis, Russian military made use of an aerositalized form of carfentanil to subdue Chechen hostage takers. Its short action, easy reversability and therapeutic index (10600 vs. 300 for fentanyl) would make it a near-perfect agent for this purpose. Wax et al surmise from the evidence available that the Moscow emergency services had not been informed of the use of the agent, and therefore did not have adequate supplies of naloxone or naltrexone (opiate antagonists) to prevent complications in many of the victims. Assuming that carfentanil was the only active constituent (which has not been verified by the Russian military), the primary acute toxic effect to the theatre victims would have been opioid-induced apnea; in this case mechanical ventilation and/or treatment with opioid antagonists would have been life-saving for many or all victims.

Reference

• Wax PM, Becker CE, Curry SC. Unexpected "gas" casualties in Moscow: a medical toxicology perspective. Ann Emerg Med 2003;41:700-5. PMID 12712038.

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