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Millenium Health, a California-based nationwide drug testing firm, has issued an advisory indicating the reemergence of carfentanil in 35 states including Kentucky, during testing results in 2023.

Carfentanil is one of the most potent fentanyl analogues known, according to Millenium Health. They say it is 100 times more potent than fentanyl and 10,000 times more potent than morphine. It is used in veterinary medicine as a large animal tranquilizer but is not approved for human use.

Its rapid proliferation in the illicit drug supply was associated with a significant spike in synthetic opioid overdose deaths in 2016-2017, before it decreased and nearly disappeared. Recent reports of carfentanil-involved overdose deaths and increasing forensic laboratory detections, prompted Millennium Health researchers to analyze their data for carfentanil detection frequencies and locations in fentanyl-positive urine drug test (UDT) specimens in 2022 and 2023.

While only one positive was uncovered for 2022, in Philadelphia County, Pennsylvania, so far this year 35 positives have been found in 12 states, including one in Hardin County, Kentucky.

As multiple data sources now point to the return of carfentanil, the testing firm says law enforcement and public health officials in some states have issued alerts about its presence in the illicit drug supply.

“The results of our analysis add to growing evidence that carfentanil may be making a comeback,” said Millennium Health Chief Clinical Officer Angela G. Huskey, PharmD, CPE. “Although any increase in carfentanil detection is concerning given its lethality, the number of detections in 2023 is substantially lower than in peak years. Fortunately, this means there’s still time to increase awareness about its dangers. We are closely monitoring carfentanil trends in our data and will provide updates as warranted.”

Millenium Health says the urine tests they analyzed “were ordered by healthcare providers on the basis of medical necessity and had valid results for carfentanil.”