A new street drug known as “Super Mario” has struck New York, including a synthetic opioid 100 times stronger than fentanyl.
The state’s health department issued a public health alert on Friday after two samples from the “Super Mario” bags tested positive for fentanyl, xylazine, a veterinary sedative, and trace amounts of heroin and carfentanil, a veterinary tranquilizer used for elephants and other large mammals.
Carfentanil is a synthetic opioid that the Drug Enforcement Administration claims is 10,000 times stronger than morphine and 100 times stronger than fentanyl. According to the Department of Veterans Affairs, only 2 milligrams are required to kill an average-sized elephant, yet the same quantity can kill over 50 individuals. In comparison, a potentially deadly dose of fentanyl is approximately 2 milligrams.
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Carfentanil is classified as a Schedule II substance under the Controlled Substances Act, which means it has a high potential for misuse and can develop to severe physiological or physical dependence, according to the National Library of Medicine. Fentanyl follows the same timetable.
However, unlike fentanyl, which can be used to treat severe pain in healthcare settings, carfentanil has no legal medical application, and New York state officials say it is no longer promoted for veterinary use due to its toxicity.
The state reported that the “Super Mario” samples containing carfentanil, which were obtained on May 20, were related to “severe wounds needing emergency department care within two to three weeks of use.” It further stated that drug monitoring program participants observed a “change in the supply” within the last two weeks, with some describing the chemical as “knocking them out.”
“The combination of these medications raises the possibility of persons experiencing adverse effects such as overdose, extended drowsiness (blackouts), prolonged respiratory suppression, and potential skin lesions. “Those who are aware of the combination are still at risk of overdose,” the New York State Department of Health stated in a public health alert.
The state health department’s Drug Checking Program community partner, ACR Health, is now conducting a third sample test on the “Super Mario” drug, while encouraging drug users to practice harm reduction strategies such as testing substances before use and having the opioid reversal agent naloxone, or Narcan, on hand.
However, another substance in the “Super Mario” bags increases the danger of users suffering fatal drug poisoning, even with Narcan: Xylazine, often known as “Tranq,” is not an opioid, therefore Narcan will not reverse its effects.
The veterinary medicine, which, like carfentanil, is not intended for human use, sparked public health concerns last year when it was found in an increasing number of illicit drug samples. According to the National Institute on Drug Abuse, it has been shown to cause dangerously low levels of respiration, heart rate, and blood pressure, as well as skin ulcers and abscesses when used repeatedly.
The White House issued a National Response Plan in July 2023 to handle the increasing threat of fentanyl combined with xylazine, which was declared an emergent threat. The DEA has recovered the mixes in 48 of the 50 states, and one CDC research found that the monthly percentage of deaths using illicit fentanyl and xylazine jumped from 3% in January 2019 to 11% in June 2022.