A new street drug labeled "Super Mario" containing a synthetic opioid that's 100 times stronger than fentanyl has hit New York.
The state's health department issued a public health alert on Friday after two samples from the "Super Mario" bags tested positive for a combination of fentanyl, a veterinary sedative called xylazine, and trace amounts of heroin and carfentanil, another a veterinary tranquilizing drug used for elephants and other large mammals.
Carfentanil is a synthetic opioid that the Drug Enforcement Administration says is 10,000 times more potent than morphine and 100 times more potent than fentanyl. The Department of Veterans Affairs says only 2 milligrams is needed to knock out an average-sized elephant, while the same amount is enough to kill about 50 humans. In comparison, one potentially lethal dose of fentanyl is about 2 milligrams.
Carfentanil is considered a Schedule II substance under the Controlled Substances Act, meaning it has a high potential for abuse which may lead to severe physiological or physical dependence, according to the National Library of Medicine. Fentanyl is in the same schedule.
But unlike fentanyl, which can be used to relieve severe pain in health care settings, carfentanil has no legitimate medical use, and New York state officials said it's no longer marketed for veterinary use because it's so dangerous.
The state reported the "Super Mario" samples containing the carfentanil, which were collected on May 20, were linked to "severe wounds needing emergency department care within two to three weeks of use." It also said drug checking program participants noticed a "change in the supply" within the last two weeks, and that individuals described the substance "knocking them out."
"The combination of these substances increases the risk of individuals experiencing adverse events such as an overdose, long periods of sedation (blackouts), prolonged respiratory suppression, and possible skin lesions. Those aware of the combination are still at risk of an overdose," the New York State Department of Health said in a public health alert.
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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 it urges people who use drugs to practice harm reduction strategies, like testing substances before use and having opioid reversal agent naloxone, or Narcan, available.
However, another ingredient in the "Super Mario" bags makes the mixture an even larger risk for users to suffer fatal drug poisoning even with Narcan: Xylazine, also known as "Tranq," isn't an opioid, so Narcan won't reverse its effects.
The veterinary drug — which, like carfentanil, is not used for humans — prompted public health alerts starting last year after it was increasingly detected in illicit drug samples. It's known to slow breathing, heart rate and blood pressure to dangerously low levels, and repeated use is associated with skin ulcers and abscesses, according to the National Institute on Drug Abuse.
In July 2023, the White House released a National Response Plan to address the emerging threat of fentanyl mixed with xylazine after declaring the combination an emerging threat. The DEA had seized the mixtures in 48 of 50 states, and one CDC study said monthly percentage deaths involving illicit fentanyl and xylazine increased from 3% in January 2019 to 11% in June 2022.
